Steven L. Almany

Early hospital discharge after percutaneous transluminal coronary angioplasty

To determine the safety and efficacy of early hospital discharge after percutaneous transluminal coronary angioplasty (PTCA), 100 patients were studied prospectively. A telemetry observation unit was established to monitor patients having uncomplicated procedures. A total of 170 lesions were dilated, with a procedural success rate of 96% and a clinical success rate of 91%. There were no deaths or patients who required emergency bypass surgery. Four patients developed abrupt vessel closure in the catheterization laboratory. No major complications developed in the telemetry observation unit or after discharge. Patients with high-risk lesion morphology, based on the American College of Cardiology/American Heart Association Task Force guidelines, tended to have a lower success rate and more procedural complications. Coronary dissections were angiographically detected in 33 patients and stratified into 6 types. To reduce possible adverse sequelae, all patients with complex dissections were triaged in the catheterization laboratory to an in-patient monitored unit for additional management. Accordingly, 20 patients were admitted to an in-patient unit for extended observation. Excluding 4 patients with myocardial infarction, 75% (12 of 16) were discharged the next day. Initial experience with early discharge suggests that under proper conditions the procedure is safe and effective. Patients with complex coronary dissections who are at high risk for abrupt vessel closure can be promptly identified after dilatation and triaged to an appropriate monitoring area. Early discharge after PTCA offers more efficient use of hospital facilities and the opportunity to reduce hospital costs.

Feasibility of early mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock: The Detroit cardiogenic shock initiative

The ‘Detroit Cardiogenic Shock Initiative’ is a single‐arm, multicenter study to assess the feasibility of early mechanical circulatory support (MCS) in patients who present with acute myocardial infarction complicated by cardiogenic shock (AMICS) who undergo percutaneous coronary intervention.

STROKE PREVENTION IN NON-VALVULAR ATRIAL FIBRILLATION: LONG-TERM RESULTS AFTER 6 YEARS OF THE WATCHMAN LEFT ATRIAL APPENDAGE OCCLUSION PILOT STUDY

Long-Term Results after 6 Years of the WATCHMAN Left Atrial Appendage Closure Pilot Study P B. Sick, Z. Turi, E. Grube, KE. Hauptmann, S. Mobius Winkler, G. Schuler, G. Mishkel, S. Yakubov, S. Almany, D. Holmes (1) Hospital Barmherzige Bruder, Department of Cardiology, Regensburg, Germany (2) Cooper Hospital, Camden, USA (3) privat, Schieder Schwalenberg, Germany (4) Hospital Barmherzige Bruder, Trier, Germany (5) University of Leipzig, Heart Center, Leipzig, Germany (6) Prairie-Heart Institute, Springfield, USA (7) Midwest Cardiology Research Foundation, Columbus, USA (8) Beaumont Hospital, Michigan, USA (9) Mayo Clinic, Rochester, USA

Value of transesophageal echocardiography during complex or high-risk coronary interventions in the cardiac catheterization laboratory

The increasing complexity of coronary intervention and the limitations of hemodynamic and electrocardiographic monitoring have facilitated the introduction of new imaging techniques in the cardiac catheterization laboratory. Transesophageal echocardiography (TEE) has proved valuable for left ventricular (LV) monitoring during high-risk surgery, but its reported use in the cardiac catheterization laboratory has been limited. Accordingly, we assessed the feasibility and value of TEE during complex or high-risk coronary intervention in the catheterization laboratory. The TEE probe was successfully introduced in 53 of 54 (98%) attempted cases. The primary imaging goals were LV monitoring in 39 (74%), left main coronary artery (LMCA) imaging in 9 (17%) and both in 5 (9%) cases. LV monitoring was successful in 43 of the 44 (98%) attempted cases. In 25 (58%) of these, additional important observations were made by TEE that were not apparent by symptoms, or hemodynamic, electrocardiographic or radiographic monitoring. These included unexpected changes in regional myocardial function (n = 20), alteration in LV size (n = 2), exclusion of considered pericardial tamponade (n = 2) and detection of unsuspected mitral regurgitation (n = 1). Management of the interventional procedure was directly influenced by the findings of TEE in 11 of the 43 (26%) monitored cases. The LMCA was successfully visualized in 13 of the 14 (93%) attempted cases. In 11 of these, measurement of the stenotic lesion diameter by TEE correlated well with quantitative angiography both before (r = 0.83, standard error of the estimate = 0.01, p less than 0.002) and after (r = 0.80, standard error of the estimate = 0.03, p less than 0.005) intervention.(ABSTRACT TRUNCATED AT 250 WORDS)

