ABSTRACT
Objective:To study the learning curve of percutaneous patent foramen ovale (PFO) occlusion guided solely by transthoracic echocardiography (TTE), as well as the success rate and safety of the learning curve.Methods:To retrospectively analyze these patients with indications for PFO occlusion admitted in our department from April 2021 to April 2022, and obtained 100 samples the author's initial cases guided solely by TTE, including 25 men and 75 women, with a mean age of (48.22±10.44) years old.Analyze preoperative baseline data: gender, age, height, weight, body mass index, the tunnel length and size of the PFO measured by transesophageal echocardiography, the grade of contrast-transcranial doppler test, combined atrial septal aneurysm, etc.Operation time, success rate, and complications were analyzed in all patients.Results:With the accumulation of cases, the operation time gradually shortened, accumulated to about 50 cases, the operation time has significantly shortened ( P<0.05), and the learning curve was leveled off after 50 cases ( P<0.05), there was statistical difference.The comparison of the success rate and complication of cases within the learning curve and those after completing the learning curve was no statistical significance( P>0.05). Conclusion:The learning curve of percutaneousc closure of patent foramen ovale guided solely by TTE is long, requiring about 50 cases to complete the learning curve. The success rate and safety of the learning curve are high. This procedure is worth popularizing.
ABSTRACT
O uso da fisiologia coronariana invasiva na seleção de indivíduos para revascularização coronariana foi estabelecido nas orientações atuais para manejo da doença arterial coronariana estável. Em comparação com a angiografia isolada, a fisiologia coronariana provou melhorar os resultados clínicos e a relação custo-efetividade no processo de revascularização. Ensaios controlados randomizados, no entanto, questionaram a eficácia do teste de isquemia na seleção de indivíduos para revascularização. Após uma intervenção coronária percutânea com sucesso angiográfico, 20 a 40% dos pacientes apresentaram angina persistente ou recorrente. A inteligência artificial é definida como o uso de vários algoritmos e conceitos computacionais para realizar tarefas complexas de maneira eficiente. Pode ser classificada em dois tipos: abordagens não supervisionadas e supervisionadas. O aprendizado supervisionado é usado principalmente nas tarefas de regressão e classificação, e nele é realizado um mapeamento otimizado entre variáveis de saída e entrada pareadas para executar as tarefas. Em contraste com isso, o aprendizado não supervisionado funciona de maneira diferente. Nesse aprendizado, os dados das variáveis de saída não estão disponíveis, e outros clusters e relações entre os dados de entrada são descobertos, usando-se vários algoritmos. Para se adquirir uma representação mais abstrata dos dados, a tecnologia de aprendizado profundo que utiliza as redes neurais multicamadas domina o aprendizado artificial atualmente.
The use of invasive coronary physiology to select individuals for coronary revascularization has been established in current guidelines for the management of stable coronary artery disease. Compared to angiography alone, coronary physiology has been proven to improve clinical outcomes and cost-effectiveness in the revascularization process. Randomized controlled trials, however, have questioned the efficacy of ischemia testing in selecting individuals for revascularization. After an angiographically successful percutaneous coronary intervention, 20 to 40% of patients experienced persistent or recurrent angina. Artificial intelligence is defined as the usage of various algorithms and computational concepts to perform the complex tasks in an efficient manner. It can be classified into two types: unsupervised and supervised approaches. Supervised learning is majorly used for the regression and classification tasks, and in this optimized mapping between output variables and paired input is carried out to perform the tasks. In contrast to this, unsupervised learning works in the different manner. In unsupervised learning, output variables data is not available and further clusters and relations between input data are found out by using the various algorithms. To acquire more abstract representation of data, deep learning technology, which uses the multilayer neural networks, dominates the artificial learning nowadays.
