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Achieving an optimal surgical result in patients with major aortopulmonary collateral arteries (MAPCAs) requires a thorough preoperative evaluation of the anatomy and physiology of the pulmonary circulation. This review provides a detailed description of diagnostic catheterization in patients with MAPCAs, including a summary of catheterization techniques, an overview of commonly used terms, and a review of MAPCA and pulmonary artery angiographic anatomy.

Cardiac catheterization can affect clinical outcomes in patients on extracorporeal membrane oxygenation (ECMO) after congenital heart surgery; however, its effect in this group of patients remains unclear. This study aimed to evaluate the safety and outcome of cardiac catheterization in patients undergoing ECMO after congenital cardiac surgery and determine predictors that influence successful weaning. This retrospective cohort study included pediatric patients who underwent cardiac catheterization while on ECMO after congenital heart surgery in two cardiac centers between November 2012 and February 2020. Predictors of successful weaning from ECMO were studied using univariate and multivariate logistic regression analyses. Of 123 patients on ECMO support after congenital cardiac surgery, 60 patients underwent 60 cardiac catheterizations (31 diagnostic and 29 interventional). Thirty-four (56.7%) and 22 patients (36.7%) underwent successful decannulation from ECMO support and survived after hospital discharge, respectively. Patients who underwent earlier catheterization (within 24 h of ECMO initiation) had more successful weaning from ECMO and survival compared to others. Patients who underwent an interventional procedure (interventional catheterization or redo cardiac surgery after cardiac catheterization) had better survival than those who underwent only diagnostic catheterization (P = 0.038). Shorter durations of ECMO was the most important predictor of successful weaning from ECMO. Early cardiac catheterization greatly impacts successful weaning from ECMO and survival. Patients with correctable lesions amenable either by catheterization or redo surgery are more likely to survive. Shorter durations of ECMO could have a significant influence on successful weaning from ECMO and survival.

Background: Cardiac catheterization is one of the most widely performed cardiac procedures. Medical record completeness and registry is a key performance indicator that is related with delivery of healthcare services in the hospital. At hospital level, statistics derived from the daily bed census and medical records are used to assess the utilization of services and enable the hospital to make appropriate financial and administrative plans and to conduct vital research.Aim of the Work: To do statistical analysis of patient’s data who underwent cardiac catheterization to evaluate the current status, the prospects of improvements and future developments.Patients and Methods: This cross sectional study included review of files of 389 patients who underwent cardiac catheterizations or invasive cardiac imaging procedures for diagnosis or treatment of various congenital heart diseases at the cardiac catheterization unit, new children's hospital, Ain Shams University during the period from first of January 2018 to the end of December 2019.Results: In our study, interventional catheterization represented 191 (49.1%) of all studied cases whereas diagnostic catheterization were 115 (29.6%). The majority of procedures were done under general anesthesia and 8 cases (2.1%) only were done under sedation. The most frequent interventional procedure done was PDA device closure (28.30%). Among our study group, the number of complicated procedures was 23 procedures representing a percentage of 5.9 % with desaturation being the most common complication (26.1%) which encountered during balloon valvuloplasty operations. Mortality was recorded in only 2 patients (0.5%). Success rate of overall procedures was 99%.Conclusion: The outcomes of the procedures done in our relatively new center were satisfactory and approximated to results of other international pediatric cardiac catheterizations centers as regards complications, mortality and success rate. Neonatal interventions were limited. Complications were higher among interventional procedures with desaturation being the most common complication which developed frequently during balloon pulmonary valvuloplasty followed by supraventricular tachycardia and arrhythmia; judicious catheter manipulation and correction of any metabolic abnormality is critical, but being prepared for such events is vital.

OBJECTIVES We aimed to explore the impact of 7-Fr sheaths on the incidence of early radial artery occlusion (RAO) after transradial coronary intervention (TRI) in Chinese patients. BACKGROUND RAO precludes future use of the vessel for vascular access. Transradial catheterization is usually performed via 5-Fr or 6-Fr catheters; 7-Fr sheath insertion enables complex coronary interventions but may increase the RAO risk. METHODS We prospectively enrolled 130 consecutive patients undergoing complex TRI using 7-Fr sheaths. Radial artery ultrasound assessment was performed before and after TRI. Early RAO was defined as the absence of flow on ultrasound within 6-24 hr after TRI. Multivariate logistic regression was used to determine the factors related to early RAO after TRI. RESULTS 7-Fr sheaths were mainly used for chronic total occlusion (44.6%), bifurcation (30.0%), and tortuous calcification (25.4%) lesions. All patients were successfully sheathed. Percutaneous coronary intervention (PCI) procedural success was 96.2%; 119 patients (91.5%) had preserved radial artery patency after TRI. All 11 RAO cases (8.5%) were asymptomatic. The radial artery diameter was significantly larger postoperatively (3.1 ± 0.4 mm) than preoperatively (2.6 ± 0.5 mm) (p

