Spontaneous coronary artery dissection: role of coronary CT angiography

To describe the role of coronary CT in the diagnosis of this ominous conditio

Ogni lungo viaggio inizia con un piccolo passo: Il Signor C e la cardiologia interventistica

La storia clinica del Signor C: un compendio delle principali procedure di cardiologia invasiva sviluppate negli ultimi 20 anni. A: valvuloplastica aortica percutanea. B: stenosi della carotide interna sinistra, pre- e post-stenting. C: impianto di protesi aortica transcatetere. D: angioplastica primaria della coronaria destra

Displacement of calcium nodules of the native valve as a possible cause of left main occlusion following transcatheter aortic valve implantation.

We describe the case of an 89-year-old woman who developed severe left main coronary artery stenosis shortly after transcatheter aortic valve implantation (TAVI) with the Medtronic CoreValve Revalving System. Urgent coronary angiography revealed the protrusion of a large calcium nodule of the native valve as the cause of left main narrowing, which was treated with bare-metal stent implantation. Angiographic and intravascular ultrasound findings at follow-up are reported. This case describes one of the mechanisms of a dreadful complication of TAVI and its difficult management

Incidence, prognostic value and management of vascular complications with transfemoral transcatheter aortic valve implantation.

Inoperable or high-risk patients with severe aortic stenosis who undergo transcatheter aortic valve implantation (TAVI) have better outcomes compared with those treated with standard medical therapy. As for any other invasive procedure, peri-procedural complications may occur, reducing the procedural success rate and potentially affecting short- and mid-term outcomes. The transfemoral approach prevails over other possible access-site options in most registries. The use of large introducer sheaths and the need for double arterial vascular access can lead to higher rates of vascular complications in this elderly population, with a high prevalence of baseline peripheral artery disease. In this article, we review the results of recent clinical trials and major registries using the two different bioprosthesis currently available for TAVI, focusing on access site-related complications with transfemoral TAVI, their management and relationship with in-hospital and 30-day survival. Awareness of the mechanisms behind these complications might help in their prevention, recognition and management and may ultimately improve the clinical outcome of TAVI procedur

Emergency balloon aortic valvuloplasty in patients with critical aortic stenosis presenting with cardiogenic shock.

This report describes 2 cases of aortic valvuloplasty performed as emergency treatment in patients with critical aortic stenosis presenting with cardiogenic shock. This procedure can be life-saving, and allows the patients to undergo further evaluation for aortic valve replacement, or other definitive treatments such as the recently developed percutaneous heart valve implantation for patients with unacceptably high surgical risk

Is balloon aortic valvuloplasty safe in patients with significant aortic valve regurgitation?

Objectives: To assess safety and effectiveness of balloon aortic valvuloplasty (BAV) in patients with symptomatic severe aortic stenosis (AS) and significant aortic regurgitation. Background: BAV is a palliative procedure that has possibly been underused in patients with symptomatic AS not suitable for surgical aortic valve replacement or transcatheter aortic valve implantation. Significant aortic regurgitation is commonly perceived as a contraindication to BAV. Methods: Among 416 consecutive patients undergoing BAV at our Institution, 73 patients showed moderate or severe AR before the procedure. Demographics and baseline characteristics, as well as in-hospital clinical outcome, have been prospectively collected in a dedicated database. Transthoracic echocardiography was regularly performed in all patients undergoing BAV before the procedure and at hospital discharge. Results: Patients had a high-risk profile, confirmed by advanced age (77.2 \uc2\ub1 11.8 years) and important comorbidity (logistic Euroscore 26.5 \uc2\ub1 16.3%). Advanced heart failure was present in 73.9%. Indication to BAV was cardiogenic shock in 9.6%, palliation in 31.5%, bridge in 58.9% of the patients. BAV was performed with standard retrograde approach. Aortic valve area increased from 0.62 \uc2\ub1 0.15 cm 2 at baseline to 0.83 \uc2\ub1 0.17 cm 2 before discharge (P < 0.001). The degree of AR was improved or unchanged in 65 patients (89%). In-hospital mortality was 6.9%, mainly limited to terminal patients. Symptomatic status at discharge was improved in all surviving patients. Acute AR occurred in seven patients; in five of them it was successfully resolved in the catheterization laboratory. Conclusions: When clinically indicated, BAV can be safely performed in patients with combined aortic stenosis and significant aortic regurgitatio