Coronary artery chronic total occlusion scores
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Scoring systems for chronic total occlusion percutaneous coronary intervention: if you fail to prepare you are preparing to fail
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Transcatheter Aortic Valve Replacement (TAVR) had become a novel and secure procedure to treat aortic stenosis that had become more accepted over the years; the approach and different types of device improve the life expectancy, diminish the complications and costs in public health. Along with the improvement in technology the minimalist approach had gain popularity to ameliorate the overall patient health.
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1) Endovascular treatment is the preferred strategy for revascularization below-the-knee (BTK) due to involvement of multiple lesions, but requires a thorough toolbox of devices.
2) Access selection and catheter positioning are critical, with ultrasound guidance recommended for pedal access. Wires are the most important devices, with specialty wires needed for different lesion types.
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This study compared outcomes of percutaneous coronary intervention (PCI) using drug-eluting stents versus coronary artery bypass grafting (CABG) for treating unprotected left main coronary artery disease over 5 years. Among 600 patients enrolled between 2004-2009 in South Korea and randomly assigned to PCI or CABG, the cumulative incidence of major adverse cardiac events was 17.5% in the PCI group and 14.3% in the CABG group, a non-significant difference. While PCI was a feasible option for selected low-risk patients, the study was limited by sample size and systematic follow-up angiography in the PCI group.
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- Left main coronary artery disease occurs in 5-7% of patients undergoing coronary angiography and is associated with high mortality if left untreated. The left main artery supplies a large portion of the heart.
- Left main disease can be caused by atherosclerosis, infections, inflammation, anomalies, or compression. Atherosclerosis particularly affects areas of low shear stress like the bifurcation.
- Percutaneous coronary intervention or coronary artery bypass grafting may be considered for treatment depending on the patient's characteristics and complexity of the disease. Outcomes are generally better when intravascular ultrasound is used to guide stenting of left main lesions. Patient selection is important to achieve good long-term results.
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Surgical management of aortic arch pathology often requires complex techniques to protect vital organs like the brain during replacement or repair of the aortic arch. Conventional techniques used hypothermic circulatory arrest and surface cooling but had limitations. Newer techniques like antegrade and retrograde selective cerebral perfusion allow prolonged safe periods of cerebral protection with improved cooling and independent control of cerebral and systemic circulation, though they are more technically challenging. The optimal approach considers individual patient and anatomical factors to maximize benefits and reduce risks.
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Investigator-Initiated Studies: Two Stories from the NIH
The document discusses two investigator-initiated studies funded by the National Heart, Lung, and Blood Institute (NHLBI). The first story describes a study that found reopening occluded arteries in patients who had a heart attack over 24 hours prior did not reduce risk of death or heart attack and was difficult to conduct due to physician bias in favor of the procedure and slow funding and recruitment. The second story discusses a study that found certain blood thinning drugs can prevent heart attacks and strokes, despite initial resistance from the medical community. The document advocates for continued government funding of investigator-initiated clinical trials to evaluate new treatments while managing conflicts of interest.
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1) A study of 455 patients undergoing transradial cardiac catheterization found that the rate of radial artery occlusion (RAO) was significantly higher when a 6-French sheath was used (30.5%) compared to a 5-French sheath (13.7%).
2) Multivariate analysis identified female sex, younger age, presence of peripheral artery disease, and use of a 6-French sheath as independent predictors of RAO.
3) For patients who developed symptomatic RAO, treatment with low molecular weight heparin showed a higher rate of recanalization (55.6%) compared to patients who did not receive anticoagulation (13.5%).
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This document discusses prosthetic heart valve thrombosis (PHVT), including its diagnosis and management guidelines. PHVT occurs more commonly in mechanical heart valves compared to bioprosthetic valves. The incidence is higher in developing countries and contributes significantly to late mortality after heart valve surgery. Guidelines vary in their recommendations for treating PHVT, with some advocating surgery for all cases while others recommend thrombolytic therapy. Recent studies have explored newer, lower dose thrombolytic regimens that achieve similar efficacy but lower risks of complications compared to older regimens. Definitive diagnosis of PHVT involves transesophageal echocardiography to assess thrombus size and differentiate thrombus from pannus, while transthoracic echocardiography
AORTO-ILIAC INTERVENTIONS
This document summarizes techniques for endovascular treatment of aorto-iliac occlusive disease. It discusses:
1) Technical success rates are high but complications can occur, especially with chronic total occlusions. Primary stenting is preferred over PTA with provisional stenting for long lesions.
