Frequent oversizing during Amplatzer device deployment for percutaneous PDA closures

Transcatheter closure of small to moderate patent ductus arteriosus [PDA] has been well established during this last decade. The Amplatzer device occluder [ADO] is self-expandable device with ease of delivery and a rapid learning curve. The aim of the study was to access the optimum sizing of ADO in regard to maximum efficacy with respect to shunt occlusion without oversizing and reducing bulk and potential protrusions. From April 2007 to July 2008, a total of twenty-four adult PDA closures were reviewed. Occlusion was achieved via antegrade venous approach. Our primary objective was an evaluating of optimum ADO sizing for PDA closures. We retrospectively compared the patients with a theoretical optimum size as regards complications and residual shunts. PDA size determination was based on the smallest diameter at pulmonary artery [PA] side. Based on specific criteria, undersizing was not observed in our cases, while oversizing was noted in 42% of cases. Oversizing did not lead to a decrease in residual shunts [37.5% vs. 36%, p=NS]. Although no short-term complications were observed in the oversized group, oversizing resulted in a characteristic mushroom deformity due to unnecessary tension applied to our device. The Chinese device also performed well in terms of deployment and short-term complications with no significant difference in comparison to its American counterpart [p=NS]. An acceptable rate of acute complications was obtained; nonetheless, we were frequently oversizing, leading to mild device deformation and protrusion. Although not previously described in the literature, the terminal ballooning of the ADO should alert us of such a complication

[Effect of positioning on patient's back pain and comfort after coronary angiography]

Coronary angiography is the golden diagnostic test for coronary heart disease. After the procedure, for minimizing the complications [mostly bleeding and hematoma] patients are restricted to bed rest for 8 to 24 hours that is always accompanied by patient's back pain and discomfort. The aim of this study was to assess the effect of changing patients' position on back pain, comfort, amount of bleeding and hematoma. Subjects were randomly assigned to the experimental [changing position] and the control group. Visual analog scale was used to measure pain intensity and comfort level, and a specific ruler was used to measure the amount of bleeding and hematoma. The experimental group had significantly lower pain scores and higher comfort scores than the control group at 3, 6, 8 hours, and at the next morning after angiography [p<0.01]. Changing patient's position according to the designed protocol produced no significant increase in the amount of bleeding and hematoma compared to the control group. The results showed that changing patient's position after angiography is practically feasible, and is associated with decreased level of back pain and increased comfort level without increasing the amount of bleeding and hematoma

effect of changing position on patients' fatigue and satisfaction after coronary angiography

Patients' satisfaction is one of the most important indices for evaluating quality of care. Restricting patients to be bed rest after angiography leads to minimize the complications bleeding which is always accompanied by patient's fatigue and dissatisfaction. The objective of this study is to assess the effect of changing patients' position on the levels of fatigue and satisfaction and to monitor the amount of bleeding and hematoma after angiography. This study was a quasi-experimental design with accessible sampling on Iranian patients [with 18-80 years old] who had undergone non-emergency angiography, were randomly allocated to experimental or control group [35 patients in each group]. A demographic questionnaire, visual analog scale to measure the fatigue intensity and the level of satisfaction, and a specific ruler to measure the amount of bleeding and hematoma were used to collect data. The experimental group was treated with the modified positioning compared to the control group with routine protocol. To analyze the data, t-test, chi square, ANOVA with repeated measure and correlation tests were used. The study finding showed that the control group had significantly higher fatigue scores, and lower satisfaction scores than the experimental group at 3, 6, 8 hours and on the next morning after angiography [P < 0.05]. There also was no significant difference in the amount of bleeding and hematoma in the experimental group compared to the control group [P > 0.05]. According to the study results, modifying positioning of the patients after angiography is associated with decreased level of fatigue and increased satisfaction level without increasing the risk of bleeding and hematoma