Spontaneous thrombosis of an unroofed coronary sinus: case report.

Background: Unroofed coronary sinus (UCS) is a rare congenital anomaly and is usually found incidentally. While coronary sinus thrombosis (CST) can occur following instrumentation of the coronary sinus, spontaneous CST is a rare occurrence and only a few cases have been reported to date. The presence of both rare entities concurrently has not been reported previously.

Valve-in-Valve in a Flail Bioprosthetic Mitral Valve With Endocarditis Using a Novel Embolic Protection Device.

A 79-year-old woman presented in cardiogenic shock with a flail bioprosthetic mitral valve leaflet and endocarditis. In the absence of other viable options, transfemoral valve-in-valve transcatheter mitral valve replacement was performed with a novel embolic protection device, resulting in trace mitral regurgitation and no neurologic complications. ().

Poor outcomes in methamphetamine-associated cardiomyopathy-a growing health issue in New Zealand.

Background: Methamphetamine-associated cardiomyopathy (MAC) is increasingly recognised as a serious consequence of chronic metamphetamine use. Evidence to guide management and prognostication of patients with MAC compared to other cardiomyopathies remain limited.

Methods: Clinical characteristics, in-hospital and post-discharge outcomes were collected in consecutive MAC patients at Middlemore Hospital from 2006-2018, and compared with a 1:1 age-range matched cohort with non-ischaemic cardiomyopathy (NCM).

Prevalence and impact of scan-related anxiety during coronary CT angiography: A prospective cohort study of 366 patients.

Background: Scanxiety, the anxiety/stress associated with an imaging test, has never been evaluated in relation to coronary CT angiography (Coronary CTA). As it could impact heart rate and thereby affect image quality of Coronary CTA, we aimed to evaluate the prevalence, severity, and impact of scanxiety on quality and interpretability of Coronary CTA.

Methods: 366 consecutive patients were prospectively presented with a clinical questionnaire comprising two tests to evaluate their scan-related anxiety: the Impact of Event IES-6 (6 questions, final score 0-24) and a visual stress-scale (1 question, score 1-10).

Role of MDCT Imaging in Planning Mitral Valve Intervention.

Purpose Of Review: Recent advancements in transcatheter valvular interventions have resulted in a growing demand for advanced cardiac imaging to help guide these procedures.

Recent Findings: Both echocardiography and multi-detector computed tomography have played essential roles in the maturation of transcatheter aortic valve replacement and are now building on these experiences and helping inform the nascent field of transcatheter mitral interventions. Advanced imaging is essential to aid in the diagnosis and determination of the mechanism of mitral regurgitation.

Fractional flow reserve computed tomography in the evaluation of coronary artery disease.

Amongst patients with suspected obstructive coronary artery disease (CAD), less than a third of patients have obstructive disease on invasive coronary angiography (ICA) and fewer still have flow-limiting obstructive disease as determined by invasive fractional flow reserve (FFR). FFR is a powerful tool in guiding revascularization of flow-limiting lesions which in turn improves clinical outcome in those with haemodynamically significant obstructive disease. However FFR is infrequently performed due to the cost, time and patient discomfort the procedure entails.

Coronary lumen volume to myocardial mass ratio in primary microvascular angina.

Background: Microvascular angina (MVA) is an incompletely understood clinical entity. Computational analysis of coronary Computed Tomography Angiography (CTA) has shown an association between low coronary lumen volume to myocardial mass (V/M) ratio and lower Fractional Flow Reserve values, independent of plaque measures. We hypothesized that low V/M ratio may be present in patients with MVA.

Fractional flow reserve derived from coronary computed tomography angiography reclassification rate using value distal to lesion compared to lowest value.

Introduction: A standardised approach to the interpretation of FFRCT data is currently lacking. We evaluated the rate of reclassification of FFRCT positivity using the FFRCT value distal to an anatomical stenoses compared to the lowest FFRCT value.

Method: Patients who underwent coronary CTA and FFRCT analysis were eligible.

