Transcatheter Mitral Valve Therapies in Patients with Mitral Annular Calcification.

Mitral annular calcification is a chronic process involving degeneration and calcium deposition within the fibrous skeleton of the mitral valve annulus, which can lead to mitral valve dysfunction. It can be asymptomatic, or it can have pathologic sequelae leading to cardiovascular morbidity and mortality. Mitral annular calcification is increasingly recognized with the advancement of diagnostic imaging modalities, especially in an era with a growing elderly population. Its presence poses considerable challenges in terms of surgical and transcatheter management. Multiple surgical and transcatheter techniques have been developed to overcome these challenges. New transcatheter technologies are under investigation to tackle this problem.

"Cool Knees" as a Measure of Systemic Vascular Resistance in Cardiac Patients.

INTRODUCTION: Clinical assessment of cardiac output (CO) and systemic vascular resistance (SVR) in cardiac patients is often inaccurate. Since the genicular arteries form a watershed zone accessible to physical examination, we hypothesized that "cool knees" would reflect abnormalities in central hemodynamics. METHODS: Nineteen patients with cardiac diagnoses, but without distributive shock, had a measurement of skin temperature over the thigh, knee, and foot in parallel with central hemodynamics derived from invasive monitoring. RESULTS: The temperature gradient from thigh to knee (DTK) reflected increased SVR, and was significantly correlated with SVR, cardiac index (CI), and CO. Cool feet (DTF) were significantly correlated only with systemic hypotension, but not central hemodynamics. CONCLUSION: Cool knees reflect increased SVR in cardiac patients and may be an important physical exam finding in their assessment and management.