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Interventional PFO Closure Using the Premere Device: Australian Experience
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Abstracts CSANZ Abstracts 2011
ABSTRACTS
321 Interventional PFO Closure Using the Premere Device: Australian Experience A. Ghoshal 1,∗ , D. Walters 1 , R. Jayasinghe 2 , S. Worthley 3 , R. Harper 4 1 Prince
Charles Hospital, Brisbane, Australia Coast Hospital, Gold Coast, Australia 3 Royal Adelaide Hospital, Adelaide, Australia 4 Monash Medical Centre, Clayton, Australia 2 Gold
Introduction: PFO has been described in 25–30% of adults. Prevalence increases in cryptogenic stroke. Interventional closure is often used for prevention of recurrent paradoxical embolisation and stroke. Premere device is specifically designed for PFO closure. Key features include limited material on left side, adjustable length tether and convenient placement control. Methods: Multicentre prospective observational registry. Twenty-five patients with PFO and history of at least one thromboembolic event (cryptogenic stroke, TIA or peripheral embolism) underwent percutaneous closure using 25 mm device. Mean follow up with echocardiography was 13 ± 9.27 months. Outcomes evaluated included incidence of stroke/TIA, closure success and device related adverse events. Results: Twenty-five patients (52% women, age 44.68 ± 12.10) underwent PFO closure. Mean PFO size was 7.57 ± 5.81 mm. Seven patients (28%) had atrial septal aneurysm (intra atrial protrusion 13.86 ± 6.96 mm). Procedure was successful in 24 (96%) patients. In one patient deployment of left anchor failed needing retrieval and closure with Amplatzer device. Three patients (12%) had minimal residual shunt. Neither device related complication nor recurrent thromboembolic events were reported during the follow up period. Unrelated adverse events include one reported death and one atrial fibrillation. Conclusion: Interventional closure PFO closure with Premere device is safe, reliable and easy to use. It has a very low rate of adverse and medium term recurrent thromboembolic events. doi:10.1016/j.hlc.2011.05.324 322 Intracoronary ECG is Predictor of Hyperaemic Blood Flow and Myocardial Injury D. Wong 1,∗ , R. Puri 1 , M. Leung 2 , G. Liew 1 , R. Das 1 , K. Teo 1 , I. Meredith 2 , M. Worthley 1 , S. Worthley 1 1 Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia 2 Monash Cardiovascular Research Centre, Department of Medicine (MMC), Monash University, and MonashHeart, Melbourne, Australia
Background: The achievement of hyperaemic-bloodflow [defined as Corrected-TIMI-Frame-Count (CTFC) of <14 frames] has been well described as a powerful predictor of left ventricular remodeling and mortal-
Heart, Lung and Circulation 2011;20S:S1–S155
ity post STEMI. We assessed the hypothesis that intracoronary-ECG (IC-ECG) is a valid surrogate of hyperaemic-blood-flow and the extent of myocardial injury by cardiac magnetic resonance (CMR) in STEMI. Methods: We performed ST-segment analysis on ICECG prior to and immediately after achieving successful patency of the infarct related artery (IRA) during primaryPCI. The IC-ECGs were acquired by connecting an ECG monitor to the angioplasty guidewire whilst situated distally within the IRA. CTFC measurements were analysed offline. Delayed contrast enhancement CMR was performed at 3 and 90 days post primary-PCI. Results: Fifty-three STEMI patients (age 60 ± 10 years; 81% male) were prospectively enrolled. Despite restoration of TIMI 3 flow in 96% of patients, only 53% achieved a CTFC of <14. Hyperaemic-blood-flow correlated with smaller infarct size (p = 0.016) and non-viable mass (p = 0.006) on CMR at three days post STEMI. Furthermore favourable remodeling reflected in reduced diastolic (p = 0.05) and systolic volumes (p = 0.05) were also seen in this group at 90 days. Immediate IC-ECG resolution >1 mm successfully predicted 70% of patients with hyperaemic blood flow (p = 0.028). Immediate IC-ECG resolution >1 mm also correlated with smaller infarct size (p = 0.012), peak creatinine kinase (p = 0.021) and better ejection fraction at 90 days (p = 0.038). Conclusions: Intracoronary-ECG is a novel and immediate “in-lab” predictor of myocardial injury and hyperaemic blood flow. It also correlates favourably with post infarct size and left ventricular remodeling. doi:10.1016/j.hlc.2011.05.325 323 Is a Left Shoulder Guard Biologically More Useful than a Left Shin Guard for Radiation Protection in Interventional Cardiology? S. Buchholz 1,∗ , N. Mughal 3 , A. Nojoumian 4 , R. Bhindi 2 1 Department
of Cardiology, St Vincent’s Hospital, Sydney, Australia 2 Department of Cardiology, Royal North Shore Hospital, Sydney, Australia 3 Department of Radiology, Royal North Shore Hospital, Sydney, Australia 4 Department of Cardiology, St Georges Hospital, Sydney, Australia Radiation exposure to the interventional cardiologist is substantial, making radiation protection paramount. By the middle of the third decade of life, radiosensitive red bone marrow is predominantly distributed in the axial skeleton and, to a lesser degree, the proximal humeri and femora. Current recommendations for radiation protection do not include shin or shoulder guards. For various reasons, radiation along the operators left side is up to 2.5 times greater as compared to the front. We hypothesised that wearing a left shoulder guard during cardiac catheterisation is as useful in reducing radiation exposure as a shin guard. A full sized mannequin and a radia-
