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We describe the case of a 60-year-old man with unstable angina and a critical stenosis of an unprotected left main stem. The patient was also affected with oligophrenia and Paget's disease that contraindicated surgical revascularization. We performed a percutaneous transluminal coronary angioplasty in the cardiac surgery operating room, preparing a femoro-femoral cardiopulmonary bypass by means of a portable X-ray system. The final results were good and they were confirmed by an angiographic control performed three months later as well as during the six-month follow-up. Angioplasty of the unprotected left main stem is feasible and adequate technologic support can reduce the risks for the patient.

Introduction: The ability to perform coronary angiography at the bedside has multiple applications., Methods: In this study, we compare the images obtained in 100 patients undergoing elective coronary angiography for coronary heart disease, with a portable X-ray imaging system (OEC 9600 Cardiac Version) to those obtained with a traditional fixed system (Siemens Coroskop C)., Results: A complete concordance between the systems for lesion location, stenosis quantification, morphologic characterization, TI-MI flow and collaterals was found., Conclusions: These findings demonstrate that a portable imaging system can produce high-quality images. The feasibility of performing a complete diagnostic procedure and the routine use of the system require more specific evaluation.

We describe the case of a patient with unstable angina and left main coronary artery occlusion, yet with good collateral circulation from the right coronary artery, and with normal left ventricular function. We identified an anomalous vessel from the ascending aorta ensuring a good supply to the left coronary artery.

To verify the advantages and the systematic use of 5 French catheters in femoral percutaneous coronaroventriculography, 500 consecutive unselected patients with confirmed or suspected coronary artery disease underwent this procedure. In one case only (0.2%) we had recourse to 7 French catheters on account of the inability to enter the left coronary ostium. There were no major local complications. General complications were represented by vagal reactions in 20 cases (4%) and by transient minor motor aphasia in one case (0.2%). The cardiac complications were represented by: -1 (0.2%) atrio-ventricular isorhythmic dissociation; -1 (0.2%) complete right bundle branch block; -3 (0.6%) atrial fibrillation; (all had a rapid and spontaneous regression) -1 (0.2%) ventricular fibrillation treated successfully with D.C. shock; -1 (0.2%) non fatal acute myocardial infarction (at the end of the procedure); -2 (0.4%) attacks of cardiac asthma treated successfully with medical therapy. 5 French catheters have proved to be extremely efficacious, with some technical experience, in percutaneous coronaroventriculography via femoral approach. The possible advantages could consist of a reduction in local complications, a patient's precocious mobilization and a minor traumatism on the arterial wall. The major complications are comparable with those observed using 7-8 French catheters. In the future it might be possible, in selected patients, to use 5 French catheters to perform ambulatory cardiac catheterization with reduction of both costs and hospitalization period.