RESUMO
BACKGROUND: Percutaneous mitral valve (MV) clipping for mitral regurgitation (MR) revolutionized MV repair; however, valve anatomies and pathologies vary. Often multiple clips are required, and predicting this pre-procedurally would be useful. We evaluated pre-procedural predictors for multiple clips. RESULTS: We retrospectively analyzed 127 severe MR patients treated by mitral clipping between January 2011 and August 2018. Patients were grouped according to the use of a single (group I) or multiple clips (group II) and pre-procedure echocardiographs compared. No demographic differences existed except group II had more males (68.1%) than group I (48.3%). Mean left atrial diameter was larger in group II, 51 ± 9 mm, than group I, 48 ± 5 mm, p = 0.026. Mean mitral annular diameter differed: 34 ± 4mm (group II) versus 33 ± 3 mm (group I), p = 0.017. The vena contracta was broader in group II than group I (6.6 ± 1 mm vs. 6 ± 0.9 mm, p = 0.001). Severe mitral annular calcification occurred more in group I (36.2%) than group II (10.1%), p = 0.0001. On multivariate analysis, vena contracta width correlated positively with multiple clips (B 0.125, p = 0.013), but severe annular calcification correlated inversely (B - 0.35, p = 0.002). CONCLUSIONS: Vena contracta width and severe annular calcification are factors to consider when planning MV clipping.
RESUMO
Coronary artery dissection is a known complication of percutaneous coronary intervention (PCI). Such dissections are often treated by antegrade PCI. When antegrade PCI fails, the options become limited to conservative management or coronary artery bypass grafting (CABG). CABG comes with its own risks, and conservative management can result in a potentially larger infarct. Here we present a novel use of retrograde chronic total occlusion (CTO) PCI techniques to treat an iatrogenic, type D dissection of the right coronary artery in a young male with an acute coronary syndrome. Reentrance of the true lumen by standard antegrade approaches failed. The rescue strategy using a retrograde CTO PCI approach not only had advantages over surgery and conservative management, but also over antegrade PCI. A soft wire, designed for collaterals, was used to "surf" the dissection and reach the antegrade guiding catheter. Thus, the true lumen could be used. This novel approach provided the advantages both of preserving major side branches, which are often lost with antegrade PCI approaches, and of not unnecessarily puncturing the dissection membrane.
RESUMO
BACKGROUND: Transradial artery (TRA) left heart catheterization is an increasingly used technique for both diagnostic and interventional coronary procedures. This study evaluates the incidence of access site complications in the current interventional era. METHODS AND RESULTS: A total of 507 procedures were performed under standardized conditions. Each procedure was performed using high levels of anticoagulation, hydrophilic sheaths, and short post-procedural compression times. Vascular complications were assessed one day after TRA catheterization using Duplex sonography and classified according to the necessity of additional medical intervention. A simple questionnaire helped identifying upper extremity neurologic or motor complications. Vascular complications were detected in 12 patients (2.36%): radial artery occlusion was detected in 9 patients (1.77%), 1 patient developed an AV-fistula (0.19%), and 2 patients had pseudoaneurysms (0.38%). None of the patients required specialized medical or surgical intervention. Under our procedural conditions, small radial artery diameter was the only significant predictor for the development of post-procedural vascular complications (2.11 ± 0.42 mm vs 2.52 ± 0.39 mm, p = 0.001). None of the previously reported risk factors, namely, advanced renal failure, diabetes, acuteness/complexity of procedure, or sheath and catheter size significantly influenced the rate of vascular complications. No major hematoma or local neurologic or motor complications were identified. CONCLUSIONS: Using current techniques and materials, we report a very low rate of local complications associated with TRA catheterization.
