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Cardiovasc. Med., Volume 19, Issue 7-8 (08 2016) – 6 articles

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3 pages, 166 KB

Open AccessCase Report

Interventional Valve-Under-Valve Implantation

by Oliver T. Reuthebuch, Christoph Kaiser, Markus Maurer, Friedrich Eckstein and Martin Grapow

Cardiovasc. Med. 2016, 19(7-8), 220; https://doi.org/10.4414/cvm.2016.00427 - 10 Aug 2016

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Abstract

We present a case of false deployment of a self-expandable transcatheter aortic valve implantation (TAVI) prosthesis due to inadvertent and incorrect release of an eyelet in the crown of the valve resulting in a tilted valve. Hence the prosthesis had to be deployed in an anatomically and functionally inappropriate position above the coronary ostia at the level of the sinotubular junction. Because of previous coronary artery bypass grafting with patent grafts, conventional re-do surgery as bailout was rejected and implantation of a second, balloon-expandable TAVI prostheses favoured instead. This caused a valveunder- valve situation. Because of the patent bypass grafts, myocardial ischaemia could be prevented, although diastolic myocardial perfusion via native coronaries was restricted in this unique setting. The postoperative course was uneventful. The gradient over the valves was 12 mm Hg with minimal paravalvular leakage. At 1-year follow-up, the patient was in good clinical condition. Transthoracic echocardiography revealed a peak/ mean gradient of 16/8 mm Hg with grade 1 paravalvular leakage. Full article

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3 pages, 181 KB

Open AccessCase Report

Dissected Woman

by Mattia Cattaneo, Daniel Sürder, Rolf Wyttenbach, Mario Alerci, Pierluigi Pedrazzi, Marcel Arnold and Augusto Gallino

Cardiovasc. Med. 2016, 19(7-8), 217; https://doi.org/10.4414/cvm.2016.00420 - 10 Aug 2016

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Abstract

A 45-year-old woman was admitted to our stroke unit because of acute focal neurological symptoms. A spontaneous left internal carotid artery dissection was later diagnosed. In the following 14 days the patient was affected by ST-segment elevation acute myocardial infarction due to distal posterior descending artery (PD) occlusion and acute right back pain due to spontaneous right renal artery dissection. A 6-month follow-up showed complete spontaneous recanalisation of the affected arteries, with the exception of the distal PD. Despite its exceptionality, this case underscores the need for comprehensive vascular evaluation in young and middle-aged patients presenting with spontaneous cervical artery dissection and clinical symptoms suggesting other organ involvement. Full article

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6 pages, 221 KB

Open AccessArticle

New Quality Indicator for Treatment of Acute Myocardial Infarction

by Milos Radosavac, Raphael Twerenbold, Max Wagener, Ursina Honegger, Christian Puelacher, Karin Wildi, Tobias Reichlin, Philipp Kreutzinger, Fabio Stallone, Petra Hillinger, Cedric Jaeger, Maria Rubini Gimenez, Samyut Shrestha, Michael Heberer, Michael Kuehne, Stefan Osswald and Christian Mueller

Cardiovasc. Med. 2016, 19(7-8), 211; https://doi.org/10.4414/cvm.2016.00426 - 10 Aug 2016

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Abstract

Introduction: Crude mortality is commonly used as a quality indicator (QI) for the treatment of acute myocardial infarction (AMI), but has important limitations including its dependence on the local case-mix. We aimed to explore the feasibility of a novel approach using risk adjustment according to the Global Registry of Acute Coronary Events (GRACE). Methods: In 1471 consecutive patients admitted with AMI to a Swiss university hospital in 2012 and 2013, we quantified working hours needed by a trained healthcare professional to complement the available administrative dataset by detailed medical review of all available medical records to: 1) differentiate the subtypes of AMI in order to separate type 1 (including type 4) AMIs from type 2 and postoperative AMIs (GRACE is only validated for type 1 AMI); 2) add all medical variables required to calculate the GRACE score. Results: Detailed medical review identified 93 additional patients (6.7%) with AMI as the main diagnosis, who were missed in the administrative dataset. Complete data for the calculation of the GRACE score could be obtained for 1233 patients (93.8%). In both years, observed crude mortality was significantly lower than the expected in-hospital mortality using the GRACE model (2012 [n = 613]: crude mortality 6.0%, mean GRACE mortality 8.3% [95% CI 7.2–9.4%]; 2013 [n = 620]: crude mortality 5.8%, mean GRACE mortality 9.4% [95%CI 8.3–10.6%]). Overall, the number of working hours required to retrospectively complement the administrative dataset was 1150 hours (575 h per year). Conclusion: Assessment of risk-adjusted in-hospital mortality in AMI is feasible, provides important insights regarding treatment results while improving comparability between hospitals, but is very time-consuming if done retrospectively. Prospective documentation of the GRACE score within the electronic medical records would help to reduce the effort needed to obtain this novel QI. Further multicentre studies are warranted. Full article

