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Acute Left Main Coronary Occlusion Following Transcatheter Aortic Valve Implantation

World Journal of Cardiovascular Diseases 2024年第11期14卷 695-700页

作者： Alekhya Abburu Basharat Ahmad Abdallah Masri David Nery Sharon Rufus aultman deuble heart and vascular center Canton OH USA Department of Cardiology Aultman Deuble Heart and Vascular Center Canton OH USA

Background: Aortic stenosis (AS) is caused by either age-related degeneration of aortic valve or congenital malformation of aortic cusps. Severe aortic valve stenosis is a clinically emerging diagnosis in the current world. The three cardinal signs of severe AS are dyspnea, syncope, and angina. Transcatheter aortic valve implantation is one of the safe and effective methods for treating severe aortic valve stenosis, and an alternative to surgery in high-risk patients. Aortic valve calcification and changes after TAVI were specifically assessed by computed tomography. Excessive aortic valve calcification is related to procedural complications. A possible consequence is obstruction of coronary ostia. Heavy calcification of the aortic valve and surrounding structure is an important risk factor for coronary obstruction, heart block, and embolization during aortic valve implantation (TAVI). Here we present a case of an elderly old man, where critical ostial left main coronary artery (LMCA) disease was caused by shifting of a calcium speck rather than obstruction with native leaflet. He was successfully rescued by an emergent CABG. Methods and Results: This is a case of a 69-year-old man with severe calcific aortic stenosis and single-vessel CAD who underwent TAVI with a relatively unremarkable course. Notably, his pre-operative TAVI angiography showed no LMCA stenosis. But 10 days later he presented to the ER with acute myocardial infarction with peak high-intensity troponins, diffuse ST changes, and cardiogenic shock. Urgent coronary angiography and intravascular ultrasound showed critical LMCA stenosis caused by a speck of calcium externally abating the vessel. He underwent emergency coronary artery bypass grafting;intraoperative TEE confirmed the etiology. He had an uneventful postoperative course and was successfully weaned off vasoactive medications. Conclusion: This case illustrates that obstruction of coronary ostia could be a possible complication of TAVI. Calciu

关键词： TAVI (Transcatheter Aortic Valve Implantation) LMCA (Left Main Coronary Artery) CAD (Coronary Artery Disease) TEE (Transoesophageal Echocardiography) Intravascular Ultrasound Severe Calcific Aortic Stenosis CABG (Coronary Artery Bypass Grafting)

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Feasibility of MRI in Patients with Non-Pacemaker/Defibrillator Metallic Devices and Abandoned Leads

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Journal of Biomedical Science and Engineering 2021年第3期14卷 83-93页

作者： Prabhakaran P. Gopalakrishnan Loretta Gevenosky Robert W. W. Biederman Division of Cardiology Aultman Deuble Heart and Vascular Hospital Canton OH USA Cardiovascular MRI center Allegheny Health Network Cardiovascular Institute Pittsburgh PA USA

Objective: To evaluate feasibility of MRI in patients with non-pacemaker (PM)/Implantable cardioverter defibrillator (ICD) metallic devices and abandoned leads. Background: Relative safety of MRI performed using specified protocol has been established in MR non-conditional PM/ICDs. With limited safety data, many non-PM/ICD metallic devices and abandoned leads continue to be a contraindication for MRI. Methods: We retrospectively analyzed consecutive patients with extra-cardiac devices, non-programmable cardiac devices, and abandoned leads, who underwent MRI (GE 1.5 Tesla, WI) at a single tertiary care center over a span of 13 years. Scan protocol was designed to maintain specific absorption rate (SAR) Results: The cohort comprised 127 MRI exams representing 94 patients, with 13 patients having two or more scans. The devices consisted of: 23 vagal nerve stimulators (VNS), 22 implantable loop recorders, 16 spinal stimulators, 5 peripheral nerve stimulators, 3 bladder stimulators, 2 deep brain stimulators, 1 gastric stimulator, 1 bone stimulator, 1 WATCHMAN device, 22 abandoned PM/lCD leads and 1 VNS lead. There was no immediate (peri-MRI exam) morbidity or mortality. Patients did not report any discomfort, palpitations, heating, or sensation of device migration during the exam. Local follow-up data was available in 65% (100% for thoracic imaging) with a mean of 190 ± 475 days (median 13 days). No device malfunction was reported during follow-up. Conclusions: With appropriate precautions, MRI is feasible in patients with extracardiac devices, nonprogrammable cardiac devices, and abandoned leads.