ABSTRACT
Percutaneous procedures through femoral access in patients with inferior vena cava (IVC) filter may be at risk of complications. We evaluated the feasibility and safety of left atrial appendage closure (LAAC) through femoral access in patients previously implanted with IVC filter. We described the WatchmanTM device implantation in two patients with formal contraindication for oral anticoagulation. First patient had a GreenfieldTM filter and the second one an OpteaseTM filter, and in this patient an attempt to withdrawal the filter immediately before the LAAC procedure failed. A femoral approach was performed in both patients using a 14 Fr sheath. Before crossing IVC filters, venographies did not detect any thrombus. All steps of IVC filter crossing were performed under fluoroscopic guidance. No immediate or intrahospital complications related to the procedure occurred. Herein, we presented two cases of successful LAAC closure with Watchman device in patients with two different kinds of IVC filters.
Subject(s)
Atrial Fibrillation , Vena Cava Filters , Heart AtriaABSTRACT
Background: Peripheral arterial disease and coronary artery disease have similar factors. The extent and severity of PAD is significantly associated with presence and severity of CAD.Methods: Patients were interviewed and clinical profile of patients including risk factors of coronary artery disease like diabetes, hypertension, smoking, dyslipidemia, obesity and family history of coronary artery disease were assessed and recorded in the proforma. Information regarding demographics, co morbidity, past history and family history was collected. Physical examination of each patient was carried and basic anthropometric data: height, weight, BMI and blood pressure, peripheral pulses calculated. Investigations both non- invasive and invasive including peripheral angiography were recorded.Results: In this prospective study fifty (50) type 2 diabetes patients admitted with CAD were studied whose mean age was 55.6+8.2 and mean duration of diabetes was 6.8+8.4. In this study none of the patients with PAD had single atherosclerosis risk factors including diabetes. 30% patients were having two risk factors. PAD in in patients with CAD is particularly enhanced by the concomitant occurrence of two or more of these risk factors (p=0.016). Hypertension as a predictor of PAD was statistically significant (p=0.0037). In this study the duration of diabetes was <5 years in 10%, 5-10 years in 40% and >10 years in 40% of patients with angiographically proven PAD.Conclusions: It was observed that presence and severity CAD was significantly associated with PAD.
ABSTRACT
@#Objective To explore the safety and efficacy of transesophageal echocardiography (TEE)-guided percutaneous intervention for patent ductus arteriosus (PDA) in obese teenagers. Methods From January 2018 to June 2019, 21 obese teenagers with PDA treated with femoral artery occlusion guided by TEE in the Department of Cardiac Surgery, Dalian Children's Hospital of Dalian Medical University were included in this study, including 13 males and 8 females aged 12.8-17.3 (15.1±1.7) years, with an average weight of 51.0-89.0 (73.4±10.1) kg. The operative effect was evaluated. Results All patients successfully received the surgery, and none was changed to radiation-guided or thoracotomy ligation. The average operating time was 23.9±6.8 min, the average postoperative hospitalization time was 3.8±0.6 d. No peripheral vascular injury, intracardiac infection or pericardial effusion occurred. The mean follow-up time was 19.5±4.9 months, and the results of all reexaminations were good. Conclusion For some PDA children with obesity, emphysema or thoracic malformation, it is difficult to block PDA by transthoracic ultrasound-guided percutaneous intervention, and TEE can avoid the interference of chest wall and lung qi, or other factors. It is an effective supplementary guidance method worthy of promotion.
ABSTRACT
@#Objective To evaluate the efficacy and safety of a novel wire for echo-guiding percutaneous atrial septal defect (ASD) closure. Methods Twenty sheep were randomly divided into two groups, an experimental group and a control group (n=10 in each group). In both groups, an animal model of ASD was established by transthoracic balloon dilatation, and percutaneous closure of atrial septal defect was finished only by echography guiding. The total procedure time, passing time (time needed for the guide wire to enter the left atrium), frequency of delivery sheath dropping into right atrium, frequency of arrhythmias and rate of complications were compared between the two groups. Results ASD model was uneventfully established in all animals. ASD devices were successfully implanted in all sheep. Compared with the control group, the experimental group had significantly less mean procedure time and mean passing time, lower frequency of guide wire dropping into right atrium and frequency of atrial and ventricular premature contractions, respectively (15.36±4.86 min vs. 25.82±7.85 min, 2.69±0.82 min vs. 5.58±3.34 min, 0% vs. 40.0%, 4.41±2.61 vs. 9.60±3.68, 0.75±0.36 vs. 1.34±0.68; all P<0.05) . Two groups did not have serious complications within postoperative one week. Conclusion The novel wire system is not only safe and effective in the treatment of ASD occlusion, but also easy to operate.
