Implantation of a Occlutech Figulla® PFO occluder in a patient with patent foramen ovale and history of embolic stroke

The most common interventions in structural heart diseases for various age groups are percutaneous occlusions of septal defects. We present the case of a woman with patent foramen ovale (PFO) periodically causing a right-to-left shunt, after an incident of stroke, with migraine attacks, treated by percutaneous closure of PFO with use of a novel occluder device - an Occlutech Figulla®. The procedure was performed under X-ray and transesophageal echocardiographic monitoring. The novel Occlutech device described above features easy manipulation, good safety and some constructional innovations that enable the time of antiplatelet prophylaxis to be shortened, thus potentially minimizing procedure related risk

Resistant hypertension: Renal denervation or pharmacovigilance? Insights from a renal denervation screening program

BACKGROUND: With emerging new therapeutic concepts including renal denervation (RDN), there is a renewed interest in resistant hypertension (ResH). Among patients suspected of having ResH, a definitive diagnosis needs to be established. OBJECTIVES: This study presents observations from a standardized single-center screening program for RDN candidates, including medical therapy modification and reassessment. MATERIAL AND METHODS: All patients referred to our center for RDN underwent a standardized screening protocol. Candidates were recruited from among patients receiving no less than 3 antihypertensive drugs, including diuretics with office blood pressure (BP) \u3e140/90 mm Hg. The assessment included 2 measurements of BP and ambulatory BP monitoring (ABPM). If needed, pharmacotherapy was intensified and the diagnosis of ResH was reconfirmed after 6 weeks. If ResH was persistent, patients were hospitalized with repeated ABPM on day 4. Further, renal CT-angio was performed and a multidisciplinary team discussed the patients\u27 suitability for RDN. RESULTS: A total of 87 patients with a ResH diagnosis were referred for RDN. Mean office BP was 159/92 (±7.0/6.5) mm Hg and mean ABPM was 154/90 (±9.0/4.8) mm Hg. The initial medication included angiotensin convertase inhibitors (ACE-I, 78%), angiotensin receptor blockers (12%), β-blockers (85%), calcium channel blockers (36%), and diuretics (93%). During the 18 months of the RDN program, 5 patients underwent RDN and 2 further had ineligible renal anatomy. A new diagnosis of secondary hypertension was made in 21 patients. However, in 59 patients, BP control was achieved after optimization of medical therapy, with a mean ABPM of 124/74 mm Hg. The final treatment included ACE-I (100%), β-blockers (92%), indapamide (94%), amlodipine (72%), and spironolactone (61%). Medication in most of these patients (88%) included single-pill triple combination (52.5%) or double combination (35.6%). CONCLUSIONS: Patients with elevated BP screened for RDN require a rigorous diagnostic workup. Up to 2/3 of patients can be managed with strict pharmacotherapy compliance and pharmaceutical intensification, including single-pill combinations and improved drug compliance. Hasty use of RDN may be a result of poor drug optimization and/or compliance. It does remain a viable treatment option in thoroughly vetted ResH patients

Krytyczne ostialne zwężenie pnia lewej tętnicy wieńcowej u 39-letniej kobiety leczonej przezskórną angioplastyką

Isolated critical stenosis of left main coronary artery (LMCA) due to atherosclerosis is very rare and affects about 0.2% ofpatients. We present the case of a 39-year-old, non-smoker women with risk factors for diseases of the cardiovascular systemin the form of hypercholesterolaemia and hypertension, in addition to positive family history and chronic oral contraception.Sick from occurring since atypical angina masked depressive symptoms, with a critical stenosis of LMCA and little suggestivesymptoms of ischaemia because of the existing collateral circulation

Prognostic value of platelet indices after acute myocardial infarction treated with primary percutaneous coronary intervention

