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Meredith T, Scheuer S, Hoffman M, Joshi Y, Kathir K, Gunalingam B, Roy D, Wilson S, Jansz P, Macdonald P, Muller D. Coronary angiography of the ex-situ beating donor heart in a portable organ care system. Catheter Cardiovasc Interv 2022; 100:1252-1260. [PMID: 36321629 PMCID: PMC10091975 DOI: 10.1002/ccd.30455] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To determine safety and feasibility of ex-situ coronary angiography. BACKGROUND To cater for the perpetually growing demand for heart donors, interest in donation following circulatory death (DCD) has been rekindled. Further pursuit of donor pool expansion has led to eligibility extension to "marginal" donors who are at higher risk of coronary artery disease (CAD). Excluding CAD in potentially eligible DCD donors, for whom ante-mortem angiography is commonly not permitted, is therefore challenging. Ex-situ coronary angiography serves as an ethical and feasible diagnostic tool to assess for preclusive CAD. METHODS We undertook a systematic review of the published literature and institutional retrospective review of case experience with ex-situ coronary angiography of donor hearts, supported by a portable organ care system. RESULTS Combined literature and institutional case review yielded nine total cases of ex-situ coronary angiography of donor human hearts plus one experimental porcine model. Of the eight cases of ex-situ coronary angiography performed at our institute, all were conducted without complication or injury to the allograft. Two thirds of reported human cases have proceeded to successful transplantation. CONCLUSIONS Diagnostic coronary angiography of the ex-situ beating donor heart is safe, feasible, and demonstrates novel clinical utility in mitigating subsequent transplantation of unsuitable allografts. In the setting of suspected coronary atherosclerosis of the donor heart, which may preclude favorable transplantation outcomes, ex-situ coronary angiography should be considered at eligible transplant centers.
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Affiliation(s)
- Thomas Meredith
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah Scheuer
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Michael Hoffman
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Yashutosh Joshi
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Krishna Kathir
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Brendan Gunalingam
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - David Roy
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Stephanie Wilson
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Paul Jansz
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Peter Macdonald
- Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia.,Department of Heart and Lung Transplantation, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - David Muller
- Department of Interventional Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
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2
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Jain P, Jacobs N, Muller DW, Gunalingam B. 1% Aspiration, 99% Perspiration. JACC Case Rep 2020; 2:866-869. [PMID: 34317369 PMCID: PMC8302059 DOI: 10.1016/j.jaccas.2020.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022]
Abstract
A 71-year-old man with chronic atrial fibrillation underwent insertion of a left atrial appendage occlusion device. Before release, a large thrombus was noted within the left atrium, attached to the left atrial appendage occluder delivery system. With continuous negative pressure, the device was deployed and thrombus successfully aspirated with no clinical sequelae. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Pankaj Jain
- Address for correspondence: Dr. Pankaj Jain, Cardiology Department, Level 4, Xavier Building, St. Vincent’s Hospital, 390 Victoria Street, Darlinghurst, New South Wales, Australia 2010. @pankajjain185
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3
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Bamford P, Parkinson MD, Gunalingam B, David M, Lau GTM. A New Era for Rotational Atherectomy: An Australian Perspective. Clin Med Insights Cardiol 2019; 13:1179546819852070. [PMID: 31217694 PMCID: PMC6557014 DOI: 10.1177/1179546819852070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 04/29/2019] [Indexed: 11/23/2022]
Abstract
Background: Rotational atherectomy (RA) has been used in percutaneous coronary intervention (PCI) for 30 years. With advances in technology, this observational study looks at how rates of RA have changed over the past decade in Australia in relation to PCI and coronary artery bypass graft (CABG) rates. Methods: Retrospective analysis of RA, PCI, and CABG rates per Australian state from Australian Government Department of Human Services’ data on Medicare items from 2007 to 2017 was carried out. Results: There were 149 RA procedures in 2007, increasing to 452 in 2017. Rotational atherectomy accounted for 0.67% of PCI procedures in 2007, increasing to 1.48% in 2018 (+0.81%, 95% confidence interval [CI] = [0.64%-0.91%]; P < .001). Most of this increase has come from procedures in New South Wales (441% increase). Australian PCI rate increased from 22 301 to 30 480. Rate of CABG decreased from 5418 to 5206. Conclusions: From 2007 to 2017, rates of RA trebled in Australia. This is despite stable rates of PCI and a fall in rates of CABG. There are several clinical explanations for this trend.
