Barik ramachandra 20211805_0648_vod
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Left guide catheter tip induced (Razor blade effect) causing aorto-left main coronary artery (LMCA) dissection can lead to no flow in the left coronary artery which is life threatening complication and must be bailed by immediate stenting or surgery. A 59-year-male patient presented with crescendo angina having history of stenting to left anterior descending coronary artery (LAD) using 3x23mm drug eluting stent 5yrs back. Coronary angiogram revealed 100% instent re-stenosis of the LAD stent and left circumflex (LCX) coronary artery had proximal chronic total occlusion with J-CTO score of ≥2 and dominant right coronary artery (RCA) was normal. LMCA dissection was noticed after stenting of the proximal LCX followed by abrupt retrograde extension into aorta resulting no flow in left coronary. The true lumen of LMCA was re-wired and timely bail out stenting from LMCA to LCX was performed.
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Prathap Kumar: Zero contrast CTO PCI with retrograde approach
14th Experts "Live" CTO
September 2nd- 3rd, 2022 - Mainz, Germany
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Selecting the patient and planning the procedure A
Zero contrast CTO PCI with retrograde approach
Prathap Kumar, Kerala, India
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06 aimradial2016 thu2 MG Cohen Guiding catheters
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This document provides guidelines for obtaining optimal views and measurements during a transesophageal echocardiogram (TEE) for mitral valve repair. It recommends obtaining 0, 60-90, 110-130 degree views of the mitral valve as well as additional views such as of the pulmonary veins and 3D imaging. It describes how to obtain measurements of flail gap, flail width, and vertical coaptation length for degenerative and functional mitral regurgitation. The document also provides indications for use and safety information for the MitraClip device intended for reducing mitral regurgitation in high-risk surgical patients.
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3. The PARTNER Trial Cohort A randomized high surgical risk patients to TAVI or SAVR and found non-inferiority of TAVI to SAVR with lower rates of bleeding, atrial fibrillation, and shorter hospital stays for TAVI
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An angiogram is an imaging test that uses x-rays and dye to map the blood vessels. A catheter is inserted into an artery and threaded to the targeted blood vessels where dye is injected to make blockages visible on x-rays. Angiograms are performed to detect blockages in arteries of the heart, brain, legs, and other organs to help diagnose and plan treatment for conditions like heart disease. While it provides detailed images of blood vessels, risks include bleeding or reaction to the dye where the catheter is inserted.
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Prathap Kumar: Zero contrast CTO PCI with retrograde approach
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conference presentation of your reseach
Dr. Ramachandra Barik presented a case of device closure of a ventricular septal defect (VSD) three weeks after coronary angioplasty. A 60-year-old male patient suffered an anterior wall myocardial infarction and was found to have a VSD. He underwent coronary angioplasty to treat the infarction. Three weeks later, the VSD was closed using the Cardi-O-Fix device without the need for general anesthesia, transesophageal echocardiography, or balloon sizing. Initial follow up echocardiograms showed no residual shunting. Dr. Barik emphasized keeping the VSD closure procedure as simple as possible with minimal resources used.
Human: [
Hybrid coronary revascularization
This document discusses hybrid coronary revascularization (HCR), which combines coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI). HCR was introduced in 1996 as a treatment for multivessel coronary artery disease. It aims to reduce surgical trauma while preserving long-term survival and minimizing adverse events. The hybrid approach involves using a left internal mammary artery graft for the left anterior descending artery and PCI for other lesions. This takes advantage of the excellent outcomes of the arterial graft and improvements in stents. HCR may provide benefits for higher surgical risk patients and allow shorter recovery times compared to traditional CABG. However, some debate remains around its additional complexity and costs compared to established treatments.
Abdul Mozis 03 - CrossBoss to bypass a fractured knuckle wire
This document describes a complex PCI procedure to treat a heavily calcified chronic total occlusion of the LAD coronary artery in a 67-year-old man. Antegrade dissection re-entry was attempted but a fractured knuckle wire became entrapped in calcium. A CrossBoss catheter was then used to perform blunt dissection to the distal vessel, allowing placement of a guidewire and successful stenting of the LAD. The summary cautions that knuckling wires can fracture in heavy calcification and that the CrossBoss catheter is a useful tool to overcome difficult anatomy in such cases.
