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Background/Purpose The transradial approach has been proposed as an alternative to traditional transfemoral access for diagnostic and therapeutic purposes in several catheterization procedures. Historically, extended length devices for lower limb endovascular interventions have been limited. The aim of this study was to investigate the acute clinical outcomes of orbital atherectomy (OA) via transradial access (TRA) for the treatment of lower extremity peripheral artery disease (PAD). Methods/materials REACH PVI was a multicenter, prospective, observational study ( NCT03943160 ) including subjects with PAD and target lesion morphology appropriate for OA. All patients were followed post-procedure through the first standard of care follow-up visit. Results A total of 50 patients were enrolled. In most cases the indication for intervention was disabling claudication (74.0%). Overall, 50 target lesions were treated, 92.0% of lesions were femoropopliteal and 8.0% were infrapopliteal. The average lesion length was 98.3 ± 87.5 mm and 78.0% of the lesions were severely calcified. Balloon angioplasty was performed in 98.0% of target lesions, while a stent was deployed in 16.0%. Treatment success was 98.0%; in only one case the result was sub-optimal (>30% stenosis with stent placement) and a significant dissection was reported. No serious distal embolization , serious thrombus formation or serious acute vessel closure were observed intra- or post-procedurally. Conclusions Transradial OA followed by percutaneous transluminal angioplasty for lower extremity PAD is feasible and demonstrates a favorable safety profile. Extended length devices such as the Extended Length Orbital Atherectomy System could further facilitate transradial endovascular procedures by increasing its spectrum of application.

Endovascular surgery has become a popular minimally invasive approach to diagnose and treat various vascular diseases. However, manipulating conventional passive guidewires and catheters still has technical challenges, such as long duration and undesired trauma. In addition, radiation exposure induced by commonly used fluoroscopic imaging has safety concerns. This letter presents a workflow that performs magnetic control of a steerable guidewire under ultrasound (US) guidance to address these issues. The designed magnetically steerable guidewire is fabricated by replica molding method, then a computational-efficient kinematic model is proposed to describe the relationship between the applied magnetic field and tip deformation. The constructed magnetic actuation system integrates three electromagnets and a US probe into a parallel mechanism, realizing large-workspace magnetic field generation and US feedback. Further, a motorized feeder is incorporated to provide the forward and backward motion of the guidewire. An autonomous control framework is proposed consisting of preoperative and intraoperative stages, through which the guidewire can be delivered to the targeted region automatically. Results show that the proposed kinematic model efficiently estimates the deformation of the guidewire. Furthermore, the overall procedure is experimentally validated on a phantom mimicking vascular structures. This letter provides a preliminary robotic solution to improve catheterization procedures by introducing magnetic actuation and US imaging.

Objective: To examine the types of procedures and analyze the frequency of anesthesia-related complications during pediatric cardiac catheterization. Study Design: A prospective observational study. Place and Duration of Study: Pediatric Cardiac Catheterization Lab at AFIC/NIHD Rawalpindi, from July 2019 to Nov 2019. Methodology: Total 180 consecutive patients undergoing cardiac catheterization fulfilling inclusion criteria were studied. Demographic variables, diseases, type of procedure, variables and anesthesia-related complications were noted. All the data was analyzed using SPSS-23. Results: The study included180 patients where 96 (53.3%) were male and 84 (46.7%) were female. Most of the patients in our study were between ages 1 to 3 years (85). 99 (55.0%) patients had diagnostic cardiac catheterizetion (CC), while 81 (45%) patients underwent interventional procedures. The overall complication rate noted as 18.9%, including arrhythmia in 11.1% followed by hypotension 4.4%, laryngospasm 3.9% and inotropic support requirement 3.3%, Mortality was 0.6%. Most of the patients presenting to the pediatric cardiac catheterization lab were for PDA device closure (16.6%). Age of child was found to be significant risk factor for cardiac catheterizetion associated complications with a p-value of 0.022. Conclusion: Congenital and structural heart disease catheterization procedures are progressively increasing, especially due to the medical advances and complex interventional therapeutic procedures. A thorough preanesthesia assessment should be carried out to optimize before cardiac catheterization.

The advancement in technologies and increased risk in treating intracranial aneurysms have created the need for the advancement of new surgical instruments which would reduce the risk of high traumatic surgeries. These aneurysms are being treated by catheterization procedures in sensitive organs like the brain and heart. The best surgical instrument for treating these vascular diseases through catheterization is microcatheter which can navigate through the narrow complex vasculature. Microcatheters are especially used in the case of the brain because of their small size cross-section that can convey liquid embolic agent and solid embolic coils to the target diseased vessel. This study presents the design of a single lumen microcatheter with a single-coil having a straight distal tip towards the distal end. The finite element analysis of the modeled microcatheter is done to determine the minimum deformation of the device so that it can be used for the medical purpose. The microcatheter is designed in a three-dimensional modeling software i.e. CATIA V5 R21 Software and the analysis of it (designed model) is done using ANSYS. The main aim of this study is to design an ease trackability microcatheter for easy perambulation inside the vessels.

Objectives The aim of this study was to enumerate and categorize quality metrics relevant to the pediatric/congenital cardiac catheterization laboratory (PCCL). Background Diagnostic and interventional catheterization procedures are an increasingly important part of the care of young patients with cardiac disease. Measurement of the performance of PCCL programs in a stringent and consistent fashion is a crucial step toward improving outcomes. To the best of our knowledge, a systematic evaluation of current quality metrics in PCCL has not been performed previously. Methods Potential metrics were evaluated by: 1) a systematic review of peer-reviewed research; 2) a review of metrics from organizations interested in quality improvement, patient safety, and/or PCCL programs; and 3) a survey of U.S. PCCL cardiologists. Collected metrics were grouped on 2 dimensions: 1) Institute of Medicine domains; and 2) the Donabedian structure/process/outcome framework. Survey responses were dichotomized between favorable and unfavorable responses and then compared within and between categories. Results In the systematic review, 6 metrics were identified (from 9 publications), all focused on safety either as an outcome (adverse events [AEs], mortality, and failure to rescue along with radiation exposure) or as a structure (procedure volume or operator experience). Four organizations measure quality metrics of PCCL programs, of which only 1 publicly reports data. For the survey, 229 cardiologists from 118 hospital programs responded (66% of individuals and 72% of hospital programs). The highest favorable ratings were for safety metrics (p Conclusions There is a limited number of PCCL quality metrics, primarily focused on safety. Confidence in current risk adjustment methodology is low. The knowledge gaps identified should guide future research in the development of new quality metrics.

The basis of optimized conventional system of surveillance and control for catheter-related bloodstream infections (CRBI) was priority in detection and risk assessment an infectious complication of puncture catheterization that substantially justified with inclusion of two main components as an addition to the existing system: monitoring of puncture catheterization, which allows to obtain and analyze data on risk factors for infections associated with the catheterization procedure and subsequent manipulations of the device, standardize approaches to working with a venous catheter and improve the diagnosis of CRBI; assessment of ensuring the epidemiological safety of medical care for catheterized patients. Epidemiological efficiency risk-based surveillance, primarily determined to reduce the incidence of CRBI by 1.8 times compared to initially defined real incidence: 12.5‰ (95% CI — CI 11,8–13 2) vs 22.8‰ (95% CI 21,1–24,5) catheterized patients, p=0.0001.

