Catheterization Research Papers - Academia.edu (original) (raw)

We present a premature infant with large intracardiac mass. She had a history of sepsis and umbilical venous catheterization in the neonatal period. Twenty-seven days after withdrawal of the catheter, a precordial murmur was noted. A... more

We present a premature infant with large intracardiac mass. She had a history of sepsis and umbilical venous catheterization in the neonatal period. Twenty-seven days after withdrawal of the catheter, a precordial murmur was noted. A large right atrial highly mobile mass suspected to be thrombus was detected by echocardiography. C-reactive protein was elevated. Three blood cultures were negative. Anticoagulation treatment was started. After one week, no resolution of the thrombus was observed. The mass was surgically resected and diagnosis of thrombus infected by fungi was made on histopathological examination. Early screening of cardiac chambers by echocardiography is recommended in all preterms with intravascular catheterization.

OBJECTIVES To evaluate the safety and efficacy of percutaneous thrombus fragmentation (PTF) for massive pulmonary embolism (PE) in patients with contraindications to the administration of thrombolytics. METHODS Between July 1999 and... more

OBJECTIVES To evaluate the safety and efficacy of percutaneous thrombus fragmentation (PTF) for massive pulmonary embolism (PE) in patients with contraindications to the administration of thrombolytics. METHODS Between July 1999 and August 2005, 10 patients (7 males, 3 females, age 57+/-18 years) with massive PE and contraindications to the administration of thrombolytics underwent PTF. A transthoracic doppler echocardiogram was used to evaluate arterial oxygen saturation (Sat O2), the Walsh index (WI), mean pulmonary artery pressure (PAP), mean systemic blood pressure (SBP) and right ventricular function (RVF) before and after the procedure. Statistical analysis was conducted using the paired Wilcoxon test, of which p was significant when < 0.05. RESULTS After the PTF treatment there was an improvement in Sat. O2 [87.4 +/- 1.3% vs 92.3 +/- 3.1% (p < 0.001)], WI [6.4 +/- 1.07 vs 4.4 +/- 1.42 (p = 0.003)], PAP [31.8 +/- 4.6 mmHg vs 25.5 +/- 3.4 mmHg (p < 0.001)] and SBP [73....

Angioplasty of totally occluded saphenous vein grafts is a very challenging procedure and the likelihood of distal embolisation and no-reflow is much higher than in any conventional angioplasty. The use of thrombus aspiration and distal... more

Angioplasty of totally occluded saphenous vein grafts is a very challenging procedure and the likelihood of distal embolisation and no-reflow is much higher than in any conventional angioplasty. The use of thrombus aspiration and distal protection devices, although not well studied in a large number of patients, has been shown to be quite effective in preventing such complications. In this case we report our satisfactory experience from the combined use of a novel aspiration catheter and a distal protection device for the treatment of a totally occluded saphenous vein graft.

Background Achalasia, an oesophageal motor disease, is associated with functional oesophageal obstruction. Food stasis can predispose for oesophagitis. Treatment aims at lowering of the lower oesophageal sphincter pressure, enhancing the... more

Background Achalasia, an oesophageal motor disease, is associated with functional oesophageal obstruction. Food stasis can predispose for oesophagitis. Treatment aims at lowering of the lower oesophageal sphincter pressure, enhancing the risk of gastro-oesophageal reflux. Nevertheless, the incidence of oesophagitis after achalasia treatment is unknown.Aim To investigate the incidence and severity of oesophagitis in achalasia patients treated with pneumatic dilatation.Methods A cohort of 331 patients with achalasia were treated with pneumatic dilatation and followed. Oesophagitis and stasis were assessed by endoscopy and inflammation was graded by histology.Results 251 patients were followed for a mean values of 8.4 years (range: 1–26). The average number of endoscopies with biopsy sample sets per patient was 4 (range: 1–17). Three patients had no histological signs of oesophagitis throughout follow-up, 139 had oesophagitis grade 1, 49 oesophagitis grade 2 and 60 grade 3. Specialized intestinal metaplasia was found in 37 patients. The association between endoscopic food stasis and histological inflammation was significant. The association between endoscopic signs of oesophagitis and histological inflammation was poor.Conclusions Forty percent of the achalasia patients develop chronic active or ulcerating oesophagitis after treatment. Inflammation was associated with food stasis. Because the sensitivity of endoscopy to detect inflammation is low, surveillance endoscopy with biopsy sampling and assessment of stasis is warranted to detect early neoplastic changes.

OBJECTIVES: The most common technique used to achieve primary deep biliary cannulation is the standard contrast-assisted method. To increase the success rate and reduce the risk of complications, a wire-guided cannulation strategy has... more

OBJECTIVES: The most common technique used to achieve primary deep biliary cannulation is the standard contrast-assisted method. To increase the success rate and reduce the risk of complications, a wire-guided cannulation strategy has been proposed. Prospective studies provided conflicting results as to whether the wire-guided cannulation technique increases the cannulation rate and reduces post-endoscopic retrograde cholangiopancreatography (post-ERCP) pancreatitis risk compared with the standard method. The objective of this study was to carry out a meta-analysis of randomized controlled trials (RCTs) that compares primary biliary cannulation and post-ERCP pancreatitis rates with the wire-guided method and the standard cannulation technique. METHODS: Literature searches of electronic databases and online clinical trial registers up to March 2009 were conducted to identify RCTs comparing primary cannulation and post-ERCP pancreatitis rates with the wire-guided method and the standa...

