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Content available remote Effect of electrical cardioversion on stented coronary artery
Direct current cardioversion, which produces electrical energy, is highly effective for the termination of cardiac arrhythmia and sometimes is indicated in patients with coronary artery stents due to arrhythmias. Only a few reports have been published describing the potential adverse interactions between foreign bodies and electrical cardioversion. The aim of this animal study was to investigate the acute effect of repeated external defibrillation on coronary artery tissue and adjacent myocardium at the implantation site of coronary stents. Custom-made stainless steel stents were implanted in the coronary arteries of 7 dogs. Rapid ventricular pacing was performed to induce ventricular fibrillation. Defibrillation was achieved [5 J/kg; n=2 and 8 J/kg; n=3]. In 2 animals, coronary stent was implanted but defibrillation was not performed [control group]. The animal’s heart were excised and sent for microscopic examination. The light and electron micrographs of heart muscles showed no histological and ultrastructural changes in defibrillated and control dogs. It is concluded that nickel coating provides good resistance to heat in coronary stents and repeated defibrillation does not cause histopathological changes typical of thermal injury at the implantation site of coronary stent.
Anomalous origin of the right coronary artery from the contralateral aortic sinus is a rare but potentially fatal congenital abnormality. We analyzed 8.066 consecutive coronary angiograms and found 4 cases demonstrating this anomaly. In 2 cases the right coronary artery was without significant atherosclerotic lesions and coursed between the aorta and pulmonary trunk. In the 2 other cases the right coronary artery was significantly stenosed. In the last case, diagnosis was based on angiographic and dual-source computed tomographic examinations. Dual-source computed tomography showed precisely the origin and course of the right coronary artery between the ascending aorta and pulmonary artery. Moreover, stenoses of the anomalous coronary artery were depicted. Subsequent coronary interventions required modification of the Amplatz left guiding catheter, which enabled a sufficient support even for coronary artery stenting. Both methods seem to be complementary in the diagnostic and therapeutic process of this coronary anomaly.
Content available remote Quality assurance of sphincterotomy: A prospective single-centre survey
Quality assurance becomes an increasingly important part of clinical medicine and of the field of endoscopy. Endoscopic sphincterotomy is associated with a fairly high complication rate. We aimed to assess our quality of sphincterotomy for benchmarking by using a prospective electronic database registry, and to identify potential risk factors for post-interventional complications. Over 2 years, 471 sphincterotomies were performed in a single tertiary referral centre. Patient- and procedure-related variables were prospectively recorded with the support of a multi-centre international sphincterotomy registry. Multivariate analysis was performed. The overall post-interventional complication rate was 9.3%. Pancreatitis happened in 5.5%, bleeding in 2.1%, perforation in 1.3%, and cholangitis in 0.4%. In the multivariate analysis following variables remained highly significant and predictive for complications: ‘papilla only in lateral view’ (p=0.001), antiplatelet therapy (p=0.024), and opacification with contrast up to the pancreatic tail (p=0.001). The primary success rate of sphincterotomy was 95.1%. The rate of post-interventional pancreatitis did not differ significantly regardless of the presence of prophylactic pancreatic stent (p=0.56). The outcome of sphincterotomy in our centre matches with literature data. The extent of pancreatic duct opacification has an influence on the pancreatitis rate. Prevention of pancreatitis by inserting pancreatic stents is not confirmed.
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