Single-session double valve replacement: TAVI+tricuspid valve-in-valve procedures.

We describe a 70-year-old lady with rheumatic heart disease and a history of the mitral valve and tricuspid valve replacement, who underwent transcatheter aortic valve implantation and the tricuspid valve-in-valve procedure in a single session.

Mitral valve-in-valve replacement supported by a transapically snared guidewire via septostomy.

We describe a 72-year-old woman, a known case of rheumatic heart disease with a history of mitral and aortic valve replacement 8 years previously, who underwent mitral valve-in-valve replacement supported by a transapically snared guidewire through septostomy.

Diagnostic performance of 64-channel multislice computed tomography in assessment of significant coronary artery disease in symptomatic subjects.

The recent development of 64-channel multislice computed tomography (MSCT) has resulted in noninvasive coronary artery imaging improvement. This study was conducted to determine the accuracy of 64-slice MSCT in a relatively unselected group of 143 patients with presentations suggestive of coronary artery disease, including those with unstable angina pectoris, who underwent both coronary computed tomographic angiography and invasive coronary angiography. No arrhythmia was considered an exclusion criterion except for atrial fibrillation or frequent extrasystoles. In patients with fast heart rates, a beta blocker was administered orally. Data were obtained using electrocardiography gated 64-slice MSCT. Computed tomographic angiography and invasive coronary angiography findings of each coronary segment were compared to determine the sensitivity, specificity, positive predictive value, and negative predictive value of MSCT in the detection of their normalcy or insignificant (<50% diameter decrease) stenosis versus significant (>or=50% diameter decrease) stenosis or total occlusion. In per-patient assessment, the calculated sensitivity, specificity, positive predictive value, and negative predictive value of MSCT were 96%, 67%, 91%, and 83%, respectively. These values in per-artery evaluation were 94%, 94%, 87%, and 97%, and corresponding values in per-segment analysis were 92%, 97%, 77%, and 99%, respectively. In conclusion, computed tomographic angiography has high diagnostic performance in the assessment of significant coronary artery disease in most patients in a daily routine practice, including those presenting with unstable angina pectoris symptoms.

Successful transcatheter aortic valve implantation through ascending aorta and total revascularization using Edwards SAPIEN Transcatheter Heart Valve System.

Transcatheter aortic valve implantation has become an established alternative treatment method for patients with symptomatic aortic stenosis who are at high risk for conventional aortic valve replacement. Problems, however, persist when using this technique in patients with associated coronary artery disease. We describe a successful case of valve implantation via the transaortic route with simultaneous full revascularization.

Impact of calcification on diagnostic accuracy of 64-slice spiral computed tomography for detecting coronary artery disease: a single center experience.

BACKGROUND: The main aim of our study was to investigate the influence of calcification on the accuracy of 64-slice computed tomography for identification of significant coronary artery disease. METHODS: A contrast-enhanced 64-slice computed tomography was performed prior to invasive coronary angiography in 168 consecutive patients with suspected coronary artery disease. All coronary segments 1.5 mm or larger in diameter were evaluated for the presence or absence of significant coronary artery stenosis, defined as a diameter reduction of >50%. The patients were also ranked by total calcium score which was expressed in Agatston units and the impacts of calcification on diagnostic accuracy of 64-slice computed tomography were assessed. Results were compared with quantitative coronary angiography as the standard of reference. RESULTS: The overall sensitivity, specificity, positive predictive value, and negative predictive value of 64-slice computed tomography for detection of significant stenosis were: by segments, 95%, 98%, 91%, and 99%, respectively; by patient, 98%, 97%, 96%, and 99%, respectively; and by artery, 94%, 93%, 91%, and 95%, respectively. In mild and moderate calcium scores (0-418 Agatston units), the sensitivity was 100%, specificity was 93%, positive predictive value was 97% and negative predictive value was 100%. Severe calcification (>419 Agatston units) reduced the sensitivity, specificity, positive, and negative predictive values of multi-slice computed tomography to 89%, 60%, 89%, and 60%, respectively. CONCLUSION: Our study revealed that the 64-slice computed tomography is a highly accurate diagnostic modality for detecting hemodynamically significant coronary stenosis; however, severe calcification is considered as a shortcoming which limits the routine application of multi-slice computed tomography in daily practice.

Assessment of patients after coronary artery bypass grafting using 64-slice computed tomography.

The aim was to investigate the diagnostic accuracy of 64-slice computed tomography (CT) for the identification of obstructive disease in both bypass grafts and native coronary vessels in symptomatic patients with a history of coronary artery bypass grafting. Eighty-nine symptomatic patients (81 men; mean age 64 +/- 8 years) were prospectively studied 8 +/- 4.5 years after bypass surgery. A total of 287 grafts (89 arterial grafts, 198 venous grafts) and 1,183 segments in 356 native coronary arteries >1.5 mm in diameter were evaluated using 64-slice computed tomographic angiography for the detection of significant stenosis, defined as >or=50% decrease in diameter of artery. Results were compared with quantitative coronary angiography as the standard of reference. Sensitivity, specificity, and positive and negative predictive values of 64-slice CT for the detection of significant lesions in bypass grafts were 98%, 97%, 96%, and 99%, respectively. Segment-by-segment analysis of native coronary arteries and distal runoff vessels for the detection of significant obstructive disease yielded sensitivity of 93% with specificity of 88%. If analysis was restricted to nongrafted and distal runoff segments, sensitivity and specificity were 89% and 94%, respectively. The diagnostic accuracy of 64-slice CT was significantly lower for the evaluation of severely calcified segments. In conclusion, 64-slice CT was a valuable and noninvasive tool for accurate comprehensive assessment of bypass grafts and native coronary circulation. However, its usefulness was limited in the presence of heavy calcium deposits.