Angioplasty, Balloon, Coronary ; instrumentation ; Cardiac Catheterization ; Humans ; Myocardial Infarction ; therapy

The addition of femoral-femoral cardiopulmonary bypass in the cardiac catheterization laboratory to support the high risk patient is a challenging new frontier for percutaneous transluminal coronary angioplasty. We report our first experience of successful supported angioplasty in patient presented with exertional angina and orthopnea who had multi-vessel coronary artery disease with depressed left ventricular ejection fraction. Although cardiopulmonary support provides excellent support for high-risk patient, CPS is a technically challenging and expensive procedure associated with significant patient morbidity or complication. Despite its drawbacks, CPS has been shown to help save the lives of selected patients undergoing high-risk procedures.
Angioplasty ; Angioplasty, Balloon, Coronary* ; Cardiac Catheterization ; Cardiac Catheters ; Cardiopulmonary Bypass ; Coronary Artery Disease ; Humans ; Stroke Volume

OBJECTIVETo develop a new technique of bilateral angiography in a single radial access (BASiRalA) which can reduce a puncture site.

METHODSFrom March 2011 to February 2012, 13 cases of coronary heart disease patients with chronic total occlusion (CTO) were treated (6 CTOs in right coronary artery and 7 in left anterior descending artery). All patients underwent percutaneous coronary intervention (PCI) via the right radial artery access and 6 F guiding catheters were delivered to the diseased artery. Once the wires crossed the CTO lesions and were uncertain if the wires were in true lumen or not, BASiRalA was performed. The Finecross microcatheters were advanced out of the 6 F guiding catheter, then withdraw 6F guiding catheter to the opening of diseased artery, the soft wires were manipulated into the middle portion of opposite coronary artery. After that, the microcatheters were advanced to this segment or the branches relative to the collateral vessels connected with CTOs. After pulling out the wires, microcatheter injections can be performed for contralateral angiography. BASiRalA related complications were observed after the procedure.

RESULTSBASiRalA technique was applied to 13 CTOs and 10 procedures succeeded (76.92%). BASiRalA failed in 3 cases and the wires and microcatheters could not be advanced to the opposite coronary arteries within 20 minutes. Alternatively, contralateral angiography via femoral arteries was performed in these 3 patients. The average time of BASiRalA technique was 7 (5 - 13) minutes and the shortest time of wires crossing to the opposite coronary artery was 5 seconds. There was no procedure induced complication during procedure or post procedure.

CONCLUSIONBASiRalA technique is feasible in treating CTO patients by PCI.

Aged ; Angioplasty, Balloon, Coronary ; Cardiac Catheterization ; methods ; Coronary Angiography ; methods ; Coronary Occlusion ; therapy ; Female ; Humans ; Male ; Middle Aged ; Radial Artery ; Retrospective Studies

BACKGROUND: Left ventricular diastolic dysfunction may precede systolic dysfunction and play a major role in producing the signs and symptoms of congestive heart failure. Ischemic heart disease can cause impairment of left ventricular filling without any alteration in systolic function so it is very important to evaluate relationship of left ventricular diastolic dysfunction and ischemic heart disease. The purpose of this study is to investigate left ventricular diastolic dysfunction during transient myocardial ischemia caused by balloon occlusion. METHODS: We prospectively studied 20 patients(11 males and 9 females, mean age : 58.5+/-5.9 years) who had been undergone coronary angiography and confirmed significant luminal stenosis(> or =75%)in proximal or middle portion of left anterior descending artery. After coronary angiography, percutaneous transluminal coronary angioplasty were performed all patients. We measured early propagation slope of left ventricular inflow, time difference(TD) between occurrence of peak velocity in the apical region and at the mitral tip and normalized TD(nTD) which dividing TD by the distance of mitral opening to apical region using color M-mode Doppler echocardiography, peak earaly diastolic transmitral inflow velocity(E), peak velocity during atrial contraction(A), E to A ratio, acceleration time of E wave and deceleration time of E wave using pulsed wave Doppler echocardiography, left ventricular end diastolic pressure using left heart catheterization. A color M-mode Doppler echocardiography, pulsed wave Doppler echocardiography and left ventricular end diastolic pressure were recorded before, during 30sec, 60sec & 90sec and after 60sec & 180sec balloon occlusion. RESULTS: Early propagation slope of left ventricular inflow was significantly decreased during 30sec & 60sec balloon occlusion and significantly increased after 60sec & 180sec balloon occlusion, respectively (64.45+/-28.23cm/sec, 39.37+/-11.77cm/sec, 32.78+/-11.77cm/sec, 51.86+/-19.78cm/sec, 65.05+/-29.99cm/sec, p<0.05). Time difference(TD) between occurrence of peak velocity in the apical region and at the mitral tip was significantly increased during 30sec & 60sec balloon occlusion and significantly decreased after 60sec & 180sec balloon occlusion, respectively(60+/-20msec, 90+/-30msec, 110+/-30msec, 80+/-20msec, 60+/-20msec, p<0.05). Normalized time difference(nTD) was significantly increased during 30sec & 60sec balloon occlusion and significantly decreased after 60sec & 180sec balloon occlusion, respectively(11.24+/-3.87msec/cm, 17.76+/-6.67msec/cm, 21.51+/-6.67msec/cm, 15.22+/-4.00msec/cm, 12.63+/-3.59msec/cm, p<0.05). Left ventricular end diastolic pressure was significantly increased during 30sec & 60sec balloon occlusion and significantly decreased after 60sec & 180sec balloon occlusion, respectively(9.70+/-3.88mmHg, 14.15+/-6.49mmHg, 17.00+/-7.14mmHg, 10.20+/-3.68mmHg, 8.75+/-3.16mmHg, p<0.05). Peak early diastolic transmitral inflow velocity(E), peak velocity during atrial contraction(A), E to A ratio, acceleration time of E wave and deceleration time of E wave were not significantly different(p>0.05). CONCLUSIONS: These data suggest that transient myocardial ischemia can cause left ventricular diastolic dysfunction and color M-mode Doppler echocardiography is very sensitive diagnostic method to detect early diastolic dysfunction compare to other echocardiographic diastolic indices.
Acceleration ; Angioplasty, Balloon, Coronary ; Arteries ; Balloon Occlusion ; Blood Pressure ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Angiography ; Deceleration ; Echocardiography ; Echocardiography, Doppler* ; Echocardiography, Doppler, Pulsed ; Female ; Heart Failure ; Heart Ventricles* ; Humans ; Male ; Myocardial Ischemia* ; Phenobarbital ; Prospective Studies

