Transient severe reversible functional mitral regurgitation: a three-dimensional transoesophageal perspective.

Mrs B, a 49-year-old female, was referred to our institution for severe mitral regurgitation. Transthoracic echocardiography showed only a moderate organic mitral regurgitation, but a transient severe reversible functional mitral regurgitation was observed during transoesophageal echocardiography (TEE). Three-dimensional TEE clearly demonstrated the functional nature of the regurgitation with a transient and sudden tenting of the mitral leaflets with a circular mitral annulus resulting in a total absence of leaflet coaptation.

Long-term clinical outcomes after rescue angioplasty are not different from those of successful thrombolysis for acute myocardial infarction.

AIMS: The long-term value of rescue percutaneous transluminal coronary angioplasty (PTCA) in patients with ST-segment elevation myocardial infarction who received thrombolytic therapy but failed to achieve early recanalization of the artery is still debated. This study aimed to compare long-term outcomes after successful thrombolysis vs. systematic attempted rescue PTCA. METHODS AND RESULTS: A total of 362 consecutive patients with STEMI hospitalized within 6 h of symptom onset and treated with intravenous thrombolytic therapy were studied. Of these, 345 underwent coronary angiography within 90 min. Sixty per cent of patients achieved TIMI 3 flow and were treated medically; the in-hospital death rate in this group was 4%. Nine per cent of patients had TIMI 2 flow and 31% TIMI 0-1 flow. In this latter group, rescue PTCA was attempted in 85.8% with a hospital death rate of 5.5% (20% with failed vs. 4% with successful rescue PTCA, P=0.03). Eight year actuarial survival without recurrent myocardial infarction was no different in patients who had successful thrombolytic therapy and in patients with attempted rescue PTCA [78 and 95% CI (71-85) vs. 78 and 95% CI (68-87), respectively, hazard ratio: 0.93 (0.52-1.65), P=0.80]. Total mortality, cardiac mortality, and other composite endpoints also did not differ between groups. CONCLUSION: Routine attempted rescue PTCA 90 min after thrombolytic therapy in patients with persistent occlusion of the infarct-related vessels achieves long-term clinical outcomes which do not differ from those obtained by successful thrombolysis.

Age and lack of beta-blocker therapy are associated with increased long-term mortality after primary coronary angioplasty for acute myocardial infarction.

BACKGROUND: Few studies have examined the long-term outcome of primary PTCA for acute myocardial infarction, especially in thrombolysis-eligible patients. METHODS: Retrospective analysis of a consecutive cohort of 228 patients treated with primary angioplasty for ST-segment elevation myocardial infarction, less than 6 h after symptom onset, of whom 203 were discharged alive and had long-term follow-up. RESULTS: With an average follow-up of 497+/-40 days, actuarial survival rates were 94.4+/-0.02 and 86.8+/-0.06% at 2 and 4 years, respectively. Multivariate analysis showed that lack of beta-blocker therapy at discharge (RR 6.5 and 95% CI: 1.97-21.47) and age (RR 1.09 per year and 95% CI: 1.03-1.16), but not left ventricular ejection fraction were the two independent predictors of late mortality. CONCLUSIONS: In thrombolysis-eligible patients treated with primary PCI and discharged alive, reinfarction and mortality rates are low. It appears particularly important to enforce prescription of beta-blockers at discharge is an important goal in this population.