Early mobilization after percutaneous catheterization and vascular closure with a novel device (Star-Close).

Arteriotomy closure devices used to obtain hemostasis at the end of cardiac catheterization represent a valid alternative to manual compression. We are the first to report on a series of 60 patients in whom a novel system was used, Star-Close, which obtains vessel closure by deployment of a clip at the puncture site. Subsequent early (2 hours) mobilization was obtained in 55 patients (92%). Unsuccessful device deployment occurred in 5 patients. We conclude that Star-Close is a novel arteriotomy closure device that, in selected patients, is safe and allows early deambulation after diagnostic cardiac catheterization.

Complication with an embolic protection device during carotid angioplasty.

A case of carotid artery stenting with an AngioGuard cerebral protection device is described in a patient with tight internal carotid stenosis. Deployment of AngioGuard induced sudden severe vasospasm, with subsequent minor stroke. According to our observations, AngioGuard may cause a vasospastic response with adverse neurologic effects.

[A fistula between the coronary artery and peripheral branches of the pulmonary artery: a case report]. / Fistola tra circolo coronarico e polmonare periferico: un caso clinico.

Coronary artery fistulas are occasionally found in patients who undergo a coronary angiography and they may involve any epicardial coronary artery; the natural history in asymptomatic adult patients is unknown. Besides the invasive diagnosis with cardiac catheterization, it is possible to detect significant coronary fistulas also with different non-invasive methods, but they need the presence of shunt of enough size. Therapeutic options can be surgical or percutaneous. The demonstration of a communication between the coronary and distal tract of the pulmonary artery is difficult to explain with the embryogenic theory. We report the case of a patient with aortic stenosis and a shunt between the distal tract of the left pulmonary artery and the circumflex coronary artery.

Gender differences in left ventricular function in patients with isolated aortic stenosis.

BACKGROUND AND AIM OF THE STUDY: Hypertrophic response of the left ventricle to systolic overload in aortic stenosis appears to be gender-dependent. METHODS: To examine gender-related differences in left ventricular (LV) function in patients with isolated severe aortic stenosis, 145 patients (65 women, 80 men; mean age 66 +/- 8 years; range: 50 to 89 years) with aortic valve area <0.8 cm2 who underwent cardiac catheterization were studied. No patient had associated myocardial, coronary or other valve disease; patients with diabetes mellitus and systemic hypertension were excluded. RESULTS: No significant differences were seen in aortic valve area between men and women. Neither were there any significant gender-related differences in LV end-systolic and end-diastolic volumes, LV end-diastolic pressure, LV mass indexed by body surface area, LV mass:volume ratio, LV mass:height ratio, elastic stiffness constant, ejection fraction, pulmonary wedge pressure, pulmonary arteriolar resistance and preload. Women showed significantly higher mean transaortic gradient, LV peak systolic pressure and peak systolic stress, end-systolic stress:end-systolic volume ratio, heart rate and cardiac index. In the subgroup of patients with LV pressure >199 mmHg, the mass:volume ratio was increased in men compared with women; of note, the mass:volume ratio in women was not increased in this subgroup compared with the general population. LV pump function in this subgroup was normal and did not differ between men and women. CONCLUSION: Although no clear-cut difference in hemodynamic parameters was seen, there was a trend towards a less compensatory increase in LV mass in females.

Percutaneous retrieval of a broken catheter from the left atrium in an adult.

We performed a percutaneous retrieval of a broken catheter from the left atrium in an adult patient using transseptal left heart catheterization and a helical basket guidewire. To our knowledge, this is the first description of such a therapeutical option for a foreign body lodged in the left atrium of an adult patient.

Neurohormones in mitral stenosis before and after percutaneous balloon mitral valvotomy.

BACKGROUND AND AIM OF THE STUDY: The hormonal response to percutaneous balloon mitral valvotomy (PBMV) has been described in patients in sinus rhythm (SR) and with atrial fibrillation (AF). The study aim was to evaluate the effect of hemodynamic parameters and PBMV on atrial natriuretic factor (ANF) secretion and plasma renin activity (PRA) in mitral stenosis in SR and AF. METHODS: Thirty-one patients (26 females, five males; mean age 50.5+/-14 years) with pure rheumatic mitral stenosis underwent PBMV. Fourteen patients had AF, and 17 were in SR. PRA and ANF were measured 24 h before, and at 30 and 60 min, 24 h and one month after PBMV, after resting in a supine position for > or =2 h. Digitalis and diuretics were withdrawn 48 h before sampling; neither had patients received ACE inhibitors or beta-blockers during the previous month. RESULTS: PBMV was successful in all cases, without complication. Mitral valve area was increased and wedge pressure decreased in both groups after PBMV. In AF patients, neither PRA nor ANF were significantly affected before and after PBMV; in SR patients, ANF was decreased and PRA increased significantly, notably 24 h after PBMV. The cardiac index was increased in both groups, but was distinctly lower in AF patients both before and after PBMV. CONCLUSION: Despite similar hemodynamic results, reversal of the hormonal pattern after PBMV occurred only in SR patients, most likely because in AF patients a low cardiac index elicits a hormonal response similar to heart failure. This abnormal hormonal pattern may limit functional recovery after PBMV; hence, PBMV is best attempted while patients are still in SR.

Emergency stenting of the unprotected left main coronary artery.

We report a case of successful stenting of the unprotected left main coronary artery as a salvage procedure in a patient with tight ostial left main coronary artery stenosis who had cardiac arrest following diagnostic coronary angiography.

Refractory angina with severe left ventricular dysfunction: a case for percutaneous transseptal ventricular assistance supported revascularization.

A 73-year-old female patient with medical refractory angina, severe multivessel disease and a critically depressed left ventricular function (ejection fraction 30%) was admitted to our hospital. Considered a poor candidate for surgical revascularization, she underwent urgent high-risk revascularization supported by use of a novel percutaneous left ventricular assist system.