Showing papers on "Ostium published in 2001"

Bifurcation lesion stent delivery using multiple guidewires

Abstract: A method for placing a stent into a main vessel such that the stent side hole aligns with a branch vessel ostium comprises inserting a main vessel guidewire into the main vessel and a branch vessel guidewire into the main vessel until a distal end of the branch vessel guidewire passes into the branch vessel. A catheter system is positioned over the main vessel guidewire and the branch vessel guidewire. The catheter system is advanced over the guidewires until the catheter body passes beyond the ostium of the branch vessel and the side member extends into the branch vessel. Marker separation is observed to indicate the catheter body passed beyond the ostium and the side member extends into the branch vessel. The balloon is inflated to deploy the stent with the side hole being aligned with the ostium. The balloon is deflated, and the catheter system is withdrawn.

A Computer‐Assisted Anatomical Study of the Nasofrontal Region

Abstract: Objectives/Hypothesis Objectives were as follows: 1) to define the variations of the uncinate process' superior attachment, 2) to study the diameter of the frontal sinus ostium, 3) to study the prevalence of the agger nasi cells, and 4) to evaluate the side-to-side variability of these structures. Study Design A retrospective clinical study at a tertiary care center. Methods One hundred forty-four consecutive computed tomography scans were studied with image-guided surgery software (InstaTrak, Visualization Technology, Inc., Wilmington, MA) that provides continuous coronal, sagittal, and axial sections. We reported the superior attachment sites of the uncinate process, the diameter of the frontal sinus ostium, and prevalence of the agger nasi cells. Results The uncinate process' main superior attachment into the surrounding structures was found to have the following distribution: 52% to the lamina papyracea, 18.5% to the posteromedial wall of the agger nasi cell, 17.5% to the lamina papyracea and the junction of the middle turbinate with the cribriform plate, 7% to the junction of the middle turbinate with the cribriform plate, 3.6% to the ethmoid roof, and 1.4% to the middle turbinate. The frontal ostium anterior–posterior diameter (mean ± SD) was 7.22 ± 2.78 mm and its transverse diameter (mean ± SD) was 8.92 ± 2.95 mm. Agger nasi cells were found in 78% of the scans. Conclusions The frontal sinus opens into the middle meatus medial to the uncinate process in 88% of the patients and lateral to the uncinate process in 12% of the patients. The naturally wide dimensions of the frontal ostium help to explain why postoperative patency can be achieved merely by exposing the ostium without the need to enlarge it. The frontal ostium dimensions in one side may differ considerably from the contralateral side. An agger nasi cell or a terminal recess, or both, are found in most cases. Image-guided surgery software is a helpful new tool for anatomical studies and for preoperative evaluation.

Role of right middle pulmonary vein in patients with paroxysmal atrial fibrillation.

Abstract: Right Middle Pulmonary Vein and AF. Introduction: Elimination of the ectopic foci from pulmonary veins (PVs) has proved to be a curative therapy for focal atrial fibrillation (AF). However, information about the importance of the right middle PV (RMPV) in initiation of AF and radiofrequency ablation of AF is limited. Method and Results: Forty-three patients (34 men and 9 women; age 65 ± 12 years) with drugrefractory paroxysmal AF underwent electrophysiologic study and catheter ablation for treatment of AF. Three-dimensional magnetic resonance angiography (MRA) of the PVs and left atrium (LA) was performed to determine the anatomic patterns of RMPV. Diameter of PV ostium was measured at the junction of the LA and each PV. MRA findings showed the following: (1) 36 (84%) of 43 patients had a discrete RMPV; (2) there are three drainage patterns of RMPV, including joining the proximal part (< 1 cm from the ostium) of the right superior PV (RSPV), joining the right inferior PV (RIPV), and a separate RMPV ostium in the LA wall; and (3) the ostial diameter of RMPV was significantly smaller than RSPV and RIPV (P < 0.01). Electrophysiologic studies demonstrated that five AF foci arose from RMPV. The coupling interval between the ectopic beat of AF and sinus beat was longer in RMPV than RSPV (262 ± 45 msec vs 212 ± 47 msec; P = 0.043). All AFs from RMPV were ablated successfully. PV stenosis or AF recurrence from RMPV was not found during follow-up of 10 ± 4 months. Conclusion: RMPV was detected by MRA in > 80% of paroxysmal AF patients. Ectopy from RMPV can initiate AF, and radiofrequency ablation of RMPV foci is feasible and safe.

