Despite the considerable literature on the overuse of new medical technologies, little attention has been paid to the biologic and monetary costs that may be incurred by underuse. Percutan...

The cost of underutilization. Percutaneous transluminal angioplasty for peripheral vascular disease.

A range-gated pulsed Doppler flowmeter has recently been developed that measures the average velocity of blood flow within a small tear-drop shaped (4 mm by 2 mm) sample volume. Unlike the continuous wave Doppler, the distance from the transducer face to the sampling site can be continuously varied by a range adjustment knob. Twenty patients with cardiac murmurs were evaluated in a noninvasive laboratory by brief cardiac physical examination, abbreviated phonocardiogram, complete echocardiogram, and localization of the murmurs by Doppler echocardiography. The localization depends on the detection of turbulent flow or jets at the sampling site. The murmurs included the diastolic rumble of mitral stenosis, mitral regurgitation, the murmur of left ventricular outflow tract obstruction, aortic stenosis, aortic insufficiency, diastolic rumble of tricuspid stenosis, augmented right ventricular filling sound in atrial septal defects, pulmonic stenosis, pulmonic insufficiency, and high velocity flow through the obstruction in ccarctation of the aorta.

Doppler echocardiography. The localization of cardiac murmurs.

Transcatheter closure of patent ductus arteriosus: Past, present and future

BACKGROUNDSeveral devices are available for transcatheter occlusion of patent ductus arteriosus. Most of these devices either require complicated intracardiac maneuvering, have not been tried in humans, or need a large-sized sheath for implantation of the device.METHODS AND RESULTSDuring a 26-month period ending November 1992, 14 patients underwent transcatheter closure of patent ductus arteriosus with an adjustable buttoned device delivered via a 7F sheath under an institutional review board-approved custom-made device protocol. The children were 15 months to 8 years of age with weight range of 7.2 to 19 kg. The patent ductus arteriosus measured from 2 to 7.5 mm (median, 3 mm) at the narrowest diameter and was conical, short, or tubular. They were occluded with devices measuring 15 to 20 mm. The ratio of pulmonary to systemic flow decreased (P < .01) from 1.9 +/- 0.6 (mean +/- SD; range, 1.3 to 3.2) to 1.05 +/- 0.1 (1 to 1.3). Continuous murmur of patent ductus arteriosus disappeared in all except 1 pati...

Transcatheter occlusion of patent ductus arteriosus with adjustable buttoned device. Initial clinical experience.

Percutaneous Vascular Recanalization

Transluminal angioplasty was carried out in a series of 100 consecutive patients with ischemic disease of the legs. One hundred twenty-one procedures were done with initial success in 76% and long-term success (more than 2–7 years) in 37–40%. Benefits obtained from angioplasty were assayed clinically in all and by follow-up arteriography in 35 patients. Angioplasty was found to be most successful in patients over 40 with short segmental occlusive disease limited to the superficial femoral artery. Maintenance anticoagulant therapy appeared to improve the chances for lasting patency. In properly chosen patients, transluminal angioplasty should be considered the primary treatment for vascular occlusive disease in the legs.

Long-term results in 100 consecutive patients treated by transluminal angioplasty.

Patent ductus arteriosus was the first inborn cardiac defect ever eliminated by percutaneous transvascular therapy. The method, results, and complications of Ivalon plugging of the ductus in 208 patients between 5 and 62 years old and treated between 1967 and 1985 are described. Permanent closure was accomplished in 197 patients (94.7%). The following particular benefits are obtainable from the method: no need for thoracotomy; local anesthesia applicable to 65% of all cases; 30 mm average time of intevention; only moderate invasiveness to the patients; only 7 days of hospitalization; good cost-benefit ratio.

Transluminal closure of patent ductus arteriosus: long-term results of 208 cases treated without thoracotomy.

We have recorded about 100 intracardiac phonocardiograms from the pulmonary artery, right ventricle, the 2 atria, the left ventricle and the ascending aorta in 28 patients with atrial septal defect. Systolic and diastolic murmurs were constantly recorded in the right atrium and often also in the right ventricle. The former were explained by the interatrial shunt, the latter by “relative tricuspid stenosis.” Our studies have allowed us to evaluate the second component of the first heart sound. This component was found in the right ventricle in only half of the cases despite the increased flow. It had no time correlation with the onset of rise of pressure in the right ventricle and therefore cannot be considered to be a result of tricuspid valve closure, tricuspid valve tension or right ventricular tension.

Renate Plass

Papers

Long-term results in 100 consecutive patients treated by transluminal angioplasty.

Transluminal closure of patent ductus arteriosus: long-term results of 208 cases treated without thoracotomy.

Intracardiac sounds and murmurs in atrial septal defect.

Twenty-five years of experience from transfemoral catheter closure of patent ductus arteriosus.