Radiation Exposure During Transcatheter Valve Replacement: What Cardiac Surgeons Need to Know

This study compared operator radiation exposure during transcatheter valve implantation when performed via a TF versus an AA approach,when performed in a catheterization lab versus a hybrid operating room(OR),and investigated the potential benefit of disposable shielding.MethodsDosimeters were worn during TAVR-TF(n=50) and TAVR-AA(n=31)procedures by operators.All TAVR-AA procedures were performed in a hybrid OR while TF procedures were performed in either catheterization labs(n=16) or a hybrid OR(n=34).Disposable radiation shielding pads(RADPAD)or a placebo(SHAM-PAD) were added in a randomized, blinded fashion.ResultsTeam radiation exposure was higher following TAVR-AA vs TAVR-TF(median 15.1mRad IQR[8.6, 32.4]vs5.5 mRad IQR[2.4, 9.8],p
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research

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ConclusionImage intensification may decrease malposition rates and mechanical complications associated with difficult central venous catheterisation. Further research comparing the safety and efficiency of ultrasound-guided and fluoroscopy-guided CVC insertion should be contemplated.
Source: Annals of Medicine and Surgery - Category: General Medicine Source Type: research
AbstractMesothelial/monocytic incidental cardiac excrescence (MICE) is a rare benign finding made of mesothelial cells, histiocytes, and fibrin, usually found during heart valve surgery. The clinical relevance resides in the potential misdiagnosis as metastatic carcinoma or arterial embolism. The pathogenesis remains uncertain, with artifactual and reactive hypotheses. Here we present a case of MICE with paradigmatic clinical, imaging, and histological features in a 28 ‐year‐old woman with undifferentiated connective tissue disease without previous cardiac catheterization with possible pathogenesis, highlighting the im...
Source: Journal of Cardiac Surgery - Category: Cardiovascular & Thoracic Surgery Authors: Tags: CASE REPORT Source Type: research
AbstractPercutaneous pulmonary valve replacement (PPVI) in native or patched right ventricular outflow tract (RVOT) has proven to be feasible. The procedure is highly dependent on the size of the RVOT. Several methods exist to evaluate the size of the RVOT by cardiovascular magnetic resonance (CMR). We evaluated different CMR modalities for measuring RVOT diameters. Thirty-one consecutive patients with native or patched RVOT were retrospectively evaluated. CMR was part of follow-up of patients with corrected Tetralogy of Fallot or pulmonary stenosis with significant pulmonary regurgitation (PR). CMR included 3D-SSFP whole-...
Source: Pediatric Cardiology - Category: Cardiology Source Type: research
AbstractPurpose of ReviewAortic stenosis is the most prevalent valvular heart disease. The purpose of this paper is to review the epidemiology, pathophysiology, and diagnosis of aortic valve stenosis.Recent FindingsThe diagnosis of aortic stenosis has evolved over time. Originally diagnosed with cardiac catheterization and echocardiography, more advance imaging techniques including computed tomography, magnetic resonance imaging, and 3D printing have improved our understanding of the physiology and hemodynamic effects of aortic stenosis.SummaryValvular heart disease affects a broad patient population, and the most common f...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research
ConclusionsAn increase in diagnostic and therapeutic procedures was reported in 2018, particularly in primary percutaneous coronary interventions. The use of the radial approach and complex procedures also increased. The number of structural procedures rose significantly, following the trend seen in recent years.ResumenIntroducción y objetivosLa Sección de Hemodinámica y Cardiología Intervencionista presenta su informe anual con los datos del registro de actividad correspondiente a 2018.MétodosLos centros españoles con laboratorio de hemodinámica proporcionan sus datos volun...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
CONCLUSIONS: NFLG-AS was the most prevalent form of LG severe AS and was associated with adequate left ventricular compensation and good prognosis. On the other hand, CLFLG-AS represents the heart-failure with reduced ejection fraction (HFrEF) form of AS and was associated with the worst prognosis, whereas PLFLG-AS represents the heart-failure with preserved ejection fraction (HFpEF) form of AS with intermediary prognosis. Both groups showed early hemodynamic reverse response after TAVR. PMID: 31566569 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
CONCLUSIONS: In these patients undergoing AVR for severe AS, even in the absence of PH, preoperative reduced PAC was independently associated with adverse surgical outcomes. It seems that preoperative PAC has potential as an independent predictor of long-term prognosis after AVR for severe AS. PMID: 31484840 [PubMed - as supplied by publisher]
Source: Circulation Journal - Category: Cardiology Authors: Tags: Circ J Source Type: research
Abstract Cardiac papillary fibroelastoma are rare, benign cardiac tumors that may lead to lethal complications from embolization or valvular dysfunction if left untreated. When working up symptomatic tumors with concomitant angina, traditional diagnostic studies such as cardiac catheterization may predispose the patient to embolic complications if the mass is located in the path of the catheter. Newer, non-invasive diagnostic testing, such as cardiac magnetic resonance imaging or dynamic computed tomography angiography, may be considered in lieu of invasive approaches to avoid potentially devastating complications. We here...
Source: Revista Brasileira de Cirurgia Cardiovascular - Category: Cardiovascular & Thoracic Surgery Source Type: research
Degradation of bioprosthetic aortic valves can eventually lead to both paravalvular and intravalvular regurgitation. However, differentiating between the two may be difficult in the case of multiple lesions in close proximity or highly eccentric jets. Whereas such exact distinction may be of little procedural significance in open cardiac surgery, it is of crucial importance when approaching such lesions in the catheterization laboratory or hybrid operating room. Interventions on one lesion often have a significant effect on the other.
Source: Journal of Cardiothoracic and Vascular Anesthesia - Category: Anesthesiology Authors: Tags: E-Challenges & Clinical Decisions Source Type: research
We report on three cases of acute coronary complications of different valvular surgical procedures diagnosed and treated in the cardiac catheterization laboratory. Intracoronary optical coherence tomography was used to identify the cause of coronary flow impairment and provided important insights on the mechanism of intra-operative vascular damage.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
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