DERMATOLOGIC SURGERY, Issue 5 2007
MITCHEL P. GOLDMAN MD
BACKGROUND Hyaluronic acid-based dermal fillers, such as hyaluronic acid gel (Restylane, Q-Medical AB, Uppsala, Sweden), are widely used for tissue augmentation of the nasolabial folds. Additional dermatologic treatments using infrared light, radiofrequency (RF), and intense pulsed light (IPL) are also important tools for facial rejuvenation. This study was designed to evaluate whether these therapies could be safely administered immediately after hyaluronic acid gel treatment without compromising the effect of the dermal filler. OBJECTIVE The objective of this study was to confirm or refute any possible subtractive effects of augmentation of the nasolabial folds when followed by 1,320-nm Nd:YAG laser, 1,450-nm diode laser, monopolar RF, and/or IPL treatments. METHODS Thirty-six patients with prominent nasolabial folds were treated with hyaluronic acid gel implantation on one side of the face and hyaluronic acid gel followed by one of the nonablative laser/RF/IPL therapies on the contralateral side of the face. RESULTS There were no statistically significant differences between wrinkle severity or global aesthetic scores for hyaluronic acid gel implantation alone and hyaluronic acid gel with laser/RF/IPL treatment at any time point. In a small sample, histologic changes were not apparent after laser/RF/IPL treatment. CONCLUSIONS Based on this small pilot study, laser, RF, and IPL treatments can safely be administered immediately after hyaluronic acid gel implantation without reduction in overall clinical effect. [source]

Complications of Expanded Polytetrafluoroethylene (e-PTFE) Facial Implant

DERMATOLOGIC SURGERY, Issue 9 2001
Harold J. Brody MD
Implantation of the expanded polytetrafluoroethylene (e-PTFE) implant to achieve correction of nasolabial folds or thinning lip has been fraught with complications in spite of patient acceptance since its introduction in 1997. The four most frequent postoperative complications are extrusion, movement, infection, and swelling. In examination of 86 insertions of the 3.2 mm tubular implants, these sequelae are generally manageable for the physician and patient. If the patient understands possible courses of healing, both physician and patient satisfaction may be achieved. [source]

Real-Time Three-Dimensional Echocardiography in Diagnosis of Right Ventricular Pseudoaneurysm after Pacemaker Implantation

ECHOCARDIOGRAPHY, Issue 3 2006
Xuedong Shen M.D.
Right ventricular rupture is a critical cardiac complication associated with cardiac tamponade and death. Occasionally, the site of rupture may be contained by the parietal pericardium and thrombus, thus forming a pseudoaneurysm. Cases of traumatic pseudoaneurysm of the right ventricle have been reported. However, right ventricular pseudoaneurysm following pacemaker implantation has not been previously reported. This case demonstrates two right ventricular pseudoaneurysms following perforation of the right ventricular wall using real-time three-dimensional echocardiography (3DE) after pacemaker implantation although only one definite pseudoaneurysm was diagnosed by routine two-dimensional echocardiography (2DE). We also found that color Doppler 3DE enhanced visualization of the connections between the right ventricle and the pseudoaneurysm. Color Doppler 3DE allowed us to peel away the myocardial tissue and rotate the image to study the jets from different angles. In summary, real-time 3DE and color Doppler 3DE provided excellent visualization of the right ventricular pseudoaneurysm, flow between the ventricle and the pseudoaneurysm, and additional information to that obtained by 2DE. [source]

Surface Structures and Osteoblast Activity on Biomedical Polytetrafluoroethylene Treated by Long-Pulse, High-Frequency Oxygen Plasma Immersion Ion Implantation

ADVANCED ENGINEERING MATERIALS, Issue 5 2010
Liping Tong
Abstract Polytetrafluoroethylene (PTFE) is a biologically safe polymer used widely in clinical medicine including oral and orthopedic surgery. However, the high bio-inertness of PTFE has hampered wider applications in the biomedical fields. In this work, we extend the treatment time in long-pulse, high-frequency oxygen plasma immersion ion implantation of PTFE and a more superhydrophobic surface with a water contact angle of 160° is created. X-ray photoelectron spectroscopy (XPS) and atomic force microscopy (AFM) reveal that the optimized long-pulse, high-frequency oxygen plasma immersion ion implantation process induces a rougher surface and to a lesser extent alters the surface oxygen concentration on the PTFE. Our data, especially long-term contact angles, suggest that the superhydrophobility stems from surface roughness alteration. Furthermore, the activity of MC3T3-E1 osteoblasts cultured on the treated surfaces is promoted in terms of quantities and morphology. [source]

Metal Ion Implantation for the Fabrication of Stretchable Electrodes on Elastomers

