Abdulah Alrifai

FOLFOX Induced Takotsubo Cardiomyopathy Treated with Impella Assist Device

Chemotherapy induced cardiotoxicity is becoming increasingly prevalent with several new agents being used recently. The incidence of Takotsubo cardiomyopathy due to 5-fluorouracil based chemotherapeutic regimens like FOLFOX is not uncommon. It is also seen with platinum based chemotherapy. Most of these patients have reversible cardiotoxicity and the cardiac function recovers within a short period with supportive treatment. Here we have a patient who presented with cardiogenic shock after 5 days of receiving FOLFOX regimen for colorectal adenocarcinoma. She was treated with a percutaneous left ventricular assist device, Impella CP, for hemodynamic support with excellent outcome.

Lower limb ischemia, Candida parapsilosis and prosthetic valve endocarditis

Learning points for clinicians We strongly recommend that when patients with prosthetic valve present with a serious embolism complication and large vegetation on echocardiogram, fungal endocarditis should be considered in the differential diagnosis. We emphasis on the importance of surgical intervention as it is generally regarded as the standard treatment in clinical practice. Infective endocarditis (IE) is a serious disease that can be observed in two different populations at risk: patients undergoing cardiac surgery and parenteral drug users. Fungal prosthetic valve endocarditis (PVE) is a rare infection that accounts for only 1.3–6% of all IE cases; however, it is a serious complication of valve replacement surgeries that has increased in incidence over the last two decades.1 We report a case of Candida parapsilosis endocarditis secondary to intravenous drug abuse in a female …

Recurrent angina from chronic coronary obstruction following transcatheter aortic valve implantation

Severe aortic stenosis and coronary artery disease often coexist. Coronary angiography (CA) and percutaneous coronary intervention (PCI) can be challenging in patients with prior transcatheter aortic valve implantation (TAVI). Depending on the type and position of the implanted valve, the procedure can be challenging or even unfeasible due to interference of diagnostic catheters and valve parts. The correct positioning of the TAVI prosthesis during TAVI was identified as an important factor with regard to the feasibility of subsequent CA or PCI. TAVI has been also associated with vascular, cerebrovascular and conduction complication. One is rare but life-threatening complication, coronary ostial obstruction. Coronary ostial obstruction can develop, especially if a safety check of more than 10 mm of coronary ostial height is not taken into consideration during TAVI. This complication can cause recurrent episodes of angina and can severely worsen the patient′s cardiac systolic function.

Trauma-Induced Conduction Disturbances

Background: Electrical disturbances following blunt cardiac injuries are rare but can be caused by electrical or structural damage to the heart. We present the case of a patient who had conduction abnormalities following blunt traumatic injury that were incidentally detected on telemetry. Case Report: A 64-year-old female with no history of cardiac disease was brought to the emergency department after a motor vehicle collision that resulted in chest wall bruising. The patient was found to have L-spine fractures and was admitted for observation. During her hospitalization, the patient had multiple episodes of heart block. A temporary pacemaker was inserted because of the recurrent episodes, and a dual-chamber permanent pacemaker was placed on day 4 of her hospitalization. Conclusion: Heart block as a consequence of blunt cardiac injury is rare; however, it needs to be recognized as early as possible. Permanent pacemaker placement is usually indicated for patients with prolonged or recurrent episodes.

Left Ventricular Aneurysm Presenting as Bidirectional Ventricular Tachycardia

Background: Bidirectional ventricular tachycardia is a rare form of ventricular arrhythmia, characterized by a changing of the mean QRS axis of 180 degrees. Digitalis toxicity is the most common cause of bidirectional ventricular tachycardia; other causes include myocarditis, aconite toxicity, metastatic cardiac tumor, myocardial infarction, and cardiac channelopathies. Case Report: A 73-year-old male with hypertension and a pacemaker implanted for sick sinus syndrome presented with a complaint of substernal chest pressure for several days. He also stated he had had an episode of near syncope. The patients physical examination was unremarkable; however, electrocardiogram demonstrated sustained bidirectional ventricular tachycardia. Echocardiogram showed severe anterior wall hypokinesis and an estimated ejection fraction of 35%, as well as an apical ventricular aneurysm. Electrophysiology study showed that the apical ventricular aneurysm was the site of the bidirectional arrhythmia. The patient was successfully treated with ventricular tachycardia ablation. Conclusion: This case is a unique example of a patient with bidirectional ventricular tachycardia originating from an apical left ventricular aneurysm that was treated successfully by ablation.

