Radial artery punctures for diagnostic coronary angiography or coronary balloon angioplasty were performed in 211 patients with a success rate of 98% (207 patients). In the four failed transradial accesses, the procedure was accomplished via the transfemoral route. Major local vascular complications included one arteriovenous fistula, one pseudoaneurysm, and one ischemic contracture of the right hand. Reduced radial pulses were noted in 25 (12%) patients at follow‐up without ischemic manifestations. Transradial diagnostic coronary angiography was successfully completed in 184 (98%) of 187 patients. The technical success for balloon angioplasty was obtained in 73 (97%) of 75 patients. Clinical success was observed in 68 (91%) patients; balloon angioplasty resulted in one nonfatal myocardial infarction and four late deaths (3 cardiac and 1 stroke). We believe that transradial catheterization for diagnostic coronary angiography and balloon angioplasty in our relatively small built Chinese population is a safe and practical alternative approach. Cathet. Cardiovasc. Diagn. 40:159–163, 1997. © 1997 Wiley‐Liss, Inc.

We present the short- and intermediate-term results of transcatheter closure of patent ductus arteriosus with Gianturco coils in adolescents and adults. During a 5-year period, 55 patients (44 females, 11 males) with ages ranging from 14 to 72 years (median, 23) underwent attempted transcatheter closure of patent ductus with the Gianturco coils. The diameter of the narrowest segment of the ductus ranged from 0.8 to 7.6 mm (3.9 +/- 1.3 mm). The 55 patients were divided into three groups. Group I consisted of nine patients with a ductal diameter < or = 3 mm, group II consisted of 27 patients with a ductal diameter > 3 mm but < or = 4 mm, and group III consisted of 19 patients with a ductal diameter > 4 mm. Four- to five-loop Gianturco coils were used, which were deployed via retrograde aortic route. Multiple-coil technique was generally applied in group II patients. Balloon occlusion technique in combination with multiple-coil technique was generally used in group III patients. Deployment of coil was successful in 51 patients (93%) but failed in 4. The success rate of coil deployment in group I, II, and III were 100% (9/9), 96% (26/27), and 84% (16/19), respectively. A mean of 1.9 +/- 0.7 coils was deployed per patient. Of the four patients with unsuccessful coil deployment, three underwent surgery and one received implantation with Amplatzer duct occluder. Distal embolization of 21 coils occurred in 10 patients (3 in group II and 7 in group III), from whom 20 coils were retrieved with a gooseneck snare and 1 coil was removed during surgery. The mean diameter of ductus in the 10 patients with distal embolization was significantly larger than that in those without (5.2 +/- 1.4 vs. 3.7 +/- 1.1 mm; P < 0.01). Among the 51 patients with successful coil deployment, immediate complete closure was achieved in 20 (39%), while trivial to mild leak was present in 31 (61%). No significant complications were encountered. After a follow-up period ranging from 5 to 42 months, four patients had a small residual shunt and three underwent a second intervention with complete occlusion. None had left pulmonary artery stenosis documented with Doppler echocardiography. Transcatheter closure of ductus with the Gianturco coils is safe and feasible in the majority of adolescents and adults. Taking high embolization rate in patients with a ductus diameter > 4 mm into consideration, controlled-release coils, Buttoned device, or Amplatzer duct occluder can be a better choice.

resolving severe pulmonary edema. Early LA decompression was reported to enhance LV recovery. 2 A few methods of achieving LA decompression have been reported, including balloon atrial septostomy, 3,4 combined blade and balloon atrial septostomy, 5 trans-septal/transaortic LV sheath, 6-8 transaortic pigtail LV drain, 9 surgical LA/LV vent and trans-septal cannula incorporated into ECMO. 10,11 However, the experience with these is mostly limited to children. Some methods are complex and destructive. Older individuals may have much thicker atrial septal walls, so whether the percutaneous balloon dilation method is feasible has been criticized. 12 The Inoue balloon was specially designed for percutaneous transvenous mitral commissurotomy (PTMC), 13 and the purpose of this article is to report our single-center experience with trans-septal LA decompression using the Inoue balloon catheter. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used in myocardial failure caused by acute myocardial infarction, myocarditis, decompensated cardiomyopathy, or intractable arrhythmia to provide immediate cardiac and respiratory support. 1 However, in such persistent pump failure patients, the arterial cannula can place additional afterload on the left ventricle (LV) and lead to rising LV end-diastolic pressure, and left atrial (LA) pressure. Finally, refractory severe pulmonary edema might develop. In this setting, both the wall stress and the oxygen consumption of the LV increase, and recovery of LV function and weaning from ECMO will be delayed. 2 Although not all patients on ECMO suffer from the described vicious circle, this complex medical condition does demand a solution to avoid additional complications.LA decompression shows good results in minimizing LA/LV volume/pressure overload, chamber dilation, and Background: Refractory pulmonary edema is an infrequent but serious complication in patients receiving venoarterial extracorporeal membrane oxygenation (VA-ECMO) for myocardial failure. Left atrial (LA) decompression in this setting is important. Although a few methods have been reported, the experience is mostly limited to children. We aimed to evaluate the feasibility of Inoue balloon catheter in percutaneous trans-septal LA decompression in adult cardiogenic patients.