RESUMO
INTRODUCTION AND OBJECTIVES: Transfemoral access is the most frequently used vascular approach in chronic total occlusion percutaneous coronary interventions (CTO-PCI). The aim of this study was to evaluate the safety and feasibility of a transradial access CTO-PCI program and its impact on angiographic and clinical results and length of hospital stay. METHODS: Retrospective multicenter cohort study including 2550 consecutive CTO-PCI procedures included in a multicenter registry with accurate information on vascular access. A total of 896 procedures were performed as radial-only access while 1654 were performed through at least 1 femoral puncture. Clinical and angiographic data were collected. RESULTS: The mean age was 66.3± 11.4 years. The mean Japan-chronic total occlusion score (2.7±0.3) was similar in the 2 groups. Successful revascularization was achieved in 2009 (79.6%) cases, 78.2% and 82.1% in the femoral and radial access cohorts, respectively (P=.002). Periprocedural in-hospital complications were observed in 5.1% and 2.3% (P=.02), with fewer access site-dependant vascular complications in the transradial cohort (2.3% vs 0.2%; P=.009). The mean length of hospital stay was significantly shorter in the transradial access group (0.89±1.4 vs 2.2±3.2 days, P<.001). CONCLUSIONS: A transradial program for CTO-PCI is safe and effective in most CTO lesions. The transradial strategy has fewer vascular complications and shorter length of hospital stay without compromising the success rate.
Assuntos
Doenças Cardiovasculares , Oclusão Coronária , Intervenção Coronária Percutânea , Humanos , Pessoa de Meia-Idade , Idoso , Intervenção Coronária Percutânea/métodos , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Estudos de Viabilidade , Estudos de Coortes , Artéria Radial/cirurgia , Artéria Femoral/cirurgia , Resultado do Tratamento , Angiografia Coronária , Sistema de Registros , Doença CrônicaRESUMO
A 56-year-old male presented with angina pectoris despite optimal medical treatment. A coronary computed tomography angiography revealed a chronic total occlusion of the proximal right coronary artery with a moderately calcified long path, and a chronic total occlusion of the distal circumflex. In selected cases with long occlusions and the need for a hybrid approach, the use of computed tomography angiography fusion could help to identify the right wire position, prevent perforations, reduce the use of contrast and fluoroscopy time, improve patient safety, and increase success rate.
Assuntos
Oclusão Coronária , Intervenção Coronária Percutânea , Doença Crônica , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Oclusão Coronária/diagnóstico , Oclusão Coronária/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: Severe tricuspid regurgitation (TR) is frequently associated with significant morbidity and mortality; such patients are often deemed to be at high surgical risk. Heterotopic bicaval stenting is an emerging, attractive transcatheter solution for these patients. OBJECTIVES: The aim of this study was to evaluate the 30-day safety and 6-month efficacy outcomes of specifically designed bioprosthetic valves for the superior and inferior vena cava. METHODS: TRICUS EURO (Safety and Efficacy of the TricValve® Transcatheter Bicaval Valves System in the Superior and Inferior Vena Cava in Patients With Severe Tricuspid Regurgitation) is a nonblinded, nonrandomized, single-arm, multicenter, prospective trial that enrolled patients from 12 European centers between December 2019 and February 2021. High-risk individuals with severe symptomatic TR despite optimal medical therapy were included. The primary endpoint was quality-of-life (QOL) improvement measured by Kansas City Cardiomyopathy Questionnaire score and New York Heart Association (NYHA) functional class improvement at 6-month follow-up. RESULTS: Thirty-five patients (mean age 76 ± 6.8 years, 83% women) were treated using the TricValve system. All patients at baseline were in NYHA functional class III or IV. At 30 days, procedural success was 94%, with no procedural deaths or conversions to surgery. A significant increase in QOL at 6 months follow-up was observed (baseline and 6-month Kansas City Cardiomyopathy Questionnaire scores 42.01 ± 22.3 and 59.7 ± 23.6, respectively; P = 0.004), correlating with a significant improvement in NYHA functional class, with 79.4% of patients noted to be in functional class I or II at 6 months (P = 0.0006). The rates of 6-month all-cause mortality and heart failure hospitalization were 8.5% and 20%, respectively. CONCLUSIONS: The dedicated bicaval system for treating severe symptomatic TR was associated with a high procedural success rate and significant improvements in both QOL and functional classification at 6 months follow-up.
