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Fredi JL, Louka BF, Mehmood SA, Master RG, Sogomonian R, Singh I. Transcatheter Electrosurgical Removal of an Aortic Valve Fibroelastoma. JACC Cardiovasc Interv 2022; 15:e141-e143. [PMID: 35568641 DOI: 10.1016/j.jcin.2022.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Joseph L Fredi
- Willis-Knighton Health Services, Departments of Cardiology and Cardiac Surgery, Shreveport, Louisiana, USA.
| | - Boshra F Louka
- Willis-Knighton Health Services, Departments of Cardiology and Cardiac Surgery, Shreveport, Louisiana, USA
| | - Syed A Mehmood
- Willis-Knighton Health Services, Departments of Cardiology and Cardiac Surgery, Shreveport, Louisiana, USA
| | - Ryan G Master
- Willis-Knighton Health Services, Departments of Cardiology and Cardiac Surgery, Shreveport, Louisiana, USA
| | - Robert Sogomonian
- Willis-Knighton Health Services, Departments of Cardiology and Cardiac Surgery, Shreveport, Louisiana, USA
| | - Iqbal Singh
- Willis-Knighton Health Services, Departments of Cardiology and Cardiac Surgery, Shreveport, Louisiana, USA
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Núñez-Gil IJ, Cerrato E, Bollati M, Nombela-Franco L, Terol B, Alfonso-Rodríguez E, Camacho Freire SJ, Villablanca PA, Amat Santos IJ, de la Torre Hernández JM, Pascual I, Liebetrau C, Camacho B, Pavani M, Albistur J, Latini RA, Varbella F, Jiménez-Díaz VA, Piraino D, Mancone M, Alfonso F, Linares JA, Rodríguez-Olivares R, Jiménez Mazuecos JM, Palazuelos Molinero J, Sánchez-Grande Flecha A, Gomez-Hospital JA, Ielasi A, Lozano Í, Omedè P, Bagur R, Ugo F, Medda M, Louka BF, Kala P, Escaned J, Bautista D, Feltes G, Salinas P, Alkhouli M, Macaya C, Fernández-Ortiz A. Coronary artery aneurysms, insights from the international coronary artery aneurysm registry (CAAR). Int J Cardiol 2019; 299:49-55. [PMID: 31378382 DOI: 10.1016/j.ijcard.2019.05.067] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 05/13/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Coronary Aneurysms are a focal dilatation of an artery segment >1.5-fold the normal size of adjacent segments. Although some series have suggested a prevalence of 0.3-12%, data are lacking. In addition, they are not mentioned in practice guidelines. Our aim was investigate its prevalence, management and long-term outcomes. METHODS AND RESULTS The coronary artery aneurysm registry (CAAR) involved 32 hospitals across 9 countries in America and Europe. We reviewed 436,467 consecutive angiograms performed over the period 2004-2016. Finally, 1565 patients were recruited. Aneurysm global prevalence was 0.35%. Most patients were male (78.5%) with a mean age of 65 years and frequent cardiovascular risk factors. The main indication for angiogram was an acute coronary syndrome, 966 cases. The number of aneurisms was ≤2 per patient in 95.8% of the cases, mostly saccular, most frequently found in the left anterior descending and with numbers proportional with coronary stenosis. Aortopathies were related with more aneurysms too. Most patients received any revascularization procedure (69%), commonly percutaneous (53%). After a median follow-up of 37.2 months, 485 suffered a combined event (MACE) and 240 died. Without major differences comparing CABG vs PCI, MACE and death were more frequent in patients who received bare metal stents. CONCLUSIONS Coronary artery aneurysms are not uncommon. Usually, they are associated with coronary stenosis and high cardiovascular risk. Antiplatelet therapy seems reasonable and a percutaneous approach is safe and effective.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
| | - Enrico Cerrato
- Interventional Cardiology, Infermi Hospital, Rivoli, Turin, Italy
| | - Mario Bollati
- Interventional Cardiology, Policlinico San Donato, Milan, Italy
| | | | - Belén Terol
- Cardiology Department, Hospital Severo Ochoa, Leganés, Spain
| | | | | | - Pedro A Villablanca
- Interventional Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA
| | - Ignacio J Amat Santos
- CIBERCV, Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Isaac Pascual
