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Background: Percutaneous aortic valve replacement is a new technology for the treatment of patients with significant aortic valve stenosis. We present the first report on a human implantation of a self-expanding aortic valve prosthesis, which is composed of three bovine pericardial leaflets inserted within a self-expanding nitinol stent. The 73-year-old woman presented with severe symptomatic aortic valve stenosis (mean transvalvular gradient of 45 mmHg; valve area of 0.7 cm(2)). Surgical valve replacement had been declined for the patient because of comorbidities, including previous bypass surgery. Method and Results: A retrograde approach via the common iliac artery was used for valve deployment. The contralateral femoral vessels were used for a temporary extracorporal circulation, unloading the left ventricle during the actual stent expansion. Clinical, hemodynamic, and echocardiographic outcomes were assessed serially during the procedure. Clinical and echocardiographic follow-up at day 1, 2, and 14 post procedure was performed to evaluate the short-term outcome. The prosthesis was successfully deployed within the native aortic valve, with accurate and stable positioning and with no impairment of the coronary artery or vein graft blood flow. 2D and doppler echo immediately after device deployment showed a significant reduction in transaortic mean pressure gradient (from 45 to 8 mmHg) without evidence of aortic or mitral valve insufficiency. The clinical status has then significantly improved. These results remained unchanged up to the day 14 follow-up. Conclusion: This case report demonstrates a successful percutaneous implantation of a self-expanding aortic valve prosthesis with remarkable functional and clinical improvements in the acute and short-term outcome. (c) 2005 Wiley-Liss Inc.

Papillary fibroelastoma (PFE) is a benign, rare, gelatinous tumour derived from the endocardium, primarily the cardiac valves, which is usually diagnosed by high resolution echocardiography. Although rarely clinically symptomatic, PFEs have a potential for coronary ischaemia, systemic embolisation with neurologic symptoms, and sometimes valvar dysfunction. There are reports of coronary occlusion and even sudden cardiac death due to a ball valve phenomenon on the coronary ostia. This report describes the characteristics of a PFE with multidetector 16 slice computed tomography and 1.5 Tesla cardiac magnetic resonance imaging.

We report about a 20-year old patient suffering cardiopulmonary resuscitation due to ventricular fibrillation. We diagnosed Brugada syndrome after exclusion structural heart disease and a positive Ajmalin test and implanted an ICD. In that there is a 20-30% familiar disposition, it was necessary that all family members undergo a cardiac examination. It was found that one brother and one sister presented the beginning of a right ventricular dilatation and a fibrolipomatous area in the anterior wall segment of the right ventricle. This result is compatible with a "concealed" arrhythmogenic right ventricular dysplasia (ARVD). As a prognostic indication we decided to implant an ICD prophylactically. The case report demonstrates the value of familiar examination of patients with an unclear ventricular arrhythmogenic event.

Ein 20-jähriger Patient wurde nach 50-minütiger kardiopulmonaler Reanimation bei dokumentierten Kammerflimmern in unsere Klinik eingewiesen. Nach Ausschluss einer strukturellen Herzerkrankung und positiven Ajmalin-Test wurde die Diagnose eines Brugada-Syndroms gestellt und eine ICD-Implantation durchgeführt. Aufgrund einer familiären Häufung in 20–30% der Fälle wurden im Anschluss die Familienangehörigen einer kardialen Basisdiagnostik unterzogen. Bei zwei Geschwistern ergaben sich dabei Befunde, die mit einer beginnenden arrhythmogenen rechtsventrikulären Dysplasie (ARVD) vereinbar waren. Aufgrund prognostischer Überlegungen entschlossen wir uns zur ICD-Implantation.    Der Fall veranschaulicht die Notwendigkeit familiärer Umfelduntersuchungen bei arrhythmogenen Ereignissen ohne strukturelle Herzerkrankung.