Endovascular Repair of an Ascending Aorta Dissection After Self-expanding TAVR by Suprasternal Approach.

Management of rare ascending aortic complications after transcatheter aortic valve replacement (TAVR) remains a poorly defined area of knowledge. Furthermore, because most patients undergoing TAVR are at intermediate to high surgical risk, the treatment of such complications often requires endovascular approaches. Herein, we present a novel technique of endovascular ascending aorta stent graft delivery from the innominate artery for the treatment of a type A aortic dissection after self-expandable TAVR implantation, specifically addressing the landing of the aortic stent within the crown of the TAVR valve.

Transcatheter balloon dilatation of cor triatriatum dexter with percutaneous atrial septal defect closure.

Cor triatriatum dexter is an extremely rare congenital heart defect and cause of hypoxia in adults. We describe a case of cor triatriatum dexter discovered incidentally due to an iatrogenic atrial septal defect. The cor triatriatum dexter resolved with balloon dilation - a novel technique to manage this rare clinical condition.

Initial Experiences with the MitraClip G4: Review of the Novel Device Features.

Objective: Percutaneous edge-to-edge mitral valve repair is an evolving procedure with increasing indications for use. The MitraClip™ G4 is the newest device with 4 device options, each with distinct characteristics. While the NTR and XTR clips have been in use, the G4 adds 2 new wider clips with additional features, the NTW and XTW.

An Updated Comparison of Conventional Coronary Angiography With Cardiac Magnetic Resonance Imaging to Diagnose the Origin and Proximal Course of Anomalous Coronary Arteries.

Background: Anomalous coronary arteries (ACAs) may present increased risk for adverse cardiac events. We sought to evaluate the accuracy of conventional coronary angiography (CCA), as it is currently used in clinical practice, compared with expert interpretation and cardiac magnetic resonance imaging (CMR) in determining the site of origin and proximal course of ACAs.

Methods: Fifty consecutive patients without concomitant congenital heart disease, who were referred for CMR to diagnose the course of an ACA, were retrospectively evaluated.

Review of Published Cases of Syncope and Sudden Death in Patients With Severe Aortic Stenosis Documented by Electrocardiography.

The ECG findings during sudden collapse (syncope or sudden death) in severe aortic stenosis (AS) are not well defined. We conducted a comprehensive review of the literature for ECG data during sudden collapse in patients with AS and provided a case report of our own. There were 37 published cases of syncope or sudden death in patients with severe AS which were documented by ECG.

Snare-Assisted Delivery for Ascending Endovascular Repair of Acute Type A Dissection.

Endovascular stenting of the ascending aorta has been described for various aortic pathologies, including type A dissection in patients who are prohibitive risk for open surgery. Endovascular treatment of ascending aortic pathology poses unique anatomic and technical challenges related to aortic morphology. Herein, we present a novel technique of endovascular ascending stent graft delivery from a transfemoral approach for treatment of an acute type A dissection, utilizing a snare-guided deployment technique to facilitate favorable device deployment.

Utility of three-dimensional transesophageal echocardiography to guide transseptal positioning of a single multistage venous cannula to provide both venous drainage and indirect left ventricular venting in veno-arterial extracorporeal membrane oxygenation.

A patient with heart failure due to dilated ischemic cardiomyopathy presented in cardiogenic shock for institution of veno-arterial extracorporeal membrane oxygenation as a bridge to cardiac transplantation. To provide adequate venous drainage and simultaneous decompression of the left atrium (indirect left ventricular venting), a single venous cannula was placed across the interatrial septum so that the distal orifice and side ports were located within the left atrium and the proximal set of side ports were positioned at the cavoatrial junction. Three-dimensional transesophageal echocardiography demonstrated utility in guiding cannula placement and appropriate positioning within the left atrium.

Femoral venoarterial extracorporeal membrane oxygenation using a novel biatrial cannula for venous drainage and left ventricular venting.

Extracorporeal life support (ECLS) is an expanding technology for patients in cardiogenic shock. The majority of patients requiring ECLS can be managed with percutaneous venoarterial (VA) femoral cannulation. Despite sufficient extracorporeal circulatory support, a unclear number of patients develop left ventricular distension which can result in increased wall tension and stress as well as worsening pulmonary edema.

Fusion imaging during balloon mitral valvulopasty: First experience.

The EchoNavigator (EchoNav, Philips, The Netherlands) is a tool that fuses live X-ray with three-dimensional (3D) transesophageal echocardiogram (TEE) images allowing for enhanced precision and accuracy during interventional cardiac procedures. We present the first case of EchoNav utilization during balloon mitral valvuloplasty using the newest version (EchoNav 3.0.

Use of echocardiography as an essential tool for targeted transcatheter biopsy of cardiac masses.

Echocardiography has emerged as an essential tool to guide targeted, transcatheter biopsy of cardiac masses. Options for imaging include transthoracic or transesophageal echocardiography and intracardiac echocardiography, with appropriate use being dictated by specific patient characteristics and institutional experience. The authors present a case of three-dimensional (3-D) transesophageal echocardiography-guided transcatheter biopsy of a right ventricular mass and review the current use of echocardiography to guide these procedures.

Guidelines in review: Comparison of the 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.

In this Guidelines in Review, we review side-by-side the recommendations provided by the 2014 AHA/ACC Guideline for the management of patients with non-ST-elevation acute coronary syndromes and the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. We review the recommendations for imaging in the evaluation of patients with possible ACS followed by the diagnostic evaluation of patients with proven NSTE-ACS, based on their risk for adverse clinical events.