Methodist DeBakey cardiovascular journal
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Methodist Debakey Cardiovasc J · Apr 2012
ReviewMultimodality noninvasive imaging for transcatheter aortic valve implantation: a primer.
Transcatheter aortic valve implantation (TAVI) has recently emerged as a treatment option for patients with severe aortic valve stenosis (AS). For patients who are deemed inoperable for surgical aortic valve replacement (SAVR), TAVI has a significant mortality benefit compared to medical therapy. This review discusses established and emerging roles for multimodality imaging and focuses on the application of these technologies for patient selection, intraprocedural guidance, and the detection and quantification of acute and chronic complications of this novel procedure.
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Methodist Debakey Cardiovasc J · Apr 2012
ReviewRole of transcatheter aortic valve implantation (TAVI) versus conventional aortic valve replacement in the treatment of aortic valve disease.
Conventional aortic valve replacement (AVR) surgery has been in clinical use since 1960. Results, particularly in high-risk populations such as the very elderly and frail, continue to improve in response to the challenges posed by this growing segment of the patient population. Transcatheter aortic valve implantation (TAVI) is a fairly recent development, performed for the first time in 2002. ⋯ Results of recent randomized prospective trials demonstrate both the future promise and current problems of the TAVI approach. Many patients deemed inoperable for AVR have been treated successfully by TAVI. However, elevated procedural and late mortality rates, excessive early and late stroke, and a significant incidence of periprosthetic aortic valve insufficiency and patient-prosthesis mismatch all suggest caution in extending this technology to patients able to undergo conventional AVR with a low risk of early or late complications.
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Methodist Debakey Cardiovasc J · Apr 2012
ReviewTranscatheter aortic valve replacement (TAVR): access planning and strategies.
Transcatheter aortic valve replacement (TAVR) has proven to be a viable tool for the high-surgical-risk population with severe aortic valve stenosis. Vascular access complications are not uncommon with TAVR and may increase early and late mortality. Avoiding these serious complications is the goal. ⋯ TAVR teams should be familiar and comfortable with these approaches as each of them has its own advantages and weaknesses. The best option is usually one in which the procedure is tailored to the patient. The present review examines our current access planning and strategies for TAVR.
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Methodist Debakey Cardiovasc J · Apr 2012
Cytomegalovirus localization in atherosclerotic plaques is associated with acute coronary syndromes: report of 105 patients.
It has been shown that cytomegalovirus (CMV) is present in coronary atherosclerotic plaques, but the clinical relevance of this presence remains to be elucidated. In this study we sought to examine CMV infection in atherosclerosis patients defined by different methods and to identify the clinical significance of CMV replication in the atherosclerotic plaques. The study included 105 consecutive patients who were admitted to our department and underwent coronary artery bypass grafting (CABG) surgical interventions. ⋯ They were also more likely to have a positive family history for cardiovascular diseases (CVD). This study confirms previous evidence about the replication of CMV virus in the atherosclerotic plaques of coronary arteries and brings clinical significance to this observation by showing a higher prevalence of acute coronary syndromes in those patients with CMV-infected plaques. Our study also suggests a familial vulnerability to CMV replication in the coronary artery walls.