Adult ; Angioplasty, Balloon, Coronary ; adverse effects ; Balloon Occlusion ; Cardiac Tamponade ; etiology ; Catheter Ablation ; adverse effects ; Catheterization ; adverse effects ; Coronary Disease ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Stenosis ; therapy ; Retrospective Studies ; Stents ; adverse effects

OBJECTIVE: To explore the application value of blunt separation method in the modified sytinger technology peripherally inserted central catheter (PICC) catheterization in the hemopathic patients. METHODS: One hundred and twenty cases of the hemopathic diseases used modified sytinger technology PICC catheterization were selected from January 2016 to July 2017 in our Hospital, and randomly divided into blunt and routine group, each with 60 patients. For the routine group, the routine longitudinal method was used to expand the skin, for the blunt group the blunt separation method was used to expand the skin. RESULTS: At the time point of 24 h after the blunt catheterization, the bleeding volume and exudation rate in the blunt group were significantly lower than those in the rouline group (P<0.05). At the 1, 3, 5 d after catheterization, pain visual analogue score (VAS) showed that the scores of blunt group were significantly lower than those of the routine group (P<0.05). in expanding skin, the successful rate of catheterization once in blunt group and routine group were not significantly different (P>0.05). CONCLUSIONS Compared with the longitudinal method, the blunt separation method has considerable skin expansion and sheath feeding effect on the modified sytinger technology PICC catheterization for the hemopathic patients. This method can effectively reduce the patient's catheter trauma and percolation, and is helpful to relieve the patients' pain symptoms, worthing for further clinical promotion.
Catheterization, Central Venous ; Catheterization, Peripheral ; Humans

OBJECTIVE: To explore the cause, the clinical manifestation and the management of peripheral vascular complications after cardiac catheterization. METHODS: Clinical data of patients with peripheral vascular complications were analyzed retrospectively. RESULTS: Of the 4,531 patients, 122 (2.7%) had peripheral vascular complications, including local hematoma (86 cases, 1.90%), pseudoaneurysm (15 cases, 0.33%), arteriovenous fistula (8 cases, 0.18%), femoral venous thrombosis (5 cases, 0.11%), excessive hemorrhage (5 cases, 0.11%), femoral arterial thrombosis (2 cases, 0.04%), and femoral nerve malfunction (1 case, 0.02%). All complications were relieved after conservative therapy except that one case needed surgery. CONCLUSION Peripheral vascular complications are associated with anticoagulation, diabetes, and hypertension. Prognosis of overwhelming complications is good, as long as patients are treated timely and appropriately.
Adult ; Aneurysm, False ; epidemiology ; etiology ; Angioplasty, Balloon, Coronary ; adverse effects ; Cardiac Catheterization ; adverse effects ; Catheter Ablation ; adverse effects ; China ; epidemiology ; Female ; Hematoma ; epidemiology ; etiology ; Humans ; Male ; Peripheral Vascular Diseases ; epidemiology ; etiology ; Retrospective Studies

