1
|
Sauter R, Lin C, Magunia H, Schreieck J, Dürschmied D, Gawaz M, Patzelt J, Langer HF. Improved mid-term stability of MR reduction with an increased number of clips after percutaneous mitral valve repair in functional MR. Int J Cardiol Heart Vasc 2023; 45:101190. [PMID: 36941997 PMCID: PMC10024191 DOI: 10.1016/j.ijcha.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 02/22/2023] [Indexed: 03/12/2023]
Abstract
Background Percutaneous mitral valve repair (PMVR) has evolved to be a standard procedure in suitable patients with mitral regurgitation (MR) not accessible for open surgery. Here, we analyzed the influence of the number and positioning of the clips implanted during the procedure on MR reduction analyzing also sub-collectives of functional and degenerative MR (DMR). Results We included 410 patients with severe MR undergoing PMVR using the MitraClip® System. MR and reduction of MR were analyzed by TEE at the beginning and at the end of the PMVR procedure. To specify the clip localization, we sub-divided segment 2 into 3 sub-segments using the segmental classification of the mitral valve. Results We found an enhanced reduction of MR predominantly in DMR patients who received more than one clip. Implantation of only one clip led to a higher MR reduction in patients with functional MR (FMR) in comparison to patients with DMR. No significant differences concerning pressure gradients could be observed in degenerative MR patients regardless of the number of clips implanted. A deterioration of half a grade of the achieved MR reduction was observed 6 months post-PMVR independent of the number of implanted clips with a better stability in FMR patients, who got 3 clips compared to patients with only one clip. Conclusions In patients with FMR, after 6 months the reduction of MR was more stable with an increased number of implanted clips, which suggests that this specific patient collective may benefit from a higher number of clips.
Collapse
Key Words
- CO, cardiac output
- COe, cardiac output echocardiographically determinded by combination of TTE and TEE parameters
- COi, invasively determined cardiac output
- Clips
- DMR, degenerative mitral regurgitation
- EDV, end-diastolic volume
- EF, ejection fraction
- ESV, end-systolic volume
- Echocardiography
- FMR, functional mitral regurgitation
- Heart failure
- Heart geometry
- Hemodynamics
- ICE, intracardiac echocardiography
- IVUS, intravascular ultrasound
- Interventional cardiology
- Interventional therapy
- LA, left atrium
- LV, left ventricle
- LVEDD, left ventricular end diastolic diameter
- MR, mitral regurgitation
- MRI, magnetic resonance imaging
- Mitral regurgitation
- NYHA, New York heart association
- PA, pulmonary artery
- PAP, pulmonary artery pressure
- PASP, pulmonary artery systolic pressure
- PCW, pulmonary capillary wedge
- PCWP, pulmonary capillary wedge pressure
- PHT, pulmonary hypertension
- PMVR
- PMVR, percutaneous mitral valve repair
- RV, right ventricle
- SD, standard deviation
- Structural heart disease
- Surgery
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
Collapse
Affiliation(s)
- Reinhard Sauter
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Chaolan Lin
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harry Magunia
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Juergen Schreieck
- University Hospital, Department of Anaesthesiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Dürschmied
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
| | - Meinrad Gawaz
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Patzelt
- University Hospital, Department of Cardiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Harald F. Langer
- Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, Mannheim, Germany
- DZHK (German Research Centre for Cardiovascular Research), Partner Site Mannheim/Heidelberg, Germany
- Corresponding author at: Cardiology, Medical Intensive Care, Angiology and Haemostaseology, University Medical Centre Mannheim, 68167 Mannheim, Germany.
| |
Collapse
|
2
|
Yin J, Hillsdon-Smith G, Rhinehart ZJ, Kaczorowski D, Jain S, Subramanian H. Left Atrial Appendage Occlusion Device Placement Aborted Because of Coronary Artery Bypass Graft. JACC Case Rep 2023; 9:101740. [PMID: 36909269 PMCID: PMC9998707 DOI: 10.1016/j.jaccas.2023.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 01/31/2023]
Abstract
Left atrial appendage occlusion device (LAAO) implantation among patients who have had coronary artery bypass grafting can be challenging. We report a case of scheduled LAAO device implantation that was aborted due to the anomalous course of a bypass graft that appeared to be adherent to the left atrial appendage. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- John Yin
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Garret Hillsdon-Smith
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Zachary J Rhinehart
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David Kaczorowski
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Sandeep Jain
- Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Harikesh Subramanian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Chen M, Sun J, Li W, Zhang PP, Zhang R, Mo BF, Yang M, Wang QS, Li YG. Sex Differences in the Combined Ablation and Left Atrial Appendage Closure: Results From LAACablation Registry. JACC Asia 2023; 3:138-149. [PMID: 36873751 PMCID: PMC9982225 DOI: 10.1016/j.jacasi.2022.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 07/25/2022] [Revised: 09/19/2022] [Accepted: 10/08/2022] [Indexed: 01/18/2023]
Abstract
Background More than 40% of left atrial appendage closure (LAAC) procedures were combined with atrial fibrillation (AF) ablation in China. Objectives This study aimed to assess the sex differences in the combined radiofrequency catheter ablation and LAAC procedures. Methods Data from the LAACablation (Left Atrial Appendage Closure in Combination With Catheter Ablation) registry, which enrolled AF patients who underwent the combined procedure between 2018 and 2021, were analyzed. Procedural complications, long-term outcomes, and quality of life (QoL) were compared between sexes. Results Of 931 patients, 402 (43.2%) were women. Compared with men, women were older (age 71.3 ± 7.4 years vs 68.7 ± 8.1 years; P < 0.001), presented more often with paroxysmal AF (52.5% vs 42.7%; P < 0.003), and had higher CHA2DS2-VASc scores (4.1 ± 1.5 vs 3.1 ± 1.5; P < 0.001), but received less often linear ablation and had shorter total procedural times and radiofrequency catheter ablation times. Women had similar rates of total and major procedural complications but presented with a higher incidence of minor complications than men (3.7% vs 1.3%; P = 0.027). Follow-up over 1,812 patient-years revealed similar adverse events between women and men, including all-cause death (HR: 0.89; 95% CI: 0.43-1.85; P = 0.754), thromboembolic events (HR: 1.17; 95% CI: 0.54-2.52; P = 0.697), major bleeding (HR: 0.96; 95% CI: 0.38-2.44; P = 0.935), and their composite (HR: 0.85; 95% CI: 0.56-1.28; P = 0.434). The recurrence rates of atrial tachyarrhythmia were also comparable between sexes presenting either paroxysmal or persistent AF. Women were seen with greater QoL impairment at baseline, but the sex gap narrowed at 1-year follow-up. Conclusions In AF patients who underwent the combined procedure, women had similar procedural safety and long-term efficacy to men and presented greater QoL improvement. (Left Atrial Appendage Closure in Combination With Catheter Ablation [LAACablation]; NCT03788941).
Collapse
Key Words
- AF, atrial fibrillation
- AFEQT, Atrial Fibrillation Effect on Quality-of-Life questionnaire
- DRT, device-related thrombus
- LAA, left atrial appendage
- LAAC, left atrial appendage closure
- PDL, peridevice leak
- PVI, pulmonary vein isolation
- QoL, quality of life
- RFCA, radiofrequency catheter ablation
- SE, systemic embolism
- TEE, transesophageal echocardiography
- TIA, transient ischemic attack
- atrial fibrillation
- catheter ablation
- left atrial appendage closure
- quality of life
- sex differences
- stroke
Collapse
Affiliation(s)
- Mu Chen
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Jian Sun
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Wei Li
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Peng-Pai Zhang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Rui Zhang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Bin-Feng Mo
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Mei Yang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Qun-Shan Wang
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| | - Yi-Gang Li
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, China
| |
Collapse
|
4
|
Fujioka K, Nishida Y, Higashi K, Eguchi Y, Fujita T, Uchiyama K, Fujimoto M. Rapid Formation of an Infected Coronary Artery Aneurysm With Stent Fracture. JACC Case Rep 2023; 6:101660. [PMID: 36704063 PMCID: PMC9871074 DOI: 10.1016/j.jaccas.2022.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/29/2022] [Indexed: 06/18/2023]
Abstract
Infected coronary artery aneurysm (ICAA) is a rare but fatal disease. We describe a case of rapid formation of ICAA with fracture of an intracoronary stent observed on coronary angiography and cardiac computed tomography. Surgery with resection of the aneurysm and coronary artery bypass grafting was performed successfully. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Kensuke Fujioka
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Yuji Nishida
- Department of Thoracic and Cardiovascular Surgery, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Keinosuke Higashi
- Department of General Medicine and Infectious Disease, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Yuya Eguchi
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Takashi Fujita
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Katsuharu Uchiyama
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Manabu Fujimoto
- Department of Cardiovascular Medicine, Kouseiren Takaoka Hospital, Takaoka, Japan
| |
Collapse
|
5
|
Cagli K, Gursoy HT, Basyigit F, Koprucu E, Golbasi Z. 3-Dimensional Images of Mitral Annulus Perforation: An Alien's Mouth. JACC Case Rep 2022; 4:101681. [PMID: 36438889 PMCID: PMC9685358 DOI: 10.1016/j.jaccas.2022.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
In this clinical vignette, we describe a case of a patient with windsock-like posterior mitral annulus perforation at the site of annular calcification caused by infective endocarditis. Three-dimensional transesophageal images of the perforation resembling an "alien's mouth" are very striking for how 3-dimensional imaging can improve visualization of anatomy of the heart. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Kumral Cagli
- University of Health Sciences, Gulhane Faculty of Medicine, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | | | - Funda Basyigit
- Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Etga Koprucu
- Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| | - Zehra Golbasi
- Yildirim Beyazit University, Faculty of Medicine, Ankara City Hospital, Department of Cardiology, Ankara, Turkey
| |
Collapse
|
6
|
James L, LaSala VR, Hill F, Ngai JY, Reyentovich A, Hussain ST, Gidea C, Piper GL, Galloway AC, Smith DE, Moazami N. Donation after circulatory death heart transplantation using normothermic regional perfusion:The NYU Protocol. JTCVS Tech 2022; 17:111-120. [PMID: 36820336 PMCID: PMC9938390 DOI: 10.1016/j.xjtc.2022.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/25/2022] [Accepted: 11/14/2022] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to evaluate the impact of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion on the metabolic milieu of donation after cardiac death organ donors before transplantation. Methods Local donation after cardiac death donor offers are assessed for suitability and willingness to participate. Withdrawal of life-sustaining therapy is performed in the operating room. After declaration of circulatory death and a 5-minute observation period, the cardiac team performs a median sternotomy, ligation of the aortic arch vessels, and initiation of thoraco-abdominal normothermic regional perfusion via central cardiopulmonary bypass at 37 °C. Three sodium chloride zero balance ultrafiltration bags containing 50 mEq sodium bicarbonate and 0.5 g calcium carbonate are infused. Arterial blood gas measurements are obtained every 15 minutes after every zero balance ultrafiltration bag is infused, and blood is transfused as needed to maintain hemoglobin greater than 8 mg/dL. Cardiopulmonary bypass is weaned with concurrent hemodynamic and transesophageal echocardiogram evaluation of the donor heart. The remainder of the procurement, including the abdominal organs, proceeds in a similar controlled fashion as is performed for a standard donation after brain death donor. Results Between January 2020 and May 2022, 18 donation after cardiac death transplants using the thoraco-abdominal normothermic regional perfusion protocol were performed at our institution. The median donor age was 42.5 years (range, 20-51 years), and 88.9% (16/18) were male. The mean total donor cardiopulmonary bypass time was 88.8 ± 51.8 minutes. At the beginning of cardiopulmonary bypass, the average donor lactate was 9.4 ± 1.5 mmol/L compared with an average final lactate of 5.3 ± 2.7 mmol/L (P<.0001). The average beginning potassium was 6.5 ± 1.8 mmol/L compared with an average end potassium of 4.2 ± 0.4 mmol/L (P<.0001) . The average beginning hemoglobin was 6.8 ± 0.7 g/dL, and the average end hemoglobin was 8.2 ± 1.3 g/dL (P<.001) . On average, donation after cardiac death donors received transfusions of 2.3 ± 1.5 units of packed red blood cells. Of the 18 donors who underwent normothermic regional perfusion, all hearts were deemed suitable for recovery and successfully transplanted, a yield of 100%. Other organs successfully recovered and transplanted include kidneys (80.6% yield), livers (66.7% yield), and bilateral lungs (27.8% yield). Conclusions The use of cardiopulmonary bypass for thoraco-abdominal normothermic regional perfusion is a burgeoning option for improving the quality of organs from donation after cardiac death donors. Meticulous intraoperative management of donation after cardiac death donors with a specific focus on improving their metabolic milieu may lead to improved graft function in transplant recipients.
