The DASI is a simple self-administered questionnaire which is a useful pretest tool to determine a patient's ability to achieve appropriate METs. In the nuclear cardiology laboratory, the DASI has the potential to guide selection of exercise treadmill vs pharmacologic stress and ultimately improve laboratory efficiency.
ranscatheter aortic valve replacement improves mortality and health-related quality of life in patients with severe symptomatic aortic stenosis. 1 Sinus of Valsalva Aneurysm (SVA) has the potential for rupture, thrombosis, and it may worsen aortic valve regurgitation after valve deployment. 2 The presence of SVA complicates procedural planning and the optimum strategy remains unknown. Herein, we present the role of advanced structural imaging that is necessary for successful procedural outcomes. A 95-year-old man with history of severe aortic stenosis presents with exertional dyspnea (New York Heart Association class III). His echocardiogram showed a calculated left ventricular ejection fraction of 25%, aortic valve area of 0.58 cm 2 , and a mean gradient of 35 mm Hg. The calculated Society of Thoracic Surgery mortality risk was 8.3%. During transcatheter aortic valve replacement evaluation, he was found to have an SVA (Figure 1; Movie I in the Data Supplement). Detailed computed tomography-derived images visualized the aortic root and showed that it was a pseudoaneurysm of the sinus of Valsalva (Figure 2). Aortic annular dimensions were noted as aortic annular area of 567 mm 2 , perimeter of 91 mm, and elliptical diameter of 26.9×28.6 mm. A 34-mm self-expanding CoreValve Evolut (Medtronic, Minneapolis, MN) was positioned at a depth of 8 mm on the noncoronary cusp to cover the SVA. Decreased filling of the aneurysm was noted immediately after deployment (Figure 3; Movie II in the Data Supplement) and during follow-up imaging (Figure 4). At 1-month follow-up, his symptoms were improved, and his calculated left ventricular ejection fraction was 45%. The presence of SVA can complicate valve positioning and increase the risk of annular rupture. A computed tomography-derived structural imaging provides 3-dimensional visualization of the annulus and root anatomy that is necessary for optimal sizing and avoidance of procedure-related complications. 3 Self-expanding valves offer passive radial force, which carries lower risk of rupture than balloon expansion. In conclusion, transcatheter aortic valve replacement is feasible in patients with SVA using 3-dimensional CT imaging that can help direct the choice of the device and inform the deployment strategy.
A 55-year-old man presented with chest pain and was diagnosed with non–ST-segment elevation myocardial infarction. Coronary angiography revealed a 95% eccentric lesion in the mid-right coronary artery. After 3 intracoronary stents were placed, the guidewire became entrapped in 1 of the stents; multiple attempts at retrieval were unsuccessful. Ultimately, the guidewire fractured, and a coronary artery bypass graft surgery was performed to remove the guidewire fragments. This report reviews the procedural steps for wire retrieval that are critical for operators to avoid coronary artery bypass surgery.
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