Coronary catheterization after transcatheter aortic valve implantation (TAVR) may be challenging. The main objective of the study is to assess the feasibility of coronary catheterization and ...angioplasty according to each type of valve.
We retrospectively studied coronary angiography or percutaneous angioplasty procedures after TAVR in two different centers. The catheterization success of coronary artery was evaluated according to the quality of engagement in ostium and opacification of the artery. Other indicators were collected including catheters used, fluoroscopy and angiography times, DAP and the volume of the contrast agent.
Among 1512 TAVR procedures, 33 patients were included. The Sapien 3® valve was implanted in 22 patients and the Evolut® in 11 patients (7 Evolut-R® and 4 Evolut Pro®). Coronary angiography with selective or partially selective catheterization has been successfully performed in all patients with a Sapien 3® valve. In the Evolut® group we identified 3 cases of non-selective catheterization for the right coronary and 1 case for the left coronary. Standard Judkins catheters seem to be the most suitable for both types of valve with very good efficiency.
The results of our study is promising for the future of TAVR with a coronary catheterization success rate close to 100% with some difficulties for the Evolut® supra-annular valves. Special attention should be paid to the technique of implantation and orientation of cups in the aortic sinus.
Vascular complications are frequent in the context of transcatheter aortic valve replacement and may require the implantation of a covered stent graft in the common femforal artery. However, common ...femoral artery is considered to be at high risk of stent fracture or occlusion due to high mobility of the hip joint.
We analyzed medical records of patients with transcatheter aortic valve replacement related vascular complications between 2015 and 2018, treated with commom femoral artery transluminal angioplasty or surgery. Vascular complications or suspect symptoms were followed up by phone calls.
Among 552 patients, 43 patients were included. Twelve (11.6 %) were managed by prolonged balloon inflation, 5 (11.6 %) by first line surgery and 26 (60.4 %) by the implantation of a covered stent graft. Among the latter group, the covered stent graft was efficient in 24 patients (92.3 %). The median follow-up was 430 days 3-1499. The first-line surgery group had a higher risk of red blood cell transfusion and all causes mortality. At follow-up, no patient had suspicious symptoms of vascular covered stent complication. Four patients (9.3 %) had US-doppler or CT vascular imaging at follow-up, showing no evidence of stent fracture or occlusion.
In our study, the implantation of a covered stent graft in the common femoral artery was an efficient and safe strategy for the management of transcatheter aortic valve replacement related vascular complications.
L'accès radial est devenu la voie d'abord privilégiée des Cardiologues interventionnels et des patients. L'occlusion de l'artère radiale conventionnelle peut limiter son utilisation à d'autres fins ...(pontages, fistules artério-veineuses, répétition des ponctions). L'abord radial distal constitue une alternative à la radiale conventionnelle, cependant son adoption reste limitée.
Évaluer la faisabilité et la sécurité à court terme de l'abord radial distal dans notre pratique quotidienne.
Nous avions mené une étude transversale, monocentrique et descriptive du 1er Mars au 30 Avril 2023.
La population d’étude était constituée des patients hospitalisés, devant bénéficier d'une intervention coronaire percutanée. Le critère d'inclusion était une bonne perception d'un pouls radial proximal et distal. Les critères d'exclusions étaient un syndrome coronaire aigu avec sus décalage du segment ST, une instabilité hémodynamique et toute contre-indication ou accès impossible à la voie radiale.
Cent neuf patients ont été inclus. L’âge moyen était de 67,52 ± 13,58 ans. On retrouvait une prédominance masculine à 84,4%. Un surpoids ou une obésité était le facteur de risque le plus fréquemment retrouvé, (74,3%) suivi de l'hypertension artérielle (62,4%) et du tabagisme (48,6%).
Les indications étaient dominées par les syndromes coronaires chroniques (42,2%) suivis des dépistages de coronaropathie (31,2%). Cinq patients étaient admis pour un infarctus sans sus décalage du segment ST.