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Affiliation(s)
- Paul Bamford
- Gosford Hospital, Gosford, NSW, Australia.,University of Newcastle, Newcastle, NSW, Australia
| | | | - Brendan Gunalingam
- Gosford Hospital, Gosford, NSW, Australia.,St Vincent's Hospital, Sydney, NSW, Australia
| | | | - George Tat-Ming Lau
- Gosford Hospital, Gosford, NSW, Australia.,Sydney Adventist Hospital, Sydney, NSW, Australia.,University of Sydney, Sydney, NSW, Australia
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4
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Nadel J, Subbiah R, Jacobs N, Muller DWM, Gunalingam B. Successful left atrial appendage closure in a patient with prior patent foramen ovale occlusion. HeartRhythm Case Rep 2019; 5:183-186. [PMID: 30997330 PMCID: PMC6453555 DOI: 10.1016/j.hrcr.2018.11.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- James Nadel
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - Rajesh Subbiah
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, NSW, Australia
| | - Neil Jacobs
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
| | - David W M Muller
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia.,Victor Chang Cardiac Research Institute, Darlinghurst, Sydney, NSW, Australia
| | - Brendan Gunalingam
- Department of Cardiology, St. Vincent's Hospital, Darlinghurst, Sydney, NSW, Australia
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5
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Parkinson M, Cheruvu S, Bamford P, Said C, Qin J, Wadsworth H, Eaves S, Colgan J, Gunalingam B. Follow-Up Outcomes of Pre-Hospital Thrombolysis and Primary PCI in Outer Metropolitan Management of STEMI. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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6
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Bart N, Parkinson M, Hungerford S, Brennan X, Gunalingam B. Staphylococcus aureus Pericarditis Presenting as Cardiac Tamponade Caused by Diabetic Foot Osteomyelitis. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Bart N, Hungerford S, Namasivayam M, Jacobs N, Gunalingam B. Caught in The Act: A Case of Newly Developed Thrombus Jailed Within the Left Atrial Appendage by a Watchman Device. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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8
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Spina R, Siriwardena M, Bart N, Namasivayam M, Connellan M, Jansz P, Spratt P, Hayward CS, Kotlyar E, Gunalingam B. Primary percutaneous coronary intervention for inferior ST-segment elevation myocardial infarction in a patient supported by the HeartWare left ventricular assist device. Intern Med J 2017; 47:1068-1071. [DOI: 10.1111/imj.13530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/07/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Roberto Spina
- Department of Interventional Cardiology; St Vincent's Hospital; Sydney New South Wales Australia
| | - Maithri Siriwardena
- Department of Intensive Care; St Vincent's Hospital; Sydney New South Wales Australia
| | - Nicole Bart
- Department of Cardiac Transplantation and Advanced Heart Failure Service; St Vincent's Hospital; Sydney New South Wales Australia
| | - Mayooran Namasivayam
- Department of Cardiac Transplantation and Advanced Heart Failure Service; St Vincent's Hospital; Sydney New South Wales Australia
| | - Mark Connellan
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Sydney New South Wales Australia
| | - Paul Jansz
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Sydney New South Wales Australia
| | - Philip Spratt
- Department of Cardiothoracic Surgery; St Vincent's Hospital; Sydney New South Wales Australia
| | - Christopher S. Hayward
- Department of Cardiac Transplantation and Advanced Heart Failure Service; St Vincent's Hospital; Sydney New South Wales Australia
