Emergent Transcatheter Aortic Valve Implantation as a Life-saving Procedure: A Primary Treatment Approach.

Severe aortic stenosis (SAS) is the most common valvular heart disease in elderly patients. Untreated SAS is known to have 50% mortality within 2 years of onset of symptoms. SAS with acute decompensated heart failure is fatal and requires immediate, appropriate treatment. Urgent transcatheter aortic valve implantation (TAVI) is acceptable with feasible outcomes for a selected group of patients with decompensated SAS. Herein, we present a case of a primary TAVI procedure with a good outcome for decompensated SAS. The patient was an 85-year female with SAS with peak/mean transvalvular gradients of 73/42 mmHg, and left ventricular ejection fraction (LVEF) of 60% on echocardiography. The TAVI procedure was confirmed with echocardiography and angiography. As there was no anatomic contraindication for TAVI, primary TAVI was selected for this patient with implantation of a No. 29 Portico™ TAVI valve (Abbott; St. Jude Medical Inc., St. Paul, MN, USA). To the best of the authors' knowledge, this case is the first to be reported as primary TAVI which was performed in 4 hours of emergency situation. A life-saving procedure was performed, which lasted 4 hours from door-tovalve placement.

Prognostic value of rising mean platelet volume during hospitalization in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: The prognostic significance of changes in mean platelet volume (MPV) during hospitalization in ST segment elevation myocardial infarction (STEMI) patients underwent primary percutaneous coronary intervention (pPCI) has not been previously evaluated. The aim of this study was to determine the association of in-hospital changes in MPV and mortality in these patients. METHODS: Four hundred eighty consecutive STEMI patients were enrolled in this retrospective study. The patients were grouped as survivors (n = 370) or non-survivors (n = 110). MPV at admission, and at 48-72 h was evaluated. Change in MPV (MPV at 48-72 h minus MPV on admission) was defined as ΔMPV. RESULTS: At follow-up, long-term mortality was 23%. The non-survivors had a high ΔMPV than survivors (0.37 (- 0.1-0.89) vs 0.79 (0.30-1.40) fL, p <  0.001). A high ΔMPV was an independent predictor of all cause mortality ((HR: 1.301 [1.070-1.582], p = 0.008). Morever, for long-term mortality, the AUC of a multivariable model that included age, LVEF, Killip class, and history of stroke/TIA was 0.781 (95% CI:0.731-0.832, p <  0.001). When ΔMPV was added to a multivariable model, the AUC was 0.800 (95% CI: 0.750-0.848, z = 2.256, difference p = 0.0241, Fig. 1). Also, the addition of ΔMPV to a multivariable model was associated with a significant net reclassification improvement estimated at 24.5% (p = 0.027) and an integrated discrimination improvement of 0.014 (p = 0.0198). CONCLUSIONS: Rising MPV during hospitalization in STEMI patients treated with pPCI was associated with long-term mortality.

Massive transient pulmonary air embolism during permanent cardiac pacemaker implantation.

Pulmonary air embolism is a rare complication with a high probability of death. We present an air embolism case during permanent cardiac pacemaker implantation procedure. When the patient worsened hemodynamically, we saw a large air embolism in the main pulmonary trunk. Air embolism can be fatal, it is always iatrogenic, but is an avoidable complication.