Tratamento percutâneo de origem anômala de coronária direita com trajeto maligno em paciente com morte súbita abortada / Percutaneous treatment of anomalous origin of the right coronary artery with malignant course in a patient with aborted sudden death

Anomalias coronarianas são menos frequentes em relação às doenças coronarianas adquiridas, como a aterosclerose, e têm sido implicadas como causa de eventos cardiovasculares. Este relato de caso descreve um achado incidental por angiografia de coronária direita anômala com origem no seio coronariano esquerdo e trajeto intra-arterial, após episódio de morte súbita abortada. A análise do Heart Team indicou como melhor tratamento a abordagem percutânea com implante de stent farmacológico em origem de coronária direita, procedimento este que foi realizado com sucesso. Este relato de caso e estudos recentes têm demonstrado que o tratamento percutâneo de anomalias coronarianas é uma opção segura para pacientes selecionados, levando em consideração quadro clínico, estudo anatômico e capacitação da equipe de hemodinâmica

Coronary anomalies are less frequent than acquired coronary diseases, such as atherosclerosis, and have been implicated as a cause of cardiovascular events. This case report describes an incidental finding on angiography of an anomalous right coronary artery with origin in the left coronary sinus and an intra-arterial course, after an episode of aborted sudden death. The Heart Team analysis indicated a percutaneous approach with drug-eluting stent implantation at the origin of the right coronary artery as the best treatment, and the procedure was successfully performed. This case report and recent studies have demonstrated percutaneous treatment of coronary anomalies is a safe option for selected patients, considering clinical presentation, anatomy study, and training of the cath lab team

Minimizing scattered radiation dose in cardiac catheterization laboratory during interventional procedures using lead free drape – MILD study

Objective: RADPAD is a lead-free sterile drape that reduces scattered radiation during fluoroscopic procedures. We aimed to study the effect of using RADPAD on primary operator (PO) and secondary operator (SO) during coronary angiography (CAG) as well as percutaneous coronary intervention (PCI). Methods: 137 patients undergoing elective CAG and PCIwere randomized in a 1:1 pattern with or without the RADPAD. The ratio of PO received dose in mrem to total Air Kerma (AK) in mGy, Dose Area Product (DAP) in mGycm2 and Cine Adjusted Screening Time (CAST) in minute, at the end of the procedure with or without RADPAD were measured and designated as dose relative to AK, DAP and CAST. The exposure ratios were compared for both cohorts. Results: There was no significant difference in CAST, DAP and AK between the two patient cohorts. PO radiation dose relative to CAST was 0.15 ± 0.18 mrem/min for RADPAD cohort and 0.43 ± 0.31 mrem/min for No RADPAD cohort (p < 0.00001). PO dose relative to DAP was 0.00042 ± 0.00049 mrem/mGycm2 for RADPAD cohort and 0.0011 ± 0.0013 mrem/mGycm2 for No RADPAD cohort (p ¼ 0.000014). PO dose relative to AK was 0.0030 ± 0.0037 mrem/mGy for RADPAD cohort and 0.0071 ± 0.0049 mrem/mGy for No RADPAD cohort (p < 0.00001). All PO doses relative to CAST, DAP and AK were significantly reduced in the RADPAD cohort compared to the No RADPAD cohort. Similar findings were observed for the SO also. Conclusion: RADPAD significantly reduces radiation exposure to both PO and SO during CAG and PCI. © 2022 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of Cardiological Society of India