| | - Eugene Kotlyar
- Department of Cardiac Transplantation and Advanced Heart Failure Service; St Vincent's Hospital; Sydney New South Wales Australia
| | - Brendan Gunalingam
- Department of Interventional Cardiology; St Vincent's Hospital; Sydney New South Wales Australia
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9
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May AN, Kull A, Gunalingam B, Francis JL, Lau GT. The uptake of coronary fractional flow reserve in Australia in the past decade. Med J Aust 2016; 205:127. [DOI: 10.5694/mja15.01225] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 02/29/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Austin N May
- Gosford Hospital, Gosford, NSW
- University of New South Wales, Sydney, NSW
| | | | | | | | - George T Lau
- Gosford Hospital, Gosford, NSW
- University of Sydney, Sydney, NSW
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10
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May A, Kull A, Hill A, Gunalingam B, William M, Andrews K, Lau G. The Uptake and Utility of FFR in a Regional Centre. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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11
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Otton JM, Spina R, Sulas R, Subbiah RN, Jacobs N, Muller DWM, Gunalingam B. Left Atrial Appendage Closure Guided by Personalized 3D-Printed Cardiac Reconstruction. JACC Cardiovasc Interv 2016; 8:1004-6. [PMID: 26088522 DOI: 10.1016/j.jcin.2015.03.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/11/2015] [Accepted: 03/26/2015] [Indexed: 10/23/2022]
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12
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Yang D, Xu Z, Zhang Y, Luo Y, Zhang J, Wang Y, Gunalingam B, Zhang X. [Application of Mimics three-dimensional imaging in percutaneous left atrial appendage closure with Watchman system]. Zhonghua Xin Xue Guan Bing Za Zhi 2015; 43:352-357. [PMID: 26082369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The three-dimensional (3D) structure of left atrial appendage (LAA) in atrial fibrillation patients were reconstructed by Mimics 3D imaging system, aiming at guiding for selection of both the size and location of the closure devices and making preliminary risk assessment of LAA closure with Watchman system. METHODS Inclusion criteria were: ten voluntary patients with both atrial fibrillation and indication for LAA closure aging from 40 to 85 years old with contraindication for oral anticoagulants or unwillingness to take long-term oral anticoagulation therapy from May to December 2014. 3D reconstruction of LAA was preoperatively made by Mimics 3D imaging system. With the Mimics 3D reconstruction model and the results of both transesophageal echocardiography (TEE) and LAA radiography, the size and location for the closure device were chosen. The devices were planted at the ostium of the LAA. RESULTS Ten atrial fibrillation patients were enrolled (average age: (66.3±11.9) years old) and all successfully implanted with the Watchman LAA closure devices. Nine of them were with non-valvular atrial fibrillation with average CHADS2-VAS score (3.2±1.7) and HAS-BLED score (2.7±1.6). The rest one was a valvular atrial fibrillation patient with the history of the percutaneous balloon mitral valvuloplasty (PBMV) without surgical indications of mitral valve replacement (MVR). There was no blood leakage around the device by regular postoperative TEE and LAA radiography examinations. There were no complications of bleeding, embolism, or stroke through both at peri-operative period and at 1 month follow-up post procedure. CONCLUSION Preoperative Mimics 3D reconstruction of LAA by Mimics 3D imaging system among atrial fibrillation patients provides essential information guiding the successful LAA closures.
