ABSTRACT
Aortic valve-in-valve (ViV) procedures are increasingly performed for the treatment of surgical bioprosthetic valve failure in patients at intermediate to high surgical risk. Although ViV procedures offer indisputable benefits in terms of procedural time, in-hospital length of stay, and avoidance of surgical complications, they also present unique challenges. Growing awareness of the technical difficulties and potential threats associated with ViV procedures mandates careful preprocedural planning. This review article offers an overview of the current state-of-the-art ViV procedures, with focus on patient and device selection, procedural planning, potential complications, and long-term outcomes. Finally, it discusses current research efforts and future directions aimed at improving ViV procedural success and patient outcomes.
ABSTRACT
Mitral annular calcium (MAC) is a common finding in older patients referred for transcatheter aortic valve implantation (TAVI). Multidetector computed tomography (MDCT) allows fine quantification of the calcific deposits. Our objective was to estimate the prevalence of MAC and associated mitral stenosis (MS) in patients referred for TAVI using MDCT. A cohort of 346 consecutive patients referred for TAVI evaluation was screened by MDCT for MAC: 174 had MAC (50%). Of these patients, 165 patients (95%) had mitral valve area (MVA) assessable by MDCT planimetry (age 83.8 ± 5.9 years). Median mitral calcium volume and MVA were 545 mm3 (193 to 1,253 mm3) and 234 mm2 (187 to 297 mm2), respectively. The MS was very severe, severe, and moderate in 2%, 22%, and 10% patients, respectively. By multivariate analysis, MVA was independently correlated to mitral calcium volume, aortic annular area, and some specific patterns of mitral leaflet calcium. Based on these findings, a formula was elaborated to predict the presence of a significant MS. In conclusion, MDCT allows detailed assessment of MAC in TAVI populations, demonstrating a high prevalence. Mitral analysis should become routine during MDCT screening before TAVI as it may alter therapeutic strategy.
Subject(s)
Aortic Valve Stenosis/diagnostic imaging , Calcinosis/diagnostic imaging , Mitral Valve Stenosis/diagnostic imaging , Mitral Valve/diagnostic imaging , Aged , Aged, 80 and over , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/surgery , Calcinosis/epidemiology , Comorbidity , Female , Humans , Male , Mitral Valve Stenosis/epidemiology , Multidetector Computed Tomography , Prevalence , Retrospective Studies , Transcatheter Aortic Valve ReplacementABSTRACT
Melanoma is a neoplasm known for its propensity for cardiac involvement. When there exists an isolated metastasis to the heart, the melanoma tends to involve the right heart. Rarely does melanoma metastasize to the left ventricle. We report the first case of choroidal melanoma that had indeed metastasized to the left ventricle and was associated with a patent foramen ovale, which may explain its initially surprising location on this side of the heart.
Subject(s)
Choroid Neoplasms/pathology , Heart Neoplasms/secondary , Melanoma/secondary , Uveal Neoplasms/secondary , Aged, 80 and over , Cardiac Surgical Procedures/methods , Choroid Neoplasms/surgery , Eye Enucleation , Follow-Up Studies , Heart Neoplasms/diagnosis , Heart Neoplasms/surgery , Heart Ventricles , Humans , Magnetic Resonance Imaging, Cine , Male , Melanoma/diagnosis , Melanoma/surgery , Uveal Neoplasms/diagnosis , Uveal Neoplasms/surgerySubject(s)
Aortic Valve Insufficiency/diagnosis , Coronary Occlusion/diagnosis , Diagnostic Imaging/methods , Imaging, Three-Dimensional/methods , Syphilis, Cardiovascular/complications , Adult , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/surgery , Combined Modality Therapy , Coronary Artery Bypass/methods , Coronary Occlusion/etiology , Coronary Occlusion/surgery , Echocardiography, Transesophageal/methods , Follow-Up Studies , Heart Valve Prosthesis Implantation/methods , Humans , Male , Penicillins/therapeutic use , Severity of Illness Index , Syphilis, Cardiovascular/diagnosis , Syphilis, Cardiovascular/drug therapy , Tomography, X-Ray Computed/methods , Treatment Outcome , User-Computer Interface , Video RecordingABSTRACT
OBJECTIVE: Atherosclerosis is a chronic inflammatory disease of the blood vessels. Toll-like receptor 4 (TLR4) is a transmembrane receptor that is involved in mediating inflammatory responses to bacterial endotoxin and other ligands. The aim of this study was to search for an association between a common functional polymorphism of TLR4--Asp299Gly--and acute coronary syndrome. METHODS AND RESULTS: We conducted a case-control study of 183 patients with acute coronary syndromes and 216 controls. We screened the TLR4 gene for the Asp299Gly polymorphism using a 5' fluorogenic assay. The 299Gly allele was associated with a decreased risk of acute coronary events independently of standard coronary risk factors. The adjusted odds ratio associated with this allele was 0.41 (95% CI, 0.18 to 0.95; P=0.037). In controls, TLR4 heterozygosity was also associated with a significant decrease in plasma fibrinogen and soluble vascular cellular adhesion molecule-1 levels (P<0.01). CONCLUSIONS: These results, which must be confirmed by a prospective longitudinal study, provide evidence of an association between the Asp299Gly polymorphism of the human TLR4 receptor and acute coronary syndromes. They confirm the previously reported involvement of TLR4 in carotid and femoral artery atherosclerosis.