This document summarizes a presentation on techniques for treating coronary chronic total occlusions (CTOs) that are balloon uncrossable or untreatable. The presentation outlines a stepwise approach beginning with crossing techniques using wires, support catheters, and modifications to the lesion. If unsuccessful, anchoring techniques using guide catheter extensions or side branch balloons are recommended. Later steps include excimer laser, rotational atherectomy, subintimal wiring techniques, and retrograde approaches. Combination techniques are emphasized for success in treating the most complex CTOs.
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
This is a comprehensive description of coronay lesion assessment from routinely used angiography to advanced imaging modalities like IVUS/OCT including their functional significance by FFR
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Although the risks of coronary angiography have declined over the years by increased clinical experience and advanced technologies, it still requires attention, knowledge and experience due to being an interventional diagnostic method. A safe coronary angiography begins with the selection of the appropriate catheter for the anatomical structure of the patient and the evaluation of the pressure when the catheter is placed in the coronary ostium. Coronary pressure waves are complementary requirements of angiography. The recognition, evaluation and precautions to be taken for abnormal pressure waves directly affect the mortality of the patient. One of the first clues to the presence of stenosis in the left main coronary artery (LMCA) is abnormal changes in pressure when the catheter is seated in the ostial LMCA. This often occurs as a “ventricularization” or “damping”. For decades, ventricularization was mostly experienced as a stenosis by invasive cardiologists [1]. Recognition of abnormal changes in pressure and precautions to be taken prevent catastrophic outcomes in patients
https://crimsonpublishers.com/ojchd/fulltext/OJCHD.000518.pdf
For more open access journals in Crimson Publishers
please click on https://crimsonpublishers.com/
For more articles in open journal of Cardiology & Heart Diseases
please click on https://crimsonpublishers.com/ojchd/
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
Based on the principle that the distal coronary pressure measured during vasodilation is directly proportional to maximum vasodilated perfusion.
FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow in the same artery if there were no stenosis.
FFR is simply calculated as a ratio of mean pressure distal to a stenosis (Pd) to the mean pressure proximal stenosis, that is the mean pressure in the aorta (Pa), during maximal hyperaemia.
Catheters used in Angiography & angioplastySatya Shukla
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
Diagnostic catheters for coronary angiography Aswin Rm
Overview of diagnostic catheters used in coronary angiography
Guide catheters not included
History of coronary catheters
Radial techniques and catheters
Although the risks of coronary angiography have declined over the years by increased clinical experience and advanced technologies, it still requires attention, knowledge and experience due to being an interventional diagnostic method. A safe coronary angiography begins with the selection of the appropriate catheter for the anatomical structure of the patient and the evaluation of the pressure when the catheter is placed in the coronary ostium. Coronary pressure waves are complementary requirements of angiography. The recognition, evaluation and precautions to be taken for abnormal pressure waves directly affect the mortality of the patient. One of the first clues to the presence of stenosis in the left main coronary artery (LMCA) is abnormal changes in pressure when the catheter is seated in the ostial LMCA. This often occurs as a “ventricularization” or “damping”. For decades, ventricularization was mostly experienced as a stenosis by invasive cardiologists [1]. Recognition of abnormal changes in pressure and precautions to be taken prevent catastrophic outcomes in patients
https://crimsonpublishers.com/ojchd/fulltext/OJCHD.000518.pdf
For more open access journals in Crimson Publishers
please click on https://crimsonpublishers.com/
For more articles in open journal of Cardiology & Heart Diseases
please click on https://crimsonpublishers.com/ojchd/
Percutaneous Balloon Mitral Valvuloplasty (PBMV) is a procedure to dilated the mitral valve in the setting of rheumatic mitral valve stenosis. A catheter is inserted into the femoral vein, advanced to the right atrium and across the interatrial septum. Then the mitral valve is crossed with a balloon and it is inflated to relieve the fusion of the mitral valve commissures effectively acting to increase the mitral valve area and reduce the degree of mitral stenosis. Mitral regurgitation is a potential complication and thus PBMV is contraindicated if moderate or severe regurgitation is present. The Wilkins score examines mitral valve morphology and is determined via echocardiography to assess the likelihood of using PBMV based on certain echocardiographic criteria.
Based on the principle that the distal coronary pressure measured during vasodilation is directly proportional to maximum vasodilated perfusion.
FFR is defined as the ratio of maximum blood flow in a stenotic artery to maximum blood flow in the same artery if there were no stenosis.
FFR is simply calculated as a ratio of mean pressure distal to a stenosis (Pd) to the mean pressure proximal stenosis, that is the mean pressure in the aorta (Pa), during maximal hyperaemia.
Catheters used in Angiography & angioplastySatya Shukla
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
CORONARY ENGAGEMENT
- Engaging the coronary artery ostia is one of the most essential steps of diagnostic angiography and PCI
- Using multiple catheters (Judkins, Amplatz) or single catheter (Tiger, Jacky)
- Requirements of an optimal catheter engagement: no pressure dampening, coaxial orientation, 2-3 mm engagement depth
- Pressure waveform monitor is of the utmost importance. Failure to recognize pressure damping/ventricularization followed by contrast injection can cause catastrophic complications.
FINAL MESSAGE
“Never take your eyes off the monitor and the pressure curve!”
“Serious complications in the cath lab often happen not out of ignorance or lack of expertise, but because of ignoring some basic principles and lack of cath lab discipline.”
Despite the advances in wire technology and development of algorithm-driven methodology for chronic
total occlusion (CTO) intervention, there is a void in the literature about the technical aspects of CTO wiring.
