Recurrent Stent Thrombosis Following Myocardial Infarction Associated With VITT-Like Antibodies.

Early stent thrombosis is a rare complication of percutaneous intervention and is associated with significant 30-day mortality. We present a novel case of multiple recurrent early stent thrombosis consistent with spontaneous vaccine-induced thrombotic thrombocytopenia. We were successfully able to manage this unusual condition through an interdisciplinary collaboration.

Gene-based bio-signature patterns and cardiac allograft rejection.

Clinicians have long awaited an alternative to invasive endomyocardial biopsy for surveillance of cardiac transplant rejection. Transcriptional signals in peripheral blood mononuclear cells allow for the development of multigene-based panels that can inform on the presence or absence of immunologic quiescence. The informative genes represent several biologic pathways, including T-cell activation (PDCD1), T-cell migration (ITGA4), and mobilization of hematopoietic precursors (WDR40A and microRNA gene family cMIR), and steroid-responsive genes such as IL1R2, the decoy receptor for interleukin 2. The greatest value may include the ability to inform on the potential of future proclivity for rejection, allowing patients to be stratified into low, intermediate, or high risk subsets for future rejection. In these individuals, this knowledge may allow clinicians to use tailored approaches to immunosuppression, thereby avoiding adverse pharmacologic effects in low-risk patients while improving rejection outcomes in those at high risk for future allograft compromise. Despite these advances, clinical entrenchment of gene-based pharmacotherapy in cardiac transplantation will require independent replication and validation of investigational findings.

Cardiomyopathy and the dilemma of geometric mitral regurgitation.

PURPOSE OF REVIEW: Geometric mitral regurgitation is a phenomenon encountered by an otherwise anatomically normal mitral valve in the setting of advanced adverse left ventricular remodeling that alters the alignment characteristics of the mitral valve apparatus leading to functional production of a leaking valve. In this review, we discuss contemporary directions in the knowledge base for managing geometric mitral regurgitation. RECENT FINDINGS: Much progress has been encountered in describing the types of geometric mitral regurgitation (nonischemic and ischemic origins), standardization of echocardiographic techniques to allow for a common language in ascertaining the severity of mitral regurgitation, knowledge on dynamic mitral regurgitation during exercise, effectiveness of therapy and appropriate use and timing of surgical repair. SUMMARY: Geometric mitral regurgitation develops in tandem with progressive ischemic or nonischemic cardiomyopathy and can improve with antiremodeling pharmacological and device-based therapy. Surgical therapy can be accomplished at experienced centers with low morbidity and mortality, and may improve symptoms and enhance pump function. Whether such therapy saves lives remains uncertain. New percutaneous approaches to tackle geometric mitral regurgitation are developing, and early data is encouraging but remains experimental.