Hepatotoxicity of Chemotherapy and Immune Checkpoint Inhibitors.

Hepatotoxicity from oncologic drugs represents an increasing clinical burden for patients, providers, and the health care system. The complexity of clinical presentations, multi-drug regimens, and the need to control the underlying cancer while preserving liver function, results in significant diagnostic and therapeutic challenges. These challenges are best met with a careful and systematic approach with multi-disciplinary management decisions between oncology and hepatology providers.

Unmet needs in the clinical management of chronic hepatitis B infection.

The hepatitis B virus (HBV) remains a global problem despite effective tools to prevent, diagnosis, and control it. Unmet needs are identifiable across its clinical care cascade, underlining the challenges providers face in delivering effective care for patients with chronic hepatitis B. The review herein will focus on three timely clinical issues in HBV.

Impact of Tricuspid Regurgitation on Outcomes After Transcatheter Mitral Valve Replacement.

Development of functional tricuspid regurgitation (TR) because of chronic mitral disease and subsequent heart failure is common. However, the effect of TR on clinical outcomes after transcatheter mitral valve replacement (TMVR) remains unclear. We aimed to evaluate the impact of baseline TR on outcomes after TMVR.

Transcatheter Paravalvular Leak Closure With Covered Stent Tract and Vascular Plug: Tootsie Roll Technique.

Background: Transcatheter closure of transcatheter heart valve (THV)-related paravalvular leak (PVL) is associated with a high failure rate with available devices due to the complex interaction of THV and aortic/mitral annulus.

Objectives: This study reports on novel transcatheter techniques to treat PVL after THV.

Methods: The authors describe consecutive patients who underwent PVL closure after transcatheter aortic valve replacement (TAVR) or transcatheter mitral valve replacement (TMVR).

Hybrid Closure of Postinfarction Apical Ventricular Septal Defect Using Septal Occluder Device and Right Ventricular Free Wall: The Apical BASSINET Concept.

Background: Postinfarction ventricular septal defect (VSD) is a catastrophic complication of myocardial infarction. Surgical repair still has poor outcomes. This report describes clinical outcomes after a novel hybrid transcatheter/surgical repair in patients with apical VSD.

Trends and outcomes of combined percutaneous (TAVI+PCI) and surgical approach (SAVR+CABG) for patients with aortic valve and coronary artery disease: A National Readmission Database (NRD) analysis.

Background: In patients with severe aortic stenosis (AS) and concomitant severe coronary artery disease (CAD), the relative merits of a combined percutaneous (transcatheter aortic valve implantation [TAVI] and percutaneous coronary intervention [PCI]] versus surgical approach (surgical aortic valve replacement [SAVR] and coronary artery bypass graft [CABG]) remain unknown.

Aims: To determine the utility of combined percutaneous versus surgical approaches in patients with severe AS and CAD.

Methods: The National Readmission Database (NRD) (2015-2019) was queried to identify all cases of TAVI+PCI and SAVR+CABG.

Physician-Modified Endograft-Facilitated Transcatheter Pulmonary Valve Replacement in Large Right Ventricular Outflow Tract.

Background: Transcatheter pulmonary valve replacement (TPVR) in patients with a congenital or acquired abnormality resulting in enlarged right ventricular outflow tract (RVOT) is challenging and may preclude treatment with dedicated devices. We describe a technique using a physician-modified endograft to facilitate TPVR.

Methods: Six patients underwent physician-modified endograft-facilitated TPVR for severe symptomatic pulmonary insufficiency with enlarged RVOT.

Persistently Elevated HBV Viral-Host Junction DNA in Urine as a Biomarker for Hepatocellular Carcinoma Minimum Residual Disease and Recurrence: A Pilot Study.

Hepatitis B virus (HBV)-host junction sequences (HBV-JSs) has been detected in the urine of patients with HBV infection. This study evaluated HBV-JSs as a marker of minimum residual disease (MRD) and tumor recurrence after treatment in HBV-hepatocellular carcinoma (HCC) patients. Archived serial urine DNA from two HBV-HCC with recurrence as confirmed by MRI and four HBV-related cirrhosis (LC) patients were used.

Chronic Hepatitis B Virus: What an Internist Needs to Know: Serologic Diagnosis, Treatment Options, and Hepatitis B Virus Reactivation.

Chronic hepatitis B virus (HBV) infection is a bloodborne infection which affects approximately 1.6 million persons in the U.S.

First Application of the LAMPOON Procedure to a Surgical Mitral Bioprosthesis.

A cardiogenic shock patient with a history of a surgical mitral valve replacement presented to the hospital with critical mitral stenosis with thickening of prosthetic valve leaflets and thrombus in left atrial appendage. We considered TMVR inside of the degenerated bioprosthetic valve. However, there were two concerns during TMVR based on multimodality imaging assessment: 1) LVOT obstruction due to the surgical bioprosthetic leaflet, 2) stroke due to left atrial appendage thrombus.

A little leak goes a long way! 5-Year-outcome after transcatheter aortic valve implantation.

Mild paravalvular leak after TAVR is associated with increased 5-year mortality. Current noninvasive and invasive prediction models for mortality may only hold for short term outcomes. Other imaging modalities aside from transthoracic echocardiography should be strongly considered when assessing paravalvular leak, regardless of severity.