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Papers by Ronnie Hershman

Research paper thumbnail of Reversal of chronic ischemic myocardial dysfunction after transluminal coronary angioplasty

Journal of the American College of Cardiology, 1988

Ihin a cohort af patients referred for ekctive traduminal coronary an&p&ty, a subset of patients ... more Ihin a cohort af patients referred for ekctive traduminal coronary an&p&ty, a subset of patients was evaluated to &ten&K wbetherrev8sc&arizatioo using cofonary an* plasty c&d salvage rhr&caily is&e& myocardium. Reverslbk chronic isrhemii left ve&icstar dysfunction was i&tit&d by a severe wall matim abtrordty at rest andatfeastoneoft!kefoWwii:1)persistentangina pectoriq 2) postextrasystok veRtricularcolltrdoa potentiaticm Of motiotl in tlte asynergk zone 011 basebe ventric-&gram; and 3) thdlimn-al uptake ia the myner& zone. Twelve patients were identitkst as having lwersibk chraic isekcllliadttRdorrrcltteorosSry~~y.~~ ~wpsO*11yclrrsolddurstianotsymptolas8.3~9.7 weeks.ImnK!diipre-~po&ail~krtverrtrieufogams were &t&cd.

Research paper thumbnail of Percutaneous coronary excimer laser-assisted angioplasty: Initial multicenter experience in 141 patients

Journal of the American College of Cardiology, 1991

Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is desc... more Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is described for 136 lesions in 141 palienu. Us@ P XTWII chloride (308 em) excimar laser gener*r and !.5 to t.76 mm catheters, exe&r tsur angtoptuty wu attempted at 135 ns put* width. 25 to 40 Hz repetttlon rate, 2 to 6 s laser ddivery time and 30 to 6rl mJ/md energy Awnee. lsrrr wxw (>ZO% improvemat in luminal diameter) was rbkved lo 158 (87%) of 158 kskns, with a rethtctitm to <SO% r(enosis n&d ia 77 lesions (49%). Overall. larrr-assiscrd batleoo a,,&,pk,'y IWCSS (<SO% mid4 .te,, titbw, n.ajor cemplkatim) was ob3ervecl in 129 (9i"s) of 141 patbaa*. Frecedurat ewplkatmar (abrupt closure 1.3% ride branch ocelurina 1.96, intimsl dkaiii 6.3%, embdiutien 1.3%. ttlling defti 1.3%.

Research paper thumbnail of Percutaneous coronary excimer laser-assisted ballon angioplasty: Intial multicenter experience

Journal of the American College of Cardiology, 1990

Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is desc... more Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is described for 136 lesions in 141 palienu. Us@ P XTWII chloride (308 em) excimar laser gener*r and !.5 to t.76 mm catheters, exe&r tsur angtoptuty wu attempted at 135 ns put* width. 25 to 40 Hz repetttlon rate, 2 to 6 s laser ddivery time and 30 to 6rl mJ/md energy Awnee. lsrrr wxw (>ZO% improvemat in luminal diameter) was rbkved lo 158 (87%) of 158 kskns, with a rethtctitm to <SO% r(enosis n&d ia 77 lesions (49%). Overall. larrr-assiscrd batleoo a,,&,pk,'y IWCSS (<SO% mid4 .te,, titbw, n.ajor cemplkatim) was ob3ervecl in 129 (9i"s) of 141 patbaa*. Frecedurat ewplkatmar (abrupt closure 1.3% ride branch ocelurina 1.96, intimsl dkaiii 6.3%, embdiutien 1.3%. ttlling defti 1.3%.

