Coronary arterial findings after accidental death immediately after successful percutaneous transluminal coronary angioplasty

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Transmission of ultrasonic contrast through the lungs

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Computed Tomography During Experimental Balloon Dilatation For Calcific Aortic Stenosis. A Look into the Mechanism of Valvuloplasty

Thin‐slice contiguous computed tomographic scanning was performed in four postmortem hearts with calcific aortic valve stenosis (mean weight: 583 ± 78 g; mean age: 65 ± 10 years) before, during, and after balloon valvuloplasty. Balloons of increasing diameter (15–19 mm single balloons, and 3 × 12‐mm trefoil‐shaped balloon) were positioned across the aortic valve and manually inflated to pressures of 3 to 4 atmospheres. During inflation of the 3 × 12‐mm balloon a larger residual orifice, potentially free for blood passage, was observed in the two cases with bicuspid valves and in one case with a fused tricuspid valve, while the reverse was noted in one case with a tricuspid valve without fusion. In most cases valvular orifice enlargement only occurred with larger diameter balloons. After valvuloplasty aortic valve area increased from 0.72 (range 0.20–0.95) cm2 to 2.36 (range 0.95–3.14) cm2. The smallest orifice enlargement after dilatation occurred in case 1, where valvular calcified deposits had the largest volume and the highest computed tomographic attenuation value. In each patient macroscopic changes (fracture of nodular calcifications, commissural splitting, tearing of the central raphe) were noted. No calcium dislodgement or aortic ring damage was observed. In autopsy specimens computed tomography provided accurate evaluation of aortic valve morphology, extent of valve calcification, balloon‐leaflet relationship during inflation, and effects of the dilatation on valve leaflets and commissures. Advances in computed tomographic cardiovascular imaging may achieve similar results in the clinical setting, and allow a more rational, individualized approach to the valvuloplasty procedure. (J Interven Cardiol 1988:1:2) Copyrigh

Alloreactive lymphoid infiltrates in human heart transplants: Loss of class II-directed cytotoxicity more than 3 months after transplantation

Abstract From 535 endomyocardial biopsies (87 heart transplant recipients) 283 cell cultures could be generated. All cultures tested contained T lymphocytes and in most cases CD4 was the predominant phenotype at any time posttransplant. A significantly higher proportion of CD8-dominated cultures was found among cultures from biopsies without myocytolysis. In the first 3 months post transplant 57% of cultures showed cytotoxicity against both class I and class II mismatched donor major histocompatibility complex (MHC) antigens, changing to an incidence of 33% at > 90 days. This proved to be due to a significant decrease in the number of cultures with human leukoctye antigen class II-directed cytotoxicity. This study shows that early after transplantation a heart transplant is infiltrated with activated donor-specific cytotoxic T cells which recognize a broad spectrum of mismatched donor MHC antigens, and that in time this spectrum becomes more restricted

Right to left shunt, with severe hypoxemia, at the atrial level in a patient with hemodynamically important right ventricular infarction

This report describes a patient with a massive right ventricular infarction, complicated by severe hypoxemia. Contrast echocardiography demonstrated a right to left shunt through a previously asymptomatic atrial septal defect. This phenomenon should be considered as a possible cause of hypoxemia in the presence of right ventricular infarction

Tenosynovitis caused by Pyracantha coccinea injury of the hand

Tenosynovitis caused by Pyracantha coccinea (fire thorn) has not been reported before, most likely because it is uncommon and the diagnosis is difficult to confirm. The symptoms, differential diagnosis, and the surgical treatment are described. Three cases are reported. It is postulated that natural fungicides in the sapwood may be implicated in the inflammatory reaction

Restenosis 3 months after successful percutaneous aortic valvoplasty. A clinicopathological report

A 76-year-old man with severe, calcific aortic stenosis experienced recurrence of symptoms 3 months after a successful percutaneous aortic valvoplasty. Echo Doppler revealed a marked increase of peak aortic flow velocity as compared with the immediate post-valvoplasty value. The patient underwent an uncomplicated aortic valve replacement. Adjacent to fragmented calcification, histology demonstrated a scarring reaction which might well be a major factor in the restenosis process

Electrical impedance of layered atherosclerotic plaques on human aortas

Electrical impedance measurements were performed on 13 atherosclerotic human aortic segments at 67 measuring spots in order to determine whether or not on the basis of these data a distinction can be made between atherosclerotic lesions and normal tissue. Stenosis localization and guidance of interventional techniques could be among the applications of an impedance measuring technique implemented on a catheter system. The experimental results, obtained with a two-electrode measuring technique, show that the apparent resistivity of an atherosclerotic spot does not necessarily deviate much from the resistivity of normal tissue. This is clarified by histology which shows that the majority of lesions has a surface layer of connective, fibrous tissue having almost similar conducting properties as the normal arterial wall. For gaining a deeper understanding of the way in which the measured data come about, a physical model of an atherosclerotic lesion is presented and confronted with the data. Both experimental data and theoretical considerations lead to the conclusion that only when the superficial fibrous layer is absent or very thin in relation to the size of the measuring electrode, the measured resistivity at a lesion is much higher than at normal spots. This occurs as a consequence of the high ohmic properties of the calcified or lipid deposits in the atherosclerotic lesion

Vaporization of atherosclerotic plaques by spark erosion

An alternative to the laser irradiation of atherosclerotic lesions has been developed. A pulsed electrocardiogram R wave-triggered electrical spark erosion technique is described. Controlled vaporization of fibrous and lipid plaques with minimal thermal side effects was achieved and documented histologically in vitro from 30 atherosclerotic segments of six human aortic autopsy specimens. Craters with a constant area and a depth that varied according to the duration of application were produced. The method was confirmed to be electrically safe during preliminary in vivo trials in the coronary arteries of seven anesthetized pigs. The main advantages of this technique are that it is simpler to execute than laser irradiation and potentially more controllable