Safety of radial coronary angiography with uninterrupted direct-acting oral anticoagulant treatment.

OBJECTIVE: It is not known whether direct-acting oral anticoagulants (DOACs), such as dabigatran, apixaban, and rivaroxaban increase the risk of bleeding complications during or after coronary catheterization. The aim of this study was to investigate the safety of uninterrupted DOAC treatment during diagnostic radial coronary angiography (CAG). METHODS: This study included 160 patients who underwent diagnostic radial cardiac catheterization. The 60 patients in the group who were using a DOAC (apixaban, rivaroxaban, or dabigatran) were enrolled in a Group A. Post-procedure results from patients in Group A were compared with those of an age- and sex-matched control group (Group B) that included 100 patients who underwent radial CAG who did not use a DOAC. RESULTS: There was no significant difference in the procedure and compression times, creatinine level, or presence of hypertension, diabetes mellitus, smoking, alcohol use, vascular disease, or congestive heart failure between the 2 groups. During the 1 -month follow-up period, only 1 radial occlusion was registered in the control group (Group B). There was no case of a large hematoma (>5 cm or extending to the forearm), dissection, fistula, perforation, or compartment syndrome. Hematomas smaller than 5 cm were seen in 2 patients (1 in each group). No thrombotic events were observed during follow-up examinations. CONCLUSION: Performing radial CAG with uninterrupted DOAC treatment appears to carry no risk of increased early or short-term complications. The simple, uninterrupted DOAC strategy is comfortable, easy, and safe.

Usefulness of live/real time three/four-dimensional transesophageal echocardiography in the percutaneous closure of an iatrogenic aorto-right ventricular fistula.

The development of an aorto-right ventricular fistula is a rare complication of cardiac surgery. The most common treatment is surgical closure of the fistula, but percutaneous closure of the fistula has become an attractive alternative option. We present a case of successful utilization of live/real time three/four-dimensional transoesophageal echocardiography (3/4DTEE) to select the correct device size for percutaneous closure of an adult patient presenting with an aorto-right ventricular (AO-RV) fistula following aortic valve replacement. To the best of our knowledge, this is the first case in which 3/4DTEE was used to select the device size and guide percutaneous closure of an iatrogenic AO-RV fistula.

Successful Endovascular Management of a Transplant Renal Artery Pseudoaneurysm Complicated With Arterioureteral Fistula.

We report a case of renal artery pseudoaneurysm at the anastomosis site complicated with arterioureteral fistula (AUF) in a 57-year-old kidney transplant recipient who presented with intermittent massive hematuria at one month post-transplant. We successfully treated the pseudoaneurysm and AUF with endovascular covered stent implantation. The diagnosis of AUF is rare and it is a condition that occurs in patients with previous pelvic or vascular surgery, chronic ureteral catheterization and radiotherapy. This diagnosis requires the expertise of the urologist, vascular surgeon and interventional radiologist. The fistula most often occur in the iliac arteries and are often associated with pseudoaneurysms or abscesses. Angiography and ureteral contrast studies (antegrade or retrograde pyelography) are the most valuable diagnostic tools. Treatment of AUF via endovascular approach using covered stents is effective and safe, and is becoming the reference treatment in AUFs.

An unusual embolic complication of percutaneous coronary artery intervention and simple percutaneous treatment.

Emboli are among the most feared complications of interventional cardiology. Although surgery is needed in most cases for the removal of peripheric foreign body emboli, some may be extracted by percutaneous intervention. We present a case of retrieval of a femoral sheath fragment via contralateral femoral access, wiring of the sheath fragment, and retrieval with an 'anchoring balloon' system.

Incidentally diagnosed unusual ascending aorta mass.

A 44-year-old female, with no medical history, was admitted to the cardiology department because of mild exertional dyspnea. Transthoracic and transesophageal echocardiography showed highly mobile, mass-like lesion in the aortic root. The patient was operated in the same week and a 1 cm × 6 cm soft tissue was excised from the ascending aorta. Pathological examination revealed a fibrin clot surrounded by a fibrous cap.

Mortality predictors in ST-elevated myocardial infarction patients undergoing coronary artery bypass grafting.

