Diana Zakarkaite

Non-invasive evaluation of myocardial reperfusion by transthoracic Doppler echocardiography and single-photon emission computed tomography in patients with anterior acute myocardial infarction

BackgroundThe study was designed to evaluate whether the preserved coronary flow reserve (CFR) 72 hours after reperfused acute myocardial infarction (AMI) is associated with less microvascular dysfunction and is predictive of left ventricular (LV) functional recovery and the final infarct size at follow-up.MethodsIn our study, CFR was assessed by transthoracic Doppler echocardiography (TDE) in 44 patients after the successful percutaneous coronary intervention during the acute AMI phase. CFR was correlated with contractile reserve assessed by low-dose dobutamine echocardiography and with the total perfusion defect measured by single-photon emission computed tomography 72 hours after reperfusion and at 5 months follow-up. The ROC analysis was performed to determine test sensitivity and specificity based on CFR. Categorical data were compared by an χ2 analysis, continuous variables were analysed with the independent Students t test. In order to analyse correlation between CFR and the parameters of LV function and perfusion, the Pearson correlation analysis was conducted. The linear regression analysis was used to assess the relationship between CFR and myocardial contractility as well as the final infarct size.ResultsWe estimated the CFR cut-off value of 1.75 as providing the maximal accuracy to distinguish between patients with preserved and impaired CFR during the acute AMI phase (sensitivity 91.7%, specificity 75%). Wall motion score index was better in the subgroup with preserved CFR as compared to the subgroup with reduced CFR: 1.74 (0.29) vs. 1.89 (0.17) (p < 0.001) during the acute phase and 1.47 (0.30) vs. 1.81 (0.20) (p < 0.001) at follow-up, respectively. LV ejection fraction was 47.78% (8.99) in preserved CFR group vs. 40.79% (7.25) in impaired CFR group (p = 0.007) 72 hours after reperfusion and 49.78% (8.70) vs. 40.36% (7.90) (p = 0.001) after 5 months at follow-up, respectively. The final infarct size was smaller in patients with preserved as compared to patients with reduced CFR: 5.26% (6.14) vs. 23.28% (12.19) (p < 0.001) at follow-up.ConclusionThe early measurement of CFR by TDE can be of high value for the assessment of successful reperfusion in AMI and can be used to predict LV functional recovery, myocardial viability and the final infarct size.

A Double-Orifice Tricuspid Valve Associated With a Divided Right Atrium

Right atrioventricular valve duplication is a rare congenital anomaly with only isolated cases of a double-orifice tricuspid valve having been described. This article presents a case of the surgical repair of a double-orifice tricuspid valve associated with a divided right atrium, a ventricular septal defect, and Wolff-Parkinson-White syndrome.

TCT-42 Transcatheter echo guided Mitral Valve Repair with Neochord Implantation for posterior leaflet disease: Results from Neochord Independent International Registry

Transapical off-pump mitral valve repair with neochordae implantation (TOP-MINI) is an innovative procedure to treat degenerative mitral valve regurgitation (MR). Assess initial results of the Neochord Independent International Registry (NIIR) for isolated treatment of posterior mitral leaflet (PML

An early European experience with transapical off-pump mitral valve repair with NeoChord implantation†