2) Patency rates at 5-10 years range from 46-96% depending on the location and type of lesion. Risk factors for restenosis include occlusion length and poor runoff.
3) Endovascular treatment has advantages over open surgery like shorter hospital stays and lower complications/mortality, though open bypass has higher long term patency. Drug-eluting devices may help address issues of rest
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excel TRIAL PTCA vs CABG biggest trial
This document summarizes the EXCEL trial, which compared everolimus-eluting stents to bypass surgery for treating left main coronary artery disease. The trial included over 2900 patients across 17 countries. At 3 years, the primary endpoint of death, stroke, or heart attack was similar between the stent and surgery groups, but the stent group had fewer adverse events in the first 30 days. However, at 5 years stent patients had higher rates of non-procedural heart attacks and required more repeat procedures, though mortality remained similar. The conclusion is that stents may be preferable to surgery for selected left main disease patients after discussion, though surgery provided better long-term outcomes.
Jorge palazuelos icp en lesiones severamente calcificadas
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Rotational atherectomy may provide benefits over plain balloon angioplasty for treating severely calcified coronary lesions. It allows for more effective preparation and debulking of hard plaque, enabling better stent expansion and apposition. However, studies comparing rotational atherectomy plus drug-eluting stent versus plain angioplasty plus drug-eluting stent have shown inconsistent results, with no clear evidence that rotational atherectomy improves long-term outcomes in the drug-eluting stent era. Further research is still needed to determine whether current generation drug-eluting stents achieve similar results with or without preceding rotational atherectomy for complex lesion subsets.Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
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This document discusses the concept of angiosomes, which are three-dimensional zones in the body supplied by specific source arteries and drained by specific veins. It summarizes several studies that found treating ulcers by revascularizing the specific angiosome had better healing rates than treating the boundary artery. However, other studies found indirect revascularization through collateral vessels provided similar results to direct revascularization. The document calls for more high-quality randomized controlled trials to standardize definitions and account for confounding factors to better understand the effect of indirect revascularization through collaterals on outcomes. It concludes that obtaining a direct revascularization to the foot, even if not to the specific injured angiosome, improves results and subsequent appropriate podiatric care is
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A PRECOMBAT trial Premier of randomized comparison of bypass surgery vs angioplasty using sirolimus-eluting stent in patients with left main coronary artery disease
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This document discusses the benefits of a hybrid operating room (OR) approach for extra cardiac procedures from a cardiovascular surgeon's perspective. It provides an overview of hybrid OR uses for both straightforward and complicated cardiac cases as well as cases with complications. Examples of procedures that can be done in a hybrid OR include endovascular repairs for structural heart and aortic diseases. The conclusion is that a hybrid approach provides a safe alternative to open heart surgery with acceptable short and mid-term results, especially for high-risk patients. Teamwork between cardiac surgeons, interventional radiologists and cardiologists is key to success with the hybrid approach.
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This document discusses treatment options for aortic stenosis (AS) in elderly patients. It states that surgical aortic valve replacement (AVR) improves symptoms and quality of life for AS patients, even in those over 80 years old. However, surgery is denied in 33% of elderly patients with severe AS, often due to older age and left ventricular dysfunction rather than comorbidities alone. Balloon valvuloplasty provides only temporary relief for AS and increased risk of restenosis. Transcatheter aortic valve implantation (TAVI) has been shown to have better 1-year survival rates than surgery for high-risk AS patients. The conclusions recommend surgical AVR for most elderly AS patients when feasible, and considering
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- Left main coronary artery disease occurs in 5-7% of patients undergoing coronary angiography and is associated with high mortality if left untreated. The left main artery supplies a large portion of the heart.
- Left main disease can be caused by atherosclerosis, infections, inflammation, anomalies, or compression. Atherosclerosis particularly affects areas of low shear stress like the bifurcation.
- Percutaneous coronary intervention or coronary artery bypass grafting may be considered for treatment depending on the patient's characteristics and complexity of the disease. Outcomes are generally better when intravascular ultrasound is used to guide stenting of left main lesions. Patient selection is important to achieve good long-term results.
AORTIC ARCH SURGERY
Surgical management of aortic arch pathology often requires complex techniques to protect vital organs like the brain during replacement or repair of the aortic arch. Conventional techniques used hypothermic circulatory arrest and surface cooling but had limitations. Newer techniques like antegrade and retrograde selective cerebral perfusion allow prolonged safe periods of cerebral protection with improved cooling and independent control of cerebral and systemic circulation, though they are more technically challenging. The optimal approach considers individual patient and anatomical factors to maximize benefits and reduce risks.
