Aortic aneurysm formation following coarctation repair by Dacron patch aortoplasty

We describe the finding of an aortic aneurysm in an asymptomatic 43-year-old male, who was managed by Dacron patch aortoplasty for native coarctation of the aorta 25 years before. The role of magnetic resonance angiography as standard imaging technique in lifelong postoperative surveillance is discussed subsequently. (Neth Heart J 2010;18:376-7.

Pretreatment with oral anticoagulants decreases platelet activation in patients before and after percutaneous coronary intervention.

Item does not contain fulltextBACKGROUND: Platelet activation plays a major role in acute vessel closure after coronary angioplasty. In the randomized Balloon Angioplasty and Anticoagulation Study (BAAS), pretreatment with oral anticoagulants in addition to aspirin resulted in a 47% reduction of acute complications as compared with aspirin alone. This result may suggest a direct effect of oral anticoagulants on platelet activation. METHODS AND RESULTS: Patients were randomized to aspirin alone (group A, n = 26) or to aspirin plus oral anticoagulants started one week before angioplasty (group B, n = 26). Platelet response tests were performed 1 hour before (baseline) and 1 hour after intervention and on day 1. Platelet activation was measured by flow cytometry, as the number of antibody-positive platelets per 10,000 counted. Platelet function was evaluated with use of the PFA-100(R) analyzer. In group B, the median number of P-selectin-positive platelets was lower before (28 vs. 54, P = 0.018) and after (13 vs. 24, P = 0.377) angioplasty than in group A. Also the median decrease in the number of P-selectin-positive platelets during angioplasty was lower in group B (Delta = 4) than in group A (Delta = 30, P = 0.022). No further significant change was observed in platelet activation on day 1 in the two groups. The ability of platelets to become stimulated as measured with the PFA-100(R) analyzer was not affected by oral anticoagulants. CONCLUSIONS: Pretreatment with oral anticoagulants resulted in less activated platelets before and after coronary angioplasty, which is in agreement with its clinical effect of reducing procedural complications. Platelet function was not affected by oral anticoagulants

A randomized trial assessing the effect of coumarins started before coronary angioplasty on restenosis: results of the 6-month angiographic substudy of the Balloon Angioplasty and Anticoagulation Study (BAAS).

Item does not contain fulltextBACKGROUND: Thrombus formation during coronary angioplasty may play a role in the restenosis process. METHODS: The effect of pretreatment with coumarins on 6-month angiographic outcome was studied. In addition, the effect of "optimal" anticoagulation, defined as an international normalized ratio >70% of the follow-up time in the target range, was studied. A total of 261 patients were assigned to aspirin alone (ASA group) and 270 patients to aspirin plus coumarins started 1 week before the procedure (coumarin group). RESULTS: The mean international normalized ratio was 2.7 +/- 1.2 at the start of the procedure and 3.1 +/- 0.5 during follow up. Quantitative coronary analysis was performed on 301 lesions in the ASA group and of 297 lesions in the coumarin group. At 6 months, the minimal luminal diameter was similar in the ASA and coumarin groups. Optimal anticoagulation, however, was an independent predictor of a larger minimal luminal diameter at follow up (P =.01). CONCLUSION: Overall, coumarins do not improve angiographic outcome 6 months after coronary angioplasty

An additional bolus of aspirin does not guarantee complete platelet inhibition during PTCA.

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Influence of planned six-month follow-up angiography on late outcome after percutaneous coronary intervention: a randomized study.

OBJECTIVES: The goal of this research was to study the effect of planned angiography on late clinical outcome after percutaneous coronary intervention. BACKGROUND: It is still largely unknown whether planned follow-up angiography after coronary angioplasty influences late outcome. METHODS: Randomization assigned 527 patients to clinical follow-up alone and 531 to clinical and six-month angiographic follow-up. The effect of planned angiography on clinical outcome at one and three years after coronary angioplasty was studied. RESULTS: The two groups were well matched. At one year, more events occurred in the angiographic group than in the clinical group: 122 (23.2%) versus 88 (16.7%) (p = 0.01). While the incidence of death or myocardial infarction (MI) was similar at one year, the revascularization rate was higher in the angiographic group: 113 (21.3%) versus 67 (12.7%) (relative risk = 1.7, 95% confidence interval: 1.3 to 2.3, p = 0.0003). At three years, still more events had occurred in the angiographic group (146 [34.5%] vs. 114 [26.3%], p = 0.03). More reinterventions did not improve late survival. However, there was a nonsignificant reduction in MI (7 [1.3%] vs. 13 [2.5%], p = NS) and a significant improvement in functional class at the end of follow-up (freedom from angina 81% vs. 74%, p = 0.03). The effect of follow-up angiography on the reintervention rate was similar for stented and nonstented patients. CONCLUSIONS: Planned follow-up angiography to evaluate the late results of coronary intervention led to a 1.7 times higher reintervention rate. This effect was similar for stented and nonstented patients. More reinterventions did not improve survival but tended to reduce the incidence of MI and led to a significantly better functional class at follow-up

Chronic thromboembolic pulmonary hypertension

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