Khaled F. Al-Shaibi, Aditya Bharadwaj, Atul Mathur, Ashish Jaikishen, Robert Riley
With an aging population, coronary calcification is increasingly encountered in modern day interventional practice. Unfortunately, it is associated with lower procedural success and higher rates of periprocedural complications, such as failure to deliver stents, perforations, dissections, and other major adverse cardiac events. Furthermore, suboptimal stent deployment in the setting of severe calcification is associated with both short- and long-term major adverse cardiac events, including stent thrombosis, MI, in-stent restenosis, and target lesion revascularization. A variety of treatment options for these lesions exist, including specialized balloons, atherectomy, and intravascular lithotripsy. While there is currently no universally accepted algorithm for choosing between these treatment strategies, several different algorithms exist, and the optimization of these treatment regimens will continue to evolve in the coming years. This review aims to provide insights on the different therapeutic modalities and an understanding of the current body of evidence.
{"title":"Management of Calcified Coronary Lesions","authors":"Khaled F. Al-Shaibi, Aditya Bharadwaj, Atul Mathur, Ashish Jaikishen, Robert Riley","doi":"10.15420/usc.2022.29","DOIUrl":"https://doi.org/10.15420/usc.2022.29","url":null,"abstract":"With an aging population, coronary calcification is increasingly encountered in modern day interventional practice. Unfortunately, it is associated with lower procedural success and higher rates of periprocedural complications, such as failure to deliver stents, perforations, dissections, and other major adverse cardiac events. Furthermore, suboptimal stent deployment in the setting of severe calcification is associated with both short- and long-term major adverse cardiac events, including stent thrombosis, MI, in-stent restenosis, and target lesion revascularization. A variety of treatment options for these lesions exist, including specialized balloons, atherectomy, and intravascular lithotripsy. While there is currently no universally accepted algorithm for choosing between these treatment strategies, several different algorithms exist, and the optimization of these treatment regimens will continue to evolve in the coming years. This review aims to provide insights on the different therapeutic modalities and an understanding of the current body of evidence.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139600954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mariem A Sawan, Rebecca S Steinberg, Michael N. Sayegh, Christian Devlin, Omid Behbahani-Nejad, Nanette K Wenger
Ischemic heart disease is a major cause of morbidity and mortality in the US, affecting both men and women significantly. The presentation of chest pain is largely similar in female and male patients, but additional non-chest pain symptoms can confound timely diagnosis in women. Management, diagnostic evaluation, and clinical outcomes for patients admitted with chest pain differ significantly between men and women, and understanding of these discrepancies is limited. The objective of this review is to familiarize readers with gender- and sex-specific differences in the presentation, diagnosis, and management of chest pain.
{"title":"Chest Pain in Women: Gender- and Sex-based Differences in the Presentation and Diagnosis of Heart Disease","authors":"Mariem A Sawan, Rebecca S Steinberg, Michael N. Sayegh, Christian Devlin, Omid Behbahani-Nejad, Nanette K Wenger","doi":"10.15420/usc.2022.30","DOIUrl":"https://doi.org/10.15420/usc.2022.30","url":null,"abstract":"Ischemic heart disease is a major cause of morbidity and mortality in the US, affecting both men and women significantly. The presentation of chest pain is largely similar in female and male patients, but additional non-chest pain symptoms can confound timely diagnosis in women. Management, diagnostic evaluation, and clinical outcomes for patients admitted with chest pain differ significantly between men and women, and understanding of these discrepancies is limited. The objective of this review is to familiarize readers with gender- and sex-specific differences in the presentation, diagnosis, and management of chest pain.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139219283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Alasnag, V. Paradies, Nicola Ryan, Sara C Martinez
Complex percutaneous cardiac intervention (PCI) is a growing procedure in modern day cath labs. The treated population is often older, with multiple comorbidities, complex coronary anatomy, left ventricular dysfunction, and possibly concomitant valvular heart disease and/or cardiogenic shock. As such, PCI of bifurcations, chronic total occlusions, and atherectomy coronary interventions are becoming more common. The outcomes in terms of acute procedural success, procedure-related complications, and long-term mortality or heart failure hospitalizations are important to consider. Unfortunately, to date there is a paucity of data identifying sex and gender disparities following such interventions. With respect to bifurcation lesions, women usually have more comorbidities with less complex coronary anatomy. However, despite less complex anatomy, women have a significantly increased risk of MI. These differences are also noted with left main stem and multivessel disease, during which women appear to have a trend towards worse outcomes following PCI compared with coronary artery bypass grafting. Randomized trials have revealed that women present with increased cardiovascular risk factors, which may contribute to adverse longer-term outcomes. Revascularization of women with concomitant valvular heart disease is particularly challenging because the existing data are conflicted on not only the indication, but also the timing of revascularization. Similarly, women undergoing PCI of calcified lesions with drug-eluting stents have a worse clinical profile and remain at increased ischemic risk. The lower incidence of coronary calcification in women, combined with the under-representation of women in randomized trials, poses a real challenge when attempting to address safety and survival benefit in women undergoing complex interventions. This warrants dedicated trials exploring the safety and efficacy of complex interventions in women.
