Ultrasound-guided antecubital vein approach for right heart catheterisation in a Brazilian tertiary centre.

Objective: As a parallel to the radial approach for left heart catheterisation, forearm veins may be considered for the performance of right heart catheterisation. However, data regarding the application of this technique under ultrasound guidance are scarce. The current study aims to demonstrate the feasibility of right heart catheterisation through ultrasound-guided antecubital venous approach in the highly heterogeneous population usually referred for right heart catheterisation. Methods: Data from consecutive right heart catheterisations performed at an academic centre in Brazil, between January 2016 and March 2017 were prospectively collected. Results: Among 152 performed right heart catheterisations, ultrasound-guided antecubital venous approach was attempted in 127 (84%) cases and it was made feasible in 92.1% of those. Yet, there was no immediate vascular complication with the antecubital venous approach in this prospective series. Conclusions: Ultrasound-guided antecubital venous approach for the performance of right heart catheterisation was feasible in the vast majority of cases in our study, without occurrence of vascular complications.

Prognostic significance of repeated brain natriuretic peptide measurements after percutaneous transluminal septal myocardial ablation in patients with drug-refractory hypertrophic obstructive cardiomyopathy.

Objectives: To evaluate whether repeated brain natriuretic peptide (BNP) measurements after percutaneous transluminal septal myocardial ablation (PTSMA) provide prognostic information regarding the response to PTSMA in patients with drug-refractory hypertrophic obstructive cardiomyopathy (HOCM). Background: Plasma BNP levels are associated with clinical outcomes in patients with HOCM. However, the prognostic value of plasma BNP level changes before and after PTSMA remains unclear. Methods: We measured the plasma BNP levels serially before and after PTSMA, and evaluated the relationship between the changes in plasma BNP levels and clinical improvement in 47 patients. The patients were assigned to two groups based on the reduction in the New York Heart Association class ≥1 (good responder) or <1 (poor responder) before and after PTSMA. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to measure health status. Results: The plasma BNP levels gradually decreased after PTSMA, although the levels plateaued 3 months until 12 months after PTSMA. Although the plasma BNP levels and resting left ventricular outflow tract peak pressure gradient before PTSMA were comparable between the groups, the ratio of the BNP levels before and after PTSMA in the good responder group was significantly lower than that in the poor responder group (0.43 (range, 0.24-0.68) vs 0.78 (range, 0.62-0.93), p=0.002). The KCCQ score changes in the good responder group were significantly higher than those in the poor responder group. Conclusions: The plasma BNP level ratio was associated with long-term clinical improvement of heart failure after PTSMA for drug-refractory HOCM.

Device closure for patent foramen ovale following cryptogenic stroke: a survey of current practice in the UK.

Patent foramen ovale (PFO) closure for cryptogenic stroke remains controversial due to a lack of conclusive randomised controlled data. Many experts feel PFO closure is indicated in selected cases; however, national and international guideline recommendations differ. We surveyed the UK cardiologists, stroke physicians and neurologists, seeking to determine specialist interpretation of the evidence base, and to gain an insight into the current UK practice. The British Cardiac Society and British Society of Stroke physicians distributed our survey which was performed using an online platform. 120 physicians (70 stroke physicians, 23 neurologists, 27 cardiologists) completed the survey. Most (89%) felt PFO closure should be considered in selected patients. Atrial fibrillation (86.6%), significant carotid stenosis (86.6%), diabetes (38.4%) and hypertension (36.6%) were considered exclusion criteria for cryptogenic stroke diagnosis. More stroke physicians than cardiologists considered an age cut-off when considering PFO as the stroke aetiology (70.4%vs 54.5%p=0.04). Anatomical features felt to support PFO closure were aneurysmal septum (89.6%), shunt size (73.6%), prominent Eustachian valve (16%). 60% discuss patients in multidisciplinary meetings prior to PFO closure, with more cardiologists than stroke physicians/neurologists favouring this approach (76.9% vs 54.8%; p=0.05). After PFO closure, patients receive Clopidogrel (72.3%), aspirin (50%) or anticoagulants (17%). 63.2% continue therapy for a limited period after PFO closure, while 34% prefer life-long therapy (14.8% cardiologists vs 40.5% non-cardiologists; p=0.02). While experts support selective PFO closure in cryptogenic stroke, current practice remains variable with significant differences in perceptions of cardiologists and neurologists/stroke physicians.

Transcatheter aortic valve implantation: Current status and future perspectives.

Although surgical aortic valve replacement is the standard therapy for severe aortic stenosis (AS), about one third of patients are considered inoperable due to unacceptable surgical risk. Under medical treatment alone these patients have a very poor prognosis with a mortality rate of 50% at 2 years. Transcatheter aortic valve implantation (TAVI) has been used in these patients, and has shown robust results in the only randomized clinical trial of severe AS treatment performed so far. In this review, we will focus on the two commercially available systems: Edwards SAPIEN valve and CoreValve Revalving system. Both systems have demonstrated success rates of over 90% with 30-d mortality rates below 10% in the most recent transfemoral TAVI studies. Moreover, long-term studies have shown that the valves have good haemodynamic performance. Some studies are currently exploring the non-inferiority of TAVI procedures vs conventional surgery in high-risk patients, and long-term clinical results of the percutaneous valves. In this article we review the current status of TAVI including selection of patients, a comparison of available prostheses, results and complications of the procedure, clinical outcomes, and future perspectives.