The role of leading centers for endovascular surgery in education and training for endovascular treatment of peripheral vascular disease.

The field of peripheral vascular disease (PVD) management is rapidly evolving with the advent of new endovascular techniques. These new techniques frequently involve hybrid approaches for treating complex aortic pathologies. Like many new procedures, endovascular techniques present new challenges for physicians who care for patients with complex vascular pathologies.

Diaphragmatic implantation of the HeartWare ventricular assist device.

The HeartWare (HeartWare Inc., Framingham, MA) ventricular assist device (HVAD) is designed to be implanted with the pump in the pericardial space and its integrally attached inflow cannula in the left ventricle. The uniquely incorporated inflow cannula was originally designed to be inserted into the diaphragmatic surface of the heart, allowing the pump to sit on the flattened diaphragmatic surface.

Non-contrast computed tomography is comparable to contrast-enhanced computed tomography for aortic volume analysis after endovascular abdominal aortic aneurysm repair.

Objectives: To evaluate whether non-contrast computed tomography (NCCT) images are as reliable as contrast-enhanced computed tomography (CECT) images for the measurement of aortic volume (AV).

Materials And Methods: A total of 316 pairs of AVs were retrospectively measured from 316 consecutive patients, who underwent endovascular aneurysm repair (EVAR). A standardised multidetector computed tomography protocol was used to obtain precontrast, arterial and delay-phase images.

Flat-panel versus 64-channel computed tomography for in vivo quantitative characterization of aortic atherosclerotic plaques.

Background: Flat-panel computed tomography (FpCT) provides better spatial resolution than 64-channel CT (64-CT) and may improve in vivo quantitative assessment of atherosclerotic plaques.

Methods And Results: Lesions in 184 aortic histology sections from 6 Watanabe heritable hyperlipidemic rabbits were quantitatively compared with 64-CT (image thickness, 0.625 mm) and FpCT (image thickness, 0.

Biologic function and clinical potential of telomerase and associated proteins in cardiovascular tissue repair and regeneration.

Telomeres comprise long tracts of double-stranded TTAGGG repeats that extend for 9-15 kb in humans. Telomere length is maintained by telomerase, a specialized ribonucleoprotein that prevents the natural ends of linear chromosomes from undergoing inappropriate repair, which could otherwise lead to deleterious chromosomal fusions. During the development of cardiovascular tissues, telomerase activity is strong but diminishes with age in adult hearts.

Technical tips for endovascular treatment of abdominal aortic aneurysms with challenging infrarenal neck anatomy using the Excluder endoprosthesis.

Purpose: To report technical tips of endovascular aneurysm repair using Excluder endografts in patients with challenging infrarenal neck anatomy (short, angled, and/or tapered necks).

Technique: Several tips are presented to achieve effective and durable fixation and sealing of Excluder stent-grafts in abdominal aortic aneurysms (AAA) with challenging necks. The primary approach to patients with short infrarenal necks is a slow and controlled deployment combined with the bending-the-wire technique to realign the axis of the aneurysm and the axis of the neck.

Catheter aspiration thrombectomy during carotid stenting is safe and potentially efficacious: a pilot retrospective study.

Aim: Despite distal embolic protection (DEP) during carotid artery stenting (CAS), there is still an appreciable risk of stroke, especially in symptomatic patients and octogenerians. The mechanism of embolic events is possibly related to microembolization of debris remaining on or forming on stent struts. We evaluated the safety of using aspiration thrombectomy after CAS.

The personal genome and the practice of cardiovascular medicine.

Recent advances in the DNA sequencing techniques have made it possible to sequence the entire protein coding regions of the genome and even the entire genome at a reasonable cost. Genetic discoveries, facilitated by these advances, have illustrated the enormous genetic diversity of the mankind. Accordingly, the genome of each individual has about 4 million sequences that are different from the general population, including a significant number of unique sequence variants.

Immunologic and inflammatory reactions to exogenous stem cells implications for experimental studies and clinical trials for myocardial repair.

Intense research is under way to determine the optimal stem cell type and regimen for repairing diseased myocardium. Although initial studies in humans focused on the use of homologous stem cells, allogeneic or xenogeneic stem cells have been studied extensively in experimental work. Clinical trials with allogeneic stem cells are now under way, an approach based on the premise that stem cells and precursor cells are characterized as being immunotolerant.

Left ventricular pseudoaneurysm arising between two papillary muscles: repair without mitral regurgitation.