ADVANCED FUNCTIONAL MATERIALS, Issue 3 2009
Samuel Rosset
Abstract Here, the use of low-energy metal ion implantation by filtered cathodic vacuum arc to create highly deformable electrodes on polydimethylsiloxane (PDMS) membranes is reported. Implantation leads to the creation of nanometer-size clusters in the first 50,nm below the surface. When the elastomer is stretched, these small clusters can move relative to one another, maintaining electrical conduction at strains of up to 175%. Sheet resistance versus ion dose, resistance versus strain, time stability of the resistance, and the impact of implantation on the elastomer's Young's modulus are investigated for gold, palladium, and titanium implantations. Of the three tested metals, gold has the best performance, combining low and stable surface resistance, very high strain capabilities before loss of electrical conduction, and low impact on the Young's modulus of the PDMS membrane. These electrodes are cyclically strained to 30% for more than 105 cycles and remain conductive. In contrast, sputtered or evaporate metals films cease to conduct at strains of order 3%. Additionally, metal ion implantation allows for creating semi-transparent electrodes. The optical transmission through 25-µm-thick PDMS membranes decreases from 90% to 60% for Pd implantations at doses used to make stretchable electrodes. The implantation technique presented here allows the rapid production of reliable stretchable electrodes for a number of applications, including dielectric elastomer actuators and foldable or rollable electronics. [source]

Fabrication of Highly Conductive 12CaO·7Al2O3 Thin Films Encaging Hydride Ions by Proton Implantation

ADVANCED MATERIALS, Issue 13 2003
M. Miyakawa
Thin films of a new transparent oxide semiconductor 12CaO·7Al2O3 consisting of subnanometer-sized cages (see Figure inset) have been fabricated, and their light-induced insulator,conductor conversion is described. Proton implantation at a fluence of 1,×,1018 cm,2 followed by UV-light irradiation increases the electrical conductivity by more than eleven orders of magnitude to the largest value ,,10 S,cm,1 (see Figure). The conducting state is erasable by heating. [source]

Surgical Techniques: Transcatheter Aortic Valve Implantation with "No Touch" of the Aortic Arch for the Treatment of Severe Aortic Stenosis Associated with Complex Aortic Atherosclerosis

JOURNAL OF CARDIAC SURGERY, Issue 5 2010
Rodrigo Bagur M.D.
[source]

Increased Incidence of Gastrointestinal Bleeding Following Implantation of the HeartMate II LVAD

JOURNAL OF CARDIAC SURGERY, Issue 3 2010
David R. Stern M.D.
To avoid device-related thromboembolic complications, antiplatelet, and anticoagulation therapy are routinely administered. A worrisome frequency of gastrointestinal (GI) bleeding events has been observed. Methods: A retrospective review of all 33 patients undergoing long-term LVAD implantation between June 1, 2006 and July 31, 2008 at our institution for any indication was conducted. Anticoagulation consisted of heparin (intravenous or subcutaneous) followed by transition to Coumadin therapy to a target INR of two to three. Antiplatelet therapy consisted of low-dose aspirin and dipyridamole. Results: Twenty patients received the HMII and 13 patients received other devices. Eight (40%) HMII recipients suffered at least one episode of GI bleeding while no GI bleeding occurred in recipients of other devices (p = 0.012). Of 17 total bleeding episodes, no definitive source could be identified in 11 instances (65%). Conclusions: Although definitive source identification remains elusive, we believe that the majority of bleeding arises in the small bowel, possibly due to angiodysplasias, similar to the pathophysiology encountered in patients with aortic stenosis and GI bleeding. As we move toward wider use of the HMII and other axial continuous-flow devices in both bridge-to-transplant patients and for destination therapy, more studies will be necessary to understand the mechanisms of this obscure GI bleeding and develop treatment strategies to minimize its development.,(J Card Surg 2010;25:352-356) [source]

Minimally Invasive Transventricular Implantation of Pulmonary Xenograft

JOURNAL OF CARDIAC SURGERY, Issue 4 2008
Howaida Al Qethamy F.R.C.S., M.D.
A number of ingenious techniques have been described for percutaneous aortic and pulmonary valve replacement as well as transventricular aortic valve replacement. We describe a technique for transventricular pulmonary valve replacement utilizing off-the-shelf bovine tissue valve, vascular stents, and simplified delivery system. After median sternotomy with limited exposure of the right ventricle, Contegra 200 pulmonary valve (Medtronic, Inc., Minneapolis, MN, USA) is transfixed inside a CP stent (NuMed, Inc., Hopkinton, NY, USA) using multiple 5/0 prolene sutures. The valve/stent composite is crimped on a Cristal balloon catheter (Balt, Montmorency, France). The valve/stent and the balloon are then introduced via a small purse-string placed at the RVOT. The stent/valve composite is then expanded in the pulmonary valve position. [source]

Risk Factors for Requirement of Permanent Pacemaker Implantation After Aortic Valve Replacement

