Pigtail catheter fracture and embolization into the abdominal aorta: an extremely rare angiographic complication.

Coronary angiography is a widely used diagnostic method for coronary artery disease. In clinical practice, although complications of the procedure often involve the vascular access point, there is no previous report of the fracture and embolization of the distal tip of a pigtail catheter. Herein, we present the case of a 51-year-old woman whose left ventriculography was interrupted by fracture of the curved tip of a pigtail catheter, which remained at the renal artery level in the abdominal aorta.

Sustainability in the cardiac cath lab.

Use of radiation for medical examinations and test is the largest man-made source of radiation exposure. Interventional procedures are only 2% of all radiological procedures, but contribute to about 20% of the total collective dose per head per year. On average, a left ventriculography and coronary angiography corresponds to a radiation exposure for the patient of about 300, a coronary stent to 1,000, a peripheral artery intervention to 1,500 to 2,500, and a cardiac radiofrequency ablation to 900-1,500 chest x-rays. Invasive cardiology procedures increased tenfold in the last ten years and growth in the field has been accompanied by concern for the safety of the staff. Interventional cardiologists have an exposure per-head per year two- to three times higher than that of radiologists, with an annual exposure equivalent to around 250 chest x-rays per head. A reduction of occupational doses by a factor of ten can be achieved simply by and intensive training program. The awareness of radiation effects may be suboptimal in the medical community. It is recommended by professional guidelines and reinforced by the European law that the responsibility of all physicians is to minimize the radiation injury hazard to their patients, to their professional staff and to themselves.

O que é necessário saber sobre bloqueio de ramo esquerdo (BRE) e ressincronização cardíaca artificial / What is relevant to know about left bundle branch block and artificial cardiac resynchronazation

Cresce o número de estudos documentando a eficácia e a segurança da ressincronização cardíaca no tratamento da insuficiência cardíaca em pacientes com disfunção sistólica e bloqueio de ramo esquerdo. Esse distúrbio de condução provoca assincronia de contração do ventrículo esquerdo que, por sua vez, leva a retardo de contração entre o septo e a parte posterior, queda da fração de ejeção e piora da sintomatologia. A indicação precisa da ressincronização cardíaca deve ser precedida por análise adequada, por meio de ecocardiografia e ventriculografia radioisotópica.

Radiation dose exposure during cardiac and peripheral arteries catheterisation.

BACKGROUND: Ionising radiation carries an oncogenic risk which is linearly related to the dose. An estimation of the effective dose can be obtained from the measurements of the dose-area product (DAP), which is a measure of stochastic risk and a potential quality indicator. AIM: To assess radiation exposure of patients in a large volume cardiac cath-lab. METHODS: A retrospective analysis of adult cardiac and peripheral percutaneous procedures (April to December 2004) was carried out to determine the DAP and estimated risk of malignancy. We identified 6 groups: Group 1 (n=100, coronary angiography and ventriculography); Group 2 (n=50, carotid stenting); Group 3 (n=50, aortography+coronary angiography+ventriculography); Group 4 (n=100, inferior extremities angiography+predilatation and stenting); Group 5 (n=100, coronary angiography+ventriculography+direct coronary stenting); Group 6 (n=100, coronary angiography+ventriculography+coronary predilation and stenting). Dose-area product meter attached on the X-ray unit was used for the estimation of the radiation dose received by the patient during the procedures. RESULTS: DAP values (mean+/-S.D.) ranged from 41+/-30 Gy cm2 in Group 1 (lowest) to 118+/-89 Gy cm2 in Group 6 (highest). Within each group, individual radiation exposure varies substantially: from 11 to 200 Gy cm2 in Group 1, and from 30 to 733 Gy cm2 in Group 6 patients. Average exposure in a Group 6 patient corresponds to a risk of mortality from a malignancy of about 1 in 1000. CONCLUSION: The radiation dose varies substantially across different types of procedures and up to tenfold within the same procedure. The enhanced knowledge of radiation dose might help the cardiologist to implement radiation sparing procedures eventually minimizing patient and operator radiation hazards in invasive cardiology.

Dipyridamole thallium imaging in patients being considered for vascular procedures.

We routinely performed intravenous dipyridamole thallium imaging and resting radionuclide ventriculography on 190 patients being considered for elective vascular procedures. Patients with thallium redistribution underwent coronary arteriography. Patients in group 1 (n = 78) had clinical evidence of coronary artery disease, and patients in group 2 (n = 112) had no history or electrocardiographic evidence of coronary artery disease. The frequency of thallium redistribution was not significantly different in the two groups (45% in group 1 and 46% in group 2). Coronary arteriography identified severe three-vessel or left main disease in eight patients (10%) in group 1 and 16 patients (14%) in group 2. Selection of patients for dipyridamole thallium imaging prior to vascular reconstruction should be based on whether or not documentation of the extent of coronary artery disease would influence therapy rather than on clinical indicators of coronary disease.