Mechanical Circulatory Support With Impella in High-Risk Patients With Chronic Total Occlusion and Complex Multivessel Disease.

Background: The therapeutic management of patients with multivessel disease and severe left ventricular dysfunction is complex and controversial.

Aims: The aim of this study was to analyze the clinical outcomes and the changes in left ventricular ejection fraction (LVEF) in patients with severe left ventricular dysfunction and at least one chronic total occlusion (CTO) undergoing percutaneous coronary intervention (PCI) with hemodynamic support provided by Impella.

Methods: Retrospective, multicenter study enrolling patients with severe left ventricular dysfunction and severe coronary artery disease with at least one CTO who required percutaneous mechanical circulatory support with Impella, from January 2019 to December 2023.

Dissection and Re-entry Techniques for Chronic Total Occlusion Percutaneous Coronary Intervention.

Despite early stagnation in success rates for percutaneous coronary intervention for chronic total occlusion with the traditional antegrade wiring approach, the introduction of dissection/re-entry techniques and the retrograde approach opened new avenues for operators to tackle more complex occlusions. Dissection/re-entry techniques (both antegrade and retrograde) are commonly used in angiographic scenarios characterised by long, tortuous and calcified occlusions, as well as in those with proximal cap ambiguity. Familiarity and comfort using the extraplaque space (with either an antegrade or retrograde approach) have become fundamental to achieving safe and effective recanalisation of complex chronic total occlusions.

Sub-Intimal Tracking and Re-Entry and Investment Procedures: Current Applications and Future Directions.

In seeking to improve upon chronic total occlusion (CTO) percutaneous coronary intervention success rates and minimize risk, CTO modification procedures (investment procedures) have been developed and utilized with increasing frequency. Two key techniques have emerged: subintimal tracking and re-entry (STAR) and subintimal plaque modification (SPM). Both require a staged approach with an index procedure for plaque modification and a second procedure weeks later for stenting.

Unraveling the Enigma of Moderate Aortic Stenosis: Challenges and Future Prospects.

According to current guidelines, only clinical surveillance is recommended for patients with moderate aortic valve stenosis (AS), while aortic valve replacement may be considered in patients undergoing surgery for other indications. Recent studies have shown that moderate AS is associated with a high risk of adverse cardiovascular events, including death, especially in patients with left ventricular dysfunction. In this context, multimodality imaging can help to improve the accuracy of moderate AS diagnosis and to assess left ventricular remodeling response.

Controlled antegrade and retrograde subintimal tracking (CART) for recanalisation of chronic total occlusions.

Background: Controlled antegrade and retrograde subintimal tracking (CART) is rarely performed in contemporary chronic total occlusion (CTO) percutaneous coronary intervention (PCI).

Aims: We aimed to analyse the indications, procedural characteristics, and outcomes of CART at a high-volume CTO programme.

Methods: We included all patients undergoing a retrograde CTO PCI in which CART was performed at our institution between January 2019 and November 2023.

Mechanical Circulatory Support for High-Risk Percutaneous Coronary Intervention.

Purpose Of Review: This review will focus on the indications of mechanical circulatory support (MCS) for high-risk percutaneous coronary intervention (PCI) and then analyze in detail all MCS devices available to the operator, evaluating their mechanisms of action, pros and cons, contraindications, and clinical data supporting their use.

Recent Findings: Over the last decade, the interventional cardiology arena has witnessed an increase in the complexity profile of the patients and lesions treated in the catheterization laboratory. Patients with significant comorbidity burden, left ventricular dysfunction, impaired hemodynamics, and/or complex coronary anatomy often cannot tolerate extensive percutaneous revascularization.

Intracoronary snaring of the retrograde guidewire: A novel method to solve compartment mismatch in complex retrograde CTO PCI.

The retrograde approach has allowed a remarkable improvement in the success rate of chronic total occlusion (CTO) percutaneous coronary intervention (PCI). After collateral channel crossing, the most crucial aspect of retrograde CTO PCI is creating the connection between the antegrade and retrograde system. Currently, the most common technique to achieve this is reverse controlled antegrade and retrograde subintimal tracking.

Aortic Valve Stenosis and Cancer: Problems of Management.

Aortic valve stenosis and malignancy frequently coexist and share the same risk factors as atherosclerotic disease. Data reporting the prognosis of patients with severe aortic stenosis and cancer are limited. Tailoring the correct and optimal care for cancer patients with severe aortic stenosis is complex.

Case Report: A rare homozygous patient affected by systemic amyloidosis with a prominent heart involvement.

Hereditary transthyretin amyloidosis is a severe, adult-onset autosomal dominant inherited systemic disease predominantly affecting the peripheral and autonomic nervous system, heart, kidney, and the eyes. We present a case of a Caucasian 65-year-old man with cardiac amyloidosis and the homozygous mutation Val142Ile (classically, Val122Ile) in the transthyretin gene. We provide a genotype-phenotype correlation regarding the genetic status of both heterozygous and homozygous individuals and their clinical conditions at the time of genetic testing.

Use and Implications of Echocardiography in the Hemodynamic Assessment of Cardiogenic Shock.

Cardiogenic shock (CS) is a complex multisystem syndrome due to pump failure, associated with high mortality and morbidity. Its hemodynamic characterization is key to the diagnostic algorithm and management. Pulmonary artery catheterization is the gold standard for the left and right hemodynamic evaluation, but some concerns exist for invasivity and untoward mechanical and infective complications.

