Percutaneous Trans Research Articles

The Impella Device

The Impella small catheter like 6 inch long device which works on principle of submersible water pump. It is inserted in to heart without any surgical procedure it provides 2.5- 5.5 litters/min blood flow. Impella device is available in various types according to their location, size and flow rate. There are some indications of Impella device implantation cardiac failure, high risk percutaneous intervention, risk of bleeding, left ventricular failure ect. This device is contraindicated in some disease conditions like Left Ventricular Thrombus, Ventricular Septal Defect, Severe Peripheral Arterial Disease, Aortic Stenosis and Regurgitation, Mechanical Haemolysis, Peripheral Vascular Ischemia. In this article we provide information about Impella device. There are total 57 cases has done till 2019 were Impella 5.0 inserted in 14 cases via axillaries access. In 36 cases Impella CP inserted via percutaneous Trans femoral approach, but one, in a young patient, who due to the small calibre of his femoral artery required inter positioning of a 6 mm Dacron graft on his common femoral artery. In 07 cases Impella RP were implanted percutaneously through the femoral accesses.

Current modalities for the diagnostic and management approach of buerger’s disease: a case report and comprehensive review

Background: Thromboangiitis obliterans (TAO or Buerger’s disease) is a non-atherosclerotic inflammatory vascular disease usually related to smoking. Until now, there is no consensus establishing the diagnosis and standard treatment. Case Illustration: A 74-year-old smoker woman complained of blackening and painful fingertips in both upper limbs. On upper-extremities examination, we found necrotic gangrene at the 3rd fingertips of the right hand, and the 2nd and 4th fingertips of the left hand, with limitation of the movement at the affected finger due to the pain. On laboratory findings, there was a leukocytosis, mild Anemia, no coagulopathy, and normal autoimmune screening. Doppler Ultrasonography showed vascular incompetence of the left palmar arch artery, with no deep or superficial vein thrombosis. Arteriography revealed multiple stenosis of the Left Radial artery and Right Ulnar artery with collateral corkscrew-shaped. The patient was diagnosed with peripheral Critical Limb Threatening Ischemia caused by TAO, which underwent conservative management for 10 days and Percutaneous Trans Angioplasty (PTA) ballooning. Discussion: Buerger disease commonly affects smoker men between 40-45 years old. Several clinical criteria were used to establish TAO, including Shinoya and Olin's criteria. There are still no specific management guidelines for TAO, and smoking cessation is the only accepted effective treatment to prevent the progression of the disease and avoid amputation, followed by conservative and interventional management for patients with Critical Limb Ischemia. Conclusions: Awareness of the entity and familiarity with the clinical, angiographic, and pathologic features are the keys to a prompt and correct diagnosis of TAO. Although still controversial, endovascular intervention is regarded as a potentially efficacious approach in TAO with critical limb ischemia management.

Fast Track Management of Primary Thyroid Lymphoma in the Very Elderly Patient

A rapid growing cervical mass mobile while swallowing is the most common clinical presentation of severe thyroid malignancy. A 91-year-old female patient with a history of Hashimoto thyroiditis presented with clinical compressive neck symptoms. The patient had gastric Maltoma diagnosed that was surgically resected thirty years ago. A straightforward process was needed to reach full histological diagnosis and initiate prompt therapy. Ultrasound (US) showed a 67 mm hypoechoic left thyroid mass with reticulated pattern without signs of locoregional invasion. Percutaneous trans isthmic US-guided 18G core needle biopsy (CNB) disclosed diffuse large B cell lymphoma of the thyroid gland. FDG PET revealed two distinct thyroid and gastric foci (both SUVmax 39.1). Therapy was initiated rapidly to decrease clinical symptoms in this aggressive stage III primitive malignant thyroid lymphoma. The prognostic nomogram was calculated by using a seven-item scale, which disclosed a one-year overall survival rate of 52%. The patient underwent three R-CVP chemotherapy courses, then refused further treatment and died within five months. Real-time US-guided CNB approach led to rapid patient’s management that was tailored to patient’s characteristics. Transformation of Maltoma into diffuse large B cell lymphoma (DLBCL) into two body areas is deemed to be extremely rare.