The debate on pulsatile flow during cardiopulmonary bypass (CPB) has continued for more than half a century. This longstanding debate stems from imprecise quantification methods for arterial pressure and pump flow waveforms and the... more

The debate on pulsatile flow during cardiopulmonary bypass (CPB) has continued for more than half a century. This longstanding debate stems from imprecise quantification methods for arterial pressure and pump flow waveforms and the inability to determine which waveforms accurately depict pulsatile flow. The differences in in vitro and in vivo research outcomes for pulsatile and non-pulsatile flow experiments compounds these issues. The concepts of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE) have been introduced in studies using pulsatile and nonpulsatile flow. Their main advantage lies in their focus on energy gradients rather than pressure gradients as the driving force of blood flow. These formulas can precisely quantify different levels of pulsatility and non-pulsatility, allowing direct and meaningful comparisons. In clinical practice, before using pulsatile flow during CPB, all components of CPB circuits, including the roller pump, membrane oxygenator,...

Aims The use of subcutaneous infusion ports has become standard practice to provide a long-term venous access in oncological patients. The aim of this retrospective study was to assess the different complications of infusion ports in our... more

Aims The use of subcutaneous infusion ports has become standard practice to provide a long-term venous access in oncological patients. The aim of this retrospective study was to assess the different complications of infusion ports in our population and to identify predisposing factors. Patients and methods We reviewed the medical records of 437 patients who were followed at the Oncology/Haematology Department of our hospital. Of these patients, there were 370 (84.4%) with solid tumours and 58 (13.2%) with haematological disease. The position of the catheter tip was evaluated by reviewing the available chest radiographs or phlebographies. Main results Analysis of the records showed that 346 patients (79.17%) had no complications. The most common complications after implantation were thrombosis (8.46%), catheter dysfunction (4.8%) and infections (4.4%). Univariate and multivariate analysis showed that catheter tip positioning was the most important predisposing risk factor for thrombosis. Catheter tips positioned in the brachiocephalic vein or in the cranial part of the superior vena cava were associated with a high risk of thrombosis. Other significant risk factors were gender and initial diagnosis. Female patients and patients with lung cancer also had an elevated risk of developing a thrombosis. Conclusions Compared to other reports, we noted a higher rate of thrombosis and port dysfunction. Since catheter tip position was a predisposing factor for developing a thrombosis, correct catheter position has to be ensured during placement. Prophylactic antithrombotic treatment might be beneficial in the event of failure to position the catheter correctly.

The use of pneumatic dilation (PD) is well established in adults with achalasia; however, it is less commonly used in children. To evaluate the efficacy of PD in pediatric achalasia and to define predictive factors for its treatment... more

The use of pneumatic dilation (PD) is well established in adults with achalasia; however, it is less commonly used in children. To evaluate the efficacy of PD in pediatric achalasia and to define predictive factors for its treatment failure. Single-center, prospective cohort study. Academic tertiary referral center. Twenty-four patients with achalasia were enrolled from January 2004 to November 2009 and were followed for a median of 6 years. PD was performed with the patients under general anesthesia. Efficacy and safety of PD. Follow-up was performed by using the Eckardt score, barium swallow contrast studies, and esophageal manometry at baseline; 1, 3, and 6 months after dilation; and every year thereafter. A Cox regression model was used to identify independent predictors of failure after the first PD. The PD success rate was 67%. In 8 patients, the first PD failed, but the parents of one patient refused a second PD and requested surgery. Of the 7 patients who underwent repeated ...

This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Six hundred forty-four patients were randomized to either... more

This study tested the safety and feasibility of coronary angioplasty on an outpatient basis. The purpose of this approach includes cost-effectiveness and patient comfort. Six hundred forty-four patients were randomized to either transradial or transfemoral PTCA using 6 Fr equipment. Patients were triaged to outpatient management based on a predefined set of predictors of an adverse outcome in the first 24 hr after initially successful coronary angioplasty. Three hundred seventy-five patients (58%) were discharged 4–6 hr after PTCA; 42% stayed in hospital overnight. In the outpatient group, one adverse event occurred (subacute stent thrombosis 7 hr postdischarge, nonfatal myocardial infarction). There were no major vascular complications. In the hospital group, 19 patients (7%) sustained an adverse cardiac even in the first 24 hr; 1 patient died. Patients treated via the femoral route had more (minor) bleeding complications (19 patients; 6%); in 17 of these, this was the sole reason that discharge was delayed. PTCA on an outpatient basis, performed via the radial or the femoral artery with low-profile equipment, is safe and feasible in a considerable part of a routine PTCA population. A larger proportion of transradial patients can be discharged due to a reduction in (minor) bleeding complications. Catheter Cardiovasc Interv 2005;64:421–427. © 2005 Wiley-Liss, Inc.