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Affiliation(s)
- Dong Yang
- Department of Cardiovascular Diseases of the Affiliated Hospital of Hangzhou Normal University, Hangzhou 310000, China
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13
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Grover R, Huang J, Gunalingam B, McCrohon J. The utility of low dose serial computed tomography coronary angiography (CTCA) in the management of spontaneous coronary artery dissection (SCAD). Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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14
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Spina R, Gunalingam B. Left atrial appendage occlusion with the Watchman device in a patient with paroxysmal atrial fibrillation and intolerance of all forms of anticoagulation due to hereditary haemorrhagic telangiectasia. Intern Med J 2014; 44:295-7. [PMID: 24621286 DOI: 10.1111/imj.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
An elderly woman presented to our attention because of paroxysmal atrial fibrillation and cerebrovascular events requiring systemic anticoagulation and a concomitant, serious bleeding diathesis (the Osler-Weber-Rendu syndrome, or hereditary haemorrhagic telangiectasia). Her risk of suffering a major stroke was significant given a CHA(2)DS(2)VASc score of 6. However, she was unable to tolerate any form of anticoagulation because of torrential epistaxis and previous gastrointestinal haemorrhage on antiplatelet therapy. We proceeded with percutaneous occlusion of the left atrial appendage with a Watchman device. Ten months post-procedure she is well, without recurrence of neurological symptoms, and off all forms of anticoagulation. The current internationally accepted practice post-deployment of the Watchman device mandates warfarin transition for 6 months to allow for endothelialisation of the device. However, there is no evidence in the literature to support left atrial appendage occlusion without any peri-procedural antiplatelet and anticoagulation therapy and therefore our case represents novel and important anecdotal evidence that secondary stroke prevention with left atrial appendage occlusion may be effective and safe even in patients who cannot tolerate any form of anticoagulation at all.
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Affiliation(s)
- R Spina
- Department of Cardiology, St Vincent's Hospital, Sydney, New South Wales, Australia
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15
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Spina R, Boland JE, Baron D, Roy P, Muller DW, Gunalingam B. TCT-687 A Comparison of Angiographic and Transesophageal Measurements of Left Atrial Appendage Dimensions during Catheter-Based Left Atrial Appendage Occlusion: Implications for Sizing and Safety. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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16
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Spina R, Subbiah R, Markus R, Gunalingam B. Percutaneous left atrial appendage occlusion with a Watchman device following recurrent stroke on warfarin and rivaroxaban in patient with paroxysmal atrial fibrillation. Heart Lung Circ 2013; 23:171-3. [PMID: 24076164 DOI: 10.1016/j.hlc.2013.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/22/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Abstract
The optimal management of recurrent cardioembolic stroke in a patient on oral anticoagulation is controversial. Therapeutic strategies for secondary stroke prevention in such circumstances may include the intensification of oral anticoagulation, the addition of antiplatelet therapy to warfarin, or the use of a non-vitamin K antagonist instead of warfarin. However, there is no evidence to support these interventions, and indeed these strategies are not endorsed by the 2011 Guidelines on the Secondary Prevention of Stroke issued by the American Heart Association/American Stroke Association. Percutaneous occlusion of the left atrial appendage (LAA) has recently emerged as an acceptable non-pharmacological strategy to reduce the risk of cardioembolism in patients who cannot tolerate oral anticoagulation, but there is little evidence to support its use in the context of recurrent stroke despite oral anticoagulation. We present the case of a 66 year-old male with paroxysmal atrial fibrillation who experienced recurrent stroke despite treatment with warfarin initially, and rivaroxaban subsequently. After excluding non-cardioembolic causes of recurrent stroke, we proceeded with percutaneous occlusion of the LAA with a Watchman device. Nine months post-procedure he has not experienced recurrence of neurological symptoms. Our case provides anectodal evidence that catheter-based LAA occlusion can be beneficial in secondary stroke prevention where oral anticoagulation has been problematic.
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Affiliation(s)
- Roberto Spina
- Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia
| | - Rajesh Subbiah
- Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia; University of New South Wales, High Street, Kensington, Sydney NSW 2052, Australia
| | - Romesh Markus
- Department of Neurology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia; University of New South Wales, High Street, Kensington, Sydney NSW 2052, Australia
| | - Brendan Gunalingam
- Department of Cardiology, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney NSW 2010, Australia.
