Successful Percutaneous Transcatheter Patent Foramen Ovale Closure Through The Right Internal Jugular Vein Using Stiff Amplatzer Catheter With A Reshaped Tip.

Percutaneous transcatheter closure of a patent foramen ovale (PFO) remains challenging when femoral venous approach is not available. We describe the successful closure of a PFO using the right internal jugular venous approach and a catheter delivery system with a reshaped tip in a patient with a PFO, recurrent stroke, recurrent gastrointestinal bleeding, bilateral deep venous thrombosis and thrombosed bilateral inferior vena cava filter.

Long-term follow-up of polytetrafluoroethylene-covered stents implanted during percutaneous coronary intervention for management of acute coronary perforation.

OBJECTIVE: To determine the long-term outcomes for patients receiving polytetrafluoroethylene (PTFE)-covered stents as definitive therapy, in our institution, for the management of acute coronary perforation. BACKGROUND: Coronary perforation as a complication of percutaneous coronary intervention (PCI) is associated with high morbidity and mortality. Management options included observation only or a combination of several or all of these approaches: reversal of anticoagulation, prolonged balloon inflation, deployment of a standard stent, emergent cardiac surgery, or insertion of a PTFE-covered stent. METHODS: With our IRB approval, records of 12,093 consecutive patients who received PCI during a 5-year period from January 2002 to December 2006 were reviewed and 50 patients who had coronary perforation as a complication of PCI were identified. RESULTS: Of the 21 patients who received a PTFE-covered stent to manage coronary perforation, one died secondary to acute thrombosis within the PTFE-covered stent in the first 24 hrs and one required emergent cardiac surgery due to continued contrast extravasation despite PTFE-covered stent deployment. The other 19 patients were followed long term (mean 55 months) and only one survivor had a potentially life-threatening outcome (subacute stent thrombosis) over that time period. CONCLUSION: Utilization of a PTFE-covered stent may be a reasonable short- and long-term option to manage acute coronary perforation that occurs during PCI. On the basis of this limited experience, successful PTFE-covered stent deployment as the conclusive treatment for coronary perforation is associated with a favorable long-term event-free survival rate.

Percutaneous closure of acquired Gerbode defect: management of a rare complication of cardiac surgery.

Although rare, acquired Gerbode defect (abnormal communication between left ventricle and right atrium) may result as a complication of myocardial infarction, endocarditis as well as aortic or mitral valve replacement resulting in resistant heart failure secondary to significant left to right shunting. We are reporting the case of a 50-year old lady with repeated aortic valve replacement presenting with resistant heart failure secondary to an acquired Gerbode defect. Management of this defect in these high-risk patients may be challenging and percutaneous closure, if feasible, may represent the best management option.

Survival and neurologic recovery in patients with ST-segment elevation myocardial infarction resuscitated from cardiac arrest.

OBJECTIVES: We examined outcomes of patients resuscitated from cardiac arrest owing to ST-segment elevation myocardial infarction (STEMI) and predictors of survival and neurologic recovery. BACKGROUND: Immediately after resuscitation from cardiac arrest owing to STEMI, many patients show signs of neurologic impairment, and benefits of percutaneous coronary intervention and subsequent prognosis are not well defined. METHODS: Between January 1, 2002, and December 31, 2006, we retrospectively identified consecutive patients resuscitated from cardiac arrest, regardless of time to return of spontaneous circulation (ROSC) and neurologic status, and reviewed the outcomes of those who had STEMI. Mortality and neurologic recovery at discharge and long-term mortality were assessed by individual chart review for those who underwent emergent angiography. RESULTS: Our study population consisted of 98 patients; 64% survived to discharge, and 92% had a full neurologic recovery. Predictors of survival were shorter time to ROSC, younger age, neurologic status post-resuscitation (alert or minimally responsive), and male sex. Predictors of neurologic recovery included shorter time to ROSC, neurologic status post-resuscitation (alert or minimally responsive), and younger age. Ninety-six percent of patients who were alert post-resuscitation survived. Ninety-three percent of patients who were minimally responsive post-resuscitation survived. Fifty-nine patients were unresponsive post-resuscitation, with 44% survival, of whom 88% had full neurologic recovery. In the unresponsive group, unwitnessed arrest, prolonged ROSC, and older age were associated with increased risk of death, and older age and prolonged ROSC predicted poor neurologic recovery. CONCLUSIONS: When resuscitated patients with STEMI are being evaluated in the emergency department, serious consideration should be given to emergent angiography and revascularization, regardless of neurologic status.