Maria Kiaffas

Nonfluoroscopic catheter navigation for radiofrequency catheter ablation of supraventricular tachycardia in children.

Background: Radiofrequency catheter ablation (RCA) of supraventricular tachycardia (SVT) in children is highly successful but requires exposure to radiation. Nonfluoroscopic mapping systems may significantly reduce fluoroscopy time.

Transcatheter closure of coronary arterial fistulas using the new Amplatzer vascular plug.

We report our initial experience in using the Amplatzer vascular plug for closure of coronary arterial fistulas. The self-expanding, cylindrical, device is made from Nitinol wire mesh, and is available from 4 to 16 millimetres in diameter. We have now used the device to close fistulas in 3 patients, aged from 3 to 14 years, who presented with ratios of pulmonary-to-systemic flow from 1.5 to 3. In 2 patients, fistulas arising from the proximal right and left coronary arteries, with maximal diameters of 9 and 10 millimetres, respectively, had their narrowest diameter, of 6 millimetres, proximal to the entrance into the right atrium via a saccular aneurysm. The third fistula, with a maximal diameter of 16 millimetres, and with its origin from the circumflex coronary artery, entered the right atrium with nearly unrestricted flow, its narrowest diameter being 8 millimetres. For interventional closure, we chose plugs twice the diameter of the narrowest segment of the fistula, thus using 2 devices of 12 millimetres and one of 16 millimetres diameter. An arteriovenous loop was established through the fistula by snaring an exchange guide wire. Using a 7 or 8 French guide catheter inserted through the femoral vein, all plugs were placed at the narrowest segment of the fistula, leading to immediate complete closure of 2 fistulas. The third patient, with a fistula of the circumflex coronary artery, who received the largest plug initially had residual flow, but the fistula was found to be completely occluded at 12 months follow-up examination. We have demonstrated, therefore, safe and effective usage of the new vascular plug for transcatheter closure of moderate- to large-sized coronary arterial fistulas. The plug offers an alternative to cardiac surgery, or occlusion using coils.

Saw-tooth cardiomyopathy

We present an unusual case of cardiomyopathy in a two month old male infant with a grade-I systolic murmur. Echocardiographic examination disclosed left ventricular (LV), dysplasia with saw-tooth like inwards myocardial projections extending from the lateral walls towards the LV cavity. There was mild LV systolic dysfunction with apical hypokinesia. Cardiovascular magnetic resonance demonstrated in detail these cross bridging muscular projections originating from the inferior interventricular septum and lateral LV wall, along with areas of hypokinesis at the LV septum and apex in a noncoronary distribution, without any late gadolinium enhancement. We have termed this condition saw-tooth cardiomyopathy because of the very characteristic appearance.

Fatal Cardiac Arrest Due to an Unusual Fibroma of the Pulmonary Valve

Fibroma, the second most common tumor in childhood, usually is a large solitary mass involving the ventricular septum or the left and rarely the right free ventricular wall. An unusual case of a 5.2-year-old boy with a large mass originating from the pulmonary valve is reported. The patient presented for evaluation of a murmur. Echocardiography and cardiac magnetic resonance imaging showed a large tumor extending from the distal right ventricular outflow tract through the pulmonary valve and into the main pulmonary artery causing moderate obstruction. The patient had a fatal cardiac arrest while awaiting surgery. The postmortem examination proved the tumor to be a fibroma.

Diverse experience with the CardioSEAL and STARFlex septal occluders.

Apart from closure of atrial septal defects, there is little information concerning the use of the CardioSEAL family of occluders in congenitally malformed hearts. We review here our initial experience using the CardioSEAL and STARFlex occluders in 12 patients aged 17.3 +/- 11.2 years, with a range from 4 to 34 years. Of the patients, 5 had fenestrated extracardiac Fontan procedures, 5 had persistent patency of the arterial duct, 1 had a leak across a Mustard baffle, and the final patient had a huge pulmonary arteriovenous malformation. We implanted successfully 9 CardioSEAL, and 3 STARFlex occluders, with sizes from 17 to 40 mm. In one patient, the occluder embolized to the right pulmonary artery, from where it was retrieved through the catheter. In two patients, there was a trivial residual leak immediately after implantation, but no patient had a residual leak after 6 months of follow-up. We noted improved ventricular dimensions, without any fractures of the arms of the occluders, perforations, or disturbances of flow after 2.4 +/- 0.9 years of follow-up. We have demonstrated, therefore, the versatility of the CardioSEAL and STARFlex occluders, which have been used safely and effectively to close a variety of intra and extracardiac communications other than atrial septal defects.

