Catheterization and Cardiovascular Interventions最新文献

Background: Transcatheter valve-in-valve (VIV) or valve-in-ring (VIR) therapies for degenerated mitral bioprosthetic valves and rings are still evolving. We aimed to characterize short- and long-term outcomes of these procedures.

Methods: An electronic literature search was conducted to retrieve articles describing mitral VIV or VIR implantation with at least 10 patients. Meta-analysis of proportions was carried out for 30-day or in-hospital outcomes of mortality, stroke, major bleeding, transfusion, acute kidney injury, procedural success, valve embolization, paravalvular leak, pacemaker implantation, and hospital stay. Individual patient data meta-analysis using Kaplan-Meier curve reconstruction was used to estimate long-term mortality of VIV, VIR and redo surgical mitral valve replacement (SMVR).

Results: We analyzed 34 studies (7047 patients). Pooled procedural success was 94.8% in VIV and 80.5% in VIR. Pooled short-term mortality and stroke risk was 6.4% and 1.9% respectively in VIV, 9.1% and 1.6% respectively in VIR, and 8.4% and 5.5% respectively in SMVR.

Conclusions: This study provides prognostic information on clinical outcomes for redo SMVR and transcatheter mitral VIV and VIR implantation.

Calcified nodule (CN) is a high-risk phenotype of coronary artery calcification that causes in-stent restenosis frequently. Stent thrombosis (ST) is a critical complication following percutaneous coronary intervention, and its onset is associated with severely calcified lesions. However, the association between CN and ST remains unclear. Moreover, while reprotrusion of CNs through the stent strut is not uncommon immediately after stenting, the risk of ST associated with this acute reprotrusion of CNs is not well recognized. We present a case of a 70-year-old female who developed acute ST following reprotrusion of a CN in the left main coronary artery. After the successful stenting to a large CN, a prominent acute protrusion occurred, followed by the acute occlusion of the implanted stent due to massive thrombus formation. This case highlights the importance of careful monitoring for thrombus formation even after good stent expansion, especially when large acute reprotrusion of CNs is observed.

Iatrogenic coronary ostial stenosis (ICOS) is a rare but life-threatening complication of aortic root surgery. It can occur with the incidence of 0.3%-5% and affect more commonly the left main coronary artery (LMCA) compared to the right coronary artery (RCA). Here, we present a case of non-ST-elevation myocardial infarction that occurred after a Bentall aortic root replacement, due to compression of the left main ostium, which was effectively treated with percutaneous coronary intervention.

Background: We often experience worsening of stenosis by balloon angioplasty of infrapopliteal (IP) lesion compared with the initial stenosis. However, reports on this phenomenon are limited.

Aims: The main purpose of this study is to evaluate vascular response after balloon angioplasty of IP artery stenosis.

Methods: Thirteen patients (15 arteries) who underwent endovascular treatment (EVT) and follow-up angiography with optical frequency domain imaging (OFDI) of intermediate IP stenosis were included. Serial OFDI images at 3 time points (before and after EVT and at follow-up) were analyzed. Diameter and area of external elastic lamina, internal elastic lamina, and lumen were measured, and plaque area and plaque burden (PB) were calculated. PB before EVT was classified into mild, moderate, and severe by 0%-20%, 21%-40%, and 41%-60%, respectively.

Results: Analyzed were 229 cross sections. External elastic lamina diameter did not change significantly among three time points (3.8 ± 0.5 [95% confidence interval (CI): 3.7 to 3.9] mm, 3.9 ± 0.4 [95% CI: 3.8 to 4.0] mm, 3.9 ± 0.4 [95% CI: 3.8 to 4.0] mm, p = 0.06). Lumen area increased after EVT but became smaller at follow-up than before EVT (4.5 ± 1.5 [95% CI: 4.3 to 4.7] mm², 5.3 ± 1.3 [95% CI: 5.1 to 5.5] mm², 3.7 ± 1.2 [95% CI: 3.5 to 3.9] mm², p < 0.001). Plaque area became smaller after EVT and larger at follow-up than before EVT (3.0 ± 1.7 [95% CI: 2.8 to 3.2] mm², 2.4 ± 1.5 [95% CI: 2.2 to 2.6] mm², 4.0 ± 1.6 [95% CI: 3.8 to 4.2] mm², p < 0.001). Lumen area was significantly smaller at follow-up than before EVT in mild and moderate PB groups, but it was not different in severe PB group (mild PB group: 5.1 ± 1.5 [95% CI: 4.7 to 5.5] mm² vs. 4.0 ± 1.3 [95% CI: 3.7 to 4.3] mm², p < 0.001, moderate PB group: 4.6 ± 1.3 [95% CI: 4.4 to 4.8] mm² vs. 3.6 ± 1.2 [95% CI: 3.4 to 3.8] mm², p < 0.001, severe PB group: 3.0 ± 1.4 [95% CI: 2.5 to 3.5] mm² vs. 3.1 ± 1.0 [95% CI: 2.7 to 3.5] mm², p = 0.93).

