Chronic inflammatory rheumatoid diseases (CIRD) such as rheumatoid arthritis, systemic lupus erythematosus, and systemic sclerosis are an important risk factor for the development of ischaemic heart disease and a source of high cardiovascular morbidity and mortality. In patients affected by CIRD, inflammation can affect coronary microvascular function and contribute to the development of myocardial ischemia and cardiovascular events, even in the absence of obstructive epicardial coronary artery disease. Understanding the molecular aspects that underlie the development of coronary microvascular dysfunction (CMD) in CIRD is of fundamental importance to identify specific therapeutic targets. In this article, we review the pathogenic mechanisms leading to CMD in CIRD, including the controversial results obtained with the use of different therapeutic strategies. We also propose that a practical diagnostic algorithm as the identification of CMD in patients with CIRD may lead to effective measures to prevent the development of angina pectoris and reduce the risk of rapid disease progression.
BACKGROUND Left main coronary artery (LMCA) disease treatment is traditionally surgical in most cases. Continuous improvement of devices and the emergence of drug-eluting stents (DES) has increased indications of percutaneous treatment in these high-risk lesions. The main objective of this study was to evaluate the efficacy and safety of percutaneous coronary intervention (PCI) with DES on LMCA at a 10 year follow-up.
METHODSWe prospectively included 324 patients (69.53 AE 12.60 years, 73.4% male) with severe LMCA disease undergoing PCI from June 2006 to April 2015. We evaluated major cardiovascular events defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (RLT) and stent thrombosis after long-term clinical follow-up (median 41.5 months).
Percutaneous pulmonary valve implantation (PPVI) is recognized as a feasible and low risk alternative to surgery to treat dysfunctional right ventricular outflow tract (RVOT) in usually pluri-operated patients. Evolving technology allowed to develop different kind of prosthesis and to go from an initial treatment exclusively of stenotic conduit to an actual approach extended also to wide native RVOT. The Melody transcatheter pulmonary valve (TPV) and the Edwards Sapien valve are nowadays the most commonly implanted prostheses. However, other devices have been developed to treat large RVOT (i.e., the Venus p-valve, the Medtronic Harmony TPV, the Alterra Adaptive Prestent, and the Pulsta valve). Indications for PPVI are the same as for surgical interventions on pulmonary valve, with limits related to the maximum diameter of the available percutaneous prosthesis. Therefore, an accurate preoperative evaluation is of paramount importance to select patients who could benefit from this procedure. The overall periprocedural mortality incidence is around 1.4%, while freedom from RVOT reintervention ranges from 100% at 4 months to 70% at 70 months, according to the different published studies.
Nowadays, percutaneous pulmonary valve implantation (PPVI) is a suitable alternative to surgical procedure in patients with right ventricle outflow tract dysfunction. Two valves are currently available for PPVI: the Melody valve and the Edwards Sapien valve. The following complications may occur: coronary artery compression, deformation of the aortic root, stent or valve embolization, damage of distal pulmonary arteries, access site injuries. Here, we report on three cases of severe tricuspid regurgitation due to valvular and subvalvular apparatus damage during Edwards Sapien XT valve implantation.
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