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  • 1
    Online Resource
    Online Resource
    Abstract 12772: Transcatheter Aortic Valve Replacement Improves Functional and Quality Of Life Outcomes in Patients With Low Gradient Aortic Stenosis
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Aortic stenosis (AS) is the most common valvular disease, and severe disease can significantly impact morbidity. Less data exists examining the functional and quality of life (QOL) effects of transcatheter aortic valve replacement (TAVR) in patients with severe low-gradient AS in both low-flow and normal-flow states. Hypothesis: Patients with symptomatic, severe, low-gradient AS would have improvements in functional and QOL outcomes at 30-days and 1-year following TAVR procedures. Methods: A single center, retrospective study examined symptomatic, severe, low-gradient AS variants. These had an aortic valve area of ≤1.0 cm 2 , mean transvalvular gradient 〈 40 mmHg, and peak aortic valve velocity of 〈 4 m/s. Classical low-flow low-gradient (CLFLG) AS was defined as a left ventricular ejection fraction (LVEF) 〈 50%. CLFLG group underwent dobutamine stress echo to assess AS severity (Stage D2). Paradoxical low-flow low-gradient (PLFLG) AS was defined as LVEF ≥50% and a stroke volume index (SVi) ≤35mL/m 2 (Stage D3). Normal-flow low-gradient (NFLG) AS was defined as LVEF ≥50% and SVi 〉 35mL/m 2 (Stage D4). The primary outcome was change in New York Heart Association (NYHA) classification and a 12-item Kansas City Cardiomyopathy Questionnaire overall score (KCCQ-OS) at 30-days and 1-year following TAVR. Results: A total of 191 patients were included for analysis: 46 CLFLG, 83 PLFLG, and 62 NFLG AS. At baseline, 130 (68%) had NYHA class III or IV symptoms. Mean baseline KCCQ-OS for all groups was 38±23 (Figure 1). The mean KCCQ-OS at 30-days and 1 year were 62±22 and 68±20. There were no significant differences in KCCQ-OS between the groups at 30-days and 1-year. Following TAVR, 92% and 88% of the cohort had NYHA class I or II symptoms at 30-days and 1 year. Conclusions: Patients with symptomatic, severe low-gradient AS had significant and sustained improvements in their functional and QOL metrics at 30-days and 1-year following TAVR procedures regardless of flow-state.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.12772
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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  • 2
    Online Resource
    Online Resource
    The pivotal role of PFO in paradoxical embolism following venous sclerotherapy: a unique case report with pathological correlations
    Oxford University Press (OUP) ; 2021
    In:  European Heart Journal - Case Reports Vol. 5, No. 8 ( 2021-08-01)
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    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 5, No. 8 ( 2021-08-01)
    Abstract: Vein sclerosing therapy for varicose veins remains an extremely popular procedure. Cerebrovascular accidents can be a serious complication. A patent foramen ovale (PFO) can act as a conduit to the arterial circulation, which could explain the adverse neurologic consequence of this procedure. This case provides pathologic evidence of this concept. Case summary  A 66-year-old female presented with syncope after undergoing varicose vein sclerotherapy. A computed tomography angiography of the head and neck in the emergency room revealed an occluded right distal M1 middle cerebral artery. Clot retrieval was performed with final pathology revealing amorphous material consistent with an exogenous agent, polidocanol foam, which was used for the patient’s vein sclerotherapy. A transthoracic echocardiogram and transoesophageal echocardiogram showed a PFO, which was ultimately closed percutaneously. Discussion  In a quarter of the population, lack of closure of the intrauterine interatrial shunt leads to the existence of a PFO. This direct communication between the atria provides an anatomical conduit for paradoxical emboli and eventually infarction of affected tissues. While a paradoxical embolism is an uncommon cause of acute arterial occlusion, it can have catastrophic sequelae. Historically, the presence of an arterial thrombus from the venous circulation has been difficult to establish unless the thrombus is visualized in transit through a PFO. Complications from vein sclerotherapy have been reported in the literature and include transient ischaemic attacks and strokes, however, this is the first case to provide pathological proof of a paradoxical embolism, which ultimately resulted in percutaneous closure of the PFO.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytab228
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2948381-5
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  • 3
    Online Resource
    Online Resource
    Percutaneous mitral valve repair: The MitraClip device
    Global Cardiology Science and Practice ; 2016
    In:  Global Cardiology Science and Practice Vol. 2016, No. 2 ( 2016-10-05)
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    In: Global Cardiology Science and Practice, Global Cardiology Science and Practice, Vol. 2016, No. 2 ( 2016-10-05)
    Abstract: Chronic mitral regurgitation (MR) is the most common cardiac valvular disease with more than 4 million people in the United States alone suffering from moderate or severe MR. Left untreated, chronic MR results in serious consequences. Surgical correction with mitral valve repair or replacement remains the mainstay of therapy for MR. Nevertheless, a large proportion of patients may not be offered treatment due to concerns over surgical risk. This unmet therapeutic need for a less invasive approach led to a marked explosion in the development of a variety of transcatheter approaches to treat mitral regurgitation in the past decade. The majority of these devices are based on principles learned from surgical mitral valve repair techniques. Inspired by the Alfieri surgical technique, the MitraClip edge-to-edge repair system is the most advanced technique with the highest safety and efficacy to date. In this review, we discuss the current status of the MitraClip repair system in the treatment of mitral regurgitation. 
