scholarly journals A coronary cameral fistula treated with coil embolization

2019 ◽  
Vol 8 ◽  
pp. 204800401985680
Author(s):  
Ethan D Hinds ◽  
Manuel J Marin ◽  
Joggy George ◽  
Reynolds Delgado
Keyword(s):  
Coil Embolization ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Orthotopic Heart Transplantation ◽  
Heart Catheterization ◽  
Left Heart ◽  
Left Heart Catheterization ◽  
Flow Through ◽  
Coronary Cameral Fistula

A 56-year-old man who had twice previously undergone orthotopic heart transplantation was admitted with dyspnea and heart failure symptoms. A biopsy excluded rejection. Left heart catheterization revealed a coronary cameral fistula. After the patient was given mild diuretics, his condition improved. No significant fistula flow was detected, and he was discharged. Several months later, the patient was readmitted with worsening chest pain and dyspnea. Left ventricular end-diastolic pressure and flow through the fistula were increased. To correct the coronary cameral fistula, we performed a coil embolization without complications. Several months later at follow-up, the patient’s symptoms had resolved, and his left ventricular end-diastolic pressure had normalized. We conclude that coronary fistulas may be caused by trauma to the heart during the de-airing process, which may be prevented in the future with the development of safer and more effective de-airing techniques.

scholarly journals Room for improvement in pulmonary capillary wedge pressure reporting: a review of hemodynamic tracings at a large academic medical center

2020 ◽  
Vol 10 (4) ◽  
pp. 204589402092915 ◽  
Author(s):  
Shelsey W. Johnson ◽  
Alison Witkin ◽  
Josanna Rodriguez-Lopez ◽  
Richard Channick
Keyword(s):  
Pulmonary Capillary Wedge Pressure ◽  
Diastolic Pressure ◽  
Right Heart Catheterization ◽  
Left Ventricular ◽  
Heart Catheterization ◽  
Left Heart ◽  
Right Heart ◽  
Pulmonary Capillary ◽  
Left Heart Catheterization ◽  
Wedge Pressure

To describe the frequency with which pulmonary capillary wedge pressure measurements, obtained during right heart catheterization, are falsely elevated and to educate operators on techniques to improve accuracy of pulmonary capillary wedge pressure reporting. Failure to completely occlude pulmonary artery branch vessels during balloon inflation can lead to falsely elevated, “incomplete” pulmonary capillary wedge pressures. Balloon deflation prior to catheter retraction may result in catheter advancement into smaller branch vessels, yielding an inadvertent but more accurate alternative pulmonary capillary wedge pressure. We hypothesized that this phenomenon can be identified on retrospective review of right heart catheterization tracings, which occurs commonly and goes unrecognized by operators. We conducted a retrospective study of patients undergoing right heart catheterization or right heart catheterization and left heart catheterization with computer-generated pulmonary capillary wedge pressure ≥20 from January 2015 to June 2017. Alternative pulmonary capillary wedge pressures were defined as a pulmonary capillary wedge pressure trace during balloon deflation ≥3 mmHg lower than the reported pulmonary capillary wedge pressure. Inter-rater reliability of tracing reviewers was also evaluated. Results showed that, of the 182 tracings reviewed, an alternative pulmonary capillary wedge pressure was identified in 26 or 14.3% of cases. Eleven of these alternative pulmonary capillary wedge pressures were ≤15 mmHg with a calculated pulmonary vascular resistance ≥3 Wood units in 10 patients, re-classifying the etiology of pulmonary hypertension from post-capillary to pre-capillary in 38.5% of cases. For the eight patients for whom left heart catheterization data were available, left ventricular end-diastolic pressure aligned with the alternative pulmonary capillary wedge pressure. In conclusion, inadvertently obtained, but likely more accurate, alternative pulmonary capillary wedge pressures were identified in almost 15% of procedures reviewed from a busy academic institution. As wedge pressures often drive diagnosis and treatment decisions for patients with cardiac and pulmonary pathology, operators should be attuned to balloon deflation as a time when alternative pulmonary capillary wedge pressures may be identified as they are likely more reflective of left ventricular end-diastolic pressure. Additional tools to ensure accuracy of pulmonary capillary wedge pressure reporting are reviewed.

scholarly journals Mitral Valve Regurgitation: A Severe Complication following Left Ventricular Biopsy 15 Years after Heart Transplantation