Background The treatment, genotyping, and phenotyping of patients with World Health Organization Group 1 pulmonary arterial hypertension (PAH) have evolved dramatically in the last decade. Research Question The United States Pulmonary Hypertension Scientific Registry was established as the first US PAH patient registry to investigate genetic information, reproductive histories, and environmental exposure data in a contemporary patient population. Study Design and Methods Investigators at 15 US centers enrolled consecutively screened adults diagnosed with Group 1 PAH who had enrolled in the National Biological Sample and Data Repository for PAH (PAH Biobank) within 5 years of a cardiac catheterization demonstrating qualifying hemodynamic criteria. Exposure and reproductive histories were collected by using a structured interview and questionnaire. The biobank provided genetic data. Results Between 2015 and 2018, a total of 499 of 979 eligible patients with clinical diagnoses of idiopathic PAH (IPAH) or familial PAH (n = 240 [48%]), associated PAH (APAH; n = 256 [51%]), or pulmonary venoocclusive disease/pulmonary capillary hemangiomatosis (n = 3 [1%]) enrolled. The mean age was 55.8 years, average BMI was 29.2 kg/m2, and 79% were women. Mean duration between symptom onset and diagnostic catheterization was 1.9 years. Sixty-six percent of patients were treated with more than one PAH medication at enrollment. Past use of prescription weight loss drugs (16%), recreational drugs (27%), and oral contraceptive pills (77%) was common. Women often reported miscarriage (37%), although PAH was rarely diagnosed within 6 months of pregnancy (1.9%). Results of genetic testing identified pathogenic or suspected pathogenic variants in 13% of patients, reclassifying 18% of IPAH patients and 5% of APAH patients to heritable PAH. Interpretation Patients with Group 1 PAH remain predominately middle-aged women diagnosed with IPAH or APAH. Delays in diagnosis of PAH persist. Treatment with combinations of PAH-targeted medications is more common than in the past. Women often report pregnancy complications, as well as exposure to anorexigens, oral contraceptives, and/or recreational drugs. Results of genetic tests frequently identify unsuspected heritable PAH.

The prevalence of iatrogenic catheter-induced ostial coronary artery dissection is very low (0.09%) (1). The incidence of coronary anomalies (total) is 5.64% and ectopic right coronary artery (RCA) (left cuspid) is also rare (0.92%) (2). To the best of our knowledge, this is the first case report of a simultaneous iatrogenic catheter-induced ostial RCA dissection and propagation to the ostial left main (LM) coronary artery by intramural hematoma (IMH). We report a case of a 61-year-old male with underlying disease of type 2 diabetes mellitus and hypertension under regular medication control. He had experienced intermittent chest pain for more than 3 months. He came to our hospital after suffering acute RCA occlusion with cardiogenic shock without management while receiving diagnostic catheterization in another hospital. To perform the initial diagnostic, we used a 6 French Ikari Left 4 (Terumo, Japan) guiding catheter and changed to a 6 French SAL1 (Medtronic, U.S.A.) guiding catheter to determine the origin of the RCA anomaly in the left coronary cuspid. Initially, ostial dissection with intramural hemorrhage at the RCA without flow compromised with the acknowledgement of LM propagation (Panel A) (Video 1). Ostial RCA was managed directly with a Xience Sierra stent (3.5 × 23 mm; Abbott, U.S.A) to seal the entry of dissection, followed by NC emerge 3.5 × 15 mm balloon (Boston, U.S.A.) inflated up to 24 atmosphere (atm). Intravascular ultrasound (IVUS) confirmed that the stent fully covered the entry point of the ostial RCA (Panel B). The left main (Panel C) was then managed by IVUS-guided (Boston iLAB Opticross, U.S.A.) cutting balloon (Wolverine 4.0 × 6 mm; Boston, U.S.A.) inflated at up to 12 atm to fenestrate the IMH (Panel D; Video 2) at the LM level, followed by the implantation of a bailout stenting Xience Sierra (4.0 × 18 mm; Abbott, U.S.A) and by NC emerge 5.0 × 15 mm balloon (Boston, U.S.A.) inflated up to 18 atm. Post procedure angiogram and IVUS confirmed the effectiveness of the intervention. (Panel E, F). In this case, due to the origin of the RCA anomaly, the dissection and IMH immediately propagated to the LM. Fortunately, the patient was hemodynamically stable. We chose to use the cutting balloon and IVUS-guided intervention strategy, which resulted in the remission of the patient's condition.

There is a paucity of data on the burden of in-stent restenosis (ISR) in the United States as well as on its presentation and appropriate treatment strategies.This study aims to provide an analysis of the temporal trends, clinical presentation, treatment strategies, and in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI) for ISR in the United States.This study is a retrospective analysis of data collected in the Diagnostic Catheterization and Percutaneous Coronary Intervention (CathPCI) registry of the National Cardiovascular Data Registry (NCDR) between 2009 and 2017. Of the total patients undergoing PCI, we identified those undergoing PCI for ISR lesions. For comparison of in-hospital outcomes, propensity-score matching was employed.Among the 5,100,394 patients undergoing PCI, 10.6% of patients underwent PCI for ISR lesions. Patients with bare-metal stent ISR declined from 2.6% in 2009 Q3 to 0.9% in 2017 Q2 (p 0.001), and drug-eluting stent ISR rose from 5.4% in 2009 Q3 to 6.3% in 2017 Q2 (p 0.001). Patients with ISR PCI were less likely to present with non-ST-segment elevation myocardial infarction (MI) (18.7% vs. 22.5%; p 0.001) or ST-segment elevation MI (8.5% vs. 15.7%; p 0.001). In the propensity-matched population of patients, there were no significant differences between patients with ISR and non-ISR PCI for in-hospital complications and hospital length of stay.ISR represents approximately 10% of all PCI and is treated most commonly with another stent. Approximately 25% of patients present with acute MI. In-hospital outcomes of patients with ISR PCI are comparable with those undergoing non-ISR PCI.

