B''lgarska kardiologiia最新文献

{"title":"Distal transradial access. Initial experience. Results","authors":"M. Mihalev","doi":"10.3897/bgcardio.28.e79042","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e79042","url":null,"abstract":"Introduction: Conventional access through the radial artery (cTRA) is a standard approach in coronary interventions. Unfortunately, it carries a risk of long-term complications such as radial artery occlusion (RAO) and local complications, usually hematomas. Aim: Sharing initial experience in the application of distal transradial access (dTRA) on 134 patients, from single operator in one center and its applicability on patients with STEMI. Number of procedures required to get experience with this access, assessed by the degree of reduction of failed procedures. Materials and methods: From 08.03.21 to 18.11.21, 134 patients with dTRA (110 successful, 24 unsuccessful) were included in the study. dTRA is comsidered to be an access to the anatomical snuffbox. Completion of the entire procedure, not just a successful puncture or insertion of an introducer, was considered the access successful. Results: It was found that the success of the method was 82% of the criteria preset. Among the successful procedures, 48% were interventions. Of these, 71% had ACS and 43.6% had STEMI. The access was used on 3 patients who had CTO. Two patients underwent rotablation using a 7 in 6 Fr introduser. On 98% of the patients a 6 Fr introducer was used. Right dTRA was used on 93% of patients. From the 134 procedures performed, it was found that 92% of failures were up to the 80th procedures. After the 80’th procedures the frequency of failures decreased significantly. Complications ‒ 3 small hematomas and 2 numbness in the thumb, which did not require additional interventions. Conclusion: The procedure with dTRA was successfully completed by high percentage of patients, including the high-risk patients with ACS and STEMI. After the 80th dTRA procedure was reached level of skills with a low frequency of failed procedures. This suggests that dTRA can be an alternative to standard radial access to prevent radial artery occlusion, which has been confirmed by previous studies, better patient comfort, and lower risk of complications. The results were achieved without the need of reduction of the introducer’s diameter or use of special devices for hemostasis.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44675621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A clinical case of a patient after COVID 19 infection and a thrombus in the right atrium, deep phlebothrombosis, and pulmonary embolism","authors":"I. Tasheva, M. Miletieva","doi":"10.3897/bgcardio.28.e86417","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e86417","url":null,"abstract":"Background: The coronavirus disease (COVID-19 disease) leads to multiple organ disease, inflammation of the endothelium, and micro- or macrovasculitis that may result in thrombosis of the small vessels, and thrombosis of vessels in various organs, as well as intracardiac thrombosis. Some of the complications may be long-lasting, as in our case, which makes it particularly interesting to discuss. Case report: We present a 73-year-old male patient with a history of permanent atrial fibrillation and chronic heart failure (II NYHA class), popliteal phlebothrombosis, and surgery of the left hip joint. 53 days after a positive rapid test for Covid 19 performed because of fever and coughing, the patient, who is not vaccinated for Covid 19, was hospitalised at our Department with clinical signs of mild respiratory failure and cardiogenic shock.  The laboratory tests revealed elevated markers of inflammation. The ECG showed tachyarrhythmia (170/min) and atrial fibrillation. The EchoCG displayed evidence of right systolic dysfunction, pulmonary hypertension, and a massive thrombus in the right atrium. The Doppler ultrasonography revealed the presence of right femoropopliteal thrombosis, while the CT-pulmoangiography showed evidence of massive bilateral PE. A decision was made to perform systemic fibrinolysis, which the patient tolerated without complications. During the hospitalisation, the examinations revealed no evidence of an oncological disease. Conclusion: The reported clinical case confirms the high risk of thrombosis due to a COVID-19 infection, such as phlebothrombosis, atrial thrombosis, and massive bilateral PE, in the absence of optimal anticoagulant therapy and against the backdrop of the administration of antiplatelet therapy roughly 2 months after the onset of the COVID-19 symptoms.