PTCA, an investigational tool and a non-operative treatment of acute ischemia

Obstruction of coronary blood flow and the resultant consequences are the center stage pathophysiologic events in cardiology today. The speculations of Jenner, Burns, Heberdin, McKenzie, Prinzmetal and many others had until now been left to observations of isolated tissue and intact animal experimentation. Only with the advent of Gruentzig's technique, which allowed us to 'work safely inside the coronary arteries' are we able to observe the effects of coronary occlusion in living conscious man. PTCA provides not only a therapeutic modality for non-operatively opening coronary obstructions, but has also provided the best model for studying the effects of acute ischemia on the heart. The procedure also lead the way to all other interventional cardiology developments, including modern thrombolysis in the setting of acute myocardial infarction. In his previous works, Serruys has examined how PTCA can serve as a model for studying acute ischemia. In this book, he and his co-authors discuss the effects of balloon-induced ischemia on the electrocardiographic changes, coronary blood flow dynamics, cardiac muscle metabolism and left ventricular function, as well as measures to counter these effects and provide for reperfusion in unstable angina and acute myocardial infarction. Technology has expanded the 'eyes' of the observer of these events. The authors use many techniques including ECG recording from surface, endocardium, and intracoronary electrodes; angiographic assessment of coronary flow pattern using digital techniques, as well as doppler flow measurements; biochemical assessment of metabolic products stimulated by ischemia; and digital angiographic and echo doppler assessment of left ventricular function. Front Matter....Pages i-xix Front Matter....Pages 1-1 Intracoronary blood flow velocity, reactive hyperemia and coronary blood flow reserve during and following PTCA....Pages 93-120 Loss of hydrogen and potassium ions after short periods of myocardial ischaemia in man....Pages 121-126 Myocardial release of hypoxanthine and lactate during coronary angioplasty....Pages 127-142 Myocardial release of hypoxanthine and urate during angioplasty....Pages 143-150 Regional myocardial nitrogen-13-glutamate uptake following successful coronary angioplasty....Pages 151-154 Left atrial function in acute transient ischemia of the left ventricle....Pages 155-165 Left ventricular filling during acute ischemia....Pages 167-174 Left ventricular function during acute coronary artery balloon occlusion in humans....Pages 175-191 Use of intravenous DSA in the assessment of LV performance during PTCA....Pages 193-205 Two dimensional echocardiography during PTCA....Pages 207-216 Doppler echocardiographic assessment of left ventricular function during PTCA....Pages 217-231 Ejection filling and diastasis during transluminal occlusion in man....Pages 233-266 Myocardial ischemia....Pages 3-22 Early changes in wall thickness and epicardial wall motion during percutaneous transluminal coronary angioplasty in man....Pages 23-35 Early mechanical changes associated with coronary artery occlusion....Pages 37-42 Coronary angiographic and hemodynamic determinants of ST-segment response to acute coronary occlusion....Pages 43-51 Dynamic appearance of collaterals during coronary occlusion and their impact on electrocardiographic changes and wall motion abnormalities....Pages 53-73 Myocardial ischemia during PTCA: Consequences and treatment strategies....Pages 267-282 Does Diltiazem protect the ischemic myocardium during PTCA?....Pages 283-304 Collaterals and coronary wedge pressure....Pages 75-91 Front Matter....Pages 1-1 Influence of anti-ischemic drug treatment on the ischemic response to acute coronary occlusion in man....Pages 305-317 Cardioprotective effects of coronary sinus retroperfusion during LAD angioplasty....Pages 319-332 Front Matter....Pages 333-333 Coronary angioplasty for unstable angina pectoris....Pages 335-356 Coronary angioplasty in patients with non-Q wave myocardial infarction....Pages 357-372 Thrombolytic therapy and PTCA in acute myocardial thrombosis....Pages 373-383 The United States thrombolysis and angioplasty trials for acute myocardial infarction....Pages 385-404 Back Matter....Pages 405-410