Intentional left subclavian artery occlusion by thoracic aortic stent-grafts without surgical transposition.

Abstract: l l Purpose: To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery. Case Reports: Three patients with an aortic type-B dissection and 1 with a thoracic aneu- rysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months. Conclusions: Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis. J Endovasc Ther 2001;8:472-476

Surgical anatomy of the natural ostium of the sphenoid sinus.

Abstract: Background and Objectives:It is important for surgeons to identify the location of natural ostium of the sphenoid sinus during sphenoidotomy for sphenoiditis and transsphenoidal approach (TSA. But, it is not easy for a beginner to find it. This study aimed to investigate from a clinical aspect the location of natural ostium of the sphenoid sinus using korean adult cadaveric heads. Material and Methods:One hundred sagittally-divided adult cadaveric heads were used. After removing the mucosa of anterior wall meticulously, they were carefully examined and documented serially by photography. The items analyzed were the distance from and the degree of nasal sill and limen nasi to the natural ostium of sphenoid sinus, and the distance from the posteroinferior end of the superior turbinate and the skull base to the natural ostium of the sphenoid sinus. In addition, we tried to investigate whether the natural ostium opens into the medial or lateral to the posterior end of the superior turbinate. Result:The natural ostium of the sphenoid sinus was located at 34.3±3.8° and 62.7±9.0 mm away from the nasal sill, and at 35.9±3.8° and 56.5±3.2 mm away from the limen nasi. It was located approximately in the middle of the anterior wall of the sphenoid sinus and medially to the posterior end of the superior turbinate in about 83%. Conclusion:By identifying the posteroinferior end of the superior turbinate, the location of natural ostium of the sphenoid sinus can be identified. We recommend that surgeons should look for the natural ostium in the middle of the anterior wall of the sphenoid sinus and medial to the posterior end of the superior turbinate. (Korean J Otolaryngol 2001;44:495-8

Endonasal laser dacryocystorhinostomy and external dacryocystorhinostomy outcome profile in a general ophthalmic service unit : A comparative retrospective study

Abstract: ■ PURPOSE: To evaluate the outcome profile of endonasal laser dacryocystorhinostomy (ENL-DCR) in comparison with external dacryocystorhinostomy (ENL-DCR) carried out as part of general ophthalmic service within the same center. ■ METHODS: Patients who have undergone external or endonasal laser DCR in the authors institute with a minimum follow-up of 9 months and at least 3 months after removal of the tubes were invited to participate in this research. We used a questionnaire and a systematic clinical examination for detecting lacrimal passage patency and function. Patients were classified into categories: complete anatomical and physiological success; anatomical success with partial relief of symptoms; anatomical success with no relief of symptoms; anatomical failure.The endoscopic view of the ostium vertical location has been classified into four levels. ■ RESULTS: One hundred and ten external-DCR and 53 Endonasal-DCR procedures were evaluated. Free communication (anatomical success) was achieved in 82% undergoing Ext-DCR and in 58% undergoing ENL-DCR. A significant number of patients continued to have symptoms in spite of a patent fistula (54% for Ext-DCR and 39% for ENL-DCR). The site of the opening of the internal ostium was significantly related to the persistence of symptoms in spite of free communication (P < 0.001, chisquare test). ■ CONCLUSION: In this series of patients undergoing DCR in a general ophthalmic unit, the standard Ext-DCR technique has a higher anatomical success rate than the endoscopic laser DCR but not necessarily with equivalent rate of relief of symptoms. An inferiorly placed ostium is more likely to result in complete relief of symptoms.

