Transcatheter tricuspid valve intervention in the presence of a cardiac implantable electronic device; state of the art review.

A large proportion of patients referred for transcatheter tricuspid valve intervention (TTVI) will have the presence of a cardiac implantable electronic device (CIED). In such patients, surgical correction of tricuspid regurgitation (TR) is associated with high rates of morbidity and mortality. Transvenous lead extraction (TLE) could potentially ameliorate CIED-induced TR; however, it carries inherent risks and frequently does not result in TR improvement.

Multiple Valvular Heart Disease in the Transcatheter Era: A State-of-the-Art Review.

Although existing guidelines offer strong recommendations for single valvular dysfunction, the growing prevalence of multiple valvular heart disease (MVHD) in our aging population is challenging the clarity of clinical guidance. Traditional diagnostic modalities, such as echocardiography, face inherent constraints in precisely quantifying valvular dysfunction due to the hemodynamic interactions that occur with multiple valve involvement. Therefore, many patients with MVHD present at a later stage in their disease course and with an elevated surgical risk.

Balloon rupture during transcatheter aortic valve replacement.

A distinctive complication with balloon-expandable (BE) THV platforms such as the Edwards Sapien (Edwards Lifescience) is the possibility of balloon rupture during THV deployment. Balloon rupture is a rare occurrence that can result in stroke due to fragment embolism, incomplete THV expansion, and/or vascular injury upon retrieval of the balloon. Careful evaluation of preoperative computed tomography is essential to identify high-risk cases.

Novel approach to treating a coronavirus disease 2019-positive patient with a complex arch and descending aneurysm and dissection for whom open surgery was prohibitive.

Ascending aortic and arch aneurysms are a challenging group of pathologies for surgeons. These typically require a complex open repair, including hypothermic circulatory arrest, and carry a high perioperative risk. The outcomes have been best when performed in centers with significant experience and expertise.

Hinge point-based annular plane with abnormal aortic cusps in transcatheter aortic valve replacement.

A virtual aortic annular plane that is built using the three hinge points, known as the hinge point-based annular plane (HPAP), is routinely used during transcatheter aortic valve replacement (TAVR). Abnormal aortic cusps (AAC) with unequal length and size influence the relationship of the HPAP to the aortic root axis significantly and pose challenges to valve deployment, leading to paravalvular leak and valve embolisation. Obtaining a centreline-based aortic annular plane in addition may help to understand valve deployment behaviour in AAC better.

Aortic Cannulation in DeBakey Type I Aortic Dissection Facilitates Subsequent Deployment of a Frozen Elephant Trunk.

Arterial cannulation in acute DeBakey type I dissection can be difficult. Moreover, the residual dissected aorta is susceptible to further adverse events in the future. Implanting a stent-graft into the descending aorta during the initial dissection repair ('frozen elephant trunk') has been demonstrated to promote favourable aortic remodelling, mitigating some of these longer-term complications.

The spectrum of transcatheter mitral valve replacement devices.

Mitral regurgitation is the most common valvular heart disease. The gold standard for patients not suitable for valve repair is a surgical valve replacement. A significant proportion of patients, however are not referred for surgery due to comorbidities, advanced age or severe LV dysfunction.

Percutaneous transapical access: current status.

Percutaneous transapical access provides a direct route to many cardiac structures difficult to reach with conventional interventional approaches. With recent developments of new technologies in structural heart disease, there has been an increasing interest in the use of transapical access for cardiac interventions. Meticulous planning, careful access and closure techniques are essential.

Response to glucose tolerance testing and solid high carbohydrate challenge: comparison between Roux-en-Y gastric bypass, vertical sleeve gastrectomy, and duodenal switch.

Background: Hyperinsulinemic hypoglycemia is common after Roux-en-Y gastric bypass (RYGB) and may result in weight regain. The purpose of our investigation was to compare the effect of RYGB, vertical sleeve gastrectomy (VSG), and duodenal switch (DS) on insulin and glucose response to carbohydrate challenge.

Methods: Patients meeting National Institutes of Health criteria for bariatric surgery selected their bariatric procedure after evaluation and education in this prospective nonrandomized study.

Transarterial treatment of congenital renal arteriovenous fistulas.

Objective: Congenital renal arteriovenous fistulas (CRAVF) represent a distinct clinical entity with characteristic hemodynamic and angiographic features. Treatment is warranted given potential for growth with renal and hemodynamic compromise. We report our experience in a rare series of treated symptomatic CRAVFs.

Direct percutaneous transhepatic portomesenteric venous stenting in management of locally advanced pancreatic cancer.

Objective: Pancreatectomy with portal and/or superior mesenteric vein resection remains a controversial procedure because of high complexity and morbidity. Neoadjuvant chemotherapy has been shown to increase resectability of these locally advanced lesions. We aimed to assess the utility and efficacy of direct percutaneous transhepatic portomesenteric venous stenting (THVS) with neoadjuvant chemotherapy in increasing surgical resectability of locally advanced pancreatic carcinoma.

Comparison between RYGB, DS, and VSG effect on glucose homeostasis.

Background: Our group has reported a high incidence of reactive hypoglycemia following Roux-en-Y gastric bypass (RYGB) with specific interest in postprandial insulin and the ratio of 1- to 2-h serum glucose levels. The purpose of this study is to compare the 6-month response to oral glucose challenge in patients undergoing RYGB, duodenal switch (DS), and vertical sleeve gastrectomy (VSG).

Methods: Thirty-eight patients meeting the NIH criteria for bariatric surgery who have reached the 6-month postoperative mark are the basis of this report.

Vacuum thrombectomy of large right atrial thrombus.

We report a novel technique for percutaneous removal of the right heart thrombi using a suction cannula. This method allowed complete en bloc removal of the right atrial thrombus avoiding surgical procedure in a high risk patient.

Clinical outcomes in patients undergoing percutaneous closure of periprosthetic paravalvular leaks.

Objectives: The purpose of this study was to evaluate the feasibility and efficacy of the percutaneous device closure of a consecutive series of patients with periprosthetic paravalvular leaks referred to our structural heart disease center with congestive heart failure and hemolytic anemia.

Background: Clinically significant periprosthetic paravalvular leak is an uncommon but serious complication after surgical valve replacement. Percutaneous closure has been utilized as an alternative to surgical repair of this defect in high-risk surgical patients.

Clinical experience with percutaneous left ventricular transapical access for interventions in structural heart defects a safe access and secure exit.

Objectives: This study sought to evaluate the safety of percutaneous direct left ventricular access for interventional procedures.

Background: Experience with percutaneous access of the left ventricle (LV) for interventional procedures has been limited and associated with a high percentage of major complications. We report our clinical experience with percutaneous direct LV access for interventional procedures.

Percutaneous closure of left ventricular pseudoaneurysm.

Background: Left ventricular pseudoaneurysm is a rare but serious complication from myocardial infarction and cardiac surgery. Although standard treatment is surgical intervention, percutaneous closure of left ventricular pseudoaneurysm has become an option for high-risk surgical candidates. Experience with percutaneous treatment is limited to a few single case reports.

A method for standardized computed tomography angiography-based measurement of aortic valvar structures.

Aims: Reliable assessment of the aortic valvar apparatus (AVAp) is essential as it may facilitate consistent outcomes with percutaneous aortic valvar therapies. The commonly referenced aortic annulus is problematic since this measurement does not correspond to any actual anatomic structure. We aim to describe a reliable method of measuring relevant structures of the AVAp based on widely available computed tomography analyses.