The use of coronary artery bypass grafting (CABG) in primary treatment of acute myocardial infarction is still debated. We evaluated the predictors of mortality in patients undergoing primary CABG for ST-elevated myocardial infarction (STEMI). Between January 2003 and January 2008, all patients referred to our institution with STEMI who did not qualify for primary angioplasty and required CABG were included in this study. Survivors and nonsurvivors were compared retrospectively in terms of demo-graphics, preoperative, intraoperative, and postoperative characteristics. Preoperatively confirmed cases of STEMI (n = 150) were included in the analysis. There were 114 survivors and 36 nonsurvivors. In-hospital mortality rate was 22%. In Cox regression analysis age, cardiogenic shock (Killip ≥3), preoperative cardiac troponin levels, preoperative use of intra-aortic balloon counterpulsation (IABP), previous myocardial infarction, and percutaneous coronary intervention were independent predictors of in-hospital mortality. After multivariate analysis, factors predicting in-hospital mortality were age, preoperative cardiac troponin levels, and preoperative IABP. Age, preoperative cardiac troponin levels, and preoperative IABP use were predictive factors of in-hospital mortality in patients undergoing primary CABG for STEMI.

Left ventricular giant pseudoaneurysm.

Left ventricular (LV) pseudoaneurysm is a rare complication of myocardial infarction. It may also occur as a complication of mitral valve surgery, chest trauma, and bacterial endocarditis. It forms when a cardiac rupture contains adherent pericardium or scar tissue and is typically located on the posterior or inferior LV wall. Pseudoaneurysms have a propensity to spontaneous rupture; hence, immediate surgical intervention is the treatment of choice for LV pseudoaneurysms diagnosed in the first months after myocardial infarction. The management of chronic LV pseudoaneurysms is still a subject of debate.

Plasma homocysteine level and left ventricular thrombus formation in acute anterior myocardial infarction patients following thrombolytic therapy with t-PA.

AIMS: The aim of this study was to evaluate the relationship between homocysteine levels and the development of left ventricular thrombus in acute anterior myocardial infarction patients directed to thrombolytic therapy. METHODS AND RESULTS: Seventy-nine patients presenting with ST elevated acute anterior myocardial infarction and treated with thrombolytic agent, t-PA, were included in the study. Two-dimensional echocardiography was used to divide patients into 2 groups according to the presence (n = 14) or absence (n = 65) of thrombus in the left ventricle following myocardial infarction. The levels of fasting plasma total homocysteine, total cholesterol, triglycerides, HDL-cholesterol, LDL-cholesterol, vitamin B12 and folic acid were assessed. There were no significant differences between two groups in terms of age, gender, hyperlipidemia and smoking. History of diabetes mellitus (28.57% versus 6.15%, p = 0.04), peak creatine phosphokinase levels (4153.54 +/- 1228.41 U/L versus 2456.92 +/- 1421.36 U/L, p < 0.001), mean left ventricular wall motion score index (2.21 +/- 0.18 versus 1.83 +/- 0.23, p < 0.001) and total fasting homocysteine levels (18.24 +/- 5.67 mmol/L versus 12.31 +/- 3.52 mmol/L, p < 0.001) were significantly higher in patients with left ventricular thrombus. In multivariate analysis; only diabetes mellitus (p = 0.03), higher wall motion score index (p = 0.001) and higher homocysteine levels (p = 0.04) were independent predictors of left ventricular thrombus formation. CONCLUSION: Our results suggest that; diabetes mellitus, higher wall motion score index and hyperhomocysteinemia independently increases the risk for the development of left ventricular thrombus formation in patients with acute anterior myocardial infarction following thrombolytic therapy.

O polimorfismo VNTR no gene codificador do antagonista do receptor da interleucina-1 está associado com a doença arterial coronariana / Interleukin-1 receptor antagonist gene VNTR polymorphism is associated with coronary artery disease

FUNDAMENTO: A Doença Arterial Coronariana (DAC) é a aterosclerose das artérias coronárias que transportam o sangue para o coração. A aterosclerose é uma doença inflamatória. As variações gênicas das citocinas - como as associadas à família IL1 - fazem parte da patogênese da aterosclerose. OBJETIVO: O objetivo deste estudo foi determinar a relação entre os polimorfismos da família IL1 (VNTR do IL1RN, posições -511 e +3953 do IL1B) e a DAC na população turca. MÉTODOS: Um total de 427 indivíduos foram submetidos à angiografia coronariana e em seguida divididos da seguinte forma: 170 no grupo controle e 257 no grupo de pacientes com DAC. Os sujeitos com DAC foram divididos em dois subgrupos: 91 no grupo de Doença Coronariana em um único vaso (Single Vessel Disease - SVD) e 166 no grupo Doença Coronariana em múltiplos vasos (Multiple Vessel Disease - MVD). Os genótipos de IL1RN e IL1B (-511, +3953) foram determinados por reação em cadeia da polimerase (RCP), seguida de análise da digestão por enzima de restrição. RESULTADOS: Não foram observadas diferenças significantes nas distribuições de genótipos de IL1RN e IL1B (-511 e +3953) entre os sujeitos com DAC e os controles, ou entre sujeitos com MVD e controles. No entanto, observou-se uma relação significante no genótipo IL1RN 2/2 entre sujeitos portadores de SVD e controles (P= 0,016, x2: 10,289, OR: 2,94IC 95 por cento 1,183 - 7,229). Tampouco foi observada diferença estatisticamente significante nas freqüências dos alelos de IL1RN e IL1B (-511 e +3953) entre os sujeitos com DAC e controles, os sujeitos com MVD e controles, ou ainda os sujeitos SVD e controles. CONCLUSÃO: Não foi observada nenhuma relação na freqüência alélica e nem na distribuição genotípica dos polimorfismos de IL1RN e IL1B entre sujeitos com DAC e grupos controle. No entanto, o genótipo IL1RN 2/2 pode representar um fator de risco para sujeitos com SVD na população turca.

