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Presence of right heart failure (RHF) is associated with a worse prognosis in patients with left ventricular failure (LVF). While the cause of RHF secondary to LVF is multifactorial, an increased right ventricular (RV) afterload is believed as the major cause of RHF. However, data are scarce on the adaptive responses of the RV in patients with LVF. Our aim was to understand the relationship of right ventricular hypertrophy (RVH) with RHF and RV systolic and diastolic properties in patients with LVF. 55 patients with a left ventricular ejection fraction of 40% or less were included in the present study. A comprehensive two-dimensional transthoracic echocardiographic examination was done to all participants. 12 patients (21.8%) had RHF, and patients with RHF had a significantly lower right ventricular free wall thickness (RVFWT) as compared to patients without RHF (5.3 ± 1.7 mm vs. 6.6 ± 0.9 mm, p = 0.02) and the difference remained statistically significant after adjusting for confounders (Δx̅:1.34 mm, p = 0.002). RVFWT had a statistically significant correlation with tricuspid annular plane systolic excursion (r = 0.479, p < 0.001) and tricuspid annular lateral systolic velocity (r = 0.360, p = 0.007), but not with the indices of the RV diastolic function. None of the patients with concentric RVH had RHF, while 22.2% of patients with eccentric RVH and 66.7% of patients without RVH had RHF (p < 0.01 as compared to patients with concentric RVH). In patients with left ventricular systolic dysfunction, absence of RVH was associated with worse RV systolic performance and a significantly higher incidence of RHF., (© 2022. Springer Japan KK, part of Springer Nature.)

Background: The accurate determination of low-density lipoprotein cholesterol (LDL-C) is important to reach guideline-recommended LDL-C concentrations and to reduce adverse cardiovascular outcomes in diabetic patients. The commonly used Friedewald equation (LDL-Cf), gives inaccurate results in diabetic patients due to accompanying diabetic dyslipidemia. Recently two new equations - Martin/Hopkins (LDL-Cmh) and Sampson (LDL-Cs) - were developed to improve the accuracy of LDL-C estimation, but data are insufficient to suggest the superiority of one equation over the other one., Objective: The present study compared the accuracy and clinical usefulness of novel Martin/Hopkins and Sampson equations in diabetic patients., Methods: This study included 402 patients with diabetes. Patients' cardiovascular risk and LDL-C targets were calculated per European guidelines. Calculated LDL-Cmh, LDL-Cs, and LDL-Cf concentrations were compared with direct LDL-C concentration (LDL-Cd) to test agreement between these equations and LDL-Cd. A p-value <0.05 was accepted as statistically significant., Results: Both LDL-Cmh and LDL-Cs had a better agreement with LDL-Cd as compared to LDL-Cf, but no statistical differences were found among novel equations for agreement with LDL-Cd (Cronbach's alpha 0.955 for both, p=1). Likewise, LDL-Cmh and LDL-Cs showed a similar degree of agreement with LDL-Cd in determining whether a patient was in a guideline-recommended LDL-C target (96.3% for LDL-Cmh and 96.0% for LDL-Cs), which were marginally better than LDL-Cf (94.6%). In patients with a triglyceride concentration >400 mg/dl, agreement with LDL-Cd was poor, regardless of the method used., Conclusion: Martin/Hopkins and Sampson's equations show a similar accuracy for calculating LDL-C concentrations in patients with diabetes, and both equations were marginally better than the Friedewald equation.

Percutaneous transluminal angioplasty has gained increasing popularity in the treatment of peripheral artery disease. However, the increase in the frequency of this procedure also increases the risk of complications. Percutaneous transluminal angioplasty has serious and general complications in terms of device and technique at puncture and dilatation sites. In this case, we describe the easy and practical management of deflating an undeflated ballon in the right superficial femoral artery.

