Search

An abstract of the article "Geometrical linearization of aortic contour: angiographic sign in acute intramural aortic hemorrhage detected with transesophageal echo" by F. Bovenzi and colleagues is presented.

An abstract of the article "Poliparametric functional evaluation of left atrial appendage obtained with transthoracic echocardiography: comparison with transesophageal echocardiography" by P. Colonna, M. Sorino, B. Del Salvatore, and colleagues is presented.

An abstract of the article "A new sign of left atrial appendage function obtained with monodimensional transthoracic 2nd harmonic echocardiography" by P. Colonna, M. Sorino, B. Del Salvatore, L. De Luca, L. B. Corlianò, and I. De Luca is presented.

Persistent left superior vena cava is a rare congenital abnormality. Cases of persistent left superior vena cava with an absent right superior vena cava or the presence of other congenital cardiovascular abnormalities have been rarely described. To the best of our knowledge, this is the first case of a patient with persistent left superior vena cava, absent right superior vena cava and tako-tsubo syndrome observed during an attempt of pacemaker implantation. Such a condition was confirmed by means of contrast echocardiography and coronary angiography.

Background: In patients with atrial fibrillation (AF) eligible for electrical cardioversion (C), the guided approach with transesophageal echocardiography (TEE) allows to avoid the 3 weeks of recommended precardioversion anticoagulation therapy. However, after sinus rhythm restoration, at least other 4 weeks of oral anticoagulation therapy are indicated, due to the postcardioversion thromboembolic risk related to left atrial (LA) and left atrial appendage (LAA) stunning. The aim of this study was to prospectively assess the effectiveness and the safety of anticoagulation therapy discontinuation 7 days after C using low-molecular-weight heparins (LMWH) in a selected group of patients who underwent a pre-C and 7 days post-C TEE evaluation., Methods: One hundred one patients (74 patients with nonvalvular AF and 27 patients with atrial flutter lasting >48 h and history of AF) were enrolled into the study. Two patients refused the TEE, therefore, in 99/101, we performed a first TEE and, within 24 h, a C if there were no LAA thrombi, complex aortic plaques or severe spontaneous echocontrast. After C and 7 days of home-administered enoxaparin, a second TEE was carried out. In the absence of any new thrombi, severe spontaneous echocontrast and/or low emptying velocity of LAA, the therapy with enoxaparin was stopped; otherwise, anticoagulation therapy with enoxaparin was overlapped with oral anticoagulation and continued for at least 3 weeks. All patients were clinically followed at 1, 6 and 12 months after C., Results: Sinus rhythm was restored in 68/99 patients after successful C. The second TEE was carried out in 53 patients. At 1 month follow-up, no thromboembolic events were recorded either in patients at risk who had continued the oral anticoagulant therapy for at least 3 weeks or in those who suspended LMWH after 7 days post-C TEE. Between the 2nd and 12th month, three ischemic strokes occurred, all in the group of patients who had anticoagulation therapy for at least 3 weeks and had shown LAA velocity <25 cm/s at first or second TEE. No thromboembolic events were recorded in patients with normal LAA velocity; conversely, among the patients who had shown low LAA velocity at either TEE, three suffered from ischemic stroke. In two of these three patients, low LAA velocity was detected only at post-C TEE., Conclusions: A brief anticoagulation therapy using LMWH appears to be safe and feasible. The 7 days post-C TEE can well-define patients without LAA stunning at low thromboembolic risk, who may take advantage of an early interruption of enoxaparin as an alternative to long oral anticoagulation. The LAA stunning, even in the absence of other thromboembolic risk factors, could select a group of patients at high risk who should continue oral anticoagulation indefinitely or until signs of LAA dysfunction disappear.

