The initial experience of 2495 cases of the ulnar artery as default access for coronary diagnostic and interventional procedures at a single center: An observational study.

INTRODUCTION: Upper limb arterial access is being increasingly used for coronary diagnostic and intervention procedures. Radial artery access is associated with reduced morbidity and mortality as compared to femoral artery access. However, access to the radial artery is not always successful with reported crossover rates to other routes between 3% and 8%. Ulnar artery access is emerging an attractive option both as upfront access and rescue access in case of failure to obtain radial artery access. AIMS -: To assess and document the feasibility and safety of ulnar access as a default strategy. METHODS: 2654 patients planned for coronary diagnostic and intervention procedureswere assessed for inclusion. Inclusion criteria were, all patients planned for coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpable ulnar pulse. Exclusion criteria included reverse Barbeau test type D, previous procedure resulting in radial artery occlusion/excision, hemodialysis patients having ipsilateral AV fistula and severe forearm deformities. RESULTS: 2525 patients were found eligible, out of which 2495 (98.81%) were successfully cannulated. Procedure was completed in 2414 patients. Local site bleeding in 40 (1.6%) and acute loss of ulnar pulse noted in 33 (1.3%) out of 2495 patients. None of the patients had gangrene of access site, pseudo-aneurysm, arteriovenous fistula or neurological deficit post procedure. CONCLUSION: The Ulnar artery access as a default access is safe and feasible option for patient undergoing coronary diagnostic and interventional procedures.

A pediatric echocardiographic Z-score nomogram for a developing country: Indian pediatric echocardiography study - The Z-score.

BACKGROUND: Almost all presently available pediatric echocardiography Z-score nomograms are based on Western data. They may not be a suitable reference standard for assessing the sizes of cardiac structures of children from developing countries. OBJECTIVE: This study's objective was to collect normative data of 21 commonly measured cardiovascular structures using M-mode and two-dimensional echocardiography in Indian children aged between 4 and 15 years and to derive Z-score nomograms for each. SUBJECTS AND METHODS: The study was conducted at two centers in India - Ajmer, Rajasthan, and Mohali, Punjab. We studied a community-based sample involving healthy school going children. After excluding children with cardiovascular abnormalities on the screening echocardiogram, 746 children were included in the final analysis. Echocardiographic assessment was performed using a Philips iE33 system. RESULTS AND ANALYSIS: For each parameter measured, seven models were evaluated to assess the relationship of that parameter with the body surface area and the one with the best fit was used to plot the Z-score chart for that parameter. Z score charts were thus derived. CONCLUSIONS: The Z-score nomograms derived by this study may be better alternatives to the Western nomograms for use in India and other developing countries for preprocedural decision making in the pediatric population. However, they will require validation in large-scale studies before they can become clinically applicable.