The aim of this study was to characterize the feasibility of coronary angiography (CA) and percutaneous coronary intervention (PCI) in acute settings among patients who have undergone transcatheter aortic valve replacement (TAVR).
The aim of this study was to assess the association between Doppler velocity index (DVI) and 2-year outcomes for balloon-expandable SAPIEN 3 transcatheter aortic valve replacement (TAVR) and for surgical aortic valve replacement (SAVR).
A 70-year-old woman presented with severe mitral stenosis and regurgitation due to severe circumferential mitral annular calcification (MAC). Surgical risk was prohibitive due to previous coronary artery bypass, end-stage renal disease requiring dialysis, and long-term corticosteroid therapy. Computed tomography (CT)-derived mitral annular area was 460 mm2. She underwent successful transapical transcatheter mitral valve implantation (TMVI) using a 26-mm SAPIEN 3 transcatheter heart valve (THV; Edwards Lifesciences) (Figures 1A to 1C, Video 1). At 1 month, transthoracic echocardiography showed a transmitral mean gradient of 5 mm Hg, trivial paravalvular regurgitation (PVR), and no left ventricular outflow tract obstruction with concurrent symptomatic improvement.
Case 1: A 72-year-old man with severe mitral regurgitation was referred to our hospital to receive a MitraClip (Abbott Vascular) implantation. The procedure was successfully completed. Immediately after extubation, the patient complained of back pain, and computed tomography (CT) revealed a type B aortic dissection in the descending aorta (Figures 1A to 1C). He was treated with antihypertensive therapy and was discharged.
An 88-year-old man underwent uneventful Watchman implantation with a #30 Watchman device (Boston Scientific, Marlborough, Massachusetts). The device placement was ostial with compressions in the 10% to 20% range. This range of implantation is the indication for use for the device, suggesting no warning signs for risk of embolization in the future. However, transesophageal echocardiogram at 6 weeks demonstrated that the device had embolized and lodged in the left ventricular outflow tract (Figure 1). There was severe mitral regurgitation and moderate aortic stenosis due to the steric effects from the device. Due to the age and comorbidities of the patient, a percutaneous rather than surgical approach toward removal of the device was adopted. A computed tomography scan for procedural planning is shown in Figure 2. On the basis of the lessons available from interventional gastroenterology, we utilized the Raptor grasping device (STERIS, Mentor, Ohio), which is an endoscopic grasper that offers the versatility needed for retrieving a variety of foreign bodies during endoscopic procedures of the gut. Although traditional gooseneck or multiloop snares may be used for removal of the device, we suspected that it would be almost impossible to grasp the device using snares, given the location of the embolized Watchman underneath the aortic valve. We also felt that removal of a 30-mm device through the aortic valve would likely lead to damage of the aortic valve leaflets and hence should be avoided.
Three weeks following prostatic surgery, a 67-year-old patient presented with hematuria and urinary retention; a computed tomogram (CT) of the abdomen–pelvis showed a distended bladder containing a large blood clot (Figure 1A). He required intubation for hypoxemia (room air oxygen saturation [SaO2] = 62%) that only partially responded to high-flow oxygen; he was extubated after 24 h when his hypoxemia resolved while supine.
Large iatrogenic laceration of a deep pelvic vein is a rare, but life-threatening, complication in interventional cardiology procedures, with no consensus for treatment. Right external iliac vein (REIV) laceration during transcatheter mitral valve repair led to hemorrhagic shock due to retroperitoneal hematoma (Figure 1A, Video 1A). Two 10-mm balloon-expandable covered stents (Advanta V12, Atrium Medical, Merrimack, New Hampshire) were deployed in series and over-dilated to 12 mm (Figures 1B and 1C, Video 1B). Bleeding was stopped before a leak being noticed at the level of the stents (Figure 1D, Video 1C). Both the reduced effective circulating volume and increased outer-vessel pressure, engendered by the hematoma, may have contributed to vein spasm at diagnostic venography. After treatment with undersized stents, bleeding recurrence most likely arose as hemodynamic parameters returned closer to baseline
A 90-year-old woman with symptomatic severe aortic stenosis, deemed at high risk for cardiac surgery, was referred for transcatheter aortic valve replacement (TAVR). Pre-procedural computed tomography imaging showed severe annular and left ventricular outflow tract calcifications, with eccentric distribution toward the interventricular septum (Figures 1A and 1B). The perimeter-derived annulus diameter was 26.7 mm. A transfemoral TAVR with self-expanding ACURATE neo2 L size (Boston Scientific, Marlborough, Massachusetts) was planned
A 49-year-old Chinese woman presented with palpitation and dyspnea on exertion for 1 year, but she denied any other symptoms. Her physical examination revealed no cyanosis of the lips, normal S1, loud P2, and 3/6 systolic murmur in the left second intercostal space, without clubbed fingers and edema of both lower limbs.
