Texas Heart Institute Journal最新文献

Brachiocephalic artery aneurysm is uncommon but may require surgery because it tends to enlarge, rupture, or cause symptoms related to thrombosis or compression. This case report describes a brachiocephalic artery aneurysm in a 72-year-old man who presented at the hospital with dyspnea and hemoptysis resulting from impending rupture and tracheal communication.

This novel case documents the successful use of transcatheter aortic valve implantation to treat severe aortic insufficiency arising from aortic root dissection following the repair of an ascending aortic aneurysm in a 75-year-old female patient. After she presented with symptoms of congestive heart failure, investigation revealed new severe aortic insufficiency and an acute aortic dissection. Given the prohibitive risks of reoperation, a self-expanding 27-mm Portico (St Jude Medical) prosthetic aortic valve was deployed, resulting in substantial clinical improvement without procedural complications. This case highlights the versatility of transcatheter aortic valve implantation in managing complex aortic disease and emphasizes the critical role of multidisciplinary evaluation and careful prosthesis selection.

This article reports the case of a 42-year-old man who presented with a saddle pulmonary embolus complicated by normotensive cardiogenic shock. The patient was first stabilized with venoarterial extracorporeal membrane oxygenation. Then, while the patient was still on extracorporeal membrane oxygenation, thrombectomy with a large-bore catheter device was performed that resulted in a large decrease in pulmonary artery pressures and a clinically significant increase in cardiac index, with rapid clinical improvement. Complete recovery of the patient's cardiopulmonary status has been maintained at intermediate-term follow-up. This treatment strategy should be considered favorably in the treatment of patients presenting with pulmonary embolism complicated by cardiogenic shock.

Background: Valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) is quickly becoming a routine and effective means by which to treat degenerated bioprosthetic valves. A known complication of ViV-TAVI is patient-prosthesis mismatch, which substantially affects survival. Bioprosthetic valve fracture is a method by which to reduce the risk of patient-prosthesis mismatch and post-ViV-TAVI transvalvular gradients. This study sought to determine the safety and efficacy of post-ViV-TAVI bioprosthetic valve fracture.

Methods: Patients with a history of surgical aortic valve replacement undergoing ViV-TAVI bioprosthetic valve fracture (N = 25) at the corresponding institution from 2015 to 2022 were cataloged for a retrospective analysis. The implanted transcatheter valves were Medtronic Evolut R, Evolut PRO, and Evolut PRO+. Gradients were assessed before and after implantation and after fracturing using transthoracic echocardiogram.

Results: The mean left ventricular ejection fraction of patients who underwent fracturing was 55.04%. The average (SD) peak and mean (SD) transvalvular gradients before the intervention were 68.17 (19.09) mm Hg and 38.98 (14.37) mm Hg, respectively. After ViV-TAVI, the same gradients were reduced to 27.25 (12.27) mm Hg and 15.63 (6.47) mm Hg, respectively. After bioprosthetic valve fracture, the gradients further decreased to 17.59 (7.93) mm Hg and 8.860 (3.334) mm Hg, respectively. The average reduction in peak gradient associated with fracturing was 12.07 mm Hg (95% CI, 5.73-18.41 mm Hg; P = .001). The average reduction in mean gradient associated with valve fracturing was 6.97 mm Hg (95% CI, 3.99-9.74 mm Hg; P < .001).

Conclusion: Bioprosthetic valve fracture is a viable option for reducing residual transvalvular gradients after ViV-TAVI and should be considered in patients with elevated gradients (>20 mm Hg) or with concern for patient-prosthesis mismatch in patients who have an unacceptable risk for a redo sternotomy and surgical aortic valve replacement.

Atrial infarction is often undiagnosed in patients with underlying ischemic heart disease and is identified only later, upon autopsy. One of the main challenges in diagnosing the condition is its localization within the affected atria. Treatment of atrial infarction focuses on acute reperfusion therapy, long-term management of cardiovascular disease risk factors, consideration of antiarrhythmia medications, and anticoagulation therapy. This review covers the anatomy of the atrial vasculature, complications associated with atrial infarction, diagnostic criteria for use of electrocardiography and other imaging modalities, and overall prognosis and management.

Background: The appropriateness of aortic valve surgery for patients with moderate aortic valve regurgitation undergoing coronary artery bypass graft (CABG), mitral valve replacement (MVR), or both is uncertain. This study aimed to investigate the outcomes of moderate aortic valve regurgitation following these procedures.

