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Nonsurgical Transcatheter Treatment
Published in Takahiro Shiota, 3D Echocardiography, 2020
Takahiro Shiota, Hiroki Ikenaga, Hiroto Utsunomiya
After TAVR, paravalvular aortic valve regurgitation (AR) is considered to be an ominous prognostic factor when its degree is greater than mild. Echocardiography is most widely used for determining the severity of AR, but it has not yet been established for determining the degree of paravalvular leak after TAVR.9 Newer types of the TAVR valves, such as the SAPIEN 3, have been developed with successful reduction of paravalvular AR and improved outcomes.10 When more than moderate AR is found, a plugging procedure can be performed immediately in the catheterization laboratory. 3D echocardiography has increased the feasibility of percutaneous approaches for the management of paravalvular regurgitation.11 Transcatheter repair of paravalvular leak after TAVR with or without 3D imaging can be safely and effectively accomplished, leading to reduction in hospitalizations, improvement in symptoms, and improvement in long-term survival rates.12 As seen in Figure 14.2, real-time 3D TEE could show the location of the catheter at the leaking site (Figure 14.2B), resulting in the successful reduction of the post-TAVR paravalvular leak (Figure 14.2A through 14.2 C, ). In this situation, as seen in Figure 14.2A and C, simultaneous 2D TEE biplane imaging as a part of 3D echocardiographic capabilities is of great value and should be applied for the detection of the leakage size and location with color Doppler in the catheterization laboratory.
Cardiac catheterization
Published in Neeraj Parakh, Ravi S. Math, Vivek Chaturvedi, Mitral Stenosis, 2018
Raghav Bansal, Ganesan Karthikeyan
Apart from recording chamber pressures, analysis of pressure waveforms in the catheterization laboratory remains important for assessment of lesion severity and for a complete understanding of the associated hemodynamic derangements. Immediate changes in the left atrial (LA) and left ventricular (LV) pressure tracings following PTMC provide clues to assessing the success of the procedure and to detect the occurrence of mitral regurgitation (MR), which is an important complication of the procedure. This chapter will discuss the hemodynamic consequences of MS and the immediate changes following PTMC.
Bioresorbable vascular scaffold in ST-segment elevation myocardial infarction: Clinical evidence, tips, and tricks
Published in Yoshinobu Onuma, Patrick W.J.C. Serruys, Bioresorbable Scaffolds, 2017
Giuseppe Giacchi, Manel Sabaté
Case #2: A 29-year-old male patient was emergently sent to the catheterization laboratory. Coronary angiography showed thrombotic lesion on the left anterior descending artery (black rim Figure 7.7.3a). OCT was performed, revealing a critical stenosis with high thrombus burden, composing multiple small channels (Figure 7.7.3b). An Absorb 3.0/18 mm was delivered, with good scaffold expansion and apposition, no signs of edge dissection, and TIMI 3 flow (Figure 7.7.3c and d).
Congenital heart disease: addressing the need for novel lower-risk percutaneous interventional strategies
Published in Expert Review of Cardiovascular Therapy, 2023
N Linnane, DP Kenny, ZM Hijazi
Novel percutaneous catheter techniques have evolved to manage these high-risk and vulnerable patients, specifically low-weight and premature babies, with newer devices and techniques. However, risk is not limited to low-weight and premature babies, and it is important to note that there are multiple interventions performed in children and young adults with congenital heart disease who have a high risk, for example pulmonary valve replacement. While surgical pulmonary valve replacement has good outcomes with low rate of complications, repeat sternotomies and cardiopulmonary bypass episodes increase risk in the congenital cardiac patient. The transcatheter option has evolved to reduce this risk, not so much by reducing the risk of the procedure, but more so reducing the risk of repeat sternotomy, repeat cardiopulmonary bypass episodes, and the increased hospital length of stay. Thus, when considering risk reduction, the entirety of a patient’s care needs to be considered and not just the procedure itself. Also, risk cannot be completely removed and understanding this and reflecting on it is key to maintaining safety in the catheterization laboratory.
Optimizing a MitraClip procedure with high frequency jet ventilation
Published in Baylor University Medical Center Proceedings, 2023
Manesh Kumar Gangwani, Fawad Haroon, Fnu Priyanka, Anthony Sonn
The procedure was performed in the catheterization laboratory with the patient under general anesthesia. Two- and three-dimensional TEE was used for guidance of the catheter during the MitraClip procedure. A 7 French sheath was placed in the right common femoral vein, followed by dilation up the vein. This was followed by transseptal puncture, and an optimal puncture site was located using TEE. This allowed advancement of the steerable guide catheter into the left atrium. Once the catheter was in the left atrium, maneuvering to the correct position for clip deployment was challenging due to the patient’s valve anatomy and cardiac movement artifact caused by respiratory variations. Three-dimensional echocardiographic imaging was used to determine the appropriate predeployment approach for direction, orientation, and trajectory. It was technically difficult to grasp the posterior leaflet for MitraClip deployment in two attempts. As a result, HFJV was utilized to stabilize the surgical field and reduce motion artifact. The clip was then moved to the correct position below the mitral valve. Once this was accomplished, the leaflet was successfully grasped, the result was assessed using TEE imaging, and the clip was successfully released (Figure 1h).
Update on shunt closure in neonates and infants
Published in Expert Review of Cardiovascular Therapy, 2021
Karim A. Diab, Younes Boujemline, Ziyad M. Hijazi
The peratrial (hybrid) technique for ASD closure can be more helpful particularly in small infants. This is particularly true in those with a weight of <3.5 kg, patients with other medical problems making surgical repair a high risk (e.g. bronchopulmonary dysplasia), or those need other simultaneous interventions such as perventricular ventricular septal defect closure. In addition, to avoiding cardiopulmonary bypass, the peratrial technique provides other advantages including avoiding damage to the femoral vessels and providing a perpendicular angle to the atrial septum that helps avoiding prolapse of the left atrial disc into the right atrium. This procedure can be performed either in the catheterization laboratory or in the operating room. In this approach, a minimal lower sternotomy is performed after full evaluation of the ASD by echocardiography. The right atrial wall is then punctured with an 18-gauge needle through which a wire is passed to the left atrium. The dilator and the introducing sheath are then placed in the mmid-left atrium. Confirmation of the position of the sheath is then performed by injecting agitated saline bubbles into the left atrium. The device is then loaded into the sheath and the left disc is deployed first followed by the right disc. The position of the device is then confirmed by echocardiography before the device is released.