Impact of dual energy cardiac CT for metal artefact reduction post aortic valve replacement.

Purpose: Assess image quality of dual-energy (DE) and single-energy (SE) cardiac multi-detector computed tomographic (MDCT) post aortic valve replacement (AVR) on a dual source MDCT scanner.

Methods: Eighty patients with cardiac MDCT acquisitions (ECG gated, dual-source) post-surgical and transcatheter AVR were retrospectively identified. Forty DE (cohort 1) and 40 SE acquisitions (cohort 2; 100 or 120 kVp) were reviewed.

Splanchnic Nerve Block for Chronic Heart Failure.

Objectives: We hypothesized that splanchnic nerve blockade (SNB) would attenuate increased exercise-induced cardiac filling pressures in patients with chronic HF.

Background: Chronic heart failure (HF) is characterized by limited exercise capacity driven in part by an excessive elevation of cardiac filling pressures.

Methods: This is a prospective, open-label, single-arm interventional study in chronic HF patients.

Transcatheter aortic valve replacement for patients with severe bicuspid aortic stenosis.

Background: Patients with bicuspid aortic valve stenosis (BAV) were excluded from all the trileaflet aortic valve stenosis (TAV) pivotal trials, and therefore, their outcomes are not clearly defined. The aim of the study was to evaluate the outcomes of transcatheter aortic valve replacement (TAVR) in patients with BAV and compared them with those of TAV.

Methods: We evaluated the outcomes following TAVR of patients with BAV at our institution between April 2011 and November 2016 and compared them with the outcomes of patients with TAV treated with TAVR.

Review of alternative access in transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) has surpassed surgical aortic valve replacement (SAVR) as the most common treatment strategy for severe symptomatic aortic stenosis over the past decade. As TAVR technology has continued to advance, it has been expanded from being an option only for extreme risk patients to now being the preferred option for the majority of patients with severe aortic stenosis. Recent trials have shown that TAVR is superior or non-inferior to SAVR even in patients at low surgical risk.

Valve-in-Ring Transcatheter Aortic Valve Replacement After Left Ventricular Assist Device Therapy.

Aortic regurgitation after left ventricular assist device (LVAD) implantation is a well-described problem that decreases the clinical effectiveness of LVAD therapy and may eventually prompt consideration of aortic valve replacement once the regurgitation becomes severe. Transcatheter aortic valve replacement is an attractive, less invasive option compared with surgical aortic valve replacement in these patients. We report a valve-in-ring transcatheter aortic valve replacement for a patient with severe aortic regurgitation associated with LVAD destination therapy.

Trends and Outcomes of Alternative-Access Transcatheter Aortic Valve Replacement.

Background: Alternative access (AA) is still required for a significant proportion of patients undergoing transcatheter aortic valve replacement (TAVR). We sought to compare the clinical outcomes of patients undergoing AA vs transfemoral (TF) access.

Methods: We retrospectively evaluated the outcomes of patients undergoing AA-TAVR between April 2011 and November 2016, and compared them with those who had TF-TAVR.

Association of Renin-Angiotensin Inhibitor Treatment With Mortality and Heart Failure Readmission in Patients With Transcatheter Aortic Valve Replacement.

Importance: Data are lacking on the effect of a renin-angiotensin system (RAS) inhibitor prescribed after transcatheter aortic valve replacement (TAVR). Treatment with a RAS inhibitor may reverse left ventricular remodeling and improve function.

Objective: To investigate the association of prescription of a RAS inhibitor and outcomes after TAVR.

Asymptomatic Severe Aortic Valve Stenosis-When to Intervene: a Review of the Literature, Current Trials, and Guidelines.

Purpose Of Review: The optimal treatment for asymptomatic patients with severe aortic valve stenosis (AS) is not clearly known. Here, we review the available data on the management of such patients.

Recent Findings: Half of patients with severe AS are asymptomatic at the time of diagnosis, and are at risk for adverse events, including sudden cardiac death.

Challenges in Aortic Valve Stenosis: Low-Flow States Diagnosis, Management, and a Review of the Current Literature.

Purpose Of Review: We will describe and define the current diagnosis, management, and potential therapy for low-flow aortic stenosis (AS) states, as well as summarize the available evidence underlying these recommendations.

Recent Findings: Low-flow aortic stenosis syndromes have worse prognoses than traditionally defined normal flow severe aortic stenosis. In this setting, aortic valve replacement is the only therapy that improves outcomes.

Coronary Artery Anomalies: When You Need to Worry.

