Intracardiac echocardiography with ultrasound probe placed in the upper left pulmonary vein to guide left atrial appendage closure: First description.

Intracardiac echocardiography (ICE) has become an effective alternative to trans-esophageal echocardiography (TEE) as a guidance during interventional procedures for structural heart diseases, allowing to proceed under conscious sedation. To guide percutaneous left atrial appendage (LAA) closure, the ICE probe is usually placed in the right atrium, in the pulmonary artery or in the left atrium (LA); however, the views from the right atrium or the pulmonary artery are often suboptimal, debarring a complete visualization of the LAA and the surrounding structures, whereas the LA location requires trans-septal puncture, may provoke LA wall mechanical stimulation and is often associated with unstable position of the ICE probe. In our case, after a second trans-septal puncture, the ICE probe was placed in the upper left pulmonary vein; this was safely performed and provided an optimal imaging of the LAA, comparable to that obtained by TEE, thus warranting an adequate guide during all procedural steps.

Net clinical benefit of patent foramen ovale closure in patients with cryptogenic stroke: Meta-analysis and meta-regression of randomized trials.

Background: Controlled randomized trials (CRTs) comparing the efficacy of patent foramen ovale (PFO) closure and medical therapy in patients with cryptogenic stroke have yielded heterogeneous results. No data are available on the net clinical benefit with the two strategies.

Methods: We pooled data of 3440 patients enrolled in five CRTs, randomized to PFO closure (n = 1829) or medical therapy (n = 1611) and followed for a mean of 4.

Efficacy and safety of oral anticoagulant therapy in frail patients with atrial fibrillation.

Antithrombotic treatment of frail patients with AF presents various challenges. The fear of bleeding often leds to a large underuse of anticoagulant agents in these patients, although more recent data indicate that oral anticoagulation  (especially with the newer, direct anticoagulants) is increasingly used. While there is a need for more real world data, available evidence suggests that non-vitamin K antagonist oral anticoagulants (NOACs) are an effective alternative to warfarin in frail patients with AF for preventing thromboembolic events, with a better safety profile.

Aortic root surgery in Marfan syndrome: Bentall procedure with the composite mechanical valved conduit versus aortic valve reimplantation with Valsalva graft.

Objectives: The aim of the study is to compare mid-term results of Bentall aortic root replacement with composite mechanical valved conduit and aortic valve reimplantation procedure using the Valsalva graft for the treatment of aortic root aneurysm in patients with Marfan syndrome.

Methods: We retrospectively compared data of 23 patients (mean age 38 + or - 14 years) who had undergone the Bentall procedure (group B) to those of 24 patients (mean age 36 + or - 12 years) who had undergone aortic valve reimplantation (group R) during a 14-year period. Follow-up (mean duration 65 + or - 44 months) was 100% complete.