CT-Defined Prosthesis-Patient Mismatch Downgrades Frequency and Severity, and Demonstrates No Association With Adverse Outcomes After Transcatheter Aortic Valve Replacement.

Objectives: This study sought to determine if indexed effective orifice area (EOAi), using left ventricular outflow tract measured from computed tomography (EOAi), reclassified prosthesis-patient mismatch (PPM) compared with conventional echocardiogram-defined measurements (EOAi).

Background: PPM does not predict mortality following transcatheter aortic valve replacement (TAVR). However, it is unknown if the EOAi of the left ventricular outflow tract improves risk stratification.

Comparison of low-dose coronary artery calcium scoring using low tube current technique and hybrid iterative reconstruction vs. filtered back projection.

Introduction: We sought to validate whether low dose CACS CT with hybrid IR (HIR) could replace standard dose filtered back projection (FBP).

Method: We enrolled 100 patients to undergo low dose CACS CT with HIR, in addition to routine full dose FBP.

Results: No significant difference between full and low dose CT in Agatston score 138.

The not so innocent heart murmur: a 5-year experience.

Background: Auckland City Hospital (ACH) established a Heart Murmur Clinic (HMC) with the aim of providing prompt assessment of patients with asymptomatic systolic murmurs. This may lead to early intervention and improved outcomes if significant structural heart disease is detected and reassurance if no significant findings are found. Similar clinics for children have proven beneficial; the benefit of a HMC in an adult population has been difficult to determine.

Computed tomography assessment for transcatheter aortic valve in valve implantation: The vancouver approach to predict anatomical risk for coronary obstruction and other considerations.

Valve-in-valve implantation of a transcatheter heart valve into a failed bioprosthetic heart valve has emerged as a treatment alternative to repeat conventional surgery. This requires careful pre-procedural assessment using non-invasive imaging to identify patients at risk for procedure related adverse events, such as ostial coronary occlusion. Herein we report how to comprehensively assess aortic root anatomy using computed tomography prior to transcatheter valve implantation for failed bioprosthetic aortic valves.

The effect of a whole heart motion-correction algorithm on CT image quality and measurement reproducibility in Pre-TAVR aortic annulus evaluation.

Background: Motion correction (MC) algorithms have been shown to improve image quality, interpretability and diagnostic accuracy in coronary CT angiography. We sought to determine whether MC extended to the whole heart would demonstrate improved image quality and reproducibility of aortic annular measurements in pre-TAVR CT.

Materials And Methods: Twenty-two consecutive contrast enhanced CT data sets acquired for pre TAVR evaluation using retrospective ECG synchronization during a single heart beat were retrospectively identified.

Clinical Characteristics and Outcomes of Patients with Amphetamine-Associated Cardiomyopathy in South Auckland, New Zealand.

Background: Amphetamine-associated cardiomyopathy (AAC) is becoming an increasingly recognised entity. The characteristics and outcomes of these patients are poorly understood.

Methods: Thirty patients admitted with heart failure and echocardiographic evidence of cardiomyopathy between 2005 and 2014 and who had a documented history of amphetamine abuse that was considered an important factor in the causation of their cardiomyopathy were retrospectively identified.

The diagnostic yield of colonoscopy in patients with isolated abdominal pain.

Aim: Colonoscopy is an overstretched resource and there is no consensus on whether isolated abdominal pain is an appropriate indication for colonoscopy. We evaluated the proportion of patients referred for colonoscopy with isolated abdominal pain and determined the diagnostic yield for this indication.

Methods: All patients registered as having a colonoscopy at Waitemata District Health Board on Endoscribe reporting database between March 2005 and February 2010 were included.

Carotid endarterectomy in octogenarians.

Aim: This study compared the postoperative complication rate between patients age 80 or older to those younger than 80 to determine if older patients were associated with higher risk of complication following carotid endarterectomy.

Method: Patients who received carotid endarterectomy between January 1997 and December 2005 were identified using the New Zealand Vascular Surgical Audit Registry. Patients were recruited into the two predetermined age groups.