O220
Percutaneous Left Ventricular Assist in Ischaemic Cardiac Arrest
V. Tuseth1
, M Salem, R Pettersen, S Rotevatn, K Grong, JE Nordrehaug . 1
Department of
Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 2
Department of
Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 3
Department of
Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 4
Department of
Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. 5
Department for
Surgical Sciences, University of Bergen, Haukeland University Hospital, N-5021 Bergen,
Norway. 6
Department of Heart Disease, Haukeland University Hospital, Institute of
Medicine.-5021 Bergen, Norway.
Background: Ischemic cardiac arrest represents a challenge for optimal emergency revascu-
larization. A percutaneous left ventricular assist device (LVAD) may help support circulation
during percutaneous coronary intervention (PCI) and could improve clinical outcomes. Such a
device could help maintain systemic blood delivery during cardiopulmonary resuscitation (CPR)
and may also facilitate PCI by allowing short-term interruption of chest compression with less
detrimental consequences. We investigated the ability of a percutaneous transfemoral left
ventricular assist device (Recover LP 2,5®; Abiomed, Aachen, Germany) to deliver blood to the
systemic circulation during cardiac arrest, and randomized two groups to receive either
conventional or intensive fluid infusion to evaluate the effect of increased right side filling on
pump function. Methods and Results: The study was an acute experimental trial with pigs
under general anaesthesia. Farm pigs (nϭ16) of both sexes had LVAD support during
ventricular fibrillation (VF) and were randomized to conventional or intensive fluid. After
randomisation for fluid infusion VF was induced by balloon occlusion of the proximal left
anterior descending artery. LVAD and fluid was started after VF had been induced. Brain, kidney
and myocardial tissue perfusion, and cardiac index, were measured with microsphere injection
technique at baseline, 3 and 15 minutes. Additional hemodynamic monitoring continued for at
most 30 minutes. Mean cardiac index at 3 minutes of VF was 1.2 L.min/m2 (28% of baseline).
Compared to baseline; mean perfusion at 3 minutes was 65% in the brain and 74% in the
epicardial myocardium supplied by the open left circumflex artery suggesting possible
autoregulation augmenting the proportion of flow to these organs. A moderate but non
significant decline was seen at 15 minutes. At 30 minutes LVAD function above 30% of the
initial value after induction of VF was sustained in 11 animals (8/8 intensified fluid vs 3/8
conventional fluid) and was associated with intensified fluid loading (PϽ0.001). Conclusions:
During VF a percutaneous LVAD may assist systemic circulation with potential preferential flow
to vital organs. Intensified fluid loading may be beneficial for LVAD performance. This approach
may improve clinical and technical results in PCI during cardiac arrest. Further investigation is
needed to establish a potential clinical benefit.
O221
The microvascular rheology of ultrasound contrast in ischemia-reperfusion
injury, diabetes and sepsis
A. Camarozano1
, F Cyrino2
, E Bouskela2
, A Siqueira-Filho1
, K Camarozano3
, R Noe1
.
1
Federal University of Rio de Janeiro 2
Estadual University of Rio de Janeiro 3
Universty of
ABC Fundation
Purpose: There has been much debate on the adhesion of microspheres to the leukocytes in
inflammatory tissue, however, little is known about their behavior in the capillaries. Evaluation
of the circulatory effects of this agent may explain its effect on the myocardium. Aim: to
evaluate the microvascular and hemodynamic behavior of the microspheres in the following
sub-groups: ischemia-reperfusion, type-2 diabetes, diabetes with ischemia and sepsis.
Method: an experimental study of the micro-circulation in 65 male hamsters’ cheek pouches
was done. The animals were divided into groups according to induction of disease:
GCϭcontrol; GIRϭischemia/reperfusion; GDϭdiabetes; GDIϭdiabetes with ischemia; and
GSϭsepsis. We analyzed arterial blood pressure (BP), heart rate (HR), blood flow (BF) and
reology, according to mean leukocyte response of three capillaries at each time point
(ALϭadhered leukocytes, RLϭrolling leukocytes), and DVϭvein diameter, at baseline, after 60
minutes intervention and the post to pre delta(⌬). During the procedure we administered:
Definity(D), a lipid coated microsphere containing perfluoropropane gas, or a placebo(P).
