Technika zabiegu przeznaczyniowego zamknięcia uszka lewego przedsionka z wykorzystaniem urządzenia AmplatzerTM AmuletTM

Percutaneous left atrial appendage occlusion (LAAO) aims at cardioembolic stroke risk reduction in patients with atrialfibrillation. LAAO procedure is currently indicated for patients with atrial fibrillation and indications for chronic oral anticoagulation who cannot pursue such therapy due to complications, drug intolerance or contraindications. Currently, the two most commonly used devices in Europe are AmplatzerTM AmuletTM (Abbott) and WATCHMAN Device® (Boston Scientific). The aim of the paper was to present step-by-step the technique of AmplatzerTM AmuletTM implantation.Przeznaczyniowe zamknięcie uszka lewego przedsionka (ang. left atrial appendage occlusion, LAAO) jest zabiegiem zmniejszającym ryzyko udaru mózgu o etiologii zatorowej u pacjentów z migotaniem przedsionków. Obecnie jest to zabieg przeznaczony głównie dla chorych z migotaniem przedsionków i wskazaniami do przewlekłej antykoagulacji, którzy nie mogą przyjmować antykoagulantów z powodu powikłań, nietolerancji lub obecność przeciwwskazań do tego typu terapii. Dwa najczęściej stosowane w Europie urządzania do przeznaczyniowego zamknięcia uszka to okluder AmplatzerTM AmuletTM (Abbott) oraz urządzenie WATCHMAN® (Boston Scientific). W niniejszym opracowaniu przedstawiona została „krok po kroku” technika wykonania zabiegu LAAO z wykorzystaniem urządzania AmplatzerTM AmuletTM

Peripartum cardiomyopathy — a cardiovascular disease in pregnancy and puerperium. The actual state of knowledge, challenges, and perspectives

Peripartum cardiomyopathy (PPCM) is an idiopathic, multifactor cause of heart failure occurring at the end of pregnancyor in the first months after delivery. Although the prevalence of the disease is increasing, the awareness of both physiciansand patients is rather low. Symptoms of PPCM are unspecific, making a prompt diagnosis even more difficult. In severefunctional insufficiency and dilatation of the left ventricle, the recovery rate is particularly low. Therefore, the later PPCMis diagnosed, the more severe heart failure, and the worse the patient’s outcome.Despite the increasing frequency of PPCM, the exact pathophysiology and predictors of outcome are still not well determined.Therapeutic management in patients with PPCM remains a challenge, requiring a multidisciplinary approach.At the base of the disease lies dysfunction of microcirculation with 16-kDa prolactin as the main trigger of this state. Therefore,adding bromocriptine to standard heart failure pharmacotherapy may be particularly beneficial.In this review, we present the current state of knowledge and diagnostic and management recommendations and perspectives

Risk factors for bleeding complications in patients undergoing transcatheter aortic valve implantation (TAVI)

Background: The risk of bleedings in transcatheter aortic valve implantation (TAVI) patientsincreases due to age and concomitant diseases. The aim of the study was to assess the risk ofbleedings, their influence on early prognosis of TAVI patients and utility of the TIMI andGUSTO scales in the evaluation of bleeding and in prediction of blood transfusion.Methods: This was a single center study of in-hospital bleedings in 56 consecutive TAVIpatients. Bleedings were classified according to the GUSTO and TIMI scales. HASBLED‘sscale risk factors, diabetes mellitus, female sex, the route of bioprosthesis implantation and inhospitalantithrombotic treatment were analyzed. Statistical analysis consisted of c2, Fisher’sexact, Wilcoxon tests and logistic regression analysis.Results: Serious bleedings occurred in 35 (62.5%) patients. There was no significantcorrelation with HASBLED score. History of anemia was a significant predictor of bleeding inGUSTO (p = 0.0013) and TIMI (p = 0.048) scales. No bleedings in patients receivingvitamin K antagonists (VKA) pre- and VKA plus clopidogrel post intervention were observed.Patients with bleedings according to the GUSTO scale more often required blood tranfusionthan in TIMI scale (p = 0.03).Conclusions: History of anemia is the strongest predictor of serious bleedings. VKA beforeand VKA with clopidogrel after TAVI are safer than dual antiplatelet or triple therapy. TheTIMI and GUSTO scales can adequately classify bleeding after TAVI, however the GUSTObetter predicts transfusions