Un abord radial distal droit était noté dans la majorité des cas (91,7%). Soixante-sept soit 61,5% des procédures étaient des coronarographies seules, 32,1% des angioplasties et 6,4% des coronarographies avec FFR seule. Une aiguille était utilisée dans 90,8% des cas et un cathlon chez le reste des patients. Un guidage échographique était utilisé chez 26 patients. Le taux de succès était de 94,5% et on notait 8 cross-over (7,3%) dont 6 liés à un échec de ponction et 2 à la présence d'une récurrente. La sonde Tiger 4 utilisée en première intention dans nos procédures diagnostiques a permis d'achever 58,5% des coronarographies; l'association à une autre sonde était nécessaire dans 16% des cas et pour le reste des patients d'autres sondes ont été utilisées.
Un taux de complication de 4,58% était retrouvé, essentiellement constitué d'un hématome mineur chez 2 patients (1,83%) et d'une abolition du pouls chez 3 patients (2,75%). Aucune complication majeure n'a été répertoriée. Un spasme radial considéré comme événement indésirable était retrouvé dans 6,4% des cas (fig. 1 à 4).
L'accès radial distal est une voie d'abord sûre, au taux de succès élevé, permettant d'achever un nombre important de procédures de coronarographies et/ou d'angioplastie et de préserver un éventuel abord radial conventionnel ultérieur. Elle reste actuellement peu répandue et son utilisation nécessite une courbe d'apprentissage.
Pas de conflit d'intérêt
Abstract
Background
Cardiovascular diseases are the leading cause of death in women, killing sevenfold more women than breast cancer. Rates of hospital death for myocardial infarction in women, ...although decreasing, remains significantly higher than in men (more than double), especially among women under the age of 50. The occurrence of myocardial infarction in non-menopausal women is not unusual, and the incidence continues to rise. While women under the age of 60 accounted for less than 12% of patients with myocardial infarction admitted in 1995, they accounted for more than 25% in 2015. In addition to the traditional cardiovascular risk factors, women present specific ones linked to hormonal modifications, inflammatory high-risk profiles, and thrombophilia.
Purpose
We comprehensively and systematically collected all clinical and biological data and the results of morphological explorations in all women admitted for myocardial infarction under the age of 50 in high-volume French centres. To date, no systematic descriptive analysis has been carried out incorporating not only clinical, morphological, and extraordinary characteristics, but biological characteristics, in particular hormonal and immunological parameters.
Methods
This prospective, observational study included all women admitted for myocardial infarction under the age of 50 years at 30 centres in France from May 2017 to June 2019.
Results
The population comprised 314 women (mean age 44.9 years): 192 presented with ST-segment elevation myocardial infarction and 122 with non-ST-segment elevation myocardial infarction, 75% were current smokers, 35 had a family history of cardiovascular disease, 33% had a complication of pregnancy, and 55% reported recent emotional stress. Ten had a normal coronary angiogram. Independent predictors of premature MI, <35 yo, were cannabis use and oral contraceptive therapy. No deaths, but 3 strokes, 3 recurrent myocardial infarctions, and 1 serious bleed occurred during hospitalization. At 12 months, 2 deaths occurred but linked to progressive cancer, 25 patients had recurrent PCI, 4 symptoms driven. Otherwise, 90.4% were event free and 72% completely symptoms free.
Conclusion
The WAMIF study showed that most young women with acute myocardial infarction reported typical symptoms of chest pain, and modifiable cardiovascular risk factors, most commonly tobacco use. Gynaecological status, history of pregnancy complications, and non-compliance with non-indication of combined contraception were overrepresented, emphasizing the urge for a better cardiological and gynaecological network. The overall prognosis for these women was better than previously reported despite the high rate of emergency consultations in the year following the index myocardial infarction, highlighting the need for more comprehensive follow-up following the myocardial infarction.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): French Society of CardiologyGrants from Indusctries Biosensors Europe SA, AstraZeneca, Boston Scientific Corporation, Abbott Medical Devices, Terumo Corporation, Daiichi Sankyo, Inc., Hexacath, France, Biotronik SE & Co. KG.
