Feb-03

Dear Readers, This issue of the Journal of Invasive Cardiology includes original research articles, case reports, a CME offering, articles from the Journal special sections “Acute Coronary Syndromes” and “Interventional Pediatric Cardiology”, as well as Part VIII of the discussion series from the International Andreas Gruentzig Society 7th Biennial Meeting held in February of 2002. In the first original research article, Dr. Lee A. MacDonald and colleagues from the Divisions of Cardiology and Hematology in the Department of Medicine at Northwestern University Medical School in Chicago, Illinois present analysis of their experience with patients receiving enoxaparin following invasive cardiac procedures. They demonstrate that patients receiving this anticoagulant are at high risk for having severe access site complications that can occur between 3 and 11 days post procedure. The second research article, submitted by Dr. Srinivas Koneru and colleagues from the Division of Cardiology at Westchester Medical Center in Valhalla, New York, describes their experience using a thrombectomy device to remove clot from the culprit lesion in patients presenting with acute coronary syndromes. They conclude that this approach assists in identifying the complexity of the underlying lesion, resulting in more successful intervention. Dr. MacDonald and other collaborators from the Northwestern University Medical School also submitted the last research article in this issue of the Journal. This article provides a comparison of arterial closure devices with manual compression in the management of arterial access sites in liver transplant patients undergoing coronary angiography. The study showed that it is possible to decrease the time to ambulation in these patients using arterial closure devices. This issue of the Journal also includes interesting case reports representing unusual clinical presentations and cases that include brief reviews of the literature. In the first case report, Dr. Ramon Villavicencio and colleagues from the Department of Interventional Cardiology and Neuroradiology Department of the Instituto Nacional de Cardiologia in Mexico City describe their approach to successfully treating a patient with a coronary artery fistula draining into the pulmonary artery. They performed selective embolization with a resin called hystoacryl at the same time the patient had coronary angioplasty for atherosclerotic disease. In the second case report, Drs. Gorog, Watkinson and Lipkin from the Departments of Cardiology and Radiology at the Royal Free Hospital in London describe a case of aortic dissection following diagnostic catheterization, which extended from the aorta to the iliac artery arch. The patient was treated with a stent that was placed in the iliac artery, occluding the entry point. In the next case report and review, submitted by Tejas Patel and collaborators from the Krishna Heart Institute in Ahmedabad, India, the authors describe their successful management using percutaneous delivery of a stent into a patient with superior vena cava occlusion secondary to portacath insertion for chemotherapy. In the next case report that includes a brief review of the literature, Dr. Jeffrey Goldstein and colleagues from the Division of Cardiovascular Medicine, Barnes-Jewish Hospital, Washington University School of Medicine in Saint Louis, Missouri present a case that illustrates their approach to the treatment of an aortocoronary dissection complication from an attempted right coronary artery intervention. In the last case report, Dr. Mario Zanchetta and associates from the Department of Cardiovascular Disease at the Cittadella General Hospital in Padova, Italy describe their use of intracardiac echocardiography using contrast transcranial Doppler to successfully deploy an Amplatz PFO occluder in a patient with obstructive pulmonary disease. In the Acute Coronary Syndromes special section, edited by Dr. Lloyd Klein from the Rush Heart Institute at Rush-Presbyterian-St. Luke’s Medical Center in Chicago Illinois, Dr. Klein has invited Dr. Ali Moustapha from the Louisiana State University in Shreveport and Dr. H. Vernon Anderson of the Texas Heart Institute to submit an article on current strategies for treating acute coronary syndromes. They have provided an excellent and comprehensive overview of the major therapies used and results from the most important trials in the area. In our special section covering advances in Interventional Pediatric Cardiology which is edited by Dr. P. Syamasundar Rao from the Division of Pediatric Cardiology at Saint Louis University School of Medicine, Dr. Rao has included an article submitted by Dr. Carlos Pilla and colleagues from the Instituto Dante Pazzanese de Cardiologia in Sao Paulo, Brazil. In the article, the authors describe their successful treatment of a 7-month-old boy who presented with massive edema of the head and systemic desaturation after surgery in which a bi-directional Glenn shunt was placed. This issue is completed with a transcript of the discussion on treatment of patients with intractable angina that occurred at the International Andreas Gruentzig Society meeting held in St. Lucia in February of 2002. This lively discussion demonstrates that there are a number of unresolved issues in managing this difficult clinical situation and points to the need for continued research into innovative treatments for these challenging clinical presentations. It is my hope that all of the articles in this issue provide information that is useful for cardiovascular specialists in their daily care of patients with cardiovascular disease.