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Marcel Vollroth ◽  
Joerg Seeburger ◽  
Philipp Kiefer ◽  
Jens Garbade ◽  
Friedrich W. Mohr ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Heart Transplantation ◽  
Surgical Intervention ◽  
Mitral Valve Regurgitation ◽  
Left Ventricular ◽  
Orthotopic Heart Transplantation ◽  
Heart Catheterization ◽  
Left Heart ◽  
Valve Regurgitation ◽  
Left Heart Catheterization

A 71-year-old male patient underwent orthotopic heart transplantation in 1995. Due to left heart catheterization 15 years later, biopsy from the left ventricular apex was performed for rejection screening. Two days later, echocardiography revealed severe mitral valve regurgitation requiring mitral valve replacement. This is a very rare case showing that left heart biopsy may lead to severe hemodynamic complications with the need for surgical intervention.

P14893D strain echocardiography in assessing left ventricular diastolic dysfunction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H T Ozer ◽  
O Ozer ◽  
C Coteli ◽  
A Kivrak ◽  
M L Sahiner ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Diastolic Dysfunction ◽  
Longitudinal Strain ◽  
Left Atrial Volume ◽  
Left Ventricular ◽  
Volume Index ◽  
Heart Catheterization ◽  
Left Heart ◽  
Left Heart Catheterization ◽  
2D Strain

Abstract Background Diastolic dysfunction is an important factor in the development of heart failure with preserved ejection fraction (HFpEF). As the ejection fraction is preserved in HFpEF, the diagnosis of this disease with non-invasive methods is difficult. Purpose In this study, the relationship of BNP, NT-proBNP, Ghrelin, and echocardiographic 3D strain findings with diastolic dysfunction was investigated in patients undergoing left heart catheterization. Methods Our study is a cross-sectional study and included 78 patients in whom echocardiography was performed, and who underwent left heart catheterization based on relevant indications. The patient data recorded for evaluation included the findings from left heart catheterization, follow-up 3D echocardiography; and the levels of blood NT-proBNP, and Ghrelin. Results The rate of diastolic dysfunction was 42.3%. Longitudinal 2D and 3D mean strain as absolute values were observed to decrease more in patients with diastolic dysfunction. The median levels of BNP, NT-proBNP, and Ghrelin levels were higher in patients with diastolic dysfunction. The independent predictors of diastolic dysfunction were determined to be the left atrial volume index (LAVI) (OR=1.17; p=0.018), longitudinal 3D strain values (OR=1.88; p<0.001), NT-proBNP (OR=1.11; p=0.001), and Ghrelin (OR=1.40; p=0.001), respectively. Relationship Between LV EDP and LV Longitudinal Strain LV EDP 2D Strain 3D Strain r p r p r p BNP, pg/ml 0.429 <0.001* 0.115 0.316 0.178 0.118 NT-proBNP, pg/ml 0.484 <0.001* 0.155 0.177 0.186 0.104 Ghrelin, pg/ml 0.478 <0.001* 0.086 0.455 0.157 0.169 SolV DB – – 0.481 <0.001* 0.591 <0.001* dP/dT −0.389 <0.001* −0.283 0.012* −0.307 0.006* Negative dP/dT −0.747 <0.001* −0.337 0.003* −0.458 <0.001* 2D. % 0.481 <0.001* – – 0.852 <0.001* 3D. % 0.591 <0.001* 0.852 <0.001* – – If p value is less than 0.05 shows statistical significance. Measurement of longitudinal strain Conclusion In conclusion, our study found out that the reduced 3D strain absolute values and increased levels of NT-proBNP and Ghrelin biomarkers predicted diastolic dysfunction. If further large-scale studies prove the efficiency of these practical, they may not only allow for making a diagnosis of HFpEF more readily but may also eliminate the confusion in diagnostic algorithms. Acknowledgement/Funding None

LEFT HEART CATHETERIZATION IN INFANTS AND CHILDREN

PEDIATRICS ◽  
1962 ◽  
Vol 30 (2) ◽  
pp. 253-261
Author(s):  
Edwin C. Brockenbrough ◽  
Eugene Braunwald ◽  
John Ross ◽  
Andrew G. Morrow
Keyword(s):  
Heart Disease ◽  
Clinical Management ◽  
Left Ventricular ◽  
Infants And Children ◽  
Heart Catheterization ◽  
Pressure Measurements ◽  
Left Heart ◽  
Left Heart Catheterization ◽  
Ventricular Puncture ◽  
In Infants And Children

Experiences with left heart pressure measurements in 111 infants and children are reviewed. These studies were performed by means of transseptal left heart catheterization or anterior percutaneous left ventricular puncture. The only significant complication was the development of left pneumothorax in two patients following the latter procedure. The techniques are briefly described, and the importance of left heart catheterization in the clinical management of infants and children with heart disease is illustrated by means of selected clinical examples.

