RESUMO
BACKGROUND: Surgery or fibrinolysis is the currently available evidence-based treatment for obstructive mechanical valve thrombus. We reported the feasibility and short-term outcomes of percutaneous transcatheter therapy with cerebral embolic protection. Mid- and long-term outcomes remain unknown. METHODS: From 2020 to 2023, 24 patients underwent percutaneous transcatheter release of stuck leaflets with cerebral embolic protection for obstructive mitral mechanical valve thrombus. The indications for the transcatheter therapy were failed fibrinolysis, contraindications for fibrinolysis, not willing for fibrinolysis, or high risk for surgery. The study participants were followed up for a median period of 344.50 (65.00-953.75) days. RESULTS: Technical success was achieved in 91.67% (n=22) of procedures. During the follow-up, 12.50% (n=3) all-cause death, 4.17% (n=1) stroke, and 16.67% (n=4) recurrence were seen. The mean survival time free from death was 1101.48 (95% CI, 929.49-1273.47) days, stroke was 1211.38 (95% CI, 1110.40-1312.35) days, and recurrence was 907.71 (95% CI, 760.20-1055.21) days. CONCLUSIONS: Transcatheter release of the stuck mitral mechanical valve with cerebral embolic protection is an alternative therapy with promising mid-term outcomes where surgery or fibrinolysis is not possible or in failed fibrinolysis subsets.
Assuntos
Cateterismo Cardíaco , Dispositivos de Proteção Embólica , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Embolia Intracraniana , Valva Mitral , Humanos , Masculino , Feminino , Valva Mitral/cirurgia , Valva Mitral/fisiopatologia , Valva Mitral/diagnóstico por imagem , Idoso , Embolia Intracraniana/prevenção & controle , Embolia Intracraniana/etiologia , Embolia Intracraniana/mortalidade , Embolia Intracraniana/diagnóstico por imagem , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/mortalidade , Pessoa de Meia-Idade , Fatores de Tempo , Fatores de Risco , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/mortalidade , Resultado do Tratamento , Estudos Retrospectivos , Idoso de 80 Anos ou mais , Recidiva , Desenho de Prótese , Trombose/prevenção & controle , Trombose/etiologia , Trombose/mortalidade , Trombose/diagnóstico por imagem , Estudos de Viabilidade , Falha de Prótese , Medição de RiscoRESUMO
Although pulmonary hypertension (PH) is widely prevalent in India, care delivery for this condition has unique challenges in a lower middle-income country (LMIC). To describe care delivery for patients with PH and associated barriers in India. We interviewed physicians across eight healthcare systems in India about PH clinical care using semi-structured enquiries to understand care delivery and associated challenges in their specific practice as well as the associated health system. Qualitative analysis was performed using content analysis methodology. Physicians reported that common causes for PH in their practice were rheumatic mitral valve disease, coronary artery disease, and congenital heart disease (CHD). No center had a dedicated PH program. Only one center had a specific protocol for PH management. Diagnostic evaluations were limited, and right heart catheterizations were recommended for patients with CHD. Pulmonary vasodilator therapy was used for severe symptoms or markers of severe disease. Agents used to treat PH were widely variable across physicians and prostacyclins are unavailable in India. Barriers included limited training in PH for physicians, lack of consensus guidelines for PH specific to LMIC, and lack of financial incentives for health care systems to organize dedicated PH programs. Other barriers included poor patient health literacy and socioeconomic barriers that limit ability to test and treat PH. PH care delivery in India is variable with widely differing clinical practices. Dedicated training in PH management and establishing guidelines specific to LMIC like India can form the first step forward.
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BACKGROUND: There are published reports of safety and feasibility of percutaneous coronary intervention (PCI) without contrast, using intravascular ultrasound (IVUS) and coronary physiology guidance in chronic kidney disease population. We prospectively evaluated the safety and feasibility of zero-contrast PCI technique. METHODS: In this prospective study, we hypothesized that PCI is feasible without contrast, using IVUS guidance alone without mandatory coronary physiology to rule out slow-flow or no-flow at the end of PCI in a population at risk of contrast-induced acute kidney injury (CI-AKI). In this study, we included 31 vessels in 27 patients at risk of CI-AKI and assessed the primary outcome of technical success at the end of PCI. Major adverse cardio-cerebro vascular events (MACCE) and percent change in estimated glomerular filtration rate(eGFR) one month after PCI were the secondary outcomes of the study. RESULTS: The primary outcome was met in 87.1%(n = 27) of the procedures. Technical failure was seen in 12.9%(n = 4) of the procedures. None of the patients developed MACCE at one-month follow-up. The median percent change in eGFR at one-month follow-up was -8.19%(-24.40%, +0.92%). There was no newer initiation of renal replacement therapy at one-month follow-up. CONCLUSIONS: Zero-contrast PCI is safe and feasible in selective coronary anatomies with IVUS guidance. Coronary physiology is not mandatory to rule out slow-flow or no-flow at the end of procedure. Contrast may be needed to tide over the crisis during the possible complications, namely slow-flow, geographical miss and intraprocedural thrombus.
