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Yaku H, Fudim M, Shah SJ. Role of splanchnic circulation in the pathogenesis of heart failure: State-of-the-art review. J Cardiol 2024; 83:330-337. [PMID: 38369183 DOI: 10.1016/j.jjcc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024]
Abstract
A hallmark of heart failure (HF), whether it presents itself during rest or periods of physical exertion, is the excessive elevation of intracardiac filling pressures at rest or with exercise. Many mechanisms contribute to the elevated intracardiac filling pressures, and notably, the concept of volume redistribution has gained attention as a cause of the elevated intracardiac filling pressures in patients with HF, particularly HF with preserved ejection fraction, who often present without symptoms at rest, with shortness of breath and fatigue appearing only during exertion. This phenomenon suggests cardiopulmonary system non-compliance and inappropriate volume distribution between the stressed and unstressed blood volume components. A substantial proportion of the intravascular blood volume is in the splanchnic vascular compartment in the abdomen. Preclinical and clinical investigations support the critical role of the sympathetic nervous system in modulating the capacitance and compliance of the splanchnic vascular bed via modulation of the greater splanchnic nerve (GSN). The GSN activation by stressors such as exercise causes excessive splanchnic vasoconstriction, which may contribute to the decompensation of chronic HF via volume redistribution from the splanchnic vascular bed to the central compartment. Accordingly, for example, GSN ablation for volume management has been proposed as a potential therapeutic intervention to increase unstressed blood volume. Here we provide a comprehensive review of the role of splanchnic circulation in the pathogenesis of HF and potential novel treatment options for redistributing blood volume to improve symptoms and prognosis in patients with HF.
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Affiliation(s)
- Hidenori Yaku
- Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Marat Fudim
- Duke Clinical Research Institute, Durham, NC, USA; Division of Cardiology, Department of Internal Medicine, Duke University School of Medicine, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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2
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Quilty F, Abel AAI, Clark AL. Bilateral renal artery revascularisation in heart failure. BMJ Case Rep 2024; 17:e256323. [PMID: 38663899 PMCID: PMC11043742 DOI: 10.1136/bcr-2023-256323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Renal artery stenosis can complicate the management of heart failure with reduced ejection fraction, as it is a conventional contraindication to the use of ACE inhibitors. We report a case in which bilateral renal artery revascularisation allowed the safe reintroduction of enalapril (and subsequently sacubitril valsartan) in a patient with severe left ventricular systolic dysfunction. There is a role for renal artery angioplasty in selected patients to allow optimal medical therapy for patients with heart failure due to impaired systolic function.
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Affiliation(s)
- Finny Quilty
- Department of Cardiorespiratory Medicine, Hull York Medical School, Hull, UK
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3
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Uniyal SC, Singh V, Rawat A, Gururani K, Belwal CM. An audit of patient radiation doses during interventional cardiology procedures in Uttarakhand, India, and establishment of local diagnostic reference levels. Radiol Phys Technol 2024:10.1007/s12194-024-00805-x. [PMID: 38652208 DOI: 10.1007/s12194-024-00805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 04/10/2024] [Accepted: 04/14/2024] [Indexed: 04/25/2024]
Abstract
The objective of this study was to investigate patient radiation doses by a dose audit of three common interventional cardiology (IC) procedures: coronary angiography (CA), percutaneous transluminal coronary angioplasty (PTCA) and CA-PTCA procedures performed in IC centres in the Uttarakhand state of India, for the establishment of local diagnostic reference levels (DRLs) and the estimation of average effective dose (Eav) for these procedures. For each procedure, the values of kerma-area product (PKA), reference air kerma (Ka,r), fluoroscopy time (FT) and the number of cine images were recorded from 1233 CA, 458 PTCA and 736 CA-PTCA procedures performed over a 12-month period at 13 IC centres of the state. From the recorded dose data, 0.6%, 1.53% and 7.9% patients were identified to have exceeded the PKA trigger level of 500 Gy cm2 for possible skin injury for CA, PTCA and CA-PTCA procedures, respectively. The 3rd quartile of the distribution of the recorded PKA values for each type of procedure was calculated to estimate local DRL values. The estimated values of DRLs and Eav were 37, 153 and 224 Gy cm2, and 6.72, 23.97 and 34.79 mSv for CA, PTCA and CA-PTCA procedures, respectively. For about 77% of the surveyed centres, the recorded patient doses were in agreement with the international standards. The local DRLs proposed in this study may be used to achieve patient dose optimization during IC procedures and the obtained patient dose data may also be archived into national dose database for the establishment of national DRLs.
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Affiliation(s)
- Satish C Uniyal
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India.
| | - Vikram Singh
- Department of Medical Physics, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Anurag Rawat
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Kunal Gururani
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
| | - Chandra Mohan Belwal
- Department of Cardiology, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, Jolly Grant, Dehradun, 248016, India
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Nagpal R, Lalani K, Ramachandran P. Giant coronary sinus aneurysm: an incidental discovery in a case of acute coronary syndrome. BMJ Case Rep 2024; 17:e258727. [PMID: 38479829 PMCID: PMC10941150 DOI: 10.1136/bcr-2023-258727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
Coronary sinus (CS) anomalies, although infrequent, are increasingly diagnosed with advances in interventional procedures and imaging techniques. Most cases are asymptomatic and incidentally diagnosed. We present a case of an elderly male without comorbidities who presented with acute angina. Coronary catheterisation revealed a double-vessel disease, but incidentally, sequential angiograms captured contrast filling in the levophase of CS, revealing a giant CS. Primary percutaneous angioplasty of the right coronary artery was performed successfully. Echocardiography confirmed the aneurysm, and a CT scan showed an aneurysmally dilated CS and other coronary veins alongside a normal-sized persistent left superior vena cava draining to the right atrium through CS. CS aneurysms may lead to complications such as thrombosis, embolic events, arrhythmias and heart failure, stressing the importance of vigilant monitoring and timely intervention. This case underscores the significance of recognising CS anomalies in cardiac procedures, even when asymptomatic, for proper management.
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Affiliation(s)
- Raghav Nagpal
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Kanhai Lalani
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Padmakumar Ramachandran
- Department of Cardiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Freund O, Shetrit A, Bar-Shai A, Zornitzki L, Frydman S, Banai A, Shamir RA, Ben-Shoshan J, Arbel Y, Banai S, Konigstein M. Smoking and Respiratory Diseases in Patients with Coronary Microvascular Dysfunction. Am J Med 2024:S0002-9343(24)00134-7. [PMID: 38485108 DOI: 10.1016/j.amjmed.2024.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/08/2023] [Revised: 01/18/2024] [Accepted: 02/18/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Coronary microvascular disease (CMD) is common in patients with and without obstructive coronary artery disease, and is associated with adverse clinical outcomes. Respiratory-related variables are associated with pulmonary and systemic microvascular dysfunction, while evidence about their relationship with CMD is limited. We aim to evaluate respiratory-related variables as risk factors of CMD. METHODS This is an observational, single-center study enrolling consecutive patients undergoing invasive evaluation of coronary microvascular function in the catheterization laboratory. Patients with evidence of obstructive coronary artery disease or with missing data were excluded. Associations between respiratory-related variables and indices of CMD were assessed using univariate and multivariate regression models. RESULTS Overall, 266 patients (mean age 67 ± 11 years, 59% females) were included in the current analysis. Of those, 155 (58%) had evidence of CMD. Among the respiratory variables, independent predictors of CMD were current smoking (adjusted odds ratio [AOR] 2.5; 95% confidence interval [CI], 1.2-5; P = .01) and obstructive sleep apnea (AOR 5.7; 95% CI, 1.2-26; P = .03), while chronic obstructive pulmonary disease was not. Among ever-smokers, higher smoking pack-years was an independent risk factor for CMD (median 35 vs 25 pack-years, AOR 1.09; 95% CI, 1.04-1.13; P < .01), and was associated with higher rates of pathologic index of microcirculatory resistance and resistive reserve ratio. CONCLUSION In patients undergoing invasive coronary microvascular evaluation, current smoking and obstructive sleep apnea are independently associated with CMD. Among smokers, higher pack-years is a strong predictor for CMD. Our findings should raise awareness for prevention and possible treatment options.
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Affiliation(s)
- Ophir Freund
- Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel; Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Aviel Shetrit
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Amir Bar-Shai
- Institute of Pulmonary Medicine, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Lior Zornitzki
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel; Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Shir Frydman
- Department of Internal Medicine B, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel; Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Ariel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Reut Amar Shamir
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Jeremy Ben-Shoshan
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel
| | - Maayan Konigstein
- Department of Cardiology, Tel Aviv Sourasky Medical Center, and Tel Aviv University School of Medicine, Israel.
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Wickramasinghe SU, Ramanathan V, Sarasanandarajah S. Assessment of dosimetric approaches in evaluating radiation exposure for interventional cardiologists in Sri Lanka. Radiol Phys Technol 2024; 17:258-268. [PMID: 38240885 DOI: 10.1007/s12194-023-00774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/06/2023] [Accepted: 12/27/2023] [Indexed: 03/01/2024]
Abstract
Interventional cardiologists face significant radiation exposure during interventional cardiology procedures. Therefore, this study focuses on assessing radiation exposure among interventional cardiologists during their procedures. Specifically, it aims to determine the effectiveness of both single and double dosimeter methods in estimating annual occupational radiation doses. This research holds pioneering significance as it represents the very first study undertaken in Sri Lanka. Thirteen interventional cardiologists performed 486 interventional cardiology procedures over three months in three different healthcare institutes. Active Hp(10) dosimeters were placed to measure radiation exposure. Effective doses were calculated using single and double dosimetric algorithms. Annual occupational doses were assessed on an operator basis. Statistical analyses were conducted to assess algorithmic differences and dose variations using the Kruskal-Wallis test and linear regression. The highest annual occupational dose for each dosimetric algorithm received as 2.00 ± 0.24 mSv, 2.29 ± 0.48 mSv, 3.35 ± 0.71 mSv, and 2.64 ± 0.42 mSv, respectively, and remained below the recommended safety limit of 20 mSv/year. The Kruskal-Wallis test revealed no significant differences in the effective doses among double dosimetric algorithms, as well as between single and double dosimetric algorithms (p > 0.05). Linear regression showed strong correlations among various algorithms, demonstrating consistency. The findings of this study hold significant effects on interventional cardiology practice in Sri Lanka, enhancing radiation safety and monitoring.