JOURNAL OF CARDIAC SURGERY, Issue 3 2006
Hasan Basri Erdogan M.D.
Methods: Among 465 patients operated between 1994 and 2004, 19(4.1%) patients with a mean age 49.9 ± 17.2 years required the implantation of a permanent pacemaker. Eleven of them were female (57.9%). The main indication was aortic stenosis (89.5%). Severe annular calcification was documented in 78.9% of them, and the aortic valve was bicuspid in 57.9%. Results: Risk factors for permanent pacing after aortic valve replacement (AVR) identified by univariate analysis were female sex, hypertension, preoperative ejection fraction, aortic stenosis, annular calcification, bicuspid aorta, presence of right bundle branch block (RBBB) or left bundle branch block (LBBB), prolonged aortic cross-clamp and perfusion times, and preoperative use of calcium channel blockers. Multivariate analysis showed that female sex (p = 0.01, OR; 5.21, 95% CI: 1.48-18.34), annular calcification (p < 0.001, OR; 0.05, 95% CI: 0.01-0.24), bicuspid aortic valve (p = 0.02, OR; 0.24, 95% CI: 0.07-0.84), presence of RBBB (p = 0.009, OR; 0.03, 95% CI: 0.003-0.44) or LBBB (p = 0.01, OR; 0.13, 95% CI: 0.02-0.69), hypertension (p = 0.03, OR; 0.22, 95%CI: 0.05-0.89), and total perfusion time (p = 0.002, OR; 1.05, 95% CI: 1.01-1.08) were associated risk factors. Conclusion: Irreversible atrioventricular block requiring a permanent pacemaker implantation is an uncommon complication after AVR. Risk factors are annular calcification, bicuspid aorta, female sex, presence of RBBB or LBBB, prolonged total perfusion time, and hypertension. [source]

Predictors of Survival 1 Hour After Implantation of an Intra-aortic Balloon Pump in Cardiac Surgery

JOURNAL OF CARDIAC SURGERY, Issue 1 2001
Harald Hausmann M.D.
From July 1996 to March 2000, 391 patients with intraoperative cardiac lowoutput syndrome who underwent surgery with heart-lung bypass and had an intre-aortic balloon pump (IABP) Implanted were analyzed in a prospective study. Of these 391 patients, 153 (39%) were operated on in an emergency situation, and 238 (61%) patients had elective surgeries. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 ,g/kg/min, a left mrial pressure higher then 15 mmHg, output of less than 100 mL/hour, and mixed venous saturation (SvO2) of less then 60% had poor outcomes. Using this data, we developed an IABP score to predict survival early after IABP implantation in cardiac surgery. We conclude that the success or failure of perioperative IABP support can be predicted early after implantation of the balloon pump. In patients with low-output syndrome despite IABP support, implantation of a vantricular assist system should be considered. [source]

Are MADIT II Criteria for Implantable Cardioverter Defibrillator Implantation Appropriate for Chinese Patients?

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2010
CHUNG-WAH SIU M.B.B.S.
MADIT II Criteria for Implantable Cardioverter.,Background: MADIT-II demonstrated that prophylactic implantation of an implantable cardioverter-defibrillator (ICD) device prevents sudden cardiac death (SCD) in patients with myocardial infarction (MI) and impaired left ventricular ejection fraction (LVEF). It remains unclear whether the MADIT-II criteria for ICD implantation are appropriate for Chinese patients. Methods and Results: We compared the clinical characteristics and outcome for a cohort of consecutive Chinese patients who satisfied MADIT-II criteria for ICD implantation with the original published MADIT-II population. Seventy consecutive patients who satisfied MADIT-II criteria but did not undergo ICD implantation (age: 67 years, male: 77%) were studied. Their baseline demographics were comparable with the original MADIT-II cohort with the exception of a higher incidence of diabetes mellitus. After follow-up of 35 months, most deaths (78%) were due to cardiac causes (72% due to SCD). The 2-year SCD rate (10.0%) was comparable with that of the MADIT-II conventional group (12.1%), but higher than the MADIT-II defibrillator group (4.9%). Similarly, the 2-year non-SCD rate was 3.0%, also comparable with the MADIT-II conventional group (4.6%), but lower than the MADIT-II defibrillator group (7.0%). Cox regression analysis revealed that advance NYHA function class (Hazard Ratio [HR]: 3.5, 95% Confidence Interval [CI]: 1.48,8.24, P = 0.004) and the lack of statin therapy (HR: 3.7, 95%CI: 1.35,10.17, P = 0.011) were independent predictors for mortality in the MADIT-II eligible patients. Conclusion: Chinese patients who satisfy MADIT-II criteria for ICD implantation are at similar risk of SCD and non-SCD as the original MADIT-II subjects. Implantation of an ICD in Chinese patients is appropriate. (J Cardiovasc Electrophysiol, Vol. 21, pp. 231,235, March 2010) [source]

Two Different Therapeutic Strategies in ICD Lead Defects: Additional Combined LeadVersus Replacement of the Lead

