Cardiology Intervention

PDA DEVICE CLOSURE

Angio Showed moderate size PDA Measuring 3.5 MM 8 / 6 PDA device deployed Through 6 F Sheath. Post development Angio Showed device In Good Position.Device Realese With No Complications. Procedure covered with 500 Units Of heparin And One Dose Of Ceftrioxone.

DISTAL​ RCA STENTING​ AFTER PROXIMAL​ RCA​ STENT

Young male admitted in hospital with chest pain
●ECG​ shows ST-T changes
●Echo​ - inferior wall
●hypokinesia​
●Cardiac​ enzymes are positive
Angiography​ reveled critical
blockages​ in right coronary artery, almost totally occulsion, distal artery underfilled Angioplasty​ done to Proximal part first distal stent crossed through Proximal stent Doublewiring​ for extrasupport​ crossing wire through Proximal stent is crucial step always cross check it with balloon whether v are crossed through stent struts​ or not? Balloon​ will not cross if wire crossed through struts always remove extra wire before inflating stent.

COMPLICATION POST.
Guidezilla induced spiral dissection.
Extend from Left Circumflex Artery (LCX) all the way to LEFT MAIN STEM (LMS) and Left Anterior Descending Artery (LAD).
TVD, not convinced for CABG.
Mid LAD, mid LCX and CTO RCA.
Plan to do LAD and LCX then staged RCA.
LAD was fixed easily. LCX was very tortuous.
Buddy wire then guidezilla used for stent deployment. Dissection proximally.
During another stent deployment guidezilla induced dissection of proximal LCX that extend all the way to LMS and then into LAD.
Hypotension.
Fixed immediately with stent in LMS to LAD then additional stent in LAD.
LMS to LCX with TAP. KBD. Final POT.
Lucky enough to bring the patient out with stable haemodynamics. Discharged next day.

Reptured sinus of valsulva into RA.
Acute heart failure.
Frank pulmonary oedema.
Mechanical ventilation.
Percutaneous closure of reptured sinus with PDA device ( off label ).

Complex trifurcation Left Circumflex Artery (LCX), Obtuse marginal(OM1) & Obtuse marginal(OM2).
Side branch was resistant to balloon dilatation, 2.0mm balloon was not able to cross and 1.5mm balloon reptured.
Rotablation of side branch1.25mm burr at 180k used multiple times.
Interventional NO REFLOW responsive to vasodilators.
Mini crush tech.
Finally TIMI III flow in all vessels.

Balloon pulmonary valvotomy for valvular Pulmonary stenosis (PS).
With rapid Right Ventricle (RV) pacing.
Peak to peak gradient reduces from 115 mmHg to 07 mmHg

https://youtu.be/JveAPfSw-68

Protected Left main stem (LMS) critical stenosis & Saphenous vein grafts (SVG) to RightCoronaryArtery (RCA) critical focal stenosis.
Left internal mammary artery (LIMA) patent.
Degenerative Saphenous vein grafts (SVG) Percutaneous Coronary Intervention (PCI) with distal protection device ( FILTER WIRE).
Percutaneous Coronary Intervention (PCI) to protected Left main stem (LMS) with 2stent mini crush tech.

Uterine artery embolization/ fibroid embolization.
Acceptable alternative to surgery for the treatment of uterine fibroids especially in women of child bearing age who wants to conceive afterwards and or in patients with high surgical risk.

Chronic totalocclusion(CTO) Percutaneous Coronary Intervention (PCI) to Right Coronary Artery(RCA).Intravascular ultrasound (IVUS) guidance. FFR.
70y short stature female. Bifemoral. 7f JR4, 6f XB 3.
Good septal, ipsilateral & contralateral epicardial collateral.
AWE, side branch balloon anchor.
Intravascular ultrasound (IVUS) __ true lumen.
Guide extension cath, for stent delivery to distal vessel.
Post Intravascular ultrasound (IVUS) good expension no malaposition.
Mid Left Anterior Descending Artery (LAD), moderate lesion, Fractional flow Rate (FFR)-ve.

Complex intervention.
Peri procedure change of strategy.
Left Anterior Descending Artery (LAD) total ostial occlusion, Left Circumflex Artery (LCX) - Obtuse marginal (OM) diffuse disease.
Viable myocardium MPI +ve
CABG refused.
Initial plan was stenting of ostial LAD and proximal Left Circumflex Artery(LCX) to Obtuse marginal (OM).
After stenting of Left Anterior Descending Artery (LAD) while doing Percutaneous CoronaryIntervention(PCI) of Left Circumflex Artery (LCX) decided to cover the distal LMS due to diffuse disease of Left Circumflex Artery (LCX).
Sort of micro crush tech. KBD of LAD LCX.
LCX OM TAP tech.
Final IVUS run from LAD to Left main stem (LMS)-- complete ostial coverage of LAD and fully opposed stent in Left main stem (LMS).

Complete revascularization in post (CABG) Paitent.
LIMA to LAD patent but severe disease in LAD after LIMA insertion.
SVG to OM patent but severe disease of LCX.
Non grafted RCA proximal stenosis.
PCI to LAD via LIMA, workhorse wire, Buddy wire but unable to straighten the LIMA.
MC then exchanged workhorse wire with extra backup Grand slam wire and did PCI to LAD via LIMA.
Then the job was straight forward for PCI of RCA and LCX.