关键词： MRI Safety Pacemaker Abandoned Leads Implantable Loop Recorder Extra-Cardiac Devices

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Repetitive narrow QRS tachycardia in a 61-year-old female patient with recent palpitations

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Journal of Geriatric Cardiology 2018年第2期15卷 193-198页

作者： Andras Vereckei Laszlo Geller 3^rd Department of Medicine Semmelwels University Budapest Hungary heart and vascular center Semmelweis University Budapest Hungary

A 61-year-old female patient suffering from recent onset palpitations and dyspnea on exertion with hypertension and mitral valve prolapse in her past history came to our outpatient department. Echocardiography revealed a mild mitral valve prolapse, slightly decreased left ventricular （LV） function （LV ejection fraction： 51%） and a mild mitral regurgitation.

关键词： Dual AV nodal nonreentrant tachycardia Electrocardiography Supraventricular tachycardia

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Evolving concept of dyssynchrony and its utility

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Journal of Geriatric Cardiology 2022年第1期19卷 44-51页

作者： Priyanka Satish Bharat Narasimhan Andreas Hagendorff Bhupendar Tayal Houston Methodist DeBakey heart and vascular center HoustonTXUSA Leipzig University Hospital Department of CardiologyLeipzigGermany

The role of electromechanical dyssynchrony in heart failure gained prominence in literature with the results of trials of cardiac resynchronization therapy(CRT).CRT has shown to significantly decrease heart failure hospitalization and mortality in heart failure patients with *** guidelines recommend the use of electrical dyssynchrony based on a QRS>150 ms and a left bundle branch block pattern on surface electrocardiogram to identify dyssynchrony in patients who will benefit from CRT ***,predicting response to CRT remains a challenge with nearly one-third of patients gaining no benefit from the *** echocardiographic measures of mechanical dyssynchrony have been studied over the past two ***,trials where mechanical dyssynchrony used as an additional or lone criteria for CRT failed to show any benefit in the response to *** shows that a deeper understanding of cardiac mechanics should be applied in the assessment of *** review discusses the evolving role of imaging techniques in assessing cardiac dyssynchrony and their application in patients considered for device therapy.

关键词： cardiac mortality gained

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Successful cardiopulmonary resuscitation combined with thrombolysis for massive pulmonary embolism during peri-cardiac arrest

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World Journal of Emergency Medicine 2022年第6期13卷 495-499页

作者： Mei-ning Li Yan-hui Lu Ya-min Li Hai-yun Wang Yu-hong Mi Emergency and Critical Care center Beijing Anzhen HospitalCapital Medical UniversityBeijing Institute of HeartLung and Blood Vascular DiseaseBeijing 100029China

Dear editor,Pulmonary thromboembolism(PTE)has become the third most lethal type of thrombotic disease in the world.[1]Thrombolysis has been advised for high-risk PTE patients,however due to its unique pathophysiology,which differs from other atherosclerotic diseases,this can still be a challenge for PTE patients.[2]We reported two cases with a high-risk of PTE that had the onset of or progressed to cardiac arrest(CA)during hospitalization and were successfully managed with cardiopulmonary resuscitation(CPR)combined with thrombolytic therapy.