Intravascular ultrasound assessment of the stenoses location and morphology in the left main coronary artery in relation to anatomic left main length.

Abstract: Eighty-seven left main stenoses were evaluated by angiography and intravascular ultrasound. Intravascular ultrasound analysis included left main length (bifurcation to ostium), stenosis location, stenosis length, stenosis external elastic membrane, lumen, plaque & media cross-sectional area (CSA), plaque burden (plaque & media/external elastic membrane CSA), calcium arc, calcium length, eccentricity, and remodeling index (stenosis/reference external elastic membrane CSA). Long anatomic left main arteries (length > or =10 mm, n = 43) were compared with short anatomic left main arteries (length <10 mm, n = 44) regarding stenosis location. Ostial (proximal third of left main artery) (n = 32) and nonostial (midthird and distal third) stenoses (n = 55) were compared regarding stenosis morphology. Short anatomic left main arteries developed stenoses more frequently near the ostium (ostium 55%, bifurcation 38%). Conversely, long anatomic left main arteries developed stenoses more frequently near the bifurcation (ostium 18%, bifurcation 77%, p = 0.001). Ostial left main stenoses were more common in women (44% vs 20%, p = 0.02), had larger lumen area (6.2 +/- 2.2 vs 4.6 +/- 2.3 mm(2), p = 0.002), less plaque burden (62 +/- 15% vs 80 +/- 9%, p <0.0001), less calcification (arc = 78 +/- 65 degrees vs 195 +/- 101 degrees, p <0.0001), and more negative remodeling (remodeling index = 0.87 +/- 0.19 vs 1.01 +/- 0.21, p = 0.005) than nonostial left main stenoses. Most ostial left main stenoses were categorized as eccentric (97% vs 76%, p = 0.01). Short and long left main arteries develop stenoses at different locations. Stenosis morphology was significantly different in these 2 locations.

Percutaneous revascularization of the internal mammary artery graft : Short- and long-term outcomes

Abstract: Previous reports in a relatively small number of patients have shown the safety of balloon angioplasty for the treatment of stenosis in the internal mammary artery graft. However, the use of alternative interventional techniques and their long-term results have not yet been evaluated. We analyzed the in-hospital and 1-year clinical outcomes of 174 consecutive patients who underwent percutaneous revascularization by either balloon angioplasty or stenting of 202 lesions located in the internal mammary artery graft. The distal anastomosis was treated in 128 cases (63%), mainly by balloon angioplasty (116/128, 91), while lesions located at the ostium (n=16, 8%) were more frequently treated with stents (11/16, 69%). Procedural success was 97%, with excellent in-hospital outcome. At 1-year follow-up, cumulative mortality rate was 4.4%, myocardial infarction 2.9%, and target lesion revascularization 7.4%. Thus, revascularization of the internal mammary artery graft can be performed safely, with high procedural success and a low rate of major complications. Long-term follow-up showed low target lesion revascularization rate.

Phased-Array intracardiac echocardiography to guide radiofrequency ablation in the left atrium and at the pulmonary vein ostium.

Abstract: Echocardiography and Pulmonary Vein Ablation. Introduction: We sought to evaluate the utility of a phased-array intracardiac echocardiography (ICE) device to identify left atrial (LA) and pulmonary vein (PV) anatomy; accurately guide radiofrequency ablation (RFA) to the right or left PV ostium and LA appendage (LAA); and evaluate PV blood flow before and after RFA using Doppler parameters. Methods and Results: Twelve adult sheep were anesthetized and an Acuson 10–French, 7–MHz ICE transducer introduced via the internal jugular vein into the right atrium. The LA was imaged and PV anatomy and blood flow documented using two-dimensional and pulsed-wave Doppler. Mean LA dimensions were 4.6 ± 0.4 × 3.5 ± 0.5 cm; mean single right and left main PV ostium diameters were 1.5 ± 0.2 and 1.3 ± 0.3 cm; and mean right and left PV first-order branch diameters were 0.8 ± 0.2 and 0.6 ± 0.1 cm. Mean PV maximum inflow velocity for the right PV were 0.30 ± 0.05 m/sec and for the left PV were 0.35 ± 0.04 m/sec. The PV ostia and LAA could be targeted accurately for RFA using ICE guidance. At pathologic evaluation, the mean distance of the lesion center to the right or left PV-LA junction was 3.0 ± 2.0 mm. The mean distance of the lesion center to the posterior margin of the LAA was < 4 mm in all cases. There was no significant increase in PV maximum inflow velocity or decrease in PV diameter following RFA at the PV ostium. Absence of PV obstruction was confirmed at pathology. Conclusion: Phased-array ICE allows detailed assessment of LA and PV anatomy when imaged from the right atrium; accurate guidance of RFA to the PV ostium and LAA; and immediate evaluation of PV patency after RFA.

