Simultaneous Transfemoral Mitral and Tricuspid Valve in Ring Implantation: First Case Report with Edwards Sapien 3 Valve.

Patients with advanced valvular disease may be at high or prohibitive risk for surgical management. We describe a patient with previous mitral and tricuspid valve repair and recurrent admissions for New York Heart Association Class IV heart failure symptoms due to severe mitral stenosis and severe tricuspid regurgitation. Due to her comorbidities and two previous sternotomies, the patient was at high risk for surgery.

Optimal positioning of self-expanding valves before deployment decreases paravalvular regurgitation following transcatheter aortic valve replacement.

Objectives: To evaluate the association between measurements performed during Medtronic CoreValve (MCV) deployment and paravalvular leak (PVL).

Background: The MCV can be recaptured and repositioned, allowing the TAVR operator to implant at a more favorable position. The association between angiographic measurements of MCV position while the valve is recapturable and PVL post deployment has not been investigated.

Postprandial Monocyte Activation in Individuals With Metabolic Syndrome.

Context: Postprandial hyperlipidemia has been suggested to contribute to atherogenesis by inducing proinflammatory changes in monocytes. Individuals with metabolic syndrome (MS), shown to have higher blood triglyceride concentration and delayed triglyceride clearance, may thus have increased risk for development of atherosclerosis.

Objective: Our objective was to examine fasting levels and effects of a high-fat meal on phenotypes of monocyte subsets in individuals with obesity and MS and in healthy controls.

Isolated perforation of left coronary cusp after blunt chest trauma.

Left coronary cusp perforation is an extremely rare consequence of blunt chest trauma. A 22-year-old male presented after a motor vehicle accident with dyspnea. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) showed moderate to severe aortic regurgitation with prolapsing right coronary cusp.

Lipid lowering with PCSK9 inhibitors.

Statins are the most-effective therapy currently available for lowering the LDL-cholesterol (LDL-C) level and preventing cardiovascular events. Additional therapies are necessary for patients who cannot reach the target LDL-C level when taking the maximum-tolerated dose of a statin. Proprotein convertase subtilisin/kexin type 9 (PCSK9) is an enzyme with an important role in lipoprotein metabolism.

The ventriculophasic response: relationship to sinus arrhythmia and the duration of interposed QRS complexes.

Background: The ventriculophasic response (VR) refers to shortening of sinus cycle length during heart block when a QRS complex is interposed between 2 P waves. Our purpose was to analyze its relationship to respiratory sinus arrhythmia (SA) and to compare VR in relation to paced versus intrinsic QRS complexes.

Methods: Patients with advanced heart block had their pacer devices temporarily programmed to ventricular inhibited mode at 30 ppm.

Ceruloplasmin and heart failure in the Atherosclerosis Risk in Communities study.

Background: Ceruloplasmin (Cp) decreases nitric oxide bioavailability in blood and has been associated with cardiovascular disease (CVD) in clinical studies. We assessed the associations between Cp and incident heart failure (HF), death, and CVD in the Atherosclerosis Risk in Communities (ARIC) study.

Methods And Results: Cp was measured at ARIC visit 4 (1996-1998).

Cardiovascular biomarkers and subclinical brain disease in the atherosclerosis risk in communities study.

Background And Purpose: Cerebrovascular and cardiovascular disease share common risk factors. Our goal was to determine whether levels of N-terminal brain natriuretic peptide (NT-proBNP) and cardiac troponin T measured with a highly sensitive assay (hs-cTnT) are associated with silent brain infarcts (BIs) and white matter lesions (WMLs) on MRI in the Atherosclerosis Risk in Communities (ARIC) study.

Methods: At ARIC visit 3 (1993-1995), 1920 participants had brain MRI.

Unusual presentation of endocarditis with nutritional variant Streptococci.

Patients presenting with endocarditis often will give clues to the diagnosis within the history and the physical exam. A history of valvular heart disease and obvious signs of bacteriemia are classical stigmata of infective endocarditis. However, we should keep in mind that endocarditis can present with unusual signs and symptoms that can mislead to the wrong diagnosis and if unrecognized it can lead to severe complications.

Developing and assessing cardiovascular biomarkers.

Atherosclerosis is a slow process that over time can lead to fatal events. Early identification and prediction of future risk can allow for preventive strategies to be instituted. There is an increasing interest in utilizing novel biomarkers in cardiovascular disease screening and management.

The ventriculophasic response revisited: analysis of clinical correlations using a new proposed definition derived in pacemaker patients.

Background: The ventriculophasic response (VR) refers to shortening of atrial cycle length during heart block when a QRS complex is interposed between P waves. No formal quantitative definition has heretofore been proposed, nor have its potential clinical correlations been studied.

Hypothesis: We hypothesized that VR is present in selected patients who are distinguished by clinical features from those who lack VR.

Cardiac injury in patients with COPD presenting with dyspnea: a pilot study.

Purpose: The aim of this pilot study was to test the hypothesis that myocardial ischemia complicates the management of some patients with chest-pain-free chronic obstructive pulmonary disease (COPD) exacerbations.

Methods: In this prospective, observational, cohort study, patients admitted to a 350-bed community teaching hospital, with dyspnea and a primary diagnosis of COPD exacerbation, were followed for enzymatic and electrocardiographic evidence of myocardial ischemia for the first 24 hours of hospital admission.

Results: A total of 114 patients were studied.

Alkaline reflux esophagitis in patients with total gastrectomy and Roux en Y esojejunostomy.

Background And Aims: Alkaline reflux esophagitis is a complication that might develop in patients with total gastrectomy. The aim of the study was to analyze the prevalence and severity of reflux esophagitis and the occurence of complications (Barrett's esophagus and esophageal stenosis) in patients with total gastrectomy and Roux en Y esojejunostomy.

Methods: 92 patients with total gastrectomy performed for gastric cancer were included in the study.

Systolic and diastolic function in patients with systemic sclerosis.

Background: Clinical and epidemiological findings indicate that symptomatic heart disease in patients with systemic sclerosis (SSc) predicts poor prognosis, but cardiac involvement may occur years before clinical manifestation. The aim of this study was to evaluate the cardiac function in patients with SSc and to correlate the echocardiographic parameters with others that quantify the diseases' severity.

Methods: Twenty consecutive patients with SSc were investigated with transthoracic echocardiography (TTE).