ABSTRACT
PURPOSE: We aimed to study the characteristics of the membranous septum (MS) and its relationship with the aortic valve (AoV) and aortic annulus (AA) in patients who required PPM post-TAVR. METHODS: We performed a retrospective case-control study of 144 patients undergoing TAVR from 2016 to 2018. Thirty-four patients, requiring PPM implantation, were compared with 34 matched controls who did not require pacing. The total MS length, supra-annular MS (SA-MS) length, infra-annular MS (IA-MS) length, angle between the plane of the AA and MS (AA-MS), and degree of AoV calcifications (AVC) were obtained from preoperative CT. AoV prosthesis implantation depth was obtained from intra-operative fluoroscopy. RESULTS: There were no significant differences in valve type (self-expandable: 23 cases vs 25 controls, and balloon-expandable: 11 vs 9, p = 0.79), degree of AVC (0.65 cm3 vs 0.82 cm3, p = 0.62), or implantation depth (7.76 mm vs 7.28 mm, p = 0.83). Compared to controls, there was no difference in total MS length (6.68 mm vs 6.06 mm, p = 0.97), but the IA-MS was significantly shorter (3.64 mm vs 4.56 mm, p = 0.02) and the SA-MS was significantly longer (2.73 mm vs 1.67 mm, p = 0.02) in patients requiring PPM. Patients requiring PPM also had a larger AA-MS angle (103.5° vs 96.7°, p = 0.01). CONCLUSION: The position of the MS with respect to the AA and MS distance below the annular plane were more closely associated with post-TAVR conduction abnormalities requiring PPM than the absolute length of the MS. Patients undergoing TAVR with such anatomy have a higher risk of requiring PPM and should be monitored for developing these complications.
Subject(s)
Aortic Valve Stenosis , Heart Valve Prosthesis , Pacemaker, Artificial , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Cardiac Pacing, Artificial , Case-Control Studies , Fluoroscopy , Humans , Retrospective Studies , Risk Factors , Treatment OutcomeABSTRACT
We report a case of 72-year-old female with prior history of takotsubo cardiomyopathy (TSC) who had recurrence of TSC during cryoablation of pulmonary veins for atrial fibrillation (AF) ablation. This case is unique because this is the first report of TSC detected during cryoablation and the procedure being stressor for recurrent TSC. We discuss possible mechanism of TSC and management of this case. Readers would have higher alertness of detecting TSC during AF ablation and therefore would be able to manage this serious condition properly.
ABSTRACT
At 22 years following heart transplantation, a patient presented with incessant atrial flutter. During electrophysiologic study, 2 simultaneous atrial arrhythmias were mapped, 1 from the donor and 1 from the recipient's heart. High-density mapping allowed for rapid identification of electrically abnormal areas, which were successfully ablated, thus restoring sinus rhythm. (Level of Difficulty: Advanced.).
ABSTRACT
Introducción: La angioplastia con balón de las lesiones ateroscleróticas renales es un procedimiento que se asocia a un bajo índice de éxito inicial y una incidencia prohibitiva de reestenosis. Los stents teóricamente corrigen estas limitaciones. El propósito de este trabajo fue determinar la eficacia de los stents en el manejo de las lesiones aorto-ostiales en las arterias renales. Materiales y Métodos: Entre junio de 1996 a agosto de 2001 se implantaron 96 stents tubulares en 79 pacientes con lesiones ateroscleroticas aorto-ostiales renales por vía femoral o braquial. Siete pacientes requirieron stent renal bilateral. Se indicó el procedimiento a los pacientes con lesiones = 70 por ciento en presencia de Hipertensión arterial (69 por ciento), o creatinina = 1.5 mg/d (31 por ciento). Antes del tratamiento todos los pacientes recibieron aspirina, y el 70 por ciento tienopiridinas. Resultados: La edad promedio de los pacientes fue 70 anos ± 10 anos. El 54 por ciento son de sexo femenino. Las patologías asociadas fueron-. Hipertensión (85 por ciento), Enfermedad Coronaria (44 por ciento), enfermedad arterial oclusiva de miembros inferiores (38 por ciento), aneurisma de aorta abdominal (13 por ciento) y diabetes mellitus (10 por ciento). Posterior a la implantación del stent el diámetro luminal mínimo aumento de 2.25 ± 0.54 mm a 5.29±0.54 mm (p< 0.001), y el porcentaje de diámetro de estenosis disminuyo del 83±5.4 por ciento al 6.5± 13.2 por ciento [p< 0.001). Conclusiones: La angioplastia percutánea con stents parece ser una excelente alternativa de revascularización en pacientes con lesiones aorto-ostiales de las arterias renales. Este tipo de intervención se asocia a un riesgo de complicaciones y muerte muy bajo (<2 por ciento), y a una probabilidad de éxito mayor del 95 por ciento...
