ABSTRACT
Coronary artery fistulae are rare anomalous connections arising from the coronary circulation. We report a case of anterior wall myocardial ischemia caused by the combination of sequential coronary-to-pulmonary artery fistula and moderate (50-60%) stenosis of the left anterior descending coronary artery. Ischemia was demonstrated by myocardial stress perfusion imaging as well as fractional flow reserve. Percutaneous coronary intervention of the lesion resulted in resolution of ischemia.
Subject(s)
Angina, Stable/therapy , Angioplasty, Balloon, Coronary , Arterio-Arterial Fistula/complications , Coronary Stenosis/therapy , Coronary Vessel Anomalies/complications , Coronary Vessels/physiopathology , Fractional Flow Reserve, Myocardial , Pulmonary Artery/physiopathology , Aged , Angina, Stable/diagnosis , Angina, Stable/etiology , Angina, Stable/physiopathology , Angioplasty, Balloon, Coronary/instrumentation , Arterio-Arterial Fistula/diagnosis , Arterio-Arterial Fistula/physiopathology , Coronary Angiography , Coronary Stenosis/complications , Coronary Stenosis/diagnosis , Coronary Stenosis/physiopathology , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/physiopathology , Coronary Vessels/diagnostic imaging , Drug-Eluting Stents , Humans , Male , Myocardial Perfusion Imaging/methods , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Severity of Illness Index , Tomography, Emission-Computed, Single-Photon , Treatment OutcomeABSTRACT
OBJECTIVE: To determine whether radial artery access is associated with a reduction in fluoroscopy time, procedure time, and other procedural variables over a 27-month period during which the radial artery approach was incorporated in a single academic Medical Center. BACKGROUND: Although previous studies have demonstrated a relationship between increased volume and decreased procedural time, no studies have looked at the integration of radial access over time. METHODS: Data were collected from consecutive patients who presented to the Vanderbilt University Medical Center cardiac catheterization laboratory from January 1, 2009 to April 1, 2011. Patients who underwent radial access diagnostic catheterization with and without percutaneous coronary intervention were included in this study. A total of 1112 diagnostic cardiac catheterizations through the radial access site were analyzed. High-volume, intermediate-volume, and low-volume operators were grouped based on the percentage of procedures performed through a radial approach. RESULTS: From 2009 to 2011, there was a significant decrease in fluoroscopy time in all operator groups for diagnostic catheterization (P=.035). The high-volume operator group had 1.88 and 3.66 minute reductions in fluoroscopy time compared to the intermediate- and low-volume operator groups, respectively (both P<.001). Likewise, the intermediate-volume operator group had a 1.77 minute improvement compared to the low-volume operator group, but this did not reach statistical significance (P=.102). The improvement in fluoroscopy time and other procedure-related parameters was seen after approximately 25 cases with further improvement after 75 cases. CONCLUSIONS: The incorporation of the radial access approach in the cardiac catheterization laboratory led to a decrease in fluoroscopy time for each operator and operator group over the last 3 years. Our data demonstrated that higher-volume radial operators have better procedure, room, and fluoroscopy times when compared to intermediate- and low-volume operators. However, lower-volume operators have a reduction in procedure-related parameters with increased radial cases. Number of procedures needed to become sufficient was demonstrated in the current study.
Subject(s)
Cardiac Catheterization/methods , Learning Curve , Radial Artery , Specialization , Aged , Fluoroscopy , Hospitals, High-Volume/statistics & numerical data , Hospitals, Low-Volume/statistics & numerical data , Humans , Middle Aged , Retrospective Studies , Time FactorsABSTRACT
Cardiac allograft vasculopathy is the most common cause of long-term graft failure in adult and pediatric heart transplant recipients. In the absence of a specific treatment for this condition, percutaneous revascularization has been the main palliative treatment in the adult population. Revascularization of pediatric patients, however, is more problematic secondary to the lack of a large pool of outcome data and the encounter of special technical challenges. We present the case of a 5-year-old girl who presented with severe cardiac allograft vasculopathy of her left main coronary artery and was treated with sirolimus stent placement.
Subject(s)
Coronary Stenosis/etiology , Coronary Stenosis/therapy , Drug Delivery Systems , Heart Transplantation/adverse effects , Sirolimus/administration & dosage , Stents , Child, Preschool , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Female , Humans , Treatment OutcomeABSTRACT
We present three patients with cryptogenic stroke who underwent transcatheter closure of a patent foramen ovale. All patients have had history of deep venous thrombosis and pulmonary embolism with placement of inferior vena caval filters. The patients were not initially considered suitable candidates for the procedure because of risk of dislodgment of previously implanted inferior vena cava filter.
Subject(s)
Heart Septal Defects, Atrial/therapy , Vena Cava Filters , Aged , Echocardiography , Female , Femoral Artery , Heart Septal Defects, Atrial/diagnostic imaging , Humans , Male , Middle Aged , Pulmonary Embolism/prevention & control , Ultrasonography, Interventional , Vena Cava, InferiorABSTRACT
Catheter-induced left main coronary artery dissection is quite rare. We describe two cases of iatrogenic left main coronary artery dissection. In the first case, the aortic root was involved in the dissection process, and stenting of the entry point did not halt the progression of dissection. In the second case, the dissection did not involve the aortic root.
Subject(s)
Aorta, Thoracic/pathology , Aortic Dissection/etiology , Cardiac Catheterization/adverse effects , Coronary Vessels/injuries , Aged , Disease Progression , Emergency Treatment , Humans , Iatrogenic Disease , Male , StentsABSTRACT
Organ malperfusion most commonly occurs in the acute stage of aortic dissection and is associated with a high mortality, but can occur with chronic dissection. We describe a case of a type 3 aortic dissection, which had a stenosed left renal artery originating from the false lumen and causing resistant hypertension. The left renal artery was successfully dilated and stented, with prompt resolution of the patient's hypertension.
Subject(s)
Aortic Aneurysm, Abdominal/surgery , Aortic Dissection/surgery , Renal Artery Obstruction/surgery , Stents , Aortic Dissection/complications , Aortic Dissection/diagnosis , Angiography, Digital Subtraction , Aortic Aneurysm, Abdominal/complications , Aortic Aneurysm, Abdominal/diagnosis , Blood Vessel Prosthesis Implantation , Cardiac Catheterization , Chronic Disease , Humans , Hypertension, Renal/diagnosis , Hypertension, Renal/etiology , Hypertension, Renal/surgery , Magnetic Resonance Angiography , Male , Middle Aged , Renal Artery Obstruction/complications , Renal Artery Obstruction/diagnosisABSTRACT
This is a case of a 65-year-old woman with a history of coronary artery disease, who presented with hypertension that was poorly controlled by medical treatment. A rotational abdominal aortogram was done, followed by selective right and left renal artery angiograms. Imaging of renal artery aneurysms can be tricky, and some aneurysms might be misdiagnosed for a tortuous renal artery. In such cases, the physician needs to maintain a high index of suspicion towards this condition. Three-dimensional reconstruction allows for a better visualization of the aneurysm and its surrounding structures. It also guides the operator to the projection that best reveals the anatomical criteria of the aneurysm.
