Treatment of splenic artery aneurysm with polytetrafluoroethylene-covered stent.

Splenic artery aneurysm (SAA) is a rare condition, mostly treated with surgery. Usually an incidental finding, prevalence varies from 0.04 to 0.

Comparison of safety and efficacy of bivalirudin versus unfractionated heparin in percutaneous peripheral intervention: a single-center experience.

Objectives: The aim of this study was to determine the efficacy and safety of bivalirudin versus low-dose unfractionated heparin (UFH) in percutaneous peripheral intervention (PPI).

Background: Anticoagulation strategies used in PPI are based primarily on studies of percutaneous coronary intervention where higher doses of heparin are used usually in combination with a glycoprotein IIb/IIIa inhibitor. There are no studies comparing bivalirudin alone versus low-dose heparin in PPI.

Combined use of Impella device and intra-aortic balloon pump to improve survival in a patient in profound cardiogenic shock post cardiac arrest.

Patients who suffer cardiogenic shock after cardiac arrest have a very poor prognosis. Left ventricular assist devices have proven to be useful in these patients to improve survival. Recently introduced percutaneous assist devices are easier to use and can be inserted quickly in the catheterization laboratory.

Incessant interfascicular reentrant ventricular tachycardia as a result of catheter ablation of the right bundle branch: case report and review of the literature.

A 72-year-old woman developed incessant interfascicular (IF) ventricular tachycardia immediately after successful right bundle branch (RBB) catheter ablation for the treatment of sustained bundle branch reentrant tachycardia. Catheter ablation of the left bundle branch and the left anterior fascicle was successful in eliminating the tachycardia (in 2 different sessions). This report discusses the direct link between the creation of an RBB block and the development of IF tachycardia, in our case, and in prior cases of IF reentry reported in the literature.

A case of flecainide-induced hyponatremia.

We present a case of flecainide-induced hyponatremia in a 67-year-old woman who was treated for paroxysmal atrial tachycardia. She developed dizziness after starting flecainide and was found to be hyponatremic with a sodium level of 122 mmol/L (decreased from 136 mmol/L). Work-up failed to reveal other causes of hyponatremia.

Cardiac Image Registration.

Long procedure time and somewhat suboptimal results hinder the widespread use of catheter ablation of complex arrhythmias such as atrial fibrillation (AF). Due to lack of contrast differentiation between the area of interest and surrounding structures in a moving organ like heart, there is a lack of proper intraprocedural guidance using current imaging techniques for ablation. Cardiac image registration is currently under investigation and is in clinical use for AF ablation.

Atrial fibrillation ablation complications.

Atrial fibrillation (AF) is a common arrhythmia. Although significant work still needs to be done, recent advances in understanding the mechanisms of AF have led to the development of elegant catheter mapping techniques for ablation of AF, complemented by the evolution of various imaging and navigational technologies. Due to the complexity of the arrhythmia, and the significant length of time needed to successfully ablate in the left atrium, it is imperative that an acceptable risk-benefit profile be defined.

Cardiac image integration implications for atrial fibrillation ablation.

Cardiac image registration using computed tomography (CT), magnetic resonance imaging (MRI), ultrasound, and fluoroscopy is currently being investigated and clinically used for atrial fibrillation (AF) ablation. Cardiac image registration, in the context of left atrium, is intermodal, with the acquired image and the real-time reference image residing in different image spaces, and involves optimization, where one image space is transformed into the other. Geometry-based methods, which include using fiducial points and/or surface-based techniques, are usually used for cardiac image registration.

Stent fracture, an incidental finding or a significant marker of clinical in-stent restenosis?

Background: The predictors and clinical significance for stent fracture (SF) in drug-eluting stents (DES) remain unknown. We identified procedural factors leading to SF and its clinical consequences in DES.

Methods: Percutaneous coronary interventions were performed on 3,920 patients with DES over 12 months.

Cardiac image registration of the left atrium and pulmonary veins.

Cardiac image registration, in the context of the left atrium, is intermodal, with the acquired image and the real-time reference image residing in different image spaces, and involves optimization, where one image space is transformed into the other. Geometry-based methods, which include using fiducial points and/or surface-based techniques, are usually used for cardiac image registration. During fiducial point registration, fiducial points are either external skin markers or manually determined by marking anatomical landmarks using mapping catheters.

Periprocedural anticoagulation for atrial fibrillation ablation.

Background: Catheter ablation for atrial fibrillation (AF) can increase risk of left atrial (LA) thrombi and stroke. Optimal periprocedural anticoagulation has not been determined.

Objective: We report the role of administering warfarin and aspirin without low molecular weight heparin in patients undergoing AF ablation.

Sudden cardiac death caused by migration of a TrapEase inferior vena cava filter: case report and review of the literature.

Case: A 43-year-old female presented with sudden onset of palpitations, chest pain, and shortness of breath associated with hypoxemia. A helical computed tomography (CT) scan of the chest revealed a large saddle pulmonary embolism. Intravenous tPA relieved the shortness of breath and improved the hypoxemia.

Computed tomography-fluoroscopy image integration-guided catheter ablation of atrial fibrillation.

Introduction: This study examines the feasibility of atrial fibrillation (AF) ablation using registered three-dimensional computed tomography (CT) images of the left atrium with fluoroscopy.

Methods And Results: A total of 50 consecutive patients with symptomatic AF refractory to medical therapy (32 paroxysmal, 18 persistent, age 55 +/- 10 years) were randomized to undergo a catheter-based AF ablation procedure with or without the CT-fluoroscopy guidance system. All patients underwent preprocedural contrast-enhanced CT imaging and segmentation of the left atrium.

Hepatic artery stenosis after liver transplant, managed with percutaneous angioplasty and stent placement.

Hepatic artery stenosis is a recognized vascular complication of orthotopic liver transplant that carries significant morbidity and mortality. The authors present a case of hepatic artery stenosis in a 50-year-old female successfully treated with balloon angioplasty and stent. This case report highlights the importance of percutaneous intervention as a preferred treatment option in patients with hepatic artery stenosis post-orthotopic liver transplant.

Registration of 3D computed tomographic images with interventional systems: implications for catheter ablation of atrial fibrillation.

Despite the great promise catheter ablation offers in the treatment of complex arrhythmias such as atrial fibrillation (AF), long procedure times and somewhat suboptimal results hinder the widespread use of this technique. As fluoroscopy does not provide contrast differentiation between the area of interest and the surrounding structures, there is a lack of proper intra procedure image guidance. Segmentation of anatomical structures such as the left atrium (LA) can be performed using images obtained with modalities such as computed tomography (CT).

Posterior left atrial-esophageal relationship throughout the cardiac cycle.

Background: Radiofrequency energy delivered throughout the cardiac cycle has the potential to cause thermal injury to the esophagus if the anatomical relationship between the posterior left atrium and the esophagus changes during cardiac motion.

Objective: To assess the posterior left atrial-esophageal relationship throughout the cardiac cycle.

Methods: In this study, the anatomical relationship between the posterior left atrium and the esophagus was assessed throughout the cardiac cycle in 10 consecutive patients.

Combined use of 1C and III agents for highly symptomatic, refractory atrial fibrillation.

Background: Despite advances in non-pharmacologic therapy for atrial fibrillation (AF), some patients remain highly refractory.

Objective: We report our experience with the unique combined use of 1C and III agents in patients with highly refractory paroxysmal atrial fibrillation.

Materials And Methods: Six patients with symptomatic AF (three persistent) were selected after failing multiple antiarrhythmic medications and radiofrequency ablation.