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7 pages, 492 KB

Open AccessArticle

Feasibility and Limitations of 2D Speckle Tracking Echocardiography

by Lina Melzer, Anja Faeh-Gunz, Barbara Naegeli, Burkhardt Seifert, Monica Pfyffer and Christine H. Attenhofer Jost

Cardiovasc. Med. 2016, 19(7-8), 204; https://doi.org/10.4414/cvm.2016.00425 - 10 Aug 2016

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Abstract

Introduction: Two-dimensional speckle tracking echocardiography (2DSTE) has been recommended as a helpful tool for assessing cardiac function. A mean global longitudinal strain (GLS) value of >18% has been one of the recommended normal cut-off limits. Little is known about the performance of GLS and its impact in daily practice. Method: Between October 2013 and January 2014, in 482 consecutive patients undergoing transthoracic echocardiography, 2DSTE was attempted from the three apical views (resulting in mean GLS values). Diagnoses, echocardiographic findings and image quality were collected. All studies were done with the GE Vingmed System E9 (AFI algorithm) and analysed during the study or offline for interobserver variability. Results: In 447 patients (93%), 2DSTE was feasible. The most important reasons for inability to do 2DSTE identified were poor echocardiographic image quality, atrial fibrillation and/or a higher body mass index (all p <0.001). Interobserver variability was acceptable with an intraclass correlation coefficient of 0.952 (95% confidence interval 0.919–0.972). Of those patients in whom 2DSTE was feasible, mean ejection fraction was 58 ± 10%; regional wall motion abnormalities were present in 139 patients (31%) and left ventricular hypertrophy in 78 (17%). Mean GLS was 17.4 ± 4.6% (in excellent image quality 18.9 ± 3.2% versus 16.4 ± 4.5% in poor image quality; p = 0.006). A GLS of less than 18% was present in 211 (47.2%) and less than 16% in 124 patients (27.7%). In 136 patients (30.4%) GLS imaging identified abnormal left ventricular myocardial segments not explained by scarring or left ventricular hypertrophy. Conclusion: Assessment of GLS by 2DSTE is feasible in most and dependent on image quality, body mass index and atrial fibrillation. Reproducibility is high with acceptable intra- and interobserver variability. GLS provides additional information, however, often showing nonspecific abnormalities. Using only a cut-off value of >18% may not be reasonable as an average number does not reflect regional abnormalities. Thus for everyday practice average GLS should be provided routinely supplemented by information on abnormal segments. Full article

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7 pages, 341 KB

Open AccessReview

Procedural Strategies for No-Reflow Prevention During PCI

by Marco Roberto and Edoardo De Benedetti

Cardiovasc. Med. 2016, 19(7-8), 197; https://doi.org/10.4414/cvm.2016.00423 - 10 Aug 2016

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Abstract

Prompt referral for myocardial reperfusion represents the gold standard emergency treatment for patients experiencing ST-elevation myocardial infarction (STEMI). However, in a considerable proportion of STEMI patients, reopening of the infarct-related artery is not always followed by myocardial reperfusion. This condition is known as no-reflow and seems to be related to microvascular obstruction. Interestingly, no-reflow has been observed also in NSTEMI patients and during elective percutaneous coronary intervention, particularly when performed on saphenous vein grafts. Distal atherothrombotic embolisation has a key role in no-reflow physiopathology. In this review we will summarise available evidence concerning the most important nonpharmacological procedural strategies tested in a clinical setting to prevent distal embolisation and, thus, no-reflow during percutaneous coronary intervention. Full article

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2 pages, 207 KB

Open AccessEditorial

The Educated Patient

by Thomas F. Lüscher

Cardiovasc. Med. 2016, 19(7-8), 195; https://doi.org/10.4414/cvm.2016.00422 - 10 Aug 2016

Viewed by 107

Abstract

Angefangen hat Medizin mit Zuwendung, als sie nur dies zu bieten hatte [1]. Mit dem Helfen und Trösten war jedoch nicht viel gewonnen, da Behandeln, und erst recht Heilen, noch in ferner Zukunft lag. Hippokrates mahnte denn auch zur Vorsicht, als er in seinem ärztlichen Eid primum nil nocere zu einem Grundprinzip machte. Zu Zeiten, als die meisten Massnahmen nur Schaden brachten und sich auch der Nutzen ärztlicher Zuwendung im Lindern von Sorge und Schmerz erschöpfte, war eine solche Haltung ein ethisches Erfordernis. Es hat auch heute noch seine Berechtigung. Full article

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