OBJECTIVES Transapical off-pump NeoChord repair is a novel minimally invasive surgical procedure to treat degenerative mitral valve regurgitation. The aim was to evaluate 1-year clinical results of the NeoChord procedure in a consecutive cohort of patients. METHODS Between February 2013 and July 2016, 213 patients were enrolled in the NeoChord Independent International Registry. All patients presented severe mitral regurgitation due to flail/prolapse of 1 or both leaflets, and they all completed postoperative echocardiographic assessment up to 1 year. We identified the primary end point as composed of procedural success, freedom from mortality, stroke, reintervention, recurrence of severe mitral regurgitation, rehospitalization and decrease of at least 1 New York Heart Association functional class at 1-year follow-up. We also compared outcomes according to the anatomical classification (Type A: isolated central posterior leaflet disease; Type B: posterior multisegment disease; Type C: anterior, bileaflet, paracommissural disease with/without leaflet/annular calcifications). RESULTS The median age was 68 years (interquartile range 56-77), and the median EuroSCORE II was 1.05% (interquartile range 0.67-1.76). The number of Type A, B and C patients was 82 (38.5%), 98 (46%) and 33 (15.5%), respectively. Procedural success was achieved in 206 (96.7%) patients. At 1-year follow-up, overall survival was 98 ± 1%. Composite end point was achieved in 84 ± 2.5% for the overall population and 94 ± 2.6%, 82.6 ± 3.8% and 63.6 ± 8.4% in Type A, Type B and Type C patients, respectively (P < 0.0001). CONCLUSIONS These results demonstrate that the NeoChord procedure is safe, effective and reproducible. Clinical and echocardiographic efficacy is maintained up to 1 year with significant differences among the anatomical groups. Specific anatomical selection criteria are necessary to achieve stable results.

Occlutech® Paravalvular Leak Device (PLD)

Since the first reported use of the double-umbrella Rashkind device [1] in 1992, transcatheter paravalvular leak (PVL) closure has been performed extensively by many centers around the world.

Fusion of real-time 3D transesophageal echocardiography and cardiac fluoroscopy imaging in transapical catheter-based mitral paravalvular leak closure

Corresponding author: Aleksejus Zorinas, Heart Surgery Centre, Vilnius University Hospital Santariskiu Klinikos, Santariskiu 2, 08406 Vilnius, Lithuania, phone: +370 52365000, fax: +370 52365111, mobile: +370 698 29079, e-mail: aleksejus.zorinas@santa.lt Received: 11.04.2017, accepted: 17.06.2017. Fusion of real-time 3D transesophageal echocardiography and cardiac fluoroscopy imaging in transapical catheter-based mitral paravalvular leak closure

Isolated mitral valve P3 prolapse with severe regurgitation – transoesophageal 2D/3D echo-guidance in transapical -artificial neochordae implantation in challenging patient

Received 12 April 2016; revision accepted for publication 30 May 2016. A 60-year-old man without significant medical history was admitted due to a loud heart murmur and increasing exercise intolerance. Transthoracic (TTE) and transoesophageal (TEE) 2D, and real-time 3D echocardiography revealed a large coaptation defect of mitral valve (MV) leaflets caused by P3 prolapse with chordal rupture (figure 1 A, D-arrows). We diagnosed severe mitral regurgitation with a wide eccentric jet in colour Doppler (figure 1B), vena contracta width approximately 7 mm, volume > 60 ml, systolic pulmonary vein flow reversal and left atrium enlargement. There was no significant annular dilatation (syst. 37 mm/diast. 39 mm and mitral annulus/anterior leaflet ratio approximately 1.3 in LAX). Coronary angiography showed no significant lesions in the arteries. The patient was qualified for an innovative minimally invasive surgical procedure of transapical beating-heart implantation of polytetrafluoroethylene neochordae with the NeoChord DS1000 system, through a mini-thoracotomy without cardiopulmonary bypass. Under TEE 2D/3D guidance the Isolated mitral valve P3 prolapse with severe regurgitation – transoesophageal 2D/3D echo-guidance in transapical artificial neochordae implantation in challenging patient

Challenging diagnosis of prosthetic infective endocarditis and para-aortic conduit abscess – the role of multimodality approach

