Volume 21 - Issue 9 - September, 2009

Structural Heart Disease Interventions: An Emerging Discipline in Cardiovascular Medicine

Roberto J. Cubeddu, MD, Ignacio Inglessis, MD, Igor F. Palacios, MD

ABSTRACT: Within the past decade, we have witnessed the exponential growth of novel percutaneous transcatheter therapies for the treatment of valvular and congenital heart disorders among others. Consequently, a new field has emerged in the world of adult cardiovascular medicine known as “structural heart disease interventions.” We herein provide a contemporary review highlighting many of the important historical landmarks that have set the stage for the development of this new and exciting subspecialty, and introduce a comprehensive overview of the structured training and challenges that ...

Post-Traumatic Ventricular Septal Defects — Review of the Literature and a Novel Technique for Percutaneous Closure

Payam Dehghani, MD, *Réda Ibrahim, MD, §Nicholas Collins, MD, David Latter, MD, Asim N. Cheema, MD, PhD, Robert J. Chisholm, MD

ABSTRACT: Post-traumatic ventricular septal defect (VSD) is infrequent, with clinical sequelae ranging from imminent death to complete spontaneous resolution. The most appropriate management strategy is unclear. Careful observation has been advocated in the management of these patients. We demonstrate this concept by reporting two different approaches in two patients with traumatic injuries to the chest and review the English-language literature of both spontaneous and percutaneous closure of these lesions. In our case of percutaneous closure, we report a novel technique involving a transsepta...

Very Late Drug-Eluting Stent Thrombosis Related to Incomplete Stent Endothelialization: (Full title below)

Santiago Jiménez-Valero, MD, Raúl Moreno, MD, Angel Sánchez-Recalde, MD

Very Late Drug-Eluting Stent Thrombosis Related to Incomplete Stent Endothelialization: In-Vivo Demonstration by Optical Coherence Tomography


ABSTRACT: Very late drug-eluting stent (DES) thrombosis is a rare but potentially life-threatening event that has become a major cause of concern. Delayed arterial healing with incomplete endothelialization is probably a pivotal factor related with DES thrombosis. Optical coherence tomography (OCT) is a new high-resolution intracoronary imaging technique that allows detailed evaluation of stent neointimal coverag...

Physician-Hospital Alignment: Finding the Sweet Spot

David E. Steckler, JD, LLM, Fielding Epstein, MHSA, JD, Ronald N. Riner, MD

Many group practices, specialists and primary-care physicians are having their practices assessed in order to determine whether the practice should: (a) remain independent; (b) merge with another practice; or (c) agree to become employed by a hospital.

We believe that these alternatives widely miss the mark. In order for a medical practice to navigate successfully in today’s economic mean streets, you have to reprogram your GPS: your “destination-goal” is no longer simply whether to stay independent, merge or seek hospital employment, since these are now just short-term decisions, and...

Consistent Door-to-Balloon Times of Less Than 90 Minutes for STEMI Patients Transferred for Primary PCI

Bina Ahmed, MD, Stefan Lischke, MD, Faye Straight, RN, Prospero Gogo, MD, Stephen Leffler, MD, Marc Kutler, MD, David J. Schneider, MD, Harold L. Dauerman, MD

Myocardial Infarction — Fusion or Confusion?

Sivakumar Ardhanari, MD, Ashok J. Shah, MD, Ranjan K. Thakur, MD, MPH

From the Thoracic and Cardiovascular Institute, Sparrow Health System & Michigan State University, Lansing, Michigan.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted February 12, 2009, provisional acceptance given March 3, 2009, final version accepted March 11, 2009.

Address for correspondence: Ranjan K. Thakur, MD, MPH, Thoracic and Cardiovascular Institute, 405 West Greenlawn, Suite 400, Lansing, MI 48910. E-mail: thakur@msu.edu



Rapid Transfer for ST-Elevation Myocardial Infarction PCI: It’s Just Not That Hard!

*James C Blankenship, MD and §Sara H. Williams

“Dost thou love life? Then do not squander time, for that is the stuff life is made of.”

— Benjamin Franklin

Seldom in medicine has an idea gained credence so rapidly as the idea that lives are saved by rapid reperfusion for ST-elevation myocardial infarction (STEMI) using percutaneous coronary intervention (PCI). Perhaps this is because it appeals to the best instincts of so many. Emergency medicine personnel are enthralled to be able to activate catheterization laboratories with pre-hospital 12-lead electrocar...

Treatment of the Budd-Chiari Syndrome (BCS) Caused by Membranous Obstruction of Inferior Vena Cava (Full title below)

Mahmoud Ebrahimi, MD

Treatment of the Budd-Chiari Syndrome (BCS) Caused by Membranous Obstruction of Inferior Vena Cava with Percutaneous Transluminal Angioplasty: Report of an Amazing Relation between Undiagnosed BCS and Infertility

From the Cardiovascular Research Center, Avicenna (Bu-Ali) Research Institute, Mashhad University of Medical Science, Mashhad, Iran, and the Interventional Cardiology Ward, Imam Reza Hospital, Mashhad University of Medical Science, Mashhad, Iran.

The author reports no conflicts of interest regarding the content herein.

Manuscript submitted February 7, 2...

Radiation Protection during Hybrid Procedures: Innovation Creates New Challenges

a,bJaclynn M. Sawdy, RT(R), a,bMark D. Gocha, RCIS, aVincent Olshove, CCP, aJoanne L. Chisolm, RN, a,dSharon L. Hill, MSN, ACNP, a,cAlistair Phillips, MD, a,b,cMark Galantowicz, MD, a,bJohn P. Cheatham, MD, a,bRalf J. Holzer, MD, MSc

ABSTRACT: Background. The cooperation between interventional cardiologists and cardiothoracic surgeons has expanded the spectrum of treatment modalities for patients with congenital heart disease. These hybrid techniques have created new challenges, one of which being the provision of adequate but practical radiation protection. This study evaluates the use of a lightweight radiation protection drape (RADPAD®) that may be suitable for shielding during hybrid procedures. Methods. To simulate a pediatric patient, an 8.7 liter water-filled tub was placed on an X-ray table and exposed to 10-secon...

Use of Rotational Atherectomy in the Body of a Saphenous Vein Coronary Graft

Creighton W. Don, MD, PhD, Igor Palacios, MD, *Kenneth Rosenfield, MD

From the Department of Medicine, Division of Cardiology, Cardiac Cath Lab and *Vascular Medicine and Intervention, Massachusetts General Hospital, Boston, Massachusetts.

The authors report no conflicts of interest regarding the content herein.

Manuscript submitted March 17, 2009, and accepted April 7, 2009.

Address for correspondence: Creighton W. Don, MD, PhD, Massachusetts General Hospital, 55 Fruit St. GB800, Boston, MA 02114. E-mail: cwdon@u.washington.edu


ABSTRACT: The use of the Rot...

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