REDUCTION IN RADIATION AND CONTRAST DOSE IN TRANSCATHETER AORTIC VALVE REPLACEMENT OVER TIME: A SINGLE-CENTER EXPERIENCE

Transcatheter aortic valve replacement (TAVR) is recommended for severe aortic valve stenosis (AS). This study aims to evaluate the association between radiation dose, time and contrast dose in TAVR with improved experience over time. A Retrospective analysis of 570 patients with severe AS who

FEASIBILITY AND SAFETY OF USING A 29 MM EDWARDS SAPIEN 3 VALVE FOR TAVR IN PATIENTS WITH ANNULAR AREA LARGER THAN 683MM2

The Edwards Sapien 3 (S3) 29 mm valve has been used for transcatheter aortic valve replacement (TAVR) with good results in patients with Aortic annular areas up to 683 mm2. TAVR is not usually performed on patients with larger than FDA recommended annular areas of 540-683 mm2. These FDA

CRT-700.26 The Impact of Gradient and Flow on the Outcomes of TAVR in Severe Aortic Stenosis with Preserved Left Ventricular Ejection Fraction

While transaortic flow and gradient are important determinant of prognosis in patients with severe aortic stenosis treated medically or with surgical aortic valve replacement, it is unclear whether these echocardiographic values are still predictive of outcomes in patients with severe aortic

Successful Coronary Protection during TAVI in Heavily Calcified Aortic Leaflets in Patient with Short and Low Left Coronary System

Transcatheter aortic valve replacement has been recently approved for patients who are high or intermediate risk for surgical aortic valve replacement. The procedure is associated with several known complications including coronary related complications. Coronary obstruction is rare but disastrous complication, and it is associated with a high mortality rate. Coronary protection technique has emerged as a preemptive technique to avoid this complication. We present a case of successful coronary protection during TAVR in severely calcified left cusp in patient with short and low left ostium.

Dual Antiplatelet Therapy Versus Single Antiplatelet Therapy After Transaortic Valve Replacement: Meta-Analysis

BACKGROUND The current guidelines recommend empirical therapy with DAPT of aspirin and clopidogrel for six months after TAVR. This recommendation is based on expert consensus only. Giving the lack of clear consensus on treatment strategy following TAVR. Goal of this meta-analysis is to assess the efficacy and safety of mono-antiplatelet therapy (MAPT) versus dual antiplatelet therapy (DAPT) following transcatheter aortic valve replacement (TAVR). METHODS AND MATERIALS We performed a meta-analysis from randomized clinical trials (RCTs) and prospective studies that tested DAPT vs. MAPT for all-cause mortality and major bleeding of 603 patients. The primary efficacy outcomes were 30 days mortality and stroke. The primary safety outcomes were major bleeding and major vascular complications. RESULTS We included 603 patients from 4 studies. The use of MAPT was associated with similar mortality rate (5.9% vs. 6.6%; RR = 0.92; 95% CI 0.49-1.71; P = 0.68) and stroke rate compared with DAPT (1.3% vs. 1.3%; RR 1.04; 95% CI 0.27 to 4.04; P = 0.81). There was no difference in major vascular complication (4.2% vs. 8.9%; RR 0.52; 95% CI 0.23 to 1.18; P = 0.17) or minor vascular complication (4.2% vs. 7.3%; RR 0.58; 95% CI 0.25 to 1.34; P = 0.14). However, MAPT was associated with significantly less risk of major bleeding (4.9% vs. 14.5%; RR 0.37; 95% CI 0.20 to 0.70; P < 0.01) but no difference in minor bleeding (4.2% vs. 3.6%; RR 1.16; 95% CI 0.43 to 3.10; P = 0.85). CONCLUSION MAPT use after TAVR is associated with lower rates of major bleeding compared with DAPT with no significant difference in mortality, stroke or vascular complications.