Aleksander Ernst

The impact of successful manual thrombus aspiration on in-stent restenosis after primary PCI: angiographic and clinical follow-up.

ObjectivesThis study sought to investigate the impact of successful manual thrombus aspiration on angiographic in-stent restenosis and clinical outcome in patients treated by bare metal stent implantation for ST-segment elevation acute myocardial infarction. BackgroundThere are very limited data on the impact of manual thrombus aspiration on the occurrence of in-stent restenosis after bare metal stent implantation. MethodsThis was a prospective, randomized, single-center study. Patients (N=60) presenting within 12 h of ST-segment elevation acute myocardial infarction symptom onset were randomized to primary percutaneous coronary intervention (PCI) with (N=30) or without (N=30) upfront manual thrombus aspiration using the Export aspiration catheter. All patients underwent control coronary angiography after 6 months. ResultsBaseline, clinical, and angiographic preprocedural findings did not differ between the two groups. Patients who underwent successful manual thrombus aspiration had significantly higher minimal lumen diameter after 6 months (2.25±0.90 vs. 1.63±0.76, P=0.005), significantly lower percentage diameter stenosis (28.81 vs. 45.03%, P=0.017), and significantly lower late lumen loss (0.73±0.84 vs. 1.18±0.79, P=0.035). There was a trend for lower rate of major adverse cardiocerebrovascular events such as death, myocardial reinfarction, stroke, and target lesion revascularization in the same group of patients (16.67 vs. 26.67%, P=0.347). ConclusionSuccessful upfront manual thrombus aspiration during primary PCI showed beneficial effects on the reduction of in-stent restenosis after bare metal stent implantation compared with standard PCI.

Apical ballooning syndrome and myocardial bridging in the patient presenting with pulmonary edema.

The apical ballooning syndrome is a relatively rare and underrecognized transient cardiomyopathy precipitated by emotional or physical stress. The role of myocardial bridging in its cause is unknown and extremely rarely reported. We present a case of a 68-year-old woman with apical ballooning syndrome and transient myocardial bridging of the left anterior descending coronary artery, clinically manifested as pulmonary edema. Ischemic ECG changes and mild elevation of cardiac biomarkers were present. She recovered well on medical treatment, and follow-up echocardiography revealed complete recovery of the left ventricular systolic function, whereas repeated coronary angiography after 1 year showed no signs of myocardial bridging. To the best of our knowledge, this is the first report of transient myocardial bridging in a patient with Takotsubo cardiomyopathy with documented normalization of the left ventriculogram and disappearance of left anterior descending coronary artery myocardial bridging.

The case of 28 year-old female after Senning procedure with persistent atrial flutter and severe triscuspid regurgitation.

E-mail: jbulum@gmail.com Transposition of the great vessels (TGA) is a rare condition with incidence of 1:5,000. The most common variant is dtransposition or complete transposition. Pivotal surgical procedure (Senning, 1957) has dramatically improved survival. However, typical long term complications include pressure overload of the systemic right ventricle with tricuspid regurgitation and atrial arrhythmias. Most of the patients are in NYHA I-II functional status 30 years after the operation but only 40-50% of them remain in sinus rhythm, while 30% of patients had minimally one episode of atrial flutter. A 28 year-old female was admitted to our Department in November 2011. When she was 9 months old, she underwent Senning procedure because of d-TGA. She was asymptomatic on beta-blocker until the age of 26 when she experienced palpitations and reduced effort tolerance. In addition, she was planning a pregnancy. Echocardiography showed the dilated and hypertrophic systemic right ventricle with reduced systolic function, and moderate to severe tricuspid regurgitation. Atrial conduits have a normal function. Cardiovascular magnetic resonance imaging showed a right ventricular hypertrophy without signs of fibrosis, and preserved Proπireni saaeetak / Extended abstract

Case report: Disappearance of left atrial appendage thrombus on dabigatran therapy

3. Morita S, Ajiro Y, Uchida Y, Iwade K. Dabigatran for left atrial thrombus. Eur Heart J. 2013; 34(35):2745. UvOD: Učinak dabigatrana je dobro poznat u prevenciji moždanog udara i tromboembolija u nevalvularnoj fibrilaciji atrija, kao i prevencije duboke venske tromboze pri operaciji kuka i koljena, no učinak dabigatrana na već formirani tromb u aurikuli lijevog atrija nije potpuno jasan. Prikazujemo dva slučaja otapanja tromba u aurikuli lijevog atrija (LAA) pod terapijom dabigatranom .

Comparison of different parameter values of T wave alternans in coronary artery disease diagnostics

1. Bloomfield DM, Hohnloser SH, Cohen RJ. Interpretation and classification of microvolt T wave alternans tests. J Cardiovasc Electrophysiol. 2002;13:502-12. Dosadašnjim ispitivanjima pokazalo se da je mikrovoltni alternans T-vala metoda koja dokazuje koronarnu bolest srca kod bolesnika bez do dosad poznate strukturne srčane bolesti. Pokazalo se da je alternans T-vala po standarnim kriterijima pozitivnosti imao sličnu senzitivnost, specifičnost, pozitivnu i negativnu prediktivnu vrijednost. Na istim bolesnicima testiranje alternansa T-vala je nastavljeno i prema postavljenim proširenim kriterijima pozitivnosti (budući da dosadašnji kriteriji prema literaturi za sada vrijede samo za procjenu rizika od maligne aritmije).