Transradial approach for renal artery stenting.

Abstract: Percutaneous interventional procedures in the renal arteries are usually performed using a femoral or brachial vascular access. The transradial approach, which has been extensively investigated for coronary angiography and intervention, could be an attractive new technique for renal artery angioplasty and stenting. In 18 patients with hemodynamically relevant unilateral renal artery stenosis (mean diameter stenosis, 83% +/- 18%; right, n = 7; left, n = 11), interventional treatment with PTA and stenting was performed using a left (n = 16) or right (n = 2) radial artery access. Indications for the transradial approach were acute aorto-renal angles or severe peripheral arterial obstructions. After engagement of the renal artery ostium with a 6 Fr Multipurpose guiding catheter (length, 125 cm; Cordis) the stenosis was passed with a 0.014" guidewire followed by stent implantation (ACS Multi-Link RX Ultra, Guidant; length, 18 mm; diameter, 5 mm). Direct stenting was successfully performed in 16 cases. Predilatations were required in two cases. In five patients, optimal stent expansion was achieved by additional postdilatations. A primary technical success (residual stenosis < 30%) could be achieved in all cases. There were no periprocedural complications. According to color-coded doppler ultrasound, all access site arteries showed a normal perfusion. Clinically blood pressure control was improved in 11 patients with a significant reduction in systolic and diastolic blood pressure values. Serum creatinine values dropped from 1.81 +/- 0.3 mg/dl to 1.49 +/- 0.3 mg/dl (P < 0.001). Transradial renal artery angioplasty and stenting is technically feasible and safe. Particularly in patients with unfavorable vessel anatomy, this new cranio-caudal approach is an attractive alternative technique.

Device and method for aligning with the tubal ostium

Abstract: The present invention relates to an alignment device and method for facilitating alignment of a medical instrument with the tubal ostium of the Fallopian tubes. More particularly, the alignment device includes an expandable member, either in the form of a balloon member or sponge member, which is expandable from a contracted state to an expanded state by a fluid. In addition, the alignment device includes a catheter member attached to the expandable member and also includes, guiding means, in the form of passageways or the like, for guiding a medical instrument through the expandable member.

Surgical treatment of 52 patients with congenital coronary artery fistulas.

Abstract: OBJECTIVE To evaluate the outcome of surgical treatment for congenital coronary artery fistulas (CAF) in 52 patients seen between May 1988 and July 1999. METHODS Fifty-two patients ranging in age from 9 months 58 years (mean 15.7 +/- 16.4 years) were studied. Thirty-six patients had no other cardiac defects, 9 of those patients were more than 20 years old and presented with symptoms. Only one of 36 patients less than 20 years old had clinical findings before surgery. Sixteen patients had associated cardiac lesions. The site of fistula origin was the right coronary artery in 37 patients (71.2%), and the left coronary artery in 15 patients (28.8%). The sites of CAF drainage were the right ventricle, right atrium, left ventricle, left atrium and pulmonary artery in 22 (42.3%), 16 (30.8%), 6 (11.5%), 3 (5.8%), and 5 (9.6%) patients, respectively. The mean diameter of the fistula in 43 patients with single ostium was 7.34 +/- 4.12 mm. RESULTS Cardiopulmonary bypass was used in all patients and no patient died. An arteriotomy was made on the anomalous coronary artery and the proximal opening of a fistula was closed within the vessel in 10 patients. Closure of the distal opening of a fistula draining into a cardiac chamber or pulmonary artery was performed in 26 patients. In 16 patients, both the proximal and distal opening were closed. Two and 3 distal opening of a fistula were found in 6 and 3 patients, respectively. No residual shunt was found before patients were discharged from the hospital. Forty patients were followed up for a mean period of 3.14 +/- 1.84 years. The remaining 12 patients could not be contacted during follow-up. No clinical symptoms were found in those patients during follow-up but one patient still presented with ST-T change. CONCLUSION Early and properly surgical management is safe and effective for congenital coronary fistula.

