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Coronary Angioplasty

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Table of Contents

1. Effects of acute myocardial ischemia and reperfusion in conscious animals.- Instrumentation techniques for measurements of regional myocardial function in conscious animals.- Relationship between reduction in regional blood flow and myocardial function.- Adjustment to global LV ischemia.- Adjustment to regional myocardial ischemia.- Effects of reperfusion.- Enzyme leakage from ischemic myocardium.- Summary.- References.- 2. Early changes in wall thickness and epicardial wall motion during coronary angioplasty in man. Similarities with in vitro and in vivo model.- Echocardiographic changes in wall thickness.- Changes in epicardial wall motion.- Regional marker motion.- Analysis of pressure-derived indexes during systole and diastole.- Results.- Changes in regional epicardial wall motion.- Changes in global left ventricular function.- Discussion.- Early wall motion changes during acute ischemia.- Wall motion abnormalities in chronic ischemia.- References.- 3. Intracoronary electrocardiogram during transluminal coronary angioplasty.- and methods.- Results.- Discussion.- References.- 4. Clinical, electrocardiographic and hemodynamic changes during coronary angioplasty. Influence of nitroglycerine and nifedipine.- Methods.- Results.- Ischemic tolerance.- Ventricular function.- Discussion.- Summary.- References.- 5. Wall thickening and motion in transient myocardial ischemia: Similarities and discrepancies between different models of ischemia in man (Prinzmetal's angina, coronary angioplasty, Dipyridamole test).- Echocardiographic markers of ischemia.- The clinical model of transmural vasospastic ischemia and coronary angioplasty.- Evaluating the site of myocardial ischemia before coronary angioplasty: a role for the Dipyridamole-echocardiography test.- References.- 6. Effect of prolonged balloon inflations on hemodynamics and coronary flow with respect to balloon position in patients undergoing coronary angioplasty.- Methods.- Results.- Coronary sinus flow.- Coronary sinus flow and hemodynamics.- Collateral flow.- Discussion.- Flow during occlusion.- Reactive hyperemia.- Coronary sinus flow and hemodynamics.- Implications.- References.- 7. Myocardial release of hypoxanthine and lactate during coronary angioplasty: A quickly reversible phenomenon, but for how long?.- Patients and methods.- PTCA technique.- Lactate measurements.- Hypoxanthine determination.- Flow measurements.- Statistical analysis.- Results.- Coronary hemodynamic measurements.- Lactate and hypoxanthine metabolism.- Discussion.- Use of purine release as a marker for ischemia during transluminal occlusion in man.- Metabolism during reperfusion.- Summary.- References.- 8. Role of potassium in the genesis of arrhythmias during ischemia. Evidence from coronary angioplasty.- Electrolytes in the ischemic myocardium.- Calcium.- Sodium.- Hydrogen ion.- Potassium.- Shortening of the action potential during myocardial ischemia.- Changes in the plasma potassium during myocardial ischemia.- Conclusion.- References.- 9 "Collateralpressure" (occlusion pressure) during coronary angioplasty in coronary artery disease.- Methods.- Results.- The relation between the collateral pressure (OP) and the amount of visible collaterals (study 1).- The influence of Nifedipine on the collateral pressure (study 2).- The relation between the collateral pressure and the occurrence of restenosis (study 3).- Discussion.- Summary.- References.- 10. Assessment of the dynamic and functional characteristics of collateral flow observed during sudden controlled coronary artery occlusion.- Methods.- Study patients.- Cardiac catheterization and angioplasty protocol.- Study protocol.- Results.- Changes in collateral filling during coronary occlusion (Fig. 5).- Hemodynamics.- Indices of myocardial ischemia with reference to collateral flow.- Discussion.- The coronary collateral circulation is a dynamic circulation.- Can collateral circulation limit ischemia?.- Present study.- Clinical implications.- Summary.- References.- 11. Left ventricular cineangiography during coronary angioplasty.- Selection of the patients.- Left ventricular cineangiography procedure during PTCA.- Results.- Left ventricular pressures.- Left ventricular volumes and ejection fraction.- Left ventricular diastolic function.- Segmental wall motion.- Reversibility of the ischemic changes.- Comments.- References.- 12. Left ventricular filling during acute ischemia.- Methods.- Results.- Left ventricular relaxation.- Left ventricular stiffness.- Left atrial contraction.- Discussion and conclusions.- References.- 13. Ejection filling diastasis during transluminal occlusion in man. Consideration on global and regional left ventricular function..- Study population and protocol.- Methods.- Analysis of pressure derived indices during systole and diastole.- Analysis of regional and global left ventricular function.- Ejecting dynamics.- Filling dynamics.- Diastasis.- Statistical analysis.- Results.- Global left ventricular function during systole and diastole.- Regional indexes of left ventricular ejection and filling and regional pressure-radius length relations.- Regional pressure-radius length relation.- Discussion.- Myocardial ischemia, transient asynergy and altered relaxation.- Uncoordinated segmental contraction as a cause of impaired filling dynamics.- Determinants of filling dynamics.- Role of the asynchronous contraction.- Effect of coronary occlusion on left ventricular chamber stiffness and regional diastolic pressure-radius relations.- Significance of the upward shift in pressure-volume and pressure-radius relations.- Comparison with animal models of acute low-flow ischemia.- Mechanism of increased myocardial stiffness.- Conclusion: PTCA as an ischemic model?.- Early wall motion during acute ischemia: how to interpret?.- Are there clinical implications in chronic ischemia?.- Are there clinical implications for the PTCA procedure?.- References.

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