Transradial access in a cath lab with moderate procedural volume: a single operator's experience.

AIM: The transradial access (TRA) for cardiovascular interventions has become increasingly popular and was shown to be effective in many clinical settings, including acute coronary syndromes. Despite offering many advantages, such as a striking reduction in access site complications, the penetration of TRA in routine practice is still low. One reason for this could be that many studies about TRA were performed in high-volume centers by expert operators, making their results not fully applicable to the real world. In order to assess the efficacy of TRA, we retrospectively reviewed the caseload of a single operator working in a community hospital with moderate procedural volume. METHODS: We considered 873 consecutive procedures, of which 406 percutaneous coronary interventions (PCI), performed by a single operator (S.R.) who had previously completed the learning curve in TRA at a high volume center. RESULTS: TRA was selected in 48.3% of patients, transfemoral approach (TFA) in 50.9% and transbrachial approach in 0.8%. TFA was used more frequently in PCI (62.5% vs 37.5%; P<0.001), largely because it was the access of choice in primary PCI. The overall procedural success rate was 94% in TRA and 98% in TFA (P=0.035); access failure was more frequent in TRA (5.9% vs 1.1%; P<0.001), whereas an increased rate of access-related vascular complications was observed in TFA as compared to TRA (1.1% vs 0%; P=0.029). CONCLUSION: After an adequate training period, the overall performance of TRA is good even in moderate-volume hospitals. Despite reducing access site complications, TRA is limited by a slightly higher rate of procedural failure as compared to TFA.

A randomized comparison between rotational and standard coronary angiography.

AIM: Selective coronary angiography is nowadays the gold standard in the definition of coronary anatomy as well as the basis for percutaneous coronary interventions. However, the diagnostic accuracy of coronary angiography can be reduced if the number of angiographic views is inadequate or if the operator does not select appropriate projections. Rotational angiography (RA) has been proposed as an alternative technique in order to provide a more complete definition of coronary anatomy reducing, at the same time, radiation exposure and contrast medium dose. METHODS: We randomly assigned 31 eligible patients, undergoing diagnostic cardiac catheterization, to RA (n=16) and traditional angiography (TA, n=15). Total procedural time, fluoroscopy time, number of cine-runs, X-ray dose and contrast medium volume were recorded in both groups. RESULTS: There were no statistically significant differences between groups in age (59+/-5.8 vs 62.8+/-9.6 years, P=ns), body mass index (26.7+/-3.5 vs 27.1+/-3.4 kg/m2, P=ns), total procedural time (20.6+/-6.6 vs 22.2+/-11.3 min, P=ns) and fluoroscopy time (3.9+/-1.5 vs 4.9+/-1.8 min, P=ns). On the contrary, number of cine-runs, X-ray dose and contrast medium volume were significantly lower in RA patients as compared with TA patients (6.2+/-1.2 vs 9.7+/-2.1, P<0.01; 530.6+/-271.6 vs 831.2+/-343.9 mGy, P<0.05; 76.9+/-22.4 vs 102.9+/-26.4 ml, P<0.01, respectively). CONCLUSIONS: RA is safe and effective in defining coronary anatomy, leading to a significant reduction in radiation exposure and contrast medium volume.

[Long-term evaluation of the endoscopic treatment of gastric polyps]. / Valutazione a lungo termine del trattamento endoscopico dei polipi gastrici.

BACKGROUND: The authors intend to evaluate the long-term efficacy of endoscopic treatment of gastric polyps. METHODS: They report their experience in 5000 upper gastro intestinal endoscopies performed between 1985 and 1998. The method used aimed to evaluate the distribution of polyps by sex and age, the frequency of various histological types and the incidence of complications in relation to histological type and the size of the polyps. The authors also analysed the indications and criteria of choice between endoscopic treatment and surgery and they calculated the incidence of malignant neoplasm and complications in relation to the endoscopic method used, as well as the incidence of relapse at the medium and long-term follow-up. They searched for the presence of neoplasms in the follow-up and compared their personal experience with data from international literature. RESULTS: The results obtained show that non-surgical treatment of gastric polyps is resolutive in most cases. The endoscopic resection of polyps was performed using a polypectomy loop. In patients converted to surgery, the necessity for the operation was caused by an unexpected hemorrhage that could not be controlled using endoscopic treatment. In this case, the operation consisted of resecting the entire wall of the lesion, including an extemporary histological analysis. CONCLUSIONS: The authors' experience allows them to state that endoscopic treatment of this gastric pathology is efficacious and free from risks and complications if stringent patient selection criteria are used (dimensions, morphological characteristics of the lesion) and control procedures over time suited to the potential malignancy of each histological type are carried out.

[Classification problems in iatrogenic hepatic traumas. 10 years of personal experience: 17 cases]. / I problemi di classificazione dei traumi epatici iatrogeni. Dieci anni di esperienza personale: 17 casi.

The authors propose modifying Moore's classification of hepatic trauma in an attempt to classify and emphasise iatrogenic hepatic lesions. Although fortunately rare, iatrogenic hepatic trauma are particularly severe since they occur in patients with liver pathologies or precarious general conditions and are therefore characterised by a high mortality rate: 29% in a series of 17 cases.

[Left ventricular thrombosis in acute myocardial infarction: incidence, complications, and clinical effects of calcium heparin]. / Trombosi ventricolare sinistra nell'infarto miocardico acuto: incidenza, complicazioni ed effetti dell'eparina calcica.

