In a prospective cross-sectional study of patients with advanced congestive heart failure (n=25), quantitative gated SPECT imaging was performed before and after CRT implantation. Individuals exhibiting a left ventricular (LV) lead placement furthest from the scar site demonstrated a considerably greater likelihood of response compared to those with lead placement in a different location. Responders' phase standard deviation (PSD) values typically exceeded 33, with a sensitivity of 866% and specificity of 90%, and their phase histogram bandwidth (PHB) values generally exceeded 153, yielding 100% sensitivity and 80% specificity. To ensure appropriate CRT implantation, quantitative gated SPECT, using PSD and PHB cut-off points, is useful for refining patient selection and guiding the LV lead placement.
The technical expertise required for left ventricular lead positioning during cardiac resynchronization therapy (CRT) device implantation is significantly heightened by complex cardiac venous structures in patients. We report a case where retrograde snaring facilitated successful placement of the left ventricular lead through a persistent left superior vena cava, enabling CRT implantation.
The Victorian era's poetic tradition includes Christina Rossetti's Up-Hill (1862), a remarkable example crafted by a female poet among the ranks of celebrated female voices, such as Emily Brontë, Elizabeth Barrett Browning, Katherine Tynan, and Alice Meynell. Faith and love were explored through allegories, a literary style prevalent during the Victorian era, mirroring Rossetti's sensibilities. With literary distinction running in her family, she came to be. Her well-known works included Up-Hill, a standout among her compositions.
The management of adult congenital heart disease (ACHD) relies heavily on the efficacy of structural interventions. Despite limited industry investment and a dearth of device development tailored to this population, significant advancements in catheter-based procedures have emerged in recent years within this field. Each patient's unique anatomy, pathophysiology, and surgical repair often leads to the off-label use of multiple devices, tailored through a best-fit strategy. 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. The incorporation of these innovations will contribute to the progress of this field, giving this expanding population less-invasive approaches, fewer complications, and quicker recovery processes. Illustrative cases from Houston Methodist are featured in this article to exemplify the current structural interventions practiced on adults with congenital deformities. We are dedicated to enriching comprehension within this field and fostering engagement with this quickly expanding area of study.
The prevalence of atrial fibrillation, the most common arrhythmia globally, leaves a substantial patient population vulnerable to potentially disabling ischemic strokes. Unfortunately, approximately 50% of those eligible for treatment are either intolerant to or medically contraindicated for oral anticoagulation therapy. Over the past 15 years, transcatheter left atrial appendage closure (LAAC) has presented a worthwhile alternative to ongoing oral anticoagulation in mitigating the risk of stroke and systemic emboli for patients diagnosed with non-valvular atrial fibrillation. Following recent US Food and Drug Administration approvals of advanced devices such as the Watchman FLX and Amulet, several large clinical trials have confirmed the safety and efficacy of transcatheter LAAC in patients with intolerance to systemic anticoagulation. This contemporary review investigates the indications for transcatheter LAAC and the supporting evidence, evaluating diverse device therapies, both those presently available and those in the developmental phase. In our review, we also look at present-day issues in intraprocedural imaging, as well as the ongoing discussions on post-implantation antithrombotic management. Ongoing trials are scrutinizing the possibility of transcatheter LAAC as a safe, initial treatment choice across the entire population of patients presenting with nonvalvular atrial fibrillation.
With the SAPIEN platform, transcatheter mitral valve replacement (TMVR) has been implemented in the treatment of failed bioprosthetic valves (valve-in-valve), surgical annuloplasty rings (valve-in-ring), and native valves exhibiting mitral annular calcification (MAC) (valve-in-MAC). Dehydrogenase inhibitor The past decade's experiences have brought to light significant challenges and viable solutions that contribute to improved clinical outcomes. The following review investigates the indications for, procedural planning of, and clinical results from valve-in-valve, valve-in-ring, and valve-in-MAC TMVR procedures, including trends in utilization and unique challenges.