Rationale & Objective Pulmonary hypertension (PH) contributes to cardiovascular disease and mortality in patients with chronic kidney disease (CKD), but the pathophysiology is mostly unknown. This study sought to estimate the prevalence and consequences of PH subtypes in the setting of CKD. Study Design Observational retrospective cohort study. Setting & Participants We examined 12,618 patients with a right heart catheterization in the Duke Databank for Cardiovascular Disease from January 1, 2000, to December 31, 2014. Exposures Baseline kidney function stratified by CKD glomerular filtration rate category and PH subtype. Outcomes All-cause mortality. Analytical Approach Multivariable Cox proportional hazards analysis. Results In this cohort, 73.4% of patients with CKD had PH, compared with 56.9% of patients without CKD. Isolated postcapillary PH (39.0%) and combined pre- and postcapillary PH (38.3%) were the most common PH subtypes in CKD. Conversely, precapillary PH was the most common subtype in the non-CKD cohort (35.9%). The relationships between mean pulmonary artery pressure, pulmonary capillary wedge pressure, and right atrial pressure with mortality were similar in both the CKD and non-CKD cohorts. Compared with those without PH, precapillary PH conferred the highest mortality risk among patients without CKD (HR, 2.27; 95% CI, 2.00-2.57). By contrast, in those with CKD, combined pre- and postcapillary PH was associated with the highest risk for mortality in CKD in adjusted analyses (compared with no PH, HRs of 1.89 [95% CI, 1.57-2.28], 1.87 [95% CI, 1.52-2.31], 2.13 [95% CI, 1.52-2.97], and 1.63 [95% CI, 1.12-2.36] for glomerular filtration rate categories G3a, G3b, G4, and G5/G5D). Limitations The cohort referred for right heart catheterization may not be generalizable to the general population. Serum creatinine data in the 6 months preceding catheterization may not reflect true baseline CKD. Observational design precludes assumptions of causality. Conclusions In patients with CKD referred for right heart catheterization, PH is common and associated with poor survival. Combined pre- and postcapillary PH was common and portended the worst survival for patients with CKD

Background/purpose Bariatric embolization of the left gastric artery (LGA) is being investigated as a technique to induce substantial weight loss in obese patients. Radial access is associated with less vascular complications than femoral access, especially in patients with severe obesity . We sought to assess the feasibility, safety and technical challenges of LGA angiography through radial access. Methods/materials Patients with suspected coronary artery disease (CAD) and obesity (BMI > 30 kg/m 2 ) referred for diagnostic catheterization and/or percutaneous coronary intervention (PCI) were eligible. After completion of diagnostic and/or PCI, selective cannulation of celiac artery was performed and images of the LGA were taken from multiple views. Detailed procedural parameters such as procedure time, contrast volume and radiation data as well as anatomical variations were assessed. Results Between February and December 2018, we successfully achieved 50 selective angiographies of celiac artery from 54 enrolled patients (92.6%) and LGA was optimally visualized in 47/50 (97%) of cases. Right radial access was used in 50 cases. Mean age was 63.9 ± 8.0 years and 74% were men. Median BMI was 34.4 kg/m2 [32.2–39.4]. The median procedural time was 7 [5–10] minutes, contrast volume was 41 ml [33–63], fluoroscopy time was 160 [103–248] seconds and radiation exposure was 3125 [1906–4735] Gy.cm 2 . No complications were noted. The mean difficulty of the procedure on a visual analogue scale was 4/10. Conclusions LGA angiography via transradial approach was feasible in the large majority of CAD patients with obesity . No safety issues were encountered.

Introduction and objectives: Today it has become increasingly common to perform procedures without withdrawing oral anticoagulation. However, the need to withdraw oral anticoagulants prior to cardiac catheterization in patients chronically anticoagulated (OACs) remains controversial. We evaluated the efficacy and safety of performing transradial catheterization in outpatients without withdrawing direct-action oral anticoagulants (DOACs). Methods: Prospective and observational study where 270 patients who underwent elective transradial cardiac catheterization were included from January 2013 through November 2017, divided into 3 groups of 90 patients based on their anticoagulant intake: group A (without OAC), with group B (with vitamin K antagonist), and group C (with DOACs), and matched according to the date of completion. In no case was the OAC discontinued before the procedure. We evaluated the complications of radial access within the first 24 h and 1 month after the procedure. Results: The group of patients on DOACs had a higher proportion of men compared to the vitamin K antagonist group (71.1% vs 47.8%; P = .01) and patients were younger in the group without OAC (63.45 ± 11.47 vs 70.22 ± 9.35; P = .03). Group B had a lower percentage of diabetic patients (22.2% vs 36.67% in group C, P = .03). In group A, patients were more prone to having a history of ischemic heart disease compared to the groups of anticoagulated patients (27.84% vs 14.44% in group C, P = .028) in addition to a more frequent intake of antiplatelet drugs. Radial access was the access of choice in most patients (98.2%). There were no significant differences when it comes to vascular access complications among the groups being the rate of hematoma and/or bleeding at discharge equal to 1.1% in the DOACs group and the arterial occlusion rates both at discharge and at 1 month between 0% and 2.2%. Conclusions: In our experience performing transradial diagnostic cardiac catheterizations without discontinuation of DOACs is safe, with low rates of thrombotic and hemorrhagic complications, without any differences with vitamin K antagonist and no OAC.

Yamaguchi syndrome or apical hypertrophic cardiomyopathy (HCM) is a unique variant of HCM. It is characterized by localized hypertrophy involving the left ventricular apex rather than the left ventricular septum. This syndrome has been traditionally seen in the Asian population, particularly those of Japanese descent. We present an interesting case of Yamaguchi syndrome seen in a Hispanic male. A 48-year-old Hispanic male presented with epigastric tenderness and was admitted to the hospital for a non-ST-segment elevation myocardial infarction. His diagnostic catheterization revealed no significant coronary artery disease. However, his echocardiogram revealed apical hypertrophy and narrowing of the left ventricular cavity at the apex, consistent with Yamaguchi syndrome. Case reports such as ours serve to help clinicians broaden their differential diagnoses when approaching patients with acute coronary syndrome-like symptoms to include diagnoses such as Yamaguchi syndrome.