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 11 2007
CHRISTIAN G. WOLLMANN M.D.
Objectives: Implantation of an additional HV-P/S lead versus extraction of the defective HV-P/S lead and implantation of a new one is one possible therapeutic approach in cases of a defective high-voltage pace/sense lead (HV-P/S). No information is available on potential differences in clinical outcome in these different approaches. Methods: Between January 2000 and February 2006, 86 patients with HV-P/S lead defect received either an additional transvenous HV-P/S lead (n = 33, group 1) or the HV-P/S lead was replaced (n = 53, group 2). The duration of the initially implanted leads was significantly different in the two groups (7.4 ± 2.9; group 1 and 4.1 ± 3.4 years; group 2). The outcome of these two groups of patients was retrospectively analyzed. Results: Seventy-three patients [85%] survived until the end of follow-up of 29 ± 15 (group 1) and 33 ± 21 (group 2) months (P = ns), respectively. Thirteen patients died: six in group 1 and seven in group 2 (P = ns). Fourteen patients experienced perioperative complications (group 1: six; group 2: eight; P = ns). ICD system-related complications occurred in 22 patients (group 1: seven; group two: 15; P = ns). The event-free cumulative survival of patients with additional and replaced HV-P/S lead for postoperative events (including death) after 1, 2, and 3 years was 82%, 70%, 70%, and 86%, 81%, 66%, respectively (P = 0.93). Conclusions: Implantation of an additional HV-P/S lead or replacement of the HV-P/S lead in case of HV-P/S lead failure is statistically not different concerning mortality and morbidity. There are no predictors for further lead defects. Implantation of an additional HV-P/S lead should not be recommended in young patients or patients with greater likelihood of living many years. Predictors for death were an age over 70 years and renal insufficiency. [source]

Habitual Cocaine Use Is Associated with High Defibrillation Threshold During ICD Implantation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 7 2007
JAY CHEN M.D.
Background: Habitual cocaine use can lead to dilated cardiomyopathy (DCM) and sudden cardiac death. Based on prior clinical observations, we hypothesized that prior habitual cocaine use is a strong predictor of high defibrillation threshold (DFT) during implantable cardioverter-defibrillator (ICD) implant. Methods: We reviewed the medical records of 130 consecutive patients undergoing initial ICD implantation or revision at Parkland Hospital and the Dallas VA Hospital, Dallas, TX, from January 2002 to November 2005. Patient characteristics and DFT data were collected retrospectively. Results: The study group includes 11 patients (8.46%) who were identified as having a history of prior habitual cocaine use as demonstrated by history and urine toxicology; the rest (119 patients) form the control group. Cocaine-using patients tended to be younger (48.2 ± 10 vs 60.1 ± 12.3 years; P = 0.0026), were less likely to have coronary disease (36.3% vs 72.2%; P = 0.032), and had less comorbidity. The average DFT was 27.9 ± 7.8 J for all cocaine-using patients and 14.5 ± 4.1 J for noncocaine-using patients (P = 0.00018). In the cocaine-using group, three out of 11 patients required a subcutaneous array compared to none in the control group. Conclusions: Our results suggest that patients with a history of habitual cocaine use may be at increased risk to have a high DFT during ICD implantation. This is the first study to demonstrate such association. ICD implantation in patients with this history should be planned with these findings in mind, as larger output generators or subcutaneous arrays might be required. [source]

Transvenous Cardioverter-Defibrillator Implantation in a Patient with Tricuspid Mechanical Prosthesis

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2007
MAURO BIFFI M.D.
Background. A 64-year-old woman was referred to our center because of poorly tolerated ventricular tachycardia (VT) at 210 bpm due to an old myocardial infarction. The patient had been operated on at age of 20 for mitral valve commissurolysis, at age of 49 for ductal carcinoma, at age of 56 for mitral valve replacement, and at age of 61 for tricuspid valve replacement. Left ventricular EF was 31%. The patient was in permanent atrial fibrillation (AF) since the age of 53. She had undergone three cardiac surgery procedures, ending with two prosthetic mechanical valves. The cardiac surgery team advised against an epicardial ICD implantation. Results. We achieved a fully transvenous implant, with a screw-in defibrillation coil in the low right atrium and a bipolar pacing/sensing lead in a posterolateral branch of the coronary sinus. Pacing/sensing parameters were reliable, and effective defibrillation occurred at 20 J by a stepdown protocol. During 16-month follow-up, three VT episodes at 210 bpm were terminated by antitachycardia pacing (ATP) therapy. Left ventricular pacing/sensing was stable at long term. Conclusion. Thanks to technologic improvements, transvenous ICD implantation is feasible and safe in patients with a tricuspid mechanical prosthesis. [source]

Newly Detected Atrial Fibrillation Following Dual Chamber Pacemaker Implantation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2006
JIM W. CHEUNG M.D.
Introduction: Pacemaker (PPM)-detected atrial high-rate episodes (AHREs) of even 5-minute duration may identify patients at increased risk for stroke and death. In this study, we sought to determine the incidence of newly detected atrial fibrillation (AF defined as an AHRE ,5 minutes) in patients following dual-chamber PPM implantation and to define the clinical predictors of developing AF. Methods and Results: We evaluated 262 patients (142 male; age 74 ± 12 years) without documented AF who underwent PPM implantation for sinus node dysfunction (n = 122) or atrioventricular block (n = 140). Information regarding patient demographics, cardiovascular diseases, and medication history was obtained. The cumulative percentages of ventricular pacing as well as the frequency, duration, and time to first episode of an AHRE were also determined. During follow-up of 596 ± 344 days, an AHRE ,5 minutes was detected in 77 (29%) patients. Of these, 47 (61%) patients had an AHRE ,1 hour, 22 (29%) patients had an AHRE ,1 day, and 12 (16%) patients had an AHRE ,1 week. An AHRE ,5 minutes was seen in 24% and 34% of patients at 1 year and 2 years, respectively. Among patients with sinus node dysfunction, ,50% cumulative ventricular pacing was the only significant predictor of an AHRE ,5 minutes (HR 2.2; CI 1.0,4.7; P = 0.04). Conclusions: Within 1 year of PPM implantation, AF is detected in 24% of patients without history of AF. In patients with sinus node dysfunction, ,50% cumulative right ventricular pacing is associated with a 2-fold increase in risk of developing AF. [source]

