Abdallah El Sabbagh

Three-dimensional prototyping for procedural simulation of transcatheter mitral valve replacement in patients with mitral annular calcification

Three‐dimensional (3D) prototyping is a novel technology which can be used to plan and guide complex procedures such as transcatheter mitral valve replacement (TMVR).

Direct transatrial implantation of balloon-expandable valve for mitral stenosis with severe annular calcifications: early experience and lessons learned

OBJECTIVES Patients with symptomatic severe mitral annular calcification present a therapeutic challenge. Direct transatrial implantation of SAPIEN valve has emerged as an alternative to surgical mitral valve (MV) replacement for high-risk surgical candidates. METHODS This series includes 6 consecutive patients with symptomatic severe mitral annular calcification deemed to be at high risk for standard surgery. All patients underwent direct transatrial implantation of balloon-expandable SAPIEN valve in the mitral position. RESULTS Mean age was 81 years [3 (50%) female], with an average Society of Thoracic Surgeons score of 10.3%. All patients had at least New York Heart Association Class III symptoms. Procedure was performed using normothermic cardiopulmonary bypass. The MV was approached through a standard left atriotomy in 4 patients and via a vertical trans-septal approach in the remaining 2 patients. Resection of the anterior leaflet of the MV was performed in 4 patients. The valve was successfully deployed in all patients. The diastolic mean gradient across the MV decreased from an average of 14 ± 3 to 5 ± 1 mmHg post deployment. There was no left ventricular outflow tract obstruction. MV periprosthetic regurgitation was severe in 3 patients and moderate to severe in 1 patient. In-hospital mortality occurred in 3 (50%) patients due to a non-cardiac cause in 1 patient and cardiogenic shock in the other 2 patients. CONCLUSIONS Early experience with direct transatrial balloon-expandable implantation for severe mitral annular calcification revealed feasibility of this approach but significant morbidity and mortality primarily related to periprosthetic regurgitation that requires further refinement of the technique.

Novel Treatment of Residual Peri-MitraClip Regurgitation With an Amplatzer Vascular Plug II

Significant residual mitral regurgitation (MR) may persist after MitraClip (Abbott Vascular, Santa Clara, California) implantation in up to 7% of patients with degenerative MR [(1)][1]. Treatment of the residual MR with an adjacent MitraClip may not be feasible, because of commissural location,

3D-Printing: Applications in Cardiovascular Imaging

AbstractPurpose of Review The current state of three-dimensional (3D) printing for cardiovascular applications will be reviewed in this article with a special emphasis placed on recent updates on the use of 3D printing.Recent FindingsCardiovascular imaging has been shown to be beneficial for planning congenital heart, valvular and other structural heart, and vascular disease treatments. 3D printing has seen increased use for education, including procedural simulation which may fundamentally change how proceduralists are trained in the future. 3D bioprinting is an emerging field of 3D printing that has the potential to revolutionize therapy, although additional development is needed to fully reach this potential. Finally, because of the increased use of 3D printing, there is an increased emphasis on regulation and quality.SummaryCardiovascular 3D printing has undergone rapid growth in the past several years and has influenced current cardiovascular therapy and, with future advancements, will aid in further improving therapies.

The art of presentation: a valuable skill in a contemporary era.

The expectation among fellows today is not only to be clinically competent, but also to participate in research. During their training, fellows will invariably have to give presentations within their institutions or at meetings for professional societies. Unfortunately, little time is spent teaching

Mitral Valve Regurgitation in the Contemporary Era: Insights Into Diagnosis, Management, and Future Directions

Mitral valve regurgitation (MR) is the most common valvular heart disease. Primary MR is a disease of the mitral valve apparatus, whereas secondary MR is a disease of the left ventricle. Diagnosing and managing MR is often challenging and requires a structured approach, integrating findings on history, physical examination, and imaging. Decisions regarding treatment depend on knowledge of the etiology, natural history, and outcome of interventions for these patients with mitral valve disease. The optimal timing of intervention requires a comprehensive 2-dimensional and Doppler echocardiogram in each patient to determine the cause of the mitral valve disease, the severity of the regurgitation, and the effect of the volume overload on the left ventricle, as well as determining if a durable valve repair can be performed. Advances in both surgical and catheter-based therapies have resulted in recommendations for lower thresholds for operation and extension of interventional treatments to the older, sicker population of patients with MR. The current review discusses the pathophysiological rationale for current diagnostic and management strategies in MR.

Cardiac Myxoma: The Great Mimicker

Cardiac myxoma is the most common primary cardiac neoplasm in adults. They most commonly arise within the left atrium, but may arise from other cardiac chambers, rarely from the valves. Histologically, cardiac myxomas consist of lepidic (“myxoma”) cells within a myxoid stroma. They can be of

Current Treatment Strategies for Tricuspid Regurgitation

Purpose of ReviewTricuspid regurgitation is common; however, recognition and diagnosis, clinical outcomes, and management strategies are poorly defined. Here, we will describe the etiology and natural history of tricuspid regurgitation (TR), evaluate existing surgical outcomes data, and review the evolving field of percutaneous interventions to treat TR.Recent FindingsPreviously, the only definitive corrective therapy for TR was surgical valve repair or replacement which is associated with significant operative mortality. Advances in percutaneous valve repair techniques are now being translated to the tricuspid valve. These novel interventions may offer a lower-risk alternative treatment in patients at increased surgical risk.SummarySignificant TR adversely impacts survival. Surgery remains the only proven therapy for treatment of TR and may be underutilized due to mixed outcomes data. Early experience with percutaneous interventions is promising, but large clinical experience is lacking. Further study will be required before these therapies are introduced into broader clinical practice.

Hypertrophic Obstructive Cardiomyopathy and Uncontrolled Hypertension : A Therapeutic Challenge

Hypertrophic obstructive cardiomyopathy and concomitant systemic hypertension can present a challenging diagnostic and therapeutic dilemma. Symptoms can occur from increased afterload from both dynamic outflow obstruction as well as the elevated systemic vascular resistance. Treatment of systemic

Percutaneous Stenting of a Left Ventricular Assist Device Outflow Kink

A 70-year old man with end-stage ischemic cardiomyopathy status post HeartMate II (Thoratec, Pleasanton, California) left ventricular assist device (LVAD) implantation as destination therapy presented with recurrent gastrointestinal bleeding. He was seen by gastroenterology and had a work-up that