CTO-- TEN COMMANDMENTS
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This document provides an overview of approaches to chronic total occlusion percutaneous coronary intervention (CTO PCI). It defines CTOs and discusses their prevalence. Key points include:
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RADIATION INDUCED CARDIAC DISEASES
This document discusses radiation-induced heart disease (RIHD) from radiotherapy for cancers near the heart. It covers:
1) Types of cancer treatment that can expose the heart to radiation like breast and lung cancer.
2) Manifestations of RIHD like coronary artery disease and arrhythmias.
3) Studies like one by Sarah Darby that showed increased heart risks proportional to mean heart dose.
4) Techniques to reduce heart exposure like deep inspiration breath hold, prone positioning, and proton beam therapy.
Isicam, high bleeding risk pci,2016,isman
The document summarizes a case study of a high bleeding risk patient who required urgent PCI prior to orthopedic surgery. The patient had multiple vessel disease including chronic total occlusions. The interventional cardiologist performed complex PCI using dual guidewires and drug-coated stents, which allowed for a shortened dual antiplatelet therapy duration of 1 month prior to surgery. The case highlights the importance of an individualized approach for high bleeding risk PCI patients, including consideration of drug-coated stents to balance risks of bleeding and restenosis.
Intravascular lithotripsy (ivl) for peripheral arterial disease
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Liver sbrt
This document summarizes the liver stereotactic body radiation therapy (SBRT) techniques used to treat hepatocellular carcinoma (HCC) and liver metastases at Meenakshi Mission Hospital & Research Centre. Key points include:
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2) Treatment plans aim to spare at least 35% of the liver from the high SBRT doses to avoid liver decompensation. Special considerations are made for cirrhotic livers.
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Left main pci
This document discusses left main coronary artery (LMCA) percutaneous coronary intervention (PCI). Key points:
1. LMCA disease can be treated with balloon angioplasty or stenting. Drug-eluting stents have reduced restenosis rates compared to bare-metal stents.
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Coronary endarterectomy and patch angioplasty for diffuse coronary artery dis...
CABG may not be sufficient to treat the diffusely diseased coronary arteries. New techniques such as coronary endarterectomy with patch angioplasty may provide a solution.
TAVI procedure review with cases
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Discretion is the Better Part of Valour - Karthik Balasubramaniam
This case report describes a patient presenting with chest pain who was found to have spontaneous coronary artery dissection (SCAD) involving the left main coronary artery, left anterior descending artery, and circumflex artery. Intravascular imaging revealed extensive dissection flaps. Due to the complex anatomy, a modified simultaneous kissing stents technique was used to treat the bifurcation involving placement of stents in the left main, left circumflex, and left anterior descending arteries simultaneously without needing to withdraw or recross wires. Intravascular ultrasound guidance was crucial for optimizing stent placement and ensuring wires remained in the true lumen. This technique proved effective for treating this challenging case of multivessel SCAD.
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A 57-year-old woman was admitted to the hospital with chest pain. Electrocardiograms and troponin levels were normal. Intravascular ultrasound was performed before placing a stent in the left main coronary artery and left anterior descending artery to treat a blockage. The minimum lumen area increased to 4.24mm x 4.13mm after stenting.
Intensive care of congenital heart disease.pptx
Congenital defects can put a strain on the heart, causing it to work harder. To stop your heart from getting weaker with this extra work, your doctor may try to treat you with medications. They are aimed at easing the burden on the heart muscle. You need to control your blood pressure if you have any type of heart problem.
Management of Hypetension.pptx
Changing your lifestyle can help control and manage high blood pressure. Your health care provider may recommend that you make lifestyle changes including:
Eating a heart-healthy diet with less salt
Getting regular physical activity
Maintaining a healthy weight or losing weight
Limiting alcohol
Not smoking
Getting 7 to 9 hours of sleep daily
CRISPR and cardiovascular diseases.pdf
CRISPR technologies have progressed by leaps and bounds over the past decade, not only having a transformative effect on
biomedical research but also yielding new therapies that are poised to enter the clinic. In this review, I give an overview of (i)
the various CRISPR DNA-editing technologies, including standard nuclease gene editing, base editing, prime editing, and epigenome editing, (ii) their impact on cardiovascular basic science research, including animal models, human pluripotent stem
cell models, and functional screens, and (iii) emerging therapeutic applications for patients with cardiovascular diseases, focusing on the examples of Hypercholesterolemia, transthyretin amyloidosis, and Duchenne muscular dystrophy.