Implantation of Bilateral Carotid Artery Filters to Allow Safe Removal of Left Atrial Thrombus During Ablation of Atrial Fibrillation

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2006
SILVIA MARTELO M.D.
Left atrial clot formation is a feared complication of catheter ablation for atrial fibrillation. We report a case of left atrial thrombus that formed around the circular mapping catheter before the delivery of RF. Successful retrieval of the clot was obtained by withdrawing the catheters while protecting the anterior cerebral circulation by positioning temporary carotid artery filters. [source]

Endocardial Implantation of a Cardioverter Defibrillator in Early Childhood

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2005
MAURIZIO GASPARINI M.D.
Introduction: Experience in endovascular/endocardial techniques for implanting implantable cardioverter defibrillators in early childhood is limited. Potentially, this type of approach could limit the surgical risk, while increasing ICD therapy efficacy. The safety and feasibility of adopting a complete endovascular/endocardial approach for implanting ICDs is assessed by considering the cases of two young children. Methods and Results: Two boys, aged 3 and 6 years, were implanted with ICD for a history of syncope and documented ventricular tachycardia (VT). A complete endovascular/endocardial approach was adopted consisting of positioning a bipolar pacing and sensing lead in the right ventricular (RV) apex with intravascular redundancy forming a loop in the inferior vena cava (IVC), and a caval coil placed in the IVC. Sensing values (7,8 mV), pacing threshold (0.5,0.6 V/0.5 msec), and defibrillation testing (case 1 = 10 J, case 2 = 20 J) were all acceptable. During follow-up, in both cases ICD intervened correctly. In one case, 16 months after implantation, because of change in the IVC coil-active can vector, the IVC coil was effectively repositioned to a more distal position. Conclusion: A complete endovascular/endocardial ICD implantation technique in early childhood is both feasible and safe. This approach avoids thoracotomy and ensures ICD therapy efficacy. [source]

Subcutaneous Array to Transvenous Proximal Coil Defibrillation as a Solution to High Defibrillation Thresholds with Implantable Cardioverter Defibrillator Distal Coil Failure

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 3 2003
BOAZ AVITALL, Ph.D.
Implantation of a subcutaneous array to improve the defibrillation threshold of an existing transvenous defibrillation lead system without the need for lead extraction is discussed.(J Cardiovasc Electrophysiol, Vol. 14, pp. 314-315, March 2003) [source]

Deproteinized bovine bone and gentamicin as an adjunct to GTR in the treatment of intrabony defects: a randomized controlled clinical study

