PATIENT AND STAFF DOSES FOR VARIOUS INTERVENTIONAL RADIOLOGY AND CARDIOLOGY EXAMINATIONS IN TURKEY

This study aims to determine the radiation doses of patients and staff during different interventional radiology and cardiology examinations. Dose measurements for interventional radiology examinations were performed in Ibn-i Sina Hospital of Ankara University using Siemens Artis-Zee medical imaging system. Patient dose measurement was carried out for interventional cardiology examinations in Cardiology Department of TOBB-ETU University, Medical Faculty Hospital using Philips Allura Centron interventional X-ray system. Patient doses were obtained in terms of kerma area product (KAP) and cumulative air kerma (CAK) from KAP meter attached to the angiography system. Performance tests of the angiography system were performed before patient dose measurements. Staff dose measurements were carried out with thermoluminescence dosimeters (TLD-100) placed in certain areas on the staff. Patient dose measurements were performed for 15 different interventional radiology examinations on a total of 431 patients and for four different cardiology examinations on a total of 299 patients. Monte Carlo based PCXMC 2.0 program was used to calculate patient effective doses. Lower extremity arteriography was the most common examination with a mean KAP value of 30 Gy cm2 and mean effective dose value of 1.2 mSv for total number of 194 patients. Mean KAP values calculated for coronary angiography, percutaneous coronary intervention, electrophysiological procedures and radiofrequency cardiac ablation examinations were 62.8, 162.8, 16.7 and 70.6 Gy cm2, respectively. Radiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.15, 0.11 and 0.14 μSv Gy-1 cm-2. Similarly, cardiologist, nurse and technician effective dose normalised to the unit KAP of patient dose were 0.22, 0.15 and 0.09 μSv Gy-1 cm-2. Measured KAP and CAK values vary depending on the type and complexity of the examination. The measured staff doses during cardiac examinations were higher when compared with that measured for interventional radiology as expected.

Characteristics of a large-scale cohort with accessory pathway(s): A cross-sectional retrospective study highlighting over a twenty-year experience

OBJECTIVE

Catheter ablation following electrophysiologic study (EPS) is the mainstay of diagnosis and treatment for patients with atrioventricular reentrant tachycardia (AVRT), demonstrating excellent long-term outcome and a low rate of complications. In this study, our aim was to assess our experience in patients with accessory pathway (AP) and to compare our data with the literature.

METHODS

We included 1,437 patients who were diagnosed and treated for AP in our hospital between 1998 and 2020. The demographic data of all the patients, AP location, and periprocedural results were recorded.

RESULTS

Of the 1,437 patients, 1,299 (90.4%) were men; and the mean age of the population was 26.67 years. The location of 1,418 APs were along the left free wall (647 [45.6%] patients), in the posteroseptal region (366 [25.3%] patients), in the anteroseptal region (290 [20.4%] patients), and along the right free wall (115 [8.1%] patients). The ratio of the second AP existence was 3.0% and AVNRT co-existence was 2.0%. A total of 55 (3.8%) patients had recurrent sessions for relapse. Our center's total success rate was 95.5%, and total complication rate was 0.26%.

CONCLUSION

According to our retrospective analysis, EPS is a highly functional tool in the diagnosis and management of arrhythmias such as AVRT for high-risk patient groups like military personnel with the aim of risk stratification and medical management.

Invasive screening for lower extremity peripheral artery disease: Killing two birds with one stone?

Objectives

There is substantial evidence that the majority of cases of lower extremity peripheral artery disease are undetected. As a result, there is great interest in the detection of lower extremity peripheral artery disease through routine screening. However, routine screening of lower extremity peripheral artery disease is still debated.

Methods

In our cross-sectional study, we included 200 consecutive patients with symptoms suggestive of angina who were undergoing coronary angiography. Irrespective of intermittent claudication, we subsequently performed peripheral angiography to detect lower extremity peripheral artery disease. The predictors of lower extremity peripheral artery disease were analyzed, and the diagnostic utility of these predictors and their combinations were determined. Additionally, the determinants of the amount of radio-opaque material used and peripheral fluoroscopy time were investigated.

Results

The overall prevalence of lower extremity peripheral disease was 16%. Being older than 65 years, having coronary artery disease and smoking history remained significant predictors after adjusting for other well-known parameters. Having the combination of age  ≥65 and smoking was associated with a positive predictive value of 50% (likelihood ratio 5.06), and having all of the predictors was associated with a positive predictive value of 100% (likelihood ratio >1000).

Conclusions

Routine screening for lower extremity peripheral disease patients undergoing coronary angiography may be useful in selected patients.