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Affiliation(s)
- Sachini Udara Wickramasinghe
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka.
| | - Vijitha Ramanathan
- Department of Radiography and Radiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Sivananthan Sarasanandarajah
- Department of Physical Sciences, Peter MacCallum Cancer Institute, Melbourne, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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Bharadwaj HR, Tan JK, Ali SH, Aderinto N, Shah MH, Marsool MDM, Jain J, Dalal P. Examining the provision of renal denervation therapy in low- and middle-income nations: Current landscape, challenges, future prospects-A mini perspective review. Curr Probl Cardiol 2024; 49:102357. [PMID: 38141794 DOI: 10.1016/j.cpcardiol.2023.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
This paper delves into Renal Denervation Therapy as a promising intervention for resistant hypertension in low- and middle-income countries. With rates of hypertension increasing in LMICs due to lifestyle factors, RDN presents a potentially transformative approach. The methodology involves a comprehensive literature review, focusing on studies in LMICs that unveil proactive developments in standardized guidelines and precision targeting in clinical trials. LMICs actively contribute to research, emphasizing the safety and efficacy of RDN. However, despite these strides, the current landscape reveals challenges, encompassing initial costs, economic disparities, and limitations in healthcare infrastructure. Despite these hurdles, the paper envisions promising future prospects, emphasizing innovative strategies for cost-effective RDN implementation. It advocates for global collaboration and partnerships with international organizations, proposing the expansion of the Global SYMPLICITY Registry to include more LMICs; a testament to a commitment to research advancement. The paper concludes by highlighting comprehensive strategies to overcome challenges, making RDN financially viable in resource-limited settings. It underscores the potential for RDN to enhance global healthcare outcomes, particularly in regions grappling with diverse economic and healthcare challenges.
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Affiliation(s)
| | - Joecelyn Kirani Tan
- Faculty of Medicine, University of St Andrews, St Andrews, Scotland, United Kingdom
| | - Syed Hasham Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nicholas Aderinto
- Internal Medicine Department, LAUTECH Teaching Hospital, Oyo, Nigeria
| | | | | | - Jyoti Jain
- Intern, Department of Internal Medicine, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India
| | - Priyal Dalal
- School of Medicine, University of Central Lancashire, Preston, United Kingdom
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8
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Di C, Wang Q, Wu Y, Lin W. Treatment of accidental puncture of the left subclavian artery and ongoing haemorrhage with vascular stenting. BMJ Case Rep 2024; 17:e258432. [PMID: 38417931 PMCID: PMC10900311 DOI: 10.1136/bcr-2023-258432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024] Open
Abstract
A man in his 60s was admitted for radiofrequency catheter ablation (RFCA) as a treatment for atrial fibrillation. A decapolar catheter (Synaptic Medical, Beijing, China) was inserted into the coronary sinus via the left subclavian vein. Two hours after RFCA, the patient presented new symptoms of cough, mild haemoptysis, mild dyspnoea and mild chest discomfort. Contrast-enhanced CT showed a mediastinal haematoma with contrast medium extravasation at the interlobular fissure outside the parietal pleura and mild-moderate pericardial effusion. Active left subclavian artery bleeding, rather than venous bleeding due to superior vena cava perforation, was finally diagnosed. Ongoing haemorrhage conservative treatment with red cell concentrate and intravenous fluid (normal saline) replacement may lead to compression of the mediastinum, and a covered stent was used to treat this iatrogenic complication.
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Affiliation(s)
- Chengye Di
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
| | - Qun Wang
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
| | - Yanxi Wu
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
| | - Wenhua Lin
- First Department of Cardiology, TEDA International Cardiovascular Hospital, Tianjin, China
- Cardiovascular Institute, Tianjin University, Tianjin, China
- College of Clinical Cardiology, Tianjin Medical University, Tianjin, China
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9
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Chatlaong T, Kosum P, Tumkosit M, Limjareon T. Unusual cause of severe transvalvular eccentric jet AR: early structure valve deterioration of Trifecta valves by flail leaflet undergoing valve-in-valve transcatheter aortic valve replacement. BMJ Case Rep 2024; 17:e256369. [PMID: 38395470 PMCID: PMC10895215 DOI: 10.1136/bcr-2023-256369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024] Open
Abstract
The Trifecta tissue valve (Abbott, Illinois, USA) is an externally mounted bovine pericardial aortic valve (AV) prosthesis with adequate haemodynamic performance and better early results than another option. However, concerns have been raised about its durability. Recently, reports have emerged about an increased incidence of early structural valve failure after Trifecta implantation, where leaflet tear(s) with dehiscence along the stent post was the primary mode of early failure. In this article, we present the case of a patient in her 70s, 7 years after AV replacement with a Trifecta valve, who developed progressive dyspnoea. Physical examination revealed signs of chronic severe aortic regurgitation (AR). The initial transthoracic echocardiogram showed severe transvalvular AR, but the aetiology could not be determined. Cardiac computed tomography (CT) revealed a flail non-coronary cusp of the Trifecta bioprosthetic valve without vegetation. After discussion, we concluded that our patient was suitable for valve-in-valve transcatheter aortic valve replacement (ViV TAVR).
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Affiliation(s)
- Thirath Chatlaong
- Division of Cardiovascular Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Paisit Kosum
- Division of Cardiovascular Medicine, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Naresuan University, Phitsanulok, Thailand
| | - Monravee Tumkosit
- Department of Radiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Radiology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Thitima Limjareon
- Cardiac Center, King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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10
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Numao Y, Otsuka T, Nuki T, Ohta H. Successful treatment with ivabradine for haemodynamically unstable junctional ectopic tachycardia occurring early after ST-elevation myocardial infarction. BMJ Case Rep 2024; 17:e258901. [PMID: 38262712 PMCID: PMC10826492 DOI: 10.1136/bcr-2023-258901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 01/25/2024] Open
Abstract
Junctional ectopic tachycardia (JET) is a relatively uncommon arrhythmia predominantly observed in infancy, often occurring after congenital heart surgery. Although JET is rare in adults, it can occur in the presence of myocardial ischaemia. We describe a woman in her early 70s who presented with multivessel ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention on left anterior descending artery and right coronary artery. She developed JET on the second day, resulting in haemodynamic compromise. Despite initial treatment attempts including amiodarone and beta-blocking agents proving insufficient in controlling JET, we successfully managed by administering ivabradine. Subsequently, she was discharged with recovered cardiac function without recurrence of JET. JET often proves refractory to multiple antiarrhythmic agents and can lead to unfavourable outcomes. Several case reports have demonstrated the effectiveness of ivabradine in treating JET during infancy, which can also be an effective therapeutic option for adult without adversely affecting haemodynamics.
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Affiliation(s)
- Yoshimi Numao
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Tatsuhiko Otsuka
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Toshiaki Nuki
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
| | - Hiroshi Ohta
- Cardiology, Itabashi Chuo Medical Center, Itabashi-ku, Tokyo, Japan
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11
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Goldberg A, Chen JN, Breaux J, Pope H. Spindly reason for a pulmonary embolism. BMJ Case Rep 2024; 17:e258084. [PMID: 38182162 PMCID: PMC10773297 DOI: 10.1136/bcr-2023-258084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
Pulmonary artery intimal sarcomas (PAISs) are rare, malignant tumours that arise from the intimal or intramural wall of the pulmonary artery and are often mistaken for pulmonary emboli. Diagnosis and treatment of this condition are difficult due to the lack of formal guidelines. Initiating treatment as soon as possible after diagnosis is essential for maximising survival. Here, we present the case of a patient with a PAIS that initially presented similar to pulmonary thromboembolic disease and was treated with a multimodal approach.
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Affiliation(s)
- Alec Goldberg
- Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jason N Chen
- Internal Medicine, NYU Grossman School of Medicine, New York, New York, USA
| | - John Breaux
- Cardiothoracic Surgery, Lakeview Regional Medical Center, Covington, Louisiana, USA
| | - Helen Pope
- Internal Medicine, Tulane University School of Medicine, New Orleans, Louisiana, USA
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12
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Khalil G, Elbadri A, Abbasi SH, Das I, Ladwiniec A. An unusual cause of acute coronary syndrome: thrombosis of right coronary artery to right atrium fistula. BMJ Case Rep 2023; 16:e257368. [PMID: 38160024 PMCID: PMC10759029 DOI: 10.1136/bcr-2023-257368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Coronary arterial fistulae are rare, but it is one of the most common coronary artery anomalies. Most of the cases are asymptomatic in younger patients unless it is large and of haemodynamic significance. The incidence of thromboembolic complications usually increases with age. We report a case of a young male in his early 20s presenting with central chest pain. Coronary computed tomographic angiography revealed acute coronary syndrome due to a fistula between right coronary artery and right atrium occluded by thrombus. After discussion with coronary and congenital heart multidisciplinary team, a consensus was agreed that we should manage him conservatively with anticoagulant and antiplatelet therapy and a 3-month follow-up strategy that included repeating cardiac imaging. After a year, his anticoagulation and antiplatelet medication was discontinued.
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Affiliation(s)
- Ghayyur Khalil
- Kettering General Hospital, Kettering, Northamptonshire, UK
| | - Azza Elbadri
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, UK
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13
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Hudák M, Rašiová M, Moščovič M, Koščo M. Exertional angina after cardiac bypass surgery successfully solved by endovascular occlusion of unligated lateral costal artery. BMJ Case Rep 2023; 16:e256654. [PMID: 38129080 DOI: 10.1136/bcr-2023-256654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
The internal mammary artery has become the primary conduit for the surgical revascularisation of the left anterior descending artery. Large side branches of internal mammary artery are typically ligated during cardiac surgery to avoid a potential coronary steal phenomenon. However, ligation of side branches can be unsuccessful due to the technically difficult surgical exploration of internal mammary artery branches. In this article, we present a case of a man who suffered from exertion angina pectoris despite successful surgical revascularisation of occluded left anterior descending artery by the internal mammary artery bypass. The coronary steal syndrome caused by the mighty side branch of internal mammary artery, that is, lateral costal artery was concluded as the reason of exertional angina. The endovascular procedure was performed and the lateral costal artery was successfully occluded using vascular plug. The occlusion of lateral costal artery has led to a complete disappearance of the exertional angina.
