OBJECTIVES: To test the effectiveness of Rheolytic Thrombectomy (RT) and distal protection balloon wires when used synergistically in an in vitro model. BACKGROUND: Although effective, currently available technologies may not be individually ideal for fresh clots removal. METHODS: Fourteen, fresh blood samples were placed in 14 plastic tubes and left to clot for 6 h. A Percusurge Guardwire balloon was inflated distal to the clot and aspiration was performed using RT in seven tubes and manual aspiration (MA) with the Export catheter in seven tubes. The residual clot in each tube was dried and weighed. Both aspiration systems were advanced over the Guardwire. RESULTS: During RT, none of the protection balloons ruptured and no retrograde clot embolization were observed. MA was most effective when the Export catheter tip was not in direct contact with the clot. The residual clot mass post RT was significantly less than post MA (9.7±2.2 versus 59.2±45.9, P = 0.01). CONCLUSION: RT is compatible with Distal Protection Balloon Wires and results in more complete clot removal than manual aspiration with the export catheter. Although manual aspiration results in a large variation in extraction efficacy, it is most effective when direct catheter‐clot contact is kept to a minimum.
Recently, portable C‐arm systems have been developed for cardiac studies. While these systems have been used at a number of centers on a small scale for procedures in the operating room, emergency room, or intensive care unit, there are no published data on the performance of the system under more demanding circumstances. Theoretically, a reliable portable C‐arm system could provide a low‐cost alternative to a fixed system in centers with limited resources, such as in developing countries. To test whether a portable C‐arm system could substitute for a permanent laboratory for cardiac catheterization and interventional procedures, we used a C‐arm system as our sole catheterization laboratory for a period of 3 months. The system's performance was compared to a comparable time period using a fixed catheterization laboratory system. The portable system was used to perform 222 procedures (36 interventional and 186 diagnostic), as compared to 236 procedures (30 interventional and 206 diagnostic) with the fixed lab during a comparable time period the preceding year. Although the image quality of the portable system was not as good as with the fixed laboratory, all procedures were performed successfully, with no difference in fluoroscopic time, radiation exposure to the patient, procedure related complications, or clinical restenosis at 1 year. However, radiation exposure to staff was greater, possibly due to the lack of shielding in the temporary lab and the need for the technician to remain close to the unit to set up views. Our results suggest that a portable C‐arm system, while subject to some limitations, can perform as a general catheterization laboratory for diagnostic and interventional procedures.
Recent studies report that American women are increasingly delaying their first births. While the proportion of births in older women has been increasing, there is also increased prevalence of cardiovascular risk factors and complications of pregnancy with increasing maternal age. We present 2 cases of acute myocardial infarction occurring during pregnancy. The mothers were both over 35 years old, and had significant risk factors for coronary disease. Both were found to have atherosclerotic coronary lesions, and were managed with coronary intervention with successful reperfusion. One woman successfully delivered a healthy infant at term. The other had a spontaneous abortion shortly after discharge from the hospital. Given current demographic trends, it is likely that such cases will be more commonly seen.
Three-dimensional (3D) modeling and printing in medicine have emerged to encompass every aspect of medical applications. This ranges from education, illustration, and treatment, as well as patient care whether for purposes of diagnosis or treatment and surgical planning. In the past few decades, these novel tools have shown promising utility to help radiologists and the medical team to improve quality of patient care and outcomes via 3D printing application and utilization. This workflow will be illustrated through a ventricular septal defect (VSD) case at which 3D analysis was critical in the assessment and treatment planning of the patient's underlying medical condition.
Abstract Background Women have a higher prevalence of tricuspid regurgitation (TR) and present at more advanced stages as compared with men. Given the high operative mortality associated with tricuspid valve (TV) surgery, transcatheter tricuspid valve interventions (TTVI) have emerged as a promising treatment option. We explored sex‐based differences among patients with significant TR who would be expected to be eligible for TTVI. Methods Between March 2021–2022, 12,677 unique adult patients underwent a transthoracic echocardiogram at our tertiary care institution. Clinical and echocardiographic data were collected for patients with more than moderate TR. The 2021 European Society of Cardiology valve guidelines were used to retrospectively define sub‐populations who would have been eligible for TTVI, TV surgery, or medical therapy. Patients were grouped by sex and compared using t‐tests, Wilcoxon rank‐sum, Pearson chi‐square, and Cox regression for survival analysis. Results Of 569 patients, 52% (296/569) were female. Men had a higher prevalence of left ventricular dysfunction ( p < 0.001), mitral regurgitation ( p = 0.023), and signs of heart failure (New York Heart Association stage III ( p = 0.031)). Women had more isolated TR ( p = 0.020) and TR due to severe pulmonary hypertension ( p < 0.001). Most patients (74.6% of women, 76.9% of men) were precluded from both transcatheter and surgical intervention due to advanced disease. 10.8% of women and 9.2% of men would have qualified for TTVI ( p = 0.511). Conclusion The majority of patients with significant TR presenting to a tertiary care center are not eligible for TTVI. Sex is not a predictor of eligibility for TTVI among patients with significant TR.