BACKGROUND Paraspinal vein misplacement is an uncommon complication of central venous catheterization via lower extremities, most of which have been reported in case reports. AIM To determine the clinical characteristics of paraspinal vein misplacement. DESIGN This was a systematic review. METHODS A systematic literature search in the PubMed, EMBASE, Scopus, and Web of Science databases was performed from their inception to 18 June 2019. Case reports and small case series describing central venous catheter misplacement in the paraspinal vein were included. Data on the catheterization procedure, catheter tip position, complications, and radiographic features of misplacement were extracted. RESULTS Thirty studies with a total of 36 patients were included. The ascending lumbar vein accounted for the majority of misplacements (n = 30), followed by the lumbar vein (n = 4), iliolumbar vein (n = 1), and vertebral venous plexus (n = 1). Six patients had eventful catheterization procedures. Twenty-six patients experienced misplacement-induced complications, of whom seven died. The most common complications included cerebrospinal fluid abnormalities, neurological symptoms, and deteriorated respiration. Among the entire case cohort, the onset of complications was the primary sign that alerted medical staff to misplacement (n = 23). The typical radiographic characteristics were posterior deviation of the catheter course overlapping with the spine on lateral X-rays and a bend, kink, or hump in the catheter course on anteroposterior X-rays at the L4 to L5 levels. CONCLUSIONS Nurses should be aware of this particular complication if a patient who has undergone catheterization via a lower extremity presents deterioration of neurological function and respiration. RELEVANCE TO CLINICAL PRACTICE Lateral X-ray radiography is an effective method to verify misplacement and is recommended as routine practice during catheterization via lower extremities.

Background The transradial approach (TRA) to cardiac catheterization is safer than the traditional transfemoral approach (TFA), with similar clinical effectiveness. However, adoption of TRA remains low, representing less than 50% of catheterization procedures in 2015. Peer coaching is one approach to facilitate implementation; however, the costs of this strategy for cardiac procedures such as TRA are unclear. Methods We conducted an activity-based costing analysis (ABC) of a multi-center, hybrid type III implementation trial of a coaching intervention designed to increase the use of TRA. We identified the key activities of the intervention and determined the personnel, resources, and time needed to complete each activity. The personnel cost per hour and the activity duration were then used to estimate the cost of each activity and the total variable cost of the implementation. Fixed costs related to designing and running the implementation were calculated separately. All costs are reported in 2019 constant US dollars. Results The total cost of the coaching intervention implementation was $374,863. Of the total cost, $367,752 were variable costs due to travel, preparatory work, in-person coaching, post-intervention evaluation, and administrative time. We estimated fixed costs of $7112. The mean marginal cost of implementing the intervention at only one additional medical center was $52,536. Conclusions We provide granular cost estimates of a conceptually rooted implementation strategy designed to increase the uptake of TRA for cardiac catheterization. We estimate that implementation costs stemming from the coaching approach would be offset after the conversion of approximately 409 to 1363 catheterizations from TFA to TRA. Our estimates provide benchmarks of the expected costs of implementing evidence-based, but expertise-intensive, cardiac procedures. Trial registration ISRCTN, ISRCTN66341299. Registered 7 July 2020—retrospectively registered

Iatrogenic vascular injuries may occur during venipuncture, arterial cannulation, or catheterization procedures. Brachial arteriovenous fistula (AVF) resulting from antecubital vascular access is rare and develops slowly. We report the case of an 18-year-old man who had developed iatrogenic brachial AVF. He had a history of several venipunctures in the left arm at the age of 10 months. Doppler ultrasonography and computed tomographic angiography were used to establish a diagnosis of brachial AVF, and surgical correction of the AVF was performed. As our case indicates, delayed surgery can be considered as a treatment option and may be associated with a decreased risk of vascular complications in the management of iatrogenic brachial AVF in infants.

There is no established hemostasis method or protocol for the transdistal radial approach. Therefore, this study aimed to determine whether “the PreludeSYNC DISTAL” radial compression device (PSD; Merit Medical Systems, Inc., South Jordan, UT) can effectively prevent distal radial artery (dRA) occlusion following catheterization procedures. This retrospective study analyzed patients who underwent hemostasis using the PSD from January 1, 2019, to March 31, 2019. The primary endpoint was occlusion or excessive stenosis of the radial artery (RA) 1 month after catheterization. Pulsatile blood flow and vessel diameters of the dRA and forearm RA (fRA) were measured using vascular ultrasound before and 1 month after catheterization to determine arterial damage. Secondary endpoints were achievement of hemostasis, bleeding, hematoma, aneurysm, neurological abnormality, and functional disturbance of the fingers or hand. Fifty patients (mean age, 70.9 ± 10.7 years; male, 72.0%) were enrolled in this study. Complete hemostasis was achieved in all cases. Total hemostasis time was 161 ± 45 min. No procedure-associated complications were noted. Pulsations of the dRA and fRA were maintained at 1 month. No functional disturbance or neurological abnormality was observed. Vessel diameters of the dRA and fRA were not significantly different before and 1 month after catheterization. No dissection, pseudoaneurysm, or occlusion/stenosis was observed on ultrasound. Distal radial access with a unique device and protocol effectively achieved hemostasis and prevented injury and occlusion of the dRA and fRA.

Introduction. Peripheral venous catheters are widely used in medical practice to provide continuous venous access for therapeutic and diagnostic purposes. Peripheral vascular catheterization can be accompanied by infectious complications, including catheter-related bloodstream infections. An effective system of epidemiological surveillance and infection control of catheter-related bloodstream infections has not been developed at the state level in Ukraine; there is no proper monitoring for administration site and no registration of complications associated with the vascular catheterization. The purpose of this work was to assess the validity and propriety of the use of peripheral venous catheters in patients who receive inpatient treatment. Materials and methods: Between October 2019 and April 2020, 93 adult patients who were peripheral venous catheterized in a surgical hospital in Kharkiv were included in a prospective epidemiological study. The author's observation card was used for data collection for each patient daily. The catheter site was observed daily, and the following symptoms were entered into the card: flushed skin, swelling, discharge, and pain at the administration site at rest and on palpation. Interpretation of symptoms was conducted using the visual infusion phlebitis scale by A. Jackson. Statistical processing of data was carried out using descriptive statistics methods. To identify the relationship between the nominative values, Pearson's criterion χ2 was determined with P < 0.01. Research results: 51 women (54.8%) and 42 men (45.2%) aged 18 to 84 were enrolled. In total, patients spent 619 bed-days in the hospital, of which the proportion of days with vascular catheters equaled 90.8% (n = 562). The main indication for the catheterization procedure was multicomponent therapy or the use of incompatible medications (98.9% / n = 92). In total, 148 peripheral venous catheters were inserted in these patients. The number of vascular catheters per patient ranged 1 to 3. According to the data of daily monitoring of the administration site, the signs of inflammation were observed in 65.5% of cases (n = 97). The incidence of signs of inflammation at the administration site with the first catheterization was significantly higher (χ2 = 25.2804; p < 0.00001) than that with the second or third catheterization. The signs of local inflammation, which were more common in patients with vascular catheters, included flushed skin in the area of the catheter site (65.5% / n = 97), complaints of pain on palpation in the area of the catheter site (60.8% / n = 90) and swelling in the area of the catheter site (57.4% / n = 85). It was found that for more than half of the cases (55.4% / n = 82), the patients had symptoms of middle-stage phlebitis. It was also revealed that the most common reason for the removal of a peripheral venous catheter (n = 148) in the studied hospital were signs of local inflammation at the catheter site (61.5% / n = 91). However, in 16.9% of cases (n = 25), the occurrence of at least two signs of local inflammation at the catheter site, which indicated the initial stage of phlebitis and required to rearrange the catheter, was not the reason for immediate catheter removal. Conclusions: Health care workers make mistakes when working with peripheral venous catheters; in particular, there is no timely replacement of vascular catheters in the event of signs of infusion phlebitis. To reduce the risk of infectious complications of vascular catheterization at a health facility, the indications for insertion and removal of peripheral venous catheters and central venous catheters should be clearly defined, and standard operating procedures for ensuring vascular access and algorithms for managing patients with vascular catheters should be developed and implemented. Keywords intravascular catheter, prospective epidemiological study, assessment of the catheter insertion site, infusion phlebitis, catheter-related bloodstream infections, infection control.

