Fibromuscular Dysplasia Implicated in Spontaneous Coronary Artery Dissection (SCAD): A Case Report of Chest Pain in Young Women.

Spontaneous coronary artery dissection (SCAD) is a well-recognized cause of acute coronary syndrome (ACS) which can lead to myocardial infarction and sudden death. Unlike typical atherosclerosis, SCAD operates through distinct pathophysiology, affecting both individuals with and without conventional cardiovascular risk factors. We present a case of a young female presented with retrosternal chest pain radiating to the left arm, mimicking ACS symptoms with mildly elevated troponin levels, and slightly reduced left ventricular ejection fraction (45%). Subsequent evaluation using coronary angiography unveiled a Type 2A SCAD. A comprehensive computed tomography angiography (CTA) of her entire body revealed findings suggestive of fibromuscular dysplasia (FMD) affecting multiple arteries in different sites. Our case entailed the successful management of a young female patient with SCAD stemming from FMD.

Transcatheter Mitral Valve Repair with MitraClip®: A Nationwide Experience.

Background: Transcatheter mitral valve repair (TMVr), using MitraClip®, is a safe and effective procedure for severe mitral valve regurgitation (MR). However, the therapeutic results of MitraClip® in Qatar remain to be elucidated. A total of 25 patients (mean age 60 ± 14.5 years, 64% males) with symptomatic severe MR and prohibitive surgical risks were enrolled in this study. The procedural success rate was 92% to achieve mild residual MR. There was no periprocedural death. All patients experienced significant improvement in heart failure symptoms and MR grade postprocedure with sustained improvement over 1-year follow-up. Conclusion: The TMVr procedure using the MitraClip® device was safe and resulted in meaningful and sustained functional status and echocardiographic parameter improvement.

Percutaneous Transvenous Balloon Mitral Commissurotomy: A Single-Center Experience.

Background: Rheumatic heart disease and its impact on cardiac health is still a concern in developing countries. Percutaneous trans-mitral commissurotomy (PTMC) is the standard of care in managing severe rheumatic mitral stenosis (MS). This article reports a single-center, 10-year real-world experience in Qatar. Methods: In this retrospective study, we reviewed all the patients who underwent PTMC in Qatar between January 1, 2012, and January 1, 2022. Periprocedural data were collected at baseline, postprocedural, 1 year, and during the last follow-up. The primary outcome was procedural success (improvement in valve area by 50%, final valve area >1.5 cm2, and freedom from > moderate mitral regurgitation, stroke, or pericardial effusion). Safety endpoints were freedom from death, periprocedural cardiogenic shock and cardiac arrest, stroke urgent mitral valve replacement (MVR), or pericardiocentesis. Long-term outcomes included the requirement of redo PTMC or MVR, in addition to rehospitalization due to arrhythmias, heart failure, or stroke. Results: Sixty-five patients were included in the review (age 42 ± 10, female 38 [58.5%]). Sixty-two patients (95.4%) had a successful procedure. One patient developed a hemorrhagic pericardial tamponade and cardiogenic shock, for which he underwent pericardiocentesis and emergency aortic root repair. One patient developed acute stroke 8 h after the procedure, and one patient had tamponade resolved with emergency pericardiocentesis. Two patients required MVR after 1 and 4 years, respectively. Conclusion: PTMC is the mainstay of rheumatic MS management in patients with suitable anatomy as most patients have excellent outcomes with long-term freedom from surgery, which has been the case in our single-center experience.

Intracoronary pharmacological therapy versus aspiration thrombectomy in STEMI (IPAT-STEMI): A systematic review and meta-analysis of randomized trials.

BACKGROUND: Thrombus load in STEMI patients remains a challenge in practice. It aggravates coronary obstruction leading to impaired myocardial perfusion, worsened cardiac function, and adverse clinical outcomes. Various strategies have been advocated to reduce thrombus burden. OBJECTIVES: This meta-analysis aimed to evaluate the effectiveness of intracoronary-administered thrombolytics or glycoprotein IIb/IIIa inhibitors (GPI) in comparison with aspiration thrombectomy (AT) as an adjunct to percutaneous coronary intervention (PCI) among patients presenting with ST-segment elevation myocardial infarction (STEMI). METHODS: A comprehensive literature search for randomized trials that compared intracoronary-administered thrombolytics or GPI with AT in STEMI patients who underwent PCI, was conducted using various databases (e.g., MEDLINE, EMBASE, CENTRALE). Primary outcome was procedural measures (e.g., TIMI flow grade 3, TIMI myocardial perfusion grade (TMPG) 3, Myocardial blush grade (MBG) 2/3, ST-segment resolution (STR)). RESULTS: Twelve randomized trials enrolled 1,466 patients: 696 were randomized to intracoronary-administered pharmacological interventions and 553 to AT. Patients randomized to PCI alone were excluded. Thrombolytics significantly improved TIMI flow grade 3 (odds ratio = 3.71, 95% CI: 1.85-7.45), complete STR (odds ratio = 3.64, 95% CI: 1.60-8.26), and TMPG 3 (odds ratio = 5.31, 95% CI: 2.48-11.36). Thrombolytics significantly reduced major adverse cardiovascular events (MACE) (odds ratio = 0.29, 95% CI: 0.13-0.65) without increasing bleeding risk. Trial sequential analysis assessment confirmed the superiority of thrombolytics for the primary outcome. Intracoronary GPI, either alone or combined with AT, did not improve procedural or clinical outcomes. CONCLUSIONS: Compared with AT, intracoronary-administered thrombolytics significantly improved myocardial perfusion and MACE in STEMI patients.

Right Coronary Artery Stent Dislodgment during Primary Percutaneous Coronary Intervention. To Leave or to Retrieve?

Coronary stent dislodgment and embolization are rare and challenging complications of percutaneous coronary intervention that may result in serious and fatal complications attributed to the loss of blood flow of the coronary, cerebral, or peripheral circulations. Percutaneous management is successful in most cases using different techniques and devices, but surgery may be required. We report two cases of stent dislodgment during primary PCI for the right coronary artery with different management approaches and outcomes.

Coronary Intramural Hematoma: Challenges in Diagnosis and Management.

Coronary intramural hematoma (CIH) after percutaneous coronary intervention (PCI) is a rare cause of acute coronary syndrome. As the diagnosis is really challenging, its incidence is really under estimated. The optimal management of post-PCI CIH has not been well defined. Conventional coronary angiography alone is often insufficient to identify a CIH. Intravascular ultrasound and optical coherence tomography (OCT) are helpful modalities for diagnosis and evaluation of its extension. We present a case of CIH after PCI, highlighting our experience in the diagnostic accuracy of OCT and our strategy in the management of this case.