Although rare in pediatrics, deep vein thromboses can occur in approximately 0.1% of admissions per year and have serious clinical sequelae (1). Deep vein thromboses are often associated with central venous catheters, but also seen in cases of infection, surgery, renal comorbidities, and hypercoagulable states. Traditionally, percutaneous mechanical thrombectomy has not been part of the treatment algorithm for this pathology in pediatrics. However, percutaneous mechanical thrombectomy is being used more in pediatrics to manage ischemic strokes (2) and systemic venous occlusions (3). Here we describe the pediatric use of a new aspiration system designed to minimize blood loss. A 10 year old with history of refractory focal segmental glomerulosclerosis presented with Pseudomonas aeruginosa peritonitis and cardiogenic shock requiring venoarterial extracorporeal membrane oxygenation. He was subsequently found to have a 6 cm × 1.2 cm inferior vena cava thrombus for which there were concerns over obstructing venous return, impeding extracorporeal membrane oxygenation functionality, and risk for pulmonary embolus. He was taken to the catheterization laboratory where angiography and ultrasonography demonstrated an extensive inferior vena cava clot burden beginning above the renal veins extending superiorly (Figure 1, Video 1). We used the 12-F Penumbra Indigo Aspiration system and Lightning Intelligent Tubing (Penumbra, Alameda, California) to remove the clot. This system uses pressure sensors for real-time blood flow monitoring and an algorithm with automated valve controls to minimize blood loss. A separator is used out the tip of the catheter to break up the clot. Ultrasonography was used to visualize precise clot removal simultaneously. Follow-up contrast hand injections showed near complete resolution of the clot. There was an estimated 30 ml of blood loss. Our patient tolerated the procedure well without complications and was ultimately able to be taken off extracorporeal membrane oxygenation.
A 37-year-old man with a history of atrial fibrillation presented to an emergency department with shortness of breath and was diagnosed with acute congestive heart failure. Upon arrival, he was poorly rate controlled and was not on anticoagulation therapy. While being investigated for possible pulmonary embolism, he suffered a pulseless electrical activity cardiac arrest. Following resuscitation, a computed tomography scan revealed a giant left main coronary sinus fistula draining into the right atrium; this finding was further confirmed with a transesophageal echocardiogram (TEE) (Figures 1A and 1B).
Axillary intra-aortic balloon pump (IABP) placement for extended durations of time while patients await cardiac transplantation is a safe and widely implemented strategy for mechanical circulatory support (1,2). Recently, the use of axillary IABP has been significantly increasing after the new heart allocation revision in 2018 (3). The most commonly reported adverse event was IABP malfunctioning, in several studies being reported up to 40% of patients. Malposition inside the ascending aorta, aortic arch, or distal abdominal aorta is a rare complication that requires fluoroscopic repositioning or exchange (4). Here, we report a case of symptomatic, incidental IABP migration into the contralateral right common carotid artery that was safely repositioned with fluoroscopic guidance.
Despite improvements in devices and procedural techniques, stroke remains a concern during transcatheter aortic valve replacement (TAVR). After results of the Cerebral Protection in Transcatheter Aortic Valve Replacement trial, the U.S. Food and Drug Administration approved the Sentinel cerebral embolic protection device (CEPD) (Claret Medical) to reduce procedural ischemic brain injury. However, in this trial, device-arm patients had a significant increase in total procedural and fluoroscopy times compared with control. Furthermore, CEPD placement required additional contrast to visualize aortic anatomy to navigate filter deployment. By overlaying computed tomographic angiography (CTA) onto radiography, live guidance is enabled in direct relation to patient-specific anatomy. We hypothesized that such composite image guidance in real time could improve CEPD navigation and deployment, leading to a decrease in contrast media volume and fluoroscopy time.
Aligned neocommissures of transcatheter heart valves (THVs) may facilitate coronary access and repeat interventions after transcatheter aortic valve replacement (TAVR) (1,2). We have recently reported that the cusp-overlap technique is useful to achieve optimal commissural alignment of the self-expanding Evolut valve (Medtronic) in a cohort of valve-in-valve patients (3). Here we report the utility of the cusp-overlap technique in achieving commissural alignment with the self-expanding ACURATE neo valve (Boston Scientific) in a cohort of patients with native aortic stenosis.
Spontaneous coronary artery dissection (SCAD) is a pathophysiologically distinct cause of acute coronary syndromes (ACS). It is increasingly recognized that optimal management is different from that for atherosclerotic ACS and that a SCAD diagnosis has specific long-term prognostic and therapeutic implications. Accurate diagnosis is therefore essential to ensure the best treatment of patients. At present this relies on the recognition of typical features of SCAD identified on invasive coronary angiography. Although most SCAD can be readily distinguished angiographically from alternative causes of ACS, false positive and false negative diagnoses remain common. In particular, sometimes non-SCAD presentations, including atherothrombosis, takotsubo cardiomyopathy, coronary embolism, coronary vasospasm, contrast streaming, and myocardial infarction with nonobstructive coronary arteries, can mimic angiographic features usually associated with SCAD. The authors present the combined experience from European and US SCAD referral centers reviewing the classical angiographic appearances of SCAD, presenting potential diagnostic pitfalls and exemplars of SCAD mimickers. The authors further review the benefits and limitations of intracoronary imaging in the context of SCAD. Finally, the authors discuss the investigation of ambiguous cases and an approach to minimize misdiagnosis in difficult cases.
