The Journal of invasive cardiology
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Review Case Reports
Spontaneous coronary artery dissection: case series and review.
Spontaneous coronary artery dissection (SCAD) is a rare but important cause of acute coronary syndromes. SCAD can cause unstable angina, acute myocardial infarction, and sudden death. Predisposing factors include atherosclerosis, the peripartum period, and structural and inflammatory conditions affecting the arterial wall. ⋯ Therapeutic options include medical therapy, percutaneous coronary intervention, and surgery. We present a series of patients with spontaneous coronary artery dissection at our institution. The etiology, pathogenesis, diagnosis, treatment, and prognosis of patients with coronary dissection are reviewed.
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Case Reports
Use of intra-arterial papaverine for severe arterial spasm during radial cardiac catheterization.
Coronary angiography and intervention can be performed safely using the radial artery. However, arterial spasm is often encountered and usually amenable to nitrate/verapamil therapy. Rarely, surgical intervention is required to remove catheters and wires. Intra-arterial papavarine can be used to treat severe radial artery spasm and prevent the need for urgent surgical intervention.
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Review Case Reports
The role of extracorporeal membrane oxygenation in emergent percutaneous coronary intervention for myocardial infarction complicated by cardiogenic shock and cardiac arrest.
Patients with myocardial infarction (MI) who have out-of-hospital cardiac arrest and cardiogenic shock have a high mortality rate. Although intra-aortic balloon counterpulsation is frequently used in patients with cardiogenic shock, it does not provide complete hemodynamic support. We report 2 cases in which extracorporeal membrane oxygenation was instituted emergently in the cardiac catheterization laboratory in patients with MI and cardiac arrest who underwent percutaneous coronary intervention and who were hemodynamically unstable despite inotropic agents and intraaortic balloon counterpulsation.
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Comparative Study
Comparison of contemporary devices used for transcatheter patent foramen ovale closure.
Transcatheter patent foramen ovale (PFO) closure can be performed with various devices. However, their handling, safety, presence of residual shunt and impact on recurrent thromboembolic events (TEs) are rarely compared with one another. Our goal was to compare the clinical performance of contemporary devices designed for PFO closure. ⋯ The clinical performance of the three PFO occluders evaluated in this study seems comparable. Device design does not seem to impact the success of the PFO closure procedure. AF was the only predictor of recurrent TEs, underscoring the importance of aggressive therapy for atrial arrhythmias early following PFO closure.
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The activated clotting time (ACT) has been reported to be sensitive to the anticoagulant activity of the low-molecular weight heparin dalteparin following intravenous (IV) administration. ⋯ ACT-guided dose adjustment of intravenously administered dalteparin during PCI appears to constitute a feasible strategy.