Difficultés de cathétérisme coronaire après TAVI Simon, I.V.; De Poli, F.; Couppié, P. ...
Annales de cardiologie et d'angéiologie,
November 2021, 2021-11-00, Letnik:
70, Številka:
5
Journal Article
Recenzirano
Le cathétérisme coronaire après implantation d'une valve aortique par voie percutanée (TAVI) peut poser certaines difficultés, variables suivant le type de valve. L'objectif principal de notre étude ...est d’évaluer le taux de réussite du cathétérisme et/ou de l'angioplastie coronaire.
Nous avons analysé rétrospectivement les procédures de coronarographie et/ou d'angioplastie percutanée réalisées à distance d'un TAVI dans deux centres de cardiologie. Le succès d'intubation de l'ostium coronaire a été évalué selon la qualité de l'engagement dans l'ostium et l'opacification de l'artère. D'autres indicateurs ont été recueillis notamment les sondes utilisées, les temps de scopie, PDS et quantités de produit de contraste utilisées.
Parmi 1512 procédures TAVI, 33 patients avec procédure invasive coronaire ont été inclus. La valve Sapien 3® a été implantée chez 22 patients et l'Evolut® chez 11 patients (7 Evolut-R® et 4 Evolut Pro®). Une coronarographie avec cathétérisme sélectif ou partiellement sélectif a été réalisée avec succès chez tous les patients porteurs d'une valve Sapien 3®. Dans le groupe Evolut®, nous avons identifié 3 cas de cathétérisme non sélectif pour la coronaire droite et 1 cas pour la coronaire gauche. Les cathéters standard Judkins semblent être les sondes les plus adaptées pour les deux types de valve.
Les résultats de notre étude sont rassurants avec un taux de succès de cathétérisme coronaire proche de 100 %. On note quelques difficultés en cas de valve supra-annulaire type Evolut®. Une attention particulière devrait être portée à la technique d'implantation et l'orientation des cusps de la prothèse, permettant de faciliter le cathétérisme coronaire ultérieur.
Coronary catheterization after transcatheter aortic valve implantation (TAVR) may be challenging. The main objective of the study is to assess the feasibility of coronary catheterization and angioplasty according to each type of valve.
We retrospectively studied coronary angiography or percutaneous angioplasty procedures after TAVR in two different centers. The catheterization success of coronary artery was evaluated according to the quality of engagement in ostium and opacification of the artery. Other indicators were collected including catheters used, fluoroscopy and angiography times, DAP and the volume of the contrast agent.
Among 1512 TAVR procedures, 33 patients were included. The Sapien 3® valve was implanted in 22 patients and the Evolut® in 11 patients (7 Evolut-R® and 4 Evolut Pro®). Coronary angiography with selective or partially selective catheterization has been successfully performed in all patients with a Sapien 3® valve. In the Evolut® group we identified 3 cases of non-selective catheterization for the right coronary and 1 case for the left coronary. Standard Judkins catheters seem to be the most suitable for both types of valve with very good efficiency.
The results of our study is promising for the future of TAVR with a coronary catheterization success rate close to 100% with some difficulties for the Evolut® supra-annular valves. Special attention should be paid to the technique of implantation and orientation of cups in the aortic sinus.
SARS-Coronavirus-2 (COVID-19) infection is a pandemic with various clinical presentations including pericarditis which seems to be rare.
The aim of this observational cohort study was to describe ...characteristics and management of the patients hospitalized for pericarditis secondary to COVID 19 in the Hospital of Haguenau, France.
We retrospectively enrolled patients admitted for pericarditis secondary to COVID 19 affection, either confirmed by a typical chest CT scan, or a positive Covid 19 PCR. Data were collected by a careful review of their medical record.
