Current Problems in PTCA by Dr. Bernhard Meier (auth.), PD Dr. B. Höfling (eds.)

By Dr. Bernhard Meier (auth.), PD Dr. B. Höfling (eds.)

Since coronary angioplasty used to be first practiced via Andreas Gruntzig in 1977, it has swiftly constructed right into a strategy universal on sufferers with continual and acute heart illness. The assembly defined during this publication used to be held lower than the auspices of the operating crew of our nationwide society, chaired by way of Prof. Kaltenbach, Frankfurt, and by way of Prof. Meyer, Mainz, in cooperation with Stanford collage. it truly is an try and current a number of cardiologists' value determinations of the present place ofPTCA in scientific drugs. PTCA is way from effortless, as its mechanism is seriously balanced among luck and fail­ ure. accordingly the event of a couple of hundred situations is mostly considered as ne­ cessary for scaling down issues and reaching a excessive cost of sli'ccess. moreover, luck and problems are a outcome not just of technical services, but additionally of sufferer choice. The emphasis of the workshop was once on dialogue of a few unsolved difficulties and open questions similar to: - What are the trustworthy indication guide-lines? - What are the confirmed guide-lines for figuring out, as soon as a worry happens, among operative and non-operative therapy? - What are the indicators and barriers for the mixed use of thrombolysis with PTCA in acute myocardial infarction? - while and at what periods may still PTCA be utilized after winning lysis? - who're the applicants for dilatation of major stem stenosis? - while should still one try to open occluded arteries and which procedure exhibits the main promise?

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Ul IJJ a:: PTCA. "z PRE OCCL ~ ....... :. J U. ) ~ .... Ul o o GCV FLOW Ul LIJ a:: PTCA: PRE 1 2 3 4 POST Fig. 4a. Changes in coronary sinus blood flow (mllmin) and resistance (mmHg/mllmin) during four episodes of occlusion. CS, coronary sinus. b Changes in great cardiac vein flow (mllmin) and resistance (mmHg/ml/min) during four transluminal occlusions. , occlusion time (s); GCV, great cardiac vein 42 Coronary Hemodynamic Measurements The results of the coronary hemodynamic observations are summarized in Fig.

Conclusions Angioplasty and aortocoronary bypass graft surgery are not competItIve procedures. PTCA is the therapy of choice for patients with one stenosis that requires revascularization. Coronary bypass graft surgery is performed predominantly in patients with multiple-vessel disease. However, in this patient group the applicability of the two types of therapy may overlap. If one tries to compare both procedures one should be aware of the differences between the patient populations and of the different periods of experience with these two methods.

Another which may have contributed to the reduction in nucleotide degradation during the second and third occlusion is the greater than normal CrP content of myocardium following a brief ischemic episode [47, 48]. Whatever the mechanism, the increased stores presumably present at the onset of the second and third coronary occlusions may provide high-energy phosphate which serves to protect ATP pools from further depletion. A third potential explanation for decreased nucelotide degradation during the ischemic period is decreased energy consumption from decreased contractile function.

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