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- Baranowski, Jacek, et al.
(författare)
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Echo-guided presentation of the aortic valve minimises contrast exposure in transcatheter valve recipients
- 2011
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Ingår i: Catheterization and cardiovascular interventions. - : Wiley. - 1522-1946 .- 1522-726X. ; 77:2, s. 272-275
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: We have developed a method using transthoracic echocardiography in establishing optimal visualization of the aortic root, to reduce the amount of contrast medium used in each patient. BACKGROUND: During transcatheter aortic valve implantation, it is necessary to obtain an optimal fluoroscopic projection for deployment of the valve showing the aortic ostium with the three cusps aligned in the beam direction. This may require repeat aortic root angiograms at this stage of the procedure with a high amount of contrast medium with a risk of detrimental influence on renal function. METHODS: We studied the conventional way and an echo guided way to optimize visualisation of the aortic root. Echocardiography was used initially allowing easier alignment of the image intensifier with the transducer's direction. RESULTS: Contrast volumes, radiation/fluoroscopy exposure times, and postoperative creatinine levels were significantly less in patients having the echo-guided orientation of the optimal fluoroscopic angles compared with patients treated with the conventional approach. CONCLUSION: We present a user-friendly echo-guided method to facilitate fluoroscopy adjustment during transcatheter aortic valve implantation. In our series, the amounts of contrast medium and radiation have been significantly reduced, with a concomitant reduction in detrimental effects on renal function in the early postoperative phase.
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| 2. |
- El-Segaier, Milad, et al.
(författare)
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Late coronary complications after arterial switch operation and their treatment.
- 2010
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Ingår i: Catheterization and Cardiovascular Interventions. - : Wiley. - 1522-726X .- 1522-1946. ; 76, s. 1027-1032
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:: To report the late coronary complications and their treatment after ASO. BACKGROUND:: Asymptomatic patients after arterial switch operation (ASO) may have coronary ostial stenosis or obstruction. METHODS:: Since 1980, 279 patients were operated with ASO. At the time of preparing this article, selective follow-up coronary angiograms were done on 81 patients. RESULTS:: Coronary stenosis was found in six patients. A six year-old patient with left coronary artery (LCA) ostial stenosis and a nine year-old patient with conus branch occlusion had good collaterals without a need for further treatment. One patient with LCA obstruction, myocardial infarction, and left ventricular failure was operated with osteoplasty at age of 16 years. In three essentially asymptomatic patients stenting of LCA ostium stenosis was done: in two of them with drug-eluting stents at nine and ten years of age and in one with bare-metal stent at 18 years of age. One of these patients was earlier treated with balloon dilatation at five years of age which caused intimal dissection. CONCLUSIONS:: Asymptomatic patients with an uneventful course after ASO may have coronary obstruction. This necessitates follow-up coronary evaluation in all patients. Stenting of the coronary arteries is an option for treatment. (c) 2010 Wiley-Liss, Inc.
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| 3. |
- Forsberg, Lena M, et al.
(författare)
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Differences in recovery of left and right ventricular function following aortic valve interventions : a longitudinal echocardiographic study in patients undergoing surgical, transapical or transfemoral aortic valve implantation
- 2013
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Ingår i: Catheterization and cardiovascular interventions. - : Wiley. - 1522-1946 .- 1522-726X. ; 82:6, s. 1004-1014
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesTo evaluate longitudinal left and right ventricular function (LVF and RVF) after transcatheter aortic valve implantation (TAVI) as compared to surgical aortic valve replacement (SAVR) and LVF and RVF after TAVI by the transfemoral (TF) or transapical (TA) approach.BackgroundKnowledge about differences in recovery of LVF and RVF after TAVI and SAVR is scarce.MethodsSixty patients (age 81 ± 7 years, logistic EuroSCORE 16 ± 10%), undergoing TAVI (TF: n = 35 and TA: n = 25), were examined by echocardiography including atrioventricular plane displacement (AVPD) and peak systolic velocities (PSV) by tissue Doppler at basal RV free wall, LV lateral wall and septum preprocedurally, 7 weeks and 6 months postprocedurally. Twenty-seven SAVR patients were matched to 27 TAVI patients by age, gender and LVF.ResultsEarly postintervention, TAVI patients had improved longitudinal LVF. However, when analyzed separately, only TF, but not TA patients, had improved LV lateral and septal AVPD and PSV (all P ≤ 0.01). All TAVI patients, as well as the TF and TA group had unchanged longitudinal LVF between the early and late follow-ups (all P > 0.05). The SAVR group had higher septal LVF than the matched TAVI group preprocedurally, while postoperatively this difference was diminished. Longitudinal RVF was better in the TF group than in the TA group pre- and postprocedurally. Although the SAVR group had superior longitudinal RVF preoperatively, this was inferior to TAVI postoperatively.Conclusions Postprocedural longitudinal LVF and RVF in patients undergoing TF-TAVI, TA-TAVI, or SAVR differ considerably. Preservation of longitudinal RVF after TAVI might influence the selection of aortic valve intervention in the future.
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| 4. |
- Jensen, Ulf J., et al.
(författare)
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The use of fluoroscopy to construct learning curves for coronary angiography
- 2012
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Ingår i: Catheterization and cardiovascular interventions. - : Wiley. - 1522-1946 .- 1522-726X. ; 80:4, s. 564-569
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Tidskriftsartikel (refereegranskat)abstract
- Objectives:The aim of this study was to assess learning curves for coronary angiography using registry data from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR).Background:ACC and ESC guidelines for cardiologists in training recommend 200300 coronary angiographies as primary operator. Whether this is safe or sufficient to reach an adequate proficiency level is not known. The development of learning curves and factors that can determine progress is not yet clearly stated.Methods:We extracted data from SCAAR 20052009 and identified 20 novel and 21 expert operators in coronary angiography during this observation period. Metrics possibly influenced by proficiency level were compared between the two groups. Learning curves were then identified with the expert's performance as reference defined as interquartile range (IQR).Results:Data from a total of 24,000 coronary angiographies were examined. Beginners used similar volumes of contrast but had longer fluoroscopy time compared with experts. Fluoroscopy time appeared to be a metric that demonstrated a clear learning curve and beginners reached experts IQR in 50 % (median) of the procedures after similar to 140 coronary angiographies. The risk of complications was independently associated with fluoroscopy time.Conclusions:Fluoroscopy time seems to be the best metric to determine coronary angiography performance level and might therefore be a good proficiency measure during training. On the basis of our results we recommend the trainee to perform at least 150 coronary angiographies during supervision before proceeding with unsupervised procedures. It is not clear if the suggested number of procedures will result in decreased number of complications but the data suggests that fluoroscopy time might be a surrogate marker for complications.
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