心血管疾患と診断

Aim: Our study aimed highlighting experience in reducing crossover rate from radial to femoral access to maintain coronary procedure safety and patients’ satisfaction.

Methods and results: A prospective, single center, single operator observational study included all comers for coronary procedures. The default access for coronary procedures was the right Radial artery, whenever failed, right Ulnar artery utilized then left Radial then left Ulnar “RURU”. We studied 1000 procedures “964 patients” whom the default access was the radial artery. Radial access succeeded in 908 “90.8%” procedures and failed in 92 “9.2%” procedures necessitating crossover to other access site. One of the right ulnar, left radial or left ulnar succeeded in 51 out of 92 patients reducing the total crossover to femoral access to 4.1%. The remaining 41 procedures were obliged to crossover to femoral access. Radial artery spasm and vessel tortuosity were the commonest causes of crossover from radial to RURU/femoral artery “p=0.012 and 0.0017 respectively”. Minor hematomas were the commonest immediate complication “p<0.022” with non significant prolongation of procedural time and radiation exposure.

Conclusion: RURU approach has resulted in significant crossover rate reduction from radial to femoral access maintaining procedural safety and patient’s satisfaction on expense of increased minor hematomas and non-significant increase of procedural time and radiation exposure.

Introduction: Cardiovascular diseases are the leading causes of death in the population. According to data from the World Health Organization of 2017, of the 21.7 million deaths from these diseases, more than ten million occur due to atherosclerotic coronary disease. In this context, anemia is a frequent problem among patients with acute myocardial infarction and ST elevation. Although there are advantages with this procedure, restenosis continues to be one of the main limiters of therapeutic success, especially in patients older than 80 years and with anemia.

Objective: Therefore, the present study aimed to conduct a retrospective longitudinal and observational study on the impact of angioplasty procedure in patients older than 80 years and with anemia.

Methods: A total of 185 participants were submitted to eligibility analysis, followed by STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), The present study followed a retrospective longitudinal and observational model on the analysis of the profile of patients who underwent angioplasty at Brazil. The predictors were anemia and older patients.

Results: The multivariate analysis showed that anemic patients older than 80 years who underwent angioplasty died, with a significance level of 33.97% in the female group and 34.40% in the male group, with a total of 68.40 % of deaths in statistical terms. The Graph matrix-Plot model showing the results of the regression analysis between continuous predictors and response, with p<0.05 as significant. All the results showed p<0.05 because the presence of the predictor “anemia” negatively influenced the angioplasty procedure in the patients.

Conclusion: The present study showed that patients with anemia showed a significant increase in life risk with death occurring after an angioplasty procedure.

A complete anatomical correction of the full form of the unroofed coronary sinus syndrome type II was performed, with the transfer of coronary sinus (CS) to the right atrium. The anatomical features for a successful procedure were the proximity of the CS mouth to the atrial septal defect, the absence of intersection between the tunnel and the mouths of the pulmonary veins and the clear visualization of the CS mouth with diagnostic cardioplegia.

Background: Secondary polycythemia in patients with Congenital Cyanotic Heart Diseases (CCHD) is associated with many complications starting from iron deficiency anemia up to extensive cerebrovascular stroke. It is noteworthy to say that there is a lot of debate about the agreed protocol for the optimal management of this particular group of patients to obtain the best outcome with less incidence of complications.

Methods: This is a prospective study comparing two different exchange transfusion protocols used for the management of secondary erythrocytosis in CCHD patients. The study included 20 CCHD patients who came to our congenital heart disease unit for elective exchange transfusion over the past 12 months. A custom-made sheet was made including age, diagnoses, number of times for venesection, all hematological parameters before and after the procedure, oxygen saturation and 6-minute walk test.

Results: A total number of 20 patients with CCHD were recruited with mean age of 20.84 years ± 7.4 years with average weight 60 kg. Tetralogy of Fallot was the most common CCHD in the recruited patients (n=5). The average oxygen saturation before the procedure was 75% which improved to 81% after the procedure. Mean hematocrit before the procedure was 70.45% which decreased to a value of 59% after the phlebotomy. A number of 12 out of 20 patients under went venesection of the recommended amount (followed by equivalent isotonic saline replacement) divided equally over an extended period of time of 3 weeks. The remaining 8 patients under went phlebotomy divided over two successive days. There was no significant difference between the 2 groups as regard hemoglobin level and 6-minute walk test, However Among the first arm only one patient developed Iron deficiency anemia versus 7 patients of the second arm.

Conclusion: The extended gradual venesection with adequate volume replacement in patients with CCHD is associated with better outcome as regards iron deficiency anemia.