In recent years, percutaneous transluminal angioplasty has become the preferred revascularization option for chronic limb-threatening ischemia (CLTI) and infrapopliteal (IP) arterial disease. CLTI and IP disease require complex and lengthy procedures that necessitate multiple balloon inflations and frequent contrast injections. It will lead to severe discomfort if periprocedural pain control is inadequate. Conventional methods such as local anesthesia and systemic opioids are usually inadequate to provide pain control for complex IP arterial disease interventions. Ultrasound-guided peripheral nerve blockade (PNB) has been recently employed in peripheral procedures, with several small studies reporting favorable results in patients who underwent not complex interventions. In the present series, we report our experience of 4 patients who underwent PNB to relieve pain during endovascular treatment of complex IP disease, and in whom we have observed excellent periprocedural pain control that led to satisfactory postprocedural outcomes.

Background: There is not a widely accepted optimal rate of stent opening in patients underwent carotid artery stenting. In this study we evaluated the effect of carotid stent opening rate (CSOR) without performing post-dilation on in-hospital and long-term outcomes., Methods: A total of 825 patient patients underwent carotid artery stenting without post-dilation enrolled to the study. The patients divided into two groups according to their final CSOR (50% ≤ Post-stent deployment (SD) <80% and 80% ≤ Post-SD ≤ 100%). In-hospital and 3-year outcomes were compared between the groups., Results: During hospitalization, the rate of ipsilateral stroke, major stroke and transient ischemic attacks were similar between the groups (respectively; 6.2% vs. 4.1, P = 0.190; 1.5% vs. 1.8, P = 0.811; 1.5% vs. 1.9%, P = 0.683). The 3-year Kaplan-Meier overall survival rates for the first and second groups were 87.6% and 84.4%, respectively (log rank test P = 0.426). The 3-year Kaplan-Meier overall cumulative ipsilateral stroke rates for the first and second groups were 88.0% and 88.6%, respectively (log rank test P = 0.409) CONCLUSION: Our study demonstrated that a CSOR higher than 50% without performing a post-dilation might be an effective therapeutic approach since there was not a significant difference regarding outcomes between the patients with a 50% ≤ Post-SD <80% and 80% ≤ Post-SD ≤ 100%. The need for post-stent balloon dilation might have been eliminated due to subsequent stent self-expansion., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Coronary artery bifurcation disease of a saphenous vein graft (SVG) is extremely rare. SVG disease remains a challenging lesion to treat because of increased morbidity and mortality with repeated coronary artery bypass graft (CABG) surgery, a high rate of periprocedural complications, and in-stent restenosis or occlusion requiring repeat revascularization with percutaneous coronary intervention. Presently described is use of the simultaneous kissing stent technique to treat inverted Y SVG bifurcation disease in a patient with a prior CABG and new-onset acute coronary syndrome.

Coronary fistulae may lead to coronary steal phenomenon or considerable volume overload on the cardiac chambers, causing significant hemodynamic problems. Coronary fistulae can be closed either surgically or percutaneously. Percutaneous closure is frequently performed with coil embolization or a vascular plug. Although percutaneous closure has significant advantages, such as a shorter duration of hospitalization and no sternal scarring, several complications, including coil embolization or failure to retrieve the device, may occasionally occur. In the current report, a patient with a left coronary to right atrium fistula who declined to have surgery underwent percutaneous coil embolization. However, after release of the coil, the catheter could not be retrieved using the standard anti-torque mechanism.

Endovascular interventions are now used more frequently in the treatment of femoropopliteal occlusions, and antegrade passage through the occlusion is preferred as the first option. However, when antegrade passage fails for any of several reasons, retrograde, or less frequently, collateral passage may be used. Although collateral passage may present serious complications, it can be successfully applied in selected cases in experienced centers. In the present case, a superficial femoral artery occlusion was successfully opened with a collateral approach.

Coronary fistulas are defined as the presence of an abnormal connection between the coronary arteries and the low-pressure vascular area or the cardiac cavity. The clinical significance depends on the amount of blood flow through the fistula segment, the volumetric load on the right and left heart chambers, and whether it leads to a coronary steal phenomenon. Although fistula flow can be better visualized by angiographic methods, it can also be seen by echocardiography. In this case, the fistula flow draining to the left ventricle was demonstratively visualized.