Guide or diagnostic catheter for right coronary artery

Abstract: A torqueable, three-dimensionally preformed guide or diagnostic catheter to selectively engage the ostium (32) of a right coronary artery (36) in a human includes: a torque-transmitting proximal shaft that receives manipulation by a user outside a human body in which the catheter is used; and a distal shaft that is responsive to torque transmitted by the proximal shaft. The distal shaft (8) also includes a preformed support section having at least a segment that abuts a posterior interior surface of the ascending aorta of the human body. The distal shaft (8) also includes a preformed ostium entry section extending from the support section. In one implementation, the ostium entry section transitions from the support segment abutting the aortic wall to a distal tip (22) end by way of at least two angles, which provide smoother transition than a single sharp angle.

Atlas of endoscopic anatomy for endonasal intrancranial surgery

Abstract: I. Anatomic preparations.- I.A. Gross anatomy.- I.A.1. Bone preparations.- I.A.2. Nose and paranasal sinuses.- I.B. Endoscopic surgical anatomy.- I.B.1. Nose.- I.B.2. Sphenoidal sinus.- I.B.3. Sella turcica region.- I.B.4. Suprasellar region.- I.B.5. Parasellar region.- I.B.6. Retrosellar region.- II. Preoperative management.- II.A. Neuroradiological investigations.- II.A.1. CT.- II.A.2. MRI.- II.B. Operating theatre.- II.B.1. Positioning of the patient.- II.B.2. Equipment.- III. Surgical procedure.- III.A. Surgical steps.- III.A.1. Endonasal approach to the sphenoidal sinus ostium.- III.A.2. Enlargement of the sphenoidal sinus ostium.- III.A.3. Preparation of the sphenoid sinus.- III.A.4. Opening of the floor of the sella turcica.- III.A.5. Opening of the dura mater.- III.A.6. Removal of the lesion.- III.A.7. Sella turcica reconstruction.- Appendix: Selected clinical cases.- Case 1: Intra-suprasellar macroadenoma.- Case 2: Intra-parasellar macroadenoma.- Case 3: Solid intra-suprasellar craniopharyngeoma.- Case 4: Cystic intra-suprasellar craniopharyngeoma.- Case 5: Arachnoid intra-suprasellar cyst.- Case 6: Intra-suprasellar RATHKE's cleft cyst.- References.

Corticosteroid therapy during endoscopic sinus surgery in children: is there a need for a second look?

Abstract: Objective To determine whether intravenous administration of dexamethasone during endoscopic sinus surgery in children will decrease scarring and edema during a second-look procedure. Design Prospective, randomized, double-blind, placebo-controlled trial. Setting University medical center. Patients Forty-eight children undergoing endoscopic sinus surgery for chronic sinusitis. Intervention Twenty-four children received intravenous dexamethasone and 24 received placebo intraoperatively before the start of the procedure. Main Outcome Measures The status of the ethmoid cavity, the status of the mucosa in the maxillary sinuses, and the patency of the maxillary sinus ostium during the second-look procedure performed 2 to 3 weeks after the primary procedure. Results Children who received intravenous dexamethasone had significantly less maxillary sinus mucosal edema, less ethmoid scarring, and a lower incidence of closure of the maxillary ostium ( P = .02). During the second-look procedure, 62% of children in the noncorticosteroid group had abnormal findings vs 29% in the corticosteroid group. Patients with asthma, lower computed tomography scores, and no exposure to smoking had a significantly lower incidence of scarring with use of corticosteroids. Children older than 6 years benefited from intravenous corticosteroid therapy vs children 6 years and younger. Conclusions Treatment with intravenous dexamethasone during endoscopic sinus surgery was safe and was helpful in reducing scarring and swelling noted during the second-look procedure. Use of corticosteroids was particularly helpful in children with asthma, lower computed tomography scores, and no exposure to smoking and in children older than 6 years.

