Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Oct 2013
ReviewState-of-the-art paper: Therapeutic hypothermia in out of hospital cardiac arrest survivors.
Out of hospital cardiac arrest (OHCA) is associated with an extremely poor survival rate, with mortality in most cases being related to neurological injury. Among patients who experience return of spontaneous circulation (ROSC), therapeutic hypothermia (TH) is the only proven intervention shown to reduce mortality and improve neurological outcome. ⋯ While recent technological advances in TH will likely improve outcomes in OHCA survivors, several fundamental questions remain to be answered including the optimal speed of cooling, which patients benefit from an early invasive strategy, and whether technological advances will facilitate application of TH in the field. An increased awareness and understanding of TH strategies, devices, monitoring, techniques, and complications will allow for a more widespread adoption of this important treatment modality.
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Catheter Cardiovasc Interv · Oct 2013
Case ReportsTranscatheter aortic valve implantation in a patient with mechanical mitral prosthesis: a lesson learned from an intraventricular clash.
We hereby present the case of a patient with severe aortic stenosis who underwent in her previous medical history a mitral valve replacement with a mechanical valve (Omnicarbon 27), and progressively developed a severe aortic stenosis. This patient was judged inoperable and then scheduled for CoreValve Revalving System implantation. Despite a good positioning of the CoreValve, an acute, severe mitral regurgitation developed soon after implantation as a consequence of the impaired movement of the mitral prosthesis leaflet. ⋯ A good mitral prosthesis function was restored disengaging the CoreValve from the aortic annulus. After few months, the patients underwent successful Edwards-Sapien valve implantation through the Corevalve. This case strongly demonstrates how much a careful evaluation of the features of the mitral prosthesis and patient anatomy is crucial to select which specific transcatheter bioprosthesis would better perform.
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Catheter Cardiovasc Interv · Oct 2013
Case ReportsAngioplasty of acquired pulmonary vein stenosis using covered stent.
One of the most serious complications post-catheter ablation of atrial fibrillation is the development of pulmonary vein stenosis. Controversy currently exists about the optimal treatment approach. The use of balloons and larger stents (~10 mm) results in more optimal outcome than just balloon angioplasty alone; however, even with stent implantation, recurrent restenosis may occur in 30 to 50% of patients. ⋯ This was initially stented with good result but soon after developed restenosis and required balloon angioplasty. Following the third episode of restenosis, stenting of the pulmonary vein was performed using a covered stent. The pulmonary vein has remained patent for the last 5 years.
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Catheter Cardiovasc Interv · Oct 2013
Case ReportsTranscatheter closure of a traumatic ventricular septal defect using an Amplatzer™ atrial septal occluder device.
A relatively rare occurrence, the incidence of ventricular septal defect (VSD) complicating penetrating cardiac trauma has been reported at 4.5%. Closing such defects may be challenging especially in an unstable patient where cardiopulmonary bypass may exponentially increase the surgical risk. In such patients, catheter-based device closure is a reliable and effective alternative. ⋯ Post-device closure, the patient developed hemolysis attributed to an intra- device residual leak. The hemolysis resolved without any complications by conservative medical management. At latest follow-up the patient is in NYHA functional class I-II.
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Catheter Cardiovasc Interv · Oct 2013
Observational StudyPredictors and outcomes after transcatheter aortic valve implantation using different approaches according to the valve academic research consortium definitions.
We report the results of a large single-center study evaluating predictors and outcomes after transcatheter aortic valve implantation (TAVI) with different devices and access routes according to the Valve Academic Research Consortium (VARC). ⋯ Comparable results were achieved with different devices and access routes in a heart team approach. Baseline and perioperative predictors of all-cause mortality were identified, contributing to the refinement of patient and device selection criteria for TAVI.