Emergent Transcatheter Tricuspid Edge-to-Edge Repair for Right Ventricular Shock From Tricuspid Regurgitation in Hypertrophic Cardiomyopathy.

Background: Transcatheter tricuspid edge-to-edge repair (T-TEER) is an emerging technology used to treat severe tricuspid regurgitation (TR). The pivotal trials demonstrating the safety and efficacy of T-TEER exclude patients with severely reduced left ventricular function (≤20%).

Case Summary: We demonstrate the use of T-TEER in a patient with end-stage hypertrophic cardiomyopathy who suffered acute, torrential TR and subsequently developed cardiogenic shock as a complication of high-risk transvenous lead extraction.

Completion peripheral angiography in single-access, Impella-assisted, high-risk PCI: Using a buddy microcatheter sheath after MANTA closure for imaging and potential bailout.

High-risk percutaneous coronary intervention (HR-PCI) is increasingly performed, often with mechanical circulatory support (MCS) provided by devices like the Impella CP. Bleeding and vascular complications remain concerns for HR-PCI, leading to significantly higher in-hospital mortality, duration of stay, and cost, which are important considerations in the decisions surrounding MCS support for HR-PCI. Newly introduced, single-catheter techniques for Impella-supported HR-PCI, along with recent approvals of dedicated large-bore closure devices (MANTA®-Vascular Closure Device) may reduce bleeding and vascular complications, but have limitations with regard to completion of peripheral angiography and/or postclosure percutaneous bailout options.

Prosthetic Valve Endocarditis After TAVR and SAVR: Insights From the PARTNER Trials.

Background: Prosthetic valve endocarditis (PVE) is a rare but critical mechanism of valve failure and death after transcatheter and surgical aortic valve replacement (TAVR, SAVR) warranting further analysis in modern aortic valve replacement experience. We characterize the incidence, risk factors, microbiological profile and outcomes of PVE from the PARTNER trials and registries (Placement of Aortic Transcatheter Valve).

Methods: We analyzed a pooled cohort of all patients in PARTNER 1 and PARTNER 2 trials and registries.

Iatrogenic Left Circumflex Coronary Artery Fistula after Mitral Valve Replacement.

• LCx injury during MV surgery occurs at a frequency of about 1%. • Injury typically occurs in the proximal vessel near the MV anterolateral commissure. • Echocardiography is important in diagnosing and assessing coronary artery fistulas.

Exercise N-13 cardiac positron emission tomography myocardial perfusion imaging detecting ischemia in an adult patient with anomalous aortic origin of the left main coronary artery from the right coronary sinus.

Anomalous aortic origin of a coronary artery is a rare congenital condition that has variable presentations from atypical chest pain to syncope and cardiac arrest. Commonly used myocardial perfusion imaging techniques, stress agents, and perfusion agents may have limited ability to detect inducible ischemia in this rare patient group. We herein describe a unique case of anomalous left main coronary artery from a common right coronary sinus ostium with a subpulmonic and intramyocardial course.

Emergency valve-in-valve transcatheter aortic valve replacement in a patient with degenerated bioprosthetic aortic stenosis and cardiogenic shock on veno-arterial extracorporeal membrane oxygenation.

The use of transcatheter aortic valve replacement (TAVR) as an acute treatment in severe decompensated bioprosthetic aortic valve disease is not well documented. We describe herein a unique case in which valve-in-valve (ViV) TAVR was successfully used as both an emergency salvage therapy and a bridge to definitive fourth reoperative aortic valve replacement (AVR) in a young patient with cardiogenic shock secondary to bioprosthetic aortic valve stenosis who was dependent on veno-arterial extracorporeal membrane oxygenation (VA-ECMO). © 2017 Wiley Periodicals, Inc.

Appropriateness of percutaneous coronary intervention: a review.

The appropriateness of coronary revascularization for various clinical scenarios has been reviewed formally by several specialty and subspecialty societies resulting in the formulation of scored appropriateness criteria. The goal of the appropriateness criteria is to guide physician decision-making and future research as well as to label coronary revascularization more clearly for patients and payors in regards to its expected benefits in certain situations. The appropriateness criteria were formulated from a standardized process and are intended to be updated at regular intervals as new data further elucidates the clinical roles of revascularization.

Takotsubo cardiomyopathy: definition and clinical profile.

Takotsubo cardiomyopathy (TTC) is an increasingly recognized, reversible cardiomyopathy with a clinical presentation that mimics an acute coronary syndrome but without evidence of obstructive coronary lesions. Typical presentation involves chest pain and/or dyspnea, transient ST-segment elevation on the electrocardiogram, and a modest increase in cardiac troponin. Cardiac imaging demonstrates wall-motion abnormalities that extend beyond the territory of a single epicardial coronary artery, and the absence of obstructive coronary lesions.

Variables associated with utilization of a centralized medical post in the Andean community of Pampas Grande, Peru.

Context: Integral to the location of health resources is the distance decay of utilization observed in a population. In rural Peru, a nongovernmental organization planning to increase the availability of health services needed this information.

Purpose: To determine variables associated with utilization of a central medical clinic and determine whether, because of the mountainous topography, travel time (TT) would be a better predictor of utilization than distance.

Coincidence of apical ballooning syndrome (tako-tsubo/stress cardiomyopathy) and posterior reversible encephalopathy syndrome: potential common substrate and pathophysiology?

Background: Apical ballooning syndrome (ABS) and posterior reversible encephalopathy syndrome (PRES) are recently described, seemingly unrelated, reversible conditions. The precise pathophysiology of these syndromes remains unknown. The aim of this study was to describe the clinical characteristics and outcomes of a unique series of patients with both ABS and PRES.

Importance of the C2, N7, and C8 positions to the mutagenic potential of 8-Oxo-2'-deoxyguanosine with two A family polymerases.

8-Oxo-2'-deoxyguanosine (OdG) is a prominent DNA lesion produced from the reaction of 2'-deoxyguanosine (dG) with reactive oxygen species. While dG directs the insertion of only dCTP during replication, OdG can direct the insertion of either dCTP or dATP, allowing for the production of dG → dT transversions. When replicated by Klenow fragment-exo (KF-exo), OdG preferentially directs the incorporation of dCTP over dATP, thus decreasing its mutagenic potential.

Myocardial ischaemia in patients with coronary endothelial dysfunction: insights from body surface ECG mapping and implications for invasive evaluation of chronic chest pain.

Aims: Coronary endothelial dysfunction (ED), by predisposing to abnormal vasomotion, may cause chest pain in individuals with non-obstructed coronary arteries. The aim of this study was to correlate the magnitude of coronary ED with the presence and extent of inducible myocardial ischaemia using body surface electrocardiogram (ECG) mapping in symptomatic patients.

Methods And Results: In 30 patients with chest pain and angiographically normal coronary arteries or mild atherosclerosis, we studied endothelium-dependent responses with acetylcholine (ACH) and endothelium-independent function with nitroglycerin and adenosine in the left anterior descending artery.

Self-assessed disability and self-rated health among rural villagers in Peru: a brief report.

Context: Risks for poor self-rated overall health in rural areas of developing nations have not been thoroughly investigated.

Purpose: The objective of this study was to assess potential risk factors for poor self-rated health among rural villagers in Peru.

Methods: A door-to-door survey of villagers residing in the Pampas Grande region in Peru, which is in the Andes Mountains, yielded complete data for 337 adults.