ABSTRACT
AIMS: We aimed to compare the diagnostic efficacy of serum cystatin C (sCyC) for contrast induced nephropathy (CIN) in Western Indians undergoing cardiac catheterization. We also aimed to propose a clinically applicable cut-off of sCyC for early identification of CIN in this ethnic group. METHODS: In this prospective study, 253 patients undergoing coronary angiography and/or percutaneous coronary intervention were enrolled. The demographic and risk factor details, levels of sCr at baseline, 24 and 48h after the procedure, whereas baseline and 24h levels of sCyC were noted. Increase of 0.5mg/dl or ≥25% from baseline sCr was used to define CIN. Optimum cut off of sCyC for CIN diagnosis was obtained using Receiver Operating Characteristic (ROC) curve analysis. RESULTS: After 48h of contrast media (CM) exposure, the incidence of CIN was 12.25% (31 patients) according to sCr definition, where only 3.9% (10 patients) had sCr rise in 24h. Overall significant (p<0.0001) rise in mean levels of sCr (48h) and sCyC (24h) was observed in CIN patients. However, the mean sCr rise at 24h was non-significant. The optimum cut off of sCyC for diagnosing CIN was found to be a rise of ≥10% from baseline (AUC - 0.901; sensitivity - 100%, specificity - 77.89%). According to sCyC, 94 (37.15%) patients had CIN. CONCLUSION: We may conclude that a rise of ≥10% in sCyC at 24h could be used as a reliable marker for identification of CIN in western Indians undergoing cardiac catheterization.
Subject(s)
Contrast Media/adverse effects , Coronary Angiography/adverse effects , Cystatin C/blood , Early Diagnosis , Kidney Diseases/diagnosis , Biomarkers/blood , Female , Humans , Incidence , India/epidemiology , Kidney Diseases/chemically induced , Kidney Diseases/epidemiology , Male , Middle Aged , Prospective Studies , ROC Curve , Reproducibility of ResultsABSTRACT
The closure of atrial septal defects through right-sided limited posterior thoracotomy has been well established in selected subsets. We present a case of large ostium secundum atrial septal defect, pulmonary valvar stenosis, absent right superior vena cava, and isolated left superior vena cava draining to right atrium via coronary sinus. The child successfully underwent total correction through limited posterior thoracotomy with necessary modifications of intraoperative steps.
Subject(s)
Abnormalities, Multiple , Cardiac Surgical Procedures/methods , Heart Defects, Congenital/surgery , Thoracotomy/methods , Echocardiography , Female , Heart Defects, Congenital/diagnosis , Humans , Infant , Tomography, X-Ray ComputedABSTRACT
A direct-fistula type communication between branch pulmonary artery (PA) to left atrium (LA), particularly left PA to LA, is a very rare congenital cardiopulmonary disorder. Although surgical repair is the conventional treatment, transcatheter device or coil closure is feasible in selected cases of a relatively frequent variant - right PA to LA fistula. Ours is the first case of successful transcatheter closure of a large left PA to LA fistula with Amplatzer duct occluder in a cyanotic neonate by transseptal approach.
Subject(s)
Cardiac Catheterization/methods , Fistula/therapy , Heart Atria/abnormalities , Heart Diseases/therapy , Pulmonary Artery/abnormalities , Septal Occluder Device , Angiography , Echocardiography , Fistula/diagnostic imaging , Heart Atria/diagnostic imaging , Heart Diseases/diagnostic imaging , Humans , Infant, Newborn , Pulmonary Artery/diagnostic imaging , Tomography, Spiral Computed , Treatment OutcomeABSTRACT
Large pulmonary arteriovenous fistula (PAVF) manifests as cyanosis and predisposes to serious complications of right-to-left shunt, and therefore necessitates early treatment. The emergence of antegrade transcatheter closure of feeding arteries as treatment of choice is limited by inherent risk of either recanalization or reappearance of new feeders and potential risk of systemic embolization. Additional closure of the draining vessel by transcatheter device occlusion should overcome the limitations of conventional antegrade technique. We describe two cases of successful transcatheter closure of a large PAVF by antegrade device closure of feeders as well as transseptal retrograde closure of the exiting channel.
Subject(s)
Arteriovenous Fistula/therapy , Catheterization, Swan-Ganz/methods , Pulmonary Artery/abnormalities , Therapeutic Occlusion/instrumentation , Adolescent , Angiography , Arteriovenous Fistula/diagnostic imaging , Catheterization, Swan-Ganz/instrumentation , Echocardiography , Female , Humans , Male , Middle Aged , Pulmonary Artery/diagnostic imaging , Therapeutic Occlusion/methods , Treatment OutcomeSubject(s)
Aorta/abnormalities , Cardiac Catheterization/methods , Cardiovascular Surgical Procedures/methods , Coronary Vessel Anomalies/surgery , Ductus Arteriosus, Patent/surgery , Heart Ventricles/abnormalities , Aorta/surgery , Child, Preschool , Coronary Vessels/surgery , Electrocardiography , Female , Heart Ventricles/surgery , Humans , Treatment OutcomeABSTRACT
Transcatheter closure of patent ductus arteriosus (PDA) using various occluders and coils via femoral vein is a well established therapeutic option. However, in patients with interrupted inferior vena cava (IVC) it is not feasible to close the PDA percutaneously using traditional methods. We present a nine-year-old girl with IVC interruption in whom percutaneous closure of PDA was successfully accomplished via the transjugular approach.
