ABSTRACT
BACKGROUND: The incremental use of transcatheter aortic valve replacement will inexorably lead to structural valve deterioration and the need for both a second and third valvular interventions, raising the question of feasibility. CASE SUMMARY: We present the case of a 76-year-old man that presented with cardiogenic shock refractory to inotropic support. His workup revealed severe bioprosthetic aortic regurgitation 5 years after undergoing transcatheter aortic valve-in-valve implantation. After confirming anatomical suitability with multimodality imaging, he underwent uncomplicated valve-in-valve-in-valve (ViViV) implantation of a 23 mm Edwards S3 Ultra valve with rapid clinical improvement. CONCLUSIONS: Whether in the form of stenosis or severe regurgitation as in our patient, ViViV is feasible. Careful preprocedural planning and confirmation of anatomical suitability with multimodality imaging are key for success and safety.
Subject(s)
Aortic Valve Insufficiency , Aortic Valve Stenosis , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Male , Humans , Aged , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Aortic Valve Stenosis/complications , Heart Valve Prosthesis/adverse effects , Treatment Outcome , Transcatheter Aortic Valve Replacement/adverse effects , Aortic Valve/diagnostic imaging , Aortic Valve/surgeryABSTRACT
Venous thromboembolism (VTE) including pulmonary embolism (PE) and deep vein thrombosis (DVT) is one of the leading causes of preventable cardiovascular disease in the United States (US) and is the number one preventable cause of death following a surgical procedure. Post-operative VTE is associated with multiple short and long-term complications. We will focus on reviewing the many faces of VTE in detail as they represent common challenging scenarios in clinical practice.
Subject(s)
Anticoagulants/therapeutic use , Venous Thromboembolism/prevention & control , Female , Humans , Male , Postoperative Care , Practice Guidelines as Topic , Precision Medicine , Risk Assessment , Venous Thromboembolism/etiologySubject(s)
Pulmonary Embolism/prevention & control , Venous Thromboembolism/epidemiology , Venous Thrombosis/epidemiology , Venous Thrombosis/therapy , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Anticoagulants/therapeutic use , Female , Humans , Incidence , Male , Middle Aged , Phlebography/methods , Pregnancy , Pulmonary Embolism/epidemiology , Risk Factors , Ultrasonography/methods , Ultrasonography, Doppler, Duplex/methods , United States/epidemiology , Venous Thromboembolism/diagnosis , Venous Thromboembolism/mortality , Venous Thrombosis/diagnostic imagingABSTRACT
Targeted prophylaxis for venous thromboembolism (VTE) using the Caprini risk score (CRS) is effective reducing postoperative VTE. Despite its availability as preventive strategy, risk scoring remains underutilized. Critics to the CRS contend the time it takes to complete, and its limitation to English language. Aim is to create and validate patient-completed CRS tools for Spanish, Arabic, and Polish speakers. We translated the first patient-completed CRS to Spanish, Arabic, and Polish. We conducted a pilot study followed by the validation study. Using PASS version 11, we determined that a sample size of 37 achieved a power of 80%, to detect a difference of 0.1 between the null hypothesis correlation of 0.5 and the alternative hypothesis correlation of 0.7 using a 2-sided hypothesis test, significance level of .05. We tabulated and categorized scores using SPSS version 23 to estimate κ, linear correlation, and Bland Altman test. κ value >0.8 was defined as "almost perfect agreement." From 129 recruited patients, 50 (39%) spoke Spanish, 40 (31%) spoke Arabic, and 39 (30%) spoke Polish; average age 51 (16.69) years, 58 (45%) were men, with less than college education (67%). Mean (standard deviation) CRS was 5 (3.90), the majority (63%) above moderate VTE risk. We report excellent agreement comparing physician and patient results (κ = 0.93) and high correlation 0.97 ( P < .01) for the overall score. Bland Altman did not show trend for extreme values. We created and validated the first Spanish, Arabic, and Polish versions of the patient-completed CRS, with excellent correlation and agreement when compared to CRS-trained physician-completed form. Based on these results, the physician needs to calculate the body mass index. Completing the form was not time-consuming.
Subject(s)
Language , Risk Assessment , Venous Thromboembolism/prevention & control , Adult , Aged , Female , Humans , Male , Middle Aged , Pilot Projects , Postoperative Complications/prevention & control , Premedication , TranslatingABSTRACT
Inappropriate Sinus Tachycardia (IST) is a chronic medical condition with a wide variety of clinical presentations making it, sometimes, very insidious at the time of the diagnosis. Several therapeutic options, including, pharmacotherapy, cardiac rehabilitation, and modification or ablation of the sinus node, have been proposed for the management of IST, but because of the complexity and lack of understanding of pathophysiology, it can be difficult to manage, despite the numerous treatment options currently available. The purpose of this review is to analyze the treatment for IST, focusing on the role of newer therapy and the potential benefits in the management of this cardiac rhythm disturbance.