The optimal management of chronic anticoagulation is still controversial to this day both in clinical cardiology and particularly in interventional cardiology. The progressive aging of the population has increased exponentially the percentage of patients with an indication for chronic oral anticoagulation who undergo percutaneous invasive procedures to up to 5%-10% of the total. Also, most of them suffer from atrial fibrillation.1

Background: The goal of the investigation was to analyze the results of heart catheterization in the Cardiac centre Shisong from December 2010 till December 2017. Methods: This retrospective study done in the Cardiac centre Shisong in adult patients that underwent a procedure in the catheterization laboratory from December 2010 till December 2017. Results: Three hundred and sixty-five adult underwent a cardiac catheterization procedure during the study period. Among the patients, 126 were female while 239 were male. The mean age at presentation was 52.6±12.9 years old. Patients were coming from neighboring countries: Nigeria n=5 (1.3%), Tchad n=3 (0.8%), Equatorial Guinea n=4 (1%), Democratic republic of Congo n=2 (0.5%). Patients were also coming from all the ten regions of Cameroon: Littoral n=122 (33.2%), Centre n=127 (34.8%), North west n=47 (12.9%), South west n=17 (4.5%), West n=26 (7.1%), North n=7 (1.8%), Adamaoua n=8 (2.1%), Far North n=5 (1.3%), South n=2 (0.5%), East n=4 (1%). Depending on the type of procedures diagnostic coronarography in case with suspicion of coronary artery disease and presurgical coronarography were the main procedures done in 171 patients (46.8%) and in 146 patients (40%) respectively. Diagnostic coronarography was positive in 31 cases (8.4%). In patients with ischemic heart disease (IHD), percutaneous intervention with dilatation of the coronary arteries and implantation of stents was done in 19 cases (5.2%). The remaining 12 cases (3.2%) were having many lesions that could be managed only by coronary artery grafting surgery, done with success in all the cases. In grown up congenital heart disease patients, diagnostic catheterization was done in 48 cases meanwhile interventional catheterization: pulmonary artery valvuloplasty, patent ductus arteriosus (PDA) closure, atrial septal defect closure and decoarctation of the aorta were done in n=11 (3.4%), n=9 (2.4%), n=12 (3.2%), n=6 (1.6%) cases respectively. Conclusions: Coronary heart disease was confirmed by angiography in 8.4% cases, and among grown up congenital heart disease ‘patients, atrial septal defect was the pathology the most managed. Heart catheterization is done in the Cardiac centre Shisong with good results.

Background: With the improved lifestyle of people, the incidence of coronary artery disease is gradually increasing. Approximately 15% - 20% of patients undergoing diagnostic catheterization had one or more chronically occluded coronary arteries. Method: The patients who were diagnosed with chronic total occlusion (CTO) in our hospital within one year period have been included. They were initially divided into two groups based on angiographic reports: single vessel disease (SVD) and non-single vessel disease (non-SVD) group, then into optimal medical therapy (OMT) group, percutaneous coronary intervention (PCI) group and coronary artery bypass graft (CABG) group. Finally, PCI group is further divided into PCI of CTO lesion (CTO PCI group) and PCI of non-CTO lesion (non-CTO PCI group). Results: A total of 261 patients were enrolled as CTO patients, mean age was 62.83 years, 70.1% were male patients. The incidence rate of common risk factors was hypertension (64.4%), followed by smoking (48.3%), diabetes (34.5%) and hyperlipidaemia (27.2%). SVD, DVD and TVD were present in 39 patients (14.94%), 81 patients (31.03%) and 141 patients (54.02%) respectively. Comparing the long term efficacy, the rates of MACE and non-target vessel revascularization were higher in CTO PCI than non-CTO PCI group, and were statistically significant (p 0.05). Conclusion: The rates of MACE, non-target vessel revascularization, CABG and all cause death are lower if PCI is successfully performed in CTO patients. CTO PCI success also improves quality of life, decreases myocardial ischemia induced angina, and overall improves long term efficacy.

Urothelial carcinoma, also known as transitional cell carcinoma, is the most common primary bladder tumour in dogs, and can also involve the prostate gland. Cytology is a common diagnostic tool utilized for dogs with bladder or prostate gland lesions. The objectives of this retrospective study were to compare the sensitivity and specificity of cytologic evaluation for urothelial or prostatic carcinoma between two institutions with different cytology review protocols as well as determine if certain collection methods resulted in higher cytologic accuracy. A total of 298 cases met inclusion criteria. The overall sensitivity and specificity for institution 1 were 91.8% and 50%, respectively, compared to 31.1% and 97.4%, respectively, for institution 2. When the urine sample review protocol at institution 2 was matched to that of institution 1, sensitivity and specificity were more similar to institution 1 (71.2% and 88.9%, respectively). Our results show that the sensitivity and specificity of cytology are affected by screening and review protocols implemented by different institutions. The data also demonstrate that sensitivity and specificity vary by collection method. Diagnostic catheterization had the highest performance: of the 11 cases between two institutions, it had 100% sensitivity and specificity. In contrast, examination of urine sediment not collected via diagnostic catheterization had low sensitivity and specificity that varied greatly by institution. In summary, cytologic interpretation should be undertaken with consideration given to both processing and collection protocols.

Background: Increasing attention is being given to the rational use of invasive procedures. In this study, we aimed to evaluate, among patients referred for coronary angiography, the appropriateness of cardiac catheterization according to the Appropriate Use Criteria (AUC) for diagnostic catheterization and to examine the relationship between the appropriateness and the presence of obstructive coronary artery disease (CAD) and revascularization. Methods: From November 2017 to December 2018, 1188 consecutive patients referred to undergo a diagnostic catheterization were included. They were categorized as having appropriate, uncertain or inappropriate indication, using a database (Melograno System). We restricted our analysis to 9 appropriate indications including acute coronary syndromes, suspected CAD, valvular heart disease, arrhythmias and cardiomyopathy. We restricted the analysis to the subgroup of patients with suspected or known CAD and, among them, we evaluate the rate of CAD and the need for revascularization. Results: The indications were appropriate in 1017 patients (85.6%), of uncertain appropriateness in 134 (11.3%), and inappropriate in 37 (3.1%). Restricting the analysis to the CAD subgroup, the indications were appropriate in 848 patients (83.3%), of uncertain appropriateness in 133 (13.1%) and inappropriate in 37 (3.6%). The proportion of patients with critical CAD were 75.9%, 44.3% and 29.7% in the appropriate, uncertain and inappropriate categories respectively (p

