Pushing the hybrid approach to the edges, three stories in one: a case report.

Background: Mitral annular calcification (MAC) is common in the elderly. Extensive calcification has been historically challenging for the cardiac surgeons, with traditional surgical approaches carrying significant risks. Less invasive approaches have recently been explored in an attempt to reduce this risk.

Coronary angioplasty post TAVI: Is the solution outside the box?

Transcatheter aortic valve replacement (TAVR) has become the standard option for high risk patients with bioprosthetic valve degeneration. However, percutaneous coronary interventions after TAVR may be challenging as the manipulation and engagement of the guiding catheters is much more limited and difficult, due to the superimposition of the metallic frame of the TAVR valve upon the bioprosthetic cage. We describe a case of percutaneous coronary intervention in a patient with history of transcatheter aortic valve implantation after bioprosthetic valve degeneration and we describe a new method for accessing coronary arteries in cases of TAVR-in-surgical aortic valve replacement with a high-frame TAVR with a supra-annular leaflet position, by using the route outside the frame.

Simultaneous implantation of MitraClip devices in a patient with severe mitral and tricuspid valve regurgitation.

We present a case of an 84-year old patient with severe mitral and tricuspid regurgitation with a lot of cormobidities who underwent a simultaneous transfemoral (one approach) mitral and tricuspid valve repair using the MitraClip system.

Cryptogenic stroke after percutaneous closure of an atrial septal defect.

We present the case of a patient who underwent a percutaneous secundum atrial septal defect (ASD II) closure with an undersized septal occluder device. One week and one month later she experienced two transient ischemic attacks. Three-dimensional transesophageal echocardiography (TEE) revealed a residual patent foramen ovale (PFO) with a positive Valsalva bubble test.

The use of rotational atherectomy and drug-eluting stents in the treatment of heavily calcified coronary lesions.

Introduction: The treatment of calcified coronary artery lesions is a challenge for percutaneous angioplasty. Rotational atherectomy is an established technique for the effective modification of these lesions prior to conventional angioplasty and stent implantation. Drug-eluting stents (DES) have shown encouraging results in complex lesions and high-risk patients.

The use of the GuideLiner™ catheter as a child-in-mother technique: an initial single-center experience.

Recently, a new interventional guide catheter, the GuideLiner™ catheter, was introduced into the market as a strategy for tackling the problem of stent delivery failure. We implemented this simplified child-in-mother technique in a series of 16 challenging coronary interventions. Balloon and stent delivery was successfully achieved in all cases and the device was both simple to deploy and remove.

ECMO as a bridge to high-risk rotablation of heavily calcified coronary arteries.

Mechanical circulatory support (MCS) with short-term ventricular assist devices has been used as a bridge to high-risk percutaneous coronary interventions (PCI), as well as during interventions and in the post-procedural recovery period. Percutaneous extracorporeal membrane oxygenation (ECMO) is used when full cardiopulmonary support is necessary due to severe biventricular and pulmonary dysfunction. Prompted by two cases of high-risk rotablation of heavily calcified coronary arteries where ECMO was used as a bridge to intervention and post-intervention recovery, we reviewed the bibliography and the new guidelines on cardiac revascularization with regard to the utility of MCS devices in high-risk PCI cases.

Rotablation in the drug eluting era: immediate and long-term results from a single center experience.

The aim of this study was to investigate the immediate and long-term outcome of patients who were treated with rotational atherectomy (RA) to facilitate the delivery of drug eluting stents (DES) in heavily calcified lesions. We analyzed 150 consecutive patients who underwent RA and subsequently DES implantation in our institution. The patients had heavily calcified coronary artery lesions requiring plaque modification prior to conventional angioplasty and stent implantation.

Percutaneous closure of atrial septal defects: immediate and mid-term results.

Introduction: The incidence of percutaneous closure of secundum atrial septal defects (ASD) and patent foramen ovale (PFO), which has become an established therapy, is constantly increasing. In this study, which is the first in the Greek literature, we present the immediate and mid-term results from this intervention in our center.

Methods: From April 2004 to April 2008, 103 patients underwent percutaneous closure of an ASD or PFO using Amplatzer closure devices.

Rheolytic thrombectomy in patients with acute coronary syndrome and large thrombus burden: initial and mid-term results from a single centre experience.

Introduction: The presence of a large intracoronary thrombus burden is a major complicating factor during percutaneous coronary intervention (PCI) in patients with an acute coronary syndrome (ACS). The use of rheolytic thrombectomy (RT) has been proposed to prevent thrombus-related complications, with conflicting results. The purpose of this study was to identify the feasibility and safety of this approach.

Left atrial function and work after surgical ventricular restoration in postmyocardial infarction heart failure.

Introduction: The purpose of the current study was to examine the effect of surgical ventricular restoration in left atrial (LA) performance and left ventricular (LV) diastolic function in patients with congestive heart failure after extensive anterior myocardial infarction.