Objectives The aim of this study was to evaluate the association between reported marijuana use and post–percutaneous coronary intervention (PCI) in-hospital outcomes.
Objectives The aim of this study was to evaluate prognostic implications of physiological 2-dimensional disease patterns on the basis of distribution and local severity of coronary atherosclerosis determined by quantitative flow ratio (QFR) virtual pull back.
Objectives The study sought to evaluate the impact of diabetes mellitus on 3-year clinical outcome in patients undergoing drug-coated balloon (DCB) or drug-eluting stent (DES) treatment for de novo lesions.
Objectives The aim of this study was to determine whether 1 month of dual-antiplatelet therapy (DAPT) followed by aspirin monotherapy after polymer-free drug-coated stent (PF-DCS) implantation is noninferior to 6 to 12 months of DAPT after biodegradable-polymer drug-eluting stent (BP-DES) implantation.
Objectives The aim of this study was to evaluate the impact of echocardiographic guidance on the safety and efficacy of left atrial appendage closure (LAAC).
Objectives The aim of this study was to investigate the associations of chronic kidney disease (CKD) and end-stage renal disease (ESRD) with in-hospital and short-term outcomes using a large national database representative of contemporary clinical practice.
A 42-year-old woman with no previous history of cardiovascular disease was admitted to our catheterization laboratory for inferolateral ST-segment elevation myocardial infarction. Urgent coronary angiography revealed type II spontaneous coronary artery dissection (SCAD) of a large, tortuous obtuse marginal (OM) branch in its middle tract, with Thrombolysis In Myocardial Infarction (TIMI) flow grade 1 (Figure 1A, Video 1). Due to anterograde flow impairment and ongoing ischemia, percutaneous coronary intervention of OM was attempted.
Commercially available left atrial appendage (LAA) closure devices allow closure of the left atrial appendage ostium up to a diameter of 32 mm. A 77-y-old male patient with high stroke (CHA2DS2-Vasc score = 6) and bleeding (HASBLED score = 3) risk and a history of cerebral embolism on direct oral anticoagulant agents therapy was evaluated for LAA occlusion. Transesophageal echocardiography (TEE) and computed tomography (CT) imaging determined ostial diameters of 36 × 47 mm and 37 × 48 mm, respectively (Figures 1A to 1D, Supplemental Figure 1, Videos 1 and 2). Because of noneligibility for long-term oral anticoagulation and high risk for stroke, a custom-made Lambre device (50 × 44 mm) (Lifetech Scientific) was produced. The device was delivered by a 10-F commercial sheet (Lifetech Scientific) to the LAA and successfully implanted (Video 3). The procedure and the handling of the device were unremarkable. Correct device position and complete sealing of the LAA was confirmed by angiography and TEE Doppler as well as CT imaging (Figures 1E to 1H, Video 4). The Lambre device was successfully and safely released. No further complications were detected. The 3-month follow-up determined the device well seated with complete sealing of the LAA, and no device-related thrombus was diagnosed by TEE and CT imaging.
Percutaneous left atrial appendage (LAA) closure (LAAC) with the latest version of the WATCHMAN FLX device (Boston Scientific, Marlborough, Massachusetts) is reported as safe and effective as its predecessor and is associated with low risk of complications. Although implanters and imagers are becoming more experienced, some technical and device-related specificities should be known with regard to the new iteration of the device. Herein, we illustrate atypical motion of the polyester fabric cover on follow-up transesophageal echocardiography (TEE). A 61-year-old man, treated with bone marrow transplant for leukemia in 1995 and with prior pericardiectomy for constrictive pericarditis, hypertension, diabetes mellitus, chronic obstructive pulmonary disease, and permanent atrial fibrillation (CHAD2DS2-VASc = 2), was referred to our center for consideration of LAAC in link with recurrent epistaxis and hemoptysis without significant predisposing factors. After TEE and fluoroscopic assessment of the LAA anatomy, a 24-mm WATCHMAN FLX was selected (Figure 1).
Cookies Sociales
Son esos botones que permiten compartir el contenido del sitio web en sus redes sociales (Facebook, Twitter y Linkedin, previo tu consentimiento y login) a través de sistemas totalmente gestionados por dichas redes sociales, así como los recursos (pej. videos) y material que se encuentra en nuestra web, y que de igual manera se presta y gestiona completamente por un tercero.
Si no acepta estas cookies, no podrá compartir nuestro contenido a través de los botones, y en su caso, no podrás visualizar el contenido de terceros que hayamos incrustado en el sitio.
No las utilizamos