Retrograde transmitral paravalvular leak closure through an antegrade transseptal approach: A novel technique.

Mitral paravalvular leak (PVL) remains a well-known complication after mitral valve replacement. Since the first report over 25 years ago, several catheter-based PVL closure techniques have been described. Most of these comprise of either an antegrade transseptal approach, or a retrograde transaortic or transapical approach.

National trends among radiologists in reporting coronary artery calcium in non-gated chest computed tomography.

Coronary artery calcification (CAC) is a known risk factor for adverse outcomes in the general population and in patients with coronary artery disease. We performed a survey of United States radiologists to evaluate the trends in reporting the presence or absence of CAC on NCCT examinations. An 11 multiple-choice questionnaire was distributed to members of the American College of Radiology, and 530 members participated in the study.

Atypical Cellular Chorangioma: A Potential Diagnostic Pitfall With Worrisome Aspects but a Favorable Prognosis.

Chorangiomas are rather frequent neoplasms encountered on placental examination but in rare cases they present some worrisome histological features that could alarm the pathologist and be misinterpreted as a malignant neoplasm, even if their biological behavior is favorable. We describe an unusual chorangioma with high cellularity and abundant mitosis that, after careful examination and postpartum follow-up, showed benign clinical course for mother and child confirming previous reported cases. This type of tumor is known in the literature as atypical cellular chorangioma and its identification is important in order to exclude potentially dangerous overtreatment.

Predictors of 30-day readmission in patients hospitalized with decompensated heart failure.

Background: Heart failure (HF) is the leading cause of hospitalizations and readmissions in the United States. Approximately one-third of patients admitted for HF are readmitted within 3 months; however, there are few markers that can identify those at highest risk for readmission. The purpose of this study was to identify clinical and laboratory markers associated with hospital readmission in decompensated HF.

Prevalence of mitral valve prolapse and congenital bicuspid aortic valves in black and white patients undergoing cardiac valve operations.

The risk factors for aortic and mitral valve diseases that require surgical repair such as congenital bicuspid aortic valve (BAV) and mitral valve prolapse include acquired clinical factors and genetic influences. Whether race affects the prevalence of certain valvular diseases has not been sufficiently investigated. Through the Cleveland Clinic's Cardiovascular Information Registry, we evaluated the data from 40,419 patients who had undergone aortic valve surgery, mitral valve surgery, and/or coronary artery bypass grafting from 1993 to 2007.

Complications of aortic valve surgery: manifestations at CT and MR imaging.

Aortic valve replacement accounts for a significant portion of cardiac surgeries in the United States. Despite advances in prosthetic heart valve design, surgical technique, and postoperative care, complications after aortic valve replacement remain a leading cause of morbidity and mortality. Routine surveillance of prosthetic heart valves with transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and fluoroscopy is important, as these techniques allow accurate detection of prosthetic valve dysfunction.

Repeat recurrence of takotsubo cardiomyopathy related to inhaled beta-2-adrenoceptor agonists.

Takotsubo cardiomyopathy (also referred to as transient apical ballooning syndrome, broken heart syndrome or stress cardiomyopathy) is an increasingly recognized entity in the western world typically characterized by reversible left ventricular dysfunction that develops in the setting of acute severe emotional or physical stress. Increased catecholamine levels have been proposed to play a central role in the pathogenesis of the disease, although the specific pathophysiology of this condition remains elusive at the present moment. In recent times, there have been reports of takotsubo cardiomyopathy (TC) following medical interventions such as invasive or surgical procedures or specific medical regimens.

African american race and prevalence of atrial fibrillation:a meta-analysis.

Background. It has been observed that African American race is associated with a lower prevalence of atrial fibrillation (AF) compared to Caucasian race. To better quantify the association between African American race and AF, we performed a meta-analysis of published studies among different patient populations which reported the presence of AF by race.

Abdominal aortic aneurysm screening during transthoracic echocardiography: Cardiologist and vascular medicine specialist interpretation.

Aim: To study the interobserver variability between a cardiologist and vascular medicine specialist in the screening of the abdominal aorta during transthoracic echocardiography (TTE).

Methods: Consecutive patients, > 55 years of age, underwent abdominal aortic imaging following standard TTE. Two cardiologists and one vascular medicine specialist performed a blinded review of the images.

Delayed chylous pericardial effusion after aortic valve replacement.

Chylopericardium after cardiac surgery is rare, and there are few reports of its occurrence after aortic valve surgery. Chylous pericardial effusion 4 months after aortic valve replacement for endocarditis is highly unusual.Herein, we report the case of a 54-year-old man who had undergone bioprosthetic aortic valve replacement because of endocarditis and valvular dysfunction.

Detection of coronary calcium during standard chest computed tomography correlates with multi-detector computed tomography coronary artery calcium score.

