Practical Cardiovascular Medicine. Elias B. Hanna

35Figure 35.1 (a) Axial cut at the level of sinuses of Valsalva. R is the righ...Figure 35.2 (a) Judkins left (JL) catheter. The size of the Judkins catheter...Figure 35.3 In the case of an elongated or enlarged aorta (elderly, hyperten...Figure 35.4 The Amplatz left (AL) catheter has a “duck” shape. AL may be use...Figure 35.5 AL sits both on the back wall of the aorta and on the aortic val...Figure 35.6 AL engaging the RCA. AL looks up if the AL curve is proportionat...Figure 35.7 The primary-to-secondary distance distinguishes Amplatz right (A...Figure 35.8 Engagement of RCA. The catheter must be positioned on the right ...Figure 35.9 The 3DRC catheter is, in a way, a JR4 that is already torqued. I...Figure 35.10 (a) Origin of the RCA in a young patient. (b) Origin of the RCA...Figure 35.11 Axial cut at the level of the sinuses of Valsalva. Instead of L...Figure 35.12 Relationship of the conus branch and RCA. If JR4 falls into the...Figure 35.13 (a) Engagement of the left coronary artery in patients with nor...Figure 35.14 In (i), the whole catheter falls down and tip points up→a longe...Figure 35.15 JL catheter engagement when it falls slightly below the left co...Figure 35.16 Catheterization of the left coronary artery with an Amplatz lef...Figure 35.17 Small-arm Amplatz catheter. Pushing it may further dive it insi...Figure 35.18 Extra-backup guides and AL guide for the left coronary artery. ...Figure 35.19 Small-arm AL guide catheter (AL1) is used to engage the LCx in ...Figure 35.20 Guide catheters for superior RCA takeoff and inferior RCA takeo...Figure 35.21 AL1 guide catheter engaging the RCA, and providing good backup ...Figure 35.22 Location of SVGs: Down to up: SVG-to-RCA, SVG-to-LAD or diag...Figure 35.23 LAO view is orthogonal to the marker of SVG-to-RCA, perfectly l...Figure 35.24 Shapes of various catheters.Figure 35.25 (a) A hockeystick 2 guide catheter is used to engage the SVG-to...Figure 35.26 (a) Engagement of the left subclavian artery with a JR4 cathete...Figure 35.27 Pigtail catheter advancement. This is an LAO view. Advance the ...Figure 35.28 Dealing with a situation when the pigtail bend is in the LV, bu...Figure 35.29 Various aortic root shapes, with various locations of the aorti...Figure 35.30 Engagement of a coronary artery through a radial approach.(...Figure 35.32 Right transradial engagement of the left coronary artery in a p...Figure 35.33 AL2 is used to engage the left coronary artery through a right ...Figure 35.34 Severe right subclavian/ innominate tortuosity or loop is prese...Figure 35.35 Specific radial catheters, particularly helpful for a right rad...Figure 35.36 Ikari left catheter engagement. Ikari left is, in a way, a modi...Figure 35.37 Examples of damping and ventricularization of the aortic pressu...Figure 35.38 Damping, ventricularization, and effect of side-hole catheters....Figure 35.39 (a) Catheter loop at the lateral RA wall allows advancement int...

      34 Chapter 36Figure 36.1 The Swan–Ganz balloon flotation catheter has four ports. (...Figure 36.2 Timing of atrial, ventricular, and arterial pressures in relatio...Figure 36.3 Atrial pressure tracing (RA or PCWP). A wave corresponds to atri...Figure 36.4 RA, RV, PA, and PCWP tracings obtained while advancing the cathe...Figure 36.5 Typical deep X and deep Y descents on RA tracing, consistent wit...Figure 36.6 Deep X with flat Y on RA tracing, suggestive of tamponade. This ...Figure 36.7 Ventricularized RA pressure in a patient with severe TR. The V w...Figure 36.8 On gross inspection of both figures, they may seem similar. In f...Figure 36.9 (a, b) PCWP tracing shows a large V wave of ~38 mmHg, with a mea...Figure 36.10 Diastolic superimposition of LA pressure (or PCWP, in blue) and...Figure 36.11 LVEDP corresponds to the bump seen on the LV upstroke (arrows),...Figure 36.12 O₂ saturation at various levels. Note that MV O₂ and SA O₂ used...Figure 36.13 Aortic stenosis. Peak-to-peak gradient is the difference bet...Figure 36.14 This simultaneous LV–aortic pressure recording simulates severe...Figure 36.15a Two examples of mitral stenosis with a diastolic pressure grad...Figure 36.15b Illustration of the difference between rheumatic MS and MAC-MS...Figure 36.16 LV, aortic (Ao) and PCWP tracing in a patient with AS (LV–Ao gr...Figure 36.17 LV–aortic pressure tracings in acute AI and chronic AI. I...Figure 36.18 (A) On the aortic tracing, the aortic pressure drops precipitou...Figure 36.19 Dynamic LVOT obstruction. (a) The LVOT obstruction worsens thr...Figure 36.20 Contrast LV–aortic tracings in HOCM vs. AS. In HOCM, the aortic...Figure 36.21 Brockenbrough phenomenon after a premature beat in HOCM. Note t...Figure 36.22 LV–aortic pullback using an endhole catheter in a patient...Figure 36.23 (a) Simultaneous pericardial and RA pressures are recorded in t...Figure 36.24 Simultaneous LV-RV recordings in a 61-year-old man with no past...Figure 36.25 PCWP rise with exercise. In normal individuals, as preload and ...Figure 36.26 The numerator of the Qp/Qs is in blue (extreme chambers), while...Figure 36.27 Figure 36.28 Figure 36.29 Figure 36.30 Figure 36.31

