Comparing Clinical and Hemodynamic Parameters between the Two Aortic Valve Replacement in Patients with Severe Aortic Stenosis.

Context: Various techniques have been proposed for suturing following prosthetic aortic valve implantation, but each has its potential side effects such as patient-prosthesis mismatch (PPM) and paravalvular leak (PVL). Aims: In the present study, we aimed to compare the postoperative sequels of aortic valve replacement (AVR) following the use of two suturing techniques including from the inside of the aorta as the common and classic suturing techniques as compared to new approach including from the outside of the aorta. Settings and Design: This cross-sectional study was performed on patients suffering from symptomatic severe aortic valve disease and candidates for AVR in one of three referral hospitals for cardiovascular disease patients in Shiraz from 2019-2021. Subjects and Methods: The patients underwent one of the two considered surgical techniques for AVR including traditional approach (n = 60) or the tested approach (suturing from the outside of the aorta) (n = 30). Statistical Analysis Used: For statistical analysis, results were presented as mean ± standard deviation for quantitative variables and were summarized by frequency (percentage) for categorical variables. Results: PVL and PPM were revealed in none of the participants undergoing the tested approach, while the pointed complications were found in 41.7% and 25.0% of patients underwent traditional approach, respectively, indicating a significant difference. There was no evidence of abnormal dimensionless valve index (DVI) in the patients undergoing sutures from outside the aorta, whereas the rate of DVI abnormality in the patients undergoing traditional procedures was shown to be 18.3%. The mean aortic valve gradient was significantly higher in the group scheduling for the traditional surgical method. Conclusions: Applying new suturing method as suturing from the outside of the aorta, due to the selection of appropriate valve size, the risk for adverse consequences including PPM, PVL, or DVI can be significantly reduced.

The value of QRS onset of the outflow tract PVC in V1 and V2 leads recorded in fourth, third, and second intercostal spaces to differentiate main origins of premature ventricular contraction-A prospective cohort study.

Background: Electrocardiography (ECG) is now proposed as a simple and cost-effective tool to determine the location of arrhythmias before ablation. We aimed to examine the value of the QRS onset of outflow tract PVC in V1 and V2 leads recorded in fourth, third, and second intercostal spaces to differentiate two main origins for premature ventricular contraction (PVC) including right ventricular outflow tract (RVOT) and left ventricular outflow tract (LVOT). Methods: In this prospective cohort study, a total of 58 patients were studied, from whom a surface ECG was obtained using V1 and V2 leads in the fourth, third, and second intercostal spaces. ECG and Electrophysiology studie (EPS) data were then recorded and compared to determine the sensitivity and specificity of QRS onset in locating arrhythmias. The reciever operating characterictic (ROC) curve analysis was applied to test diagnostic performance. Results: Based on the time of PVC initiation in each of the V1 and V2 leads in the fourth intercostal space, if PVC is recorded earlier in the V1 lead, its source in 95.8% of the patients is RVOT and if PVC preceded the V2 lead, 70.59% of the patients had PVC from LVOT. Comparing of QRS onset in V1 and V2 leadsrecorded from third% and and second intercostal spaces had considerable sensitivity and specificity to determine the origin of the outflow tract PVC (81.82 and 94.12%, respectively). Conclusion: Simultaneous recording of outflow tract PVCs from second third and fourth intercostal spaces and comparing their onset can determine the left and right outflow tract PVCs with high sensitivity and specificity.

A Novel Technique for Managing Guidewire-Induced Distal Coronary Perforation Using Coronary Balloon Pieces.

We report the case of a 49-year-old female patient who underwent percutaneous coronary intervention of the right coronary and posterior descending arteries complicated with guidewire-induced coronary artery perforation. We successfully managed and sealed this perforation through the embolization of balloon pieces into the target vessel. (Level of Difficulty: Advanced.).

aVR ST-segment changes and prognosis of ST-segment elevation myocardial infarction.

