In recent years there has been an increasing interest in quantitative analysis of coronary cineangiograms and already for a longer time of left ventricular cin eangiograms. The needfor quantitationofcoronary arterialdimensions has been stimulated by the introduction ofnew therapeutic procedures in the catheteriza tionlaboratory, suchas the balloon dilatationtechnique (PTCA) and thromboly tic therapy, by the need to study the vasoactive responses of pharmaceutical agents, and also by the desire to study the progressive nature ofcoronary artery disease with the ultimate goal to find ways to bring a halt to the progression of coronary atherosclerosis or even achieve regression of the disease. Parallel with these clinical developments, rapid technical developments in computerarchitect ures and semiconductor memories have made it possible to digitize and store cineframesor selected portions thereof in image processors and to analyze these pictorial data quantitatively at affordable prices. More than 15 years of research have been directed by various groups towards the semi- or fully-automated delineation of the left ventricular boundaries on a frame-to-frame basis. Yet not a single system with fully-automated capability is commercially available. In the mean time many different left ventricular wall motion models have been developed, again with little consensuson which model is to be preferred as no golden standard exists.

Packed with useful information, The Interventional Cardiac Catheterization Handbook, 4th Edition, by Drs. Morton J. Kern, Michael J. Lim, and Paul Sorajja, is the perfect hands-on resource for physicians, nurses, and technicians who need to understand and perform these complex procedures. Easy-to-read text, hundreds of clear images, and narrated videos from Dr. Kern ensure that health care workers at all levels have quick access to easily accessible guidelines on procedures and patient care. Features a wealth of quick-reference tables, and more than 500 images – making this handbook a must-have reference for physicians and staff members in every cath lab. Includes a chapter dedicated to interventional pharmacology. Includes new content on correction of mitral regurgitation with Mitra ClipTM, enhanced coverage of aortic valve stenosis with TAVR, expansion of biodegradable and drug-eluting stents, enhanced descriptions of lesion assessment, chronic total occlusion intervention, and radial access approach to intervention. Covers the latest treatment of mitral valve regurgitation and mitral stenosis, new procedural enhancements for the treatment of aortic valve stenosis, and chronic total occlusion intervention technique updates.

In June 1989, a third conference concentrating on the progress in quantita tive coronary angiography and related techniques was held in Rotterdam, again very successful as the two preceding events in 1985 and 1987. Tech nical as well as clinical aspects of digital and digitized coronarography, morphometry, parametric imaging and functional quantification of the human coronary circulation were presented and discussed by prominent exponents of those groups who have been active in this particular field for many years. This book contains the chapters representing the lectures held by leading experts during the symposium that update the knowledge currently available, including most recent aspects in angioscopy and intravascular ultrasound imaging. It also includes a historical review on the development of angiogra phic techniques from the very early days on to our times given by one of the pioneers in heart catheterization and angiography, Dr. Kurt Amplatz. Those who had the chance to listen to his talk, will surely remember his impressive, humorous lecture as one of the highlights of this meeting.

In this fourth book in the series on quantitative coronary arteriography (QCA) with the earlier three volumes published in 1986, 1988 and 1991, the latest developments in this exciting field are covered. Both the methodolog ical and clinical application aspects of these advances are presented in a comprehensive manner in a total of 37 chapters by world renowned experts. The book is subdivided into a total of eight parts, beginning with the more methodological issues, such as QCA and other modalities (3 chapters), cine film versus digital arteriography (3 chapters), quality control in QCA (4 chapters), and coronary blood flow and flow reserve (3 chapters). Since QCA has been well established as the technique for the assessment of regression and progression in atherosclerotic disease, and of restenosis after recanaliz ation procedures, major clinical trials in both groups are described extensively by their principal investigators in a total of 11 chapters. In addition, the QCA results after the application of various recanalization techniques are presented in another eight chapters. In the last part the experiences with various intracoronary prostheses with the emphasis on QCA are discussed in five chapters. This large increase in application oriented chapters means that QCA is well alive and gaining momentum. Although the accuracy and precision of the analytical methods steadily improve with the increasing complexity of the algorithms, there is still always the human factor involved in these processes in terms of frame selection, segment definition, etc.

​Vascular management and care has become a truly multidisciplinary enterprise as the number of specialists involved in the treatment of patients with vascular diseases has steadily increased. While in the past, treatments were delivered by individual specialists, in the twenty-first century a team approach is without doubt the most effective strategy. In order to promote professional excellence in this dynamic and rapidly evolving field, a shared knowledge base and interdisciplinary standards need to be established. Pan Vascular Medicine, 2nd edition has been designed to offer such an interdisciplinary platform, providing vascular specialists with state-of-the art descriptive and procedural knowledge. Basic science, diagnostics, and therapy are all comprehensively covered. In a series of succinct, clearly written chapters, renowned specialists introduce and comment on the current international guidelines and present up-to-date reviews of all aspects of vascular care.

Whenever the coronary flow is inadequate to provide enough oxygen to meet the energy demands of the tissue, the heart becomes ischemic. Manifestations of myocardial ischemia include depression in contractile activity, changes in metabolic pattern, abnormalities in ultrastructure, and alterations in membrane potential. Ischemic changes during the early phase are reversible but as the period of ischemia is extended, the injury becomes irreversible. The transition from reversible to irreversible ischemic injury is usually associated with some membrane defects. It is worthwhile to consider that the irreversible damage to the ischemic myocardium occurs when the sarcolemmal membrane is altered in suoh a way that it would promote 2 a net gain of ca + in the cardiac cell upon reinstitution of blood flow. Suoh a lesion could result when mechanisms for the entry as well as removal 2 of ca + from the myocardial oell become defective. In this regard, 2 depression of the sarcolemmal ca + pump would favour the oocurrenoe of 2 intracellular ca + overload. Furthermore, inhibition of the Na+-K+ pump would lead to elevation of myoplasmic Na+ which oould then increase the 2 2 intracellular concentration of ca + through the sarcolemmal Na+-ca + exchange mechanism. In faot recent studies have revealed an inhibition of 2 the sarcolemmal Na+-ca + exchange mechanism in the ischemic heart and this 2 change could also contribute towards the occurrence of intracellular ca + 2 overload.

Although some investigators have questioned the importance and even the existence of silent myocardial ischemia, documentation presented at this two day symposium leaves little doubt about its existence and importance. It has been estimated that about 3 million of the estimated 4 million angina sufferers in the United states have frequent episodes of silent myocardial ischemia. Although it is not possible to define how many Americans die due to silent ischemia, it has been suggested that the mortality rate may exceed hundreds of thousands of victims annually. Unfortunately, there still remains a lack of definitive information as to why some ischemic events are painless. Some suggest the concept that the location and size of the myocardium at jeopardy relates to pain, that the pain threshold varies from patient to patient or that there are neurological deficits in the myocardium of some patients with silent ischemia. Abnormalities in myocardial perfusion and function can occur without pain. An interesting observation presented by several investigators has been that when a coronary artery is occluded in man, no ischemic pain is perceived for the first 30 seconds. Only after a 30 second period or so of occlusion does angina occur. An even more confusing observation is that some 30 second periods of occlusion of the same vessel in the same patient results in angina while the next occlusion can be a totally silent event.