ABSTRACT
Purpose@#The incidence and prognostic implications of atrial fibrillation (AF) in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI) are controversial, especially for Korean patients. Furthermore, the pattern of antithrombotic therapy for these patients is unknown. The present study sought to identify the impact of AF on Korean patients undergoing TAVI and demonstrate the status of antithrombotic therapy for these patients. @*Materials and Methods@#A total of 660 patients who underwent TAVI for severe AS were recruited from the nationwide K-TAVI registry in Korea. The enrolled patients were stratified into sinus rhythm (SR) and AF groups. The primary endpoint was all-cause death at 1-year. @*Results@#AF was recorded in 135 patients [pre-existing AF 108 (16.4%) and new-onset AF 27 (4.1%)]. The rate of all-cause death at 1 year was significantly higher in patients with AF than in those with SR [16.2% vs. 6.4%, adjusted hazard ratio (HR): 2.207, 95% confidence interval (CI): 1.182–4.120, p=0.013], regardless of the onset timing of AF. The rate of new pacemaker insertion at 1 year was also significantly higher in patients with AF than in those with SR (14.0% vs. 5.5%, adjusted HR: 3.137, 95%CI: 1.621–6.071, p=0.001).Among AF patients, substantial number of patients received the combination of multiple antithrombotic agents (77.8%), and the most common combination was that of aspirin and clopidogrel (38.1%). @*Conclusion@#AF was an independent predictor of 1-year mortality and new pacemaker insertion in Korean patients undergoing TAVI.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus 2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities; the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.
ABSTRACT
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the novel virus severe acute respiratory syndrome coronavirus-2. The first case developed in December, 2019 in Wuhan, China; several months later, COVID-19 has become pandemic, and there is no end in sight. This disaster is also causing serious health problems in the area of cardiovascular intervention. In response, the Korean Society of Interventional Cardiology formed a COVID-19 task force to develop practice guidelines. This special article introduces clinical practice guidelines to prevent secondary transmission of COVID-19 within facilities;the guidelines were developed to protect patients and healthcare workers from this highly contagious virus. We hope these guidelines help healthcare workers and cardiovascular disease patients around the world cope with the COVID-19 pandemic.
ABSTRACT
BACKGROUND AND OBJECTIVES: There has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea. METHODS: The first cohort of Korean-TAVI (K-TAVI) registry includes 576 consecutive patients with severe symptomatic aortic stenosis who underwent TAVI from 17 Korean hospitals for 2 years. RESULTS: Most of TAVI procedures were performed for septuagenarians and octogenarians (90.8%) through transfemoral approach (98.3%). The rate of device success was 92.5% and permanent pacemaker was implanted in 5.6%. In successive years, incidences of paravalvular leakage (PVL) and major bleeding declined. Society of Thoracic Surgeons (STS) score was 5.2 (3.0 to 9.0) and 34.7% of patients had high surgical risk (STS ≥8). One-year all-cause death occurred in 8.9% and was significantly lower in low to intermediate risk one than in high risk (5.4% vs. 15.5%, p < 0.001). The independent predictors of 1-year mortality were age (hazard ratio [HR], 1.087; 95% confidence interval [CI], 1.036–1.141; p=0.001), moderate or severe PVL (HR, 4.631; 95% CI, 1.624–13.203; p=0.004) and end-stage renal disease (HR, 5.785; 95% CI, 2.717–12.316; p < 0.001). CONCLUSIONS: K-TAVI registry showed favorable 1-year outcomes with decreasing complication rate over time in real-world Korean patients. Two-thirds of patients were low to intermediate surgical risk and showed a significantly lower mortality than the high-risk patients, suggesting the promising future on the expanded indications of TAVI.