关键词： resuscitation cardiac embolism

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Diagnosis and treatment of hypertensive crises in the elderly patients

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Journal of Geriatric Cardiology 2007年第1期4卷 50-55页

作者： Joseph Varon Neil E. Strickman University of Texas Health Science center at Houston Houston Texas USA Peripheral vascular Lab at HGCA Peripheral Vascular Interventional Cardiology at Texas Heart Institute / St Lukes Episcopal Hospital Houston Texas USA

Hypertension is a common clinical problem in the elderly worldwide and physicians of all types are likely to encounter patients with hypertensive urgencies and emergencies in these patients. Although various terms have been applied to these conditions, they are all characterized by acute elevations in blood pressure and evidence of end-organ injury. Prompt, but carefully considered therapy is necessary to limit morbidity and mortality. A wide range of pharmacologic alternatives are available to the practitioner to control blood pressure and treat complications in these patients. The management of the elderly patient with hypertensive crises needs to include close monitoring and a gentle decline in blood pressure to avoid catastrophic complications, exacerbation of ischemic myopathy, and vascular insufficiency.

关键词： hypertension hypertensive crises hypertensive encephalopathy aortic dissection beta-blocker calcium channel blocker clevidipine fenoldopam nitroprusside labetalol nicardipine elderly

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MitraClip:a novel percutaneous approach to mitral valve repair

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2011年第8期12卷 633-637页

作者： Hasan JILAIHAWI Asma HUSSAINI Saibal KAR Cardiovascular Interventional center Heart InstituteCedars-Sinai Medical Center

As life expectancy increases,valvular heart disease is becoming more *** of heart disease and primarily valvular heart disease is expected to represent a significant proportion of healthcare provided to the elderly *** years have brought a progression of surgical treatments toward less invasive *** has given rise to percutaneous approaches for the correction of valvular heart *** mitral valve repair using the MitraClip system (Abbott vascular,Santa Clara,CA,USA) creates a double orifice and has been successfully used in selected patients with mitral *** review the rationale,procedural aspects,and clinical data thus far available for the MitraClip approach to mitral regurgitation.

关键词： MitraClip Mitral valve Mitral regurgitation

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The role of sphingosine-1-phosphate in bone remodeling and osteoporosis

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Bone Research 2022年第2期10卷 265-273页

作者： Justus M.Grewe Paul-Richard Knapstein Antonia Donat Shan Jiang Daniel JSmit Weixin Xie Johannes Keller Department of Trauma and Orthopedic Surgery University Medical Center Hamburg-Eppendorf20246 HamburgGermany Clinic and Polyclinic for vascular Medicine University Heart Center Hamburg-Eppendorf20246 HamburgGermany Institute of Biochemistry and Signal Transduction University Medical Center Hamburg-Eppendorf20246 HamburgGermany

Osteoporosis is a systemic bone disease that affects more than 200 million people worldwide and is caused by the disruption of the equilibrium between osteoclastic bone resorption and osteoblastic bone formation. Sphingosine-1-phosphate(S1 P) is a natural,bioactive sphingolipid that has been shown to play a major role in cardiovascular and immunological pathologies by regulating biological and cellular processes, including migration, differentiation, proliferation and survival. Recent studies also suggest a central role for S1 P in bone diseases, including osteoporosis;however, the effects of S1 P, particularly in bone metabolism, remain to be further elucidated. In this review, we summarize the available literature on the role of S1 P in bone metabolism with a focus on osteoporosis. On the cellular level, S1 P acts as an osteoclast-osteoblast coupling factor to promote osteoblast proliferation and bone formation. Moreover, the recruitment of osteoclast precursors to resorption sites is regulated by the interplay of S1 P gradients and S1 P receptor expression. From a clinical perspective, increasing evidence suggests that systemically elevated S1 P blood levels may serve as an independent risk factor for osteoporosis-related fractures. Taken together, S1 P signaling is a potential therapeutic target and may serve as a novel biomarker in patients with systemic bone disease.