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41713092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular treatment of subclavian artery stenosis","authors":"I. Petrov, Z. Stankov, J. Stoykova, G. Zlatancheva, S. Vasilev, I. Tasheva, K. Vaseva","doi":"10.3897/bgcardio.28.e91105","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e91105","url":null,"abstract":"The most common localizations for upper extremity atherosclerosis are the subclavian artery and the brachiocephalic trunk. Significant stenosis of the subclavian artery occurs in 2% of the population and in 7-11% of patients with manifest cardiovascular disease. Revascularization is indicated in symptomatic or asymptomatic patients with coronary disease with planned surgical revascularization. In addition to atherosclerosis, other causes of the appearance of subclavian artery stenosis include dissection, radiation-induced inflammation of the fibromusculature, and various vasculities, especially Takayasu arteritis. The left subclavian artery is about four times more commonly affected than the right. It usually occurs over the age of 50 years and in 1.5-2 times more common in men than in women. Disease of the subclavian artery is usually focal and the lesion is predominantly in the first 2 cm proximal to the origin of the aorta. Between 2016-2021 in the clinic of cardiology and angiology we treated endovascularly 81 patients (41 men and 40 females, median age 64 ± 11) with either intraluminal balloon dilatation and/or primary stent implantation followed by balloon post dilatation. We achieved a high technical success rate (93.8%) and immediate clinical success, with only a few minor complications. ","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45243388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional treatment of pulmonary embolism - where do we currently stand?","authors":"G. Dobrev, I. Petrov, Z. Stankov, I. Tasheva, P. Polomski","doi":"10.3897/bgcardio.28.e89800","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e89800","url":null,"abstract":"Acute pulmonary embolism is the third most common cause of cardiovascular mortality in the world. The sudden pressure overload of the right ventricle, caused by the thrombotic masses in the pulmonary artery, may quickly progress to profound cardiogenic shock. That results in a mortality rate of more than 50% in patients with a massive form of pulmonary embolism. In such cases, systemic fibrinolysis is warranted, which leads to rapid improvement of the right ventricular function and hemodynamic stabilization. The thrombolytic effect of systemic fibrinolysis is, unfortunately, accompanied by an almost 5 times increased risk of bleeding, especially intracranial one. Therefore, in most cases, for patients with uncompromised hemodynamics, only anticoagulation treatment is offered. Interventional treatment of acute pulmonary embolism consists of the usage of very low-dose fibrinolytic devices or percutaneous thrombus aspiration devices. The goal is to provide rapid removal of the thrombotic masses from the pulmonary artery circulation while keeping the hemorrhagic risk at a minimum. This paper will try to provide a concise review of the most widely used and available devices, together with the latest clinical data, supporting their use. Also, the future perspectives in the field of endovascular treatment of acute pulmonary embolism will be presented.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41793260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Еditorial","authors":"I. Petrov","doi":"10.3897/bgcardio.28.e95811","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e95811","url":null,"abstract":"Еditorial","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43335706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shortenеd and prolonged dual antiplatelet therapy after percutaneous coronary interventions – why, when and how?","authors":"P. Gatzov","doi":"10.3897/bgcardio.28.e81705","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e81705","url":null,"abstract":"The antithrombotic therapy is an important part of medical treatment in percutaneous coronary interventions (PCI). The so called dual antiplatelet therapy (DAPT), usually including acetyl salicylic acid (aspirin) plus platelet P2Y12 receptor inhibitors is an important part of that therapy. The careful balance between the protective effect regarding thrombotic/ischemic events and the risk of bleeding is an important task of the attending physician. Apart of the standard dosing regiments, in some of the cases a judgment regarding shortened or prolonged DAPT, as its de-escalation is mandatory. To present the causes and the way of application of that individualized approach in patients with PCI is the aim of this review. ","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46119548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiogenic shock - novelty and emerging therapeutic concepts","authors":"I. Petrov, Z. Stankov, S. Vasilev","doi":"10.3897/bgcardio.28.e87553","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e87553","url":null,"abstract":"The cardiogenic shock is a state of low cardiac output, primarily due to cardiac dysfunction, which leads to severe organ hypoperfusion with tissue hypoxia and increased lactate levels. It presents a severe complication with a prevalence of around 15% of all forms of shock and 2-5% of the cardiogenic shock is a complications of acute heart failure. Despite the diverse etiology of the cardiogenic shock, up to 80% of the cases are due to acute myocardial infarction. The ischemia, leads to dysfunction of the myocardium cells, which causes a decline in the blood pressure and subsequent tissue hypoperfusion. The most important part is to start the treatment regime as soon as possible in the pre-shock stage. The treatment of refractory cardiogenic shock is complex, as it contains an intravenous therapy with inotropes/vasopressors and mechanical circulatory support (MCS). The MCS devices are supposed to reduce the workload of the heart and the oxygen need of the myocardial cells and in the same time to maintain an adequate coronary and systemic perfusion. There are different MCS devices like IABP, Impella, Tandem Heart, V-A ECMO. The aim of this review article is to present the new trends in the treatment approach to cardiogenic shock and to bring clarity in the treatment regimes, based on the latest studies and guidelines.