Research paper thumbnail of Percutaneous coronary excimer laser-assisted balloon angioplasty: Initial clinical and quantitative angiographic results in 50 patients

Journal of The American College of Cardiology, 1991

The initial clinical experience and quantitative angiographic results of percutaneous coronary ex... more The initial clinical experience and quantitative angiographic results of percutaneous coronary excimer laser-assisted balloon angioplasty are described for 55 lesions in 50 patients. With use of a xenon chloride (308 nm) excimer laser generator and 1.5 to 1.75 mm catheters, excimer laser angioplasty was attempted at 135 ns pulse width, 25 to 40 Hz repetition rate, 2 to 5 s laser delivery lime and 30 to 60 mj/mm2 energy fluence. Laser success (>20% reduction in absolute percent diameter stenosis) was achieved in 41 (75%) of 55 lesions, with 100% subsequent balloon angioplasty success (<50% residual stenosis).By quantitative digital caliper technique, the percent diameter stenosis (mean ± SE) was reduced from 81 ± 1 % to 50 ± 3% after excimer laser angioplasty (p < 0.001) and to 20 ± 1% after balloon angioplasty (p < 0.001); minimal luminal diameter increased from 0.56 ± 0.04 to 1.46 ± 0.08 mm (p < 0.001) and 2.03 ± 0.07 mm (p < 0.001), respectively. By videodensitometric techniques, the percent area stenosis decreased from 86 ± 2% to 54 ± 3% after excimer angioplasty (p < 0.001) and to 26 ± 3% after balloon angioplasty (p < 0.001).There were no perforations, need for emergency bypass surgery or deaths. The overall incidence of abrupt closure (3.6%), dissection (1.8%), embolization (1.8%), filling defect (6%), myecardial infarction (5.5%), side branch occlusion (3.6%) or spasm (3.6%) was infrequent and more related to subsequent balloon angioplasty than to the laser procedure. In the early follow-up period (range 1 to 10 months, mean 7), 36 (72%) of the 50 patients remained asymptomatic; symptoms recurred in 14 patients (28%) in relation to abrupt closure in the first 24 h in 2 patients (3.6%), late closure in the first week in 2 patients (3.6%) and restenosis in 10 patients (20%).Thus, percutaneous coronary excimer laser angioplasty appears to be a feasible and safe procedure in selected patients. At present, the procedure is undergoing significant development, including modification of the delivery catheters and operating techniques. The impact of this technology on the angioplasty restenosis rate awaits further follow-up analysis.

Research paper thumbnail of Pulmonic balloon valvuloplasty in adults

American Heart Journal, 1990

Research paper thumbnail of Reversal of chronic ischemic myocardial dysfunction after transluminal coronary angioplasty

Journal of the American College of Cardiology, 1988

Ihin a cohort af patients referred for ekctive traduminal coronary an&p&ty, a subset of patients ... more Ihin a cohort af patients referred for ekctive traduminal coronary an&p&ty, a subset of patients was evaluated to &ten&K wbetherrev8sc&arizatioo using cofonary an* plasty c&d salvage rhr&caily is&e& myocardium. Reverslbk chronic isrhemii left ve&icstar dysfunction was i&tit&d by a severe wall matim abtrordty at rest andatfeastoneoft!kefoWwii:1)persistentangina pectoriq 2) postextrasystok veRtricularcolltrdoa potentiaticm Of motiotl in tlte asynergk zone 011 basebe ventric-&gram; and 3) thdlimn-al uptake ia the myner& zone. Twelve patients were identitkst as having lwersibk chraic isekcllliadttRdorrrcltteorosSry~~y.~~ ~wpsO*11yclrrsolddurstianotsymptolas8.3~9.7 weeks.ImnK!diipre-~po&ail~krtverrtrieufogams were &t&cd.

Research paper thumbnail of Percutaneous coronary excimer laser-assisted angioplasty: Initial multicenter experience in 141 patients

Journal of the American College of Cardiology, 1991

Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is desc... more Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is described for 136 lesions in 141 palienu. Us@ P XTWII chloride (308 em) excimar laser gener*r and !.5 to t.76 mm catheters, exe&r tsur angtoptuty wu attempted at 135 ns put* width. 25 to 40 Hz repetttlon rate, 2 to 6 s laser ddivery time and 30 to 6rl mJ/md energy Awnee. lsrrr wxw (>ZO% improvemat in luminal diameter) was rbkved lo 158 (87%) of 158 kskns, with a rethtctitm to <SO% r(enosis n&d ia 77 lesions (49%). Overall. larrr-assiscrd batleoo a,,&,pk,'y IWCSS (<SO% mid4 .te,, titbw, n.ajor cemplkatim) was ob3ervecl in 129 (9i"s) of 141 patbaa*. Frecedurat ewplkatmar (abrupt closure 1.3% ride branch ocelurina 1.96, intimsl dkaiii 6.3%, embdiutien 1.3%. ttlling defti 1.3%.

