Realization of Open Software Chain for 3D Modeling and Printing of Organs in Simulation Centers: Example of Renal Pelvis Reconstruction.

Objective: Three-dimensional (3D) printing has many uses in healthcare such as in surgical training. It is becoming an interesting tool finding new pedagogical purposes in medical simulation. In this study, using a process consisting of 3D modeling, a simulator dedicated to pyeloplasty was designed, manufactured, and evaluated by experts.

Delayed prosthesis malposition after transcatheter aortic valve implantation causing coronaries obstruction.

A case of delayed malposition of a CoreValve device causing obstruction of coronary ostia is described. Nine months after the original implant, the patient developed an acute coronary syndrome and was readmitted to hospital. Angiogram demonstrated an ostial stenosis of both the left main stem and the right coronary ostia, which were filled by a paravalvular leakage of the bioprosthesis.

TAVR vs SAVR: Rising Expectations and Changing Indications for Surgery in Response to PARTNER II.

Despite the criticisms and concerns raised on the data published in the PARTNER II trial and related analyses, we are undeniably witnessing a revolution in the management of aortic valve disease, in which conventional full sternotomy surgical aortic valve replacement (SAVR), with all related complications and clinical burden, will soon become a nonviable option. Several of the findings described in the PARTNER II trial, although considerable as points of incongruence and study biases in comparison with SAVR, could be taken as lessons to found a new course in SAVR and redesign the respective roles of surgery and interventional procedures in aortic disease. In particular, the results of these trials can actually be considered as a stimulus to invest more effort to improve the current surgical practice that should embrace alternative solutions and least invasive approaches to provide a competitive advantage over percutaneous procedures.

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients.

Background: Coronary heart disease is a significant cause of morbidity and mortality in stroke patients. The coronary artery calcium score (CACS) has emerged as a robust and noninvasive predictor of coronary events. We assessed the predictive ability of CACS to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/transient ischemic attack population, in addition to the PRECORIS score, based on Framingham Risk Score and presence of cervicocephalic artery stenosis, which was derived and validated for that purpose.

Pushing the Limits in Transcatheter Aortic Valve Replacement: High-Volume Center's Effect, Overconfidence, or Something Else?

The recent literature on transcatheter aortic valve replacement (TAVR) is shedding new light on the perspective to extend this procedure to other lower risk-category of patients, leading in fact to a potential erosion of the current guidelines. Notwithstanding the warnings provided in the literature regarding the risk of severely impairing complications, unclear survival advantage, and cost-inefficiency, many observational studies, especially performed in high-volume centers, support a general drive toward the recruitment of intermediate-low risk patients in the expectation of clinical advantages versus standard surgical replacement. It appears that, in combination with the development of more refined technologies, medical groups with matured experience and centers able to successfully manage patients with different profiles have been progressively "selected" and emerged pushing further the limits of the procedure itself.

Predicting asymptomatic coronary artery disease in patients with ischemic stroke and transient ischemic attack: the PRECORIS score.

Background And Purpose: Identifying occult coronary artery stenosis may improve secondary prevention of stroke patients. The aim of this study was to derive and validate a simple score to predict severe occult coronary artery stenosis in stroke patients.

Methods: We derived a score from a French hospital-based cohort of consecutive patients (n=300) who had an ischemic stroke or a transient ischemic attack and no previous history of coronary heart disease (Predicting Asymptomatic Coronary Artery Disease in Patients With Ischemic Stroke and Transient Ischemic Attack [PRECORIS] score) and validated the score in a similar Korean cohort (n=1602).

Aortic stiffness measurement improves the prediction of asymptomatic coronary artery disease in stroke/transient ischemic attack patients.

Background: Aortic stiffness is an independent predictor of coronary events.

Aims: We assessed the predictive value of aortic stiffness for ≥50% asymptomatic coronary artery disease in a stroke/transient ischemic attack population.

Methods: We enrolled 300 consecutive patients aged 45-75 years with nondisabling, noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary artery disease.

Septic rupture of an atherosclerotic plaque of the ascending aorta.

Infectious aortitis has become a rare disease thanks to the widespread use of antibiotics. We report the case of a patient who, 15 days after initiation of antibiotics for bacteraemia due to methicillin-resistant Staphylococcus aureus (MRSA), developed acute chest pain followed by haemodynamic instability. A tamponade due to a rupture into the pericardium of the ascending aorta at the site of an atherosclerotic plaque was diagnosed by an emergent chest contrasted computed tomography (CT).

Coronary artery stenosis in high-risk patients: 64-section CT and coronary angiography--prospective study and analysis of discordance.

Purpose: To assess the diagnostic accuracy of multisection (64-section) computed tomography (CT) versus coronary angiography in detection of and assignment of grades for coronary artery stenoses in a high-risk population and to investigate causes for discordance between the two.

Materials And Methods: The protocol was approved by the local ethics committee. Patients gave informed consent.

Coronary computed tomography angiography: overview of technical aspects, current concepts, and perspectives.

Multidetector-row electrocardiogram (ECG)-gated cardiac computed tomography (CT) will probably be a major noninvasive imaging option in the near future. Recent developments indicate that this new technology is improving rapidly. This article presents an overview of the current concepts, perspectives, and technical capabilities in coronary CT angiography (CTA).

Diagnosis of aortic valvular stenosis by multislice cardiac computed tomography.

Aims: Current improvements in spatial, temporal, and contrast resolution of multislice computed tomography (CT) could be useful in the assessment of valvular diseases. We evaluated the diagnostic accuracy of multislice CT for the identification and quantification of aortic valvular stenosis (AS), compared with echography.

Methods And Results: Consecutive patients, referred for coronary CT, were evaluated for AS, by the use of standard electrocardiography-gated 16-slice CT protocol.

New trends in non-invasive coronary angiography with multislice CT.

Recent trends in computed tomography (CT) scanner technology has opened new frontiers in the field of non-invasive coronary angiography. Given the relatively important number of negative invasive angiographies performed each year, eliminating the risks inherent to this procedure by non-invasive methods greatly contribute to diminishing the risk. After injection of contrast, the procedure is performed under short apnea and triggered by electrocardiographic (ECG) recording that provides a multitude of possible image reconstructions; ie, volume rendering, virtual angioscopy, and three-dimensional (3D) reconstruction of the heart and coronary vessels.