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Affiliation(s)
- Marek Hudák
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Košice, Slovakia
| | - Mária Rašiová
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Košice, Slovakia
| | - Matej Moščovič
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Košice, Slovakia
| | - Martin Koščo
- Department of Angiology, East Slovak Institute of Cardiovascular Diseases, Košice, Slovakia
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Bdiwi M, Ramaseshan K, Uddin M, Goel M, Razzaq S, Alrayyashi M, Afonso L. Carcinoid heart disease: a potentially fatal complication of carcinoid syndrome. BMJ Case Rep 2023; 16:e255518. [PMID: 38056921 DOI: 10.1136/bcr-2023-255518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023] Open
Abstract
Carcinoid heart disease is a unique and serious cardiac complication of the neuroendocrine tumour that affects the right side of the heart, especially the tricuspid and pulmonic valves, eventually causing right heart failure. We present a middle-aged man with a history of well-differentiated neuroendocrine tumours of the small intestine with extensive metastases to the liver, mesentery and spine who is receiving monthly octreotide therapy. He presented with generalised fatigue, severe ascites and worsening dyspnoea. Both the transthoracic echocardiography and transoesophageal echocardiography revealed severe tricuspid and pulmonic regurgitations. He was considered a poor surgical candidate, underwent transcatheter pulmonic valve replacement with two bioprosthetic valve-in-valve implantations and was discharged in a stable condition.
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Affiliation(s)
- Mustafa Bdiwi
- Department of Internal Medicine, Wayne State University/ Detroit Medical Center, Detroit, Michigan, USA
| | - Karthik Ramaseshan
- Department of Internal Medicine, Wayne State University/ Detroit Medical Center, Detroit, Michigan, USA
| | - Mohammed Uddin
- Cardiology/Department of Internal medicine, Wayne State University/ Detroit Medical Center, Detroit, Michigan, USA
| | - Mishita Goel
- Cardiology/Department of Internal medicine, Wayne State University/ Detroit Medical Center, Detroit, Michigan, USA
| | - Saman Razzaq
- Department of Internal Medicine, Wayne State University/ Detroit Medical Center, Detroit, Michigan, USA
| | - Mohamed Alrayyashi
- Department of Internal Medicine, Wayne State University/ Detroit Medical Center, Detroit, Michigan, USA
| | - Luis Afonso
- Cardiology/Department of Internal medicine, Wayne State University/ Detroit Medical Center, Detroit, Michigan, USA
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15
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Jurado-Román A, Freixa X, Cid B, Cruz-González I, Sarnago Cebada F, Baz JA, Lozano Í, Sabaté M, Jiménez J, Íñigo García LA, Subinas Elorriaga A, Berenguer Jofresa A, Novo García E, Pérez Vizcayno MJ, Carrillo Suárez X, Pinar Bermúdez E, Calviño Santos R, Álvarez Antón S, Trillo Nouche R, Ruíz Arroyo JR, Fernández Cisnal A, Amat-Santos IJ, Jerez Valero M, Rama Merchán JC, Vaquerizo B, Tejada Ponce D, Ruiz Nodar JM, Sánchez Pérez I, Tejedor P, Elizaga J, Jiménez Cabrera FM, Bullones Ramírez JA, Sánchez Aquino R, Portero Pérez MP, Roura G, Mohandes M, Sáez Moreno R, Avanzas P, Caballero J, Torres Bosco AM, Merchán Herrera A, Robles Alonso J, Bosa Ojeda F, García San Román K, Agudelo VH, Martin Lorenzo P, Fernández JC, Pérez de Prado A, Ruiz Quevedo V, Cruz González I, Moreu Burgos J, Ruiz García J, Sánchez Burguillos FJ, Núñez Pernas D, Baello Monge P, Hernando Marrupe L, Franco Peláez JA, Jurado Román A, Pomar Domingo F, Fuertes Ferre G, Pimienta González R, Morales Ponce FJ, Sánchez Recalde Á, Ojeda Pineda S, Frutos Garcia A, Millán Segovia R, Fajardo Molina R, Díez Gil JL, Guisado Rasco A, Gómez Menchero AE, Bosch E, Oteo Domínguez JF, Gutiérrez-Barrios A, Cascón Pérez JD, Casanova Sandoval JM, Fernández Portales J, Rivero Crespo F, Gonzalez Caballero E, Ocaranza Sánchez R, Zueco J, García Del Blanco B, Alonso Briales JH, Sánchez Gila J, Vizcaino Arellano M, Carballo Garrido J, Andraka L, Gómez Jaume A, Merino Otermin Á, Artaiz Urdaci M, Arellano Serrano C, Íñigo García LA, García E, Unzué L, Ruiz Nodar JM, Arzamendi D, Freixa X, Mainar V, Usón M, Palazuelos Molinero J, López Palop R, Bethencourt A, Alegría Barrero E, Camacho Freire SJ, Peña G, Vázquez Álvarez ME, Muñoz Camacho JF, Ramírez Moreno A, Larman Tellechea M, García de la Borbolla Fernández R. Spanish cardiac catheterization and coronary intervention registry. 32nd official report of the Interventional Cardiology Association of the Spanish Society of Cardiology (1990-2022). Rev Esp Cardiol (Engl Ed) 2023; 76:1021-1031. [PMID: 37863184 DOI: 10.1016/j.rec.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/26/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION AND OBJECTIVES This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. METHODS All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. RESULTS A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. CONCLUSIONS The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.
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Affiliation(s)
| | - Xavier Freixa
- Servicio de Cardiología, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Belén Cid
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ángel Sánchez Recalde
- Hospital Universitario Ramón y Cajal, Hospital Universitario Sanitas La Moraleja, Hospital Universitario Sanitas Zarzuela
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16
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Alonso-Felipe M, Aguiar-Pérez JM, Pérez-Juárez MÁ, Baladrón C, Peral-Oliveira J, Amat-Santos IJ. Application of Mixed Reality to Ultrasound-guided Femoral Arterial Cannulation During Real-time Practice in Cardiac Interventions. J Healthc Inform Res 2023; 7:527-541. [PMID: 37927377 PMCID: PMC10620372 DOI: 10.1007/s41666-023-00147-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 07/12/2023] [Accepted: 08/29/2023] [Indexed: 11/07/2023]
Abstract
Mixed reality opens interesting possibilities as it allows physicians to interact with both, the real physical and the virtual computer-generated environment and objects, in a powerful way. A mixed reality system, based in the HoloLens 2 glasses, has been developed to assist cardiologists in a quite complex interventional procedure: the ultrasound-guided femoral arterial cannulations, during real-time practice in interventional cardiology. The system is divided into two modules, the transmitter module, responsible for sending medical images to HoloLens 2 glasses, and the receiver module, hosted in the HoloLens 2, which renders those medical images, allowing the practitioner to watch and manage them in a 3D environment. The system has been successfully used, between November 2021 and August 2022, in up to 9 interventions by 2 different practitioners, in a large public hospital in central Spain. The practitioners using the system confirmed it as easy to use, reliable, real-time, reachable, and cost-effective, allowing a reduction of operating times, a better control of typical errors associated to the interventional procedure, and opening the possibility to use the medical imagery produced in ubiquitous e-learning. These strengths and opportunities were only nuanced by the risk of potential medical complications emerging from system malfunction or operator errors when using the system (e.g., unexpected momentary lag). In summary, the proposed system can be taken as a realistic proof of concept of how mixed reality technologies can support practitioners when performing interventional and surgical procedures during real-time daily practice.
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Affiliation(s)
- Miguel Alonso-Felipe
- Data Engineering Research Group, School of Telecommunications Engineering, TSCIT Department, University of Valladolid, Valladolid, Spain
| | - Javier Manuel Aguiar-Pérez
- Data Engineering Research Group, School of Telecommunications Engineering, TSCIT Department, University of Valladolid, Valladolid, Spain
| | - María Ángeles Pérez-Juárez
- Data Engineering Research Group, School of Telecommunications Engineering, TSCIT Department, University of Valladolid, Valladolid, Spain
| | - Carlos Baladrón
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
| | - Julio Peral-Oliveira
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ignacio J. Amat-Santos
- Cardiology Department, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, Spain
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17
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Whitehead T, Moore A, Agarwal A, Appleby J. Isolated pulmonary valve endocarditis in a patient without structural heart disease or a history of intravenous drug use. BMJ Case Rep 2023; 16:e250098. [PMID: 37914175 PMCID: PMC10626919 DOI: 10.1136/bcr-2022-250098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
We present a case of a febrile patient in his 70s who was found to have isolated native pulmonary valve vegetations on echocardiography, and Enterococcus faecalis on blood cultures. Of note, our patient had none of the typical risk factors associated with this rare form of endocarditis previously described in only a handful of case reports.
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Affiliation(s)
| | - Amber Moore
- Buckinghamshire Healthcare NHS Trust, Aylesbury, UK
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18
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Hansen AC, Piranavan P, Kundu A, A El-Dalati S, Ahmed T. Embolic myocardial infarction with cardiac arrest as an initial manifestation of non-bacterial thrombotic endocarditis. BMJ Case Rep 2023; 16:e257466. [PMID: 37914173 PMCID: PMC10626879 DOI: 10.1136/bcr-2023-257466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023] Open
Abstract
Non-bacterial thrombotic endocarditis, characterised by sterile vegetations, is commonly caused by systemic lupus erythematosus and is known to be complicated with embolic cerebrovascular disease. Embolic myocardial infarction with non-bacterial thrombotic endocarditis is extremely rare. We report a case of ventricular fibrillation arrest from presumed coronary embolisation in non-bacterial thrombotic endocarditis. While there are no standardised guidelines on the management of embolic myocardial infarction in endocarditis, it requires a multidisciplinary approach unique for every encountered clinical scenario.
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Affiliation(s)
- Anna C Hansen
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Paramarajan Piranavan
- Department of Rheumatology, University of Kentucky Medical Center, Lexington, KY, USA
| | - Amartya Kundu
- Department of Cardiovascular Medicine, Gill Heart & Vascular Institute, Lexington, KY, USA
| | - Sami A El-Dalati
- Department of Infectious Disease, University of Kentucky Medical Center, Lexington, KY, USA
| | - Taha Ahmed
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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19
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Schutyser W, Budts W, Verhamme P. Percutaneous embolization of pulmonary arteriovenous malformations in adult patient with Rendu-Osler-Weber: a case report. Eur Heart J Case Rep 2023; 7:ytad533. [PMID: 37954570 PMCID: PMC10639099 DOI: 10.1093/ehjcr/ytad533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/15/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
Background Hereditary haemorrhagic telangiectasia (HHT), or Rendu-Osler-Weber syndrome, is a rare genetic disorder characterized by the development of telangiectasias and arteriovenous malformations (AVMs) throughout the body. We present a case of percutaneous embolization of pulmonary AVMs in an adult patient. Case summary A 26-year-old male patient with polycythaemia of unknown origin and a family history of secundum atrial septal defect underwent cardiac evaluation which revealed clubbing as a sign of peripheral cyanosis. Transthoracic echocardiography showed no intracardiac shunting, but further imaging revealed pulmonary AVMs in the lower lobe of the left lung. Magnetic resonance imaging of the brain detected vascular-ischaemic lesions, likely due to embolization through the pulmonary malformations. Right heart catheterization and pulmonary angiography confirmed the presence of large AVMs in the left lower pulmonary lobe. Percutaneous closure using Amplatzer devices was performed, followed by temporary anticoagulation therapy. Oxygen saturation improved and follow-up imaging confirmed successful closure of the AVMs. Genetic testing using whole exome sequencing identified a mutation in the ENG gene, confirming the diagnosis of HHT. Discussion Our case highlights the importance of investigating both intra- and extracardiac shunting in patients with clinical features of right-to-left shunting. Arteriovenous malformations can serve as a pathway for paradoxical emboli, potentially leading to ischaemic brain events, and might cause pulmonary arterial hypertension. Screening for arteriovenous malformations in various organs and embolization of significant shunts are essential aspects of managing HHT. Genetic testing aids in confirming the diagnosis and guides family testing.
