Recent developments in antiplatelet therapy after percutaneus coronary intervention

© 2014 Bentham Science Publishers.Antiplatelet therapy plays an important role in the treatment of patients suffering from acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) in order to prevent atherothrombotic events and restenosis or ischemic reocclusion, respectively. Moreover, stent implantation is often performed along with PCI to ensure that the arteries remain open. However, stent thrombosis ST is a possible complication which can occur up to about one year after the procedure. Therefore, it is standard to treat patients with a dual antiplatelet regime whereby aspirin is combined with either clopidogrel, prasugrel or ticagrelor. This review summarizes the characteristics of these P2Y12 antagonists and evaluates the current and future clinical guidelines for antiplatelet therapy in the setting of PCI with or without stenting

Recent developments in drug-eluting coronary stents

© 2014 Bentham Science Publishers.The interventional treatment of coronary artery disease was introduced in 1970's by Andreas Grüntzig. The initial treatment strategy with plain old balloon angioplasty (POBA) was associated with high restenosis rates. The introduction of coronary stents, especially drug-eluting stents (DES) in 2002 has improved the results by lowering the rate of in-stent restenosis from 20-40% in the era of bare-metal stent (BMS) to 6-8%. However, in 2006 with the observation of late stent thrombosis the reputations of DES have decreased. However, improvements in stent design especially antiproliferative agents, polymeric agents as well as stent platforms improved newer generation DES. In controlled trials as well as registries the use of second-generation DES as compared to bare-metal stents (BMS) was associated with better clinical and angiographic results. A further development of these stents with use of biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly L-lactide (PLLA) or magnesium resulted in third-generation DES and has been evaluated in preclinical and first clinical trials. However, to date, there is a lack of data comparing these thirdgeneration DES with first- and second-generatrion DES in a large scale

Multimodality Imaging of the Mitral Paravalvular Abscess Cavity with Left Ventriculo-atrial Fistula

Paravalvular complications may occur in patients with infective endocarditis. Paravalvular abscess formation rarely occurs and if so it generally involves the aortic valve. Herein we present a case of left ventriculo-atrial fistula formation through mitral paravalvular abscess cavity shown by multimodality imaging including two- and real-time three-dimensional transoesophageal echocardiography (RT 3-D TEE), cardiac magnetic resonance imaging (CMRI), multislice computed tomography (MSCT) and ventriculography in a patient with a mechanical prosthetic mitral valve. This is the first case in the literature of a mechanical prosthetic mitral valve complicated by a left ventriculo-atrial fistula formation in a healed abscess cavity that is demonstrated with RT-3D TEE, cardiac MRI and MSCT. (Heart, Lung and Circulation 2012;21:284-286) (C) 2012 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved

Successful treatment of renal artery thromboembolism with low-dose prolonged infusion of tissue-typed plasminogen activator in a patient with mitral mechanical heart valve thrombosis under the guidance of multimodality imaging

This case report describes the use of low-dose prolonged infusion of tissue-typed plasminogen activator in the treatment of renal artery thromboembolism secondary to prosthetic valve thrombosis, under the guidance of multimodality imaging. Thromboembolic occlusion of renal arteries is a rare disorder with serious consequences. It is generally associated with cardiac diseases and arrhytmias. Four consecutive doses of low-dose prolonged infusion of tissue-typed plasminogen activator [25mg tissue-typed plasminogen activator (tpa) in 6 h] were administered to the patient. This case of renal artery thromboembolism secondary to mitral mechanical prosthetic valve thrombosis was successfully treated with low-dose prolonged infusion of tPA under the guidance of multimodality imaging with renal artery Doppler ultrasonography, multislice computerized tomographic angiography, renal angiography, two-dimensional and real-time three-dimensional transesophageal echocardiography. This case has demonstrated that low-dose prolonged infusion of tissue-typed plasminogen activator may be effective and well tolerated in the treatment of renal embolism. Blood Coagul Fibrinolysis 23: 663-665 (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins

An Alternative Approach for Mitral Paravalvular Leak with Dacron Patch Curtaining under the Guidance of Real-Time 3-Dimensional Transesophageal Echocardiography

