Background: Transcatheter aortic valve implantation (TAVI) is a widely used treatment of severe aortic stenosis. Implantation of a self-expanding valve into a dense calcified aortic annulus can be challenging and may result in device malposition and malfunction. Aim: The aim of our case report is to present a novel technique of transcatheter aortic valve dislocation treatment. Case presentation: An 86-year-old woman with severely calcified aortic valve underwent TAVI using a 27-mm self-expanding Portico valve (Abbott Vasc, USA). In the last phase of implantation, the valve dislocated deep into the left ventricular outflow tract resulting in significant paravalvular regurgitation and patient instability. Repositioning of the valve with a single snare was ineffective because of severe aortic ring calcifications. A novel "double snare" technique was applied and the valve was successfully repositioned upward with an excellent anatomic and haemodynamic result. Conclusion: "Double snare" technique can be an effective strategy for repositioning of deeply implanted self-expanding transcatheter aortic valves. It represents an efficient bailout strategy in case of single snare approach failure, especially in cases of severe aortic ring calcifications.
Tachycardia-induced cardiomyopathy (T-CMP) related to supraventricular arrhythmia is a rare and often unrecognized cause of refractory cardiogenic shock. When rhythm control interventions are ineffective or no longer pursued, atrioventricular node ablation (AVNA) with pacemaker implantation is indicated. Conduction system pacing provides normal synchronous activation of the ventricles after AVNA. However, there is a lack of data on pace and ablate strategy in hemodynamically unstable patients. We report on 2 patients with T-CMP presenting with refractory cardiogenic shock who were successfully treated with His bundle pacing in conjunction with AVNA.
Funding Acknowledgements Type of funding sources: None. Introduction Left bundle branch area pacing (LBBAP) is an emerging new method of cardiac resynchronization therapy (CRT) in patients with left bundle branch block (LBBB). Studies comparing LBBAP with standard biventricular pacing (BiV) have shown similar post-operative shortening of QRS duration and left ventricular activation times. Calculation of equivalent dipole (ED) trajectories from 12-lead high-resolution ECG (hrECG) provides additional insight into myocardial depolarization and may be used for further assessment of left ventricular activation. Purpose The aim of this study was to determine myocardial depolarization patterns with assessment of ED trajectories in patients undergoing CRT with LBBAP or BiV and to compare them to myocardial depolarization patterns of healthy controls. Methods Twenty-five heart failure patients in sinus rhythm and LBBB with indication for CRT were randomized in LBBAP or BiV pacing group. Five-minute supine 12-lead hrECG recordings before and one month after implantation were assessed. LBBAP group was compared to BiV group and both groups were compared to the control of healthy subjects with normal surface ECG. The QRS duration was measured manually by two independent electrophysiologists and averaged. ED trajectories were constructed with the use of inverse algorithm method. The length of ED trajectory was defined as a line between the start and the end of the ED trajectory and its orientation with azimuth and elevation angles. (Figure 1). Results Eleven patients received LBBAP and 14 BiV. There were no differences in baseline characteristics (72% male, 64% non-ischemic cardiomyopathy) between groups. The average baseline QRS duration was 174±20 ms in LBBAP and 180±17 ms in BiV group (p=0.42). QRS duration decreased to 134±14 ms after LBBAP (p<0.01) and 137±11 ms after BiV pacing (p<0.01) and was comparable in both groups (p=0.59). There was also no difference in absolute (p=0.72) or relative (p=0.72) QRS shortening. The absolute and relative ED shortening did not differ (p=0.43 and p=0.38, respectively). At follow-up, analysis of ED trajectories showed a significant difference in elevation angle in both groups (p<0.01). The elevation angle in LBBAP group (6±30°) was significantly different from the angle in BiV group (-44±33°) (p < 0.01), pointing more toward apex of the heart (Figure 2). Furthermore, elevation angle in LBBAP was more similar (absolute difference 49°) to healthy subjects than the elevation angle in BiV group (absolute difference 103°) (p<0.01). There was no intergroup difference in azimuth angle (p=0.07). Conclusion Compared to BiV pacing, resynchronization with LBBAP produces significantly different ED trajectory orientation, which was more comparable to orientation in healthy controls. While both resynchronization methods result in similar QRS narrowing, LBBAP may provide more physiological depolarization of the left ventricle in comparison to BiV.
Od prve koronarne angioplastike leta 1977 preko femoralnega pristopa je intervencijska kardiologija drastično spremenila zdravljenje ishemične bolezni srca. Prvotna perkutana transluminalna angioplastika z uporabo navadnih balonskih katetrov je sčasoma postala le pomožna tehnika za pripravo žilne spremembe in optimiziranje vstavljene žilne opornice. S pojavom navadnih žilnih opornic smo izboljšali rezultate na račun zmanjšanega elastičnega odsunka, poškodbe in konstriktivnega remodeliranja koronarnih arterij, z razvojem antiagregacijske terapije pa dosegli manjše število tromboz v žilnih opornicah. Ob nadaljnjih raziskavah neointimalne hiperplazije so se pojavile metode za lokalno apliciranje antiproliferacijskih zdravil. Razvile so se z zdravili prevlečene opornice, ki so leta 2019 postale novi zlati standard. Ob uporabi modernejših materialov so poskrbele za izboljšanje rezultatov na račun zmanjšanja neointimalne hiperplazije in števila zapletov. A kljub temu so še vedno tujek v žilni steni, ki spodbuja kronično vnetje, neoaterosklerozo, s tem pa restenozo ter zelo pozne pojave tromboze. To spoznanje zadnja leta vodi v razvijanje tehnik, ki bi za sabo pustile čim manj tujega materiala oziroma bi bil le-ta čimbolj biološko kompatibilen. Ob razvoju razgradljivih žilnih opornic so ena obetajočih terapevtskih možnosti z zdravili prevlečeni balonski katetri, ki razširijo žilno svetlino in lokalno aplicirajo antiproliferativno zdravilo na samo mesto spremembe brez uporabe opornice, ki bi ostala v žilni steni in spodbujala vnetje.
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.