Hospitalized children with underlying heart disease are at high risk for cardiac arrest, particularly when they undergo invasive catheterization procedures for diagnostic and therapeutic interventions. Outcomes for children experiencing cardiac arrest in the cardiac catheterization laboratory remain under-reported with few studies reporting survival beyond the catheterization laboratory. We aim to describe survival outcomes after cardiac arrest in the cardiac catheterization laboratory while identifying risk factors associated with hospital mortality after these events.Retrospective observational study of data from a multicenter cardiac arrest registry from November 2005 to November 2016. Cardiac arrest in the cardiac catheterization laboratory was defined as the need for chest compressions greater than or equal to 1 minute in the cardiac catheterization laboratory. Primary outcome was survival to discharge. Variables analyzed using generalized estimating equations for association with survival included age, illness category (surgical cardiac, medical cardiac), preexisting conditions, pharmacologic interventions, and event duration.American Heart Association's Get With the Guidelines-Resuscitation registry of in-hospital cardiac arrest.Consecutive patients less than 18 years old experiencing an index (i.e., first) cardiac arrest event reported to the Get With the Guidelines-Resuscitation.None.A total of 203 patients met definition of index cardiac arrest in the cardiac catheterization laboratory composed primarily of surgical and medical cardiac patients (54% and 41%, respectively). Children less than 1 year old comprised the majority of patients, 58% (117/203). Overall survival to hospital discharge was 69% (141/203). No differences in survival were observed between surgical and medical cardiac patients (p = 0.15). The majority of deaths (69%, 43/62) occurred in patients less than 1 year old. Bradycardia (with pulse) followed by pulseless electrical activity/asystole were the most common first documented rhythms observed (50% and 27%, respectively). Preexisting metabolic/electrolyte abnormalities (p = 0.02), need for vasoactive infusions (p = 0.03) prior to arrest, and use of calcium products (p = 0.005) were found to be significantly associated with lower rates of survival to discharge on multivariable regression.The majority of children experiencing cardiac arrest in the cardiac catheterization laboratory in this large multicenter registry analysis survived to hospital discharge, with no observable difference in outcomes between surgical and medical cardiac patients. Future investigations that focus on stratifying medical complexity in addition to procedural characteristics at the time of catheterization are needed to better identify risks for mortality after cardiac arrest in the cardiac catheterization laboratory.

Introduction: Central venous catheter (CVC) is an essential part of modern medical care that delivers the drugs, intravenous fluids, and intravenous feeding to the vein. So far, limited studies have been carried out on the brachiocephalic vein (BCV) in adults. This study aimed to compare the CVC in the internal jugular vein (IJV) and BCV in order to ease of access and incidence of complication such as infectious and mechanical complications. Materials and Methods: This clinical trial was performed on 52 patients who underwent BCV and the IJV catheterization. The patients were compared in two groups of IJV and BCV in order to facilitate catheterization and measure the success rate and catheterization-induced complications. The difference between the two groups was analyzed by Independent t-test and Chi-square tests. Results: Overall, 52 patients underwent intravenous catheterization. The success rate of catheterization in the first attempt was 100%. The problems of catheterization procedure in the IJV group (11.5%) were greater than the BCV group (6.6%). There was no significant difference between the two groups regarding the duration of catheterization, pneumothorax, emphysema, hematoma, arterial puncture, infection, and complete thrombosis, whereas the partial thrombosis in the IJV group (30.76%) was significantly (P < 0.05) greater than the BCV group (23.07%). Conclusion: Catheterization in both brachiocephalic and the IJV is an appropriate, highly efficient, stable, and safe procedure and ultrasound-guided catheterization is very reliable and safe method.

BACKGROUND Coronary microvascular functional and structural obstruction (CMVO) remains a major complication in patients with ST-segment elevation myocardial infarction (STEMI). This study was designed to develop and validate a nomogram model to predict CMVO risk during primary percutaneous catheterization procedure. MATERIAL AND METHODS Starting January 2014 to December 2016, a cohort of eligible candidates were enrolled and divided into a training or a validation database. Each database was divided into MO or NMO subgroups based on TIMI myocardial perfusion grade results after recanalization. Independent factors were identified by multivariate logistic regression, from which the nomogram was plotted. The echocardiography measurement of the left ventricular ejection fraction (LVEF) was arranged within 7 days after the procedure. RESULTS A nomogram was built for CMVO risk prediction for the first time. There were 446 participants in the training database with 319 cases in the NMO subgroup and 127 participants in the MO subgroup. The validation database included 99 participants with 25 cases in the NMO subgroup and 74 in the MO subgroup. The risk model was developed by 6 independently significant factors: age, symptom onset to balloon time, Killip classification, admission activated clotting time, neutrophil/lymphocyte ratio, and glucose value. Internal receiver operating characteristic displayed favorable performance with concordance index of 0.925, while external validation area under curve was 0.939. There were significant differences in LVEF values during hospitalization between the subgroups of each database (both P

Background To evaluate the safety and efficacy of intra-arterial chemotherapy (IAC) for the primary or secondary treatment of infants diagnosed with advanced retinoblastoma before 3 months of age. Methods This single-center retrospective study included 39 infants (42 eyes) aged ≤3 months who were diagnosed with unilateral or bilateral advanced intraocular retinoblastoma (group D and E eyes) and received IAC as primary or secondary treatment between June 2012 and February 2017. Based on each patient’s therapeutic history and response to chemotherapeutic drugs, melphalan, topotecan, and/or carboplatin were used for IAC. The main outcomes included the technical success rate for IAC, survival rates, and adverse events. Results In total, 29 and 13 eyes received IAC as primary and secondary treatments, respectively. Catheterization was successful in 136 of 137 procedures. All eyes in the secondary IAC group had previously received intravenous chemotherapy. The mean number of IAC sessions for each eye was 3 (range, 2–6). The 2-year ocular survival rates were 80.7% (95% confidence interval [CI], 58.9–91.7) in the primary IAC group and 91.7% (95% CI, 53.9–98.8) in the secondary IAC group. During the follow-up period, 1 patient with unilateral disease (group E) developed extraocular disease and died. The 2-year recurrence-free survival rates in the primary and secondary IAC groups were 71.9% (95% CI, 49.4–85.7) and 75.0% (95% CI, 40.8–91.2), respectively. During each catheterization procedure, the main complications included eyelid erythema (2.4%), fundus hemorrhage (11.9%), myelosuppression (7.7%), transient vomiting and hair loss (2.6%), and transient pancytopenia (2.6%). Prolonged complications included phthisis bulbi (19.0%), vision loss (19.0%), poor vision (9.5%), and cataract (2.4%). There was no case of stroke, neurological impairment, secondary malignant tumor, or metastasis. Conclusions Our findings suggest that IAC, whether primary or secondary, is effective and fairly safe for the management of advanced retinoblastoma in infants aged

The study was conducted to evaluate the effect of inhaler aromatherapy on invasive pain, procedure adherence, vital signs, and saturation during port catheter insertion among patients diagnosed with cancer. The study was conducted in a nonrandomized controlled trial. Sixty patients including 30 patients in the intervention group and 30 patients in the control group, who were subjected with the same local anesthetic protocol, were included in the study. Aromatic mixture prepared by diluting orange, chamomile, and lavender oil in 70 mL distilled water was inhaled by the intervention group during the procedure. The data of the study were collected by using questionnaire, vital follow-up form, and visual analog scale. The patients in the intervention and control groups were similar in terms of sociodemographic and disease characteristics (P.05). It was determined that inhaler aromatherapy applied to patients in the intervention group decreased pain experienced during the procedure and facilitated the procedure adherence (P.05); however, it did not affect vital signs and saturation (P.05). It can be recommended to administer inhaler aromatherapy with pharmacological therapies during catheterization procedure since it decreases invasive pain and facilitates the procedure adherence.

