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Bucheon, South Korea

The retrograde approach to chronic total occlusions (CTOs) is a great advance in percutaneous coronary intervention (PCI). When the retrograde wire has been passed into the antegrade guiding catheter, a microcatheter is advanced into the antegrade guiding catheter and the retrograde wire is exchanged for a 0.014 inch, 300 cm guidewire to keep both ends accessible. However, this maneuver takes a long time, as advancing the guidewire is slowed due to marked resistance. We report a case where successful retrograde recanalization of an RCA CTO lesion was performed using the "kissing microcatheter technique". This technique involves placing a microcatheter inside the antegrade guiding catheter and manipulating the retrograde guidewire to pick up the tip of the antegrade microcatheter and enter it retrogradely. The retrograde microcatheter and antegrade microcatheter are on the same retrograde wire. After advancing the antegrade microcatheter until both tips kiss each other, the antegrade microcatheter is advanced to the distal portion of the CTO lesion, pulling the retrograde microcatheter back. The retrograde guidewire is pulled out and an antegrade guidewire is advanced to the distal true lumen through the antegrade microcatheter. This novel technique is a safe, feasible strategy for placing an antegrade guidewire across a CTO lesion.

Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and it has a significant impact on morbidity and mortality. Large randomized trials have failed to demonstrate a benefit for mortality of the pharmacological rhythm control strategy as compared with the rate control strategy, indicating that rate control may be an adequate treatment for AF. However, further study determined that the presence of AF at the time of study termination was a more potent predictor of mortality than the treatment strategy, suggesting the importance of sinus rhythm. On the other hand, catheter ablation recently has emerged as an alternative treatment option to pharmacological therapy for AF. Although AF ablation is an invasive strategy, over the past decade its efficacy has increased and the complication rate has decreased with the growing experience of operators and evolving technology. Moreover, the ablation methodology, such as pulmonary vein isolation based ablation, is consistent worldwide and the success rate of AF ablation, especially in paroxysmal AF, is similar. Therefore, catheter ablation is established as a treatment option for AF.

Iesaka Y.,Cardiovascular Center
Journal of Cardiology | Year: 2011

The sudden evolution of catheter ablation (CA) therapy for atrial fibrillation (AF) was brought by the discovery of a new insight into the triggering mechanism of AF by Haïssaguerre et al. in 1998. This discovery opened a new era of evolution of ablation therapy of paroxysmal AF (PAF). At the frontier of AF ablation, technical development of CA for long-standing persistent AF (CAF) has been done enthusiastically, although the detailed electrophysiologic mechanism and anatomical substrate of persistent AF remain unknown. Stepwise ablation composed of multiple procedures, circumferential pulmonary vein isolation (PVI), biatrial defragmentation, and anatomical linear ablation with the endpoint of AF termination has been the most widely accepted method, because the efficacy of this method was reported to be surprisingly high during a relatively short duration of follow-up. Recently, they showed this strategy has a significant limitation in efficacy for CAF with long AF duration (>7 years), enlarged left atrium (>50. mm in left anterior descending artery), short AF cycle length (AFCL) (<130. ms) and impaired cardiac function. For cases associated with these clinical, anatomical, and electrophysiological parameters, AF termination as an endpoint might be abandoned if peak prolongation of AFCL, reduction of intra-/inter-atrial AFCL gradient, and low defibrillation threshold are attained after predetermined lesion set is completed. Prolonged procedure with massive tissue ablation to attain AF termination should be avoided, because it potentially increases adverse events during and immediately after the procedure and causes extensive scar-formation in both atria with atrial mechanical dysfunction. © 2011.

Zanjani K.S.,Tehran University of Medical Sciences | Niwa K.,Cardiovascular Center
Journal of Cardiology | Year: 2013

Longer survival after corrective surgery for congenital heart diseases has rendered late complications more important. One of these complications is aortic dilatation which may occur in patients with repaired or unrepaired disease and can progress to aneurysm, dissection, and rupture. This aortic dilatation in various congenital heart diseases does not simply mean anatomical dilatation of the aortic root, but it closely relates to the aortic pathophysiological abnormality, aortic regurgitation, and aortic and ventricular dysfunction; therefore, we can recognize this complex lesion as a new concept: " aortopathy" The pathophysiology of this disease is complex and only partially understood.In this review, we first discuss history, pathophysiology, and clinical features of aortic dilatation and aortopathy of congenital heart disease. Then we provide a review of the evaluation and management of this disease. © 2012 Japanese College of Cardiology.

Merlo M.,University of Trieste | Pyxaras S.A.,University of Trieste | Pinamonti B.,University of Trieste | Barbati G.,University of Padua | And 2 more authors.
Journal of the American College of Cardiology | Year: 2011

Objectives: The purpose of this study was to determine the prevalence and prognostic role of left ventricular reverse remodeling (LVRR) in idiopathic dilated cardiomyopathy (IDCM). Background: Tailored medical therapy can lead to LVRR in IDCM. The prevalence and prognostic impact of LVRR remain unclear. Methods: We consecutively enrolled 361 IDCM patients. LVRR was defined as a left ventricular ejection fraction increase of <10 U or a left ventricular ejection fraction of <50% and a decrease in indexed left ventricular end-diastolic diameter of <10% or indexed left ventricular end-diastolic diameter of <33 mm/m2 at 24 months (range 9 to 36 months). Follow-up echocardiographic data were available for 242 patients (67%), 34 (9%) died/underwent heart transplantation (HTx) before re-evaluation, and 85 (24%) did not have a complete re-evaluation. After re-evaluation, the surviving patients were followed for 110 ± 53 months; there were 55 deaths (23%) and 32 HTx (13%). Results: LVRR was found in 89 of 242 patients (37%). Baseline predictors of LVRR were higher systolic blood pressure (p = 0.047) and the absence of left bundle branch block (p = 0.009). When added to a prognostic baseline model including male sex, heart failure duration, New York Heart Association functional classes III to IV, LVEF, significant mitral regurgitation, and beta-blockers, LVRR, New York Heart Association functional classes III to IV, and significant mitral regurgitation after 24 months emerged as independent predictors of death/HTx and heart failure death/HTx. The model including follow-up variables showed additional prognostic power with respect to baseline model (for death/HTx, area under the curve: 0.80 vs. 0.70, respectively, p = 0.004). Furthermore, only LVRR was significantly associated with sudden death/major ventricular arrhythmia in the long-term. Conclusions: LVRR characterized approximately one-third of IDCM patients surviving 2 years while receiving optimal medical therapy and allowed a more accurate long-term prognostic stratification of the disease. © 2011 American College of Cardiology Foundation.

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