Arterio-venous fistulae: a possible complication of transradial approach with a possible non invasive management

Arteriovenous fistulae is rarely reported as a complication of percutaneous coronary interventions with trans-radial approach

We report herein a case of radial arteriovenous fistulae that was treated conservatively by applying manual compression and avoiding surgical intervention

Accordion phenomenon in the radial artery should we treat the radial as a coronary artery?

The accordion phenomenon is a well-known finding mechanism in the field of interventional cardiology. It is a benign condition and has mainly been described in tortuous coronary arteries during percutaneous coronary interventions. It is believed to be induced by a stiff guidewire. However, this phenomenon has not been observed previously in the radial artery. We present a case of accordion phenomenon in the radial artery, which was successfully resolved after the catheters and the wire were retrieved, with the pseudolesions found to have completely disappeared in subsequent image findings

Tako-Tsubo Cardiomyopathy Triggered by Misdirection

Tako-Tsubo cardiomyopathy (TTC), also known as transient left ventricular apical ballooning syndrome or stress-induced cardiomyopathy, is a novel reversible cardiomyopathy mimicking acute myocardial infarction without epicardial coronary artery disease. The exact physiopathology of TTC remains unclear. It is usually precipitated by acute physical or emotional stress and it most commonly affects postmenopausal women. The growing number of clinical cases of TTC have demonstrated a wide field of possible etiologies beyond the emotional stress. We report a case of a 67-year-old postmenopausal woman who was being supplemented by enteral feeding via a nasogastric tube and who developed TTC due to misdirection, probably favored by the mechanical blockade by the nasogastric tube, while swallowing the drug pills.

[Cardiac tumor epidemiology in adults in Lebanpn]

Primary cardiac tumors are rare but potentially fatal. No studies have discussed this issue yet on the national level. We describe the epidemiology of cardiac tumors in adults in Lebanon. The data were taken from the hospitals, the patients and/or their doctors by means of a questionnaire. Fifty-seven cases of cardiac tumors were found, mainly myxomas in the left atrium. Dyspnea was the most frequent symptom. Transthoracic echocardiography was the main diagnostic tool. Transesophageal echocardiography was inconstantly made, scanner and MRI rarely while contrast echocardiography has never been used. Almost half of the patients had a follow-up and none had a familial screening. The collected data urged us to propose a unique and homogenous strategy for diagnosis, treatment and follow-up of cardiac tumors in Lebanon

[Coronary angioplasty for primary cardiogenic schock following myocardial infraction]

In the setting of acute myocardial infarction [AMI], several investigators have demonstrated that emergency coronary angioplasty [PTCA] reduces in-hospital mortality of primary cardiogenic shock [CS] from 90% to less than 50% however, few studies have focused on the current outcome of non selected patients in whom the onset of AMI is immediately complicated by CS.To evaluate in-hospital mortality of the patients admitted to our institution for Q wave AMI presented in CS. Between 05/93 and 05/03, 30 consecutive pts, 26 men and 4 women, in CS following AMI were treated with direct PTCA, 26 without thrombolysis and 4 as rescue after failed streptokinase. AMI was defined by prolonged chest pain and 1 mm ST segment elevation in 2 contiguous peripheral leads or 2 mm for precordial leads on the admission ECG. The diagnosis of CS was based on the combination of systolic blood pressure of r 90 mm Hg, unresponsive to volume expansion, signs of acute circulatory failure [cyanosis, cold extremities, restlessness, mental confusion or coma] and congestive heart failure secondary to myocardial dysfunc-tion. In 40% of cases the diagnosis of CS was only clinical and in 60% of cases was confirmed by a Swan Ganz catheter. Mean age was 62,3 +/- 12,3 years, 7 had triple vessel disease, 14 a double vessel disease, 8 a single vessel disease and in one case a left main disease. The AMI was anterior in 22 pts [73%], inferior in 8 [27%]. Intraaortic balloon was used in 3 pts, CPR in 16 [47%], transitory pacemaker in 1 pt, inotropes in 25 pts, emergency coronary artery bypass grafting [CABG] in 1 pt. Success for PTCA with a residual stenosis r 50% and a TIMI flow III was obtained in 26 pts [87%]. Mean time between CS and revascularization was 219 +/- 302 minutes. 19 pts [63%] survived and 11 pts [37%] died while at the hos-pital, 6 from intractable shock, 4 from multiple organ failure and in 1 case from pulmonary hemorrhage. Mean time of revascularization for the surviving was 190 +/- 329 min, and for the dead 295 +/- 212 min. Hospital mortality for inferior infarction is 12.5% after successful angioplasty. Comparison of surviving and non surviving number of patients according to revascularization time showed a significant difference of these groups whether the revascularization was accomplished before or after 120 minutes

Angioplastie primaire au stade aigu de l'infarctus du myocarde

The success of thrombolytic therapy for acute myocardial infarction is limited by failure of reperfusing 25% of occluded arteries, bleeding complications in 0.4 to 1% of patients and the possibility of recurrent ischemia. These problems can be overcome by the use of immediate angioplasty without previous thrombolytic therapy. Between February and December 1993, twelve patients [ten men and two women] admitted for acute myocardial infarction were treated by immediate angioplasty. Five patients had a contraindication to thrombolysis and seven had angioplasty as a deliberate choice. Successful recanalisation was obtained in 11 patients [92%] with one reocclusion at 24 hours. Two patients admitted in cardiogenic shock 12 hours after the onset symptoms died lately with multiorgan failure. Only one case of clinical restenosis was observed and was redilated. In conclusion, immediate angioplasty without prior thrombolytic therapy is a rapid method of revascularisation with minimal risk and good outcome when it is used early after acute myocardial infarction