Collapse
Key Words
- CIT, cold ischemic time
- CPB, cardiopulmonary bypass
- DBD, donation after brain death
- DCD, donation after circulatory death
- DWIT, donor warm ischemic time
- ICU, intensive care unit
- NRP, normothermic regional perfusion
- OPO, Organ Procurement Organization
- TEE, transesophageal echocardiography
- UF, ultrafiltration
- WLST, withdrawal of life-sustaining therapy
- Z-BUF, zero-balance ultrafiltration
- donation after circulatory death
- heart transplantation
- normothermic regional perfusion
Collapse
Affiliation(s)
- Les James
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - V. Reed LaSala
- Department of General Surgery, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Fredrick Hill
- Perfusion Services, NYU Langone Health, New York, NY
| | - Jennie Y. Ngai
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Langone Health, New York, NY
| | - Alex Reyentovich
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY
| | - Syed T. Hussain
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Claudia Gidea
- Division of Cardiology, Department of Medicine, NYU Langone Health, New York, NY
| | | | | | - Deane E. Smith
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY
| | - Nader Moazami
- Department of Cardiothoracic Surgery, NYU Langone Health, New York, NY,Address for reprints: Nader Moazami, MD, Division of Heart and Lung Transplantation and Mechanical Circulatory Support, Department of Cardiothoracic Surgery, NYU Grossman School of Medicine, 530 1st Ave, Suite 9V, New York, NY 10016.
| |
Collapse
|
7
|
Song S, Shao Z, Fan T, Li B, Liang W, Dong H, Wu K, Hu M, Han Y, Cui C. Favorable mid-term performance of fully biodegradable implantable device for ventricular septal defect closure. JTCVS Tech 2022; 17:133-137. [PMID: 36820343 PMCID: PMC9938384 DOI: 10.1016/j.xjtc.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/22/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
Objectives To assess the mid-term safety and efficacy of transthoracic perimembranous ventricular septal defect (Pm-VSD) closure using a new biodegradable device. Implantation entailed right subaxillary minithoracotomy under transesophageal echocardiography guidance. Methods Between October 2019 and January 2020, 13 patients (males, 5; mean age, 3.6 ± 2.5 years) with Pm-VSDs underwent transthoracic device closures at Zhengzhou University Central China Fuwai Hospital as described previously. Delivery pathways were established by manipulating a hollow probe from right atrium through tricuspid valve to right ventricle and then through VSDs to left ventricle, whereupon installation took place. Results All occluder implantations were successfully executed. Mean defect size was 4.1 ± 1.0 mm, and mean device waist size was 5.2 ± 1.1 mm. One patient (7.7%) with 1.5-mm residual shunt showed complete closure at discharge. There was 1 instance of postoperative incomplete right bundle branch block, which converted to complete right bundle branch block at month 1. During patient follow-up (mean, 24.6 ± 0.8 months), no device dislocations, new residual shunts, new valvular regurgitation, or detectable atrioventricular block ensued. Conclusions Closure of Pm-VSDs using a novel, fully biodegradable occluder in the manner described has proven safe and effective at mid-term follow-up. Long-term safety and efficacy of this device must be further corroborated in a large patient cohort going forward.
Collapse
Affiliation(s)
- Shubo Song
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Zehua Shao
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Taibing Fan
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China,Address for reprints: Taibing Fan, Prof, Department of Children's Heart Center, Zhengzhou University People's Hospital, No. 7 Weiwu Rd, Zhengzhou 450000, China.
| | - Bin Li
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Weijie Liang
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Haoju Dong
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Kaiyuan Wu
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Manman Hu
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Yu Han
- Department of Children's Heart Center, Zhengzhou University People's Hospital, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| | - Cunying Cui
- Department of Ultrasound, Zhengzhou University Central China Fuwai Hospital, Zhengzhou, China
| |
Collapse
|
8
|
Jinno T, Kato Y, Yamauchi H, Iwasaki T, Date Y, Nishiyama S, Sasaki K, Shimizu A, Kiyama H, Koyanagi T. Report of Accidental Anchoring of an Impella Device to a Perceval Bioprosthesis in a Patient. JACC Case Rep 2022; 4:101674. [PMID: 36438430 PMCID: PMC9681665 DOI: 10.1016/j.jaccas.2022.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
We herein report a case in which we encountered complications when placing an Impella CP ventricular assist device (catheter-based ventricular assist device) in a patient with a Perceval bioprosthetic valve (sutureless valve). Specifically, the catheter-based ventricular assist device became anchored to the sutureless valve and needed to be removed under cardiopulmonary bypass. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Taiyo Jinno
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Yasuyuki Kato
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Hidetaka Yamauchi
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Tsukasa Iwasaki
- Department of Cardiology, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Yusuke Date
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Shigeki Nishiyama
- Department of Cardiology, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Kenichi Sasaki
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Atsushi Shimizu
- Department of Cardiac Surgery, Kawasaki Saiwai Hospital, Kawasaki, Kanagawa, Japan
| | - Hiroshi Kiyama
- Department of Cardiovascular Surgery, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | | |
Collapse
|
9
|
Ferraris F, Millesimo M, Anselmino M, Castagno D, Vairo A, Alunni G, De Ferrari GM. Successful Percutaneous Retrieval of an Embolized Left Atrial Appendage Occluder. JACC Case Rep 2022; 4:101689. [PMID: 36684032 DOI: 10.1016/j.jaccas.2022.101689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 09/27/2022] [Accepted: 10/28/2022] [Indexed: 12/03/2022]
Abstract
A 75-year-old man with a previous mitral valve repair experienced embolization of a left atrial appendage occlusion device in the left atrium. The device was successfully retrieved using a double snaring technique, without the need for open surgery. This is an unusual report of left atrial appendage occluder retrieval, confirming the feasibility of the technique and the high flexibility of the device. (Level of Difficulty: Advanced.).
Collapse
|
10
|
Al Abri Q, El Nihum LI, Hinohara T, Chang SM, Faza NN, Goel SS, Kleiman NS, Wyler von Ballmoos MC, Atkins MD, Reardon MJ. Late Transcatheter Aortic Valve Thrombosis Leading to Cardiogenic Shock. JACC Case Rep 2022; 4:1459-1463. [PMID: 36444179 PMCID: PMC9700056 DOI: 10.1016/j.jaccas.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 06/16/2023]
Abstract
A 67-year-old woman with prior transcatheter aortic valve replacement presented with worsening dyspnea. Imaging revealed transcatheter aortic valve thrombosis and aortic stenosis. Despite oral anticoagulation, she progressively deteriorated and developed cardiogenic shock. We highlight the Heart Team's role in treating this unusual late thrombosis. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- CT, computed tomography
- DAPT, dual antiplatelet therapy
- HALT, hypoattenuated leaflet thrombosis
- IABP, intra-aortic balloon pump
- LVEF, left ventricular ejection fraction
- OAC, oral anticoagulation
- SAPT, single antiplatelet therapy
- SAVR, surgical aortic valve replacement
- TAV, transcatheter aortic valve
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- hypoattenuated leaflet thrombosis
- transcatheter heart valve
Collapse
Affiliation(s)
- Qasim Al Abri
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Lamees I. El Nihum
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
- Texas A&M College of Medicine, Bryan, Texas, USA
| | - Tomoya Hinohara
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Su Min Chang
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Nadeen N. Faza
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Sachin S. Goel
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Neal S. Kleiman
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Marvin D. Atkins
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael J. Reardon
- DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| |
Collapse
|
11
|
Tozzi P, Locca D, Siniscalchi G, Ait-Tigrine S. Percutaneous reduction of septal-to-lateral mitral annular distance to increase mitral leaflet coaptation length: Preclinical study results. JTCVS Tech 2022; 17:65-72. [PMID: 36820354 PMCID: PMC9938367 DOI: 10.1016/j.xjtc.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/15/2022] [Accepted: 10/03/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives Percutaneous indirect annuloplasty has emerged as a treatment strategy for functional/ischemic mitral regurgitation. This study sought to evaluate the feasibility of percutaneous indirect annuloplasty technique using a new device. Methods The device has 3 components: the "saddle" inserted into the great cardiac vein, the "plug" positioned in the left ventricular outflow tract, and the "bridge," a transatrial suture connecting the 2 holding elements. The aim was to shorten the septal-to-lateral distance of the mitral annulus by pulling on the saddle element. The procedure was performed through venous access in healthy adult sheep. A dedicated catheter holding a needle was used to deploy the saddle into the great cardiac vein and pierce its wall toward the left atrium to deploy the expanded polytetrafluoroethylene suture that is part of the bridge. A catheter for transseptal puncture was inserted for crossing the interatrial septum and piercing the aortic-mitral curtain, thereby allowing the plug to be deployed. The plug was held in place by the second part of the expanded polytetrafluoroethylene bridge. The 2 parts of the bridge were then joined to reduce the septal-to-lateral mitral annular distance. The septal-to-lateral distance and the coaptation length at P2 level were measured before and after the procedure using echocardiography. Results Overall, 10 animals were treated, 7 successfully. The mean procedure duration was 110 ± 81 minutes. Septal-to-lateral distance decreased from 3.8 mm to 2.6 mm (30%), and maximum increase of mitral leaflet coaptation was 4 mm. Conclusions This new approach seems promising for percutaneous treatment of functional mitral regurgitation.
