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Sakriss C, Roehl P, Schwenzky A, Hoyme M, Ebelt H. Transition from WATCHMAN V.2.5 to WATCHMAN FLX for closure of the left atrial appendage: echocardiographic and clinical findings. Open Heart 2023; 10:openhrt-2022-002246. [PMID: 36918230 PMCID: PMC10016248 DOI: 10.1136/openhrt-2022-002246] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023] Open
Abstract
INTRODUCTION Interventional closure of the left atrial appendage (LAAC) has been established as an alternative treatment for patients with atrial fibrillation (AF) and an elevated risk of stroke. The WATCHMAN FLX (WM FLX) as the newest WATCHMAN LAAC device differs in several technical characteristics from its precursor, the WATCHMAN V.2.5 (WM V.2.5). METHODS The data presented here are derived from a retrospective single-centre study. All patients in which an LAAC was performed between February 2017 and March 2021 with either a WM V.2.5 or WM FLX device were included. RESULTS 169 patients were included in this study, of whom 95 had been treated with WM V.2.5 and 74 with WM FLX, respectively. Directly after implantation, only minor differences regarding membrane thickness and connector protrusion were noted, whereas no relevant differences were found regarding device sizing, device compression or peridevice leakage, respectively. However, at 3-month follow-up, device compression was significantly reduced in WM FLX indicating a continued device expansion which was paralleled by a reduced number of peridevice leakage in comparison to WM V.2.5. Additionally, the combined clinical endpoint of death, stroke/transistoric ischaemic attack, tamponade, device embolisation, device-related thrombosis or peridevice leakage was reduced in WM FLX. CONCLUSION LAAC using the WM FLX device results in a continued device expansion over the first 3 months based on differences in radial force in comparison to WM V.2.5. This is accompanied by a reduction in adverse clinical endpoints.
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Affiliation(s)
- Charlotte Sakriss
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Peter Roehl
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Andreas Schwenzky
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Matthias Hoyme
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
| | - Henning Ebelt
- Department of Medicine II, Sankt Johann Nepomuk, Catholic Hospital Erfurt, Erfurt, Thüringen, Germany
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Ebelt H, Domagala T, Offhaus A, Wiora M, Schwenzky A, Hoyme M, Anacker J, Röhl P. Correction to: Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure. Cardiovasc Drugs Ther 2020; 34:789. [PMID: 33108625 PMCID: PMC7674318 DOI: 10.1007/s10557-020-07102-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 10/31/2022]
Abstract
The article "Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure."
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Affiliation(s)
- Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany.
| | - Thomas Domagala
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Alexandra Offhaus
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Wiora
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Andreas Schwenzky
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Hoyme
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Jelena Anacker
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Peter Röhl
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
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Ebelt H, Domagala T, Offhaus A, Wiora M, Schwenzky A, Hoyme M, Anacker J, Röhl P. Fusion Imaging of X-ray and Transesophageal Echocardiography Improves the Procedure of Left Atrial Appendage Closure. Cardiovasc Drugs Ther 2020; 34:781-787. [PMID: 32761486 PMCID: PMC7674364 DOI: 10.1007/s10557-020-07048-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2020] [Indexed: 12/16/2022]
Abstract
Background Left atrial appendage closure (LAAC) is an alternative treatment strategy for patients with atrial fibrillation who are at risk for thromboembolic events and considered not suitable for oral anticoagulation (OAC). LAAC is mainly performed under the guidance of transesophageal echocardiography (TEE) and fluoroscopy. The study presented here should analyze whether fusion imaging (FI) of transesophageal echocardiography and X-ray performed during LAAC is feasible and can improve the results of the procedure. Methods The data presented here are from a retrospective single center study. Sample size was defined as 50 patients in which LAAC was performed without fusion imaging (control group) and 25 patients were the LAAC procedure was guided by fusion imaging (treatment group). Inclusion criteria were defined as age > 18 years and completion of an LAAC procedure defined as deployment of a WATCHMAN 2.5 LAA occluder. Study endpoints were procedure time, amount of used contrast medium, radiation dose, final position of the WATCHMAN in TEE (deviation from ideal positioning), and clinical endpoints, respectively. Results LAA closure was successfully performed in all patients. No case of device embolism was occurring, and none of the patients experienced a periprocedural stroke/TIA nor a systemic embolism, respectively. Mean procedure time was 15 min shorter in the group of patients where fusion imaging was applied (p < 0.001). Additionally, the use of fusion imaging was associated with a significant reduction of contrast medium (20.6 ml less than in control; p < 0.045). Regarding the final position of the WATCHMAN, no relevant differences were found between the groups. Summary The use of fusion imaging significantly reduced procedure time and the amount of contrast medium in patients undergoing LAAC.
