20 research outputs found
Az első 200 transzkatéteres aortabillentyű-implantáció a Gottsegen György Országos Kardiológiai Intézetben | The first 200 transcatheter aortic valve implantations in the Gottsegen György Institute of Cardiology, Hungary
Absztrakt
Bevezetés: Napjainkban a súlyos panaszos aortastenosis
kezelésében a transzkatéteres billentyűimplantáció a sebészi billentyűcsere
elĂ©rhetĹ‘ alternatĂváját jelenti sebĂ©szi kontraindikáciĂł Ă©s elfogadhatatlanul
magas műtéti kockázat esetén. A szerzők intézetében ez a beavatkozás ma már a
mindennapi rutin rĂ©szĂ©nek számĂt. CĂ©lkitűzĂ©s: A szerzĹ‘k az elsĹ‘
200, transzkatéteres billentyűimplantációban részesült beteg eredményeit
tárgyalják. Módszer: 2016. januárig 200 sikeres implantáció
történt. A betegek 55%-a nő, átlagéletkoruk 79,9 év volt, az átlagos EuroSCORE:
19,3%, az átlagos ejekciós frakció: 54%, az aortabillentyűn mérhető
csúcsgradiens 81,2 Hgmm, az átlaggradiens: 50,9 Hgmm volt.
Eredmények: A beavatkozásokat 99%-os sikeraránnyal
végezték, a szövődmények feldolgozása a VARC-2 kritériumrendszer alapján
történt. Az egy hónapos mortalitás 5%, az egyéves pedig 17,4% volt, utóbbiból a
kardiális mortalitás 13,6% volt. Az egyéves cerebrovascularis történések
előfordulása 5% volt. Az egyéves kontroll során a betegek 95%-a NYHA I vagy II
funkcionális állapotban volt. Következtetés: Az eredmények nem
térnek el lényegesen a nemzetközi vizsgálatok eredményeitől. Orv. Hetil., 2016,
157(45), 1786–1792.
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Abstract
Introduction: Transcatheter aortic valve implantation is a
therapeutic alternative for contraindicated and high surgical risk patients with
severe symptomatic aortic stenosis. This intervention is part of daily routine
in the Institute of the authors. Aim: In the present work the
results of the first 200 patients are discussed. Method: Until
January, 2016, 200 patients (female 55%, mean age 79.9 years, average EuroSCORE
19.3%, left ventricular ejection fraction 54%, peak gradient 81.2 mmHg, mean
aortic gradient 50.9 mmHg) underwent transcatheter aortic valve implantation.
Results: The procedure was performed with 99% success rate.
Complications were evaluated according to VARC 2 definitions. Mortality was 5%
at one month and 17.4% at one year. Cardiac mortality was 13.6 at one year.
Cerebrovascular complications were 5% within one year, and 95% of patients were
in NYHA I or II functional classes at one year. Conclusion:
These findings are consistent with worldwide results. Orv. Hetil., 2016,
157(45), 1786–1792
Ventricular septal rupture caused by myocardial bridge, solved by interventional closure device
Myocardial bridging is a common coronary anomaly, which
is generally described as a benign phenomenon. However,
a growing number of studies consider this anomaly a relevant
pathophysiological phenomenon with serious pathological
consequences. Here we report on the case of an
88-year-old woman suffering from myocardial infarction
and ventricular septal rupture, lacking any recognizable
coronary disease except for a myocardial bridge causing
the systolic compression of the left anterior descending
coronary artery. A wide range of diagnostic procedures, including
coronarography, echocardiography, and magnetic
resonance imaging were used. The septal rupture was finally
closed by using a percutaneous closure device. This
event indicates that myocardial bridges – at least in some
cases – may have notable clinical relevance
Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease
Background Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. Methods We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. Results At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the patients in the PCI group and in 7.9% in the CABG group (P<0.001 for noninferiority, P=0.008 for superiority). The secondary end-point event of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years occurred in 23.1% of the patients in the PCI group and in 19.1% in the CABG group (P=0.01 for noninferiority, P=0.10 for superiority). Conclusions In patients with left main coronary artery disease and low or intermediate SYNTAX scores by site assessment, PCI with everolimus-eluting stents was noninferior to CABG with respect to the rate of the composite end point of death, stroke, or myocardial infarction at 3 years. (Funded by Abbott Vascular; EXCEL ClinicalTrials.gov number, NCT01205776 .)