Collapse
Affiliation(s)
- Piergiorgio Tozzi
- Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland,Address for reprints: Piergiorgio Tozzi, MD, Cardiac Surgery Department, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
| | - Didier Locca
- Centre Cardiovasculaire Grand Chêne, Lausanne, Switzerland
| | | | | |
Collapse
|
12
|
Babur Guler G, Memic Sancar K, Corekcioglu B, Topel C, Erturk M. Early Valve Thrombosis Management After Successful Transcatheter Tricuspid Valve-in-Valve Implantation. JACC Case Rep 2022; 5:101584. [PMID: 36636503 PMCID: PMC9830461 DOI: 10.1016/j.jaccas.2022.07.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022]
Abstract
Transcatheter tricuspid valve-in-valve implantation is a critical option in high risk bioprosthetic tricuspid valve dysfunction. In this case report, balloon-expandable transcatheter heart valve was implanted successfully into the tricuspid valve and early thrombosis was managed successfully. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- ACC/AHA, American College of Cardiology/American Heart Association
- ASA, acetylsalicylic acid
- ESC, European Society of Cardiology
- IVC, inferior vena cava
- PHT, pressure half time
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- TTVIV, transcatheter tricuspid valve-in-valve
- TV, tricuspid valve
- VIV, valve-in-valve
- VKA, vitamin K antagonist
- percutaneous valve
- thrombus
- transcatheter valve implantation
- tricuspid valve
Collapse
Affiliation(s)
- Gamze Babur Guler
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Kadriye Memic Sancar
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey,Address for correspondence: Dr Kadriye Memic Sancar, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istasyon, Turgut Ozal Bulvari No: 11, 34303 Kuçukcekmece/Istanbul, Turkey.
| | - Busra Corekcioglu
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cagdas Topel
- Department of Cardiovascular Radiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, University of Health Sciences Istanbul, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
13
|
Assi AEH, Tabibiazar R, Dave PR, Shemin RJ, Rafique AM. An Unusual Case of Left Ventricular Outflow Tract Pseudoaneurysm. JACC Case Rep 2022; 6:101670. [PMID: 36704061 PMCID: PMC9871057 DOI: 10.1016/j.jaccas.2022.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/28/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare condition with a wide range of causes and various clinical outcomes. The causes range from infections, trauma to the chest wall, and iatrogenic origins. We present a unique case of idiopathic LVOT pseudoaneurysm in a patient with no obvious clinical risk factors. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Abdul Elah H. Assi
- Address for correspondence: Dr. Abdul Elah H. Assi, University of California-Los Angeles, 2020 Santa Monica Boulevard, Suite 220, Santa Monica, California 90404, USA.
| | | | | | | | | |
Collapse
|
14
|
Fiore G, Stella S, Conversano A, Agricola E. An Unusual Cause of Stroke: A "Forgotten" Intracardiac Catheter Discovered After 48 Years. JACC Case Rep 2022; 6:101668. [PMID: 36704064 PMCID: PMC9871056 DOI: 10.1016/j.jaccas.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 09/26/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
A 48-year-old man with recurrent cerebral ischemic events underwent transesophageal echocardiography to investigate cardioembolic sources because transthoracic echocardiography had spotted a dubious filamentous mass on the mitral valve. A venous umbilical catheter, lost during the hospital stay after his birth, was surprisingly identified in his cardiac chambers. (Level of Difficulty: Beginner.).
Collapse
Affiliation(s)
- Giorgio Fiore
- Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy,Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Address for correspondence: Dr. Giorgio Fiore, Department of Clinical Cardiology, Vita-Salute San Raffaele University, Via Olgettina 60, 20132 Milano, Italy.
| | - Stefano Stella
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Conversano
- Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy,Unit of Cardiovascular Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
15
|
Higuchi Y, Hirayama A, Hamanaka Y, Kobayashi T, Sotomi Y, Komatsu S, Yutani C, Kodama K. Significant Contribution of Aortogenic Mechanism in Ischemic Stroke: Observation of Aortic Plaque Rupture by Angioscopy. JACC Asia 2022; 2:750-759. [PMID: 36444317 PMCID: PMC9700032 DOI: 10.1016/j.jacasi.2022.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 06/10/2022] [Revised: 07/05/2022] [Accepted: 07/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Although embolic stroke accounts for most cerebral infarction, examinations to identify the embolic source have been insufficient. Nonobstructive general angioscopy (NOGA) has developed to allow the detailed observation of atheromatous changes of the aorta. OBJECTIVES The purpose of this study was to clarify the importance of the aortogenic mechanism in the development of ischemic stroke. METHODS We examined 114 consecutive patients whose aorta was observed by NOGA and who subsequently underwent brain magnetic resonance imaging to detect ischemic stroke lesions. In the evaluation of the aorta, the presence and location of spontaneously ruptured aortic plaque (SRAP) were determined. The aorta was observed from the origin to the arch (proximal aorta [PAo]) and the proximal descending aorta. RESULTS Forty-nine of 114 patients had SRAP observed by NOGA. Among these, 24 had SRAP in the PAo, and 43 had SRAP in the descending aorta. Thirty-three patients had ischemic stroke lesions, including 6 with a clinical neurologic deficit. The frequency at which SRAP was detected in these patients was significantly higher in comparison to 81 patients without ischemic stroke (69% vs 33%; P < 0.01). The sensitivity and specificity of the presence of SRAP for ischemic stroke were 0.70 and 0.68, respectively. The presence of SRAP in PAo was significantly correlated with ischemic stroke (odds ratio: 14.3; P < 0.001). CONCLUSIONS In the treatment of ischemic stroke, attention should be paid to SRAP, especially that in the PAo. (STROKE-NOGA [SponTaneously Ruptured aOrtic plaques as a potential cause of embolic stroKEs visualized by Non-Obstructive General Angioscopy] Study; UMIN000034588).
Collapse
Key Words
- AF, atrial fibrillation
- DAo, proximal descending aorta
- DOAC, direct oral anticoagulant
- DWI, diffusion-weighted imaging
- FLAIR, fluid-attenuated inversion recovery
- MRA, magnetic resonance angiography
- MRI, magnetic resonance imaging
- NOGA, nonobstructive general angioscopy
- PAo, proximal aorta
- SRAP, spontaneously ruptured aortic plaque
- TEE, transesophageal echocardiography
- angioscopy
- aortic plaque
- embolic stroke
- ischemic stroke
Collapse
Affiliation(s)
| | | | - Yuma Hamanaka
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | | | - Yohei Sotomi
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Sei Komatsu
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| | - Chikao Yutani
- Morinomiya Academy of Medical Arts and Sciences, Osaka, Japan
| | - Kazuhisa Kodama
- Cardiovascular Center, Osaka Gyoumeikan Hospital, Osaka, Japan
| |
Collapse
|
16
|
Aziz J, Aziz S. Putative computed tomography scan-negative type A dissection. JTCVS Open 2022; 12:30-36. [PMID: 36590711 PMCID: PMC9801335 DOI: 10.1016/j.xjon.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/11/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
Objectives Computed tomography angiography (CTA) is the imaging modality most frequently used to diagnosis type A aortic dissection for chest pain with a high degree of sensitivity and specificity. False negative and positive errors in diagnosis are infrequent. Despite initial negative imaging studies for dissection, surgeons must consider early operation in patients with recent onset chest pain in the presence of an ascending aortic aneurysm. Methods We report 4 cases (2004-2021) of patients with a mean age of 51.25 years (male:female = 3:1) who presented with chest pain. Two had a history of syncope. On computed tomography angiography, all had an ascending aortic aneurysm and no dissection flap. Three had thickening of the ascending aorta and 1 had a chronic type B dissection. On echocardiography, aortic regurgitation was moderate-severe in 2 patients, 2 had a pericardial effusion, and none had a definitive dissection flap. All were operated on because of the surgeon's concern for the association of chest pain and an ascending aortic aneurysm. The Institutional Review Board at George Washington University Committee on Human Research has determined that the research is exempt from review under Department of Health and Human Services regulatory category 4 (#FWA00005945). The project as described in the application may proceed without further oversight by the Office of Human Resources on September 9, 2022. Results The diagnosis of type A aortic dissection was made at operation (3 on median sternotomy and 1 after aortotomy). All patients did well. One patient who had peripheral cannulation (no malperfusion) and severe coagulopathy developed a compartment syndrome and postoperatively required a below-knee amputation. Conclusions Surgeons must maintain a high index of suspicion for aortic dissection when patients present with chest pain and are found to have an ascending aortic aneurysm even in the absence of initial, classic features of dissection on computed tomography angiography. Improvements in imaging techniques and analysis are required.
Collapse
Affiliation(s)
- Jenna Aziz
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio,Address for reprints: Jenna Aziz, MD, Division of Cardiothoracic Surgery, The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210.
| | - Salim Aziz
- Division of Cardiac Surgery, George Washington University Hospital, Washington, DC
| |
Collapse
|
17
|
Gaignard S, Babaliaros V, Perdoncin E, Gleason P, Xie J, Jokhadar M. Transcatheter Mitral Valve Repair in a Tricuspid Atresia Patient With Potts and Glenn Shunts. JACC Case Rep 2022; 4:1379-1383. [PMID: 36299650 PMCID: PMC9588587 DOI: 10.1016/j.jaccas.2022.08.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/26/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
Our patient was a 50-year-old woman with tricuspid atresia who had undergone palliation with a Potts shunt to the left pulmonary artery as an infant and a classic Glenn shunt to the right pulmonary artery as a young child. Under general anesthesia, she underwent transcatheter edge-to-edge repair of the mitral valve for severe symptomatic mitral regurgitation. (Level of Difficulty: Advanced.)
Collapse
Key Words
- ASD, atrial septal defect
- EROA, effective regurgitant orifice area
- LPA, left pulmonary artery
- LV, left ventricular
- MC, MitraClip
- MR, mitral regurgitation
- PEEP, positive end-expiratory pressure
- RPA, right pulmonary artery
- TEE, transesophageal echocardiography
- TEER, transcatheter edge-to-edge repair
- congenital heart disease
- cyanotic heart disease
- echocardiography
- mitral valve
- pulmonary circulation
- systolic heart failure
Collapse
Affiliation(s)
- Scott Gaignard
- Address for correspondence: Dr Scott Gaignard, Emory University School of Medicine, Emory Faculty Office Building, 49 Jesse Hill Jr Drive Southeast, Atlanta, Georgia 30303, USA.
| | | | | | | | | | | |
Collapse
|
18
|
Rajotte K, Shalen E, Song HK, Golwala H, Cigarroa J, Burch G, Zahr F, Chadderdon SM. Severe MR With Prior Alfieri Stitch Treated With Transcatheter Edge-to-Edge Repair and a Vascular Plug. JACC Case Rep 2022; 4:1314-1318. [PMID: 36406907 PMCID: PMC9666753 DOI: 10.1016/j.jaccas.2022.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
We present a case of a high-risk surgical patient with prior surgical Alfieri stitch and recurrent severe mitral regurgitation. In cases with suitable anatomy, mitral valve transcatheter edge-to-edge repair and vascular plug closure of a small regurgitant orifice can be used with excellent results. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Scott M. Chadderdon
- Address for correspondence: Dr Scott M. Chadderdon, Knight Cardiovascular Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239, USA.