Methods: Seventeen consecutive patients (age 63 +/- 9 years, 14 male, 4 with diabetes) were studied prospectively. All patients underwent surgical ventricular restoration and concomitant coronary artery bypass surgery.

Prognostic significance of right ventricular diastolic function in thalassaemia major.

While left ventricular (LV) restrictive filling pattern is an ominous echocardiographic finding in thalassaemia major (TM), the prognostic significance of right ventricular (RV) diastolic function in patients with TM has not been thoroughly investigated. We studied 45 TM asymptomatic transfusion-dependent patients with normal LV systolic function by Doppler echocardiography. The 15-year cumulative survival rate was 34% in patients with RV restrictive filling pattern (RFP) and 82% in patients with RV non-RFP (log-rank = 10.

In vivo comparative study of linear versus geometrically correct three-dimensional reconstruction of coronary arteries.

Although conventional linear 3-dimensional (3D) reconstruction of coronary arteries by intravascular ultrasound has been widely used for the assessment of plaque volume and progression; the volumetric error (VE) that is produced has not been adequately studied. Linear and geometrically correct 3D reconstruction was applied in 16 coronary arterial segments from 9 patients. Using geometrically correct reconstruction as reference, VE was assessed in 1-mm-long arterial slices.

Modified (Valsalva graft) aortic root reimplantation for successful repair of pulmonary autograft aneurysm after Ross procedure.

Dilatation of the pulmonary autograft after the Ross procedure is a possible complication, necessitating aortic valve replacement. We present a case of a patient who developed pulmonary autograft dilatation and was treated successfully with valve-sparing aortic root reimplantation with a Valsalva graft.

In-vivo validation of spatially correct three-dimensional reconstruction of human coronary arteries by integrating intravascular ultrasound and biplane angiography.

Objectives: The in-vivo validation of geometrically correct three-dimensional reconstruction of human coronary arteries by integrating intravascular ultrasound and biplane coronary angiography has not been adequately investigated. The purpose of this study was to describe the reconstruction method and investigate its in-vivo feasibility and accuracy.

Methods: In 17 coronary arteries (mean length, 85.

Clinical and angiographic follow-up after overlapping implantation of polytetrafluoroethylene covered stents with drug eluting stents.

Unlabelled: Polytetrafluoroethylene-covered stents (PCS) were recently proposed as a new modality mainly for the treatment of saphenous vein graft lesions, but restenosis occurring principally at the edges restricted their clinical use in the management of coronary aneurysms and perforations.

Aims: To investigate the safety and effectiveness of the overlapping implantation of drug-eluting stents (DES) with PCS in clinical scenarios where the latter are indicated.

Methods: Since April 2002, when DES were introduced in clinical practice, 14 consecutive patients were -treated with overlapping implantation of PCS with DES in 3 centres.

Survival in thalassaemia major patients.

Background: The present study evaluated the prognostic significance of Doppler-demonstrated left ventricular (LV) restrictive filling pattern (RFP) in patients with thalassaemia major (TM), which carries an adverse cardiovascular prognosis.

Methods And Results: The study group comprised 45 asymptomatic transfusion-dependent patients with TM and normal LV systolic function. All patients were chelated with desferrioxamine.

Ross procedure: medium-term results.

Introduction: The Ross procedure is a safe alternative option for aortic valve replacement in selected patients. Here we present the medium-term results of our experience with this procedure.

Methods: Between December 1998 and January 2004, 21 patients (16 male, 5 female, mean age 42 years) underwent aortic valve replacement using the Ross operation.

Rheolytic thrombectomy combined with a protective filter and platelet glycoprotein IIb/IIIa receptor inhibitors in rescue angioplasty.

Rescue angioplasty is used in patients in whom thrombolysis has been unsuccessful, in order to achieve a better restoration of flow and to improve left ventricular function and the long term prognosis. However, patients who undergo rescue angioplasty have a higher rate of reocclusion of the vessel or distal embolism, resulting in increased mortality. Rheolytic thrombectomy, which reduces the quantity of thrombus and improves flow in the vessel, has been used successfully in such cases.

Papillary fibroelastoma of the cardiac valves: a rare cause of embolic stroke.

Papillary fibroelastomas are rare, primary, benign cardiac tumours most frequently located in the heart valves. They are a potential cause of systemic emboli, stroke, myocardial infarction and sudden death. We present two cases of papillary fibroelastomas located in the mitral and aortic valves of patients who had suffered multiple strokes.

Medium-term results from the clinical and angiographic follow-up of patients after angioplasty and implantation of sirolimus-eluting stents.

Introduction: The aim of this study was to evaluate the medium-term clinical and angiographic results, as well as the occurrence and treatment of restenosis, following the implantation of sirolimus-eluting stents (SES) in patients undergoing coronary angioplasty.

Methods: All patients who have an SES implanted in our department are entered into a database, with a view to evaluating the use of such stents in everyday clinical practice. This study included patients who consented to repeat angiography 8+/-2.