Management and outcomes of coronary artery perforations during percutaneous treatment of acute coronary syndromes.

BACKGROUND: Coronary artery perforation (CAP) is an infrequent and life-threatening complication of percutaneous coronary intervention (PCI), requiring prompt intervention. There is insufficient data about the prognosis and management of CAP in patients with acute coronary syndrome (ACS). The aim of this study was to investigate the management of CAP in patients with ACS. METHODS: The results of 25 patients with CAP were retrospectively analyzed. RESULTS: Of the 25 patients, 14 patients (56%) had ACS. According to the Ellis classification, the grade of perforation was type-I in 8 (32%) patients, type-II in 6 (24%) patients and type-III in 11 (44%) patients. Prolonged balloon inflation was performed to 20 (80%) cases of CAP. It successfully sealed the perforation in three cases of type-I, five cases of type-II CAP and in seven cases of type-III CAP. Seven patients underwent covered stent implantation. Emergent CABG was required in two patients with type-III CAP. In-hospital mortality was not observed in the patients. CONCLUSION: The outcomes of CAP in patients with ACS were similar to patients with stable coronary disease. The continuation of anti-platelet agents after the successful management of CAP may be encouraged in these patients.

Cilostazol decreases total atrial conduction time in patients with peripheral artery disease.

OBJECTIVE: Total atrial conduction time (TACT) is the most important parameter in predicting the development of new-onset atrial fibrillation. We investigated the effect of cilostazol therapy on TACT in patients with peripheral artery disease. METHODS: Thirty patients with peripheral artery disease were treated with cilostazol (200 mg/day) for 6 months. The baseline echocardiographic total atrial conduction time parameter was compared with the 6-month follow-up. RESULTS: The TACT duration was decreased in all patients compared with the baseline after therapy (121.8 ± 19.3 vs. 109.1 ± 15.9 milliseconds, p<0.001). However, left atrial (LA) diameter was not changed with the therapy. The reduction of TACT duration was correlated with the increase in mitral E wave velocity/mitral A wave velocity ratio (r=-0.48, p<0.003). CONCLUSION: Our results showed that 200 mg cilostazol treatment decreased TACT duration in patients with peripheral artery disease, which may also prevent the development and/or recurrence of atrial fibrillation (AF).

Delayed right atrial lateral electromechanical coupling relative to the septal one can be associated with paroxysmal atrial fibrillation.

BACKGROUND: Non-invasive prediction of paroxysmal atrial fibrillation (PAF) is one of the most recent interests of cardiology. AIM: The current study investigates the relationship between the atrial electromechanical coupling time (EMCT) and PAF. PATIENTS AND METHODS: A group of 35 patients with PAF was compared with a group of 37 subjects without PAF. Pulsed wave tissue Doppler evaluations of atrial walls were performed from apical four chambers view under ECG monitoring. The time intervals from the onset of P wave to the onset of late diastolic wave (A') at right atrial wall (P-RA), interatrial septum (P-IAS), and left atrial wall (P-LA, maximum EMCT) were measured. The right atrial EMCT (P-RA minus P-IAS), left atrial EMCT (P-LA minus P-IAS) and interatrial EMCT (P-LA minus P-RA) were computed. A' wave velocities were measured from each atrial wall. RESULTS: RA (16.0±13.1 vs. -8.7±18.6 ms, p < 0.001) and maximum (91.5±32.6 vs. 72.0±23.1 ms, p = 0.001) EMCT were longer, RA A' velocity was higher in the patient group. There were no differences between the groups in LA and interatrial EMCT, and septal and LA A' velocities. Regression analysis revealed that only RA [OR: 1.148 (1.041-1.267), p = 0.006] and maximum [OR: 1.099 (1.009-1.197), p = 0.031] EMCT were independent variables for PAF. In order to predict patients with PAF, we have chosen +7.5 msn for the RA EMCT which yielded 69% sensitivity and 71.4% specificity to predict patients. CONCLUSIONS: Delayed RA lateral EMCT relative to septal one and delayed maximum EMCT detected by tissue Doppler could be a valuable method for identifying patients with PAF.