Subject(s)
Aged, 80 and over , Humans , Aortic Valve Stenosis , Asian People , Cohort Studies , Hemorrhage , Incidence , Kidney Failure, Chronic , Korea , Mortality , Surgeons , Transcatheter Aortic Valve ReplacementABSTRACT
BACKGROUND AND OBJECTIVES@#There has been no nation-wide data on the outcomes of transcatheter aortic valve implantation (TAVI) after commercialization of TAVI in Korea. We report clinical features and outcomes of the first cohort of TAVI performed from Jun 2015 to Jun 2017 in Korea.@*METHODS@#The first cohort of Korean-TAVI (K-TAVI) registry includes 576 consecutive patients with severe symptomatic aortic stenosis who underwent TAVI from 17 Korean hospitals for 2 years.@*RESULTS@#Most of TAVI procedures were performed for septuagenarians and octogenarians (90.8%) through transfemoral approach (98.3%). The rate of device success was 92.5% and permanent pacemaker was implanted in 5.6%. In successive years, incidences of paravalvular leakage (PVL) and major bleeding declined. Society of Thoracic Surgeons (STS) score was 5.2 (3.0 to 9.0) and 34.7% of patients had high surgical risk (STS ≥8). One-year all-cause death occurred in 8.9% and was significantly lower in low to intermediate risk one than in high risk (5.4% vs. 15.5%, p < 0.001). The independent predictors of 1-year mortality were age (hazard ratio [HR], 1.087; 95% confidence interval [CI], 1.036–1.141; p=0.001), moderate or severe PVL (HR, 4.631; 95% CI, 1.624–13.203; p=0.004) and end-stage renal disease (HR, 5.785; 95% CI, 2.717–12.316; p < 0.001).@*CONCLUSIONS@#K-TAVI registry showed favorable 1-year outcomes with decreasing complication rate over time in real-world Korean patients. Two-thirds of patients were low to intermediate surgical risk and showed a significantly lower mortality than the high-risk patients, suggesting the promising future on the expanded indications of TAVI.
ABSTRACT
Bioresorbable vascular scaffold (BRS) is an innovative device that provides structural support and drug release to prevent early recoil or restenosis, and then degrades into nontoxic compounds to avoid late complications related with metallic drug-eluting stents (DESs). BRS has several putative advantages. However, recent randomized trials and registry studies raised clinical concerns about the safety and efficacy of first generation BRS. In addition, the general guidance for the optimal practice with BRS has not been suggested due to limited long-term clinical data in Korea. To address the safety and efficacy of BRS, we reviewed the clinical evidence of BRS implantation, and suggested the appropriate criteria for patient and lesion selection, scaffold implantation technique, and management.
Subject(s)
Humans , Coronary Disease , Drug Liberation , Drug-Eluting Stents , Korea , Stents , ThrombosisABSTRACT
Current guidelines recommend that coronary artery calcium (CAC) screening should only be used for intermediate risk groups (Framingham risk score [FRS] of 10%-20%). The CAC distributions and coronary artery disease (CAD) prevalence in various FRS strata were determined. The benefit to lower risk populations of CAC score-based screening was also assessed. In total, 1,854 participants (aged 40-79 years) without history of CAD, stroke, or diabetes were enrolled. CAC scores of > 0, ≥ 100, and ≥ 300 were present in 33.8%, 8.2%, and 2.9% of the participants, respectively. The CAC scores rose significantly as the FRS grew more severe (P 20% strata were 3.4%, 6.7%, 9.0%, and 11.6% (P 20%; P < 0.05). In conclusion, the yield of screening for significant CAC and occult CAD is low in the very low risk population but it rises in low and intermediate risk populations.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Calcium/analysis , Coronary Artery Disease/diagnosis , Coronary Vessels/chemistry , Logistic Models , Multivariate Analysis , Prevalence , Risk Factors , Severity of Illness Index , Tomography, X-Ray ComputedABSTRACT
Noonan syndrome is an autosomal dominant disorder characterized by dysmorphic facial features, congenital heart defects and short stature. To date, renal artery stenosis has not been associated with Noonan syndrome. We report the case of a 27-year old male who presented with malignant hypertension associated with renal artery stenosis, dysmorphic facial features, pectus excavatum, pulmonary stenosis and hypertrophic cardiomyopathy who was diagnosed with Noonan syndrome.