ABSTRACT
Objective@#To evaluate and compare cardiac structure and function pre- and post-percutaneous interventional treatment of pulmonary hypertension (PH) using echocardiography.@*Methods@#Eight female patients received percutaneous interventional treatment in our hospital were enrolled. All of them were suffered moderate to severe PH. Echocardiographic parameters included: right ventricular diameter (RVD), left ventricular diameter (LVD), right atrial diameter (RAD), left atrial diameter (LAD), main pulmonary arterial diameter (DMPA), left ventricular eccentric index (EI), left ventricular ejection fraction (LVEF), right ventricular systolic pressure (RVSP), tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), tissue Doppler-derived tricuspid lateral annular systolic velocity (s′), right ventricular index of myocardial performance (RIMP) and right ventricular free wall longitudinal strain (RVLSFW). The median time for follow-up after interventional treatment was 98 d.@*Results@#①In our study, 8 patients had no significant serious complications, and only one patient had mild intimal avulsion during stenting. ②RVSP and RVD/LVD increased significantly before intervention in patients with PH (P<0.05). After interventional treatment, RVSP (P<0.01) and RVD/LVD decreased significantly (P<0.05). ③The result of follow-up showed that RVFAC, RIMP, s′and RVLSFW improved significantly(P<0.05).@*Conclusions@#Echocardiography could evaluate the recent effect of interventional treatment and illustrates that the interventional treatment for pulmonary artery stenosis is effective and safe.
ABSTRACT
Objectives: The present first-in-human study aimed to assess the feasibility of percutaneous balloon mitral valvuloplasty (PBMV) for the treatment of isolated mitral stenosis (MS) under echocardiography guidance only. Methods: Data were obtained from 24 consecutive patients with severe MS, who underwent PBMV from October 2016 to October 2017 under the guidance of echocardiography only. Outpatient follow-up including chest radiography, electrocardiography, and transthoracic echocardiography was conducted at 1, 3, 6 and 12 months post procedure. Results: PBMV was successful in all 24 patients under echocardiography guidance without radiation and contrast agent. Mitral transvalvular pressure gradient derived invasive catheterization measurement dropped from(15.0±5.1) mmHg to (6.7±2.9) mmHg (P<0.01). Mitral valve area increased from (0.8±0.1) cm2at pre-PBMV to (1.7±0.1) cm2post-PBMV (P<0.01). Mean balloon diameter was (26.7±1.2) mm. Mild mitral regurgitation developed in 8 patients. Mean follow-up duration was (7.4±3.1) months. At the last follow-up, mitral valve area remained high (1.6±0.1) cm2and mean transmitral pressure gradient remained low (9.0±4.3) mmHg. No pericardial effusion or peripheral vascular complications occurred. Conclusions: In this patient cohort, PBMV could be successfully performed with echocardiography as the single imaging guidance modality, this procedure is safe and effective and avoids the radiation exposure and contrast agent use.
ABSTRACT
Objective To evaluate the predictive value of IABP SHOCK Ⅱ risk score in in-hospital mortality of patients with ST segment elevation myocardial infarction complicated with cardiogenic shock (CS). Methods From August 2011 to August 2013, the clinical data of 89 patients with cardiogenic shock after STEMI treated with primary PCI and then supported by using IABP were retrospectively analyzed. The IABP SHOCK Ⅱ risk score were calculated from the data at admission and primary PCI. Comparisons of general information, medication and intervention, pre/post IABP vital life signs and in-hospital death were carried out among patients with different risk stratifications. Results The area under ROC curve of risk stratification was 0.723. The patients were categorized into low risk group (score 0-2, n=71) and intermediate-high risk group (score 3-9, n=18).The patients in intermediate-high risk group were with advanced age, high rate of diabetes mellitus, history of stroke, renal insufficiency, higher serum lactate and glucose at admission compared with low risk group. And more patients in intermediate-high risk group had impaired post-PCI coronary flow (TIMI flow grade<3). Conclusions The IABP SHOCK Ⅱ risk score is a simple and useful risk score for predicting in-hospital mortality of STEMIpatients complicated with CS. Though the patietns are treated with primary PCI and then supported by IABP, the in-hospital mortality of patients with IABP SHOCK Ⅱ risk score ≥ 3 increases significantly.
