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The aim of the study was to demonstrate the possibility of transfemoral balloon occlusion of the coronary sinus and to detect changes of the left ventricular function during this occlusion in patients with angina pectoris. In 9 of 18 patients a stable occlusion over 15 seconds was performed. There were found only short term negative effects on the left ventricular contraction and relaxation. The coronary sinus pressure increased to 53 +/- 11 mm Hg. Numerous venous anastomoses made it difficult to occlude completely the sinus. The retrograde perfusion of the myocardium reached 20-30% of the antegrade one.

From a pool of patients, treated because of cardiac diseases on ward for 4 years, 8 subjects, the mean age of which amounted to 46 (SD 12) years, showing stable angina pectoris in usual physical activity, were chosen. In these patients widespread examinations including invasive procedures had not been evident for one of the well defined heart diseases. In two patients dysrhythmias appeared during standardized exercise test while in four other subjects acute cardiac findings consisted of chest pain, significant depression of ST segments or inversion of T waves were observed. One patient had a normal result of the exercise test. A myocardial thallium-201 imaging was performed in four subjects. In three patients imaging showed questionable or mild signs of ischemia. The result suggest the existence of unknown shapes in coronary heart disease, the origin of which is possibly connected with a disorder of microvascular smooth muscle reactivity.

Since the introduction into practice in may 1986 at the Institute of Cardiovascular Diagnostics we performed 45 valvuloplasties until March 1990 in 34 children (6.2 +/- 4.9 years old) and 11 adults (29.5 +/- 9.6 years) with valvular pulmonary stenosis. The invasively obtained pressure gradient at the valve diminished from 83.4 +/- 30.7 mm Hg to 35.7 +/- 19.0 mm Hg. Intraoperative complications in three patients (short term asystole, severe bradycardia, increase of right ventricular pressure to 300 mm Hg after valvuloplasty) were controlled, but demanded the end of the intervention. No significant insufficiency of pulmonary valves after valvuloplasty was seen. 18 patients were clinically investigated 14.6 +/- 9.4 months after intervention. The late results for these patients proved the method as a long term curing treatment. According to our present results pulmonary valvuloplasty is the alternative method for valve surgery especially in critical pulmonary valve stenosis in newborns.

Within a short term of 7 years percutaneous valvuloplasty of congenital and acquired stenosis, the cardiac valves and the great central vessels has significantly improved. If strict criteria for the selection of patients are used the method is an important addition to cardiac therapy, since it requires no thoracotomy, no heart lung machine surgery, no complicated interventional follow up treatment and gives remarkable short and long term results. Starting from a thorough study of 300 publications (4836 patients) a survey of possible complications, their frequency and in percutaneous valvuloplasty is given for various methods. The compiled data and commentaries give a negative survey and shall lead to a new evaluation of indications. Some types of interventions (primarily the percutaneous rupture of degenerative calcified stenosis of the aortic valve in higher age) will lead only by significant improvements of technique (stabilization of myocardiac circulation, prevention of extreme hypotonic phases, use of cutting and sawing instruments: valvuloplasty under cardioscopy?) to acceptable long term therapy results.

315 percutaneous transluminal coronary angioplasties performed during 1978-1988 in 261 patients with ischemic heart disease were analyzed for three different variants according to primary effectiveness, failure rate the most frequent complications and costs of materials as well as duration of intervention and fluoroscopy. Only variant 3 of the proceeding (soft-tip-applicators, flat profile balloon catheter, Kaltenbach long-wire technique, streptokinase rinsing of instruments, permanent infusion of instruments during the procedure) is an applicable routine method. It has a primary effectiveness of 86%. For multiple vessel PTCA this variant however resulted in significantly prolonged investigation and fluoroscopy intervals, so it is advisable only for selected groups of patients.

Report on the application of a new (valve equipped) detachable balloon for percutaneous transvasal embolization therapy in 372 patients with (noncerebral) curative preoperative and palliative indications.

The influence of injections of Amidotrizoate and Iopromide into the left coronary artery on global myocardial perfusion and function (pressures in the left ventricle, heart rate) as well as excitation formation and transmission was studied in 16 patients with ischaemic heart disease. No statistically significant differences in myocardial perfusion measured were found with xenon-133 in this small group between rest and dipyridamole load for ionic and non-ionic contrast media.

In 30 patients the influence of ionic (Amidotrizoate) and non-ionic (Iopromide) contrast agents on the heart parameters contractility, relaxation, perfusion and the rate of extrasystoles was investigated. They were significantly less influenced by Iopromide than by Amidotrizoate. A negative inotropic action was detectable only for Amidotrizoate. It is concluded that non-ionic contrast media should be used especially for critical patients.