Hybrid interventional procedures in congenital heart disease.

The evolution of congenital cardiac surgery has seen significant innovative advances in collaborative efforts between congenital cardiac surgeons and interventionalists to provide the least invasive intervention with the greatest hemodynamic benefit for patients with congenital heart disease. This review looks at how this collaborative approach has evolved and is being applied to treat a number of congenital conditions across the age ranges.

Adverse outcomes in hospitalized patients who develop ST-elevation myocardial infarction.

Background: There has been considerable emphasis on the care of patients with ST-elevation myocardial infarction (STEMI) with the wide implementation of protocols to quickly identify and triage them from the emergency department (ED) to a cardiac catheterization laboratory for percutaneous coronary intervention. However, a small but important number of patients with STEMI develop ST-elevation while hospitalized for another medical problem.

Methods: A single-center, retrospective chart review was performed on 172 consecutive patients with STEMI who underwent emergency percutaneous coronary intervention.

How should I treat prosthetic tricuspid stenosis in an extreme surgical risk patient?

Background: A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion.

Investigation: Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography.

Diagnosis: She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure.

Perventricular Melody valve implantation in a 12 kg child.

Transcatheter pulmonic valve implantation has emerged as a safe and effective alternative to valve surgery in patients with surgically corrected congenital heart disease. In cases where the transcatheter approach has failed, or was thought to be technically challenging, a hybrid approach to pulmonic valve implantation has been described. This approach involves a small subxyphoid incision made by the cardiac surgeon and implantation of the pulmonic valve through the appropriate delivery sheath through this incision.

The Edwards SAPIEN Transcatheter Heart Valve for Calcific Aortic Stenosis: A Review of the Valve, Procedure, and Current Literature.

The Edwards SAPIEN™ transcatheter heart valve (Edwards Lifesciences LLC, Irvine, CA, USA) is approved by the US Food and drug administration for use in the aortic position in patients with severe aortic stenosis who are not surgical candidates. This approval was backed by data from the Placement of AoRTic TraNscathetER Valve (PARTNER) I clinical trial, which showed the valve to be superior to standard medical therapy in high-risk nonoperative patients in cohort B of the trial. Although insertion of the valve is considered to be very safe, stroke, major vascular complications, and conduction abnormalities are the most frequent procedural complications.

A case report of atrial fibrillation potentially induced by hydroxycut: a multicomponent dietary weight loss supplement devoid of sympathomimetic amines.

Multicomponent dietary weight loss supplements comprise the single largest segment of herbal preparations available to the public. As a result of limited de novo regulatory oversight, supplement-related adverse events are underreported secondary to the lack of adequate pharmacodynamic, pharmacokinetic, and clinical data. Here we report the case of an obese 63-year-old caucasian female with a 2-day history of symptomatic paroxysmal atrial fibrillation (AF) with rapid ventricular response following a 2-week course of therapy with hydroxycut, a multicomponent dietary weight loss supplement devoid of sympathomimetic amines.

Relative safety of gemfibrozil and fenofibrate in the absence of concomitant cerivastatin use.

Previous analyses of fibrate safety may have been driven by a higher propensity for gemfibrozil to interact with cerivastatin, which is currently off the market because of safety concerns. We reviewed gemfibrozil- and fenofibrate-associated adverse event reports (AERs) submitted to the US Food and Drug Administration over a 5-year period. To control for cerivastatin's impact on fibrate-associated AERs, reports with concomitant cerivastatin use were excluded.