Coronary Artery Disease
Impact of Side-Branch Predilation on Angiographic Outcomes in Non-Left Main Coronary Bifurcation Lesions
Sam Mirzaee, MD, MPH; Mourushi Isa, BMedSc; Udit Thakur, MBBS, MPH; James D. Cameron, MBBS, MD, BE(Elec), MEngSc; Stephen J. Nicholls, MBBS, PhD; Benjamin K. Dundon, MBBS, PhD
Despite the high prevalence of coronary bifurcation lesions in routine interventional cardiology practice, the best strategy for managing this challenging lesion subset remains debatable. Due to potential for complications, the routine practice of side-branch (SB) predilation is controversial. We performed an electronic search of online databases up until April 2018 for studies reporting periprocedural angiographic outcomes comparing provisional main-branch stenting with and without SB predilation. Random-effects model odds ratios were calculated.
Mitral Valve Disease
Outcomes After Transcatheter Mitral Valve-in-Valve Replacement in Patients With Degenerated Bioprosthesis: A Single-Center Experience
Alexis K. Okoh, MD; Aakash Shah, BS; Nathan Kang, MS; Biruk Almaz, MD; Jordan Resnick, MD; Abdul Ghaffar, MD; Chunguang Chen, MD; Bruce Haik, MD; Marc Cohen, MD; Mark J. Russo, MD, MS
This study sought to describe a single center’s experience with transcatheter mitral valve-in-valve (TM-ViV) implantation. Fifteen consecutive patients who had TM-ViV due to degenerative biological valve prosthesis over a 4-year period were identified from a prospectively maintained database and mid-term clinical and hemodynamic outcomes were examined.
Chronic Total Occlusions
Electrocautery-Facilitated Crossing (ECFC) of Chronic Total Occlusions
Saroj Neupane, MD; Mir Basir, DO; Khaldoon Alaswad, MD
The use of electrocautery (EC)-facilitated re-entry in an aorto-ostial chronic total occlusion (CTO) of the right coronary artery was first described in 2016. Since then, little has been reported about the use of EC in lesion crossing during CTO percutaneous coronary intervention. This case series demonstrates that the use of energized stiff guidewires to perform EC-faciliated crossing can be of great value for CTO lesions when standard CTO techniques fail.
Chronic Total Occlusions
No-Reflow Complicating Chronic Total Occlusion Coronary Revascularization
Gianni Dall’Ara, MD, PhD; Luca Testa, MD; Carlo Tumscitz, MD; Alessio Mattesini, MD; Gabriele Luigi Gasparini, MD; Simone Grotti, MD; Mario Bollati, MD; Fabio Tarantino, MD; Carlo Di Mario, MD, PhD; Jacopo Andrea Oreglia, MD
Our objectives were to assess the incidence of no-reflow in patients undergoing CTO-PCI, to analyze possible causes and differential diagnoses, and to identify useful management approaches. We reviewed no-reflow complications in this multicenter observational study, all CTO-PCIs performed between January 2018 and April 2019.
Initiation of Extracorporeal Membrane Oxygenation in the Cardiac Catheterization Laboratory: The Mayo Clinic Experience
Bradley Ternus, MD; Jacob Jentzer, MD; Kyle Bohman, MD; Gregory Barsness, MD; Gregory Schears, MD; Charanjit Rihal, MD; Gurpreet Sandhu, MD, PhD
Extracorporeal membrane oxygenation (ECMO) support is indicated for the management of patients with cardiogenic shock or refractory cardiac arrest in the cardiac catheterization laboratory. We reviewed 25 patients initiated on ECMO support and assessed outcomes for 30-day mortality, blood product transfusion, vascular injury, prolonged respiratory failure, stroke, ischemic bowel, renal failure requiring hemodialysis, and compartment syndrome.
Coronary Artery Disease
Hemopericardium Following Transseptal Puncture During Balloon Mitral Valvotomy: Management Strategies and Outcomes
Arunkumar Panneerselvam, MD, DM; Rajiv Ananthakrishna, MD, DM; Budanur Chikkaswamy Srinivas, MD, DM; Srinivasa K. Hemanna Setty, MD, DM, DNB; Satvic C. Manjunath, MD, DM; Dinesha Basavanna, MD, DM; Manjunath C. Nanjappa, MD, DM
Hemopericardium is a major complication of balloon mitral valvotomy (BMV). Only a few studies are available to address this issue following transseptal access. In addition, the management strategy regarding completion of BMV is uncertain. In this prospective study, we sought to determine the incidence of hemopericardium complicating transseptal puncture during BMV. Management strategies and outcomes are also highlighted.
Innovations in Clinical Education
Virtual-Reality Guided Versus Fluoroscopy-Guided Transseptal Puncture in a Cardiac Phantom
Ryan C. James, PhD; Wayne L. Monsky, MD, PhD; Neal W. Jorgensen, PhD; Stephen P. Seslar, MD, PhD
We compared virtual-reality guided versus fluoroscopy-guided transseptal puncture by novice and experienced operators in a cardiac phantom. Outcome measures included accuracy, time, transseptal path distance, and a survey of the operators’ experience. Virtual reality compared with fluoroscopic guidance for transseptal puncture shows considerable promise, particularly for novice trainees, where it could lessen the learning curve. Current barriers to widespread implementation are discussed.