Radiologic anatomy of the sphenoid sinus for intranasal surgery.

Abstract: Endoscopic surgery of the sphenoid sinus can present the operator with a considerable challenge. The relationship of the sphenoid sinuses, in particular on the lateral wall, to the carotid artery, optic nerve, as well as the other anatomic structures, is of utmost importance. Surgical complications can occur because of a lack of orientation during dissection. To avoid the complications or lessen, somehow, the rate of complications, some described the technique consisting of the opening of the sphenoid sinus ostium medially. We studied 69 axial high resolution computed tomography (HRCT) of temporal bones to reveal the relationship of sphenoid sinus to the vital structures and to get some measurements in the sphenoid sinus. The lateral distance from the sphenoid ostium revealed that the lateral distance was about the distance between both ostea. We consider that in selected cases the dissection might be carried out laterally from the sphenoid ostium for safe enlargement of the ostium and approaching the sinus.

Accessory pathway associated with an anomalous coronary vein in a patient with Wolff-Parkinson-White syndrome

Abstract: We report a case of Wolff-Parkinson-White syndrome coexistent with atresia of the coronary sinus (CS) ostium and persistence of the left superior vena cava. The accessory pathway was located at the blind end of the CS, which was bumped with mechanical loss of preexcitation during mapping by a catheter from within the CS. The accessory pathway was successfully ablated with radiofrequency energy applied to this site from the right atrium. This unique combination of anatomically matched anomalies may be important in suggesting a potential embryologic link between the accessory pathway and the coronary vein.

Technical results of falloposcopy for infertility diagnosis in a large multicentre study

Abstract: Despite increasing evidence of its potential clinical value, falloposcopy has not yet found widespread use. In a large prospective international multicentre study we investigated the hypothesis that limited technical reproducibility may be of crucial significance in this regard. From 1994 to 1998, data on 367 patients with 639 tubes were recorded from 18 centres (median number of falloposcopies 22). Falloposcopy was performed using hysteroscopic ostium access, coaxial tubal cannulation and retrograde visualization under laparoscopic control. The procedure was successful in 69.6% of the tubes. Failures occurred in 6.1% during hysteroscopy, in 10.6% during the cannulation step and in 16.4% during visualization. While predominantly intracavitary pathology or thick endometrium were found to interfere with hysteroscopic ostium access, technical insufficiencies resulting in catheter damage or vision disturbing light reflexions were identified to be responsible for most cannulation and visualization failures, confirming the importance of these factors. The number of patients who received a complete falloposcopic evaluation did not exceed 57%. Additionally, 23.7% of patients may have profited from unilateral success depending on the individual indication. As a consequence of these technically limited results it was concluded that the method currently qualifies for selected indications rather than for routine clinical application.

Guide catheter for placing cardiac lead

Abstract: An improved guide catheter provides a distal tip with one or more members that assist a surgeon with locating and inserting the guide catheter through the ostium in the wall of the right atrium that leads to the coronary sinus of the heart. The guide catheter is used to implant a cardiac lead so that its electrodes are positioned in the vasculature associated with the left side of the heart.

Anomalous origin of the left coronary artery (LCA) from pulmonary trunk (Bland-White-Garland syndrome) with systemic collateral supply to LCA.

