Complications of transcatheter paravalvular leak device closure of mitral valve: An updated review of the literature and a rare case presentation.

Paravalvular leak (PVL) is an uncommon complication of prosthetic valve implantation, which can lead to infective endocarditis, heart failure, and hemolytic anemia. Surgical reintervention of PVLs is associated with high mortality rates. Transcatheter PVL closure (TPVLc) has emerged as an alternative to surgical reoperation. This method provides a high success rate with a low rate of complications. This article reviews the pathogenesis, clinical manifestation, diagnosis, and management of PVL and complications following TPVLc. Besides, we presented a case of a patient with severe PVL following mitral valve replacement, who experienced complete heart block (CHB) during TPVLc. The first TPVLc procedure failed in our patient due to possible AV-node insult during catheterization. After 1 week of persistent CHB, a permanent pacemaker was implanted. The defect was successfully passed using the previous attempt. Considering the advantages of TPVLc, procedure failure should be regarded as a concern. TPVLc should be performed by experienced medical teams in carefully selected patients.

Use of SAFARI 2™ as workhorse wire for left-sided structural heart interventions.

BACKGROUND: With the advances in percutaneous treatment technologies, the left atrial appendage occlusion (LAAO) and the transcatheter mitral valve repair using MitraClip (TMVR) are increasingly being performed today. The SAFARI 2™ guidewire is primarily used during transcatheter aortic valve implantation (TAVI), our group has also been using it during MitraClip and LAAO procedures. Our clinical study aimed to share our data on the safety and effectiveness for the use of the SAFARI 2™ guidewire during MitraClip or LAAO procedures. METHODS: This study included a total of 1730 patients (948 patients of MitraClip and 782 of LAAO). It was designed as single arm, retrospective, and multicenter between July 2016 and August 2022. SAFARI 2™ guidewire was used exclusively during all the procedures. RESULTS: A total of 1730 patients (male 55.8 %) were included in the study. There was no guidewire-related complications, stroke/transient ischemic attack, bleeding (minor/major/life-threatening), need for cardiac surgery, pneumonia, and vascular dissection/rupture in patients undergoing LAAO. There were 2 device-related pericardial effusions without tamponade. No stroke/transient ischemic attack, bleeding (minor/major/life-threatening), mortality, need for cardiac surgery, pneumonia, guidewire-related complication, pericardial effusion, vascular dissection/rupture, or clip embolization was observed in patients undergoing MitraClip. CONCLUSIONS: By taking advantage of its pre-shaped structure, the SAFARI 2™ guidewire seems to offer a reliable and safe device delivery for both MitraClip and LAAO procedures as a regular work horse wire. Our results should be confirmed by larger randomized or prospective trials.

Open Radial Artery Study.

Radial artery occlusion (RAO) has been the most common postprocedural complication of transradial artery access. The optimal method of prevention of RAO is still lacking. In our study, we aimed to evaluate the effect of patent hemostasis on early (24 hours) and late (2 weeks) RAO prevention. The Open Radial Artery Study was a single-arm, prospective, and multicenter study. The primary end points were early and late RAO at the vascular access site after transradial coronary procedures. Secondary end points were access site hematoma, pseudoaneurysm formation, arteriovenous fistula, and nerve injury. A total of 2,181 patients were analyzed (67% male, mean age 68 years). The mean interventional duration and hemostatic times were 75.6 ± 55.6 and 60 ± 5.6 minutes, respectively. Radial artery spasm occurred in 10% of patients (n = 218). Catheter kinking, radial artery rupture, or dissection were not observed during the procedure. RAO, hematoma, pseudoaneurysm, arteriovenous fistula, or nerve damage was not observed in any of the patients in the early or late period. In patients who undergo coronary diagnostic or interventional procedures through transradial artery access, the patent hemostasis method seems a critical step in the prevention of early and late RAO.

Case report: Thoracic endovascular aortic repair using a non-touch exclusion technique with a custom-made device for the treatment of a large patent ductus arteriosus.