A 55-year-old man with a 1-year history of Benthal-deBonn procedure presented with febrile fever and chill. Physical examination showed hypotension and tachycardia, blood examination – anaemia and increased inflammatory markers. After inconclusive transthoracic echocardiography (TTE), we performed transoesophageal echocardiography (TEE) that revealed normally functioning aortic mechanical prosthesis, mobile echodense masses attached to the prosthetic ring (Figure 1(A), arrow), the hypoechogenic areas around the posterior wall of the ascending aorta conduit (AAC) (Figure 1(A–C), white asterisks) and the anterior wall of the AAC distal part (Figure 1(D), white asterisk), the hyperechogenic areas compatible with inflammation (Figure 1(B,C), black asterisks) around the left coronary artery (Figure 1(C), arrow) and the anterior wall of AAC. On CMR T2 haste sequence with fat suppression, the encapsulated and septated fluid around the AAC (Figure 1(E), arrows) with bilateral pleural effusion (Figure 1(E), white asterisks) was observed. The capsule was enhanced in post-contract T1 vibe sequence with fat suppression (Figure 1(F), arrows). Despite the antimicrobial treatment (AT) based on Staphylococcus aureus positive blood cultures, infection was not controlled and the patient underwent reoperation. Intraoperative findings confirmed the diagnosis of PVE and para-aortic conduit abscess (PACA). Aortic root, ascending aorta and aortic valve replacement with biological valve conduit and PACA debriding surgery was performed. After long-term specific AT, surgical wound drainage and irrigation the patient was discharged and had an uneventful 6 months’ clinical follow-up. The diagnosis of PVE could be challenging and often requires multimodality approach. On MR T2weighted with fat suppression images, the central portion of the abscess is usually hyperintense, but the capsule may display isointense or hypointense signal intensity relative to skeletal muscle (Figure 1(E)). After intravenous contrast medium injection in T1-weighted sequence, a peripheral rim of hyperenhancement is seen, corresponding to the inflammatory and cellular component of the abscess (Figure 1(F)). Thus, CMR offers the opportunity to characterize the para-aortic fluid accumulations by differentiating between abscess and non-abscessed accumulation of fluid. In summary, CMR primarily can be used for the evaluation of complications of PVE such as paravalvular and myocardial abscesses and infectious pseudoaneurysms but is less accurate than TTE and TEE for identifying valvular vegetations.

Off pump mitral valve repair

The NeoChord DS1000 is a disposable device used to replace damaged chordae by delivering artificial chordae tendinae in a beating heart through small anterolateral thoracotomy. It gives alternative approach in treating degenerative mitral valve insufficiency.

Off pump implantation of artificial chordae to correct mitral regurgitation – early results

Background New technologies for mitral valve repair are emerging. One of them is NeoChord DS1000 system (Neochord, Inc., Minneapolis, MN). This device is designed to deliver artificial chordae tendinae to mitral valve leaflets on a beating heart through left ventricle wall. This is our initial experience with this device. Methods This data is part of multi-center, nonrandomized, prospective Transapical Artificial Chordae Tendinae [TACT] trial. 13 patients with severe mitral regurgitation caused by isolated posterior mitral valve leaflet prolapse, were included in the study. The operation was done through left anterolateral thoracotomy on a beating heart. With TEE guidance, the NeoChord DS1000 was introduced into the left ventricle. The prolapsing segment was grasped with the device and ePTFE suture was attached to the posterior leaflet. Six patients received 2 ePTFE sutures to achieve competence of mitral valve, four patients - 3 ePTFE sutures, and two patients - 4 ePTFE sutures. At six months follow up all patients had TTE. Results Median duration of operation was 110 min (80 to 150 min). Less than second degree mitral regurgitation in six months was achieved in 11 (85%) patients. 1 (8%) patient has developed recurrent third degree mitral regurgitation in one month. 1 (8%) patient has been converted to conventional mitral valve repair during procedure. There were no other adverse events related to the procedure. Conclusions Treatment of mitral regurgitation by off-pump implantation of artificial chordae using NeoChord device is feasible and safe method in selected group of patients. To evaluate long term results and improve patient selection more patients and later follow up data are needed. Trial registration ClinicalTrials.gov ID: NCT01777815.