Arch final harkit2015 __
This document summarizes Dicky Aligheri's experience with hybrid procedures for aortic arch involvement between 2013-2014 at the National Cardiac & Vascular Centre Harapan Kita in Jakarta. It describes several case studies of patients who received treatments like total arch replacement, hemi arch replacement, and the frozen elephant trunk procedure. It also reviews literature on debates around the best surgical strategies for aortic arch pathology and the safety and efficacy of hybrid techniques compared to open surgery.
Investigator-Initiated Studies: Two Stories from the NIH
The document discusses two investigator-initiated studies funded by the National Heart, Lung, and Blood Institute (NHLBI). The first story describes a study that found reopening occluded arteries in patients who had a heart attack over 24 hours prior did not reduce risk of death or heart attack and was difficult to conduct due to physician bias in favor of the procedure and slow funding and recruitment. The second story discusses a study that found certain blood thinning drugs can prevent heart attacks and strokes, despite initial resistance from the medical community. The document advocates for continued government funding of investigator-initiated clinical trials to evaluate new treatments while managing conflicts of interest.
Abdelaal E 201304
1) A study of 455 patients undergoing transradial cardiac catheterization found that the rate of radial artery occlusion (RAO) was significantly higher when a 6-French sheath was used (30.5%) compared to a 5-French sheath (13.7%).
2) Multivariate analysis identified female sex, younger age, presence of peripheral artery disease, and use of a 6-French sheath as independent predictors of RAO.
3) For patients who developed symptomatic RAO, treatment with low molecular weight heparin showed a higher rate of recanalization (55.6%) compared to patients who did not receive anticoagulation (13.5%).
Thrombolysis of thrombosed prosthetic heart valve
This document discusses prosthetic heart valve thrombosis (PHVT), including its diagnosis and management guidelines. PHVT occurs more commonly in mechanical heart valves compared to bioprosthetic valves. The incidence is higher in developing countries and contributes significantly to late mortality after heart valve surgery. Guidelines vary in their recommendations for treating PHVT, with some advocating surgery for all cases while others recommend thrombolytic therapy. Recent studies have explored newer, lower dose thrombolytic regimens that achieve similar efficacy but lower risks of complications compared to older regimens. Definitive diagnosis of PHVT involves transesophageal echocardiography to assess thrombus size and differentiate thrombus from pannus, while transthoracic echocardiography
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This document summarizes techniques for endovascular treatment of aorto-iliac occlusive disease. It discusses:
1) Technical success rates are high but complications can occur, especially with chronic total occlusions. Primary stenting is preferred over PTA with provisional stenting for long lesions.
2) Patency rates at 5-10 years range from 46-96% depending on the location and type of lesion. Risk factors for restenosis include occlusion length and poor runoff.
3) Endovascular treatment has advantages over open surgery like shorter hospital stays and lower complications/mortality, though open bypass has higher long term patency. Drug-eluting devices may help address issues of rest
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This document summarizes the EXCEL trial, which compared everolimus-eluting stents to bypass surgery for treating left main coronary artery disease. The trial included over 2900 patients across 17 countries. At 3 years, the primary endpoint of death, stroke, or heart attack was similar between the stent and surgery groups, but the stent group had fewer adverse events in the first 30 days. However, at 5 years stent patients had higher rates of non-procedural heart attacks and required more repeat procedures, though mortality remained similar. The conclusion is that stents may be preferable to surgery for selected left main disease patients after discussion, though surgery provided better long-term outcomes.
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Rotational atherectomy may provide benefits over plain balloon angioplasty for treating severely calcified coronary lesions. It allows for more effective preparation and debulking of hard plaque, enabling better stent expansion and apposition. However, studies comparing rotational atherectomy plus drug-eluting stent versus plain angioplasty plus drug-eluting stent have shown inconsistent results, with no clear evidence that rotational atherectomy improves long-term outcomes in the drug-eluting stent era. Further research is still needed to determine whether current generation drug-eluting stents achieve similar results with or without preceding rotational atherectomy for complex lesion subsets.Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
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Critical Care and Trauma.pdf
The document provides an overview of surgical critical care and trauma. It discusses the initial evaluation and resuscitation of injured patients, including the primary and secondary surveys. It also covers topics like shock, head injuries, maxillofacial trauma, chest trauma (blunt and penetrating), abdominal trauma including injuries to specific organs like the liver and spleen, duodenal injuries, pancreatic injuries, and colon/rectal injuries. Retroperitoneal injuries are also summarized.
