Periprocedural hemodynamic assessment of percutaneous balloon mitral valvuloplasty

Besides the standart echcardiografic parameters for mitral stenosis assessment it is necessary to inquire the hemodynamic characteristics as well. The following article describes and illustrates step-by-step the invasive parameters and their significance in the assessment of mitral stenosis in patients who underwent percutaneous balloon mitral valvuloplasty.

Аortic regurgitation – hemodynamic changes and evaluation

Valvular diseases are a leading cause of morbidity, mortality and impaired quality of life in all over the world with different epidemiology. It is extremely important to know the hemodynamic changes for the proper development of a strategy for future interventions. The recent years shows progress in various methodologies of the field of surgery and interventional treatments of valvular diseases. In this section, we focus mainly on aortic regurgitation and its clinical significance.

Periprocedural complications and risk factors after carotid stenting in patients with concomitant coronary artery disease

Backgrounds and purpose: To analyse the periprocedural CAS complications in patients with concomitant coronary disease. Material and methods: A prospective study analysed the frequency and characteristics of periprocedural complications after CAS in 329 patients, of whom 62.2% had symptomatic carotid stenosis > 50% and 37.8% had asymptomatic > 70%. The mean age was 70.2 (45-88) years, male/female ratio – 253/76. The degree of carotid stenosis was assessed angiographically according to NASCET criteria and was stratified by a newly proposed carotid score in three risk groups. Distal embolic protection was used in all patients. Results: Periprocedural complications were observed in 25/349 CAS interventions: TIA – 4.9%, major stroke – 0.6%, minor stroke – 1.4%, hyperperfusion syndrome – 0.3%. No MI and death were registered. Out of more than 20 factors analysed, previous MI (χ2 = 7,707; p = 0.021) and stroke (χ2 = 9,835, p = 0.043), “slow flow” (χ2 = 3.752; p = 0.001), residual stenosis> 20% (χ2 = 13.752; p = 0.001), radiation time (F = 13.323; p = 0.000), the amount of contrast used (F = 5.297; p = 0.006), contrast- induced OBN (χ2 = 25.845; p = 0.000), females with CKD (χ2 = 8.681; p = 0.013) or with a high carotid score (χ2 = 7.329; p = 0.026) were found to be predictors of complications. Conclusion: CAS is a safe procedure with low risk of MI and death in patients with concomitant coronary disease.

Invasive hemodynamic assessment of patients with cardiomyopathies

Invasive hemodynamic assessment of cardiac diseases has become an important diagnostic tool in recent decades. Non-invasive methods are the main techniques used to assess cardiac function, due to their wider availability. Cardiac catheterization is useful when there are diagnostic problems that cannot be solved with routine methods. Cardiac catheterization should be individualized according to the specific problems of the patient and based on the results from non-invasive methods. Invasive diagnostics is used in the assessment of patients with various cardiovascular diseases, including cardiomyopathies. In this review, we consider the role of cardiac catheterization, its advantages and disadvantages as part of the overall assessment of patients with cardiomyopathies.  

Survival of patients with cardiomyopathies

Cardiomyopathies are a heterogeneous group of diseases. The main pathogenetic mechanism is myocardial damage due to genetic mutations. Cardiomyopathies are one of the leading causes of heart failure, sudden cardiac death, and life-threatening arrhythmias. Certain factors associated with poor prognosis determined the prognosis in this group of patients. Survival in different types of cardiomyopathies depends on the time of diagnosis and initial treatment. The types of cardiomyopathies discussed in this review are hypertrophic cardiomyopathy, dilative cardiomyopathy, restrictive cardiomyopathy, left ventricle non-compaction, and arrhythmogenic right ventricular cardiomyopathy.

Survival and prognostic factors in patients after carotid stenting and coronary revascularization

Aim: To analyze the prognostic factors and create a model for survival in patients after interventional carotid revascularization. Methods: In 329 patients after carotid artery stenting (CAS), the median (MS) and overall survival (OS) were calculated for a follow-up period of 2-101 months. All patients underwent coronary angiography prior to carotid stenting and, if indicated, coronary revascularization. 4 groups of factors were analyzed: carotid disease, coronary artery disease (CAD), underlying cardiac pathology and concomitant diseases. Results: MS in all patients was 86 months, OS at 1, 3, 5, and 9 years was – 94%, 85%, 73%, and 51% respectively. Event free survival was 85 months. Log Rank- Mantel-Cox analysis demonstrated significantly reduced MS in 21 tested factors, most of them related to CAD. Two-step multifactorial Cox regression analysis defined only 7 of them as independent prognostic factors for the survival of patients after CAS: left main stenosis, complete revascularization, late myocardial infarction (MI), stroke, age over 70 years, valvular disease and carotid score. Conclusion: Survival of patients after CAS is limited mainly by CAD and underlying cardiac pathology. Staged revascularization treatment strategy may improve the prognosis and survival of patients with both carotid and coronary disease.

