The experience with the Epiclose-T vascular access closure device: a human study

OBJECTIVE

The Epiclose-T, a novel closure device for arterial access sites, is designed as a double-balloon device that applies direct pressure on the arteriotomy site, allowing natural coagulation and leaving no artificial material behind. We assessed prospectively the initial safety and efficacy of the Epiclose-T after diagnostic cardiac catheterization, and evaluated patient comfort.

METHODS

In our randomized, controlled, prospective study, the study group consisted of 32 patients (17 male, mean age 52.8+/-11.0 years) treated with Epiclose-T device. The control group included 39 patients (20 male, mean age 55.5+/-11.0 years) treated with manual compression.

RESULTS

Hemostasis was achieved successfully in 90.6% of the study group. For the 30-day follow-up, there were no statistically significant differences between the groups in the rate of major and minor complications. No bleeding requiring transfusion was seen in both groups. However, the number of major complications, including large hematoma (0 vs. 1 patient-2.6%) and pseudoaneursym (0 vs. 1 patient-2.6%), occurred more often in the control group. The number of small hematomas was 3 (7.7%) in the compression group and 2 (6.9%) in the Epiclose-T group. In the failure group (3 patients), body-mass-index was somewhat lower than that of the success group (median--26 (25-33) kg/m2 vs. 27 (24-32) kg/m2, p=0.07). Most patients were satisfied by the Epiclose-T closure device and grade it as excellent or good.

CONCLUSION

Hemostasis can be easily and safely achieved by Epiclose-T device with no significant minor and major complications with patients' total satisfaction.

Effect of octreotide in the prevention of doxorubicin cardiotoxicity

OBJECTIVE

A precise method for prevention from doxorubicin cardiotoxicity is not known. We examined whether octreotide has a protective effect against doxorubicin cardiotoxicity.

METHODS

New Zealand rabbits (n=44) were divided into 4 groups according to drugs given: Group A (n=12) doxorubicin and octreotide, Group B (n=12) only doxorubicin, Group C (n=10) only octreotide and Group D (n=10) only saline. Effects of the drugs were evaluated in terms of histopathological score, fractional shortening (FS) and prolongation of the QTc interval.

RESULTS

Mean pathological score for cardiotoxicity (Group A: 3.7+/-0.5, Group B: 3.9+/-0.3), prolongation of QTc (Group A: from 244.5+/-21.2 ms to 282.9+/-25.9 ms, p<0.0001; Group B: from 248.5+/-17.7 ms to 298.3+/-13.7 ms, p<0.00001) and the rate of decrease in FS (Group A: from 34.4+/-2.0 to 28.0+/-2.0, p<0.05; Group B: from 35.1+/-1.9 to 24.8+/-1.3, p<0.05) were higher in Group B when compared to Group A, but only difference in the rate of decrease in FS was statistically significant (p<0.001). None of these variables changed significantly in groups C and D.

CONCLUSION

In this preliminary study, octreotide seems not to reduce doxorubicin cardiotoxicity. On the other hand, a consistent tendency of decreased cardiotoxicity in octreotide+doxorubicin group was observed, although only the difference in FS decrease was significant. Further investigations are needed to address the issue of the extent and the mechanisms of this effect.

Effects of chronic alcohol consumption on myocardial ischemia in rats

The effects of chronic alcohol consumption on myocardial ischemia and gas perfusion with 95% O(2)-5% CO(2) were investigated in isolated rat heart. Eighteen adult male Wistar rats were used. Rats were assigned into six groups for each group to contain three rats: normal, alcoholic, normal ischemic, alcoholic ischemic, normal ischemic and 95% O(2)-5% CO(2) perfused, alcoholic ischemic and 95% O(2)-5% CO(2) perfused, respectively. Alcohol (7.2%, v/v) was given to rats by a modified liquid diet for 21 days. Rats were anaesthetized with ketamine (1-2mg kg(-1)). Hearts were quickly isolated. Normal and alcoholic rat hearts were directly sent to the electron microscopic preparation. The other hearts were cut into small pieces and put into Krebs solution. The solution was continuously bubbled using 95% N(2)-5% CO(2) 20 min for ischemia. After removal of normal ischemic and alcoholic ischemic heart specimens for electron microscopic examination, the remaining hearts of the last two groups were bubbled with 95% O(2)-5% CO(2) for another 20 min for the purpose of reperfusion and then were also prepared for electron microscopic examination. The hearts were investigated with a transmission electron microscope (Jeol 100 CXII TEM). Twenty-one days of chronic alcohol consumption was found to have no significant effect on myocardial ischemia determined by transmission electron microscopic examination. Our results suggest that there is no significant relationship between 21 days of alcohol consumption by a liquid diet and myocardial protection.

Papillary fibroelastoma of the mitral valve with systemic embolization

Primary tumors of the heart are rare disorders. In autopsy studies, their incidence was reported to be 0.01-0.5%. We present the case of a papillary fibroelastoma of the mitral valve with systemic embolization in a young man.