ABSTRACT
Coarctation of aorta is a discrete narrowness of the aorta and most commonly occurs in the isthmus.It is a common congenital cardiovascular malformation with morbidity of 5％ ～ 8％ among all congenital heart defects.Coarctation can result in the increase of upper limb blood pressure,the decrease of limb blood pressure,and a decline in cardiac function.Treatments include surgical repair and percutaneous interventions with different complications.Long-term complications and heart functions are important indices for evaluating prognosis and should be closely evaluated postoperatively.This review focuses on progresses of therapy methods,postoperative complications and cardiac function.
ABSTRACT
Objective To investigate the efficacy and safety of percutaneous induced thrombosis closure on small patent ductus arteriosus (PDA) solely under echocardiography guidance.Methods From June 2013 to September 2016,276 PDA patients were treated by femoral artery retrograde approach under echocardiography guidance.Twenty-five patients (14 boys,11 girls) among them with small PDA received percutaneous induced thrombosis closure because the delivery sheath could not pass PDA,with mean age (3.7 ± 1.6) years,mean body weight (16.6 ±5.4) kg and the mean diameter of the most narrow PDA was (1.3 ± 0.4) mm.All patients were assessed by transthoracic echocardiography,chest radiography and electrocardiography preoperatively.The intraoperative and postoperative effects were evaluated by echocardiography.Outpatient assessment was performed at 1,3,6 and 12 months after operation with electrocardiography and echocardiography,and yearly thereafter.Results Twenty-five patients were successfully treated with percutaneous induced thrombosis closure solely under echocardiography guidance.The mean operation time was (35.2 ± 6.1) minutes.The immediate residual shunt rates and 24 hours after operation were 28.0％ (7/25 cases) and 16.0％ (4/25 cases),respectively.All patients recovered and were discharged from hospital.The average hospitalization stay was (3.0 ± 0.6) days.The mean follow-up was (16.8 ± 12.3) months,residual shunt was observed in 2 patients (8.0％),and it decreased from 1.5 mm and 2.0 mm preoperatively to 0.8 mm and 1.0 mm postoperatively,respectively.All patients survived without peripheral vascular injury,cardiac perforation,PDA rupture or thrombembolia.Conclusions Percutaneous induced thrombosis closure of small PDA solely under echocardiography guidance is safe and effective.It can avoid occluder implantation and radiation injury.However,the residual shunt after operation needs following up closely.
ABSTRACT
Objective To compare the biomechanical characteristics of a novel guide wire with that of the conventional guide wire by using cadaver specimen test,and to evaluate the safety and effectiveness of this new guide wire through clinical experiment.Methods By using cadaver specimen test,the average push-out force on the guide wire and the extra-force required to penetrate the anterior wall of the vertebral bodies,from L1 to L5,were determined,and the results were compared between the novel guide wire and the conventional guide wire.Results The definition of push-out force was a force that caused the tip of the guide wire to bend or disperse within the vertebral body and then the further moving of the wire to the front of the vertebral body was impeded.The average push-out forces for the novel guide wire and the conventional guide wire were (15.5±1.9) and (5.7±0.8) newton respectively (P＜0.001).The mean force required to penetrate the anterior wall of the vertebral body for the novel guide wire and the conventional guide wire were (69.1±4.2) and (37.1±4.8) newton respectively (P＜0.000 5).A total of 222 novel guide wires were used in clinical trial,and no penetration of vertebral anterior wall by the guide wire occurred.Conclusion The average push-out force within the vertebral body and the mean force required to penetrate the anterior wall of the vertebral body for the novel guide wire are about 2 times and 3 times greater than those for the conventional guide wire respectively.The use of this novel guide wire can effectively prevent the wire from moving forward in the vertebral body as well as from penetrating the vertebral anterior wall.Therefore,the use of this novel guide wire can reliably improve the safety for patients with osteoporosis receiving percutaneous pedicle screw insertion procedure.