Purpose Of Review: There is a broad spectrum of coronary artery anomalies that cardiologists may encounter either incidentally or during evaluation for cardiac symptoms. These anomalies include anomalous coronary arteries arising from the opposite sinus of Valsalva (ACAOS), coronary fistulae, and coronary artery aneurysms. This manuscript outlines the unique features, diagnostic characteristics, and treatment considerations for these lesions.

Platypnea-Orthodeoxia Syndrome: To Shunt or Not to Shunt, That is the Question.

Platypnea-orthodeoxia syndrome is a rare disease defined by dyspnea and deoxygenation, induced by an upright position, and relieved by recumbency. Causes include shunting through a patent foramen ovale and pulmonary arteriovenous malformations. A 79-year-old woman experienced 2 syncopal episodes at rest and presented at another hospital.

Resolution of severe hemolysis and paravalvular aortic regurgitation employing an Amplatzer Vascular Plug 4: the importance of detailed pre-procedural planning using CT angiography.

A 76-year-old woman presented with progressive heart failure and transfusion-dependent hemolytic anemia due to severe paravalvular aortic regurgitation 4 years after bioprosthetic aortic valve replacement. She was deemed not to be a candidate for redo cardiac surgery due to a porcelain aorta and multiple comorbid medical conditions. We describe the role of pre-procedure contrast-enhanced, ECG-gated computed tomographic angiography to characterize the anatomy of the paravalvular leak connection for appropriate occluder device selection leading to successful percutaneous closure and resolution of the paravalvular regurgitation and hemolytic anemia.

Comparison of aortic annulus size by transesophageal echocardiography and computed tomography angiography with direct surgical measurement.

This study sought to compare the accuracy of 2-dimensional transesophageal echocardiography (TEE) and computed tomography angiography (CTA) for noninvasive aortic annular sizing as required for transcatheter aortic valve implantation (TAVI). Direct intraoperative (OR) sizing is the gold standard for aortic annular measurement in surgical aortic valve replacement. Unlike surgical aortic valve replacement, TAVI requires noninvasive assessment of aortic annular dimensions for determining the size of prosthesis to be implanted and controversy exists regarding the best imaging technique for TAVI sizing.

Assessment of single-bolus contrast administration technique using hybrid dual-source ECG-gated thoracic and dual-source non-ECG-gated high-pitch abdominopelvic CT acquisitions for procedural planning before transcatheter aortic valve replacement.

Purpose: This study aimed to assess vascular contrast opacification and homogeneity using single-bolus contrast administration with hybrid thoracic and abdominopelvic computed tomographic angiography in patients with severe aortic valve stenosis.

Materials And Methods: Combination electrocardiogram-gated thoracic and dual-source, high-pitch abdominopelvic computed tomographic angiography examinations of 50 patients with severe aortic stenosis between December 2013 and March 2014 were reviewed. Contrast administration was individualized to patient-specific physiology.

Radiation-associated valvular heart disease.

Therapeutic ionizing radiation, such as that used in the treatment of Hodgkin's lymphoma, can cause cardiac valvular damage that may take several years to manifest as radiation-associated valvular heart disease. Treatment can be complicated by comorbid radiation injury to other cardiac and mediastinal structures that lead to traditional surgical valve replacement or repair becoming high-risk. A representative case is presented that demonstrates the complexity of radiation-associated valvular heart disease and its successful treatment with percutaneous transcatheter valve replacement.

Treatment of mechanical aortic valve thrombosis with heparin and eptifibatide.

A 75-year old woman with a history of coronary disease status post 3-vessel coronary artery bypass grafting (CABG) 8 years ago and a repeat one-vessel CABG 2 years ago in the setting of aortic valve replacement with a #19 mm St. Jude bileaflet mechanical valve for severe aortic stenosis presented with two to three weeks of progressive dyspnea and increasing substernal chest discomfort. Echocardiography revealed a gradient to 31 mmHg across her aortic valve, increased from a baseline of 13 mmHg five months previously.

Aortic subannular left ventricular aneurysm: a rare and surgically correctable cause of angina.

Aortic subannular left ventricular aneurysm is a rare form of cardiac pathology. We report a case, including noninvasive and intraoperative imaging, of this entity in a young woman presenting with angina. The patient underwent successful surgical repair and is now asymptomatic.

Thrombolytic therapy for thrombosis of continuous flow ventricular assist devices.

Background: Despite chronic systemic anticoagulation, advanced heart failure patients treated with a continuous-flow left ventricular assist device (LVAD) remain at risk for pump thrombosis. Pump thrombosis may initially be suspected in the setting of clinical and biochemical evidence for intravascular hemolysis, putatively related to shear stress on red blood cells propelled through a partially occluded pump. Limited data exist to guide management in these patients.