Reverse Takotsubo Cardiomyopathy with Severe Dengue: Case Report from Pakistan.

Takotsubo Cardiomyopathy is an established transient cardiomyopathy found predominately in females with intense emotional and physical strain. It has four notable variants: Apical, Mid-Ventricular, Basal and Focal. Mid Ventricular variant is also referred to as Reverse Takotsubo Cardiomyopathy.

Rota Ablation - When There is No Other Option. A Complex Case of 86 Years Old Male with Multiple Comorbids Presenting With Stemi.

The aim of this report is to explore the direct and long-term outcome in a high risk patient who was treated with rotational atherectomy (RA) to assist the placement of drug eluting stents in heavily calcified lesions. The patient presented with acute STEMI and had severely calcified Left main stem (LMS) disease, requiring plaque modification before coronary angioplasty and stent implantation. As the patient was elderly, with multiple comorbids including a number of coronary interventions, a decision of conservative management was made.

Impaired right ventricular reserve predicts adverse cardiac outcomes in adults with congenital right heart disease.

Objective: The prevalence of heart failure (HF) among adult patients with congenital heart disease (ACHD) is rising. Right ventricle (RV) exercise reserve and its relationship to outcomes have not been characterised. We aim to evaluate the prognostic impact of impaired RV reserve in an ACHD population referred for cardiopulmonary exercise testing (CPET).

Overlapping bio-absorbable scaffolds: Aim for D2D technique?

The results of overlapping metallic stents have been concerning but this practice is often unavoidable in the setting of long or tortuous lesions, diameter discrepancy of proximal and distal vessel, and for residual dissections. Theoretically, bio-absorbable scaffolds may carry an advantage over metallic stents due to the progressive resorption of the scaffold theoretically rendering the overlap a non-issue; this has not been clinically evident. Since stent/scaffold overlap cannot be entirely avoided, improved stent delivery/deployment and scaffold design modification may reduce complications in this complex patient subset.

The quest for a "diabetic" stent.

Patients with diabetes mellitus and extensive coronary artery disease generally had worse outcomes with early generation drug eluting stents (DES) as compared to coronary artery bypass grafting. Initial results with Amphilimus eluting coronary stent in patients with diabetes have been promising in small studies The data from Sardella et al. should be used, in conjunction with previous clinical studies with this DES type, as hypothesis generating for a large multicenter randomized trial to aid in our quest to find the "new diabetic stent.

Coronary chronic total occlusions: How to dilate the tough ones.

Several chronic total occlusions (CTOs) may be undilatable despite successful wire passage; several techniques can be used for lesion preparation, such as high-pressure balloon inflations, rotational atherectomy laser, cutting balloon, and scoring balloons. Presence of moderate to severe calcification and lesion length over 40 mm in association with comorbidities, such as diabetes mellitus and reduced ejection fraction, may contribute to making a CTO lesion undilatable. Still, appropriate therapy selection for a patient with CTO should be individualized and procedure safety attended to.

Emergent unilateral renal artery stenting for treatment of flash pulmonary edema: fact or fiction?

Flash pulmonary edema is characteristically sudden in onset with rapid resolution once appropriate therapy has been instituted (Messerli et al., 2011). Acute increase of left ventricular (LV) end diastolic pressure is the usual cause of sudden decompensated cardiac failure in this patient population.

Challenges in the echocardiographic assessment of aortic stenosis.

Calcific aortic valve stenosis is common in the elderly. While history and examination can establish the diagnosis, determination of its severity typically requires echocardiography to define valve anatomy, measure stenosis severity and assess left ventricular response. The purpose of this review is to describe some of the commonly encountered challenges in the echocardiographic assessment of aortic stenosis.