Úvod: ischemická choroba srdeční (ichS) je celosvětově hlavní příčinou úmrtí, což je jedním z důvodů významných technologických pokroků intervenční kardiologie v posledních dekádách. Kombinace intravaskulárního ultrazvuku (iVuS) a infračervenému spektru blízké spektroskopie (nirS) nabízí detailní pohled na morfologii koronárních tepen a složení aterosklerotických plátů. tyto pokročilé zobrazovací technologie umožňují přesnější hodnocení ichS a zlepšují terapeutické strategie. Cíl: nirS dokáže detekovat a určitým způsobem kvantifikovat obsah lipidů v aterosklerotickém plátu pomocí indexů lcBi (lipid-core Burden index) a maxlcBi4mm (Maximal lipid core Burden index ve 4mm segmen- tu). V této studii jsme zkoumali vztah mezi těmito indexy a progresí aterosklerotického plátu v období 9–12 měsíců od perkutánní koronární intervence (Pci) s implantací lékového stentu v kmeni levé koronární tepny. Metody: Jednalo se o prospektivní, monocentrickou studii zahrnující 27 pacientů s významnou stenózou kmene levé věnčité tepny, kteří podstoupili iVuS-nrS vedenou Pci. Sériově byly hodnoceny lcBi, maxlcBi- 4mm a objem plátu (PV) před Pci, bezprostředně po Pci a v rámci kontrolního vyšetření za 9 až 12 měsíců u 18 pacientů. Výsledky: Průměrný věk pacientů dosahoval 72,7 roku, přičemž převládali muži (88 %). Průměrný lcBi před Pci byl 128,9 ± 122,0, zatímco maxlcBi4mm byl 263,7 ± 172,0. Volumetricky pomocí iVuS měřený PV po Pci byl 418,7 ± 203,3 mm3, při kontrole se zvýšil na 454,5 ± 209,4 mm3 (p = 0,105). Analýza neodhalila významnou korelaci mezi rozdílem PV (po Pci a při kontrole) a výchozími hodnotami lcBi, resp. maxlcBi4mm (p = 0,626, resp. 0,786). Závěr: Výsledky neprokázaly statisticky významnou korelaci mezi počátečními hodnotami lcBi, resp. maxlcBi4mm a progresí PV v kmeni levé věnčité tepny. Korelační grafy však naznačují trend ke snížení PV u pacientů s vysokými výchozími hodnotami lcBi a maxlcBi4mm jako možný efekt vysoce intenzivní statinové terapie.
Background: Coronary artery disease (CAD) is the leading cause of death worldwide, which has driven significant advances in the field of interventional cardiology. The combination of intravascular ultrasound (IVUS) and near-infrared light spectroscopy (NIRS) offers a detailed view of coronary artery morphology and plaque composition. This advanced imaging capability facilitates a more accurate assessment of CAD and enhances therapeutic strategies. Objective: NIRS can detect and quantify lipid content in atherosclerotic plaque using the Lipid Core Burden Index (LCBI) and the Maximal Lipid Core Burden Index in a 4 mm segment (maxLCBI4mm). In this study, we examined the relationship between these indices and atherosclerotic plaque progression in the crucial area of the left main coronary artery (LM) during a follow-up period of 9 to 12 months after percutaneous coronary interventions (PCI). Methods: A prospective, single-centre study was conducted involving 27 patients with significant left main stenosis who underwent IVUS-NIRS guided PCI. Serial assessments of the LCBI, maxLCBI4mm, and IVUS-derived plaque volume (PV) were performed at baseline, immediately post-PCI, and during follow-up at 9 to 12 months in 18 patients. Results: The mean age of the study population was 72.7 years, with a predominance of male patients (88%). The average LCBI of the LM coronary artery before PCI was 128.9 ± 122.0, while maxLCBI4mm was 263.7 ± 172.0. The IVUS-measured PV post-PCI was 418.7 ± 203.3 mm3, increasing to 454.5 ± 209.4 mm3 at follow-up (p = 0.105). Analysis revealed no significant correlation between the difference in PV and baseline LCBI or maxLCBI4mm, with p-values of 0.626 and 0.786, respectively. Conclusion: This study found no significant association between initial LCBI and maxLCBI4mm segment values and subsequent changes in PV in the left main coronary artery. However, correlation graphs indicate a trend toward decreased PV in patients with high initial LCBI and maxLCBI4mm.