Abstract: We present the case of 15-year-old asymptomatic girl referred to our institution with the diagnosis of mitral valve prolapse and a suspicion of coronary artery fistula. Detailed diagnostics revealed Bland-White-Garland syndrome (B-W-G) with tortuous aneurysmatic right coronary artery (9 mm in diameter). In addition, on surgery, multiple collateral vessels between the right and left coronary arteries were found crossing over the pulmonary trunk and right ventricle. Because of fragile and calcified anterior walls of the main pulmonary artery we had to elect Hamilton rather than Takeuchi technique. The procedure was aggravated by continuous blood outflow from enlarged LCA ostium suggesting systemic collateral supply. Weaning from cardiopulmonary bypass and postoperative period was uneventful. There are only two published reports on systemic collateral supply to LCA in patients with BWG.

Electrical Connections Between Pulmonary Veins in Humans Evidence After Radiofrequency Ablation of the Venoatrial Junction

Abstract: A 47-year-old man with an uncorrected ostium primum atrial septal defect complained of frequent episodes of paroxysmal atrial fibrillation since 1990. Class IC and III antiarrhythmic drugs failed to control the recurrences, and the patient was referred to our institution for electrophysiological evaluation. During the procedure, the focal origin of the atrial fibrillation episodes from the right superior and left pulmonary veins (PVs) was demonstrated by means of multielectrode mapping. For this reason, after selective PV angiography, PV electrical disconnection attempts were performed by delivering low-energy radiofrequency pulses close to the corresponding venoatrial junctions. To facilitate the recognition of electrical PV disconnection, a double-catheter technique was used with a reference quadripolar catheter placed distally in the mapped PV and a quadripolar, 4-mm tip, steerable catheter positioned immediately within the ostium of the same vein for mapping and ablation. Target areas were considered those …

Contrast harmonic power Doppler imaging of congenital ventricular diverticulum--a case report.

Abstract: A case of an 81-year-old woman with a left ventricular diverticulum who underwent myocardial contrast echocardiography is reported. After administration of the contrast agent, a pulsed Doppler flow measurement clearly revealed the biphasic waveform of the ejection flow in the pre-systolic and systolic phase at the ostium of the diverticular cavity. A harmonic power Doppler image showed that part of the diverticulum wall had similar acoustic properties to the ventricular septal wall. Intracardiac blood flow and myocardial perfusion could be clearly evaluated and a ventricular diverticulum was correctly diagnosed using contrast echocardiography.

Guide catheter with backup support system

Abstract: An intravascular catheter (e.g. guide or diagnostic catheter) that includes a specially designed distal tip to provide enhanced back-up support. The distal tip (e.g., distal 2 cm of the shaft) has a lateral extent or profile (e.g., wave shape) that is larger than the lumen of the coronary artery adjacent the ostium when the tip is in a relaxed state. The over-sized lateral extent causes the distal tip to frictionally engage the coronary artery and anchor within the ostium. The lateral extent or profile of the distal tip may be decreased by inserting a guide wire therethrough to facilitate insertion of the distal tip into the ostium. After the distal tip is inserted into the ostium, the guide wire may be removed to allow the lateral extent of the distal tip to increase and thereby anchor the distal tip in the ostium.

Platelet reactivity in coronary ostial blood: a reflection of the thrombotic state accompanying plaque rupture and of the adequacy of anti-thrombotic therapy.