Subject(s)
Adult , Humans , Male , Balloon Valvuloplasty , Cardiomyopathy, Hypertrophic , Funnel Chest , Heart Defects, Congenital , Hypertension, Malignant , Noonan Syndrome , Pulmonary Valve Stenosis , Renal Artery ObstructionABSTRACT
Acquired factor V inhibitor is a rare condition with a variety of clinical manifestations that range from no bleeding symptoms to life-threatening hemorrhage or thromboembolic events. Treatment is determined by the clinical course and focuses on controlling the hemorrhagic event and decreasing the antibody titer if bleeding symptoms are present. We report herein a case involving a 70-year-old man who developed acquired factor V inhibitor after antibiotic administration (11-day course of ceftriaxone and successive 5-day course of piperacillin-tazobactam) for pneumonia. His condition was characterized by elevated prothrombin and activated partial thromboplastin times without bleeding events. Coagulation factor assays revealed undetectable factor V activity and a factor V inhibitor level of 3.29 Bethesda units. After cessation of the antibiotics, both the prothrombin and activated partial thromboplastin times gradually normalized.
Subject(s)
Aged , Humans , Anti-Bacterial Agents , Blood Coagulation Factors , Ceftriaxone , Factor V Deficiency , Factor V , Hemorrhage , Pneumonia , Prothrombin , ThromboplastinABSTRACT
BACKGROUND AND OBJECTIVES: Transcatheter aortic valve implantation (TAVI) was recently introduced in Korea. The present report describes the experience of early TAVI cases. SUBJECTS AND METHODS: Between March, 2010 and October, 2011, 48 patients with severe symptomatic aortic stenosis (AS) were screened at the Asan Medical Center to determine their suitability for surgical intervention. Of these, 23 were considered unsuitable and underwent TAVI. Procedural success rates, procedure-related complications, and clinical outcomes were evaluated in the TAVI patients. RESULTS: Transfemoral (n=20) or transapical (n=3) TAVI was performed. The mean age of patients was 75.9+/-5.4 years and 57% were females. The mean logistic European System for Cardiac Operative Risk Evaluation was 25.6+/-5.1%. Implantation was successful in 22 patients (19 transfemoral, three transapical). After successful implantation, the mean aortic valve area increased from 0.68+/-0.14 cm2 to 1.45+/-0.33 cm2. There were no procedure-related complications or mortality. The patients showed no paravalvular aortic regurgitation with > or = moderate degree and remained stable without progression during follow-up. During follow-up (interquartile range, 1.1-12.9), all patients were alive without any occurrence of valve failure. CONCLUSION: TAVI procedure is feasible in patients with inoperative symptomatic AS leading to hemodynamic and clinical improvement. With accumulation of experience, proper patient selection and development of device technologies, TAVI should decrease adverse events and expand the indications in the near future.
