The primary goal of therapy for acute myocardial infarction (AMI) is rapid, complete and sustained restoration of infarct-related artery (IRA) blood flow and myocardial perfusion, with a consequent positive impact on the patient’s outcome. Both fibrinolytic and mechanical restoration of anterograde coronary blood flow in patients suffering AMI have shown to improve left ventricular function, reduce infarct size and reduce mortality.1–10 The benefits of myocardial reperfusion, including the prevention of infarct expansion and improvement of electrical stability, are amplified whe... continue reading about Rescue Percutaneous Coronary Intervention: A Review
A 42-year-old man presented with heavy chest pain of four hours’ duration. Physical examination was unremarkable. The ECG showed an acute septoapical infarction. Nitroglycerin, aspirin, clopidogrel and heparin were administered, and an emergency coronary angiography was performed from the right femoral artery (Figures 1 A and B). The left anterior descending artery was occluded distally. The left main trunk ostium was deeply intubated by a slightly too large Q4 6 French intervention catheter. There was, however, no damping or ventriculization of pressure. The occlusion was crossed with a ... continue reading about The “Zipper” Lesion: A Rare but Serious Guiding Catheter-Induced Complication of a PCI Procedure
The Fontan operation was first described for management of univentricular heart disease in 1971. Since it was first described, there have been several modifications to the original operation.1 In 1988, de Laval2 first proposed the concept of total cavopulmonary anastomosis (construction of an intra-atrial lateral tunnel to connect the inferior vena cava to the pulmonary artery together with a bidirectional cavopulmonary shunt) as an alternative to atriopulmonary connection. The extracardiac approach remains popular because it eliminates the need for aortic cross-clamping,... continue reading about Transcatheter Fenestration of Autologous Pericardial Extracardiac Fontan via the Transhepatic Approach
Percutaneous intervention of saphenous vein grafts is associated with approximately 20% risk of major adverse cardiovascular events secondary to decreased antegrade flow or “no-reflow” during the procedure.1 The mechanism of this phenomenon is probably multifactorial and involves microvascular dysfunction and potentially platelet-mediated loss of capillary autoregulation. Since the typical vein graft lesion is friable with large plaque volume, it may be that embolization of thrombotic and atheromatous material during the intervention is the trigger that starts a cascade of event... continue reading about Soluble Mediators of Microvascular Dysfunction — Identifying the Invisible Culprits?