New Frontiers in Percutaneous Interventions

__Abstract__ In 1977 Andreas Gruntzig introduced a catheter-based therapy for the percutaneous management of patients with coronary artery disease. This became known as percutaneous transluminal coronary angioplasty (PTCA). Initially there were many skeptics and pessimists. The technology, however, evolved rapidly. With the advent of specialized catheters, guidewires, stents, and adjuvant pharmacotherapy, the indications for PTCA have expanded to include more urgent, comorbid cases and complex coronary disease. Furthermore, these innovations have largely solved earlier problems related to elastic recoil, dissection and restenosis of the treated segment. In particular, the introduction of stents with the capacity to elute drugs to the injured arterial wall has been shown to be an effective and overall safe approach to suppress intimal hyperplasia. The excellent results of DES in clinical trials and everyday clinical practice, in synergy with important improvements in adjuvant drug therapy, have expanded the indications of percutaneous coronary interventions even further. Within 10 years of its introduction, the number of PTCA procedures

Prevalence, predictors, and outcomes of patient prosthesis mismatch in women undergoing TAVI for severe aortic stenosis: Insights from the WIN-TAVI registry

Objective: To evaluate the incidence, predictors and outcomes of female patients with patient-prosthesis mismatch (PPM) following transcatheter aortic valve intervention (TAVI) for severe aortic stenosis (AS). Background: Female AS TAVI recipients have a significantly lower mortality than surgical aortic valve replacement (SAVR) recipients, which could be attributed to the potentially lower PPM rates. TAVI has been associated with lower rates of PPM compared to SAVR. PPM in females post TAVI has not been investigated to date. Methods: The WIN-TAVI (Women's INternational Transcatheter Aortic Valve Implantation) registry i

Acute hemodynamic changes in percutaneous transluminal septal coil embolization for hypertrophic obstructive cardiomyopathy

Background A 48-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) presented with palpitations, symptoms of medically refractory class II angina, and NYHA class II-III heart failure. Investigations Physical examination revealed a grade 3 systolic murmur that increased to grade 4 with exercise. Echocardiography showed marked septal thickening (17 mm), a left ventricular outflow tract gradient (LVOTG) of 95 mmHg, and a 3+ systolic anterior motion of the mitral valve apparatus. No other pathology was noted with cardiac MRI or with coronary angiography. Diagnosis Severe symptomatic HOCM. Management Coil embolization of the first two septal vessels resulted in a limited septal infarct (creatine kinase-MB 36.6 mu g/l; troponin T 0.43 mu g/l) that corresponded to a mass of 8.1 g on gadolinium contrast cardiac MRI. The LVOTG decreased immediately from 78 mmHg to 35 mmHg. On pressure-volume loops, contractile isovolemic and systolic ejectional parameters decreased, while an improvement in diastolic left ventricular function was observed. Conclusion Septal coil embolization acutely and effectively reduced the LVOTG in a patient with drug-refractory HOCM. keywords coil embolization, hypertrophic obstructive cardiomyopathy