Electrosurgery in Structural Heart Interventions
Electrosurgery has emerged as a groundbreaking tool in the field of structural cardiac interventions, revolutionizing the approach to complex cardiac conditions. This review delves into the core principles, procedural techniques, outcomes, and potential challenges associated with various electrosurgical procedures within the realm of structural cardiology. Five key electrosurgical procedures performed in complex structural interventions are highlighted in this review. They are the Transcaval Access, BASILICA, LAMPOON, ELASTIC/ELASTA-Clip, and SESAME procedures. While these electrosurgery procedures hold promise and have de...
Source: Cardiology Clinics - April 3, 2024 Category: Cardiology Authors: Ajoe John Kattoor, Vijay Iyer Source Type: research
Patent Foramen Ovale and Atrial Septal Defect
Patent foramen ovale (PFO) and atrial septal defects (ASDs) are two types of interatrial communications with unique clinical presentations and management strategies. The PFO is a normal part of fetal development that typically closes shortly after birth but may persist in as many as 25% to 30% of adults. The communication between atria may result in paradoxic embolism and embolic stroke. On the other hand, ASDs (anatomically defined as secundum, primum, sinus venosus, and coronary sinus in order of prevalence) typically result in right heart volume overload and are often associated with other congenital defects. The diagno...
Source: Cardiology Clinics - March 28, 2024 Category: Cardiology Authors: Joe Aoun, Taha Hatab, John Volpi, Chun Huie Lin Source Type: research
Late Outcomes After Transcatheter Aortic Valve Implantation with Balloon-Versus Self-Expandable Valves
Self-expanding valves (SEV) and balloon-expandable valves (BEV) for transcatheter aortic valve implantation (TAVI) have their own features. There is a growing interest in long-term outcomes with the adoption of lifetime management in younger patients. To evaluate late outcomes in TAVI with SEV versus BEV, we performed a study-level meta-analysis of reconstructed time-to-event data published by May 31, 2023. We found no statistically significant difference in all-cause death after TAVI with SEV versus BEV. Randomized controlled trials are warranted to validate our results. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 26, 2024 Category: Cardiology Authors: Xander Jacquemyn, Jef Van den Eynde, Tulio Caldonazo, James A. Brown, Aleksander Dokollari, Derek Serna-Gallegos, Marie-Annick Clavel, Philippe Pibarot, Ibrahim Sultan, Michel Pompeu S á Source Type: research
Coronary Risk in Transcatheter Aortic Valve Replacement, Overview of Data, Challenges, and Best Practices
Coronary artery obstruction is a rare complication of transcatheter aortic valve replacement (TAVR). This risk increases in TAVR-valve-in-valve procedure. Several anatomic risk factors were described in many studies to identify the predictive elements of coronary artery occlusion on computed tomography cardiac scan. Rescue percutaneous coronary intervention was the first approach described to treat this complication with a high mortality rate. Later on, preventive chimney stenting technique was evaluated and results showed that is a safe and effective strategy but it leads to a difficult coronary access later. New preventi...
Source: Cardiology Clinics - March 24, 2024 Category: Cardiology Authors: Louay Dandach, Khalil Mahmoudi, Maroun Sfeir, Alaa Masri Source Type: research
Emergencies in Pulmonary Hypertension
Pulmonary hypertension is a challenging disease entity with various underlying etiologies. The management of patients with pulmonary arterial hypertension (WHO Group 1) remains challenging especially in the critical care setting. With risk of high morbidity and mortality, these patients require a multidisciplinary team approach at a speciality care facility for pulmonary hypertension for comprehensive evaluation and rapid initiation of treatment. For acute decompensated right heart failure, management should concentrate on optimizing preload and after load with use of pulmonary vasodilator therapy. A careful evaluation of ...
Source: Cardiology Clinics - March 23, 2024 Category: Cardiology Authors: Sanjeeb Bhattacharya Source Type: research
Left Atrial Appendage Closure
The left atrial appendage (LAA) has gained increasing attention in the field of cardiology as a potential site for intervention in patients with atrial fibrillation (AF) and an elevated risk of thromboembolic events. Left atrial appendage occlusion (LAAO) has emerged as a promising therapeutic strategy to mitigate the risk of stroke and systemic embolism, especially in individuals who are unsuitable candidates for long-term anticoagulation therapy. This review aims to provide a comprehensive analysis of the current state of LAAO, encompassing its anatomic considerations, procedural techniques, clinical outcomes, and future...