Ischaemic burden and changes in absolute myocardial perfusion after chronic t...
Presenter: Stefan Schumacher
13th Experts "Live" CTO Workshop
17th–18th September 2021 - Florence, Italy
What do we need to indicate CTO PCI?
1. Successful PCI of chronic total occlusions (CTO) is associated with improved symptoms, increased exercise capacity, reduced need for CABG, and survival benefit compared to failed CTO PCI based on observational studies.
2. Randomized trials are still needed to provide high-level evidence on the benefits of CTO PCI given limitations of observational data though several large randomized trials are underway.
3. Expert operators can now achieve high success rates of over 90% for CTO PCI with low complication rates even for complex CTOs, using bilateral injections, IVUS, retrograde approaches and specialized guidewires and catheters.
Fluido y choque
This document discusses optimal fluid therapy for patients with traumatic hemorrhagic shock. It begins by noting that hemorrhage is a leading cause of preventable trauma deaths. Advances in treatment of hemorrhagic shock have often occurred during times of war. The document then reviews patient evaluation, massive transfusion protocols, and damage control resuscitation, which emphasizes early use of plasma over crystalloids. Large volumes of crystalloids are associated with worse outcomes for patients with hemorrhagic shock, and even small amounts may be harmful. Plasma should be the primary means of volume expansion in resuscitation of trauma patients with hemorrhagic shock.
Which CTO should be treated by PCI or CABG & The specific problems of PCI for...
Which CTO should be treated by PCI or CABG & The specific problems of PCI for post CABG patients
Gerald S. Werner, Darmstadt, Germany
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
Infrapopliteal pad
This document discusses endovascular interventions for infrapopliteal peripheral vascular disease. Infrapopliteal disease is rising due to an aging population and increased rates of diabetes and kidney disease. Surgical and early endovascular interventions historically had high failure rates in this region. Endovascular procedures now provide an alternative to bypass surgery for treating critical limb ischemia in the infrapopliteal arteries, with the goal of establishing straight line blood flow to the foot. Success depends on factors like number of vessels opened, inflow status, and addressing more proximal disease first when needed. Complications can include access issues, vessel spasm or perforation, embolism, and contrast nephropathy.
Vedantham_2008-12-12.ppt
This document discusses endovascular thrombolytic therapy for acute deep vein thrombosis (DVT). It provides background on the quality of life issues for DVT patients, including long term complications like post-thrombotic syndrome (PTS). It reviews evidence that immediate clot removal may help prevent PTS by preserving venous valves and function. The document outlines the ATTRACT trial, a large multicenter randomized controlled trial testing whether catheter-directed thrombolysis (CDT) plus standard therapy is more effective than standard therapy alone for reducing PTS in patients with acute proximal DVT. It lists the primary and secondary outcomes that will be assessed to determine if CDT is safer, improves quality of life, and is cost-
ISR published
This document discusses a study evaluating the incidence, predictors, and long-term outcomes of patients experiencing in-stent restenosis (ISR) after receiving long drug-eluting stents for coronary arteries. 421 patients received long drug-eluting stents and 371 patients underwent follow up. The overall incidence of ISR was 4%. Risk factors for ISR included diabetes and long lesions. Of those with ISR, 40% underwent repeat PCI, 46.7% underwent bypass surgery, and 13.3% were treated medically. During long-term follow up of 12-26 months, there were no deaths from ISR and the incidence of major adverse cardiac events was low. ISR did not
Iliofemoral DVT thrombolysis
This document discusses current methods for treating deep vein thrombosis (DVT) and the impact of post-thrombotic syndrome (PTS). It provides statistics on the prevalence and costs of DVT and PTS in the US. The document reviews changes to DVT treatment guidelines supporting early thrombus removal through pharmacomechanical thrombolysis. Clinical studies demonstrate pharmacomechanical thrombolysis improves outcomes over anticoagulation alone by increasing patency and reducing long-term PTS symptoms. The document concludes that early thrombus removal through pharmacomechanical techniques is the new standard of care for proximal DVT due to decreased complications and improved patient outcomes compared to anticoagulation or catheter-directed thrombolysis alone.
Bypass graft intervention2
This document provides guidance on percutaneous coronary intervention (PCI) of saphenous vein grafts (SVGs). It notes that PCI of native coronary arteries is preferred when feasible. For SVG PCI, it recommends the liberal use of embolic protection devices to reduce the risk of atheroembolism. It also provides tips for technical considerations like guide catheter selection and balloon inflation pressures. It discusses the indications for and results of SVG intervention in different time periods after CABG, noting higher risks for early reintervention but short-term benefits of PCI over reoperation.