- Department of Cardiology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto de Investigación Sanitaria del Principado de Asturias, ISPA, Oviedo, Spain; University of Oviedo, Oviedo, Spain
| | - Christoph Liebetrau
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | - Benjamín Camacho
- Interventional Cardiology, Hospital Arnau de Vilanova, Lérida, Spain
| | - Marco Pavani
- Cardiology, Città della Salute e della Scienza, Molinnette II, Torino, Italy
| | - Juan Albistur
- Cardiology, Hospital de Clínicas Dr, Manuel Quintela, Montevideo, Uruguay
| | | | | | | | - Davide Piraino
- UO di Cardiologia Interventistica ed Emodinamica, Azienda Ospedaliera Universitaria Policlinico "P,Giaccone" Palermo, Italy
| | - Massimo Mancone
- Is Sapienza University of Rome, Policlinico Umberto I. Department of Cardiovascular, Respiratory, Neurological, Anaesthesiology and Geriatric Sciences
| | - Fernando Alfonso
- Cardiology Department, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | | | | | | | | | - Alfonso Ielasi
- Cardiology Division, ASST Bergamo Est, Bolognini Hospital Seriate, Italy
| | - Íñigo Lozano
- Interventional Cardiology, Hospital de Cabueñes, Gijon, Spain
| | - Pierluigi Omedè
- Cardiology, Città della Salute e della Scienza, Molinnette I, Torino, Italy
| | - Rodrigo Bagur
- Interventional Cardiology, University Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Fabrizio Ugo
- Interventional Cardiology, H San Giovanni Bosco, Turin, Italy
| | - Massimo Medda
- Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, USA
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Javier Escaned
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Daniel Bautista
- Cardiology, Instituto dominicano de Cardiología, Santo Domingo, Dominican Republic
| | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Pablo Salinas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Mohamad Alkhouli
- Cardiology, West Virginia University Heart and Vascular Institute, Morgantown, WV, United States of America
| | - Carlos Macaya
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Núñez-Gil IJ, Nombela-Franco L, Bagur R, Bollati M, Cerrato E, Alfonso E, Liebetrau C, De la Torre Hernandez JM, Camacho B, Mila R, Amat-Santos IJ, Alfonso F, Rodríguez-Olivares R, Camacho Freire SJ, Lozano Í, Jiménez Díaz VA, Piraino D, Latini RA, Feltes G, Linares JA, Mancone M, Ielasi A, Sánchez-Grande Flecha A, Fernández Cisnal A, Ugo F, Jiménez Mazuecos JM, Omedè P, Pavani M, Villablanca PA, Louka BF, Fernández-Ortiz A. Rationale and design of a multicenter, international and collaborative Coronary Artery Aneurysm Registry (CAAR). Clin Cardiol 2017; 40:580-585. [PMID: 28337781 DOI: 10.1002/clc.22705] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/22/2017] [Accepted: 02/15/2017] [Indexed: 11/09/2022] Open
Abstract
Coronary artery aneurysm is defined as a coronary dilation that exceeds the diameter of adjacent segments or the diameter of the patient's largest normal coronary vessel by 1.5×. It is an uncommon disease that has been diagnosed with increasing frequency since the widespread appearance of coronary angiography. The published incidence varies from 1.5% to 5%, suggesting male dominance and a predilection for the right coronary artery. Although several causes have been described, atherosclerosis accounts for ≥50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture, and vasospasm, causing ischemia, heart failure, or arrhythmias. The natural history and prognosis remain unknown, as definitive data are scarce. Controversies persist regarding the use of medical management (antithrombotic therapy) or interventional/surgical procedures. Only some case reports or small case series are available about this condition. The Coronary Artery Aneurysm Registry (CAAR; http://www.ClinicalTrials.gov NCT02563626) is a multicenter international ambispective registry that aims to provide insights on anatomic, epidemiologic, and clinical aspects of this substantially unknown entity. In addition, the registry will assess management strategies (conservative, interventional, or surgical) and their short- and long-term results in a large cohort of patients. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov. Unique identifier: NCT02563626.
