ABSTRACT
AIMS: We developed a catheter simulator for percutaneous transvenous mitral commissurotomy (PTMC) based on the data from a patient with mitral valve stenosis. The simulator has the following characteristics: 1) the simulator is portable and easy to assemble and disassemble, 2) the cardiac portion is created using a 3D-printer, based on patient computed tomography data, 3) the simulator uses a foot-operated water pump to create pulsatile flow, and 4) the fossa ovalis in the atrial septum of the heart model is made of a thin polyurethane membrane and is interchangeable. We aimed to assess the effectiveness of this novel simulator for training in PTMC using the Inoue balloon in developing countries. METHODS AND RESULTS: We used this simulator for training in the National Institute of Cardiovascular Diseases in Bangladesh (13 physicians), and in Kenyatta National Hospital in Kenya (11 physicians). The effectiveness of training was evaluated by questionnaire and the procedure time in simulation. The questionnaire obtained from the trainees showed that the model scored 4.7±0.5 for realism, utility of pulsatile flow scored 4.7±0.5, simulator utility scored 4.9±0.3, and the effect of training on PTMC performance scored 4.9±0.5. The procedure time in simulation was shortened from 30.0±12.6 min (first time), to 23.4±11.9 min (second time) and to 20.4 ± 11.1 min (third time) (p<0.01). CONCLUSIONS: The novel portable assembly catheter simulator using a 3D-printed heart model for PTMC received positive comments and improved the skills of trainees.
ABSTRACT
AIMS: We aimed to compare the GRACE and TIMI risk scores in patients with non- ST elevation acute coronary syndrome for their accuracy in predicting the angiographic severity of coronary artery disease. METHOD: The cross-sectional study done in the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from April, 2015-April, 2016. The patients admitted with non-ST elevation acute coronary syndrome were evaluated to calculate the GRACE and TIMI risk score. Coronary angiogram was done during index hospitalization and the severity of coronary artery disease was assessed by vessel score and Gensini score. RESULTS: Of 205 patients, a positive correlation of the vessel score and Gensini score was observed with both the GRACE and TIMI risk scores (pâ¯=â¯<0.001) and the GRACE score (râ¯=â¯0.55) correlated better than the TIMI score (râ¯=â¯0.51). The GRACE score presented area under the Receiver Operating Characteristic (ROC) curve (0.943; 95% CIâ¯=â¯0.893-0.993) significantly superior to the area under the ROC curve (0.892; 95% CIâ¯=â¯0.853-0.937) of the TIMI score. CONCLUSION: Both the GRACE and TIMI risk scores had good predictive value in assessment the severity of coronary artery disease in patients with non-ST elevation acute coronary syndrome, when they were compared, the GRACE score was found to be superior to the TIMI score.