Percutaneous Transmitral Commissurotomy - Clinical and Echocardiographic Follow-up in Severe Mitral Stenosis

Objectives: To study the long term clinical and echocardiographic outcomes of percutaneous Trans mitral balloon commissurotomy (PTMC) performed in patients with severe mitral stenosis. Methodology: Total 103 patients were enrolled in this study. Their PTMC procedure was performed between the years 2015 to 2019. Those patients who returned for follow-up in the year 2021 were enrolled. At the time of follow-up their clinical and echocardiographic parameters were recorded. Results: The mean age was 27.44±6.26 years and 97 (94.2%) of them were female. Mitral valve area was improved significantly, planimetry; 0.813±1.39 vs. 1.288±0.21cm2 and PHT; 0.871±0.13 vs. 1.336±0.19 cm2 between baseline and follow-up, respectively. Pressure gradient across mitral valve also improved 7.233±2.81 vs. 14.407±0.92 mmHg between baseline and follow-up, respectively. Pulmonary artery pressures were also reduced significantly 24±0.27 vs. 55±2.41 mmHg as well as the right ventricular systolic pressures 24.4±2.94 vs. 62.34±10.98 mmHg between baseline and follow-up, respectively. At follow-up, 70.9% had NYHA I class, 16.5% had NYHA II class, 11.7% had NYHA III class, and 1% had NYHA IV class compared to 6.8%, 5.8%, 33.9%, and 53.4% pre-procedure, respectively. Conclusion: Long term follow-up of patients after PTMC showed satisfactory outcomes both clinically, as evident from improvement in NYHA functional class, and from echocardiographic stand point with sustained increase in mitral valve area over the period of years. Overall the results of PTMC performed in patients with severe mitral stenosis are satisfactory.

Reduction in pulmonary artery pressures on right heart cath after percutaneous transmitral commissurotomy.

Objectives: To find out the reduction in pulmonary artery pressures on right heart Cath after percutaneous trans mitral commissurotomy. Study Design: Cross-sectional Observational study. Setting: Catheterization Lab Faisalabad Institute of Cardiology, Faisalabad. Period: April 2022 till October 2022. Material & Methods: After approval from hospital ethical committee 67 patients of severe mitral stenosis having pliable valve suitable for PTMC on TTE followed by TEE to exclude its contraindications and then finalized for PTMC procedure were enrolled in study after informed consent. PTMC was performed through femoral route using INNOUE balloon. Pre PTMC and post PTMC Right ventricle pressures were measured on table in cath lab. Results: Mean age was 33.8 ± 8.4 with 28.4% (n=19) were male, 71.6% (n=48) were females. 79 % patients had NYHA III symptoms of dyspnea. Mean LA diameter was 50.4mm and mean MVA was 1.02 cm2. 65.7% patients had A.fib before PTMC. Others were in sinus rhythm. Majority of patients had severe pulmonary hypertension before PTMC which had significant reduction (mean 23mmHg) in catheterization lab 10 minutes after PTMC procedure. Conclusion: PTMC is quite effective procedure with significant reduction of not only LA pressure but also of right ventricle indicating its effectiveness from the day of procedure.

Computed tomography guided percutaneous trans discal splanchnic nerve block for cancer pain treatment. Case report