The Asia Pacific CTO Club, a group of 10 experienced operators in the Asia Pacific region, has tried to fill this
void with this state-of-the-art review on CTO wiring
15th Experts Live CTO - Carlo Di Mario: ConclusionsEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Francesco Burzotta: Wrap up Gemelli CasesEuro CTO Club
PLENARY SESSION
Wrap up of live cases, awards to the winners of the best abstracts and case competitions and take home messages
Auditorium Zubin Mehta - Saturday 16:00 - 17:00
Speakers:
Daniela Benedetto (Rome),
Francesco Burzotta (Rome),
Carlo Di Mario (Florence),
Roberto Garbo (Turin),
Rocco Stio (Rome)
Challengers:
Stelios Pyxaras (Furth - D),
Sudhir Rathore (London - UK)
Discussants:
Shunsuke Matsuno (Tokyo - J),
Alexander Nap (Amsterdam - NL),
Masahisa Yamane (Tokyo - J)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Jonathan Hill: Role of mechanica support in CTO recanalizationEuro CTO Club
10:42
Role of mechanica support in CTO recanalization
Jonathan Hill (London - UK)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Gregor Leibundgut: Role of DEB in CTO-PCIEuro CTO Club
10:35 Role of DEB in CTO-PCI
Gregor Leibundgut (Basel - CH)
___________________________________________
PARALLEL SESSION
Challenges And Opportunities In Cto Recanalization
Auditorium Zubin Mehta - Saturday 10:00 - 11:10
Chairperson:
Jonathan Hill (London - UK)
Discussants:
Lesnek Bryniarski (Krakow - PL),
Ugo Fabrizio (Vercelli),
Paul Knaapen (Amsterdam - NL),
Eugenio La Scala (Ollioiouls - F)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Kambis Mashayekhi: EuroCTO Consensus on treatment of Calcified CTO lesion Eur...Euro CTO Club
AUDITORIUM ZUBIN MEHTA
08/09/2023 04:30 - 05:20
PLENARY SESSION - INTERVENTIONAL CTO & CHIP RESEARCH Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Emmanouil S. Brilakis - CTO PCI Outcome associated with poor quality of the d...Euro CTO Club
16:53
CTO PCI Outcome associated with poor quality of the distal target vessel
Emmanouil Brilakis (Minneapolis - USA)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
Mario Iannaccone - 2 EuroCTO Consensus on Guide Catheter Extensions JACC Card...Euro CTO Club
16:33
EuroCTO Consensus on Guide Catheter Extensions JACC Cardiovasc Interventions
Mario Iannaccone (Turin)
_____________________________________________
PARALLEL SESSION
Interventional CTO & Chip Research
Best CTO Publications 2022-23 (selected by the Editors of the Cardiology Interventional journals)
Auditorium Zubin Mehta - Friday 16:30 - 17:16
Chairpersons:
Davide Capodanno (Catania),
Carlo Di Mario (Florence),
Giuseppe Tarantini (Padua)
Panelist:
Roberto Diletti (Rotterdam - NL),
Giovanni Esposito (Naples),
Paul Knaapen (Amsterdam - NL),
Maksymilian Opolski (Warsaw - PL)
___________________________________________
15th Experts Live CTO,
EUROCTO Club meeting in partnership with the GISE CTO meeting.
September 8th - 9th, 2023
Florence, Italy
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
Saturday 1630 – brilakis balloon uncrossable
1. EuroCTO Club 2015
Saturday, September 19, 2015
Prevalence and treatment of balloon
uncrossable or untreatable CTOs
4.30 -4.45 pm
Emmanouil S. Brilakis, MD, PhD
Director, Cardiac Catheterization Laboratories
VA North Texas Health Care System
Professor of Medicine, University of Texas
Southwestern Medical School, Dallas, Texas
2. Speaker honoraria/consulting fees:
Abbott Vascular, Asahi, Boston
Scientific, Elsevier, Somahlution, St
Jude Medical, Terumo
Research funding: InfraRedx, Boston
Scientific
Employment (spouse): Medtronic
Grants: VA - CLIN-007-11F
VA CSP#571 – DIVA
Disclosures
4. DO NOT TRY ANYTHING OF WHAT
WILL BE PRESENTED
UNTIL AFTER
YOU HAVE CONFIRMED THAT
YOUR WIRE IS INTO THE DISTAL
TRUE LUMEN USING TWO
ORTHOGONAL PROJECTIONS!
DOING OTHERWISE MAY RESULT
IN SEVERE INJURY OR DEATH…
DISCLAIMER
12. 1st line
2nd line
Brilakis ES. Manual of coronary CTO interventions. Elsevier 2013
Approach to “balloon uncrossable” CTO
“Balloon Uncrossable” CTO
• Inflate 1.20-1.5 mm balloon, Threader, Glider
• Rupture balloon in vessel (grenadoplasty)
• Tornus, Corsair, Turnpike, Finecross
• Wire “cutting”
FINECROSS MG
13. Tornus Counter-
clockwise
advancement
• Support Catheter:
• Constructed with eight (8) individual wires stranded together
to form the catheter
• Two sizes:
• 2.1Fr - Diameter increases from 0.024” to 0.028”
• 2.6Fr - Diameter increases from 0.028” to 0.035”
14. Corsair: Support and Penetration
2 Thick Braids
③②①
8 Thin Braids
Counter or
clockwise
advancement
Tsuchikane et al. J Am Coll Cardiol Intv. 2010;3(2):165-171
15. Turnpike Multi-Layer Shaft
Pebax outer layer
for smooth outer surface
Dual-layer, bidirectional coil
for kink-resistance with torque
Braid
for longitudinal strength
PTFE liner
for excellent
guidewire movement