Methods: This retrospective cohort study included 113 eligible participants with moderate aortic valve regurgitation who underwent CABG, MVR, or both procedures between January 2014 and January 2015 at Tehran Heart Center. Echocardiographic index data were extracted from the Tehran Heart Center data center after a 2-year follow-up to examine changes in the patients' conditions.

Results: A total of 113 patients (mean [SD] age, 64.7 [9.9] years; 78 [69.0%] female patients) were included in the study and followed up for a mean (SD) of 24 (6) months. Among those patients, 38 (33.6%) experienced improvement, with their aortic valve regurgitation downgraded to mild, while the remaining 75 (66.4%) patients maintained a moderate aortic valve regurgitation level. Notably, combined CABG and MVR procedures were associated with statistically significant improvement, with all cases downgraded to mild aortic valve regurgitation. Baseline characteristics, including diabetes, hypertension, dyslipidemia, smoking, family history of aortic valve regurgitation, and a history of drug use, did not differ statistically significantly between patients with improved aortic valve regurgitation and patients with no changes. Echocardiographic indices related to the aorta, such as aortic valve pressure gradient, showed improvement (P < .001), and ejection fractions before and after surgery remained comparable. Changes in aortic valve regurgitation severity were found to differ statistically significantly between the various procedures (P = .001).

Conclusion: These findings suggest that it is not likely that moderate aortic valve regurgitation will progress after CABG or MVR. Hence, no support was found for concurrent aortic valve replacement during these procedures.

Transcatheter heart valve embolization is a serious and rare complication of transcatheter aortic valve replacement. Having a strategy for promptly managing transcatheter heart valve embolization is crucial to avoid emergency conversion from transcatheter aortic valve replacement to open-heart surgery. Many cases of transcatheter heart valve embolization occurring with balloon-expandable prostheses such as the SAPIEN 3 (Edwards LifeSciences Corporation) valve and self-expandable prostheses such as the ACURATE neo (Boston Scientific Corporation) valve have been reported in the literature. Here, for the first time (to the authors' knowledge), the case of a Myval (Meril Life Sciences Pvt Ltd) transcatheter heart valve embolization during transcatheter aortic valve replacement, which was treated percutaneously with favorable outcomes, is reported.

Left ventricular pseudoaneurysm is a serious and rare disorder that usually develops after acute myocardial infarction. It can lead to potentially lethal mechanical complications, such as acute left ventricular free wall rupture. This report presents the case of a 64-year-old man with a left ventricular pseudoaneurysm and myocardial rupture that was managed by left ventricular restoration with aneurysmectomy and coronary artery bypass with 2 grafts.

Background: Cardiovascular disease is the leading cause of death among women in the United States. Past research has highlighted the importance of the relationship between female-specific demographics and traditional risk factors. The present analysis aimed to identify the prevalence of modifiable risk factors in women attending a community cardiovascular health screening.

Methods: Data collected between 2011 and 2019 were obtained from the Houston HeartReach Registry. Participants were classified as having or not having each of 4 traditional cardiometabolic risk factors: hypertension, diabetes, body mass index indicating overweight or obesity, and dyslipidemia. Differences in prevalence were compared using the Pearson χ2 test.

Results: Most participants had hypertension, overweight or obesity, and dyslipidemia. Older women (≥65 years) had the highest prevalence of all cardiometabolic risk factors. Black participants had a higher prevalence of hypertension (P = .006) and a lower prevalence of dyslipidemia (P = .009) than non-Black participants. Hispanic participants had a lower prevalence of hypertension (P < .001) and a higher prevalence of overweight or obesity (P = .03) than non-Hispanic participants. Participants in the lowest household income bracket (<$25,000) were more likely to have diabetes (P = .001) and overweight or obesity (P = .004) than participants in the highest income bracket (≥$50,000). Unemployed participants had a higher prevalence of diabetes (P < .001), overweight or obesity (P = .004), and dyslipidemia (P < .001) than employed participants. Comorbidity analysis revealed clustering of multiple cardiometabolic risk factors. Moreover, risk factor hot spots were identified by zip code, which could help select future sites for targeted screening.

Conclusion: The analysis found that cardiometabolic risk factor prevalence varies with demographic and socioeconomic status. Geographic areas where cardiometabolic risk factor prevalence was highest were also identified. Further participant recruitment and analysis are required to create predictive models of cardiovascular disease risk in women.