The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: DataData from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY).

BACKGROUND: Arterial tortuosity is linked to a higher risk of adverse clinical events after transfemoral transcatheter aortic valve replacement (TF-TAVR). Currently, there are no assessment tools that can quantify this variable in three-dimensional space. This study investigated the impact of novel scoring methods of iliofemoral tortuosity on access and bleeding complications after TF-TAVR. METHODS: The main access vessel was assessed between the aortoiliacal and femoral bifurcation in preoperative multislice computed tomography scans of 240 consecutive patients undergoing TF-TAVR. Tortuosity was assessed by three methods: largest single angle, sum of all angles, and iliofemoral tortuosity (IFT) score [((true vessel length/ideal vessel length)-1)*100]. The primary study endpoint was a composite of access and bleeding complications. The secondary study endpoints were 30-day mortality and long-term survival. RESULTS: Among 240 patients, only the IFT score demonstrated a good positive correlation with the composite primary endpoint of access and bleeding complications (P = 0.031). A higher incidence of access and bleeding complications was found in patients with a higher IFT score (56 [36.8%] vs 17 [19.3%]; P = 0.003). In a multivariate logistic regression analysis, only the IFT score was a significant predictor of the primary endpoint (OR: 2.11; 95% CI: 1.09-4.05; P = 0.026). CONCLUSION: Vascular tortuosity is an underestimated risk factor during TF-TAVR. The IFT score is a valuable tool in risk stratification before TF-TAVR, predicting periprocedural access and bleeding complications.

Transcatheter closure of patent foramen ovale for the secondary prevention of decompression illness in professional divers: a single-centre experience with long-term follow-up.

BACKGROUND: Patent foramen ovale (PFO) with occasional right-to-left shunting is associated with an increased risk of decompression illness (DCI). Divers with a history of repetitive or severe DCI and diagnosed with PFO should be considered for transcatheter closure if they wish to continue with unrestricted diving. AIM: To summarise our centre's experience in transcatheter PFO closure in professional divers with a history of DCI. METHODS: A follow-up of 11 consecutive divers (nine males, two females) in whom device PFO closure was performed between 2001 and 2015 was carried out by phone contact. Available medical records and diving logbooks were reviewed to determine individual DCI symptomatology, indications to the procedure, and to evaluate modifications in the diving practice. RESULTS: Each patient experienced at least one event of DCI before the procedure, and eight patients experienced more than one event. Total number of reported events was 62. The vast majority of events (97%) followed dives consistent with safe decompression policies. The median follow-up was 91 (minimum nine, maximum 172) months. No complications of the intervention were observed. All patients returned to unrestricted, deep diving, performing a total of 3610 dives with the median number of 225 dives (lower quartile value: 82.5 dives, upper quartile value: 725 dives). The majority of subjects dived as deep as they did before the intervention, or deeper, achieving mean maximum depth of 93.8 ± 35.6 m (vs. 89.7 ± 25.9 m before the intervention, p = 0.71). No episodes of DCI were reported during the follow-up period. CONCLUSIONS: Transcatheter closure of PFO appears to be reasonably effective in secondary prevention of DCI associated with intra-cardiac shunting.

Transcatheter Valve-in-Valve Implantation in a Degenerated Mitral Bioprosthesis Using a Trans-Septal Anterograde Approach and 3-D Transesophageal Echocardiography Guidance.

Degenerated and dysfunctional prosthetic valves are usually replaced surgically. However, repeated cardiac surgery can cause prohibitive risk, especially in patients with many associated co-morbidities. Transcatheter valve-in-valve implantation (TVIV) is a novel, technically very challenging, but less invasive alternative treatment for patients with unacceptably high surgical risk of degenerated prosthetic valves. The method is attractive because it takes advantage of the presence of the degenerated prosthesis, which serves as an anchoring zone. Here, the case is presented of TVIV in an 82-year-old female with significant stenosis of a biological mitral prosthesis. In 2011, Himbert et al. were the first to successfully insert a transcatheter heart valve in the mitral ring using a transfemoral approach. To date, only a small case series has been reported on the effectiveness of TVIV using a transfemoral venous access and a trans-septal anterograde approach. The present patient was the first in which TVIV was performed in Poland and Eastern Europe.

Pulmonary artery rupture as a complication of Swan-Ganz catheter application. Diagnosis and endovascular treatment: a single centre's experience.

