Using a prospective cross-sectional design, 25 patients with advanced congestive heart failure underwent quantitative gated SPECT before and after cardiac resynchronization therapy (CRT) implantation. The likelihood of a positive response was substantially greater in patients with a left ventricular (LV) lead located at the latest activation segment, well clear of the scar, in comparison with patients having the lead placed in a contrasting location. Responders' phase standard deviation (PSD) values were commonly above 33, possessing 866% sensitivity and 90% specificity, and their phase histogram bandwidth (PHB) values were often above 153, displaying 100% sensitivity and 80% specificity. With the aid of quantitative gated SPECT, and using PSD and PHB cut-off values, CRT implant procedures can improve patient selection and help in accurately placing the LV lead.
Implanting a cardiac resynchronization therapy (CRT) device, especially in patients with complex venous anatomy, necessitates precise and challenging left ventricular lead positioning. Successfully implanting the left ventricular lead for CRT, a case report details the use of retrograde snaring through a persistent left superior vena cava.
Among the prominent voices of the Victorian era, Christina Rossetti's Up-Hill (1862) is a distinguished example of poetry, alongside the contributions of exceptional female poets like Emily Brontë, Elizabeth Barrett Browning, Katherine Tynan, and Alice Meynell. Faith and love, as central subjects, were represented in allegories, a hallmark of Rossetti's Victorian era writing style and genre. From a family steeped in literary distinction, she arose. Her more prominent work, Up-Hill, stood out amongst her other creations.
Management of adult congenital heart disease (ACHD) is significantly influenced by structural interventions. This field's recent advancements in catheter-based procedures stand in contrast to the limited industrial investment and the lack of device development specifically designed for this group. Many devices are utilized off-label, adhering to a best-fit strategy, given the individual patient variability in anatomy, pathophysiology, and surgical repair. For this reason, ongoing ingenuity is needed to modify and improve existing resources for application to ACHD, and to increase collaboration with industry and regulatory bodies in the creation of specialized equipment. These improvements will foster advancement in the field, providing this expanding population with less invasive alternatives, fewer complications, and faster recovery times. Case studies from Houston Methodist hospital are integrated within this article to exemplify contemporary structural interventions for adults with congenital defects. We aim to deliver a broader awareness of this area and stimulate enthusiasm for this rapidly expanding field of study.
Globally, atrial fibrillation, the prevailing arrhythmia, exposes a significant patient population to the threat of incapacitating ischemic strokes. Nonetheless, roughly half of eligible individuals are either intolerant to or medically ineligible for oral anticoagulant therapy. Transcatheter techniques for left atrial appendage closure (LAAC) over the past 15 years have become a useful alternative to chronic oral anticoagulation, decreasing the incidence of stroke and systemic embolisms in patients with non-valvular atrial fibrillation. In recent years, large clinical trials have underscored the safety and effectiveness of transcatheter LAAC in patients intolerant to systemic anticoagulation, building upon the FDA approval of devices such as the Watchman FLX and Amulet. A contemporary review scrutinizes the indications for transcatheter LAAC and the evidence regarding the effectiveness of a range of device therapies currently in use or in development. In our review, we also look at present-day issues in intraprocedural imaging, as well as the ongoing discussions on post-implantation antithrombotic management. Several significant trials are underway to determine if transcatheter LAAC can be a secure, initial treatment choice for all cases of nonvalvular atrial fibrillation.
Transcatheter mitral valve replacement (TMVR), employing the SAPIEN platform, has been applied to cases of failed bioprosthetic valves (valve-in-valve), surgical annuloplasty rings (valve-in-ring), and native valves afflicted with mitral annular calcification (MAC) (valve-in-MAC). medial sphenoid wing meningiomas Improvements in clinical outcomes over the past ten years have been shaped by the identification of significant challenges and effective solutions. A comprehensive review of the clinical outcomes, utilization trends, unique difficulties, procedural strategies, and indications for valve-in-valve, valve-in-ring, and valve-in-MAC TMVR procedures is presented here.