The Global Burden of Valvular Heart Disease: From Clinical Epidemiology to Management.

Valvular heart disease is a leading cause of cardiovascular morbidity and mortality and a major contributor of symptoms and functional disability. Knowledge of valvular heart disease epidemiology and a deep comprehension of the geographical and temporal trends are crucial for clinical advances and the formulation of effective health policy for primary and secondary prevention. This review mainly focuses on the epidemiology of primary (organic, related to the valve itself) valvular disease and its management, especially emphasizing the importance of heart valve centers in ensuring the best care of patients through a multidisciplinary team.

Management of Dyslipidemia in Secondary Prevention of Cardiovascular Disease: The Gap between Theory and Practice.

Hypercholesterolemia is one of the most important modifiable risk factors for cardiovascular events (CV) representing the principal driving force in the development of atherosclerotic cardiovascular diseases (ASCVD) [...

Secondary hemophagocytic lymphohistiocytosis: a case report.

Hemophagocytic lymphohistiocytosis (HLH) is a rare hematologic syndrome presenting either as an inherited life-threatening inflammatory disorder in children or as a secondary disease in adults. Inherited HLH involves inborn defects in lymphocytes and includes autosomal recessive and X-linked disorders characterized by uncontrolled activation of T cells and macrophages and overproduction of inflammatory cytokines. Secondary or acquired HLH occurs in the settings of infections, systemic connective tissue disease and lymphoid malignancies, possibly due to underlying genetic predisposition to develop HLH.

Long-Term Outcomes of Chronic Total Occlusion Recanalization Versus Percutaneous Coronary Intervention for Complex Non-Occlusive Coronary Artery Disease.

The durability of chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is uncertain. We aimed to compare the long-term outcomes of CTO PCI with those of complex non-CTO PCI. We built a single-center registry including all patients who underwent CTO and complex non-CTO PCI between 2012 and 2017.

Risk of contrast-induced nephropathy in patients undergoing complex percutaneous coronary intervention.

Background: Complex percutaneous coronary intervention (PCI) is associated with increased procedural challenges and high contrast load. We aimed to evaluate the association between complex PCI and contrast-induced nephropathy (CIN).

Methods: This single-center retrospective study included all-comers undergoing PCI between January 2012 and December 2016.

Case study of the use of evaluation evidence to inform diabetes prevention programming in two Canadian health regions: effectiveness of evaluation evidence.

This study compares the use of evidence in two 18-month Canadian projects with a similar goal: improved prevention of type II diabetes in women from ethno-cultural communities with a gestational diabetes diagnosis. Evidence used for both projects included epidemiological data and research literature, needs assessments with the target population, and project evaluations. Contexts for the use of evidence differed between the two projects in terms of the innovation and its level of complexity; organizational context and system readiness for change; and partnership characteristics.

Indoor exposure to perchloroethylene (PCE) in individuals living with dry-cleaning workers.

Perchloroethylene (PCE) is the most widely used solvent in dry-cleaning; it is toxic to the liver, kidney and central nervous system and may be a human carcinogen. PCE levels in the ambient air of dry-cleaners' homes were measured, and samples of end-exhaled air (alveolar air) from subjects who were not themselves occupationally exposed, but who were members of the household of dry-cleaners were compared with samples from the general population. Thirty apartments were visited housing dry-cleaners and their families, and located well away from the dry-cleaning premises.

[Multidimensional diagnosis in general medicine. Comparative study of the use of various instruments].

This study was performed to test three instruments for functional status assessment in General Practice: the Dartmouth Coop Charts (COOP Charts), the Functional Status Questionnaire (FSQ) and the Duke University Health Profile (DUHP). All the instruments covered a score of functional aspects in physical, mental and social areas, providing a multidimensional measure of health status. We used these three instruments, validated by international studies, to acquire information concerning their feasibility and acceptability among patients from rural communities needing primary care and to test their validity in differentiating between patient subgroups.

Postnatal development of epididymis and ductus deferens in the rat. A correlation between the ultrastructure of the epithelium and tubule wall, and the fluorescence-microscopic distribution of actin, myosin, fibronectin, and basement membrane.

The postnatal maturation of regions of the epididymis and intragonadal segment of the deferens duct was studied in the rat by light- and transmission electron microscopy. Maturation of the genital duct starts in the distal cauda epididymidis and ductus deferens after one week of life, and one week later, in the more cranial segments of the epididymis. Epithelial principal cells and peritubular contractile cells are structurally mature 35 days after birth.

The postnatal maturation of efferent tubules in the rat: a light and electron microscopy study.

The postnatal maturation of the epithelium and tubule wall of efferent tubules in the rat was investigated by light and transmission electron microscopy, from birth to 50 days of age, when sperms were released from the seminiferous tubules and appeared in the genital duct. At the end of the first week of life, an endocytotic apparatus is differentiated in the epithelial cells. During the third week of life, efferent tubules developed specializations for the transport of sperms and fluids, namely the appearance of ciliated elements interspersed among the principal cells of the epithelium, and differentiation of myoid elements in the tubule wall.

Quantitative evaluation of Leydig cells in testicular biopsies of men with varicocele.

A quantitative analysis of Leydig cells was performed in 23 testicular biopsies of men with left varicocele and sperm count ranging from zero to 95,000 sperm/mm3. The oligozoospermic patients had more Leydig cells and higher FSH and LH serum levels than the patient group with more than 10,000 sperm/mm3. The Leydig cell density appeared tightly correlated (p less than 0.