| |
Collapse
|
19
|
Zhang X, Hou S, Liu W, Chen W, Chen F, Ma W, Wang J, Fan Y, Wang Y, Chang D, Fu H, Cai H, Zhang Y, Hou CR, Xu Y, Zhou D, Ge J. Percutaneous Left Atrial Appendage Closure With a Novel LAA Occluder for Stroke Prevention in Atrial Fibrillation. JACC Asia 2022; 2:547-556. [PMID: 36518725 PMCID: PMC9743450 DOI: 10.1016/j.jacasi.2022.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/29/2022] [Accepted: 04/25/2022] [Indexed: 01/11/2023]
Abstract
Background More than 90% of thromboses originate from the left atrial appendage (LAA) in patients with nonvalvular atrial fibrillation (NVAF). Objectives This study was designed to investigate the safety and efficacy of LAA closure with the Leftear device (Pulse Scientific) in NVAF patients. Methods A prospective, multicenter, registry-based study was conducted in 200 NVAF patients with CHA2DS2-VASc (congestive heart failure, hypertension, age, diabetes, previous stroke/transient ischemic attack, vascular disease, female sex) scores ≥2. The primary safety endpoint was defined as any serious adverse events. Efficacy was assessed by a primary composite endpoint of hemorrhagic or ischemic stroke, systemic embolism, and cardiac or unexplained death at 1 year of follow-up. Results The device was implanted in 196 patients, with 1-stop LAA closure combined with atrial fibrillation ablation implemented in 133 patients. The immediate success rate was 100%. There were serious adverse events in 9 patients (4.5%; 95% CI: 1.6%-7.4%), which mainly occurred in 1-stop LAA closure. All pericardial tamponades occurred in 6 patients with 1-stop LAA closure. No patient experienced a major bleeding event or acute device-related thrombus. During the 12-month follow-up period, the risk of the primary composite endpoint was 1.6% (95% CI: 0.3%-4.5%), and statistical noninferiority was achieved (the upper bound of 95% CI: 4.5% < the prespecified maximum annual incidence of 8.0%). Ischemic stroke occurred in 1 patient, 3 patients had incomplete LAA sealing, and no delayed device-related thrombus was found. Conclusions LAA closure with the novel disc-like occluder shows high procedural success, satisfactory safety, and encouraging efficacy for stroke prevention in patients with NVAF. Compared with 1-stop LAA closure, single LAA closure may be more tolerable. (A multicenter, single-arm clinical trial to evaluate the efficacy and safety of left atrial appendage system for left atrial appendage occlusion in patients with non-valvular atrial fibrillation; ChiCTR1900023035).
Collapse
Affiliation(s)
- Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
| | - Shiqiang Hou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
| | - Weijing Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Chen
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Fadong Chen
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
| | - Wei Ma
- Department of Cardiology, Peking University First Hospital, Beijing, People’s Republic of China
| | - Jian’an Wang
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, People’s Republic of China
| | - Youqi Fan
- Department of Cardiology, The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, People’s Republic of China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Fujian, People’s Republic of China
| | - Dong Chang
- Department of Cardiology, Xiamen Cardiovascular Hospital, Xiamen University, Fujian, People’s Republic of China
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Heng Cai
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, People’s Republic of China
| | - Yushun Zhang
- Department of Cardiology, First Affiliated Hospital of Xi 'an Jiaotong University, Shaanxi, People’s Republic of China
| | - Cody R. Hou
- College of Biological Sciences, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China
- Address for correspondence: Dr Yawei Xu, Department of Cardiology, Shanghai Tenth People's Hospital, No. 301 Yanchang Middle Road, Shanghai 200072, People’s Republic of China.
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
- Dr Daxin Zhou, Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, No.180 Fenglin Road, Shanghai 200032, People's Republic of China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai, People’s Republic of China
- National Clinical Research Center for Interventional Medicine, Shanghai, People’s Republic of China
| |
Collapse
|
20
|
Sunder V, Sabir S, Mark G, Kaddissi G, Peters P, Ragupathi L. Closure of Iatrogenic Atrial Septal Defect After Placement of Left Atrial Appendage Closure Device. JACC Case Rep 2022; 4:1053-1055. [PMID: 36062052 PMCID: PMC9434646 DOI: 10.1016/j.jaccas.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
An 86-year-old woman experienced hypoxia with right-to-left flow across an iatrogenic atrial septal defect after deployment of a left atrial appendage closure device. Emergent closure of the defect was performed with an atrial septal occluder device with resolution of hypoxia. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Vikas Sunder
- Address for correspondence: Dr. Vikas Sunder, Cooper University Hospital, 3 Cooper Plaza, Suite 311, Camden, New Jersey 08103, USA. @CooperCVFellows
| | | | | | | | | | | |
Collapse
|
21
|
Guber K, Ranard LS, Ng V, Hahn RT, Sommer R, Vahl TP. An Unusual Cause of Shortness of Breath: Pulmonary Vein Stenosis After Surgical Mitral Valve Replacement. JACC Case Rep 2022; 4:533-537. [PMID: 35573843 PMCID: PMC9091516 DOI: 10.1016/j.jaccas.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/19/2022] [Accepted: 01/28/2022] [Indexed: 12/03/2022]
Abstract
A 79-year-old man with prior bioprosthetic mitral valve replacement presented with progressive shortness of breath and was found to have right upper pulmonary vein stenosis and paravalvular leak diagnosed with the use of multimodal imaging. The patient underwent balloon angioplasty, stenting of the pulmonary vein, and paravalvular leak closure with ultimate resolution of symptoms. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- AF, atrial fibrillation
- CCTA, cardiac computed tomographic angiography
- CT, computed tomography
- DOE, dyspnea on exertion
- PV, pulmonary vein
- PVL, paravalvular leak
- PVS, pulmonary vein stenosis
- RUPV, right upper pulmonary vein
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- V/Q, ventilation-perfusion
- iatrogenic complication
- paravalvular leak
- pulmonary vein stenosis
Collapse
Affiliation(s)
- Kenneth Guber
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Lauren S Ranard
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Vivian Ng
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert Sommer
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| | - Torsten P Vahl
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York, USA
| |
Collapse
|
22
|
Bachini JP, Torrado J, Vignolo G, Durán A, Biondi-Zoccai G. Postinfarction Ventricular Septal Rupture: Identification of the Failure Mechanism of a Percutaneous Closure Procedure. JACC Case Rep 2022; 4:255-61. [PMID: 35257098 DOI: 10.1016/j.jaccas.2021.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 02/08/2023]
Abstract
Ventricular septal rupture (VSR) is a rare but highly lethal (∼60%) mechanical complication of myocardial infarction (MI). Although surgical repair has been the gold standard to correct the structural anomaly, percutaneous closure of the defect may represent a valuable therapeutic alternative, with the advantage of immediate shunt reduction to prevent further hemodynamic deterioration in patients with prohibitive surgical risk. Nonetheless, catheter-based VSR closure has faced certain drawbacks that have hampered its application. We describe a clinical case of postinfarction VSR treated with a percutaneous closure device and discuss the procedure's failure mechanism. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- ASD, atrial septal defect
- CMR, cardiac magnetic resonance
- CT, computed tomography
- IABP, intra-aortic balloon pump
- LAD, left anterior descending
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- STEMI, ST-segment myocardial infarction
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- VSD, ventricular septal defect
- VSR, ventricular septal rupture
- acute myocardial infarction
- mechanical complication
- percutaneous closure device
- percutaneous septal defect closure
- ventricular septal defect
- ventricular septal rupture
Collapse
|
23
|
Cruz-González I, Torres Saura F, Trejo-Velasco B, Antonio Fernández Díaz J, Fajardo Molina R, del Valle-Fernández R, Moreno Terribas G, Martí Sánchez D, López-Mínguez JR, Gomez-Blazquez I, Sanmartin Pena JC, Botas J, Martin Lorenzo P, Palazuelos J, Albarrán Rincon R, Mohandes M, Rodriguez Entem FJ, Martí G, Valero E, Gutiérrez H, Amat-Santos IJ, Nombela-Franco L, Salinas P, Teruel L, Gomez-Hospital JA, Arzamendi D, Torres Sanabria M, Calle Pérez G, Cañadas Pruaño D, Pérez de Prado A, Benito González T, Arroyo-Úcar E, Estévez-Loureiro R, Caneiro-Queija B, Ibañez Criado JL, Ruiz-Nodar JM. Impact of operatoŕs experience on peri-procedural outcomes with Watchman FLX: Insights from the FLX-SPA registry. Int J Cardiol Heart Vasc 2022; 38:100941. [PMID: 35024431 PMCID: PMC8728396 DOI: 10.1016/j.ijcha.2021.100941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/09/2021] [Accepted: 12/23/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND The Watchman FLX is a device upgrade of the Watchman 2.5 that incorporates several design enhancements intended to simplify left atrial appendage occlusion (LAAO) and improve procedural outcomes. This study compares peri-procedural results of LAAO with Watchman FLX (Boston Scientific, Marlborough, Massachusetts) in centers with varying degrees of experience with the Watchman 2.5 and Watchman FLX. METHODS Prospective, multicenter, "real-world" registry including consecutive patients undergoing LAAO with the Watchman FLX at 26 Spanish sites (FLX-SPA registry). Implanting centers were classified according to the center's prior experience with the Watchman 2.5. A further division of centers according to whether or not they had performed ≤ 10 or > 10Watchman FLX implants was prespecified at the beginning of the study. Procedural outcomes of institutions stratified according to their experience with the Watchman 2.5 and FLX devices were compared. RESULTS 359 patients [mean age 75.5 (SD8.1), CHA2DS2-VASc 4.4 (SD1.4), HAS-BLED 3.8(SD0.9)] were included. Global success rate was 98.6%, successful LAAO with the first selected device size was achieved in 95.5% patients and the device was implanted at first attempt in 78.6% cases. There were only 9(2.5%) major peri-procedural complications. No differences in efficacy or safety results according to the centeŕs previous experience with Watchman 2.5 and procedural volume with Watchman FLX existed. CONCLUSIONS The Watchman FLX attains high procedural success rates with complete LAA sealing in unselected, real-world patients, along with a low incidence of peri-procedural complications, regardless of operatoŕs experience with its previous device iteration or the number of Watchman FLX devices implanted.
