Search

Aims The aim of the present study was to describe a 10 years single-centre experience in pacing and defibrillating leads removal using an effective and safe modified mechanical dilatation technique. Methods and results We developed a single mechanical dilating sheath extraction technique with multiple venous entry site approaches. We performed a venous entry site approach (VEA) in cases of exposed leads and an alternative transvenous femoral approach (TFA) combined with an internal transjugular approach (ITA) in the presence of very tight binding sites causing failure of VEA extraction or in cases of free-floating leads. We attempted to remove 2062 leads [1825 pacing and 237 implantable cardiac defibrillating (ICD) leads; 1989 exposed at the venous entry site and 73 free-floating] in 1193 consecutive patients. The VEA was effective in 1799 leads, the TFA in 28, and the ITA in 205; in the overall population, we completely removed 2032 leads (98.4%), partially removed 18 (0.9%), and failed to remove 12 leads (0.6%). Major complications were observed in eight patients (0.7%), causing three deaths (0.3%). Conclusion Mechanical single sheath extraction technique with multiple venous entry site approaches is effective, safe, and with a good cost effective profile for pacing and ICD leads removal.

Aims We explored the role of microcirculation integrity following the chronic occlusion of an infarct-related artery to assess the behaviour of collateral circulation during and after reperfusion by coronary angioplasty Methods and Results Eighteen patients with a proximally occluded left anterior descending artery and firm evidence of intercoronary collateral circulation were studied with selective coronary angiography and selective intracoronary myocardial contrast echocardiography, before coronary angioplasty, and at 5 and 15min and 12h later. Myocardial enhancement during myocardial contrast echocardiography was evaluated with a semiquantitative score (0–3), which was correlated to basal and 6 months’ regional left ventricular wall motion results. 16/18 procedures were successfully performed; four patients with an inadequate acoustic window were excluded. Restenosis was evident at the 6 months’ follow-up in two patients. Basal myocardial contrast echocardiography indicated that 81/192 segments from the left anterior descending coronary artery and 90/192 from the right coronary artery were perfused; no perfusion was observed in 21 segments either before or after coronary angioplasty. After coronary angioplasty, the angiographic intercoronary collateral circulation immediately disappeared, and myocardial contrast echocardiography revealed that there was a progressive reduction of segments perfused by the right coronary artery and an increase in segments perfused by the left anterior descending coronary artery. Regional left ventricular wall motion analysis demonstrated that there was abnormal motion in 51/192 segments. There was no improvement in segments with score 0 and abnormal motion after 6 months (100% sensitivity), but 16/17 segments with score 3 did show an improvement (98% specificity). The predictive value of intermediate scores (1–2) in detecting long-term improvement, was only 43%. Conclusion These data show that the adaptive mechanism observed in the behaviour of epicardial and microvascular circulation after reperfusion of a chronic occluded infarct-related artery can vary. In addition, this study clearly shows that microvascular integrity detected by myocardial contrast echocardiography can provide myocardial viability The European Society of Cardiology

Purpose: This study evaluated if the color doppler ultrasound (CDU) parameters such as location, extention and adhesion of thrombi of Deep Vein Thrombosis (DVT) of the lower limbs are predictive of Pulmonary Embolism (PE) complication and its gravity. The latter was assessed on clinical evaluations and imaging including pathognomonic symptoms (dyspnea, thoracic pain and syncope), perfusion lung scans and mortality risk. Methods: 224 patients (pts) diagnosed of PE were subjected to lower limb deep vein CDU and perfusion lung scan within 5 days from admission. The sample was divided into 4 categories by the presence or absence of DVT and its position. The presence or absence of symptoms at the PE emergence, the average Perfusion Damage Index for each category as well as the early mortality risk (calculated on the base of right ventricular disfunction using echocardiography and/or miocardial injury marker based on European Society of Cardiology 2008 guidelines) were also considered. Moreover cancer pts (n° 101, 45%) were evaluated indipendently, as well as pts with freefloating thrombus (FFT) proximal DVT. Results: See Table 1. View this table: Table 1 Conclusions: Pts without DVT had similar clinical and imaging PE results compared to pts with DVT. Distal DVT has less risk and gravity of PE compared to the Proximal DVT, whereas in the FFT and bilateral cases the gravity is higher. We can conclude that neoplasms are the most frequent causes of secondary venous thromboembolic disease, particularly in pts with bilateral DVT as well as in pts without DVT. In our study also emerged that cancer pts are prevalently asymptomatic at onset of PE.