OBJECTIVES:The objectives of the present study were to evaluate the feasibility and safety of implanting a prophylactic left ventricular (LV) assist device prior to high-risk percutaneous coronary intervention (PCI) and to assess the impact of suturemediated preclosure of the arteriotomy site on minimizing vascular complications.BACKGROUND:Patients with multivessel disease, left main coronary artery disease (LMCA) or left main equivalent and/or moderate-to-severe LV dysfunction with elevated LV end-diastolic pressure are at increased risk of complications during PCI. The TandemHeart (TH) is a nonpulsatile percutaneous transseptal ventricular assist device (PTVA) that offers vital temporary hemodynamic support during high-risk PCI.METHODS:Between April 2004 and November 2005, the TH was implanted in 20 patients undergoing high-risk PCI. Eight patients underwent unprotected LMCA stenting, and rotational atherectomy was used in 17 patients. Suture-mediated femoral artery preclosure was performed prior to inserting a large-bore arterial cannula.RESULTS:The TH was successfully implanted in all 20 patients. Mean LV ejection fraction of the study patients was 38 +/- 18%. Time-to-implantation of the TH, duration of hemodynamic support and mean flow of the TH device were 31 +/- 9 minutes, 74 +/- 40 minutes and 2.5 +/- 1.3 L/minute, respectively. At the end of PCI, the TH was removed in all cases and Perclose sutures were deployed in 18/20 (90%) patients. There was only 1 minor vascular complication, and the average length of stay was 2 +/- 1 days. Periprocedural and inhospital mortality was 0%.CONCLUSIONS:Implantation of the TH PTVA is safe and feasible in patients undergoing high-risk PCI with excellent hemodynamic support. Application of suture-mediated devices prior to large arteriotomies can significantly reduce the incidence of vascular complications.

Objectives: The aim of the present study was to study the outcome of coronary stenting in patients with symptomatic myocardial bridging refractory to standard medical therapy. Background: Medical therapy constitutes the first line treatment for patients with symptomatic myocardial bridge, surgical correction may be offered to select patients with refractory symptoms. Limited data exists on the outcome of coronary stenting in this patient cohort. Methods: Twenty-nine patients with symptoms of angina, documented myocardial ischemia and angiographically documented myocardial bridge of the left anterior descending artery (defined as [mt]50% systolic compression) were identified retrospectively. Seventeen (59%) patients responded to maximized medical therapy (mean age 51 +/- 16 years, range 29-80, 7 female) and 12 (41%) patients received coronary stents following a failed attempt of minimum 3 months of maximal medical therapy (mean age 49 +/- 15 years, range 32-76 years, 5 females). Medical therapy responders were compared with intracoronary stent group for recurrent severe angina, target vessel revascularization (TVR), myocardial infarction (MI), and death at follow-up. Results: Intracoronary stents were placed in all patients successfully. The incidence of recurrent severe angina and TVR were significantly greater in the stent group (P = 0.04) while MI and death in two groups were similar at mean follow-up of 15 +/- 3 months. Conclusions: Coronary stent placement for medically refractory symptomatic myocardial bridge failed to relieve severe angina and is associated with high clinical restenosis and hence should be avoided. (C) 2008 Wiley-Liss, Inc.

Periprocedural hemodynamic stability is the cornerstone of success for complex percutaneous interventions. Percutaneous left ventricular assist devices (VSD) are increasingly being used to perform complex percutaneous coronary and non-coronary interventions. We report our experience in utilizing the TandemHeart, a percutaneous VSD, to successfully perform complex tandem procedures; balloon aortic valvuloplasty and angioplasty.

The TandemHeart is a recently-introduced percutaneous ventricular assist device that may be used for short-term hemodynamic support. Its utility has been shown for assisting the left ventricle in a variety of high-risk percutaneous interventions, in helping the left ventricle recover from myocarditis, in cardiomyopathies and in cardiogenic shock following acute coronary syndromes. Limited data exist on its applications in patients with right ventricular failure. We report our experience, possibly the first human case description, of a patient in cardiogenic shock secondary to severe pulmonary artery hypertension where the TandemHeart was used as a short-term hemodynamic support tool.

