The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology.

Vacuum-assisted thrombectomy (VAT) is a mechanical suction device that can be deployed to aspirate thrombi in the heart and vascular system. Successful percutaneous aspiration of iliocaval, right heart, and pulmonary arterial thrombi have been reported, in addition to the debulking of intravascular and intracardiac masses and vegetations. VAT is indicated for patients who are poor surgical candidates and/or have a contraindication to thrombolysis.

Congenital Abnormalities of the Pericardium.

Congenital abnormalities of the pericardium are a rare group of disorders that include congenital absence of the pericardium, pericardial cysts, and diverticula. These congenital defects result from alterations in the embryologic formation and structure of the pericardium. Although many cases are incidentally found, they can present as symptomatic, life-threatening disease.

Intracardiac Echocardiography for Structural Heart and Electrophysiological Interventions.

Purpose Of Review: With an increasing number of interventional procedures performed for structural heart disease and cardiac arrhythmias each year, echocardiographic guidance is necessary for safe and efficient results. The purpose of this review article is to overview the principles of intracardiac echocardiography (ICE) and describes the peri-interventional role of ICE in a variety of structural heart disease and electrophysiological interventions.

Recent Findings: Both transthoracic (TTE) and transesophageal echocardiography have limitations.

Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis.

The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint definitions to be used in clinical trials of PVL closure devices.

Clinical Trial Principles and Endpoint Definitions for Paravalvular Leaks in Surgical Prosthesis: An Expert Statement.

The VARC (Valve Academic Research Consortium) for transcatheter aortic valve replacement set the standard for selecting appropriate clinical endpoints reflecting safety and effectiveness of transcatheter devices, and defining single and composite clinical endpoints for clinical trials. No such standardization exists for circumferentially sutured surgical valve paravalvular leak (PVL) closure. This document seeks to provide core principles, appropriate clinical endpoints, and endpoint definitions to be used in clinical trials of PVL closure devices.

Acute Pericarditis.

Acute pericarditis is an acute inflammatory disease of the pericardium, which may occur in many different disease states (both infectious and non-infectious). Usually the diagnosis is based on symptoms (chest pain, shortness of breath), electrocardiographic changes (ST elevation), physical examination (pericardial friction rub) and elevation of cardiac biomarkers. It may occur in isolation or be associated with an underlying inflammatory disorder.

Right Atrial Vacuum-Assisted Thrombectomy: Single-Center Experience.

Background: Right heart thrombus in the absence of structural heart disease, atrial fibrillation, or intracardiac catheter is rare. It typically represents a thrombus migrating from the venous system to the lung, known as thrombi-in-transit, and can lead to a life-threatening pulmonary embolism. The optimal therapy for thrombi-in-transit remains controversial.

Guidelines for the Use of Echocardiography in the Evaluation of a Cardiac Source of Embolism.

Embolism from the heart or the thoracic aorta often leads to clinically significant morbidity and mortality due to transient ischemic attack, stroke or occlusion of peripheral arteries. Transthoracic and transesophageal echocardiography are the key diagnostic modalities for evaluation, diagnosis, and management of stroke, systemic and pulmonary embolism. This document provides comprehensive American Society of Echocardiography guidelines on the use of echocardiography for evaluation of cardiac sources of embolism.

Transcatheter Therapies for the Treatment of Valvular and Paravalvular Regurgitation in Acquired and Congenital Valvular Heart Disease.

Transcatheter therapies in structural heart disease have evolved tremendously over the past 15 years. Since the introduction of the first balloon-expandable valves for stenotic lesions with implantation in the pulmonic position in 2000, treatment for valvular heart disease in the outflow position has become more refined, with newer-generation devices, alternative techniques, and novel access approaches. Recent efforts into the inflow position and regurgitant lesions, with transcatheter repair and replacement technologies, have expanded our potential to treat a broader, more heterogeneous patient population.

Congenital defects of the pericardium: a review.

Pericardial defects are a rare disorder that can be characterized as acquired or congenital. Congenital defects can be further characterized by location and size of the defect, e.g.

Successful first-in-man percutaneous transapical-transseptal Melody mitral valve-in-ring implantation after complicated closure of a para-annular ring leak.

Aims: Transcatheter techniques can theoretically be applied to the treatment of para-annular ring (PAR) leaks. Little is known about their potential application and resultant complications in such cases. We describe the first-in-man percutaneous transapical-transseptal Melody valve-in-ring (ViR) implantation after a complication from percutaneous PAR leak closure.

Percutaneous transapical access: current status.

Percutaneous transapical access provides a direct route to many cardiac structures difficult to reach with conventional interventional approaches. With recent developments of new technologies in structural heart disease, there has been an increasing interest in the use of transapical access for cardiac interventions. Meticulous planning, careful access and closure techniques are essential.

Footprints of cardiac mechanical activity as expressed in lung Doppler signals.

Aims: To determine the diagnostic information contained in cardiac pulsatile pressure waves as expressed in the Doppler signals recorded over the right lung.

Methods And Results: The pulsatile characteristics of the pulmonary vascular system were studied by means of the novel pulse Doppler technology in 38 control volunteers, 31 patients with atrial fibrillation (AF) and 7 patients with atrial flutter. The Doppler velocity waveforms recorded were interpreted in relation to the cardiac cycle mechanical events that generate them: Ventricular systole (S), diastole (D) and presystolic left atrial contraction (A).