Full conversion from transfemoral to transradial approach for percutaneous coronary interventions results in a similar success rate and a rapid reduction of in-hospital cardiac and vascular major events.

Aims: The transradial approach (TRA) for percutaneous coronary intervention (PCI) recently emerged as a safer vascular access with a similar rate of MACE but a lower success rate requiring crossover to another approach when compared to the transfemoral approach (TFA).

Methods And Results: In our hospital the introduction of the TRA in November 2003 resulted in a progressive decline of TFA use. Over the five years of conversion to TRA, from 2002 (100% TFA) to 2007 (98% TRA), major adverse cardiac events (MACE) and all in-hospital vascular and bleeding events, related or not to vascular access, were prospectively collected to assess performances of each approach in the specific setting of PCI (percutaneous coronary interventions).

The different mechanisms of periprocedural myocardial infarction and their impact on in-hospital outcome.

Background: CK-MB levels exceeding 3 times the upper limit of normal (ULN) following percutaneous coronary intervention (PCI), defining periprocedural myocardial infarction (PMI), are associated with worse outcomes. This study assessed the incidence and mechanisms of PMI and their impact on in-hospital stay.

Methods And Results: Over a 12-year period (1996-2007), 272 cases of PMI (overall incidence, 3.

Aberrantly inserted chordae tendineae without significant mitral regurgitation.

Aberrantly inserted chordae tendineae in the left atrial side are a rare find. We report here the case of a young patient with aberrantly inserted chordae tendineae not causing significant mitral regurgitation. Because the patient remained asymptomatic and the anomalous chord of the left atrium could be considered within normal human anatomic variation, the authors decided to only monitor the patient's condition for the time being.

Predictive value of thromboembolic risk scores before an atrial fibrillation ablation procedure.

Introduction: It is not clear whether transesophageal echocardiography (TEE) should be performed prior to a planned atrial fibrillation (AF) ablation in all patients.

Methods And Results: The objectives of this study were to determine in 681 consecutive patients: (i) the relationship between the CHADS2 and CHA2DS2-VASc scores, the presence of a thrombogenic milieu and left atrial (LA) volume; (ii) the need for TEE in patients with low and intermediate thromboembolic risk assessed; and (iii) the predictive accuracy of the these 2 scores for the presence of thrombi in the LA/LAA (LA appendage) before a planned AF ablation. The prevalence of thrombi was 1%.

The effect of clonidine, an alpha-2 adrenergic receptor agonist, on inflammatory response and postischemic endothelium function during early reperfusion in healthy volunteers.

Ischemia-reperfusion disturbs endothelial physiology and generates a proinflammatory state. Animal studies showed that clonidine administered prior hypoxia improves posthypoxic endothelial function. To investigate this effect in human, we have assessed the postischemic endothelium function and the proinflammatory state in healthy volunteers with and without clonidine.

Successful anticoagulation for treatment of a giant left atrial thrombus.

We report the discovery at transthoracic echocardiography of a very large, sessile formation in the left atrium in a 77-year-old woman with permanent non-valvular atrial fibrillation who did not receive anticoagulant therapy. After six weeks of anticoagulation by subcutaneous low-molecular-weight heparin, a control echocardiogram demonstrated an almost complete resolution of the mass without systemic embolisation. This case highlights the success, without complications, of a medical anticoagulant therapy for giant left atrial thrombus.

Low rate of conversion to transfemoral approach when attempting both radial arteries for coronary angiography and percutaneous coronary intervention: a study of 1,826 consecutive procedures.

Aims: Despite a proven safety profile, the transradial approach (TRA) for coronary procedures is regarded by many as complicated and the second-choice arterial access, with a high conversion rate to transfemoral access (TFA). This study reports causes of failure and the contemporary success rate of TRA when both radial arteries are attempted first before converting to TFA.

Methods: This prospective, single-center study included 1,826 consecutive patients referred for cardiac catheterization, which was performed by two trained operators between January 2005 and June 2007.