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Affiliation(s)
- Wouter Schutyser
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Werner Budts
- Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Peter Verhamme
- Department of Cardiovascular Sciences, University Hospitals Leuven, Belgium
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20
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Yousaf A, Ahmad S, Ahsan MZ, Ahsan MJ. Bivalvular infective endocarditis complicated by perivalvular abscess and aorto-right atrium fistula. BMJ Case Rep 2023; 16:e255993. [PMID: 37899086 PMCID: PMC10619057 DOI: 10.1136/bcr-2023-255993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Infective endocarditis caused by Pseudomonas aeruginosa in patients without a history of intravenous drug abuse and endovascular procedures is rare. We present a middle-aged man with fever, chills, night sweats and dyspnoea for 2 weeks. Physical examination and blood cultures were drawn, and the patient was empirically started on antibiotics. Unfortunately, the patient experienced progressive clinical deterioration requiring endotracheal intubation and vasopressor support. Transthoracic echocardiogram followed by transesophageal echocardiogram was performed that showed bicuspid aortic valve, severe aortic regurgitation, membranous ventricular septal defect, vegetations on aortic and tricuspid valves, dilated aortic root, and a fistula between the aorta and right atrium. The patient underwent emergent aortic valve and aortic root replacement along with tricuspid commissuroplasty and ventricular septal defect (VSD) closure. Later, intraoperative tissue cultures grew P. aeruginosa, and antipseudomonal antibiotic coverage was added. This case highlights that P. aeruginosa endocarditis can occur without risk factors and can lead to fatal cardiovascular complications.
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Affiliation(s)
- Amman Yousaf
- Internal Medicine, McLaren Health Care Corp, Flint, Michigan, USA
| | - Soban Ahmad
- Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
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21
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Erdem A, Çınar T, Kılıç Ş, Öztürk NB. Unexpected cause of Kounis syndrome: hypersensitivity reaction to omeprazole. BMJ Case Rep 2023; 16:e254799. [PMID: 37879707 PMCID: PMC10603422 DOI: 10.1136/bcr-2023-254799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023] Open
Abstract
Kounis syndrome is a rare type of acute coronary syndrome (ACS) that occurs as a result of an allergic or anaphylactic reaction. Kounis syndrome can be induced by various medications including antibiotics, proton pump inhibitors, antihypertensive medications, corticosteroids, and antineoplastic medications. Additionally, cases of Kounis syndrome associated with lansoprazole and pantoprazole have been previously reported in the literature. In this report, we present a case of Kounis syndrome associated with omeprazole use, and discuss the need for a high index of suspicion as it is often underrecognised.
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Affiliation(s)
- Almina Erdem
- Cardiology, Istanbul Sultan II Abdulhamid Han Egitim ve Arastirma Hastanesi, Istanbul, Turkey
| | - Tufan Çınar
- İnternal Medicine, University of Maryland Midtown Campus, Baltimore, Maryland, USA
| | - Şahhan Kılıç
- Cardiology, Istanbul Sultan II Abdulhamid Han Egitim ve Arastirma Hastanesi, Istanbul, Turkey
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22
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Gupta A, Russal Starlet A, Shrivastava Y, Jhalani I. Emergency retrieval of embolised patent ductus arteriosus device from the right pulmonary artery. BMJ Case Rep 2023; 16:e255857. [PMID: 37857537 PMCID: PMC10603519 DOI: 10.1136/bcr-2023-255857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Percutaneous closure of patent ductus arteriosus using a duct occluder has become standard of care in its management especially in children more than 6 months of age, weighing more than 6 kg but device embolisation is a potential life-threatening complication and may require immediate open-heart surgery. We describe a case of successful surgical management of a patient in early childhood, in which device has embolised deep into the right pulmonary artery.
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Affiliation(s)
- Anish Gupta
- CTVS, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | | | - Yash Shrivastava
- Pediatric cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ishan Jhalani
- CTVS, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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23
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Jaalouk E, Jaalouk S. Bilateral persistent sciatic arteries presenting with lower extremity claudication. BMJ Case Rep 2023; 16:e255732. [PMID: 37798041 PMCID: PMC10565311 DOI: 10.1136/bcr-2023-255732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
This is a case report of a woman in her 60s with Rutherford class 3 bilateral calf claudication and a resting right Ankle Brachial Index (ABI) 0.49 and left ABI 0.57. The arteriogram of lower extremities demonstrates bilateral persistent sciatic arteries (PSAs). The patient had severe stenosis of left common iliac artery, and thus underwent successful stenting resulting in normalisation of flow and filling of PSA with symptom resolution.
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Affiliation(s)
- Emily Jaalouk
- Internal Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Safwan Jaalouk
- Cardiology, Florida State University College of Medicine, Tallahassee, Florida, USA
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24
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Mehta R, Sorbo D, Ronco F, Ronco C. Key Considerations regarding the Renal Risks of Iodinated Contrast Media: The Nephrologist's Role. Cardiorenal Med 2023; 13:324-331. [PMID: 37757781 PMCID: PMC10664334 DOI: 10.1159/000533282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/23/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND The administration of iodinated contrast medium during diagnostic and therapeutic procedures has always been associated with the fear of causing acute kidney injury (AKI) or an exacerbation of chronic kidney disease. This has led, on the one hand, to the deterrence, when possible, of the use of contrast medium (preferring other imaging methods with the risk of loss of diagnostic power), and on the other hand, to the trialling of multiple prophylaxis protocols in an attempt to reduce the risk of kidney injury. SUMMARY A literature review on contrast-induced (CI)-AKI risk mitigation strategies was performed, focussing on the recognition of individual risk factors and on the most recent evidence regarding prophylaxis. KEY MESSAGES Nephrologists can contribute significantly in the CI-AKI context, from the early stages of the decision-making process to stratifying patients by risk, individualising prophylaxis measures based on the risk profile, and ensuring appropriate evaluation of kidney function and damage post-procedure to improve care.
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Affiliation(s)
- Ravindra Mehta
- Division of Nephrology-Hypertension University of California – San Diego, San Diego, CA, USA
| | - David Sorbo
- Nephrology, Dialysis and Transplantation Unit, St. Bortolo Hospital, ULSS8 Berica, Vicenza, Italy
| | - Federico Ronco
- Interventional Cardiology – Department of Cardiac Thoracic and Vascular Sciences Ospedale dell’Angelo – Mestre (Venice), Venice, Italy
| | - Claudio Ronco
- Nephrology, Dialysis and Transplantation Unit and International Renal Research Institute, St Bortolo Hospital, ULSS8 Berica, Vicenza, Italy
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25
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Salavitabar A, Zampi JD, Thomas C, Zanaboni D, Les A, Lowery R, Yu S, Whiteside W. Augmented Reality Visualization of 3D Rotational Angiography in Congenital Heart Disease: A Comparative Study to Standard Computer Visualization. Pediatr Cardiol 2023:10.1007/s00246-023-03278-8. [PMID: 37725124 DOI: 10.1007/s00246-023-03278-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/14/2023] [Accepted: 08/12/2023] [Indexed: 09/21/2023]
Abstract
Augmented reality (AR) visualization of 3D rotational angiography (3DRA) provides 3D representations of cardiac structures with full visualization of the procedural environment. The purpose of this study was to evaluate the feasibility of converting 3DRAs of congenital heart disease patients to AR models, highlight the workflow for 3DRA optimization for AR visualization, and assess physicians' perceptions of their use. This single-center study prospectively evaluated 30 retrospectively-acquired 3DRAs that were converted to AR, compared to Computer Models (CM). Median patient age 6.5 years (0.24-38.8) and weight 20.6 kg (3.4-107.0). AR and CM quality were graded highly. RV pacing was associated with higher quality of both model types (p = 0.02). Visualization and identification of structures were graded as "very easy" in 81.1% (n = 73) and 67.8% (n = 61) of AR and CM, respectively. Fifty-nine (66%) grades 'Agreed' or 'Strongly Agreed' that AR models provided superior appreciation of 3D relationships; AR was found to be least beneficial in visualization of aortic arch obstruction. AR models were thought to be helpful in identifying pathology and assisting in interventional planning in 85 assessments (94.4%). There was significant potential seen in the opportunity for patient/family counseling and trainee/staff education with AR models. It is feasible to convert 3D models of 3DRAs into AR models, which are of similar image quality as compared to CM. AR models provided additional benefits to visualization of 3D relationships in most anatomies. Future directions include integration of interventional simulation, peri-procedural counseling of patients and families, and education of trainees and staff with AR models.