Coronary artery disease is a leading cause of mortality, however, it is challenging to determine the functional significance of a given plaque, i.e. the likelihood of plaque rupture and major adverse cardiac events. One indicator of plaque vulnerability is intra-plaque neovascularization. If neovascularization within the plaque could be visualized with intravascular ultrasound (IVUS) imaging, it might be possible to stratify risk of rupture and determine appropriate treatment for patients with stable coronary artery disease (CAD) while the patient is undergoing diagnostic catheterization. While side-viewing IVUS is commonly used in the cardiac catheterization lab, current methods for imaging blood flow are limited to large vessels and are not sensitive slow flow in smaller vessels (< 1 mm). We propose a power Doppler approach for imaging blood flow in smaller vessels using side-viewing, mechanically-steered IVUS and singular value decomposition (SVD) filtering. This imaging approach was tested using a laboratory setup in which porcine blood was introduced at a rate of 5.6 mm/s within a 200 µm-diameter microtube positioned adjacent to the inner wall of an ex vivo porcine artery while acquiring pulse-echo data. SVD filtering allowed sufficient tissue suppression to visualize flow in the microtube, resulting in a Doppler CNR of 13.1 ± 1 dB. In the future, such an approach may allow identification of microvasculature within plaques during IVUS exams in patients undergoing cardiac catheterization.

Objective We sought to describe the prevalence, management strategies and evaluate the prognosis of patients with iatrogenic catheter‐induced ostial coronary artery dissection (ICOCAD). Background ICOCAD is a rare but potentially devastating complication of cardiac catheterisation. The clinical manifestations of ICOCAD vary from asymptomatic angiographic findings to abrupt vessel closure leading to myocardial infarction and death. Methods 55,968 patients who underwent coronary angiography over a 10‐year period were screened for ICOCAD as defined by the National Heart, Lung, and Blood Institute. The management and all‐cause mortality were retrieved from local and national databases. Results The overall prevalence of ICOCAD was 0.09% (51/55,968 patients). Guide catheters accounted for 75% (n = 37) of cases. Half of the ICOCAD cases involved the right coronary artery while the remaining were related to left main stem (23/51; 45%) and left internal mammary artery (2/51; 4%). Two‐thirds of ICOCAD were high grade (type D, E, and F). The majority of cases were type F dissections (n = 18; 66%), of which two third occurred in females in their 60s. The majority of ICOCAD patients (42/51; 82%) were treated with percutaneous coronary intervention while the remaining underwent coronary artery bypass grafting (3/51; 6%) or managed conservatively (6/51; 12%). Three deaths occurred during the index admission while 48/51 patients (94.1%) were safely discharged without further mortality over a median follow‐up of 3.6 years. Conclusions ICOCAD is a rare but life‐threatening complication of coronary angiography. Timely recognition and prompt bailout PCI is a safe option for majority of patients with good clinical outcomes.

WOS:000507337400004 PubMed: 32030031 Background : Carotid artery (CA) access allows a more straight route for many left heart lesions. This has previously been achieved via a surgical cut-down approach in certain pediatric cardiac interventions. However, there are little data considering CA access in pediatric cases, percutaneously. Aim : We hypothesized that there would be notable improvements in efficiency as well as overall success when using the CA for access in selected cases. Methods : Between November 2016 and January 2019, records of patients undergoing attempted percutaneous CA access under ultrasound guidance for cardiac catheterization were reviewed. Results Thirty patients underwent 36 catheterizations; median age 17 days (range, 6 days-9 months) and median weight 3.2 kg (1.2-7.8). Procedures performed were stenting or stent redilatation of the patent ductus arteriosus in 23, stenting or angioplasty of modified Blalock-Taussig shunts in four, aortic valvuloplasty in three, angioplasty for coarctation of the aorta in four, renal angioplasty in one, and diagnostic catheterization in one case. The intended intervention was unsuccessful in two patients despite successful CA access. Follow-up imaging showed a normal carotid in 28 of 30 (94%), with mild luminal narrowing with normal Doppler velocities in two instances. No patient had clinically apparent neurological sequelae attributable to CA access. Conclusions: Our data indicate that CA access should be employed when dealing with a select group of infants requiring vertical approach for left-sided cardiac lesions. Percutaneous CA access, even in very small preterm infants, is safe and feasible with negligible vascular injury and no neurological adverse events.

Objetivo. Identificar si el procedimiento de cateterismo cardíaco es indicado adecuadamente a los pacientes con sospecha de enfermedad arterial coronaria, en el Hospital Médico Quirúrgico del Instituto Salvadoreño del Seguro Social, de enero a diciembre 2016. Metodología. Estudio descriptivo retrospectivo. Se realizó una revisión de 290 expedientes clínicos, se calculó la muestra a través del net quest, resultando 209 expedientes de pacientes sometidos a cateterismo cardíaco. Se cataloga la indicación del cateterismo como apropiada, incierta o inadecuada. El riesgo pre test de coronariopatía se calculó con los Global Registry of Acute Coronary Events and Thrombolysis in Myocardial Infarction Scores. Utilizando Chi-cuadrado se compararon las variables categóricas. Resultados. La mayor parte de pacientes sometidos a cateterismo cardíaco fueron hombres mayores de 50 años, con alto riesgo pretest para coronariopatía, tanto por el Global Registry of Acute Coronary Events Score como por el Thrombolysis in Myocardial Infarction Score. Se observó una relación entre el grado del riesgo pre test para coronariopatía y la identificación de lesión angiográfica. Respecto a la categoría asignada con base en los “Criterios de uso apropiado del cateterismo cardiaco diagnóstico”, el 68% de los cateterismos se catalogaron como indicación apropiada y de estos, en el 99% se pudo detectar enfermedad arterial coronaria. Conclusiones. Los cateterismos cardíacos están siendo indicados de manera adecuada en el Hospital Médico Quirúrgico. Existe relación entre el riesgo pretest para coronariopatía y la categoría asignada a la indicación del cateterismo, de acuerdo con el Appropriate Use Criteria for Diagnostic Catheterization en la identificación de enfermedad arterial coronaria.Alerta Año 2018, Vol. 1 No. 1: 18-25