Purpose To perform a multi-centre survey on the eye lens equivalent dose absorbed by primary interventionalist during catheterization procedures, using a personal dosimeter placed close to the eye lens. Methods 15 different cardiologists working in 3 different centers, for a total of 5 operating rooms were enrolled. All of them were provided with a single thermoluminescent dosimeter positioned on the inner side of the temples of eyeglasses. The dose monitoring, performed on a two-months basis, started in 2016 and is still running. All dose measurements were performed by a ISO 17025 standard accredited dosimetry service thus providing certified uncertainties as well. Correlation of eye lens and wrist dose with KAP was also investigated. Results A total number of 101 eye lens measurements were performed. Annual eye lens dose estimation was obtained for all 15 surgeons (mean, mode, range, standard deviation: 10.8, 8, 4.9–27.3, 5.6 mSv, respectively). Uncertainties on annual eye lens dose estimations ranged between 10% and 20%. No significant correlation was found between eye lens dose and KAP. Conclusions Cardiologists involved in catheterization procedures may receive annual eye lens doses close to the ICRP 118 dose limit and thus individual monitoring with a dedicated dosimeter should be carried out. Uncertainty assessment play a relevant role in eye lens equivalent dose estimation to ensure not to exceed dose limit.

Distal transradial access (dTRA) is a novel alternative to conventional radial artery access for coronary catheterization. However, the feasibility and safety of repeated use of dTRA have not been fully elucidated. This study aimed to evaluate the feasibility and safety of the repeated use of dTRA for coronary angiography and intervention in the same arm. A total of 1717 patients underwent angiography or angioplasty via dTRA. We retrospectively analyzed the catheterization records of patients who underwent repeated puncture of the distal radial artery in the same arm. The incidence of successive applications of dTRA and the reasons for dropout were retrospectively investigated. A total of 416 patients, including three who underwent coronary catheterization with the bilateral dTRA in the initial attempt were analyzed. A 3-, 4-, 5-, or 6-French sheath or sheathless guide catheter was used in the initial procedure. A maximum of four successive coronary catheterization procedures were performed. The second procedure with dTRA on the same arm was successfully performed in 395 cases (94.3%), with a successive rate of 89.6% for both the third and fourth dTRA procedures. Conversion to another approach site (n = 30) was attributed to radial artery occlusion (n = 9), narrowing of the distal radial artery (n = 19), and puncture failure (n = 2). The current data indicate that the repeated use of dTRA is safe and feasible, and this approach may become a standard approach site in the future.

Recent insights from human-robot intelligence and deep learning raise hope towards task-specific autonomy in robotic intravascular coronary interventions. However, lack of learning-based methods for characterizing the interventionists' kinesthetic data hinders the drive for shared control and robotic autonomy during cyborg catheterization. In this study, a deep multimodal network model is proposed for classification and recognition of interventionists' hand movements during cyborg intravascular catheterization. The model has two modules for extracting salient features in electromyography signal datasets, and classification of hand motions made during intravascular catheterization procedures. Network training and evaluation observed for in-vitro and in-vivo datasets obtained from trained novice subjects and expert with about 5 years of experience in percutaneous coronary interventions. Performance evaluation shows the learning model could classify interventionists' hand movements accurately in manual and robot-assisted navigations, respectively. This study is suggested to further stimulate the development of appropriate skill level assessments towards cyborg catheterization for cardiac interventions.

Significance The octopus quickly reconfigures its arms to perform highly integrated tasks, such as swimming, walking, and preying. Inspired by such a soft-bodied cephalopod biosystem, we engineer compliant origami robotic arms to achieve multimodal deformations that integrate stretching, folding, omnidirectional bending, and twisting for functions such as grasping and lifting objects by means of precise magnetic actuation. The remote magnetic field control allows distributed actuation of the multiple degree-of-freedom robotic system for complex motions to achieve the aforementioned shape-changing capabilities and functionalities. Origami robotic arms with untethered control are applicable to biomedical devices and morphing mechanisms in environments with limited access., Inspired by the embodied intelligence observed in octopus arms, we introduce magnetically controlled origami robotic arms based on Kresling patterns for multimodal deformations, including stretching, folding, omnidirectional bending, and twisting. The highly integrated motion of the robotic arms is attributed to inherent features of the reconfigurable Kresling unit, whose controllable bistable deploying/folding and omnidirectional bending are achieved through precise magnetic actuation. We investigate single- and multiple-unit robotic systems, the latter exhibiting higher biomimetic resemblance to octopus’ arms. We start from the single Kresling unit to delineate the working mechanism of the magnetic actuation for deploying/folding and bending. The two-unit Kresling assembly demonstrates the basic integrated motion that combines omnidirectional bending with deploying. The four-unit Kresling assembly constitutes a robotic arm with a larger omnidirectional bending angle and stretchability. With the foundation of the basic integrated motion, scalability of Kresling assemblies is demonstrated through distributed magnetic actuation of double-digit number of units, which enables robotic arms with sophisticated motions, such as continuous stretching and contracting, reconfigurable bending, and multiaxis twisting. Such complex motions allow for functions mimicking octopus arms that grasp and manipulate objects. The Kresling robotic arm with noncontact actuation provides a distinctive mechanism for applications that require synergistic robotic motions for navigation, sensing, and interaction with objects in environments with limited or constrained access. Based on small-scale Kresling robotic arms, miniaturized medical devices, such as tubes and catheters, can be developed in conjunction with endoscopy, intubation, and catheterization procedures using functionalities of object manipulation and motion under remote control.

Having a real sense of the applied force in catheterization procedures can help surgeons with proper treatment for cardiovascular diseases. Using sensors is not common because of the limitations of catheters and complications related to the safety of patients. In this regard, a sensor free method can be deemed as a safe solution, in which it uses available equipment in the real operation room. In this work, we propose a deep learning method to estimate the contact forces directly from the catheters’ image tip without embedding further sensors. A convolutional neural network extracts the catheter’s deflections through input images and translates them into the corresponding forces. The architecture of the proposed model has been inspired by the ResNet graph so as to perform a regression. The model can make predictions based on the input images without utilizing any feature extraction or preprocessing steps. An experimental setup was designed and implemented to simulate catheter ablation therapy. Evaluation results show that the proposed method is able to elicit a robust model from the given dataset and approximate the force with proper accuracy. Opting RMSE as the preferred performance metric, the model reached 0.028 N and 0.023 N in estimation error in the x and y direction on the test data set, respectively.

Surgeons now rely on X-ray fluoroscopy to guide intravascular catheterization procedures during cardiovascular interventions. While this modality poses radiation exposure threats to the interventionists, use of teleoperated robot are being proposed to further reduce radiation exposure and as well provide a more ergonomic workflow. However, the real-time tracking and segmentation of intravascular tools, such as guidewire and catheter, within the blood vessel process is still challenging. In this paper, a Gaussian-based method is adapted for segmentation and tracking of guidewire in angiographic frames obtained during teleoperated robotic catheterization. By assuming the guidewire's curvature as a Gaussian process, Radon transformation is performed to extract features of guidewire pixels in the X-ray frames, and these were taken as input to the Gaussian process to segment the guidewire pixels from the background. Further, the prior segmentation information was used to predict the guidewire direction in the angiographs. Finally, performance of the segmentation results was evaluated with six existing methods using six binary pixel classification indicators. It was observed that the Gaussian-based method achieves good results in all the indicators, and surpasses the previous segmentation methods.

