Choosing a treatment method for post-catheterization pseudoaneurysms guided by the late to early velocity index.

Ultrasound-guided thrombin injection (UGTI) is often the first-line treatment for iatrogenic post-catheterization pseudoaneurysms (psA). There are also first reports of the use of biologically derived tissue glues (TG) instead of sole thrombin especially when UGTI was unsuccessful or in case of psA recurrence. Previously, we have established that a late to early velocity index (LEVI) < 0.2 could be a predictor of an increased risk of psA recurrence after standard UGTI. In this paper, we report our first experiences when the choice of the first-line treatment method was based on LEVI assessment. From May 2017 till January 2020 we included 36 patients with psA. Of them, 10 had LEVI < 0.2 and they underwent ultrasound-guided tissue glue injection (UGTGI) with biological TG and 26 had LEVI > 0.2 and they underwent UGTI. The injection set containing human thrombin and fibrinogen was used for UGTGI. Bovine thrombin was used for UGTI. The success rate was 100% and no psA recurrence was detected during a 2-week follow-up. It was significantly better when compared to the expected recurrence rates based on our previous 14 years of experience (0% vs. 13%, p = 0.01). All complications (10% in the UGTGI group and 15% in the UGTI group) were mild and transient and included clinical symptoms of paresthesia, numbness, tingling, or pain. Their rates were comparable to the rates we previously reported. No significant differences in other characteristics were observed. The approach to choose the first-line treatment method for iatrogenic psA based on LEVI is encouraging. It may increase the success rate and avoid unnecessary repetition of the procedure, without increasing complication rate while keeping costs of the procedure reasonable.

Ten-year study of late electrotherapy complications. Single-centre analysis of indications and safety of transvenous leads extraction.

BACKGROUND: An increase in the number of cardiac implantable electronic device (CIED) implantations is associated with a higher frequency of electrotherapy complications. AIM: The aim of the study was to determine the risk factors for late electrotherapy complications and to evaluate the effectiveness of transvenous lead extraction (TLE) and survival after TLE. METHODS: We analysed the clinical data of 225 patients with electrotherapy complications referred for TLE in a single centre in the years 2006 to 2015. Indications for TLE, risk factors for infectious complications, effectiveness of TLE, and survival after the procedure were assessed. RESULTS: In the study group, non-infectious indications for TLE predominated (78.2%). Analysis of risk for infectious complications demonstrated the important role of chronic renal failure (hazard ratio [HR] 1.842, p = 0.034) and a greater number of CIED-related procedures (HR 4.768, p < 0.001). High effectiveness of TLE and significantly higher long-term mortality of patients with infectious complications compared with the remainder (50% vs. 20%, p < 0.05) were documented. CONCLUSIONS: The study demonstrated a high rate of patients with non-infectious complications referred for TLE and very high effectiveness of the procedure. The worse long-term survival of patients with infectious complications, as well as increased risk for such complications due to the greater number of prior procedures, should prompt the consideration of early referral for TLE in the case of lead dysfunctions.

Complications of electrotherapy - the dark side of treatment with cardiac implantable electronic devices.

In the past years we have been observing the dynamic development of electrotherapy, as evidenced by the steadily rising number of implanted pacemakers (PM), as well as devices used in the treatment of dangerous arrhythmia and heart failure, such as implantable cardioverter defibrillators (ICD) and cardiac resynchronisation therapy (CRT-P/D). This is a consequence of the ageing of the populations of the majority of developed countries and also the gradually widening indications for the use of such devices. Along with the observed rise in the number of new implantations, the number of complications of electrotherapy is rising as well. In view of the increase in the incidence of complications, it is necessary to systematize the knowledge on this subject, because there is still no official classification of this type of complication and guidelines for dealing with such cases do not appear to cover the scale of the problem. In addition, late complications of electrotherapy play the most important role, in which case the removal of the entire pacing system, transvenous lead extraction (TLE), is a challenge due to the older age of leads strongly attached to the venous walls and endocardium of the heart cavity. The present paper presents a modern classification of electrotherapy complications and discusses the types of complications according to the most recent literature reports. Moreover, the diagnosis and management of particular types of complications with the assessment of indications for TLE are discussed.

[Transcatheter aortic valve implantation and its place in the contemporary treatment]. / Przezskórna implantacja zastawki aortalnej -- miejsce we wspólczesnej terapii.

Symptomatic stenosis of the aortic valve has recently been an important clinical issue. On one hand the number of patients who need surgical treatment of valve failure is increasing. On the other hand their general state of health and concomitant diseases determine that they are disqualified from surgery. The trasncutaneus technique of replacement of the aortic valve is for these patients a promising alternative. Therefore TAVI procedures have been developed and the number of performed transcatheter aortic valve replacements is still increasing. Although it would appear unlikely that TAVI could replace traditional surgery in the nearest future, it remains a possible treatment option for some of the high risk patients not suitable for surgery.

[Acute pulmonary embolism in pregnant women]. / Ostra zatorowosc plucna u kobiet w ciazy.

A case of a 19 year-old woman in the third trimester of her second pregnancy admitted due to suspected of acute pulmonary embolism (PE) is presented. The diagnosis was confirmed by transthoracic echocardiography (TTE) which revealed an immobile wall-adherent thrombus in the left pulmonary artery. A complete regression of the thrombus was obtained after antithrombotic treatment. We conclude that TTE examination can be useful in diagnosing of PE and may be safely used during pregnancy.

Myocardial infarction in a low risk patient with hereditary hemorrhagic telangiectasia.

We describe the case of a 57 year-old woman with NSTE ACS, a history of recurrent and prolonged epistaxis, and low prior cardiovascular risk. Additional findings revealed anemia and an aneurysm in her central nervous system. During her hospital stay, hereditary hemorrhagic telangiectasia (HHT) was diagnosed. After application of two antiplatelet drugs, the patient was scheduled for coronarography, followed by coronary artery bypass grafting. During her hospital stay, only a minor episode of epistaxis was observed. We conclude that anemization due to HTT may significantly accelerate the progress of ischemic heart disease, resulting in acute coronary syndrome. Moreover, coronarography preceded by routine application of two antiplatelet drugs seems not to increase the risk of hemorrhage in HHT patients complicated with myocardial infarction.

[A patient with coronaro-pulmonary fistula and acute coronary syndrome - clinical and diagnostic problem]. / Przetoka wiencowo-plucna u pacjenta z ostrym zespolem wiencowym z uniesieniem odcinka ST- problem kliniczny i diagnostryczny.

Coronary fistula is a rare congenital heart disease. Usually it is diagnosed because of mild clinical event and sometimes detected by coronary angiography performed during acute phase of myocardial infarction. When the coronary fistula have an aneurysmatic form, it should be closed due to the risk of rupture and sudden death, especially when volumetric and pressure overload or coronary steal syndrome are present. The closure may be performed invasively or non-invasively; the latter method is prefered in asymptomatic patients.