JOURNAL OF CLINICAL PERIODONTOLOGY, Issue 6 2003
A. Stavropoulos
Abstract Objectives: To evaluate whether Bio-Oss® used as an adjunct to guided tissue regeneration (GTR) improves the healing of 1- or 2-wall intrabony defects as compared with GTR alone, and to examine whether impregnation of Bio-Oss® with gentamicin may have an added effect. Material and methods: Sixty patients, with at least one interproximal intrabony defect with probing pocket depth (PPD) 7 mm and radiographic evidence of an intrabony component (IC) 4 mm, were treated at random with either a resorbable membrane (GTR), a resorbable membrane in combination with Bio-Oss® impregnated with saline (DBB,), a resorbable membrane in combination with Bio-Oss® impregnated with gentamicin (DBB+), or with flap surgery (RBF). Results: All treatment modalities resulted in statistically significant clinical improvements after 1 year. Defects treated with GTR alone presented a probing attachment level (PAL) gain of 2.9 mm, a residual PPD (PPD12) of 4.9 mm, a radiographic bone level (RBL) gain of 3.1 mm, and a residual IC (IC12) of 2.7 mm. GTR combined with Bio-Oss® did not improve the healing outcome (PAL gain: 2.5 mm; PPD12: 4.9 mm; RBL gain: 2.8 mm; IC12: 3.3 mm). Impregnation of the Bio-Oss® with gentamicin 2% mg/ml resulted in clinical improvements (PAL gain: 3.8 mm; PPD12: 4.2 mm; RBL gain: 4.7 mm; IC12: 2.1 mm), superior to those of the other treatment modalities, but the difference was not statistically significant. Defects treated with only flap surgery showed the most inferior clinical response (PAL gain: 1.5 mm; PPD12: 5.1 mm; RBL gain: 1.2 mm; IC12: 4.2 mm) of all groups. Conclusion: The results failed to demonstrate an added effect of Bio-Oss® implantation in combination with GTR on the healing of deep interproximal 1- or 2-wall, or combined 1- and 2-wall intrabony defects compared with GTR alone. Local application of gentamicin, on the other hand, improved the treatment outcome but not to an extent that it was statistically significant. Zusammenfassung Von Proteinen befreiter boviner Knochen und Gentamycin als Adjuvans der GTR bei der Behandlung von infraalveolären Knochentaschen. Eine randomisierte kontrollierte klinische Studie. Ziele: Die Evaluation ob, Bio-Oss® welches als Adjuvans zur GTR verwendet wird, die Heilung von 1- oder 2-wandigen Knochentaschen im Vergleich zu alleiniger GTR verbessert. Sowie die Untersuchung, ob die Imprägnierung von Bio-Oss® mit Gentamycin einen zusätzlichen Effekt haben könnte. Material und Methoden: 60 mit wenigstens einer approximalen Knochentasche mit Sondierungstiefe (PPD) ,7 mm und röntgenologischem Nachweis einer infraalveolären Komponente (IC) von ,4 mm, wurden randomisiert entweder mit einer resorbierbaren Membran (GTR), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Kochsalzlösung imprägniert war (DBB-), einer resorbierbaren Membran in Kombination mit Bio-Oss® welche mit Gentamycin imprägniert war (DBB+) oder mit Lappen-OP (RPF) behandelt. Ergebnisse: Nach einem Jahr hatten alle Behandlungsweisen eine statistisch signifikante klinische Verbesserung zum Ergebnis. Defekte, die mit alleiniger GTR behandelt wurden zeigten einen Gewinn an klinischem Attachmentniveau (PAL) von 2,9 mm, einer PPD (PPD12) von 4,9 mm, einem Gewinn an röntgenologischem Knochenniveau (RBL) von 3,1 mm und einer IC (IC12) von 2,7 mm. GTR in Kombination mit Bio-Oss® verbesserte das Ergebnis der Heilung nicht (PAL Gewinn: 2,5 mm; PPD12: 4,9; RBL Gewinn: 2,8 mm; IC12: 3,3 mm). Die Imprägnierung von Bio-Oss® mit Gentamycin 2% mg/ml hatte klinische Verbesserungen zum Ergebnis (PAL Gewinn: 3,8 mm; PPD12: 4,2 mm; RBL Gewinn: 4,7 mm; IC12: 2,1 mm), die größer waren als die der anderen Behandlungsweisen, jedoch waren die Unterschiede nicht statistisch signifikant. Defekte, die nur mit Lappen-OP behandelt wurden zeigten das schlechteste klinische Ergebnis von allen Gruppen (PAL Gewinn: 1,5 mm; PPD12: 5,1 mm; RBL Gewinn: 1,2 mm; IC12: 4,2 mm). Schlussfolgerung: Die Ergebnisse konnten im Vergleich mit alleiniger GTR keinen zusätzlichen Effekt der Bio-Oss®-Implantation in Kombination mit GTR hinsichtlich der Heilung von tiefen approximalen 1- oder 2-wandigen oder kombinierten 1- oder 2-wandigen Knochentaschen aufzeigen. Auf der anderen Seite verbessert die lokale Applikation von Gentamycin das Behandlungsergebnis, jedoch war das Ausmaß nicht statistisch signifikant. Résumé Os bovin déprotéiné et gentamicine comme adjuvant à la RTG pour le traitement des lésions intra-osseuses. Une étude clinique contrôlée et randomisée. Objectifs: Evaluer si Bio-Oss® utilisé comme adjuvant de la RTG améliore la cicatrisation des lésions intra-osseuses par rapport à la RTG seule et examiner si l'imprégnation de Bio-Oss® avec de la gentamicine pourrait avoir un effet supplémentaire. Matériels et Méthodes: 60 patients, présentant au moins une lésion intra-osseuse interproximale avec une profondeur de poche au sondage (PPD) ,7 mm et la présence avérée radiologiquement d'une composante intra-osseuse (IC) ,4 mm, ont été traités au hasard avec soit une membrane résorbable (GTR), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de solution saline (DBB-), une membrane résorbable en combinaison avec du Bio-Oss® imprégné de gentamicine (DBB+), ou par chirurgie à lambeau (RBF). Résultats: Toutes les modalités de traitement entraînaient des améliorations cliniques significatives statistiquement après un an. Les lésions traitées par RTG seule présentaient un gain d'attache de 2.9 mm, une PPD résiduelle (PPD12) de 4.9 mm, un gain de niveau osseux radiographique (RBL) de 3.1 mm, et un IC résiduel (IC12) de 2.7 mm. La RTG combinée avec le Bio-Oss® n'améliorait pas le devenir de la cicatrisation. (gain de PAL: 2.5 mm; PPD12: 4.9; gain de RBL: 2.8 mm; IC12: 3.3 mm). L'imprégnation du Bio-Oss®avec la gentamicine (2% mg/ml) apportait des améliorations cliniques (gain de PAL: 3.8 mm; PPD12: 4.2 mm; gain de RBL: 4.7 mm; IC12: 2.1 mm), supérieurs à ceux des autres modalités de traitement, mais la différence n'était pas significative. Le traitement des lésions par lambeaux seulement entraînait la réponse clinique la moins bonne (gain de PAL: 1.5 mm; PPD12: 5.1 mm; gain de RBL: 1.2 mm; IC12: 4.2 mm). Conclusion: Ces résultats ne pouvaient démontrer un effet supplémentaire, sur la cicatrisation de lésions profondes interproximales avec une ou deux parois, de l'implantation de Bio-Oss® en combinaison avec la RTG par rapport à la RTG seule. L'application locale de gentamicine, par contre, améliorait le devenir du traitement mais pas suffisamment pour être statistiquement significatif. [source]