ABSTRACT
Takayasu’s arteritis is a chronic vasculitis affecting aorta and its branches. We report a case series of Takayasu’s disease. Percutaneous intervention with stent implantation is better choice for stenosis and occlusion of coronary and carotid arteries as well as peripheral lesions, and is increasingly used for the management of Takayasu’s arteritis.
ABSTRACT
The Cardiovascular disease is leading the cause of mortality and morbidity and constantly increasingevery year for past decades. World wide 32 million people gets acute heart attack and 2.5 million deaths occur every year due to AMI. In Mongolia Cardiovascular disease is also leading the cause of mortality and morbidity. It is dramatically increasing every year, 479.4 per 10,000 population in 2012 was increased to 848.1 per 10,000 population in 2013. Dr.B.Jerardin, Prof.Z.Lkhagvasuren and his junior L.Jargalsaikhan jointly implanted first stent inMongolia in 2010. There is rapid development in interventional treatment skills since then. Since 2000 until 2014, total of 3791 coronary angioraphy, 1841 stent implantations was performed.This study has included the patients of last 5 years. Total of 898 patients who are treated with AMI during October 2010 to October 2014 at Third State Central Hospital were analyzed. 73.7% of the patients had left coronary artery disease and 26.3% had right coronary disease. Thisfinding was same with other local researchers study (Galtsog et al. 1987, D.Narantuya et al. 2001).59.4% of the occlusions were 75-99% stenosis, 23.5% had total occlusion. 62.9% of the LAD occlusionwere stenosis of over 75%. It demonstrated majority of the cases performed were high severe lesions.This also may be demonstrating that patients are receiving treatment in their late stage of the disease. Early stage complication such as mortality, restenosis was 3.5%, complication within following one month of after stent implantation was 9-13.1%. Overall mortality rate has decreased each year, 11.9% in 2010, 7.8% in 2012, 4.6% in 2013 relatively. General achievement is now 88.1%-95.4%, which is comparable to other countries.Implementation of coronary procedures in daily practice was one of the major achievements in thecardiovascular field in Mongolia. Patients from capital city are relatively been able to receive coronaryinterventional treatment within 12 hours of onset. However, patients arriving golden standard timingis not sufficient enough as well there are still major concerns for patients living in distant rural areas.
ABSTRACT
Background Primary percutaneous intervention (PPCI) is the treatment of choice for ST elevation myocardial infarction (STEMI) but robust evidence in the very elderly is lacking. We compared PPCI outcomes between different age quartiles (quartile 1<60 years, quartile 2≥60 to<70 years, quartile 3≥70 to<80 years, quartile 4≥80 years). Methods Retrospective observational analysis of our Morriston Tertiary Cardiac Center (Abertawe Bro Morgannwg University Health Board) patients from 2005 to 2010 with STEMI who underwent PPCI. Results Of 434 patients, 57 (13%) were in quartile 4 (≥80 years). In older age quartiles, patients were less likely to receive a drug eluting stent (DES, P=0.001) or glycoprotein IIb/IIIa inhibitor (GPI, P<0.0001). Increase in age was associated with reduced time to survival (β-coefficient:?0.192, t:?3.70, 95%CI:?4.91 to?1.50, P<0.0001) as was the presence of cardiogenic shock (β-coefficient:?0.194, t=3.77, 95%CI: ?5.26 to?1.65, P<0.0001). Use of GPI was associated with increased time to survival (β-coefficient: 0.138, t= 2.82, 95%CI:1.58–8.58, P=0.005) but older age quartiles were less likely to receive GPI (P<0.0001). In-hospital mortality (1.8%quartile 1, 3.6%quar-tile 2, 10.9%quartile 3 and 12.3%quartile 4, P=0.002) and 1-year mortality (5.4%quartile 1, 5.5%quartile 2, 16.8%quartile 3 and 24.6%quartile 4, P<0.0001, respectively) was significantly higher in older age quartiles. Conclusions Increased short term and intermediate term mortality is seen in the very elderly after PPCI. Age and cardiogenic shock were prognostic factors. Intervention should not be based on age alone and awareness regarding prognostic factors can help improve management.