Subject(s)
Female , Humans , Aortic Valve , Aortic Valve Insufficiency , Aortic Valve Stenosis , Follow-Up Studies , Hemodynamics , Korea , Patient SelectionABSTRACT
This was designed to assess the outcomes of side branch (SB) stenosis after implantation of three drug-eluting stents (DES). From 2,645 patients in the ZEST (Comparison of the Efficacy and Safety of Zotarolimus-Eluting Stent with Sirolimus-Eluting and PacliTaxel-Eluting Stent for Coronary Lesions) Trial, 788 patients had 923 bifurcation lesions with SB > or = 1.5 mm were included. SB was treated in 150 lesions, including 35 (3.8%) receiving SB stenting. Of untreated SB with baseline stenosis < 50%, the incidences of periprocedural SB compromise was similar in the zotarolimus (15.8%), sirolimus (17.2%), and paclitaxel (16.6%) stent groups (P = 0.92). At follow-up angiography, delayed SB compromise occurred in 13.9%, 3.2%, and 9.4% (P = 0.010) of these groups. When classified into four groups (< 50%, 50%-70%, 70%-99%, and 100%), 9.0% of untreated SB were worsened, whereas improvement and stationary were observed in 9.6% and 81.4%. In a multivariable logistic regression model, main branch (MB) stenosis at follow-up (%) was the only independent predictor of SB stenosis worsening (odds ratio, 1.03; 95% confidence interval, 1.01-1.04; P < 0.001). After MB stenting in bifurcation lesions, a minority of SB appears to worsen. DES with strong anti-restenotic efficacy may help maintain SB patency.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Acute Disease , Blood Vessels/physiopathology , Cardiovascular Agents/therapeutic use , Coronary Angiography , Coronary Stenosis/drug therapy , Drug-Eluting Stents/adverse effects , Follow-Up Studies , Logistic Models , Myocardial Infarction/etiology , Myocardial Revascularization , Odds Ratio , Paclitaxel/therapeutic use , Predictive Value of Tests , Sirolimus/analogs & derivatives , Thrombosis/etiology , Treatment OutcomeABSTRACT
Primary cardiac angiosarcoma is a rare and rapidly progressing tumor characterized by high predilection for right-sided heart involvement and a very poor prognosis. In this report, we present a case of angiosarcoma involving right atrium and ventricle in 61-year old woman with clinical presentation of repeated bloody pericardial effusion. Right atrial perforation was confirmed by contrast echocardiography using hand-agitated saline contrast. Primary cardiac angiosarcoma was confirmed by histological and immunohistochemical studies.
Subject(s)
Female , Humans , Echocardiography , Heart , Heart Atria , Hemangiosarcoma , Pericardial Effusion , PrognosisABSTRACT
Extrahepatic obstruction of the portal vein, resulting in portal hypertension, may cause extensive collateral circulation at the porta hepatis. These collateral veins may compress and narrow the common bile duct, sometimes causing obstructive jaundice. Until recently, ERCP and percutaneous angiography have been used to diagnose choledochal varix. Now, MR cholangiography is replacing the diagnostic role of ERCP. This imaging has the advantage of obtaining angiography at the same time. We present a 62-year-old male patient, in whom choledochal varix accompanying choledocholithiasis, was diagnosed by MR cholangiography and contrast-enhanced MR angiography.
Subject(s)
Humans , Male , Middle Aged , Angiography , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Choledocholithiasis , Collateral Circulation , Common Bile Duct , Hypertension, Portal , Jaundice, Obstructive , Portal Vein , Varicose Veins , VeinsABSTRACT
Primary sclerosing cholangitis (PSC) is a rare disease entity. The medical therapy for PSC has not been reasonably beneficial. Thus liver transplantation is known to be the ultimate therapy. Because liver transplantation for PSC has been performed rarely in Korea, we report a case of liver transplantation for PSC with a review of the literature. A 35-year-old male was admitted to our hospital with recurrent jaundice for seven years. ERCP showed multiple strictures of intrahepatic duct and an irregularity of the extrahepatic duct wall. Despite medication and endoscopic treatment, liver functions did not imporve and clinical status got worsened. Thus liver transplantation was performed for the correction of hepatic failure. Two months after transplantation, liver functions and general weakness gradually improved and now, one year after liver transplantation, the patient is in normal life.
Subject(s)
Adult , Humans , Male , Cholangitis, Sclerosing/diagnosis , Liver TransplantationABSTRACT
Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Subject(s)
Adenoma , Ampulla of Vater , Cholangitis , Constriction, Pathologic , Hemorrhage , Pancreatitis , StentsABSTRACT
Adenomas of the major duodenal papilla are rare but clinically important since they are a premalignant condition. Endoscopic mucosal resection has emerged as the first line therary for ampullary adenoma. However, various complications such as pancreatitis, bleeding or duodenal perforation have been reported after endoscopic mucosal resection. To our knowledge, cholangitis has not been reported as a complication of the procedure in the literature. We report a case of papillary stenosis and cholangitis caused by endoscopic mucosal resection of ampullary adenoma. We performed the endoscopic biliary spincterotomy followed by biliary stenting and cholangitis was successfully controlled.