Tricuspid regurgitation (TR) arises from either primary valve issues or secondary (functional) regurgitation due to elevated hemodynamic pressure or volume within the right heart. Patients with severe tricuspid regurgitation, independent of all other variables, experience an outcome that is less favorable. The predominant surgical strategy for TR has been to incorporate it with left-sided cardiac procedures for patients. Estradiol molecular weight The long-term implications, in terms of both outcomes and durability, for surgical repair or replacement remain unclear. While transcatheter interventions might be beneficial for patients exhibiting significant and symptomatic tricuspid regurgitation, the progress in developing these techniques and devices has been rather slow. Neglect and difficulties in defining the symptoms of TR are largely responsible for the delay. hepatocyte differentiation Along these lines, the anatomical and physiological aspects of the tricuspid valve apparatus present exceptional challenges. Various phases of clinical trials are currently encompassing several devices and techniques. Future prospects and the current status of transcatheter tricuspid procedures are analyzed in this review. The commercial availability and widespread adoption of these therapies, now imminent, will significantly benefit the millions of neglected patients.
Valvular heart disease's most frequent manifestation is mitral regurgitation. The intricate anatomy and pathophysiology of mitral valve regurgitation demand specialized devices for transcatheter mitral valve replacement in high-risk or prohibitive surgical patients. Transcatheter mitral valve replacement devices are still undergoing study in the United States and have not yet received approval for widespread commercial use. Feasibility studies conducted early on have shown strong technical competence and positive immediate impacts, but a complete evaluation requires investigation into broader samples and long-term outcomes. Moreover, substantial improvements in device engineering, delivery methods, and implantation procedures are critical to circumvent left ventricular outflow tract obstruction, and both valvular and paravalvular regurgitation, while also ensuring robust prosthesis anchorage.
The standard of care for symptomatic older patients with severe aortic stenosis, regardless of surgical risk, has evolved to include transcatheter aortic valve implantation (TAVI). The burgeoning use of transcatheter aortic valve implantation (TAVI) in younger, low- or intermediate-surgical-risk patients is a testament to the progress in bioprosthetic technologies, delivery systems, pre-procedural imaging, operator expertise, reduced hospital stays, and minimal short- and mid-term complications. For this younger population, the long-term consequences and durability of transcatheter heart valves have become a crucial factor, owing to their projected longer life expectancies. The evaluation of transcatheter versus surgical bioprosthetic heart valves was previously hampered by the absence of universal standards for defining bioprosthetic valve dysfunction and conflicting risk-assessment approaches until relatively recent times. This review delves into the mid- to long-term (five-year) clinical outcomes of the pivotal TAVI trials, scrutinizing the available long-term durability data to highlight the importance of using uniform definitions for bioprosthetic valve dysfunction.
Philip Alexander, M.D., a retired physician from Texas, is a skilled musician and artist of considerable achievement. With 41 years of experience in internal medicine, Dr. Phil retired from his practice in College Station, Texas, in 2016. A former music professor and lifelong musician, he frequently performs as an oboe soloist with the Brazos Valley Symphony Orchestra. His visual artistic journey, initiated in 1980, evolved from straightforward pencil sketches, including an official portrait of President Ronald Reagan for the White House, to the computer-generated artwork featured in this journal. In the spring of 2012, his original images first appeared in this journal, demonstrating his unique artistic vision. The online submission portal for the Methodist DeBakey Cardiovascular Journal's Humanities section is journal.houstonmethodist.org. Submit your artistic creation there.
The valvular heart disease mitral regurgitation (MR) is a prevalent condition, yet many patients are deemed ineligible for surgical treatment options. In high-risk cases, transcatheter edge-to-edge repair (TEER) proves a rapidly evolving and effective method for safely reducing the presence of mitral regurgitation (MR). However, successful completion of the procedure hinges significantly on the careful selection of patients based on clinical examination and imaging. This review emphasizes recent advancements in TEER technologies, enlarging the patient population and allowing detailed evaluation of the mitral valve and adjacent structures for the best patient selection criteria.
Cardiac imaging is the crucial foundation for achieving safe and optimal outcomes in transcatheter structural interventions. Transthoracic echocardiography serves as the initial modality for assessing valvular conditions, transesophageal echocardiography being superior in establishing the basis of valvular regurgitation, preoperative evaluations for transcatheter edge-to-edge repair, and intraprocedural guidance.