Impact of Bifurcation Involvement and Location in Chronic Total Occlusion Percutaneous Coronary Intervention: Insights From the EuroCTO Registry.

Bifurcation involvement close to or within the occluded segment poses increasing difficulties for chronic total occlusion (CTO)-percutaneous coronary intervention (PCI). However, this variable is not considered in the angiography-based CTO scoring systems nor has been extensively investigated in large multicenter series. Accordingly, we analyzed a CTO-PCI registry involving 92 European centers to explore the incidence, angiographic and procedural characteristics, and outcomes specific to CTO-PCIs with bifurcation involvement. A total of 3,948 procedures performed between January and November 2023 were examined (33% with bifurcation involvement). Among bifurcation lesions, 38% and 37% were located within 5 mm of the proximal and distal cap, respectively, 16% within the CTO body, and in 9% of cases proximal and distal bifurcations coexisted. When compared with lesions without bifurcation involvement, CTO bifurcation lesions had higher complexity (J-CTO 2.33 ± 1.21 vs 2.11 ± 1.27, p <0.001) and were associated with higher use of additional devices (dual-lumen microcatheter in 27.6% vs 8.4%, p <0.001, and intravascular ultrasound in 32.2% vs 21.7%, p <0.001). Radiation dose (1,544 [836 to 2,819] vs 1,298.5 [699.1 to 2,386.6] mGy, p <0.001) and contrast volume (230 [160 to 300] vs 190 [130 to 250] ml, p <0.001) were also higher. Technical success was similar (91.5% with bifurcation involvement vs 90.4% without bifurcation involvement, p = 0.271). However, the bifurcation lesions within the CTO segment (intralesion) were associated with lower technical success than the other bifurcation-location subgroups (83.7% vs 93.3% proximal, 93.4% distal, and 89.0% proximal and distal, p <0.001). On multivariable analysis, the presence of an intralesion bifurcation was independently associated with technical failure (odds ratio 2.04, 95% confidence interval 1.24 to 3.35, p = 0.005). In conclusion, bifurcations are present in approximately one-third of CTOs who underwent PCI. PCI of CTOs with bifurcation can be achieved with high success rates except for bifurcations within the occluded segment, which were associated with higher technical failure.

[The concomitance of pericarditis constrictiva in patient with Silver-Russell syndrome, primary hyperparathyroidism and oncologic history: causal coincidence or pathogenetic sequence?]. / Zaciskajace zapalenie osierdzia u pacjentki z zespolem Silver-Russella, pierwotna nadczynnoscia przytarczyc i wywiadem onkologicznym: przypadkowa koincydencja czy sekwencja patogenetyczna?

The most common cause of calcific pericarditis is idiopathic. We report a case of a 24 year-old woman with Silver-Russell syndrome, history of Wilms' tumour in childhood, constrictive pericarditis and primary hyperparathyroidism. We analyse pathologic mechanisms of disseminated calcification and possible genetic factors that may contribute to aetiology and clinical presentation of calcific pericarditis.

[Non-surgical retrieval of coronary stent from the left ventricle following failed stent deployment in the left anterior descending coronary artery--a case report]. / Usuniecie stentu z lewej komory serca po nieudanej próbie implantacji do galezi miedzykomorowej przedniej lewej tetnicy wiencowej.

A case of a 66-year-old male with acute myocardial infarction (MI) treated with streptokinase is presented. Due to the recurrence of angina six days from the acute phase of MI, the patient underwent coronary angiography which revealed critical stenosis of the left anterior descending coronary artery. During intracoronary intervention, stent was lost and migrated to the left ventricular cavity, being trapped in chordae tendinae of the posterior mitral leaflet. The procedure was stopped. After transferring the patient to our department a few days later, a successful non-surgical retrieval of stent with the use of biopsy forceps was performed. Treatment of dislodged coronary stents is discussed.

[Partial anomalous pulmonary venous drainage with atrial septal defect of the sinus venosus type. Diagnostic role of multi-slice spiral computerised tomography--a case report]. / Nieprawidlowy splyw zyl plucnych do zyly glównej górnej z ubytkiem w przegrodzie miedzyprzedsionkowej typu sinus venosus--rola wielorzedowej spiralnej tomografii komputerowej.

