Primary percutaneous coronary intervention (PPCI) has been shown to be superior to thrombolysis in patients presenting with ST-segment elevation acute myocardial infarction (STEMI) in reducing death, stroke and re-infarction. However, bleeding and thrombotic complications can occur despite successful PPCI and slow fl ow/no-reflow or poor microvascular reperfusion can occur in a significant minority despite a technically successful procedure. Bleeding or need for peri-procedural transfusion has been shown to increase short- and long-term mortality. Newer anticoagulants appear to reduce the bleeding risk and improve overall clinical outcomes. A novel combination of antiplatelet agents also appears to further improve the outcomes after PPCI. Although PPCI can achieve high rates of epicardial artery patency, some patients experience suboptimal microvascular perfusion, which affects long-term prognosis. Several pharmacologic agents have been shown to improve microvascular perfusion and left ventricular function, although none impacts on clinical outcomes. Of the mechanical devices available to reduce distal embolisation, the simple aspiration catheter holds the most promise in reducing clinical adverse events. Additional research and well designed studies are needed to further enhance the outcomes after PPCI.
Angioplasty, Balloon, Coronary ; adverse effects ; instrumentation ; Anticoagulants ; therapeutic use ; Cardiac Catheterization ; instrumentation ; Electrocardiography ; Embolism ; prevention & control ; Humans ; Myocardial Infarction ; drug therapy ; surgery ; Platelet Aggregation Inhibitors ; therapeutic use

Adolescent ; Adult ; Cardiac Catheterization ; Cardiac Surgical Procedures ; adverse effects ; instrumentation ; Child ; Child, Preschool ; Electrocardiography ; Heart Block ; etiology ; Heart Septal Defects, Ventricular ; physiopathology ; surgery ; Humans ; Middle Aged

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a case of stent dislodgement in the ascending thoracic aorta. The stent was mechanically distorted in the left circumflex artery (LCX) while being delivered to the proximal LCX lesion. The balloon catheter was withdrawn, but the stent with the guide wire was remained in the ascending thoracic aorta. The stent was unable to be retrieved into the guide catheter, as it was distorted. A goose neck snare was used successfully to catch the stent in the ascending thoracic aorta and retrieved the stent externally via the arterial sheath.
Angioplasty, Balloon, Coronary/*adverse effects/*instrumentation ; *Aorta, Thoracic/radiography ; Cardiac Catheterization/*adverse effects/*instrumentation ; Coronary Angiography ; Device Removal/*instrumentation ; Foreign Bodies/etiology/radiography/*therapy ; Humans ; Male ; Middle Aged ; Radiography, Interventional ; *Stents ; Treatment Outcome

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex artery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, because the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation ; Cardiac Catheterization/adverse effects/*instrumentation ; Coronary Angiography ; Coronary Stenosis/diagnosis/*therapy ; Female ; Humans ; Middle Aged ; Prosthesis Failure ; Shock, Cardiogenic/etiology/therapy ; *Stents ; Treatment Outcome

OBJECTIVETo evaluate the safety and efficacy of transcatheter closure of perimembranous ventricular septal defects (TCVSD) in children.

METHODSFrom November 2002 to July 2004, fifty children (26 males and 24 females) with perimembranous (ventricular septal defect, VSD) underwent an attempt of transcatheter closure using the amplatzer occluder specially designed for perimembranous VSD. Among the 50 children, one of them was diagnosed with aneurysm of aortic sinus, one with dextrocardia, and two with leakage after the surgical repair of VSD. The mean age of patients was (9.1 +/- 4.8) years (ranged from 2 to 17 years). The mean body weight of patients was (33.5 +/- 19.7) kg (ranged from 9 to 81 kg). The mean diameter of VSD measured by transthoracic echocardiography (TTE) was (4.8 +/- 0.9) mm (ranged from 3 to 7 mm). The mean rate of quantity of pulmonary flow/quantity of systemic flow (Qp/Qs) was 1.3 +/- 0.3 (ranged from 1.1 to 2.0), the moderate shunt from left to right was found in 4 patients and the small shunt from left to right in the rest. Occluder was released through the right heart system. All patients were followed up in 1, 3, 6 and 12 months after procedures of TTE, X-ray and electrocardiography.

RESULTSThe devices were deployed successfully in 47 patients, the rate of success was 94%. There was a tiny (< 3 mm) residual shunt in 2 patients after closure. During the follow-up of 6 months, only one patient had a tiny residual shunt. Complete left bundle branch block (LBBB) was found in one child who was examined with electrocardiograph 2 weeks later. There was no other severe complication. After 1 to 18 months (mean 7 months) follow-up, all patients demonstrated a great decrease (from 38.5 +/- 4.6 mm pre-closure to 35.2 +/- 5.1 mm post-closure) in their left ventricle end-diastolic dimension (LVEDD, P < 0.05).

CONCLUSIONThis study demonstrated that transcatheter closure of membranous VSD using occluder would be safe and effective for children, and the results of short-term was satisfied. Further clinical trials are underway to assess the long-term result.