关键词： osteoporosis metabolism expression.

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Congenital left ventricular aneurysms and diverticula： an entity in search of an identity

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Journal of Geriatric Cardiology 2017年第12期14卷 750-762页

作者： Marc-Alexander Ohlow heart center Department of Cardiology Zentralklinik Bad Berka Germany

Congenital left ventricular aneurysm or diverticulum are rare cardiac malformations described in 809 cases since the first description in 1816, being associated with other cardiac, vascular or thoraco-abdominal abnormalities in about 70%. It appears to be a developmental anomaly, starting in the 4th embryonic week. In an experimental study, targeted knockdown of cardiac troponin T in the chick was performed at day 3, after the heart tube has formed. Morpholino treatment of gene TNNT2 at this stage led to the development of left ventricular diver- ticula （LVD） in the primitive left ventricular wall. Diagnosis of left ventricular aneurysms （LVA）/LVD can be made after exclusion of coro- nary artery disease, local or systemic inflammation or traumatic causes as well as cardiomyopathies. Clinically, most of LVA and LVD are asymptomatic or may cause systemic embolization, congestive heart failure, valvular regurgitation, ventricular wall rupture, ventricular tachycardia or sudden cardiac death. Diagnosis is established by imaging studies （echocardiography, magnetic resonance imaging or left ventricular angiography） visualizing the structural changes and accompanying abnormalities. Mode of treatment has to be individually tai- lored and depends on clinical presentation, accompanying abnormalities and possible complications, options include surgical resection （espe- cially in symptomatic patients）, anticoagulation after systemic embolization, radiofrequency ablation or implantation of an implantable car- dioverter defibrillator （ICD） in case of symptomatic ventricular tachycardias, and occasionally combined with class I- or III-antiarrhythmic drugs. Cardiac death occurs usually in childhood, is significantly more frequent in LVA patients and caused by congestive heart failure in most of the cases, whereas patients diagnosed with LVD died more frequently from rupture of the LVD.

关键词： Aneurysm Congenital Diverticulum Left ventricular Prognosis Therapy

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Role of cardiovascular intervention as a bridge to liver transplantation

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World Journal of Gastroenterology 2014年第31期20卷 10651-10657页

作者： Zankhana Raval Matthew E Harinstein James D Flaherty Bluhm Cardiovascular Institute Feinberg School of Medicine of Northwestern UniversityChicago IL 60611 United States University of Pittsburgh Medical center heart and vascular Institute Pittsburgh PA 15219 United States

End stage liver disease(ESLD) is associated with many specific derangements in cardiovascular physiology, which influence perioperative outcomes and may pro-foundly influence diagnostic and management strate-gies in the preoperative period. This review focuses on evidence-based diagnosis and management of coro-nary, hemodynamic and pulmonary vascular disease in this population with an emphasis on specific strategies that may provide a bridge to transplantation. Specifi-cally, we address the underlying prevalence of cardio-vascular disease states in the ESLD population, and relevant diagnostic criteria thereof. We highlight tradi-tional and non-traditional predictors of cardiovascular outcomes following liver transplant, as well as data to guide risk-factor based diagnostic strategies. We go on to discuss the alterations in cardiovascular physiology which influence positive- and negative-predictive values of standard noninvasive testing modalities in the ESLD population, and review the data regarding the safetyand efficacy of invasive testing in the face of ESLD and its co-morbidities. Finally, based upon the totality of available data, we outline an evidence-based ap-proach for the management of ischemia, heart failure and pulmonary vascular disease in this population. It is our hope that such evidence-driven strategies can be employed to more safely bridge appropriate candidates to liver transplant, and to improve their cardiovascular health and outcomes in the peri-operative period.

关键词： Perioperative management Liver transplantation Coronary heart disease Cirrhotic cardiomyopathy heart failure Pulmonary vascular disease

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