#Stitch Puncture .

#Definition.

Stitch effect is a rare complication where the needle pierces the intrapericardial space from the right atrial side and re-enter the left atria #Mechanism.

•Alignment of IAS with reference to RA and LA is key a determinant

•Normally RA & LA Roofs lie in same plane & IAS makes their common wall

•In MS LA can outgrow RA , bringing superior aspect of LA in a different plane with reference to IAS

#Guidewire Structure
..
It has 3 Basic Components

1.Shaft (Central core )
2.Distal Tip with coils/ cover & sleeve
3.Surface coating

1.#Centeral Core

It is inner & longest portion of guidewire making it backbone .it extends from proximal to distal end where it tapers. There are 3 important aspects regarding centeral core are

i) #Core material

•Stainless steel
•High tensile Stainless steel
•Nitinol

ii) #Core diameter

O.010"-0.018" (0.014"Most common )

iii) #Tapering towards tip

•Short Tappered

•Long Tappered

#Pericardiocentesis Site of Puncture;

There are 3 Options .

1.Subxiphoid
2.Parasternal
3.Apical

Factors to choose site .

•It depends on location ,type (eg circumferential)

•In situation of cardiac arrest or emergency situation ,subxiphoid is best . For other situations ,Apical is safest when performed under ultrasound guidance with biopsy line function of probe.

•Choose the location with probe with biopsy line ,avoiding any parallel structure (heart,liver,lung)

#Classification of Guidewires
( very important Topic)
..........................

Guidewires have different properties ,it is classified on different parameters but most practical classification is ""Based on Lesion -Type Classification.
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@Hragy A.Based on Tip -Flexibility ( Tip -Load )

#Tip Load..Amount of force ( in grams) needed to buckle distal 1cm of Tip

1.Floppy wires (<1.5gm)
2.Intermediate wires (2-4gm)
3.Stiff wires (>4gm)
.............. ..............

#GulfPCR
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Program of 15 Dec 2022 Schedule Gulf -PCR
Venue:Grand Hyatt -Dubai

1.Room Baniyas
2.Room Almeera 
3.Case Corner 1
4.Case Corner 2. Room Baniyas

1.Severe MR  &  TR
2.PCI in HBR Pts 
3.Essential drugs that every interventionalist needs to know

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Program of 14 Dec 2022 Schedule Gulf -PCR
Venue:Grand Hyatt -Dubai

1.Room Baniyas
2.Room Almeera 
3.Case Corner 1
4.Case Corner 2. Room Baniyas

1.TAVI challenging scenarios - LIVE case from Chest Diseases Hospital - Kuwait
2Imaging in TAVI challenging anatomy
3.Trial review 2022: my five most impactful clinical trials

4Multivessel disease PCI: LIVE case from Kuwait

5Challenging & complication cases

Antegrade Approach for #CTO Lesions #Cardiotwitter

Method A..Antegrade wire Escaltation ;

It consists of advancing various guidewires in antegrade direction to cross CTO while remaining within true lumen of vessel (True to True )
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@PCRonline #crossing proximal cap.

Wire escaltation

Wire Gear 1

For proximal cap penetration, tapered polymer GW with low-penetration power soft-tip (Fielder family guidewires; Ashai Intecc), allowing advancement along visible or invisible microchannels, are the first choice

RCA Views;#Intervention

First keep in mind RCA Portions .

RCA appears as Letter "C" 

Proximal RCA ..R1
Middle RCA......R2
Distal RCA ..R3 

Distal RCA divides into PLV & PDA branches Sequence of 3 views are used .

1.LAO Straight 30°. ( Best for Proximal Portion .R1)
RCA appears as Letter "C"

2.AP Cranial 15° with 5° - 10 LAO angulation

( Distal RCA R3 ,Bifurcation portion )

3.RAO Straight 30°.(Middle Portion .R2)

RCA appears as Letter "L"
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