Pacemaker Pocket Infection After Splenectomy
This case report describes a patient who underwent seven operations over one year to treat recurrent pacemaker pocket infections. The patient had undergone a splenectomy seven years prior due to a splenic rupture from a traffic accident. This left the patient immunocompromised and at higher risk for infection. The patient later required a pacemaker implantation for complete heart block. The pacemaker pocket developed repeated infections, likely due to the patient's asplenic state impairing immunity. The infections were difficult to treat due to multiple complicating factors, including an abandoned pacemaker lead and reuse of a sterilized pacemaker. This highlights the influence of patient factors like asplenia on procedural outcomes like pacemaker implantation.
Piccolo Duct Occluder.pdf
Transcatheter closure of patent ductus arteriosus (PDA) is feasible in low-birth-weight infants. A female baby was born prematurely with a birth weight of 924 g. She had a PDA measuring 3.7 mm. She was dependent on positive pressure ventilation for congestive heart failure in addition to the heart failure medications. She could not be discharged from the hospital even after 79 days of birth, and even though her weight reached 1.9 kg in the neonatal intensive care unit. We attempted to plug the PDA using an Amplatzer Piccolo Occluder, but the device failed to anchor. Then, the PDA was plugged using a 4-6 Amplatzer Duct Occluder using a 6-Fr sheath which was challenging.
MISPLACED ECG LEADS.pptx
Accidental misplacement of the limb lead electrodes is a common cause of ECG abnormality and may simulate pathology such as ectopic atrial rhythm, chamber enlargement or myocardial ischaemia and infarction
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...
Device closure of an eccentric atrial septal defect can be challenging and needs technical modifications to avoid unnecessary complications. Here, we present a case of a 45-year-old woman who underwent device closure of an eccentric defect with a large device. The patient developed pericardial effusion and left-sided pleural effusion due to injury to the junction of right atrium and superior vena cava because of the malalignment of the delivery sheath and left atrial disc before the device was pulled across the eccentric defect despite releasing the left atrial disc in the left atrium in place of the left pulmonary vein. These two serious complications were managed conservatively with close monitoring of the case during and after the procedure.
Arrythmia-IV.pptx
1) Bradycardia can be caused by abnormalities in the conduction system or autonomic nervous system. The conduction system includes the sinus node, AV node, His-Purkinje system and different types of heart block can occur when impulses are blocked at different locations.
2) There are three main types of AV block - first degree, second degree (Mobitz types I and II), and third degree. High grade AV block involves blockage of two or more consecutive impulses.
3) Third degree or complete heart block results in complete dissociation between the atria and ventricles with independent pacemakers. It can occur at the AV node or below in the His-Purkin
Arrythmia-III.pptx
1. Bradycardia is defined as a resting heart rate below 50 beats per minute. It can be physiological or pathological.
2. Sinus bradycardia originates from the sinus node and has a normal P wave morphology with a prolonged PR interval. It can be caused by increased vagal tone, medications, or hypothyroidism.
3. Sick sinus syndrome is characterized by sinus bradycardia, sinus arrest, or combinations of sinus node and AV node dysfunction. It may involve intermittent bradycardia and tachycardia. Pacemaker implantation is usually treatment.
Arrythmia-II.pptx
This document discusses ventricular arrhythmias including their origins, characteristics, classifications, and causes. It provides details on:
- The sites of origin for supraventricular tachycardia (SVT) and ventricular arrhythmias.
- Characteristics that distinguish SVT from ventricular arrhythmias such as QRS width.
- Classifications of ventricular arrhythmias including premature ventricular complexes, ventricular tachycardia, fibrillation, and electrical storm.
- Causes and characteristics of different types of ventricular tachycardia such as monomorphic VT, polymorphic VT, and torsades de pointes.
- Investigations and treatments for ventricular arrhythmias including cardiac imaging
Arrythmia-I.pptx
This document provides information on supraventricular tachycardia (SVT), including:
- The anatomy and conduction system of the heart that is relevant to SVT.
- The mechanisms that can cause cardiac arrhythmias, including disorders of impulse formation, conduction, and combinations of the two.
- Characteristics used to classify different types of arrhythmias based on rate, rhythm, site of origin, and QRS morphology.
- Specific types of SVT like atrial fibrillation, AV nodal reentry tachycardia, and accessory pathway mediated tachycardias.
- Methods for diagnosing and treating SVT such as electrophysiology studies, catheter ablation
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...
