Intrapericardial paraganglioma: The role of integrated advanced multi-modality cardiac imaging for the assessment and management of rare primary cardiac tumors

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Complexity assessment and technical aspect of coronary angiogram and percutaneous coronary intervention following transcatheter aortic valve implantation

Background: Performing selective coronary angiogram (CA) and percutaneous coronary intervention (PCI) post transcatheter aortic valve implantation (TAVI) may be challenging with various success rates of coronary ostia engagement. Methods: Among all patients who underwent CA and/or PCI after TAVI from our single center TAVI registry, ostia cannulation success was reported according to the quality of ostia engagement and artery opacification, and was classified as either selective, partially selective or non-selective but sufficient for diagnosis. Results: Among the 424 consecutive TAVI procedures performed at the aforementioned institution, 20 (4.7%) CA were performed in 19 (4.5%) patients at a median time of 464 days post TAVI (25–75% IQ: 213–634 days). CA were performed in 7 CoreValve, 9 Evolut R, 1 Evolut PRO and 2 Edwards Sapien 3 devices. Transradial vascular approach was attempted in 9 procedures (45%, right n = 6 and left n = 3) and was successful in 8 (40%) patients. A total of 20 left main artery ostium cannulation were attempted leading to a diagnostic CA in all of them with selective engagement in 65%.  Engagement of the right coronary artery in 2 out of 15 attempted cases failed due to a low ostium in conjunction with a high implantation of a CoreValve prosthesis. 11 PCI (55% of CA) including 2 left main lesions were performed. In 4 patients (36.4% of the PCI), an extension catheter was required to engage the left main. All planned PCI were successful. Conclusions: Post TAVI CA and PCI are challenging but feasible even after supra-annular self-expandable valve implantation

Effets comparatifs du fentanyl et de la morphine sur l'inhibition plaquettaire induite par le ticagrelor chez les patients avec un infarctus du myocarde aigu traités par angioplastie primaire

L’anti-agrégation plaquettaire combinant l’aspirine et un inhibiteur du récepteur plaquettaire P2Y12, constitue la pierre angulaire du traitement pharmacologique de l’infarctus du myocarde avec sus-décalage du segment ST (STEMI) traité par angioplastie primaire. L’utilisation de la morphine chez les patients avec STEMI, diminue de manière significative l’absorption des inhibiteurs oraux du P2Y12, retarde leur entrée en action et diminue leur effet antiplaquettaire. Dans ce contexte nous avons effectué une étude preuve de concept comparant les effets de la morphine et du fentanyl sur la pharmacodynamique et pharmacocinétique du ticagrelor chez des patients avec STEMI, traités par angioplastie primaire. Les données pharmacodynamiques et pharmacocinétiques de notre étude suggèrent que le fentanyl peut diminuer le délai d’absorption du ticagrelor et améliorer l’inhibition plaquettaire, par rapport à la morphine. Des études ultérieures sont nécessaires afin d’étudier les effets cliniques comparatifs du fentanyl versus morphine chez les patients avec STEMI traités par angioplastie primaire