Continuing Cardiology Education最新文献

Transcatheter aortic valve replacement (TAVI) is an established treatment for inoperable patients or patients at high surgical risk with severe aortic stenosis. Herein, we illustrate the key design features of the main new generation devices that are entering contemporary clinical practice, the labeled and off-labeled indications, the basic principles of screening process, and the clinical outcomes of the TAVI procedure.

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Cardiac computed tomography (CT) is a rapidly evolving imaging modality that has developed quickly over the last decade, to establish itself as a robust non-invasive method to assess coronary artery disease. Qualitative and quantitative assessment of atherosclerotic coronary stenosis with cardiac CT has been favorably compared with invasive coronary angiography and intravascular ultrasound (IVUS) and importantly may help improve risk stratification and predict prognosis. Cardiac CT can visualize coronary artery bypass grafts with high diagnostic accuracy, with the evaluation of stents improving all the time. Importantly for the interventional cardiologist, it has evolved into a crucial tool assisting in the planning of both coronary and structural heart interventions, with transcatheter aortic valve implantation the most successful example. With its resemblance to IVUS in the capability to assess both the lumen and vessel wall, cardiac CT provides additional information on the composition of the lesion and reference segments which might allow accurate selection of devices, potentially leading to complete lesion coverage, less incomplete stent apposition, and larger postprocedural diameters. An understanding of the uses of CT and keeping up to date with evolving CT technology is critical for the interventional cardiologist as the use of CT continues to evolve and establish itself as an everyday adjunct to cardiac intervention.

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Paravalvular leak (PVL) is an uncommon, however, serious complication associated with prosthetic valve implantation. Although most PVLs are asymptomatic and have a benign clinical course, an estimated small percentage of patients with PVLs can lead to serious clinical consequences 1-3. Until recently, surgery has been the only available therapy for the treatment of clinically significant PVLs despite the significant mortality associated with reoperation 4. Percutaneous transcatheter closure, routinely applied in the management of various intracardiac defects, has been utilized for the treatment of PVLs using a variety of techniques 5. As a result, percutaneous PVL closure has been slowly evolving and is now successfully performed in a number of Heart centers with significant experience in structural cardiac intervention. Herein, we discuss the current understanding of PVLs, the utilization of multi-modality imaging in PVL diagnosis, treatment, the clinical results, and our initial experience.

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Left atrial appendage occlusion (LAAO) is a promising alternative to oral anti-coagulation in patients with non-valvular atrial fibrillation. Recently, four-year results of PROTECT-AF demonstrated superiority of LAAO in all-cause mortality and stroke reduction compared to optimal medical treatment with warfarin. In this new era, it is important to identify the patients who would benefit more from LAAO and offer them priority for treatment.

Answer questions and earn CME: https://wileyhealthlearning.com/Activity2/4193475/Activity.aspx