{"title":"Outcomes of Complex Percutaneous Cardiac Interventions in Women","authors":"M. Alasnag, V. Paradies, Nicola Ryan, Sara C Martinez","doi":"10.15420/usc.2022.21","DOIUrl":"https://doi.org/10.15420/usc.2022.21","url":null,"abstract":"Complex percutaneous cardiac intervention (PCI) is a growing procedure in modern day cath labs. The treated population is often older, with multiple comorbidities, complex coronary anatomy, left ventricular dysfunction, and possibly concomitant valvular heart disease and/or cardiogenic shock. As such, PCI of bifurcations, chronic total occlusions, and atherectomy coronary interventions are becoming more common. The outcomes in terms of acute procedural success, procedure-related complications, and long-term mortality or heart failure hospitalizations are important to consider. Unfortunately, to date there is a paucity of data identifying sex and gender disparities following such interventions. With respect to bifurcation lesions, women usually have more comorbidities with less complex coronary anatomy. However, despite less complex anatomy, women have a significantly increased risk of MI. These differences are also noted with left main stem and multivessel disease, during which women appear to have a trend towards worse outcomes following PCI compared with coronary artery bypass grafting. Randomized trials have revealed that women present with increased cardiovascular risk factors, which may contribute to adverse longer-term outcomes. Revascularization of women with concomitant valvular heart disease is particularly challenging because the existing data are conflicted on not only the indication, but also the timing of revascularization. Similarly, women undergoing PCI of calcified lesions with drug-eluting stents have a worse clinical profile and remain at increased ischemic risk. The lower incidence of coronary calcification in women, combined with the under-representation of women in randomized trials, poses a real challenge when attempting to address safety and survival benefit in women undergoing complex interventions. This warrants dedicated trials exploring the safety and efficacy of complex interventions in women.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139244845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Shabbir, Pradeep K Yadav, N. Tiwari, P. Velagapudi
Tricuspid regurgitation (TR) is a highly prevalent valve disorder in the US, with prevalence increasing with age. Without treatment, severe TR carries a poor prognosis. Tricuspid valve (TV) surgery is recommended for patients with severe TR undergoing left-sided valve surgery. Transcatheter TV repair or transcatheter TV replacement are potential options for patients who are not surgical candidates. A few small studies have demonstrated the feasibility and efficacy of transcatheter TV repair in patients with severe symptomatic TR. Careful patient selection by assessing tricuspid valve anatomy, right ventricular and pulmonary hemodynamics, candidacy for anticoagulation, comorbid conditions, and frailty is key to procedural success. Transcatheter TV repair can be performed via the transjugular or transfemoral access, and requires a large-caliber sheath (up to 45 Fr) and delivery system, particularly with dilated tricuspid annulus due to right ventricular enlargement. Multimodality imaging is essential for diagnosing TR severity, defining valve anatomy, and comprehensive functional assessment of the tricuspid valve, right atrium, and right ventricle. Several prosthetic valves, including the EVOQUE system, NaviGate system, Intrepid valve, and Cardiovalve, are currently being investigated in clinical trials.
