Comparison of two different techniques for balloon sizing in percutaneous mitral balloon valvuloplasty: which is preferable?

BACKGROUND: Percutaneous balloon mitral valvuloplasty (BMV) is an important option for the treatment of mitral valve stenosis. The crux of this process is choosing the appropriate Inoue balloon size. There are two methods to do this. One is an empirical formula based on the patient's height, and other is to choose according to the maximal inter-commissural distance of the mitral valve provided by echocardiography. METHODS: The study, performed between January 2006 and December 2011, included 128 patients who had moderate to severe mitral stenosis and whose valve morphology was suitable for BMV. Patients were randomised into two groups. One group was allocated to conventional height-based balloon reference sizing (the HBRS group) and the other was allocated to balloons sized by the echocardiographic measurement of the diastolic inter-commissural diameter (the EBRS group). RESULTS: BMV was assessed as successful in 60 (92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p = 0.03). The mean of the calculated balloon reference sizes was significantly higher in the HBRS than in the EBRS group [26.3 ± 1.2 mm, 95% confidence interval (CI): 26.1-26.6 vs 25.2 ± 1.1, 95% CI: 25.0-25.4, respectively; p = 0.007]. Final mitral valve areas (MVA) were larger and mitral regurgitation (MR) gt; 2+ was less in the EBRS group (p = 0.02 and p = 0.05, respectively) CONCLUSIONS: EBRS is a method that is independent of body structure. Choosing Inoue balloon size by measuring maximal diastolic annulus diameter by echocardiography for BMV may be an acceptable method for appropriate final MVA and to avoid risk of significant MR.

What is better for predilatation in bioresorbable vascular scaffold implantation: a non-compliant or a compliant balloon?

OBJECTIVE: The bioresorbable vascular scaffold system (BVS) is a fully absorbable vascular treatment system. In this study, we aimed to compare the periprocedural effectiveness and long term results of non-compliant balloon (NCB) and compliant balloon (CB) systems, which are used for predilatation before BVS implantation. METHODS: One hundred forty-six BVS-treated lesions from 119 patients were retrospectively analyzed in the study. Patients with acute coronary syndrome, stable angina and silent ischemia were included in the study. Lesions and patients were categorized into the NCB and CB groups according to the type of balloon used for predilatation. NCB was implemented on 72 lesions (59 patients) and CB was implemented on 74 lesions (60 patients). The two groups were compared on terms of procedural features and both in-hospital and 1-year clinical follow-up results. Chi-square and independent sample t test were performed for statistical analysis. RESULTS: There was no significant difference between the two groups in terms of patient characteristics and lesion properties. The number of postdilated lesions was significantly higher in the CB group. Procedure time, fluoroscopy time, and contrast volume were significantly lower in the NCB group. At follow-up, one patient had myocardial infarction in the CB group because of scaffold thrombosis and no mortality was observed. CONCLUSION: Predilatation with NCB before BVS implantation reduces the need for postdilatation. In addition, use of NCB reduces the procedure time, fluoroscopy time, and contrast volume but had no effect on 1 year clinical follow-up results compared with CB.

Thrombosed left circumflex artery aneurysm presenting with myocardial infarction.

Coronary artery aneurysms are life-threatening conditions that are quite uncommon in adults. They are observed in 1.1% to 4.9% of patients undergoing coronary angiography. They are usually located in the right coronary artery, may sometimes be thrombosed or rupture, and occasionally reach an enormous size leading to compressive symptoms. We report a case of thrombosed left circumflex artery aneurysm presenting with myocardial infarction. The thrombosed aneurysm, which could not be clearly demonstrated by coronary angiography, was definitively diagnosed by coronary computed tomography angiography. No operation was planned owing to total thrombosis of the aneurysm.

The importance of contrast volume/glomerular filtration rate ratio in contrast-induced nephropathy patients after transcatheter aortic valve implantation.

BACKGROUND/AIM: Transcatheter aortic valve implantation (TAVI) is a method which is increasingly applied in severe aortic stenosis treatment. The development of contrast-induced nephropathy (CIN) after TAVI increases morbidity and mortality rates. Within the scope of this study, the importance of the contrast medium volume to glomerular filtration rate (CV/GFR) ratio in determining the development of CIN and the amount of CV that could be applied was evaluated. METHODS: Seventy-two patients (aged 78.6 ± 11.6 years; 38 females) who underwent aortic valve replacement with the TAVI method between June 2013 and August 2014 were included in the study. CIN was defined as an absolute increase in serum creatinine of >0.5 mg/dl or a relative increase of >25% within 48-72 h after TAVI. CIN+ and CIN-patients were classified into two groups. The χ(2) test, t test, Mann-Whitney U test, ROC analysis, and univariate and multivariate regression analyses were applied for statistical analyses. RESULTS: CIN was detected in 16 patients (22%) in our study. Baseline creatinine, baseline GFR, the Mehran risk score, CV, and the CV/GFR ratio were determined as the predictive factors of CIN development. A CV/GFR ratio of 3.9 was specified to predict CIN development with 71% sensitivity and 80% specificity. CONCLUSION: After TAVI, CIN may develop due to various reasons. In patients to whom TAVI was applied, the CV/GFR ratio may be a guideline helping to prevent the development of renal pathologies. The amount of contrast medium that can be given to a patient can be calculated in terms of baseline GFR.

