Hospital Chronicles (E-Journal)
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Partially Protected Left Main Stenting in a Patient with Complete Obstruction of Left Internal Mammary Graft
Get PDFWe present a 59-year-old patient with a previous history of coronary artery bypass grafting (CABG) for left main and mid-left anterior descending (LAD) coronary artery disease with the use of left internal mammary artery (LIMA) and a radial graft six years ago. He performed a treadmill stress test which documented extensive ischemia in V2-V6 precordial leads with significant blood pressure drop. Coronary angiogram revealed complete obstruction of the LIMA and patent radial graft. The patient preferred percutaneous intervention (PCI) to CABG as a revascularization strategy. The procedure was guided by intravascular ultrasound. We implanted two drug eluting stents, the first one in the mid-LAD overlapped with the second one which covered the vessel up to the ostium of the left main. Significant plaque shift to the ostium of the left circumflex was treated with a kissing balloon techniqu
Shock After a Caesarian Section for Placenta Previa
Get PDFA 34-year-old lady, pregnant at 32 weeks of gestation, with a history of bronchial asthma treated with bronchodilators was admitted in the Obstetrics Department with uterus contractions and a tamponading placenta previa. She was initially treated with tocolytics and a caesarean section was planned three weeks later. After the caesarean section and the placenta excision, severe hemorrhage occurred which made a hysterectomy necessary... (excerpt
Optimal Timing of Coronary Angiography and Potential Intervention in Non-ST Elevation Acute Coronary Syndromes
Get PDFAn invasive approach is currently considered superior to medicalmanagement for the treatment of patients with non-ST elevation acute coronary syndromes (ACS) (NSTE-ACS). However, the optimal timing of coronary angiography and subsequent intervention, if indicated, i.e. immediately after admission or after pre-treatment with optimal medical therapy including potent antiplatelet agents, has not been settled. Thrombotic material in patients with unstable angina may increasethe risk of immediate coronary intervention and there is concern that adverse events such as myocardial infarction may be increased with routine early intervention. Thus, delayed catheterization to allow plaque passivation by pre-treatment with optimal antithrombotic medication has been proposed, particularly since the effectiveness of invasive strategies has been enhanced by the widespread use of glycoprotein IIb/IIIa inhibitors... (excerpt
Transcatheter Mitral Valve Repair: Is there a Future?
Get PDFMitral regurgitation (MR) is a common disease in developed countries, affecting an estimated 9.3% of the population aged ≥75 years. Although surgical valve repair or replacement is currently the “gold standard” treatment for severe symptomatic MR, almost one-half of the patients are denied surgery. These are usually older patients with moderate left ventricular dysfunction and several non-cardiac co-morbidities. The aim of transcatheter mitral valve repair is to provide a treatment that is at least as effective as conventional valve surgery, and is associated with less morbidity and mortality. Currently an important number of devices are under evaluation, and can be categorized according to the treatment strategy.... (excerpt
Novel Technique for Atrial Fibrillation Ablation: Use of Anatomically Designed Pulmonary Vein Ablation Catheter
Get PDFBACKGROUND: Catheter ablation of atrial fibrillation (AF) has been increasingly used in experienced electrophysiology centers. A novel ablation system delivering duty-cycled phased radiofrequency energy via an over-the-wire multipolar circular ablation catheter (PVAC™, Medtronic) to perform linear continuous ablation has been tested for isolation of pulmonary veins (PVs). Methods: Consecutive patients with indication for AF ablation have been included. Patients underwent PV isolation using the novel ablation system and the PVAC catheter. PV isolation was confirmed by mapping of PV potentials using the PVAC catheter demonstrating entrance and exit block. Success was defined as no AF (no documentation of AF episodes > 30 seconds during 7-day Holter EKG analysis and no symptomatic recurrences after a 3-month blanking period). Results: 152 patients (35 female) with a mean age of 55 (±12) years were included. 106 patients (70%) had paroxysmal and 46 patients (30%) persistent AF. During the ablation procedure, 594 out of 598 (99%) PVs were effectively isolated during a mean procedure duration of 100 (±26) min and radiation duration of 20 (±8) min. During a median follow-up of 6 months, 65% of paroxysmal patients and 47% of persistent AF patients had no AF documented after a single ablation procedure. Conclusions: Using a novel duty-cycled phased radiofrequency ablation system is effective and safe in treating AF patients. PV isolation can acutely be achieved in 99% of targeted veins. Mid-term success using a stringent criterion of no AF after a blanking period of 3 months is 65% for paroxysmal and 47% for persistent AF patients using mainly PV-isolation alone