Mann-Whitney test was used for comparisons, with significance level set at 5%. Results: the
diabetic hamsters presented greater weight while the septic animals showed a worsening of
general condition with higher mortality. The number of AL and RL was higher in the pre and
post in GDI (mainly RL) and GS (mainly AL) compared to GC and GIR (pϽ0,05). There was no
difference in VD, AL, RL, and ⌬ with or without microspheres in the different groups. There was
also no difference in BP and HR before and after Definity(NS) and BF was subjectively worse
in GS. The mortality was significantly higher in GS. Conclusion: The inflammatory response
seemed to be higher in GDI and GS, independent of microsphere-Definity usage. Reology and
hemodynamics showed no alteration with this agent. These findings may be important to
establish the safety level when using contrast for ultrasound.
O222
Imaging of coronary artery fistulas by multidetector computed tomography:
Is Multidetector computed tomography sensitive?
F. Kacmaz1
, N. Isiksalan Ozbulbul2
, O. Alyan3
, O. Maden4
, A.D. Demir4
, R. Atak4
, A.R.
Erbay4
, Y. Balbay4
, T. Olcer2
, E. Ilkay5
. 1
Bingol State Hospital, Department of Cardiology,
Bingol, TURKEY 2
Turkiye Yuksek Ihtisas Hospital,Department of Radiology, Ankara, TURKEY
3
Dicle University, Department of Cardiology, Diyarbakir, TURKEY 4
Turkiye Yuksek Ihtisas
Hospital,Department of Cardiology, Ankara, TURKEY 5
Mesa Hospital, Department of
Cardiology, Ankara, TURKEY
Background: Coronary artery fistula (CAF) is a rare anomaly in which a communication is
present between a coronary arteries and either a cardiac chambers or another vascular
structures. It is observed in 0.3% to 0.8% of patients who underwent coronary angiography.
Coronary angiography is gold standart for diagnosis of coronary artery fistulas (CAFs).
Multidetector computed tomography(MDCT) is a recently developed imaging technique to
detect coronary artery stenosis, coronary artery anomalies and coronary artery fistulas and their
courses. Objective: We aimed to discribe diagnostic sensitivity of MDCT in a series of 13
patients with 15 coronary artery fistulas. This is first study as well as we know in current
literature.We aimed to determine accuracy or sensitivity of MDCT in patients having CAF.
Method: Between June 2005 and June 2006 a total of 7854 consecutive patients underwent
coronary angiography and 13 patients were incidentally found to have coronary artery fistulas.
All patients were informed clearly about study orally and study was started after obtaining
approval of patients whose gave written informed consent and the study protocol was approved
by the institutional review board. To detection sensitivity of MDCT, the results of MDCT were
evaluated by two experienced radiologist and one cardiologist who were unaware about study
protocol. Finally, we determined diagnostic sensitivity of MDCT in patients had coronary artery
fistula detected by coronary angiography before. Results: Thirteen patients (8 men, 5 women;
age ranged 31–78) had CAFs detected by coronary angiography before were evaulated. All
patients had sinus rhythm. In present study 12 of 15 (80%) CAFs were originated from left
coronary artery system. CAFs were originated from right coronary artery(RCA) in remain. Eleven
of 15 CAFs were shown on MDCT and the overall sensitivity of MDCT was found 73%. Seven
of 8 CAFs that coursing between two vascular structures were detected and the sensitivity of
MDCT in these group was found 87%. However, the sensitivity of 58% of MDCT in patients with
fistula coursing between coronary arteries and cardiac chambers was found. Conclusion:
Although coronary angiography is gold standart diagnostic test for detection CAF, MDCT may
be alternative test especially, CAF coursing between vascular structures to detect origin, course
and drainage site of fistula via its excellent spatial resolution and ability to show relationship
of anatomic structures. Key words: coronary artery fistula, coronary angiography, multidetector
computed tomography
O224
Biventricular Pacing Using Conventional Dual-Chamber Pacemakers in
Patients with Permanent Atrial Fibrillation and Heart Block
S. Pinski1
, B Kuo1
, F Arnaldo1
, M Helguera1
. 1
Cleveland Clinic Florida
Background: Biventricular pacing is an attractive option in patients with heart block,
permanent atrial fibrillation, and congestive heart failure. However, the atrial channel is
“wasted” when using resynchronization pacemakers in patients with chronic AF. Objective: We
propose that properly adapted and programmed conventional dual-chamber pacemakers
(DCPM) are safe and cost-effective for these patients. Methods: DCPM were used in patients
with permanent AF and indication for biventricular pacing. Patients underwent complete AV
nodal ablation followed by “modified” DCPM implantation. The left ventricular (LV) lead was
connected to the atrial port and the right ventricular (RV) lead to the ventricular port.