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Affiliation(s)
- Arash Salavitabar
- Cardiac Catheterization & Interventional Therapies, The Heart Center, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Jeffrey D Zampi
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Courtney Thomas
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Dominic Zanaboni
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Andrea Les
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Ray Lowery
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Sunkyung Yu
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
| | - Wendy Whiteside
- University of Michigan Congenital Heart Center, Ann Arbor, MI, USA
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26
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Rizwi K, Sharma S, Prasad SN, Khan AA. Giant left ventricular peripherally calcified pseudoaneurysm. BMJ Case Rep 2023; 16:e256983. [PMID: 37666568 PMCID: PMC10481724 DOI: 10.1136/bcr-2023-256983] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2023] Open
Affiliation(s)
- Kashif Rizwi
- Radiodiagnosis, AIIMS Patna, Patna, Bihar, India
| | - Srishti Sharma
- Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Bainiwal JS, Ham JA, Aksoy O. Trans-catheter mitral valve-in-valve replacement in a patient on venoarterial extracorporeal membrane oxygenation: a case report. Eur Heart J Case Rep 2023; 7:ytad427. [PMID: 37719001 PMCID: PMC10500414 DOI: 10.1093/ehjcr/ytad427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/24/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023]
Abstract
Background Bioprosthetic mitral valves on average have a median durability between 8 and 10 years. After the failure of a bioprosthetic valve, surgical replacement is often indicated. However, the options for those patients at high or prohibitive surgical risks are limited. Here, we describe a case of a successful trans-catheter mitral valve-in-valve (TMViV) replacement on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Case summary We describe a case of a 39-year-old female with a history notable for systemic lupus erythematosus, severe pulmonary arterial hypertension (now mixed pre and post) thought to be secondary to prior substance use, and infective endocarditis complicated by severe mitral stenosis status post-bioprosthetic mitral valve replacement who presented with symptoms of acute hypoxic respiratory failure secondary to severe bioprosthetic mitral valve stenosis. The patient had a prolonged hospital course complicated by a pulseless electrical activity arrest, (continuous renal replacement therapy) for acute renal failure, and hypertonic saline due to cerebral oedema. Due to her significant co-morbidities and haemodynamic instability with acute kidney injury and recent neurologic insult, the patient was thought not to be a good surgical candidate. However, given her young age and overall improved neurologic status, it was thought the patient could benefit from a TMViV with bi-ventricular support given her right- and left-sided heart failure and was placed on VA-ECMO in anticipation of a TMViV procedure for circulatory support. The patient underwent a successful TMViV replacement using a trans-septal approach with a 26 mm SAPIEN 3 valve and atrial septal defect closure with a 14 mm Amplatzer device on hospital Day 12. The patient was successfully de-cannulated from VA-ECMO on hospital Day 13. The patient had a prolonged hospital course but eventually had renal recovery and tracheostomy de-cannulation. A trans-thoracic echocardiogram prior to discharge was notable for a well-functioning valve and normal ejection fraction. The patient was discharged to a nursing home for further rehabilitation. Discussion The gold standard for bioprosthetic mitral valve stenosis is surgical replacement of the valve. However, the options for those at high or prohibitive surgical risk are lacking. Recent studies have demonstrated TMViV is a safe alternative to surgical mitral valve redo cases in high-risk patients. To our knowledge, there are limited data on trans-catheter valve placement while on VA-ECMO. Successful implantation in our patient suggests that TMViV in a stenotic bioprosthesis is feasible in very high-risk patients with the use of VA-ECMO to support haemodynamics.
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Affiliation(s)
| | - Jeremy-Ann Ham
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Olcay Aksoy
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
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Sykes R, Doherty D, Morrow A, Mangion K, Rushd A, Berry C. NT-proBNP in patients presenting with myocardial infarction and non-obstructive coronary arteries without left ventricular systolic dysfunction. Am Heart J Plus 2023; 33:100311. [PMID: 38510556 PMCID: PMC10946058 DOI: 10.1016/j.ahjo.2023.100311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/18/2023] [Accepted: 07/23/2023] [Indexed: 03/22/2024]
Abstract
Background Myocardial infarction and non-obstructive coronary arteries (MINOCA) affects 1 in 9 patients with acute coronary syndrome and has no evidence-based therapy. NT-proBNP is an established biomarker associated with prognosis in heart failure and ischemic heart disease, although there is a paucity of data in patients with MINOCA. Methods Prospective study of the diagnostic and clinical utility of measuring NT-proBNP in patients with MINOCA without left ventricular dysfunction or heart failure. Data collection was undertaken for patients with an initial diagnosis of MINOCA following urgent coronary angiography in the Golden Jubilee National Hospital (Clydebank, UK), a tertiary center. Demographics were collected in addition to left ventricular function by transthoracic echocardiography. NT-proBNP was measured from a clinically indicated blood sample obtained during routine venepuncture or within the catheter laboratory. Patient outcomes were collected prospectively by the clinical care team using digital follow-up. Results Fifty-five patients with an initial diagnosis of MINOCA and left ventricular ejection fraction >40 % were included. NT-proBNP was available in 87 % of patients with a median value of 312 pg/mL (interquartile range: 107, 725). Post-discharge, 40 % (n = 24) of patients were readmitted to the hospital, including 15 with chest pain. NT-proBNP ≥125 pg/mL was associated with rehospitalization (P = 0.02). Two patients died and bleeding complications with concomitant antiplatelet therapy occurred in eight patients. Conclusion NT-proBNP ≥ 125 pg/mL occurred in 72 % of patients presenting with MINOCA and an ejection fraction > 40% and was associated with rehospitalization.
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Affiliation(s)
- Robert Sykes
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
| | - Daniel Doherty
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
| | - Andrew Morrow
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
| | - Kenneth Mangion
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
| | - Ahsan Rushd
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
| | - Colin Berry
- School of Cardiovascular and Metabolic Health, University of Glasgow, G12 8TA, UK
- West of Scotland Heart and Lung Center, Golden Jubilee National Hospital, Glasgow, UK
- Department of Cardiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde Health Board, Glasgow, UK
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Enany BEM. 'Retrograde' balloon-assisted tracking to rescue a kinked guide catheter in the radial artery. BMJ Case Rep 2023; 16:e254029. [PMID: 37586756 PMCID: PMC10432655 DOI: 10.1136/bcr-2022-254029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
After a successful percutaneous coronary intervention to the left anterior descending artery, the guide catheter was pulled without a wire inside and so was kinked in the radial artery. It was not possible to pull or push the kinked catheter due to severe pain and fear of radial artery injury/perforation due to 'razor effect' of the two sharp edges of the kinked segment. Retrograde balloon-assisted tracking technique was used through femoral access, 7 F guide catheter, percutaneous transluminal coronary angioplasty wire and inflated 2.5×15 mm balloon partially outside the catheter tip to facilitate moving the kinked catheter to the aorta where unravelling was possible using a snare and a 0.035' wire. This technique helped to keep control of both catheters, and avoid the 'razor effect' and radial artery injury. It could be suggested as the initial solution to sort similar problems due to its safety and efficacy.
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Affiliation(s)
- Basem Elsaid Mohamed Enany
- Cardiology, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Cardiology, Ain Shams University Faculty of Medicine, Cairo, Egypt
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Martins C, Mateus RM, Cunha D, Gomes R. Percutaneous left ventricular assistance in cardiogenic shock due to Takotsubo cardiomyopathy secondary to status epilepticus. BMJ Case Rep 2023; 16:e254125. [PMID: 37558277 PMCID: PMC10414084 DOI: 10.1136/bcr-2022-254125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
Takotsubo syndrome is an acute reversible cardiomyopathy with left ventricular dysfunction and a clinical presentation similar to an acute coronary syndrome. Emotional or physical triggers can cause it, including neurological conditions such as seizures. We describe a case of a woman in her 50s with Takotsubo syndrome secondary to status epilepticus, presenting with cardiac arrest and cardiogenic shock. We excluded acute coronary syndrome with coronary angiography. Despite inotropic support, she remained haemodynamically unstable and a percutaneous left ventricular assistance with an Impella CP catheter was initiated. This resulted in a quick weaning of haemodynamic support and recovery of left ventricle systolic function in 2 weeks. This case illustrates the importance of a high index of suspicion to make this diagnosis and link it to neurological triggers, as well as to consider mechanical circulatory support in managing cardiogenic shock due to this cardiomyopathy.
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Affiliation(s)
| | | | - Diogo Cunha
- Cardiology, Garcia de Orta Hospital, Almada, Portugal
| | - Rui Gomes
- Intensive Care Unit, Garcia de Orta Hospital, Almada, Portugal
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Ukita K, Egami Y, Nishino M. Angioscopic and histopathological findings of in-stent restenosis in external iliac artery. BMJ Case Rep 2023; 16:e256241. [PMID: 37474140 PMCID: PMC10357669 DOI: 10.1136/bcr-2023-256241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Little has been reported on the angioscopic and histopathological findings of in-stent restenosis (ISR) in the iliac artery. Here, we report a case of a male patient in his 70s who showed recurrent ISR in the right external iliac artery. We observed the ISR lesions with not only an intravascular ultrasound (IVUS) but also an angioscopy and a biopsy to clarify the mechanism of ISR. These imaging and histopathological findings showed neointimal hyperplasia, and we performed endovascular therapy with covered stent placement to prevent neointimal formation. Not only the IVUS but also the angioscopic and histopathological findings were helpful to clarify the mechanism of ISR and to determine the treatment plan.
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Affiliation(s)
- Kohei Ukita
- Cardiology, Osaka Rosai Hospital, Sakai, Osaka, Japan
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32
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Watson S, Bampouri T, El-Daly I, O'Gallagher K. Management of a complex acetabular fracture following defibrillation for ventricular fibrillation cardiac arrest. BMJ Case Rep 2023; 16:e253421. [PMID: 37429645 DOI: 10.1136/bcr-2022-253421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
In this case report, we describe the first case of a patient who sustained a complex acetabular fracture following defibrillation for ventricular fibrillation cardiac arrest in the context of acute myocardial infarction. The patient was unable to undergo definitive open reduction internal fixation surgery due to the need to continue dual antiplatelet therapy following coronary stenting of his occluded left anterior descending artery. Following multidisciplinary discussions, a staged approach was opted for, with percutaneous closed reduction screw fixation of the fracture performed while the patient was maintained on dual antiplatelet therapy. The patient was discharged with a plan to perform definitive surgical management when safe to discontinue dual antiplatelets. This is the first confirmed case of defibrillation causing an acetabular fracture. We discuss the various aspects that need to be considered when patients are being worked up for surgery while on dual antiplatelet therapy.
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Affiliation(s)
- Samuel Watson
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Theodora Bampouri
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ibraheim El-Daly
- Department of Orthopaedic Surgery, King's College Hospital NHS Foundation Trust, London, UK
| | - Kevin O'Gallagher
- School of Cardiovascular and Metabolic Medicine & Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK kevin.o'
- Department of Cardiology, King's College Hospital NHS Foundation Trust, London, UK
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Abstract
Pulmonary arterial hypertension (PAH) is a progressive, life-limiting disease. Despite significant medical progress over the last three decades, the prognosis of PAH remains poor. PAH is associated with sympathetic nervous system over-stimulation and baroreceptor-mediated vasoconstriction, leading to pathologic pulmonary artery (PA) and right ventricular remodeling. PA denervation is a minimally-invasive intervention that ablates local sympathetic nerve fibers and baroreceptors to modulate pathologic vasoconstriction. Preliminary animal and clinical studies have shown improvements in short-term pulmonary hemodynamics and PA remodeling. However, future studies are needed to elucidate appropriate patient selection, timing of intervention, and long-term efficacy before integration into standard of care.
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Affiliation(s)
- Manasi Tannu
- Division of Cardiology, Duke University Health System, DUMC 3012, Durham, NC 27710, USA
| | - Richard A Krasuski
- Division of Cardiology, Duke University Health System, DUMC 3012, Durham, NC 27710, USA.