Adolescent ; Cardiac Catheterization ; Child ; Child, Preschool ; Female ; Heart Septal Defects, Ventricular ; therapy ; Humans ; Male ; Prosthesis Implantation ; adverse effects ; instrumentation ; Recurrence ; Treatment Outcome

The aim of this study was to investigate the pulsatile-flow performance in vitro of a new heart valve prostheses implanted with minimally invasive techniques (HVPMIT). Three HVPMITs were tested valves and another three original biological heart valve prostheses acted as reference valves. The pulsatile-flow parameters (including mean pressure drop, regurgitant percentage of stroke volume, and effective orifice area) were tested in a pulse duplicator according to the methods listed in ISO5840-2005 and GB 12279-2008. The results demonstrated that the regurgitant percentage of stroke volume of tested valves was up to 13%. It was significantly higher than that of the reference valves. This result suggested that paravalvular leakage had occurred in the tested valves. It was found in the further analysis that because HVPMIT was not sewn into the heart tissue when the HVPMIT was implanted in vivo and there was not a sewing ring in the HVPMIT, when tested valves were fixed in the pulse duplicator, some gaps might exist between the stent of HVPMIT and the fix gasket, and the paravalvular leakage could therefore take place through these gaps. This study demonstrated that there are significant differences in the shape, structure, fixation in vivo and clinical operational methods between HVPMIT and original biological heart valve prostheses. It is necessary to establish new test methods which adapt for HVPMIT to evaluate its pulsatile-flow performance according to its own features.
Animals ; Cardiac Catheterization ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation ; adverse effects ; instrumentation ; methods ; Minimally Invasive Surgical Procedures ; methods ; Prosthesis Design ; Pulsatile Flow

Cardiac Catheterization ; instrumentation ; methods ; Echocardiography, Three-Dimensional ; instrumentation ; methods ; Heart Valve Prosthesis ; adverse effects ; Hemodynamics ; Humans ; Hypertension, Pulmonary ; Male ; Middle Aged ; Mitral Valve ; pathology ; Mitral Valve Insufficiency ; pathology ; therapy

OBJECTIVE: To determine the therapeutic effect and safety of transcatheter closure of ventricular septal defects (VSD) in 50 patients. METHODS: Fifty patients were diagnosed by transthoracic echocardiography. To perform the operation, transthoracic echocardiography and X ray were used continuously to monitor the procedure. Transthoracic echocardiography and ECG were performed at 1, 3, and 6 months after the operation to evaluate the therapeutic effect. RESULTS: The VSD diameter ranged from 1.8 to 13.4 (5.54 +/- 2. 75) mm. The successful rate of the operation was 96.0%, and the complication rate of the operation was 16.7%. A 3 month follow-up was completed in 20 patients, and the median left ventricle end-diastolic dimension significantly decreased from (40.20 +/- 8.80) mm to (32.90 +/- 8.36) mm (P < 0.001). CONCLUSION Transcatheter closure of ventricular septal defects is a good method with a high success rate of placement, fewer complications, and a good occlusion effect.
Adolescent ; Adult ; Balloon Occlusion ; adverse effects ; instrumentation ; methods ; Cardiac Catheterization ; methods ; Child ; Child, Preschool ; Echocardiography ; Female ; Heart Septal Defects, Ventricular ; diagnostic imaging ; therapy ; Humans ; Male ; Prostheses and Implants ; Treatment Outcome

Transcatheter aortic valve implantation and transcatheter mitral valve repair (MitraClip) procedures have been performed worldwide. In this paper, we review the use of two-dimensional and three-dimensional transesophageal echo for guiding transcatheter aortic valve replacement and mitral valve repair.
Aged ; Aged, 80 and over ; Aortic Valve Stenosis/*therapy/*ultrasonography ; Balloon Valvuloplasty ; Bioprosthesis ; *Cardiac Catheterization/adverse effects/instrumentation ; *Echocardiography ; Echocardiography, Doppler, Color ; Echocardiography, Three-Dimensional ; Echocardiography, Transesophageal ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation/adverse effects/instrumentation/*methods ; Humans ; Mitral Valve Insufficiency/*therapy/*ultrasonography ; Predictive Value of Tests ; Prosthesis Design ; Severity of Illness Index ; Surgical Instruments ; Ultrasonography, Interventional/*methods

OBJECTIVETo document the five-year follow-up results of transcatheter Amplatzer duct occluder (ADO) occlusion of patent ductus arteriosus (PDA) in children and to assess the safety and effectiveness of this method for PDA closure.

METHODSA retrospective cohort study was completed in patients with PDA underwent transcatheter closure by the ADO in Guangdong Cardiovascular Institute from April 1998 to December 2003.

RESULTSTranscatheter closure of PDA with ADO was attempted in 250 children patients. The median age was 5.3 years and median weight was 15.1 kg. The PDAs were from 1.8 mm to 11.0 mm (median 4.2 mm) in the narrowest diameter, of which 52 were larger than 5 mm (20.0%). All PDAs were occluded with 4 approximately 14 mm ADO through 6F (n = 205) or 7F (n = 45) sheaths. Devices were successfully implanted in 245 patients (98.0%). The Qp/Qs decreased from 1.90 +/- 0.60 to 1.03 +/- 0.21 (P < 0.05). All shapes of the PDA could be closed. Late complication occurred in five patients, including hemolysis in three patients and the los of the pulse of femoral artery in two patients. Follow-up after device implantation was accomplished in 205 patients (82.0%). The incidence of residual shunt at follow-up periods of 1 d, 1 m, 6 m, 12 m, 24 m, 36 m, 48m and 60 m after device occlusion was 9.2%, 2.8%, 1.2%, 0.8%, 0, 0, 0 and 0, respectively. Five patients (2.0%) required re-intervention to treat residual shunt with or without hemolysis. Event-free rates were 98.0% at one year and five years.

CONCLUSIONThis long-term follow-up result confirmed the safety and effectiveness of ADO closure of PDAs in children.

Adolescent ; Balloon Occlusion ; adverse effects ; instrumentation ; methods ; Cardiac Catheterization ; Child ; Child, Preschool ; Ductus Arteriosus, Patent ; diagnostic imaging ; therapy ; Echocardiography, Doppler, Color ; Embolization, Therapeutic ; adverse effects ; methods ; Female ; Follow-Up Studies ; Hemolysis ; Humans ; Infant ; Male ; Radiography, Interventional ; Retrospective Studies ; Time Factors ; Treatment Outcome