On the course of the intra-arterial PRRT with 111In-DTPA0-Octreotide, often, due to the multiple (approximately 12) consecutive catheterizations, the femoral arteries get hardened; a port system ending at the proper hepatic artery is subcutaneously, temporarily implanted. The implantable port absolves the patients of the repeated discomfort due to the catheterization procedure and the obligatory 24 h-immobilization of the lower limb to avoid a possible hematoma, due to the preceded puncture of the femoral artery that the patient had to undergo for the hepatic artery catheterization. This port system offers stable connection mechanism at port chamber/catheter junction, high flow rate in thin catheters, secure placement of the puncture needle in the chamber septum, easy location of the puncture site, and quality of life. This chapter describes in detail the therapeutic scheme with repeated high doses of 111In-DTPA0-Octreotide, applied by means of this temporary implemented Intra-arterial Port System.

The rapid growth of cardiovascular and neurovascular diseases compelled the modern generation researchers to develop more superior quality catheter tubes that would reduce the risk of high invasive surgeries at the time of catheterization procedure. Microcatheters play an imperative role in perambulating through the small size cross-section of the complex vascular pathway with the best possible attributes (of the superior quality tube) which can meet the necessities required for the treatment of the vascular diseases. This study reveals the design and analysis of a four-helical coiled microcatheter tube, to find the deformation using a finite element analysis software, i.e. ANSYS. The designing of the catheter tube is done in a three-dimensional modelling software, i.e. CATIA. The microcatheter has three layers, one is the inner layer through which the embolic agent is to be delivered, the middle layer is a braided four-helical coiled structure which provides strength to the catheter, and the outer layer is lubricious. The main aim of this paper is to design a highly flexible microcatheter with minimum deformation. The boundary condition applied here is the maximum blood pressure which is applied on the outer surface of the outer layer, and the pressure of 1 ml syringe and the embolic agent is applied in the inner surface of the inner layer.

Introduction and purpose Patient risk in non-ST-segment elevation myocardial infarction (NSTEMI) depends on clinical setting, individual patient variables and procedural characteristics. Standardized risk-adjusted periprocedural management for catheterization procedures using a Standard Operating Procedure (SOP) was investigated to evaluate associations with in-hospital clinical outcomes. Methods In 01/2018, our heart center established an SOP for coronary catheterization procedures in NSTEMI, targeting 1) standardized pre-procedural risk assessment using National Cardiovascular Data Registry (NCDR) risk models, and 2) standardized post-procedural risk-adjusted safety measures, including advanced patient monitoring (intermediate/intensive care) and use of vascular closure devices. All patients presenting with invasively-managed NSTEMI in 2018 were retrospectively evaluated for SOP-based pre-procedural risk scoring, SOP-based post-procedural management and in-hospital clinical outcomes of mortality, major bleeding (MB, according to BARC ≥3) and acute kidney injury (AKI, according to KDIGO). Results A total of 430 patients (age 72±12 years, 71% male, BMI 27±5) presenting with NSTEMI from 01 to 12/2018 were included, 9.8% presented in cardiogenic shock and 4.7% had suffered a preclinical cardiac arrest. Overall in-hospital mortality was 3.7%, MB occurred in 6.5%. 207 patients (48.1%, SOP+ group) had received both 1) pre-procedural risk assessment and 2) post-procedural risk-adjusted safety measures; the other 223 patients (51.9%, SOP- group) had not received either 1) or 2). There were no significant differences in baseline characteristics and prior-existing medical conditions between groups, however, significantly more patients in SOP- group were treated in emergency settings (39.9% vs. 21.7%, p=0.004). However, significantly more patients in SOP- were treated in emergency settings at higher risk (39.9% (SOP-) vs. 21.7% (SOP+); p Conclusion Standardized risk management in invasively managed NSTEMI was associated with significantly lower rates of in-hospital major bleedings. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Junior Clinician Scientist Track, Medical faculty, Heinrich-Heine-University Düsseldorf, Germany

We evaluated the safety and feasibility of ipsilateral radial and ulnar artery cannulation during the same catheterization procedure. Crossover from radial to femoral was done in 122 patients. Both ipsilateral radial and ulnar catheterization were performed in 16 patients without any complications, which was further supported by Doppler ultrasonography.

IntroductionThe Killip-Kimball Classification (KC) is used to group patients with acute coronary syndrome (ACS) based on their clinical profile. It has proven to be useful while predicting both short- and long-term mortality. Contemporary data in the elderly population is limited. We sought to analyze trends in outcomes of patients 80 years or older admitted for ACS, by Killip Class. In addition, we assess the validity of the KC in this population.MethodologyA retrospective analysis of patients who underwent a catheterization procedure for ACS was performed. ACS was defined as per AHA guidelines, and included STEMI, non-STEMI and Unstable Angina. We determined factors influencing the KC in which patients present to the emergency room. Likewise, we compared inhospital mortality, length of stay, and other outcomes dividing the patients by KC.ResultsA total of 133 patients were analyzed. Included were: 86, 9, 23 and 15 patients in KC-I through IV respectively with a mean age of 83. The main comorbidities were hypertension (73%), and diabetes (43%). In-hospital mortality was 12%, which was different between KC groups (p < 0.01). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p< 0.01).ConclusionDespite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher Killip class have a high mortality rate, as described in younger cohorts. The Killip-Kimball classification remains a reliable prognostic tool, with applicability in octogenarian patients.

The objective of this work was to investigate if central cardiac pressures are obtainable noninvasively using the subharmonic aided pressure estimation (SHAPE) technique with Definity (Lantheus Medical Imaging Inc, N Billerica, MA, USA) or Sonazoid (GE Healthcare, Oslo, Norway) microbubbles. Patients scheduled for a left and/or right heart catheterization procedure and providing written informed consent were included in IRB approved clinical trials (NCT03243942 for Definity; NCT03245255 for Sonazoid). A standard-of-care catheterization procedure was performed advancing clinically used pressure catheter into the left and/or right ventricles and/or the aorta. After pressure catheter placement, patients received an infusion of either Definity (56 patients; 2 vials in 50 mL of saline; infusion rate: 4–10 mL/min) or Sonazoid (60 patients; rate (mL/hour) = 0.18 mL/hour/kg x weight in kg co-infused with saline at 120 mL/hour). A customized interface on a SonixTablet scanner (BK Ultrasound, Peabody, MA, USA) was used to acquire SHAPE data synchronously with the pressure catheter data. Linear correlation between the SHAPE and pressure catheter data were computed using MATLAB (Mathworks, Natick, MA, USA). Central aortic pressures were estimated using cuff-based brachial pressure measurements with a SphygmoCor device (AtCor Medical Pty Ltd, West Ryde, NSW, Australia). Central aortic pressures and SHAPE data from the aorta were used to calculate a conversion factor (in mmHg/dB) for each patient to estimate pressures and determine errors associated with the SHAPE technique. Two adverse events were observed during Definity infusion; both were resolved. Errors between the pressure catheter and SHAPE derived mean diastolic pressures were less than 5 mmHg when using Definity microbubbles and greater than 5 mmHg when using Sonazoid microbubbles. These results indicate that SHAPE is a useful technique to noninvasively obtain central cardiac pressures.