Percutaneous closure of atrial septal defects is accepted as a safe and effective treatment method. Device embolization is a rare, but potentially fatal complication. While embolized devices are typically removed surgically, in eligible cases, they can also be removed percutaneously at an experienced center. Presently described is the retrieval of an embolized device with a novel percutaneous technique.

Objective: The aim of this study was to evaluate the relation between blood gamma-glutamyltransferase (GGT) levels and coronary collateral circulation in patients with chronic total occlusion (CTO)., Methods: Two hundred twenty-two patients with chronic stable coronary artery disease (CAD) and CTO were included in this cross-sectional, observational study. Coronary collaterals were graded from 0 to 3 according to the Rentrop method. Patients with grade 0-1 collateral development were regarded as poor collateral group (n=66) while patients with grade 2-3 collateral development were regarded as good collateral group (n=156). Statistical analysis was performed using independent samples t, Mann-Whitney U and Chi-square tests, logistic regression and receiver operator curve analysis., Results: The poor coronary collateral group had significantly higher levels of serum GGT compared to the good collateral group (p<0.001). Multiple logistic regression analysis showed that GGT levels were independent predictors of poor collateral circulation (OR-0.946, 95% CI=0.918-0.9719, p<0.001). The result of ROC curve analysis for GGT was as following: area under the ROC curve (AUC)=0.732, 95% CI: 0.622-0.841, p<0.001., Conclusion: Higher GGT levels are associated with poor coronary collateral circulation in patients with CTO. GGT may be used to predict the grade of coronary collateral circulation in CTO patients with chronic stable CAD.

Chronic upper extremity deep vein thrombosis (UEDVT) and superior vena cava syndrome (SVCS) are becoming increasingly common due to the use of indwelling catheters and implantable central venous access devices. Hypercoagulable syndromes, malignancy, extrinsic compression, and tumor invasion are other causes. Endovascular management of chronic UEDVT and SVCS is accepted as an important first-line treatment given its high overall success rate and low morbidity as compared with medical and surgical treatments. In this case, we present successful management with stenting of superior vena cava obstruction syndrome as a result of chronic thrombosis. A 48-year-old woman was diagnosed with SVCS one year ago. Despite the use of warfarin therapy, her symptoms (swelling of the face and both upper extremities) progressively increased. It was thus decided to treat the patient with percutaneous angioplasty and stenting. Details of the occlusion were evaluated with computed tomography and venography. The right femoral vein and right jugular vein were used for the intervention. The occlusion was passed with a Miracle 12-g guidewire. After balloon pre-dilatation, two self-expandable stents were implanted. After stent placement, her clinical symptoms improved and she was discharged without complication.

Aim: The aims of this study were to determine the early mortality rate in low-risk coronary artery bypass graft (CABG) patients and examine the causes of death, to identify problems that could be avoided in future surgeries., Methods: All low-risk patients (EuroSCORE ≤ 2) who died after CABG were included. Their peri-operative information was meticulously studied by internal and independent external reviewers to identify causes of death, which were classified as: cardiac or non-cardiac; and a further division as: (1) non-preventable, (2) preventable (technical error), and (3) preventable (system error)., Results: Early mortality was 0.93% (24/2570). Eleven patients (45.8%) were classified as preventable deaths. In six of them the main problem was identified as graft thrombosis, which was secondary to a technical error of either the harvesting or anastomosis of the left internal mammarian artery. There were also five system errors identified as delays in the treatment of an identified and potentially reversible problem., Conclusion: Correction of technical and system errors, such as harvesting of the left internal mammarian artery, haemostasis during surgery, and establishing standard protocols for the transfer of patients from ward to intensive care units will eventually lead to improvement in both the quality of care and patient outcomes, even in low-risk groups.