Aim. In the issue we report first in Russia experience of transcatheter “valve-invalve” implantation (TVIV) for treatment of severe tricuspid stenosis due to the structural deterioration of surgical tricuspid bioprosthesis.Material and methods. TVIV was performed in 4 high-risk redo patients (1 to 3 previous sternotomies) of various ages across (18-68 years) with structural deterioration of surgical tricuspid bioprosthesis.Results. Technical success was achieved in 100% cases. Diastolic gradients on tricuspid valve markedly decreased in all patients. Peak transtricuspidal gradient decreased from 20,4 to 10 mmHg in average. Clinical improvement as assessed by 6-minute walk test after TVIV was observed in 3 patients with congestive heart failure. In 1 patient with asymptomatic right ventricle dysfunction TVIV resulted in the enhancement of echocardiographic parameters.Conclusion. TVIV is a mininvasive alternative to conventional surgical tricuspid valve redo replacement. Based on available data including own experience TVIV should be considered an effective and safe treatment option for failed TV bioprostheses in high-risk patients of different age. Further studies are needed to assess long-term results of the method.
А clinical case of a young patient with recurrent ischemic strokes is presented. The problems of diagnostic embolic strokes are discussed. We set out the algorithm for identifying patients, in whom patent foramen ovale is the most probable cause of embolic stroke. Detailed consideration of imaging diagnostic methods possibility is included. Hypothesis of probable source of cardioembolism from patent foramen ovale is presented. Recommendations for the secondary prevention of recurrent ischemic stroke, associated with patent foramen ovale, are provided. We also considered the issues of antithrombotic treatment.
Aim. To evaluate the effect of angiotensin-neprilysin receptor inhibitors on myocardial remodeling in patients with chronic heart failure and atrial fibrillation. Materials and methods. We studied dynamics of the parameters of ultrasound structural and functional parameters of the left atrium and left ventricle of the heart was during 3-month therapy with sacubitryl-valsartan in a group of 15 patients with a combination of chronic heart failure due to dilated and paroxysmal paroxysmal forms of atrial fibrillation. Results. Showed a statistically significant positive effect of the use of angiotensin receptors and neprilysin inhibitors on the parameters of remodeling of the left atrium (according to transthoracic and transesophageal echocardiography), left ventricle, as well as levels of natriuretic peptides ANP and NT-pro-BNP. Conclusion. The use of ARNI may be promising in terms of treatment and prevention of AF in patients with heart failure.
A 63-year-old man with a history of hypertension, hyperlipidemia and severe COVID-19 3 months earlier presented with NYHA class III-IV heart failure (HF) and intermittent claudication. Three months before, patient noted increasing dyspnea. SARS-CoV2 was verified. CT scan showed pneumonia; the severity of disease required dexamethasone and tocilizumab. Atrial fibrillation (AF) and LV EF 30% were first detected. CT scan disclosed left atrial appendage (LAA) thrombosis. Despite anticoagulants, 3 weeks later the patient developed lower limbs ischemia. Ultrasound and CT scan showed multiple thrombosis in the abdominal aorta and lower limbs arteries (Figure A). Surgery for limb ischemia was not performed due to a further decrease of LV EF to 18%. At that point, diagnosis was SARSCoV2-induced myocarditis. Нe visited our hospital for second opinion. ECG showed AF with mean heart rate (HR) of 158/min (B). Careful history collection suggested a longer AF duration which was missed and untreated due to lockdown. CRP, troponin were normal. NT-proBNP was 9326 pg/ml. After strict rate control was achieved, LV EF became 23%. Cardiac MRI with delayed gadolinium contrast revealed no fibrosis or active myocarditis (C). Angiography showed stenosis >70% of the left anterior descending artery (D). After PCI, LV EF became 27%. The patient was discharged on guideline-recommended optimal medical therapy. Three months later LV EF became 30%, six months later - 47%. Thrombus in LAA was dissolved. Pulmonary vein isolation and cardioversion were performed. One week later LV EF was 60%. Currently, the patient has stable sinus rhythm and no signs of HF for > 6 months. Thus, COVID-19 could contribute to the progression of atherosclerosis, modify the substrate and aggravate the severity of AF, but it was not the only cause of a serious illness in the patient. COVID-19 also had an indirect negative impact - delay the detection of cardiac pathology and cause its underdiagnosis under the guise of "post-COVID".
