MINOCA-induced apical ballooning case report: a diagnostic conundrum.

Background: Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a recently described phenomenon where no flow-limiting lesions are noted on coronary angiography in a patient with electrocardiogram changes, elevated cardiac biomarkers, and symptoms suggesting acute myocardial infarction. Patients with MINOCA can also potentially develop structural cardiac defects through ischaemic injury. Therefore, the absence of a flow-limiting lesion on angiography coupled with structural defects (e.

Percutaneous device closure of a large complex aortic root pseudoaneurysm.

Pseudoaneurysm of the aorta is a rare and high-risk complication of native aortic valve endocarditis and can develop following cardiac surgery for aortic valve and root disease. If left untreated, there is a significant risk of aortic wall rupture and fatality. Given the high risk of mortality associated with traditional open surgical repair of aortic pseudoaneurysms, endovascular approach is a potentially favourable alternative.

Percutaneous Device Closure of Paravalvular Leak: Combined Experience From the United Kingdom and Ireland.

Background: Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery.

Methods: All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry.

Strategies to attenuate micro-vascular obstruction during P-PCI: the randomized reperfusion facilitated by local adjunctive therapy in ST-elevation myocardial infarction trial.

Background: Microvascular obstruction (MVO) following primary percutaneous coronary intervention (PPCI) treatment of ST-segment elevation myocardial infarction (STEMI) contributes to infarct expansion, left ventricular (LV) remodelling, and worse clinical outcomes. The REFLO-STEMI trial tested whether intra-coronary (IC) high-dose adenosine or sodium nitroprusside (SNP) reduce infarct size and/or MVO determined by cardiac magnetic resonance (CMR).

Methods And Results: REFLO-STEMI, a prospective, open-label, multi-centre trial with blinded endpoints, randomized (1:1:1) 247 STEMI patients with single vessel disease presenting within 6 h of symptom onset to IC adenosine (2-3 mg total) or SNP (500 μg total) immediately following thrombectomy and again following stenting, or to standard PPCI.

The REFLO-STEMI trial comparing intracoronary adenosine, sodium nitroprusside and standard therapy for the attenuation of infarct size and microvascular obstruction during primary percutaneous coronary intervention: study protocol for a randomised controlled trial.

Background: Microvascular obstruction (MVO) secondary to ischaemic-reperfusion injury is an important but underappreciated determinant of short- and longer-term outcome following percutaneous coronary intervention (PCI) treatment of ST-elevation myocardial infarction (STEMI). Several small studies have demonstrated a reduction in the degree of MVO utilising a variety of vasoactive agents, with adenosine and sodium nitroprusside (SNP) being most evaluated. However, the evidence base remains weak as the trials have had variable endpoints, differing drug doses and delivery.

Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience.

Background: Postinfarction ventricular septal defect carries a grim prognosis. Surgical repair offers reasonable outcomes in patients who survive a healing phase. Percutaneous device implantation represents a potentially attractive early alternative.

Giant cell myocarditis: an unusual presentation.

Giant cell myocarditis is a rare but often devastating disease affecting young, otherwise healthy individuals. Patients often die of heart failure and ventricular arrhythmia unless cardiac transplantation is performed. Cardiac magnetic resonance imaging with or without cardiac biopsy can be helpful in making the correct diagnosis and ensuring that correct timely treatment is administered.

G-protein coupled estrogen receptor 1 expression in rat and human heart: Protective role during ischaemic stress.

G-protein coupled estrogen receptor 1, GPER, formerly known as GPR30, is a seven transmembrane domain receptor that mediates rapid estrogen responses in a wide variety of cell types. To date, little is known about the role of GPER during ischaemia/reperfusion injury. In this study, we report both mRNA and protein expression of GPER in the rat and human heart.

Left ventricular diastolic collapse and late regional cardiac tamponade postcardiac surgery caused by large left pleural effusion.

Cardiac tamponade is a well-recognized early complication (ie, within 15 days) of cardiac surgery usually a result of the development of a pericardial effusion postoperatively. However, left ventricular diastolic collapse as a result of the presence of a large pleural effusion, but in the absence of any pericardial effusion, is rare, particularly late (ie, after 15 days) after cardiac surgery. We present the echocardiographic findings of a man presenting with recurrent exertional breathlessness, after elective tissue aortic valve replacement, and demonstrate, by echocardiography, the mechanism of left ventricular diastolic collapse and late regional cardiac tamponade, after cardiac surgery, as a result of the effects of a large pleural effusion but in the absence of any pericardial effusion.

Presentation of an embolised Amplatzer septal occluder to the main pulmonary artery 2 years after implantation.

Percutaneous occlusion techniques of secundum type atrial septal defects have recently become the treatment of choice, delivering excellent results and being associated with a low rate of early and late complications. The investigators report an unusually delayed presentation of acute right heart failure due to Amplatzer septal device embolisation into the main pulmonary artery, 2 years after implantation.

A simple risk score for prediction of mortality in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTEACS).

Aims: To develop an easily applicable prognostic model that can predict mortality risk in patients undergoing percutaneous coronary intervention (PCI) for non-ST segment elevation acute coronary syndromes (NSTEACS).

Methods And Results: A retrospective analysis of 630 consecutive patients undergoing PCI for NSTEACS at our institution between January 1999 and December 2000 (development phase). Multivariate logistic regression analysis to identify independent predictors of mortality.