Hemodynamics in mitral regurgitation – before and after correction with MitraClip

Haemodynamic changes in mitral regurgitation underlie triggering of patient’s symptoms and development of heart failure. A number of endovascular methods for the correction of mitral regurgitation successfully counteract pathological hemodynamics and thus manage to improve both the manifestations of heart failure and the patient's symptoms. This article is a review of the physiology of the mitral valve and the changes that occur in the presence of mitral regurgitation. The peculiarities of the hemodynamics of the left atrium in the conditions of mitral regurgitation and after some types of transcatheter treatment – edge-to-edge correction of the valve with Mitraclip and the implantation of an occluder in paraprosthetic mitral regurgitation are considered. The change in left atrial parameters immediately after correction of the defect is of value both for the assessment of immediate procedural success and for the patient's prognosis.

Distal radial access. Occlussion of the radial artery after percutaneus coronary intervention with radial access

In 2015, The European Society of Cardiology for Acute Coronary Syndrome recommended that Class I use radial as the preferred access method for any percutaneous coronary intervention regardless of clinical presentation. However, the use of TRA is associated with some complications: radiation artery occlusion (RAO) (The reported incidence of RAO is highly variable in the range of 2-11%, radial arterial spasm, radial arterial perforation, radial artery pseudoaneurysm, arteriovenous fistula, bleeding, nerve damage, and complex regional pain syndrome. Limited data are available regarding the technique of distal radial access, complications, and potential benefits. The purpose of our study is to compare the incidence of radial artery occlusion between distal radial and conventional radial access. The study included 292 patients (who underwent percutaneous coronary intervention)in who is felt pulsations at the site of a puncture of the radial artery. Patients were followed one month after the procedure, with Doppler ultrasonography or access from the same artery. After a month, the occlusion of the radial artery occurred in 8 (5.7%) patients in conventional radial access, there was no occlusion of the radial artery in the distal radial access group. This investigation shows that distal radial access is associated with a lower incidence of occlusion of the radial artery.

Anatomic variants of pulmonary venous drainage and their relation to recurrences of atrial fibrillation after pulmonary vein isolation

Anatomical variants of pulmonary venous drainage in the left atrium are often found. Divergent results have been reported on the impact of variant anatomy on atrial fi brillation (AF) recurrence after catheter ablation. We aimed to study the frequency of different anatomical variants of pulmonary venous drainage and their relationship with documented recurrences of AF after ablation. Material and methods: A retrospective study of patients with AF in whom radiofrequency pulmonary vein isolation was done after previously performed cardiac contrast-enhanced multidetector computed tomography. Clinical and procedural characteristics, type and frequency of anatomical variants of the veno-atrial junction and their association with AF recurrences were studied. Results: One hundred seventy-seven patients (112 men, 63.3%) with AF were studied, of which 148 (83.6%) with paroxysmal AF. Variant anatomy was found in 91 patients (51.4%). In 20.9% there was a common left trunk, in 23.2% – more or less than two right-sided veins, and in 7.3% – variations for both right and left veins. No differences in clinical and procedural characteristics were found between the groups with normal and variant anatomy. Recurrences of AF and their association with pulmonary venous anatomy were studied in 104 patients with follow-up ≥ 3 months. No signifi cant relation was found between the presence of variant anatomy and AF recurrences within the blinding period after ablation, OR = 0.864, 95% CI = 0.397 – 1.88, p = 0.843, nor afterwards, OR = 1.12, 95% CI = 0.5 – 2.5, p = 0.839. Cox regression analysis showed no differences in AF recurrence-free survival regardless of the anatomical variant of pulmonary venous drainage, HR = 1.09, 95% CI = 0.58 – 2.05, p = 0.779. Conclusion: In this local population of patients with AF, the incidence of variant pulmonary venous drainage is just over 50%. No association was found between variant anatomy and the rate of AF recurrences after fi rst pulmonary vein isolation.