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Affiliation(s)
- Iván J Núñez-Gil
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
| | - Luis Nombela-Franco
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
| | - Rodrigo Bagur
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, and Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Mario Bollati
- Department of Interventional Cardiology, SS Annanziata Hospital, Savigliano, Italy
| | - Enrico Cerrato
- Interventional Unit, San Luigi Gonzaga University Hospital, Orbassano and Infermi HOspital, Rivoli (Turin), Italy
| | - Emilio Alfonso
- Instituto de Cardiología y Cirugía Cardiovascular, La Habana, Cuba
| | - Christoph Liebetrau
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany; DZHK (German Centre for Cardiovascular Research), partner site Rhein-Main, Frankfurt am Main, Germany
| | | | - Benjamín Camacho
- Department of Interventional Cardiology, Hospital Arnau de Vilanova, Lérida, Spain
| | - Rafael Mila
- Department of Cardiology, Hospital de Clínicas Dr. Manuel Quintela, Montevideo, Uruguay
| | - Ignacio J Amat-Santos
- Department of Interventional Cardiology, Hospital Clínico Universitario de Valladolid, Spain
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Madrid, Spain
| | | | | | - Íñigo Lozano
- Department of Interventional Cardiology, Hospital de Cabueñes, Gijon, Spain
| | | | - Davide Piraino
- UO di Cardiologia Interventistica ed Hemodinámica, Azienda Ospedaliera Universitaria Policlinico "P. Giaccone,", Palermo, Italy
| | | | - Gisela Feltes
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
| | | | - Massimo Mancone
- Department of Interventional Cardiology, Hospital La Sapienza, Rome, Italy
| | | | | | | | - Fabrizio Ugo
- Department of Interventional Cardiology, Hospital San Giovanni Bosco, Turin, Italy
| | | | - Pierluigi Omedè
- Department of Cardiology, Città della Salute e della Scienza I, Turin, Italy
| | - Marco Pavani
- Department of Cardiology, Città della Salute e della Scienza II, Turin, Italy
| | - Pedro A Villablanca
- Department of Interventional Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York City, New York
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic, Phoenix, Arizona
| | - Antonio Fernández-Ortiz
- Cardiovascular Institute, Hospital Clínico San Carlos and Department of Medicine, Complutense University, Madrid, Spain
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Seamans DP, Louka BF, Fortuin FD, Patel BM, Sweeney JP, Lanza LA, DeValeria PA, Ezrre KM, Ramakrishna H. The utility of live video capture to enhance debriefing following transcatheter aortic valve replacement. Ann Card Anaesth 2017; 19:S6-S11. [PMID: 27762242 PMCID: PMC5100244 DOI: 10.4103/0971-9784.192576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The surgical and procedural specialties are continually evolving their methods to include more complex and technically difficult cases. These cases can be longer and incorporate multiple teams in a different model of operating room synergy. Patients are frequently older, with comorbidities adding to the complexity of these cases. Recording of this environment has become more feasible recently with advancement in video and audio capture systems often used in the simulation realm. Aims: We began using live capture to record a new procedure shortly after starting these cases in our institution. This has provided continued assessment and evaluation of live procedures. The goal of this was to improve human factors and situational challenges by review and debriefing. Setting and Design: B-Line Medical's LiveCapture video system was used to record successive transcatheter aortic valve replacement (TAVR) procedures in our cardiac catheterization/laboratory. An illustrative case is used to discuss analysis and debriefing of the case using this system. Results and Conclusions: An illustrative case is presented that resulted in long-term changes to our approach of these cases. The video capture documented rare events during one of our TAVR procedures. Analysis and debriefing led to definitive changes in our practice. While there are hurdles to the use of this technology in every institution, the role for the ongoing use of video capture, analysis, and debriefing may play an important role in the future of patient safety and human factors analysis in the operating environment.
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Affiliation(s)
- David P Seamans
- Department of Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
| | - Boshra F Louka
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - F David Fortuin
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Bhavesh M Patel
- Department of Critical Care, Mayo Clinic Arizona, AZ 85054, USA
| | - John P Sweeney
- Division of Cardiovascular Diseases, Mayo Clinic Arizona, AZ 85054, USA
| | - Louis A Lanza
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Patrick A DeValeria
- Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Arizona, AZ 85054, USA
| | - Kim M Ezrre
- Department of Catheterization Laboratory, Mayo Clinic Arizona, AZ 85054, USA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic Arizona, AZ 85054, USA
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