Introduction Tricuspid valve repair with the MitraClip system (Abbott Vascular, Santa Clara, California) remains challenging despite increased adoption. In this procedure, clips are used to facilitate coaptation of the tricuspid leaflets and reduce regurgitation (1,2). Here, we describe how left-sided femoral vein access, a novel and straightforward modification, can simplify the procedure and improve results. The mis-key technique, previously described, is one method to overcome anatomic obstacles inherent to tricuspid interventions. With this method, the clip delivery system is rotated counterclockwise by 90° (“mis-keyed”) before inserting into the guide, and A-knob is primarily used for steering (3,4). The guide is also rotated approximately 180° to center the clip in the right atrium. Once the guide is positioned appropriately, A-knob steers the clip to the valve, although trajectory and height often remain problematic. With the addition of left-sided access, the guide and clip delivery system shift away from the valve due to the trajectory from the left femoral vein to the right atrium. This positions the clip higher in the atrium and farther from the septum to maximize device height and maneuverability
Introduction A 65-year-old man, known for a dilated nonischemic cardiomyopathy, was admitted with cardiogenic shock. On examination, he had elevated jugular venous pulse with the Lancisi‘s sign and pitting edema. Transthoracic echocardiography confirmed a severe dilation of the right ventricle and a severe tricuspid regurgitation with noncoapting leaflets (Figures 1A and 1B). During right heart catheterization, we found out a systolic thrill and murmur of the femoral veins, which were also pulsatiles. The vascular ultrasound confirmed the pulsatility of the femoral veins, with a reverse systolic flow detected by color Doppler (Figure 1C, Videos 1 to 4). Furthermore, the right atrial pressure waveform showed a “ventricularization” of the contour of the right atrial pressure tracing
Introduction The case involved an elderly woman who presented with abdominal pain and was found to be in atrial fibrillation with rapid ventricular response. The cause of her abdominal pain was discovered to be an acute thrombus of the superior mesenteric artery. Incidentally, computed tomography scan demonstrated bilateral lower lobe pulmonary emboli. During emergent vascular surgery intervention for her superior mesenteric artery occlusion, she was found to have clots in the right popliteal and right tibial arteries. Given the high clot burden, emergent transthoracic echocardiography was done, which revealed a large mobile thrombus in both atria that was adherent to the septum across a suspected patent foramen ovale (PFO) (Figure 1, Video 1). AngioVac (Vortex Medical, Norwell, Massachusetts) aspiration under fluoroscopic and echocardiographic guidance was performed. Within seconds of engaging the clot with the AngioVac, evidence of the thrombus disappeared from echocardiographic view. After successful aspiration, the clot was measured at 14 cm in length. Analysis of the clot revealed a right atrial component, a left atrial component, and a PFO segment
Introduction A 57-year-old woman with history of atrial septal defect (ASD) closure 27 years prior by transcatheter Sideris buttoned device (Custom Medical Devices, Athens, Greece) and history of breast cancer presented with precordial pain, dyspnea, and rapid hemodynamic collapse. Clinical and echocardiographic evaluation revealed cardiac tamponade. Emergency pericardiocentesis under echocardiographic guidance was performed, and 250 ml of bloody pericardial effusion was drained, with rapid improvement of her clinical status. The hematocrit of the fluid was 38%. Transesophageal echocardiography excluded aortic dissection and demonstrated large ASD with left-to-right shunt
Objectives The aim of this study was to explore the difference in target vessel failure (TVF) 3 years after intravascular ultrasound (IVUS) guidance versus angiographic guidance among all comers undergoing second-generation drug-eluting stent (DES) implantation.
Objectives This study sought to better understand out-of-hospital 30-day mortality following transfemoral transcatheter aortic valve replacement (TAVR) and identify factors associated with poor outcomes.
Objectives The aim of this study was to determine the association of procedural outcomes with long-term mortality and myocardial infarction (MI) after chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
Objectives The aim of this study was to explore characteristics and outcomes of patients undergoing elective percutaneous coronary intervention (PCI) in ambulatory surgery centers (ASCs).