{"title":"Transcatheter Tricuspid Valve Replacement: Case Selection, Technical Considerations, and Procedural Planning","authors":"M. Shabbir, Pradeep K Yadav, N. Tiwari, P. Velagapudi","doi":"10.15420/usc.2023.07","DOIUrl":"https://doi.org/10.15420/usc.2023.07","url":null,"abstract":"Tricuspid regurgitation (TR) is a highly prevalent valve disorder in the US, with prevalence increasing with age. Without treatment, severe TR carries a poor prognosis. Tricuspid valve (TV) surgery is recommended for patients with severe TR undergoing left-sided valve surgery. Transcatheter TV repair or transcatheter TV replacement are potential options for patients who are not surgical candidates. A few small studies have demonstrated the feasibility and efficacy of transcatheter TV repair in patients with severe symptomatic TR. Careful patient selection by assessing tricuspid valve anatomy, right ventricular and pulmonary hemodynamics, candidacy for anticoagulation, comorbid conditions, and frailty is key to procedural success. Transcatheter TV repair can be performed via the transjugular or transfemoral access, and requires a large-caliber sheath (up to 45 Fr) and delivery system, particularly with dilated tricuspid annulus due to right ventricular enlargement. Multimodality imaging is essential for diagnosing TR severity, defining valve anatomy, and comprehensive functional assessment of the tricuspid valve, right atrium, and right ventricle. Several prosthetic valves, including the EVOQUE system, NaviGate system, Intrepid valve, and Cardiovalve, are currently being investigated in clinical trials.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45544421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Çalık, F. Cader, E. Rafflenbeul, S. Okutucu, S. Khan, I. P. Canbolat, U. Sinan, M. Alasnag
Bifurcated anatomical locations in the arterial tree, such as coronary artery bifurcations, are prone to develop obstructive atherosclerotic lesions due to the pro-atherogenic low wall shear stress. The percutaneous treatment of bifurcation lesions is among the most challenging complex coronary interventions, including different multistep stenting strategies. Even though provisional side branch (SB) stenting is recommended as the primary approach in most cases, the debate continues between provisional SB and upfront two-stent strategies, particularly in complex bifurcations consisting of a significantly diseased SB that supplies a crucial myocardial territory. This review will highlight the importance of understanding the bifurcation philosophy and provide an individual algorithmic approach to find the optimal treatment strategy for each patient with a non-left main coronary bifurcation lesion. Considering the most recent scientific evidence, the advantages and disadvantages of each stenting technique and the role of intracoronary imaging to optimize bifurcation percutaneous coronary intervention outcomes will be discussed.
{"title":"An Approach to Non-left Main Bifurcation Lesions: A Contemporary Review","authors":"A. Çalık, F. Cader, E. Rafflenbeul, S. Okutucu, S. Khan, I. P. Canbolat, U. Sinan, M. Alasnag","doi":"10.15420/usc.2022.25","DOIUrl":"https://doi.org/10.15420/usc.2022.25","url":null,"abstract":"Bifurcated anatomical locations in the arterial tree, such as coronary artery bifurcations, are prone to develop obstructive atherosclerotic lesions due to the pro-atherogenic low wall shear stress. The percutaneous treatment of bifurcation lesions is among the most challenging complex coronary interventions, including different multistep stenting strategies. Even though provisional side branch (SB) stenting is recommended as the primary approach in most cases, the debate continues between provisional SB and upfront two-stent strategies, particularly in complex bifurcations consisting of a significantly diseased SB that supplies a crucial myocardial territory. This review will highlight the importance of understanding the bifurcation philosophy and provide an individual algorithmic approach to find the optimal treatment strategy for each patient with a non-left main coronary bifurcation lesion. Considering the most recent scientific evidence, the advantages and disadvantages of each stenting technique and the role of intracoronary imaging to optimize bifurcation percutaneous coronary intervention outcomes will be discussed.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46676021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Almoghairi, Nayef Al-Asiri, K. Aljohani, Ayman Alsaleh, Nasser G Alqahtani, M. Alasmary, Rudaynah A Alali, Khaled Tamam, M. Alasnag
Left main (LM) coronary artery disease accounts for approximately 4–6% of all percutaneous coronary interventions (PCIs). There has been mounting evidence indicating the non-inferiority of LM PCI as a revascularization option, particularly for those with a low SYNTAX score. The EXCEL and NOBEL trials have shaped current guidelines. The European Society of Cardiology assigned a class 2a level of evidence B for isolated LM disease involving the shaft and ostium and a class IIb level of evidence B for isolated LM disease involving the bifurcation or additional two- or three-vessel disease and a SYNTAX score <32. However, data on the use of a single stent or an upfront two-stent strategy for distal LM disease are conflicting, wherein the EBC Main trial reported similar outcomes with a stepwise provisional approach and the DKCRUSH-V trial reported better outcomes with an upfront two-stent strategy using the ‘double-kissing’ crush technique. Although several studies have noted better immediate results with image-guided PCI, there are few data on outcomes in LM disease specifically. In fact, the uptake of imaging in the aforementioned landmark trials was only 40%. More importantly, the role of mechanical circulatory support (MCS) has been less well studied in LM PCI. Indiscriminate use of MCS for LM PCI has been noted in clinical practice. Trials evaluating the benefit of MCS in high-risk PCI demonstrated no benefit. This review highlights contemporary trials as they apply to current practice in LM PCI.