Aim. To study myocardial remodeling in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and atrial fibrillation (AF) against the background of cardiac contractility modulation (CCM) therapy.Material and methods. In a group of 100 patients with HFrEF and AF, transthoracic echocardiography was performed before CCM device implantation and after 2, 6 and 12 months. All patients received longterm optimal medical therapy for HF before surgery.Results. Against the background of CCM therapy, there was a significant increase in left ventricular (LV) ejection fraction, a decrease in LV volume and linear dimensions, a decrease in left atrial volume in patients with coronary and non-coronary HFrEF, with an initial LVEF < and >35%, and also regardless of AF type.Conclusion. CCM therapy in patients with HFrEF and AF led to favorable myocardial remodeling changes. Further study of CCM effect on echocardiographic parameters in randomized clinical trials is needed.
Aim To evaluate 30-day results of the transcatheter correction of degenerative aortic stenosis using a novel self-expandable valve, PorticoTM.Material and methods Transcatheter aortic valve implantation (TAVI) was performed in 42 patients with an intermediate surgical risk (mean age, 74.3±6.5 years, 8 men, 34 women, EuroSCORE II risk, 2.5 (1.5;4.1)) with severe degenerative aortic stenosis (AS). 20 (48 %) patients had ischemic heart disease; 8 (19%) of patients had atrial fibrillation, and 16 (38%) of patients had type 2 diabetes mellitus. Most of the patients (88 %) had preserved systolic function, and 5 patients had a pronounced decrease in left ventricular ejection fraction. Early efficacy and safety of the intervention were evaluated with VARC-2 criteria.Results In-hospital and 30-day mortality following TAVI was absent. Also, there were no adverse events, including cerebrovascular disorders, perioperative myocardial infarction, and conversion to open surgery. One patient had prosthesis migration to the aorta, which required implantation of the second self-expandable valve. Mean duration of the procedure was 90 min (80;110), fluoroscopy time was 21 min (19;24), and contrast volume 154 ml (200;240). Following TAVI, the mean aortic valve (AV) pressure gradient significantly decreased from 56.1±21.2 to 11.2±4.0 mm Hg, the maximal gradient decreased from 88.9±27.8 to 20.0±7.0 mm Hg, and the AV effective orifice area increased from 0.67±0.2 to 1.9±0.3 cm2 (p<0.001). By the time of discharge from the hospital, all patients showed regression of AS clinical manifestations. The percentage of patients with NYHA functional class III chronic heart failure reduced from 62 % to 7 % (p<0.001) after TAVI. In one case after the implantation, grade 3 aortic regurgitation was observed, which required endovascular occlusion to close the paraprosthetic fistula. Moderate paraprosthetic regurgitation (grade <2) was observed in 3 (7 %) patients. Only 2 (4.8%) patients required permanent pacemaker implantation.Conclusion Results of the single-center prospective TAVI study using a novel self-expandable valve Porticoтм showed satisfactory hemodynamic parameters, efficacy and safety of the procedure for the 30-day follow-up period. A relatively low radial force of the carcass can be beneficial for reducing the incidence of permanent pacemaker implantation after TAVI.
This article presents a clinical case of successful transcatheter aortic valve implantation in an elderly patient with critical aortic stenosis at the stage of systolic dysfunction with development of genuine cardiogenic shock. The role of transcatheter aortic valve implantation in the pathogenetic treatment of acute heart failure due to decompensated aortic stenosis was briefly discussed.
В основе контрастного трансторакального исследования ушка левого предсердия (УЛП) лежит возможность оценки его тромбоза у пациентов с пароксизмальной и персистирующей формами мерцательной аритмии с высоким риском тромбоэмболических событий. Известно, что причиной развития ишемического инсульта у больных с фибрилляцией предсердий более чем в 90% случаев является образование и дисло- кация тромба в УЛП. До настоящего времени основным методом диагностики тромбоза УЛП является чреспищеводная эхокардиография. Однако не во всех случаях она может быть использована. Внедрение современных эхокардиографических технологий, а также появление ультразвуковых контрастов нового поколения сподвигло нас к проведению данного исследования. Метод трансторакальной контрастной эхокардиографии в сочетании с технологией спекл-трекинг эхокардиографии позволил визуализировать тромбы в УЛП у больных, а также выявить пациентов с высокой степенью спонтанного эхоконтрастирования The contrast transthoracic echocardiography of the left atrial appendage (LAA) is based on the possibility of assessing its thrombosis in patients with paroxysmal and persistent forms of atrial fibrillation with a high risk of thromboembolic events. It is known that the cause of ischemic stroke in patients with AF in more than 90% of cases is the formation and dislocation of a thrombus in the LAA. Until now the main method for diagnosing LAA thrombosis is transesophageal echocardiography. However, it cannot be used in all cases. The introduction of modern echocardiographic technologies, as well as the emergence of a new generation of ultrasound contrasts, prompted us to conduct this study. The method of transthoracic contrast echocardiography in combination with speckle-tracking echocardiography technology made it possible to visualize thrombi in the LA in patients, as well as to identify patients with a high degree of spontaneous echocontrast
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.