Characteristics and Outcomes of Patients With History of CABG Undergoing Cardiac Catheterization Via the Radial Versus Femoral Approach

Takotsubo cardiomyopathy (TTC) is a recently identified transient cardiomyopathy that is usually associated with emotional or physical stress. Catecholamine surge appears to be central to the mechanism of TTC. TTC in the setting of anaphylaxis is rare. We present a case of a 58-year-old female was referred from an outside hospital after being diagnosed with anaphylaxis. She received 0.3 mg epinephrine intramuscularly and 1 mg intravenously. Upon admission to our hospital, she was complaining of chest pain. EKG done in the outside hospital showed ST elevations in the anterior leads but the EKG done at our hospital was normal. She had to be intubated in view of impending airway obstruction. She was subsequently started on epinephrine infusion in the intensive care unit for hypotension. She was found to have elevated troponins that trended up. An echocardiogram performed on day 3 revealed a left ventricular ejection fraction of 25% and apical hypokinesis suggestive of TTC. Cardiac catheterization was initially deferred in view of a history of dye allergy. A nuclear stress test was done instead that revealed reversible ischemia in anteroseptal regions. Cardiac catheterization was performed eventually with pre-medication that showed a near-normal coronary circulation. A repeat echocardiogram performed 6 weeks after discharge showed normal systolic function.

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Deterioration of peripheral microvascular tissue perfusion after transcatheter aortic valve implantation (TAVI) measured by 2D near-infrared spectroscopy (NIRS)

European Heart Journal ◽

10.1093/ehjci/ehaa946.2383 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Herbrand ◽

S Baasen ◽

V Veulemans ◽

M Kelm ◽

L Busch

Keyword(s):

Infrared Spectroscopy ◽

Aortic Valve ◽

Cardiac Catheterization ◽

Near Infrared ◽

Tissue Perfusion ◽

Transcatheter Aortic Valve ◽

Before And After ◽

History Of ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background The data on the effect of transcatheter aortic valve implantation (TAVI) on peripheral microcirculation is scarce. Therefore, in this study, we investigate the changes of peripheral microvascular tissue perfusion before and after TAVI measured by a 2D near-infrared spectroscopy (NIRS) camera. NIRS allows measurement of hemoglobin oxygen saturation (StO2) in the blood perfusing the volume tissue under scrutiny. Methods In this prospective, single center study, patients with symptomatic, severe aortic stenosis either planned for elective TAVI procedure or elective cardiac catheterization were included. 2-D StO2 maps of all distal extremities (i.e. hand/foot) were acquired before and after TAVI by using a NIRS camera; macrovascular function of the tibial and forearm arteries was assessed by Doppler ultrasound with spectral analysis including ankle-brachial index (ABI) and applanation tonometry. Results 26 subjects (19 male, age 83±6 years) undergoing TAVI procedure and 5 subjects (4 male, age 76±10) undergoing cardiac catheterization were included in this trial. In the group undergoing TAVI procedure, 5 patients had diabetes mellitus (19%), one of whom was insulin-dependent, 3 patients had a history of peripheral artery disease (12%) and 1 patient had a history of smoking (4%). TAVI procedure was successful without major complications in all cases.Mean peripheral StO2 decreased significantly on all extremities after TAVI, i.e. right hand (from 71±14% to 61±16%; p=0.01), left hand (from 70±12 to 62±16%; p=0.03), right foot (from 70±11% to 61±15%; p<0.01) and left foot (from 66±15% to 58±14%; p=0.03). ABI did not change after TAVI (right ABI baseline mean 1.08±0.2; Δ0.06; left ABI baseline 1.05; Δ0.05). Macrovascular function of the forearm and tibial arteries did not deteriorate as measured by Doppler ultrasound. Furthermore, aortic mean pressure (from 108±21 mmHg to 87±13 mmHg; p=0.002) and augmentation index (from 34±8 mmHg to 24±8 mmHg; p<0.001) decreased significantly while subendocardial viability ratio (from 128±22 to 147±7; p<0.001), a marker for coronary microvascular function, improved significantly after TAVI. In the group undergoing cardiac catheterization, there were no statistically significant changes in macro- or microvascular function. Conclusion This is, to our knowledge, the first study investigating the effect of peripheral microvascular tissue perfusion measured by NIRS after TAVI. Our results show that peripheral microvascular tissue perfusion was significantly deteriorated after TAVI procedure. StO2 before and after TAVI procedure Funding Acknowledgement Type of funding source: None