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17
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Spina R, Wynne D, Roy P, Baron D, Muller D, Gunalingam B. Dual Anti-Platelet Therapy Following Percutaneous Left Atrial Appendage Occlusion with the Watchman Device is not Associated with Increased Risk of Thromboembolism Compared with Warfarin. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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18
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Choong P, Wong T, Chan R, William M, Woods J, Hill A, Wilkes N, Kull T, Gunalingam B. Fluoroscopic Femoral Artery Puncture: Reducing the Risk of Vascular Complications. Heart Lung Circ 2010. [DOI: 10.1016/j.hlc.2010.06.694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Chan RYJ, Gunalingam B. A rare coronary anomaly. Heart Lung Circ 2009; 18:407-8. [PMID: 19919857 DOI: 10.1016/j.hlc.2008.05.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Revised: 11/13/2007] [Accepted: 05/11/2008] [Indexed: 10/21/2022]
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20
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Wilsmore B, Gunalingam B. Iatrogenic coronary arteriovenous fistula during percutaneous coronary intervention: unique insight into intra-procedural management. J Interv Cardiol 2009; 22:460-5. [PMID: 19732283 DOI: 10.1111/j.1540-8183.2009.00496.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
We report the case of a 69-year-old man who presented with worsening exertional angina where subsequent percutaneous coronary intervention resulted in a coronary arteriovenous fistula. Attempts to occlude the fistula using a relatively conservative management approach with acute reversal of intraprocedural heparin and prolonged balloon inflation unfortunately resulted in extensive coronary artery thrombosis without immediate resolution of the arteriovenous fistula. However, follow-up at 6 months revealed resolution of the fistula. This case study emphasizes the uncommon but potentially life-threatening complications of percutaneous coronary interventions with implications not only relating to the hazards of managing iatrogenic arteriovenous fistula, but reversing intraprocedural heparin using protamine, during any coronary angiogram.
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Affiliation(s)
- Bradley Wilsmore
- Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
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Abstract
The T technique is not uncommonly used to stent bifurcation lesions. It requires recrossing into the side branch with a guidewire and balloon to perform final Kissing Balloon dilations, but recrossing can be difficult. We describe a case of bifurcation stenting where balloon recrossing following guidewire placement into the side branch proved very challenging, and was finally achieved via a combination of forward pressure on a low-profile balloon with its tip wedged at the stent struts along with simultaneous low-pressure inflation of a larger parallel balloon. This altered the stent architecture and also allowed for a more favorable vector of force transmission to allow recrossing and hence successful completion of the procedure.
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Affiliation(s)
- Brendan Gunalingam
- Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia.
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Gunalingam B, Bates F, Wilkes N, Hill A, Wang D. Percutaneous Coronary Interventions without On-Site Cardiac Surgery: A Remote Australian Experience. Heart Lung Circ 2008; 17:388-94. [DOI: 10.1016/j.hlc.2008.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2007] [Revised: 01/02/2008] [Accepted: 01/23/2008] [Indexed: 12/01/2022]
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Abstract
Coronary artery aneurysm associated with the Paclitaxel drug eluting stent (Taxus) is a rare complication. We describe the case of a 71-year-old female, who developed two coronary artery aneurysms in her right coronary artery associated with the insertion of a Taxus stent. Although no adverse clinical outcome resulted, this case highlights a potential problem going forward.
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Affiliation(s)
- Dennis Wang
- Department of Cardiology, Gosford Hospital, Holden Street, Gosford, NSW 2250, Australia
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24
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Abstract
We report the case of an 85-year-old man who presented with worsening exertional dyspnoea 18 months after coronary artery bypass surgery for critical three vessel coronary artery disease. Coronary angiography revealed an anastomotic stricture between a radial artery graft and the first diagonal branch. Percutaneous coronary intervention utilizing a retrograde application of the "buddy" wire technique was then performed.
