Does lowering pulmonary arterial pressure eliminate severe functional tricuspid regurgitation? Insights from pulmonary thromboendarterectomy.

Objectives: Because pulmonary thromboendarterectomy (PTE) can result in an immediate reduction in pulmonary artery (PA) pressure, we sought to evaluate the effect of PTE on severe tricuspid regurgitation (TR) without tricuspid annuloplasty.

Background: Few data exist regarding the frequency and magnitude of functional TR improvement after reduction in PA pressure.

Methods: We identified 27 patients with severe TR, defined by a regurgitant index (RI) >33%, who underwent PTE.

Concomitant coronary and multiple arch vessel stenoses in patients treated with external beam radiation: pathophysiological basis and endovascular treatment.

External beam radiation-induced stenoses isolated to the coronary arteries or peripheral vessels have been previously described. We report for the first time the clinical presentation of two patients with concomitant coronary artery and multiple arch vessel disease following external beam radiation of the chest. We review the pathophysiology, discuss the treatment options and describe the percutaneous treatment of coronary, carotid, subclavian, and axillary stenoses related to this rare but likely underdiagnosed disorder.

Usefulness of compensatory hyperkinesis in the noninfarcted left ventricular wall in separating single from multivessel coronary artery disease in patients with initial ST-elevation acute myocardial infarction.

We assessed the contractility of the contralateral wall on 2-dimensional echocardiography in 50 patients with an initial ST-elevation acute myocardial infarction who underwent coronary angiography. Compensatory hyperkinesis, which we defined as a fractional thickening of >/=60% in the contralateral wall, was a strong predictor of single-vessel coronary artery disease, with a positive predictive value of 85%.

Severe ostial saphenous vein graft disease leading to acute coronary syndromes following proximal aorto-saphenous anastomoses with the symmetry bypass connector device: is it a suture device or a "stent"?

The Symmetry Bypass Connector (St. Jude Medical, St. Paul, Minnesota) is a nitinol, star-shaped device that was designed to facilitate placement of sutureless aorto-saphenous anastomoses during off-pump coronary artery bypass graft surgery (CABG).

Patients at low risk for periprocedural myocardial infarction can be identified by assessment immediately following percutaneous coronary intervention.

Despite utilizing optimal anticoagulant therapy during percutaneous coronary intervention (PCI), the incidence of periprocedural myocardial infarction (PPMI) remains 5 7% and evaluation of preprocedural clinical/angiographic characteristics has failed to reliably predict the likelihood of a PPMI. We hypothesized that immediate post-PCI assessment could identify a group of patients at very low risk for PPMI. A consecutive series of 258 PCI patients was stratified into 3 groups based on immediate post-PCI assessment.

Beyond peripheral arteries in Buerger's disease: angiographic considerations in thromboangiitis obliterans.

Thromboangiitis obliterans is an inflammatory peripheral vascular disease that is strongly associated with smoking. It predominantly affects distal small- and medium-sized blood vessels of both the upper and lower extremities. We present histological evidence of this disease process affecting the internal mammary arteries.

Correlation of left ventricular diastolic filling characteristics with right ventricular overload and pulmonary artery pressure in chronic thromboembolic pulmonary hypertension.

Objectives: This study was designed to determine a quantitative relationship between right ventricular (RV) pressure overload and left ventricular (LV) diastolic filling characteristics in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Background: Right ventricular pressure overload in patients with CTEPH causes abnormal LV diastolic filling. However, a quantitative relationship between RV pressure overload and LV diastolic function has not been established.