Echocardiographic evaluation of right ventricular functions after successful percutaneous recanalization of right coronary artery chronic total occlusions.

BACKGROUND: No data exist on regarding possible improvement will occur in right ventricular (RV) functions after successful recanalization of right coronary artery chronic total occlusions (RCA CTOs). AIM: Our aim was to evaluate the revascularization induced changes in RV functions by novel echocardiographic techniques like tissue Doppler imaging (TDI) and two dimensional speckle tracking echocardiography (2DSTE). PATIENTS AND METHODS: Forty-one consecutive successfully recanalized patients with RCA CTOs were included in our study. All included patients underwent standard echocardiography with TDI and 2DSTE to assess RV function before procedure and repeated after 24 hours and 1 month. RESULTS: There were no significant changes in tricuspid annular plane systolic excursion, systolic myocardial velocities, and fractional area change values. However, RV global longitudinal strain and systolic strain rate values showed a significant increase at 24 hours after percutaneous coronary intervention compared to baseline (-23.6±4.1% vs. -19.7±3.9%, p < 0.001 and -1.55±0.18s-1 vs. -1.18±0.17s-1, p < 0.001, respectively). Moreover, improvement of the RV functions in patients with RCA CTOs was further suggested by the higher RV isovolumic acceleration values at 1-month compared with baseline (2.29±0.62 vs. 2.05±0.5 m/s2, p = 0.014). CONCLUSIONS: TDI derived isovolumic acceleration and 2DSTE derived global longitudinal strain and systolic strain rate values showed improvement in RV functions after successful percutaneous recanalization of RCACTOs suggesting viability of RV in chronic ischemia.

Elevated uric acid and functional mitral regurgitation in dilated cardiomyopathy.

BACKGROUND: Recent findings suggest that there is a close relationship between chronic heart failure and uric acid. AIMS: The aim of the study was to assess whether increased uric acid levels in patients with dilated cardiomyopathy might correlate with the degree of functional mitral regurgitation (MR). MATERIALS AND METHODS: Sixty two consecutive patients diagnosed with dilated cardiomyopathy were included in the study. The patients were classified according to severity of functional MR into two groups: mild-moderate functional MR (ERO < 0.2 cm2) and severe functional MR. RESULTS: The patients with severe functional MR had significantly higher serum uric acid levels compared to patients without severe functional MR (6.34 ± 1.61 mg/dL vs 5.43 ± 1.17 mg/dL respectively, p = 0.012). Furthermore, tenting area, an important predictor of functional MR severity, was moderately correlated with the serum uric acid levels (r = 0.351, p = 0.005). It was also shown that the serum uric acid concentrations were inversely correlated with left ventricular (LV) ejection fraction, and positively correlated with LV volumes. There was also a significant relation between the serum uric acid and left atrial volumes and also brain natriuretic peptide (BNP) levels. CONCLUSIONS: In conclusion, this study demonstrates that elevated serum uric acid levels in patients with dilated cardiomyopathy are correlated with the severity of functional MR and echocardiographic volume indices.

Successful percutaneous closure in patients with difficult atrial septal defects: case series and review of literature.

Atrial septal defect is a common form of congenital heart disease. Percutenous closure is an important treatment option for these patients. In this case series, we intend to share the percutaneous closure of the difficult types of secundum atrial septal defects.

Coronary muscular bridge mimicking acute stent thrombosis.

A patient who develops hypotension or angina pectoris after intravenous inotropic agents should be assessed for dynamic left ventricular outflow obstruction or the presence of a muscular bridge. In this case report, we present a patient with low ejection fraction who developed hypotension and angina pectoris with inotropic therapy after coronary intervention. We performed a coronary angiogram to exclude stent thrombosis but a muscular bridge was found in the segment distal to the stent.