Iatrogenic acute dissection of ascending aorta following coronary angiography and percutaneous intervention is a rare complication. Most reports involve localized aortic dissections as a complication of cannulation of a coronary artery with propagation into the ascending aorta. It is usually treated by sealing the intima with a stent in the ostium of the coronary artery or conservative management, while extensive dissections may require a surgical intervention. We describe a case of the subclavian dissection extending into the ascending aorta that occurred during diagnostic catheterization using the radial approach. The patient was successfully treated utilizing conservative management.

Purpose More than half of patients with advanced heart failure (HF) requiring left ventricular assist device (LVAD) support have severe ischemic cardiomyopathy, yet the incidence, indications, and outcomes of coronary interventions in the LVAD population are unknown. The objective of this study was to describe outcomes of percutaneous coronary interventions (PCI) in LVAD patients. Methods Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS), we identified LVAD patients who underwent diagnostic coronary angiography from 2015-2017. The index admission for LVAD implantation was excluded. Baseline characteristics and in-hospital outcomes of those who underwent PCI vs. diagnostic catheterization only were described. Results A total of 33,456 admissions for LVAD patients were identified. Coronary catheterization was performed in 3,830 admissions (11.5%) and 260 of these resulted in PCI (6.8%). Overall, patients were more commonly men (77.3%), white (62.3%), with a high burden of comorbidities based on Elixhauser index ≥3 (99.3%). Acute myocardial infarction (AMI) (83%) was the most common indication for PCI; 35.6% were identified as a ST-elevation MI and 40% presented with or developed cardiogenic shock. Among patients undergoing PCI, the median length-of-stay was 6 days (IQR 4-10) and in-hospital mortality was 15.4%. Among patients undergoing diagnostic catheterization only, the median length-of-stay was 10 days (IQR 5-18) and in-hospital mortality was 4.3%. Other in-hospital outcomes are described in Table 1. Conclusion Although PCI procedures are uncommon in LVAD patients, they may be appropriately performed in severe AMI cases. PCI in LVAD patients is associated with significantly high in-hospital mortality. Further studies are warranted to better characterize the risk and outcomes of CAD progression in LVAD patients, as well as the utility of PCI in this complex population.

Cardiac Catheterization for diagnostic has been routinely used for the last few years in national heart centre in Nepal. Complications have been recognized as an important factor in morbidity and mortality after diagnostic catheterization. Improvements of technique and technology have reduced the morbidity of routine diagnostic catheterization, but occasional mortality seems to be unavoidable. A total of 6074 consecutive diagnostic cardiac diagnostic cardiac catheterization performed in Shahid Gangalal National Heart Centre, Kathmandu, Nepal between 2004 to 2008 were evaluated for their complications. Among them 4584 (75.46%) were coronary angiogram. 894 (14.71%) were right heart study and 596 (9.81%) were left heart study. There were 5 deaths (0.09%). Four deaths occurred following coronary angiogram and I death following left heart study in a 3 years old boy with Tetralogy of Fallot. Vascular complications occurred in 20(0.33% patients) with groin haematoma in 8 (0.13%), pseudoaneurysm in 5 (0.09%), arterrio venous fistula in 3 (0.05%) and femoral artery thrombosis in 4 (0.06%) patients. Contrast allergy occurred in 7(0.12%), cerebrovascular complication in 3 (0.05%), vasovagal reaction in 5 (0.09%) and pyrogen reaction in 10 (0.16%) of patients. The diagnostic cardiac catheterization in national heart centre has acceptable low rate of complication which includes death.

Background Atrial transseptal puncture (TSP) for cardiac catheterization procedures remain challenging in children and adults with complex congenital heart disease (CHD). Objectives We sought to evaluate our experience using radiofrequency (RF) current via surgical electrocautery needle for TSP to facilitate diagnostic and interventional procedures. Methods Retrospective chart review of all patients (pts) who underwent TSP using RF energy (10–25 W) via surgical electrocautery from three centers from January 2011 to January 2017 were evaluated. Echocardiograms were reviewed to define the atrial septum as normal and complex (thin aneurysmal, thick/fibrotic, synthetic patch material, and extra cardiac conduit). Results A total of 54 pts underwent 55 successful TSP. Median age was 12.5 years (1 day–54 years) and weight was 52.7 kg (2–162). Indications for TSP included; EP study and ablation procedures in structurally normal hearts (n = 24) and in complex atrial septum/CHD and structural heart disease pts (n = 30): Electrophysiology study and ablation in 4, diagnostic catheterization in 9, and interventional procedures in 17 pts were performed. Atrial TSP was successful in 54/55 (98%). Atrial perforation with tiny-small pericardial effusion not requiring intervention was noted in 2 pts. TSP was unsuccessful in one critically ill neonate with unobstructed TAPVR and restricted atrial septum who experienced cardiac arrest requiring CPR, ECMO, and emergent surgery. Conclusions RF current delivery using surgical electrocautery for TSP is a feasible and an effective option in patients with complex CHD for diagnostic, interventional, and electrophysiology procedures.

Key Clinical Message We are presenting rare, but life-threatening complication of diagnostic coronary catheterization. To overcome the problem requires operator's experience and appropriate actions. We want to share our experience to interventionalists to be aware and ready to recognize and overcome such complication.