Patent ductus arteriosus (PDA) is a common congenital heart disease affecting roughly one in every 2,000 term births. Although most of the patients are diagnosed and treated during childhood, few cases may persist into adulthood. We presented a 27-year-old male patient with a 20.2 mm diameter PDA who was referred to our hospital with progressive fatigue and exertional dyspnea. Given the potential complications, usual techniques such as coil occlusion and duct occluders were deemed inappropriate for this patient. Thoracic endovascular aortic repair (TEVAR) using a non-touch exclusion technique was successfully performed for this patient. The patient was discharged with no major post-surgical complications. TEVAR could be a new, safe, and effective alternative treatment to other transcatheter procedures for complicated PDAs in some patients.

Percutaneous Treatment of Severe Acute Mitral Regurgitation Early After Myocardial Infarction and a Short Review of the Literature.

Transcatheter edge-to-edge repair treatment is mainly used for patients with chronic heart failure concomitant severe mitral regurgitation. However, utilization of this system in the acute seting of myocardial infarction is still limited. In this case report authors aimed to show the effectiveness of the percutaneous treatment for severe acute mitral regurgitation early after myocardial infarction.

EMCAPT study: the effect of MitraClip treatment on the mitral annulus and left atrial appendage evaluation by transoesophageal echocardiography.

Introduction: Data on the change in mitral valve annulus diameter (MAD), and left atrial appendage (LAA) structure and function after transcatheter edge-to-edge repair (TEER) of the mitral valve in patients with secondary mitral regurgitation (MR) are lacking. Aim: To evaluate the change in these parameters just after the clip insertion and its relationship with prognosis in the long term. Material and methods: A total of 50 patients (age: 71.5 ±11.3 years, 70% male) with moderate-to-severe or severe MR were included in the study. Transthoracic (TTE) and transoesophageal echocardiography (TEE) were performed before and after the procedure. Prognostic data were recorded with post-procedure telephone calls and follow-up visits. Results: TEE performed during the procedure showed that LAA contraction and filling velocity significantly increased (p < 0.001 for all). Systolic pulmonary artery pressure (SPAP), MAD, and LAA landing zone dimension significantly decreased (p < 0.001 for all). There was only a significant correlation between the MAD before clip placement and the MAD change after clip placement (r = 0.6, p < 0.001). During a mean follow-up period of 10.5 ±8.9 months, no significant correlation was found between MAD change, LAA contraction and filling velocity change, and LAA landing zone dimension change and rehospitalization, stroke, mortality, and composite outcome. Conclusions: The contraction and filling velocity of LAA, SPAP, MAD, and LAA landing zone dimension changed significantly immediately after the MitraClip procedure. Although these parameters are not related to composite outcome in our study, MAD, LAA diameter, and velocity need to be compared between successful and unsuccessful procedures to predict their clinical relevance.

Comparison of American and European Guidelines for the Management of Patients With Valvular Heart Disease.

This review compares the recommendations of the recent 2020 American College of Cardiology (ACC)/American Heart Association (AHA) and 2021 European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) guidelines on the management of patients with valvular heart disease (VHD). ACC/AHA and ESC/EACTS guidelines are both the updated versions of previous 2017 documents. Both guidelines fundamentally agree on the extended indications of percutaneous valve interventions, the optimal use of imaging modalities other than 2D echocardiography, the importance of a multidisciplinary Heart Team as well as active patient participation in clinical decision making, more widespread use of NOACs and earlier intervention with lower left ventricular dilatation thresholds to decrease long-term mortality. The differences between the guidelines are mainly related to the classification of the severity of valve pathologies and frequency of follow-up, level of recommendations of valve intervention indications in special patient groups such as frail patients and the left ventricular diameter and ejection fraction thresholds for intervention.

Transcatheter mitral valve repair in a liver transplant candidate.

Untreated severe mitral regurgitation (MR) is associated with poor outcomes due to the adverse consequences of long-standing volume overload on the left ventricle and left atrium, which leads to pulmonary hypertension and right-sided heart failure. Early intervention results in favorable long-term outcomes making appropriate timing of intervention very critical. We present a 53-year-old male with severe symptomatic MR and right sided-heart failure which progressed to cardiac cirrhosis necessitating enrollment to the liver transplant list. Transcatheter mitral valve repair (TMVR) using MitraClip implantation resulted in impressive clinical improvement and resolution of cirrhosis. Eventually, the patient was taken off the transplant list. Treatment of severe MR may lead to improvements in congestive hepatopathy.

