ABSTRACT
Transcatheter aortic valve implantation (TAVI) is a rapidly evolving treatment option with an inherent risk of causing cerebral infarctions. The mechanism of cerebral infarction during TAVI mainly involves embolisms from the aortic wall and valve. Transoesophageal echocardiography (TEE) is useful for detecting aortic atheromas. We present the case of a patient in whom the dispersal of aortic atheromas was monitored by TEE during TAVI. This report demonstrates the importance of preoperatively predicting embolisms from aortic atheromas in patients with severe aortic stenosis.
Subject(s)
Aorta/diagnostic imaging , Aortic Valve Stenosis , Atherosclerosis , Cerebral Infarction , Echocardiography, Transesophageal/methods , Intraoperative Complications/diagnostic imaging , Plaque, Atherosclerotic/diagnostic imaging , Transcatheter Aortic Valve Replacement , Aged, 80 and over , Aortic Valve Stenosis/complications , Aortic Valve Stenosis/surgery , Atherosclerosis/complications , Atherosclerosis/diagnosis , Cerebral Infarction/diagnostic imaging , Cerebral Infarction/etiology , Humans , Intraoperative Complications/prevention & control , Male , Monitoring, Intraoperative/methods , Preoperative Care/methods , Risk Adjustment , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/instrumentation , Transcatheter Aortic Valve Replacement/methods , Treatment OutcomeABSTRACT
The clinical expert consensus statement on takotsubo syndrome (TTS) part II focuses on the diagnostic workup, outcome, and management. The recommendations are based on interpretation of the limited clinical trial data currently available and experience of international TTS experts. It summarizes the diagnostic approach, which may facilitate correct and timely diagnosis. Furthermore, the document covers areas where controversies still exist in risk stratification and management of TTS. Based on available data the document provides recommendations on optimal care of such patients for practising physicians.
Subject(s)
Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/therapy , Algorithms , Arrhythmias, Cardiac/etiology , Computed Tomography Angiography , Coronary Angiography , Disease Management , Echocardiography , Electrocardiography , Humans , Magnetic Resonance Imaging , Myocardial Perfusion Imaging , Recurrence , Takotsubo Cardiomyopathy/complications , Treatment OutcomeABSTRACT
Takotsubo syndrome (TTS) is a poorly recognized heart disease that was initially regarded as a benign condition. Recently, it has been shown that TTS may be associated with severe clinical complications including death and that its prevalence is probably underestimated. Since current guidelines on TTS are lacking, it appears timely and important to provide an expert consensus statement on TTS. The clinical expert consensus document part I summarizes the current state of knowledge on clinical presentation and characteristics of TTS and agrees on controversies surrounding TTS such as nomenclature, different TTS types, role of coronary artery disease, and etiology. This consensus also proposes new diagnostic criteria based on current knowledge to improve diagnostic accuracy.
