Technika zabiegu przeznaczyniowego zamknięcia uszka lewego przedsionka z wykorzystaniem urządzenia AmplatzerTM AmuletTM

Percutaneous left atrial appendage occlusion (LAAO) aims at cardioembolic stroke risk reduction in patients with atrialfibrillation. LAAO procedure is currently indicated for patients with atrial fibrillation and indications for chronic oral anticoagulation who cannot pursue such therapy due to complications, drug intolerance or contraindications. Currently, the two most commonly used devices in Europe are AmplatzerTM AmuletTM (Abbott) and WATCHMAN Device® (Boston Scientific). The aim of the paper was to present step-by-step the technique of AmplatzerTM AmuletTM implantation.Przeznaczyniowe zamknięcie uszka lewego przedsionka (ang. left atrial appendage occlusion, LAAO) jest zabiegiem zmniejszającym ryzyko udaru mózgu o etiologii zatorowej u pacjentów z migotaniem przedsionków. Obecnie jest to zabieg przeznaczony głównie dla chorych z migotaniem przedsionków i wskazaniami do przewlekłej antykoagulacji, którzy nie mogą przyjmować antykoagulantów z powodu powikłań, nietolerancji lub obecność przeciwwskazań do tego typu terapii. Dwa najczęściej stosowane w Europie urządzania do przeznaczyniowego zamknięcia uszka to okluder AmplatzerTM AmuletTM (Abbott) oraz urządzenie WATCHMAN® (Boston Scientific). W niniejszym opracowaniu przedstawiona została „krok po kroku” technika wykonania zabiegu LAAO z wykorzystaniem urządzania AmplatzerTM AmuletTM

Superior early diagnostic performance of a sensitive cardiac troponin assay as compared to a standard troponin test in the diagnosis of acute myocardial infarction

Background: New generation cardiac troponin assays have sufficient precision to detect and quantify plasma troponin concentrations below the lower threshold of detection of the currently employed troponin tests. However, diagnostic performance of the newer generation assays in daily clinical practice is not well established. Aim: To evaluate the diagnostic performance of a sensitive assay as compared to a standard assay in a single reading at admission in the diagnosis of acute myocardial infarction (AMI) in patients presenting to the Emergency Department with chest pain. Methods: The study comprised 187 consecutive patients admitted to the Institute of Cardiology in Warsaw in June and July 2010 with chest pain in whom the attending physician ordered troponin assay to rule AMI in or out. In all of these patients, in addition to the standard Dimension Flex Troponin I (Siemens Healthcare Diagnostics, Inc.) the sensitive Architect Stat Troponin I (Abbott Diagnostics) test was assayed. The triage of patients as well as all diagnostic and treatment decisions were left to the discretion of the attending physician who was blinded to the sensitive troponin test readings. The final diagnosis was adjudicated by a team of two cardiologists on the basis of all the available medical records except for sensitive troponin test results. Results: Mean age of the study cohort (n = 187) was 64.3 ± 13.9 years and 119 (63.6%) were males. The final diagnosis of AMI was adjudicated in 84 (44.9%) patients (mean age 67.5 ± 12.9 years; 119 [63.6%] males). Receiver operating characteristic (ROC) analysis showed greater area under the curve (AUC) for the sensitive cardiac troponin assay compared to the standard assay (AUC = 0.916, 95% CI = 0.866–0.951 vs AUC = 0.863, 95% CI = 0.806–0.909, respectively; p = 0.02) in a single reading at admission. Sensitive assay was characterised by higher sensitivity (87%), specificity (88%), positive (86%) and negative (89%) predictive values in the detection of AMI compared to the standard troponin test (82%, 81%, 78%, and 85% respectively). Conclusions: The newer generation sensitive cardiac troponin assay presented superior diagnostic accuracy in the diagnosis of AMI compared to the standard troponin test in a single reading at admission with improved sensitivity and specificity. The sensitive troponin assay has the potential to improve early detection and/or exclusion of AMI.Background: New generation cardiac troponin assays have sufficient precision to detect and quantify plasma troponin concentrations below the lower threshold of detection of the currently employed troponin tests. However, diagnostic performance of the newer generation assays in daily clinical practice is not well established. Aim: To evaluate the diagnostic performance of a sensitive assay as compared to a standard assay in a single reading at admission in the diagnosis of acute myocardial infarction (AMI) in patients presenting to the Emergency Department with chest pain. Methods: The study comprised 187 consecutive patients admitted to the Institute of Cardiology in Warsaw in June and July 2010 with chest pain in whom the attending physician ordered troponin assay to rule AMI in or out. In all of these patients, in addition to the standard Dimension Flex Troponin I (Siemens Healthcare Diagnostics, Inc.) the sensitive Architect Stat Troponin I (Abbott Diagnostics) test was assayed. The triage of patients as well as all diagnostic and treatment decisions were left to the discretion of the attending physician who was blinded to the sensitive troponin test readings. The final diagnosis was adjudicated by a team of two cardiologists on the basis of all the available medical records except for sensitive troponin test results. Results: Mean age of the study cohort (n = 187) was 64.3 +- 13.9 years and 119 (63.6%) were males. The final diagnosis of AMI was adjudicated in 84 (44.9%) patients (mean age 67.5 +- 12.9 years; 119 [63.6%] males). Receiver operating characteristic (ROC) analysis showed greater area under the curve (AUC) for the sensitive cardiac troponin assay compared to the standard assay (AUC = 0.916, 95% CI = 0.866–0.951 vs AUC = 0.863, 95% CI = 0.806–0.909, respectively; p = 0.02) in a single reading at admission. Sensitive assay was characterised by higher sensitivity (87%), specificity (88%), positive (86%) and negative (89%) predictive values in the detection of AMI compared to the standard troponin test (82%, 81%, 78%, and 85% respectively). Conclusions: The newer generation sensitive cardiac troponin assay presented superior diagnostic accuracy in the diagnosis of AMI compared to the standard troponin test in a single reading at admission with improved sensitivity and specificity. The sensitive troponin assay has the potential to improve early detection and/or exclusion of AMI