A 57-year-old male presented with recurrent palpitations. He was diagnosed with rheumatic mitral stenosis, right posterior septal accessory pathway and atrial flutter. An electrophysiological study after percutaneous balloon mitral valvotomy showed that the palpitations were due to atrial flutter with right bundle branch aberrancy. The right posterior septal pathway was a bystander because it had a higher refractory period than the atrioventricular node.
Anticoagulation therapy during pregnancy
This document discusses anticoagulation therapy options during pregnancy for different cardiac conditions. It notes that vitamin K antagonists (VKAs) should be avoided in the first trimester due to risk of embryopathy but can be used in the second and third trimester with risks of 0.7-2% of foetopathy. Unfractionated heparin does not cross the placenta but its use throughout pregnancy is not recommended due to risk of foetopathy. Low molecular weight heparin is considered the safest option for anticoagulation in weeks 6-12 when risk of embryopathy is a concern and has not been associated with risk of foetopathy. Fondaparinux use should be limited
Coronary guidewire
Percutaneous balloon dilatation, first described by
Andreas Gruentzig in 1979, was initially performed
without the use of guidewires.1 The prototype
balloon catheter was developed as a double lumen
catheter (one lumen for pressure monitoring or
distal perfusion, the other lumen for balloon inflation/deflation) with a short fixed and atraumatic
guidewire at the tip. Indeed, initially the technique
involved advancing a rather rigid balloon catheter
freely without much torque control into a coronary
artery. Bends, tortuosities, angulations, bifurcations,
and eccentric lesions could hardly, if at all, be negotiated, resulting in a rather frustrating low procedural success rate whenever the initial limited
indications (proximal, short, concentric, noncalcified) were negated.2 Luck was almost as
important as expertise, not only for the operator,
but also for the patient. It is to the merit of
Simpson who, in 1982, introduced the novelty of
advancing the balloon catheter over a removable
guidewire, which had first been advanced in the
target vessel.3 This major technical improvement
resulted overnight in a notable increase in the procedural success rate. Guidewires have since evolved
into very sophisticated devices.
Intracoronary optical coherence tomography
Optical coherence tomography-guided algorithm for percutaneous coronary intervention. Vessel diameter should be assessed using the external elastic lamina (EEL)-EEL diameter at the reference segments, and rounded down to select interventional devices (balloons, stents). If the EEL cannot be identified, luminal measures are used and rounded up to 0.5 mm larger for selection of the devices. Optical coherence tomography (OCT)-guided optimisation strategies post stent implantation per EEL-based diameter measurement and per lumen-based diameter measurement are shown. For instance, if the distal EEL-EEL diameter measures 3.2 mm×3.1 mm (i.e., the mean EEL-based diameter is 3.15 mm), this number is rounded down to the next available stent size and post-dilation balloon to be used at the distal segment. Thus, a 3.0 mm stent and non-compliant balloon diameter is selected. If the proximal EEL cannot be visualised, the mean lumen diameter should be used for device sizing. For instance, if the mean proximal lumen diameter measures 3.4 mm, this number is rounded up to the next available balloon diameter (within up to 0.5 mm larger) for post-dilation. MLA: minimal lumen area; MSA: minimal stent area;NC: non-compliant
Brugada syndrome
Brugada syndrome (BrS) is an inherited cardiac disorder,
characterised by a typical ECG pattern and an increased
risk of arrhythmias and sudden cardiac death (SCD).
BrS is a challenging entity, in regard to diagnosis as
well as arrhythmia risk prediction and management.
Nowadays, asymptomatic patients represent the majority
of newly diagnosed patients with BrS, and its incidence
is expected to rise due to (genetic) family screening.
Progress in our understanding of the genetic and
molecular pathophysiology is limited by the absence
of a true gold standard, with consensus on its clinical
definition changing over time. Nevertheless, novel
insights continue to arise from detailed and in-depth
studies, including the complex genetic and molecular
basis. This includes the increasingly recognised
relevance of an underlying structural substrate. Risk
stratification in patients with BrS remains challenging,
particularly in those who are asymptomatic, but recent
studies have demonstrated the potential usefulness
of risk scores to identify patients at high risk of
arrhythmia and SCD. Development and validation of
a model that incorporates clinical and genetic factors,
comorbidities, age and gender, and environmental
aspects may facilitate improved prediction of disease
expressivity and arrhythmia/SCD risk, and potentially
guide patient management and therapy. This review
provides an update of the diagnosis, pathophysiology
and management of BrS, and discusses its future
perspectives.
