Joerg Kellermair

Subcutaneous Double "Purse String Suture"-A Safe Method for Femoral Vein Access Site Closure after Leadless Pacemaker Implantation.

Leadless cardiac pacemaker (LCP) requires large‐caliber venous sheaths for device placement. Sheath sizes for these procedures vary from 18‐ to 23‐French (F). The most common complications are hematomas, pseudoaneurysms, and arteriovenous fistulas. Complete and secure closure of the venous access is an important step at the end of such a procedure.

Characterization of Von Willebrand Factor Multimer Structure in Patients With Severe Aortic Stenosis

Acquired von Willebrand syndrome (AVWS) associated with severe aortic stenosis (AS) has been frequently subclassified into a subtype 2A based on the deficiency of high-molecular-weight (HMW) multimers as it is seen in inherited von Willebrand disease (VWD) type 2A. However, the multimeric phenotype of VWD type 2A does not only include an HMW deficiency but also a decrease in intermediate-molecular-weight (IMW) multimers and an abnormal inner triplet band pattern. These additional characteristics have not been evaluated in AVWS associated with severe AS. Therefore, we recruited N = 31 consecutive patients with severe AS and performed a high-resolution Western blot with densitometrical band quantification to characterize the von Willebrand factor (VWF) multimeric structure and reevaluate the AVWS subtype classification. Study patients showed an isolated HMW VWF multimer deficiency without additional abnormalities of the IMW portions and the inner triplet structure in 65%. In conclusion, the multimeric pattern of AVWS associated with severe AS does neither resemble that seen in AVWS type 2A nor that seen in inherited VWD type 2A. Therefore, a subclassification into a type 2A should not be used.

Economic assessment of traditional surgical intervention versus use of a new innovative radiofrequency based surgical system in device replacements

Introduction Intra-operative complications like mechanical damages to the leads, infections and hematomas during generator replacements of implantable pacemakers and defibrillators contribute to additional costs for hospitals. The aim of this study was to evaluate operation room use, costs and budget impact of generator replacements using either a traditional surgical intervention (TSI) with scissors, scalpel and electrocautery vs. a new radiofrequency energy based surgical system, called PEAK PlasmaBladeTM (PPB). Materials and methods We conducted a retrospective analysis of a population including 508 patients with TSI and 254 patients with PPB who underwent generator replacement at the Kepler University Hospital in Linz or the St. Josef Hospital in Braunau, Austria. The economic analysis included costs of resources used for intra-operative complications (lead damages) and of procedure time for TSI vs. PPB. Results Proportion of males, mean age and type of generator replaced were similar between the two groups. Lead damages occurred significantly more frequent with TSI than with PPB (5.3% and 0.4%; p< 0.001) and the procedure time was significantly longer with TSI than with PPB (47.9±24.9 and 34.1±18.1 minutes; p<0.001). Shorter procedure time and a lower rate of lead damages with PPB resulted in per patient cost savings of €81. Based on estimated 2,700 patients annually undergoing generator replacement in Austria, the use of PPB may translate into cost savings of €219,600 and 621 saved operating facility hours. Conclusion PPB has the potential to minimize the risk of lead damage with more efficient utilization of the operating room. Along with cost savings and improved quality of care, hospitals may use the saved operating room hours to increase the number of daily surgeries.

Reversible impairment of coronary flow reserve in acute myocarditis

Acute myocarditis is accompanied by an impaired coronary microcirculation. These microcirculatory disturbances are not well defined, and data are derived from complex invasive measurements. Therefore, this study aimed to evaluate the inflammation‐induced microcirculatory dysfunction including its reversibility and association with markers of inflammation severity (extent of LGE on CMR imaging and laboratory markers of myocardial necrosis) using the noninvasive technique of echocardiographic CFR measurement.

High-Molecular-Weight von Willebrand Factor Multimer Ratio: A Novel Biomarker for Low-Flow, Low-Gradient Aortic Stenosis Subclassification

Low-flow, low-gradient (LF/LG) aortic stenosis (AS) is a diagnostic dilemma [(1)][1] as routine work-up remains challenging. Dobutamine stress echocardiography (DSE) and multidetector computed tomography (MDCT) represent accepted imaging modalities for further subcategorization into a true severe (

Monocenter Investigation Micra® MRI study (MIMICRY): feasibility study of the magnetic resonance imaging compatibility of a leadless pacemaker system

Aims As in vivo real-life data are still scarce, we conducted a study to assess the safety and feasibility of cardiac magnetic resonance imaging (MRI) in patients with a leadless pacemaker system. Methods and results In this prospective non-randomized interventional trial, we enrolled 15 patients with an MRI conditional Micra® leadless pacemaker system to undergo either a 1.5 T or 3.0 T cardiac MRI scan. Clinical adverse events as well as device parameters such as pacing threshold, sensing, impedance, and battery life were assessed at baseline as well as 1 and 3 months after the scan. Device parameter changes between different time points were tested for statistical significance and compared with pre-set cut-off values. Fourteen patients underwent the cardiac MRI scan according to the protocol as well as the scheduled follow-up visits. One participant was excluded from analysis, as the MRI scan was not possible because of severe claustrophobia. Other clinical events did not occur during the scan and the follow-up period. Device parameters stayed stable and changes during the observational period were statistically not significant (changes vs. baseline: pacing threshold: 0.01 ± 0.05 V, P = 0.308, 0.01 ± 0.07 V, P = 0.419, sensing: -0.15 ± 1.11 mV, P = 0.658, -0.19 ± 1.17 mV, P = 0.800, impedance: -7.86 ± 30.7 Ohm, P = 0.447, -7.86 ± 25.77 Ohm, P = 0.183, at 1 and 3 months follow-up, respectively). Parameter changes were not statistically different between patients who underwent imaging at 1.5 T (n = 7) or 3.0 T (n = 7). Conclusion In our set of patients with a Micra® leadless pacemaker, cardiac magnetic resonance imaging at either 1.5 T or 3.0 T proved feasible and safe with no relevant changes in device parameters within 3 months of follow-up.

