ABSTRACT
We report a case of giant aneurysm of left main coronary artery in a patient with coronary artery disease (CAD).
Subject(s)
Coronary Aneurysm/diagnostic imaging , Contrast Media , Coronary Angiography , Diagnosis, Differential , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Persistent Left Superior Vena Cava (PLSVC) is the most common thoracic venous anomaly encountered during device implantation. The most common problems related to the unusual anatomic access to the heart are reaching a convenient pacing site and ensuring stable lead placement. This report describes left sided implantation of RA, RV and LV leads in a patient with a PLSVC who was referred for cardiac resynchronizaiton therapy. The literature regarding the interventional approach for device implantation in patients with PLSVC is reviewed.
Subject(s)
Heart Failure/therapy , Pacemaker, Artificial , Vena Cava, Superior/abnormalities , Contrast Media/administration & dosage , Fluoroscopy , Humans , Male , Middle AgedABSTRACT
Radial artery spasm is a frequent complication of the transradial approach for coronary angiography and angioplasty. Recently, we have been able to quantify spasm using the automatic pullback device. The objective of this study was to assess the efficacy of an intra-arterial vasodilating cocktail in reducing the incidence and severity of radial artery spasm. A hundred patients undergoing coronary procedures via the radial artery were divided into two groups of 50 each. Patients in group A received intra-arterial cocktail (5 mg of verapamil plus 200 micro g nitroglycerine in 10 ml of normal saline), while patients in group B did not receive any vasodilating drug. The pullback device was used for sheath removal at the end of the procedure. Seven (14%) patients in group A experienced pain (i.e., pain score of III-V) during automatic sheath removal, as compared to 17 (34%) in group B (P = 0.019). The mean pain score was significantly lower in group A than in group B (1.7 +/- 0.94 vs. 2.08 +/- 1.07; P = 0.03). The maximal pullback force (MPF) was also significantly lower for group A (0.53 +/- 0.52 kg; range, 0.10-3.03 kg) as compared to group B (0.76 +/- 0.45 kg; range, 0.24-1.99 kg; P = 0.013). Only 4 (8%) patients in group A had an MPF value greater than 1.0 kg, suggesting the presence of significant radial artery spasm, as opposed to 11 (22%) in group B (P = 0.029). Administration of an intra-arterial vasodilating cocktail prior to sheath insertion reduces the occurrence and severity of radial artery spasm.