Source: Cardiology Clinics - March 23, 2024 Category: Cardiology Authors: George H. Nasr, Parker M. Rushworth, David M. Donaldson Source Type: research
Cardiac Emergencies: A Blueprint for Rescue
Acute cardiovascular care in the twenty-first century has seen a rapid timeline of focus, evolution, and expansion. Gone are the days when care for the acutely ill patient with a cardiac emergency focused solely on myocardial infarction and its electrical or mechanical sequelae. Now, comprehensive cardiovascular intensive care units are tasked with assessment and management of a multitude of diverse disease entities, such as cardiac tamponade, acute heart failure, cardiogenic shock, pulmonary embolism, valve failure, pulmonary hypertension, and cardiac arrest. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 21, 2024 Category: Cardiology Authors: Ran Lee Tags: Preface Source Type: research
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This issue on patent foramen ovale (PFO) is dedicated to my oncologist, Alexandra Drakaki, MD, and the researchers who developed immunotherapy. Without their support, I would not have been alive to help write and edit this compendium on PFO. I had a nephrectomy for renal cell carcinoma in April 2023 and began immunotherapy for metastatic disease in November 2023. I appreciate the opportunity I have been given to describe the research in this field over the past 25 years. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 21, 2024 Category: Cardiology Authors: Jonathan M. Tobis Tags: Dedication Source Type: research
Patent Foramen Ovale –Associated Stroke
Paradoxic embolism through a patent foramen ovale (PFO) is a common cause of ischemic stroke, accounting for 1 in 20 of all ischemic strokes. Neurologists play the leading role in diagnosing PFO-associated stroke, determining that a cerebral infarct is embolic in distribution and excluding other potential stroke mechanisms. Among patients aged 18 to 60 years old with a PFO and an otherwise cryptogenic stroke, the PFO-Associated Stroke Causal Likelihood classification system should be used to identify the 85% of patients likely to benefit from PFO closure and the 15% of patients likely to be harmed by PFO closure. (Source...
Source: Cardiology Clinics - March 14, 2024 Category: Cardiology Authors: Jeffrey L. Saver Source Type: research
Acute Heart Failure
Acute heart failure (AHF) is a frequent cause of hospitalization around the world and is associated with high in-hospital and post-discharge morbidity and mortality. This review summarizes data on diagnosis and management of AHF from the emergency department to the intensive care unit. While more evidence is needed to guide risk stratification and care of patients with AHF, hospitalization is a key opportunity to optimize evidence-based medical therapy for heart failure. Close linkage to outpatient care is essential to improve post-hospitalization outcomes. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 14, 2024 Category: Cardiology Authors: Megan Sheehan, Lara Sokoloff, Nosheen Reza Source Type: research
Initial Triage and Management of Patients with Acute Aortic Syndromes
The acute aortic syndromes (AAS) are life-threatening vascular compromises within the aortic wall. These include aortic dissection (AD), intramural hematoma (IMH), penetrating aortic ulcer (PAU), and blunt traumatic thoracic aortic injury (BTTAI). While patients classically present with chest pain, the presentation may be highly variable. Timely diagnosis is critical to initiate definitive treatment and maximize chances of survival. In high-risk patients, treatment should begin immediately, even while diagnostic evaluation proceeds. The mainstay of medical therapy is acute reduction of heart rate and blood pressure. Surgic...
Source: Cardiology Clinics - March 14, 2024 Category: Cardiology Authors: Willard N. Applefeld, Jacob C. Jentzer Source Type: research
Practical Aspects of Patent Foramen Ovale Closure
Percutaneous PFO closure is a well-established medical procedure to mitigate paradoxic embolism and the future risk of stroke in a well-selected patient clientele. When it comes to procedural guidance during PFO closure, various modalities exist, each with its own advantages and disadvantages. Guidance by transesophageal echocardiography (in combination with fluoroscopy) offers high-resolution 2D/3D imaging, however, it requires the presence of a peri-interventional imager and conscious sedation (or endotracheal intubation). Intracardiac echocardiography and fluoroscopy guidance can be performed by a single operator and om...
Source: Cardiology Clinics - March 13, 2024 Category: Cardiology Authors: Kerstin Piayda, Stefan Bertog, Mackenzie Mbai, Alok Sharma, Verena Veulemans, Horst Sievert Source Type: research
Practical Aspects of Persistent Formaen Ovale Closure
Percutaneous PFO closure is a well-established medical procedure to mitigate paradoxic embolism and the future risk of stroke in a well-selected patient clientele. When it comes to procedural guidance during PFO closure, various modalities exist, each with its own advantages and disadvantages. Guidance by transesophageal echocardiography (in combination with fluoroscopy) offers high-resolution 2D/3D imaging, however, it requires the presence of a peri-interventional imager and conscious sedation (or endotracheal intubation). Intracardiac echocardiography and fluoroscopy guidance can be performed by a single operator and om...
Source: Cardiology Clinics - March 13, 2024 Category: Cardiology Authors: Kerstin Piayda, Stefan Bertog, Mackenzie Mbai, Alok Sharma, Verena Veulemans, Horst Sievert Source Type: research
A Cardiologist ’s Perspective on Patent Foramen Ovale-Associated Conditions
The patent foramen ovale (PFO) jeopardizes health and its problems may be major. A nineteenth century case report was the first description of a PFO as cause of death. To the present day, the PFO does not get the deserved attention. A PFO is found in roughly 25% of people, its particularly dangerous forms in about 5%. Those have a high enough risk for harm by the PFO to justify screening for it for closure, even as primary prevention. After all, closing a PFO is as simple as fixing a tooth and can be considered a mechanical vaccination. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 6, 2024 Category: Cardiology Authors: Bernhard Meier Source Type: research
Some Practical Points About Patent Foramen Ovale Conditions that May Not Be Covered in the Rest of the Book
This introductory article provides many key lessons that I have learned in my 23 years of studying patent foramen ovale (PFO). It discusses issues related to the diagnosis, clinical presentation, and treatment of PFO. (Source: Cardiology Clinics)
Source: Cardiology Clinics - March 5, 2024 Category: Cardiology Authors: Jonathan M. Tobis Source Type: research
