Jun-05

Dear Readers, It is my hope that the articles in this issue provide cardiovascular healthcare professionals with important information that assists them in the effective management of cardiac patients. Along with these articles, please visit www.invasivecardiology.com to read session 4 from the proceedings of the 8th Biennial International Andreas Gruentzig Society meeting. In our Rapid Communication section we have included a report from Dr. Robert Ecker and associates from the Department of Neurosurgery and Toshiba Stroke Center at the State University of New York at Buffalo. They describe their experience in managing perforation of the external carotid artery branch arteries that occurred during endoluminal carotid revascularization procedures. The authors discuss early recognition and the approach to treatment in this potentially life-threatening situation. In the first original research article, Dr. Shahar Lavi and associates from Rambam Medical Center in Haifa, Israel report on the impact of using GP IIb/IIIa inhibitors during primary coronary intervention in patients presenting with acute myocardial infarction. They demonstrated that patients who were treated adjunctively with GP IIb/IIIa inhibitors had significantly better in-hospital outcomes and better 12-month survival compared to those treated with primary PCI alone. Dr. John Young from our editorial board has provided a commentary to accompany this article. In the next study, Dr. Ramanjit Bagga and colleagues from the Mount Sinai Medical Center in New York, describe their attempt to determine if debulking techniques used before brachytherapy along with longer use of brachytherapy would result in more favorable rates of clinical restenosis. Patients who underwent this treatment approach and were maintained on dual antiplatelet therapy had rates of target vessel and lesion revascularization rates below 10%. Drs. Patrick McCollom from Eli Lilly and Lida Etemad from i3magnifi have provided results of a study analyzing demographics, health characteristics and health care utilization in patients presenting with acute coronary syndrome. In this retrospective claims analysis, early revascularization was frequently used in these patients, with a majority of the costs medical and most revascularization PCI. Next, Dr. Eduardo Aptecar and colleagues report on their experience using the ulnar artery as the primary entry site showing that the diagnostic catheterization and therapeutic intervention could be safely performed using the transulnar approach. The last research article is also part of our Interventional Pediatric Cardiology section which is edited by Dr. P. Syamasundar Rao from the Division of Pediatric Cardiology at Saint Louis University School of Medicine. This study, from Dr. Yael Garty and colleagues from the Hospital for Sick Children in Toronto, presents late outcomes after pulmonary valve dilatation in neonates, infants and children. They found that gradient reduction persists and cardiac structures develop appropriately in most children after the initial procedure, although some do experience some pulmonary regurgitation that is typically well tolerated. Two additional articles in this issue focus on the treatment of pediatric patients and provide insight into the treatment of unusual presentations not often encountered in clinical practice. Drs. Rashid, Ringewald and Saucedo from the Oklahoma University Health Sciences Center describe their approach to placing a sirolimus-coated stent in the distal left internal mammary artery of an 8 year old boy. They provide a comprehensive discussion of the factors that may lead to graft stenoses in young children in whom coronary artery bypass surgery itself is not frequently performed. Drs. Yalcin, Ozcelik and Celiker from Hacettepe University Faculty of Medicine in Ankara, Turkey describe their use of a stent in the left pulmonary artery of a child who developed plastic bronchitis 5 years after a Fontan procedure. Next, we have included several case reports. Dr. Dennis Katechis and associates from the North Shore University Hospital in Manhasset, New York present their approach to identification and management of a patient with pheochromocytoma and neurofibromatosis who presented with acute myocardial infarction. They emphasize the necessity of quick diagnosis of this condition and the need to begin appropriate therapy as soon as possible. In a second case review, Dr. Tim Fischell and colleagues from the Heart Institute at Borgess in Kalamazoo present two cases demonstrating the effect of injecting nicardipine prophylactically directly into a graft to prevent no-reflow in triple-vessel saphenous vein graft intervention. They review the use of distal embolic protection devices and conclude that the use of nicardipine should be evaluated in larger prospective clinical trials. Finally, Dr. Saleem Sharieff and colleagues from the National Institute of Cardiovascular Disease in Karachi, Pakistan, report successful outcomes in two cases involving concurrent double valvuloplasty with a metallic valvulotome and the Inoue balloon for mitral and tricuspid stenoses. They discuss this approach in contrast to treatment with surgical commissurotomy. In the Electrophysiology Corner this month, edited by Dr. Todd Cohen of the Winthrop-University Hospital, Drs. Christopher Lang and Neil Grubb from the Royal Infirmary of Edinburgh describe their approach in treating a patient with aortic endocarditis and acquired tri-fascicular block in which they placed a lead hooked to a single chamber pulse generator that was maintained for a period of four months, and subsequently removed with resolution of the problem. This hybrid long-term temporary pacing proved to be very effective and did not result in complications or infections. Dr. Eftihia Hamodraka et al. display an unusual case in the Clinical Images section, edited by Dr. David Rizik from the Scottsdale Heart Group. They illustrate a case in which the LAD terminates into a PDA into the posterior interventricular septum, thus supplying blood to both the anterior and posterior interventricular septum.