Improvement of Myocardial Perfusion : Thrombolysis, Angioplasty, Bypass Surgery

This book contains the manuscripts of the majority of the papers given during the symposium 'Improvement of Myocardial Perfusion' which was held from Sep­ tember 27-29,1984 in Mainz/Germany. It has been the purpose of this meeting to focus the interest of scientifically and clinically interested cardiologists on the new developments in this field. We therefore chose the subtitle 'Medical-Mechanical -Surgical Approach'. The medical improvements in myocardial perfusion have been brought about by the application of streptokinase, urokinase and tissue-type plasminogen ac­ tivator in the first hours after the onset of an acute myocardial infarction. The different modes of application and the possibilities to evaluate and eventually to quantify the results of these treatments were addressed during the first part of the meeting. The mechanical way to improve perfusion nowadays mainly consists of the application of intracoronary balloon angioplasty. Although since 1977 the treat­ ment has become a routine method, several questions are still open such as the exact mode of action, the reaction of the vessel wall, the optimal pressure and balloon size as well as the long term results and the prevention of restenosis. Front Matter....Pages I-XVIII Systemic streptolysis of acute myocardial infarction....Pages 1-10 Efficacy of BRL 26921, a new fibrinolytic agent for intravenous infusion, in acute myocardial infarction....Pages 11-14 Coronary venous retroperfusion support of reperfusion following acute coronary occlusion....Pages 15-24 Elevation of coronary sinus pressure improves myocardial protection....Pages 25-27 Improvement of myocardial perfusion and enhancement of washout during coronary artery occlusion by intermittent pressure controlled coronary sinus occlusions....Pages 28-31 Medical-mechanical treatment of myocardial infarction....Pages 32-41 Autopsy findings in 14 patients with myocardial infarction treated with thrombolysis or combined thrombolysis and PTCA....Pages 42-44 Thrombolytic therapy in myocardial infarction: Are fibrinolytic drugs comparable, and similarly effective?....Pages 45-51 Coronary thrombolysis with tissue-type plasminogen activator (t-PA)....Pages 52-56 Financial background of PTCR and PTCA and regional distribution of cardiac catheterization laboratories in the Federal Republic of Germany....Pages 57-64 Natural history of coronary artery stenosis....Pages 65-73 ECG and reperfusion....Pages 74-78 Intracoronary myocardial scintigraphy during intracoronary thrombolysis....Pages 79-89 Opposite ends of the intervention spectrum: Effects of intracoronary thrombolysis on long-term survival and LV function — Detection of early CAD by non-invasive positron imaging....Pages 90-103 Improvement of myocardial perfusion by thrombolysis evaluation of left-ventricular function by two-dimensional echocardiography....Pages 104-111 Right ventricular infarction: Echocardiography hemodynamic feature....Pages 112-124 Limitation of myocardial necrosis by thrombolysis during acute myocardial infarction....Pages 125-137 Pathophysiology of transluminal angioplasty....Pages 138-141 Does angioplasty improve or accelerate atherosclerosis?....Pages 142-149 Elective PCTA of totally occluded coronary arteries not associated with acute myocardial infarction: short and long term results....Pages 150-165 Acute changes of myocardial function by PTCA. Evaluation by two-dimensional echocardiography....Pages 166-173 Coronary sinus potassium and pH during percutaneous transluminal angioplasty: Temporal relation to contractility and action potential duration....Pages 174-180 Validity of myocardial scintigraphy, measurement of pulmonary artery pressure and intravenous digital subtraction angiocardiography in the evaluation of the effect of PTCA....Pages 181-185 Monitoring of myocardial ischaemia during PTCA improved sensivity with 12 — Lead ECG....Pages 186-189 Results of percutaneous transluminal coronary angioplasty assessed by TL-201 perfusion scintigraphy....Pages 190-193 Automated computer- assisted quantitative assessment of stenosis geometry and hemodynamics pre and post PTCA....Pages 194-197 Relationship of the occlusion pressure during PTCA to collaterals....Pages 198-200 Changes in creatine phosphokinase after coronary angioplasty....Pages 201-203 Antiischemic properties of intracoronary Diltiazem....Pages 204-206 Cardio-computertomography for assessing regional myocardial perfusion abnormalities in coronary heart disease....Pages 207-209 Clinical significance of microsphere myocardial scintigraphy in coronary artery disease....Pages 210-213 Current aspects of transluminal coronary angioplasty....Pages 214-218 Treatment of unstable angina by transluminal coronary angioplasty PTCA....Pages 219-230 Coronary angioplasty in multivessel disease....Pages 231-235 Effect of coronary occlusion during percutaneous transluminal angioplasty on systolic and diastolic left ventricular function....Pages 236-254 Restenosis following successful coronary angioplasty (PTCA): The result of inadequate dilatation? Relation between primary success and late results....Pages 255-264 Results of repetitive controls after successful transluminal coronary angioplasty....Pages 265-270 Longterm results after angioplasty of stenosed coronary artery bypass grafts....Pages 271-273 In vitro studies to investigate the possibility of protective intracoronary perfusion during percutaneous transluminal coronary angioplasty (PTCA)....Pages 274-276 Haemodynamic and haemorheologic effects of intracoronary perfusion during percutaneous transluminal coronary angioplasty (PTCA)....Pages 277-279 Improved tolerance of intracoronary balloon inflation with a modified Grüntzig balloon angioplasty catheter....Pages 280-283 Pressure transmission characteristics of the Grüntzig superlow-profile catheter....Pages 284-286 Increased hemolysis during coronary perfusion via angioplasty catheters as a result of side-hole jet effect....Pages 287-290 Intraoperative angioplasty in the treatment of coronary artery disease....Pages 291-299 Treatment of coronary artery stenosis by laser technique....Pages 300-309 Reoperative myocardial revascularization....Pages 310-316 Aortocoronary polygrafting and coronary endarterectomy in diffuse cad....Pages 317-319 Coronary artery bypass in the elderly....Pages 320-328 Combination of valve replacement and coronary bypass....Pages 329-340 Cardiac valve replacement and simultaneous myocardial revascularisation....Pages 341-343 Bypass surgery for stenosis and occlusion of the left main coronary artery....Pages 344-351 Bypass surgery adjacent to streptolysis theraphy....Pages 352-358 Emergency bypass operation after PTCA....Pages 359-361 Massive coronary artery spasm with resultant myocardial infarction after ACVB — surgery. A case report....Pages 362-363 Back Matter....Pages 365-366