Double kissing crush v trial
1) The DKCRUSH-V trial randomized 482 patients with true distal left main coronary artery bifurcation lesions to either double kissing (DK) crush stenting or provisional stenting (PS).
2) At 1-year follow-up, the primary endpoint of target lesion failure was lower in the DK crush group compared to the PS group.
3) At 3-year follow-up, target lesion failure rates remained lower in the DK crush group driven by lower rates of myocardial infarction and revascularization compared to the PS group. Definite or probable stent thrombosis was also lower in the DK crush group.
TIPS VS BRTO
review of literature for transjugular intrahepatic portosystemic shunt placement and balloon occluded retrograde transvenous obliteration in management of patients with varices hemorrhage
Bon Secours Heart Valve Center
This document discusses mitral valve disease and treatment options such as surgical repair/replacement and the MitraClip procedure. Some key points:
- Mitral regurgitation (MR) is the most common valve problem and increases in prevalence with age. Left untreated, MR can lead to heart failure and death.
- Surgical treatment has traditionally been the only option to reliably reduce MR, but many patients are considered too high-risk for surgery.
- The MitraClip procedure is a minimally invasive treatment that fills this gap for inoperable patients by using a clip to repair the mitral valve and reduce MR without open heart surgery.
- Clinical trials show the MitraClip procedure reduces MR
Chronic total occlusion
A 56-year-old male with a history of heart disease presented with ongoing chest pain after an unsuccessful attempt to open a chronic total occlusion of the right coronary artery via percutaneous coronary intervention 6 weeks prior. The patient underwent a second PCI procedure where the CTO was successfully opened using an antegrade approach, resolving his symptoms. At follow-ups 6 months, 12 months and 18 months later, the patient reported continued relief from symptoms and was able to return to exercising and training for triathlons without any chest pain.
Intracranial haemorrhage
literature summary of different types of intracranial haemorrhage and their management highlighting relevent or controversial papers
Jic 2-174
Coronary artery bypass grafting (CABG) with adjunctive endarterectomy (CE) is a useful technique for treating complex cases of diffuse coronary artery disease. CE aims to completely revascularize the heart by removing coronary artery blockages. While results of CE are debated, one study found acceptable mid-term results with CE and CABG, including a 2.7% in-hospital mortality rate. The study also compared outcomes of patients treated postoperatively with single antiplatelet therapy (aspirin) versus dual antiplatelet therapy (aspirin and clopidogrel). No significant differences in outcomes were found between the two groups in the mid-term follow up period, though dual antiplate
IS STENTING TO MAINTAIN VASCULAR PATENCY GOING TO BE THE FUTURE
This document discusses the use of stenting to maintain vascular patency for hemodialysis access and whether it will be the future standard. It notes that while stenting is established for coronary arteries, its role for arteriovenous fistulas (AVFs) and grafts (AVGs) is still controversial. The document reviews several studies that showed no benefit or increased complications from stenting AVFs/AVGs compared to angioplasty alone. However, it also discusses some limited evidence that covered stents or stents placed in specific situations like central venous stenosis may improve patency compared to angioplasty. Overall, the document questions whether stenting will become the standard given the lack of strong evidence, complications risks
Similar to Coronary artery chronic total occlusion scores (20)
Jorge palazuelos icp en lesiones severamente calcificadas
Jorge palazuelos icp en lesiones severamente calcificadas
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...
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Ischaemic burden and changes in absolute myocardial perfusion after chronic t...
Ischaemic burden and changes in absolute myocardial perfusion after chronic t...
Which CTO should be treated by PCI or CABG & The specific problems of PCI for...
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IS STENTING TO MAINTAIN VASCULAR PATENCY GOING TO BE THE FUTURE
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COMPLETE ATRIOVENTRICULAR HEART BLOCK.pptx
first degree second degree and third degree atrioventricular block
Willens's syndrome.pptx
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...
A Case of Device Closure of an Eccentric Atrial Septal Defect Using a Large D...https://aiimsbhubaneswar.nic.in/
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...
Trio of Rheumatic Mitral Stenosis, Right Posterior Septal Accessory Pathway a...https://aiimsbhubaneswar.nic.in/
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.