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Development of Multiple Aortic Mycotic Aneurysms After Cardiac Catheterization

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709617740907 ◽

2017 ◽

Vol 5 (4) ◽

pp. 232470961774090

Author(s):

Desiree A. Steimer ◽

John J. Squiers ◽

J. Michael DiMaio ◽

Katherine B. Harrington

Keyword(s):

Cardiac Catheterization ◽

Aortic Root ◽

Coronary Artery Bypass Surgery ◽

Bypass Surgery ◽

Artery Bypass ◽

Ascending Aorta ◽

Aortic Root Replacement ◽

Past Medical History ◽

History Of ◽

Mycotic Aneurysms

A 71-year-old male with a past medical history of coronary artery bypass surgery developed multiple, infected pseudoaneurysms of the ascending aorta and aortic root 1 year after cardiac catheterization. He underwent aortic root replacement with a 24-mm homograft. Tissue culture from operative specimens revealed invasive Aspergillus fumigatus infection. He was treated with voriconazole for 3 months. After 1 year, he had no recurrence of symptoms, pseudoaneurysm, or fungal infection.

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A brief history of the clinical application of cardiac catheterization, 1929–1979

History and perspectives of cardiology ◽

10.1007/978-94-009-8621-3_3 ◽

1981 ◽

pp. 11-16

Author(s):

Lewis Dexter

Keyword(s):

Clinical Application ◽

Cardiac Catheterization ◽

History Of

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Pulmonary Hypertension in SS, SC and Sβ Thalassemia: Prevalence, Associated Clinical Syndromes, and Mortality.

Blood ◽

10.1182/blood.v104.11.1663.1663 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1663-1663 ◽

Cited By ~ 8

Author(s):

Laura M. De Castro ◽

Jude C. Jonassaint ◽

Felicia L. Graham ◽

Allison Ashley-koch ◽

Marilyn J. Telen

Keyword(s):

Pulmonary Hypertension ◽

Cardiac Catheterization ◽

Laboratory Findings ◽

Sufficient Cause ◽

High Prevalence ◽

High Positive Predictive Value ◽

History Of ◽

The Mean ◽

Jet Velocity ◽

Clinical Conditions

Abstract The natural history and mechanisms associated with pulmonary hypertension (pHTN) in sickle cell disease (SCD) are incompletely characterized. We investigated the prevalence of pHTN, diagnosed by echocardiography and/or cardiac catheterization, in adults with all types of SCD, to determine whether the frequency of pHTN varied by Hgb diagnosis. We also analyzed which clinical conditions and laboratory findings were associated with pHTN. We screened 125 outpatients with Hgb SS, SC, Sβ0 or Sβ+ thalassemia who presented with symptoms including either shortness of breath, fatigue, or low or decreasing O2 saturation. PHTN was defined by tricuspid regurgitation jet velocity (TRjet) of ≥ 2.5 m/s by echo and was present in 36% (28/77) of SS & Sβ0 and in 25% (12/48) of SC & Sβ+ patients studied. Of patients with pHTN, 16 (57%) of the SS & Sβ0 patients had a peak TR jet >3.0 m/sec and 12 (43%) ≥2.5-<3.0m/sec, whereas 8(67%) of the SC & Sβ+ patients had a peak TR jet ≥3.0 m/sec (50% of these were ≥4.0) and 4 (33%) TR jet ≥2.5-<3.0m/sec. Two SS patients included in our analysis were diagnosed with pHTN by cardiac catheterization when echo failed to show pHTN. Other patients’ echos (83) were reported as either normal or abnormal but not consistent with pHTN. In SS & Sβ0, the mean age of patients whose echos were consistent with pHTN was significantly higher than of those without pHTN (43.3 vs. 34.4yrs, p=0.001). A similar trend was observed in SC & Sβ+(48.8 vs 42.6 yrs). No significant association was noted between the presence of pHTN and history of CVA, AVN, or renal failure. Patients with pHTN had higher mean systolic BP than patients without pHTN (SS & Sβ0126.3±19.4 vs 122.0±17.6 and SC & Sβ+130.7±15.0 vs 124.4±19.02 mmHg), but these differences were not statistically significant. SS & Sβ0 patients with pHTN had significantly lower Hgb values than patients without pHTN. Leukocyte, platelet and reticulocyte counts, creatinine, and O2 saturation were not significantly different for patients with and without pHTN. LDH and bilirubin values were slightly higher in patients with pHTN. Most interestingly, 18/29 SS & Sβ0 patients with pHTN had proteinuria ≥ 1+, while only 13/46 SS & Sβ0 patients without pHTN had proteinuria (p<0.05). The presence of proteinuria was found to have a high positive predictive value (0.60) for the presence of pHTN in patients with SS and Sβ0. Proteinuria overall was rarely present in SC & Sβ+. During the 2 yr study period, 6/42 (14%) patients with pHTN died; deaths were limited to patients with Hgb SS and occurred at a mean of 30 months (range 5 – 53 months) after diagnosis of pHTN. The mean TR jet velocity and peak RV pressure in patients who died was 2.8m/s and 39.5, respectively. Two of 83 patients (2 %) without pHTN died during this period, suggesting that pHTN markedly increased the death rate. In conclusion, our data confirm the high prevalence of pHTN in Hgb SS, SC, and Sβ thal. Although a higher prevalence of pHTN, higher TR jet velocities, and increased mortality were seen in patients with Hgb SS or Sβ0, mortality was also seen in patients with relatively mild pHTN. Moreover, our data suggest that the presence of proteinuria in patients with SS or Sβ0 is sufficient cause to screen for pHTN by echocardiography. The mechanism by which proteinuria and pHTN are associated remains to be determined.

