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Cardiac catheterizations are used to diagnose and, if necessary, treat stenoses of the heart vessels. However, many patients fear this procedure. The present study has evaluated a specially produced educational film on cardiac catheterization. Patients and Methods: In order to assess the anxiety reducing effects of this film, we examined 50 patients who underwent an elective inpatient cardiac catheterization. Participating patients either watched a specific information film (15 min) or an unspecific film of equal duration on hospital care. At 3 different points in time (hospital admission, evening before catheterization, morning of day of catherization) we assessed state anxiety (STAI-S) and specific fears of the catheterization. Results: The information film significantly reduced general state anxiety as well as specific fears of the cardiac catheterization. In addition, a short knowledge test revealed that patients who had watched the information film knew more about the catheterization procedure. We assume that the information presented in the film reduced uncertainty about the procedure and thus also anxiety. Conclusion: The patients’ fears of a cardiac catheterization can be effectively reduced by means of an information film. [ABSTRACT FROM AUTHOR]

Aims: Persistent foramen ovale (PFO) is found in 9·2–32% of echocardiographic examinations. The gold standard for the detection of a PFO is transoesophageal echocardiography (TEE) and the mostly used provocation test is the Valsalva manoeuvre. The aim of our study was to evaluate the effectiveness of the Valsalva manoeuvre compared to other provocation tests by simultaneous haemodynamic measurements of the right and left atrial pressure.Methods: Fifty patients underwent Swan-Ganz catheterization. Right atrial pressure and pulmonal capillary wedge pressure, which corresponds to the left atrial pressure, were measured simultaneously. The following manoeuvres were compared: the Valsalva manoeuvre, coughing, deep inspiration and expiration pressures of 20 mmHg, 40 mmHg and 60 mmHg. The main objective of our study was to compare the occurrence of pressure gradients (right atrial pressure) left atrial pressure). For further quantification mean gradients, time duration of pressure overlap, as well as products of mean gradients and overlap time were analysed.Results: During the Valsalva manoeuvre a significant pressure gradient could be observed in 84% of the patients, followed by an expiration pressure of 60 mmHg (82%), inspiration (78%), expiration pressure of 40 mmHg (76%), coughing (75%) and an expiration pressure of 20 mmHg (62%). Comparing the mean gradients and the products of mean gradients and overlap time duration during the different manoeuvres, we could detect the significantly best results with the Valsalva manoeuvre.Conclusions: The Valsalva manoeuvre might be the most effective test to provoke a right-to-left atrial shunt for the detection of a PFO during echocardiographic examinations. [ABSTRACT FROM AUTHOR]

To study the ablation effects induced by excimer laser coronary angioplasty (ELCA), we examined 41 segments of nine isolated coronary arteries. An electronic intracoronary ultrasound device (ICUS: 20 MHz, 3.5F, Endosonics) was positioned coaxially within the vessel. Angioplasty was performed using a 1.7 mm ELCA catheter (Spectranetics) which was placed in the lumen and directed vertically onto the intimal surface of the vessel (fluence: 10–50 mJ. mm ). The laser catheter was removed after each losing cycle to allow the stepwise evaluation of the morphological effects of ELCA and to avoid reaching the adventitia. Ultrasound images were compared with the corresponding histological specimens. [ABSTRACT FROM PUBLISHER]

In order to develop a predictive model for the risk of early lesion deterioration following successful coronary balloon angioplasty (PTCA) based on clinical, pre-angioplasty and procedural characteristics, 154 lesions in 146 consecutive patients undergoing successful PTCA for stable/unstable angina were examined by quantitative coronary analysis immediately after and within 24 h of angioplasty. An angiographic complication score was used prospectively, classifying the lesion morphology post-PTCA into class 0: no complication and classes 1 to 3, according to purely descriptive morphological characteristics. Significant deterioration, defined as a decrease in minimal luminal diameter of more than 2 standard deviations of duplicate measurements post-intervention (0.54 mm; 95% confidence limit for variability using quantitative angiography) was found in 28 lesions (18%), and a total reocclusion in seven lesions (5%). The angiographic complication score (P=0.019), prior to myocardial infarction (P=0.076), minimal luminal diameter immediately post-intervention (P=0.021) and gain of PTCA (P=0.042) were found to be independently predictive of early lesion deterioration by multiple logistic regression analysis. Identification of these factors and their associated risk should improve success, and understanding of the early vascular response following coronary angioplasty. Moreover, these results have implications for clinical restenosis studies, particularly those assessing the effect of pharmacological interventions on late restenosis rates. [ABSTRACT FROM PUBLISHER]

