Recurrent angina from chronic coronary obstruction following transcatheter aortic valve implantation

Severe aortic stenosis and coronary artery disease often coexist. Coronary angiography (CA) and percutaneous coronary intervention (PCI) can be challenging in patients with prior transcatheter aortic valve implantation (TAVI). Depending on the type and position of the implanted valve, the procedure can be challenging or even unfeasible due to interference of diagnostic catheters and valve parts. The correct positioning of the TAVI prosthesis during TAVI was identified as an important factor with regard to the feasibility of subsequent CA or PCI. TAVI has been also associated with vascular, cerebrovascular and conduction complication. One is rare but life-threatening complication, coronary ostial obstruction. Coronary ostial obstruction can develop, especially if a safety check of more than 10 mm of coronary ostial height is not taken into consideration during TAVI. This complication can cause recurrent episodes of angina and can severely worsen the patient′s cardiac systolic function

Left Ventricular Aneurysm Presenting as Bidirectional Ventricular Tachycardia

Bidirectional ventricular tachycardia is a rare form of ventricular arrhythmia, characterized by a changing of the mean QRS axis of 180 degrees. Digitalis toxicity is the most common cause of bidirectional ventricular tachycardia; other causes include myocarditis, aconite toxicity, metastatic cardiac tumor, myocardial infarction, and cardiac channelopathies. A 73-year-old male with hypertension and a pacemaker implanted for sick sinus syndrome presented with a complaint of substernal chest pressure for several days. He also stated he had had an episode of near syncope. The patient's physical examination was unremarkable; however, electrocardiogram demonstrated sustained bidirectional ventricular tachycardia. Echocardiogram showed severe anterior wall hypokinesis and an estimated ejection fraction of 35%, as well as an apical ventricular aneurysm. Electrophysiology study showed that the apical ventricular aneurysm was the site of the bidirectional arrhythmia. The patient was successfully treated with ventricular tachycardia ablation. This case is a unique example of a patient with bidirectional ventricular tachycardia originating from an apical left ventricular aneurysm that was treated successfully by ablation

FOLFOX Induced Takotsubo Cardiomyopathy Treated with Impella Assist Device

Chemotherapy induced cardiotoxicity is becoming increasingly prevalent with several new agents being used recently. The incidence of Takotsubo cardiomyopathy due to 5-fluorouracil based chemotherapeutic regimens like FOLFOX is not uncommon. It is also seen with platinum based chemotherapy. Most of these patients have reversible cardiotoxicity and the cardiac function recovers within a short period with supportive treatment. Here we have a patient who presented with cardiogenic shock after 5 days of receiving FOLFOX regimen for colorectal adenocarcinoma. She was treated with a percutaneous left ventricular assist device, Impella CP, for hemodynamic support with excellent outcome

Congestive Heart Failure Clinics: How to Make Them Work in a Community-Based Hospital System

Introduction: Congestive heart failure (CHF) accounts for over $32 billion in health care costs per year and is at the epicenter of health care reform. CHF remains a major cause of hospitalizations. It is known and has been reported that missed diagnosis of and missed opportunities to treat heart failure are associated with higher mortality and morbidity. CHF disease management programs have emerged as a potential solution to the CHF epidemic. The paradox remains that CHF disease management programs still cluster in tertiary hospital systems. The impact of heart failure specialists and specialty teams in community health systems is less well understood. Currently there are not enough CHF-trained teams in the community setting to address this unmet health need.Methods: We explored the impact of CHF clinics in a community-based hospital system on readmission rates, mortality, and symptomatic relief. A total of 384 patients were enrolled in the clinic between 2012 and 2015. Data collected included age, sex, type of heart failure, New York Heart Association class, ejection fraction, serum creatinine and brain natriuretic peptide values, and readmission and mortality rates within 30 days, 3 months, 6 months, and 1 year. We also compared readmission rates between patients who were followed up in the CHF clinic versus those who were not seen in the CHF clinic.Results: A statistically significant difference was demonstrated in readmission rates between patients who were followed up in the CHF clinic versus those who did not visit the CHF clinic for up to 1 year of follow-up.Conclusion: CHF community hospital clinics that use a rapid and frequent follow-up format with CHF-trained teams effectively reduce rehospitalization rates up to 1 year

Successful Coronary Protection during TAVI in Heavily Calcified Aortic Leaflets in Patient with Short and Low Left Coronary System

Transcatheter aortic valve replacement has been recently approved for patients who are high or intermediate risk for surgical aortic valve replacement. The procedure is associated with several known complications including coronary related complications. Coronary obstruction is rare but disastrous complication, and it is associated with a high mortality rate. Coronary protection technique has emerged as a preemptive technique to avoid this complication. We present a case of successful coronary protection during TAVR in severely calcified left cusp in patient with short and low left ostium

Severe aortic stenosis in dextrocardia with situs invertus and anomalous single coronary ostium treated with transcatheter aortic valve replacement

Dextrocardia with situs inversus presents a unique anatomy with right-sided vascular system that may be associated with a number of additional cardiac and vascular malformations. A rare association is the presence of a single coronary artery ostium. To our knowledge, this is the first reported case of transcatheter aortic valve replacement using Edwards SAPIEN S3 valve in Dextrocardia patient with single coronary artery take off. •TAVR is an excellent option in high-risk patients or old patients with intermediate risk as well as inoperable in severe aortic stenosis patients.•Dextrocardia with anomalous single left main and situs inversus provides a unique anatomy that can be a real challenge to the operator and the team.•TAVR in Dextrocardia patient with single left main and situs inversus for treating severe aortic stenosis is feasible and safe