{"title":"Left Main Percutaneous Coronary Revascularization","authors":"A. Almoghairi, Nayef Al-Asiri, K. Aljohani, Ayman Alsaleh, Nasser G Alqahtani, M. Alasmary, Rudaynah A Alali, Khaled Tamam, M. Alasnag","doi":"10.15420/usc.2022.24","DOIUrl":"https://doi.org/10.15420/usc.2022.24","url":null,"abstract":"Left main (LM) coronary artery disease accounts for approximately 4–6% of all percutaneous coronary interventions (PCIs). There has been mounting evidence indicating the non-inferiority of LM PCI as a revascularization option, particularly for those with a low SYNTAX score. The EXCEL and NOBEL trials have shaped current guidelines. The European Society of Cardiology assigned a class 2a level of evidence B for isolated LM disease involving the shaft and ostium and a class IIb level of evidence B for isolated LM disease involving the bifurcation or additional two- or three-vessel disease and a SYNTAX score <32. However, data on the use of a single stent or an upfront two-stent strategy for distal LM disease are conflicting, wherein the EBC Main trial reported similar outcomes with a stepwise provisional approach and the DKCRUSH-V trial reported better outcomes with an upfront two-stent strategy using the ‘double-kissing’ crush technique. Although several studies have noted better immediate results with image-guided PCI, there are few data on outcomes in LM disease specifically. In fact, the uptake of imaging in the aforementioned landmark trials was only 40%. More importantly, the role of mechanical circulatory support (MCS) has been less well studied in LM PCI. Indiscriminate use of MCS for LM PCI has been noted in clinical practice. Trials evaluating the benefit of MCS in high-risk PCI demonstrated no benefit. This review highlights contemporary trials as they apply to current practice in LM PCI.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45816328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin Lee, I. Minga, E. Cameron, J. P. S. Adum, A. Pursnani
Primary cardiac tumors account for only 0.3% of all cardiac tumors; of these, lymphomas account for only 2% of all primary cardiac tumors. Cardiac lymphomas have a grim prognosis, often less than 1 year due to delays in diagnosis and treatment. Cardiac MRI is the gold standard for the imaging of cardiac tumors. We describe the case of a 76-year-old man with no significant past medical history who presented to the emergency department with a large pericardial effusion that was found to be consistent with cardiac lymphoma on cardiac MRI prior to tissue diagnosis of a primary cardiac diffuse large B-cell lymphoma. The clinical and radiological features of cardiac lymphoma are reviewed, and the therapeutic management and side-effects that the patient experienced are discussed.
{"title":"A Case of Primary Cardiac B-cell Lymphoma Diagnosed with Cardiac MRI","authors":"Kevin Lee, I. Minga, E. Cameron, J. P. S. Adum, A. Pursnani","doi":"10.15420/usc.2022.31","DOIUrl":"https://doi.org/10.15420/usc.2022.31","url":null,"abstract":"Primary cardiac tumors account for only 0.3% of all cardiac tumors; of these, lymphomas account for only 2% of all primary cardiac tumors. Cardiac lymphomas have a grim prognosis, often less than 1 year due to delays in diagnosis and treatment. Cardiac MRI is the gold standard for the imaging of cardiac tumors. We describe the case of a 76-year-old man with no significant past medical history who presented to the emergency department with a large pericardial effusion that was found to be consistent with cardiac lymphoma on cardiac MRI prior to tissue diagnosis of a primary cardiac diffuse large B-cell lymphoma. The clinical and radiological features of cardiac lymphoma are reviewed, and the therapeutic management and side-effects that the patient experienced are discussed.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47503180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jing Huang, R. Steinberg, Matthew J Brown, S. Rinfret, O. Toleva
Vasospastic angina (VSA) occurs at rest and on exertion, with transient electrocardiographic ischemic changes. VSA presents with spontaneous coronary artery spasm (CAS); it has been associated with stable angina, acute coronary syndromes, and sudden cardiac death. CAS can be identified in normal arteries or non-obstructive coronary atherosclerosis, but is also prevalent in patients with coronary artery disease. The diagnosis is made with invasive coronary reactivity testing with provocation using acetylcholine (Ach). Epicardial spasms can be visualized through coronary angiography as a reversible epicardial vessel narrowing, while the diagnosis of microvascular spasm can be made when angina symptoms and ECG changes happen following intracoronary Ach without epicardial spasm. Identification of CAS allows for risk stratification and specific therapies targeting endothelial dysfunction and paradoxical vascular smooth muscle cell constriction. Therapies include calcium channel blockers as monotherapy or in a combination of a dihydropyridine and non-dihydropyridine. Short-acting nitrates offer acute symptomatic relief but long-acting nitrates should be used sparingly. This current update on invasive evaluation of VSA discusses unified Ach protocols.