Primary valve pathology or secondary (functional) regurgitation from heightened right-sided heart hemodynamic pressure or volume are the etiologies of tricuspid regurgitation (TR). Patients suffering from severe tricuspid regurgitation encounter a less favorable outcome, regardless of any other influencing factors. TR surgical remedies have generally been limited to cases where patients are also undergoing left-sided cardiac operations. structural and biochemical markers The extent to which surgical repair or replacement procedures produce enduring results is not clearly characterized. Patients with pronounced and symptomatic tricuspid regurgitation may find transcatheter interventions advantageous, yet the advancement of these procedures and accompanying devices has been slow and incremental. A significant contributor to the delay is the neglect and difficulty in articulating the symptoms associated with TR. deep genetic divergences Furthermore, the anatomical and physiological intricacies of the tricuspid valve apparatus pose unique difficulties. Investigations into diverse devices and techniques are currently progressing through various clinical phases. This review analyzes the current situation regarding transcatheter tricuspid procedures and future potential developments. The imminent commercial availability and widespread adoption of these therapies promises a substantial positive effect on the millions of neglected patients.
Mitral regurgitation stands as the most common manifestation of valvular heart disease. Mitral valve regurgitation's complex anatomy and pathophysiology necessitate specialized transcatheter replacement devices for high-surgical-risk or prohibitive patients. Commercial use of transcatheter mitral valve replacement devices is currently prohibited in the United States while further studies are conducted. Though initial feasibility studies have demonstrated promising technical achievements and favorable short-term results, a more extensive evaluation involving larger groups and long-term monitoring is required for a complete understanding. Essential to achieving success are substantial innovations in device design, delivery systems, and implantation techniques, which are needed to prevent left ventricular outflow tract obstruction and valvular and paravalvular regurgitation, and to guarantee the prosthesis's secure anchorage.
Regardless of surgical risk factors, TAVI (transcatheter aortic valve implantation) has become the accepted standard of care for elderly patients experiencing symptoms from severe aortic stenosis. The increased use of transcatheter aortic valve implantation (TAVI) in younger patients with reduced surgical risk stems from notable improvements in transcatheter bioprostheses, more efficient delivery systems, improved pre-procedure imaging, enhanced operator experience, a reduced length of hospital stay, and remarkably low short- and mid-term complication rates. For this younger group, the long-term results and durability of transcatheter heart valves are increasingly vital, given their enhanced life expectancy. 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. The authors of this review evaluate the mid- to long-term (five-year) clinical outcomes from the landmark TAVI trials, further analyzing long-term durability data and emphasizing the significance of using consistent definitions for bioprosthetic valve dysfunction.
Philip Alexander, a retired medical doctor from Texas, is not only a renowned musician but also an accomplished artist, demonstrating his versatility. Dr. Phil, an internal medicine physician for 41 years, concluded his practice in College Station in 2016. A former music professor and lifelong musician, he stands out as an oboe soloist for the Brazos Valley Symphony Orchestra, performing with distinction. Beginning in 1980, his artistic journey with visual art developed from simple pencil sketches, including a notable White House portrait of President Ronald Reagan, to the digitally crafted drawings that appear in this publication. First appearing in this journal during the spring of 2012, his images are expressions of his original artistic vision. If you desire to see your artistic creation published in the Methodist DeBakey Cardiovascular Journal's Humanities section, upload your work to journal.houstonmethodist.org online.
Valvular heart disease, notably mitral regurgitation (MR), frequently affects patients, many of whom are unsuitable candidates for surgical intervention. High-risk patients benefit from the rapidly evolving transcatheter edge-to-edge repair (TEER) procedure, which ensures safe and effective mitral regurgitation (MR) reduction. Nevertheless, judicious patient selection, guided by clinical evaluation and imaging techniques, continues to be crucial for the successful outcome of the procedure. Expanding the scope of TEER technologies and imaging modalities, as highlighted in the following review, allows for detailed mitral valve and surrounding structure evaluation, optimizing patient selection.
The cornerstone of secure and optimal transcatheter structural interventions is cardiac imaging. 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.