Halboos 04 - CTO of a ostial LAD with continuous drop in blood pressure due to bleeding next to the sheet
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A 48-year-old male presented with a CTO of the ostial LAD. During the procedure to recanalize the LAD, the patient's blood pressure began to drop slowly due to bleeding next to the sheet. An antegrade approach with a Gaia 3rd wire was used due to the sharp angle of the ostial LAD. The procedure was stopped due to decreasing blood pressure, and an 8F angio-seal was used to stop the bleeding. The challenging case was made more difficult by the sharp angle of the ostial LAD and time pressure due to the decreasing blood pressure.
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CABG final.docx
Introduction
Review about coronary vein
Definition CABG
Propose of CABG
Indication of CABG
Contraindication of CABG
Coronary artery bypass graft sides
Types of CABG
Traditional
procedure
Off pump
Minimally invasive CABG
MIDCAB
Port-access coronary artery bypass
Robot-Assisted technique
Complication
Diagnosis evaluation
Recovery
Recovery at hospital
Recovery at home
Follow up
rehabilitation
Nursing management for CABG
Preoperative
Intraoperative
Postoperative
Nurse care plan
Summary
Reference
Aortic stenosis.pptx
This document discusses aortic valve stenosis, including its anatomy, function, causes, pathophysiology, classification, signs and symptoms, diagnostic evaluation, and treatment options. Key points include:
- Aortic stenosis is caused by calcification and stiffening of the aortic valve leaflets, restricting their opening and increasing the pressure gradient between the left ventricle and aorta.
- It can be congenital due to a bicuspid aortic valve or acquired from degeneration, rheumatic fever, or radiation exposure.
- Symptoms include angina, syncope, and dyspnea as the left ventricle hypertrophies and diastolic function declines in response to the increased
Cardiac surgical procedures
The document discusses guidelines for coronary artery bypass grafting (CABG). It summarizes that the left internal thoracic artery is associated with improved outcomes compared to leg vein grafts for CABG. The guidelines were updated to recommend using the left internal thoracic artery to bypass the left anterior descending artery when needed. The document also provides an overview of the CABG procedure and preoperative considerations for patients undergoing the surgery.
aortic stenosis AHA guidlines 2014
This document discusses aortic stenosis, including its etiology, pathogenesis, pathophysiology, clinical manifestations, diagnosis and management. It notes that aortic stenosis can be caused by congenitally abnormal heart valves, rheumatic heart disease or calcific degeneration of the aortic valve. Symptoms include dyspnea, dizziness, syncope and angina. Physical exam may reveal a diminished carotid pulse and ejection murmur. Echocardiography is the primary diagnostic test to assess aortic valve area and function.
Acs0525 splenectomy-2005
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- Additional branches of the splenic artery before it enters the spleen, including short gastric and pancreatic arteries.
- A history of splenectomy beginning in the 16th century and its increasing use through the 20th century for trauma and hematologic disorders.
- The development of laparoscopic splenectomy in the early 1990s and ongoing refinement of minim
Acs0525 Splenectomy 2005
This document discusses the anatomy and surgical procedure of splenectomy. It describes:
- The spleen's highly variable arterial blood supply, which can take bundled or distributed patterns. This variability impacts the difficulty of surgery.
- The splenic artery typically branches off the celiac axis but can originate from other nearby arteries in rare cases.
- In addition to main branches, the splenic artery also forms transverse anastomoses with collateral vessels at 90 degree angles, complicating efforts to occlude branches.
- A brief history of splenectomy, from its first reported use in the 16th century to modern adoption of laparoscopic techniques. Splenectomy became more common with automobile use and
Mitral stenosis.pptx
Mitral stenosis is a narrowing of the mitral valve that occurs most commonly as a result of rheumatic fever. It is characterized by thickening and scarring of the mitral valve leaflets that causes the opening to narrow over time. The narrowing obstructs blood flow from the left atrium to the left ventricle, causing elevated pressures in the left atrium and lungs. Common symptoms include shortness of breath, cough, hemoptysis, and right-sided heart failure. Diagnosis is made through echocardiogram and treatment involves medications, balloon valvuloplasty, or valve replacement surgery depending on severity.
Similar to Halboos 04 - CTO of a ostial LAD with continuous drop in blood pressure due to bleeding next to the sheet (20)
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Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
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Protect IV and PROTECT-Europe trial
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PARALLEL SESSION
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Update on the ORBITA - CTO trial
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Auditorium Zubin Mehta - Friday 11:00 - 12:00
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Masahisa Yamane: The Complex CTO Japanese Registry
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15th Experts Live CTO - Carlo Di Mario: Conclusions
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Shunsuke Matsuno: Progress in dedicated novel CTO material
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Jonathan Hill: Role of mechanica support in CTO recanalization
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Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
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Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
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Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
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Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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Halboos 04 - CTO of a ostial LAD with continuous drop in blood pressure due to bleeding next to the sheet
- 1. CTO of a ostial LAD with continuous drop in blood pressure due to bleeding next to the sheet Ali Halboos
- 2. - Male, 48yo - 2 Month ago presenting with a posterolater STEMI - Marginal branche was recanalised and stented - In total 3-vessel coronary artery disease - LAD occluded at the ostium - RCA with a proximal stenosis and tortuous, filling up the LAD retrograde - Decission to try an antegrade LAD CTO, avoiding a retrograde approch via the tortuous RCA - initially planed biradial (7F right, 5F left), due to massiv spasm changed to bifemoral.
- 4. 1st attemp with Fielder XT, antegrad injection to understand why the wire failed.
- 5. 2nd attemp with a Gaia 3rd, very hard proximal cap
- 6. The wire stocked at distal cap and passed with some more force
- 7. Thereafter the mircokatheter stocked at distal cap and passed after a while
- 8. Meanwhile the bload pressure decreased slowy down to 67/38mmHg. What happend? We started with 115/69mmHg
- 9. There was some spasm due to adrenaline and Akrinor
- 11. Opend LAD, Time to put the first stent!
- 12. Maybe a dissection or just spasm due to the ongoning necassarity of volume and Akrinor….but in dubio pro.
- 13. Afterwards I think it was only spasm, so I can go one with more stents.
- 15. Final result
- 16. 6 Weeks later
- 17. • Sharp angle of the ostial LAD with a open RD where the FielderXT was always dislocated in. There must be a very small side branche at the ostial LAD wich makes it additionally complicated. • A Gaia 3rd was used with a unusual 2nd selfmade curve under notice what could happen. • Stop the procedure due to decreasing blood pressure? • Even „simple looking“ bleeding beside 7F sheet could last into a desaster, when the blood dripps under steril cover. • The patient haemoglobine decresed 2 points (14->12) • The bleeding could be stoped with 8F angio-seal. • Challaging case due to CTO under „time pressure“ Conclusion
- 18. • Sharp angle of the ostial LAD with a open RD where the FielderXT was always dislocated in. There must be a very small side branche at the ostial LAD wich makes it additionally complicated. • A Gaia 3rd was used with a unusual 2nd selfmade curve under notice what could happen. • Stop the procedure due to decreasing blood pressure? • Even „simple looking“ bleeding beside 7F sheet could last into a desaster, when the blood dripps under steril cover. • The patient haemoglobine decresed 2 points (14->12) • The bleeding could be stoped with 8F angio-seal. • Challaging case due to CTO under „time pressure“ Conclusion
Editor's Notes
- Folie 1: Titel, Autoren, Affiliation, Disclosure-Informationen, Posternr.