Management and outcomes of patients with left atrial appendage thrombus prior to percutaneous closure.

Left atrial appendage (LAA) thrombus has heretofore been considered a contraindication to percutaneous LAA closure (LAAC). Data regarding its management are very limited. The aim of this study was to analyse the medical and invasive treatment of patients referred for LAAC in the presence of LAA thrombus. This multicentre observational registry included 126 consecutive patients referred for LAAC with LAA thrombus on preprocedural imaging. Treatment strategies included intensification of antithrombotic therapy (IAT) or direct LAAC. The primary and secondary endpoints were a composite of bleeding, stroke and death at 18 months, and procedural success, respectively. IAT was the preferred strategy in 57.9% of patients, with total thrombus resolution observed in 60.3% and 75.3% after initial and subsequent IAT, respectively. Bleeding complications and stroke during IAT occurred in 9.6% and 2.9%, respectively, compared with 3.8% bleeding and no embolic events in the direct LAAC group before the procedure. Procedural success was 90.5% (96.2% vs 86.3% in direct LAAC and IAT group, respectively, p=0.072), without cases of in-hospital thromboembolic complications. The primary endpoint occurred in 29.3% and device-related thrombosis was found in 12.8%, without significant difference according to treatment strategy. Bleeding complications at 18 months occurred in 22.5% vs 10.5% in the IAT and direct LAAC group, respectively (p=0.102). In the presence of LAA thrombus, IAT was the initial management strategy in half of our cohort, with initial thrombus resolution in 60% of these, but with a relatively high bleeding rate (~10%). Direct LAAC was feasible, with high procedural success and absence of periprocedural embolic complications. However, a high rate of device-related thrombosis was detected during follow-up

Pulmonary artery rupture as a complication of Swan-Ganz catheter application. Diagnosis and endovascular treatment: a single centre’s experience

Introduction: The placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2–17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage – pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices. Aim: To evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization. Material and methods : In this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology. Results : We report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood. Conclusions : Despite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery

Interwencyjne zamykanie przetrwałego otworu owalnego (PFO) w prewencji incydentów zakrzepowo-zatorowych

Przetrwały otwór owalny (PFO) to połączenie między przedsionkami serca, które jest pozostałością po krążeniu płodowym. Udowodniono, że obecność PFO wiąże się z częstszym występowaniem wielu schorzeń, w tym udaru niedokrwiennego mózgu i nawracających przejściowych incydentów niedokrwiennych na tle zakrzepowo‑zatorowym. Zamykanie PFO budziło kontrowersje, lecz w ostatnio opublikowanym stanowisku Europejskie Stowarzyszenie Przezskórnych Interwencji Sercowo‑Naczyniowych (EAPCI) we współpracy z 7 towarzystwami naukowymi, odwołując się do najnowszych badań klinicznych z randomizacją, wyraźnie zalecili przezskórne zamknięcie PFO w zapobieganiu nawrotom incydentów zakrzepowo‑zatorowych. W związku z powyższym oraz przez wzgląd na spodziewane częstsze wykonywanie zabiegów przezskórnego zamykania PFO grupa ekspertów Asocjacji Interwencji Sercowo‑Naczyniowych oraz Sekcji Wrodzonych Wad Serca u Młodocianych i Dorosłych Polskiego Towarzystwa Kardiologicznego opracowała poniższą opinię, ujednolicając zasady dotyczące diagnostyki PFO, wskazań oraz metod wykonywania zabiegów i odnosząc je do polskich warunków i doświadczeń

Interventional closure of patent foramen ovale in prevention of thromboembolic events. Consensus document of the Association of Cardiovascular Interventions and the Section of Grown‑up Congenital Heart Disease of the Polish Cardiac Society

ABSTRACT The presence of patent foramen ovale (PFO) was found to be associated with a number of medical conditions, including embolic stroke and recurrent transient neurological defects. The closure of PFO remains controversial; however, in recently published guidelines from the European Association of Percutaneous Cardiovascular Interventions in collaboration with 7 other European societies, which extensively refer to the latest randomized clinical trials, it is explicitly recommended to perform percutaneous PFO closure in the prevention of recurrent thromboembolic events. In connection with the above facts and expected increasing number of PFO closure procedures, the joint expert group of the Association of Cardiovascular Interventions and the Grown‑Up Congenital Heart Disease Section of the Polish Cardiac Society developed the following consensus opinion in order to standardize the principles of diagnosis, indications, methods of performing procedures, and postoperative care in relation to Polish conditions and experiences