ABSTRACT
Objective: Traditional percutaneous ventricular septal defect (VSD) closure had disadvantages of radiation and contrast media reaction in relevant patients. We want to investigate the efifcacy and safety of percutaneous VSD closure under solely guidance of echocardiography. Methods: A total of 28 VSD patients treated by percutaneous VSD closure under solely guidance of trans-thoracic echocardiography in our hospital from 2014-02 to 2014-10 were summarized. The patients mean age was (9.5 ± 3.1) years with the body weight at (31.3 ± 7.7) kg. The average diameter of VSD was (4.6 ± 0.9) mm, and the clinical follow-up study was conducted by echocardiography at 1, 3, 6 and 12 months after the procedure. Results: There were 26 patients with successful treatment by percutaneous VSD closure under solely guidance of echocardiography. 1 patient was converted to perventricular closure with trans-esophageal echocardiography guidance because the catheter could not pass through the defect; another patient was converted to surgical repair because of the residual shunt > 2 mm. The average procedural time was (63.3 ± 11.7) min and the mean diameter of symmetrical occluder was (6.6 ± 1.0) mm. There were 2 patients with immediate post-operative residual shunt, and the average in-hospital time was (3.7 ± 1.3) days. All patients discharged without the complications as peripheral vascular injury or cardiac perforation. The average follow-up time was (6.2 ± 3.4) months. The residual shunt disappeared in 2 patients at 1 month follow-up time point. No patients suffered from pericardial effusion, occluder malposition, atrio-ventricular block and aortic valve regurgitation. Conclusion: Echocardiography guided percutaneous VSD closure is safe and effective, it may avoid the radiation and contrast media reaction in relevant patients.
ABSTRACT
Resumen Finalidades: la intervención percutánea coronaria primaria (pPCI, por sus siglas en inglés) ha reemplazado la trombolisis como tratamiento de elección para el infarto de miocardo con elevación del segmento ST (STEMI por sus siglas en inglés). Sin embargo, la incidencia y la importancia pronóstica del bloqueo aurículoventricular de alto grado (BAV-AG) en pacientes con STEMI en la era de pPCI han sido poco estudiadas. El objetivo de este estudio fue evaluar la incidencia, los predictores y la importancia pronóstica of BAV-AG en pacientes con STEMI tratados con pPCI. Métodos y resultados: este estudio incluyó 2073 pacientes con STEMI tratado con pPCI. Los pacientes fueron identificados a través de un registro hospitalario y el Registro Nacional de Pacientes de Dinamarca. Ambos registros se usaron también para establecer el diagnóstico de BAV-AG. La mortalidad por todas las causas fue la variable evaluable primaria. Durante un seguimiento con una mediana de 2,9 años [rango del intercuartil (IQR): 1,8-4,0] fallecieron 266 pacientes. Se documentó bloqueo aurículoventricular de alto grado en 67 (3,2%) pacientes, 25 de los cuales murieron. Entre los predictores independientes importantes de presentar BAV-AG, se incluyeron la oclusión de la arteria coronaria derecha, edad >65 años, género femenino, hipertensión, y diabetes. La tasa de mortalidad ajustada aumentó significativamente en pacientes con BAV-AG comparado con pacientes sin BAV-AG [cociente de riesgos instantáneos » 3,14 (intervalo de confianza 95%: 2,04-4,84), P < 0,001]. Un análisis relevante 30 días después del STEMI mostró iguales tasas de mortalidad en los dos grupos. Conclusión: la incidencia de BAV-AG en pacientes con STEMI tratado con pPCI se ha reducido comparado con los informes de la era trombolítica. Sin embargo, a pesar de esta mejora, en la era de pPCI el bloqueo AV de alto grado sigue siendo un marcador pronóstico severo. La tasa de mortalidad solo aumentó dentro de los primeros 30 días. Los pacientes con bloqueo aurículoventricular de alto grado que sobrevivieron más allá de este punto temporal tuvieron así un pronóstico igual al de los pacientes sin BAV-AG
