Deep sedation vs femoral block anesthesia: beat-by-beat hemodynamic impact on TAVI procedure.

Background: In spite of the increased use of Trans-catheter Aortic Valve Implantation (TAVI) due to the better patient selection, well-trained operators and improved technology, the choice of the best anesthesia regimen remains an open question. In particular, it remains to be clarified whether deep sedation (DS) in spontaneous breathing or femoral local anesthesia (LA) is best.

Objective: This study compared the hemodynamic variations determined by deep sedation (DS) with spontaneous breathing and local femoral anesthesia (LA) in 2 groups of patients submitted to TAVI with two different kinds of anesthesia, using a beat-by-beat pulse contour method (MostCare).

[Patent foramen ovale closure: how to choose the right device for the right patient].

Percutaneous patent foramen ovale (PFO) closure is an intervention aimed to prevent cardioembolic stroke. It recently proved to be superior to antiplatelet therapy in preventing recurrent strokes in a well-selected population of patients with a previous cryptogenic cerebral ischemic event. A large part of the clinical advantage of PFO transcatheter therapy derives from the very high efficacy and safety of the maneuver.

Hemodynamic monitoring by pulse contour analysis during trans-catheter aortic valve replacement: A fast and easy method to optimize procedure results.

Background: Residual aortic regurgitation (AR) complicates a not negligible number of transcatheter aortic valve replacement (TAVR) procedures, and its entity is not always clear at intraprocedural angiographic and echocardiographic control. We applied a minimally invasive hemodynamic monitoring system (Pressure Recording Analytical Method, PRAM) in the setting of TAVR, with the aim of identifying parameters that may help in detection and quantification of residual AR.

Methods: We performed hemodynamic monitoring with PRAM in 43 patients undergoing trans-femoral TAVR.

Percutaneous closure of a small posterior mitral paravalvular leak in a patient with coexistent monoleaflet mechanical aortic valve.

Percutaneous closure of a paravalvular leak is a challenging procedure that often presents with multiple simultaneous hurdles. We report a case of percutaneous retrograde paravalvular leak closure in a patient with a coexistent monoleaflet mechanical aortic valve. The leak was crossed and occluded using a combination of techniques deriving from the coronary and peripheral angioplasty fields.

[Inferior vena cava filters: any indications anymore?].

Inferior vena cava filters (IVCFs) are metal alloy devices that mechanically trap fragmented thromboemboli from the deep leg veins en route to the pulmonary circulation. Filters are introduced (and in the case of retrievable filters, removed) percutaneously. Although their deployment seems of theoretical benefit, their clinical efficacy and adverse event profile are unclear because there are very few controlled and randomized data.

Updated management of non-st-segment elevation acute coronary syndromes: selection of patients for low-cost care: an analysis of outcome and cost effectiveness.

Background: The management of patients with acute coronary syndromes without ST-segment elevation (NSTEACS) in a chest pain unit (CPU) should represent a cost-effective advantage over conventional management in a coronary care unit (CCU). However, the safety and advantages of this approach are still unresolved.

Material/methods: Outcomes and management costs were evaluated in patients with NSTEACS with intermediate-high TIMI risk scores (> or =3) randomized to receive management in a CPU or a CCU.

[Association of pulmonary and portal hypertension].

The association between portal venous hypertension and pulmonary arterial hypertension has received scarce attention in the italian medical literature. Nevertheless the association is relatively frequent, it needs a multidisciplinary approach and it is a stimulus for the search of causes of so-called primary pulmonary hypertension. The purpose of the article is to review the frequency of the association, the main pathogenetic hypothesis formulated to explain the appearance of pulmonary hypertension, the clinical and the laboratory findings, the evolution of the association and to present briefly a personal series of cases.

[Obstruction of the superior vena cava following a corrective intervention for total anomalous pulmonary venous return treated by percutaneous angioplasty].

We report a case of a patient operated on for total anomalous pulmonary venous drainage at the age of six months. Seven years later an angiographic examination showed a obstruction of superior vena cava at Juxta right atrial. The patient, asymptomatic until the age of fifteen, was then subjected to further hemodynamic and angiocardiographic examination due to the appearance of an incessant and therapy-resistant cough.

[Pulmonary valve angioplasty via the jugular vein in a 73-year-old female patient].

Percutaneous balloon valvuloplasty was successfully performed in a 73-year-old woman with severe congestive heart failure due to severe calcific valvular pulmonary stenosis. An approach by right internal jugular vein was used for the procedure.

[Pulmonary atelectasis and massive pleural effusion. Echocardiography].

Pulmonary atelectasis can be detected by Two Dimensional Echocardiography (2D-E) when massive pleural effusion is present. A triangular mass, base toward the mediastinum and apex moving freely in the pleural cavity, is shown by 2D-E either in an apical modified view in left pleural effusions or in a subcostal modified view in right pleural effusions. The texture of the mass is liver-like.

Diastolic time intervals before and after nadolol in patients with hypertrophic cardiomyopathy.

In 9 patients with hypertrophic cardiomyopathy, diastolic function was evaluated by noninvasive measurements of diastolic time intervals before and after nadolol administration. No significant variation of the intervals was observed after therapy. The method therefore appears scarcely useful in the evaluation of beta-blocker therapy in these patients.

[Correlations between electrocardiographic findings and echocardiographic patterns in 116 patients with hypertrophic cardiomyopathy].

To evaluate the correlation between electrocardiographic and echocardiographic m-mode (E-TM) and two-dimensional (E-2D) patterns, 116 patients with hypertrophic cardiomyopathy (HCM) were studied by these two methods. Patients were classified into four types, according to Maron et al's E-2D classification of HCM. In addition a subgroup (IIIb) of 15 patients in types III, had typical left ventricular concentric hypertrophy.