Collapse
Affiliation(s)
- Ignacio Cruz-González
- Cardiology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca, Spain
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
| | | | - Blanca Trejo-Velasco
- Cardiology Department, University Hospital of Salamanca, Institute of Biomedical Research of Salamanca, Spain
| | | | | | | | - Gerardo Moreno Terribas
- Interventional Cardiology Unit, Cardiology Department, University Hospital Clinico San Cecilio Granada, Spain
- Medical School, University of Granada, Spain
| | - David Martí Sánchez
- Cardiology Department, Hospital Central de la Defensa, Madrid, Spain
- Medical School, University of Alcalá, Madrid, Spain
| | - José-Ramón López-Mínguez
- Cardiology Department, Infanta Cristina University Hospital of Badajoz, Spain
- Medical School, University of Extremadura, Badajoz, Spain
| | | | | | - Javier Botas
- Cardiology Department, University Hospital Fundación Alcorcón, Madrid, Spain
- Rey Juan Carlos University School of Medicine, Madrid, Spain
| | - Pedro Martin Lorenzo
- Interventional Cardiology Unit, Cardiology Department, University Hospital of Gran Canaria Dr. Negrin, Las Palmas de Gran Canaria, Spain
| | | | - Ramón Albarrán Rincon
- Cardiology and Cardiac Surgery Department, University Clinic of Navarra, Pamplona, Spain
| | - Mohsen Mohandes
- Interventional Cardiology Unit, Joan XXIII University Hospital, Tarragona, Spain
| | | | - Gerard Martí
- Cardiology Department, University Hospital Vall d́Hebron, Barcelona, Spain
| | - Ernesto Valero
- Cardiology Department, Clinic University Hospital of Valencia, Valencia, Spain
| | - Hipólito Gutiérrez
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cardiology Department, Clinic University Hospital of Valladolid, Spain
| | - Ignacio J. Amat-Santos
- Biomedical Research Networking Center on Cardiovascular Diseases (CIBERCV), Madrid, Spain
- Cardiology Department, Clinic University Hospital of Valladolid, Spain
| | | | - Pablo Salinas
- Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain
| | - Luis Teruel
- Cardiology Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan-Antoni Gomez-Hospital
- Cardiology Department, Bellvitge University Hospital-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Dabit Arzamendi
- Cardiology Department, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Mario Torres Sanabria
- Cardiology Department, University Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | | | | | | | - Eduardo Arroyo-Úcar
- Interventional Cardiology Unit, University Hospital del Vinalopó, Elche, Spain
| | | | | | - Jose L. Ibañez Criado
- Cardiology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Spain
| | - Juan M. Ruiz-Nodar
- Cardiology Department, Hospital General Universitario de Alicante, Instituto de Investigación Sanitaria y Biomédica de Alicante, Spain
- Facultad de Medicina, Universidad Miguel Hernández, Sant Joan, Alicante, Spain
| |
Collapse
|
24
|
Espinoza Rueda MA, Alcántara Meléndez MA, González RM, Jiménez Valverde AS, García García J, Rivas Gálvez RE, Esparza TH, Rodríguez G, Sandoval Castillo LD, Merino Rajme JA. Successful Closure of Paravalvular Leak Using Computed Tomography Image Fusion and Planning With 3-Dimensional Printing. JACC Case Rep 2022; 4:36-41. [PMID: 35036941 PMCID: PMC8743814 DOI: 10.1016/j.jaccas.2021.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022]
Abstract
The presence of moderate to severe paravalvular leak increases mortality. We present a case of giant paravalvular leak closure using the 3-dimensional printing model to assess the success of the device to be used for its closure, computed tomography was performed for planning and guiding the procedure by image fusion. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Manuel A. Espinoza Rueda
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Marco A. Alcántara Meléndez
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Roberto Muratalla González
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Arnoldo S. Jiménez Valverde
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Juan.F. García García
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Ronald E. Rivas Gálvez
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Tomas Hernández Esparza
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Gustavo Rodríguez
- Department of Echocardiography, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - Luz D. Sandoval Castillo
- Department of Cardiovascular Imaging, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| | - José A. Merino Rajme
- Department of Interventional Cardiology, National Medical Center “November 20,” Institute of Social Security and Services for State Workers, Mexico City, Mexico
| |
Collapse
|
25
|
Budra M, Janušauskas V, Zorinas A, Zakarkaitė D, Aidietis A, Samalavičius R, Ručinskas K. Rescue transventricular off-pump mitral valve repair with artificial neochords for acute mitral regurgitation due to postinfarction papillary muscle rupture. JTCVS Tech 2022; 10:231-242. [PMID: 34977729 PMCID: PMC8691823 DOI: 10.1016/j.xjtc.2021.09.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/27/2021] [Indexed: 12/18/2022] Open
Abstract
Background We report 3 cases of rescue transventricular off-pump mitral valve (MV) repair in high-risk patients with acute mitral regurgitation (MR) due to post–myocardial infarction (MI) papillary muscle rupture (PMR). Methods The 3 patients presented with acute inferior ST elevation myocardial infarction, cardiogenic shock, and pulmonary edema. Their preoperative peak troponin I levels were 1909 ng/L, 16,963 ng/L, and 8299 ng/L. All 3 patients underwent successful percutaneous intervention to the culprit coronary artery, and antiplatelet therapy was initiated. All patients required inotropic support and had an intra-aortic balloon pump inserted preoperatively. Transesophageal echocardiography (TEE) demonstrated severe eccentric MR due to the leaflet prolapse secondary to PMR. The patients’ estimated EuroSCORE II scores were 16.03%, 16.68%, and 7.81%, and their Society of Thoracic Surgeons scores were 14.77%, 18.24%, and 9.8%, respectively. All 3 patients underwent urgent transventricular off-pump MV repair using artificial chords, with 2 or 3 three neochords implanted. The duration of operation was <2 hours, and intraoperative and postoperative drainage was minimal in all cases. MV function was assessed by qualitative and semiquantitative TEE. Results Intraoperative MR reduction to a mild level was achieved in all 3 patients. All patients had moderate MR at discharge, likely due to left ventricular remodeling. Severe MR recurred in all patients, at 5, 4, and 2 months of follow-up, respectively. All 3 patients underwent an elective MV reoperation via conventional approach. Conclusions Off-pump transventricular MV repair may offer a safe and feasible alternative to stabilize high-risk patients with acute MR due to post-MI PMR. Although early MR recurrence is concerning, urgent transventricular MV repair may serve as a bridge to conventional surgery in such unstable patients.
Collapse
Key Words
- AF, atrial fibrillation
- ECG, electrocardiography
- IABP, intra-aortic balloon pump
- LAD, left anterior descending artery
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- MR, mitral regurgitation
- MV, mitral valve
- PCI, percutaneous coronary intervention
- PMR, papillary muscle rupture
- RCA, right coronary artery
- STEMI, ST elevation myocardial infarction
- STS, Society of Thoracic Surgeons
- TEE, transesophageal echocardiography
- TR, tricuspid regurgitation
- acute mitral regurgitation
- artificial chords
- cardiogenic shock
- minimally invasive
- mitral valve
- off-pump
- papillary muscle rupture
- transventricular mitral repair
Collapse
Affiliation(s)
- Mindaugas Budra
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vilius Janušauskas
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Aleksejus Zorinas
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Diana Zakarkaitė
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Audrius Aidietis
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Robertas Samalavičius
- II Department of Anesthesia, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Kęstutis Ručinskas
- Centre of Cardiac and Thoracic Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
26
|
Bhangui P, Bhangui P, Aneja M, Sharma N, Gupta N, Soin A, Vohra V. Living Donor Liver Transplantation in a Cohort of Recipients With Left Ventricular Systolic Dysfunction. J Clin Exp Hepatol 2022; 12:1040-1047. [PMID: 35814511 PMCID: PMC9257861 DOI: 10.1016/j.jceh.2022.03.001] [Citation(s) in RCA: 2] [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: 01/09/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Data on feasibility, management, and outcomes of liver transplantation (LT) in patients with pre-existing left ventricular systolic dysfunction (LVSD), severe coronary artery disease (CAD) or cirrhotic cardiomyopathy (CCM) is scarce. METHODS We reviewed outcomes of living donor liver transplantation (LDLT) in recipients with LVSD (ejection fraction [EF] < 50%) from our series of 1946 LDLT's performed between July 2010 and July 2018. RESULTS LVSD was detected in 12 male patients with a mean age, BMI and MELD of 52 ± 9 years, 25 ± 5 kg/m2, and 19 ± 4 respectively. Out of these, 6 patients had CAD (2 with previous coronary artery bypass graft, 1 following recent percutaneous transluminal coronary angioplasty, 2 post myocardial infarction, 1 noncritical CAD), and 6 had CCM. The EF ranged from 25% to 45%. Ethanol was the predominant underlying etiology for cirrhosis (50%). During LDLT, 2 patients developed ventricular ectopic rhythm and were managed successfully with intravenous lidocaine. Stress cardiomyopathy manifested in 3 patients post operatively with decreased EF, of which 2 improved, while 1 needed IABP support and succumbed to multiorgan failure on 8th postoperative day (POD). Another patient died on POD30 due to septic shock. Both these patients had higher MELD scores (actual MELD), extremes of BMI (17.3and 35.8 kg/m2) and were diabetic. There were no long-term cardiac deaths. The 1-year, and 5-year survival were 75%, and 66%, respectively. CONCLUSION Among potential LT recipients with LVSD, those with stable CAD and good performance status, and well optimized CCM patients may be considered for LDLT after careful risk stratification in experienced centers.
Collapse
Key Words
- CABG, Coronary artery bypass graft
- CAC, coronary artery calcium score
- CAD, coronary artery disease
- CCM, cirrhotic cardiomyopathy
- CLD, chronic liver disease
- CTP, Child Turcotte Pugh
- DDLT, Deceased donor liver transplantation
- DSE, dobutamine stress echo
- ECG, electrocardiogram
- EF, ejection fraction
- ESLD, end stage liver disease
- GRWR, Graft to recipient weight ratio
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- IABP, intra-aortic balloon pump
- ICU, intensive care unit
- LDLT outcomes
- LDLT, Living donor liver transplantation
- LT, Liver transplantation
- LVSD, left ventricular systolic dysfunction
- MELD, Model for End Stage Liver Disease
- METS score, metabolic equivalents score
- NAFLD, nonalcoholic fatty liver disease
- OS, Overall survival
- PAC, pulmonary artery catheter
- PHT, portal hypertension
- PTCA, percutaneous transluminal coronary angioplasty
- TEE, transesophageal echocardiography
- cardiac complications
- cardiac evaluation
- cirrhotic cardiomyopathy
- coronary artery disease
Collapse
Affiliation(s)
- Pooja Bhangui
- Department of Liver Transplant and GI Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India
- Address for correspondence: Pooja Bhangui, Department of Liver Transplant and GI Anesthesia, Medanta-The Medicity, Gurugram, Delhi, 122001, NCR, India.
| | - Prashant Bhangui
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi, NCR, India
| | - Manish Aneja
- Department of Liver Transplant and GI Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Nishant Sharma
- Department of Liver Transplant and GI Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India
| | - Nikunj Gupta
- Department of Liver Transplant and GI Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India
| | - A.S. Soin
- Medanta Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Delhi, NCR, India
| | - Vijay Vohra
- Department of Liver Transplant and GI Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India
| |
Collapse
|
27
|
Steinhorn R, Dalia AA, Bittner EA, Chang MG. Surgical pulmonary embolectomy on VA-ECMO. Respir Med Case Rep 2021; 34:101551. [PMID: 34868870 PMCID: PMC8626575 DOI: 10.1016/j.rmcr.2021.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 11/01/2022] Open
Abstract
Surgical pulmonary embolectomy is a procedure that is often used to rescue patients with massive pulmonary embolism (PE) and circulatory collapse that have failed or may not be ideal candidates for other systemic and endovascular treatment modalities. This procedure typically involves a sternotomy and the use of cardiopulmonary bypass (CPB), which requires full systemic anticoagulation. Here, we report the case of a surgical pulmonary embolectomy performed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) rather than CPB to minimize systemic anticoagulation. The patient had suffered a cardiac arrest due to a saddle PE and required VA-ECMO which was complicated by a concomitant intracranial hemorrhage. The patient tolerated the surgical pulmonary embolectomy performed on VA-ECMO without procedure-related complications, and the ECMO support did not substantially complicate the technical performance of the procedure. In contrast to surgical pulmonary embolectomy performed on CPB, greater attention must be paid to volume status when performing the procedure on VA-ECMO since there is no blood reservoir. This case suggests cardiopulmonary support on ECMO as a viable strategy for surgical embolectomy in patients with unstable PEs in whom thrombolysis or full systemic anticoagulation are contraindicated.