{"title":"Invasive Evaluation for Coronary Vasospasm","authors":"Jing Huang, R. Steinberg, Matthew J Brown, S. Rinfret, O. Toleva","doi":"10.15420/usc.2022.33","DOIUrl":"https://doi.org/10.15420/usc.2022.33","url":null,"abstract":"Vasospastic angina (VSA) occurs at rest and on exertion, with transient electrocardiographic ischemic changes. VSA presents with spontaneous coronary artery spasm (CAS); it has been associated with stable angina, acute coronary syndromes, and sudden cardiac death. CAS can be identified in normal arteries or non-obstructive coronary atherosclerosis, but is also prevalent in patients with coronary artery disease. The diagnosis is made with invasive coronary reactivity testing with provocation using acetylcholine (Ach). Epicardial spasms can be visualized through coronary angiography as a reversible epicardial vessel narrowing, while the diagnosis of microvascular spasm can be made when angina symptoms and ECG changes happen following intracoronary Ach without epicardial spasm. Identification of CAS allows for risk stratification and specific therapies targeting endothelial dysfunction and paradoxical vascular smooth muscle cell constriction. Therapies include calcium channel blockers as monotherapy or in a combination of a dihydropyridine and non-dihydropyridine. Short-acting nitrates offer acute symptomatic relief but long-acting nitrates should be used sparingly. This current update on invasive evaluation of VSA discusses unified Ach protocols.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42919751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Transcatheter left atrial appendage closure has emerged as a non-pharmacological alternative to long-term anticoagulation for stroke prevention in appropriately selected patients with AF. In this concise review article, the Food and Drug Administration-approved and some other left atrial appendage closure devices that are under investigation are discussed. Currently, Watchman Flx and Amplatzer Amulet are the only two devices that have been approved for commercial use by the Food and Drug Administration. A brief overview of device designs, clinical data on efficacy and safety, major limitations of left atrial appendage closure devices, and perspectives on future direction are provided. The current generation of devices is effective; however, efforts should continue on innovations and refinement of device technology.
{"title":"Transcatheter Left Atrial Appendage Closure: Devices Available, Pitfalls, Advantages, and Future Directions","authors":"Chirag P Bavishi","doi":"10.15420/usc.2022.37","DOIUrl":"https://doi.org/10.15420/usc.2022.37","url":null,"abstract":"Transcatheter left atrial appendage closure has emerged as a non-pharmacological alternative to long-term anticoagulation for stroke prevention in appropriately selected patients with AF. In this concise review article, the Food and Drug Administration-approved and some other left atrial appendage closure devices that are under investigation are discussed. Currently, Watchman Flx and Amplatzer Amulet are the only two devices that have been approved for commercial use by the Food and Drug Administration. A brief overview of device designs, clinical data on efficacy and safety, major limitations of left atrial appendage closure devices, and perspectives on future direction are provided. The current generation of devices is effective; however, efforts should continue on innovations and refinement of device technology.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49403160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Women with congenital heart disease have increased risks of complications during pregnancy. Several risk scoring tools have been developed to quantify the likelihood of adverse cardiac outcomes during pregnancy. This article describes how comprehensive pre-pregnancy or early pregnancy counseling needs to go well beyond these risk scores. Non-cardiac risk factors and adverse obstetric and fetal outcomes are vital components of the dialogue between the multidisciplinary team and the patient embarking on, or contemplating, pregnancy.
{"title":"Pregnancy and Congenital Heart Disease: Moving Beyond the Current Risk Stratification Tools","authors":"Ajitha Kulasekaran, L. Swan","doi":"10.15420/usc.2022.16","DOIUrl":"https://doi.org/10.15420/usc.2022.16","url":null,"abstract":"Women with congenital heart disease have increased risks of complications during pregnancy. Several risk scoring tools have been developed to quantify the likelihood of adverse cardiac outcomes during pregnancy. This article describes how comprehensive pre-pregnancy or early pregnancy counseling needs to go well beyond these risk scores. Non-cardiac risk factors and adverse obstetric and fetal outcomes are vital components of the dialogue between the multidisciplinary team and the patient embarking on, or contemplating, pregnancy.","PeriodicalId":37809,"journal":{"name":"US Cardiology Review","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49177516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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