Two cases of percutaneous transdiscal splanchnic nerve block for cancer pain treatment presented. Case 1. 50 years old man with pancreatic head and trunk cancer T4N1M0. Patients condition: intractable pain in upper abdomen during last two weeks, dysphagia, weight loss. Cholecysto-entero, gastro-entero and entero- entero anastomoses performed under epidural+general anesthesia. During 7 postoperative days pain relieved by continuous epidural anesthesia (0.2% ropivacain 5ml/hour). On postoperative day 8 epidural catheter removed due to dis lodgement. Morphine sulphate 10 mg iv injections with 4 hour intervals and cox- 2 pathway inhibitors was not sufficient for pain relief (pain score – 6-8 VAS). Splanchnic neurolysis performed on postoperative day 14. Patient laid in prone position on the computed tomography table. After marking of injection sites, definition of needles traces and deep local infiltration with 1% lidocain, two 22 gauge 20 cm Chiba needles had been inserted transdiscally on the level of T12/ L1. Pain relieved after injection of 4 ml 2% lidocaine on each side10 ml 10% aqueous phenol had been injected on each side for neurolytic block 0.1 g cefazolin injected intradiscally Patient had complete pain relief until day 5, when he felt severe continuous pain on his upper right abdomen. After two weeks of follow-up incomplete right splanchnic block diagnosed and to perform of repeated right side splanchnic neurolysis had been decided. On day 14 after 1-st neurolysis, a 3½ inch 25 gauge Quincke needle had been inserted in right retrocrural space on the level of L1. After contrast and 4ml 2% lidocaine injection, 15 ml 95% alcohol injected Pain relieved completely. No additional analgesia requirements lifetime (10 weeks). Case 2. 62 years old male with gastric cancer. Cancer recurrence after partial gastrectomy and severe intractable abdominal pain. 120 mg morphine hydrochloride daily, pain score 6-8 VAS. T12-L1 computed tomography guided transdiscal splanchnic nerve block performed in patient prone position. After marking of injection site at left side from vertebral column and deep infiltration with 1% lidocaine, a 22G 20 cm Chiba needle had been inserted. 0.1g cefazolin injected intradiscally. Intervertebral disk penetrated centrally and contrast spread was equal on both sides between aorta and L1 vertebra. Pain relieved after injection of 5 ml 2% lidocaine and 15 ml 95% alcohol. After procedure pain score – 3-4, patient was needed in 10 mg morphine hydrochloride and 150 mg lyrica daily. Computed tomography guided transdiscal splanchnic neurolysis is a safe and effective treatment tool for upper abdomen cancer pain relief. In cases of incomplete neurolysis repeated neurolytic block may be helpful.

Maternal and Fetal Outcomes Following Percutaneous Transluminal Mitral Commissurotomy in Pregnant Women with Critical Mitral Stenosis: An Experience of a Tertiary Care Center from Northern India.

Background:Rheumatic mitral stenosis is the common valvular heart disease seen during pregnancy. Percutaneous transvenous mitral commissurotomy is an effective, safe, and recommended treatment for critical mitral stenosis during pregnancy. We hereby report the maternal and fetal outcomes of pregnant women subjected to percutaneous transvenous mitral commissurotomy at our institute. Methods:Seventy consecutive pregnant women with critical mitral stenosis, who underwent PTMC during the last 10 years, were retrospectively analyzed. All patients had a detailed clinical and obstetric evaluation and were optimally managed with drugs, before the intervention. A comprehensive pre- and post-percutaneous transvenous mitral commissurotomy transthoracic echocardiographic evaluation was performed. Detailed obstetric and fetal outcomes were noted at the time of delivery. Six weeks of post-­partum follow-up was noted in all patients. Results:The mean gestational age at the time of percutaneous transvenous mitral commissurotomy was 29.5 ± 6.68 weeks. Percutaneous transvenous mitral commissurotomy was successful in 97% of patients. Post-percutaneous transvenous mitral commissurotomy New York Heart Association functional class, mitral valve area, trans-mitral pressure gradient, and left atrial pressure had a significant improvement (P < .001). The mean gestational age at the time of delivery was 36.92 ± 3.02 weeks. The mean birth weight of live newborn was 2.29 ± 0.55 kg. The fetal complications include growth restriction in 62.85%, preterm delivery in 34.37%, and low birth weight in 67.21%. A delayed percutaneous transvenous mitral commissurotomy at about 30 weeks of gestation did not affect the maternal and fetal outcomes. Conclusion:Percutaneous transvenous mitral commissurotomy is safe and efficacious in managing pregnant women with critical mitral stenosis. There was a significant improvement in clinical symptoms and echocardiographic parameters following percutaneous transvenous mitral commissurotomy.

Percutaneous transluminal mitral valve commissurotomy Via Veno-Arterial loop method.

