Emergency polytetrafluoroethylene-covered stent implantation to treat right coronary artery perforation during percutaneous coronary intervention

Coronary artery perforations are life-threatening complications with a poor outcome. Historically, if the perforation was not controlled using conservative methods such as prolonged balloon inflation and protamine administration, emergency cardiac surgery has been performed. However, several percutaneous methods including covered stents and embolization materials have emerged as therapeutic options to manage coronary perforations. We report a case of right coronary artery perforation after high pressure stent post-dilatation that was successfully sealed with a polytetrafluoroethylene-covered stent

Effects of pacemaker and implantable cardioverter defibrillator electrodes on tricuspid regurgitation and right sided heart functions

Background: The aim of this study was to assess the effect of trans-tricuspid placement of permanent pacemaker (PPM), implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy (CRT) leads prospectively on tricuspid valve and right-sided heart functions using two-dimensional echocardiography. Methods: A total of 41 patients (31 male, mean age: 63.6 ± 12.2 years) were included in this prospective study. Initial echocardiographic evaluation was performed before cardiac device implantation and re-evaluation by echocardiography was performed immediately after the procedure and at 1st, 6th and 12th months. In addition to standard echocardiographic examinations, vena contracta (VC), proximal isovelocity surface area (PISA), and tissue Doppler evaluations were also performed in the study population. Results: Tricuspid regurgitation (TR) is worsened by 1 grade in 70.8% of the patients and 2 grades in 17.1% of the patients in the follow-up. Eight patients without baseline TR developed new-onset TR (9.8% mild, 9.8% moderate) after lead implantation. In the follow-up period, 41.5% of the patients who had mild TR before lead implantation developed moderate TR and 7.3% developed severe TR, whereas 19.5% of the patients with moderate TR developed severe TR during the follow-up. In the follow-up period, VC of TR was increased [median: 0.32 (0.16–0.60) cm in pre-implantation period, and 0.41 (0.18–0.80) cm at 12th month, p = 0.001]. Similarly PISA value of TR was also increased [median: 0.46 (0.15–1.10) cm in pre-implantation period and 0.52 (0.28–1.20) cm at 12th month, p = 0.001]. However, there is not a significant difference between PPMs/ICDs and CRTs regarding the effects on TR (p < 0.05). In addition, right ventricular dimensions and right atrial volumes were increased during the follow-up. Conclusions: Implantation of permanent transvenous right ventricular electrode is associated with worsening of TR, right atrial and right ventricular dimensions. Further studies are needed in order to both outline the effect of those findings on outcomes and clarify the time dependent changes in those functions

The use of Amplatzer Vascular Plug® to treat coronary steal due to unligated thoracic side branch of left internal mammary artery: Four year follow-up results

Left internal mammary artery (LIMA) is the most commonly used graft during coronary bypass surgery. LIMA side branches are clipped during surgery in order to prevent coronary steal. In cases of patent LIMA side branches, there are differingapproaches. Herein, we report a case with patent thoracic side branch of LIMA graft, occlusion of this side branch by Amplatzer Vascular Plug because of documented myocardial ischemia, and long term follow-up results. (Cardiol J 2012; 19, 2: 197–200

Scary Acute Left Main Coronary Artery Thrombus as an Initial Presentation of a Hereditary Thrombophilia: When to Go Out of Routine?

Patients with either hereditary or acquired thrombophilia can present with arterial and venous thrombotic complications. However, it is unclear to whom the thrombophilia panel should be assessed, particularly in patients presenting with a common cardiovascular risk factor and acute coronary thrombus. Herein, we presented the management of an active smoker female patient who presented to our emergency room with inferior acute ST-segment elevation myocardial infarction, and hereditary thrombophilia has been diagnosed due to the presence of substantial left main coronary artery thrombus

Tissue Doppler echocardiography can be a useful technique to evaluate atrial conduction time

Background: The main purpose of this study is to determine the correlation of inter- and intraatrial conduction times between the electrophysiological and tissue Doppler echocardiographic measurements, and to evaluate the appropriateness of tissue Doppler echocardiography for this measurement. Methods: One-hundred and one patients were included in the study who underwent electrophysiological study for clinical arrhythmias. Inter- and intraatrial conduction times were measured from intracardiac electrograms. Atrial conduction times were also measured by tissue Doppler echocardiography by evaluating atrial electromechanical delay between lateral mitral annulus, septal mitral annulus, and right ventricular tricuspid annulus. The correlation between electrophysiological and echocardiographic atrial conduction times were analyzed. Results: We found a weak correlation between the measurements of interatrial conduction times with the electrophysiological and tissue Doppler techniques (r = 0.308; p = 0.002). The correlation for intraleft atrial conduction times was moderate (r = 0.652; p < 0.001). There was no correlation between the measurements of intra-right atrial conduction times. Conclusions: We concluded that tissue Doppler echocardiography can be used for the measurement of interatrial and intra-left atrial conduction times. Tissue Doppler echocardiography can be a suitable technique to evaluate atrial substrate. (Cardiol J 2012; 19, 5: 487-493