Assuntos
Injúria Renal Aguda , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/diagnóstico , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Estudos de Viabilidade , Humanos , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Estudos Prospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodosRESUMO
AIMS: Established, evidence-based measures of radiation are required to minimise its hazards, while maintaining adequate image quality. The aim of this study is to evaluate radiation data and generate reference radiation levels for commonly performed coronary catheterisation procedures in India. METHODS AND RESULTS: In this prospective, observational study, all procedures were performed in accordance with the established standards using Innova IGS 520/2100-IQ catheterisation laboratories. Demographic, procedural and radiation data were collected. Dose reference limits (DRL) were established as the 75th percentile of the total distribution. There were 2,906 coronary angiograms (CAG), 750 percutaneous coronary interventions (PCI) and 715 CAG+PCI. DRLs for dose area product were: 19.6 Gy·cm2 for CAG, 49.8 Gy·cm2 for PCI and 72.0 Gy·cm2 for CAG+PCI, respectively. Median cumulative air kerma levels were: 185 mGy for CAG, 533mGy for PCI, and 891 mGy for CAG+PCI. Male gender, higher BMI, combining CAG+PCI, fluoroscopy time, number of cine frames, and image acquisition settings were significant contributors to increased radiation dose. CONCLUSIONS: This study established reference radiation dose levels for diagnostic and interventional coronary procedures in India, which were comparable to and in the lower range of international standards.
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Abstract In India and México, cardiovascular diseases are the first cause of death and potential years of life lost. Close similarities exist between these two countries when facing the difficulties to establish a universal reperfusion program for ST elevation myocardial infarction (STEMI). This paper describes the situation of STEMI treatment in both countries, and examines the lessons that Mexico's health care system could adopt from the recent advances accomplished by the STEMI initiative in India. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Published by Masson Doyma México S.A. This is an open access article under the CC BY-NC-ND license (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Resumen En India y México, las enfermedades cardiovasculares constituyen la primera causa de muerte y pérdida de años potenciales de vida. Existen similitudes cercanas entre estos 2 países en cuanto a las dificultades a enfrentar al establecer un programa de reperfusión universal para el infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Este artículo describe la situación del tratamiento del IAMCEST en ambas naciones y explora las lecciones que el sistema de salud de México podría adoptar de los recientes avances logrados por la iniciativa STEMI India. © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. Este es un artículo Open Access bajo la licencia CC BY-NC-ND (https://creativecommons.org/licenses/by-nc-nd/4.0/)
Assuntos
Humanos , Reperfusão Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Índia , MéxicoRESUMO
Patent hemostasis technique is used with the trans radial (TR) band to prevent radial artery occlusion following diagnostic coronary angiogram or percutaneous coronary intervention using radial artery access. We report epidermal bulla as a complication of TR band usage and a modified patent hemostasis technique using barbeau test to prevent this complication.
Assuntos
Vesícula/etiologia , Epiderme/patologia , Técnicas Hemostáticas/efeitos adversos , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias , Vesícula/diagnóstico , Humanos , Artéria RadialRESUMO
Percutaneous coronary intervention (PCI) is often denied for individuals with coronary artery disease who are prone to develop contrast-induced acute kidney injury. We report a 73-year-old, stage 3 chronic kidney disease patient (CKD), who underwent coronary artery bypass surgery and saphenous vein graft (SVG) stenting in the past, presented with in-stent restenosis (ISR) of SVG stent. Zero contrast optical coherence tomography (OCT) guided-PCI was successfully performed using low molecular weight dextran-40 (LMWD-40) as the flush medium. Our report suggests the safety and feasibility of LMWD-40-based OCT-guided zero contrast PCI in ISR of SVG in a CKD patient, although further prospective studies are needed to evaluate this technique.