Comparison of floating wire and single wire techniques in right coronary ostial lesions in terms of procedural features and one-year clinical follow-up results.

OBJECTIVE: The floating wire technique is a special technique for solving interventional problems in aorta- ostial lesions. There are no long-term data in the literature for the floating wire technique in right aorto-ostial lesions. METHODS: One hundred twenty six patients were retrospectively analyzed in this study. All of these patients had a critical right coronary aorto-ostial lesion. The floating wire technique was performed on 64 patients, and the single wire technique was performed on 62 patients. The two groups were compared with each other in terms of lesional and procedural properties. Additionally, 1-year clinical follow-up results were compared between the two groups. RESULTS: There was no significant difference in terms of lesion properties between the groups. In the floating wire group, mean stent length, number of stents, mean procedure time, mean contrast volume, and mean fluoroscopy time were significantly lower than in the single wire group. At 1 year, 1 patient from each group had myocardial infarction, and no mortality was observed. In the floating wire group, the number of patients who experienced angina and the target lesion revascularization rate were both significantly lower than in the single wire group. CONCLUSION: The floating wire technique in right coronary ostial lesions provides a significant advantage over the single wire technique according to procedural and clinical follow-up results.

Medical treatment of an adult with uncorrected isolated interrupted aorta resulted in no complications after 4 years of follow-up.

PATIENT: Female, 56. FINAL DIAGNOSIS: Isolated adult interrupted aortic arch. SYMPTOMS: Headache • hypertension • left ventricular hypertrophy. MEDICATION: -. CLINICAL PROCEDURE: -. SPECIALTY: Surgery. OBJECTIVE: Congenital defects/diseases. BACKGROUND: Interrupted aorta is a rare congenital malformation defined as the lack of continuity between the ascending and descending parts of the aorta. CASE REPORT: This malformation was first described by Steidele in 1778. To date a few isolated adult interrupted aortic arch patients have been reported and most of them were treated surgically. However, there is not data about outcome of patients who decline surgery or who are not good candidates for surgery because of excessive risks, and there is not a data about how to follow these patients. CONCLUSIONS: Herein we present a case of adult type A isolated interrupted aorta followed-up for 4 years by medical therapy without complications.

Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery.

PATIENT: Male, 73 FINAL DIAGNOSIS: Coronary artery thrombosis Symptoms: Angina pectoris • short of breath MEDICATION: - Clinical Procedure: CABG Specialty: Cardiology. OBJECTIVE: Management of emergency care. BACKGROUND: Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. CASE REPORT: We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. CONCLUSIONS: In this case report, we emphasize the importance of the TEE during the preoperational period and during CABG, as well as in the preoperative evaluation of pulmonary hypertension.

Circumflex-to-bronchial artery fistula with saccular aneurysm.

We report a case of fistulous communication with two saccular aneurysms (9 mm and 7 mm) between the sinoatrial branch of the circumflex artery and the bronchial arteries.

H1N1 infection in Pregnancy: clinical course in two women.

Pregnant women are one of the major risk groups for disease related morbidity and mortality from influenza A (H1N1, swine flu) pandemic. Healthy pregnant women are supposed to have 4 to 5 fold increased rate of serious illness and hospitalization compared to non-pregnant subjects. Herein, the clinical course of novel influenza A (H1N1) infection in two pregnant women was presented. One woman expired due to delay in treatment, while the other one was discharged on day six after prompt treatment. We would like to emphasize that obstetricians should be aware of the clinical and radiological manifestations of influenza A for prompt diagnosis and treatment. Obstetricians also should prepare themselves to provide adequate care for pregnancy related complications encountered by pregnant women with H1N1 infection.

Are complex coronary lesions more frequent in patients with diabetes mellitus?

BACKGROUND: Coronary atherosclerotic burden is excessive in diabetic patients. Diabetes mellitus (DM) is an independent predictor for both death and myocardial infarction. It is not known whether the prevalence of complex coronary lesions, such as bifurcation and ostial lesions, is different in diabetics from nondiabetics. OBJECTIVE: The aim of present study was to investigate the prevalence of these lesions in patients with DM. METHODS: One thousand fourteen consecutive patients (mean age 61.3+/-10.7 years) were investigated. Coronary angiograms were examined for bifurcation and ostial lesions using a digital quantitative system. Patients were classified as diabetic (n=281) or nondiabetic (n=733). RESULTS: Patient mean age, and rates of hypertension and hyperlipidemia were significantly higher in the diabetic group than in the nondiabetic group (P<0.0001), although smoking was significantly lower (P=0.001). Reasons for coronary angiography and treatment were comparable between the two groups. The prevalence of bifurcation lesions and ostial lesions was significantly greater in the diabetic group than in the nondiabetic group (9.8% versus 4.3% [P=0.001] and 38.4% versus 29.2% [P=0.003] in the diabetic group versus the nondiabetic group). The presence of DM and greater age were found to be independent predictors for bifurcation lesions (OR=2.27 [P=0.004] and OR=1.03 [P=0.01], for DM and age, respectively) and ostial lesions (OR=1.40 [P=0.027] and OR=1.02 [P=0.001], for DM and age, respectively) in multivariate analysis. CONCLUSIONS: Complex coronary lesions such as bifurcation and ostial lesions were significantly more common in diabetic patients than in nondiabetic patients. Greater age and the presence of DM were independent predictors for these complex lesions. These results may help to explain the poor prognosis of coronary artery disease among diabetic patients.