Percutaneous retrieval of an embolized catheter tip with the balloon dilatation technique

Introduction: Increasing numbers of complex percutaneous coronary interventions have been accompanied by various intra-procedural complications. The fracture and embolization of devices or their fragments are potentially life-threatening situations, depending on the site of embolization. Different non-surgical methods to handle embolic complications have been proposed for different clinical situations. Case Presentation: We present a case of a distally embolized catheter fragment that was percutaneously retrieved. The catheter fragment was tightly held by the inflated balloon, moved together with the system, and successfully retrieved out of the circulation via the femoral sheath. Considerable distal embolization of the foreign body and retrieval with the balloon dilatation technique are the unique features of this case. Conclusions: The present case appears to offer a safe and relatively simple method of balloon dilatation inside the lumen of the embolized fragment when the foreign body is too distal to retrieve with conventional snare systems

The effects of preoperative non-invasive cardiac tests on delay to surgery and subsequent mortality in elderly patients with hip fracture

OBJECTIVE: To investigate the effects of preoperative cardiac tests on the surgical treatment plan and subsequent effects on mortality in elderly patients with hip fracture

Evans syndrome with non-ST segment elevation myocardial infarction complicated by hemopericardium

Evans syndrome (ES) is a rare hematological disease characterized by autoimmune hemolytic anemia, immune thrombocytopenia, and/or neutropenia, all of which may be seen simultaneously or subsequently. Thrombotic events in ES are uncommon. Furthermore, non-ST segment-elevation myocardial infarction (NSTEMI) during ES is a very rare condition. Here, we describe a case of a 69-year-old female patient presenting with NSTEMI and ES. Revascularization via percutaneous coronary intervention (PCI) was scheduled and performed. Hemopericardium and cardiac tamponade occurred 5 h after PCI, and urgent pericardiocentesis was performed. Follow-up was uneventful, and the patient was safely discharged. Early recognition and appropriate management of NSTEMI is crucial to prevent morbidity and mortality. Coexistence of NSTEMI and ES, which is associated with increased bleeding risk, is a challenging scenario and these patients should be closely monitored in order to achieve early recognition and treatment of complications

Assessment of the influence of radiofrequency catheter ablation of the slow pathway of the atrioventricular node on cardiac function in patients with atrioventricular nodal reentrant tachycardia: a speckle tracking echocardiography study

Objectives: Typical atrioventricular nodal reentrant tachycardia (AVNRT) can be cured with slow pathway ablation. This study was designed to assess the alterations in atrial and ventricular functioning using speckle tracking echocardiography in consecutive patients with typical AVNRT who underwent slow pathway radiofrequency (RF) ablation

An Alternative Approach for Mitral Paravalvular Leak with Dacron Patch Curtaining under the Guidance of Real-Time 3-Dimensional Transesophageal Echocardiography

Objectives: The aim of this study was to evaluate real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) in the assessment of mitral paravalvular leakage curtaining surgery with a Dacron patch. Methods: RT-3D TEE was used before and after the operation. Results: Repairing a mitral paravalvular leak with Dacron patch curtaining was a useful, simple and new technique with promising feasibility and durability. Conclusions: In selected patients in whom the mitral paravalvular defect is relatively large, and may thus not be suitable for closing with primary suture, Dacron patch curtaining may be feasible for repair guided with RT-3D TEE; both are described for the first time. Copyright (C) 2011 S. Karger AG, Base

Biomarkery uszkodzenia miokardium po przezcewnikowej ablacji prądem o wysokiej częstotliwości i krioablacji balonowej z powodu migotania przedsionków oraz ich wpływ na nawrót migotania

Background: Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels. Aim: This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters. Methods: We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence. Results: Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p < 0.001 for all). TnI elevation (DTnI) was correlated with age (p = 0.033) and median temperature reached during ablation (p < 0.005) in the CBA group, while it was correlated with application time in the RFA group (p < 0.001). Multivariate analysis in the CBA group revealed age and left atrium diameter as positive independent predictors (p = 0.029 and p = 0.046), and DTnI as a negative independent predictor for AF recurrence (p = 0.001). Elevated cardiac biomarkers were not associated with AF recurrence in the RFA group (p > 0.05). Conclusions: The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome.Wstęp: Uszkodzenie miokardium w wyniku ablacji przezcewnikowej (CA) z powodu migotania przedsionków (AF) wiąże się z podwyższonymi stężeniami biomarkerów. Cel: W tym prospektywnym badaniu zmierzono stężenia biomarkerów uszkodzenia miokardium (kinaza kreatynowa [CK]), izoenzym sercowy kinazy kreatynowej [CK-MB], troponina I [TnI]) oraz oceniono ich wpływ na nawrót AF po zabiegu ablacji wykonanym jedną z dwóch metod: krioablacji balonowej (CBA) i ablacji prądem o wysokiej częstotliwości (RFA). Autorzy zamierzali również ocenić zależność między nawrotem AF po CA a innymi parametrami klinicznymi, echokardiograficznymi i związanymi z metodą zabiegową. Metody: Do badania włączono 98 chorych z AF, spośród których u 21% rozpoznano przetrwałe AF, a u 79% — napadowe AF. U 58% chorych wykonano CBA, a u 42% osób — RFA. Stężenia CK, CK-MB i TnI zmierzono przed zabiegiem i 6 godzin po zabiegu. Wizyty kontrolne odbyły się 3, 6 i 9 miesięcy po ablacji. Porównano stężenia biomarkerów u pacjentów z nawrotem AF i bez nawrotu. Wyniki: Zmierzone po ablacji stężenia CK (postCK), CK-MB (postCKMB) i TnI (postTnI) były istotnie wyższe w grupach CBA i RFA (p < 0,001 dla wszystkich porównań). Zwiększenie stężenia TnI (DTnI) w grupie CBA korelowało z wiekiem (p = 0,033) i medianą temperatury osiągniętej w czasie ablacji (p < 0,005), natomiast w grupie RFA korelowało z czasem aplikacji (p < 0,001). Analiza wieloczynnikowa danych pacjentów z grupy CBA wykazała, że wiek i średnica lewego przedsionka były niezależnymi czynnikami predykcyjnymi dodatnimi (p = 0,029 i p = 0,046), a DTnI — niezależnym czynnikiem predykcyjnym ujemnym nawrotu AF (p = 0,001). Podwyższone stężenia biomarkerów sercowych nie wiązały się z nawrotem AF w grupie RFA (p > 0,05). Wnioski: Po CBA i RFA stężenia wszystkich biomarkerów sercowych były podwyższone. Zwiększone stężenia TnI po CBA stanowiły niezależny czynnik prognostyczny ujemny nawrotu AF. Pomiary stężeń TnI po CBA mogą być użyteczne w prognozowaniu lepszego efektu klinicznego

An Alternative Approach for Mitral Paravalvular Leak with Dacron Patch Curtaining under the Guidance of Real-Time 3-Dimensional Transesophageal Echocardiography

Objectives: The aim of this study was to evaluate real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) in the assessment of mitral paravalvular leakage curtaining surgery with a Dacron patch. Methods: RT-3D TEE was used before and after the operation. Results: Repairing a mitral paravalvular leak with Dacron patch curtaining was a useful, simple and new technique with promising feasibility and durability. Conclusions: In selected patients in whom the mitral paravalvular defect is relatively large, and may thus not be suitable for closing with primary suture, Dacron patch curtaining may be feasible for repair guided with RT-3D TEE; both are described for the first time. Copyright (C) 2011 S. Karger AG, Base