心血管疾患と診断

Background: Percutaneous coronary intervention (PCI) in nonagenarians has been shown to be feasible, with a high success rate. However, there is paucity of data regarding the prevalence, vascular access, procedural data and mortality after PCI in this population.

Methods: All patients aged 90 and older referred to our institution from 2004 to 2014 for coronary angiogram were included in our retrospective study. Clinical and procedural data including vascular access and 3-month mortality rates were obtained for all patients.

Results: A total of 26696 PCI were performed over the last 11 years, of which 177 PCI (0.66%) were realized in 167 nonagenarians. The prevalence of PCI in nonagenarians increased from 0.17% in 2004 to 1.22% in 2014. In this population, with an age of 92 ± 2 years and 51.4% of males, 76 (43%) PCI were performed in the setting of ST-elevation myocardial infarction, and 89 (50%) of the procedures were non-ST elevation myocardial infarction or unstable angina. Transradial approach (TRA) was used in 76 (43%) and transfemoral approach (TFA) in 101 (57%) procedures. Comparing TRA to TFA, the total fluoroscopic time and contrast volume was similar between the two groups. Overall complications, including cardiogenic shock, iatrogenic coronary dissection, perforation or no reflow phenomenon occurred in 22 of 177 procedures (12.4%). Overall survival rate was 92.8% at 3 months.

Conclusion: The majority of the procedures was performed in acute coronary syndrome clinical setting. TRA and TFA were comparable in terms of fluoroscopic time and contrast volume. Overall procedural success rate was high and complication rates were low.

Continuous-flow ventricular assist devices are being implanted with increased frequency in the United States in children with end-stage heart failure. We report the first reported use of the HeartWare HVAD in an 8 year old boy who had a history of biventricular support with Berlin Heart EXCOR devices 4 years previously. He was supported on the HeartWare for 198 days prior to receiving a heart transplantation. The implantable HeartWare HVAD can be used to provide circulatory support for those who have had previous paracorporeal mechanical circulatory support.

Chest pain is the one of the most common reason for adult visits to the emergency department. Screening for life threatening conditions is high priority in these patients; however keeping in mind lesser known yet important etiologies may help triage patients better. Apical Hypertrophic Cardiomyopathy (HCM) is a relatively benign variant commonly seen in East Asian population that may present as acute coronary syndrome and work up in these patients are often similar to coronary artery disease. We discuss in this case report about a middle aged male presenting with chest pain and later found to have apical HCM guided by imaging.

Single coronary artery is a very rare congenital anomaly in the general population. We presented a 51 year-old male with typical chest pain, and coronary angiogram showed a single trunk from the right coronary sinus.

Multivisceral location of cardiac hydatid cyst is exceptional. A 37 year-old female, with past medical history of surgery of hydatid cyst of the right lung, underwent a systematic radiological follow-up.

CT scan defined a cystic mass of the heart, of the left lung, the liver, and cysts in the two breasts. So, the patient was operated under cardiopulmonary bypass via a sternotomy. Intra-operative examination revealed a cyst of the inferior wall of the left ventricle.

The cysts of the heart, the lung, and the breasts were excised in a single session, and the patient was discharged on the fourth postoperative day without symptoms. The cyst of the liver was operated one month later.

We described a case of chronic total occlusion (CTO) of the ostial right coronary artery (RCA) in a 79-year-old woman that had been undergoing hemodialysis.

Coronary intervention of the ostial RCA-CTO was performed via the retrograde approach. The retrograde hard wire was able to pass through the CTO segment via a transseptal collateral and advanced at the ascending aorta. However, the microcatheter tip could not advance into the heavily calcified plaque of the CTO segment. Moreover, it was very difficult to catch the retrograde hard wire tip in the ascending aorta using a 10mm Gooseneck snare at the ostium of the antegrade guiding catheter due to three-dimensional size mismatch. Thereby, we attempted to cross the occluded segment directly using a long-shaft soft guidewire designed for retrograde CTO intervention (0.009 inch 330 cm). The unassisted long-shaft wire tip was passed successfully through the CTO segment retrogradely. After the retrograde wire tip was pushed ahead of the terminal aorta, it was caught using the former snaring system, and another guiding catheter for the antegrade approach was pulled in. After wire externalization was completed, balloon dilatation and stent deployment through the CTO segment were performed successfully via the antegrade approach.

Here, we report a case of successful interventional revascularization of a heavily calcified and device-uncrossable CTO lesion by the retrograde wire trapping technique using a gooseneck snare device at the terminal aorta. The method in which the capture of a retrograde wire using Gooseneck snare system may be not novel in itself. But, in case of difficulty in uncrossability devices and catching it at the ascending aorta as well, this combinative technique is beneficial to the ease of wire externalization.