Cardiology Commons^™

Type Ii Endoleak Following Endovascular Repair Of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach To Contemporary Management, M. Fuad Jan, Mark W. Mewissen

Journal of Patient-Centered Research and Reviews

Elective endovascular aneurysm repair (EVAR) is the first-line therapeutic option for patients with infrarenal abdominal aortic aneurysm. However, endoleaks –– persistent blood flow outside the lumen of the stent graft (or endograft) but within the aneurysm sac or adjacent vascular segment being treated by the graft –– continue to be a persistent problem in the post-EVAR setting. The type II endoleak is the most common of these and can be a demanding challenge to address by standard endovascular techniques. Currently, two prominent endovascular techniques exist for the management of type II endoleaks: direct translumbar embolization and transarterial embolization. Both of …

Use Of Coronary Techniques In Celiac And Hepatic Artery Stenting In Post-Hepatic Transplant Patients, Harpreet Parmar, Ryan Beard, Mark W. Mewissen, Armaan Shaikh, Tanvir Bajwa

Journal of Patient-Centered Research and Reviews

Hepatic artery stenosis (HAS) remains a rare but serious complication after liver transplantation. While invasive surgical techniques were needed for HAS treatment in the past, recently endovascular techniques, including hepatic artery stenting, have been proven to be a safe and effective treatment. The present work focused on a review of the recent literature regarding HAS as well as recent cases demonstrating the various presentations of HAS and the variety of approaches to endovascular intervention. Our single-center experience has shown endovascular treatment of HAS to be safe and effective, including the two specific cases discussed here. While further research is needed, …

Subclavian Vein Stenosis/Occlusion Following Transvenous Cardiac Pacemaker And Defibrillator Implantation: Incidence, Pathophysiology And Current Management, Brian O'Leary, Suhail Allaqaband

Journal of Patient-Centered Research and Reviews

Subclavian vein stenosis is a common, but usually asymptomatic, complication following cardiac device placement. In addition to reviewing the literature on incidence, pathogenesis and management options for this important clinical problem, we describe two cases of symptomatic subclavian vein occlusion following pacemaker/defibrillator placement and successful treatment with venoplasty and stenting.

Novel Oral Anticoagulants For Stroke Prophylaxis And Venous Thromboembolism Prevention And Treatment, Laith G. Alsayegh

Journal of Patient-Centered Research and Reviews

Novel oral anticoagulants (NOACs) are becoming popular management options for stroke prophylaxis in nonvalvular atrial fibrillation as well as deep vein thrombosis and pulmonary embolism treatment and prophylaxis. NOACs have similar efficacy to warfarin along with noninferior safety profiles. Patient comorbidities, size, renal and hepatic function, and concomitant drug regimen play a role in which NOAC a physician may choose.

Clinical Outcomes After Drug-Eluting Stents Versus Coronary Artery Bypass Surgery In High Surgical Risk Patients With Left Main Or Three-Vessel Coronary Artery Disease, Tonga Nfor, Kambiz Shetabi, Wael Hassan, Quinta Nfor, Jayant Khitha, Anjan Gupta, Tanvir Bajwa, Suhail Allaqaband

Journal of Patient-Centered Research and Reviews

Purpose

Previous studies comparing percutaneous coronary intervention (PCI) with coronary artery bypass graft surgery (CABG) in patients with unprotected left main or three-vessel coronary artery disease (LM-3VD) have excluded patients at high surgical risk. We compared clinical outcomes after PCI with drug-eluting stents to CABG in high surgical risk patients with LM-3VD.

Methods

Patients with symptomatic LM-3VD who had Society of Thoracic Surgeons (STS)-predicted operative mortality >5% and were undergoing either PCI with drug-eluting stents or CABG at a tertiary care center from January 2009 to December 2010 were enrolled in this nonrandomized prospective study.

Results

Mean STS score was …

Old Dog, New Tricks - Usefulness Of The Ecg In Monitoring Acute Rejection Post Cardiac Transplantation, Paul Anaya, Samy-Claude Elayi

The VAD Journal

Electrocardiographic abnormalities have been described in the setting of acute rejection following orthotopic cardiac transplantation. The following is a brief commentary related to an interesting case report by Goldraich et al. which was recently published in the VAD Journal.

