Uzasadnienie zamknięcia jatrogennego ubytku przegrody międzyprzedsionkowej podczas zabiegu MitraClip

Introduction. The formation of an iatrogenic septal defect (iASD) during the MitraClip procedure may be associated with adverse consequences, including right ventricular (RV) volume overload resulting in worsening heart failure, hospitalizations, and increased mortality. The aim of the study is to evaluate the effects of closing the iASD simultaneously during MitraClip on the RV function. Material and methods. Four patients who underwent the MitraClip procedure were analysed. The resulting iASD was closed using an Amplatzer occluder during the indexed procedure. The patients were followed up for 12 months. Results. The complete iASD closure was achieved in all patients. There were no deaths during 12 months of observation. In all cases, the RV dimensions decreased, on average, from 38 ± 5.35 mm to 34.35 ± 5.06 mm. No patient had progression of tricuspid regurgitation to significant regurgitation (TR ≥ 3+). Right ventricular systolic pressure (RVSP) decreased from an average of 47.50 ± 7.82 mm Hg to 38.00 ± 8.57 mm Hg. Conclusions. The results indicate a beneficial effect of concomitant closure of iASD during the MitraClip procedure by reducing RV exposure to volume overload and the associated severity of tricuspid valve regurgitation and pulmonary hypertension.Wstęp. Powstawanie jatrogennego ubytku przegrody (iASD) podczas zabiegu MitraClip może wiązać się z niekorzystnymi konsekwencjami, między innymi z przeciążeniem objętościowym prawej komory serca skutkującym nasileniem objawów niewydolności serca, hospitalizacjami i zwiększoną śmiertelnością. Celem tej pracy jest ocena wpływu jednoczesnego zamykania iASD podczas zabiegów MitraClip na funkcję prawej komory serca (RV). Materiał i metody. Przeanalizowano przypadki 4 pacjentów, którzy przeszli zabieg MitraClip, u których zamknięto powstały iASD za pomocą okludera Amplatzer podczas indeksowanej procedury. Pacjenci byli obserwowani przez 12 miesięcy. Wyniki. Całkowite zamknięcie iASD osiągnięto u wszystkich pacjentów. Nie było zgonów podczas 12 miesięcy obserwacji. We wszystkich przypadkach wymiary RV zmniejszyły się średnio z 38 ± 5,35 mm do 34,35 ± 5,06 mm. U żadnego pacjenta nie wystąpiła progresja niedomykalności trójdzielnej do niedomykalności istotnej (TR ≥ 3+). Ciśnienie skurczowe prawej komory (RVSP) zmniejszyło się ze średnio 47,50 ± 7,82 mm Hg do 38 ± 8,57 mm Hg. Wnioski. Wyniki wskazują na korzystny wpływ równoczesnego zamknięcia iASD podczas procedury MitraClip poprzez zmniejszanie ekspozycji RV na przeciążenie objętościowe i związane z tym nasilenie niedomykalności trójdzielnej i nadciśnienia płucnego

Impact of CoreValve size selection based on multi-slice computed tomography on paravalvular leak after transcatheter aortic valve implantation

Background: Paravalvular leak (PVL) has significant impact on long-term outcomes in patients after transcatheter aortic valve implantation (TAVI). This study sought to determine whether multi-slice computed tomography (MSCT)-guided valve selection reduces PVL after CoreValve implantation. Methods: The analysis encompassed 69 patients implanted with CoreValve and were divided into two groups. In Group I (30 patients), valve selection was based on standard procedures, in Group II (39 patients), on MSCT measurements. Paravalvular leak was assessed with angiography and echocardiography. Results: Multi-slice computed tomography results influenced a change of decision as to the size of the implanted valve in 12 (30.9%) patients in Group II and would have caused the decision to change in 9 (37.5%) patients in Group I. The degree of oversizing in Group I and II was 12.8% ± ± 7.6% vs. 18.6% ± 5.1% (p = 0.0006), respectively. The oversizing among the patients with leak degree of 0–1 and ≥ 2 was 18.1% ± 6.0% and 12.8% ± 7.4% (p = 0.0036). Angiographic assessment indicated post-procedural PVL ≥ 2 in 50% of patients in Group I and 20.5% in Group II (p = 0.01), while echocardiographic assessment indicated the same in 73.3% of patients in Group I and 45.6% in Group II (p = 0.0136). The composite endpoint occurred in 26.6% (8/30) patients in Group I vs. 5.1% (2/39) patients in Group II (p = 0.0118). Conclusions: Selecting the CoreValve device based on MSCT resulted in smaller rates of PVL and less frequent composite endpoint. In 1/3 of patients MSCT led to a change of the valve size. The degree of oversizing had a significant impact on PVL

The incidence and risk factors of stroke in patients with acute myocardial infarction treated invasively and concomitant impaired renal function

Background: Impaired renal function is a marker of poor prognosis in patients with acutemyocardial infarction (AMI). The aim of the study was to assess the incidence and independent predictors of stroke in population of patients with AMI treated invasively and concomitant impaired renal function (IRF).Methods: We analyzed 2,520 consecutive AMI patients admitted to our Center between 2003 and 2007 and treated with percutaneous coronary intervention. The whole population was divided into patients with IRF, defined as glomerular filtration rate < 60 mL/min/1.73 m2 or contrast induced nephropathy (IRF group, n = 933; 37.02%) and patients without IRF (control group, n = 1587; 62.98%). The IRF group was subjected to further analysis. Data onlong-term follow-up were screened to identify the patients who experienced stroke.Results: During median of 25.5 months of follow-up 52 (2.07%) the patients experienced stroke — 33 (3.54%) in the IRF group and 19 (1.2%) patients in the control group. The risk of major adverse cardiovascular events in the IRF group, including repeated AMI (68.8 vs.14.9%, p < 0.001) and death (45.5 vs. 25.1%, p < 0.05) was significantly higher in patients with stroke. Previous stroke (HR 6.85), female gender (HR 3.13), as well as STEMI anterior (HR 2.55) were independent risk factors of stroke in this population.Conclusions: Patients with AMI treated invasively and concomitant IRF were at higher risk of stroke occurrence in the future. Stroke was associated with poor outcome in the studied population. Independent predictors of stroke in patients with IRF and AMI treated invasively were different from commonly recognized stroke predictors