disease at this institution. By the end of 1989, 12 of 268 patients (4.5%) had significant coronary artery disease and of these, only 1 had died within 2 years (unpublished data). It has been suggested that catheter-induced spasm is related to spontaneous spasm.25 We have noted at least 6 cases of catheter tip spasm in transplant recipients since 1980, but none had significant fxed coronary artery dis- ease. 1. Maseri A, Chierchia S. Coronary artery spasm: demonstration, definition, diagnosis, and consequences. Prog Cardiouasc Dis 1982:25:169-192. 2. Conti RC. Mywardial infarction: thoughts about pathogenesis and the role of coronary artery spasm. Am Heart J 1985;110:187-193. 3. Ginsburg R, Bristow MR. Kantrowitz N, Bairn DS, Harrison DC. Histamine provocation of clinical coronary artery spasm: implications concerning the patho- genesis of variant angina pectoris. Am Heart J 1981;102:819. 4. Yasue H, Touyama M, Shimamoto M, Kato H, Tanaka S, Akiyama F. Role of the autonomic nervous system in the pathogenesis of Prinzmetal’s variant form of angina. Circulation 1974;50:534-539. 5. Shimokawa H, Tomoike H, Nakayama S, Yamamoto H, Arakari H, Naka- mura M. Coronary artery spasm induced in atherosclerotic miniature swine. Science 1983:221:560-562. 6. Brasile L, Zerbe T, Rabin B, Clarke J, Abrams A, Cerilli J. Identification of antibody to vascular endothelial cells in patients undergoing cardiac transplanta- tion. Transplantation 1985;40:672-675. 7. Young MA, Vatner SF. Regulation of large coronary arteries. Circ Res 1986:59:579-596. 6. Yusuf SF, Theodoropoulos S, MathiasCJ, Dhalla N, Wittes J, Mitchell A, Yacoub M. Increased sensitivity of the denervatcd transplanted human heart to isoprenaline both before and after beta-adrenergic blockade. Circulation 1987:75:696-704. 9. Bertrand ME, Lablanche JM, Tilmant PY, Ducloux G, Warembaurg H, Soots G. Complete denervation of the heart (autotransplantation) for treatment of severe, refractory coronary spasm. Am J Cardiol 1981:47:1375-1378. 10. Buda AJ, Fowles RE, Schroeder JS, Hunt SA, Cipriano PR, Stinson EB, Harrison DC. Coronary artery spasm in the denervated transplanted human heart. A clue to underlying mechanisms. Am J Med 198/;70: /144-J 149. 11. Cattan S, Drobinski G, Artigou J-Y, Grogogea Y, Cabrol C. Coronary artery spasm in a transplant patient. Eur Heart J J988,9:557-560. 12. Boffa GM, Faggian G, Buja G. Livi U, Bortolotti U, St&n G, Razzolini R, Stritoni P, Mazzucco A, Thiene G, Chioin R, Gallucci V. Coronary artery spasm in heart transplant recipients. J Heart Tram-plant J989;8:J54~~/58. 13. Goldenberg IF, Levine BT. Coronary artery spasm in a denervated orthotopic transplanted human heart. Cathet Cardioumc Diagn /986;/2:44--47. 14. Marzilli M, Goldstein S, Trivella MA, Palumbo C, Maseri A. Some clinical considerations regarding the relation of coronary vasospasm to coronary athero- sclerosis: a hypothetical pathogenesis. Am J Cardiol 1980;45:882-886. 15. Yasue H, Touyama M, Tanaka S, Akiyama F. Prinzmetal’s variant form of angina as a manifestation of alpha-adrenergic receptor mediated coronary artery spasm: documentation by coronary arteriography. Am Heart J 1976:91:148-152. 16. Rowan RA, Billingham ME. Myocardial innervation in long-term heart transplant survivors: a quantitative ultrastructural survey. J Heart Trmsplant J988;7:448-452. 17. Kaski JC, Crea F, Meran D, Rodriguez L, Araujo L, Chierchia S, Davies G, Maseri A. Local coronary supersensitivity to diverse vaswonstrictive stimuli in patients with variant angina. Circulation 1986;74:1255-1265. 16. Maseri A, Kaski JC. Pathogenetic mechanisms of coronary artery spasm. JACC 1989:14:610-612. 