The correlation between formal coronary artery calcium scoring (CACS) determined by multi-detector CT (MDCT) and the presence of coronary calcium on standard non-gated CT chest examinations was evaluated. In 163 consecutive healthy participants, we performed screening same-day standard non-gated, non-enhanced CT chest exams followed by high-resolution, ECG-synchronized MDCT exams for CACS. For the standard CT examinations, a scoring system (Weston score, range 0-12) was developed assigning a score (0-3) for each coronary vessel including the left main trunk.

Congenital rock and a hard place: unicuspid aortic valve with sinus of valsalva aneurysm.

Cardiac CT angiography (CTA) is an ideal tool to investigate possible cardiac malformations. In this case, careful planning of the CTA acquisition and reconstruction provided high resolution images of cardiac anatomy revealing 2 extremely rare coexisting congenital defects; a unicuspid aortic valve (UAV) and sinus of Valsalva aneurysm (SVA). Detailed planning of CTA acquisition reconstruction protocols is essential in obtaining necessary information for clinical decision-making strategies and interventions in the patients with suspected cardiac anomalies.

Accuracy of transthoracic echocardiography for the measurement of the ascending aorta: comparison with transesophageal echocardiography.

Background: There has been a substantial increase in the number of imaging studies performed to assess thoracic aortic pathology. We sought to determine the accuracy of transthoracic echocardiography (TTE) compared to transesophageal echocardiography (TEE) for measuring ascending aortic size.

Hypothesis: Transthoracic echocardiography is reasonably accurate for assessing ascending aortic dimension.

Association of body mass index and lipid profiles: evaluation of a broad spectrum of body mass index patients including the morbidly obese.

Prior epidemiologic studies have shown that increasing body mass index (BMI) is associated with higher total cholesterol and low-density lipoprotein cholesterol (LDL). However, these studies were limited by underrepresentation of obese subjects. The aim of this study was to determine whether there is an association between BMI and lipid profiles in a population of patients with a broad spectrum of BMI values.

Reduced estrogen in menopause may predispose women to takotsubo cardiomyopathy.

Background: Takotsubo cardiomyopathy (apical ballooning syndrome) has been reported with increased frequency, most commonly in postmenopausal women. Despite the gender disparity, no clear link between estrogen and its possible cardioprotective effects has been shown.

Objectives: We present a case series of takotsubo cardiomyopathy in women and examine the prevalence of estrogen replacement therapy (ERT), in addition to conducting a systematic literature review on this topic.

Mitral valve prolapse: evaluation with ECG-gated cardiac CT angiography.

Objective: The purpose of our study was to evaluate the feasibility of detecting mitral valve prolapse with ECG-gated 64-MDCT angiography in comparison with the reference standard, transthoracic echocardiography.

Materials And Methods: The charts of patients consecutively referred for clinically indicated 64-MDCT angiography were reviewed. The study cohort consisted of patients who had undergone transthoracic echocardiography.

Cardiovascular emergencies in cruise ship passengers.

More than 10 million people, many elderly and likely to harbor cardiovascular (CV) disease, embark on cruise ship travel worldwide every year. The clinical presentation and outcome of CV emergencies presenting during cruise ship travel remain largely unknown. Our department provides contracted cardiology consultations to several large cruise lines.

Predictive value of high sensitivity C-reactive protein in the diagnosis and outcomes of acute aortic syndromes.

Objective: The purpose of this study was to determine whether high-sensitivity C-reactive protein (hsCRP) levels differ among patients with acute aortic syndromes (AAS) and if hsCRP could predict their long-term outcomes.

Design: Retrospective observational study.

Setting: Cleveland Clinic Hospital, Cleveland, Ohio.

Cardiovascular complications of obesity surgery in patients with increased preoperative cardiac risk.

Background: Obesity surgery reduces the incidence of long-term cardiovascular events by modifying the associated risk factors. The derived benefits of weight loss surgery might be counterbalanced by the increased cardiovascular risks in some patients. The primary objective of the present study was to determine the rate of cardiovascular events after obesity surgery in patients considered to have an increased cardiac risk profile at a tertiary referral hospital.

Release pattern of N-terminal probrain natriuretic peptide after intra-aortic balloon pump counterpulsation: Insights into the effects of mechanical unloading in patients with acute decompensated heart failure.

A 60-year-old man with dilated cardiomyopathy and severe decompensated heart failure was acutely managed with intra-aortic balloon pump (IABP) counterpulsation. The present report shows the release pattern of plasma natriuretic peptides after IABP therapy. Preliminary findings suggest that natriuretic peptide levels can be used to measure adequate ventricular unloading by IABP counterpulsation, and that a significant early decrease in natriuretic peptide levels after IABP therapy may potentially help identify future candidates for cardiac recovery after prolonged circulatory support.

Aortic valve area: meta-analysis of diagnostic performance of multi-detector computed tomography for aortic valve area measurements as compared to transthoracic echocardiography.

Degenerative aortic valve stenosis (AS) has an incidence of 2-7% in the Western European and North American populations over 65 years of age. The aim of this study was to perform a meta-analysis of the published literature evaluating the accuracy of CT planimetry to measure the aortic valve area. The PUBMED and OVID databases were searched up to May 2008.