The difficulties of recanalization in chronic superior cava vein obstruction by penetrating diagnostic catheter, PTA, and stenting: A case report.

Superior vena cava obstruction is caused by a blockage in its blood flow; one of its few causes can be device related. This case follows a patient presented with superior vena cava obstruction following a septal cardiac implant. Endovascular intervention has been associated with more rapid, complete symptom relief and lower complication rates. The use of stenting as first-line therapy has gathered popularity to become standard practice in the past 2 decades. This paper illustrates a successful recanalization with penetrating diagnostic catheter, followed with percutaneous transluminal angioplasty stenting in order to preserve the patency superior vena cava.

Tachycardia and Pre-existing Chronic Kidney Disease Are Predictors of the Worse Clinical Outcomes in Patients Recently Hospitalized With Acute Heart Failure.

BACKGROUND: This study aimed to assess the factors contributing to the outcomes of recently hospitalized patients with heart failure (HF). METHODS: A prospective data of 76 adults who were admitted due to acute HF between October 1, 2019 and June 30, 2020 at our center were analyzed. Endpoints included survival and rehospitalization within six months after discharge. RESULTS: The mean age was 64.9 ± 13.8 years, with a male preponderance (68.4%). Approximately 60.5% of patients had the left ventricular ejection fraction (LVEF) <40%, whereas 26.3% of patients had LVEF ≥50%. Coronary artery disease (75%), arterial hypertension (72.4%), chronic kidney disease (46.1%), and diabetes mellitus (46.1%) were the most frequent comorbidities. Poor compliance (40.8%) and non-cardiac infection (21.1%) were the common precipitating factors for hospitalization. The majority of subjects had severe symptoms, indicated by the frequent need of intensive care unit (43%), high N-terminal prohormone brain natriuretic peptide levels [NT-proBNP; median, 4765 (1539.7-11782.2) pg/mL], and presence of either atrial fibrillation, severe mitral regurgitation, or significant pulmonary hypertension in approximately one-third of cases. Even though in-hospital mortality was relatively low (2.6%), the all-cause mortality and rehospitalization rates in the next six months after discharge were still high, reaching 22.54% and 19.72%, respectively. Further survival analysis showed that tachycardia on admission and pre-existing chronic kidney disease (CKD) resulted in low six-month survival rates among these patients. CONCLUSION: After hospital discharge, patients with HF were still exposed to higher risks of death and readmission albeit with the medication addressed. Tachycardia on admission and pre-existing CKD might predict worse outcomes.

Safety and feasibility of X-sizer-facilitated rescue percutaneous coronary intervention: a preliminary experience.

Failed thrombolysis following ST-elevation myocardial infarction (STEMI) is associated with a poor prognosis. Rescue balloon angioplasty with or without stent implantation is an established treatment for failed thrombolysis. Recently, X-Sizer thrombectomy has been shown to be effective in removing intracoronary thrombi and improving coronary perfusion in patients with acute coronary syndrome. In this retrospective study, we sought to evaluate the safety and feasibility of X-Sizer-facilitated rescue percutaneous coronary intervention (PCI) for the treatment of STEMI after failed thrombolysis. Clinical data are from a retrospective review of 95 patients who underwent X-Sizer-facilitated primary PCI (n = 80) or rescue PCI (n = 15) during the period from November 2000 to February 2003. Baseline and procedural characteristics of the 2 groups were similar, except for a higher prevalence of hypercholesterolemia in the rescue PCI group. Angiographic success was achieved in 96% in the primary PCI group and 100% in the rescue PCI group. The 30-day mortality (7.5% vs. 13.3%), major acute coronary event (MACE; 7.5% vs. 13.3%), and MACE with angina (15% vs. 13.3%) rates were similar between the primary PCI and the rescue PCI groups. Similarly, the 6-month mortality (10% vs. 13.3%), MACE (16.3% vs. 13.3%) and MACE with angina (25% vs. 26.7%) rates were also comparable (p = NS for all comparison). In particular, there were no incidences of death, reinfarction or repeat revascularization between 30 days and 6 months in the rescue PCI group. In conclusion, X-Sizer-facilitated rescue PCI was safe and feasible. The outcomes of patients who underwent X-Sizer-facilitated rescue PCI were similar to those who underwent X-Sizer-facilitated primary PCI.