19. Schroeder JS, Bolen JL, Quint RA, Clark DA, Hayden WG, Higgins CB, Wexler L. Provocation of coronary spasm with ergonovine maleate. New test with results in 57 patients undergoing coronary arteriography. Am J Cardiol 1977; 40:487-491, 20. Hackett D, Larkin S, Chierchia S, Davies G. Kaski JC, Maseri A. Induction of coronary artery spasm by a direct local action of ergonovine. Circulation J987:75:577-582. 21. Griffith TM, Hughes Edwards D, Lewis MJ, Henderson AH. Ergometrine induced arterial dilatation: an endothelial mediated effect. J Mel Cell Cmdiol 1984;16:479-482. 22. Shimokawa H, Flavahan NA, Shepherd JT, Vanhoutte PM. Endothelium- dependent inhibition of ergonovine induced contraction is impaired in porcine coronary arteries with regenerated endothelium. Circulation J989;80:643-650. 23. Cooper DKC, Boyd ST, Lanza RP, Barnard CN. Factors influencing survival following heart transplantation. Heart Transplant J983;3:86-91. 24. Schroeder JS, Hunt SA. Cardiac transplantation: where arc we? N Engl J Med 1986;3J5:961-963. 25. Roberts DJ, Isner JY, Dcckelbaum LI, Konstam MA, Salem BN. Acute myocardial infarction, normal coronary arteries and catheter-induced spasm. Am J Cardiol 1986;58:360-362. Transcatheter Occlusion of High Flow Blalocldaussig Shunts with a Detachable Balloon Marc Gewillig, MD, Luc Van der Hauwaert, MD, and Wim Daenen, MD T ranscatheter occlusion of Blalock-Taussig shunts has been reported.1-4 However, because of specific features of these shunts-such as common lack of distal stenosis and abundant, high velocity, turbulent blood flow-the reported procedures were difficult and cum- bersome, and the final result was frequently suboptimal. We evaluated the feasibility and effectiveness of gold- valve detachable balloons for occluding high flow Bla- lock-Taussig shunts. A modified Blalock-Taussig shunt (4 to 6 cm of 6 mm Gore- Tex) was created in 8 mongrel dogs (weight I8 to 29 kg, mean 22). When reevaluated 4 to 6 weeks after surgery, there was evidence of a significant shunt be- cause thepulsepressure had increasedfrom 30 f 4 to 60 f 8 mm Hg and the left ventricular end-diastolic volume From the Laboratory of Experimental Cardiology, Gasthuisberg Uni- versity Hospital Leuven, B-3000 Leuven, Belgium. This study was supported in part by the Belgian National Research Foundation, Brus- sels, and Gore-Tex Belgium, Lii?ge, Belgium. Manuscript received De- cember 18, 1989; revised manuscript received and accepted February 13, 1990. had increased by 55 f 24%. The shunt was approached from the brachial artery in order to reach it in an obtuse angle. An 8Fr delivery catheter was advanced into the shunt over h previously positioned guidewire. A gold- valve detachable balloon (deflated 2.7 X I .4 mm, fully inflated 14.7 X 7.8 mm, Ingenor) was slipped over a 2.2Fr on a 3Fr carrier catheter, which was previously slid through a 5Fr guiding catheter. The balloon was posi- tionedproximally in the shunt and injlated swifrly with 0.5 ml of diluted (1:2) contrast medium. Slow inflation of the balloon resulted in significant displacement into the pulmonary artery: the 3Fr carrier catheter was very stretchable. The use of a luberculine syringe, however, made nearly instantaneous inflation of the balloon possible. Despite abundant and high velocity (>4 m/s) bloodjlow, the connection between the nozzle and the valve did with- stand the turbulent flow in the shunt and accurate posi- Coning of the balloon was obtained in all dogs. Deflation and repositioning were possible until the balloon was detached with gentle traction on the 3Fr catheter while 1518 THE AMERICAN JOURNAL OF CARDIOLOGY VOLUME 65