Primary Endovascular Treatment of Late-Onset Type 3 Endovascular Aortic Repair Rupture Using The Endurant II Stent Graft and Rapid Response Protocol.

The objective of this article is to describe a patient with hemorrhagic shock due to type 3 postendovascular aortic repair rupture successfully treated with the endurant II stent graft via a primary endovascular approach with a rapid response protocol. A 65-year-old male patient who underwent endovascular aortic repair 3 years ago was admitted to the emergency department with severe abdominal pain and hemorrhagic shock. The patient was rapidly taken to the angiography laboratory, and aortography demonstrated distal aortic graft rupture and extravasation of contrast media. The repair was performed successfully with 3 stent-grafts by paying attention to rupture localization and renal artery ostia. The hemodynamics of the patient improved very quickly, and the patient was discharged after 5 days. Emergency primary stent grafting using a rapid response protocol could be a crucial alternative to open surgery for late endoleaks, which are complicated with hemorrhagic shock.

Single Radial Access Simultaneous Left Ventricular and Ascending Aortic Pressure for the Evaluation of Aortic Stenosis: The "Double-Barrel" Technique.

The use of simultaneous left ventricular and ascending aortic pressure tracings by cardiac catheterization is the gold standard of care for accurate hemodynamic assessment of aortic stenosis severity in patients with equivocal echocardiogram. We describe the first-in-man single radial access "double-barrel" technique for the evaluation of aortic stenosis. A 7-Fr Glidesheath Slender hydrophilic-coated introducer sheath (Terumo) was placed in the right radial artery. Two 4-Fr pigtails, 1 in the left ventricle and 1 in the ascending aorta, were advanced through the single sheath. The single radial access "double-barrel" technique is a simple way to accurately evaluate patients with aortic stenosis, avoiding multiple access sites or femoral access.

Changes in the frequency and pattern of drugs detected among suspected drug users during the COVID-19 pandemic in Turkey.

From March 13 until May 31, 2020, a complete lockdown in Turkey was planned and implemented by the government of Turkey. The vulnerable population with substance use disorders was affected more than others due to the social isolation measures meant to control the pandemic. This study presents detailed and broad data on drug abuse in suspected cases during the first wave of the COVID-19 pandemic in Turkey and compares the frequencies and patterns of drug abuse before and during the pandemic. The samples were screened by liquid chromatography-high resolution mass spectrometry and liquid chromatography-tandem mass spectrometry. Blood and urine samples of suspected users (n = 9669) were analyzed for drugs of abuse during the first wave of the COVID-19 pandemic and compared with their results (n = 8727) obtained just before the COVID-19 pandemic. The use of party drugs, such as MDMA and cocaine, and the classic illicit drug cannabis was significantly decreased and followed the same trend after complete lockdown was over. In contrast, methamphetamine use increased significantly during the lockdown period and continued after the lockdown. Interestingly, the number of tests that were positive for pregabalin as a misused licit drug increased, and this increase continued after the lockdown. The results showed a significant increase in drug abuse cases and changes in drug abuse trends, with an alteration toward more easily obtainable and lower-priced drugs. Using more dangerous and easily available licit and illicit drugs may cause serious health problems.

TAVR in Cancer Patients: Comprehensive Review, Meta-Analysis, and Meta-Regression.