    Type of Medium: Online Resource
    ISSN: 2305-7823
    URL: Article
    DOI: 10.21542/gcsp.2016.17
    Language: Unknown
    Publisher: Global Cardiology Science and Practice
    Publication Date: 2016
    detail.hit.zdb_id: 2738381-7
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  • 4
    Online Resource
    Online Resource
    Case report: percutaneous closure of residual leak following left atrial appendage occlusion
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Case Reports Vol. 4, No. 4 ( 2020-08-01), p. 1-4
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    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 4, No. 4 ( 2020-08-01), p. 1-4
    Abstract: Transcatheter left atrial appendage occlusion (LAAO) using Watchman device has been demonstrated to be efficacious in decreasing stroke risk in patients with atrial fibrillation who are not suitable for long-term anticoagulation. Residual leaks are frequently encountered following LAAO procedures and their clinical implications and optimal management remain controversial. Case summary In this report, we describe a case of peri-Watchman device leak treated successfully with percutaneous device closure using an Amplatzer Vascular Plug II device. Discussion The clinical implications of peri-device leaks remain controversial with general consensus to continue anticoagulation along with serial imaging for larger leaks ( & gt;5 mm). As an alternative strategy, percutaneous closure of these leaks has been attempted in hope of avoiding anticoagulation and minimizing the risk of stroke and should be studied further.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytaa139
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2948381-5
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  • 5
    Online Resource
    Online Resource
    Case report: Buddy wire technique to facilitate atrial septal crossing during transcatheter transseptal mitral valve implantation
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Case Reports Vol. 4, No. 6 ( 2020-12-01), p. 1-4
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 4, No. 6 ( 2020-12-01), p. 1-4
    Abstract: Transcatheter mitral valve-in-valve implantation (MVIV) has emerged as a viable treatment option in patients at high risk for surgery. Occasionally, despite appropriate puncture location and adequate dilation, difficulty is encountered in advancing the transcatheter heart valve across interatrial septum. Case summary We describe a case of a 79-year-old woman with severe chronic obstructive pulmonary disease (COPD), prior surgical bioprosthetic aortic and mitral valve replacement implanted in 2007, atrial fibrillation, and Group II pulmonary hypertension who presented with progressively worsening heart failure symptoms secondary to severe bioprosthetic mitral valve stenosis and moderate-severe mitral regurgitation. Her symptoms had worsened over several months, with multiple admissions at other institutions with treatment for both COPD exacerbation and heart failure. Transoesophageal echocardiogram demonstrated preserved ejection fraction, normal functioning aortic valve, and dysfunctional mitral prosthesis with severe stenosis (mean gradient 13 mmHg) and moderate-severe regurgitation. After a multi-disciplinary heart team discussion, the patient underwent a transcatheter MVIV implantation. During the case, inability in advancing the transcatheter heart valve (THV) across interatrial septum despite adequate septal balloon pre-dilation was successfully managed with the support of a stiff ‘buddy wire’ anchored in the left upper pulmonary vein using the same septal puncture. The patient tolerated the procedure well and was discharged home. Discussion Operators should be aware of potential strategies to advance the THV when difficulty is encountered in crossing the atrial septum despite adequate septal preparation. One such strategy is the use of stiff ‘buddy wire’ for support which avoids the need for more aggressive septal dilatation.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytaa373
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2948381-5
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  • 6
    Online Resource
    Online Resource
    Abstract 13525: The Mitraclip System Improves Cardiovascular Outcomes Compared to Medical Management in the Setting of Cardiogenic Shock
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Circulation Vol. 146, No. Suppl_1 ( 2022-11-08)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 146, No. Suppl_1 ( 2022-11-08)
    Abstract: Introduction: Cardiogenic shock (CS) is associated with high mortality and morbidity. Severe mitral regurgitation (MR) in the setting of CS is associated with poor outcomes. Transcatheter Edge-to-Edge Repair (TEER) with the Mitraclip system is commonly used to treat MR, though its use in CS is less defined. Hypothesis: TEER with Mitraclip in patients with moderate to severe MR and CS improves cardiovascular outcomes compared to medical management alone. Methods: A single-center, retrospective study included adult patients with moderate to severe MR and CS between 2012 and 2021. Moderate to severe MR was defined by grades 3+ and 4+ MR. CS was defined as a sustained systolic blood pressure 〈 90mmHg for at least 1 hour, use of inotropes, vasopressors, or mechanical circulatory support, and clinical and laboratory findings of end-organ damage. The primary outcome was major adverse cardiovascular events (MACE) defined as cardiovascular death, heart failure admission, stroke, and myocardial infarction at 30 days and 6 months. The secondary outcome was change in New York Heart Association (NYHA) classification. Results: There were 28 patients included in the medical management and 33 in the Mitraclip groups. Table 1 includes this study’s outcomes. There were no significant differences in patients with a MACE at 30 days (13 vs. 8, p=0.069), though there were significant differences at 6 months (12 vs. 7, p=0.002). There were no differences in cardiovascular death. Patients in the Mitraclip group had fewer heart failure admissions at 6 months (p= 〈 0.001), though not at 30 days. At 30 days, more patients in the Mitraclip group improved to NYHA classes I/II compared to medical management alone (10 [35.7%] vs. 16 [50%] , p=0.043). There were no differences in NYHA classes I/II at 6 months (7 [43.7%] vs. 13 [54.2%] , p=0.63). Conclusions: TEER using the Mitraclip system improves mid-term cardiovascular outcomes in patients with CS compared to medical management alone.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.146.suppl_1.13525
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1466401-X
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