Percutaneous coronary intervention in Europe 1992-2003
peer reviewedAims: The purpose of this registry is to collect data on trends in interventional cardiology within Europe.
Special interest focuses on relative increases and ratios in newer revascularization approaches and its distribution
in different regions in Europe. We report the data of the year 2003 and give an overview of the
development of coronary interventions since 1992, when the first data collection was performed.
Methods and results: Questionnaires were distributed yearly to delegates of all national societies of cardiology
represented in the European Society of Cardiology to collect the case numbers of all local institutions
and operators. The overall numbers of coronary angiographies increased from 1992 to 2003 from 684,000
to 1,993,000 (from 1,250 to 3,500 per million inhabitants). The respective numbers for percutaneous
coronary interventions (PCI-coronary angioplasty) and coronary stenting procedures increased from
184,000 to 733,000 (from 335 to 1,300) and from 3,000 to 610,000 (from 5 to 1,100), respectively.
Germany has been the most active country for the past years with 653,000 angiographies (7,800),
222,000 angioplasties (2,500), and 180,000 stenting procedures (2,200) in 2003. The indication has shifted
towards acute coronary syndromes, as demonstrated by raising rates of interventions for acute myocardial
infarction over the last decade. The procedures are more readily performed and safer, as shown by
increasing rate of “ad hoc” PCI and decreasing need for emergency coronary artery bypass surgery
(CABG). In 2003, use of drug-eluting stents had further increased. However, an enormous variability is
reported with the highest rate in Portugal (55%).
Conclusion: Interventional cardiology in Europe is still expanding, mainly but not exclusively due to rapid
growth in the eastern European countries. A number of new coronary revascularization procedures introduced
over the years have all but disappeared. Only stenting has experienced an exponential growth. The
same can be forecast for drug-eluting stenting
A multimodális képalkotás szerepe a paravalvularis leak katéteres zárásában
CĂ©lkitűzĂ©s: A paravalvularis leak (PVL) incidenciája 5-18% műbillentyű-beĂĽltetĂ©st követĹ‘en. Az esetek 3%-ában tĂĽnetes megjelenĂ©sű, ami szĂvelĂ©gtelensĂ©g tĂĽnetegyĂĽttesĂ©t, valamint hemolitikus anĂ©miát jelenthet. A betegpopuláciĂłt magas perioperatĂv rizikĂł jellemzi, az ismĂ©telt szĂvműtĂ©t 30 napos mortalitása 10% feletti. Ezen betegeknĂ©l jelent lehetĹ‘sĂ©get a katĂ©teres leak-zárás. CĂ©lunk a Gottsegen György Országos Kardiovaszkuláris IntĂ©zetben vĂ©gzett beavatkozások periprocedurális kĂ©palkotásának vizsgálata. MĂłdszerek: RetrospektĂv vizsgálatunkba a 2009 szeptembere Ă©s 2021 decembere között vĂ©gzett 62 katĂ©teres PVL-zárást (36 fĂ©rfi , 26 nĹ‘, átlagĂ©letkor 69,5±10,9 Ă©v) vontuk