ABSTRACT
A 27-year-old male with history of IV drug use and recurrent endocarditis necessitating bioprosthetic mitral and tricuspid valve replacements presented with 2 weeks of fevers and chest pain. ECG revealed inferior ST-elevation myocardial infarction and he was taken urgently to the cardiac catheterization laboratory. Coronary angiography revealed thrombotic occlusion of the distal right coronary artery (RCA) with no angiographic evidence of atherosclerotic disease. Aspiration thrombectomy was performed followed by rheolytic thrombectomy. Despite multiple attempts at thrombectomy, significant residual organized thrombus persisted in the distal RCA. Therefore, further thrombectomy was performed by placing a GuideLiner catheter (Vascular Solutions, Minneapolis, MN) deep within the right coronary artery near the bifurcation into the posterior descending and posterior left ventricular arteries. After repeat aspiration, there was significant improvement with thrombolysis in myocardial infarction 3 flow. Intravascular ultrasound of the RCA revealed a normal-appearing vessel without evidence of atherosclerotic disease and mild residual thrombus. The decision was made to not pursue stent placement, given the concern for a likely embolic source. Following the procedure, the patient's chest pain resolved and his ST-segments normalized.
Subject(s)
Cardiac Catheterization/instrumentation , Cardiac Catheters , Coronary Occlusion/therapy , Coronary Thrombosis/therapy , Embolism/therapy , Endocarditis, Bacterial/surgery , Gram-Positive Bacterial Infections/surgery , Heart Valve Prosthesis Implantation/adverse effects , Thrombectomy/instrumentation , Adult , Cardiac Catheterization/methods , Coronary Angiography , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/microbiology , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/microbiology , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Electrocardiography , Embolism/diagnostic imaging , Embolism/microbiology , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Enterococcus faecalis/isolation & purification , Equipment Design , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/microbiology , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Humans , Male , Recurrence , ST Elevation Myocardial Infarction/etiology , Substance Abuse, Intravenous/complications , Thrombectomy/methods , Treatment Outcome , Ultrasonography, InterventionalABSTRACT
OPINION STATEMENT: Stent thrombosis (ST) is an uncommon but highly morbid complication of percutaneous coronary interventions. The mechanisms leading to ST are heterogeneous, likely accounting for the variable timing and outcomes of ST. For the clinician, it is important to recognize major risk factors for ST, including discontinuation of dual antiplatelet therapy. Once ST occurs, management includes intensive antithrombotic and antiplatelet therapies. Newer antiplatelet agents may reduce the risk of ST and possibly minimize adverse outcomes after presentation with ST.
ABSTRACT
OBJECTIVES: Today, acute cardiac rejection is detected by endomyocardial biopsy, which harbours many risks. Thus, there is a necessity for less invasive methods. Since interleukin-2 (IL2) is over-expressed in acute graft rejection, we use radioactive DNA-fragments complementary to the mRNA of IL2 to detect graft rejection scintigraphically. METHODS: In a rat model of acute graft rejection, the oligonucleotide sequence complementary to the mRNA of IL2 is labelled with 99m-Technetium and injected intravenously. Scintigraphic and Geiger-counter activity of the transplants are evaluated and correlated with the current rejection classification of the International Society for Heart and Lung Transplantation (ISHLT). RESULTS: From the fourth postoperative day onwards, the scintigraphic images show a significant increase of radioactivity (p<0.05) in the rejected organs than in the accepted grafts. While scintigraphy is not significantly correlated with the standard rejections classification of the ISHLT, there is significant correlation between the ISHLT classification and radioactivity in the Geiger-counter analysis. CONCLUSIONS: Radioactively labelled anti-sense-oligonucleotides against mRNA of IL2 may be a promising approach for the detection of acute transplant rejection in vivo.