Assuntos
Cardiomiopatias , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Tricúspide , Idoso , Idoso de 80 Anos ou mais , Cateterismo Cardíaco/efeitos adversos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Masculino , Estudos Prospectivos , Qualidade de Vida , Índice de Gravidade de Doença , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/cirurgiaRESUMO
PURPOSE: Antitachycardia pacing (ATP) terminates the majority (but not all) of slow ventricular tachycardias (S-VT) with a cycle length (CL) > 320 ms. Usually, several ATP therapies are programmed in the S-VT zone. Our objective is to analyse the ATP effectiveness, comparing the first ATP attempt (ATP-1) to the second (ATP-2) and third (ATP-3) attempts. METHODS: We studied 556 S-VT (CL = 354 ± 18). ATP programming was standardized and included three bursts of 15 pulses at 91% of VT CL. RESULTS: ATP effectiveness declined from ATP-1 (436/556: 78%) compared to ATP-2 (24/103: 23%) and ATP-3 (10/79: 13%) (p < 0.01) for all comparisons. The percentage of variation of RR intervals (P-RR, %) was higher prior to effective ATP-1 (2.73 ± 1.45 vs. 1.23 ± 0.9; p < 0.001). After an ineffective ATP-1, the P-RR decreased dramatically, with no differences between episodes terminated or not at ATP-2 (0.6 ± 0.14 vs. 0.44 ± 0.16; p = 0.6) or ATP-3 (0.54 ± 0.15 vs. 0.52 ± 0.14; p = 0.7). The post-pacing interval-CL difference (PPI-TCLd) after an unsuccessful ATP-1 was shorter in episodes terminating at ATP-2 or ATP-3 (180 ± 24 vs. 211 ± 15 ms; p < 0.001). Several independent predictors of ATP efficacy were found, as follows: (a) ATP-1: P-RR, % (OR = 7.3; p < 0.001), beta-blockers (OR = 4.1; p < 0.001) and QRS ≥ 120 ms (OR = 0.3; p < 0.001); (b) ATP-2: PPI-TCLd, ms (OR = 0.94; p = 0.001) and QRS ≥ 120 ms (OR = 0.6; p = 0.04); (c) ATP-3: PPI-TCLd, ms (OR = 0.93; p = 0.009). CONCLUSIONS: The effectiveness of ATP is mainly due to ATP-1. The regularization of RR intervals after ineffective ATP-1 underlies the lower efficacy of successive attempts. Shorter PPI-TCLd is associated with higher effectiveness of ATP-2 and ATP-3. Since a duration of QRS ≥ 120 ms predicts a longer PPI-TCLd, patients with wide QRS complexes have less effective ATP-2 and APT-3.
Assuntos
Estimulação Cardíaca Artificial/métodos , Taquicardia Ventricular/terapia , Idoso , Eletrocardiografia , Feminino , Humanos , Masculino , Volume Sistólico , Taquicardia Ventricular/fisiopatologiaRESUMO
Parasitic infections of the central nervous system (CNS) comprise a plethora of infectious agents leading to a multitude of different disease courses and thus diagnostic and therapeutic challenges. The prevalence of different pathogens is basically dependent on geographic and ethnic backgrounds, its infectious route frequently involving a third party, such as flies or domestic animals. The present review focuses on cerebral malaria due to Plasmodium falciparum infection, and Toxoplasma gondii encephalitis. Fungi produce a large variety of inflammatory conditions of the CNS with a variegated spectrum of signs and symptoms, which may involve the meninges and the brain parenchyma, where they produce cerebritis or abscesses and granulomatous lesions, respectively. Fungal CNS lesions are increasingly prevalent and diagnostically relevant due to increasing numbers of human immunodeficiency virus-positive patients, increasing numbers of patients reaching old age suffering from malignant tumors or decreased immunity, and finally the increasing use of established and new immunosuppressive treatments, which increase the susceptibility of patients to develop invasive mycoses. Fungi appear with characteristic morphotypes comprising hyphae, yeasts, and pseudohyphae. The mode by which fungi penetrate into the CNS, and the host/immune requirements are incompletely understood and remain a challenge for research.
Assuntos
Sistema Nervoso Central/microbiologia , Sistema Nervoso Central/patologia , Micoses , Doenças Parasitárias , Animais , Sistema Nervoso Central/parasitologia , Humanos , Micoses/epidemiologia , Micoses/imunologia , Micoses/patologia , Doenças Parasitárias/epidemiologia , Doenças Parasitárias/imunologia , Doenças Parasitárias/patologiaAssuntos
Ecocardiografia Tridimensional , Implante de Prótese de Valva Cardíaca , Insuficiência da Valva Mitral , Cateterismo Cardíaco , Ecocardiografia , Ecocardiografia Transesofagiana , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Insuficiência da Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/cirurgia , Transiluminação , Resultado do TratamentoRESUMO
Abstract Atrial fibrillation (AF) is an increasing health care problem associated with thromboembolic risk about 5% per year, with high mortality and morbidity when associated to stroke. Oral anticoagulants (OAC) are the treatment of choice for preventing ischemic stroke in patients with nonvalvular atrial fibrillation (NVAF). However, these drugs are associated with an increased risk of serious complications such an intracranial hemorrhage (ICH). In this context percutaneous closure of the left atrial appendage (LAA) is an effective therapeutic alternative to OACs, with an increasing success rate. Novel devices might allow or facilitate the procedure in some anatomically and technically complicated cases. Two patients with a complex morphology of the LAA, in which the LAmbre (Lifetech Scientific [Shenzhen] Co. Ltd.) device was implanted with good technical and clinical results are presented.