be. ÉrtĂ©keltĂĽk a csak 2D transoesophageális echokardiográfi án (TEE) átesett csoporttal összehasonlĂtva a multimodális kĂ©palkotás (3D TEE Ă©s szĂv-CT) szerepĂ©t a mortalitás, a szövĹ‘dmĂ©nyek Ă©s a technikai siker vonatkozásában. EredmĂ©nyek: A vizsgált idĹ‘szakban a zárás indikáciĂłja az esetek 82%-ában szĂvelĂ©gtelensĂ©g, 19%-ában hemolitikus anĂ©mia volt. A műbillentyű beĂĽltetĂ©sĂ©tĹ‘l számĂtott medián idĹ‘ 4,3 Ă©v volt. Mitralis Ă©rintettsĂ©g 42 esetben fordult elĹ‘ (mechanikus műbillentyű 34 eset, biolĂłgiai 8 eset), aorta 21 esetben volt Ă©rintett (mechanikus 15 eset, biolĂłgiai 3 eset, TAVI 3 eset). Azokban az esetekben, amikor csak 2D TEE-t vĂ©geztek, a technikai sikeressĂ©g 86%, a 30 napos mortalitás 8% volt. A beavatkozást megelĹ‘zĹ‘en 26 esetben kerĂĽlt sor multimodális kĂ©palkotásra, ezen esetek technikai sikeressĂ©ge 96%, a 30 napos mortalitása 11%-nak adĂłdott. KövetkeztetĂ©sek: A tĂĽnetes, de magas rizikĂłjĂş páciensek esetĂ©n eredmĂ©nyes Ă©s biztonságos alternatĂvát jelent a katĂ©teres PVL-zárás. A multimodális kĂ©palkotás alkalmazása segĂthet a PVL paramĂ©tereinek meghatározásában, a beavatkozás hosszának, illetve a komplikáciĂłk száma csökkentĂ©sĂ©ben
A bal pitvari fülcse perkután zárása nonvalvularis pitvarfibrillációban – nemzetközi és hazai tapasztalatok = Percutaneous left atrial appendage closure in non-valvular atrial fibrillation – review of literature and own experiences
Nonvalvularis pitvarfibrilláciĂłban szenvedĹ‘ betegek esetĂ©n az orális antikoaguláns kezelĂ©s stroke-prevenciĂłs hatĂ©konysága egyĂ©rtelműen bizonyĂtott. Ezen betegek nem elhanyagolhatĂł hányada számára azonban a magas thromboemboliás kockázat ellenĂ©re sem kivitelezhetĹ‘ a hosszĂş távĂş antikoaguláns kezelĂ©s. ElsĹ‘sorban ennek köszönhetĹ‘, hogy napjainkban egyre inkább az alternatĂv kezelĂ©si stratĂ©giák kerĂĽlnek az Ă©rdeklĹ‘dĂ©s homlokterĂ©be. Nonvalvularis pitvarfibrilláciĂłban a thrombuskĂ©pzĹ‘dĂ©s leggyakoribb helye a bal pitvari fĂĽlcse. Az eurĂłpai piacon jelenleg kĂ©t perkután fĂĽlcsezárĂł eszköz Ă©rhetĹ‘ el: Watchman LAA System (Atritech Inc.) Ă©s az Amplatzer Cardiac Plug (AGA Medical Corporation). Bár a közelmĂşltban zárult klinikai vizsgálatok (PLAATO, PROTECT AF) szerint a perkután bal pitvari fĂĽlcsezárás elfogadhatĂł biztonságossági profil mellett csökkenti a hosszĂş távĂş stroke-kockázatot, a rendelkezĂ©sĂĽnkre állĂł adatok mĂ©g korlátozottak. Jelenleg ezek a beavatkozások a nonvalvularis pitvarfibrilláciĂłban szenvedĹ‘ magas stroke-kockázatĂş betegek azon csoportja számára jelenthetnek elfogadhatĂł megoldást, akiknĂ©l az orális antikoaguláns terápia nem alkalmazhatĂł vagy az optimális hatĂ©konyság nem elĂ©rhetĹ‘. A Gottsegen György Országos KardiolĂłgiai IntĂ©zetben 2010. január 28-án, Magyarországon elsĹ‘kĂ©nt, három, nonvalvularis pitvarfibrilláciĂłban szenvedĹ‘ betegĂĽnknĂ©l vĂ©geztĂĽnk sikeres perkután bal pitvari fĂĽlcsezárást.