7 patients (4 men, 3 women) were included, with a median age of 60 and a median body mass index of 27.8 kg/m2. One of them took angiotensin II receptor antagonists, and none angiotensin converting enzyme inhibitors. Chest pain and dyspnea were the most common initial symptoms. Pericarditis were diagnosed with a median delay of 21 days after the onset of symptoms. The biology showed an inflammatory syndrome (median CRP at 104mg/L). The troponin peak value was increased in two cases. Chest computed tomography revealed a typical lung COVID-19 affection in 4 cases and a pericardial effusion in every cases. Left ventricle ejection fraction assessed by echocardiography was normal. Two cases evolved into cardiac tamponade, which needed pericardiocentesis. One of the two cases of tamponade had a negative COVID 19 nasopharyngeal PCR and no pulmonary sign of the affection on the chest CT, but the Covid-19 PCR on pericardial fluid was positive. One patient required oxygen supply. Treatment with Colchicine was systematically initiated. Non-steroidal anti-inflammatory drugs were not introduced considering the risk of respiratory worsening. The 1-month follow-up revealed no death and a decrease of the pericardial effusion.
This study suggest a higher prevalence of COVID-19-associated pericarditis than initially presumed, with heterogeneous clinical presentations.
Les complications vasculaires au cours d’un remplacement valvulaire aortique percutané nécessitent parfois la mise en place d’un stent couvert dans l’artère fémorale commune. Or, il s’agit d’une zone ...anatomique soumise à de fortes contraintes de mobilisation, exposant au risque de fracture voire d’occlusion de stent.
Nous avons analysé rétrospectivement les dossiers des patients ayant présenté une complication vasculaire per-procédure entre 2015 et 2018, traités par angioplastie de l’artère fémorale commune ou chirurgie conventionnelle. Des symptômes vasculaires suspects ont été recherchés à distance par suivi téléphonique.
Parmi 552 patients, 43 patients ont présenté une complication vasculaire, 12 (27,9 %) ont été traités par angioplastie au ballon seul, 5 (11,6 %) ont été traités par chirurgie d’emblée et 26 (60,4 %) ont été traités par implantation d’un stent couvert. Chez ces derniers, le succès d’implantation du stent était de 100 % et l’efficacité sur la complication était de 92,3 %. Le suivi médian était de 430jours 3–1499. Le groupe chirurgie présentait un sur-risque de transfusion et de décès toute cause. Aucun patient des trois groupes ne présentait de complication ou de symptôme vasculaire suspect au suivi. Quatre patients (9,3 %) du groupe stent couvert ont bénéficié d’une imagerie de réévaluation, sans fracture ni occlusion de stent retrouvée.
Dans notre population, l’implantation d’un stent couvert dans l’artère fémorale commune au décours d’une complication de remplacement valvulaire aortique percutané était une stratégie efficace et n’était associée à aucune complication à distance.
Vascular complications are frequent in the context of transcatheter aortic valve replacement and may require the implantation of a covered stent graft in the common femforal artery. However, common femoral artery is considered to be at high risk of stent fracture or occlusion due to high mobility of the hip joint.
We analyzed medical records of patients with transcatheter aortic valve replacement related vascular complications between 2015 and 2018, treated with commom femoral artery transluminal angioplasty or surgery. Vascular complications or suspect symptoms were followed up by phone calls.
Among 552 patients, 43 patients were included. Twelve (11.6 %) were managed by prolonged balloon inflation, 5 (11.6 %) by first line surgery and 26 (60.4 %) by the implantation of a covered stent graft. Among the latter group, the covered stent graft was efficient in 24 patients (92.3 %). The median follow-up was 430 days 3–1499. The first-line surgery group had a higher risk of red blood cell transfusion and all causes mortality. At follow-up, no patient had suspicious symptoms of vascular covered stent complication. Four patients (9.3 %) had US-doppler or CT vascular imaging at follow-up, showing no evidence of stent fracture or occlusion.
In our study, the implantation of a covered stent graft in the common femoral artery was an efficient and safe strategy for the management of transcatheter aortic valve replacement related vascular complications.
