Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Jan 2014
Pediatric patient radiation dosage during endomyocardial biopsies and right heart catheterization using a standard "ALARA" radiation reduction protocol in the modern fluoroscopic era.
Surveillance endomyocardial biopsy (EMB) with right heart catheterization (RHC) is the standard of care for the assessment of post cardiac transplantation rejection. This procedure has traditionally relied upon fluoroscopy, which exposes both patient and staff to the risks of ionizing radiation. These risks may be of particular concern in the transplant patient who must undergo many such procedures lifelong. We present data on a new "ALARA - As Low As Reasonably Achievable" protocol to reduce radiation exposure during the performance of RHC with EMB. ⋯ The use of a novel ALARA protocol for RHC and EMB in pediatric cardiac transplantation patients markedly reduced radiation exposure to levels far below any previously reported values without negatively affecting the safety or efficacy of these procedures.
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Catheter Cardiovasc Interv · Jan 2014
Case ReportsA lumen sizing workhorse guidewire for peripheral vasculature: two functions in one device.
Ideally, guidewires used during peripheral vasculature (PV) interventions could serve both as a therapy delivery platform and a diagnostic tool for real-time vessel sizing (2-in-1 function). ⋯ Real-time, accurate, and safe PV dimension assessment and therapy-delivery (2-in-1 function) is possible using a novel workhorse 0.035″ bodied CGW.
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Catheter Cardiovasc Interv · Dec 2013
Multicenter Study Observational StudyThe management of patients with atrial fibrillation undergoing percutaneous coronary intervention with stent implantation: in-hospital-data from the Atrial Fibrillation undergoing Coronary Artery Stenting study.
Current recommendations on the management of patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention with stent (PCI-S) essentially derive from small, single-center, retrospective datasets. To obtain larger and better quality data, we carried out the prospective, multicenter Atrial Fibrillation undergoing Coronary Artery Stenting (AFCAS) study. Therefore, consecutive patients with history of or ongoing AF undergoing PCI-S were enrolled, and occurrence of adverse ischemic and bleeding events recorded during 12 months follow-up. ⋯ In a logistic regression analysis, no risk factor was independently associated with bleeding events, whereas Clopidogrel treatment decreased and female gender/treatment with gpIIb/IIIa-antagonists, respectively increased the risk for the combined ischemic endpoint. The majority of AF patients undergoing PCI-S are at high stroke risk, and therefore VKA treatment should not be withdrawn and combined anticoagulant and antiplatelet treatment is warranted. Current management appears largely in accordance with current recommendations, whereby accounting for the limited occurrence of in-hospital adverse ischemic and bleeding events.
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Catheter Cardiovasc Interv · Dec 2013
Case ReportsSubclavian artery pseudoaneurysm complicating central venous catheterization: endovascular treatment with Amplatzer Vascular Plug 4 and covered stent.
Central venous catheterization is a routine vascular access procedure; however, it may be associated with life-threatening complications such as arterial puncture, leading to pseudoaneurysm formation. We report a case of a 41-year-old female that developed an iatrogenic left subclavian pseudoaneurysm complicating the attempt of left internal jugular vein cannulation for temporary hemodialysis therapy. ⋯ The patient's recovery was unremarkable. Follow-up till 24 months reveals total exclusion of the pseudoaneurysm of the left SCA with patency of the distal branches.