Collapse
Key Words
- ACT, activated clotting time
- ASD, atrial septal defect
- CI, cardiac index
- CPB, cardiopulmonary bypass
- CT, computed tomography
- Cardiopulmonary bypass
- Case report
- EEG, electroencephalogram
- Extracorporeal membrane oxygenation
- ICU, intensive care unit
- LPA, left pulmonary artery
- MPA, main pulmonary artery
- MPAP, mean pulmonary artery pressure
- MRI, magnetic resonance imaging
- PA, pulmonary artery
- PE, pulmonary embolism
- PERT, pulmonary embolism response team
- PFO, patent foramen ovale
- PTT, partial thromboplastin time
- Pulmonary embolectomy
- Pulmonary embolism
- RPA, right pulmonary artery
- SDH, subdural hemorrhage
- TEE, transesophageal echocardiography
- TPA, tissue plasminogen activator
- VA-ECMO
- VA-ECMO, venoarterial extracorporeal membrane oxygenation
Collapse
Affiliation(s)
- Rachel Steinhorn
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
| | - Adam A Dalia
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
| | - Edward A Bittner
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
| | - Marvin G Chang
- Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, United States
| |
Collapse
|
28
|
Leclercq F, Odorico X, Marin G, Christophe Macia J, Delseny D, Agullo A, Pages L, Robert P, Lattuca B, Cayla G, Roubille F, Gaillard N, Arquizan C, Akodad M. Atrial fibrillation screening on systematic ambulatory electrocardiogram monitoring after percutaneous patent foramen ovale closure: A prospective study. Int J Cardiol Heart Vasc 2021; 37:100919. [PMID: 34849392 PMCID: PMC8609133 DOI: 10.1016/j.ijcha.2021.100919] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/02/2021] [Accepted: 11/14/2021] [Indexed: 11/17/2022]
Abstract
Incidence of atrial fibrillation (AF) following patent foramen ovale (PFO) closure is low (<5%) AF occurs early following PFO closure and is not associated with an increased risk of embolic complications. Symptomatic atrial ectopic beats are frequent following PFO closure and not associated with AF.
Background Increased risk of new-onset atrial fibrillation (AF) after patent foramen ovale (PFO) closure was observed in randomized trials without however systematic AF screening. We aimed to evaluate the incidence of AF within 6-month following PFO closure with serial 24-hour ambulatory electrocardiogram (AECG) monitoring. Methods All patients undergoing PFO closure were prospectively included in 2 centers. AF was defined as irregular rhythm without discernible P waves > 30 s on AECG at day 0, 1-month and 6-month follow-up. Primary endpoint was the incidence of AF within the study period. Secondary endpoints evaluated clinical outcomes within 6-month follow-up. Results Between February 2018 and March 2019, 62 patients underwent PFO closure including 40 male (64.5%) with a mean age of 48 ± 9.5. Atrial septal aneurysm was observed in 37 patients (64.9%), 57 patients (91.9%) received an Amplatzer Occluder device (Abbott Vascular) and 5 (8.1%) an Occlutech device (Occlutech). After a mean follow-up of 7.7 ± 2.8 months, new-onset AF occurred in 3 patients (4.8%), all within the first month following PFO closure, including one per-procedural, all were asymptomatic and paroxysmal. Two patients with AF (3.2%) required chronic oral anticoagulant therapy. No adverse outcomes occurred at follow-up. No predictive factors of AF were highlighted. A total of 16 patients (25.8%) reported palpitations without AF on the AECGs. Conclusion In highly selected patients, incidence of AF, evaluated with 3 systematic 24-hour AECG within 6-month following PFO closure, was low (<5%). Always paroxysmal, AF occurred within the first month after the procedure and was not associated with adverse outcomes.
Collapse
Affiliation(s)
- Florence Leclercq
- Department of Cardiology, University Hospital of Montpellier, France
| | - Xavier Odorico
- Department of Cardiology, University Hospital of Montpellier, France
| | - Gregory Marin
- Department of Medical Information, University Hospital of Montpellier, France
| | | | - Delphine Delseny
- Department of Cardiology, University Hospital of Montpellier, France
| | - Audrey Agullo
- Department of Cardiology, University Hospital of Montpellier, France
| | - Laurence Pages
- Department of Medical Information, University Hospital of Montpellier, France
| | - Pierre Robert
- Department of Cardiology, University Hospital of Montpellier, France
| | - Benoit Lattuca
- Department of Cardiology, University Hospital of Nimes, France
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, France
| | - François Roubille
- Department of Cardiology, University Hospital of Montpellier, France.,PhyMedExp INSERM U1046, University Hospital of Montpellier, France
| | - Nicolas Gaillard
- Department of Neurology, University Hospital of Montpellier, France
| | | | - Mariama Akodad
- Department of Cardiology, University Hospital of Montpellier, France.,PhyMedExp INSERM U1046, University Hospital of Montpellier, France
| |
Collapse
|
29
|
Espinoza Rueda MA, Muratalla González R, García García JF, Morales Portano JD, Alcántara Meléndez MA, Jiménez Valverde AS, Rivas Gálvez RE, Campos Delgadillo JL, González CL, Gayosso Ortiz JR, Merino Rajme JA. Description of the Step-by-Step Technique With Snare Catheter for TAVR in Horizontal Aorta. JACC Case Rep 2021; 3:1811-5. [PMID: 34917960 DOI: 10.1016/j.jaccas.2021.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/05/2022]
Abstract
The presence of a horizontal aorta in patients treated with transcatheter aortic valve replacement increases the difficulty of the procedure. We present 5 cases with aortic stenosis with a horizontal aorta who underwent transcatheter aortic valve replacement using a self-expanding prostheses, with the objective of describing the techniques used and obtaining success with a snare catheter. (Level of Difficulty: Intermediate.)
Collapse
|
30
|
Lopez-Mattei JC, Yang EH, Ferencik M, Baldassarre LA, Dent S, Budoff MJ. Cardiac Computed Tomography in Cardio-Oncology: JACC: CardioOncology Primer. JACC CardioOncol 2021; 3:635-649. [PMID: 34988472 PMCID: PMC8702811 DOI: 10.1016/j.jaccao.2021.09.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 12/12/2022] Open
Abstract
Cancer patients and survivors have elevated cardiovascular risk when compared with noncancer patients. Cardio-oncology has emerged as a new subspecialty to comanage and address cardiovascular complications in cancer patients such as heart failure, atherosclerotic cardiovascular disease (ASCVD), valvular heart disease, pericardial disease, and arrhythmias. Cardiac computed tomography (CT) can be helpful in identifying both clinical and subclinical ASCVD in cancer patients and survivors. Radiation therapy treatment planning CT scans and cancer staging/re-staging imaging studies can quantify calcium scores which can identify pre-existing subclinical ASCVD. Cardiac CT can be helpful in the evaluation of cardiac tumors and pericardial diseases, especially in patients who cannot tolerate or have a contraindication to cardiac magnetic resonance. In this review, we describe the optimal utilization of cardiac CT in cancer patients, including risk assessment for ASCVD and identification of cancer treatment-related cardiovascular toxicity.
Collapse
Affiliation(s)
| | - Eric H. Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health and Science University, Portland, Oregon, USA
| | - Lauren A. Baldassarre
- Section of Cardiovascular Medicine, Department of Medicine and Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Susan Dent
- Duke Cancer Institute, Department of Medicine, Duke University, Durham, North Carolina, USA
| | - Matthew J. Budoff
- Department of Medicine, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA
| |
Collapse
|
31
|
Saad M, Risha O, Sano M, Fink T, Heeger CH, Vogler J, Sciacca V, Eitel C, Stiermaier T, Joost A, Keelani A, Fuernau G, Meyer-Saraei R, Kuck KH, Eitel I, Richard Tilz R. Comparison between Amulet and Watchman left atrial appendage closure devices: A real-world, single center experience. Int J Cardiol Heart Vasc 2021; 37:100893. [PMID: 34712772 PMCID: PMC8529070 DOI: 10.1016/j.ijcha.2021.100893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 11/20/2022]
Abstract
Background Data reporting a head-to-head comparison between Amulet and Watchman devices are scarce. The aim of this study was to compare the Watchman™ versus Amulet™ left atrial appendage closure (LAAC) devices in a consecutive, industry-independent registry. Methods Patients who underwent LAAC using Watchman or Amulet devices from January 2014 to December 2019 at the University Heart Center Lübeck, Lübeck, Germany were included in the present analysis. Primary endpoints included periprocedural complications (in-hospital death, pericardial tamponade, device embolization, stroke, major bleeding and vascular access complications), and complications during long-term follow-up (ischemic stroke, hemorrhagic stroke, thromboembolism, device thrombus, bleeding and death). Results After matching the patients for age (±5 years), gender, CHA2DS2Vasc score (±1) and HASBLED score (±1), each of the Watchman and the Amulet groups included 113 patients. Patients in the Amulet group had significantly more periprocedural complications (2.7% vs 10.6%, p = 0.029; respectively) and more major bleeding complications (0% vs 5.3%, p = 0.029; respectively). During long-term follow-up, the rate of events was comparable between the Watchman and Amulet groups (18.3% versus 20.8%, p = 0.729; respectively). Conclusion Amulet LAAC device was associated with increased periprocedural complications as compared to Watchman LAAC device. On long-term follow-up, both devices showed comparable efficacy and safety.
Collapse
Affiliation(s)
- Mohammed Saad
- Medical Clinic III, University Hospital Schleswig-Holstein, Kiel, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Osama Risha
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Makoto Sano
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Fink
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian-Hendrik Heeger
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Julia Vogler
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Sciacca
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Charlotte Eitel
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Thomas Stiermaier
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Alexander Joost
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ahmad Keelani
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Georg Fuernau
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Roza Meyer-Saraei
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Karl-Heinz Kuck
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Roland Richard Tilz
- Medical Clinic II, University Heart Center Lübeck, Division of Electrophysiology, Lübeck, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| |
Collapse
|
32
|
Corona S, Sirbu V. Coronary Artery Perforation, Subepicardial Hematoma, and Cardiac Tamponade After Complex Percutaneous Coronary Intervention. JACC Case Rep 2021; 3:1594-1598. [PMID: 34729508 PMCID: PMC8543142 DOI: 10.1016/j.jaccas.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 06/02/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
This report presents the case of fissured subepicardial hematoma and cardiac tamponade after coronary artery perforation during a complex percutaneous intervention. Surgical therapy was required to achieve hemostasis because a percutaneous sealing result was insufficient. Prompt recognition and cardiac surgery availability are essential for patient survival in such situations. (Level of Difficulty: Beginner.).