Transcatheter Aortic Valve Replacement
Investigation of Computed-Tomography Based Predictors of Acute Stroke Related to Transcatheter Aortic Valve Replacement: Aortic Wall Plaque Thickness Might be a Predictive Parameter of Stroke
Masaki Miyasaka, MD; Rahul P. Sharma, MD; Yoshio Maeno, MD, PhD; Masataka Taguri, PhD; Sung-Han Yoon, MD; Hiroyuki Kawamori, MD, PhD; Norio Tada, MD; Shigeaki Kato, Prof, PhD; Sharjeel Israr, MD; Takahiro Nomura, MD; Tomoki Ochiai, MD; Yigal Abramowitz, MD; Tarun Chakravarty, MD; Mamoo Nakamura, MD; Wen Cheng, MD; John D. Friedman, MD; Daniel S. Berman, MD; Raj R. Makkar, MD
Little information is available on computed tomography (CT)-based predictors of stroke related to transcatheter aortic valve replacement (TAVR). The objective of this study was to determine whether anatomical features of the aortic valve and aorta visualized by CT are predictive parameters of stroke. We included 1270 patients who underwent a pre-procedural contrast-enhanced CT assessment and TAVR for severe aortic valve stenosis.
Excimer Laser Coronary Angioplasty (ELCA): Fundamentals, Mechanism of Action, and Clinical Applications
Mohaned Egred, BSc (Hons), MB ChB, MD and Emmanouil S. Brilakis, MD, PhD
Laser coronary angioplasty was developed to modify atherosclerotic plaque and help with the limitations of balloon angioplasty. We outline the practical procedural techniques and clinical applications of ELCA.
Sequential Use of Alcohol Septal Ablation and Electrosurgical Leaflet Resection Prior to Transcatheter Mitral Valve Replacement (TMVR)
Ashleigh Long, MD, PhD and Paul Mahoney, MD
To our knowledge, this is the first time the sequential use of alcohol septal ablation followed by electrosurgical leaflet resection prior to TMVR has been reported. This dual strategy approach may allow more patients with severe mitral valve disease to undergo TMVR in the future.
Left Ventricular Noncompaction: A Rare Cause of Effort Angina Unveiled During Left Heart Catheterization
L. Graça Santos, MD; R. Carvalho, MD; F. Montenegro, MD; F. Saraiva, MD; J. Guardado, MD; J. Morais, PhD
Effort angina is an under-appreciated presentation of left ventricular non-compaction that frequently leads to a late diagnosis. Cardiac ventriculography can assist in this diagnosis.
Late Manifestation of Pulmonary Cement Embolism Visualized by Coronary Angiography
Ali Dogan, MD; Humam Baki, MD; Emrah Ozdemir, MD; Nuri Kurtoglu, MD
Following percutaneous vertebroplasty for vertebral compression fracture 6 years prior, late pulmonary cement embolism developed after leakage of the cement into the paravertebral venous plexus.
Uncorrected Univentricular Heart in an Adult
Nicholas Suraci, MD; Hisham Kassem, MD; Christos Mihos, MD; Sebastian Baquero, MD; Orlando Santana, MD
An 18-year-old male with an unknown medical history presented with palpitations and paroxysmal episodes of shortness of breath over a 7-year period. Transthoracic echocardiography displayed a univentricle with an ejection fraction of 45%. The patient refused treatment and was lost to follow-up.
Left Atrial “Pinball” Thrombus Causing Recurrent Syncope
Nicholas Suraci, MD; Adrian Santana; Guillermo Garcia, MD; Ivan Arenas, MD
A 75-year-old female was admitted due to a syncopal episode. Transesophageal echocardiography demonstrated severe mitral stenosis with a 5 cm, free-floating, left atrial thrombus intermittently obstructing the mitral valve orifice; she underwent thrombus removal and mitral valve replacement.
First Reported Case of Skin Necrosis Due to Prolonged Mechanical Compression After Transradial Catheterization
Ioannis Tsiafoutis, MD; Theodoros Zografos, MD, PhD; Michael Koutouzis, MD; Konstatina Katsanou, MD; Dimosthenis Tsoutsos, MD
We present a patient under triple-antithrombotic therapy who underwent prolonged mechanical compression after radial intervention; the subsequent necrosis at the access site required surgical repair.
Urschel’s Sign in Paget-Schroetter Syndrome: Multimodality Evaluation by Extravascular and Intravascular Imaging
Wai Kin Chi, MBChB; G.M. Tan, MBChB; Bryan P. Yan, FRCP
Paget-Schroetter Syndrome is potentially life-threatening. In this case, multidisciplinary imaging with extravascular and intravascular evaluation guided the proper diagnosis and treatment planning.