Methodist DeBakey cardiovascular journal
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Methodist Debakey Cardiovasc J · Apr 2015
ReviewThe Left Atrial Appendage: Target for Stroke Reduction in Atrial Fibrillation.
A patient with atrial fibrillation (AF) has a greater than 5% annual risk of major stroke, a 5-fold increase compared to the general population. While anticoagulation remains the standard stroke prevention strategy, the nature of lifelong anticoagulation inevitably carries an increased risk of bleeding, increased stroke during periods of interruption, increased cost, and significant lifestyle modification. Many patients with atrial fibrillation have had their left atrial appendage (LAA) ligated or excised by surgeons during cardiac surgery, a decision based largely on intuition and with no clear evidence of efficacy in stroke risk reduction. ⋯ The surgical AtriClip has been FDA approved since 2009 and is currently the most widely used LAA exclusion device placed through an epicardial approach. Small studies have shown excellent reliability and success of complete LAA closure with the AtriClip device, which is implanted through an epicardial approach. Currently, we are conducting a multicenter trial to demonstrate the stroke prevention potential of this epicardial device through a short (45 minute), stand-alone, minimally invasive procedure in lieu of lifelong anticoagulation in patients at high risk of bleeding.
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Methodist Debakey Cardiovasc J · Oct 2014
ReviewRole of embolization for cerebral arteriovenous malformations.
Cerebral arteriovenous malformations (AVMs) are complex high-flow lesions that can result in devastating neurological injury when they hemorrhage. Embolization is a critical component in the management of many patients with cerebral AVMs. ⋯ Although the treatment-related morbidity and mortality for AVMs--including that due to microsurgery, embolization, and radiosurgery--can be substantial, its natural history offers little solace. Fortunately, care by a multidisciplinary team experienced in the comprehensive management of AVMs can offer excellent results in most cases.
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Methodist Debakey Cardiovasc J · Oct 2014
ReviewBypasses and reconstruction for complex brain aneurysms.
Microsurgery for brain aneurysms is a current relevant technique, as advances in endovascular and stent-assisted coiling have not solved many of the difficulties inherent in the management of complex brain aneurysms. The following review highlights the importance of microsurgical bypass techniques for the management of complex cerebrovascular aneurysms and emphasizes, through two clinical cases, the technical difficulties and indications for bypass surgery. These cases demonstrate that in selected scenarios, bypass microsurgery still offers the only viable treatment for complex aneurysms.
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Methodist Debakey Cardiovasc J · Oct 2014
ReviewThe role of microsurgical resection and radiosurgery for cerebral arteriovenous malformations.
Cerebral arteriovenous malformations (AVMs) present unique challenges to cerebrovascular specialists. Management of these lesions begins with assessing their natural history. ⋯ Microsurgical resection and radiosurgery are both well-validated tools used in selectively treating cerebral AVMs. This manuscript offers a general review of the management of cerebral AVMs with multimodality treatment recommendations.
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Methodist Debakey Cardiovasc J · Jul 2014
ReviewInterventional imaging: the role of echocardiography.
Interventional echocardiography is a rapidly evolving field requiring imaging expertise. An increasing number of structural heart interventions now require real-time imaging guidance for device placement and immediate functional evaluation. Continuous 2- and 3-dimensional transesophageal echocardiography are now required by many heart teams during complex structural interventions, including percutaneous closure of atrial septal defects, left atrial appendage occlusion, transcatheter aortic valve replacement (TAVR), transcatheter repair of paravalvular regurgitation, and percutaneous mitral valve repair. In this review, we describe the role of echocardiography during the initial structural evaluation, throughout the device placement procedure, and for the assessment of acute device function and complications.