Post-infarction ventricular septal defect: percutaneous or surgical management in the UK national registry.

Aims: Post-infarction ventricular septal defect (PIVSD) is a mechanical complication of acute myocardial infarction (AMI) with a poor prognosis. Surgical repair is the mainstay of treatment, although percutaneous closure is increasingly undertaken.

Methods And Resuts: Patients treated with surgical or percutaneous repair of PIVSD (2010-2021) were identified at 16 UK centres.

Double-blind, placebo-controlled evaluation of biorest liposomal alendronate in diabetic patients undergoing PCI: The BLADE-PCI trial.

Background: Diabetes mellitus (DM) is an important predictor of neointimal hyperplasia (NIH) and adverse clinical outcomes after percutaneous coronary intervention (PCI). LABR-312, a novel intravenous formulation of liposomal alendronate, has been shown in animal models to decrease NIH at vascular injury sites and around stent struts. The aim of the Biorest Liposomal Alendronate Administration for Diabetic Patients Undergoing Drug-Eluting Stent Percutaneous Coronary Intervention trial was to assess the safety, effectiveness, and dose response of LABR-312 administered intravenously at the time of PCI withDES in reducing NIH as measured by optical coherence tomography postprocedure in patients with DM.

Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

Background: Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically.

Radial versus femoral vascular access in ST-elevation myocardial infarction: Are the results of femoral operators unfairly represented in observational research?

Background: Recent randomized controlled trials comparing femoral and radial access in primary percutaneous coronary intervention (PPCI) have shown conflicting results regarding the incidence of major adverse cardiovascular events (MACE) and major bleeding.

Methods: Using data from the HEAT-PPCI trial, we compared the primary efficacy (all-cause mortality, stroke, new myocardial infarction or unplanned repeat revascularization) and safety (major bleeding BARC 3-5) outcomes at 28 days, by final access site used (radial or femoral) and by default operator type. We then assessed outcomes in femoral cases performed by both operator types.

Patterns of solid particle embolization during transcatheter aortic valve implantation and correlation with aortic valve calcification.

Objectives: To evaluate solid embolization during transcatheter aortic valve implantation (TAVI) and correlate this with aortic valve calcification.

Background: There is a known stroke risk with TAVI, thought partly to be due to dislodgement of native aortic valve particles during implantation. However, to date there is little evidence that aortic valve calcification actually impacts embolic risk.

Percutaneous Device Closure of Paravalvular Leak: Combined Experience From the United Kingdom and Ireland.

Background: Paravalvular leak (PVL) occurs in 5% to 17% of patients following surgical valve replacement. Percutaneous device closure represents an alternative to repeat surgery.

Methods: All UK and Ireland centers undertaking percutaneous PVL closure submitted data to the UK PVL Registry.

Balloon-Expandable Transcatheter Aortic Valves Can Be Successfully and Safely Implanted Transfemorally Without Balloon Valvuloplasty.

Objectives: To assess the necessity for balloon aortic valvuloplasty (BAV) during transfemoral transcatheter aortic valve implantation (TAVI) when using balloon-expandable valves.

Background: BAV is a usual part of TAVI procedures, prior to valve implantation. However, the benefits and necessity of this are unknown and recent evidence in self-expanding valves suggests it may not be necessary.

Closure of Long-Tunnel PFOs With the Coherex Flatstent EF - A Tailored Approach.

Aims: Despite rapid progress in device technologies for patent foramen ovale (PFO) closure over the past decade, long-tunnel anatomies still constitute a challenge. The present study investigated the performance of a novel in-tunnel device (Flatstent EF; Coherex Medical) in long-tunnel PFOs.

Methods And Results: Three different umbrella devices (n = 61) and the Coherex Flatstent (n = 27) were used for PFO closure.

Safety and performance of a novel embolic deflection device in patients undergoing transcatheter aortic valve replacement: results from the DEFLECT I study.

Aims: This study aimed to evaluate the safety and performance of the TriGuard™ Embolic Deflection Device (EDD), a nitinol mesh filter positioned in the aortic arch across all three major cerebral artery take-offs to deflect emboli away from the cerebral circulation, in patients undergoing transcatheter aortic valve replacement (TAVR).

Methods And Results: The prospective, multicentre DEFLECT I study (NCT01448421) enrolled 37 consecutive subjects undergoing TAVR with the TriGuard EDD. Subjects underwent clinical and cognitive follow-up to 30 days; cerebral diffusion-weighted magnetic resonance imaging (DW-MRI) was performed pre-procedure and at 4±2 days post procedure.

Post-procedural arterial hypertension: implications for clinical outcome after transcatheter aortic valve implantation.

Background And Aim Of The Study: Persistent arterial hypertension (HT) has been associated with increased morbidity and mortality after surgical aortic valve replacement (AVR). The impact of increased blood pressure (BP) after transcatheter aortic valve implantation (TAVI) has not yet been fully elucidated.

Methods: The mean systolic and diastolic BP after TAVI were calculated from the last 10 non-invasive recordings performed before discharge in 176 patients.