BACKGROUND Balloon aortic valvuloplasty (BAV) is a well-established treatment modality for congenital aortic valve stenosis. AIM To evaluate the role of rapid right ventricular pacing (RRVP) in balloon stabilization during BAV on aortic regurgitation (AR) in pediatric patients. METHODS A systematic review of the MEDLINE, Cochrane Library, and Scopus databases was conducted according to the PRISMA guidelines (end-of-search date: July 8, 2020). The National Heart, Lung, and Blood Institute and Newcastle-Ottawa scales was utilized for quality assessment. RESULTS Five studies reporting on 72 patients were included. The studies investigated the use of RRVP-assisted BAV in infants (> 1 mo) and older children, but not in neonates. Ten (13.9%) patients had a history of some type of aortic valve surgical or catheterization procedure. Before BAV, 58 (84.0%), 7 (10.1%), 4 (5.9%) patients had AR grade 0 (none), 1 (trivial), 2 (mild), respectively. After BAV, 34 (49.3%), 6 (8.7%), 26 (37.7%), 3 (4.3%), patients had AR grade 0, 1, 2, and 3 (moderate), respectively. No patient developed severe AR after RRVP. One (1.4%) developed ventricular fibrillation and was defibrillated successfully. No additional arrhythmias or complications occurred during RRVP. CONCLUSION RRVP can be safely used to achieve balloon stability during pediatric BAV, which could potentially decrease AR rates.

Background Vascular closure devices have been widely used to achieve rapid hemostasis after percutaneous catheterization procedures via the common femoral artery. The EXOSEAL vascular closure device is a device that can deliver a bioabsorbable polyglycolic acid plug to fill the subcutaneous puncture route at the groin for rapid hemostasis, and this device has a lower risk of arterial occlusion than other vascular closure devices. Case presentation An 83-year-old Japanese man underwent percutaneous coronary intervention for a proximal stenosis in his left circumflex artery through a 7-Fr sheath from his right common femoral artery. We encountered acute popliteal artery occlusion associated with EXOSEAL vascular closure device. We detected the plug material of this device at the occluded lesion by intravascular ultrasound, and performed successful bailout stenting after pulling the embolus with an inflated balloon catheter up to the superficial femoral artery from the popliteal artery. Conclusion Acute limb ischemia caused by an EXOSEAL vascular closure device is a very rare complication. Balloon angioplasty and stenting are considered to be effective options to deal with the plug dislodgement of an EXOSEAL vascular closure device. We must be prepared for every rare complication during endovascular treatment.

Background: Coronary catheterization can be a stressful experience for many patients because of its invasive nature and potential risks. Aim: Assess psychosocial problems among patients undergoing coronary catheterization. Setting: the cardiac department and cardiac care unit at Ain Shams University specialized hospital, Egypt. Sample: A purposive sample composed of 100 patients undergoing coronary catheterization attending the previous mentioned setting. Tools: First tool, socio demographic interviewing sheet. Second tool, disease history questionnaire. Third tool, Patients' psychological and social problems questionnaire. Results: The mean age of studied patients was 53.6±4.2, more than two thirds of them were married, more than one third of them had technical institute education, the majority of the studied patients were working, More than two thirds of the studied patients were males and more than half of the studied patients were had enough monthly income. There is a highly statistical significant relation between age, gender and marital status of the studied patients and their severity of psychosocial problems. Conclusion: About half of the studied patients were always fear from death, anxious due to unknown procedure about catheterization & fear from hearing that someone death due to catheterization. Also, more than one third of the studied patients were always had family support by frequent visits, need others help before and after procedure, fear from affecting sexual desire & feel fatigue when doing any activities. Moreover, more than one third of the studied patients were always change work style after catheterization procedure, decrease ability to prognosis & decrease working hours. One third of the studied patients were sometimes had medical insurance & treatment at the expense of the state, while one third of them was rarely not had enough monthly income. More than one third of the studied patients were always had psychological, social & work respectively. Recommendations: Further research studies are needed for ongoing assessment of patients including large sample for generalization of results

Percutaneous closure of arteriotomy wound during peripheral venoarterial extracorporeal membrane oxygenation decannulation was shown to be safe and allow earlier mobilization. The new MantaTM vascular closure device (Essential Medical), designed for the closure of arterotomy wound created by large-bore vascular sheaths up to 25Fr during endovascular catheterization procedures, was reported to be applicable in venoarterial extracorporeal membrane oxygenation decannulation. In this article, we would like to share our experience of using real-time ultrasound guidance to ensure the safe application of Manta during bedside venoarterial extracorporeal membrane oxygenation decannulation.

Extracorporeal membrane oxygenation (ECMO) is the most common mechanical circulatory support strategy used to treat pediatric patients presenting with low cardiac output or cardiogenic shock. While transthoracic central cannulation is feasible and mostly utilized for early postoperative support, peripheral cannulation is preferred as a primary strategy in the late postoperative period. Redo-sternotomy and venous cannulation are difficult to achieve in patients with occluded peripheral veins or complex venous anatomy like Glenn circulation. In pediatric patients with multiple prior sternotomy and catheterization procedures, vascular access for cannulation is frequently limited. Peripheral cannulation for venoarterial ECMO (VA-ECMO) may be challenging or even impossible. In our case series, four pediatric patients with prior sternotomy underwent right atrial cannulation emergently in patients to secure venous drainage for ECMO support. Extracorporeal membrane oxygenation support could be established rapidly with adequate venous drainage in all cases. We conclude that right atrial cannulation via right thoracotomy can be a useful technique for venous cannulation in cases with prior sternotomy and is particularly useful in cases with Glenn circulation.

Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus-dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic-related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

Summary Background Cardiac catheterization is the gold-standard modality for investigation of cardiovascular morphology before bidirectional cavopulmonary connection, but requires general anaesthesia and is associated with procedural risk. Aims To assess the diagnostic accuracy and safety of computed tomography in diagnosing great vessel stenosis/hypoplasia compared with cardiac catheterization and surgical findings. Methods Twenty-seven patients (10 after Norwood stage I) underwent computed tomography before surgery between January 2010 and June 2016; 16 of these patients also underwent cardiac catheterization. Proximal and distal pulmonary artery, aortic isthmus and descending aorta measurements, radiation dose and complications were compared via Bland-Altman analyses and correlation coefficients. Results The accuracy of computed tomography in detecting stenosis/hypoplasia of either pulmonary artery was 96.1% compared with surgical findings. For absolute vessel measurements and Z-scores, there was high correlation between computed tomography and angiography at catheterization (r = 0.98 for both) and a low mean bias (0.71 mm and 0.48; respectively). The magnitude of intertechnique differences observed for individual patients was low (95% of the values ranged between −0.9 and 2.3 mm and between −0.7 and 1.7, respectively). Four patients (25%) experienced minor complications from cardiac catheterization, whereas there were no complications from computed tomography. Patients tended to receive a higher radiation dose with cardiac catheterization than with computed tomography, even after exclusion of interventional catheterization procedures (median 2.5 mSv [interquartile range 1.3 to 3.4 mSv] versus median 1.3 mSv [interquartile range 0.9 to 2.6 mSv], respectively; P = 0.13). All computed tomography scans were performed without sedation. Conclusions Computed tomography may replace cardiac catheterization in identification of great vessel stenosis/hypoplasia before bidirectional cavopulmonary connection when no intervention before surgery is required. Computed tomography carries lower morbidity, can be performed without sedation and may be associated with less radiation.