Summary Aims: Primary percutaneous coronary intervention (pPCI) has replaced thrombolysis as treatment-of-choice for ST-segment elevation myocardial infarction (STEMI). However, the incidence and prognostic significance of high-degree atrioventricular block (HAVB) in STEMI patients in the pPCI era has been only sparsely investigated. The objective of this study was to assess the incidence, predictors and prognostic significance of HAVB in STEMI patients treated with pPCI. Methods and results: This study included 2073 STEMI patients treated with pPCI. The patients were identified through a hospital register and the Danish National Patient Register. Both registers were also used to establish the diagnosis of HAVB. All-cause mortality was the primary endpoint. During a median follow-up of 2.9 years [interquartile range (IQR) 1.8-4.0] 266 patients died. High-degree atrioventricular block was documented in 67 (3.2%) patients of whom 25 died. Significant independent predictors of HAVB included right coronary artery occlusion, age .65 years, female gender, hypertension, and diabetes. The adjusted mortality rate was significantly increased in patients with HAVB compared to patients without HAVB [hazard ratio = 3.14 (95% confidence interval 2.04-4.84), P < 0.001]. A landmark-analysis 30 days post-STEMI showed equal mortality rates in the two groups. Conclusion: The incidence of HAVB in STEMI patients treated with pPCI has been reduced compared with reports from the thrombolytic era. However, despite this improvement high-degree AV block remains a severe prognostic marker in the pPCI era. The mortality rate was only increased within the first 30 days. High-degree atrioventricular block patients who survived beyond this time-point thus had a prognosis equal to patients without HAVB
ABSTRACT
El cierre percutáneo ha aparecido como una alternativa en el tratamiento de la persistencia del conducto arterioso. Presentamos la experiencia en un único centro (Centro Cardiovascular Regional-ASCARDIO-Lara-Venezuela) en el cierre percutáneo de 250 pacientes portadores de la persistencia del conducto arterioso desde octubre 1998 a agosto 2010. La indicación de cierre fue persistencia del conducto arterioso con soplo, sobrecarga de volumen de cavidades izquierdas, sin o con HAP leve a moderada. Se utilizaron 4 tipos de dispositivos: 190 casos con 3 tipos de Amplatzer Duct Ocludder (Tipo 1: 183 casos, Tipo Angulado: 2 casos y Tipo 2: 5 casos), 2 casos con Gianturco coil, 35 casos con Flipper Coil y 23 casos con Duct/Nit-Oclud. En forma global la tasa de éxito de cierre fue 99,6% (249/250), siendo para los 3 dispositivos Amplatzer de 99,4% (189/190), 100% para dispositivo de Gianturco coil (2/2), 100% para dispositivo de Flipper coil (35/35) y 100% para dispositivos Duct/Nit-oclud (23/23), sin shunt residual a las 24 h en 98,8% (247/250) de los casos. Hubo una embolizaciónde dispositivo de Amplatzer tipo 1(1/250=0,4%) que ameritó cirugía y tasa general de complicaciones (menores) fue por debajo del 1% (0,8%), con cero mortalidad. El cierre percutáneo de la persistencia del conducto arterioso ha resultado ser una técnica segura y eficaz con morbilidad mínima y mortalidad cero, en el CCR-Ascardio.
Percutaneous closure has been a new alternative of treatment of persistent ductus arteriosus (PDA). We present our experience in a only Center (Regional Cardiovascular Center-ASCARDIO-Lara-Venezuela) with percutaneous closure in 250 patients with this congenital pathology (isolated persistent ductus arteriosus) since October 1998 until August 2010. Indication for percutaneous closure was all persistent ductus arteriosus with murmur, Diastolic overload of left cavities, without or mild to moderate Pulmonary Hypertension. Four type of devices were used: 190 cases with three types of Amplatzer Duct Ocludder (Type 1: 183 cases, Type angulated or asymmetric: 2 cases and Type 2: 5 cases), Gianturco coil in 2 cases, Flipper coil in 35 cases and Duct/Nit Oclud were used in 23 cases. Overall successful closure rate was 99.6% (249/250), with no 24 hours residual shunt residual in 98.8% (247/250) of cases. According with three types of amplatzer devices, successful closure rate were 99.4% (189/190), 100% for Gianturco coil 2/2, 100% for Flipper Coil (35/35) and 100% for Duct/Nit Oclud (23/23). There was one embolization of amplatzer device type 1(1/250=0.4%) and patient was sent for surgery, and minor complications was less than 1% (0,8%) with no mortality. We can conclude that percutaneous closure of persistent ductus arteriosus is a very safe and secure technique with very low minor complications and with no mortality.