A roadmap for the human development
The Human Developmental Cell Atlas (HDCA) initiative, which is part of the Human Cell Atlas, aims to create a comprehensive reference map of cells during development. This will be critical to understanding normal organogenesis, the effect of mutations, environmental factors and infectious agents on human development, congenital and childhood disorders, and the cellular basis of ageing, cancer and regenerative medicine. Here we outline the HDCA initiative and the challenges of mapping and modelling human development using state-of-the-art technologies to create a reference atlas across gestation. Similar to the Human Genome Project, the HDCA will integrate the output from a growing community of scientists who are mapping human development into a unified atlas. We describe the early milestones that have been achieved and the use of human stem-cell-derived cultures, organoids and animal models to inform the HDCA, especially for prenatal tissues that are hard to acquire. Finally, we provide a roadmap towards a complete atlas of human development.
Intra aortic balloon pump
The treatment of patients with advanced acute heart failure is still challenging.
Intra-aortic balloon pump (IABP) has widely been used in the management of
patients with cardiogenic shock. However, according to international guidelines, its
routinary use in patients with cardiogenic shock is not recommended. This recommendation is derived from the results of the IABP-SHOCK II trial, which demonstrated
that IABP does not reduce all-cause mortality in patients with acute myocardial infarction and cardiogenic shock. The present position paper, released by the Italian
Association of Hospital Cardiologists, reviews the available data derived from clinical
studies. It also provides practical recommendations for the optimal use of IABP in
the treatment of cardiogenic shock and advanced acute heart failure.
Left ventricular false tendons
Left ventricular false tendons (LVFTs) are fibromuscular
structures, connecting the left ventricular
free wall or papillary muscle and the ventricular
septum.
There is some discussion about safety issues during
intense exercise in athletes with LVFTs, as these
bands have been associated with ventricular arrhythmias
and abnormal cardiac remodelling. However,
presence of LVFTs appears to be much more common
than previously noted as imaging techniques
have improved and the association between LVFTs
and abnormal remodelling could very well be explained
by better visibility in a dilated left ventricular
lumen.
Although LVFTsmay result in electrocardiographic abnormalities
and could form a substrate for ventricular
arrhythmias, it should be considered as a normal
anatomic variant. Persons with LVFTs do not appear
to have increased risk for ventricular arrhythmias or
sudden cardiac death.
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Barik ramachandra 20211805_0648_vod
- 1. A BAIL OUT LEFT MAIN CORONARY ARTERY STENTING Dr Ramachandra Barik, Associate Prof Dept Of Cardiology All India Institute Of Medical Sciences, Bhubaneswar
- 2. CLINICAL PROFILE • 59yrs/m • 2015: CAD, AWMI ,HFrEF, S/P PTCA+stenting LAD one DES,2.75x30mm treated outside • 2019 :Increasing SOB and angina • ECG: Old AWMI(4th universal definition) • ECHO :RWMA IN LAD territory ,EF:25-30% • CAG : 100%,LCX:CTO and RCA : Normal • STRESS MPI :Significant hibernating myocardium • He did not give consent for CABG despite heart team suggestion • Plan: PTCA to LAD/LCX with informed consent
- 3. FAILED TO CROSS TO CROSS LAD ISR ,LCX WAS STENTED USING 3X20MM ORSIRO STENT
- 4. HIBERNATING MYOCARDIUM IN LAD/LCX AREA GAVE US SOME TIME TO WIRE THROUGH TYPE-F DISSECTION
- 5. LMCA TO LAD AREA WAS PREDILATED BEFORE LMCA TO LCX STENTING
- 6. FINAL RESULT:GOOD ANGIOGRAGHY WITH SETTLING AORTIC DISSECTION
- 7. PATIENT WAS WATCHED IN WARD FOR FOUR DAYS • NoAngina or other symptoms • Serial 2D echo :Dissection is not visible (resolving) • Discharged on 4th-day of the procedure • Secondary prophylaxis for CAD • GDMT based HF Rx with 4 pillars :ARNI+BB+MRA+SGLT-2i
- 8. TAKE HOME • Completed 6months Follow up • No angina or significant SOB • Serial echo showed No dissection • Guide catheter tip induced type-II aorto- coronary dissection due to razor blade effect is a treatable emergency • Timely detection is key • Serial ECHO is must