Background: We prospectively investigated whether plasma homocysteine (HCY) concentrations are related to target lesion revascularization (TLR) rates in patients with unstable angina undergoing stenting., Methods: We enrolled 196 consecutive patients with at least one successful coronary stent implantation for unstable angina., Results: The mean vessel diameter was 3.1 +/- 0.5 mm. At follow-up (17.8 +/- 7.5 months), patients with higher HCY levels (> 17 micromol/l, 4th quartile) had similar TLR rates to the rest of the sample (11.1 vs 13.2%, p = 0.90). On the other hand, high HCY levels did seem to be associated with higher total (13.3 vs 0.7%, p = 0.001) and cardiac (6.7 vs 0%, p = 0.01) mortality rates. At multivariate analysis, only target vessel diameter independently predicted TLR, while both HCY levels and target vessel size predicted late total mortality., Conclusions: At least in patients with a mean vessel diameter > 3 mm, HCY levels cannot be taken as a prognostic indicator of in-stent restenosis for patients with unstable angina. However, in spite of successful percutaneous revascularization, HCY values do seem to strongly influence late mortality.

Background: The aim of the study was to evaluate, on single center prospective data, long-term angiographic and clinical results of intracoronary beta (32P) brachytherapy in "real world" patients with high-risk in-stent restenosis lesions., Methods: Sixty-nine consecutive patients (77 lesions) with high-risk in-stent restenosis (mean lesion length 30.3 +/- 16.1 mm, pattern III-IV 57.2%, diabetes 33.3%) treated with percutaneous dilation procedures and beta-radiation therapy, underwent 7-month clinical and angiographic follow-up., Results: One patient (1.4%) presented with procedural non-Q wave myocardial infarction. At a mean follow-up of 7 +/- 1.5 months, death was observed in 1 patient (1.4%) and non-Q wave myocardial infarction in 3 (4.3%) (in 2 patients, who prematurely discontinued antiplatelet therapy, caused by late coronary thrombosis). Seven-month binary angiographic restenosis occurred in 20 lesions (25.9%) (in-stent restenosis 11.6%). Target lesion and target vessel revascularization occurred in 20 (28.9%) and 21 (30.4%) patients. At follow-up only 12 (17.3%) patients presented with CCS class III-IV angina. After intracoronary beta brachytherapy angiographic restenosis occurred regardless of the vessel size, lesion length and ostial location. On the contrary a high restenosis rate was documented in obstructive lesions., Conclusions: As applied in routine clinical practice, radiation therapy is safe and effective in the treatment of high-risk in-stent restenosis. In spite of all that, total occlusion at baseline predicts late angiographic restenosis.

Background: Many studies have indicated that a small lumen size is one of the most important predictors of acute events and of late restenosis after balloon angioplasty or stent implantation. In the last few years many studies have shown that intravascular ultrasound (IVUS) guidance makes it possible to optimize stent implantation. The aim of this pilot study was to evaluate the feasibility and safety of IVUS imaging of small vessels. Secondary endpoints were the immediate and long-term results of IVUS-guided elective BeStent implantation in small vessels., Methods: Fourteen symptomatic patients with small coronary vessel (mean angiographic reference diameter 2.3 +/- 0.2 mm) disease underwent IVUS-guided BeStent implantation. IVUS success was defined as the achievement of a final minimal intrastent cross-sectional area (CSA) > 90% of the smaller reference lumen CSA., Results: IVUS evaluation was feasible in all patients without any clinical or angiographic adverse events. Procedural success was achieved in all patients with implantation of a BeStent 15 mm. No major complication (death, myocardial infarction, stent acute or subacute thrombosis, coronary artery bypass, re-coronary angioplasty) occurred during the in-hospital phase. Two non-flow-limiting, asymptomatic coronary dissections were detected after stent expansion. The post-stenting lesion stenosis rate decreased from 72.9 +/- 12.9% to 0.75 +/- 11.7% with an acute gain of 1.8 +/- 0.4 mm. The final IVUS minimal stent CSA was 5.6 +/- 1.1 mm2. The IVUS criteria of adequate stent expansion were reached in 11 (78.6%) patients. At 6 months of follow-up, the rate of angiographically diagnosed in-stent restenosis was 30.7%; the 6-month late loss in stent diameter was 1.1 +/- 0.6 mm. No patient died or presented with a myocardial infarction. The target lesion revascularization rate was 30.7%., Conclusions: Coronary IVUS-guided stenting can be performed in small vessels with a high success rate and low incidence of in-hospital complications. However, despite these encouraging short-term results, the long-term clinical and angiographic outcome is less favorable. Further larger and randomized IVUS studies, probably employing more aggressive IVUS criteria, are needed to clarify the true role of IVUS guidance in this particular field.