Objectives: This study sought to systematically analyze the available clinical evidence on TAVR therapy in cancer patients with symptomatic severe AS. Background: Aortic stenosis is the most common valvular heart disease in the world. TAVR has expanded the treatment options for this lethal disease process. The safety and efficacy of TAVR in cancer patients has not yet been reliably established. We thus conducted the largest known multi-center meta-analysis on TAVR and cancer status. Methods: We performed a literature search using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials from January 2015 to 2020. Studies that compared the use of TAVR in patients with severe symptomatic aortic stenosis and cancer against patients without cancer were included. Meta-regression was also conducted to determine if common clinical factors modified the possible association between cancer status and TAVR mortality. Results: Five studies with 11,129 patients in the cancer group and 41,706 patients in the control group met inclusion criteria. The short-term mortality in the cancer group was 2.4% compared with 3.3% in the control group (odds ratio: 0.72, 95% confidence interval: 0.63-0.82; p < 0.0001). The frequency of stroke was 2.4% compared with 2.7% (odds ratio of 0.87, 95% confidence interval: 0.76-0.99; p < 0.04). The frequency of AKI was 14.2% in cancer patients vs. 16.4% (odds ratio of 0.81, 95% confidence interval: 0.76-0.85; p < 0.04). The rates of bleeding and need for new pacemaker implantation were not significantly different. Meta-regression demonstrated there was no significant association modifying. Conclusions: On the basis of the results of this meta-analysis TAVR may be a safe and effective therapeutic option for patients with cancer and symptomatic severe aortic stenosis. Larger, longer, and randomized trials are required to adequately test this above hypothesis.

Percutaneous Muscular Ventricular Septal Defect Closure with 2D Transthoracic Echocardiography: Can We Sufficiently Visualize It?

Ventricular septal defect (VSD) is one of the most common congenital heart diseases worldwide today. Although the majority close spontaneously, transcatheter VSD closure is a common option for symptomatic patients with suitable anatomy in adult age. Although transesophageal echocardiography (TEE) and intracardiac echocardiography are the most common imaging modalities for the procedure, in patients with poor TEE images, Transthoracic echocardiography (TTE) can be used as a reliable alternative. Here we present an adult patient with pulmonary hypertension associated with a muscular VSD which was closed percutaneously using 2-dimensional TTE because of poor TEE images.

Transcatheter Mitral Valve Repair Using MitraClip in Patients With Renal Transplantation.

OBJECTIVES: To evaluate the renal function in patients with renal transplantation 1 month after treatment of their severe symptomatic mitral regurgitation using transcatheter mitral valve repair (TMVRep) using MitraClip (Abbott Cardiovascular). METHODS: We enrolled 22 patients with previous history of end-stage renal disease and kidney transplant with severe symptomatic mitral regurgitation (MR) in this study. Each patient was evaluated by the structural heart team and underwent transesophageal echocardiographic evaluation for MR etiology, severity, and location of the MR jet, as well as to rule out left atrial appendage clot formation. Serum creatinine and estimated glomerular filtration rate using the Modification of Diet in Renal Disease formula were measured at baseline and at 1-month follow-up. RESULTS: Fourteen patients (64%) were male and mean age of the study group was 50.4 ± 11.0 years. Mean ejection fraction was 29.0 ± 5.6%. The majority (86%) of the MRs treated were classified as functional MR. Follow-up creatinine values were significantly lower after treatment of their symptomatic MR with TMVRep compared with baseline creatinine values (baseline, 3.2 ± 0.49 mg/dL; follow-up, 1.99 ± 0.31 mg/dL; P<.05). CONCLUSIONS: TMVRep in patients with renal transplantation was associated with lower serum creatinine values at 1-month follow-up and represents an alternative to surgery in this high-risk group of patients. Further studies are needed to confirm our findings and to find the best treatment option for these patients.

New indane derivatives containing 2-hydrazinothiazole as potential acetylcholinesterase and monoamine oxidase-B inhibitors.

Although radical treatment of Alzheimer's and Parkinson's disease is not possible yet, it is aimed to slow the course of the disease and increase the life quality of individuals with the drugs used in the clinic at the present time. Successful results have been achieved in the use of cholinesterase inhibitors and monoamine oxidase inhibitors together in these neurodegenerative diseases. In this study, indane ring which are in the structure of anticholinesterase effective molecules and 2-hydrazinothiazole structure whose inhibitory activities reported on monoamine oxidase-B (MAO-B) were combined; 4-(substituted phenyl)-2-[2-(3-phenyl-2,3-dihydro-1H-inden-1-ylidene) hydrazinyl]thiazole derivatives (3a-3i) were synthesized as dual inhibitors. The structures of the compounds were verified by IR, 1H-NMR, 13C-NMR, and HRMS spectroscopy. When enzyme inhibition activities were evaluated, it was determined that the compounds 3a (42.33%) and 3d (42.39%) on acetylcholinesterase (AChE) enzyme; compounds 3g (75.42%) and 3h (60.33%) showed inhibition on MAO-B enzyme at most, at 10-3 M concentration.