Clinical Guidelines: Where Environment Meets Medicine, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

N/A

Association Between Body Surface Area And Outcomes After Percutaneous Coronary Intervention, Kambiz Shetabi, Tonga Nfor, Fengyi Shen, Anjan Gupta, Tanvir Bajwa, Suhail Allaqaband

Journal of Patient-Centered Research and Reviews

Purpose

Obesity is a well-known risk factor for adverse cardiovascular events, but some studies suggest higher body mass index (BMI) is associated with better outcomes after ST-segment elevation myocardial infarction (STEMI). We sought to determine the effect of body surface area (BSA) on adverse events after primary percutaneous coronary intervention (PCI) for STEMI and how this relates to the reported obesity paradox theory.

Methods

We analyzed a prospective registry of patients with STEMI who underwent primary PCI at a tertiary care hospital from 2003 to 2009. Post-PCI complications and 1-year all-cause mortality were compared across BSA quartiles. Relationship with 1-year …

Lead Burden As A Factor For Higher Complication Rate In Patients With Implantable Cardiac Devices, Christopher Kolibash, Naoyo Mori, Jasbir Sra, Masood Akhtar, M. Eyman Mortada

Journal of Patient-Centered Research and Reviews

Purpose

Lead revisions have increased over the last decade. Patients who do not undergo lead extraction face an increased lead burden. Consequences of increased lead burden have not been fully defined. We sought to characterize the complication rate and outcomes in patients with sterile redundant leads.

Methods

We retrospectively reviewed 242 consecutive patients [mean age 74 ± 12 years; 66.9% male] who underwent lead revision that resulted in an abandoned lead from January 2005 to June 2010. Patients were placed in a cohort based on number of leads after last recorded procedure (Group A: ≤2 [n=58]; Group B: 3-4 [n=168]; …

Clinical Outcomes Of Unprotected Left Main Coronary Artery Stenting In Nonsurgical Patients: A Single-Center Experience, John-Paul Pham, Abdelazim Hashim, Naoyo Mori, Mohamed Taha, Mohamed Djelmami-Hani, Joaquin Solis, Suhail Allaqaband, Tanvir Bajwa, Anjan Gupta

Journal of Patient-Centered Research and Reviews

Purpose: Coronary artery bypass graft is the standard treatment for unprotected left main disease; however, some patients are poor surgical candidates due to comorbidities. We assessed the safety and clinical outcome of elective, unprotected left main coronary artery stenting in nonsurgical patients.

Methods: Between October 2004 and June 2006, 50 consecutive patients underwent elective, unprotected left main coronary artery stenting at our institution. Patients were followed for a median of 16 and 96 months and clinical outcomes monitored.

Results: Median logistic euroSCORE was 28.6 (interquartile range: 14.6-43.4). Median baseline left ventricular ejection fraction (LVEF) was 50%. Procedural success rate was …

A Coronary Rupture In The Left Anterior Descending Artery At Second Diagonal Artery Bifurcation Level In An Intervention With A Tryton Side Branch Stent, Muhammed Hakan Tas, Ziya Simsek, Yavuzer Koza, Zakir Lazoglu

Journal of the Hong Kong College of Cardiology

Percutaneous coronary intervention (PCI) for bifurcation lesions (BLs) is considered high risk due to increased procedural adverse events when compared to non-bifurcation lesion. Dedicated bifurcation stents, specifically designed to allow minimally traumatic implantation in the main vessel and/or side branch while providing adequate scaffolding of the side branch ostium may offer an advantage over utilization of conventional stents. Coronary perforation as a complication of PCI is a rare but potentially lethal complication that is associated with a high rate of morbidity. Coronary artery perforation during PCI has been reported repeatedly. To our best knowledge perforation in a BL, PCI with …

Seventeenth Annual Scientific Meeting Institute Of Cardiovascular Science And Medicine

Journal of the Hong Kong College of Cardiology

No abstract provided.

Inflammatory Biomarkers And Subclinical Atherosclerosis In African-American Women With Systemic Lupus Erythematosus (Sle), Edith Williams, Carlos Crespo, Joan Dorn

Journal of Health Disparities Research and Practice

Women with lupus are at increased risk for developing cardiovascular disease (CVD). Previous studies of atherosclerosis in SLE have not been representative of the minority groups most affected by lupus and its complications. Therefore, a study of 41 lupus cases and 83 controls was conducted to investigate the relationship between carotid atherosclerosis and inflammation in African-American women. Participation consisted of a questionnaire, physical examination, fasting blood draw, and ultrasound of the carotid arteries. There were observed differences between cases and controls with regard to carotid intima media thickness (IMT) and traditional cardiovascular risk factors, although few reached statistical significance. Tumor …

Is Dynamic Atrial Overdrive Pacing Anti-Arrhythmic Or Proarrhythmic: A Case Report, Ngai-Yin Chan, Miu-Fong Kwok, Chi-Chung Choy

Journal of the Hong Kong College of Cardiology

No abstract provided.