However, women younger than 50 years accounted for 11% of MI admitted in hospital and their incidence is increasing.
The main objective of this study is to systematically collect and describe ...clinical, morphological and biological characteristics, in hospital mortality and 12 months outcomes.
We performed a clinical prospective observational multicenter study including all female patients admitted for MI under the age of 50. Three hundred and fourteen patients were included in twenty-eight participating centers. Mean age was 42.9 (±5.7) years old. One hundred and ninety two presented with ST elevation MI and One hundred and twenty two with non ST elevation MI. A total of 75% were active smokers, 14.6% had diabetes, 26.4% high blood pressure but only 15.3% with antihypertensive therapy, 35% had a family history of cardiovascular disease. Their specific risk factor included 33% of prior complication of pregnancy, 45.5% were under hormonal contraception 15.6% were already menopaused. Among STEMI patient 90.6% presented with typical chest pain and 58.9% reported also associated symptoms (nausea, vomiting, asthenia, sweats, dizziness or palpitation). A total of 10.4% reported prior symptoms for more than 1 week before. At admission, 13% presented with cardiac arrest. Interestingly, for STEMI patients, pre-hospital antiplatelet drugs were not systematically administered. At angiography, normal coronary angiogram was found in 6.8% of STEMI and 10.7% of NSTEMI. 29.6% of the patients included had significant multivessel disease despite their young age. Spontaneous coronary artery dissection was reported in 14.6% of STEMI and 20.5% of NSTEMI. No death, but 3 strokes, 3 recurrences of MI and 1 serious bleeding occurred during the hospitalization.
A comprehensive and systematized analysis of MI in young woman would improve our understanding and enable physician to offer patients a more appropriate therapeutic and monitoring.
Nous rapportons le cas de Monsieur M. âgé de 78ans porteur d’une cardiopathie post-hypertensive avec des antécédents de flutter auriculaire paroxystique. Celui-ci consulte son cardiologue traitant ...pour palpitations et douleurs thoraciques atypiques. L’ECG inscrit un rythme sinusal régulier, un hémibloc antérieur gauche isolé sans trouble de rythme, ni signe d’ischémie. L’échocardiographie transthoracique met en évidence un épanchement péricardique circonférentiel sans tamponnade et une masse ovale hypoéchogène au niveau de la paroi inférieure du ventricule gauche et de l’oreillette gauche. L’IRM cardiaque confirme l’existence d’une masse tissulaire bourgeonnante dans le massif auriculaire (38,5×28,9mm) principalement localisée sur la paroi latérale de l’oreillette gauche, mais s’étendant dans la paroi inférieure et paroi postérieure de l’oreillette droite. Un TDM thoraco-abdomino-pelvien ne retrouve pas d’autre anomalie suspecte, ni d’adénopathie. Une thoracotomie gauche avec drainage péricardique et biopsie sont réalisés. L’analyse histologique est en faveur d’un lymphome B diffus à grande cellule CD 20+; CD 10–. Une chimiothérapie R-COMP (Rituximab; Myocet®, cyclophosphamide; vincristine; prednisone) est alors initiée. L’IRM cardiaque de contrôle montre une régression significative de la tumeur par évolution nécrotique ou rétractile avec persistance de la masse dans le sillon auriculo-ventriculaire gauche.
Nous rapportons le cas d’une patiente de 70ans présentant une liquéfaction caséeuse de calcification mitrale découverte fortuitement lors d’une échographie cardiaque. Un suivi clinique et par ...imagerie échographique et IRM est réalisé dans les suites. La patiente reste totalement asymptomatique sur le plan cardiovasculaire.
We report the case of an asymptomatic 70-year-old woman with a liquefaction necrosis of mitral annulus calcification. This mass was discovered incidentally during an echocardiographic examination. Additional treatment was not performed because liquefaction necrosis of mitral calcification usually has a benign prognosic. A scheduled clinical review with an echocardiographic examination and cardiac MRI was planified. The patient is actually healthy without any complication.
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