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The experience of the use of the Magnum wire in a single center is reported. Percutaneous balloon coronary angioplasty, using the Magnum 0.021 inch wire, was attempted in 723 patients with 850 lesions; of these, 453 (53%) were chronic total occlusions and 50 (7%) recent occlusions of less than 24 hours (patients presenting with acute myocardial infarction). The overall technical success rate per lesion was 655/850 (77%). It was 255/280 (91%) for non-total lesions, 311/453 (69%) for chronic total occlusions, 53/67 (79%) for functional (TIMI grade I) occlusions, and 36/50 (72%) for recent occlusions. Clinical success was achieved in 196/232 patients (84%) with non-total lesions, in 292/436 (67%) with total chronic occlusions, in 49/65 (75%) with functional occlusions, and in 34/50 (68%) with recent occlusions. Complications (significant creatine kinase rise, new Q-wave infarction, need for coronary bypass surgery or in-hospital death) occurred in 7% (3% if patients presenting with unstable ischemic syndromes were excluded from the analysis). These data confirm that the use of the Magnum wire has success rates competitive with other systems both in setting of chronic total occlusion and in that of routine percutaneous transluminal coronary angioplasty.

Between July 1992 and February 1994, we attempted bailout Palmaz-Schatz stent implantation through a 6F guiding catheter after 52 failed coronary balloon angioplasty procedures to reverse (14 [27%] cases) or prevent (38 [73%] cases) abrupt vessel closure. The stents or half-stents were manually crimped onto a monorail balloon catheter for delivery. Thirty-nine (75%) procedures involved a single stent, and 13 (25%) involved two or three stents. Technical success was achieved in 50 (96%) procedures, and clinical success without major complications was obtained in 45 (87%) cases. Target vessel occlusion was documented angiographically or suggested clinically in 2 (4%) cases. Two (4%) patients underwent semielective bypass surgery, and in 4 (8%) patients a non-Q-wave and in 1 (2%) a Q-wave myocardial infarction developed. There were no deaths. Major bleeding occurred in 2 patients: 1 had an important groin hematoma that was treated with local surgery followed by coronary bypass surgery, and one had macroscopic hematuria that required interruption of anticoagulation therapy on day 4. Three (6%) femoral pseudoaneurysms were diagnosed by ultrasound and could be obliterated by external compression alone. Bailout coronary stent implantation through 6F guiding catheters after failed balloon angioplasty is technically reliable, safe, and cost-efficient. As a consequence, use of 6F guiding catheters is a good option for a large majority of routine balloon angioplasty procedures.

Based upon the findings of eosinophilia and concomitant ECG changes, hypersensitivity myocarditis was diagnosed in a patient who had been given longstanding antibiotic therapy. With cessation of drug treatment the disease resolved spontaneously.

The purpose of this study was to assess the reliability of conventional transthoracic and transoesophageal two-dimensional echocardiography combined with color-coded Doppler flow imaging (TEE) and ECG-triggered magnetic resonance imaging (MRI) for the diagnosis of thoracic aortic dissection and associated epiphenomena. A total of 53 patients with clinically suspected aortic dissection were subjected to a transthoracic and transoesophageal ultrasound examination and magnetic resonance imaging; the results of each imaging modality were compared and validated against the morphological standards of contrast angiography (n = 53) and/or intraoperative findings (n = 27) or autopsy (n = 7). In this series no deleterious events were encountered with either non-invasive imaging method. In contrast to conventional echocardiography the sensitivities of both MRI and TEE were 100% for detecting a dissection of the thoracic aorta, irrespective of its location. However, the specificity of TEE was lower than the specificity of MRI for a dissection (TEE 68.2% versus MRI 100%; p less than 0.005), which resulted from false positive TEE findings mainly confined to the ascending segment of the aorta (specificity of TEE 78.8% versus 100% by MRI; p less than 0.01). In addition, MRI proved to be more sensitive than TEE in detecting the formation of thrombus in the false lumen of both the aortic arch (p less than 0.01) and the descending segment of the aorta (p less than 0.05). There were no discrepancies between the two imaging techniques in detecting the site of entry to a dissection, aortic regurgitation or pericardial effusion. Both MRI and TEE are atraumatic, safe, and highly sensitive methods to identify and classify acute and subacute dissections of the entire thoracic aorta. However, TEE is associated with lower specificity for lesions in the ascending aorta. These results may still favor TEE after a precursory screening transthoracic echogram in suspected aortic dissection, but will establish MRI as an excellent method to avoid false positive findings. Anatomical mapping by MRI may emerge as a promising comprehensive approach and, eventually, as a morphological standard to guide surgical interventions.