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Pericardial abnormalities remain the most common manifestation of radiation-induced cardiac disease, but coronary artery lesions are not rare. In this report we describe a left coronary ostial stenosis which appeared five years after mediastinal irradiation for breast carcinoma in a 50-year-old woman. The patient underwent coronary angiography. A pressure drop was observed as the left catheter tip engaged the left coronary ostium; so, only nonselective coronary opacifications were performed showing an isolated, marked narrowing of the left coronary ostia. During surgery, a circumferential aortotomy allowed the examination of the left coronary ostium which appeared severely stenosed. The coronary tree was otherwise normal. A termino-terminal saphenous vein graft was anastomosed on the left stem and its proximal part was implanted on the ascending aorta. The coronary ostium and the proximal part of the left main stem were excised and the macroscopic examination of the proximal part of the left coronary artery confirmed the diagnosis of severe ostial stenosis. Microscopic examination of the coronary ostium showed a severe intimal thickening without any evident lesion of the media. This intimal thickening consisted of fibrous tissue without extracellular lipid deposit. Microscopic examination of the aorta near the coronary ostium also demonstrated an intimal thickening without any lesion of the media. Coronary ostial stenosis appears to be a rare lesion; its incidence has varied between 0.13 and 2.7% in angiographic studies and there is co-existing disease in multiple coronary vessels in the majority of cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Recently, percutaneous aortic valvuloplasty has been considered as a possible palliative procedure in elderly patients with critical valvular stenosis in whom valve replacement is deferred or contra-indicated because of high operative risk. However, the demonstration of the efficacy of such a procedure is based on immediate post dilatation haemodynamic data and clinical improvement. The purpose of this study was to evaluate the haemodynamic consequences of this procedure on the eighth day after a post procedure haemodynamic control. Thirty consecutive patients (mean age 75 +/- 8.4 years) with long-standing aortic stenosis were treated at the time of cardiac catheterization with balloon dilatation. Of these 30 patients, 24 (mean age 76 +/- 8) underwent haemodynamic evaluation eight days after the procedure. Prevalvuloplasty examination revealed a mean aortic valve gradient (MAVG) of 82 +/- 19.9 mmHg, a mean thermodilution calculated cardiac output (CO) of 3.6 +/- 0.9 l min-1 and a mean aortic valve area (VA) of 0.37 +/- 0.14 cm2. Immediate postvalvuloplasty control showed a fall in MAVG to 44.5 +/- 16.7 mmHg (P less than or equal to 0.001), a decrease in CO to 3.3 +/- 1.4 l min-1 (NS) and an increase in VA to 0.60 +/- 0.35 cm2 (P less than or equal to 0.01). Eighth-day haemodynamic control revealed an increase in MAVG to 71 +/- 18.8 mmHg (P less than or equal to 0.001), an increase in CO to 4.1 +/- 1.3 l min-1 (P less than or equal to 0.001) and a decrease in VA down to 0.47 +/- 0.10 cm2 (P less than or equal to 0.03).(ABSTRACT TRUNCATED AT 250 WORDS)

Aims Direct stenting (DS) may not be as safe and effective as conventional stenting. The objective was to demonstrate equivalence of post-procedural mean luminal diameter (MLD) by angiography after BeStent2 placement between DS and pre-dilatation (PD) strategy. [ABSTRACT FROM PUBLISHER]

Severe congestive heart failure developed in an acromegalic patient, and was successfully treated with octreotide followed by trans-sphenoidal surgery. Clinical, hormonal echocardiographic and haemodynamic findings as well as histological heart examination before and after treatment revealed tliat over-production of growth hormone may induce the myocardial cell degeneration responsible for mechanical heart dysfunction. In addition, this unique example demonstrates the reversibility of myocardial damage following octreotide and trans-sphenoidal surgery, leading to significant improvement in cardiac function with minimal diastolic dysfunction and moderate interstitial fibrosis. [ABSTRACT FROM PUBLISHER]

Dilated hypokinetic cardiomyopathy in an acromegalic patient is an uncommon event. Specific hormonal therapy with octreotide (a somatostatin analogue) is now recognized as able to improve cardiac failure. A case of worsening of cardiac function under such a therapy is described in this report. Octreotide was finally discontinued and a cardiac transplantation performed. Soon after surgery, treatment with octreotide was started again and no other adverse reaction was noticed. Furthermore, no deleterious or synergistic interaction between the somatostatin analogue and cyclosporine A was detected. A pharmacological hypothesis is given to explain the inability of octreotide to counteract cardiac failure. The patient died 6 months after surgery probably because of an acute episode of arrhythmia. [ABSTRACT FROM PUBLISHER]

We report on the development of features of the postpericardiotomy syndrome following coronary perforation during balloon angioplasty, in a patient that was managed conservatively. The case illustrates that while cardiac tamponade does not invariably follow coronary perforation, late consequences derived from this complication may occur. It also widens the spectrum of conditions where the postpericardiotomy syndrome has been observed. [ABSTRACT FROM PUBLISHER]