A 95-year-old woman who had undergone transcatheter aortic valve replacement (TAVR) with a CoreValve 26-mm system (Medtronic) in 2012 was referred to our center due to increasing dyspnea and reduced physical capacity (New York Heart Association functional class III). Two-dimensional transesophageal echocardiography revealed severe aortic stenosis owing to calcified cusp degeneration of the TAVR prosthesis, accompanied by severe mitral (MR) and tricuspid regurgitation (TR) (Figure 1). Because of the advanced age of the patient and the difficulty of multiple hospital admissions during the COVID pandemic, the heart team decided to percutaneously address the triple valvular diseases in 1 procedure. First, we performed transfemoral TAVR using a 23-mm SAPIEN 3 Ultra system (Edwards Lifesciences) in the CoreValve prosthesis under coronary protection due to the small distance between the left coronary artery and valve cusps (Figures 2A and 2B). Secondly, transcatheter edge-to-edge mitral valve repair was conducted for severe MR by implanting a MitraClip G4-NTW (Abbott Vascular) in A2P2 of the mitral leaflets, thus achieving a substantial reduction to mild MR (Figures 2C and 2D). Third, we addressed TR, which was graded as massive on a 5-grade scale. A successful reduction to moderate TR was achieved after deploying 2 TriClip-XTs (Figures 2E and 2F). The patient was extubated on the table. She recovered quickly and reported a significant improvement of her physical capacity.
Ventricular septal rupture (VSR) represents a rare complication of acute myocardial infarction, often presenting with cardiogenic shock and associated with high in-hospital mortality despite prompt intervention. Although immediate surgery is recommended for patients who cannot be effectively stabilized, the ideal timing of intervention remains controversial. Mechanical circulatory support (MCS) may allow hemodynamic stabilization and delay definitive treatment even in critical patients. However, the interactions between MCS and VSR pathophysiology as well as potentially related adverse effects remain unclear. A systematic review was performed, from 2000 onward, to identify reports describing MCS types, effects, complications, and outcomes in the pre-operative VSR-related setting. One hundred eleven studies (2,440 patients) were included. Most patients had well-known negative predictors (e.g., cardiogenic shock, inferior infarction). Almost all patients had intra-aortic balloon pumps, with additional MCS adopted in 129 patients (77.5% being venoarterial extracorporeal membrane oxygenation). Mean MCS bridging time was 6 days (range: 0 to 23 days). In-hospital mortality was 50.4%, with the lowest mortality rate in the extracorporeal membrane oxygenation group (29.2%). MCS may enhance hemodynamic stabilization and delayed VSR treatment. However, the actual effects and interaction of the MCS-VSR association should be carefully assessed to avoid further complications or incorrect MCS-VSR coupling.
The aim of this study was to compare in-hospital outcomes and long-term mortality of multivessel versus culprit vessel–only percutaneous coronary intervention (PCI) in patients with non–ST-segment elevation myocardial infarction (NSTEMI), multivessel disease (MVD) and cardiogenic shock
The primary objective of the current analysis was to assess the association between the clinical presentation at index procedure and mortality in patients with second-generation drug-eluting stent thrombosis (G2-ST).
This study sought to define the risk of stent thrombosis (ST) and myocardial infarction (MI) in cancer patients compared with noncancer patients after percutaneous coronary intervention (PCI).
This study sought to define the risk of stent thrombosis (ST) and myocardial infarction (MI) in cancer patients compared with noncancer patients after percutaneous coronary intervention (PCI).
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