Assuntos
Reestenose Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/métodos , Veia Safena/transplante , Stents/efeitos adversos , Tomografia de Coerência Óptica/métodos , Idoso , Meios de Contraste , Reestenose Coronária/diagnóstico , Vasos Coronários/cirurgia , Humanos , MasculinoRESUMO
In India and México, cardiovascular diseases are the first cause of death and potential years of life lost. Close similarities exist between these two countries when facing the difficulties to establish a universal reperfusion program for ST elevation myocardial infarction (STEMI). This paper describes the situation of STEMI treatment in both countries, and examines the lessons that Mexico's health care system could adopt from the recent advances accomplished by the STEMI initiative in India.
Assuntos
Reperfusão Miocárdica , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Humanos , Índia , MéxicoAssuntos
Angiografia por Tomografia Computadorizada/métodos , Aneurisma Coronário/diagnóstico , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Gerenciamento Clínico , Intervenção Coronária Percutânea/métodos , Guias de Prática Clínica como Assunto , Idoso , Aneurisma Coronário/cirurgia , Vasos Coronários/cirurgia , Feminino , Humanos , Imageamento Tridimensional , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
AIM: To assess the prevalence of suboptimal bioresorbable vascular scaffold (BVS, Abbott Vascular, Santa Clara, California) deployment in real world practice with intracoronary optical coherence tomography (OCT) imaging. METHODS: Consecutive patients who underwent percutaneous coronary intervention using BVS and the final optimization assessed with OCT imaging in two tertiary care centers between December 2012 and February 2015 were evaluated for parameters of suboptimal scaffold deployment by OCT. RESULTS: Overall, 36 scaffolds were implanted in 27 patients during this period. Mean age of the population was 54.7±8.2years and 19 (70.4%) were type B2/C lesions. The prevalence of parameters of suboptimal scaffold deployment were: underexpansion-22(61.1%), geographic miss-3(8.3%), tissue prolapse-7(25.9%), scaffold pattern irregularity-1(2.8%), longitudinal elongation-7(38.8%). Of the 7 overlaps imaged: excessive overlap was observed in 3 and scaffold gap in one. The median duration of follow up was 679days (range 193-963days). There were four events during this period. None were associated with suboptimal scaffold deployment. CONCLUSION: OCT based parameters of suboptimal scaffold deployment are common in real world scenario and were not associated with adverse outcomes on long term follow up. These findings need to be confirmed in larger studies.
Assuntos
Implantes Absorvíveis , Prótese Vascular , Angiografia Coronária/métodos , Intervenção Coronária Percutânea/métodos , Tomografia de Coerência Óptica/métodos , Prótese Vascular/tendências , Angiografia Coronária/tendências , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/tendências , Prevalência , Estudos Retrospectivos , Alicerces TeciduaisRESUMO
Macrophages transformed foam cell formation occurs as a result of leukocyte accumulation mediated through intercellular adhesion molecule 1 (ICAM1), vascular cell adhesion molecule 1 (VCAM1), and E-selectin, secreted by inflamed or damaged endothelium. The key molecule is the ICAM-1, member of the adhesion immunoglobulin super family that maps to chromosome 19 p13.2-p13.3 codes for 505 amino acids have five extracellular domains including circulatory leukocytes binding site (primarily monocytes) for recruiting it at the sites of inflammation and the tight adhesion with vascular endothelium for the above mentioned pathogenesis as an initial step. Hence the objective of the current paper is to review the Genome Wide Association (GWA) studies and summarizes its understanding of functional Single Nucleotide Polymorphism (SNP's) of ICAM-1 clinical association to provide better guidance for the clinicians and researchers of the merits, demerits of the current results and direct them to do research on larger number of population for better prospective.
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Endotélio Vascular/metabolismo , Estudo de Associação Genômica Ampla , Molécula 1 de Adesão Intercelular/genética , Polimorfismo de Nucleotídeo Único , Doenças Vasculares , Remodelação Vascular , Vasodilatação/fisiologia , Endotélio Vascular/fisiopatologia , Humanos , Molécula 1 de Adesão Intercelular/metabolismo , Estresse Oxidativo , Doenças Vasculares/genética , Doenças Vasculares/metabolismo , Doenças Vasculares/fisiopatologiaRESUMO
A 65-year-old gentleman was admitted with recurrent dyspnea. Two-dimensional and transesophageal echocardiography revealed a highly mobile echogenic mass attached to the tricuspid valve. A (99m)Tc lung perfusion scan was suggestive of pulmonary embolism. The patient underwent surgical resection of the mass. Histopathological examination revealed a papillary fibroelastoma.