- MeSH
- aterosklerotický plát * chemie patologie MeSH
- blízká infračervená spektroskopie * metody přístrojové vybavení MeSH
- intervenční ultrasonografie MeSH
- koronární angioplastika MeSH
- koronární stenóza chirurgie diagnostické zobrazování MeSH
- lidé MeSH
- lipidy analýza MeSH
- prospektivní studie MeSH
- senioři MeSH
- statistika jako téma MeSH
- ukazatele zdravotního stavu MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- klinická studie MeSH
- práce podpořená grantem MeSH
Ventriculoatrial shunts are the alternative treatments when it is impossible to use ventriculoperitoneal shunts. Limited indication for ventriculoatrial shunt is due to the possibility of very serious complications inherent with this procedure. We present a case report of a young patient who suffered from disconnection of an atrial catheter from the valve after an accidental blow to his neck. The atrial catheter was dislocated to the heart and pulmonary artery and it was extracted through the femoral vein in the groin area using an endovascular technique. The procedure went without complications. A new atrial catheter was introduced under ultrasonic guidance during surgical revision.
- MeSH
- arteria pulmonalis * chirurgie MeSH
- dospělí MeSH
- lidé MeSH
- migrace cizích těles chirurgie diagnostické zobrazování MeSH
- shunty pro odvod mozkomíšního moku škodlivé účinky MeSH
- srdeční síně chirurgie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
- přehledy MeSH
Kangrelor v dnešní době představuje jediný intravenózní inhibitor destičkového receptoru P2Y12 s klinicky prokázanou účinností pro snížení ischemických komplikací perkutánní koronární intervence (PCI). Dle souhrnu údajů o léčivém přípravku (SPC) je kangrelor doporučen u pacientů podstupující PCI, kteří nebyli léčení perorálním P2Y12 inhibitorem, nebo u nichž tato terapie není možná nebo vhodná. V následující kazuistice bude představen případ vysoce rizikového pacienta s komplexním intervenčním výkonem za použití tohoto přípravku (1).
Kangrelor represents the only intravenous inhibitor of the platelet receptor P2Y12 with clinically proven effectiveness in reducing ischemic complications of percutaneous coronary intervention (PCI). According to the Summary of Product Characteristics (SPC), Kangrelor is recommended for patients undergoing PCI who have not been treated with an oral P2Y12 inhibitor or for whom this therapy is not possible or suitable. In the following case study, a high-risk patient undergoing a complex interventional procedure using this preparation will be presented (1).
- Klíčová slova
- Kangrelor,
- MeSH
- adenosinmonofosfát farmakologie terapeutické užití MeSH
- akutní koronární syndrom farmakoterapie MeSH
- antagonisté purinergních receptorů P2Y * farmakologie terapeutické užití MeSH
- infarkt myokardu * diagnóza terapie MeSH
- inhibitory agregace trombocytů farmakologie terapeutické užití MeSH
- lidé MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- Publikační typ
- kazuistiky MeSH
BACKGROUND: The presented study investigates the application of bi-arterial 3D printed models to guide transseptal puncture (TSP) in left atrial appendage closure (LAAC). AIMS: The objectives are to (1) test the feasibility of 3D printing (3DP) for TSP guidance, (2) analyse the distribution of the optimal TSP locations, and (3) define a CT-derived 2D parameter suitable for predicting the optimal TSP locations. METHODS: Preprocedural planning included multiplanar CT reconstruction, 3D segmentation, and 3DP. TSP was preprocedurally simulated in vitro at six defined sites. Based on the position of the sheath, TSP sites were classified as optimal, suboptimal, or nonoptimal. The aim was to target the TSP in the recommended position during the procedure. Procedure progress was assessed post hoc by the operator. RESULTS: Of 68 screened patients, 60 patients in five centers (mean age of 74.68 ± 7.64 years, 71.66% males) were prospectively analyzed (3DP failed in one case, and seven patients did not finally undergo the procedure). In 55 patients (91.66%), TSP was performed in the optimal location as recommended by the 3DP. The optimal locations for TSP were postero-inferior in 45.3%, mid-inferior in 45.3%, and antero-inferior in 37.7%, with a mean number of optimal segments of 1.34 ± 0.51 per patient. When the optimal TSP location was achieved, the procedure was considered difficult in only two (3.6%) patients (but in both due to complicated LAA anatomy). Comparing anterior versus posterior TSP in 2D CCT, two parameters differed significantly: (1) the angle supplementary to the LAA ostium and the interatrial septum angle (160.83° ± 9.42° vs. 146.49° ± 8.67°; p = 0.001), and (2) the angle between the LAA ostium and the mitral annulus (95.02° ± 3.73° vs. 107.38° ± 6.76°; p < 0.001), both in the sagittal plane. CONCLUSIONS: In vitro TSP simulation accurately determined the optimal TSP locations for LAAC and facilitated the procedure. More than one-third of the optimal TSP sites were anterior.