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Affiliation(s)
- Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany.
| | - Thomas Domagala
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Alexandra Offhaus
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Wiora
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Andreas Schwenzky
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Matthias Hoyme
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Jelena Anacker
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
| | - Peter Röhl
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Germany
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Ebelt H, Röhl P, Schwenzky A, Hoyme M, Wiora M. A nasty surprise: cardiogenic shock induced by extensive dissection of the left internal mammary artery graft occurring 3 months after coronary angiography-a case report. Eur Heart J Case Rep 2019; 3:ytz149. [PMID: 31660508 PMCID: PMC6764578 DOI: 10.1093/ehjcr/ytz149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 04/03/2019] [Accepted: 08/27/2019] [Indexed: 11/17/2022]
Abstract
Background Acute dissection of the left internal mammary artery (LIMA) graft in patients with previous cardiac bypass surgery is a rare but potentially life-threatening condition. Case summary A 58-year-old man with history of coronary artery disease and bypass surgery 15 years ago presented with acute coronary syndrome (non-ST-elevation myocardial infarction, NSTEMI). Angiography showed severe three-vessel disease with occlusion of a saphenous vein graft (SVG) to the first diagonal branch but patents grafts to left artery descendent (LIMA) and SVG to the right coronary artery. No coronary intervention was performed and the patient was treated medically (aspirin and ticagrelor) and discharged home after 6 days. Three months later, the patient again was admitted to the hospital with acute coronary syndrome (NSTEMI) and developing cardiogenic shock. Angiography now showed an extensive flow limiting dissection of his LIMA graft with the dissection starting at the ostium of the LIMA. After implantation of an Impella 2.5, percutaneous coronary intervention (PCI) of the graft was performed under guidance by optical coherence tomography (OCT) leading to implantation of a drug-eluting stent into the ostium of the LIMA and repeated balloon dilatations of the medial and distal parts of the graft. Antegrade flow was established and the patient’s condition improved so that the Impella was removed in the cath lab. After an uneventful course, the patient was discharged home after 6 days. Elective repeat angiography after 8 weeks showed an excellent functional result without persisting signs of LIMA dissection or stenosis. Discussion Acute dissection of a LIMA graft is a rare event that may lead to a life-threatening condition. According to the literature, LIMA dissection happens during coronary interventions in approximately half of the cases but it also may evolve spontaneously. However, as seen from our case, there might be a substantial delay between LIMA angiography and the clinical onset of dissection. In the vast majority of cases, dissection of LIMA can be treated by PCI. The use of Impella as reported for the first time in this case may improve the safety of the procedure. In accordance to PCI of the native coronary arteries, it seems possible to leave non-flow limiting dissections in cases of extensive disease in order to avoid the late complications of complete stenting of the graft.