First report of an acute, obstructive thrombosis of a Melody® valve used for transcatheter pulmonary replacement

Transcatheter pulmonary valve (TPV) replacement is an effective therapy of right ventricular outflow tract conduit dysfunction. Acute complications after TPV implantation include infective endocarditis, stent fracture, and device dislocation. We present a novel, life-threatening complication: an acute, noninfectious TPV thrombosis. Within 24 hours after implantation of a Melody system (Medtronic, Inc, Minneapolis, MN), the patient developed an acute TPV thrombosis characterized by severe TPV stenosis on echocardiography and contrast filling defects on computed tomography pulmonary angiography images. Genetic testing revealed heterozygous prothrombin G20210A polymorphism and homozygous 4G/4G polymorphism of the plasminogen-activator-inhibitor. The patient recovered after surgical valve replacement with a pulmonary homograft.

Erratum to: Peri-interventional neurological complication rates in patients undergoing carotid artery stenting depend on the side of the stenosis treated

CAS has emerged as an alternative to carotid endarterectomy for the treatment of significant carotid artery stenosis. We investigated if the side of the stenosis treated has an influence on the neurological outcome of our patients. CAS was performed in 1124 patients at our center. The left carotid artery (group L) was intervened in 557 and the right carotid artery (group R) in 567 patients. Data of both patient groups were analyzed with respect to the total rate of peri-interventional ischemic cerebral events, defined as transient ischemic attacks, minor and major strokes, respectively. The total peri-interventional ischemic cerebral event rate was 10.1% in group L and 6.7% in group R (p = 0.042), respectively. The routine use of a filter wire resulted in a significant reduction of complication rates in group L (from 14.7 to 7.1%; p = 0.005) but not in group R (from 7.8 to 6.0%; p = 0.505). Ischemic cerebral events did not differ between group L and R, when only patients in whom a filter wire was used were analyzed (7.1% in group L and 6.0% in group R, p = 0.174). Peri-interventional ischemic cerebral complication rates in patients undergoing CAS differ with respect to the side treated. This may be due to a more frequent plaque mobilization caused by the guiding catheter.

Presentation of unrepaired pulmonary atresia with ventricular septum defect and major aortopulmonary collateral arteries arising from a left brachiocephalic trunk in a 52-year-old female

Severe unrepaired congenital heart defects in adults are rare in countries with developed paediatric health systems. However, this medical topic has become of growing interest as the number of refugees is raising worldwide. A 52-year-old-female refugee (who had given birth to 3 children) presented with mild dyspnoea, cyanotic lips and an arterial oxygen saturation of 82%. Her past medical history was only significant for a syncope without prodromal symptoms a few years ago. Laboratory results were normal except an elevated NT-proBNP level of 4151 pg/mL. Transthoracic echocardiography showed a perimembranous ventricular septum defect (VSD), an overrinding aorta, right-sided aortic arch, right ventricular (RV) hypertrophy and pulmonary atresia (PA) (Figure 1). Cardiac magnetic resonance angiography (A/B) and computed tomography (C/D) confirmed the diagnosis of PA with VSD and showed an isolated vascular structure with a diameter of 21mm arising from a left-sided brachiocephalic trunk (BCT) supplying blood to the complete left lung as well as the right lower and right upper pulmonary lobe through a complex vascular collateral network (G). Analysis of a 3D printed cardiac model (E/F; printer: ZPrinter 650,3D Systems, Rock Hill, USA; software: Mimics 19.0, Materialise, Leuven, Belgium) contributed to identify the correct anatomy of the pulmonary circulation: the middle lobe of the right lung showed retrograde blood supply by the left pulmonary artery (via confluent right pulmonary artery). The left pulmonary artery received the blood from a peripheral left-sided collateral artery that did not feature anatomical characteristics of a persistent ductus arteriosus (PDA). The arterial network showed dilatations and calcifications as signs of pulmonary vascular remodelling. In this palliative situation the patient was scheduled for frequent follow-up at our outpatient clinic without any drug treatment.

Primary antiphospholipid syndrome, hypertrophic non-obstructive cardiomyopathy and hypotelorism

Antiphospholipid syndrome (APS) is an autoimmune disorder associated with arterial/venous thrombosis. Cardiac manifestations of APS include valve stenosis/insufficiency, coronary artery disease and myocardial dysfunction presenting as dilated cardiomyopathy. In the following report, we present the case of a man with primary APS, hypertrophic non-obstructive cardiomyopathy and hypotelorism—a combination that has not yet been reported in the literature.