      35 Chapter 37Figure 37.1 The left image is duplicated on the right with blue shading high...Figure 37.2 The left image is duplicated on the right with blue shading high...Figure 37.3 (a) Intima is marked in blue in the right-hand image. Note that ...Figure 37.4 (a) Ostial LAD with LCx adjacent to it. The blue shading marks t...Figure 37.5 Diseased LAD at the level of first septal and first diagonal bra...Figure 37.6 (a, b) Two IVUS images of a left main bifurcating into LAD and L...Figure 37.7 Positive and negative remodeling.Figure 37.8 Example of positive remodeling (EEM area has expanded to accommo...Figure 37.9 Lesion with necrotic core. Intima and necrotic core are highligh...Figure 37.10 Ulcerated lesions. (a) Ulcer demarcated at 6 o’clock. (b) Steno...Figure 37.11 Further examples of ulcers. (a) LAD ulcer at 6 o’clock (star). ...Figure 37.12 Stent thrombosis and neointimal hyperplasia.Figure 37.13 Illustration of various IVUS-determined areas. The luminal diam...Figure 37.14 Stents. (a) Ostial LM stent with intima seen underneath the str...Figure 37.15 Stent with neointimal hyperplasia. In-stent restenosis percent ...Figure 37.16 Causes of lesion haziness. Interpretation of how a severe steno...Figure 37.17 The stent is well expanded in the ostial LAD with one strut han...Figure 37.18 OCT. Fibrotic plaque is characterized by being bright (high sig...Figure 37.19 Thrombus, macrophage accumulation, and cholesterol crystals ima...Figure 37.20 Stent edge dissection. Arrows show the dissection planes. The d...

      36 Chapter 38Figure 38.1 Main mechanism of action of balloon angioplasty. Angioplasty pus...Figure 38.2 A pseudoaneurysm is characterized by a non-clotted active bleed ...Figure 38.3 IABP catheter connected to two lumens: arterial lumen and gas lu...Figure 38.4 Unassisted and assisted aortic pressure. Balloon inflation occur...Figure 38.5 1:2 IABP inflation. Note that in a 1:2 or 1:3 mode, the SBP that...Figure 38.6 IABP monitor showing the ECG, the arterial pressure waveform, an...Figure 38.7 Impella CP assist device. Blood is pulled from the LV through th...Figure 38.8 (a) The Impella console shows two waveforms: the aortic waveform...Figure 38.9 Both the motor current and the pressure waveform are flat, which...Figure 38.10 Simultaneous LV-aortic pressure waveforms in a patient with sev...Figure 38.11 Concept of FFR. FFR evaluates the ratio of maximal myocardial f...Figure 38.12 The drop in pressure and thus the drop in flow across a stenosi...Figure 38.13 The upper tracing illustrates Pa, the pressure at the guide cat...Figure 38.14 Serial stenoses. The calculation of local FFR across each steno...Figure 38.15

      37 1Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 Figure 13 Figure 14 Figure 15 Figure 16 Figure 17 Figure 18 Figure 19 Figure 20 Figure 21 Figure 22 Figure 23 Figure 24 Figure 25 Figure 26 Figure 27 Figure 28 Figure 29 Figure 30 Figure 31 Figure 32 Figure 33 Figure 34 Figure 35 Figure 36 Figure 37 Figure 38 Figure 39 Figure 40 Figure 41 Figure 42 Figure 43 Figure 44 Figure 45 Figure 46 Figure 47 Figure 48 Figure 49 Figure 50 Figure 51 Figure 52 Figure 53 Figure 54 Figure 55 Figure 56 Figure 57 Figure 58 Figure 59 Figure 60 Figure 61 Figure 62 Figure 63 Figure 64 Surgeon’s view of the tricuspid and mitral valves. Note their rela...Figure 65

      Guide

      1  Cover