Coronary-Subclavian Steal Syndrome Presenting with Ventricular Tachycardia

Coronary-subclavian steal through the left internal mammary graft is a rare cause of myocardial ischemia in patients who have had a coronary bypass surgery. We report a 70-year-old man who presented with sustained monomorphic ventricular tachycardia 5 years after the surgical creation of a left internal mammary to the left anterior descending artery. Cardiac catheterization illustrated that the left subclavian artery was occluded proximally and that the distal course was visualized by retrograde filling through the left internal mammary graft. Clinical ventricular tachycardia was reproducibly induced with a single ventricular extrastimulus, and antitachycardia pacing terminated the tachycardia. Restoration of blood flow by way of a Dacron graft placed between the descending aorta and the subclavian artery resulted in the total relief of symptoms. Ventricular tachycardia could not be induced during the control electrophysiologic study after surgical revascularization

Baseline aortic pre-ejection interval predicts reverse remodeling and clinical improvement after cardiac resynchronization therapy

Background: Cardiac resynchronization therapy (CRT) has been shown to reduce heart failure-related morbidity and mortality. However, approximately one in three patients do not respond to CRT. The aim of the current study was to determine the parameter(s) which predict reverse remodeling and clinical improvement after CRT. Methods: A total of 54 patients (43 male, 11 female; mean age 61.9 &#177; 10.5 years) with heart failure and New York Heart Association (NYHA) class III&#8211;IV symptoms and in whom left ventricular ejection fraction (LVEF) was &#163; 35% and QRS duration was &#8805; 120 ms, despite optimal medical therapy, were enrolled. An echocardiographic examination was performed before, and six months after, CRT. An echocardiographic response was defined as a reduction of end-systolic volume &#8805; 10% after six months, and a clinical response was defined as a reduction &#8805; 1 in the NYHA functional class score. Results: An echocardiographic response was observed in 38 (70.4%) of the patients and a clinical response occurred in 41 (75.9%) of the patients. Of the dyssynchrony parameters, only the aortic pre-ejection interval (APEI) was observed to significantly predict the clinical response (p = 0.048) and echocardiographic response (p = 0.037). A 180.5 ms cut-off value for the APEI predicted the clinical response with a sensitivity of 92.3% and a specificity of 39%, and the echocardiographic response with a sensitivity of 93.0% and a specificity of 42%. Conclusions: APEI derived from pulsed-wave Doppler, which is available in every echocardiography machine, is a simple and practical method that could be used to select patients for CRT. (Cardiol J 2011; 18, 6: 639&#8211;647

Evaluation of Anaesthetic Approaches in Transcatheter Aortic Valv Implantation Procedures

Objective:Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement and has become a popular treatment modality for inoperable or patients at high surgical risk with severe aortic stenosis. We aimed to evaluate our perioperative anaesthetic experiences with patients undergoing TAVI under sedation or general anaesthesia (GA).Methods:One hundred and fifty-nine patients who underwent TAVI procedures were enrolled. Effects on TAVI outcomes of sedation and GA were compared.Results:The duration of surgery and anaesthesia was significantly longer in patients who received GA. Insertion site complication and post-TAVI pacemaker implantation rates were similar between the groups, but the frequency of intraoperative complications (10% vs. 0.8%; P=0.015), intraoperative hypotension (35.3% vs. 70%; P < 0.001), and acute kidney injury (12.6% vs. 27.5%; P=0.028) was significantly higher in the GA group. Stroke occurred in seven patients, and all were in the sedation group.Conclusion:GA is related to increased procedure time and acute kidney injury; therefore, local anaesthesia and sedation may be the first option in patients undergoing TAVI

Aggressive Treatment of Refractory Coronary Artery Vasospasm in a Patient with Malignant Ventricular Tachyarrhythmia and Cardiac Arrest

Coronary artery vasospasm (CAVS) is a clinical entity that can cause angina, but also unstable angina pectoris, acute myocardial infarction, fatal arrhythmias, and sudden death. Although it is a condition that is usually controlled with medical treatment, more aggressive treatments may rarely be required. In this case, the patient with a known diagnosis of CAVS had multiple arrests despite optimal medical treatment. We observed that fatal arrhythmias persisted in the Implantable Cardioverter Defibrillator (ICD) records, even though we implanted a stent and gave the patient maximal medical treatment. We performed sympathectomy as a last resort and we did not detect any recurrence in the 6-month follow-up of the patient. ICD implantation and sympathectomy should always be considered in resistant CAVS cases