Transcatheter Closure of Large-Sized Coronary Artery Fistula

The present case report describes a patient who sustained an acute inferior wall myocardial infarction, but initially remained clinically stable, then he underwent a successful coronary angioplasty and stenting procedure of a totally occluded right coronary artery, subsequently developing a dramatic clinical course with cardiogenic shock and cardiac arrest due to acute stent thrombosis which was successfully managed with repeat coronary angioplasty. We attributed this discrepant clinical manifestation of acute coronary occlusion to coronary collaterals, initially being present and then disappearing following the recanalization procedure, as being responsible for the dramatic clinical picture following the stent thrombosis.Aim: The purpose of this investigation was to collect data on the appropriate nursing care to patients supported with an intra-aortic balloon pump (IABP).Patients: All 39 patients who were supported with an IABP during the year 2006 (23 men ??? 16 women) took part in this investigation. They received nursing and medical care in the Intensive Care Cardiovascular Unit (ICCU) of Evagelismos General Hospital of Athens.Πeριγράφeται η πeρίπτωση eνός ασθeνούς, 66 eτών, που παρουσιάσθηκe μe πολλαπλά eπeισόδια eμμένουσας μονόμορφης κοιλιακής ταχυκαρδίας 30 και 14 έτη μeτά δύο eμφράγματα του κατωτέρου και του προσθίου τοιχώματος του μυοκαρδίου. Αφού η ηλeκτρική θύeλλα κατeστάλη μe ένα μeικτό σχήμα τριπλής αντιαρρυθμικής αγωγής, ο ασθeνής υπeβλήθη σe eνδοκαρδιακή κατάλυση της αρρυθμιογόνου eστίας μe τη βοήθeια του ηλeκτροανατομικού συστήματος χαρτογράφησης στο ηλeκτροφυσιολογικό eργαστήριο. Ακολούθησe η eμφύτeυση eνός αντιταχυκαρδιακού βηματοδότου απινιδωτού που στους eπακόλουθους 30 μήνeς παρακολούθησης κινητοποιήθηκe αθόρυβα σe ένα μοναδικό στιγμιότυπο αντιταχυκαρδιακής βηματοδότησης.Ο όρος οξύ στeφανιαίο σύνδρομο ( ACS ) αναφέρeται σe ένα φάσμα τριών πιθανών κλινικών eκδηλώσeων της στeφανιαίας νόσου, την ασταθή στηθάγχη (UA), το έμφραγμα χωρίς ανάσπαση του ST (NSTEM) και το έμφραγμα μe ανάσπαση του ST (STEMI). Η διάκριση αυτή eίναι χρήσιμη στην ανάπτυξη θeραπeυτικών στρατηγικών. Το Αμeρικανικό κολλέγιο καρδιολογίας ( ACC ) και η Αμeρικανική καρδιολογική eταιρία ( AHA ), από κοινού δημοσιeύουν κατeυθυντήριeς οδηγίeς για την αντιμeτώπιση των οξέων στeφανιαίων συνδρόμων. Η τeλeυταία αναθeώρηση των προτeινόμeνων κατeυθυντήριων οδηγιών έγινe το 2007. Η ασταθής στηθάγχη ( UA ) και το NSTEMI έμφραγμα eίναι δύο δυσδιάκριτeς μeταξύ τους οντότητeς και η διαφορά τους έγκeιται στο γeγονός ότι το NSTEMI χαρακτηρίζeται από πeρισσότeρο eκτeταμένη μυοκαρδιακή βλάβη, μe απeλeυθέρωση στην κυκλοφορία τροπονίνης (TnT ή TnI ) ή CK-MB. Eίναι σημαντικό στην αντιμeτώπιση της ασταθούς στηθάγχης/NSTEMI να eπιλέξουμe πρώιμα ανάμeσα σe eπeμβατική ή συντηρητική θeραπeυτική στρατηγική. Η eπιλογή γίνeται μe βάση στοιχeία από το ιστορικό, την κλινική eικόνα και τα eργαστηριακά eυρήματα του ασθeνούς ... (excerpt)Despite primary and secondary methods for the prevention of acute coronary syndromes, there is still poor patient and physician understanding of the importance of smoking cessation. Cardiovascular risk decreases significantly after smoking cessation, however, there is a paucity of counseling programs regarding this issue after hospitalization. Such programs have proved to be cost effective and should be provided as standard care.

Complete heart block complicating the acute phase of respiratory syncytial virus bronchiolitis

Respiratory syncytial virus is the most common pathogen causing lower respiratory tract infection in infants. In recent years, the importance of extrapulmonary complications and longterm sequelae including those involving the cardiovascular system has become apparent. We report on a 10 month old infant with respiratory syncytial virus bronchiolitis, the acute phase of which was complicated by irreversible complete heart block, which was managed conservatively.

Pulmonary Atresia with Intact Ventricular Septum: Right Ventricular and Coronary Artery Anatomy

In this series of 71 postmortem cases of pulmonary atresia with intact ventricular septum (PAt

Large single centre experience with the Cera™ and CeraFlex™ occluders for closure of interatrial communications: usefulness of the flexible rotation feature

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