[Reversible first-degree atrioventricular block due to hyperthyroidism]

Hyperthyroidism often causes tachyarrhythmia. Reversible atrioventricular block caused by hyperthyroidism is rare occurrence. Presently described is a case of atrioventricular block due to hyperthyroidism and recovery after antithyroid treatment.

One-year results of primary stenting for TASC II D lesions of the superficial femoral and popliteal arteries

Objective This study aimed to evaluate the safety and the efficacy of primary stenting to treat Trans-Atlantic Inter-Society Consensus II (TASC) D femoropopliteal lesions. Background Advances in wire, balloon and stent design have been reported to improve the durability of stenting of longer femoropopliteal lesions. Methods A total of 57 limbs of 53 patients with Rutherford stage 3 to 6 due to TASC D femoropopliteal lesions were treated with a self-expanding nitinol stent in a prospective, single-centre, observational study. End points of interest included primary and secondary patency, target lesion revascularization, in-stent restenosis, major adverse cardiovascular events, Rutherford class improvement and change in walking capacity at 1 year. Results A total of 53 patients (57 lesions) were treated with a self-expanding nitinol stent and final procedural success was 91.2%. The median length of the treated segment was 330 ± 96 mm. The median stented segment was 366 ± 71 mm and the mean number of the stents was 2.1 ± 0.9. At 1 year, primary and secondary patency rates were 63.9% and 82.1%, respectively. Major adverse cardiovascular events occurred in 11 patients (22.9%), and[[strike_start]] [[strike_end]]significant benefits were observed in Rutherford class and walking distance (both P < 0.001). Conclusions Primary implantation of self-expanding nitinol stents for the treatment of TASC D femoropopliteal lesions appears to be safe and effective, especially in patients who have multiple co-morbidities and a high risk for surgical bypass. The risk of restenosis was higher when long stenting was extended to the popliteal artery.

Arrhythmogenic right ventricular cardiomyopathy in monozygotic twin sisters, and persistent left superior vena cava in one complicating implantation of ICD

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited cardiomyopathy characterized histologically by fibro-fatty replacement of heart muscle, and clinically by ventricular arrhythmias and right ventricular dysfunction. This report presents monozygotic twins with ARVC, suggesting a genetic abnormality as the most probable cause.

Retrograde recanalisation of popliteal artery occlusion

The increasing prevalence of critical lower limb ischemia is frequently associated with complex tibioperoneal obstructive disease and a high rate of amputation. In this article, we report our recent experience in order to highlight this valuable and underutilised technique, which proved successful in a complicated case where a conventional approach failed.

Relationship between platelet-to-lymphocyte ratio and coronary slow flow

OBJECTIVE

The coronary slow flow phenomenon (CSFP), which is characterized by delayed distal vessel opacification in the absence of significant epicardial coronary disease, is an angiographic finding. The aim of this study is to investigate the association between platelet-to-lymphocyte ratio (PLR) and coronary blood flow rate.

METHODS

This is a retrospective observational study. It was based on two medical centers. A total of 197 patients undergoing coronary angiography were included in the study, 95 of whom were patients with coronary slow flow without stenosis in coronary angiography and 102 of whom had normal coronary arteries and normal flow.

RESULTS

The PLR was higher in the coronary slow flow group compared with the control groups (p=0.001). In the correlation analysis, PLR showed a significant correlation with left anterior descending (LAD) artery thrombolysis in myocardial infarction (TIMI) frame count. After multiple logistic regression, high levels of PLR were independently associated with coronary slow flow, together with hemoglobin.

CONCLUSION

PLR was higher in patients with CSFP, and we also showed that PLR was significantly and independently associated with CSFP.

Intermittent QT prolongation induced by short-term oral amiodarone therapy

Although amiodarone appears to have few pro-arrhythmic effects, torsade de pointes (TdP) has been observed after administration of a low dose and short term use of oral amiodarone, in the absence of predisposing factors. We describe the case of a 41-year-old woman admitted to hospital because of a cardiac arrest from TdP. On hospital admission, ECG showed sinus bradycardia 46 bpm with marked QT prolongation.

Simultaneous conduction over the fast and slow pathways during induction of atrioventricular nodal reentrant arrhythmia with a rate of less than 100 bpm and infra-His block after radiofrequency ablation of the slow pathway

Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common form of paroxysmal regular supraventricular tachycardia in adults. It is typically induced with an anterograde block over the fast pathway (FP) and conduction over the slow pathway (SP), with subsequent retrograde conduction over the FP. Rarely, a simultaneous conduction of a premature atrial complex occurs over the FP and SP to induce AVNRT and is called "one for two phenomenon". We present a 46-year-old woman with atrioventricular nodal rhythm with a rate of 95 beats per minute with distinct electrophysiological characteristics showing simultaneous conduction over the FP and SP during induction of tachycardia and an infra-His block after radiofrequency ablation of the SP.