PREOPERATIVE CARDIAC EVALUATION : ASSESSING RISK BEFORE NONCARDIAC SURGERY

Preview Medical clearance for patients who need surgery is commonly requested of primary care physicians. A focused evaluation of the cardiovascular and other major body systems is the key to assessing preoperative risk. Which diagnostic tools and laboratory tests are most helpful? And which findings are most significant? The authors answer these questions and suggest ways primary care doctors can help minimize complications in the perioperative period.

Rapid and Affordable 3-Dimensional Prototyping for Left Atrial Appendage Closure Planning

An 82-year-old male with the past medical history of right-sided cerebrovascular accident with mild residual deficits, paroxysmal atrial fibrillation, and recurrent gastrointestinal bleeds while on oral anticoagulation was referred for transcatheter left atrial appendage (LAA) closure using the commercially available Watchman closure device (Boston Scientific, Natick, MA). Prescreening transesophageal echocardiogram images were obtained to assess the LAA size and morphology. The initial transesophageal echocardiogram images revealed a cauliflower configuration of the LAA with an os measurement of 18 mm (Figure 1A through 1C). A proximal posteriorly directed pocket was noted on imaging. Given that this pocket could act as the landing zone for the device, it may lead to inadequate depth and inadequate LAA coverage. Figure 1. Ostial and depth measurements of the left atrial appendage on preprocedural transesophageal echocardiogram (TEE; A – C ). Corresponding post-Watchman implant TEE images with the device occupying the posterior pocket ( D – F ). …

Large LV aneurysm and multiple diverticula in a patient with normal coronary arteries: another form of cardiomyopathy?

Newer multimodality imaging may help uncover unique ventricular morphology that might be consistent with unrecognized forms of possible cardiomyopathies ([1–3][1]). We describe one such possibility in a 52-year-old man with chronic atypical chest pain and no prior cardiac history who had a fixed

Aggressive treatment of acute myocardial infarction. Management options for various settings.

Multiple lifesaving options are currently available for treatment of acute myocardial infarction as a medical emergency. Serial electrocardiography and continuous ST-segment monitoring, urgent echocardiography, rapid enzyme analysis, and cardiac catheterization may all assist in the accurate and early diagnosis of acute myocardial infarction. Both intravenous thrombolytic therapy and direct infarct percutaneous transluminal coronary angioplasty are of benefit in early treatment. The choice of therapy depends on the individual patient and the hospital capabilities. Adjunctive pharmacologic therapies can be easily administered in the community hospital setting and should be considered for every patient with suspected acute myocardial infarction. The risk of serious morbidity and hospital death in these patients has not been eliminated, and a more aggressive approach to diagnosis and treatment is sorely needed.

Lesion length assessment using a new vessel caliper

Assessment of coronary lesion length using visual estimation or quantitative coronary angiography can be unreliable. We tested the accuracy of a new handheld caliper device to measure lesion length in a bench‐top model and in eight patients undergoing percutaneous coronary intervention (PCI). Caliper–derived length measurements were compared to the known reference distance in the bench‐top model and visual or intravascular ultrasound (IVUS)‐derived measurements in vivo. In the coronary model, caliper‐derived measurements were accurate and correlated well with known reference distances regardless of the angiographic projection. During PCI, there was a poor correlation between the best visual estimate of length and IVUS‐derived measurements. In contrast, caliper‐derived measurements correlated closely with IVUS‐derived measurements. This handheld caliper provides a simple and accurate method of assessing intracoronary lesion length and may be particularly useful during coronary stenting and when adjunctive brachytherapy is performed. Cathet Cardiovasc Intervent 2003;58:168–174.