Subject(s)
Humans , Male , Female , Administration, Cutaneous , Congenital Abnormalities/pathology , Congenital Abnormalities/therapy , Ductus Arteriosus , CardiologyABSTRACT
A introdução de stents farmacológicos em 2002 revolucionou a cardiologia invasiva através da redução de reestenoses. No final de 2006 surgiram relatos de aumento da incidência de trombose tardia de stent com esses stents em comparação com os de metal sem revestimento, provavelmente em decorrência do atraso de endotelização. No entanto, esses estudos continham sérias falhas metodológicas. Meta-análises posteriores mostraram de forma clara um risco apenas discretamente aumentado de trombose tardia de stent entre todos os grupos de pacientes. Um achado importante foi o de que os stents farmacológicos proporcionaram benefício significativo e mantido devido à redução de reestenose e, portanto, de revascularização de repetição. Vários registros obtidos na prática clínica confirmaram esses resultados e sugeriram que o uso de stents farmacológicos em situações mais complexas não está associado a resultados desfavoráveis. A trombose de stent é um problema multifatorial no qual o stent é apenas um dos elementos. Novos estudos serão necessários para determinar a técnica para o procedimento e o esquema antiplaquetário ideais. Os stents farmacológicos são seguros e eficazes em longo prazo, embora estudos intensivos continuem sendo realizados com o propósito de reduzir o risco de trombose de stent na próxima geração.
The introduction of drug-eluting stents in 2002 revolutionized interventional cardiology by minimizing restenosis. Reports of increased late stent thrombosis with these stents compared with bare metal stents, probably due to delayed endothelialization, emerged late in 2006. These studies contained serious methodological flaws, however. Subsequent meta-analyses clearly showed only a small incremental risk of late stent thrombosis across all patient groups. Importantly, a significant and sustained benefit of drug-eluting stents due to reduced restenosis and thus repeat revascularization was also shown. Several 'real-world' registries have confirmed these results and suggested that the use of these stents in more complex situations is not associated with adverse outcomes. Stent thrombosis is a multifactorial problem, in which the stent is only one element. Further research is required to determine optimal procedural technique and antiplatelet regimens. Drug-eluting stents are safe and effective in the long-term, though intensive research continues into ways to reduce the risk of stent thrombosis in the next generation.
La introducción de stents farmacológicos en 2002 revolucionó la cardiología invasiva a través de la reducción de reestenosis. En el final de 2006 surgieron relatos de aumento de la incidencia de trombosis tardía de stent con esos stents en comparación con los de metal sin revestimientos, probablemente en consecuencia del atraso de endotelización. Mientras tanto, esos estudios contenían serias fallas metodológicas. Metanálisis posteriores mostraron de forma clara un riesgo apenas discretamente aumentado de trombosis tardía de stent entre todos los grupos de pacientes. Un hallazgo importante fue el de que los stents farmacológicos proporcionaron beneficio significativo y mantenido debido a la reducción de reestenosis y, por lo tanto, de revascularización de repetición. Varios registros obtenidos en la práctica clínica confirmaron esos resultados y sugirieron que el uso de stents farmacológicos en situaciones más complejas no está asociado a resultados desfavorables. La trombosis de stent es un problema multifactorial en el cual el stent es apenas uno de los elementos. Nuevos estudios serán necesarios para determinar la técnica para el procedimiento y el esquema antiplaquetario ideales. Los stents farmacológicos son seguros y eficaces a largo plazo, aunque estudios intensivos continúen siendo realizados con el propósito de reducir el riesgo de trombosis de stent en la próxima generación.