Subject(s)
Adenoma , Ampulla of Vater , Cholangitis , Constriction, Pathologic , Hemorrhage , Pancreatitis , StentsABSTRACT
The secondary amyloidosis (AA type), a complication of inflammation or infection, is caused by the deposition of serum amyloid protein A in various organs. The clinical manifestations of amyloidosis are various according to involved organs. The gastrointestinal tract is one of the commonly affected organs. However, the endoscopic findings of gastrointestinal amyloidosis are nonspecific, and symptoms are diverse. Hepatic involvement of amyloidosis rarely leads to hepatic dysfunction, threfore is not a clinical concern. We report a 54-year-old women with intestinal tuberculosis whose major symptom was watery diarrhea lasting several months. The amyloid deposits were histologically proven in the rectum of which mucosa showed redness and swelling endoscopically and hepatic involvement of amyloidosis was suspected on abdominopelvic CT scan. After anti-tuberculosis medication for 6 months, abdominopelvic CT scan showed resolution of hepatic involvement and colonoscopy revealed improvement of redness and loss of vascularity of the rectum.
Subject(s)
Female , Humans , Middle Aged , Amyloidosis , Colonoscopy , Diarrhea , Gastrointestinal Tract , Inflammation , Mucous Membrane , Plaque, Amyloid , Rectum , Serum Amyloid A Protein , Tomography, X-Ray Computed , TuberculosisABSTRACT
The secondary amyloidosis (AA type), a complication of inflammation or infection, is caused by the deposition of serum amyloid protein A in various organs. The clinical manifestations of amyloidosis are various according to involved organs. The gastrointestinal tract is one of the commonly affected organs. However, the endoscopic findings of gastrointestinal amyloidosis are nonspecific, and symptoms are diverse. Hepatic involvement of amyloidosis rarely leads to hepatic dysfunction, threfore is not a clinical concern. We report a 54-year-old women with intestinal tuberculosis whose major symptom was watery diarrhea lasting several months. The amyloid deposits were histologically proven in the rectum of which mucosa showed redness and swelling endoscopically and hepatic involvement of amyloidosis was suspected on abdominopelvic CT scan. After anti-tuberculosis medication for 6 months, abdominopelvic CT scan showed resolution of hepatic involvement and colonoscopy revealed improvement of redness and loss of vascularity of the rectum.
Subject(s)
Female , Humans , Middle Aged , Amyloidosis , Colonoscopy , Diarrhea , Gastrointestinal Tract , Inflammation , Mucous Membrane , Plaque, Amyloid , Rectum , Serum Amyloid A Protein , Tomography, X-Ray Computed , TuberculosisABSTRACT
A 77-year-old female was admitted 3 hours after intentionally ingesting 5 g of aluminum ammonium sulfate ('Alum') powder dissolved in water. Gastric lavage with normal saline, activated charcoal chelation, and supportive therapies were performed. She showed a high anion gap metabolic acidosis, which rapidly progressed to multiple organ failure including ARDS. The patient subsequently progressed to a refractory shock which eventually led to death.
Subject(s)
Female , HumansABSTRACT
A 77-year-old female was admitted 3 hours after intentionally ingesting 5 g of aluminum ammonium sulfate ('Alum') powder dissolved in water. Gastric lavage with normal saline, activated charcoal chelation, and supportive therapies were performed. She showed a high anion gap metabolic acidosis, which rapidly progressed to multiple organ failure including ARDS. The patient subsequently progressed to a refractory shock which eventually led to death.