Venous access closure using a purse-string suture without heparin antagonism or additional compression after MitraClip implantation.

OBJECTIVES: This observational study was designed to analyze the safety and feasibility of percutaneous skin closure using a purse-string suture (PSS) after MitraClip procedures. METHODS: Forty-one consecutive patients with severe mitral regurgitation who underwent MitraClip implantation from February 2018 to January 2019 at our institution received a PSS after percutaneous mitral valve repair before withdrawal of the 24-French (Fr) sheath. Protamine was not administered after venous closure at procedure end. No compression therapy (e.g., compression bandage or pneumatic compression device) was used. Patients were on bed rest for 6 hrs prior to suture removal, which was accomplished 18-24 hrs after MitraClip implantation. We analyzed the occurrence of any vascular or thromboembolic complications during the hospital stay and until the 3-month follow-up. RESULTS: The primary endpoint-any access-related major complication-did not occur in any patients. None of the patients revealed a pseudoaneurysm or an arteriovenous fistula, a thromboembolic complication, or local stenosis related to the PSS closure. The secondary endpoint- minor access-site vascular complications (hematoma)- was documented in six (14.6%) patients. CONCLUSIONS: Venous access-site closure with a PSS without the need for protamine administration or compression therapy appears to be safe and feasible in patients undergoing MitraClip implantation with access via a 24-Fr sheath.

Cardiac magnetic resonance imaging using an open 0.35 T system.

OBJECTIVE: To evaluate cardiac magnetic resonance imaging (MRI) using a 0.35 T magnetic resonance system with open design. METHODS: Eleven patients were examined in an open MRI system with a field strength of 0.35 T. Myocardial function was assessed with cine true fast imaging with steady-state precession sequences in 2 planes. Perfusion images were acquired with a T1-weighted gradient echo sequence. Late enhancement was performed using an inversion recovery-prepared fast gradient echo technique. Image quality was assessed using a 4-point score in consensus. Signal-noise ratio was measured. RESULTS: For functional imaging, average score was 1.65 (SD, 0.6). For perfusion imaging, the value was 2.25 (SD, 0.68). For late enhancement, quality score was 2.6 (SD, 0.82). Average value of signal-noise ratio for functional, perfusion, and late enhancement imaging was 50.6 (SD, 16.4), 91.8 (SD, 52.8), and 33.2 (SD, 20.4), respectively. CONCLUSIONS: Open MRI with lower field strength can be used for functional imaging of the heart. For perfusion and viability imaging (late enhancement), higher field strength is needed. Open low-field cardiac MRI may provide a helpful alternative for obese or claustrophobic patients or patients who are difficult to move.

Prevalence of right ventricular dysplasia-cardiomyopathy in a non-referral hospital.

In a cardiological department of a non-referral hospital responsible for 80,000 inhabitants with 2500 in-hospital patients and 1500 out-hospital patients per year, the prevalence, symptoms and prognosis of arrhythmogenic right ventricular dysplasia-cardiomyopathy (ARVD/C) were examined retrospectively. From 1997 to 2002, ARVD/C was diagnosed in 35 females and 45 males (overall prevalence 1 in 1000 inhabitants) with a mean age of 45.6 years. Symptoms were chest pain (80%), palpitations (60%) and syncopes (30%), and clinical findings were repetitive ventricular premature beats (50%), supraventricular arrhythmias (30%), ventricular tachycardia (20%), aborted sudden death due to ventricular fibrillation (1%), right heart failure (4%), biventricular heart failure (1%) and high grade AV nodal block (4%). Endomyocardial biopsies were not performed. Aborted sudden death occurred in only one patient (0.3%) before the diagnosis was made, annual heart failure rate was 1%. No deaths appeared in a follow-up of 1-5 (mean 2.4) years with clinical assessment as the basis of diagnosis. The prevalence of ARVD/C is much higher and the prognosis better than expected from results of reference centers.