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Sinclair JE, Plante M, Harrison MF, Sanghavi DK. ST-elevation myocardial infarction after thrombolytic therapy with Tenecteplase for acute ischaemic stroke. BMJ Case Rep 2023; 16:e252253. [PMID: 37316282 DOI: 10.1136/bcr-2022-252253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Myocardial infarction (MI) secondary to thrombolytic therapy in the setting of acute ischaemic stroke (AIS) is a rare but severe complication. This phenomenon has been well documented in the past with recombinant tissue-type plasminogen activator, also known as Alteplase. However, there are no documented reports of MI secondary to Tenecteplase (TNKase), an alternative thrombolytic agent rapidly gaining favour in managing AIS. We report a male patient in his 50s who received TNKase for an AIS and subsequently developed an inferolateral ST elevation MI.
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Affiliation(s)
- Jorge Enrique Sinclair
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
| | - Marie Plante
- Department of Internal Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Michael F Harrison
- Department of Emergency Medicine, Mayo Clinic, Jacksonville, Florida, USA
| | - Devang K Sanghavi
- Department of Critical Care Medicine, Mayo Clinic in Florida, Jacksonville, Florida, USA
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Giovachini L, Pham V, Picard F, Fischer Q. Obstructive valve thrombosis after transcatheter aortic valve replacement (TAVR) in Sneddon syndrome without antiphospholipid antibodies. BMJ Case Rep 2023; 16:16/6/e254309. [PMID: 37308246 DOI: 10.1136/bcr-2022-254309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
We study a case of early obstructive leaflet thrombosis following a transcatheter aortic valve replacement (TAVR) in a woman in her 50s with a history of Sneddon syndrome treated by antiplatelet therapy. The thrombosis regressed following the use of vitamin K antagonists (VKA) for 6 weeks. Subacute TAVR leaflet thrombosis reappeared after discontinuation of VKA use. The main takeaways of this study were the detection of high-risk patients that could benefit from systematic post-TAVR anticoagulation and the early diagnosis of obstructive leaflet thrombosis associated with elevated transvalvular gradient, whose management differs from that of subclinical leaflet thrombosis.
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Affiliation(s)
| | - Vincent Pham
- Department of Cardiology, Hospital Cochin, Paris, France
| | - Fabien Picard
- Department of Cardiology, Hospital Cochin, Paris, France
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Matsuo K, Asada D, Aoki H, Kayatani F. Successful bailout stenting for critical aortic coarctation in a premature baby weighing 590 g. BMJ Case Rep 2023; 16:16/6/e255215. [PMID: 37295815 DOI: 10.1136/bcr-2023-255215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
Severe aortic coarctation (CoA) is a critical congenital heart disease that requires surgery as the first-line treatment in neonates. However, in very small premature infants, aortic arch repair has a relatively high mortality and morbidity rate. Bailout stenting is an alternative method that can be performed safely and effectively with low morbidity.We present a case of severe CoA in a premature baby, a monochorionic twin with selective intrauterine growth restriction. The patient was born at 31 weeks of gestation with a birth weight of 570 g. Seven days following her birth, she experienced anuria due to critical neonatal isthmic CoA. She underwent a stent implantation procedure at term neonatal, weighing 590 g. She had good dilatation of the coarcted segment with no complications. Follow-up at infancy showed no CoA recurrence. This is the world's smallest case of stenting for CoA.
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Affiliation(s)
- Kumiyo Matsuo
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Dai Asada
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Hisaaki Aoki
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
| | - Futoshi Kayatani
- Pediatric Cardiology, Osaka Women's and Children's Hospital, Izumi City, Osaka, Japan
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37
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Chacon L, Sheldon M, Riangwiwat T, Blankenship J. Aspiration thrombectomy: safe removal of thrombi too big to aspirate. BMJ Case Rep 2023; 16:16/5/e251129. [PMID: 37156566 PMCID: PMC10173972 DOI: 10.1136/bcr-2022-251129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Aspiration thrombectomy has been associated with an increased risk of stroke, and its routine use is not recommended. Ill-defined procedural techniques for aspiration thrombectomy may provide an explanation for inconsistent outcomes and adverse event rates in trials. Large thrombi can plug the aspiration port of the aspiration catheter and then be dislodged into the central circulation when they are retracted into the guide catheter, or when the aspiration catheter is removed from the Tuohy connector. We report a case of thrombus aspiration where a large distal thrombus was aspirated into the mouth of the aspiration catheter, held there with suction as it was removed and delivered outside the body without being dislodged. We offer several tips for safe removal of coronary thrombi too big to aspirate.
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Affiliation(s)
- Lucas Chacon
- Cardiology, University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - Mark Sheldon
- Cardiology, University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | | | - James Blankenship
- Cardiology, University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
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Patti G, Wang R, Marston XL, Yeh YC, Zimmermann L, Ye X, Gao X, Brüggenjürgen B. Anticoagulant Treatment Adherence and Persistence in German Patients with Atrial Fibrillation. Cardiol Ther 2023; 12:371-391. [PMID: 37138193 DOI: 10.1007/s40119-023-00315-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Treatment adherence and persistence impact the effectiveness of edoxaban for the prevention of thromboembolism in patients with atrial fibrillation (AF). The objective of this analysis was to assess adherence and persistence of edoxaban vs. other non-vitamin K antagonist oral anticoagulants (NOACs) and vitamin K antagonists (VKAs). METHODS Utilizing a German claims database, adults with AF with the first pharmacy claim identified for edoxaban, apixaban, dabigatran, rivaroxaban, or VKAs from January 2013 to December 2017 were included in a propensity score-matched analysis. The first pharmacy claim was the index claim. Adherence (i.e., proportion of days covered [PDC]) and persistence (proportion of patients who continued therapy) were compared between edoxaban and other therapies. Patients receiving once-daily (QD) vs. twice-daily (BID) NOAC were also analyzed. RESULTS Overall, 21,038 patients were included (1236 edoxaban, 6053 apixaban, 1306 dabigatran, 7013 rivaroxaban, and 5430 VKA). After matching, baseline characteristics were well balanced across cohorts. Adherence was significantly higher for edoxaban vs. apixaban, dabigatran, and VKAs (all P < 0.0001). Significantly more edoxaban patients continued therapy vs. rivaroxaban (P = 0.0153), dabigatran (P < 0.0001), and VKAs (P < 0.0001). Time to discontinuation was significantly longer for edoxaban vs. dabigatran, rivaroxaban, and VKAs (all P < 0.0001). More patients receiving NOACs QD had a PDC ≥ 0.8 compared with those receiving NOACs BID (65.3 vs. 49.6%, respectively; P < 0.05); persistence rates were comparable between QD and BID groups. CONCLUSIONS Patients with AF receiving edoxaban had significantly higher adherence and persistence compared with those receiving VKAs. This trend was also seen in NOAC QD regimens vs. NOAC BID regimens for adherence. These results provide insight into how adherence and persistence may contribute to the effectiveness of edoxaban for stroke prevention in patients with AF in Germany.
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Affiliation(s)
- Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy.
| | - Rosa Wang
- Daiichi Sankyo Inc., Basking Ridge, NJ, USA
| | | | | | | | - Xin Ye
- Daiichi Sankyo Inc., Basking Ridge, NJ, USA
| | - Xin Gao
- OPEN Health, Bethesda, MD, USA
| | - Bernd Brüggenjürgen
- Orthopedic Department, Medical School Hannover at DIAKOVERE Annastift Hospital, Hannover, Germany
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Abstract
INTRODUCTION With the advent of improved neonatal care, increasingly vulnerable higher-risk patients with complex congenital heart anomalies are presenting for intervention. This group of patients will always have a higher risk of an adverse event during a procedure but by recognising this risk and with the introduction risk scoring systems and thus the development of novel lower risk procedures, the rate of adverse events can be reduced. AREA COVERED This article reviews risk scoring systems for congenital catheterization and demonstrates how they can be used to reduce the rate of adverse events. Then novel low risk strategies are discussed for low weight infants e.g. patent ductus arteriosus (PDA) stent insertion; premature infants e.g. PDA device closure; and transcatheter pulmonary valve replacement. Finally, how risk is assessed and managed within the inherent bias of an institution is discussed. EXPERT OPINION There has been a remarkable improvement in the rate of adverse events in congenital cardiac interventions but now, as the benchmark of mortality rate is switched to morbidity and quality of life, continued innovation into lower risk strategies and understanding inherent bias when assessing risk will be key to continuing this improvement.
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Affiliation(s)
- N Linnane
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
| | - D P Kenny
- Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- Royal College of Surgeons, Dublin, Ireland
| | - Z M Hijazi
- Department of Cardiovascular Diseases, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, New York, NY, USA
- Jordan University, Amman, Jordan
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40
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Lim PO. Non-traumatic parasternal pericardiocentesis. BMJ Case Rep 2023; 16:16/4/e253728. [PMID: 37080634 PMCID: PMC10124190 DOI: 10.1136/bcr-2022-253728] [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] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Affiliation(s)
- Pitt O Lim
- Department of Cardiology, Atkinson-Morley Wing, St George's University Hospitals NHS Foundation Trust, Tooting, London SW17 0QT, UK
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41
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Janus SE, Al-Kindi S, Pollock G, Laster S. Ruptured mycotic coronary artery aneurysm. BMJ Case Rep 2023; 16:16/4/e254488. [PMID: 37045550 PMCID: PMC10105988 DOI: 10.1136/bcr-2022-254488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
Aneurysms complicated by rupture of the coronary arteries are exceedingly rare. Literature regarding management of mycotic aneurysms resulting in rupture is limited. Therefore, we describe a fascinating diagnosis, imaging progression and management of a ruptured mycotic coronary artery aneurysm.
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Affiliation(s)
- Scott E Janus
- Cardiology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
| | - Sadeer Al-Kindi
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, Ohio, USA
| | - Graham Pollock
- St Luke's Mid America Heart Institute, St Luke's Hospital, University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Steven Laster
- University of Missouri Kansas City School of Medicine, Kansas City, Missouri, USA
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Sauter R, Lin C, Magunia H, Schreieck J, Dürschmied D, Gawaz M, Patzelt J, Langer HF. Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR. Int J Cardiol Heart Vasc 2023; 45:101190. [PMID: 36941997 PMCID: PMC10024191 DOI: 10.1016/j.ijcha.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Background Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR). Results We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve. Results We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip. Conclusions In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
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Key Words
- CO, cardiac output
- COe, cardiac output echocardiographically determinded by combination of TTE and TEE parameters
- COi, invasively determined cardiac output
- Clips
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FMR, functional mitral regurgitation
- Heart failure
- Heart geometry
- Hemodynamics
- ICE, intracardiac echocardiography
- IVUS, intravascular ultrasound
- Interventional cardiology
- Interventional therapy
- LA, left atrium
- LV, left ventricle
- LVEDD, left ventricular end diastolic diameter
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association
- PA, pulmonary artery
- PAP, pulmonary artery pressure
- PASP, pulmonary artery systolic pressure
- PCW, pulmonary capillary wedge
- PCWP, pulmonary capillary wedge pressure
- PHT, pulmonary hypertension
- PMVR
- PMVR, percutaneous mitral valve repair
- RV, right ventricle
- SD, standard deviation
- Structural heart disease
- Surgery
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
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Affiliation(s)
- Reinhard Sauter
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Chaolan Lin
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Dürschmied
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F. Langer
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
- Corresponding author at: Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, 68167 Mannheim, Germany.