Background: Since its inception in 1984 by Inoue and colleagues, percutaneous trans venous mitral commissurotomy (PTMC) is the first line treatment option for severe mitral stenosis with favorable valve morphology. Critical mitral stenosis can however pose a challenge for balloon crossing to the left ventricle. Various techniques have been demonstrated to overcome this difficulty. We use a novel technique to cross mitral valve.&#x0D; Case Presentation: We describe a case where critical stenosis of rheumatic mitral valve in a young lady which was not amenable to conventional PTMC procedure, was successfully performed via veno-arterial rail method.&#x0D; Management &amp; Results: After crossing the interatrial septum, mitral valve was tried to cross with the standard technique using Inoue balloon, but failed because the stenosis was very tight. So we have crossed mitral valve through exchanged length terumo wire which was snared in descending aorta and externalized through right femoral artery and then we were able to pass the balloon through the tight mitral valve and the procedure was completed without any complication. Post procedure the pressure gradient dropped to 4mmHg and the mitral valve area was recorded as 1.8cm 2 with 2D echo planimetry.&#x0D; Conclusion: In difficult to cross MV during PTMC, the veno-arterial rail method can be used easily for a successful procedure.

Multi Slice CT Cholangiography Using Minimum Intensity Projection in Evaluation of Patients with Biliary Obstruction: Comparison with Percutaneous Trans Hepatic Cholangiography

ABSTRACT Background: Evaluation of the diagnostic value of computed tomography (CT) cholangiography with minimum intensity projection (MinIP) in the work up of patients with obstructive biliary disease through correlation with percutaneous trans hepatic cholangiography (PTC) results. Objective: In this study, we aimed to evaluate the diagnostic value of CT cholangiography with MinIP in the work up of patients with obstructive biliary disease through correlation with PTC results. Patients and Method: The study included 36 patients (26 males and 10 females), with biliary obstruction. CT cholangiography was done to reach a definite diagnosis for the cause of obstruction and PTC was done during their management plan. Analysis of the image data with (MinIP) images was created on a separate workstation and compared to that of PTC. Results: The CT cholangiography using MinIP technique correctly diagnosed the cause of obstruction among all included cases. No significant difference was found between measurements of obstructing lesion size. We had a novel observation about that axial images are significantly better to reveal the obstructing biliary lesion if the cause of obstruction is intrahepatic; while coronal images are significantly better to reveal the obstructing biliary lesion if the cause of obstruction is extrahepatic. Conclusion: CT cholangiography with MinIP is a complete noninvasive technique that provides projectional images similar to that of PTC without administration of oral specific contrast agents, requires no medications, less operator dependent and no complications were encountered in adequately screened patients.

Frequency of atrial septal defect in patients of rheumatic mitral stenosis undergoing percutaneous transseptal mitral commisurotomy.

Objectives: To determine the frequency of atrial septal defect in patients of rheumatic mitral stenosis undergoing percutaneous trans septal mitral commissurotomy. Study Design: Cross sectional study. Setting: Faisalabad Institute of Cardiology, Faisalabad. Period: 15-07-2018 to 14-01-2019. Material &amp; Methods: Study was approved by hospital ethical committee. A total of 45 patients were included in the study that fulfilled the study inclusion criteria and gave written informed consent. PTMC was performed using Inoue balloon technique through right femoral venous route under local anesthesia. Transthoracic echocardiography was done after 48 hours of PTMC for ASD assessment. Results: Out of 45 patients there were 17 (37.8%) males and 28 (62.2%) females. The mean age was (29.06±10.85) years. There were 9 (20%) patients with NYHA functional class II, 28(62.2%) with NYHA functional class III and 8(17.8%) with NYHA functional class IV symptoms. ASD was detected in 15 (33.3%) patients after 48 hours of PTMC. Conclusion: In this study frequency of ASD in patients of mitral stenosis undergoing PTMC was 33.3%. Results of this study can help to identify the patients who will be potential candidates for closure of residual ASD.

