Intracardiac Echocardiography as a Guide for Transcatheter Closure of Patent Ductus Arteriosus.
- 作者列表："Yoshimoto H","Yasuto M","Inoue T","Kagiyama Y","Teramachi Y","Takase R","Koteda Y","Fukumoto Y","Iemura M","Suda K
Background:Transcatheter closure of patent ductus arteriosus (TC-PDA), conventionally guided by aortography, has become the standard treatment of this disease. The purposes of this study were to evaluate whether intracardiac echocardiography (ICE) may be used for measuring PDA size and be used as a guide for TC-PDA. Methods:This study had 2 phases. In phase 1, we compared the measurements of PDA size: pulmonary artery side diameter (PA-D), length, and aortic side diameter (Ao-D) of PDA, as measured by ICE with those measured by aortography or cardiac computed tomography (AoG/CCT) in 23 patients who underwent TC-PDA. In phase 2, we compared the demographics, fluoroscopic time, contrast volume, and complications of the TC-PDAs between 10 adult patients with ICE guidance and 16 without it. Results:In phase 1, we found great correlation and agreement between ICE and AoG/CCT in PA-D (r = 0.985, bias -0.077 to 0.224), but moderate to poor correlation and agreement in length (r = 0.653, bias -0.491 to 3.065) and Ao-D (r = 0.704, bias 0.738 to 4.732), respectively. Nevertheless, all patients underwent successful TC-PDA with ICE guidance that allowed us to continuously monitor the whole process. In phase 2, TC-PDA required a significantly lower contrast volume with ICE guidance than without it, and there was no significant difference in the remaining variables between the 2 groups. Conclusion:ICE is comparable to AoG/CCT in providing accurate PA-D of the PDA and may be a safe alternative to guide TC-PDA as compared to conventional aortography.
背景: 动脉导管未闭 (TC-PDA) 经导管封堵术已成为该病的标准治疗方法。本研究的目的是评估心内超声心动图 (ICE) 是否可用于测量PDA尺寸并作为TC-PDA的指导。 方法: 本研究分为2个阶段。在第一阶段，我们比较了PDA大小的测量结果: PDA的肺动脉侧直径 (pa-d) 、长度和主动脉侧直径 (Ao-D)，如ICE测量的与主动脉造影或心脏计算机断层扫描 (AoG/CCT) 测量的。在23例接受TC-PDA的患者中。在第2阶段，我们比较了10例使用ICE指导的成年患者和16例不使用ICE指导的成年患者的人口统计学、透视时间、对比剂量和tc-pdas的并发症。 结果: 在第一阶段，我们发现在PA-D中ICE和AoG/CCT之间有很大的相关性和一致性 (r = 0.985，偏倚-0.077至0.224)，但在长度上有中等至差的相关性和一致性 (r = 0.653，偏倚-0.491至3.065) 和Ao-D (r = 0.704，偏差0.738至4.732)。尽管如此，所有患者都在ICE指导下成功接受了TC-PDA，这使我们能够持续监测整个过程。在第2阶段，TC-PDA在ICE引导下需要比没有ICE引导下显著更低的对比体积，并且在2组之间其余变量没有显著差异。 结论: ICE在提供准确的PDA pa-d方面与AoG/CCT相当，并且与常规主动脉造影相比，ICE可能是引导TC-PDA的安全替代方案。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.