Implementation of NICE Clinical Guideline 95 for assessment of stable chest pain in a rapid access chest pain clinic reduces the mean number of investigations and cost per patient.

Objective: In 2010, the National Institute for Health and Care Excellence (NICE) in the UK published Clinical Guideline 95 (CG95) advocating risk stratification of patients using 'CADScore' to guide appropriate cardiac investigations for chest pain of recent onset. Implementation of the guideline in the University College London Hospitals NHS Foundation Trust was evaluated to see if it led to a reduction in the average cost of the diagnostic journey per patient and fewer investigations per patient in order to confirm a diagnosis.

Methods: This was a single centre study at a Tertiary Centre in Central London.

Concurrent diagnosis of rheumatic mitral stenosis & aortoarteritis: a rare combination.

A 21-year-old lady was initially diagnosed with rheumatic mitral stenosis and then 18 months later with asymptomatic aortoarteritis. She was treated with percutaneous interventions for both problems. This is a very rare combination of conditions, which has previously been reported in a few autopsy specimens.

Quadricuspid aortic valve with ruptured sinus of valsalva aneurysm to the right atrium.

A 32-year-old man with a sudden onset of chest pain and progressive dyspnea was found to have a ruptured sinus of Valsalva aneurysm to the right atrium with an associated quadricuspid aortic valve. Echocardiographic and angiographic images are presented, with real time transthoracic 3D echo. The patient was successfully operated.

Factors predicting the progress of mitral valve disease in surgically treated adults with ostium primum atrial septal defects.

Objective: This study was undertaken to analyze the clinical profile, associated features, and surgical treatments of adults operated on for ostium primum atrial septal defects, particularly factors influencing progression of mitral valve disease.

Methods: We retrospectively studied all patients aged 18 years and older operated on at our institution with reference to patient clinical features, investigation findings, surgical records, and outpatient follow-up data.

Results: Fifty-one patients, 29 female and 22 male, underwent operation at a mean age of 27.

Giant single left coronary artery with right ventricular fistula diagnosed in early childhood.

We present an unusual case of an 18-month-old boy, who presented with dyspnea and recurrent respiratory tract infections. Echocardiography and subsequent angiography were suggestive of a fistula from a coronary artery to the right ventricle. Finally, only on table could the actual diagnosis of a single left coronary artery with right ventricular fistula be made.

Aortopulmonary window in adults: diagnosis and treatment of late-presenting patients.

Objectives: Aortopulmonary window is an uncommon condition, particularly so in adulthood because it is usually fatal in infancy or childhood if untreated. Very few cases of those who have survived to adulthood and been operated on successfully have been described. Our study aimed to provide clinical, investigative, surgical, and outcome details of such patients.

Mixed supra- and infradiaphragmatic totally anomalous pulmonary venous connection in an adolescent.

An unusual type of mixed totally anomalous pulmonary venous drainage in an 11-year-old boy was diagnosed on angiography. The left-side veins drained via a vertical vein into the portal venous system, while the right-side veins drained high into the superior vena cava. Surgical correction of this abnormality was successfully performed.

Imaging features of aorto-right atrial tunnel: a report of two cases.

Aorto-right atrial tunnel is a rare congenital anomaly with very few cases described in the literature. It has been classified into anterior and posterior types and we present two operated cases, one of each type. The radiologic, echocardiographic, and angiographic features of the condition are highlighted.

Clinical presentation and investigation findings in cardiac myxomas: new insights from the developing world.

Background: Cardiac myxomas are an uncommon condition and most of the available information on their clinical features comes from smaller series of patients from developed countries. Our aim was to quantify and correlate the clinical and investigation findings in cardiac myxomas in a developing country and compare them with existing data.

Methods: A retrospective study of case notes, electrocardiograms, and x-rays of 171 patients treated for cardiac myxoma from February 1992 to October 2006 at a large charitable institution in South India was conducted.

Ruptured sinus of valsalva: unexpected finding in a patient diagnosed with ventricular septal defect with aortic regurgitation.

Ruptured sinus of Valsalva aneurysm is an uncommon condition which has a good prognosis if surgically corrected. However, sometimes making the diagnosis on echocardiography and even cardiac catheterization can be difficult. We describe a case which was diagnosed as ventricular septal defect with aortic regurgitation but, on the table, was found to be a ruptured sinus of Valsalva aneurysm.

Giant ruptured sinus of Valsalva aneurysm: diagnosis on echocardiography.

A giant ruptured sinus of Valsalva aneurysm was diagnosed on transthoracic and subsequent transesophageal echocardiography, in a 45-year-old man who presented with gradual onset shortness of breath. Although the initial presentation was insidious, he later rapidly deteriorated. We discuss the unusual clinical course in a patient with such a large aneurysm and discuss the likely reasons.

Snake venom for acute myocardial infarction: natural serendipity or an obstruction to treatment?

A 55-year-old man developed an acute myocardial infarction and was bitten by a snake with haemotoxic venom prior to any treatment being given. We discuss our treatment of myocardial infarction in a patient who had been unintentionally anticoagulated.