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Affiliation(s)
- Henning Ebelt
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Peter Röhl
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Andreas Schwenzky
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Matthias Hoyme
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
| | - Matthias Wiora
- Department for Medicine II, Catholic Hospital "St. Johann Nepomuk", Haarbergstr. 72, Erfurt, Germany
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Ebelt H, Offhaus A, Wiora M, Roehl P, Schwenzky A, Weida A, Hoyme M, Bindemann-Koecher J, Anacker J. Impact of ultrasound contrast agent on the detection of thrombi during transoesophageal echocardiography. Open Heart 2019; 6:e001024. [PMID: 31673382 PMCID: PMC6803001 DOI: 10.1136/openhrt-2019-001024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 07/14/2019] [Accepted: 09/12/2019] [Indexed: 11/12/2022] Open
Abstract
Background Atrial fibrillation (AF) carries the risk of thrombus formation in the left atrium and especially in the left atrial appendage (LAA). A transoesophageal echocardiography (TOE) is routinely performed in these patients to rule out thrombi before cardioversion or structural interventions like LAA closure or pulmonary vein isolation. However, in a certain number of cases, inconclusive results of the TOE may result. This study was performed to analyse whether the routine use of ultrasound contrast agent (UCA) has an influence on the frequency of thrombus detection. Methods In patients with AF who were scheduled for a subsequent interventional procedure, a TOE was initially performed without contrast agent. Then, the TOE was repeated with the use of UCA. The percentage of diagnostic findings regarding the prevalence of thrombus in the LAA with and without UCA were compared (thrombus present (T+), no thrombus (T−) and inconclusive result (T+/−)). Results 223 patients were prospectively included into the trial. The numbers of thrombus detection were as follows: without UCA: 17 T+ (7.6%), 154 T− (69.1%), 52 T+/− (23,3%); with UCA: 16 T+ (7.2%), 179 T− (80.3%), 28 T+/− (12.6%; χ2: p<0.01). In 29 examinations (13.0%), the use of UCA had an impact on the subsequent treatment strategy. Conclusions The use of UCA during TOE in patients with AF has a significant impact on the subsequent patient management especially due to an improved rule out of LAA thrombi.
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Affiliation(s)
- Henning Ebelt
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Alexandra Offhaus
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Matthias Wiora
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Peter Roehl
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Andreas Schwenzky
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Anja Weida
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | - Matthias Hoyme
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
| | | | - Jelena Anacker
- Department of Medicine II, Catholic Hospital 'St. Johann Nepomuk', Erfurt, Germany
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Prochnau D, Hoyme M. Renal denervation as a second-line option in a patient with electrical storm resistant to medical treatment and conventional radiofrequency catheter ablation. J Electrocardiol 2018; 51:475-478. [DOI: 10.1016/j.jelectrocard.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Indexed: 10/18/2022]
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Hoyme M, Surber R, Schulze PC, Prochnau D. [Acute chest pain and new ECG changes in pacemaker patients : A clinical challenge]. Herzschrittmacherther Elektrophysiol 2017; 28:60-63. [PMID: 28204915 DOI: 10.1007/s00399-017-0491-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 01/25/2017] [Indexed: 06/06/2023]
Abstract
We report the case of a 82-year-old woman who was admitted to our institution with acute chest pain, nausea, and vomiting. Because of atrial fibrillation with intermittent bradycardia, a single-chamber pacemaker was implanted 4 years ago. The initial 12-lead ECG showed atrial fibrillation with a heart rate of 70 bpm, narrow QRS, and T‑wave inversions in the inferolateral leads. Coronary artery disease was excluded by immediate cardiac catheterization. A subsequent ECG three hours later showed a ventricular paced rhythm. During the subsequent clinical course, cardiac injury markers remained normal. However, serum amylase and lipase levels were 5 times above the normal range. According to these clinical findings, acute pancreatitis was the most likely diagnosis. Abdominal ultrasound excluded pancreatic necrosis and gallstones. Initial treatment consists of fasting, pain control, and intravenous fluids with resolution of symptoms after a few days. The patient could be discharged 7 days later. In conclusion, the observed ECG findings in combination with chest pain are suggestive for myocardial ischemia mandating immediate cardiac catheterization. However, acute pancreatitis might present with the aforementioned ECG changes and symptoms. The case was further complicated by a distinct electrocardiographic memory effect due to intermittent ventricular pacing.