Aim. To assess manifestations and risk factors of epidemiological process of catheter-associated urinary tract infections (UTI) in patients of the urological unit of “Altai Territory Hospital for War Veterans” (ATHWV). Materials and methods. One hundred medical records of UTI patients, treated in this urological unit were analyzed to determine the association between the UTI sickness rate and the insertion of catheters among patients, treated in the urological unit of “Altai Territory Hospital for War Veterans” during 2017. Results. Assessment of epidemiological process in catheter-associated UTI patients of “ATHWV” urological unit resulted in the following: UTI sickness rate in “ATHWV” is associated with urinary bladder catheterization and can be interpreted as health care-associated infections since all the observed patients underwent urinary tract catheterization procedure in conditions of “ATHWV” urological unit. Conclusions. Microbiological urine analysis with determination of antibiotic-resistance and disinfectant-resistance of the excreted pathogens should be conducted in all the patients, who undergo urinary bladder catheterization procedure since there is a high percentage of microbiologically-evidenced symptomatic UTI (35.9 %).

Cardiac catheterization is an integral part of medical management for pediatric patients with congenital heart disease. Owing to age and lack of cooperation in children who need this procedure, general anesthesia is typically required. These patients have increased anesthesia risk secondary to cardiac pathology. Furthermore, multiple catheterization procedures result in exposure to harmful ionizing radiation. Magnetic resonance imaging-guided right-heart catheterization offers decreased radiation exposure and diagnostic imaging benefits over traditional fluoroscopy but potentially increases anesthetic complexity and risk. We describe our early experience with anesthetic techniques and challenges for pediatric magnetic resonance imaging-guided right-heart catheterization.

Endovascular surgery has gained increasing acceptance over the last few years. The current practice of endovascular procedures, however, is limited by some factors including patient-specific operation requirements, high-risk surgery procedures, and time-consuming operations. As a solution, studies have introduced magnetically-actuated surgical catheters to the field of surgical robotics. More recently, advances in steerable catheters and development in the context of magnetic steering have been studied. However, limited research has been conducted in quantifying the effectiveness of magnetic actuation for catheterization procedures. The objectives of this review are to summarize the literature as it relates to catheter-based magnetic steering, actuation, and imaging-guided tracking. The mechanisms for these procedures are then analyzed to provide an extensive overview of the research gaps and their proposed solutions. Endovascular interventions employing magnetically-actuated catheters deliver the promise of higher accuracy and shorter duration when compared to current manual techniques. Moreover, they can allow the surgeons to access these areas of cardiovascular systems, which cannot be reached with standard minimally invasive techniques.

PURPOSE OF REVIEW Pulmonary vascular disease (PVD) complicates the course of many cardiovascular, pulmonary and other systemic diseases in children. The physiological sequelae (pulmonary hypertension and elevated pulmonary vascular resistance) can overwhelm the right ventricle and lead to circulatory collapse. Despite the common end-point, the preceding pathophysiology is complex and variable and requires a tailored approach to diagnosis and management. In this article, we will review the most recent evidence and explore an approach to current controversies in the diagnosis and management of common or challenging patient subgroups. RECENT FINDINGS New methods of interpreting data derived from echocardiography and cardiac magnetic resonance imaging may assist in risk stratification and response to therapy. In specific patient subgroups, standard pharmacological therapies to reduce right ventricle afterload may be overutilized, ineffective and in some cases harmful. In the patient failing pharmacological therapy, new and novel techniques are being explored including temporary extracorporeal mechanical circulatory support, pumpless lung assist devices and novel surgical and catheterization procedures. SUMMARY PVD is a diverse entity, and attention to the underlying pathophysiology is essential for appropriate management. Despite significant advances in our understanding, the majority of data comes from small uncontrolled studies and must be interpreted with caution.

Background There remains limited options for end stage pulmonary arterial hypertension that is refractory to medical therapy. The reprisal of the Potts shunt (pulmonary artery to descending aorta anastomosis) has been used to decrease right ventricle (RV) afterload by creating a right to left shunt in effort to promote lung transplant free survival. Methods Retrospective review of three patients ages 16, 19, and 27 years old who underwent the creation of a “reverse” Potts shunt at our institution in 2016. Results The patients were WHO functional class III or IV and on three classes of pulmonary hypertension specific drug therapy including IV prostacyclin. All patients had RV dysfunction and suprasystemic RV pressures. Two patients had a catheterization for dilation and stenting of a tiny patent ductus arteriosus (PDA) and one had emergent surgical placement of a pulmonary artery to descending aorta conduit. The catheterization procedures were well tolerated without complications. The surgical procedure was complicated with heavy bleeding and respiratory failure. All patients recovered from their procedure and experienced improved functional class with decrease in RV pressures to systemic levels but no improvement in RV function. One catheterization patient required restenting due to stent fracture at 7 months. Our surgical patient died from massive hemoptysis 13 months after the procedure. Conclusions Reverse Potts shunt physiology may be an option for end-stage PAH patients with suprasystemic RV pressures. Optimal timing of this procedure remains unclear, but if feasible, PDA stenting, even in adult patients may be accomplished with low morbidity.

Introduction: Central venous catheterization is a routine procedure for long-term infusion therapy and central venous pressure measurement. Sometimes, the catheter tip may be unintentionally placed at the position other than the junction of superior vena cava and right atrium. This is called malposition and can lead to erroneous pressure measurement, increase risk of thrombosis, venous obstruction or other life threatening complications like pneumothorax, cardiac temponade. Objectives: This study aimed to observe the incidence of the malposition and compare the same between ultrasound guided catheterization and blind anatomical landmark technique. Methodology: This study was a prospective comparative study conducted at the intensive care unit of Birat Medical College and Teaching Hospital for two-year duration. All the catheterizations were done either with the use of real time ultrasound or blind anatomical landmark technique. The total numbers of central venous catheterization, the total incidences of malposition were observed. Finally the incidences were compared between real time ultrasound guided technique and blind anatomical landmark technique. Results: In two-year duration of the study, a total of 422 central venous cannulations were successfully done. The real time ultrasound was used for 280 cannulations while blind anatomical landmark technique was used for 162 patients. The study observed various malposition in 36 cases (8.5%). The most common malposition was observed for subclavian vein to ipsilateral internal jugular vein (33.3%) followed by subclavian to subclavian vein (27.8%) and internal jugular to ipsilateral subclavian vein (16.7%). In four patients the catheter had a reverse course in the internal jugular vein while the tip was placed in pleural cavity in three cannulations. There was coiling of the catheter inside left subclavian vein in one patient. The malposition was significantly reduced with the use of the real time ultrasound (P< 0.001). However there is no significant difference in the incidence of the various malposition between ultrasound guidance technique and blind anatomical landmark technique when compared individually. Conclusion: The malposition of the central venous catheter tip was common complication with the overall incidence of 8.5%. The most common malposition was subclavian vein to internal jugular vein. The use of real time ultrasound during the catheterization procedure can significantly reduced the risk of malposition. Birat Journal of Health Sciences Vol.2/No.3/Issue 4/Sep- Dec 2017, Page: 277-281

Background: Arrhythmia and sudden cardiac decompensation (acute myocardial infarct or acute heart failure) are the most often causes of out-of-hospital cardiac arrest (OHCA). Emergency cardiac catheterization followed by coronary revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting surgery [CABG]) or valvular surgery is a lifesaving procedure. However, the result of this emergency room resuscitated OHCA patients underwent cardiac invasive procedure was not well defined before. Materials and Methods: One hundred and seventy (including 23 traumatic and stroke, etc.,) out of 705 OHCA patients were resuscitated and achieved a return of spontaneous circulation (ROSC) at Emergency Room of Chung Shan Medical University Hospital from January 1, 2011, to March 31, 2015. Only 23 (M/F = 25/8) out of 147 medically resuscitated OHCA patient with one or more cardiac risk factors were transferred for emergency cardiac catheterization (33/147). Thirty-one of them (31/33) underwent PCI (either balloon angioplasty or stent deployment) with coronary culprit stenotic lesions (>70%) of right coronary artery (15), left anterior descending artery (12), circumflex branch of left coronary artery (5), and left main coronary artery (1). One of the rest two patients with aortic valvular stenosis who underwent aortic valve replacement; and another with triple vessel disease of coronary artery received CABG. Results: All 33 patients (22.4%) survived the catheterization procedures and were sent to intensive care units. 31 patients were in comatose state and 24 eventually deceased due to cardiogenic shock (16), septic shock (4), ventricular tachycardia and ventricular fibrillation (2), hyperkalemia (1) and multiple organ failure (1). Nine patients (27.3%) survived to hospital discharge and were followed up at OPD periodically (1.3–43 months, mean 30.4 months). Four OHCA patients required extra-corporeal membrane oxygenation support, but only one out of four underwent PCI and survived. Conclusions: The resuscitated OHCA (ROSC) patients with any cardiac disease in the past should undergo emergency cardiac catheterization and possible intervention procedure with an acceptable result (survival to hospital discharge rate of 27.3%).