Feasibility of Same-Day Discharge Approach After Transcatheter Mitral Valve Repair Procedures.

INTRODUCTION: Early discharge strategies are increasingly adopted after percutaneous cardiac interventions. However, there is a paucity of data on early discharge after transcatheter mitral valve repair (TMVRep) procedures. In this report, we aimed to present our data on same-day discharge after MitraClip (Abbott Structural) procedures. METHODS: A total of 82 patients who underwent TMVRep and were discharged the same day were included in the study. Patients who underwent the procedure with moderate conscious anesthesia, and without periprocedural complications and a stable early course post procedure, were considered candidates for same-day discharge. A next-day follow-up exam at the cardiology clinic was scheduled for all patients for removal of the groin access figure-of-eight subcutaneous sutures and for echocardiographic examination. RESULTS: Thirty-nine patients had primary mitral regurgitation (MR), while 43 patients had secondary MR. A mean of 1.4 ± 0.4 clips were implanted per patient (range, 1 to 2 clips). Postprocedural MR grade was 1+ or lower in 64 patients (63.6%) and 2+ in 38 patients (36.4%). All patients were evaluated in the office clinic the next day, and had no major complications. CONCLUSION: Same-day discharge approach can be safely performed in selected patients after TMVRep procedures. However, further studies with larger sample sizes are needed.

Effectiveness and safety of same day discharge after left atrial appendage closure under moderate conscious sedation.

BACKGROUND: Left atrial appendage occlusion (LAAO) using Watchman device has become a world-wide, well-established therapeutic alternative to chronic systemic oral anticoagulation in patient who are at high-risk of bleeding with paroxysmal (PAF) or chronic atrial fibrillation (Afib). Currently, LAAO procedures are performed under general anesthesia (GA) and patients stay overnight post procedure in the United States. We aimed to present the effectiveness and safety of same day discharge following LAAO under moderate conscious sedation (MCS) in patients without procedural complications. METHODS: A total of 112 patients between August 2019 and May 2020 with elevated CHA2 DS2 VASc (median score of 3) underwent transesophageal echocardiography (TEE)-guided LAAO with FDA approved Watchman (Boston Scientific, MN) under MCS and discharged home on the same day 6 hr following their post procedural transthoracic echocardiogram (TTE) evaluations. All patients had next day TTE and follow up at the cardiology clinic. We prospectively evaluated clinical and procedural outcomes using medical records of these patients. RESULTS: Among all the patients, the mean age was 83.5 ± 8.5 years, 45 (40%) were women. Procedural duration, device implant time and fluoroscopic times were 45 ± 8.6, 14.5 ± 7.8 and 10.2 ± 1.2 min, respectively. The median required dosage of propofol was 105 ± 2.8 mg. No complications arose from MCS. There was no need for conversion to GA in any of the patients during the procedure. All patients were able to be discharged 6 hr following their TTE evaluation post procedure. There were no procedural complications. CONCLUSIONS: Same day discharge following LAAO closure seems to be safe and effective in patients without procedural complications. LAAO can also be performed safely and effectively under moderate conscious sedation. Applying moderate conscious sedation may simplify the LAAO procedure, reduce procedural time, procedural costs and hospital stay while increasing overall patient satisfaction.

Virtual Histology Optical Coherence Tomography Imaging of Orbital Rotational Atherectomy for Calcified Peripheral Arterial Disease.

In order to assess the vascular effects of rotational orbital atherectomy, we performed intravascular imaging with virtual histology intravascular optical coherence tomography in a 72-year-old man with critical limb ischemia of the right lower extremity.