Carotid Artery Stenting 2013: Thumbs up.

It has been customary for interventional cardiologists involved in carotid artery stenting, to underline non-inferiority of the percutaneous technique versus surgical carotid endarterectomy. To that end, all cause morbidity and mortality figures of both methods are compared. Surgery has, in most large randomized studies, had an edge over stenting in terms of cerebrovascular adverse events.

Percutaneous Closure of the Left Atrial Appendage in Atrial Fibrillation, Second Thoughts?

Life expectancy of the population is steadily increasing world wide. Consequently, the incidence and ultimately the prevalence of atrial fibrillation (AF) and it's sequelae will be rising proportionately. It is estimated that 3-5% of persons above 65 years of age have chronic AF, 30% of which will suffer at least one stroke.

Can computer tomography help predict feasibility of transseptal puncture after percutaneous closure of an interatrial septal communication?

Background: Transseptal puncture (TSP) is the first step in pulmonary vein isolation and catheter ablation, as well as in left atrial appendage closure in atrial fibrillation. Although TSP has been reported to be successful in patients with device closure of interatrial septal communications, questions pertinent to its feasibility in patients with large devices still remain. We sought to determine whether a "safe zone" for TSP could be visualised by computer tomography (CT), especially if larger device sizes for interatrial septal communication closure (IASC-C) had been used.

[Which patient with chronic atrial fibrillation suits well for device closure of the left atrial appendage?].

Atrial fibrillation affects about 3% of all persons older than 65 years of age. About 30% of patients with chronic atrial fibrillation suffer from at least one cerebrovascular accident. On the other hand, atrial fibrillation is responsible for 15 - 20% of all cerebrovascular insults.

Closure of Interatrial Septal Communications: Adverse Events and Lessons Learned.

Background: Percutaneous closure of interatrial septal communications (IASC) is generally being regarded as a safe and straightforward intervention. Reporting and classification of adverse events (AE) as is the case for percutaneous coronary intervention (PCI) is not standardized. Also, the focus of reported larger studies has not been primarily on AE and strategies to avoid them.

Incidence and predictors of atrial fibrillation following transcatheter closure of interatrial septal communications using contemporary devices.

Background: Transcatheter closure of interatrial septal communications (IASC) is being increasingly performed, while less is known about predictors and incidence of new onset atrial fibrillation (AF) after device closure. Hitherto, most studies have only analyzed some parameters potentially influencing the occurrence of AF, variously omitting others and thus limiting interpretation of results.

Methods: Descriptive, single author, observational study with 68 consecutive patients [aged 53.

The impact of cardiac CT on the appropriate utilization of catheter coronary angiography.

The purpose of this study was to evaluate the impact of computed tomography coronary angiography (CTCA) on the appropriate utilization of catheter angiography (CA). This observational trial analyzed all patients undergoing CA in 2006 and 2007 in one hospital. In 2007, patients having a low to intermediate cardiovascular risk and suspicion of coronary artery disease (CAD) and those with suspicion of progression of known organic heart disease (OHD) underwent CTCA either prior to CA or as the sole imaging modality.

Patient radiation dose during percutaneous interventional closure of interatrial communications.

Objective: To determine fluoroscopy time (FT) and radiation dose (RD) applied in percutaneous closure of interatrial septal communications (IAC).

Background: Percutaneous closure of IAC, namely patent foramen ovale (PFO) and atrial septal defect (ASD) is increasingly performed. In this often young population in full reproductive age, radiation dosage should be an important issue, yet consistent data on applied radiation dose have not been available to date.

Percutaneous, minimally invasive retrieval of a dislodged and impacted device from the abdominal aorta, four months after closure of an atrial septal defect.

Four months after the successful implantation of a closure device in a 67-year-old woman with an atrial septal defect, the device was found to be impacted in the abdominal aorta. Severe bouts of only partially containable coughing episodes had occurred some days after implantation. Despite unknown endothelialization status and extent of adhesion to the aorta, percutaneous retrieval was favored over conventional surgical retrieval.

[Selective kidney angiography within the scope of heart catheterization: pathological findings and therapeutic consequences].

Background: The importance of renal artery stenosis as a cause of refractory hypertension, recurrent pulmonary edema and renal failure is being increasingly recognized. The prevalence and clinical consequences of renovascular and macroscopic renal parenchymal pathology in patients undergoing coronary angiography is assessed prospectively.

Patients And Methods: Selective renal artery angiography was performed in 190 consecutive patients following coronary angiography and prior to PTCA if indicated.

[Differential diagnosis and therapy of secondary hypertension (with special reference to renal artery stenosis) in general practice].