Left ventricular pseudoaneurysm is a rare lesion that occurs when a contained free-wall rupture occurs after a transmural myocardial infarction. Such a pseudoaneurysm may be lethal if subsequent rupture or progressive heart failure occurs. We describe a 67-year-old man who, one year after undergoing coronary artery bypass grafting, developed an infero-apical left ventricular pseudoaneurysm between the bases of two papillary muscles without incurring significant mitral regurgitation.

Reoperative myectomy via the left ventricular apex in a patient with hypertrophic obstructive cardiomyopathy.

Transaortic myectomy is the standard treatment for symptomatic patients with hypertrophic obstructive cardiomyopathy that proves to be refractive to medical therapy. We encountered a case that required a modified surgical approach to relieve a left ventricular outflow tract obstruction that could not be adequately resected through the aortic annulus because of poor exposure of the ventricular septum. Persistent high gradients after the 1st operation necessitated a 2nd operation.

Perigraft hemorrhage after abdominal aortic aneurysm repair in a heart transplant patient.

Spontaneous perigraft hemorrhage can occur years after a successful aortic aneurysm repair. Such hemorrhage can result, in part, from inadequate graft healing. Herein, we describe the case of a heart transplant recipient who underwent an abdominal aortic aneurysm repair that was complicated by an acute perigraft leak 6 weeks later.

Nephrogenic systemic fibrosis: a concise review for cardiologists.

Nephrogenic systemic fibrosis is a recently recognized disease entity that is potentially debilitating. The exact pathogenesis of nephrogenic systemic fibrosis is unclear, but the disease has been linked with the use of gadolinium-based contrast agents, predominantly in patients with acute renal failure or end-stage renal disease. Consequent to increased physician awareness of this link, the incidence of nephrogenic systemic fibrosis has begun to decrease.

Contrast pericardiography facilitates intrapericardial navigation under fluoroscopy.

Background: We used contrast pericardiography during fluoroscopy to facilitate intrapericardial navigation in pigs.

Methods: In 8 juvenile pigs, we performed standard, noncontrast-enhanced fluoroscopy of the heart in an attempt to identify the location of the left and right atrial appendages, the atrioventricular (AV) groove, the coronary sinus, the superior and inferior vena cavae, and the right ventricular outflow tract. Then we injected ionic contrast into the pericardial space and repeated fluoroscopy.

Cell-based therapy for chronic ischemic heart disease--a clinical perspective.

In patients with ischemic heart disease, the goal of cell therapy is to improve perfusion and function of the damaged heart muscle. For this review, we selected articles that reported the findings from the major clinical studies of cardiovascular stem cell therapy in patients with chronic ischemic heart disease. Because of the current status of development of clinical investigation in this field, all relevant studies were included.

Endomyocardial nodular calcification as a cause of heart failure.

Massive cardiac calcification is rare, occurring in association with chronic diseases or more commonly with previous myocardial infarction. We present an intriguing case of massive myocardial calcification of the left ventricle in a young patient with restrictive cardiomyopathy and progressive heart failure who required transplantation. The patient's history and clinical presentation did not reveal the etiology of the myocardial calcification.

The percutaneous ventricular assist device in severe refractory cardiogenic shock.

Objectives: We evaluated the efficacy and safety of the percutaneous ventricular assist device (pVAD) in patients in severe refractory cardiogenic shock (SRCS) despite intra-aortic balloon pump (IABP) and/or high-dose vasopressor support.

Background: SRCS is associated with substantial mortality despite IABP counterpulsation. Until recently, there was no rapid, minimally invasive means of providing increased hemodynamic support in SRCS.

Results of HeartMate II left ventricular assist device implantation on renal function in patients requiring post-implant renal replacement therapy.

Background: Renal function is often compromised in patients with advanced heart failure.

Methods: We evaluated renal function in heart failure patients supported by the HeartMate II (Thoratec Corporation, Pleasanton, CA) continuous-flow left ventricular assist device (LVAD) who required renal replacement therapy (RRT) by continuous venovenous hemofiltration dialysis (CVVHD) or hemodialysis, or both. Indications for RRT included oliguria (urine < 400 ml/day) unresponsive to diuretic therapy for > 24 hours with a creatinine level > 2.

Surgical closure of left ventricular outflow tract after left ventricular assist device implantation in patients with aortic valve pathology.

Background: In patients with refractory heart failure, aortic valve (AV) insufficiency or the presence of a prosthetic AV has been considered a relative contraindication to left ventricular assist device (LVAD) therapy. Nevertheless, we have successfully implanted LVADs in 5 patients with native AV insufficiency or an AV prosthesis by closing the left ventricular outflow tract (LVOT).

Methods: The method of LVOT closure was tailored to the patients' differing circumstances.