Abstract 258: Mortality Comparison of Right Bundle Branch Block and Left Bundle Branch Block in US Veterans Undergoing Left Heart Catheterization - A Long Term Follow-up Study

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Swapnil Garg ◽  
Muhammad Soofi ◽  
Ronald Markert ◽  
Ajay Agarwal
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Ejection Fraction ◽  
Heart Catheterization ◽  
Left Heart ◽  
Bundle Branch Block ◽  
Reduced Ejection Fraction ◽  
Left Heart Catheterization

Background: The prognostic importance of right bundle branch block (RBBB) has been debated. It has been described as a benign variant, especially when compared to left bundle branch block (LBBB). We studied the presence of bundle branch blocks in a high-risk U.S. Veteran cohort. Methods: Retrospective electrocardiogram (ECG) analysis for presence of RBBB or LBBB was conducted in 1,535 consecutive patients presenting for left heart catheterization. Evaluated risk factors were gender, age, BMI, hypertension, hyperlipidemia, diabetes, smoking history, chronic kidney disease, reduced ejection fraction and history of previous revascularization. Mean follow up time was 112 ± 66 months. Results: Analysis of 1,535 ECGs revealed 113 patients with RBBB and 65 patients with LBBB. Risk factor burden between the two groups appeared similar with exception of higher incidence of reduced ejection fraction and previous revascularization in the LBBB group. Mortality of RBBB group was 92.0% compared to 96.9% of LBBB group. Mean time to death for RBBB group was 74.1 months compared to 61.0 months for LBBB group. Hazard ratio (HR) for RBBB with Cox regression controlling for aforementioned risk factors was 1.41, 95% CI = 1.14-1.74; p =.002. HR for LBBB controlling for the same risk factors was 1.84, 95% CI = 1.42-2.40; p =<.001. Conclusion: In a high-risk cohort of US Veterans, both LBBB and RBBB are independent risk factors for mortality. While LBBB is a known adverse risk factor, presence of RBBB portends a poor prognosis and warrants further research.

scholarly journals Multi-vessel coronary artery aneurysms in a patient with Parry Romberg syndrome: a case report

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Andrew Mehlman ◽  
Jaymin Patel ◽  
Christopher Bitetzakis ◽  
Michael Berlowitz
Keyword(s):  
Coronary Artery ◽  
Underlying Mechanism ◽  
Heart Catheterization ◽  
Left Heart ◽  
Coronary Artery Aneurysms ◽  
Left Heart Catheterization ◽  
History Of ◽  
Parry Romberg Syndrome ◽  
Vessel Coronary Artery

Abstract Background Coronary artery aneurysms (CAAs) are a very rare finding on coronary angiograms with multiple known aetiologies. Parry Romberg syndrome (PRS) is also a very rare disease, and the underlying aetiology remains unknown. We present a rare case of CAAs in a patient with PRS, and discuss possible implications regarding the primary pathophysiological cause for both of these diseases. Case summary A 48-year-old woman with a history of PRS presented with atypical and non-exertional chest pain. Initial evaluation demonstrated a rising troponin without associated electrocardiogram changes, and as such she was taken for left heart catheterization. Left heart catheterization demonstrated diffuse aneurysmal and ectatic disease of multiple coronary arteries. Further evaluation with magnetic resonance angiogram and autoantibody panel did not demonstrate other vascular anomalies or rheumatologic disease, respectively. She was treated with dual anti-platelet therapy and statin, and at 1 year follow-up, she had resolution of her symptoms. Discussion It has been postulated that the underlying mechanism causing CAA is intravascular inflammation. Parry Romberg syndrome is theorized to be a neurovasculopathy, as evidenced by cases of associated intracranial aneurysms. Intravascular inflammation may play a key pathological role in CAA, and an association between CAA and PRS may exist.

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