Main Branch Bifurcation Stent
(PROViSiONaL) by
Advanced Bifurcation Systems

Heart Attack
Acute Coronary Syndrome And Myocardial Infraction

▪︎ Unsuccessful Closure Of Complex Atrial Septal Defects Supported By Live 3D TEE Imaging

▪︎ Anyone Explain This Procedure Problem???

▪︎Chronic total occlusion(CTO) lesion of Mid Left Anterior Descending Artery (LAD)
▪︎Antegrade Wire Escalation technique
Initial sub intinmal tracking and crossed in to the side branch with The CTO guide wire (GAIA)
2nd guide used for retrograde approach but no good interventional channel except obtuse marginal branche (OM) to Left Anterior Descending Artery (LAD) epicardial collateral but that was not a good choice
So another microcatheter and GAIA 3rd wire used to cross the main vessel
Finally 2 stents used in Left Anterior Descending Artery (LAD) and Diagonal bifurcation was done with Technical aspects of the T And small Protrusion (TAP) technique
Finally TIMI III flow achieved in both vessels

https://youtube.com/playlist?list=PLcvpgFFLM_2YqQQz80e4T-F5nehLTQipj

▪︎Stenting of Left main stem, left anterior descending artery & The posterior left ventricular (PLV) artery using Intravascular ultrasound (IVUS).

▪︎Severe diffuse Triple vessel coronary artery disease
Not suitble for CABG
Planned PCI to Proximal LAD & PLV
IVUS done for assessment of LMS Ostium
Found significant
Post stenting IVUS showed good proximation
No dissection

ACS, SHOCK.
LMS 0.1.1.
IABP.
SKS Technique.
For me this is the only indication for SKS Technique.
7f guide.
Simultaneous 2 DES deployed(SKS).

Left Distal Radial Access.
For Graft study and complex PCI of LCX.
LIMA patent, SVG to OM occluded.
CKD.
Iso osmolar contrast diluted with N/S 50:50.
CTO LCX. Antegrade wire escalation.

Pulmonary balloon valvuloplasty is not simple and straight forward always.
20y old male with critical PS, cyanosis & clubbing.
Supra systemic RV pressures.
Grossly dilated RA, RV with severe TR.
Difficult to stabilize cath in RV, make a loop of glide wire and cross the PV
Then take another venous access to cross the PV without loop in RV.
Gradual balloon dilatation initially with 18mm, ruptured then with 25mm.
Significant reduction in transvalvular gradient achieved.

75y old male, S/p CABG 24y ago.
Recurrent chest pain at rest, USA. Frequent use of S/L nitrates.
SVG to OM & D patent no graft to LAD.
SVG to RCA severe degeneration with sub occlusive thrombus and slow flow.
CULPRIT lesion, decided to intervene the native RCA. Difficult guide engagement due to ostial calcification, AR, AL& LIMA guide tried.
RA started inside the guide 1.25 burr at 160k.
Guidzella used for stent delivery.
Timi III flow achieved.
Stage intervention for LMS -LAD after MPI.

Complex proximal LAD CTO, MPI +ve. CABG refused.
Blunt proximal cap +big diag.at proximal cap.
AWE, NC + flextom Cutting balloon used for lesion preparation.
LAD D1 MINI CRUSH tech.
L*D and stent deformation at ostial LAD.
Another DES from LMS to LAD & LCX with TAP tech.
TIMI III flow with good angiographic results.

To Rescue the LIMA.
Post CABG patient.
HFrEF.
All SVG occluded. LIMA patent.
Left SubClavian total ostial occlusion (CTO).
LIMA fills retrograde from vertebral artery.
Retrograde CTO intervention of subclavian via left radial to improve antigrade flow to LIMA.

LMS critical stenosis, protected LMS.
Previous failed attempt at some other place.
8F guide, rotablation 1.75mm & 2.0mm burr.
Addition cutting balloon athrectomy 3.5x10mm.
Minicrush tech.
Satisfactory final result.

Balloon ruptured during BAV.
16y old patient with severe bicuspid Aortic stenosis.
Peak gradient was 145mmHg.
BAV.
Balloon ruptured during inflation.
But no complications.
Post procedure gradient 42 mmHg.
Fu echo mild AR no complications.

Complex intervention.
Peri procedure change of strategy.
LAD total ostial occlusion, LCX - OM diffuse disease.
Viable myocardium MPI +ve
CABG refused.
Initial plan was stenting of ostial LAD and proximal LCX to OM.
After stenting of LAD while doing PCI of LCX decided to cover the distal LMS due to diffuse disease of LCX.
Sort of micro crush tech. KBD of LAD LCX.
LCX OM TAP tech.
Final IVUS run from LAD to LMS -- complete ostial coverage of LAD and fully opposed stent in LMS.

Complete revascularization in post CABG pt.
LIMA to LAD patent but severe disease in LAD after LIMA insertion.
SVG to OM patent but severe disease of LCX.
Non grafted RCA proximal stenosis.
PCI to LAD via LIMA, workhorse wire, Buddy wire but unable to straighten the LIMA.
MC then exchanged workhorse wire with extra backup Grand slam wire and did PCI to LAD via LIMA.
Then the job was straight forward for PCI of RCA and LCX.