Background: Mean platelet volume (MPV) is a strong predictor of impaired angiographic reperfusion and 6-month mortality in ST-elevation myocardial infarction (MI) treated with primary percutaneous coronary intervention (PCI). No data is available for other platelet volume indices: platelet distribution width (PDW) and platelet large cell ratio (P-LCR). The aim was to assess the impact of 3 platelet volume indices on long-term prognosis in patients treated with primary PCI in acute MI.Methods: This prospective study enrolled 538 patients who underwent primary PCI in acute MI. Admission blood samples were measured for MPV, PDW, and P-LCR. The patients were followed-up a mean period of 26 ± 11 months with regard to cardiac death, non-fatal reinfarction, re-PCI or coronary artery bypass grafting.Results: Kaplan-Meier survival analysis showed a significantly higher 26-month mortalityrate in patients with high MPV (≥ 11.7 fL) than in those with low MPV (< 11.7 fL) (14.6% vs. 5.5%, p = 0.0008). Similar findings were related to high P-LCR (≥ 38.1%) vs. low P-LCR (< 38.1%) — mortality 13.8% vs. 5.8%, p = 0.0025. Higher PDW values (≥ 16 fL) correlated with higher mortality rate as compared to PDW < 16 fL (17.4% vs. 6.3%, p = 0.0012). PDW was found to be an independent prognostic factor for cardiac mortality and composite endpoint.Conclusions: Mean platelet volume, platelet distribution width and platelet large cell ratio measured on admission are strong, independent prognostic factors in PCI-treated acute MI

Relationship of serum angiogenin, adiponectin and resistin levels with biochemical risk factors and the angiographic severity of three-vessel coronary disease

Background: Patients with advanced coronary artery disease (CAD) have an unfavorable prognosis. Therefore, early identification of this high-risk group is important. The aim of this study was to assess the usefulness of clinical, electrocardiographic and echocardiographic parameters supported by novel atherogenesis and angiogenesis markers in identifying patients with stable, three-vessel coronary artery disease. Methods: The study group comprised 107 patients suffering from three-vessel CAD and a control group of 15 patients presenting with typical angina, a positive exercise stress test and abnormal segmental contractility, but no hemodynamically significant coronary stenosis in their angiograms. In each patient, we characterized a biochemistry test panel including novel markers: angiogenin, resistin, adiponectin, IL-8 and a TNF-a. The angiographic severity of CAD was expressed as a Gensini score. Results: There were significant differences between three-vessel CAD patients and control groups with respect to the serum levels of: hsCRP (2.8 vs 1.4 mg/L, p = 0.01), HDL-cholesterol (45 vs 54 mg/dL, p = 0.04), LDL-cholesterol (102 vs 95 mg/dL, p = 0.04), NT-proBNP (392 vs 151 pg/mL, p = 0.008) and a marker of angiogenetic activity, angiogenin (414 vs 275 ng/mL, p = 0.02), However, no significant differences were found between three-vessel CAD and the control group with respect to the serum level of adiponectin (8.08 vs 7.82 μg/mL), resistin (17.5 vs 21 ng/mL), IL-8 (20.7 vs 26.8 pg/mL) and TNF-a (4.1 vs 4.3 pg/mL). Angiogenin tended to be higher in patients with higher Gensini scores (p = 0.06) but no influence of ejection fraction was noted. Conclusions: Angiogenin is a novel marker of three-vessel coronary disease showing a relationship with the angiographic severity of the disease. (Cardiol J 2010; 17, 6: 599-606

Usefulness of assessment of fractional flow reserve and coronary flow velocity reserve in determination of the significance of borderline stenoses in the anterior descending artery in patients with multivessel disease