Research paper thumbnail of Percutaneous coronary excimer laser-assisted ballon angioplasty: Intial multicenter experience

Journal of the American College of Cardiology, 1990

Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is desc... more Initial multirenter clinkal experience with preubmeous ronmary excinw Ilur-wisk6 ~gio~mly is described for 136 lesions in 141 palienu. Us@ P XTWII chloride (308 em) excimar laser gener*r and !.5 to t.76 mm catheters, exe&r tsur angtoptuty wu attempted at 135 ns put* width. 25 to 40 Hz repetttlon rate, 2 to 6 s laser ddivery time and 30 to 6rl mJ/md energy Awnee. lsrrr wxw (>ZO% improvemat in luminal diameter) was rbkved lo 158 (87%) of 158 kskns, with a rethtctitm to <SO% r(enosis n&d ia 77 lesions (49%). Overall. larrr-assiscrd batleoo a,,&,pk,'y IWCSS (<SO% mid4 .te,, titbw, n.ajor cemplkatim) was ob3ervecl in 129 (9i"s) of 141 patbaa*. Frecedurat ewplkatmar (abrupt closure 1.3% ride branch ocelurina 1.96, intimsl dkaiii 6.3%, embdiutien 1.3%. ttlling defti 1.3%.

Research paper thumbnail of Percutaneous coronary excimer laser-assisted balloon angioplasty: Initial clinical and quantitative angiographic results in 50 patients

Journal of The American College of Cardiology, 1991

The initial clinical experience and quantitative angiographic results of percutaneous coronary ex... more The initial clinical experience and quantitative angiographic results of percutaneous coronary excimer laser-assisted balloon angioplasty are described for 55 lesions in 50 patients. With use of a xenon chloride (308 nm) excimer laser generator and 1.5 to 1.75 mm catheters, excimer laser angioplasty was attempted at 135 ns pulse width, 25 to 40 Hz repetition rate, 2 to 5 s laser delivery lime and 30 to 60 mj/mm2 energy fluence. Laser success (>20% reduction in absolute percent diameter stenosis) was achieved in 41 (75%) of 55 lesions, with 100% subsequent balloon angioplasty success (<50% residual stenosis).By quantitative digital caliper technique, the percent diameter stenosis (mean ± SE) was reduced from 81 ± 1 % to 50 ± 3% after excimer laser angioplasty (p < 0.001) and to 20 ± 1% after balloon angioplasty (p < 0.001); minimal luminal diameter increased from 0.56 ± 0.04 to 1.46 ± 0.08 mm (p < 0.001) and 2.03 ± 0.07 mm (p < 0.001), respectively. By videodensitometric techniques, the percent area stenosis decreased from 86 ± 2% to 54 ± 3% after excimer angioplasty (p < 0.001) and to 26 ± 3% after balloon angioplasty (p < 0.001).There were no perforations, need for emergency bypass surgery or deaths. The overall incidence of abrupt closure (3.6%), dissection (1.8%), embolization (1.8%), filling defect (6%), myecardial infarction (5.5%), side branch occlusion (3.6%) or spasm (3.6%) was infrequent and more related to subsequent balloon angioplasty than to the laser procedure. In the early follow-up period (range 1 to 10 months, mean 7), 36 (72%) of the 50 patients remained asymptomatic; symptoms recurred in 14 patients (28%) in relation to abrupt closure in the first 24 h in 2 patients (3.6%), late closure in the first week in 2 patients (3.6%) and restenosis in 10 patients (20%).Thus, percutaneous coronary excimer laser angioplasty appears to be a feasible and safe procedure in selected patients. At present, the procedure is undergoing significant development, including modification of the delivery catheters and operating techniques. The impact of this technology on the angioplasty restenosis rate awaits further follow-up analysis.

Research paper thumbnail of Pulmonic balloon valvuloplasty in adults

American Heart Journal, 1990