Impact of glycemic control on occurrence of no-reflow and 30-day outcomes in diabetic patients undergoing primary angioplasty for myocardial infarction.

Diabetes mellitus is associated with endothelial dysfunction and platelet activation that may contribute to the occurrence of no-reflow. We postulate that optimal glycemic control is associated with the lower risk of no-reflow and better outcomes. Diabetic patients who underwent primary angioplasty for myocardial infarction from January 2001 to June 2004 were analyzed. No-reflow was defined as TIMI flow < 3 in the absence of mechanical obstruction. Patients were divided into 2 glycemic control groups according to the HbA1c value: optimal (less than or equal to 7%), and suboptimal (> 7%). A total of 183 diabetic patients (93% noninsulin-requiring) were included for analysis. The median HbA1c of the optimal (n = 37) and suboptimal (n = 146) glycemic control groups were 6.5% and 8.5%, respectively. Compared to the suboptimal glycemic control group, the optimal glycemic control group was older, likely to have hypertension, previously suffered a stroke, have renal failure and a higher baseline creatinine. No-reflow occurred in 16% of the optimal and 18% of the suboptimal glycemic control groups. Multivariate analysis showed that optimal glycemic control was not associated with a lesser occurrence of no-reflow (OR 1.27, 95% CI 0.19-8.29; p = 0.807). The optimal glycemic control group had 30-day survival (90% versus 93%; p = 0.698) and 30-day event-free survival (84% versus 86%; p = 0.695) rates similar to the suboptimal glycemic control group. Among diabetic patients undergoing primary angioplasty, optimal glycemic control was not associated with a lesser occurrence of no-reflow or better 30-day outcomes.

Transplantation of autologous bone marrow-derived cells into the myocardium of patients undergoing coronary bypass.

BACKGROUND: Animal studies suggest that cell transplantation, including bone marrow-derived cells, can ameliorate left ventricular remodeling following myocardial ischemia. Clinical evaluation of the potential benefits of this approach is limited by the lack of safety and feasibility studies. We have assessed the safety and feasibility of intramyocardial transplantation of autologous bone marrow-derived cells in patients undergoing coronary artery bypass graft (CABG) surgery. METHODS AND RESULTS: Between December 2001 and May 2002 7 patients, scheduled for CABG, consented to the trial. All had CABG using hypothermic cardiopulmonary bypass (CPB) and cold cardioplegic arrest. An average of 21 10(6) (8.6 10(6) to 35.1 10(6)) nucleated cells, and 4.2 10(4) (2.5 10(4) to 8.1 10(4)) CD34+ cells were injected into the anterior-lateral wall of the left ventricle, after discontinuation of cardiopulmonary bypass. The end points to assess safety included death, massive bleeding, electrocardiographic or biochemical evidence of myocardial infarction, ventricular dysrhythmia, myocardial perfusion, ventricular function, and the patients' functional status. All patients recovered well without ventricular arrhythmia, bleeding, or other major peri-operative complications. The average intensive care unit (ICU) and hospital stay was 1 and 7 days, respectively. Repeat Technetium-99m myocardial perfusion stress imaging and echocardiography 6 weeks after surgery showed improvement in tissue perfusion, and an average improvement of left ventricular function of 13.5% +/- 11.54% (the mean pre- and post-operative left ventricular EF were 32.5% +/- 15.46% and 46% +/- 18.55%, respectively). Twenty-four hours Holter monitoring showed no significant arrhythmia, 3 months post-operatively. All patients with narrow QRS complex showed no evidence of late potential, on signal-averaged electrocardiogram. At 4 to 9 months after surgery patients were in NYHA functional class "I". CONCLUSIONS: This early clinical experience shows that autologous bone marrow-derived cell transplantation into myocardium is feasible and relatively safe. Further clinical trials to assess the role of cell transplantation for myocardial repair are required.