Drug-eluting stents (DES) reduce restenosis but require prolonged antiplatelet therapy, when compared with bare metal stents. Ideally, the patient should be involved in this risk:benefit assessment prior to selecting DES, to maximize the benefits and cost-effectiveness of care, and to improve medication adherence. However, accurate estimation of restenosis risk may require angiographic factors identified at cardiac catheterization.In a large PCI registry, we used logistic regression to identify clinical and angiographic predictors of clinically-driven target lesion revascularization (TLR) over the first year after stent placement. Discrimination c-statistic and integrated discrimination improvement (IDI) were used to calculate the incremental utility of angiographic variables when added to clinical predictors.Of 8501 PCI patients, TLR occurred in 4.5%. After adjusting for DES use, clinical TLR predictors were younger age, female sex, diabetes, prior PCI, and prior bypass surgery (model c-statistic 0.630). Angiographic predictors were vein graft PCI, in-stent restenosis lesion, longer stent length, and smaller stent diameter (c-statistic 0.650). After adding angiographic factors to the clinical model, c-statistic improved to 0.680 and the average separation in TLR risk among patients with and without TLR improved by 1% (IDI=0.010, 95% CI 0.009-0.014), primarily driven by those experiencing TLR (from 5.9% to 6.9% absolute risk).Among unselected PCI patients, the incidence of clinically-indicated TLR is5% at 1-year, and standard clinical variables only moderately discriminate who will and will not experience TLR. Angiographic variables significantly improve TLR risk assessment, suggesting that stent selection may be best performed after coronary anatomy has been delineated.Although several recent studies have challenged traditional expectations regarding the duration of dual antiplatelet therapy, current guidelines recommend at least 6 to 12months of treatment after implantation of a drug eluting stent, with a shorter course for bare metal stents. Stent selection ideally should involve input from the patient receiving these stents, but multiple studies have suggested that angiographic factors - obtained after the patient has received sedation during the diagnostic catheterization - are important predictors of repeat revascularization. In this analysis from a large registry of patients receiving coronary stents, angiographic characteristics were found to significantly improve risk assessment for target lesion revascularization, when added to clinical variables alone.

Uric acid is a risk factor for coronary artery disease in postmenopausal women, but the association with inflammation and coronary endothelial dysfunction (CED) is not well defined. The aim of this study was to determine the relationship of serum uric acid (SUA), inflammatory markers, and CED. In this prospective cohort study, SUA, high-sensitivity C-reactive protein levels, and neutrophil count were measured in 229 postmenopausal women who underwent diagnostic catheterization, were found to have no obstructive coronary artery disease, and underwent coronary microvascular function testing, to measure coronary blood flow response to intracoronary acetylcholine. The average age was 58 years (interquartile range, 52–66 years). Hypertension was present in 48%, type 2 diabetes mellitus in 5.6%, and hyperlipidemia in 61.8%. CED was diagnosed in 59% of postmenopausal women. Mean uric acid level was 4.7±1.3 mg/dL. Postmenopausal women with CED had significantly higher SUA compared with patients without CED (4.9±1.3 versus 4.4±1.3 mg/dL; P =0.02). There was a significant correlation between SUA and percent change in coronary blood flow to acetylcholine ( P =0.009), and this correlation persisted in multivariable analysis. SUA levels were significantly associated with increased neutrophil count ( P =0.02) and high-sensitivity C-reactive protein levels ( P =0.006) among patients with CED, but not among those without CED. SUA is associated with CED in postmenopausal women and may be related to inflammation. These findings link SUA levels to early coronary atherosclerosis in postmenopausal women.

A 17-month-old infant with multiple aorto-pulmonary collateral arteries (MAPCAs) and pulmonary hypertension presented for diagnostic catheterization. On the day of the procedure, the infant was asymptomatic with oxygen saturation in the 90’s on 1.0 L/min O2 nasal cannula. His parents denied any recent illness. During the procedure, one coil was inadvertently embolized into the right lung resulting in markedly increased pulmonary artery pressures. The Pa-etCO2 gradient increased to 25 mmHg from a baseline of 2 mmHg. Therapy was initiated to reduce the PaCO2. The patient could not be weaned from mechanical ventilation due to elevated PA pressures.

A 53‐year‐old man presented with symptomatic severe pulmonary valve regurgitation. He underwent a diagnostic catheterization. A heavily calcified pericardium and the pressure tracings illustrate typical features of constrictive pericarditis physiology, including the "square root sign." This condition is important to recognize given the progressive nature and poor prognosis if untreated.

Background Cardiac catheterisation was considered the gold standard for confirmation of diagnosis and analyzing various management issues in congenital heart diseases. It is now frequently used for therapeutic reasons. Purpose Our study aims to describe the current state of paediatric catheterisation and analyse the type, the result, the anaesthetic principles and the main complications of the performed procedures. Methods This was a retrospective study conducted in the Cardiology department in conjunction with the Paediatric Resuscitation-Anaesthesia department at the University Hospital Centre of Casablanca from January 2013 to June 2017, including patients having undergone paediatric catheterisation. Results Fifty patients were included. The male sex was more common with a sex ratio of 1.4 and the mean age was 5.5 years. In total, 74% of patients underwent interventional catheterisation; the main indications were Rashkind's atrioseptostomy (26%), dilatation of pulmonary stenosis (21%), and the success rate was 95%. A diagnostic catheterization was performed in 26% of cases mainly in the Tetralogy of Fallot (31%) and the Ventricular septal defect (23%) in order to explore the anatomy, the hemodynamics and to look for pulmonary hypertension that will determine the operability; 67% were operable. Concerning anaesthesia, the controlled administration of anesthetics and the appropriate monitoring were necessary for the proper course of interventions. Complications occur in 18% of cases including post-procedure infection (4%), death (4%) by cardiorespiratory arrest and septic shock, bleeding from the puncture site (4%), acute limb ischemia (2%), extreme bradycardia (2%) and allergic reaction to contrast (2%) ( Fig. 1 ). Conclusion Interventional paediatric catheterisation has grown remarkably in Morocco. These procedures have become the treatment of choice for many cardiac lesions, and serve as alternatives or adjuncts to surgical treatment.