Radiological Intervention and Imaging Procedures in Management of Patients with Malignant Obstructive Jaundice

AbstractBackground: Malignant biliary obstruction has a bad prognosis and adverse effect on the quality of life, with most of those patients are inoperable at time of diagnosis. Patients who underwent whipple operation may develop anastomotic site (choledocho-jujenostomy) stenosis with subsequent ele-vated bilirubin level and related complications.Aim of Study: This prospective study will be conducted to evaluate the efficacy of different modalities of interventional radiological and imaging procedures as Percutaneous Trans hepatic Cholangiography (PTC), Percutaneous Trans hepatic Drainage (PTD) and biliary stenting in management of patients with malignant obstructive jaundice.Patients and Methods: This study was conducted on 30 patients (19 males and 11 females) with mean age of 56 years, 28 of 30 patients (93.3%) are non operable and the other 2 of 30 patients (6.7%) operated patients for choledocho-jujenostomy stenosis were subjected to intervention techniques. 10 of 30 patients (33.3%) underwent percutaneous external biliary drainage, 15 of 30 patients (50%) underwent percuta-neous stent insertion (8 of 30 patients (26.7%) with metallic stents & 7 of 30 patients (23.3%) with plastic stents), 3 of 30 patients (10%) underwent internal external drainage and 2 of 30 patients (6.66%) underwent biliary drainage through combined (randez-voux) technique.Results: High success rate (86.6%) with reduction of total bilirubin level was observed in metallic stenting group of patients.Conclusion: Biliary intervention procedures help to reduce high bilirubin level, bypass obstruction level and help in dilatation of post-operative stenosis site.

The effectiveness of the percutaneous trans hepatic cholangiostomy in the treatment of obstructive jaundice

The effectiveness of the percutaneous trans hepatic cholangiostomy in the treatment of obstructive jaundice

Hepatobiliary tuberculosis: a 10 years retrospective study in Sarawak general hospital, Sarawak Malaysia

Introduction: Tuberculosis (TB) is endemic in South East Asia and in Malaysia it is not an uncommon infective disease. In our country extra pulmonary tuberculosis represents 14% of overall cases. Hepatobiliary tuberculosis (HBTB) is one of the rare extrapulmonary (TB) manifestations. The complications can be devastating, hence the diagnosis and management of the disease is remarkably challenging. Method: Patients were identified by reviewing our Endoscopic Retrograde Cholangiopancreaticography (ERCP) registry and the hospital tuberculosis database. Thirty six patients were identified from 2008 till 2018 and the data was studied. Result: 36 patients were identified from 2008 until 2018. Majorities were aborigines staying in rural areas (75%). The patients’ age ranged from 24 to 77 years old (median age of 47 years old) . 23 patients had history of pulmonary TB (63.8%) while 13 had history of isolated HBTB (36.2%). The presentation was jaundice (76.9%), constitutional symptoms (59.8%), right hypochondrium pain (38.5%) and cholanigitis (25.9%). All patients had CT scan of the abdomen done. 18 patients who diagnosed with TB had positive involvement of liver and biliary system in CT scan. Sixteen was diagnosed through image-guided liver biopsy and two had open biopsy. All patients had ERCP done. 2 underwent Percutaneous Trans hepatic Biliary Drainage( PTBD) prior to ERCP. All patients took anti TB medication for at least 6 months. 1 patient passed away due to liver failure and 7 patients loss to follow up. Conclusion: HBTB is rare but it causes high morbidity. The diagnosis and management of the disease is challenging. Early identification of the disease and appropriate intervention might helps in reducing the complications of the disease.

Challenges in diagnosis and management of infective endocarditis by Stenotrophomonas maltophilia: A case report of an unusual nosocomial infection

Stenotrophomonas maltophilia is a Gram-negative bacillus found as a free-living organism in most aquatic and humid environments including hospital drinking water, and often associated with nosocomial infections. It is an uncommon cause of infective endocarditis. In Sri Lanka there are no reported cases in literature. Here we report a 46 years old patient who presented with fever following Percutaneous Trans Mitral Commissurotomy (PTMC). He was diagnosed as an acute mitral valve endocarditis based on echocardiograph findings and 2 blood cultures taken 6 hours apart which grew Stenotrophomonas maltophilia. The patient responded rapidly to targeted antibiotic treatment with piperacillin tazobactam and oral cotrimoxazole for 4 weeks and a further 2 weeks of cotrimoxazole. He remained well at the 3 month follow up. There is limited information on the best choice of antibiotics and the ideal duration of treatment. Early diagnosis and identification of the organism, prompt treatment with appropriate antibiotics and close collaboration between the clinical and laboratory teams contributed towards the successful management of this case.

