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Day Case Patent Foramen Ovale Closure Facilitated by Intracardiac Echocardiography: The Oxford Experience
Abstracts
372 Day Case Patent Foramen Ovale Closure Facilitated by Intracardiac Echocardiography: The Oxford Experience F.A. Ponnuthurai ∗ , W.J. Ormerod
van
Gaal, A.
Burchell, O.
The John Radcliffe Hospital, Oxford, United Kingdom Background: Ultrasound guided patent foramen ovale (PFO) closure has traditionally utilized transoesophageal echocardiography (TOE) under general anaesthesia. Some centres use fluoroscopic guidance alone to facilitate daycase PFO closure. Intracardiac echocardiography (ICE) is performed via femoral vein access using an 11 Fr sheath providing accurate guidance without the necessity for general anaesthesia. The safety and feasibility of PFO closure using ICE guidance as a daycase procedure has not been documented. Methods: We present a consecutive series of patients undergoing planned daycase PFO closure under ICE guidance with transthoracic echocardiogram (TTE) follow up. Patients excluded from daycase PFO closure were those with early pregnancy or unfavourable social circumstances. Results: Fifty-three consecutive adult patients (44.2 ± 11.0 years; 24 males) were planned for daycase PFO closure facilitated by ICE. Referral indications were stroke or TIA (n = 39), peripheral embolism (n = 6), decompression sickness (n = 7) and severe migraine (n = 1). All 53 patients underwent ICE, with 9/53 (17%) having an atrial septal aneurysm. In 5 patients no PFO was found. In the remaining 48 patients, PFO closure was achieved using the HELEX occluder (n = 47) or the Amplatzer device (n = 1). Mean procedure and fluoroscopy times were 31.0 ± 12.4 and 5.3 ± 3.9 min, respectively. Only one patient failed same day discharge due to groin haematoma. There were no other complications. At 3-month follow up, 3 patients had small residual shunts. Conclusions: Percutaneous PFO closure as a daycase procedure is safe and feasible when facilitated by ICE. doi:10.1016/j.hlc.2007.06.377 373 Prevalence and Significance of Normal Coronary Arteries in Patients Referred for Primary Percutaneous Coronary Intervention (PPCI) S. Prasad ∗ , D.A.B. Richards, N. Sadick, G. Sivagangabalan, K. Byth, A. Ong, A. Narayan, A.-M. Gerke, P. Kovoor Department of Cardiology, Westmead Hospital, Westmead, Australia Background: PPCI is the treatment of choice for Acute Myocardial Infarction (AMI). With the need for assessing patients rapidly there is room for error in the diagnosis. Aims: We sought to determine the clinical and electrocardiographic (ECG) correlates of patients referred for PPCI who had normal coronary arteries.
S151
Methods: We conducted a prospective observational study involving 690 consecutive patients referred for PPCI. Clinical and ECG characteristics of patients with normal coronaries (n = 87, 12.6%) were compared with patients with angiographically demonstrated culprit lesions (n = 594). ECGs were reviewed by two experienced cardiologists blinded to the angiogram findings in an ECG substudy. Conventional ECG diagnostic criteria for AMI was used: ST elevation ≥1 mm in 2 contiguous limb leads or ≥2 mm in 2 contiguous chest leads or new LBBB. Results: Patients with normal coronaries were younger and had fewer risk factors. On expert review of ECGs, 55% of patients with normal coronaries had ST elevation criteria for STEMI, but the ECG was considered to be consistent with a diagnosis of AMI in only 33%. LBBB was found to independently correlate with normal coronaries(p < 0.05). Conclusion: The incidence of normal coronary arteries in patients referred for Primary PCI is significant (around 13%). This can be approximately halved by adhering to conventional ECG criteria for AMI diagnosis and by careful review of ECGs by experienced clinicians. The value of new LBBB as a criterion for urgent intervention in chest pain patients needs to be reviewed.
ECG Sub-Study Results
Normal Group (N = 87)
AMI Group (N = 594)
P-Value
LBBB
11 (12.6%)
8 (1.3%)
<0.001
EXPERT R/v: ST-elevation (mm)
1.54(±1.0)
3.33(±1.9)
<0.001
ST elevation criteria met
55.3%
93.0%
<0.001
AMI likely diagnosis
32.9%
91.6%
<0.001
doi:10.1016/j.hlc.2007.06.378 374 Intra-Coronary Abciximab Administration in Acute Myocardial Infarction—Results of an Ongoing, Prospective, Randomised Double-Blind Trial M. Rahman ∗ , R. Huq, L. Ponnuthurai, M. Sebastian, T. Yip, B. Wai, S. Al-Daher, R. Reddy, A. Black Cardiology Department, The Geelong Hospital, Geelong, Victoria, Australia Background: Intravenous (IV) abciximab is used in patients (pts) undergoing percutaneous coronary intervention (PCI) for Acute Myocardial Infarction (AMI) and had shown to reduce major adverse cardiac events (MACE). Retrospective studies had suggested improvement in 30-day MACE with Intracoronary (IC) abciximab versus (vs.) IV route. We planned to prospectively assess the safety and feasibility of IC vs. IV abciximab in acute PCI, to examine 30-day MACE, and to measure platelet Glycoprotein IIbIIIa receptors inhibition (PRI) during the procedure.
