Percutaneous patent foramen ovale (PFO) closure is a treatment for cryptogenic stroke and migraine headache. The goal of this study was to assess long-term outcomes of patients treated with percutaneous PFO closure. Records of patients with percutaneous PFO closure at Emory University Hospital from February 2002 to July 2009 were reviewed. Follow-up telephone questionnaire and chart review assessed recurrent stroke, migraine, and complications. Data was reviewed on 414 consecutive patients. Long-term follow-up was obtained in 207 of patients, and mean follow up was 4.6 ± 2.0 years. Cryptogenic stroke was the primary indication for intervention in 193 (93%) patients. Thirteen (7%) patients had a recurrent neurologic event post closure. In patients with multiple neurological events at baseline, 17% (n = 11) had a recurrent event, compared with 2% (n = 2) of patients with a single neurological event prior to PFO-closure (P < 0.002). Post closure, migraine frequency and severity declined from 4.5 to 1.1 migraine/month (P < 0.01) and 7.2 to 3.6 out of 10 (P < 0.01) in patients with history of migraine (n = 60). Thirty-day mortality was 1% (n = 2). One patient had device erosion 5 years post-procedure requiring emergent surgery. Atrial fibrillation was newly diagnosed in 8 (4%) patients within 6 months. In conclusion, the long-term rate of recurrent stroke after PFO closure is low in patients with a single neurological event at baseline. Serious long-term complications after PFO closure are rare. PFO closure may decrease the frequency and severity of migraine.

Patients who present with significant paravalvular regurgitation after mitral valve replacement remain a difficult patient population and high-risk surgical candidates. We present 3 cases of transapical closure of mitral valve paravalvular leak (PVL) after mitral valve replacement using Amplatzer closure devices (AGA Medical Corp, Plymouth, MN). All 3 patients experienced decreased regurgitation at the site of the closure as well as symptomatic improvement in their heart failure. (Ann Thorac Surg 2012; 94: 275-78) (C) 2012 by The Society of Thoracic Surgeons

An 80-year-old woman was referred for transcatheter aortic valve implantation for correction of aortic stenosis. An echocardiogram at the author’s institution revealed severe hypertrophy of the left ventricle with deep recesses into the myocardium and hypokinesis involving the left ventricular apex. In addition, there was subaortic stenosis secondary to a muscular ridge. The aortic valve was only mildly stenotic. In this Cardiology Grand Rounds, the authors present a rare case of ventricular noncompaction and review the literature on this subject and its association with other cardiac abnormalities.

Senile aortic stenosis (AS), the narrowing and progressive dysfunction of the valve between the heart and the aorta, is the most common structural heart disease in the elderly, with an estimated increase in prevalence from approximately 38.7 million in 2008 to 88.5 million by 2050. The indications for conventional open aortic valve replacement (AVR) utilizing cardiopulmonary bypass remains the standard of care with excellent results. However, physicians remain reluctant to recommend AVR for elderly patients or those considered very high risk. The advent of transcatheter aortic valve intervention (TAVI, transfemoral, and transapical) represents a tremendous advance in our ability to treat high-risk patients with severe AS. By avoiding the risks associated with aortic cross-clamping and cardiopulmonary bypass, it provides a treatment alternative for patients deemed too high risk for conventional AVR. However, this technology is still in the initial stages of clinical use and thus several design challenges and opportunities for improvements in the engineering concepts exist. This paper reviews the outcomes of the two TAVI technologies currently in wide clinical use, the Edwards Sapien® Valve (ESV) and the Medtronic CoreValve® (MCV) and discusses potential improvements in the current design.

Conclusion The absence of response to dobutamine may not be enough to preclude the presence of myocardial reserve in low flow/low gradient aortic stenosis. This small cohort raises the question that CMR-DE may be needed in pts that do not respond to LDD since the presence of myocardial reserve may affect the management of these pts and has prognositic implications. from 13th Annual SCMR Scientific Sessions Phoenix, AZ, USA. 21-24 January 2010

A 33-year-old woman with a history of gestational trophoblastic disease presented for investigation of a right atrial mass. She had been receiving chemotherapy administered via a Port-a-Cath system for 2 months prior to presentation. On transesophageal echocardiography and magnetic resonance imaging, she was found to have a mass attached to the right atrial free wall, with a segment projecting across a patent foramen ovale. Because of the risk for an embolic event, the mass was surgically removed and the patent foramen ovale repaired. Pathology showed an organized thrombus. This case emphasizes the need for high suspicion for thrombus when a right atrial mass is found in a patient with a hypercoagulable state due to underlying malignancy who has a central venous catheter.

Advances in antithrombotic and antiplatelet therapies have led to a reduction in ischemic event rates in percutaneous coronary intervention (PCI), acute coronary syndromes (ACS), and ST-segment elevation myocardial infarction (STEMI) but have generally resulted in an increased risk of hemorrhagic complications. In these settings, both baseline anemia and acute hemorrhage occur with relative frequency and are associated with increased morbidity and mortality. Although commonly treated with blood transfusion, this intervention may accentuate rather than attenuate both short-term and long-term risk. This review discusses the pathophysiology of anemia and the impact of anemia and transfusion on morbidity and mortality in PCI, ACS, and STEMI. (C) 2009 Published by Elsevier Inc. (Am J Cardiol 2009; 104[suppl]:34C-38C)