China
Africa
Explore chapters and articles related to this topic
Other devices and how to use them
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Distal protection devices, or embolic protection devices, were developed for use in the carotid vascular bed (Figure 20.14). Other applications include protection during renal stenting or complex lower extremity revascularization. Recanalizing or debulking an occluded SFA stent is another situation in which a filter may be of value. Likewise, during atherectomy of long or heavily calcified SFA lesions, embolization is a risk and filters probably play a role in making the procedure safer. Distal protection devices have some risk and cost of their own. In the carotid circulation, protection is considered mandatory during stenting, but distal filters may not provide complete protection for the brain. It is likely that the filters catch most major emboli and this makes them useful for the lower extremity. Distal protection devices were first approved for use in the coronary circulation when there is stenosis within a previously placed coronary vein graft. There are several approved distal protection devices for carotid stenting. Some of them are approved for use along with a concurrently used stent such as the Emboshield NAV6™ and the Accunet®. Other devices, such as the Spider filter (SpiderFX™ Embolic Protection Device), are approved for use with any of the approved stents.
Direct Myocardial Revascularization Sequential Grafting Techniques
Published in Waldemar L. Olszewski, CRC Handbook of Microsurgery, 2019
Standard cardiopulmonary bypass is used for coronary vein grafting. Standard bypass usually consists of flows between 1.8 and 2.4 ℓ/min/m2 body surface area, moderate hypothermia of 25°C, and moderate hemodilution with the hematocrit between 25 and 30.16
Coronary angiography: Techniques and tools of the trade
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
The Multipurpose catheter is designed such that it is capable of selectively catheterising both left and right coronary arteries and can then be used to perform ventriculography without the need to exchange to other diagnostic catheters. This inherently requires greater manipulative skills and involves longer fluoroscopy times, hence making the multipurpose catheter a second choice for most operators. Coronary vein graft catheters (left and right) are specifically designed to cater for the high, anterior origin of the left grafts and the vertically oriented take-off of right grafts. In difficult cases, it is often possible to selectively cannulate the grafts using Amplatz and/or Multipurpose catheters.
Biochanin A attenuates obesity cardiomyopathy in rats by inhibiting oxidative stress and inflammation through the Nrf-2 pathway
Published in Archives of Physiology and Biochemistry, 2023
Jansy Isabella Rani A, V. V. Sathibabu Uddandrao, Sangeethadevi G, Saravanan G, Chandrasekaran P, Sengottuvelu S, Tamilmani P, Sethumathi P P, S. Vadivukkarasi
Obesity is associated with cardiometabolic complications such as diabetes, dyslipidaemia, high blood pressure, coronary vein illness, stroke, and mortality (Bray et al. 2018). Edible fat is one of the most significant risk factors for CVDs; elevated cholesterol and saturated fat diets increase the risk of atherosclerosis (McNamara 2000). Chronic oxidative stress and inflammation have been implicated in the pathophysiology of obesity-associated CVD (Fernandez-Sanchez et al. 2011). Uncontrolled production of provocative cytokines and ROS due to hyperlipidaemia weakens the customary cell capacity and induces cell apoptosis in various tissues, including the heart (Wende et al. 2012). Therefore, due to the potential roles of oxidative stress and inflammation in CVDs, molecules with antioxidant and anti-inflammatory properties can improve the efficiency of remedial interventions for obesity and HFD-induced CVD. Thus, the present study was designed to evaluate the effect of BCA on the suppression of oxidative stress and inflammation through the Nrf-2 pathway.
Multi-modality management of hypertrophic cardiomyopathy
Published in Hospital Practice, 2023
Shiavax J. Rao, Shaikh B. Iqbal, Arjun S. Kanwal, Wilbert S. Aronow, Srihari S. Naidu
Recently, two studies introduced a novel approach using RF to decrease LVOT gradient [85,86]. In Liu et al, 15 patients, unsuitable for surgery or ASA, underwent percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) through a percutaneous apical approach. This technique demonstrated significant reduction of LVOT gradient, intraventricular septum, and mitral regurgitation volume that sustained at 6-month follow-up. Peri-procedural complications were seen with transient ventricular ectopic beats that resolved after ablation ceased and pericardial tamponade due to coronary vein injury and abnormal blood coagulation [85]. In Zhou et al, 200 patients were selected between 2016 and 2020 for PIMSRA. Similar to Liu et al, positive results were seen at 19-month follow-up with sustained reduction in LVOT gradient, intraventricular septum, and NYHA improvement. However, significant 30-day major adverse rate was 10.5% with death (1.0%), pericardial effusion requiring mini-thoracotomy (3.5%), pericardial effusion requiring pericardiocentesis (6%), permanent right bundle branch block (RBBB) (2.5%), resuscitated ventricular fibrillation (1%), and septal branch aneurysm (1.0%) [86]. This new approach will need further study given its high 30-day adverse rates. Currently, cerclage RF ablation is being developed on animal models [87]. Taken together, both forms of RFA remain investigational, and clinical experience is limited.
Percutaneous Management of Acquired Right Ventricular Outflow Tract Obstruction due to Giant Coronary Vein Graft Aneurysm
Published in Structural Heart, 2019
Matthew J. Daniels, James D. Newton, Andrew D. Kelion, Mario Petrou, Oliver J. Ormerod
A 56-year-old fireman previously revascularized by coronary artery bypass presented unable to work 9 years following index surgery. Investigations revealed extrinsic compression of the right ventricular outflow tract between a coronary vein graft aneurysm and the ascending aorta (Figure 1A,B). Invasive systolic right ventricular pressure was elevated (83 mmHg peak pressure), with dynamic outflow tract obstruction (Figure 1C, Supplemental Video 1). Following heart team discussion in the absence of distal run off from the graft aneurysm the patient was offered transcatheter closure of the feeding vessel. The vein graft was cannulated with a JR4 catheter, sized (Figure 1D), and an 0.035ʹʹ Terumo wire used to advance distally to position an Amplatzer superstiff wire in the aneurysm. A 5F Amplatzer Torquevue 2 delivery system was used to deploy an 8 mm AVPII device within the proximal part of the vein graft. Non-invasive follow-up over the next 12 months showed resolution of acquired RVOT obstruction. The patient returned to work at 6 months