Abstracts CSANZ Abstracts 2011
ABSTRACTS
321 Interventional PFO Closure Using the Premere Device: Australian Experience A. Ghoshal 1,∗ , D. Walters 1 , R. Jayasinghe 2 , S. Worthley 3 , R. Harper 4 1 Prince
Charles Hospital, Brisbane, Australia Coast Hospital, Gold Coast, Australia 3 Royal Adelaide Hospital, Adelaide, Australia 4 Monash Medical Centre, Clayton, Australia 2 Gold
Introduction: PFO has been described in 25–30% of adults. Prevalence increases in cryptogenic stroke. Interventional closure is often used for prevention of recurrent paradoxical embolisation and stroke. Premere device is specifically designed for PFO closure. Key features include limited material on left side, adjustable length tether and convenient placement control. Methods: Multicentre prospective observational registry. Twenty-five patients with PFO and history of at least one thromboembolic event (cryptogenic stroke, TIA or peripheral embolism) underwent percutaneous closure using 25 mm device. Mean follow up with echocardiography was 13 ± 9.27 months. Outcomes evaluated included incidence of stroke/TIA, closure success and device related adverse events. Results: Twenty-five patients (52% women, age 44.68 ± 12.10) underwent PFO closure. Mean PFO size was 7.57 ± 5.81 mm. Seven patients (28%) had atrial septal aneurysm (intra atrial protrusion 13.86 ± 6.96 mm). Procedure was successful in 24 (96%) patients. In one patient deployment of left anchor failed needing retrieval and closure with Amplatzer device. Three patients (12%) had minimal residual shunt. Neither device related complication nor recurrent thromboembolic events were reported during the follow up period. Unrelated adverse events include one reported death and one atrial fibrillation. Conclusion: Interventional closure PFO closure with Premere device is safe, reliable and easy to use. It has a very low rate of adverse and medium term recurrent thromboembolic events. doi:10.1016/j.hlc.2011.05.324 322 Intracoronary ECG is Predictor of Hyperaemic Blood Flow and Myocardial Injury D. Wong 1,∗ , R. Puri 1 , M. Leung 2 , G. Liew 1 , R. Das 1 , K. Teo 1 , I. Meredith 2 , M. Worthley 1 , S. Worthley 1 1 Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia 2 Monash Cardiovascular Research Centre, Department of Medicine (MMC), Monash University, and MonashHeart, Melbourne, Australia
Background: The achievement of hyperaemic-bloodflow [defined as Corrected-TIMI-Frame-Count (CTFC) of <14 frames] has been well described as a powerful predictor of left ventricular remodeling and mortal-
Heart, Lung and Circulation 2011;20S:S1–S155
ity post STEMI. We assessed the hypothesis that intracoronary-ECG (IC-ECG) is a valid surrogate of hyperaemic-blood-flow and the extent of myocardial injury by cardiac magnetic resonance (CMR) in STEMI. Methods: We performed ST-segment analysis on ICECG prior to and immediately after achieving successful patency of the infarct related artery (IRA) during primaryPCI. The IC-ECGs were acquired by connecting an ECG monitor to the angioplasty guidewire whilst situated distally within the IRA. CTFC measurements were analysed offline. Delayed contrast enhancement CMR was performed at 3 and 90 days post primary-PCI. Results: Fifty-three STEMI patients (age 60 ± 10 years; 81% male) were prospectively enrolled. Despite restoration of TIMI 3 flow in 96% of patients, only 53% achieved a CTFC of <14. Hyperaemic-blood-flow correlated with smaller infarct size (p = 0.016) and non-viable mass (p = 0.006) on CMR at three days post STEMI. Furthermore favourable remodeling reflected in reduced diastolic (p = 0.05) and systolic volumes (p = 0.05) were also seen in this group at 90 days. Immediate IC-ECG resolution >1 mm successfully predicted 70% of patients with hyperaemic blood flow (p = 0.028). Immediate IC-ECG resolution >1 mm also correlated with smaller infarct size (p = 0.012), peak creatinine kinase (p = 0.021) and better ejection fraction at 90 days (p = 0.038). Conclusions: Intracoronary-ECG is a novel and immediate “in-lab” predictor of myocardial injury and hyperaemic blood flow. It also correlates favourably with post infarct size and left ventricular remodeling. doi:10.1016/j.hlc.2011.05.325 323 Is a Left Shoulder Guard Biologically More Useful than a Left Shin Guard for Radiation Protection in Interventional Cardiology? S. Buchholz 1,∗ , N. Mughal 3 , A. Nojoumian 4 , R. Bhindi 2 1 Department
of Cardiology, St Vincent’s Hospital, Sydney, Australia 2 Department of Cardiology, Royal North Shore Hospital, Sydney, Australia 3 Department of Radiology, Royal North Shore Hospital, Sydney, Australia 4 Department of Cardiology, St Georges Hospital, Sydney, Australia Radiation exposure to the interventional cardiologist is substantial, making radiation protection paramount. By the middle of the third decade of life, radiosensitive red bone marrow is predominantly distributed in the axial skeleton and, to a lesser degree, the proximal humeri and femora. Current recommendations for radiation protection do not include shin or shoulder guards. For various reasons, radiation along the operators left side is up to 2.5 times greater as compared to the front. We hypothesised that wearing a left shoulder guard during cardiac catheterisation is as useful in reducing radiation exposure as a shin guard. A full sized mannequin and a radia-