BACKGROUND: Coronary Artery Disease (CAD) is the atherosclerosis of coronary arteries that carry blood to the heart muscle. Atherosclerosis is an inflammatory disease. Cytokine gene variations such as those associated with the IL1 family are involved in the pathogenesis of atherosclerosis. OBJECTIVE: The purpose of this study was to determine the relationship between IL1 family polymorphisms (IL1RN VNTR, IL1B positions -511 and +3953) and CAD in Turkish population. METHODS: 427 individuals were submitted to coronary angiography and were grouped as 170 control subjects and 257 CAD patients. The CAD subjects were divided into two subgroups: 91 Single Vessel Disease (SVD) and 166 Multiple Vessel Disease (MVD) subjects. The genotypes of IL1RN and of IL1B (-511, +3953) were determined by polymerase chain reaction (PCR) followed by restriction digestion analysis. RESULTS: No significant difference was found in IL1RN and IL1B (-511 and +3953) genotype distributions between CAD and control subjects or MVD and control subjects. However, significant association was seen in IL1RN 2/2 genotype between SVD and control subjects (P= 0.016, x2: 10.289, OR: 2.94, 95 percent CI: 1.183-7.229). Similarly, no statistically significant difference was found in IL1RN and IL1B (-511 and +3953) allele frequencies between CAD and control subjects, MVD and control subjects or SVD and control subjects. CONCLUSION: No association was found in either allele frequency or genotype distribution of IL1RN and IL1B polymorphisms between CAD and the control groups. However; IL1RN 2/2 genotype may be a risk factor for SVD in the Turkish population.

Increased dispersion of refractoriness in patients with atrial fibrillation in the early postoperative period after coronary artery bypass grafting.

INTRODUCTION: Increased atrial effective refractory period (AERP) dispersion is well correlated with vulnerability to atrial fibrillation (AF). However, the preoperative electrophysiologic characteristics of atrial abnormalities that may play an important role in the development of AF postoperatively in patients with coronary artery bypass grafting (CABG) have not been investigated in detail. METHODS AND RESULTS: Fifty-six consecutive patients who underwent CABG were enrolled in this study. Eighteen patients (14 men and 4 women; mean age 57.7 +/- 5.2 years) with AF in the early postoperative period and 38 patients (28 men and 10 women; mean age 56.3 +/- 6.4 years) without AF were compared with regard to preoperative clinical, echocardiographic, angiographic, and electrophysiologic parameters. Preoperative PA interval and AERP dispersion values were higher (P < 0.05) in patients who developed AF in the early postoperative period. PA interval (P < 0.05, odds ratio = 1.64, 95% confidence interval 1.17-2.30), AERP in the high right atrium (AERP(HRA); P < 0.05, odds ratio = 0.94, 95% confidence interval 0.91-0.97), AERP in the right posterolateral atrium (AERP(RPL); P < 0.05, odds ratio = 0.79, 95% confidence interval 0.63-0.98), AERP in the distal coronary sinus (AERP(DCS); P < 0.05, odds ratio = 0.84, 95% confidence interval 0.74-1.02), and AERP dispersion (P < 0.001, odds ratio = 1.29, 95% confidence interval 1.12-1.47) were independently related to post-CABG AF in univariate analysis. Increases in preoperative PA interval and AERP dispersion were found to be associated with a high risk for development of post-CABG AF. CONCLUSION: AERP dispersion is a suitable electrophysiologic indicator for atrial vulnerability. The presence of increased preoperative AERP dispersion and PA interval may indicate patients at high risk for development of AF in the early postoperative period after coronary artery bypass grafting.