Safety and Efficacy of Trans-Ulnar Coronary Intervention

Background: Primary aim of our study to evaluate the safety and feasibility of percutaneous Trans- Ulnar approach for coronary angiogram and intervention.Methods: Patient whom radial pulse was very feeble and difficult to cannulate and having very good volume Ulnar pulse were selected in this study. Total 48(Male 37: Female 11) patients were enrolled in this very preliminary study who underwent elective coronary angiogram (CAG) and subsequent adhoc percutaneous coronary intervention (PCI) in same sitting. Total 11 stents were deployed in 10 territories. Mean ages of male and female were 59 and 52 years respectively. Associated coronary artery artery disease (CAD) risk factors were dyslipidemia, high blood pressure, diabetes mellitus, positive family history of CAD and smoking (all male).Results: Among the study group; 36(75%) were Dyslipidemic, 35(73%) were hypertensive; 34(70.1%) patients were Diabetic, FH 11(23%), and 12(25%) were all male smoker.PCI performed in 9 patients i.e., 18.8% of the total population of this study. Angiographic diagnosis of TVD 8(16.6%), DVD 6(25%), SVD 17 (35.4%), Normal Coronaries 8(16.6%), ISR or patent stent 5(10.4%), Severe Calcified disease 4(12%). Common stented territory was LAD 6(66%), LCX 2(22%) and RCA 2 (22%). Vaso-spasm was not noted as it is quite often in trans-radial approach. Procedural complication like hematoma was not present.Conclusion: We conclude that trans-ulnar approach is a safe, feasible and effective alternative to Transfemoral and Trans-radial approach, specially due to sluggish flow or feeble radial pulsation with severe spasm of radial artery for coronary angiogram and subsequent PCI.Cardiovasc. j. 2018; 11(1): 5-9

Portal vein pseudoaneurysm secondary to pancreatic lymphoma and biliary stent insertion: a rare cause of haemobilia

BackgroundHaemobilia, defined as bleeding from the biliary tree, is a rare entity. The most common cause of haemobilia is iatrogenic trauma, which accounts for 70% of cases. Pseudoaneurysms of the portal vein are an extremely rare cause of haemobilia with only four reported cases to date. Conservative treatment, open surgical repair and percutaneous trans hepatic stent-grafting have all been employed in these cases. This displays the lack of consensus regarding the treatment of this condition.We report the first case of a portal vein pseudoaneurysm following endoscopic common bile duct stent placement performed to relieve obstruction of the common bile duct for lymphomatous infiltration of the pancreatic head. The pseudoaneurysm was successfully treated by placement of a percutaneous trans hepatic covered stent-graft.Case presentationA 42-year-old man with a history of lymphomatous infiltration of the pancreatic head and recent endoscopic common bile duct stent placement presented with sudden onset large volume haematemesis. On the portal venous phase of a triple phase CT, this was found to be secondary to a portal vein pseudoaneurysm bulging into the upper portion of the indwelling biliary stent. The pseudoaneurysm was successfully treated by percutaneous trans hepatic placement of a covered vascular stent-graft.ConclusionsWe report a rare case of portal vein pseudo aneurysm successfully treated by percutaneous trans hepatic portal venous covered vascular stent-graft insertion.