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201
372 Day Case Patent Foramen Ovale Closure Facilitated by Intracardiac Echocardiography: The Oxford Experience F.A. Ponnuthurai ∗ , W.J. Ormerod
van
Gaal, A.
Burchell, O.
The John Radcliffe Hospital, Oxford, United Kingdom Background: Ultrasound guided patent foramen ovale (PFO) closure has traditionally utilized transoesophageal echocardiography (TOE) under general anaesthesia. Some centres use fluoroscopic guidance alone to facilitate daycase PFO closure. Intracardiac echocardiography (ICE) is performed via femoral vein access using an 11 Fr sheath providing accurate guidance without the necessity for general anaesthesia. The safety and feasibility of PFO closure using ICE guidance as a daycase procedure has not been documented. Methods: We present a consecutive series of patients undergoing planned daycase PFO closure under ICE guidance with transthoracic echocardiogram (TTE) follow up. Patients excluded from daycase PFO closure were those with early pregnancy or unfavourable social circumstances. Results: Fifty-three consecutive adult patients (44.2 ± 11.0 years; 24 males) were planned for daycase PFO closure facilitated by ICE. Referral indications were stroke or TIA (n = 39), peripheral embolism (n = 6), decompression sickness (n = 7) and severe migraine (n = 1). All 53 patients underwent ICE, with 9/53 (17%) having an atrial septal aneurysm. In 5 patients no PFO was found. In the remaining 48 patients, PFO closure was achieved using the HELEX occluder (n = 47) or the Amplatzer device (n = 1). Mean procedure and fluoroscopy times were 31.0 ± 12.4 and 5.3 ± 3.9 min, respectively. Only one patient failed same day discharge due to groin haematoma. There were no other complications. At 3-month follow up, 3 patients had small residual shunts. Conclusions: Percutaneous PFO closure as a daycase procedure is safe and feasible when facilitated by ICE. doi:10.1016/j.hlc.2007.06.377 373 Prevalence and Significance of Normal Coronary Arteries in Patients Referred for Primary Percutaneous Coronary Intervention (PPCI) S. Prasad ∗ , D.A.B. Richards, N. Sadick, G. Sivagangabalan, K. Byth, A. Ong, A. Narayan, A.-M. Gerke, P. Kovoor Department of Cardiology, Westmead Hospital, Westmead, Australia Background: PPCI is the treatment of choice for Acute Myocardial Infarction (AMI). With the need for assessing patients rapidly there is room for error in the diagnosis. Aims: We sought to determine the clinical and electrocardiographic (ECG) correlates of patients referred for PPCI who had normal coronary arteries.
S151
Methods: We conducted a prospective observational study involving 690 consecutive patients referred for PPCI. Clinical and ECG characteristics of patients with normal coronaries (n = 87, 12.6%) were compared with patients with angiographically demonstrated culprit lesions (n = 594). ECGs were reviewed by two experienced cardiologists blinded to the angiogram findings in an ECG substudy. Conventional ECG diagnostic criteria for AMI was used: ST elevation ≥1 mm in 2 contiguous limb leads or ≥2 mm in 2 contiguous chest leads or new LBBB. Results: Patients with normal coronaries were younger and had fewer risk factors. On expert review of ECGs, 55% of patients with normal coronaries had ST elevation criteria for STEMI, but the ECG was considered to be consistent with a diagnosis of AMI in only 33%. LBBB was found to independently correlate with normal coronaries(p < 0.05). Conclusion: The incidence of normal coronary arteries in patients referred for Primary PCI is significant (around 13%). This can be approximately halved by adhering to conventional ECG criteria for AMI diagnosis and by careful review of ECGs by experienced clinicians. The value of new LBBB as a criterion for urgent intervention in chest pain patients needs to be reviewed.
ECG Sub-Study Results
Normal Group (N = 87)
AMI Group (N = 594)
P-Value
LBBB
11 (12.6%)
8 (1.3%)
<0.001
EXPERT R/v: ST-elevation (mm)
1.54(±1.0)
3.33(±1.9)
<0.001
ST elevation criteria met
55.3%
93.0%
<0.001
AMI likely diagnosis
32.9%
91.6%
<0.001
doi:10.1016/j.hlc.2007.06.378 374 Intra-Coronary Abciximab Administration in Acute Myocardial Infarction—Results of an Ongoing, Prospective, Randomised Double-Blind Trial M. Rahman ∗ , R. Huq, L. Ponnuthurai, M. Sebastian, T. Yip, B. Wai, S. Al-Daher, R. Reddy, A. Black Cardiology Department, The Geelong Hospital, Geelong, Victoria, Australia Background: Intravenous (IV) abciximab is used in patients (pts) undergoing percutaneous coronary intervention (PCI) for Acute Myocardial Infarction (AMI) and had shown to reduce major adverse cardiac events (MACE). Retrospective studies had suggested improvement in 30-day MACE with Intracoronary (IC) abciximab versus (vs.) IV route. We planned to prospectively assess the safety and feasibility of IC vs. IV abciximab in acute PCI, to examine 30-day MACE, and to measure platelet Glycoprotein IIbIIIa receptors inhibition (PRI) during the procedure.
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201