Drug Eluting Stent: A Major Advance In Fighting Coronary Artery Restenosis, Yuk-Kong Lau

Journal of the Hong Kong College of Cardiology

Since the first use of coronary angioplasty in 1977, there have been major growth and development in percutaneous coronary intervention (PCI). Due to the advances in techniques, experiences, devices, and newer potent antiplatelet and antithrombotic medications, PCI is increasingly performed in highly complex and high risk patients with a reasonably low complication rate. Coupled with reduced discomfort, shorter hospital stay and recovery time, it has far outnumbered the volume of coronary artery bypass surgery. Currently, 1.7 million PCI procedures are performed annually worldwide with increases by 15-20% per year the last decade.

The Post-Madit Ii Era: Icd For All Post-Infarct Patients With Moderate To Severe Left Ventricular Dysfunction?, Kathy Lai-Fun Lee, Chu-Pak Lau

Journal of the Hong Kong College of Cardiology

Device therapy has become the preferred treatment for patients who have survived sudden cardiac death. Throughout the last decade, large-scale randomized clinical trials have provided consistent evidence on the clinical efficacy of device therapy. ICD is proven to be superior to anti-arrhythmic drugs in patients with structural heart diseases who suffer from haemodynamically significant ventricular arrhythmias. The role of ICD in primary prevention of sudden death in selected patients with coronary artery disease and left ventricular dysfunction is also widely established after the Multicenter Automatic Defibrillator Implant Trial (MADIT) and the Multicenter Unsustained Tachycardia Trial (MUSTT).

Role Of Signal-Averaged Ecg In Predicting Results Of Flecainide Provocation Test Used In Family Screening For Brugada Syndrome, Ngai-Shing Mok, Chi-Chung Choy, Ngai-Yin Chan, Amy Ho

Journal of the Hong Kong College of Cardiology

Brugada syndrome (BS) is an inherited arrhythmogenic disease with an autosomal dominant mode of inheritance. Flecainide provocation test (FPT) has been shown to be highly sensitive and specific in unmasking the Brugada ECG pattern in affected subjects. We sought to test if late potential (LP) in signal averaged electrocardiogram (SAECG) is helpful in predicting the results of FPT used in family screening for BS. The study included 17 asymptomatic Chinese subjects from 8 families (M:F 10:7, mean age 24.8±11.4 years) who have undergone family screening for BS. All screened subjects had a normal 12-lead ECG at baseline. None had structural …

Percutaneous Revascularisation In Diabetic Patients With Coronary Artery Disease, Wai-Hong Chen, Chu-Pak Lau

Journal of the Hong Kong College of Cardiology

Diabetic patients with coronary artery disease are associated with an unfavourable long-term outcome. Surgical revascularisation on top of medical therapy has been shown to confer survival benefit in patients with mutivessel and left main disease. With the emergence of the percutaneous approach of revascularisation, several clinical trials have been conducted to compare these two modalities of treatment. Consistent results were demonstrated in the diabetic subgroup that coronary artery bypass grafting is superior to balloon angioplasty in preventing late adverse cardiac event. With the advancement of percutaneous technique using coronary stenting as the predominant mode of catheter based revascularisation, the latest …

The Long-Term Clinical Prognosis In Patients With Anterior Wall And Non-Anterior Wall Acute Myocardial Infarction Referred To Primary Percutaneous Transluminal Coronary Angioplasty, Mingzhong Zhao, Dayi Hu, Tianchang Li, Sanqing Jia

Journal of the Hong Kong College of Cardiology

Objective: To investigate the long-term clinical prognosis in patients with anterior wall acute myocardial infarction (AW-AMI) and non AW-AMI (NAW-AMI) referred to primary percutaneous transluminal coronary angioplasty (P-PTCA). Methods: 287 patients with AMI who underwent P-PTCA were divided into AW-AMI group (142 cases) and NAW AMI group (145 cases) according to different sites of AMI. The baseline characteristics and coronary artery lesions of patients were analysed. The primary end points were in-hospital mortality and the major cardiovascular events (MACE) during a mean 17.3±9.8 months follow-up including the occurrences of non-fatal myocardial infarction, non-fatal congestive heart failure, revascularization of target vessels …

