Transcatheter closure of acquired left ventricle to right atrium shunts

We describe transcatheter closure of an acquired Gerbode defect (left ventricle to right atrium shunt) in four patients, ranging in age from 8 to 75 years. All of them had undergone previous surgery (VSD closure in 3, aortic valve replacement in 1), and either had persistent symptoms of heart failure, or developed new symptoms several months or years later. The diagnosis was made by one of several imaging modalities (transthoracic or transesophageal echocardiography, or MRI), and confirmed at cardiac catheterization. Device closure using a variety of devices was successful in all, with resolution of symptoms. One patient developed complete heart block, requiring permanent pacemaker implantation. Transcatheter closure is effective, and may replace surgery in the management of these defects. © 2013 Wiley Periodicals, Inc.     

New guiding catheter for transrad PTCA

A new guiding catheter for PTCA is described. In our department, 302 patients (405 lesions) underwent transradial coronary angioplasty using the 6 Fr Kimny guiding catheter since January 1996. The total engagement rate using the Kimny guiding catheter was 91.3% (370/405). The engagement rate after the modified Kimny guiding catheter was introduced in May 1996 increased to 96.0% (243/253). The stent delivery success rate was 98.4%. We had two dislodged stents. PTCA for both left and right coronary arteries in a single procedure with the Kimny guiding catheter was performed via the radial artery in 27 patients. In 24 of these patients (89%) we engaged both coronaries successfully. In the remaining 3 patients we switched to another catheter. Except for 4 patients with non-Q-wave myocardial infarction, no major cardiac complications were encountered. No major entry site-related complications were seen, and no patient required vascular surgery or blood transfusions. In one patient the Kimny guiding catheter tip caused a minor dissection of the LMT, but no ischemic event occurred as a result. In conclusion, the Kimny device is a useful PTCA guiding catheter for routine angioplasty and stenting. Cathet. Cardiovasc. Diagn. 43:344–351, 1998. © 1998 Wiley-Liss, Inc.     

The hybrid cardiac catheterization laboratory for congenital heart disease: From conception to completion

There has been a recent trend toward hybrid cardiac catheterization procedures for the treatment of patients with various forms of congenital heart disease. Hybrid procedures offer the combined advantages of outstanding imaging in a full operating room environment, allowing direct access onto the heart or the great vessels for access or procedure completion, or complementary imaging before, during, or after surgical correction when necessary. With the increase in frequency of hybrid procedures, more medical centers are contemplating the conversion of standard cardiac catheterization rooms to hybrid facilities, or de novo construction. In this report, we detail a single‐center experience of conversion from a standard catheterization facility into a hybrid suite. The strategic planning, design, system integration, and the challenges inherent to this project are discussed. Many of the solutions to these challenges are likely to be applicable to other institutions planning on similar hybrid conversion or construction. © 2007 Wiley‐Liss, Inc.     

Brachial loop: transradial technique to overcome this rare anatomic variation.

A brachial loop is a rare anatomic variation and can result in the failure of transradial coronary procedures. We report a brachial loop encountered in a patient undergoing a coronary angiogram. During this angiogram, a 0.035' J-tipped Teflon-coated guidewire met with resistance in the brachial artery because of this rare vascular loop. In this case report, we discuss the technique we used to manage this rare condition. Interventional cardiologists should keep in mind that resistance of the guidewire can result in major vessel complications during the transradial approach.     

经桡动脉冠状动脉介入术后伤口的观察与护理

目的探讨经桡动脉介入术后伤口的观察和护理。方法对221例经桡动脉冠状动脉介入术后伤口的观察与护理进行总结。结果穿刺处伤口无并发症205例,穿刺点皮下淤血6例,右手肿胀5例,压迫周围水泡3例,右上臂肿胀1例,桡动脉闭塞1例,对症处理后均治愈出院。结论细致的观察和及时、正确的处理对于对经桡动脉穿刺患者的伤口护理非常重要。     

Novel diagnostic catheter specifically designed for both coronary arteries via the right transradial approach

The aim of this study was to assess the feasibility, safety, and performance of a novel diagnostic catheter specifically designed for engaging both coronary arteries via the right transradial artery approach. A total of 160 patients were randomized between the standard Judkins (5F R4, L4; Cordis Corporation, Miami, FL) and the 5F Tiger II (Terumo Corporation, Tokyo, Japan) catheters. End points included the duration of various procedures and the assessments of angiographic image quality and catheter performance. The Tiger II was associated with a significantly shorter (40%) total procedure time (199.6±50.2 vs. 331.5±72.9 s, p=0.001) and a 33% shorter total fluoroscopic time (93.1±33.8 vs. 138.2±47.6 s, p=0.001) for diagnostic coronary angiography, compared with those with the Judkins catheter. There was no significant difference between the Tiger II and Judkins catheters for left coronary angiographic quality (left anterior descending, 2.82±0.48 vs. 2.94±0.29, p=0.084; left circumflex, 2.90±0.38 vs. 2.87±0.44, p=0.629). The Tiger II provided superior right coronary angiograms, compared with the Judkins catheter (2.99± 0.11 vs. 2.82±0.48, p=0.003). For the left coronary angiograms, the initial randomized catheter completed the procedure in 91% of the patients with the Tiger II and in 98% with the Judkins (p=0.167) catheters. For the right coronary angiograms, 100% were completed with the Tiger II and 95% with the Judkins (p=0.120) catheters. There were no angiographic or clinical complications in either group, so the procedural success rate was 100%. The potential of the Tiger II catheter for use as a multipurpose catheter for right transradial coronary angiography to reduce procedural and X-ray times to the level of classic transfemoral coronary angiography has to be confirmed in a randomized study.     

Endovascular transluminal stent grafting

Iliac vessels are prone to injury during lumbar spine surgery due to their proximity to the lumbar spine. Arterio‐venous fistula formation during lumbar spine surgery is an uncommon complication and can present as an asymptomatic incidental finding to rapidly deteriorating hemodynamics leading to cardiopulmonary collapse. We have reported three patients who had symptomatic iliac arterio‐venous fistula detected soon after lumbar spine surgery. All these patients were successfully treated by endovascular transluminal stent grafting. © 2013 Wiley Periodicals, Inc.     

Modified dual guide catheter (“ping‐pong”) technique to treat left internal mammary artery graft perforation

Perforation of a left internal mammary artery (LIMA) graft during percutaneous coronary intervention is a rare event. We report a case of mid‐LIMA perforation treated by a polytetrafluoroethylene‐covered stent using a modification of the dual catheter (“ping pong”) technique. We propose that use of this modification when possible will further improve safety of treating a perforation. © 2014 Wiley Periodicals, Inc.