Effect of Mitral Valve Leaflets Excursion on Mitral Valve area after Percutaneous Trans- Venous Mitral Commissurotomy

Background: Aim of our study was to predict the effect of mitral valve leaflets excursion on mitral valve area following percutaneous transvenous mitral commissurotomy PTMC in patients of mitral stenosis.Methods: Total 70 patients with severe mitral stenosis who underwent PTMC were enrolled in the study.Transthoracic echocardiography was done the day before PTMC and 24-48 hours after PTMC. Mitral valve area, anterior and posterior leaflets excursion were recorded. The relation between leaftlet excursion and mitral valve after PTMC was evaluated.Results: Following PTMC there were significant increasein anterior leaflet excursion from 1.9 ± 0.2 to 2.3 ± 0.2cm (p&lt;0.001), posterior leaflet excursion from 1.6±0.2to1.9 ± 0.2cm (p&lt;0.001). Mitral valve areas increased from 0.8 ± 0.1 to1.7 ± 0.2cm²(p&lt;0.001). Both leaflet excursion increased significantly with the increase in mitral valve area till the area reached a value of about 1.5 cm2, after which any further increase in mitral valve area was not associated with any further increase in leaflet excursion.Conclusion: PTMC is associated with immediate significant changes in mitral valve morphology in terms of splitting of fused mitral commissures, increased leaflets excursion and splitting of the subvalvular structures. Post PTMC leaflet excursion increases significantly with the increase in mitral valve area till the area reaches a value of about 1.5 cm2 after which any further increase in mitral valve area is not associated with any further increase in leaflet excursion.Cardiovasc. j. 2017; 10(1): 3-7

MON-P242: 5 Cases Trial of the New Technique of Percutaneous Trans Esophageal Gastrotubing (PTEG) with 130cm Long Rupture Free Balloon Catheter for Placing to Post Pylorus with one Step Procedure

MON-P242: 5 Cases Trial of the New Technique of Percutaneous Trans Esophageal Gastrotubing (PTEG) with 130cm Long Rupture Free Balloon Catheter for Placing to Post Pylorus with one Step Procedure

WCC 2017-C-103: Emergency Surgical Retrieval of Embolized Atrial Septal Defect Closure Device from Left Atrium

AbstractWith the introduction of technological improvements, invasive cardiologic interventions have become increasingly used alternatives to surgery. Despite its numerous benefits, serious and potentially life-threatening complications of invasive cardiology interventions may occur. Atrial septal defect is usually closed in the cardiac catheterisation laboratory using atrial septal occluder (ASO) device. One of the complications associated with the procedure is dislodgement of the device. We present a case of percutaneous trans catheter closure of an ostium secundum atrial septal defect in a 21 years old female, complicated by device dislodgement to the left atrium necessitating emergency surgical retrieval.

IMMEDIATE OUTCOMES OF PERCUTANEOUS TRANSVENOUS MITRAL COMMISUROTOMY IN PATIENTS OF RHEUMATIC MITRAL STENOSIS

Objective: To determine the immediate outcome of PTMC in patients ofRheumatic Mitral stenosis. Methodology: This cross sectional study was conducted from 1st January 2011to 31st December 2016, at Department of Cardiology, Lady Reading Hospital,Peshawar. Patients with severe MS fulfilling the inclusion and exclusion criteriawere enrolled in the study. Detailed history and examination was done followedby transthoracic and transesophageal echocardiography. PTMC was performed.Pre and post-PTMC echocardiographic parameters were recorded. Post PTMCcomplications like moderate to severe mitral regurgitation, stroke, pericardialeffusion, new onset arrhythmias and death within 24 hours were also recorded .P<0.05 was taken as significant. Results: Total of 300 patients with mean age of 26.26 ± 11.54 years wereenrolled, of which 78 (26%) were males. Mean MVA pre-PTMC was 0.96 ± 0.902 2 cm , dilated successfully to 1.81 ± 0.48 cm (p = 0.000). Immediatecomplications like moderate MR (30%), severe MR (2%) , CVA (6%), pericardialeffusion (0.33%), new onset arrhythmias (8% ) and death (4% ) were observed. Conclusion: Although complications are observed during PTMC but it is a safeand effective procedure in patients of rheumatic mitral stenosis with suitablevalve morphology. Key Words: Per cutaneous trans venous mitral commisurotomy. Mitral stenosis.Mitral regurgitation. cerebro vascular accident. Mitral valve area.