Conclusions: Balloon angioplasty of intermediate IP artery stenosis with mild or moderate PB led to smaller lumen area at follow-up than before EVT.

Iatrogenic aortocoronary dissection (IAD) during percutaneous coronary intervention (PCI) is an uncommon and potentially life-threatening complication. Extension of dissection to the ascending aorta, despite early surgical management, carries a high morbidity and mortality risk. Depending on the severity of dissection, the approach to management ranges from monitoring to surgical intervention; more extensive dissections into the ascending aorta, typically more than 40 mm above the coronary ostium, are considered an indication for surgery. We report six cases of IAD, highlighting the critical considerations concerning conservative management. These cases highlight the potential role of individualized management strategies, demonstrating instances where a conservative stance may prove effective in ensuring an optimal patient outcome and the key procedural features essential to optimize outcomes when considering nonsurgical management.

Pulsus alternans describes an arterial pulse waveform that shows alternating strong and weak beats despite a regular rhythm. Either discovered during physical examination or catheterization, pulsus alternans indicates severe left ventricular (LV) dysfunction and poor prognosis. There has been considerable debate about the underlying mechanism. We present a tracing which depicts a classic example of pulsus alternans and gives some clues about its initiation mechanism.

We report two cases of successful percutaneous coronary intervention (PCI) of a chronic total occlusion (CTO) lesion with an anomalous origin of the right coronary artery (AORCA) and challenging guiding catheter engagement using a new 3D virtual reality (VR) guiding catheter simulation system. Appropriate guiding catheter selection is critical for a successful complex PCI. A more suitable guiding catheter size, shape, and position with a robust backup force often leads to the successful completion of more accessible and safer procedures. The present case report highlights that VR simulation provides a greater possibility than usual of pre-procedural planning when selecting appropriate guiding catheters and vascular access. The present VR simulation system is based on three-dimensional volume rendering reconstructions of the computed tomography (CT) imaging data; thus, another strength of this technology is that it does not require radiation or radiocontrast exposure to patients. Therefore, transcatheter interventionalists who usually perform complex PCI should be familiar with this innovative system.

Carcinoid heart disease is an important complication of neuroendocrine tumors that may lead to significant morbidity and mortality. Right-sided heart valve involvement with consequent valve dysfunction is one of the common manifestations. Patients often have multiple, significant comorbidities with advanced metastatic disease and, as such, may not be suitable for surgical valve replacement due to excessive risk. Transcatheter valve replacement using balloon-expandable valves has been the mainstay of management for these patients, particularly with stenotic lesions but there is limited experience in patients with pulmonary regurgitation and dilated pulmonary arteries outside the dimensions that would be suitable for these valves. We report three successful cases of percutaneous pulmonary valve implantation with the VenusP-valve, a large self-expanding valve platform, and highlight the technical aspects and challenges specific to treatment of pulmonary regurgitation in patients with carcinoid heart disease. Percutaneous pulmonary valve implantation, using the VenusP-valve, may be considered an effective treatment in this patient group.

Background: Coronary microvascular and vasomotor dysfunction (CMVD) is associated with a threefold increased risk of major adverse cardiovascular events (MACE) and is the primary mechanism responsible for angina/ischemia in patients with nonobstructive coronary artery disease (ANOCA/INOCA). Proper assessment for CMVD is vital to provide targeted treatment and improve patient outcomes. Invasive coronary functional testing (ICFT) is the "gold standard," for CMVD assessment and can be used to diagnose all endotypes. However, there is a lack of standardization for ICFT protocols and use in the treatment of CMVD.

Aims: To provide a comprehensive overview of ICFT protocols utilized at the Christ Hospital Womens Heart Center (TCH-WHC).

Methods: Here, we outline our standard operating procedures for ICFT utilized at TCH-WHC, including the procedures two main methods: Doppler and Thermodilution. We describe our structured approach for ICFT referral and postdiagnostic clinical management utilized at The Christ Hospital Women's Heart Center (TCH-WHC) CMVD program. We then quantified how ICFT has contributed to growth of the TCH-WHC.

Results: From October of 2020 until July of 2024, a total of 422 patients have undergone ICFT at TCH-WCH, 64% were performed via the Doppler protocol and 36% were performed via the Thermodilution protocol. Based on exclusive endotype categories, 19% had an endothelial-independent CMD alone, 19% had endothelial-dependent CMD or microvascular VSA alone, 3% had epicardial VSA alone, 42% had mixed disease (any combination of the above categories), and 17% had a normal ICFT.

Conclusions: ICFT provides opportunity to provide diagnostic clarity and optimize medical treatment for CMVD. TCH-WHC's structured approach for ICFT referral and protocol for conducting comprehensive ICFT which has been vital for the growth of our specialized CMVD program.