Image in Cardiology
Transbrachial intra-aortic balloon pump before urgent coronary artery bypass graft in a patient with severe peripheral atherosclerosis
Implantação de balão intra-aórtico por via braquial antes de cirurgia urgente de revascularização coronária num doente com aterosclerose periférica grave
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Alihanoglu, Dogu I. Kilic, Bekir S. Yildiz, Bilgin Emrecan, Harun Evrengul" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Yusuf I." "apellidos" => "Alihanoglu" ] 1 => array:2 [ "nombre" => "Dogu I." "apellidos" => "Kilic" ] 2 => array:2 [ "nombre" => "Bekir S." "apellidos" => "Yildiz" ] 3 => array:2 [ "nombre" => "Bilgin" "apellidos" => "Emrecan" ] 4 => array:2 [ "nombre" => "Harun" "apellidos" => "Evrengul" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300564?idApp=UINPBA00004E" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300564/v1_201803200458/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2174204918300540" "issn" => "21742049" "doi" => "10.1016/j.repce.2018.03.003" "estado" => "S300" "fechaPublicacion" => "2018-02-01" "aid" => "1134" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Rev Port Cardiol. 2018;37:203.e1-5" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1485 "formatos" => array:3 [ "EPUB" => 144 "HTML" => 1120 "PDF" => 221 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>" "titulo" => "Giant coronary aneurysm culprit of an acute coronary syndrome" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "203.e1" "paginaFinal" => "203.e5" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Aneurisma coronário gigante como lesão alvo de uma síndrome coronária aguda" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3067 "Ancho" => 1733 "Tamanyo" => 776454 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A) Angiographic comparison (spider view). Pre-treatment. The white arrow points out the aneurysm's neck area. B) Final angiographic result. C) Initial IVUS LCx imaging study. D) Initial OCT LCx imaging pullback. E) Final IVUS LCx imaging pullback. F) Final OCT LCx imaging pullback.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Iván J. Núñez-Gil, Pedro Marcos Alberca, Nieves Gonzalo, Luis Nombela-Franco, Pablo Salinas, Antonio Fernández-Ortiz" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Iván J." "apellidos" => "Núñez-Gil" ] 1 => array:2 [ "nombre" => "Pedro Marcos" "apellidos" => "Alberca" ] 2 => array:2 [ "nombre" => "Nieves" "apellidos" => "Gonzalo" ] 3 => array:2 [ "nombre" => "Luis" "apellidos" => "Nombela-Franco" ] 4 => array:2 [ "nombre" => "Pablo" "apellidos" => "Salinas" ] 5 => array:2 [ "nombre" => "Antonio" "apellidos" => "Fernández-Ortiz" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300540?idApp=UINPBA00004E" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300540/v1_201803200458/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>" "titulo" => "Transbrachial intra-aortic balloon pump before urgent coronary artery bypass graft in a patient with severe peripheral atherosclerosis" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "205" "paginaFinal" => "207" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Laura Alvarez-Roy, Tomás Benito-González, Armando Pérez de Prado, Javier Gualis Cardona, Samuel del Castillo, Felipe Fernández-Vázquez" "autores" => array:6 [ 0 => array:3 [ "nombre" => "Laura" "apellidos" => "Alvarez-Roy" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Tomás" "apellidos" => "Benito-González" "email" => array:1 [ 0 => "tomasbenito@outlook.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Armando" "apellidos" => "Pérez de Prado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Javier" "apellidos" => "Gualis Cardona" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Samuel" "apellidos" => "del Castillo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Felipe" "apellidos" => "Fernández-Vázquez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Cardiology, University Hospital of León, León, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Cardiovascular Surgery, University Hospital of León, León, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Implantação de balão intra-aórtico por via braquial antes de cirurgia urgente de revascularização coronária num doente com aterosclerose periférica grave" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1313 "Ancho" => 2333 "Tamanyo" => 385628 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Fluoroscopy reconstruction showing antegrade placement of an intra-aortic balloon pump at the descending aorta with the proximal radiopaque marker distal to the emergence of the subclavian artery (blue arrow). (b) Bedside chest X-ray on postoperative day 1 (balloon pump position is highlighted in blue). (c) Effective 1:2 counterpulsation through 7 Fr transbrachial access.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 76-year-old man, a current smoker with a long-standing history of diabetes, was admitted to our institution due to non-ST segment elevation acute coronary syndrome. He was haemodynamically unstable, with signs of pulmonary oedema and hypotension, so intravenous inotropes were initiated. A transradial angiogram showed severe three-vessel coronary artery disease involving the distal left main coronary artery (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>a and b). A bedside echocardiogram displayed severe left ventricular dysfunction and grade IV mitral regurgitation. The patient presented severely calcified peripheral arteriopathy (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>c) and both inferior limbs were pulseless. A left transbrachial approach was used under fluoroscopy guidance to implant an intra-aortic balloon pump (size 40 ml) through a 7.5 F catheter and counterpulsation was performed successfully (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>). Forearm perfusion was monitored continuously by means of distal pulse oximetry and heparin IV infusion was initiated (bolus of 5000 IU and an activated partial thromboplastin time ratio of 2 times control value as a target). The patient was referred for emergency open-heart surgery a few hours later and multivessel coronary artery bypass graft and mitral valve replacement were carried out uneventfully. Haemodynamic support was maintained for the following 48 hours and the balloon pump could then be removed without thrombotic or ischaemic complications.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The intra-aortic balloon pump offers limited circulatory support and did not show prognostic benefit in recent clinical trials. For this reason, its use is not routinely recommended in patients with cardiogenic shock according to the latest guidelines. Nevertheless, it is still widely available in most centres and provides an increase in diastolic coronary flow that might be beneficial in patients with high risk coronary anatomy and left ventricular impaired systolic function until revascularisation is performed. Therefore, its use as a bridge to coronary artery bypass surgery is still largely recommended.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The need for less-aggressive vascular access, using an introducer of much smaller size compared to other peripheral circulatory assist devices, may be of interest for elderly patients or patients with severe systemic arteriosclerosis. A left transbrachial percutaneous approach may be a safe and effective alternative if femoral artery access cannot be achieved. Adequate selection of the sheath size according to pre-implantation brachial angiography (7 to 8F), continuous distal perfusion monitoring and early anticoagulation infusion are key points in avoiding potential vascular complications.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-11-09" "fechaAceptado" => "2017-03-03" "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1394 "Ancho" => 2333 "Tamanyo" => 440861 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a, b) Invasive angiogram showing severe coronary artery disease affecting the distal part of the left main and proximal segments of the three vessels. (c) Fluoroscopy revealing very severe calcification of the terminal abdominal aorta and bilateral iliofemoral arteries.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1313 "Ancho" => 2333 "Tamanyo" => 385628 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(a) Fluoroscopy reconstruction showing antegrade placement of an intra-aortic balloon pump at the descending aorta with the proximal radiopaque marker distal to the emergence of the subclavian artery (blue arrow). (b) Bedside chest X-ray on postoperative day 1 (balloon pump position is highlighted in blue). (c) Effective 1:2 counterpulsation through 7 Fr transbrachial access.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003700000002/v1_201803200458/S2174204918300576/v1_201803200458/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003700000002/v1_201803200458/S2174204918300576/v1_201803200458/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918300576?idApp=UINPBA00004E" ]
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