[Heart catheterization via the femoral artery with a 4 French and mobilization at 2 hours]. / Cateterismo cardiaco per via arteriosa femorale con 4 French e mobilizzazione a 2 ore.

The use of small catheters for cardiac catheterization, as well as for other diagnostic and interventional procedures, can reduce iatrogenic trauma on cardiac and vascular structures. Early patient mobilization may thus reduce both patient discomfort and the length and cost of stays. The performance of 4 French catheters was evaluated in a pilot cohort of consecutive in patients who underwent coronary arteriography with the use of the femoral Judkins technique and who had no restriction to full ambulation. Patients were helped to resume full ambulation two hours after the procedure, and the femoral access site was inspected 24 hours later upon discharge. Coronary arteriography with 4 French catheters was performed in 45 patients (10 women) aged 62 +/- 10 years. In one patient with anomalous origin of the right coronary artery, selective catheterization of the coronary ostium required a catheter style available only in 5 French. In all cases, selective opacification with 4 French catheters was adequate for diagnosis. Forty-three patients were mobilized 115 +/- 10 minutes after the end of manual compression. Hematoma, bleeding or limb perfusion disturbances were absent in all cases upon inspection 22 +/- 4 hours later. This pilot experience indicates that coronary arteriography with femoral 4 French Judkins catheters is technically feasible and that patient ambulation 2 hours later is safe. This data requires confirmation in a larger patient cohort and can lead to new standards for both patient comfort and the use of hospital resources in coronary arteriography.

Ambulation three hours after elective cardiac catheterisation through the femoral artery.

OBJECTIVE: To test whether very early resumption of ambulation after femoral cardiac catheterisation is feasible and safe in patients with stable symptoms. DESIGN: Prospective study in a selected group of men and women undergoing elective cardiac catheterisation, with next day physical inspection. SETTING: Inpatient study. SUBJECTS: Two hundred consecutive ambulant patients submitted to diagnostic cardiac catheterisation through the femoral arterial route using 5F catheters: a femoral right heart study was done at the same time in 40 patients (20%). RESULTS: No patient had major complications during the study. Early ambulation was not allowed in two patients (1%) because of haematoma formation immediately after sheath removal, and in seven (3%) because of poor haemostasis or haematoma on inspection at 3 h. Early ambulation was interrupted in two patients (1%) because of transient arterial hypotension on standing in one, and the patient's preference in the other. Of 189 patients who resumed full ambulation at 3 h, one (0.5%) had a groin haematoma on discharge the next morning. Overall, haematoma 12 h after cardiac catheterisation was present in seven of the 200 patients initially included in the study (3.5%). None of the 191 patients with attempted early mobilisation had signs or symptoms of vascular complications one month or later after discharge. CONCLUSION: Supervised resumption of ambulation 3 h after uncomplicated cardiac studies with 5F femoral arterial catheters is safe and feasible in most ambulant patients undergoing elective cardiac catheterisation.

[Emergency angioplasty in high-risk acute infarct]. / Angioplastica d'emergenza nell'infarto acuto ad alto rischio.

BACKGROUND: Primary coronary angioplasty in acute myocardial infarction yields superior results in terms of effective vessel patency, recurrent ischemia and acute morbidity, as compared to intravenous thrombolysis. Despite obvious logistic and economic limitations, this early invasive approach could be strictly indicated in selected groups of patients. AIM: A prospective study to test the immediate and short-term results of an early invasive strategy with angioplasty in patients with high-risk acute myocardial infarction. METHODS: Forty-one consecutive patients with high-risk acute myocardial infarction were submitted to coronary angiography and angioplasty of the involved vessel within 12 hours of onset of symptoms. Twenty-eight had anterior myocardial infarction and 6 were in cardiogenic shock. RESULTS: Primary success was achieved in 38 patients (93%): 30 of these were discharged without complications or further revascularization procedures, and none has symptoms or re-infarction at one-month follow-up. CONCLUSIONS: Immediate invasive treatment with angioplasty in high-risk acute myocardial infarction seems to achieve good results, due to both effective infarct vessel recanalization, and early identification of candidates to urgent complete surgical revascularization.

[Quality assurance and cost control in invasive and interventional cardiology]. / Quality assurance e controllo dei costi in cardiologia invasiva ed interventistica.

We report our experience of Quality Assurance in a Cardiac Catheterization Laboratory of the National Health Service. An attempt was made to apply these criteria to the medical activities as well as to the management and economic aspects of our work. Limits and perspectives of this experience are discussed as a contribution to ongoing debate among cardiologists and public health Authorities.

[Elective coronary angioplasty in total absence of heart surgery]. / Angioplastica coronarica elettiva in totale assenza di cardiochirurgia.

BACKGROUND: One-hundred consecutive procedures of elective coronary angioplasty were attempted in 95 patients, in the absence of any surgical stand-by. All patients had angina and/or signs of inducible ischemia. METHODS: All patients and attending physicians were informed that no surgical coverage was available, and gave their consent. The choice was made on the basis of the estimate, on clinical and angiographic grounds, of the consequences of vessel occlusion, of the possible help offered by percutaneous bail-out techniques, and of the applicability of surgical stand-by. RESULTS: A primary success was achieved in 92 cases: in 5 cases a Palmaz-Schatz stent was implanted. In 6 cases the procedure was unsuccessful, with no complications. Two patients sustained a myocardial infarction without new Q-waves. No patient died, nor underwent cardiac surgery within 1 month of discharge. CONCLUSIONS: Our initial experience suggests that, in the absence of surgical stand-by, elective coronary angioplasty can be performed in selected patients at an acceptable risk.

[Diagnostic hemodynamics in day-hospital care]. / Emodinamica diagnostica in regime di day-hospital.

Our initial experience with 180 consecutive cases of transfemoral cardiac catheterization in ambulatory patients is presented. It accounts for 21% of 864 diagnostic cardiac catheterization procedures in our laboratory in the first 12 months of activity. There were no complications. Patient satisfaction was high, and a substantial reduction of unnecessary overnight admissions in the cardiology ward could be achieved. This confirms the safety and the advantages of this practice. Implications for the organization of the Catheterization Laboratory are also discussed, as well as possible causes for the sofar limited use of ambulatory cardiac catheterization in our country.