Long-Term Outcomes after Drug-Eluting Stent Implantation: Get Your Feet Wet in the Real-World

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2010
STÉPHANE COOK M.D.
(J Interven Cardiol 2010;23:176-178) [source]

Observance of Antiplatelet Therapy after Stent Implantation in Patients under Chronic Oral Anticoagulant Treatment

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2008
JOSÉ VALENCIA M.D., Ph.D.
Purpose: Patients undergoing coronary stenting must take dual antiplatelet therapy during a variable period. The combination of chronic oral anticoagulants (COA) with antiplatelet therapy has been related to an increased risk of hemorrhage. The aim of this study was to evaluate the level of the antiplatelet therapy observance in those patients and the incidence of adverse events after 1 year. Methods: Patients with prior COA treatment with coronary lesions suitable for stenting were included. Clinical assessment was performed on admission, with follow-up at 1, 6, and 12 months. Antiplatelet and COA treatment, adverse cardiac events, and hemorrhagic episodes were registered. Results: A total of 70 patients were included. Mean age was 70.5 ± 8.7 years. The most common cause of COA was atrial fibrillation. Conventional stents were used in 40% and drug-eluting stents (DES) in 60%. Treatment at discharge was: ASA + clopidogrel + COA 64.2%, ASA + clopidogrel 25.4%, COA + clopidogrel 7.5%, and COA + ASA 3%. Observance of antiplatelet and COA therapy at 1-6-12 month follow-up after conventional stent was: COA 73.1-70.8-69.6%; ASA 92.3-75.4-65.2%; clopidogrel 92.3-62.5-43.5%. In patients receiving DES, it was: COA 76.9-78.9-80.6%, ASA 79.5-65.8-55.7%, and clopidogrel 94.9-84.2-61.1%. Dual antiplatelet therapy in patients with DES over these periods was taken in 79.5-51.4-27.8%, respectively. The incidence of adverse events was minor bleeding 11.4%, major bleeding 8.6%, myocardial infarction 4.3%, stent thrombosis 1.4%, and death 12.8%. Conclusions: There is a great variability in the treatment prescribed at discharge. Low observance with dual antiplatelet therapy has been detected in these patients, particularly after DES implantation, and they present a very high rate of complications in the follow-up. [source]

Coronary Artery Bypass Surgery Versus Percutaneous Coronary Intervention with Drug-Eluting Stent Implantation in Patients with Multivessel Coronary Disease

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2007
ZHEN KUN YANG M.D.
Background: Drug-eluting stents (DES) constitute a major breakthrough in restenosis prevention after percutaneous coronary intervention (PCI). This study compared the clinical outcomes of PCI using DES versus coronary artery bypass graft (CABG) in patients with multivessel coronary artery disease (MVD) in real-world. Methods: From January 2003 to December 2004, 466 consecutive patients with MVD underwent revascularization, 235 by PCI with DES and 231 by CABG. The study end-point was the incidence of major adverse cardiovascular events (MACEs) at the first 30 days after procedure and during follow-up. Results: Most preoperative characteristics were similar in the two groups, but left main disease (24.7% vs 2.6%, P<0.001) and three-vessel disease (65% vs 54%, P = 0.02) were more prevalent in CABG group. The number of coronary lesions was also greater in CABG group (3.7 ± 1.1 vs 3.3 ± 1.1, P<0.001). Despite higher early morbidity (3.9% vs 0.8%, P = 0.03) associated with CABG, there were no significant differences in composite MACEs at the first 30 days between the two groups. During follow-up (mean 25±8 months), the incidence of death, myocardial infarction, or cerebrovascular event was similar in both groups (PCI 6.3% vs CABG 5.6%, P = 0.84). However, bypass surgery still afforded a lower need for repeat revascularization (2.8% vs 10.4%, p = 0.001). Consequently, overall MACE rate (14.5% vs 7.9%, P = 0.03) remained higher after PCI. Conclusion: PCI with DES is a safe and feasible alternative to CABG for selected patients with MVD. The reintervention gap was further narrowed in the era of DES. Aside from restenosis, progression of disease needs to receive substantial emphasis. [source]

Predictors of Complete Heart Block After Alcohol Septal Ablation for Hypertrophic Cardiomyopathy and the Timing of Pacemaker Implantation