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Procedimentos Cirúrgicos Cardíacos/métodos , Dispneia/diagnóstico , Fibroma , Neoplasias Cardíacas , Embolia Pulmonar/diagnóstico , Valva Tricúspide , Idoso , Diagnóstico Diferencial , Dissecação/métodos , Dispneia/etiologia , Dispneia/fisiopatologia , Fibroma/complicações , Fibroma/patologia , Fibroma/fisiopatologia , Fibroma/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/fisiopatologia , Humanos , Masculino , Recidiva , Resultado do Tratamento , Valva Tricúspide/patologia , Valva Tricúspide/cirurgiaRESUMO
Apical ballooning syndrome (Takotsubo cardiomyopathy) is an unusual stress-related reversible cardiomyopathy occurring commonly in postmenopausal females. Genetic etiology of this condition is uncertain. A 68-year-old female and her daughter aged 43 got admitted to our institute simultaneously with acute chest pain following demise of one of their close relative. Both had features typical of Takotsubo cardiomyopathy and recovered completely. This reports point to the possible genetic predisposition to this abnormality.
Assuntos
Predisposição Genética para Doença , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/genética , Idoso , Angiografia Coronária , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
A single coronary artery is a rare coronary anomaly. A 68-year-old male underwent coronary angiography for recent inferior wall myocardial infarction. It revealed a common coronary trunk arising from the right sinus of Valsalva and bifurcated into the right coronary artery (RCA) and anterior descending coronary arteries. The RCA, after its usual distribution in the right atrioventricular groove, continued as the left circumflex artery in the left atrioventricular groove. There were significant stenoses in the mid and distal RCA, which were treated percutaneously.
Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Cardiopatias Congênitas/diagnóstico , Infarto Miocárdico de Parede Inferior/diagnóstico , Seio Aórtico/anormalidades , Idoso , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Cardiopatias Congênitas/complicações , Humanos , Infarto Miocárdico de Parede Inferior/etiologia , Masculino , Intervenção Coronária Percutânea , Seio Aórtico/diagnóstico por imagemRESUMO
Posterior mitral leaflet aneurysm is a very rare complication of infective endocarditis. A 28-year-old athlete got admitted with fever, congestive heart failure and multi-organ dysfunction syndrome. The echocardiogram showed large aneurysm of the posterior mitral leaflet with severe mitral regurgitation. Patient succumbed to refractory heart failure.
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Endocardite/complicações , Aneurisma Cardíaco/etiologia , Doenças das Valvas Cardíacas/etiologia , Insuficiência da Valva Mitral/etiologia , Valva Mitral , Adulto , Evolução Fatal , Aneurisma Cardíaco/complicações , Aneurisma Cardíaco/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Masculino , Insuficiência da Valva Mitral/complicações , UltrassonografiaAssuntos
Aneurisma da Aorta Torácica/diagnóstico , Dissecção Aórtica/diagnóstico , Ruptura Aórtica/diagnóstico , Derrame Pleural/etiologia , Idoso , Dissecção Aórtica/complicações , Dissecção Aórtica/terapia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/terapia , Ruptura Aórtica/complicações , Ruptura Aórtica/terapia , Humanos , Masculino , Derrame Pleural/diagnóstico , Derrame Pleural/terapiaAssuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Embolectomia/métodos , Neoplasias Cardíacas/complicações , Mixoma/complicações , Embolia Pulmonar/etiologia , Adulto , Angiografia/métodos , Biópsia por Agulha , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia/métodos , Feminino , Seguimentos , Átrios do Coração/patologia , Átrios do Coração/cirurgia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/cirurgia , Humanos , Imuno-Histoquímica , Mixoma/diagnóstico , Mixoma/cirurgia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Doenças Raras , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
Patients with acute myocardial infection are vulnerable in the early period for death and recurrent coronary events due to an underlying unstable coronary plaque. Stabilizing the vulnerable plaque is a key strategy in treating these high risk patients. Statins in high doses have proved their utility and safety in secondary prevention trials. Early initiations of statins are beneficial by way of their pleiotropic effects in stabilizing the vulnerable plaque and thus reducing coronary events and death.