Abstract: Background: Optimal anti-thrombotic therapy for acute coronary syndromes (ACS) should suppress pro-thrombotic activity at the site of plaque rupture. We sought to determine whether platelet reactivity is increased in blood in the immediate vicinity of a ruptured plaque and is apparent even when blood is obtained by sampling from a catheter placed proximal to the lesion. Methods: Blood was obtained from a catheter placed in the aorta and from the same catheter after engaging the culprit coronary artery. Platelet reactivity was determined with the use of flow cytometry by surface expression of P-selectin. Results: In preliminary studies we demonstrated that a marker of thrombin activity, fibrinopeptide A, was similarly increased in blood taken from the coronary sinus and coronary arterial ostium of patients with ACS. Subsequently blood was obtained from the aorta and coronary arterial ostium through a coronary guide catheter for assessment of platelet reactivity in 23 subjects with ACS and 22 subjects with stable angina. The percentage of platelets expressing P-selectin in response to 0.2[emsp4 ]μM adenosine diphosphate (ADP) was greater in coronary arterial samples from patients with ACS (aorta=6.1±1%, coronary artery=8.8±1.6%, p=0.02) compared with that in patients with stable symptoms (aorta=6.9±1.2, coronary artery=6.5±1.4, p=NS). Conclusions: Coronary arterial blood obtained from the ostium through a coronary guide catheter can be used to determine whether thrombin activity and platelet reactivity are increased in the immediate vicinity of a ruptured atherosclerotic plaque. The simplicity of the approach developed should facilitate its use in future studies designed to determine the impact of optimal suppression of platelet reactivity and the pro-thrombotic state before coronary interventions on short- and long-term clinical outcomes.

Effects of long-term induced ostial obstruction in the rabbit maxillary sinus.

Abstract: One of the widely proposed theories for mucocele formation is sinus ostial obstruction. Accordingly, this study was undertaken to investigate the long-term effects of ostial obstruction in the rabbit maxillary sinus and its potential role in the pathogenesis of mucoceles. Maxillary sinus ostial obstruction was induced on one side in eight Pasteurella-free White New Zealand rabbits using Histoacryl. The rabbits were housed in a Pasteurella-free zone for 24 weeks. At re-exploration, only three of the eight maxillary sinuses where ostial obstruction was induced showed pressure recording consistent with ostial obstruction. Mucociliary clearance activity was assessed using India ink. Swabs for culture were taken from the infected maxillary sinuses. Mucosal specimens for histopathological examination were harvested from one of the maxillary sinuses with obstructed ostium as well as from another sinus with nonobstructed ostium. The three maxillary sinuses with obstructed ostia showed gross evidence of infection and deranged mucociliary clearance, but no mucocele formation. Based on the findings of this study it is concluded that long-term ostial obstruction indeed plays a role in the pathogenesis of chronic sinusitis, but it did not induce mucocele formation in the rabbit maxillary sinus.

Long-Term Clinical Follow-up in A Case of Takayasu's Arteritis Involving the Ostium of Left Coronary Artery after Ostioplasty

Abstract: A 25-year-old woman presented with effort-induced chest pain. Physical examination revealed different blood pressures, 180/100 mmHg in right arm and 100/60 mmHg in left arm. Resting electrocardiogram was normal, but down-slope depression of ST segment more than 3 mm in V3-6, II, III, aVF developed at the stage 1 of treadmill exercise test. Stress Thallium-201 scan showed severe ischemia in the anteroseptal and lateral wall of left ventricle. Diagnostic coronary angiogram showed critical stenosis in the ostium of left main coronary artery. The left subclavian artery was occluded totally with well-developed collateral circulation. The patient underwent ostioplasty of left coronary ostium using pericardial patch, and her symptom improved after surgery. Follow-up coronary angiogram one year after surgery showed patent coronary artery ostium with good flow and myocardial perfusion improved on follow-up Thallium-201 SPECT. She has no major cardiac events during 7-year clinical follow-up. (Korean Circulation J 2001;31(2):246-250)

Emergency angioplasty and stent deployment for acute occlusion of an anomalous single coronary artery (all three coronary arteries from one ostium in the right sinus of Valsalva).

Abstract: A single coronary ostium is traditionally considered to be of little clinical significance. We report a case of a single ostium in the right sinus of Valsalva, giving rise to the right coronary artery, from which the left main coronary artery originated. Sudden death occurred seven days after acute gastrointestinal bleeding and subsequent interruption of aspirin therapy. Acute coronary angiography following successful resuscitation revealed an ascending thrombus in the right coronary artery. The patient underwent a complex percutaneous coronary angioplasty with stent deployment. We conclude that coronary artery disease may lead to severe ischemia with a large area at risk and major complications in patients with coronary anomalies. Patients with acute stent implantation might benefit from platelet aggregation even in cases of recent intestinal bleeding.