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Tackett MS, Ahmed T, El-Dalati SA, Ahmed T. Paradoxical embolisation to the brain in right-sided infective endocarditis and patent foramen ovale in a pregnant woman. BMJ Case Rep 2023; 16:16/3/e254403. [PMID: 36997240 PMCID: PMC10069541 DOI: 10.1136/bcr-2022-254403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
The incidence of infective endocarditis in pregnancy has increased as a result of the opioid epidemic. Right-sided infective endocarditis (RSIE), specifically tricuspid valve endocarditis, is more commonly linked to injection drug use. In pregnant patients, a prompt diagnosis and treatment of infective endocarditis are crucial to prevent fetal and maternal morbidity and mortality. Complications associated with infective endocarditis in pregnancy include death, preterm labour and embolic disease. RSIE is classically linked to septic pulmonary emboli; however, we report a unique case of a pregnant patient with known tricuspid valve infective endocarditis. Our patient unfortunately developed an ischaemic stroke from paradoxical brain embolisation in the setting of a previously undiagnosed patient foramen ovale. Furthermore, we demonstrate the importance of considering how normal cardiac physiological changes associated with pregnancy can impact the clinical course in patients with RSIE.
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Affiliation(s)
- Madison S Tackett
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Taimoor Ahmed
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Sami A El-Dalati
- Department of Infectious Disease, University of Kentucky Medical Center, Lexington, Kentucky, USA
| | - Taha Ahmed
- Department of Internal Medicine, University of Kentucky Medical Center, Lexington, Kentucky, USA
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Ali H, Lupo P, Cristiano E, Nicolì L, Foresti S, De Ambroggi G, Anderson RH, De Lucia C, Turturiello D, Paganini EM, Bessi R, Farghaly AAA, Butera G, Cappato R. Chiari network for the interventional cardiologist: A hidden enemy at the heart gate - A systematic review of the literature. Int J Cardiol 2023; 375:23-28. [PMID: 36587656 DOI: 10.1016/j.ijcard.2022.12.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/15/2022] [Revised: 12/20/2022] [Accepted: 12/23/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study aimed to collect and analyze the literature data regarding Chiari network (CN) and other right atrium (RA) remnants comprising the Eustachian and Thebesian valves (EV, ThV) as a potential entrapment site during different percutaneous cardiac procedures (PCP). METHODS AND RESULTS A systematic search was conducted using Pubmed and Embase databases following the PRISMA guidelines to obtain available data concerning PCP associated with entrapment of inserted materials within CN-EV-ThV. The final analysis included 41 patients who underwent PCP with reported material entrapment within these RA remnants. The PCP was atrial septal defect (ASD)/patent foramen ovale (PFO) closure, catheter ablation, and pacemaker/defibrillator implantation in 44%, 22%, and 17% of patients, respectively. The entrapped materials were ASD/PFO devices, multipolar electrophysiology catheters, passive-fixation pacing leads, and J-guidewires in about 30%, 20%, 15%, and 10% of patients, respectively. Intraprocedural transthoracic, transoesophageal and intracardiac echocardiography showed sensitivity to reveal these structures of 20%, ∼95%, and 100%, respectively. A percutaneous approach successfully managed 70% of patients, while cardiovascular surgery was required in 20% and three patients died (7.3%). CONCLUSIONS CN and other RA remnants may cause entrapment of various devices or catheters during PCP requiring right heart access. The percutaneous approach, guided by intraprocedural imaging, appears safe and effective in managing most patients. Prevention includes recognizing these anatomical structures at baseline cardiac imaging and intraprocedural precautions. Further studies are needed to analyze the actual incidence of this condition, its clinical impact and appropriate management.
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Affiliation(s)
- Hussam Ali
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy.
| | - Pierpaolo Lupo
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Ernesto Cristiano
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Leoluca Nicolì
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Sara Foresti
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Guido De Ambroggi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, United Kingdom
| | - Carmine De Lucia
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Dario Turturiello
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Edoardo Maria Paganini
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Riccardo Bessi
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
| | - Ahmad Abdelrady Abdelsalam Farghaly
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy; Cardiovascular Department, Assiut University, Assiut, Egypt
| | - Gianfranco Butera
- Department of Paediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, ERN GUARD HEART: Bambin Gesù Hospital and Research Institute, IRCCS, Rome, Italy; Department of Paediatric and Adult Congenital Heart Disease, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, United Kingdom
| | - Riccardo Cappato
- Arrhythmia & Electrophysiology Centre, IRCCS MultiMedica, Sesto San Giovanni, Milan, Italy
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Buchanan GL, Paradies V, Karam N, Holmvang L, Mamas MA, Mehilli J, Capodanno D, Capranzano P, Appelman Y, Manzo-Silberman S, Kunadian V, Mauri J, Shuepke S, Petronio AS, Kaluzna-Oleksy M, Gilard M, Morice MC, Barbato E, Dudek D, Chieffo A. Overcoming professional barriers encountered by women in interventional cardiology: an EAPCI statement. Eur Heart J 2023; 44:1301-1312. [PMID: 36881724 DOI: 10.1093/eurheartj/ehad053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/25/2022] [Revised: 10/28/2022] [Accepted: 01/25/2023] [Indexed: 03/09/2023] Open
Abstract
Despite the increasing proportion of female medical and nursing students, there is still a significant under-representation of women working as healthcare providers in interventional cardiology, with very few of them reaching senior leadership, academic positions, or acting principal investigators, as well as actively involved in company advisory boards. In this position paper, we will describe the current status of women working in interventional cardiology across Europe. We will also provide an overview of the most relevant determinants of the under-representation of women at each stage of the interventional cardiology career path and offer practical suggestions for overcoming these challenges.
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Affiliation(s)
- Gill Louise Buchanan
- Cardiology Department, North Cumbria Integrated Care NHS Foundation Trust, Carlisle, UK
| | - Valeria Paradies
- Cardiology Department, Maasstad Hospital, Rotterdam, The Netherlands
| | - Nicole Karam
- Cardiology Department, European Hospital Georges Pompidou, Paris, France
| | - Lene Holmvang
- Cardiology Department, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mamas A Mamas
- Keele Cardiovascular Group, Centre for Prognosis Research, Keele University, Stoke on Trent, UK
| | - Julinda Mehilli
- Cardiology Department, Hospital Landshut-Achdorf and Ludwig-Maximilians-University Clinic, Munich, Germany
| | - Davide Capodanno
- Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico-San Marco", University of Catania, Catania, Italy
| | - Piera Capranzano
- Cardio-Thoracic-Vascular and Transplant Department, Azienda Ospedaliero-Universitaria Policlinico "Gaspare Rodolico - San Marco", University of Catania, Catania, Italy
| | - Yolande Appelman
- Cardiology Department, Amsterdam UMC, location VU University Medical Center, The Netherlands
| | | | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Josepa Mauri
- Cardiology Department, University Hospital, Germans Trias i Pujol, Badalona, Spain
| | - Stefanie Shuepke
- Cardiology Department, Technical University of Munich, Munich, Germany
| | | | - Marta Kaluzna-Oleksy
- First Cardiology Department, Poznan University of Medical Sciences, Poznań, Poland
| | - Martine Gilard
- Cardiology Department, Centre Hospitalier Universitaire de Brest, Brest, France
| | - Marie Claude Morice
- Cardiology Department, Institute Cardiovasculaire Paris Sud, Ramsay, Massy, France
| | - Emanuele Barbato
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Dariusz Dudek
- Department of Cardiology and Cardiovascular Interventions, Jagiellonian University Hospital, Krakow, Poland.,Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Ravenna, Italy
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy
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Schenker N, Kaiser L, Bohnen S, Hakmi S. Think outside the box: a case report of utilization of an excimer laser sheath as an intracardiac bioptome. Eur Heart J Case Rep 2023; 7:ytad107. [PMID: 36923115 PMCID: PMC10010480 DOI: 10.1093/ehjcr/ytad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/01/2022] [Accepted: 02/23/2023] [Indexed: 03/02/2023]
Abstract
Background Malignant cardiac tumours are rare entities that cause severe morbidity and mortality. Possible treatment options vary between surgical removement, (immuno-) chemotherapy, and palliative care, whilst diagnostic workup comprises of imaging and histopathology analysis. Excimer laser sheaths are a new possibility to extract significant tissue samples to offer adequate treatment. Case summary A 67-year-old Caucasian female presented with progressive shortness of breath, new onset of fevers, weight loss, and recurrent night sweats. She showed signs of upper venous stasis.Cardiac imaging revealed an obstructive, hypoperfused right atrial mass superior to the tricuspid valve and a sessile structure at the mitral valve. Guideline-directed therapy for endocarditis was started subsequently.A conventional intracardiac biopsy of the tumour was unsuccessful, but an off-label approach using an excimer laser sheath as bioptome leads to the diagnosis of a diffuse large B-cell lymphoma. Immuno-chemotherapy was commenced, leading to reduction in tumour size and rapid improvement in the quality of life. Discussion Intracardiac biopsies are an important piece of the puzzle in the diagnostic workup of cardiac neoplasms. This case report is the first description of the utilization of a laser lead extraction tool as a bioptome for intracardiac tumours. Two imaging modalities (echocardiogram, fluoroscopy), as well as the precise technique of the excimer laser, ensured safety for the patient. Clinical studies are paramount to further evaluate the laser sheath as a possible new instrument in the toolbox of an interventional cardiologist.
