Editorial Message - August 2002

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports, articles from the Journal special sections "Practice Management and Economics", "Clinical Decision Making", "The Electrophysiology Corner" and "Interventional Pediatric Cardiology", and a summary of the discussion on treating patients in shock from the International Andreas Gruentzig Society Meeting held in February of 2002. The first research article, submitted by Dr. Wai-Hong Chen and colleagues from the Departments of Medicine and Pathology at Ruttonjee Hospital in Hong Kong, China, assessed the pharmacokinetics, safety and efficacy of intravenous enoxaparin given as a single dose to patients undergoing PCI. They found that the patient sample has a very low rate of ischemic complications and showed peak drug action at 4-hours post administration. In the second research article, Dr. Yusuf Atmaca and associates from the Department of Cardiology at Ankara University in Ankara, Turkey, examined the effect of direct versus pre-dilation placement of stents on the occurrence of minor myocardial injury in stable angina patients with simple lesion morphology. Their study showed that direct stenting resulted in lower levels of cardiac troponin T, suggesting less minor myocardial damage. In the third original research submission, Drs. Allison Morton and Julian Gunn from the Department of Cardiology at Northern General Hospital in Sheffield, UK, evaluated the potential benefit of using an additional stent to provide extra support in situations where the placement of the first stent was suboptimal. This issue of the Journal also includes three interesting case reports representing unusual clinical presentations and two case reports with brief reviews of the literature. In the first case report, submitted by Dr. Omer Goktekin and associates from the Departments of Cardiology and Cardiac Surgery at Osmangazi University in Eskisehir, Turkey, the authors describe a patient who had blunt chest trauma and manifested complete occlusion of the left main coronary artery. The second case report, from Dr. Aytul Belgi and colleagues from the Department of Cardiology at Akdeniz University School of Medicine in Antalya, Turkey, describes a rare occurrence of a dislodged stent that embolized and needed to be retrieved from the left ventricle during intervention to the LAD. The third case report, submitted by Drs. Atmaca, Dandachi and Oral from the Department of Cardiology at Ankara University in Ankara, Turkey, describes an unusual presentation of a variant on a single coronary artery in which the ostium of the right coronary artery is absent and with the origin of the RCA as a continuum of the distal circumflex. They describe their treatment of a patient presenting with this anomaly and non-obstructive hypertrophic cardiomyopathy. The fourth case report, submitted by Dr. Antonio Bartorelli and colleagues from the Institute of Cardiology, University of Milan and the Centro Cardiologico "Monzino" IRCCS in Milan, Italy describes a patient with a coronary aneurysm that was treated with a PTFE-covered stent but developed restenosis at 7 months and required surgical intervention. The authors provide a thorough discussion of the case with a short review of the literature on this clinical presentation. The last case report, from Drs. Sharma, Morice and Catineau from the Institut Cardiovasculaire Paris Sud in Massey, France, presents a patient in which bilateral multiple renal artery stenting was successfully accomplished at a single catheterization laboratory visit. Four of our special clinical sections are featured in this issue of the Journal. The first special section, which covers advances in the field of Interventional Pediatric Cardiology and is edited by Dr. P. Syamasundar Rao from the Division of Pediatric Cardiology at Saint Louis University School of Medicine in St. Louis, Missouri, includes an article submitted by Drs. Recto and Sobczyk from the Divisions of Pediatric Cardiology and Pediatrics at the University of Louisville, Kosair Children’s Hospital, in Louisville, Kentucky. The authors present a novel technique to prevent displacement of the inferior vena cava filter during cardiac catheterization and follow the treatment provided to this patient with subsequent transcatheter closure of a patent foramen ovale in this patient with cryptogenic stroke. In the Clinical Decision Making section, edited by Dr. Michael Sketch from Duke University Medical Center in Durham, North Carolina, Dr. Sketch has submitted along with his associates Drs. Dixon and Peter a case in which a patient presented with thrombus prior to stent placement. They describe their approach to management of this patient and then invite Dr. Stanley Bleich, Dr. George Dangas and Dr. Robert Safian to comment on their evaluation and approach to treating the patient. Their comments provide valuable dimensions to understanding the complexity of the case and the variety of ways available to approach the problem. In the third special section, the Electrophysiology Corner, edited by Dr. Todd Cohen of the Department of Cardiology at Winthrop-University Hospital in Mineola, New York, Dr. Cohen has collaborated with Drs. von zur Muhlen, Quan and Agate to report on their study of carotid sinus massage and head-up tilt testing in patients with syncope and near-syncope. In the last special section, Practice Managment and Economics, edited by Dr. Ronald N. Riner from The Riner Group, Inc., in St. Louis, Dr. Riner has provided an editorial on the article by Dr. Don Barbo from the Value Management Group, LLC, in Dallas, Texas. Dr. Barbo’s article covers the use of lease agreements and purchased services agreements in cardiac catheterization laboratories. This issue of the Journal is completed with a transcript of the discussion on treatment of patients in shock that occurred at the International Andreas Gruentzig Society meeting held in St. Lucia in February of this year. This lively discussion demonstrates that there are a number of unresolved issues in managing patients with shock, which remains an infrequent yet challenging clinical presentation for the invasive cardiologist. It is my hope that all of the articles in this issue of the Journal provide information that is useful for cardiovascular specialists in their daily care of patients with cardiovascular disease.