Appropriate Use Of Clopidogrel, Cyrus R Kumana, Bernard Man-Yung Cheung, Ij Lauder

Journal of the Hong Kong College of Cardiology

Clopidogrel (Plavix®) is an orally administered pro-drug, whose pharmacology and therapeutic role has been extensively reviewed in recent publications.1-5 In essence, it results in selective and irreversible antagonism of ADP-induced platelet aggregation. Such aggregation normally results in the surface expression of platelet glycoprotein (GP) IIb/IIIa receptors, which facilitate fibrinogen binding as well as consequential further platelet aggregation – the final common pathway of vascular occlusion. Specific cytochrome P450 enzymes are thought to generate the responsible active metabolite (believed to persist transiently). However, dosage adjustment is not recommended in hepatic impairment (unless severe) and drug-drug interactions and co-administration with meals are …

Mapping And Ablation Of Complex Cardiac Arrhythmia Guided By A Novel Three Dimensional Non-Contact Endocardial Activation Mapping System, Wing-Hong Fung, Chi-Kin Chan, Kam-Sang Woo, Wilson Wai-Man Chan

Journal of the Hong Kong College of Cardiology

Conventional cardiac activation mapping requires a sequentially-based method of positioning a catheter in contact with the endocardium to generate intracardiac electrograms at single points during sustained arrhythmia. Significant limitation of such point by point mapping may be encountered when applying to complex arrhythmia e.g. non-sustained arrhythmia or haemodynamically unstable arrhythmia. A novel non-contact mapping system (Ensite 3000 system) providing a three-dimensional simultaneous display of arrhythmia activation may offer a solution. The non-contact mapping system consists of a specially designed balloon catheter (Ensite EP catheter) with 64 insulated wires over the surface of the balloon for sensing electrical potentials on the …

The Use Of Wallstent And Smart Stents Incarotid Stent-Supported Angioplasty, Steven Siu-Lung Li

Journal of the Hong Kong College of Cardiology

In the endovascular approach of carotid stenosis treatment, stent-supported angioplasty is current state-of-the-art technique. Self-expandable stents are preferable to balloon-expandable stents due to the potential risk of deformation of the latter by external pressure. Wallstents and SMART stents are the more commonly used self-expandable stents. They appear to be of similar efficacy and safety but due to their different characteristics, their applications may be different according to different lesion characteristics.

Arrhythmogenic Right Ventricular Cardiomyopathy, Wing-Hong Fung, Chi-Kin Chan, John E. Sanderson

Journal of the Hong Kong College of Cardiology

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a familial form of cardiomyopathy predominantly affecting the right ventricle but may progress to involve the left ventricle as well. At the late stage of the disease, it is sometimes difficult to differentiate with other forms of dilated cardiomyopathy. In most affected families, the mode of inheritance of the disease is autosomal dominant. Lately, the gene accounting for the autosomal recessive form of ARVC, which was associated with palmoplantar keratosis, was identified. ARVC can present with sudden cardiac death without any preceding symptoms in the young population. Therefore, ARVC must be included in the …

Thrombolytic Therapy For Acute Myocardial Infarction In The Elderly, Bernard Bun-Lap Wong, Wai-Hong Chen

Journal of the Hong Kong College of Cardiology

Acute myocardial infarction (MI) is a leading cause of morbidity and mortality in developed countries. Patients ≥75 years constitute up to 30% of the acute MI population and are associated with a 50% in-hospital mortality. Thrombolytic therapy was shown in a metaanalysis of 9 largest randomized controlled trials to reduce 35-day mortality. However, the benefit was observed mainly among patients < 75 years old. For patients ≥ 75 years, the 35-day mortality was 24.3% in those treated with thrombolytic therapy and 25.3% in the placebo group, a difference not reaching statistical significance.

Brachytherapy In The New Millennium Abstracts, Jilin Chen, Runlin Gao, Qiangjun Cai, Yuejin Yang

Journal of the Hong Kong College of Cardiology

In order to examine long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA), coronary stenting and to assess the factors affecting its efficacy, 790 patients who underwent successful PTCA and PTCS+Stent in this Hospital were followed by direct interview or letter.