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Affiliation(s)
- Matthias Hoyme
- Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - Ralf Surber
- Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - P Christian Schulze
- Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland
| | - Dirk Prochnau
- Klinik für Innere Medizin I, Universitätsklinikum Jena, Erlanger Allee 101, 07740, Jena, Deutschland.
- Klinik für Innere Medizin ll, Katholisches Krankenhaus "St. Johann Nepomuk", Haarbergstr. 72, 99097, Erfurt, Deutschland.
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Prochnau D, Schweizer C, Hoyme M, Figulla HR, Schulze PC, Surber R. Resistant hypertension: Comparison of unifocal versus multifocal radiofrequency ablation for renal denervation up to 24months follow-up. Int J Cardiol 2016; 223:31-33. [PMID: 27529585 DOI: 10.1016/j.ijcard.2016.08.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 08/06/2016] [Accepted: 08/08/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Dirk Prochnau
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany.
| | | | - Matthias Hoyme
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
| | | | | | - Ralf Surber
- Department of Internal Medicine I, Jena University Hospital, Jena, Germany
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Palmiero G, Imbalzano E, Van Zalen JJ, Svensson F, Lagerstrand KM, Hamdanchi A, Kim KJ, Ascione L, Carlomagno G, Sordelli C, Ferro A, Ascione R, Severino S, Caso P, Vatrano M, Mandraffino G, Dalbeni A, Carerj S, D'angelo M, Ceravolo R, Ciconte VA, Saitta A, Zito C, Badiani S, Ewer J, Patel NR, Lloyd GW, Bech-Hanssen O, Polte CL, Johnsson ÅA, Lagerstrand KM, Svensson F, Polte CL, Johnsson ÅA, Gao SA, Bech-Hanssen O, Asadi Y, Otto S, Hoyme M, Jung C, Lauten A, Doenst T, Figulla HR, Poerner TC, Goebel B, Park JB, Kim HK, Yoon YE, Lee SP, Kim YJ, Cho GY, Sohn DW, Kim KH, Ahn H. Rapid Fire Abstract session: novelties in valves regurgitation831Significant functional mitral regurgitation impairs left atrial function in patients with heart failure due to left ventricular systolic dysfunction832Arterial stiffness and mitral regurgitation: an intriguing pathophysiological link833Progression rate of mild and moderate aortic regurgitation in a physiologist led valve clinic834The blood flow complexity affect the reliability of aortic regurgitation assessment by phase-contrast magnetic resonance imaging835Two-dimensional phase-contrast magnetic resonance imaging can describe the complexity of flow in ascending aorta in patients with aortic regurgitation836A cross-sectional study of endocardial lead-related tricuspid regurgitation: towards proposing a new practical 2D/3D echocardiographic approach for better risk stratification837Prognostic value of cardiac magnetic resonance for preoperative assessment of patients with severe functional tricuspid regurgitation. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hoyme M, Scheungraber C, Reinhart K, Schummer W. Comparison of Norepinephrine and Cafedrine/Theodrenaline Regimens for Maintaining Maternal Blood Pressure during Spinal Anaesthesia for Caesarean Section. ACTA ACUST UNITED AC 2015. [DOI: 10.5171/2015.714966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Hohenstein C, Herdtle S, Hoyme M, Lauten A, Chaudhary T. Rescue of the limb after accidental injection of diazepam into femoral artery. Am J Emerg Med 2014; 32:1149.e5-6. [DOI: 10.1016/j.ajem.2014.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022] Open
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Lauten A, Hoyme M, Figulla HR. Severe pulmonary regurgitation after tetralogy-of-Fallot repair: transcatheter treatment with the Edwards SAPIEN XT heart valve: Figure 1. Heart 2012; 98:623-4. [DOI: 10.1136/heartjnl-2011-301399] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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