A case of a 53-year-old male with a long-lasting pulmonary hypertension of an unknown cause is presented. Both transthoracic and transesophageal echocardiography as well as cardiac catheterisation failed to document any cardiac defect. Finally, a multi-slice spiral computerised tomography revealed the presence of an anomalous pulmonary vein drainage to the superior vena cava with concomitant inter-atrial septal defect of a sinus venosus type. The patient was selected for surgery.

Coronary atherosclerosis in patients with acquired valvular disease.

BACKGROUND: Coronary atherosclerosis often coexists with acquired valvular disorders. There is growing evidence in literature that these two conditions may have common aetiology. AIM: To assess the incidence of coronary atherosclerosis in patients with acquired valvular disorders and to compare clinical parameters as well as the prevalence of risk factors between patients with aortic and mitral valve diseases. METHODS: The study group consisted of 155 patients (101 males, 54 females, mean age 58.2+/-9.7 years) with acquired valvular disorder who between 2000 and 2002 underwent invasive cardiac evaluation in our department prior to planned cardiac surgery. Aortic stenosis was detected in 74 patients, aortic insufficiency -- in 26, mitral stenosis -- in 33, and mitral regurgitation -- in 14 subjects. All patients underwent clinical evaluation, echocardiography, coronary angiography and laboratory tests. RESULTS: Patients with aortic stenosis had similar prevalence of coronary atherosclerosis to patients with aortic insufficiency, and patients with mitral stenosis -- to patients with mitral regurgitation. When the two groups -- patients with aortic valve disease and patients with mitral valve disease were compared, significant coronary lesions were more often detected in patients with aortic valve disease (36% vs 12.8%, p<0.05). Also, patients with aortic valve disorder were older, predominantly of male gender, had more often angina but less often heart failure, and had higher total cholesterol level than patients with mitral valve disease. CONCLUSIONS: Significant coronary lesions are more frequently encountered in patients with aortic valve disorder than in those with mitral valve disease. A high prevalence of atherosclerotic risk factors in patients with aortic valve disease may suggest that this condition has similar aetiology to that of coronary artery disease.

[Angina pectoris in patients with aortic valvular stenosis]. / Bóle wiencowe u chorych ze zwezeniem lewego ujscia tetniczego.

AIM: The aim of the study was to analyze the factors contributing to the development of anginal pain common in patients with aortic valvular stenosis (SOAS). METHODS: The study included 74 consecutive patients, aged 60,5 (+/- 10,7), with severe acquired valvular aortic stenosis (resting maximum systolic pressure gradient above 50 mm Hg) who were referred for evaluation prior to elective cardiac surgery. The history of angina and its severity according to CCS classification and of common atherosclerosis risk factors including: hypertension, hyperlipidaemia, smoking, diabetes mellitus and family history was taken. The laboratory tests included: lipidogram, white blood count and serum creatinine. The transthoracic echocardiography (TEE) date were collected: LVEDd, IVSDd, LVPWDd, LAd, EF, SF, SV, EDV, ESV, maximum systolic transvalvular pressure gradient and degree of aortic insufficiency. Coronary angiography was then performed. The presence of severe atherosclerosis was defined as more than 50% stenosis of one of three main coronary arteries: right, anterior descending or circumflex artery. Haemodynamic protocol involved LVEDP, PCWP, CO, PASP, aortic pressure gradient and aortic insufficiency evaluation. RESULTS: Patients with severe anginal symptoms (CCS III/IV) were older, had higher LDL cholesterol and triglycerides concentrations, more often had obesity and positive family history of ischemic heart disease than patients with mild (CCS I/II) or without symptoms. They had also higher number of vessels with significant stenosis which most frequently presented in left anterior descending artery. The maximum systolic pressure gradient according to TTE as well as to invasive measurements was also higher in symptomatic patients. The interventricular septum measured using TTE was thicker in patients with severe anginal symptoms. CONCLUSION: The frequency of anginal symptoms in patients with severe aortic valvular stenosis is higher than actual frequency of significant coronary stenosis on angiography. Angina is more common in a subgroup with coronary stenoses than in patients without coronary heart disease and the severity of anginal symptoms correlates with the number of coronary arteries involved. The severity of angina also correlates with the maximum pressure gradient across the aortic valve and the thickness of interventricular septum. In the study group hypercholesterolaemia, obesity and positive family history of IHD were more often found in patients with severe (CCS III/IV) symptoms.