Advances in Post-Resuscitation Care: the Role of Therapeutic Hypothermia
Get PDFMild therapeutic hypothermia (32°C – 34°C) is the only therapy that improved neurological outcome after cardiac arrest in randomized, controlled trials. It protects the brain after ischemia by reduction of brain metabolism, attenuation of reactive oxygen species formation, inhibition of excitatory amino acid release, attenuation of the immune response during reperfusion and inhibition of apoptosis. Its use is recommended by the American Heart Association and the International Liaison Committee on Resuscitation for unconscious adult patients with spontaneous circulation after out-of-hospital ventricular fibrillation cardiac arrest, 12 to 24 hrs following resuscitation. The role of therapeutic hypothermia is uncertain when the initial cardiac rhythm is asystole or pulseless electrical activity, or when the cardiac arrest is primarily due to a noncardiac cause, such as asphyxia or drug overdose. Therefore, in patients with anoxic brain injury after nonventricular fibrillation cardiac arrest, clinicians will need to balance the possible benefit of therapeutic hypothermia with the possible side effects of this therapy
Adalimumab-Associated Isolated Splenic Tuberculosis In A Patient With Psoriasis Following A Negative Screening With Tuberculin Skin Test And QuantiFERON-Gold
Get PDFWe describe a rare form of extrapulmonary tuberculosis and, to our knowledge, the first reported case of isolated splenic tuberculosis in association with adalimumab treatment. In addition, our case demonstrates that the interpretation of a negative tuberculin skin test may prove problematic even in otherwise healthy individuals with no predisposing factors, especially in the face of biologic treatment. A history of BCG vaccination in adulthood may pose additional burdens in the evaluation of such patients facing the risks of anti-TNF agents. As to QuantiFERON, further investigation is warranted in order to be incorporated in the screening for latent tuberculosis infection
Mid-ventricular obstructive hypertrophic cardiomyopathy
Get PDFMid-ventricular obstructive hypertrophic cardiomyopathy was diagnosed in a 72-year-old woman, referred to our hospital because of an episode of syncope. It was characterized by an abnormal ECG (ST segment elevation in leads V3 through V6 ) and the presence of pressure gradient between apical and basal sites in the left ventricle, asymmetric left ventricular hypertrophy and an apical aneurysm on echocardiography
Imaging of Cardiac Tumors and Masses
Get PDFObjective: As noninvasive imaging is gaining widespread acceptance, the aim of the present study was to review our experience with the use of cross sectional imaging modalities to evaluate cardiac tumors and masses. Background: Proper diagnosis of the type and extension of a cardiac tumor or mass is very important for therapy planning. Echocardiography has an established role as a non-invasive diagnostic imaging modality. Computed tomography (CT) and magnetic resonance imaging (MRI) also provide adequate delineation of cardiac tumors and masses. Methods: Twenty-two patients referred to our department with a suspected cardiac mass, previously detected by cardiac ultrasound, were evaluated by CT (12 patients) and MRI (4 patients). Six patients were examined by both modalities. In 2 cases of staging of a known primary neoplasm and one case of a suspected epicardiac lesion, positron emission tomography (PET-CT) was performed. The CT cardiac examinations were performed using a 16-slice multislice scanner with ECG gating. The MRI examination was performed on a 1.5 Tesla MRI scanner using an ECG-gated cardiac protocol and the PET-CT examination was performed on an integrated PET-CT four-slice scanner, using 370 mMBq of fluorodeoxyglucose. Results: Twenty-two cardiac masses were successfully detected and their characteristics adequately delineated, including eight myxomas, one angiosarcoma, one ventricular lymphoma, one endocardiac metastasis, one epicardiac paraganglioma, and 10 cases of intracardiac thrombi. Conclusion: CT and MRI are noninvasive imaging modalities which can delineate cardiac tumors and masses and provide essential information for adequate diagnosis, staging and treatment planning. Compared to cardiac ultrasound, CT and MRI are superior in preoperative planning. Key words: cardiac tumors, cross sectional imaging modalities, computed tomography, magnetic resonance imaging 
Thromboaspiration of Heavy Thrombotic Load Salvages Myocardium and Prevents the No-Reflow Phenomenon in Acute Myocardial Infarction
Get PDFThe combination of thromboaspiration of heavy thrombotic load, coronary stenting and use of a IIB/IIIA antiplatlet agent led to full mechanical recanalization and complete restoration of TIMI 3 blood flow to the right coronary artery and obviation of the no-reflow phenomenonin in a patient with acute inferior ST-elevation myocardial infarction