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In patients with non-valvular atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. Despite their high risk for thromboembolic events, there are substantial numbers of patients who are not candidates for long-term oral anticoagulant therapy, therefore the interest in alternative treatment strategies are in focus these days. The most common place within the heart for thrombus formation in patients with non-valvular atrial fibrillation is the left atrial appendage. Two devices specifically designed for percutaneous left atrial appendage closure are currently available in Europe: the WATCHMAN LAA system (Atritech, Inc) and the AMPLATZER Cardiac Plug (AGA Medical Corporation). Although present trial results (PLAATO, PROTECT AF) suggest that LAA closure may be performed at acceptable safety and it may reduce the long-term stroke risk, available data are still very limited. At present these procedures may be an acceptable alternative in selected high-risk patients with non-valvular atrial fibrillation who are not or suboptimal candidates for oral anticoagulant therapy. On 28. January, 2010 we performed the first three successful percutaneous left atrial appendage closure procedures in Gottsegen György Hungarian Institute of Cardiology in Hungary
A háromér-betegség kezelése a FAME-3 vizsgálat eredményeinek tükrében
A korábbi randomizált vizsgálatok rendre azt igazolták, hogy a coronariabypass-műtét előnyösebb a percutan coro-
nariaintervencióval szemben a súlyos, kiterjedt koszorúér-betegség kezelésében. Ezt elsősorban az ismételt revascu-
larisatio ritkább igĂ©nyĂ©vel magyarázzák, sĹ‘t bizonyos alcsoportokban mĂ©g mortalitási elĹ‘nyt Ă©s kevesebb szĂvinfarctust is regisztráltak az operáltak között. A közelmĂşltban publikált multicentrikus, randomizált FAME (Fractional Flow Reserve Versus Angiography in Multivessel Evaluation)-3 tanulmány 1500 beteg bevonásával azt kutatta, hogy a frakcionált „flow reserve” mĂ©rĂ©ssel vezĂ©relt, ĂşjgeneráciĂłs gyĂłgyszerkibocsátĂł stent implantáciĂłjával vĂ©gzett percutan coronariaintervenciĂł non-inferior-e a modern koszorúérbypass-műtĂ©ttel szemben az egyĂ©ves halálozás, a szĂvinfarctus, a stroke Ă©s az ismĂ©telt revascularisatiĂłs igĂ©ny szempontjábĂłl. A FAME-3 vizsgálatban aktĂvan rĂ©szt vevĹ‘ szerzĹ‘k ismertetik a vizsgálatok, a vizsgált populáciĂł Ă©s az elvĂ©gzett beavatkozások jellemzĹ‘it, illetve az eredmĂ©nyeket. A FAME-3 vizsgálatban nem sikerĂĽlt igazolni a percutan coronariaintervenciĂł non-inferior voltát a bypassműtĂ©ttel szemben a háromĂ©r-betegsĂ©g kezelĂ©sĂ©ben. A szerzĹ‘k rĂ©szletesen elemzik ennek lehetsĂ©ges okait, illetve a vizsgálatbĂłl származĂł egyĂ©b fontos következtetĂ©seket. Idetartozik a „kemĂ©ny vĂ©gpontok” tekintetĂ©ben a szignifikáns
kĂĽlönbsĂ©g hiánya a kĂ©t kar között, illetve az, hogy a perioperatĂv morbiditás tekintetĂ©ben a percutan revascularisatio szignifikánsan jobbnak bizonyult. Bár a primer vĂ©gpont Ă©rtĂ©kelĂ©se meghatározĂł a klinikai döntĂ©shozatalban, a másodlagos szempontok figyelembevĂ©tele is elengedhetetlen a rĂ©szletes betegfelvilágosĂtásnál Ă©s az egyĂ©ni revascularisatiĂłs stratĂ©gia meghatározásában
Ventricular septal rupture caused by myocardial bridge, solved by interventional closure device
Myocardial bridging is a common coronary anomaly, which
is generally described as a benign phenomenon. However,
a growing number of studies consider this anomaly a relevant
pathophysiological phenomenon with serious pathological
consequences. Here we report on the case of an
88-year-old woman suffering from myocardial infarction
and ventricular septal rupture, lacking any recognizable
coronary disease except for a myocardial bridge causing
the systolic compression of the left anterior descending
coronary artery. A wide range of diagnostic procedures, including
coronarography, echocardiography, and magnetic
resonance imaging were used. The septal rupture was finally
closed by using a percutaneous closure device. This
event indicates that myocardial bridges – at least in some
cases – may have notable clinical relevance