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A Combination of Two Rare Coronary Anomalies Makes It Even Rarer: Right Sided Single Coronary Artery with Dual Left Anterior Descending Artery

Case Reports in Cardiology ◽

10.1155/2016/4905941 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Aram Barbaryan ◽

Theodore Addai ◽

Monahar Kola ◽

Muhammad Wajih Raqeem ◽

Sergey Barsamyan ◽

...

Keyword(s):

Coronary Artery ◽

Cardiac Catheterization ◽

Coronary Intervention ◽

Common Trunk ◽

Single Coronary Artery ◽

Aortic Sinus ◽

Exertional Dyspnea ◽

Left Anterior Descending Artery ◽

History Of ◽

The Right

An 82-year-old female with history of hyperlipidemia and hypertension presented to the clinic with chief complaint of nonradiating chest tightness accompanied by exertional dyspnea. Cardiac catheterization showed the absence of left coronary system; the entire coronary system originated from the right aortic sinus as a common trunk which then gave off the right coronary artery and the left main coronary artery. Cardiac catheterization demonstrated also another rare coronary anomaly: dual left anterior descending artery. Patient underwent percutaneous coronary intervention and subsequent multidetector computed tomography angiography confirmed the above angiography findings. Patient was subsequently discharged home on double antiplatelet therapy with aspirin and clopidogrel and has been asymptomatic since then.

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Constrictive pericarditis presenting with massive ascites without hemodynamic echocardiographic features

Case Reports in Internal Medicine ◽

10.5430/crim.v4n1p54 ◽

2017 ◽

Vol 4 (1) ◽

pp. 54

Author(s):

Hasan Ashraf

Keyword(s):

Cardiac Catheterization ◽

Constrictive Pericarditis ◽

Vena Cava ◽

Abdominal Distension ◽

Good Sensitivity ◽

Characteristic Finding ◽

Mitral Inflow ◽

History Of ◽

Diagnostic Modalities ◽

Echocardiographic Findings

A 27-year-old woman presented to the hospital because of a five-month-history of rapidly-accumulating ascites, dyspnea, and fatigue. The patient was otherwise asymptomatic, and required repeated large volume paracenteses. Physical exam was benign except for hepatomegaly and abdominal distension. Laboratory testing demonstrated elevation of transaminases, but further testing was all negative. A chest CT showed pericardial thickening. Subsequent echocardiography was performed to evaluate for constrictive pericarditis, but apart from inferior vena cava (IVC) dilation, there were no other findings suggestive of pericardial constriction. A subsequent cardiac catheterization was suggestive of constrictive pericarditis, so the patient underwent a pericardiectomy. The Mayo Clinic echocardiography diagnostic criteria presents a diagnostic paradigm where the presence of mitral inflow E/A > 0.8 and the presence of a dilated IVC concomitantly provide good sensitivity for echocardiographic diagnosis of constrictive pericarditis (CP). Due to the good sensitivity and specificity of echocardiographic findings, the lack of any characteristic finding is surprising, and suggests the importance of other diagnostic modalities such as CT, cardiac MRI, and cardiac catheterization in conjunction with echocardiography when there is a high suspicion for CP.

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