It is known that the myocardial infarction may be associated with left intraventricular thrombosis (LIT) as the anatomopathologic studies and the heart surgery operations confirmed. The authors verified in this study the incidence and the complications of de LIT in the patients with acute myocardial infarction treated with low-dose heparin.

[Left ventricular thrombosis with acute myocardial infarction: morphologic aspects indicative of an elevated embolic risk]. / Trombosi ventricolare sinistra dopo infarto miocardico acuto: aspetti morfologici indicativi di elevato rischio embolico.

In this study the authors evaluate the potentiality of two-dimensional echocardiography to detect the left ventricular thrombus in the myocardial infarction. The authors emphasize the morphological echocardiographic patterns suggestive of the high embolic risk of the ventricular thrombus.

[Assessment of the ejection fraction in ischemic cardiopathy with two-dimensional echocardiography. Validity and limits of the method]. / Il calcolo della frazione di eiezione nella cardiopatia ischemica con l'ecocardiografia bidimensionale. Validità e limiti della metodica.

In this study the authors compare the Ejection Fraction (EF) as determined by the Single Plane Ellipse Echocardiographic method versus the Ventriculographic EF. The authors emphasize the validity of the two-dimensional echocardiography to assess left ventricular EF in order to improve the clinical and pharmacologic management of the patients with the cardiac ischaemic disease.

[Electrocardiographic evaluation of myocardial co-involvement in Duchenne muscular dystrophy: prognostic implications in a case with multiple localizations]. / Valutazione ecocardiografica di coinvolgimento miocardico nella distrofia muscolare di Duchenne: implicazioni prognostiche in un caso con localizzazioni multiple.

After a review of the literature on myocardial involvement (MI) in Duchenne's progressive muscular dystrophy (DMD), the authors report a case with an extensive MI. This severe myocardial functional impairment is a poor index in the prognosis of DMD. The authors emphasize the use of echocardiography in the screening of MI in DMD.

[Infective endocarditis of the tricuspid valve: echocardiographic diagnosis and a therapeutic approach]. / Endocardite infettiva della valvola tricuspide: diagnosi ecocardiografica ed approccio terapeutico.

The authors report a case of Infective Endocarditis (IE) to emphasize the most characteristic echocardiographic features that permit to detect the tricuspid valve involvement in IE, the management of the medica and/or surgical therapy of this disease and the limitations of this noninvasive technique.

[Acute aortic dissection: diagnostic possiblities of mono- and two-dimensional echocardiography]. / Dissezione aortica acuta: possibilità diagnostiche dell'ecocardiografia mono e bidimensionale.

A case of an acute aortic dissection (AAD) has been reported in a 61-year-old woman, in whom, by the mono and two-dimensional echocardiography (M and 2D E) the authors have detected: 1) The disconnection between the intima and adventitia. 2) A flap of the intima in the aortic cavity. The authors emphasize the usefulness of the M and 2D E because it permits: 1) An early diagnosis of the AAD. 2) A reduction of the lapse between the angiographic examination and the surgical therapy. 3) A better prognosis.

[Left atrial thrombosis and mitral rheumatic stenosis: role of two-dimensional echocardiography]. / Trombosi atriale sinistra nella stenosi mitralica reumatica. Ruolo dell'ecocardiografia bidimensionale.

The authors report six cases of left atrial thrombosis with mitral rheumatic stenosis and atrial fibrillation (AF). They analyse the diagnostical possibility of two-dimensional echocardiography (2D-E) and doppler in clinical study of left atrial thrombosis (LAT) for a correct and tempestive medical and/or cardio-surgical indication.

[Phono-mechano-cardiographic assessment in hypertensive heart disease: value of the apex cardiographic parameters (author's transl)]. / L'esame fono-meccano-cardiografico nella cardiopatia ipertensiva: utilità dei parametri diastolici apicografici.

In 15 normal subjects and in 19 patients with essential hypertension (NYHA I-II) systolic time intervals (STI) and diastolic more expressive parameters of the left ventricular performance were studied by phono-meccano-cardiography. ICT, LVET, ICT/LVET, iso-volumic relaxation period (A2-0) and rapid filling time (O-F) were measured. On the apexcardiogram relative height of rapid filling (RF) and atrial (A) waves measured too. "Diastolic index", a ratio between this two phenomena (hRFw/hAw) was calculated. Results were evaluated in relation with ECG, arterial pressure and subjective sympthoms. There were no statistically significant differences in mean values of the STI among normotensive and hypertensive subjects. On the contrary the parameters which explore into diastolic period result in disagreement and significantly influenced by diastolic arterial pressure. Comparison showed that patients in the hypertensive group had longer mean isovolumic relaxation period (P < 0.01), longer mean O-F time (P:ns), lower mean RF wave (P < 0,01) and higher mean atrial wave (P < 0,01). Consequently hRFw/hAw mean ratio was lower (P < 0,01) and frequently reversed. The lengthening of iso-volumic relaxation period and reduction of diastolic index were more consistent in the symtomatic patients (P:ns). It is concluded that poligraphic research, in patient with hypertensive heart disease, must not be restricted to the STI but it has to include a poliparametric evaluation of all phases of cardiac circle. The diastolic index may prove a simple, readily available and noninvasive guide in the assessment of left ventricular function.