Tatsuo Kikuchi

Outcome of prolonged balloon inflation for the management of coronary perforation.

BACKGROUND Coronary perforation (CP) is a rare, sometimes lethal complication of percutaneous coronary intervention (PCI). OBJECTIVES The purpose of this study was to review the cases of CP and to investigate the management after CP. METHODS A total of 3469 PCIs were performed in our institution from April 1999 to April 2008. All CP cases were identified from our computerized database. RESULTS Thirty patients were identified as having CP (0.86%). According to the Ellis classification, we determined the grade of perforation as type I in 17 cases (56%), type II in 2 cases (7%), and type III in 11 cases (37%). Most CPs were caused by wires (53%), while balloons, stents, and atherectomy devices were responsible for 7%, 37%, and 3%, respectively. Wire caused only 1 case of type III CP (6%), while stent caused 9 type III CPs (82%, p<0.01). Four patients (36%) with type III CP required urgent coronary artery bypass graft surgery (CABG), while no patient with type I/II CP required it (p<0.01). Prolonged balloon inflations were effective for 8 cases out of 11 stent CPs, however, the ballooning duration was significantly longer than that in wire and balloon CP (44±37min vs. 21±13min, p<0.05). CONCLUSIONS Stent CP often causes type III CP and one third of type III CP required urgent CABG. Although stent CP required longer balloon inflations for the management, prolonged balloon inflation might be useful for the management even in the stent CP.

Radiation Exposure Associated with Preoperative Multidetector Computed Tomography of Pulmonary Vein Isolation

Background: Multidetector computed tomography (MDCT) visualization of the pulmonary veins (PV) and left atrium provides the necessary anatomic information for successful left atrial ablation and PV isolation. However, the potential risks due to exposure to ionizing radiation associated with MDCT have raised concerns. Objectives: The purpose of this study was to compare radiation exposure between prospective and retrospective ECG-gated CT angiography (hereafter, prospective CTA, retrospective CTA). Methods: The 64-slice MDCT (Discovery CT 750HD, GE Healthcare) was performed 78 consecutive patients. Twenty-eight patients were analyzed by prospective CTA using step-and-shoot protocol, and 50 patients were analyzed by retrospective CTA. Results: Mean (±SD) effective radiation exposure in the prospective CTA group was 2.2±0.8 mSv compared to 15.4±5.9 mSv in the retrospective CTA group (p<0.001). Conclusion: In preoperative evaluation of PV isolation, prospective CTA can reduce radiation exposure than retrospective CTA.