Papers by Marin Bistirlic
Cardiologia Croatica, Oct 29, 2014
Cardiologia Croatica, Feb 17, 2014
Cardiologia Croatica, Mar 1, 2023
Cardiologia Croatica, Nov 1, 2022
Cardiologia Croatica, Nov 1, 2016
Cardiologia Croatica, Mar 1, 2023
Introduction: Patent foramen ovale (PFO) is a vestigial congenital cardiovascular structure prese... more Introduction: Patent foramen ovale (PFO) is a vestigial congenital cardiovascular structure present in around 25% of adults. In most cases, PFO is entirely benign and requires no treatment. The most wellestablished complication of PFO is stroke, defined as an ischemic stroke in the presence of a PFO and no other identified likely cause, but it has also been associated with other adverse neurological and embolic events. PFO may be treated with blood thinning medication alone, or with a percutaneous procedure to close the PFO and medication. 1 Methods and Results: Closure of a patent foramen ovale (PFO) has been shown to reduce the risk of recurrent stroke in selected patients. From December 2019 till February 2023, 26 patients were selected for PFO closure procedure in Zadar General Hospital. For 25 patients indication was cryptogenic stroke and one patient was professional scuba diver with repetitive decompression illness and evident PFO. All patients were screened for atrial fibrillation and thrombophilia. Mean age was 44.3 (25-70) and 52% were female. Risk of Paradoxical Embolism (RoPE) Score has been calculated for each patient and mean was 7.64. PFO closure was performed with Amplatzer devices in deep sedation with 3D transesophageal control. There were no periprocedural and follow up complications. Conclusion: With good patient selection, transcatheter PFO closure significantly reduces the risk of recurrent stroke compared with medical therapy in patients with cryptogenic stroke, with no increased risk of serious adverse events or influence on major bleeding.
Cardiologia Croatica, Nov 1, 2022
Cardiologia Croatica, Nov 1, 2022
Introduction: Stent loss is challenging and potentially lethal complication of percutaneous coron... more Introduction: Stent loss is challenging and potentially lethal complication of percutaneous coronary intervention. Although the lost stents were successfully retrieved in most cases, stent loss was associated with high rates of complications, such as coronary artery bypass graft surgery, myocardial infarction, and death 1. Case report: 56-years-old man who was admitted to Coronary Care Unit due to ongoing chest pain and rise of troponin as a sign of cardiac injury. An electrocardiogram showed a biphasic T wave in leads V2-V5. After standard treatment patient became asymptomatic and the coronary angiography was scheduled for the next morning. Bedside echocardiography was normal. Coronary angiography showed two-vessel disease with a long, significant stenosis of proximal and mid part of left descending artery (LAD) and significant, short stenosis of mid right coronary artery. Percutaneous coronary intervention (PCI) of LAD was planned. A guide catheter "EBU 3.5, 6Fr" in left main (LM), a guidewire "Hi-Torque BMW" was set in distal part of LAD. Predilatation of LAD was performed after which first DE stent "Orsiro, Biotornik" 2.75x30 mm was placed in mid part of LAD. Rest of the mid and the distal part of proximal segment we planned to place another drug-eluting (DE) stent "Ultimaster" 3.5x30mm. After impossibility to place the stent on desired position we planned to do additional redilatations. During withdrawing the stent, it stucked at the tip of the guiding catheter and we noticed stent loss in LM. We decided to put 8Fr introducer in right femoral artery, setting a new guiding catheter "EBU 3.75, 7Fr" in LM. With a new guidewire "Hi-Torque Whisper" we managed to pass through a middle part of the stent and put the guidewire in a distal LAD. A non-compliant balloon 2.5x8 mm was inflated distally to the stent after which we managed to pull/retrieve the stent in guiding catheter. In continuation of procedure the additional predilatation with "scoring balloon" NSE Alpha 2.75x13 mm was preformed after which two stent were placed in the mid and proximal part of LAD (3.0x22 mm, 3.5x18 mm). Final angiography showed good result in LAD and LM. The patient was discharged after 3 days. Conclusion: Stent loss is uncommon but serious complication of PCI. Several techniques can be applied to resolve the problem (snare, stent crush) but we managed to pull it back in guiding catheter by passing with a new wire through the stent.
Cardiologia Croatica, Nov 1, 2022
Figure 2. Heart catheterization confirming the reciprocal respiratory pressure changes in the rig... more Figure 2. Heart catheterization confirming the reciprocal respiratory pressure changes in the right and left ventricle.