Collapse
Key Words
- CTO, chronic total occlusion
- EF, ejection fraction
- LAD, left anterior descending
- LV, left ventricle
- PCI, percutaneous coronary intervention
- RCA, right coronary artery
- SEH, sub epicardial hematoma
- STEMI, ST-segment elevation myocardial infarction
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- cardiac surgery
- cardiac tamponade
- coronary artery perforation
- percutaneous coronary intervention
- pericardiocentesis
- subepicardial hematoma
Collapse
Affiliation(s)
- Silvia Corona
- Department of Cardiac Surgery, Centro Cardiologico Monzino, IRCCS, Milan, Italy
- Department of Cardiac Surgery, Jilin Heart Hospital, Changchun, Jilin, China
| | - Vasile Sirbu
- Department of Cardiology, Jilin Heart Hospital, Changchun, Jilin, China
| |
Collapse
|
33
|
Antaki T, Michaelman J, McGroarty J. Robotics-assisted epicardial left atrial appendage clip exclusion. JTCVS Tech 2021; 9:59-68. [PMID: 34647061 DOI: 10.1016/j.xjtc.2021.07.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 07/16/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives We demonstrate the feasibility and safety of robotics-assisted left atrial appendage clip exclusion in clinical practice. Methods Analysis of a single center robotics-assisted left atrial appendage clip exclusion experience using an epicardial linear clip device in patients with atrial fibrillation with high-risk of thromboembolic stroke and intolerance to oral anticoagulants. Results During the period from December 2017 to September 2020, we performed 42 robotics-assisted left atrial appendage clip exclusions in response to increased risk of bleeding in patients with atrial fibrillation and intolerance to oral anticoagulants. The average congestive heart failure, hypertension, age, diabetes, stroke, and vascular disease score was 5.2 ± 1.6 and hypertension, abnormal liver or kidney function, stroke, bleeding, labile international normalized ratio, elderly, drugs (aspirin, other antiplatelets, or anticoagulants) score was 4.5 ± 0.9. No patients died intraoperatively or within 30 days, or due to conversion to thoracotomy, intraoperative complications, or failure to apply the clip satisfactorily. The procedure was successfully completed despite pericardial adhesions in 2 patients with prior coronary bypass grafts and 3 with postpericarditis scars. Intraoperative transesophageal echocardiography was performed in 38 out of 42 patients; satisfactory exclusion with left atrial appendage stump <5 mm was confirmed in all. Average length of stay was 3.4 ± 3 days with 12 out of 42 patients discharged within 24 hours. Oral anticoagulants were discontinued in 41 out of 42 patients and no cases of 30-day stroke, myocardial ischemia, or new arrhythmias were observed. One case of hemothorax required thoracoscopy a day later. There was no reported thromboembolic stroke or transient ischemic attack at 12 months. One case of late lacunar stroke was due to in situ small intracranial vessel thrombosis without left atrial appendage thrombus on imaging. Conclusions Robotics-assisted left atrial appendage clip exclusion is a safe and feasible minimally invasive method for left atrial appendage management in patients with atrial fibrillation with intolerance to oral anticoagulants and increased risk of thromboembolic stroke.
Collapse
Key Words
- AF, atrial fibrillation
- CHA2DS2-VASc, congestive heart failure, hypertension, age, diabetes, stroke, vascular disease score
- CTA, computerized tomographic angiography
- DAPT, dual antiplatelets therapy
- HAS-BLED, hypertension, abnormal liver or kidney function, stroke, bleeding, labile international normalized ratio, elderly, drugs (aspirin, other antiplatelets, or anticoagulants) score
- LAA, left atrial appendage
- LCX, left circumflex artery
- OACs, oral anticoagulants
- RLAAC, robotics-assisted left atrial appendage clip exclusion
- TEE, transesophageal echocardiography
- TES, thromboembolic stroke
- atrial fibrillation
- left atrial appendage
- oral anticoagulant intolerance
- robotic cardiac surgery
- stroke prevention
Collapse
|
34
|
Suzuki W, Nakano Y, Ando H, Takashima H, Amano T. Dynamic Changes in Coronary Flow Pattern During Transcatheter Aortic Valve Replacement in Severe Aortic Stenosis. JACC Case Rep 2021; 3:1480-1482. [PMID: 34693346 PMCID: PMC8511413 DOI: 10.1016/j.jaccas.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
Coronary flow reserve in patients with severe aortic stenosis decreases even in the absence of coronary stenosis. In this case, the dynamic changes in the coronary flow pattern around transcatheter aortic valve replacement were observed by periprocedural transesophageal echocardiography. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
| | - Yusuke Nakano
- Address for correspondence: Dr. Yusuke Nakano, Department of Cardiology, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi 480-1195, Japan. @Osky59035187
| | | | | | | |
Collapse
|
35
|
Muller SA, Leavis HL, Taha K, Koenderman L, Chamuleau SAJ, Suyker WJL, Cramer MJ. Repetitive Immune-Mediated Noninfectious Endocarditis Necessitating 5 Mitral Valve Replacements. JACC Case Rep 2021; 3:1483-8. [PMID: 34693347 DOI: 10.1016/j.jaccas.2021.07.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/13/2021] [Accepted: 07/26/2021] [Indexed: 01/31/2023]
Abstract
We present a young patient who had to undergo 5 mitral valve replacements (MVR) because of a repetitive immune-mediated noninfectious endocarditis. The patient was treated with multiple anti-inflammatory drugs and high-dose prednisone. After the fifth MVR, the patient remained in stable condition using Anakinra after 22 months of follow-up. (Level of Difficulty: Advanced.).
Collapse
|
36
|
Elsherif A, Nadir A, Ludman PF, Khan SQ. Retrieval of Entrapped Catheter-Mounted Axial Flow Pump From Mitral Subvalvular Apparatus Using a Snare Catheter. JACC Case Rep 2021; 3:1494-1498. [PMID: 34693349 PMCID: PMC8511436 DOI: 10.1016/j.jaccas.2021.06.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/10/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022]
Abstract
Axial-flow ventricular assist devices are being increasingly used to support hemodynamically compromised patients undergoing percutaneous coronary intervention. Periprocedural valvular complications have been recognized in a few case reports. We present a unique case of entanglement of the Impella within he mitral subvalvular apparatus, retrieved successfully using a snare under fluoroscopic guidance. (Level of Difficulty: Advanced.)
Collapse
Key Words
- ACS, acute coronary syndrome
- CA, coronary angiography
- CABG, coronary artery bypass graft
- CMR, cardiac magnetic resonance
- ECG, electrocardiogram
- LVEF, left ventricular ejection fraction
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- axial-flow pump
- double kiss crush stenting
- left main stem
- left ventricular assist device
- mechanical circulatory support
- mitral valve injury
- percutaneous coronary intervention
Collapse
Affiliation(s)
- Ahmed Elsherif
- Department of Interventional Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Cardiology Department, Faculty of Medicine, Suez Canal University Hospital, Egypt
| | - Adnan Nadir
- Department of Interventional Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Peter F Ludman
- Department of Interventional Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Sohail Q Khan
- Department of Interventional Cardiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
37
|
Vaidy A, Sadek A, Patil P, Van Decker W, Kumaran M, Holten J, Isaac-Walshon M, Nobee A, Akhtar I, Gannon MP. An Anatomic Curiosity: A Sliver of a Liver in an Unusual Location. JACC Case Rep 2021; 3:1541-4. [PMID: 34693356 DOI: 10.1016/j.jaccas.2021.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/27/2021] [Accepted: 08/16/2021] [Indexed: 11/23/2022]
Abstract
A 48-year-old woman underwent preoperative cardiac testing prior to gastric bypass. She was incidentally found to have a right atrial mass on transthoracic echocardiography. Subsequent cardiac magnetic resonance confirmed this finding. She underwent excision of the mass. Tissue pathology revealed ectopic hepatic tissue. (Level of Difficulty: Advanced.)
Collapse
|
38
|
Carr K, Yetman A, Garg R. Mitral Annular Disjunction Associated With Fatal Ventricular Arrhythmia in an Adolescent With Marfan Syndrome. JACC Case Rep 2021; 3:1551-1556. [PMID: 34693358 PMCID: PMC8511475 DOI: 10.1016/j.jaccas.2021.08.006] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/11/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
We discuss an adolescent with Marfan syndrome and a previous aortic valve-sparing root replacement who was found to have mitral annular disjunction on surveillance cardiac imaging in the setting of recurrent palpitations. Ambulatory heart rate monitoring incidentally captured a fatal ventricular arrhythmia, a well-recognized but underappreciated cause of sudden cardiac death in patients with Marfan syndrome. (Level of Difficulty: Advanced.)
Collapse
Key Words
- AHRM, ambulatory heart rate monitor
- CMR, cardiac magnetic resonance
- CT, computed tomography
- MAD, mitral annular disjunction
- MFS, Marfan syndrome
- MRA, magnetic resonance angiography
- MVP, mitral valve prolapse
- Marfan
- SCD, sudden cardiac death
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- arrhythmia
- connective tissue disorder
- mitral annular disjunction
- sudden cardiac death
Collapse
Affiliation(s)
- Karen Carr
- Department of Pediatrics, University of California-Los Angeles, Los Angeles, California, USA
| | - Anji Yetman
- Internal Medicine and Pediatric Cardiology, Division of Cardiovascular Medicine, Children's Hospital & Medical Center, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ruchira Garg
- Department of Pediatric Cardiology, The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| |
Collapse
|
39
|
van Rijn D, Hendriks AA, Noten AMME, van Heerebeek L, Khan M. Practical Applications of Concomitant Pulmonary Vein Isolation and Left Atrial Appendix Closure Device Implantation. JACC Case Rep 2021; 3:1409-1412. [PMID: 34557681 PMCID: PMC8446027 DOI: 10.1016/j.jaccas.2021.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022]
Abstract
Pulmonary vein isolation (PVI) using cryoballoon causes acute tissue edema of the osteal region of the pulmonary veins and the left atrium. In two cases combining PVI with an implantation of a left atrial appendage closure device led to malsizing of the device, device shouldering, and a paraprosthetic residual flow. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Dafne van Rijn
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Astrid A Hendriks
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Anne-Marie M E Noten
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Loek van Heerebeek
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Muchtiar Khan
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| |
Collapse
|
40
|
Zern EK, Ramirez PR, Rubin J, Rosenfield K, Manning P, Raz Y, Funamoto M, D'Alessandro D, Crowley JC, Shelton K. Severe Tricuspid Valve Endocarditis: A Tale of 2 Circuits. JACC Case Rep 2021; 3:1343-1349. [PMID: 34505066 PMCID: PMC8414435 DOI: 10.1016/j.jaccas.2021.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 10/31/2022]
Abstract
A 25-year-old woman with severe tricuspid valve endocarditis and septic pulmonary emboli required VA-ECMO for recurrent hypoxemia-induced cardiac arrest. We present the clinical challenges requiring ECMO circuit reconfiguration and a percutaneous approach for vegetation debulking. (Level of Difficulty: Intermediate.).
Collapse
Affiliation(s)
- Emily K Zern
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paolo R Ramirez
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Jonah Rubin
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Rosenfield
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Patrick Manning
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yuval Raz
- Pulmonary and Critical Care Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Masaki Funamoto
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David D'Alessandro
- Cardiac Surgery Division, Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jerome C Crowley
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Shelton
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
41
|
Vaturi M, Vaknin-Assa H, Shapira Y, Perl L, Levi A, Koren A, Kornowski R. First-in-Human Percutaneous Transcatheter Tricuspid Valve Replacement With a Novel Valve. JACC Case Rep 2021; 3:1281-1286. [PMID: 34471878 PMCID: PMC8387838 DOI: 10.1016/j.jaccas.2021.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/07/2021] [Accepted: 06/11/2021] [Indexed: 05/08/2023]
Abstract
The surgical intervention to treat isolated severe tricuspid regurgitation (TR) is challenging due to the severe TR patients' high-risk profile, hence associated with a high complication rate. Herein, we describe a first-in-human percutaneous deployment of a novel transcatheter prosthetic xenograft valve to treat severe TR. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Mordehay Vaturi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Address for correspondence: Dr. Mordehay Vaturi, Department of Cardiology, Rabin Medical Center, Beilinson Hospital, 39 Jabotinsky Street, Petach Tikva 4941492, Israel.
