Kardiol Pol
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Case Reports
Transcatheter aortic valve implantation using direct aortic access: first procedures in Poland.
Transcatheter aortic valve implantation (TAVI) is an alternative option for the treatment of severe aortic stenosis in patients carrying an elevated operative risk of conventional surgical aortic valve replacement (AVR). Recently, data from randomised clinical trials confirmed superiority of TAVI when compared with the conservative treatment in inoperable patients, and its non-inferiority when compared with AVR in a high-risk population. Transfemoral vascular access remains the preferred route for delivering the bioprosthesis. However, in a significant proportion of patients, the presence of severe iliac-femoral arteriopathy or small vessel diameter render the transfemoral approach unusable. In this article, we report the first Polish experience of two successful TAVI procedures with bioprostheses (both balloon- and self-expandable) delivered using direct aortic access.
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Efficacy and safety of radiofrequency (RF) ablation in patients with atrial fibrillation (AF) strongly depend on the possibility of three-dimensional (3D) visualisation of atria as well as the ostia of pulmonary veins. Current angiographic systems allow 3D visualisation of anatomical heart structures using rotational angiography. ⋯ We conclude that 3D-ATG after contrast agent administration into the right atrium seems to be a safe and effective method to visualise pulmonary venous ostia and left atrial anatomy. It remains to be established whether it enables evaluation of anatomical anomalies.
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Acute aortic dissection occurs in 0.5-2.95 cases per 100,000 citizens-year. Although the modern diagnostic tools help in more accurate diagnosis, the missleading findings still occure. We present a case of a 72-year-old man who was admitted to cardiology ward due to persistent chest pain. ⋯ Neither CT nor transthoracic echocardiography were negative for aortic dissection. Intraoperatively aortic dissection limited to Valsalva sinuses was found. Left main orifice was blindly closed followed by Bentall procedure and coronary artery revascularisation.
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The rate of early complications of carotid artery stenting (CAS) should not exceed 3% in asymptomatic and 6% in symptomatic patients. However, some recent studies/registries failed to reach this threshold, fueling a debate on the role of CAS in the treatment of patients with carotid artery stenosis. ⋯ CAS with EPD and stent type selection on the basis of thorough non-invasive diagnostic work-up (tailored- -CAS) is safe. Advanced age was associated with an increased risk of death and the presence of prior neurological symptoms was a predictor of death/stroke at 30 days. With the tailored-CAS approach, high-risk lesion features (soft/thrombus- -containing/tight/ulcerated) are eliminated as a risk factor. Hyperperfusion syndrome is a severe CAS complication which may lead to intracranial bleeding and death. Acute, iatrogenic embolic cerebral artery occlusion is rare and may be managed by combined intracranial mechanical and local thrombolytic therapy.