Development and testing of a transcatheter heart valve with reduced calcification potential.

Introduction: Patients from developing countries who require heart valve surgery are younger and have less access to open heart surgery than those from developed countries. Transcatheter heart valves (THVs) may be an alternative but are currently unsuitable for young patients because of their inadequate durability. We developed and tested a THV utilizing two new types of decellularized bovine pericardial leaflets in an ovine model.

Transcatheter heart valve interventions for patients with rheumatic heart disease.

Rheumatic heart disease [RHD] is the most prevalent cause of valvular heart disease in the world, outstripping degenerative aortic stenosis numbers fourfold. Despite this, global resources are firmly aimed at improving the management of degenerative disease. Reasons remain complex and include lack of resources, expertise, and overall access to valve interventions in developing nations, where RHD is most prevalent.

Dynamic Left Ventricular Outflow Tract Obstruction Post-Transcatheter Aortic Valve Replacement.

We describe the first case of successful management of left ventricular outflow tract obstruction developing late after transcatheter aortic valve replacement with right ventricular apical pacing. The possible mechanisms of obstruction resolution are described. ().

A new over-the-wire percutaneous mitral balloon valvuloplasty technique.

Objectives: To develop and evaluate a new over-the-wire technique for mitral valvuloplasty that is both technically easier and less costly.

Background: Rheumatic heart disease (RHD) and resultant mitral stenosis (MS) carries a significant burden of disease worldwide. The prevalence is however concentrated in lower income countries where the current gold standard for percutaneous mitral valvuloplasty (PMBV)-the Inoue technique, is not always available due to cost and technical complexity.

Extensive pulmonary metastases in young boy with primary cardiac angiosarcoma: a case report.

Background: Malignant primary cardiac neoplasms are rare and primary cardiac angiosarcoma is the most common and aggressive subtype. It most commonly presents in middle-aged males and due to its non-specific clinical presentation, the diagnosis is often delayed until advanced disease is already present. Clinical presentation is determined by manifestations of local infiltration or metastatic disease and making an early diagnosis is extremely challenging.

The de Winter's pattern revisited: a case series.

Background: The de Winter's electrocardiogram (ECG) pattern signifying proximal left anterior descending (LAD) artery occlusion was first described in 2008. The ECG changes were thought to be static and mechanisms for this were suggested. In addition, the optimal management of these patients was reported to be via a primary percutaneous coronary intervention (PCI) strategy.

Radial artery dilatation to improve access and lower complications during coronary angiography: the RADIAL trial.

Aims: The aim of this study was to explore the use of prolonged occlusion flow-mediated dilatation (PO-FMD) to dilate the radial artery prior to cannulation to increase cannulation success, reduce puncture attempts and reduce access-site complications in transradial coronary angiography.

Methods And Results: A total of 1,156 patients undergoing transradial coronary angiography were randomised into PO-FMD and sham PO-FMD groups. PO-FMD was achieved by a 10-minute inflation of a blood pressure cuff on the arm to above systolic pressure, followed by deflation with resultant radial artery dilation.

Balloon Aortic Valvuloplasty Using a Non-Occlusive Balloon Catheter: First Animal Experience.

Background: Transcatheter aortic valve implants (TAVI) have revolutionised the treatment of elderly patients requiring aortic valve replacement. These patients often do not tolerate balloon valvuloplasty well, and a valvuloplasty balloon that would allow a degree of continued cardiac output during expansion would be beneficial. We tested such a balloon and describe our results in the sheep model.

Hybrid internal mammary to left anterior descending bypass and transaortic transcatheter aortic valve implantation: a new treatment option for patients with complex disease.

The case is described of a hybrid trans-aortic transcatheter aortic valve implantation and off-pump left internal mammary artery to left anterior descending artery bypass surgery in a man with a tight left main lesion and severe symptomatic aortic stenosis.

Non-ST elevation myocardial infarction (NSTEMI) in three hospital settings in South Africa: does geography influence management and outcome? A retrospective cohort study.

Background: Guidelines advise early angiography in non-ST elevation myocardial infarction (NSTEMI) to ensure an optimal outcome. Resource limitations in secondary hospitals in the Western Cape dictate a local guideline to treat NSTEMIs medically with out-patient assessment for angiography, unless mandatory indications for early angiography occur.

Methods: A retrospective cohort study assessed NSTEMIs at Tygerberg Hospital (TBH), Karl Bremer Hospital (KBH) and Worcester Hospital (WH) over one year.

First case of trans apical implantation of an aortic valve in a patient with dextrocardia.

We describe the clinical presentation and implantation procedure of the first transcatheter aortic valve implantation described in a patient with dextrocardia.

Transcatheter aortic valve replacement in a patient with an anomalous origin of the right coronary artery.

We describe the first case of implantation of a transcatheter aortic valve implantation (TAVI) in a patient with an anomalous origin of the right coronary artery, coursing in between the aorta and pulmonary truncus to the right. After assessment of the risk of compression of the anomalous origin of the right coronary artery from the left coronary sinus (ARCA), the procedure was performed without complication. A brief discussion of the pathophysiology of ARCA is provided and the implications for TAVI as well as our recommendations are offered.

Bilateral ostial coronary stenosis and rheumatic aortic valve stenosis.

A 49-year-old patient presented with angina pectoris and clinical findings of aortic valve stenosis and regurgitation. Rheumatic aortic valve stenosis and regurgitation was diagnosed on echocardiography. Coronary angiography findings showed severe calcification in the aorta root with right coronary ostial occlusion, and were suggestive of left main ostial stenosis and proximal main stem stenosis, which was confirmed on CT angiography.