Cardiologia Croatica, May 14, 2013
Background: This is a single center experience and validation of transseptal punctures (TSP) assi... more Background: This is a single center experience and validation of transseptal punctures (TSP) assisted by fluoroscopy and intracardiac echocardiography (ICE). Methods: 2 operators unexperienced in TSP performed initial 10 TSP each under supervision of experienced operator and with fluoroscopy and ICE guidance. Further 60 TSP were validated in a way that TSP assembly was positioned only under fluoroscopy guidance and after operator felt assembly is at eligible place for performing TSP, the position was checked and corrected if needed according to the ICE image. Results: 93% of all TSP were made during atrial fibrillation ablation procedure. After typical fluoro markers of good positioning of transseptal sheath had been observed, ICE guided reposition was needed in 7% of the TSP mostly due to the anterior position of TSP assembly. There were no cases in where solely fluoroscopy guided positioning would point the assembly toward aorta(too anteriorly), and there was one case in which where solely fluoro guided TSP would very likely result in cardiac tamponade due to posterior atrial puncture. No complication due to transseptal puncture happened. Conclusion: ICE guided TSP is safe and easy. ICE usage resulted in TSP assembly repositioning in 7% of the cases in which typical fluoro markers of ideal position were observed. Thus ICE usage helped avoid too anterior punctions that would make catheter navigation throughout AF ablation procedure more difficult and helped avoid too posterior punction that would likely result in cardiac tamponade. There were no cases were the danger to puncture aorta was caused.
Cardiologia Croatica, May 14, 2013
Background: The purpose is to give an overview of application of intracardiac echocardiography (I... more Background: The purpose is to give an overview of application of intracardiac echocardiography (ICE) in routine electrophysiology (EP) practice. Validation of ICE in improving the safety of transseptal puncture is shown separately. Methods and Results: During the observed period (11/2009-03/2013) ICE was used in 83 procedures. 75 were AF ablations in which ICE was used initially to facilitate transseptal puncture and later on to check catheter contact with tissue and to monitor for the complications (pericardial effusion, thrombus formation at materials used in the left atrium). There were 4 left atrial tachycardias ablations, 2 left ventricular tachycardias and 1 accessory pathway and AVNRT ablation assisted by ICE. Conclusion: ICE is essential tool in EP lab. Its use not only improves safety yet efficacy through helping catheter navigation and validating the catheter-tissue contact.
Cardiologia Croatica, Feb 17, 2014
Cardiologia Croatica, Mar 1, 2023
Cardiologia Croatica
Introduction: Stent loss is challenging and potentially lethal complication of percutaneous coron... more Introduction: Stent loss is challenging and potentially lethal complication of percutaneous coronary intervention. Although the lost stents were successfully retrieved in most cases, stent loss was associated with high rates of complications, such as coronary artery bypass graft surgery, myocardial infarction, and death 1. Case report: 56-years-old man who was admitted to Coronary Care Unit due to ongoing chest pain and rise of troponin as a sign of cardiac injury. An electrocardiogram showed a biphasic T wave in leads V2-V5. After standard treatment patient became asymptomatic and the coronary angiography was scheduled for the next morning. Bedside echocardiography was normal. Coronary angiography showed two-vessel disease with a long, significant stenosis of proximal and mid part of left descending artery (LAD) and significant, short stenosis of mid right coronary artery. Percutaneous coronary intervention (PCI) of LAD was planned. A guide catheter "EBU 3.5, 6Fr" in left main (LM), a guidewire "Hi-Torque BMW" was set in distal part of LAD. Predilatation of LAD was performed after which first DE stent "Orsiro, Biotornik" 2.75x30 mm was placed in mid part of LAD. Rest of the mid and the distal part of proximal segment we planned to place another drug-eluting (DE) stent "Ultimaster" 3.5x30mm. After impossibility to place the stent on desired position we planned to do additional redilatations. During withdrawing the stent, it stucked at the tip of the guiding catheter and we noticed stent loss in LM. We decided to put 8Fr introducer in right femoral artery, setting a new guiding catheter "EBU 3.75, 7Fr" in LM. With a new guidewire "Hi-Torque Whisper" we managed to pass through a middle part of the stent and put the guidewire in a distal LAD. A non-compliant balloon 2.5x8 mm was inflated distally to the stent after which we managed to pull/retrieve the stent in guiding catheter. In continuation of procedure the additional predilatation with "scoring balloon" NSE Alpha 2.75x13 mm was preformed after which two stent were placed in the mid and proximal part of LAD (3.0x22 mm, 3.5x18 mm). Final angiography showed good result in LAD and LM. The patient was discharged after 3 days. Conclusion: Stent loss is uncommon but serious complication of PCI. Several techniques can be applied to resolve the problem (snare, stent crush) but we managed to pull it back in guiding catheter by passing with a new wire through the stent.
Cardiologia Croatica, 2022
Cardiologia Croatica, 2014
Cardiologia Croatica, 2014
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Papers by Marin Bistirlic