Twenty‐one patients (mean age 47.5 years, 9 females) with left ventricular noncompaction (LVNC) diagnosed by both two‐dimensional transthoracic echocardiography (2DTTE) and live/real time three‐dimensional transthoracic echocardiography (3DTTE) were included in the study. Left ventricular (LV) mass was calculated with epicardial and endocardial border tracings first including the LV trabeculations and then excluding them. LV trabecular mass was then derived as the difference between the two measurements. This was done by 2DTTE using the modified biplane Simpson's method and by live/real time 3DTTE using the Tom Tec imaging system. The number of trabeculations arising from each segment of LV walls as well as the segmental distribution of trabeculations were also assessed by both 2DTTE and 3DTTE. The calculated LV trabecular mass by 3DTTE (mean 11.8 ± 5.5 g) was significantly greater than 2DTTE (mean 7.3 ± 4.3 g, P = 0.005). The total number of trabeculations assessed by 3DTTE (mean 11.2 ± 3.3) was also significantly greater than 2DTTE (mean 3.76 ± 1.2, P < 0.0001). The values for inter‐ and intraobserver variability were lower for 3DTTE than 2DTTE. In conclusion, both LV trabecular mass as well as the total number of trabeculations in patients with LVNC were significantly underestimated by 2DTTE as compared to 3DTTE.

TandemHeart is a recently-introduced percutaneous left ventricular assist device that can be used for hemodynamic support during high-risk interventional procedures in severely compromised patients. Angioplasty and stent placement in patients with coronary artery disease and high-risk coronary anatomy including the left main coronary artery have been described using this device. We report the first human case description of a high-risk percutaneous balloon aortic valvuloplasty for critical bicuspid aortic stenosis using the TandemHeart for periprocedural hemodynamic support. Also not previously reported is the use of bivaluridin as the periprocedural antithrombin agent during and after high-risk aortic valvuloplasty.

We describe an adult patient in whom the valve of foramen ovale and its opening and closing movements were well visualized by live/real time three‐dimensional transthoracic echocardiography.

In this report, we present 34 patients in whom surgical intervention was undertaken for severe mitral insufficiency due to mitral valve prolapse (MVP). Location and severity of MVP and regurgitation were assessed preoperatively by live/real time three-dimensional transthoracic echocardiography and closely agreed with the surgical findings.

The American Journal of Geriatric CardiologyVolume 15, Issue 3 p. 188-190 Live/Real-Time Three-Dimensional Transthoracic Echocardiographic Assessment of Combined Valvar and Supravalvar Aortic Stenosis Sanjay Rajdev MD, Sanjay Rajdev MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Navin C. Nanda MD, Navin C. Nanda MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Vinod Patel MD, Vinod Patel MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Farhat Mehmood MD, Farhat Mehmood MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Anurag Singh MD, Anurag Singh MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 David C. McGiffin MD, David C. McGiffin MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 2 Sanjay Rajdev MD, Sanjay Rajdev MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Navin C. Nanda MD, Navin C. Nanda MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Vinod Patel MD, Vinod Patel MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Farhat Mehmood MD, Farhat Mehmood MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 Anurag Singh MD, Anurag Singh MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 1 David C. McGiffin MD, David C. McGiffin MD From the Divisions of Cardiovascular Disease1 and Cardiovascular Surgery,2 University of Alabama at Birmingham, Birmingham, ALSearch for more papers by this author 2 First published: 26 January 2007 https://doi.org/10.1111/j.1076-7460.2006.05249.xCitations: 11 Navin C. Nanda, MD, University of Alabama at Birmingham, Heart Station, SWB/S102, 619 19th Street South, Birmingham, AL 35249E-mail: [email protected] Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume15, Issue3May/June 2006Pages 188-190 RelatedInformation

We read with interest the report by Lofiego et al. 1 Lofiego C. Biagini E. Ferlito M. Pasquale F. Rocchi G. Perugini E. Leone O. Bracchetti G. Caliskan K. Branzi A. Ten Cate F.J. Rapezzi C. Paradoxical contributions of non-compacted and compacted segments to global left ventricular dysfunction in isolated left ventricular noncompaction. Am J Cardiol. 2006; 97: 738-741 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar