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GASTROINTESTINAL INFECTIONS AND GASTRITIS
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Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
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To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
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Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
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Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
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Hemodialysis: Chapter 6, Hemodialysis Adequacy and Dose - Dr.Gawad
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Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
Academy of Oriental Medicine at Austin
About AOMA: The Academy of Oriental Medicine at Austin offers a masters-level graduate program in acupuncture and Oriental medicine, preparing its students for careers as skilled, professional practitioners. AOMA is known for its internationally recognized faculty, award-winning student clinical internship program, and herbal medicine program. Since its founding in 1993, AOMA has grown rapidly in size and reputation, drawing students from around the nation and faculty from around the world. AOMA also conducts more than 20,000 patient visits annually in its student and professional clinics. AOMA collaborates with Western healthcare institutions including the Seton Family of Hospitals, and gives back to the community through partnerships with nonprofit organizations and by providing free and reduced price treatments to people who cannot afford them. The Academy of Oriental Medicine at Austin is located at 2700 West Anderson Lane. AOMA also serves patients and retail customers at its south Austin location, 4701 West Gate Blvd. For more information see www.aoma.edu or call 512-492-303434.
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Coronary artery chronic total occlusion scores
- 1. Coronary artery chronic total occlusion scores
- 2. Chronic total occlusion • Chronic coronary total occlusion (CTO) occurs when either the left main or right coronary artery — one of the arteries that delivers oxygen- rich blood to your heart — has become completely blocked or occluded for three months or longer. Approximately 15 to 20 percent of people with coronary artery disease have a CTO • Ivanhoe RJ, Weintraub WS, Douglas JS, Lembo NJ, Furman M, Gershony G, Cohen CL, King SB. Percutaneous transluminal coronary angioplasty of chronic total occlusions. Primary success, restenosis, and long-term clinical follow-up. Circulation. 1992 Jan;85(1):106-15
- 3. PCI • The success of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) significantly increased from 77% between 2000 and 2011 1 to 85% to 90% currently at experienced centers and depends on center and operator experience and lesion characteristics • Patel VG, Brayton KM, Tamayo A, Mogabgab O, Michael TT, Lo N, Alomar M, Shorrock D, Cipher D, Abdullah S, et al. Angiographic success and procedural complications in patients undergoing percutaneous coronary chronic total occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACC Cardiovasc Interv. 2013;6:128-136
- 4. Japan chronic total occlusion (J-CTO) score • the Japan chronic total occlusion (J- CTO) score that estimates the likelihood of successful guidewire crossing within the first 30 minutes based on 5 variables: 1. Blunt stump 2. Calcification 3. Lesion tortuosity 4. Prior failed attempt 5. Occlusion length >=20 mm • Morino Y, Abe M, Morimoto T, Kimura T, Hayashi Y, Muramatsu T, Ochiai M, Noguchi Y, Kato K, Shibata Y, et al; J-CTO Registry Investigators. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within 30 minutes: the J- CTO (Multicenter CTO Registry in Japan) Score as a difficulty grading and time assessment tool. JACC Cardiovasc Interv. 2011;4:213-221.
- 6. PROGRESS- CTO score 1. moderate/severe proximal vessel tortuosity 2. proximal cap ambiguity 3. circumflex coronary artery CTO 4. absence of interventional collaterals to predict technical • Christopoulos G, Kandzari DE, Yeh RW, Jaffer FA, Karmpaliotis D, Wyman MR, Alaswad K, Lombardi W, Grantham JA, Moses J, et al. Development and validation of a novel scoring system for predicting technical success of chronic total occlusion percutaneous coronary interventions: the PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) Score. JACC Cardiovasc Interv. 2016;9:1-9.
- 7. The EuroCTO CASTLE score • 6 variables for assessing the likelihood of success 1. Prior Coronary artery bypass graft surgery 2. Age (>=70 years) 3. Stump anatomy (blunt or invisible) 4. Tortuosity degree (severe or unseen) 5. Length of occlusion (>=20 mm) 6. Extent of calcification (>50% of the segment) • Szijgyarto Z, Rampat R, Werner GS, Ho C, Reifart N, Lefevre T, Louvard Y, Avran A, Kambis M, Buettner HJ, et al. Derivation and validation of a chronic total coronary occlusion intervention procedural success score from the 20,000-Patient EuroCTO Registry: the EuroCTO (CASTLE) Score. JACC Cardiovasc Interv. 2019;12:335-342.
- 9. Conclusion • the PROGRESS-CTO, the J-CTO, and the CASTLE CTO scores perform moderately well in predicting the technical success of CTO PCI with the J-CTO score having the best overall performance