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yaron Shapira
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arnon Koren
- Department of Vascular Surgery, Rabin Medical Center, Petach Tikva, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva, affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
42
|
Aroney NP, Rajani R, Patterson T, Allen CJ, Gill H, Grapsa J, Hancock J, Prendergast B, Redwood S. "Gazing Into the Abyss": Transcatheter Mitral Valve-in-Valve Implantation Through a Cavernous Left Atrium. JACC Case Rep 2021; 3:1332-1335. [PMID: 34471889 PMCID: PMC8387806 DOI: 10.1016/j.jaccas.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/28/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
We describe the case of a 73-year-old woman presenting with heart failure, a degenerating bioprosthetic mitral valve, and severely dilated left atrium, and highlight the role of multimodality imaging in planning transseptal transcatheter mitral valve-in-valve implantation. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Nicholas P Aroney
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Ronak Rajani
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Bioengineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Tiffany Patterson
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher J Allen
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Harminder Gill
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.,School of Bioengineering and Imaging Sciences, King's College London, London, United Kingdom
| | - Julia Grapsa
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jane Hancock
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Bernard Prendergast
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Simon Redwood
- Cardiovascular Directorate, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
43
|
Bhatnagar R, Rabadia SV, Gupta B, Prosper AE, Ptaszny ME, Shamsa K. Intracardiac Aspergilloma in a Post-Transplant Patient: A Multimodal Approach to Diagnosis. JACC Case Rep 2021; 3:1264-1268. [PMID: 34471875 PMCID: PMC8387809 DOI: 10.1016/j.jaccas.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 02/05/2021] [Indexed: 11/30/2022]
Abstract
Cardiac aspergillomas are rare and associated with high mortality. We present a case of right ventricular cardiac aspergilloma in an asymptomatic renal transplant recipient. Intracavitary aspergilloma is an important consideration in evaluation of an intracardiac mass in an immunocompromised patient. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Roshni Bhatnagar
- Department of Internal Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Soniya V Rabadia
- Department of Internal Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Bali Gupta
- Department of Internal Medicine, University of California-Los Angeles Olive View, Sylmar, California, USA
| | - Ashley E Prosper
- Department of Radiology, University of California Los Angeles, Los Angeles, California, USA
| | - Magdalena E Ptaszny
- Department of Internal Medicine, University of California-Los Angeles, Los Angeles, California, USA
| | - Kamran Shamsa
- Department of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| |
Collapse
|
44
|
Carmeliet T, Vermeersch P, Prihadi EA. Late Clinical Valve Thrombosis After Transcatheter Aortic Valve Replacement Despite Non-Vitamin K Anticoagulant. JACC Case Rep 2021; 3:1275-1280. [PMID: 34471877 PMCID: PMC8387837 DOI: 10.1016/j.jaccas.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/20/2022]
Abstract
This study presents the case of a late clinical leaflet thrombosis 1.5 years after percutaneous aortic valve replacement, despite adequate non-vitamin K anticoagulant therapy. Optimal antithrombotic therapy after transcatheter aortic valve replacement remains undetermined. After switching to vitamin K antagonist therapy, complete resolution occurred at 3 months follow-up. (Level of Difficulty: Intermediate.).
Collapse
Key Words
- AF, atrial fibrillation
- DOAC, direct oral anticoagulants
- INR, international normalized ratio
- LVEF, left ventricular ejection faction
- MDCT, multidetector computed tomography
- OAC, oral anticoagulation
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- VKA, vitamin K antagonist
- anticoagulation
- case report
- heart failure
- thrombosis
- transcatheter aortic valve replacement
Collapse
Affiliation(s)
- Tom Carmeliet
- Cardiology Department, University Hospital of Brussels, Brussels, Belgium
| | | | | |
Collapse
|
45
|
Shoda M, Yamamoto H, Kawashima M, Kondo T, Murakami H, Kawai H, Takaya T. Acute Coronary and Cerebral Emboli From a Pedunculated Ascending Aorta Thrombus. JACC Case Rep 2021; 3:1194-1199. [PMID: 34401758 PMCID: PMC8353561 DOI: 10.1016/j.jaccas.2021.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 11/26/2022]
Abstract
Hyperprolactinemia is a risk factor for thrombus formation. We present a rare case of a mobile ascending aorta thrombus leading to acute myocardial infarction and cerebral infarction in a patient with idiopathic hyperprolactinemia. (Level of Difficulty: Beginner.).
Collapse
Affiliation(s)
- Mitsuhiko Shoda
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hiroyuki Yamamoto
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan
| | - Motoharu Kawashima
- Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Takeshi Kondo
- Division of Legal Medicine, Department of Community Medicine and Social Healthcare Science, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hirohisa Murakami
- Division of Cardiovascular Surgery, Hyogo Brain and Heart Center, Himeji, Japan
| | - Hiroya Kawai
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan.,Division of Cardiovascular Medicine, Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomofumi Takaya
- Division of Cardiovascular Medicine, Hyogo Brain and Heart Center, Himeji, Japan.,Division of Cardiovascular Medicine, Department of Exploratory and Advanced Search in Cardiology, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
46
|
Ibrahim W, Hoschtitzky A, Thakuria L, Li W, Semple T, Clague J, Ghonim S, Seitler S, Gatzoulis MA, Al-Sakini N. Follow the Lead: The Challenges of Cardiogenic Shock in Device-Related Infective Endocarditis. JACC Case Rep 2021; 3:1163-1169. [PMID: 34401751 PMCID: PMC8353571 DOI: 10.1016/j.jaccas.2021.05.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/17/2021] [Indexed: 01/19/2023]
Abstract
We present the challenging case of a young man with congenital heart disease who survived severe device-related infective endocarditis and new pulmonary hypertension. He required prolonged mechanical circulatory support and had multiple significant complications. His case posed a management dilemma that was successfully resolved by effective multidisciplinary, tertiary center care. (Level of Difficulty: Beginner.).
Collapse
Key Words
- CT, computed tomography
- DRE, device-related endocarditis
- ECMO
- ECMO, extracorporeal membrane oxygenation
- ICU, intensive care unit
- MCS, mechanical circulatory support
- MDT, multidisciplinary team
- PET, positron emission tomography
- PH, pulmonary hypertension
- PPM, permanent pacemaker
- RV, right ventricular
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- congenital
- infective endocarditis
- mechanical circulatory support
- mycotic aneurysm
- pulmonary embolism
- pulmonary hypertension
Collapse
Affiliation(s)
- Wasyla Ibrahim
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Andreas Hoschtitzky
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom.,Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Louit Thakuria
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Wei Li
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Thomas Semple
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Jonathan Clague
- Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Sarah Ghonim
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Samuel Seitler
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | - Michael A Gatzoulis
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Nada Al-Sakini
- Adult Congenital Heart Centre and National Centre for Pulmonary Hypertension, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
47
|
Shetty M, Lampert MB, Levisay J, Erwin JP, Ricciardi MJ. Iatrogenic Atrial Septal Defect Closure Following Mitral Transcatheter Edge-to-Edge Repair: When Do You Close? JACC Case Rep 2021; 3:357-360. [PMID: 34317536 PMCID: PMC8311052 DOI: 10.1016/j.jaccas.2020.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/02/2020] [Accepted: 12/09/2020] [Indexed: 12/02/2022]
Abstract
Transcatheter edge-to-edge repair has revolutionized the management of mitral regurgitation in the high surgical-risk population. Iatrogenic atrial septal defects (iASDs) are an obligatory consequence of the procedure. The long-term sequelae of persistent iASDs are unknown but are believed to be dependent on their size, directionality of flow, and underlying hemodynamics. We discuss an uncommon scenario of a post–transcatheter edge-to-edge repair iASD that required immediate closure. (Level of Difficulty: Intermediate.)
Collapse
Affiliation(s)
- Mrinali Shetty
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Mark B Lampert
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Justin Levisay
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - John P Erwin
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA.,University of Chicago Pritzker School of Medicine, Chicago Illinois, USA
| | - Mark J Ricciardi
- Division of Cardiology, Department of Medicine, NorthShore University Healthsystem, Evanston, Illinois, USA
| |
Collapse
|
48
|
Petrov IS, Stankov ZI, Boychev DB. Valve Cracking Before Valve-In-Valve Transcatheter Aortic Valve Implantation to Treat Severe Paravalvular Leak. JACC Case Rep 2021; 3:875-881. [PMID: 34317645 PMCID: PMC8311279 DOI: 10.1016/j.jaccas.2020.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 12/01/2020] [Accepted: 12/24/2020] [Indexed: 11/29/2022]
Abstract
A patient with severe bioprosthesic patient-prosthesis mismatch, severe paravalvular leak, and symptoms of heart failure New York Heart Association functional class III was successfully treated using valve cracking followed by valve-in-valve transcatheter aortic valve implantation with excellent results at 1-year follow-up. (Level of Difficulty: Advanced.)
Collapse
Key Words
- BVF, bioprosthetic valve fracturing
- NYHA, New York Heart Association
- PPM, patient-prosthesis mismatch
- PVL, paravalvular leak
- RCA, right coronary artery
- SHV, surgical heart valve
- TAVI, transcatheter aortic valve implantation
- TEE, transesophageal echocardiography
- THV, transcatheter heart valve
- TTE, transthoracic echocardiography
- ViV, valve-in-valve
- balloon valve fracturing
- paravalvular leak
- transcatheter aortic valve implantation
- valve cracking
- valve-in valve
Collapse
Affiliation(s)
| | | | - Damyan B. Boychev
- Address for correspondence: Dr. Damyan B. Boychev, Acibadem City Clinic Cardiovascular Center, Sofia, Sofia 1000, Bulgaria.
| |
Collapse
|
49
|
Shah MA, Dalak FA, Alsamadi F, Shah SH, Qattea MB. Complications Following Percutaneous Mitral Valve Edge-to-Edge Repair Using MitraClip. JACC Case Rep 2021; 3:370-376. [PMID: 34317539 PMCID: PMC8311053 DOI: 10.1016/j.jaccas.2020.12.046] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/21/2020] [Accepted: 12/24/2020] [Indexed: 11/17/2022]
Abstract
Percutaneous mitral valve edge-to-edge repair with MitraClip (Abbott, Abbott Park, Illinois) has emerged as an effective and safe treatment for symptomatic mitral regurgitation in suitable patients. The safety of the MitraClip procedure is well established, and the rate of major complications is 4.35%. We present 4 cases of mitral regurgitation in patients who had complications following the MitraClip procedure. (Level of Difficulty: Intermediate.)
Collapse
|
50
|
Sammour Y, Chawla S, Tsutsui RS, Patel J, Harb S, Kapadia S. Transcatheter Closure of Left Ventricular Outflow Tract-to-Left Atrium Fistula. JACC Case Rep 2021; 3:760-765. [PMID: 34317621 PMCID: PMC8311196 DOI: 10.1016/j.jaccas.2021.02.040] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/05/2021] [Accepted: 02/15/2021] [Indexed: 10/29/2022]
Abstract
Surgical and rarely transcatheter aortic valve replacement can be complicated by intracardiac fistula. Transcatheter closure of those shunts has been previously reported with favorable results. We describe a case of percutaneous closure of left ventricular outflow tract-to-left atrium fistula after surgical aortic valve replacement using an Amplatzer Vascular Plug II. (Level of Difficulty: Advanced.).
Collapse
Affiliation(s)
- Yasser Sammour
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sanchit Chawla
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Rayji S Tsutsui
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Jayendrakumar Patel
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Serge Harb
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| |
Collapse
|