The Use of Intraoperative Three-Dimensional Echocardiography to Evaluate Origin of Bioprosthetic Aortic Valve Regurgitant Jets

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

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This study aimed to evaluate effects of remote ischemic preconditioning (RIPC) on myocardial injury in patients undergoing off-pump coronary artery bypass graft surgery (OPCABG). Methods: Sixty-five patients scheduled for the OPCABG were randomly assigned to control (n = 32) or RIPC group (n = 33). All patients received general anesthesia. Before the surgical incision, RIPC was induced on an upper limb with repeated 5-min ischemia and 5-min reperfusion for four times. Blood samples were collected from right internal jugular vein. Plasma levels of IL-6, IL-8, IL-10, TNF-α, cTnT, HFABP, IMA, and MDA were detected at p...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
CONCLUSIONS: TAVR in local anesthesia can be safely performed by a minimalist heart team. We did not observe any differences in fatal periprocedural complications and mortality when comparing with results of a complete heart team. PMID: 30636681 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
CONCLUSION: Our early data clearly shows that in our country, TAVR is a good alternative for symptomatic severe AS for high surgical risk cases. Large-scale multicenter studies are required to study the real impact of TAVR in the Indian scenario. During initial years of implementation of a nationwide TAVR program, it may be prudent to focus on creating TAVR Centers of Excellence by developing an ideal hub and spokes model. PMID: 30595287 [PubMed - in process]
Source: Indian Heart J - Category: Cardiology Authors: Tags: Indian Heart J Source Type: research
ConclusionOur early data clearly shows that in our country, TAVR is a good alternative for symptomatic severe AS for high surgical risk cases. Large-scale multicenter studies are required to study the real impact of TAVR in the Indian scenario. During initial years of implementation of a nationwide TAVR program, it may be prudent to focus on creating TAVR Centers of Excellence by developing an ideal hub and spokes model.
Source: Indian Heart Journal - Category: Cardiology Source Type: research
We describe the first use of TAVR to treat iatrogenic severe acute pure aortic incompetence following mitral valve surgery. A 71 ‐year‐old gentleman developed life‐threatening acute aortic regurgitation (AR) within hours of a very challenging fifth open heart mitral valve replacement. Careful inspection of echocardiographic and computed tomographic imaging identified the cause as a disrupted left coronary cusp at the co mmissure caused by the surgical mitral annular reconstruction. Medical management with afterload reduction failed with recurrent pulmonary edema, and a sixth open heart surgery was deemed prohibitivel...
Source: Catheterization and Cardiovascular Interventions - Category: Cardiovascular & Thoracic Surgery Authors: Tags: VALVULAR AND STRUCTURAL HEART DISEASES Source Type: research
CONCLUSION: An elevated pulmonary pressure obtained preoperatively during right heart catheterization is not indicative of an elevated pulmonary pressure either intraoperatively or postoperatively. There are various explanations for the differences (e.g., different physiological and pathophysiological settings, such as sedation with potential hypercapnia versus anesthesia with vasodilation when measured; newly prescribed medication coming into effect between the right heart catheterization and surgery; intraoperative positioning). Even though the inherent risks of a PAC seem to be low, we recommend refraining from usi...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
This study aimed at testing NEXCO-PACCO agreement in a large sample size, multi-centre study. We hypothesized that agreement between NEXCO and PACCO would be demonstrated by a mean accuracy (bias)
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research
Publication date: December 2017 Source:Anesthesiology Clinics, Volume 35, Issue 4 Author(s): Paul N. Fiorilli, Saif Anwaruddin, Elizabeth Zhou, Ronak ShahTeaser The cardiac catheterization laboratory is advancing medicine by performing procedures on patients who would usually require sternotomy and cardiopulmonary bypass. These procedures are done percutaneously, allowing them to be performed on patients considered inoperable. Patients have compromised cardiovascular function or advanced age. An anesthesiologist is essential for these procedures in case of hemodynamic compromise. Interventionalists are becoming more famil...
Source: Anesthesiology Clinics - Category: Anesthesiology Source Type: research
ConclusionsPercutaneous paravalvular leak closure guided by ICE without the requirement of general anesthesia is feasible, safe, and associated with acceptable procedural success rates.
Source: Catheterization and Cardiovascular Interventions - Category: Cardiovascular & Thoracic Surgery Authors: Tags: VALVULAR AND STRUCTURAL HEART DISEASES Source Type: research
Background: Patients who undergo transcatheter aortic valve replacement (TAVR) for severe, symptomatic aortic stenosis (AS) frequently have heart failure (HF) and impaired ejection fraction (EF). We perform TAVRs using a minimally invasive strategy (MIS) in a standard catheterization suite, using local anesthesia and surface echocardiography, which minimizes invasiveness compared to the conventional strategy (CS) in a hybrid OR, with general anesthesia and transesophageal echocardiography. There is scant data on the effect on clinical outcomes of pre-procedural ejection fraction (EF) in patients undergoing TAVR using MIS.
Source: Journal of Cardiac Failure - Category: Cardiology Authors: Source Type: research
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