Objectives The aim of this study was to understand the anatomy of periarterial nerve distribution in human accessory renal arteries (ARAs).
Objectives This study sought to prospectively evaluate the safety and efficacy of the Indigo aspiration system in submassive acute pulmonary embolism (PE).
Objectives The authors analyzed data from the NCDR (National Cardiovascular Data Registry) PVI Registry and defined acute kidney injury (AKI) as increased creatinine of ≥0.3 mg/dl or 50%, or a new requirement for dialysis after PVI.
Introduction A 37-year-old man presented with worsening chest pain and positive severe acute respiratory syndrome coronavirus 2 assay with blood pressure of 80/40 mm Hg. Electrocardiography showed diffuse ST-segment elevation. Right-heart catheterization revealed a cardiac power index of 0.3 W/m2 and normal pulmonary artery pulsatility index. After an Impella CP (Abiomed, Danvers, Massachusetts) was placed, coronary angiography demonstrated large thrombus burden in the distal left main coronary artery with complete occlusion of ostial left anterior descending artery (LAD) and ramus intermedius and partial occlusion of the left circumflex artery (LCx) (Figure 1A). After heparin and cangrelor were initiated, percutaneous coronary intervention with the STRIATE-G (Stent RetRIever and Aspiration ThrombEctomy from Guide catheter) technique was planned. Using an 8-F Extra-backup 3.5 guide catheter (Cordis, Hialeah, Florida), a 0.014-inch Cougar guidewire (Medtronic, Minneapolis, Minnesota) was advanced past the lesion into the LCx, followed by advancement of a Terumo MicroVention Headway-27 microcatheter (MicroVention, Aliso Viejo, California). The guidewire was then removed, and a Solitaire 6.0/40-mm Platinum stent retriever (SR) (Medtronic) was advanced through the microcatheter into the LCx. Next, the microcatheter was pulled back into the guide to “unsheath” and deploy the SR (Figure 1B). The guiding catheter’s injecting port was attached to the Penumbra aspiration pump (Penumbra, Alameda, California) (Figures 1C and 1D). After 3-min dwell time with the SR fully deployed, the Penumbra was activated to initiate aspiration, and the SR was pulled back into the guiding catheter. A similar technique was applied in the LAD
A 43-year-old woman underwent an atrial flutter ablation. For invasive blood pressure monitor a 5-F arterial sheath was placed via the right femoral artery. Within 12 h of the procedure, the patient developed severe right lower extremity edema with extensive ecchymosis
A 3-year-old boy underwent transcatheter occlusion of a large right coronary artery (RCA) to right ventricular fistula (Figure 1, Video 1) with an 8-mm Amplatzer vascular plug II device (AGA Medical Corp., Plymouth, Minnesota) (Video 2). Immediate post-closure, he was treated with an intracoronary single dose of 0.25 mg tissue plasminogen activator (tPA), and with enoxaparin, then placed on a therapeutic heparin drip and transferred to the cardiac intensive care unit. Twenty hours later, he complained of acute chest pain with radiation to the left shoulder. An electrocardiogram demonstrated acute inferior myocardial infarction, and he had an elevated troponin I (0.042 ng/dl). He was immediately taken to the cardiac catheterization laboratory, and coronary angiography demonstrated complete occlusion of the distal acute marginal and posterior descending artery branches (Figure 2, Video 3). Selective tPA infusion of 0.5 mg resolved the clot. The vascular plug was retrieved using a snare, and a 4-mm Amplatzer vascular plug IV device was deployed at the drainage site just distal to the coronary branches (Figure 2, Video 4). He was again treated with local tPA (0.25 mg) and continued on enoxaparin and heparin. He was discharged a few days later following resolution of his electrocardiogram changes and troponin leak. He was placed on aspirin and enoxaparin.
A 68-year-old man diagnosed with chronic thromboembolic pulmonary disease was refused for pulmonary thromboendarterectomy and started a balloon pulmonary angioplasty program. A total of 5 sessions was completed with clinical improvement and no adverse event. At the second session, a chronic total occlusion (CTO) at the A10 segment of the left lower lobe was treated
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