Secondary hypertension is present in 3-5% of patients suffering from high blood pressure. Some of the causes of secondary hypertension can be cured and all of them need specific treatment. This can only be provided when an accurate diagnosis is sought.

[Catheter-induced dissection of the right coronary ostium and aortic root].

We describe a catheter-induced dissection of the ostium of the right coronary artery extending to the aortic root. As an alternative to emergency surgery, a dacron stent-graft was placed in the proximal right coronary artery, thus, sealing the dissection. The patient later underwent elective aortocoronary bypass surgery.

[Physician referral versus self-referral for initial outpatient cardiological examination].

Background And Objective: To compare the clinical characteristics of patients who referred themselves for specialist cardiological examination with those of patients referred by a general practitioner, to assess the usefulness of inserting a general practitioner or general physician before referral, and to project the likely cost effectiveness.

Patients And Methods: The data on 77 patients referred by a medical practitioner (group 1) were prospectively compared with those of a cohort of 65 patients who referred themselves for specialist cardiological examination (group 2). All patients fulfilling the inclusion criteria had been included consecutively over a period of one year.

Long-term Doppler echocardiographic follow up in normally functioning aortic St. Jude Medical prosthesis.

Background And Aims Of The Study: Mean and peak Doppler gradients remain the most frequently used parameters for follow up of prosthetic aortic valves. Gradients that deviate from baseline recordings can lead to uncertainty among physician and patient, especially if symptoms have not completely subsided after surgery, or have recurred. This study aimed to document long-term evolution of mean and peak gradients in patients with stationary clinical symptoms and signs.

Regional wall motion changes with dobutamine as a pharmacological stress test during cardiac catheterization in patients with significant coronary artery disease.

Background: Preliminary study to test the feasibility of pharmacological stress testing during cardiac catheterization, thus combining anatomical and functional information.

Patients And Methods: 21 consecutive patients with known or suspected coronary artery disease, referred for diagnostic catheterization. Biplane ventriculography was performed before and during dobutamine infusion.

Cardioprotection in patients undergoing chemo- and/or radiotherapy for neoplastic disease. A pilot study.

Objectives: To assess the cardioprotective efficiency of an antioxidant regimen (vitamins E, C and N-acetylcysteine) in patients receiving high dose chemo- and/or radiotherapy for malignant disease.

Methods: Prospective, placebo controlled, randomized and double blinded pilot study involving 13 patients receiving chemotherapy and 12 patients receiving radiotherapy.

Results: In patients receiving antioxidants, left ventricular ejection fraction did not change (63 +/- 4% to 63 +/- 4%).

High dose dipyridamole as a pharmacological stress test during cardiac catheterisation in patients with coronary artery disease.

Aim: To validate dipyridamole as a pharmacological stress test during cardiac catheterisation, allowing both functional and morphological estimation of stenosis severity.

Methods: The study encompassed 74 patients: 62 patients with significant coronary artery disease (age 61 (SD 8) years; seven women, 55 men) and 12 controls. Regional wall motion, left ventricular ejection fraction and end diastolic pressure were analysed in the resting state and after high dose intravenous dipyridamole.

[-Aneurysm of the pulmonary artery and pulmonary artery hypertension 22 years after Mustard reversal operation in transposition of great vessels-].

An increasing number of patients with transposition of great arteries reaches adult age after an atrial redirection operation. The well known late sequelae of the Mustard and Senning operations include supraventricular brady-tachyarrhythmias, dilatation and failure of the systemic ventricle, severe tricuspid valve incompetence, obstruction of either the systemic or pulmonary venous return as well as left ventricular outflow tract obstruction, and baffle leaks. The case of a 26-year-old woman with a rarer postoperative course, namely severe aneurysmal dilatation of the pulmonary artery and pulmonary arterial hypertension 22 years after a Mustard operation is described.

[Cardioprotection in chemo- and radiotherapy for malignant diseases--an echocardiographic pilot study].

Aim: Pilot study, examining the cardioprotective effect of an antioxidant regimen in patients with malignancies receiving high dose chemo- or radiotherapy.

Patients And Methods: 14 patients with chemotherapy and 10 patients with radiotherapy were randomized in a double-blind fashion (placebo versus vitamin E and C and N-acetylcysteine). Systolic and diastolic echocardiographic parameters were determined before and within three weeks of treatment completion.

[Adult patients with congenital heart diseases: Berne statistics].

Data of the 272 adult patients with congenital heart disease followed up in our department are analyzed. We emphasize the lack of reliable statistical surveys of this group of patients at the present time. The need for better intra- and interdisciplinary cooperation, specially between referring physicians and tertiary centers, is stressed.