Introduction. Assessment of the significance of borderline stenosis in the area of the anterior descending artery in patients with multivessel coronary artery disease is a challenge. Currently, ractional flow reserve (FFR) and coronary flow reverse (CFR) methods are available. Aim. The aim of the study was to compare the usefulness of fractional flow reverse (FFR) and CFR methods in the assessment of left anterior descending artery (LAD) borderline stenosis in patients with multivessel coronary disease (MVD) and isolated LAD stenosis. Material and methods. We examined 100 patients with suspected ischemic heart disease. The examination revealed MVD disease with borderline stenosis of the LAD in 23 patients. Significant changes were confirmed with FFR and CFR. Results. Abnormal FFR (82% vs. 22%; p &lt; 0.001) and abnormal CFR (32% vs. 12%; p = 0.029) were significantly more commonly observed in patients with MVD. The mean FFR (0.76 vs. 0.84; p &lt; 0.001), the mean CFR (2.13 vs. 2.31; p = 0.075). Positive CFR and FFR values were found in 7 MVD patients and in 3 patients with single-vessel lesions (32% vs. 4%; p &lt; 0.001). Negative CFR and positive FFR values were noted in 11 patients with MVD and 14 with lesions only in LAD (50% vs. 18%; p &lt; 0.001). Positive CFR and negative FFR 0 vs 6 patients (0% vs. 8%; p &lt; 0.001). Negative CFR and negative FFR were obtained in 4 patients from the MVD group and in 55 patients from the group of borderline stenosis only in LAD (18% vs. 71%; p &lt; 0.001). MACE was observed significantly more frequently in the MVD group than in the group of patients with borderline lesions only in LAD (47% vs. 6%; p = 0.004). Conclusions. Positive FFR and CFR results correlate with more frequent MACE episodes.Introduction. Assessment of the significance of borderline stenosis in the area of the anterior descending artery in patients with multivessel coronary artery disease is a challenge. Currently, ractional flow reserve (FFR) and coronary flow reverse (CFR) methods are available. Aim. The aim of the study was to compare the usefulness of fractional flow reverse (FFR) and CFR methods in the assessment of left anterior descending artery (LAD) borderline stenosis in patients with multivessel coronary disease (MVD) and isolated LAD stenosis. Material and methods. We examined 100 patients with suspected ischemic heart disease. The examination revealed MVD disease with borderline stenosis of the LAD in 23 patients. Significant changes were confirmed with FFR and CFR. Results. Abnormal FFR (82% vs. 22%; p < 0.001) and abnormal CFR (32% vs. 12%; p = 0.029) were significantly more commonly observed in patients with MVD. The mean FFR (0.76 vs. 0.84; p < 0.001), the mean CFR (2.13 vs. 2.31; p = 0.075). Positive CFR and FFR values were found in 7 MVD patients and in 3 patients with single-vessel lesions (32% vs. 4%; p < 0.001). Negative CFR and positive FFR values were noted in 11 patients with MVD and 14 with lesions only in LAD (50% vs. 18%; p < 0.001). Positive CFR and negative FFR 0 vs 6 patients (0% vs. 8%; p < 0.001). Negative CFR and negative FFR were obtained in 4 patients from the MVD group and in 55 patients from the group of borderline stenosis only in LAD (18% vs. 71%; p < 0.001). MACE was observed significantly more frequently in the MVD group than in the group of patients with borderline lesions only in LAD (47% vs. 6%; p = 0.004). Conclusions. Positive FFR and CFR results correlate with more frequent MACE episodes

Ocena ultrasonograficzna tętnic przedramienia u chorych kwalifikowanych do przezskórnych zabiegów wieńcowych z dostępu promieniowego: obserwacja jednoroczna