BACKGROUND AND OBJECTIVES: Measurements obtained using an intracoronary electrocardiogram (IC-ECG) reflect the electrical activity in various regions of the myocardium. This technique can be easily used in the catheterization laboratory during percutaneous coronary intervention (PCI) procedures. Furthermore, IC-ECG could be used to evaluate myocardial viability in patients with acute myocardial infarction (AMI). The aim of this study was to evaluate the usefulness of IC-ECG in predicting the microvascular integrity and late improvement of left ventricular (LV) function after primary PCI in patients with AMI. SUBJECTS AND METHODS: A total of 78 patients (62 male, 16 female) who underwent primary PCI with stent implantation were enrolled in this study. After the implantation of the stent, IC-ECG was recorded from the tip of an insulated angioplasty guidewire before and after balloon occlusion of the infarct-related artery. The IC-ECG was obtained from the inferior and inferolateral areas in inferior wall MI, or apex and apical anterior wall regions in anterior wall MI. Significant ST segment elevation was defined as a further ST segment elevation of > or =0.2 mV at 80 msec after the J-point in comparison to the baseline value. The microvascular integrity of the myocardium was evaluated by myocardial contrast echocardiography (MCE) one day after the PCI was performed. Six months later, all of the patients were followed up by echocardiography and the wall motion score index (WMSI) and ejection fraction (EF) were measured. RESULTS: Significant ST elevation was noted in 47 patients (Group A) after coronary occlusion. There was no significant change in the other 31 patients (Group B). MCE showed microvascular perfusion in 41 patients in group A (87%) and in four patients in group B (13%) (p<0.05). The six-month follow-up echocardiography showed that group A had a lower WMSI (1.20+/-0.18 vs 1.56+/-0.34, p<0.05) and higher EF (57.6+/-7 vs 47+/-11, p<0.05) than group B. The LV end diastolic dimension (LVEDD) in group B was increased compared to group A (p=0.021). The LV end systolic dimension (LVESD) was also increased in group B; however, the LVESD in group A was decreased after six months (p=0.002). CONCLUSION: IC-ECG during PCI is a simple and useful method for assessing the microvascular integrity of the myocardium and for predicting the long-term improvement of LV function.
Angioplasty ; Arteries ; Balloon Occlusion ; Catheterization ; Catheters ; Coronary Occlusion ; Echocardiography ; Electrocardiography* ; Follow-Up Studies ; Humans ; Male ; Myocardial Infarction* ; Myocardium ; Percutaneous Coronary Intervention* ; Perfusion ; Stents ; Ventricular Function

BACKGROUNDNatural disasters have been frequent in recent years. Effective treatment of patients with cardiovascular disease following natural disasters is an unsolved problem. We aimed to develop a novel miniature mobile cardiac catheterization laboratory (Mini Mobile Cath Lab) to provide emergency interventional services for patients with critical cardiovascular disease following natural disasters. A feasibility study was performed by testing the Mini Mobile Cath Lab on dogs with ST-elevation myocardial infarction (STEMI) model in a hypothetical natural-disaster-stricken area.

METHODSThe Mini Mobile Cath Lab was transported to the hypothetical natural-disaster-stricken area by truck. Coronary angiography and primary percutaneous coronary intervention (PCI) were performed on six dogs with STEMI model. The transportation and transformation of the Mini Mobile Cath Lab were monitored and its functioning was evaluated through the results of animal experiments.

RESULTSThe Mini Mobile Cath Lab could be transported by truck at an average speed of 80 km/h on mountain roads during daytime in the winter, under conditions of light snow (-15°C to -20°C/-68°F to -59°F). The average time required to prepare the Mini Mobile Cath Lab after transportation, in a wetland area, was 30 minutes. Coronary angiography, and primary PCI were performed successfully.

CONCLUSIONThis preliminary feasibility study of the use of the Mini Mobile Cath Lab for emergency interventional treatment of dogs with STEMI indicated that it may perform well in the rescue of critical cardiovascular disease following natural disasters.

Angioplasty, Balloon, Coronary ; Animals ; Cardiac Catheterization ; Cardiovascular Diseases ; therapy ; Coronary Angiography ; Disasters ; Dogs ; Electrocardiography ; Feasibility Studies ; Laboratories ; Myocardial Infarction ; therapy

Atrial fibrillation (AF) is a common arrhythmia, and restoration of sinus rhythm is very important in treating this condition. Recently, we experienced a rare case of immediate cardioversion from AF after successful revascularization in a patient with chronic total proximal part of the right coronary artery (RCA) occlusion. A 72-year-old woman with hypertension and diabetes mellitus experienced chest discomfort. An electrocardiogram (ECG) revealed AF. Despite 3 months of appropriate pharmacologic therapy for AF, she continued to complain of effort angina, which was relieved by sublingual nitroglycerin. She subsequently underwent cardiac catheterization, which revealed chronic total occlusion of the proximal RCA with grade III collateral vessels from the left anterior descending (LAD) artery. Balloon angioplasty and stenting restored the blood flow of the RCA, and the AF promptly reverted to sinus rhythm. There was no recurrence of AF over 12 months of follow-up at the outpatient clinic.
Aged ; Ambulatory Care Facilities ; Angioplasty, Balloon ; Arrhythmias, Cardiac ; Arteries ; Atrial Fibrillation* ; Cardiac Catheterization ; Cardiac Catheters ; Coronary Occlusion ; Coronary Vessels ; Diabetes Mellitus ; Electric Countershock ; Electrocardiography ; Female ; Follow-Up Studies ; Humans ; Hypertension ; Myocardial Ischemia ; Nitroglycerin ; Perfusion* ; Recurrence ; Stents ; Thorax