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Affiliation(s)
- Niklas Schenker
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Lukas Kaiser
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Sebastian Bohnen
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
| | - Samer Hakmi
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, 20099 Hamburg, Germany
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Sundaram N, Sampson L, Marica S, Ronsivalle J, Rizzo A, Cagir B. Starting a Vascular Surgery Fellowship at a Rural Healthcare Center. J Surg Res 2023; 283:611-618. [PMID: 36446248 DOI: 10.1016/j.jss.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 05/03/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In the United States, there is an anticipated critical shortage of vascular surgeons in the coming decades. The shortage is expected to be particularly pronounced in rural areas. Our institution serves a rural and underserved population in which the incidence and prevalence of cardiovascular disease continues to rise. Our institution maintains a general surgery residency and has all the required Accreditation Council for Graduate Medical Education (ACGME) rotations and educational infrastructure to support a vascular surgery fellowship. This study aims to analyze the vascular caseload at our institution to determine if we and other institutions with similar surgical volumes can support the creation of a 2-year vascular fellowship. METHODS A single-site retrospective review of the number and type of vascular cases conducted at our institution between July 2016 and June 2021 was performed. The procedures were grouped into the following ACGME-defined categories: abdominal, cerebrovascular, complex, endovascular aneurysm repair, endovascular diagnostic or therapeutic, and peripheral. The total number and annual average for each category was obtained. Using the annual average, a 2-year estimate was calculated and compared to the ACGME minimum for each category. Our 2-year estimate was then compared to the national average for graduating vascular surgery fellows in order to generate a z-score for each category. RESULTS In the specified period, 6100 total surgical procedures were performed by three vascular surgeons at our institution. Two thousand five hundred and seventy-eight of the 6100 procedures met at least one of the ACGME-defined category requirements. Our center greatly exceeded the requirements for each category except for abdominal. This is consistent with trends observed in most centers across the nation, which are seeing a decline in open repairs across all categories, especially in open abdominal repairs. Our center's vascular case volume shows no significant difference the national average in each ACGME category (P ≥ 0.05 for all). CONCLUSIONS Despite our center's large vascular caseload and need for more vascular providers, there were not enough open abdominal cases performed to support the training of a vascular fellow. Given the continued decline in open aortic volume across the country, we anticipate that rural centers similar to our own will have difficulty establishing programs to train and recruit vascular surgeons. Flexibility in the abdominal category requirement or creation of open aortic fellowships may be necessary for smaller rural centers to train vascular surgeons and meet the future needs of the specialty.
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Affiliation(s)
- Niteesh Sundaram
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Lawrence Sampson
- Department of Vascular Surgery, The Guthrie Clinic, Sayre, Pennsylvania
| | - Silviu Marica
- Department of Vascular Surgery, The Guthrie Clinic, Sayre, Pennsylvania
| | - Joseph Ronsivalle
- Department of Interventional Radiology, The Guthrie Clinic, Sayre, Pennsylvania
| | - Anne Rizzo
- Department of General Surgery, The Guthrie Clinic, Sayre, Pennsylvania
| | - Burt Cagir
- Department of General Surgery, The Guthrie Clinic, Sayre, Pennsylvania
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Lourtet-Hascoët J, Valdeolmillos E, Houeijeh A, Bonnet E, Karsenty C, Sharma SR, Kempny A, Iung B, Gatzoulis MA, Fraisse A, Hascoët S. Infective endocarditis after transcatheter pulmonary valve implantation in patients with congenital heart disease: Distinctive features. Arch Cardiovasc Dis 2023; 116:159-166. [PMID: 36842868 DOI: 10.1016/j.acvd.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/23/2023] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
The introduction of transcatheter pulmonary valve implantation (TPVI) has greatly benefited the management of right ventricular outflow tract dysfunction. Infective endocarditis (IE) is a feared complication of TPVI that affects valve durability and patient outcomes. Current recommendations provide only limited guidance on the management of IE after TPVI (TPVI-IE). This article, by a group of experts in congenital heart disease in children and adults, interventional cardiology, infectious diseases including IE, and microbiology, provides a comprehensive review of the current evidence on TPVI-IE, including its incidence, risk factors, causative organisms, diagnosis, and treatment. The incidence of TPVI-IE varies from 13-91/1000 person-years for Melody valves to 8-17/1000 person-years for SAPIEN valves. Risk factors include history of IE, DiGeorge syndrome, immunosuppression, male sex, high residual transpulmonary gradient and portal of bacteria entry. Staphylococci and streptococci are the most common culprits, whereas Staphylococcus aureus is associated with the most severe disease. In addition to the modified Duke criteria, a high residual gradient warrants a strong suspicion. Imaging studies are helpful for the diagnosis. Intravenous antibiotics guided by blood culture results are the mainstay of treatment. Invasive re-intervention may be required. TPVI-IE in patients with congenital heart disease exhibits several distinctive features. Whether specific valve types are associated with a higher risk of TPVI-IE requires further investigation. Patient and parent education regarding IE prevention may have a role to play and should be offered to all patients.
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Affiliation(s)
- Julie Lourtet-Hascoët
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; Clinical Microbiology Laboratory, Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Estibaliz Valdeolmillos
- Pôle des cardiopathies congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes-réseau M3C, Faculté de Médecine, Université Paris-Saclay, INSERM UMR-S999, BME Lab, 92350 Le Plessis-Robinson, France
| | - Ali Houeijeh
- Department of Congenital Heart Disease, Lille University Hospital, 59000 Lille, France
| | - Eric Bonnet
- Infectious Diseases Mobile Unit, Clinique Pasteur, 31000 Toulouse, France
| | - Clément Karsenty
- Cardiologie pédiatrie, Hôpital des enfants, Centre de Compétence Cardiopathies Congénitales Complexes-réseau M3C- CHU Toulouse, 31000 Toulouse, France
| | - Shiv-Raj Sharma
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Aleksander Kempny
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Bernard Iung
- Service de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Cité, 75018 Paris, France
| | - Michael A Gatzoulis
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; National Heart and Lung Institute, Imperial College, SW3 6LY London, UK
| | - Alain Fraisse
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Sébastien Hascoët
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; Pôle des cardiopathies congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes-réseau M3C, Faculté de Médecine, Université Paris-Saclay, INSERM UMR-S999, BME Lab, 92350 Le Plessis-Robinson, France.
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Islam S, Khan J, Khan Y. Balloon mitral valvuloplasty: a re-emerging technique enhanced with real-time, three-dimensional transoesophageal cardiac ultrasound/echocardiography (3D-TOE). BMJ Case Rep 2023; 16:16/2/e253123. [PMID: 36750298 PMCID: PMC9906269 DOI: 10.1136/bcr-2022-253123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
We describe the case of a woman in her 60s with mitral stenosis, rate-controlled atrial fibrillation and a history of childhood rheumatic fever. She successfully underwent elective percutaneous transvenous mitral commissurotomy (PTMC), also described as balloon mitral valvuloplasty, for severe, symptomatic mitral stenosis. This was completed via right femoral vein access, trans-septal puncture and commissural separation guided by real-time three-dimensional (3D) transoesophageal echocardiography under general anaesthesia.Balloon mitral valvuloplasty is being completed more frequently in the UK due to the population having a higher incidence of mitral valve disease as a result of migration and as a palliative measure in those considered too high risk for mitral valve replacement cardiothoracic surgery.Rheumatic mitral stenosis is known to be a disease prevalent in countries of low and middle income and with increased migration to the UK, resulting in an increased prevalence of rheumatic mitral valve disease in the UK. It is estimated that within the UK, one in seven persons are migrants, and as such, we believe it is important to pay attention to diseases which affect the evolving population of the UK.Technological advancements, including availability and use of 3D transoesophageal cardiac ultrasound/echocardiography, have made PTMC much safer and more effective than previously. Additionally, the multidisciplinary team approach to PTMC is very important to its success. The procedure was completed successfully, with no complications.
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Affiliation(s)
- Samsul Islam
- Medicine, New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Jawad Khan
- Cardiology, Birmingham City Hospital, Sandwell & West Birmingham NHS Trust, Birmingham, UK
| | - Yusuf Khan
- Medicine, Queen Mary University of London, Bart's and The London School of Medicine and Dentistry, London, UK
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50
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Anim-Sampong S, Antwi WK, Adomako JB, Botwe BO, Sarkodie BD, Brakohiapa EK. Patient radiation dose during diagnostic and interventional cardiology procedures: A study in a tertiary hospital. J Med Imaging Radiat Sci 2023; 54:298-305. [PMID: 36746713 DOI: 10.1016/j.jmir.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/14/2022] [Accepted: 12/20/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND Fluoroscopy-guided diagnostic and interventional cardiology (IC) procedures help to identify and treat several problems associated with the heart. However, these procedures expose patients, cardiologists, radiographers, and nurses to radiation doses. Due to the risk that ionizing radiation poses, concerns have been raised and studies are continually being done to ensure that optimization is achieved during such procedures. This study assessed patient radiation dose during diagnostic and interventional cardiology procedures as well as right heart studies at a tertiary hospital in Ghana to formulate the facility's diagnostic reference levels (DRLs) for optimization purposes. As this study was the first of its kind in Ghana, it was a vital step towards dose optimization within the local department, as well as contributing to future DRLs in Ghana. METHODS The study collected dose (air kerma, and kerma area product (KAP) and procedural data, and assessed any correlation between parameters such as fluoroscopy time and KAP, and between body mass index (BMI) and KAP. The DRL values were determined as the 75th percentile level for the dose distribution for the various IC procedures including percutaneous coronary interventions (PCI), coronary angiography (CA), and right heart catheterization (RHC). Data were analyzed using SPSS version 23. RESULTS CA was the most frequently performed IC procedure (77.3%), while RHC was the least recorded (3.3%). The highest mean KAP was observed during the PCI procedure. The proposed diagnostic reference levels (DRLs) were 162.0 Gy.cm2 (PCI), 69.4 Gy.cm2 (CA), 39.8 Gy.cm2 (RHC) and 159.9 Gy.cm2 (CA+PCI). Patients who presented for the CA+PCI and RHC procedures received the highest and lowest mean KAP of 159.9 Gy.cm2 and 39.8 Gy.cm2 of radiation respectively. CONCLUSION This study, therefore, concludes that there is a need for dose optimization of radiation exposures for IC procedures at the cardiothoracic center in Ghana.
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Affiliation(s)
- Samuel Anim-Sampong
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - William Kwadwo Antwi
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana.
| | - John Bright Adomako
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana
| | - Benard Ohene Botwe
- Department. of Radiography, University of Ghana School of Biomedical and Allied Health Sciences, P.O. Box KB 143, Korle Bu, Accra, Ghana; Department of Midwifery and Radiography Division School of Health & Psychological Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK
| | - Benjamin Dabo Sarkodie
- Department of Radiology, University of Ghana School of Medical and Dental Science, Accra, Ghana
| | - Edmund K Brakohiapa
- Department of Radiology, University of Ghana School of Medical and Dental Science, Accra, Ghana
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