Tissue Doppler imaging (TDI) in 38 adult patients with pulmonary artery hypertension of varied etiology and normal left ventricular systolic function by two‐dimensional transthoracic echocardiography showed significantly reduced peak systolic strain (SS) in all three segments of left ventricular free wall and ventricular septum and two of three segments of right ventricular free wall when compared to 29 adults with no clinical or echocardiographic evidence of heart disease and normal left and right ventricular systolic function. A similar reduction in peak diastolic strain (DS) was also noted in all three segments of left ventricular free wall and ventricular septum and one of three segments of right ventricular free wall. This reduction in strain indices in patients with pulmonary hypertension was noted irrespective of whether right ventricular systolic function was normal or reduced as assessed by two‐dimensional transthoracic echocardiography. SS and DS rates also showed reductions in patients with pulmonary artery hypertension. Our study shows the potential value of TDI indices in identifying reduced regional left ventricular systolic and diastolic longitudinal function in patients with pulmonary artery hypertension and normal left ventricular systolic function by two‐dimensional transthoracic echocardiography. This reduction in left ventricular function was noted in patients with both normal and reduced right ventricular systolic functions by two‐dimensional echocardiography.

We evaluated tricuspid regurgitation (TR) by multiple echocardiographic techniques in 93 consecutive patients who underwent standard two-dimensional (2D) and live three-dimensional (3D) transthoracic echocardiography (TTE). TR vena contracta (VC) area was obtained by 3D TTE by systematic and sequential cropping of the acquired 3D TTE dataset. Assessment of VC area by 3D TTE was compared to 2D TTE measurements of the ratio of TR regurgitant jet area to right atrial area (RJA/RAA), RJA alone, VC width, and calculated VC area. VC area from 3D TTE closely correlated with RJA/RAA and RJA alone as determined from 2D TTE measurements. Live 3D TTE color Doppler measurements of VC area can be used for quantitative assessment of TR and offer incremental value for quantification of particularly severe regurgitant lesions.

TherapeuticsMay 1, 2006Review: Evidence supporting reduced death and reinfarction by percutaneous coronary intervention after thrombolysis is inconclusiveAlfonso Suarez, MD, Sanjay Rajdev, MD, William B. Hillegass, MD, MPHAlfonso Suarez, MDUniversity of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.)Search for more papers by this author, Sanjay Rajdev, MDUniversity of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.)Search for more papers by this author, William B. Hillegass, MD, MPHUniversity of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2006-144-3-061 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationCantor WJ, Brunet F, Ziegler CP, Kiss A, Morrison LJ. Immediate angioplasty after thrombolysis: a systematic review. CMAJ. 2005;173:1473-81. https://pubmed.ncbi.nlm.nih.gov/16330637Clinical Impact RatingsEmergency Med: Hospitalists: Cardiology: References1 Eagle KA, Goodman SG, Avezum A, et al. Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet. 2002;359:373-7. [PMID: 11844506] Google Scholar2 Cannon CP, Gibson CM, McCabe CH, et al. TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial. Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation. 1998;98:2805-14. [PMID: 9860780] Google Scholar3 Widimský P, Groch L, Zelízko M, et al. Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study. Eur Heart J. 2000;21:823-31. [PMID: 10781354] Google Scholar4 Fernandez-Avilés F, Alonso JJ, Castro-Beiras A, et al. Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial. Lancet. 2004;364:1045-53. [PMID: 15380963] Google Scholar5 Scheller B, Hennen B, Hammer B, et al. Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 2003;42:634-41. [PMID: 12932593] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoRescue angioplasty reduced cardiovascular and cerebrovascular outcomes in acute MI after failed thrombolytic therapy Alfonso Suarez , Sanjay Rajdev , and William B. Hillegass May 1, 2006Volume 144, Issue 3Page: 61KeywordsAnginaAngiographyArrhythmiaArteriesBlood flowDatabasesGlycoproteinsHeartHospitalistsInformation storage and retrievalLibrariesMyocardial infarctionPercutaneous coronary interventionReperfusionResuscitationRevascularizationStent implantationSystematic reviews ePublished: 9 March 2020 Issue Published: May 1, 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

