Continuous invasive hemodynamic monitoring using steerable guide catheter to optimize mitraclip transcatheter mitral valve repair: A multicenter, proof-of-concept study.

OBJECTIVES: We report our multicenter experience on continuous hemodynamic monitoring using exclusively the steerable guide catheter (SGC) during MitraClip repair. BACKGROUND: Left atrial pressure (LAP) and V-wave are useful to evaluate MitraClip repair but no simple method of continuous monitoring exists. METHODS: From 11/2016 to 8/2017, 74 patients from four centers with symptomatic moderate-severe to severe mitral regurgitation (MR), underwent MitraClip NT repair with continuous hemodynamic monitoring via the SGC. Real-time LAP/V-wave changes were compared with transesophageal echocardiography (TEE). When mitral stenosis was suspected, transmitral gradients were verified by invasive hemodynamics. Clinical and echocardiographic outcomes were determined. RESULTS: Mean age was 78 ± 10 years and STS score 9.1 ± 11.0%. Pathology included leaflet prolapse/flail (45%), restriction (35%), and mixed (20%). Number of clips averaged 1.7 ± 0.7 per case. There was a significant reduction in LAP (21 ± 10 to 15 ± 7 mmHg, P < 0.0001) and V-wave(37 ± 19 to 24 ± 10 mmHg, P < 0.0001) post MitraClip, but the decrease was less in patients with atrial fibrillation (P < 0.05). Transmitral gradient significantly increased from 2.0 ± 1.2 to 4.0 ± 1.7 mmHg (P < 0.0001). Paradoxical increases in LAP and V-wave despite MR reduction were observed in three cases requiring MitraClip repositioning or retrieval to avoid stenosis. Follow-up averaged 5.0 ± 2.9 months and was 100% complete. KCCQ improvement was significant and MR reduction to <1+ was 67% and <2+ was 93% at 30 days. CONCLUSIONS: Continuous hemodynamic monitoring using the SGC complements TEE to assess and optimize MitraClip repair in real-time. Further validation is necessary but this feature may be part of future MitraClip and other transcatheter mitral repair systems.

Antidiabetic, antioxidant and antihyperlipidemic status of Heliotropium zeylanicum extract on streptozotocin-induced diabetes in rats.

The potential role of the methanolic extract of Heliotropium zeylanicum (BURM.F) LAMK (MEHZ) in the treatment of diabetes along with its antioxidant and antihyperlipidemic effects was studied in streptozotocin-induced diabetic rats. Oral administration of (MEHZ) 150 and 300 mg/kg/d for 14 d significantly decreased the blood glucose level and considerably increased the body weight, food intake, and liquid intake of diabetic-induced rats. MEHZ significantly decreased thiobarbituric acid reactive substances and significantly increased reduced glutathione, superoxide dismutase and catalase in streptozotocin-induced diabetic rats at the end of 14 d of treatment. The study also investigated the antihyperlipidemic potential of MEHZ. The results show that the active fraction of MEHZ is promising for development of a standardized phytomedicine for the treatment of diabetes mellitus.

Synthesis and characterization of a new resin functionalized with 2-naphthol-3,6-disulfonic acid and its application for the speciation of chromium in natural water.

A polystyrene divinyl benzene (8%) copolymer has been functionalized by coupling it through NN group with 2-naphthol-3,6-disulfonic acid (NDSA). The resulting resin has been characterized by elemental analysis, thermogravimetric analysis and infrared spectra. The hydrogen ion, water regain and metal ion capacities of the resin have been determined. Two forms of chromium show different exchange capacities at different pH values, viz. Cr(III) selectively retained at pH 6.5 whereas Cr(VI) retained at pH 1.5. Hence complete separation of the two forms of chromium is possible. The kinetic studies show that the exchange of Cr(III) and Cr(VI) follows second-order kinetics. The metal ion concentration was measured by flame atomic absorption spectrometry. The method has been successfully applied for the speciation of chromium in natural water samples.