BACKGROUND: Clinical importance of aVR lead-related changes in predicting the prognosis of acute myocardial infarction remains uncertain. The present study aimed to assess the value of ST-segment changes in aVR lead and the outcome and sequels of the first episode of acute ST-segment elevation myocardial infarction. METHODS: This prospective cohort study was conducted on patients suffering first episode of ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Information was collected through hospital-recorded files reading. The electrocardiogram (ECG) was taken from the patients upon entering the hospital and followed-up for 30 days to assess cardiovascular complications. RESULTS: In patients with anterior STEMI, with the use of multivariate analysis, admission aVR ST elevation ≥1 mm was found to be a strong and independent predictor of major cardiovascular adverse events (MACE) within 30 days of discharging (P value for trend .002). In patients with inferior (± RV) ST-segment elevation myocardial infarction (STEMI), with the use of multivariate analysis, admission aVR ST depression ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging (P value for trend .01). CONCLUSION: In patients with anterior STEMI, admission aVR STE ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging. On the other hand, in patients with inferior STEMI, aVR ST depression ≥1 mm was found to be a strong and independent predictor of MACE within 30 days of discharging.

Significance of ST-Segment elevation in V4R lead in patients with anterior myocardial infarction.

BACKGROUND: There is some evidence of the association between ST-segment elevation in the V4R chest lead and the likelihood of anterior wall myocardial infarction; however, the link of this phenomenon with the location and the severity of the coronary involvements in such patients remains uncertain. We aimed to investigate the ST-segment elevation in V4R leads in patients with anterior myocardial infarction and also its effect on prognosis as well as the detection and prediction of the location of arterial stenosis in coronary angiography. METHODS: Data collection was performed by reviewing the hospital recorded files of 195 patients' suspicion of acute myocardial infarction who have been referred within 2 h of the onset of cardiac symptoms. The patients were then categorized into two groups with and without ST elevation in the V4R chest lead. RESULTS: Comparing two groups showed a significantly higher rate of concurrent ST-segment elevation in V1 lead in those with ST-segment elevation in V4R. Echocardiography on the day after anterior myocardial infarction showed LVEF <40% in 74% and 35.2% of patients with and without ST-segment elevation in V4R, respectively, indicating a significant difference. The lesions on proximal LAD were more common in the group with ST-segment elevation in V4R. CONCLUSION: Our study emphasized a high likelihood of ST-segment elevation in V4R lead concurrently with ST-elevation in V1 lead. Also, the appearance of ST-segment elevation in V4R lead can be accompanied with a lower LVEF, myocardial infarct size, involvement of proximal part of LAD, and Wrap around LAD.

Signal averaged ECG in patients with early repolarization.

BACKGROUND: Early repolarization (ER) pattern is diagnosed when the J-point is elevated on the patient's electrocardiogram. The aim of this study was to evaluate signal-averaged electrocardiography (SAECG) in patients with ER pattern. METHODS: Subjects were divided into three groups: 1-patients with normal ECG pattern (control group); 2-patients with J-point elevation in the inferior leads; and 3-patients with J-point elevation in non-inferior leads. RESULTS: The mean filtered QRS duration in groups with J-point elevation in inferior leads and non-inferior leads and in the control, was 86.4 ± 23.4 msec, 84.8 ± 26.6 msec, and 85.8 ± 24.8 msec, respectively, indicating no significant difference across the three groups. The mean duration of terminal QRS < 40µV was 21.2 ± 4.2 msec, 22.8 ± 4.6 msec, and 23.1 ± 4.5 msec in the mentioned groups, respectively, without a significant difference between the groups. Additionally, the mean root-mean-square voltage of terminal 40 msec was 34.5 ± 8.3 µV, 35.3 ± 8.6µV, and 35.7 ± 9.2 µV in patients with increased J-point in inferior leads, non-inferior leads, and the control group, respectively, showing no difference between the groups. CONCLUSION: In conclusion, we found that parameters in SAECG did not have any significant difference between patients with ER pattern and healthy individuals. Moreover, we concluded that SAECG cannot distinguish the patients with elevated J-point in inferior leads from non-inferior leads. Overall, SAECG does not appear to be a reliable diagnostic tool for the assessment of ER pattern.