Cardiovascular revascularization medicine : including molecular interventions
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Cardiovasc Revasc Med · Jan 2019
ReviewTakotsubo syndrome: State-of-the-art review by an expert panel - Part 1.
Takotsubo syndrome (TTS) is an acute cardiac condition independent of epicardial coronary obstruction that mimics acute coronary syndrome and is characterized by acute heart failure with reversible ventricular motion abnormalities. This consensus paper is the result of a multinational effort aiming to summarize the current state of the art on TTS. ⋯ Several novel and unique sections are emphasized in this document, including the current state of the art on genetics of takotsubo syndrome, microRNAs (miRs), racial differences, role of cardiac spectroscopy and intracoronary imaging, as well as mechanical circulatory support. In part 1 of this two-part manuscript, we discuss how TTS came to be known, several patterns and forms it can take in patients, epidemiology and pathophysiology of the syndrome, and clinical presentation.
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Cardiovasc Revasc Med · Dec 2018
Case ReportsIatrogenic atrial septal defect post mitral valve in valve implantation.
A 75 year-old female with symptomatic severe mitral regurgitation of a bio-prosthetic valve secondary to valve leaflet perforation due to endocarditis underwent a mitral valve in valve replacement in an existing Hancock 27 mm valve using a trans-femoral/trans-septal approach. The procedure was complicated by an iatrogenic atrial septal defect post trans-septal puncture causing a severe right-to-left shunt due, possibly, to the combination of severe pulmonary hypertension and moderate tricuspid regurgitation the patient had suffered from at base line. Once the sheath was removed an immediate desaturation was observed which required emergent closure with an AMPLATZER ASD Occluder device (St. ⋯ This stabilized the patient and returned her blood oxygen levels to normal. The case brings forth a rare but important complication that may occur during trans-septal procedures especially when using large sheaths. It emphasizes the importance of proper echocardiographic and hemodynamic evaluation prior to such procedures in order to be prepared for such complications.
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Cardiovasc Revasc Med · Oct 2018
Review Case ReportsTransseptal transcatheter mitral valve-in-valve for treatment of severe mitral regurgitation in failed bioprosthesis complicated with cardiogenic shock: Case report and review of the literature.
Patients in cardiogenic shock due to severe failure of a mitral bioprosthesis have extremely high risk for repeat standard cardiac surgery. This patient population may benefit the most form the least invasive intervention. We report a successful transseptal mitral valve-in-valve implant performed in a patient in cardiogenic shock due to a flail mitral bioprosthesis requiring bridging intravenous inotropic and intra-aortic balloon pump support.
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Cardiovasc Revasc Med · Sep 2018
Review Meta AnalysisLong term outcomes of new generation drug eluting stents versus coronary artery bypass grafting for multivessel and/or left main coronary artery disease. A Bayesian network meta-analysis of randomized controlled trials.
Most data guiding revascularization of multivessel disease (MVD) and/or left main disease (LMD) favor coronary artery bypass grafting (CABG) over percutaneous coronary intervention (PCI). However, those data are based on trials comparing CABG to bare metal stents (BMS) or old generation drug eluting stents (OG-DES). Hence, it is essential to outcomes of CABG to those of new generation drug eluting stents (NG-DES). ⋯ Our study suggests that NG-DES is an acceptable alternative to CABG in patients with MVD and/or LMD. However, repeat revascularization remains to be lower with CABG than with PCI.