Objectives: The aim of this study was to evaluate real-time 3-dimensional transesophageal echocardiography (RT-3D TEE) in the assessment of mitral paravalvular leakage curtaining surgery with a Dacron patch. Methods: RT-3D TEE was used before and after the operation. Results: Repairing a mitral paravalvular leak with Dacron patch curtaining was a useful, simple and new technique with promising feasibility and durability. Conclusions: In selected patients in whom the mitral paravalvular defect is relatively large, and may thus not be suitable for closing with primary suture, Dacron patch curtaining may be feasible for repair guided with RT-3D TEE; both are described for the first time. Copyright (C) 2011 S. Karger AG, Base

Normal echocardiographic measurements in a Turkish population: The Healthy Heart ECHO-TR Trial

Objective: Normal reference values for the cardiac chambers are widely based on cohorts from European or American populations. In this study, we aimed to obtain normal echocardiographic measurements of healthy Turkish volunteers to reveal the age, gender, and geographical region dependent differences between Turkish populations and other populations. Methods: Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination. Blood biochemical parameters were also obtained for all patients on admission. The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used to assess the echocardiographic cardiac chamber quantification. Results: The study included 1154 volunteers (men: 609; women: 545), with a mean age of 33.5 +/- 11 years. Compared to men, women had a smaller body surface area, lower blood pressure and heart rate, lower hemoglobin, total cholesterol, lower low-density lipoprotein (LW levels, and higher high density lipoprotein (HOL) levels. Cardiac chambers were also smaller in women and their size varied with age. When we compared the regions in Turkey, the lowest values of left cardiac chamber indices were seen in the Marmara region and the highest values were observed in the Mediterranean region. Regarding the right cardiac indices, the Mediterranean region reported the lowest values, while the Black Sea region and the Eastern Anatolia region reported the highest values. Conclusion: This is the first study that evaluates the normal echocardiographic reference values for a healthy Turkish population. These results may provide important reference values that could be useful in routine clinical practice as well as in further clinical trials

Comparison of Different Anticoagulation Regimens Regarding Maternal and Fetal Outcomes in Pregnant Patients With Mechanical Prosthetic Heart Valves (from the Multicenter ANATOLIA-PREG Registry)

Mechanical prosthetic heart valves (MPHVs) are highly thrombogenic, and a pregnancyinduced procoagulant status increases the risk of MPHV thrombosis. Despite numerous case reports, 2 major registries and meta-analyses/systematic reviews, optimal anticoagulation therapy during pregnancy remains controversial. The goal of this study was to evaluate different anticoagulation regimens in pregnant patients with MPHVs. The outcomes of anticoagulation regimens were assessed retrospectively in pregnant women (110 women; 155 pregnancies) with MPHVs. The study population was divided into 5 groups according to anticoagulation regimens used; high-dose warfarin (>5 mg/d) throughout pregnancy (group 1), low-dose warfarin (<= 5 mg/d) throughout pregnancy (group 2), low molecular weight heparin (LMWH) throughout pregnancy (group 3), first trimester LMWH, 2nd and 3rd trimester warfarin (group 4), first 2 trimester LMWH, and 3rd trimester warfarin (group 5). Of 155 pregnancies, 55 (35%) resulted in fetal loss; whereas 41 (27%) cases with abortion (miscarriage and therapeutic) and 14 (9%) stillbirths occurred. The comparison of the groups showed that the whole abortion rates including therapeutic abortion were significantly higher in Group 1, and lower in groups 3 and 5 (p <0.001). However, miscarriage rates were similar between the groups. A total of 53 pregnancies (34%) suffered from prosthetic valves thrombosis (PVT) during pregnancy or in the postpartum period. Group 2 had significantly lower rates of PVT than the other groups (p <0.001). In conclusion, the current data suggests that there is no optimal therapy, and that all managements have advantages and disadvantages. Low-dose warfarin (<= 5 mg/day) regimen with therapeutic international normalized ratio levels may provide effective maternal protection throughout pregnancy with acceptable fetal outcomes. (C) 2020 Elsevier Inc. All rights reserved