Programming was DDIR with the shortest available AV delay (10 ms in Guidant, 30 ms in
Medtronic pacemakers), resulting in biventricular stimulation with the LV preceding the RV.
Sensitivity was decreased in the LV channel (2.5 mV or above), to prevent oversensing of T
waves or far-field atrial signals. Results: Twenty-one patients (11 men, age 80 Ϯ 8) were
fitted with DCPM as described, 5 patients were upgrades from single-chamber RV pacing.
During the follow up 1 patient had dislodgement of the RV lead to the RA shortly after implant,
with intermittent pacing inhibition. His DCPM was reprogrammed AAI ( LV pacing alone) until
the lead was repositioned. Twenty patients remained alive during a follow-up of 18 Ϯ 12
months. All DCPM worked as intended, providing close to 100% biventricular pacing. No
pacemaker-mediated arrhythmias were observed. The estimated cost-saving was $4300 per
case as compared with conventional resynchronization pacemakers. Conclusion: Conventional
dual-chamber pacemakers provide reliable biventricular pacing in patients with permanent AF
at significant cost-savings. Manufacturers could easily modify their existing platforms to
commercialize dedicated resynchronization pacemakers for this indication.
O225
Alarming prevalence of metabolic risk for cardiovascular diseases in a
physician population of southern India
A Mathavan1
, A Chockalingam2
, S Chockalingam3
, B Bilchik4
, V Saini4
. 1
Apollo
Hospital,Madurai, Tamilnadu, India 2
Simon Fraser University,Vancouver, Canada 3
Somayya
Foundation,Karaikudi, Tamilnadu, India 4
Harvard School of Public Health and the Lown
Cardiovascular Research Foundation, Boston, MA, USA.
In the past decade we have observed an increasing incidence of cardiovascular disease (CVD)
among people living in the southern districts of Tamilnadu, India. Metabolic syndrome has been
increasingly recognized as a major risk factor for CVD and stroke in South Asian populations.
In order to evaluate the prevalence of constituent elements of the metabolic syndrome among
a well-educated and high-income sector of the population, we conducted a cross-sectional
survey of physicians living in and around Madurai, a major metropolis. We contacted over 4,000
physicians in the districts of Madurai, Sivaganga, Virudhunagar, Dindugal, Karur, Ramanatha-
puram, Thirunelveli and Theni. The population of these 8 districts is about 16 million. 1,514
physicians between the ages of 30–81 responded, completed questionnaires provided blood
pressure measurements and fasting blood samples. All samples were assessed in a central
laboratory in Madurai where quality control was maintained. Blood pressures were measured
using a WHO approved automatic monitor. Complete data were available for a total of 1,433
(942 M and 491 F) physicians and were used in our analysis. 94% of the participants earned
their University 5-year medical degree or further post graduation and 6% obtained indigenous
medical qualifications such as ‘ayurvedhic’ or ‘siddha’. All of them reported a monthly income
in the highest quintile of the population in this region. Thus this cohort of participants belongs
to a high socioeconomic stratum of the society. The prevalence of risk factors in this population
are: BP (Ͼ 130/Ͼ 85 mmHg): 22.5% F, 41.2%M; HDL-C (F Ͻ 50 & M Ͻ 40 mg/dl): 75.6%
F, 46.8% M; Triglycerides (Ͼ 150 mg/dl): 32.6% F, 53.2% M; FBG using ATP III criteria (Ͼ 110
2008 World Congress of Cardiology Abstracts e459
by guest on March 17, 2014http://circ.ahajournals.org/Downloaded from