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25
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Chan RYJ, Gunalingam B. "Backdoor" Alternative Approach to Stenting of a Post-Anastomotic Coronary Artery Lesion via a Chronically Obstructed Right Coronary Artery after Failure to Stent through a Tortuous Free Internal Mammary Graft. J Interv Cardiol 2007; 20:243-7. [PMID: 17680853 DOI: 10.1111/j.1540-8183.2007.00257.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We describe the case of a patient who previously had coronary artery bypass grafting including a free right internal mammary artery graft anastomosed to a chronic totally occluded right coronary artery (RCA) proximally and distally and who presented with a high-risk acute coronary syndrome. Coronary angiography revealed the graft to be patent with a distal post-anastomotic culprit lesion within the posterolateral branch of the native RCA. Because of technical challenges, PCI could not be performed through the graft and the lesion was stented via the chronically occluded RCA instead, in a "backdoor" approach with a good final result.
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Affiliation(s)
- Richard Y J Chan
- Department of Cardiology, Gosford Hospital, Holden Street, Gosford, New South Wales, Australia
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26
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Abstract
We report the case of a 67-year-old man who presented with a [corrected] non-ST-elevation acute myocardial infarction 41 months after implantation of a sirolimus-eluting stent in his left circumflex coronary artery. Coronary angiography revealed stent thrombosis.
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Affiliation(s)
- David Henderson
- Department of Cardiology, Gosford Hospital, Gosford, New South Wales, Australia
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Abstract
BACKGROUND Carotid stenting was initially proposed as an alternative to surgical endarterectomy for selected high-risk patients. More recently, patients of standard surgical risk are being considered for percutaneous treatment of their carotid disease. AIMS To describe the clinical outcomes of an initial consecutive cohort of patients treated by carotid stenting at one institution. METHODS Between December 1997 and July 2003, 111 patients underwent stenting of 118 carotid arteries. Peri-procedural and long-term outcome data were collected. RESULTS Most patients (>70%) were high-risk candidates for endarterectomy. Stents were successfully placed in 117/118 carotid arteries (99.2%). Distal protection devices were used in 43/118 (36.4%). The peri-procedural rate of death or disabling stroke was 3/118 (2.5%). Death or any stroke occurred in 11/118 (9.3%). However, only 7/118 (5.9%) procedures resulted in death or any persistent stroke (neurological deficit >1 week post-procedure). No myocardial infarction occurred. Median length of post-procedure hospitalization was 1 day. Long-term follow up was possible for 101 patients (91.0%) over a mean period of 27.1 months. The Kaplan-Meier estimate of survival free of ipsilateral stroke 36 and 66 months after carotid stenting was 77.0 +/- 9.5% and 68.2 +/- 15.1%, respectively. The estimated survival free of any stroke or stent failure was 70.9 +/- 10.7% and 60.7 +/- 17.4%, respectively. The majority of late deaths (7/11) were due to cardiac disease. CONCLUSION We conclude that stenting of carotid stenoses is feasible, with a high procedural success rate and low complication rate. Carotid stenting should be considered the procedure of choice for high-risk patients.
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Affiliation(s)
- J C Kovacic
- St Vincent's Hospital, Darlinghurst, NSW, Australia
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28
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Gunalingam B, Roy P, Baron D, Muller D. Carotid stenting - a viable alternative to surgery? Heart Lung Circ 2000. [DOI: 10.1046/j.1443-9506.2000.0756x.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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29
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Abstract
We report the case of a 69-year-old man with an aortic valve bioprosthesis in whom a diagnosis of Salmonella typhimurium prosthetic valve endocarditis was made. During the prolonged hospital admission early aggressive antibiotic therapy and early valve replacement surgery were the deciding factors enabling him to survive this otherwise lethal condition.
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Affiliation(s)
- B Gunalingam
- St Vincent's Hospital, Darlinghurst, Sydney, New South Wales, Australia.
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30
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Gunalingam B, Sammel N, Thorburn C, Kuchar D. Cardiomyopathy secondary to ventricular tachycardia--an unusual case of reversible heart failure. Aust N Z J Med 1999; 29:100-1. [PMID: 10200828 DOI: 10.1111/j.1445-5994.1999.tb01603.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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