Background Urine flow rate (UFR)-guided and left-ventricular end-diastolic pressure (LVEDP)-guided hydration regimens have been proposed to prevent contrast-induced acute kidney injury (CIAKI). The REnal Insufficiency Following Contrast MEDIA Administration triaL III (REMEDIAL III) is a randomized, multicenter, investigator-sponsored trial aiming to compare these two hydration strategies. Methods Patients at high risk for CIAKI (that is, those with estimated glomerular filtration rate ≤ 45 mL/min/1.73 m2 and/or with Mehran's score ≥11 and/or Gurm's score >7) will be enrolled. Patients will be randomly assigned to (a) LVEDP-guided hydration with normal saline (LVEDP-guided group) and (b) UFR-guided hydration carried out by the RenalGuard system (RenalGuard group). Seven-hundred patients (350 in each arm) will be enrolled. In the LVEDP-guided group the fluid infusion rate will be adjusted according to the LVEDP as follows: 5 mL kg-1 hr-1 for LVEDP ≤12 mmHg, 3 mL kg-1 hr-1 for LVEDP 13-18 mmHg, and 1.5 mL kg-1 hr-1 for LVEDP >18 mmHg. In the RenalGuard group hydration with normal saline plus low-dose of furosemide is controlled by the RenalGuard system, in order to reach and maintain a high (>300 mL/hr) UFR. In all cases, iobitridol (a low-osmolar, nonionic contrast agent) will be administered. Results The primary endpoint is the composite of CIAKI (i.e., serum creatinine increase ≥25% and/or ≥0.5 mg/dL from the baseline to 48 hr after contrast media exposure) and/or acute pulmonary edema. Conclusion The REMEDIAL III will test the hypothesis that the UFR-guided hydration is superior to the LVEDP-guided hydration to prevent the composite of CIAKI and/or acute pulmonary edema.

Objectives The goal of the present study was to survey the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists to evaluate contemporary practice patterns with regards to contrast use, acute kidney injury (AKI) risk assessment, and prevention in patients undergoing invasive angiography. We sought to compare the physician responses against guideline statements and evidence-based data from clinical studies. Methods A 20-question online survey based on a modified Likert scale was sent out via email to the Society of Cardiovascular Angiography and Intervention (SCAI) member cardiologists. The survey questions focused on prophylaxis methods, medication management, risk assessment, contrast agent use, and postprocedure care. A scoring system was developed which examined the individual responses to analyze the 10 questions with the greatest strength of evidence in the literature and guidelines. Results The survey was completed by 506 individuals. Selected responses of note included the use of standardized volume expansion protocols: 64.8%, use of iso-osmolar contrast (iodixanol) in the majority of patients at risk of AKI: 55%, and 27% of individuals reported diluting contrast with saline for patients at risk of AKI during coronary angiography. For questions with support from guideline documents, 56.9% of the responses were scored as concordant with evidence-based data. Individuals who reported that the risk of AKI was often or always important in planning angiography for “at risk patients” were more likely to closely monitor renal function (76.7% vs. 40.0%, P = 0.003), obtain nephrology consultation (45.2% vs. 13.3%, P = 0.016) and use iso-osmolar contrast agents (56.0% vs. 26.7%, P = 0.033). Conclusions The majority of cardiologists participating in this survey, reported practice patterns consistent with guideline and evidence-based recommendations. However, over 40% of responses to questions were inconsistent with these recommendations, suggesting continued opportunities for education and quality improvement concerning AKI prevention. © 2016 Wiley Periodicals, Inc.

A 28-year-old male with single ventricular heart disease status post Fontan palliation and subsequent placement of left ventricle to ascending aorta (LV-AAo) valved conduit developed ascites and edema. Diagnostic catheterization revealed elevated ventricular end diastolic pressures (EDP) secondary to severe LV-AAo conduit regurgitation. Given the unique anatomy, surgical access via the right axillary artery provided optimal route for transcatheter valve implantation within the conduit. The procedure resulted in significant hemodynamic improvement with no complications. © 2016 Wiley Periodicals, Inc.

Although the utility of diagnostic cardiac catheterization in the clinical setting has diminished over the last years, due to the emergence of noninvasive imaging modalities, such as echocardiography, magnetic resonance imaging and computed tomography, catheterization for diagnostic reasons still constitutes a valuable tool in certain parts in the workup of pediatric heart disease. As a result, awareness of the main aspects of diagnostic catheterization is of great importance for the clinical cardiologist. In this article, the main variables measured and the main actions performed during diagnostic cardiac catheterization in children are discussed.

Objectives To evaluate radiation reduction by reducing fluoroscopy pulse rate in diagnostic cardiac catheterizations and percutaneous coronary interventions (PCI) as well as outcomes at 30 days and six months. Background Radiation exposure to the public at large has increased dramatically over the past three decades, and the cardiac catheterization laboratory is a large contributor. Fluoroscopy pulse rate is one way to decrease radiation exposure. Methods Fluoroscopy pulse rate was reduced from 10 pulses/sec (p/s) to 7.5 p/s as part of an internal quality improvement project. A retrospective analysis of all cardiac catheterizations was performed, evaluating Air KERMA at the interventional reference point (Ka, r), Air KERMA area product (PKA), procedural complications and major adverse cardiac events at 30 days and 6 months. Results In diagnostic catheterization median PKA (µGy·m2) and Ka,r (mGy) were significantly reduced (PKA – 5,613.3 vs. 4,400, P