Aim Previous studies have reported a 10.2%-22% rate of silent cerebral infarction and a 0.1%-1% rate of symptomatic cerebral infarction after coronary angiography (CAG). However, the risk factors of cerebral infarction after CAG have not been fully elucidated. For this reason, we investigated the incidence and risk factors of CVD complications within 48 h after CAG using magnetic resonance imaging (MRI) (Diffusion-weighted MRI) at Kagoshima University Hospital. Methods From September 2013 to April 2015, we examined the incidence and risk factors, including procedural data and patients characteristics, of cerebrovascular disease after CAG in consecutive 61 patients who underwent CAG and MRI in our hospital. Results Silent cerebral infarction after CAG was observed in 6 cases (9.8%), and they should not show any neurological symptoms of cerebral infarction. Only prior coronary artery bypass grafting (CABG) was more frequently found in the stroke group (n=6) than that in the non-stroke group (n=55); however, no significant difference was observed (P=0.07). After adjusting for confounders, prior CABG was a significant independent risk factor for the incidence of stroke after CAG (odds ratio: 11.7, 95% confidence interval: 1.14-129.8, P=0.04). Conclusions We suggested that the incidence of cerebral infarction after CAG was not related to the catheterization procedure per se but may be caused by atherosclerosis with CABG.

Diseases of the urinary bladder have high incidence rates and burden healthcare costs. Their pharmacological treatment involves systemic and local drug administration. The latter is generally accomplished through instillation of liquid formulations and requires repeated or long-term catheterization that is associated with discomfort, inflammation and bacterial infections. Consequently, compliance issues and dropouts are frequently reported. Moreover, instilled drugs are progressively diluted as the urine volume increases and rapidly excreted. When penetration of drugs into the bladder wall is needed, the poor permeability of the urothelium has also to be accounted for. Therefore, much research effort is spent to overcome these hurdles, thereby improving the efficacy of available therapies. Particularly, indwelling delivery systems suited for i) insertion into the bladder through the urethra, ii) intra-organ retention and prolonged release for the desired time lapse, iii) final elimination, either spontaneous or by manual removal, have been proposed to reduce the number of catheterization procedures and reach higher drug levels at the target site. Vesical retention of such devices is allowed by the relevant expansion that can either be triggered from the outside or achieved exploiting elastic and purposely 4D printed shape memory materials. In this article, the main rationales and strategies for improved intravesical delivery are reviewed., Graphical abstract Unlabelled Image

Background: Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Tranexamic acid is an antifibrinolytic drug used to control bleeding in various situations, including dental bleeding in hemophilia, postpartum hemorrhage, and hemoptysis. (1) Side effects associated with tranexamic acid are rare. There are five reported cases of tranexamic acid anaphylaxis. (2) We report a case of a patient who developed Takotsubo cardiomyopathy after its use. To our knowledge, this is the first reported case of Takotsubo cardiomyopathy associated with tranexamic acid. CASE PRESENTATION: A 68-year-old female with a past medical history significant for chronic obstructive pulmonary disease, coronary artery disease with a left circumflex stent placed in 2019, and previous Takotsubo cardiomyopathy in 2019 presented to the hospital with complaints of dyspnea. COVID-19 PCR was positive and she was treated with convalescent plasma, remdesivir, and dexamethasone. She developed mild but persistent hemoptysis during her stay at the hospital. CT chest revealed chronic bronchiectasis and her hemoglobin levels remained stable. Enoxaparin was stopped and inhaled tranexamic acid was prescribed by the pulmonary team as she was deemed high risk for bronchoscopy and her known bronchiectasis was thought to be contributing to her hemoptysis. Immediately following the first treatment with tranexamic acid, she became hypertensive, dyspneic, and a chest x-ray revealed new pulmonary edema. EKG revealed ST-segment elevations in leads V2-V4.(fig 1) She was placed on BiPAP which did not help her respiratory status and was subsequently intubated with improved blood pressures. Cardiac catheterization was emergently performed and was negative for coronary artery obstruction;however, it showed apical ballooning of the left ventricle with a reduced ejection fraction of 20%. (Fig 2, 3 ) A few hours after her return from the catheterization procedure, she developed cardiogenic shock requiring both ionotropic and vasopressor therapy. Swan Ganz catheter was placed that showed elevated filling pressure and low cardiac index. Over the next 24 hours, the patient developed acute renal and liver failure and her pressor requirement increased, and she was placed on five different agents. She was deemed not a candidate for mechanical circulatory support given her multiple organ failure and underlying oxygen-dependent chronic lung disease. She was transitioned to comfort care and expired. DISCUSSION: This is the first reported case of Takotsubo cardiomyopathy associated with exposure to tranexamic acid. Our patient rapidly deteriorated clinically with the first dose of tranexamic acid. Li et al. proposed a protocol to diagnose suspected adverse reactions to tranexamic acid that includes measuring serum tryptase level after the suspected reaction, skin prick test, and intradermal test. (3) CONCLUSIONS: Clinicians should keep the adverse reaction in their minds while prescribing tranexamic acid to patients. REFERENCE #1: 1)Wand O, Guber E, Guber A, Epstein Shochet G, Israeli-Shani L, Shitrit D. Inhaled Tranexamic Acid for Hemoptysis Treatment: A Randomized Controlled Trial. Chest. 2018;154(6):1379-1384. doi: 10.1016/j.chest.2018.09.026 REFERENCE #2: 2) Plaster S, Holy F, Antony AK. Anaphylactic Reaction to Tranexamic Acid During Posterior Spinal Fusion: A Case Report. JBJS Case Connect. 2020;10(3): e2000130. doi:10.2106/JBJS.CC.20.00130 REFERENCE #3: 3) Li PH, Trigg C, Rutkowski R, Rutkowski K. Anaphylaxis to tranexamic acid—a rare reaction to a common drug. J Allergy Clin Immunol Pract. 2017;5(3):839-41. DISCLOSURES: No relevant relationships by Junaid mir, source=Web Response No relevant relationships by Krystle Shafer, source=Web Response

The aim of this study was to define characteristics of those patients who are referred for device closure of an Atrial septal defect (ASD), but identified to “crossover” surgery. All patients who underwent surgical and device (Amplatzer or Helex occluder) closures of secundum ASDs from 2001 to 2010 were reviewed and organized into three groups: surgical closure, device closure, and “crossover” group. 369 patients underwent ASD closure (265 device, 104 surgical). 42 of the 265 patients referred for device closure “crossed over” to the surgical group at various stages of the catheterization procedure. The device group had defect size measuring 14.2 mm (mean) and an ASD index (Defect Size (mm)/BSA) of 14.0 compared to the corresponding values in the surgical group (20.1 mm, ASD index 25.9) (P