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2007
F.R.A.C.P., SEIFEDDIN S. EL-JACK M.B.B.S.
Catheter-based alcohol septal ablation has recently been introduced for the treatment of left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy. It is associated with various conduction disturbances and may lead to transient or persistent complete heart block (CHB). Electrocardiographic (ECG) changes and predictors of developing CHB and the timing of permanent pacemaker implantation have been variable among the different studies. Among 50 patients studied, we found that a new right bundle branch pattern was the most common new ECG change after septal ablation and that baseline left bundle branch block was strongly associated with the development of CHB (P = 0.004); 9 patients (18%) required permanent pacemaker implantation of whom 7 (78%) remained pacemaker dependent at 14 days with no delayed recovery of atrioventricular conduction. This favors an early pacemaker implantation strategy. [source]

Patent Foramen Ovale Using the Premere Device: The Results of the CLOSEUP Trial

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 4 2006
FRANZISKA BÜSCHECK M.D.
Objectives: The CLOSEUP trial was conducted to determine the safety and effectiveness of the Premere closure device in closure of patent foramen ovale (PFO). Background: PFO is a relatively common congenital condition, associated with cryptogenic stroke and migraine with aura. The Premere device is specifically designed to close PFO of variable size and length, with right and left anchor arms connected by a flexible tether. The device has an open architecture, a low profile, and a small surface area on the left atrial side which may discourage thrombus formation. Methods: Patients between 18 and 65 years of age who had a cryptogenic ischemic stroke or a transient ischemic attack and a PFO underwent percutaneous PFO closure using the Premere device. Results: Of the 73 enrolled patients, six patients had atrial anatomy not appropriate for the Premere; 27 patients received the 15 mm and 40 patients received the 20 mm device. Implantation was successful in all patients. At 6 months of follow-up, 86% of patients had no shunt that could be provoked with Valsalva as assessed during contrast echocardiography. Closure rates were better with the 20 mm versus the 15 mm device, and three patients with residual shunt had atrial septal aneurysms at baseline. One patient had transient atrial fibrillation which resolved by 3 months. There were no instances of thrombus, death, or stroke. Conclusions: These data demonstrate that the Premere device can safely and effectively close PFO. Additional studies should be undertaken to demonstrate the effectiveness of PFO closure in reducing thrombo-embolic events such as stroke. [source]

Dysfunction of an Atrial Septal Defect Occluder 8 Years after Implantation

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2006
HENRIK TEN FREYHAUS M.D.
Catheter interventional treatment of atrial septal defect (ASD) is widely accepted. The ASD occluder system (ASDOS) is no longer a widely used device nowadays. However, it is implanted in a substantial number of patients. We report a case of severe left-to-right shunt 8 years after catheter interventional closure of an ASD with an ASDOS device. The shunt was due to a membrane perforation, while the arms of the device were not dislocated. Microscopy, microbiology, and histology could not establish a proper explanation for the dysfunction; so long-term follow-up investigation may be required in patients with an implanted ASDOS device. [source]

Perforation of Aortic Root as Secondary Complication after Implantation of Patent Foramen Ovale Occlusion Device in a 31-Year-Old Woman

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2006
STEFAN A. LANGE M.D.
Transesophageal echocardiography (TEE) revealed a 3-mm-large patent foramen ovale (PFO). No other reason for these neurological events could be found and the patient underwent percutaneous closure of the PFO with a CARDIA® Star 03/30 device without periprocedural complications. Four weeks later, the patient underwent a routine control of device without any adverse clinical symptoms. Surprisingly, echocardiography revealed a perforation of the aortic root by an umbrella strut with a small shunt from the aortic root to the right atrium. Magnetic resonance imaging (MRI) confirmed the diagnosis of device malposition. Consecutively, the patient underwent minimal invasive surgery. After removal of the single perforating strut, the bleeding lesion was closed. The patient remained free of any additional complications during the postoperative course and up until now has had uneventful follow-ups. [source]

Stent Implantation for Coarctation in Adults

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2003
JEAN-FRANÇOIS PIÉCHAUD M.D.
Transcatheter dilatation is considered the elective treatment of residual coarctation. In the presence of native coarctation, dilatation is often effective but in the first months of life, and the risk of aneurysm formation is not low. The use of stents in adolescents and adults provides excellent results and seems to reduce the complication and aneurysm rates. A perfect technique, now well codified, is necessary. (J Interven Cardiol 2003;16:413,418) [source]

Descending Thoracic Aorta to Left Pulmonary Artery Fistula After Stent Implantation for Acquired Left Pulmonary Artery Stenosis

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2002
NICOLA CARANO M.D.
This is a case report of a Fontan patient with previous Potts anastomosis who underwent stent implantation for left pulmonary artery stenosis. At follow-up the patient developed a fistula between the descending thoracic aorta and the left pulmonary artery at the site of the stent. This represents a late complication of stent placement. [source]

Device Implantation and Anticoagulation

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 2 2002
MICHAEL C. GIUDICI M.D.
[source]