- MeSH
- 3D tisk MeSH
- fibrilace síní * terapie chirurgie MeSH
- lidé MeSH
- počítačová rentgenová tomografie MeSH
- punkce metody MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- síňové ouško * diagnostické zobrazování chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
INTRODUCTION: Observational studies have shown low bleeding rates in patients with atrial fibrillation (AF) treated by left atrial appendage closure (LAAC); however, data from randomized studies are lacking. This study compared bleeding events among patients with AF treated by LAAC and nonvitamin K anticoagulants (NOAC). METHODS: The Prague-17 trial was a prospective, multicenter, randomized trial that compared LAAC to NOAC in high-risk AF patients. The primary endpoint was a composite of a cardioembolic event, cardiovascular death, and major and clinically relevant nonmajor bleeding (CRNMB) defined according to the International Society on Thrombosis and Hemostasis (ISTH). RESULTS: The trial enrolled 402 patients (201 per arm), and the median follow-up was 3.5 (IQR 2.6-4.2) years. Bleeding occurred in 24 patients (29 events) and 32 patients (40 events) in the LAAC and NOAC groups, respectively. Six of the LAAC bleeding events were procedure/device-related. In the primary intention-to-treat analysis, LAAC was associated with similar rates of ISTH major or CRNMB (sHR 0.75, 95% CI 0.44-1.27, p = 0.28), but with a reduction in nonprocedural major or CRNMB (sHR 0.55, 95% CI 0.31-0.97, p = 0.039). This reduction for nonprocedural bleeding with LAAC was mainly driven by a reduced rate of CRNMB (sHR for major bleeding 0.69, 95% CI 0.34-1.39, p = .30; sHR for CRNMB 0.43, 95% CI 0.18-1.03, p = 0.059). History of bleeding was a predictor of bleeding during follow-up. Gastrointestinal bleeding was the most common bleeding site in both groups. CONCLUSION: During the 4-year follow-up, LAAC was associated with less nonprocedural bleeding. The reduction is mainly driven by a decrease in CRNMB.
- MeSH
- antikoagulancia škodlivé účinky MeSH
- cévní mozková příhoda * diagnóza etiologie prevence a kontrola MeSH
- fibrilace síní * komplikace diagnóza farmakoterapie MeSH
- krvácení chemicky indukované MeSH
- lidé MeSH
- prospektivní studie MeSH
- síňové ouško * chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
AIMS: The management of congestion is one of the key treatment targets in heart failure. Assessing congestion is, however, difficult. The purpose of this study was to investigate the safety and dynamic response of a novel, passive, inferior vena cava (IVC) sensor in a chronic ovine model. METHODS AND RESULTS: A total of 20 sheep divided into three groups were studied in acute and chronic in vivo settings. Group I and Group II included 14 sheep in total with 12 sheep receiving the sensor and two sheep receiving a control device (IVC filter). Group III included an additional six animals for studying responses to volume challenges via infusion of blood and saline solutions. Deployment was 100% successful with all devices implanted; performing as expected with no device-related complications and signals were received at all observations. At similar volume states no significant differences in IVC area normalized to absolute area range were measured (55 ± 17% on day 0 and 62 ± 12% on day 120, p = 0.51). Chronically, the sensors were completely integrated with a thin, reendothelialized neointima with no loss of sensitivity to infused volume. Normalized IVC area changed significantly from 25 ± 17% to 43 ± 11% (p = 0.007) with 300 ml infused. In contrast, right atrial pressure required 1200 ml of infused volume prior to a statistically significant change from 3.1 ± 2.6 mmHg to 7.5 ± 2.0 mmHg (p = 0.02). CONCLUSION: In conclusion, IVC area can be measured remotely in real-time using a safe, accurate, wireless, and chronic implantable sensor promising to detect congestion with higher sensitivity than filling pressures.
- MeSH
- ovce MeSH
- srdeční selhání * terapie MeSH
- vena cava inferior * diagnostické zobrazování MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