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49382074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum biomarkers for pulmonary hypertension","authors":"T. Boneva, R. Ivanova, G. Zlatantcheva, D. Vasilev, K. Karamfiloff","doi":"10.3897/bgcardio.28.e79181","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e79181","url":null,"abstract":"In the fi eld of development of pathophysiology of pulmonary hypertension, there are growing number of signifi cant recent advances, which leads to new therapeutic agents. Traditional methods of diagnosing and monitoring this condition have comprised echocardiography and right heart catheterization, in addition to functional measures, such as estimation of functional class and the 6-min walk test. An increasing number of biomarkers have been described that are elevated in pulmonary hypertension and which may assist the clinician in diagnosis and in the assessment of disease severity and response to treatment.\u0000  ","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44054520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventional electrophysiology in Bulgaria in 2021: data from the electronic registry BG-EPHY","authors":"T. Shalganov, M. Stoyanov, V. Traykov","doi":"10.3897/bgcardio.28.e82407","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e82407","url":null,"abstract":"This study presents data from the national electronic registry BG-EPHY on electrophysiologic (EP) cardiac ablations in 2021. Material and methods: This is a retrospective study of a full one-year sample of the BG-EPHY registry. Sex and age distribution of the patients, number of ablations, electroanatomic mapping (EAM), irrigated and cryoablations, distribution of different types of arrhythmias, acute procedural success and complications are presented. Results: In 2021 fi ve EP centers performed 872 ablations in 546 men (62.6%) and 326 women (4.4% increase compared to previous year), incl. 6 ablations in pediatric patients (0.7%). EAM was used in 60.9% of the procedures, irrigation catheter was used in 55.2%, cryoballoon catheter – in 6%, and intracardiac echocardiography – in 4.2%. The most common ablation was pulmonary vein isolation, followed by ablation for AV nodal reentrant tachycardia and typical atrial fl utter. The acute success was over 98%, while intraprocedural complications were less than 2%. Conclusion: The national registry of electrophysiology collects systematically and continuously basic data on all ablations of cardiac arrhythmias performed in the country. In 2021, during a continuing COVID-19 pandemic the number of ablations increased slightly compared to the previous year. Distribution of EP procedure types was similar to previous years. Acute success was very high, while intraprocedural complications were rare.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46096252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The predictive role of fully revascularized coronary artery disease in patients undergoing transaortic valve implantation","authors":"R. Pencheva, J. Shabani, D. Trendafilova, J. Jorgova, H. Angelov, P. Simeonov, I. Dimitrova","doi":"10.3897/bgcardio.28.e82423","DOIUrl":"https://doi.org/10.3897/bgcardio.28.e82423","url":null,"abstract":"In the modern days and the era of the rapid development of medical technology, the introduction of innovative invasive methods of treatment is gradually displacing traditional conventional surgery. In 2002 was performed the fi rst transcatheter implantation of an aortic valve. Over the next twenty years, with the advancement of technology and the accumulation of experience in clinical centers, transcatheter aortic valve implantation has become the standard in adult and high-risk patients with high-grade Ao stenosis. In a large percentage of cases enrolled under the transcatheter aortic valve protocol a concomitant ischemic heart disease is detected or known. Globally, there is no signifi cant difference in overall mortality on the thirtieth day after TAVI in patients with ischemic heart disease. However, the overall mortality was signifi cantly higher in one – year follow - up of patients after transcatheter aortic valve implantation with underlying coronary pathology. We conducted a study comparing the number of late and early adverse events in patients with concomitant fully revascularized ischemic heart disease and those with insignifi cant coronary atherosclerosis. Based on the data collected, analyzed and summarized in our clinical center, fully revascularized ischemic heart disease does not increase the percentage of major adverse events after transcatheter aortic valve implantation. It can be considered when assessing the risk of transcatheter aortic implantation, as part of the individual approach for each case.","PeriodicalId":33976,"journal":{"name":"B''lgarska kardiologiia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41707103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}