In this report, we present 12 patients (range 14-76 years, mean 40 +/- 22.7 years) who underwent surgical repair of a ventricular septal defect (VSD). Location, size, and surrounding anatomy of the VSD were assessed prior to intervention in all patients with live/real time three-dimensional transthoracic echocardiography (3DTTE). In 9 patients, measurements of maximum dimension, circumference, and area by 3DTTE correlated well with the same measurements from intraoperative three-dimensional transesophageal echocardiographic (3DTEE) reconstruction. 3DTTE measurement of maximum dimension of VSDs also agreed well with maximum dimension by surgery in 10 patients. Live/real time 3DTTE accurately defined VSD location, size, and surrounding anatomy in all patients studied by us. VSD characterization by live 3DTTE agreed well with surgery descriptions and 3DTEE measurements.

The differential diagnosis of a cardiac valve mass includes fibroelastoma, myxoma, lipoma, Lambl's excrescences, thrombus, and vegetation. Fibroelastomas are extremely rare primary cardiac tumors. Their incidence is 0.00017-0.033% in autopsy series and 0.019% in clinical series identified on echocardiography. Although rare, fibroelastomas are the most common tumors affecting the cardiac valves with aortic, mitral, tricuspid, and pulmonary valves being involved in this order. In the current report we describe a case of pulmonary valve mass in which a confident prospective diagnosis of fibroelastoma could be made utilizing the technique of three-dimensional transthoracic echocardiography.

We report a 49‐year‐old morbidly obese female with a poor acoustic window in whom live/real time three‐dimensional transthoracic echocardiography was able to make a confident diagnosis of cor triatriatum sinister. En face views of the membrane facilitated accurate assessment of the size and shape of the large nonobstructing opening in the membrane. Maximum dimensions of the opening were 3.06 × 1.03 cm and area was 2.3 cm2.

TherapeuticsMay 1, 2006Rescue angioplasty reduced cardiovascular and cerebrovascular outcomes in acute MI after failed thrombolytic therapyAlfonso Suarez, MD, Sanjay Rajdev, MD, William B. Hillegass, MD, MPHAlfonso Suarez, MDUniversity of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.)Search for more papers by this author, Sanjay Rajdev, MDUniversity of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.)Search for more papers by this author, William B. Hillegass, MD, MPHUniversity of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-2006-144-3-060 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationGershlick AH, Stephens-Lloyd A, Hughes S, et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med. 2005;353:2758-68. https://pubmed.ncbi.nlm.nih.gov/16382062Clinical Impact RatingsHospitalists: Cardiology: References1 Eagle KA, Goodman SG, Avezum A, et al. Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet. 2002;359:373-7. [PMID: 11844506] Google Scholar2 Cannon CP, Gibson CM, McCabe CH, et al. TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial. Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation. 1998;98:2805-14. [PMID: 9860780] Google Scholar3 Widimský P, Groch L, Zelízko M, et al. Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study. Eur Heart J. 2000;21:823-31. [PMID: 10781354] Google Scholar4 Fernandez-Avilés F, Alonso JJ, Castro-Beiras A, et al. Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial. Lancet. 2004;364:1045-53. [PMID: 15380963] Google Scholar5 Scheller B, Hennen B, Hammer B, et al. Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 2003;42:634-41. [PMID: 12932593] Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Alabama at Birmingham, Birmingham, Alabama, USA (A.S., S.R., W.B.H.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoReview: Evidence supporting reduced death and reinfarction by percutaneous coronary intervention after thrombolysis is inconclusive Alfonso Suarez , Sanjay Rajdev , and William B. Hillegass May 1, 2006Volume 144, Issue 3Page: 60KeywordsAngiographyAngioplastyArteriesBlood pressureComputed axial tomographyElectrocardiographyGlycoproteinsHeart failureHemoglobinHemorrhageHeparinHospitalistsLife expectancyMyocardial infarctionPercutaneous coronary interventionPlateletsReperfusionRevascularization ePublished: 9 March 2020 Issue Published: May 1, 2006 Copyright & PermissionsCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...