INTRODUCTION: The placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2-17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage - pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices. AIM: To evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization. MATERIAL AND METHODS: In this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology. RESULTS: We report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood. CONCLUSIONS: Despite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery.

Percutaneous retrieval of centrally embolized fragments of central venous access devices or knotted Swan-Ganz catheters. Clinical report of 14 retrievals with detailed angiographic analysis and review of procedural aspects.

INTRODUCTION: Totally implantable venous access systems (TIVAS), Swan-Ganz (SG) and central venous catheters (CVC) allow easy and repetitive entry to the central cardiovascular system. Fragments of them may be released inadvertently into the cardiovascular system during their insertion or as a result of mechanical complications encountered during long-term utilization. AIM: To present results of percutaneous retrieval of embolized fragments of central venous devices or knotted SG and review the procedural aspects with a series of detailed angiographies. MATERIAL AND METHODS: Between January 2003 and December 2012 there were 14 (~0.025%) successful retrievals in 13 patients (44 ±16 years, 15% females) of embolized fragments of TIVAS (n = 10) or CVC (n = 1) or of dislodged guide-wires (n = 2) or knotted SG (n = 1). RESULTS: Foreign bodies with the forward end located in the right ventricle (RV), as well as those found in the pulmonary artery (PA), often required repositioning with a pigtail catheter as compared to those catheter fragments which were located in the right atrium (RA) and/or great vein and possessed an accessible free end allowing their direct ensnarement with the loop snare (57.0% (4/7) vs. 66.7% (2/3) vs. 0.0% (0/3); p = 0.074 respectively). Procedure duration was 2-3 times longer among catheters retrieved from the PA than among those with the forward edge located in the RV or RA (30 (18-68) vs. 13.5 (11-37) vs. 8 min (8-13); p = 0.054 respectively). The SG catheter knotted in the vena cava superior (VCS) was encircled with the loop snare introduced transfemorally, subsequently cut at its skin entrance and then pulled down inside the 14 Fr vascular sheath. CONCLUSIONS: By using the pigtail catheter and the loop snare, it is feasible to retrieve centrally embolized fragments or knotted central venous access devices.

Coronary artery computed tomography as the first-choice imaging diagnostics in patients with high pre-test probability of coronary artery disease (CAT-CAD).

INTRODUCTION: The primary diagnostic examination performed in patients with a high pre-test probability of coronary artery disease (CAD) is invasive coronary angiography. Currently, approximately 50% of all invasive coronary angiographies do not end with percutaneous coronary intervention (PCI) because of the absence of significant coronary artery lesions. It is desirable to eliminate such situations. There is an alternative, non-invasive method useful for exclusion of significant CAD, which is coronary computed tomography angiography (CCTA). AIM: We hypothesize that use of CCTA as the first choice method in the diagnosis of patients with high pre-test probability of CAD may reduce the number of invasive coronary angiographies not followed by interventional treatment. Coronary computed tomography angiography also seems not to be connected with additional risks and costs of the diagnosis. Confirmation of these assumptions may impact cardiology guidelines. MATERIAL AND METHODS: One hundred and twenty patients with indications for invasive coronary angiography determined by current ESC guidelines regarding stable CAD are randomized 1 : 1 to classic invasive coronary angiography group and the CCTA group. RESULTS: All patients included in the study are monitored for the occurrence of possible end points during the diagnostic and therapeutic cycle (from the first imaging examination to either complete revascularization or disqualification from the invasive treatment), or during the follow-up period. CONCLUSIONS: Based on the literature, it appears that the use of modern CT systems in patients with high pre-test probability of CAD, as well as appropriate clinical interpretation of the imaging study by invasive cardiologists, enables precise planning of invasive therapeutic procedures. Our randomized study will provide data to verify these assumptions.

Endovascular treatment of PA pseudoaneurysm caused by Swan-Ganz catheter.

The following case report describes a complication of Swan-Ganz catheterization and its endovascular treatment with a single coil. Application of this particular catheter in the pulmonary artery during cardiac surgery may lead to mechanical perforation and creation of an extravascular sac, which is called a pseudoaneurysm. There are different methods that lead to tamponade or closure of the leakage. Interventional cardiology procedures are nowadays the most appropriate way of treatment of Swan-Ganz catheter induced vascular complications.