Balloon Expandable Sheath for Transfemoral Aortic Valve Implantation: A Viable Option for Patients with Challenging Access

Background and Objectives

Transcatheter aortic valve replacement (TAVR) via femoral access is a new option for patients with severe aortic valve stenosis considered to be at high risk for conventional open‐heart surgery. This procedure requires peripheral arteries that are able to accommodate the large sheaths required for valve delivery. We present a series of patients with suboptimal vascular conditions, who received a self‐expandable vascular sheath.

Methods and Results

From January 2009 to September 2011, a total of 96 patients (43% male) were treated with the 18F Medtronic CoreValve (Medtronic, Minneapolis, MN, USA). The patients' average age was 82.5 ± 4.6 years, and the mean EuroSCORE was 29%. In eight cases, vascular conditions were inadequate either due to advanced atherosclerotic disease (n = 5, 62.5%), or an arterial diameter ≤7 mm (n = 3, 37.5%). Instead of the standard 18F sheath, a balloon‐expandable transfemoral introducer (SoloPath?‐Introducer, Onset Medical Corporation, Irvine, CA, USA) was delivered and removed without complications in all but one (87.5%) patient. In the last case, rupture of the right femoral artery occurred after removal of the sheath with the need of vascular surgery.

Conclusion

The SoloPath sheath is a feasible alternative to conventional sheaths for transfemoral TAVR patients with difficult femoral vascular access.

     

Percutaneous Extraction of an Abandoned Coiled Pacing Lead

Abandoning redundant pacing leads has been an accepted practice in most cases. Late migration of a lead is a rare, unpredictable, and potentially lethal complication of this approach and requires immediate removal. We report the case of an atrial pacing lead that had migrated and was found coiled in the right atrium. It was removed by a snare catheter via a femoral approach.     

Biological Changes on the Compressing Side of Orthodontic Teeth Stimulating by Soft laser

目的：研究在弱激光作用下接受正畸力作用的牙齿的压力侧出现的生物学变化，为临床应用弱激光加速牙齿移动提供理论依据。方法：实验动物分2组，每组20只。A组动物接受正畸力，B组动物除接受正畸力之外，还接受弱激光照射。采用免疫组化检测层连蛋白的组间表达变化，采用原位杂交检测RANKL(receptor activator of NF-kB ligand)mRNA的组间表达变化。结果：免疫组化结果表明，新生血管活跃的高峰期出现在接受正畸力的第7d。与A组相比，接受弱激光照射的B组呈现层连蛋白的高表达。同样，与A组相比，原位杂交检测发现在接受弱激光照射的B组中，正畸牙压力侧呈现RANKL mRNA的高表达。结论：弱激光照射后能够促进正畸牙压力侧血管新生(呈现层连蛋白高表达)，从而促进破骨细胞的分化激活。此外弱激光还能够促进破骨细胞活化因子RANKL的表达，增强正畸牙压力侧的破骨细胞的活性，加快骨改建。     

Patient Acceptance of the Implantable Cardioverter Defibrillator in Ventricular Tachyarrhythmias

Besides surgical problems, recipierifs of implantable cardioverter defibrillators (ICDs) are faced with psychological and social adjustments. Successful ICD therapy is influenced by the patients' perceived concerns regarding device, discharge, changes in life style, and complications. In order to assess patients' acceptance of the ICD, the psychological profile of 57 consecutive patients was evaluated using a specifically designed questionnaire and the State Trait Anxiety Inventory (STAI). The results showed that 20 patients staled fear of ICD discharge, 12 patients revealed physical discomfort due to the device, and limited quality-of-life occurred in 8 patients. Fifty-five of 57 patients answered that it was worth having an ICD device implanted, 30 (53%) patients returned to active life, and 56 (98%) would advise another patient to undergo implantation if necessary. Overall, there was only a slight, but insignificant, decrease in the level of anxiety within the total patient population after ICD implantation. However, a comparison of two subgroups indicated that the state of anxiety was significantly higher in patients < 50 years of age as well as in patients having received > 5 shocks versus those > 50 years of age and having experienced < 5 shocks. In general, the acceptance of the ICD as a tool in managing life-threatening ventricular tachyarrhythmias is high. Besides the increased survival rate, quality-of-life and patient acceptance are important criteria for successful ICD therapy.