Of 523 consecutive patients undergoing elective percutaneous transluminal coronary angioplasty (PTCA) and 83 patients treated with coronary excimer laser angioplasty (ELCA), 17 (3.3%) had in-laboratory occlusion following PTCA and 25 (30%)following ELCA; they were enrolled into a prospective study. Successful management (reopened vessel, patency at repeat angiography within 24 h, no death, no myocardial infarction (MI), no emergency bypass surgery) including repeat lasing, subsequent PTCA, use of intracoronary nitroglycerin or streptokinase was achieved in 24 (96%) of the 25 patients with acute occlusion during ELCA. An anterior MI occurred in one patient of the laser group. Repeat balloon dilatation was successfully performed in seven of the 17 patients (41%) with acute closure during PTCA. Among the 10 patients with persistent occlusion after PTCA, five developed a limited myocardial infarction (35%). One patient required emergency CABG, and died peri-operatively. Severe spasm prior to occlusion defined by a new coronary flow depression without evidence of dissection or thrombus showed a significant positive association with acute occlusion during ELCA ( =0.0008). Thus, in contrast to occlusion during PTCA, subsequent balloon dilatation was successfully performed in the majority of patients with acute occlusion during ELCA, implying that different underlying mechanisms are responsible for this complication. In this limited patient group, occlusion after excimer laser angioplasty was much more frequent than closure during PTCA, but was infrequently associated with major events such as myocardial infarction or death. [ABSTRACT FROM PUBLISHER]

To study the effect of heart rate changes on Doppler measurements of mitral valve area atrial pacing was performed in 14 patients with mitral stenosis andsinus rhythm. Continuous wave Doppler and haemodynamic measurements were performed simultaneously at rest and during pacing-induced tachycardia. (1) Mitral valve area was determined using the conventional pressure half time method. (2) Additionally, mitral valve area was calculated with a combined Doppler and thermodilution technique according to the continuity equation. (3) Simultaneous invasive measurements were used for calculation of the mitral valve area according to the Gorlin formula. With increasing heart rate (69 ± 13−97 ± 15−114 ± 13 beats min) mitral valve area either determined by the continuity equation (1.0 ± 0.2−1.0 ± 0.3−1.1± 0.4 cm) or the Gorlin formula (1.2±0.3−1.2±0.4−1.3±0.4cm) remained constant. Both methods correlated closely not only at rest (r=0.88, =0.11 cm, P<0.001), but also during atrial pacing (first level: r=0.95, =0.10 cm, P<0.001 second level: r=0.95, =0.13 cm, P<0.001). In contrast, mitral valve area calculated according to the pressure half time method increased significantly during atrial pacing (1.0 ± 0.3−1.8 ±0.5 − 2.O ± 0.5 cm). Mitral valve area determined either by the pressure half time method or the Gorlin formula correlated in patients with heart rates ≤80 beats min (r=0.75, SEE = 0.15 cm, p <0.01), while no significant correlation was found in patients with heart rates above 80 beats min. Our conclusion is that while the pressure half time method progressively overestimates mitral valve area with increasing heart rate, the accuracy of the continuity equation method based on a combined Doppler/thermodilution technique is independent of heart rate changes in patients with mitral stenosis and sinus rhythm. This method is superior to the pressure half time method in patients with mitral stenosis and heart rates exceeding 80 beats min. [ABSTRACT FROM PUBLISHER]

It has been speculated that ACE inhibitors may have beneficial effects in patients with coronary artery disease not only by their vasodilator properties but also by an effect on an assumed local renin-angiotensin system in atherosclerotic coronary arteries. Thus, the aim of the present study was to evaluate the effect of a single intravenous infusion of captopril on haemodynamics and coronary diameter at rest and during myocardial ischaemia induced by rapid atrial pacing. The study was performed in 12 patients with coronary artery disease and exertional angina pectoris despite medical therapy. Central haemodynamics (PAO, PAP) and left ventricular end-diartolic pressure were measured. Biplane cineventriculography and coronary arteriography were performed during control pacing (10% above the normal heart rate) before and after 15 min of captopril infusion, as well as during angina pectoris induced by rapid atrial pacing before and after captopril (six patients 0·15mg kg−1, six patients 0·3 mg kg−1).Mean aortic pressure was not significantly decreased by either 0·15 mg kg−1 or 0·3mg kg−1, whereas mean pulmonary pressure was significantly reduced by captopril by 28% at rest and 34% during rapid atrial pacing. Neither the endsystolic volume index nor left ventricular ejection fraction was significantly affected by captopril. Left ventricular end-diastolic volume index was reduced by 9% at rest and 7% during pacing-induced angina. Left ventricular end-diastolic pressure decreased from 11 ± 9 mmHg to 4·8 ± 4·1 mmHg at rest after captopril, and from 10 ± 11 mmHg to 5·1 ± 5·0 mmHg during pacing-induced angina after captopril. Quantitative coronary analysis revealed an increase of 0·1 mm at rest after captopril and an increase from 0·9 ± 0·1 to 1·1 ± 0·2 mm during ischaemia after captopril. This increase was even more pronounced by measurernenf of the minimal diameter ratio which increased at rest from 0·4 ± 0·2 to 0·54 ± 0·1 mmHg after captopril and during pacing-induced ischaemia from 0·4 ± 0·1 to 0·6 ± 0·1 mmHg after captopril.The results are compatible to patients with chronic heart failure and substantiate the predominant effect of ACE inhibitors as vasodilators by reducing preload significantly. If the mild vasodilation seen at the site of the atherosclerotic lesion is indeed due to a local effect of ACE inhibitors during myocardial ischaemia remains still open to question. Thus, therapy with ACE inhibitors for coronary artery disease requires validation in further clinical studies. [ABSTRACT FROM PUBLISHER]