Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis. This review discusses the mechanism, current results, potential clinical indications, and limitations of VAT for iliocaval and intracardiac mass removal.
Both transthoracic (TTE) and transesophageal echocardiography have limitations. ICE provides the advantage of imaging from within the heart, providing shorter image distances and higher resolution. ICE may be performed without sedation and avoids esophageal intubation as with transesophageal echocardiography (TEE). Limitations of ICE include the need for additional venous access with possibility of vascular complications, potentially higher costs, and a learning curve for new operators. Data supports the use of ICE in guiding device closure of interatrial shunts, transseptal puncture, and electrophysiologic procedures. This paper reviews the more recent reports that ICE may be used for primary guidance or as a supplement to TEE in patients undergoing left atrial appendage (LAA) closure, interatrial shunt closure, transaortic valve implantation (TAVI), percutaneous mitral valve repair (PMVR), paravalvular leak (PVL) closure, aortic interventions, transcatheter pulmonary valve replacement (tPVR), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) closure. ICE imaging technology will continue to expand and help improve structural heart and electrophysiology interventions.
We describe a case of dengue shock syndrome, perimyocarditis, and low-pressure cardiac tamponade following a trip to the Caribbean. The case was managed in the critical care unit and 6 weeks after discharge the patient was asymptomatic with a normal ejection fraction. Dengue fever presenting as cardiac tamponade is exceedingly rare and emphasizes the importance of taking a thorough travel history as well as being aware of atypical manifestations of rare diseases to make a correct diagnosis.
Pharmacotherapy for percutaneous coronary interventions is essential to optimize the balance between thrombosis and bleeding. Currently, choices abound for the selection of antiplatelet and anticoagulation therapies during percutaneous intervention (PCI). This review article discusses the mechanisms, pharmacokinetics/dynamics, and clinical data behind the various pharmacotherapies including; aspirin, thienopyridines, glycoprotein IIb/IIIa inhibitors, vorapaxar, heparin, direct thrombin inhibitors, and factor Xa inhibitors.
Atherosclerotic changes in the aorta result in progressive accumulation of cholesterol and other lipids in the intimal–medial layer with secondary inflammation, fibrous tissue deposition, surface erosions (ulcers), and plaque formation. The plaques and ulcers are associated with clot formation and emboli resulting in a variety of clinical symptoms. Modern imaging technologies such as contrast-enhanced computed tomography, magnetic resonance imaging, and echocardiography are used in the diagnosis; however, transoesophageal echocardiography remains the gold standard for plaque visualization in the thoracic aorta. Treatment strategies revolve around risk factor reduction and management of general atherosclerosis, as there are no other proven therapies to date.
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