Comparison of the X-SIZER thrombectomy device with adjunct abciximab during primary angioplasty and stenting for ST-segment elevation myocardial infarction.

OBJECTIVE: To evaluate the safety and efficacy of the X-SIZER thrombectomy device versus the use of abciximab during primary angioplasty for acute ST-elevation myocardial infarction (STEMI). DESIGN: Retrospective analysis of patients undergoing primary angioplasty for STEMI from October 2000 to December 2002 using the X-SIZER thrombectomy device versus abciximab. SETTING: National University Hospital, Singapore. PATIENTS: Out of 79 patients, 44 underwent X-SIZER use, while 35 received adjunct abciximab. Both groups were similarly represented with regards to age, gender, risk factors, target vessel site/diameter, cardiogenic shock, and onset of chest pain to procedure time. The infarct-related artery was occluded in 88.6% in both groups. INTERVENTIONS: A 2-mm X-SIZER was used in 34/44 (77.3%), while a 1.5-mm device was used in the remainder. Final TIMI 3 flow was obtained in 38/44 (86.4%) in the X-SIZER group compared to 26/35 (74.3%) in the abciximab group (P = 0.175). MAIN OUTCOME MEASURES: Coronary TIMI flow rate, electrocardiogram (ECG) resolution, slow flow/no reflow phenomenon, and patient outcome (death, cardiac failure, or repeat revascularization) at 1 month. RESULTS: ECG resolution and slow flow/no reflow were better in the X-SIZER group (77.3% vs 54.3%, P = 0.031; 9.1% vs 25.7%, P = 0.047, respectively). Patient outcome at 1 month was, however, not significantly different (18.2% vs 17.1%, P = 0.904, respectively, for X-SIZER and abciximab). CONCLUSION: X-SIZER thrombectomy during primary percutaneous coronary intervention for thrombus-laden STEMI is a safe and effective strategy. When compared to patients receiving abciximab, it was associated with improved ECG resolution, less slow flow/no reflow and a trend to better TIMI 3 flow.

Impact of reversibility of no reflow phenomenon on 30-day mortality following percutaneous revascularization for acute myocardial infarction-insights from a 1,328 patient registry.

BACKGROUND: Occurrence of no reflow phenomenon during percutaneous coronary intervention (PCI) is associated with increased mortality. Although intracoronary medications can improve coronary flow, the effect on mortality is not known. METHODS: Patients who had PCI for myocardial infarction (MI) at the Singapore National University Hospital from January 2000 to March 2004 were studied. Our analysis stratified patients into three groups according to the occurrence and persistence of no reflow during PCI. (1) Adequate reflow: without no reflow occurrence; (2) Reversible no reflow: no reflow occurred, but final thrombolysis in myocardial infarction (TIMI) 3 flow restored after intracoronary medications; and (3) Refractory no reflow: no reflow occurred and persisted, final TIMI flow < 3 despite medications. Thirty-day mortality was determined for each group. RESULTS: A total of 1,328 patients (82% male), 703 (53%) underwent primary PCI and 625 (47%) rescue PCI were analyzed. Among the study patients, no reflow (including reversible and refractory) occurred in 135 patients (10.2%). Intracoronary verapamil, adenosine, nitroprusside, or a combination of drugs were used to treat the no reflow in 70.0%, 17.7%, 3.5%, and 8.8% of cases, respectively. Intracoronary medications successfully restored final TIMI 3 in 108 patients (80%, reversible no reflow). The remaining 27 patients (20%) have final TIMI < 3 (refractory no reflow). In comparison with the adequate reflow and reversible no reflow groups, those with refractory no reflow had an increased 30-day mortality (3.7% vs 2.8% vs 32.0%, P < 0.001). Logistic regression analyses showed that patients with refractory no reflow had a significantly higher 30-day mortality compared to patients with adequate reflow (P < 0.001) and reversible no reflow (P = 0.001), but no significant differences in the 30-day mortality between patients with adequate reflow and reversible no reflow (P = 0.157) were detected after adjusting for relevant covariates. CONCLUSION: Among patients undergoing PCI for MI, reversible no reflow was associated with a significantly lower 30-day mortality compared with the refractory counterpart.