change in mitral regurgitation severity after trans-catheter aortic valve implantation

Mitral regurgitation [MR] is a frequent finding in patients with aortic stenosis [AS]. The objective of this study is to assess the change in MR severity following transcatheter aortic valve implantation [TAVI]. MR changes were assessed by comparing transthoracic echocardiography before and after the procedure. The prosthetic aortic valve was successfully implanted in 65 patients. The number of patients with pre-procedure MR was reduced from 58 [85.3%] to 43 [63.2%] [p < 0.001]. Vena contracta width was decreased from 0.47 +/- 0.28 to 0.25 +/- 0.21, [p = 0.043]. About 59.4% [19/32] of those who had moderate to severe MR and 85.7% [12/14] of those with severe MR experienced a significant improvement in MR after the procedure [p < 0.001]. Improvement in MR was independent of prosthetic valve type with 54.2% in CoreValve and 43.9% in Edwards SAPIEN, p = 0.424; valve sizes were 25.8 +/- 1.9 in those who improved vs. 25.0 +/- 1.9 mm in those who did not improve, p = 0.105; femoral approach was 51.2% and apical approach was 41.7%, p = 0.457; MR etiology was 48.1% in organic and 48.6% in functional, p = 0.968; and operative risk was 50.0% in EuroScore >20 and 48.6% in EuroScore <20, p = 0.356. TAVI is associated with a significant improvement in MR, especially in severe types. The lack of influence of MR improvement by the etiology of MR, the type of valve implanted, and the operative risk need to be confirmed in a larger multi-center study

Lessons from the SYNTAX trial

Despite the fact that CABG is the standard of care for patients with multivessel coronary arteries and/or left main stem stenosis, PCI has become a rival to CABG in patients with multivessel coronary artery disease or left main disease. However, the need for repeat revascularization, in-stent stenosis and thrombosis remain the achilis heal of PCI. SYNTAX trial randomized patients with left main disease and/or three-vessel disease to PCI with TAXus stent or CABG with the concept that PCI is not inferior to CABG. At 1 and 2 years follow up, MACCE was significantly increased in PCI patients mainly attributed to increased rate of repeat revascularization; however, stroke was significantly more with CABG. The composite safety endpoint of death/stroke/MI was comparable between the 2 groups. Therefore the criterion for non-inferiority was not met. What we learn from SYNTAX is that multi disciplinary team approach should be the standard of care when recommending treatment in more complex coronary artery disease. SYNTAX makes interventionists and surgeons come together, it may set the benchmark for MVD revascularization. PCI and CABG should be considered complementary rather than competitive revascularization strategies. There is no substitute for sound clinical judgment that takes into account the patient's overall clinical profile, functionality, co-morbidities, as well as the patient's coronary anatomy. The SYNTAX Score should be utilized to decide on treatment of patients with LM/MVD. Patients with low and intermediate score can be treated with PCI or CABG with equal results. Those with high score do better with CABG. SYNTAX trial showed that 66% of patients with 3VD or LMD are still best treated

Stress-induced cardiomyopathy [Tako-Tsubo] in a premenopausal woman: a case report from Saudi Arabia

Tako-Tsubo cardiomyopathy [TTC] is a nonischemic cardiomyopathy characterized by reversible left ventricular dysfunction that is seen predominantly in postmenopausal women [>80%]. The syndrome has symptoms that are similar to acute myocardial infarction, such as electrocardiogram changes [ST-segment elevation and subsequent giant T wave inversion] and abnormal cardiac enzymes. The clinical prognosis is usually benign. This article reports the first case of a TTC in a premenopausal Saudi woman. Early diagnosis of TTC excludes the use of stents, thrombolytics, and long-term coronary heart disease medications