Background: A proven advantage of radial over femoral arterial access has led to an increase in the number of interventions performed via radial artery access in patients with acute coronary syndromes. Both assessment of the pulse volume and the Allen’s test are subjective and subject to investigator bias. An ultrasound examination of the forearm arteries provides important information about the anatomy of the forearm vessels, and indirectly also about the efficiency of collateral blood supply to the hand. It also enables determination of the relevant vessel diameter before the planned intervention, and may be used to assess local complications. Aim: To assess the morphology of forearm blood vessels and measure the diameter of both radial and ulnar arteries at the cannulation site using ultrasound imaging. We also aimed to identify potential vascular anomalies and local complications associated with radial artery puncture. Methods: The study included 109 patients with cardiologic indications for coronary angiography or coronary angioplasty. An ultrasound evaluation of forearm arteries was performed prior to the intervention, and the vascular anatomy was later verified by angiography during the procedure. Ultrasound measurements of the vessel diameter were also performed and local complications of the cannulation were assessed. Measurements were performed immediately after the procedure and at 30 days and 12 months. Results: Fifty-nine right and 50 left forearm arteries were evaluated. Women were 29% of the study population. The mean patient age was 59.2 ± 7.9 years. The mean diameter of the right radial artery was 2.17 ± 0.54 mm, and the mean diameter of the left radial artery was 2.25 ± 0.43 mm. The measurements revealed gender-related differences in forearm artery diameter (p = 0.003). Vascular anomalies of the radial artery were identified by ultrasound examination in 10% of subjects. A significant dilatation of the cannulated blood vessel was observed which lasted up to 12 months. An occlusion of the cannulated artery was demonstrated in 6.4% of patients. Conclusions: Ultrasound imaging is a reliable method to evaluate the diameter of forearm arteries and track their course in patients undergoing invasive cardiovascular procedures via radial artery access. The diameter of the radial artery by ultrasound evaluation is larger compared to that of the ulnar artery. The diameter of forearm arteries in women is smaller compared to men. A dilatation of the radial artery which may last up to 12 months develops following its percutaneous cannulation. Ultrasound imaging allows detection and monitoring of local complications such as radial artery occlusion. An unfavourable ratio of blood vessel diameter to the size of the used introducer sheath is a predictor of radial artery occlusion. Ultrasound imaging enables reliable evaluation of vascular anomalies involving the radial artery, especially within the distal forearm.Wstęp: Wykazanie przewagi dostępu promieniowego nad udowym u chorych z ostrymi zespołami wieńcowymi leczonych przezskórną angioplastyką wieńcową spowodowało wzrost liczby procedur wykonywanych tym sposobem. Ocena tętna i przeprowadzenie testu Allena są obarczone błędem wynikającym z subiektywnej oceny badacza. Ultrasonografia tętnic przedramienia przynosi informację o anatomii naczyń przedramienia i sprawności podwójnego ukrwienia dłoni, pozwala uzyskać dane o średnicy naczynia przed planowanym zabiegiem oraz rozpoznać i monitorować powikłania miejscowe. Cel: Celem pracy była ocena ultrasonograficzna morfologii naczyń przedramienia z pomiarem średnicy tętnicy promieniowej i łokciowej w miejscu ich kaniulacji oraz poszukiwanie anomalii naczyniowych i powikłań miejscowych po nakłuciu tętnicy promieniowej, ocenianych ultrasonograficznie. Metody: Do badania zakwalifikowano 109 pacjentów ze wskazaniami kardiologicznymi do wykonania koronarografii lub koronaroplastyki. U wszystkich przeprowadzono ocenę ultrasonograficzną tętnic przedramienia poprzedzającą zabieg oraz zweryfikowano anatomię w angiogramie w czasie zabiegu. Po kaniulacji oceniano ultrasonograficznie średnicę naczyń i obecność powikłań. Badania wykonywano bezpośrednio po zabiegu, po 30 dniach i po 12 miesiącach. Wyniki: Przebadano 59 prawych i 50 lewych tętnic przedramienia. W całej grupie średnia wieku wynosiła 59,2 ±7,9 roku, 29% stanowiły kobiety. Uzyskano parametry populacyjne średnicy prawej tętnicy promieniowej — 2,17 ± 0,54 mm i lewej tętnicy promieniowej — 2,25 ± 0,43 mm. Wykazano zależność średnicy tętnic przedramienia od płci (p = 0,003). W 10% za pomocą badania ultrasonograficznego wykazano anomalie naczyniowe tętnicy promieniowej. Zaobserwowano istotne poszerzenie naczynia użytego do zabiegu utrzymujące się do 12 miesięcy. U 6,4% pacjentów stwierdzono zamknięcie tętnicy poddanej kaniulacji. Wnioski: Ultrasonografia jest wiarygodną metodą pozwalającą na ocenę średnicy i przebiegu tętnic przedramienia u chorych poddawanych zabiegom kardiologii inwazyjnej z dostępu promieniowego. Średnica tętnicy promieniowej ocenianej ultrasonograficznie jest większa niż tętnicy łokciowej. Średnica tętnic przedramienia po stronie prawej jest mniejsza u kobiet niż u mężczyzn. Po zabiegu kaniulacji tętnicy promieniowej dochodzi do jej poszerzenia, utrzymującego się do 12 miesięcy. Ocena ultrasonograficzna pozwala wykryć i monitorować powikłania miejscowe pod postacią okluzji tętnicy promieniowej. Predyktorem okluzji tętnicy promieniowej jest niekorzystny stosunek średnicy naczynia do użytej koszulki naczyniowej. Ultrasonografia pozwala wiarygodnie ocenić anomalie naczyniowe tętnicy promieniowej, zwłaszcza dystalnego odcinka przedramienia