Patrick Gleason

Bedside Modification of Delivery System for Transcatheter Transseptal Mitral Replacement With POULEZ System and SAPIEN-3 Valve

Transcatheter mitral valve replacement (TMVR), using a balloon-expandable valve, recently received approval for degenerated surgical mitral prostheses. It is a relatively straightforward procedure because the prior surgical valve frame enforces coaxiality of the new transcatheter valve. By contrast

Exercise and Competitive Sport: Physiology, Adaptations, and Uncertain Long-Term Risks

Opinion statementThe benefits of regular and moderate exercise training on cardiovascular outcomes have been well established. In addition, strenuous exercise training leads to corollary cardiac structural and functional adaptations that are sport-specific and facilitate athletic performance. In this review, the normal physiologic and hemodynamic changes that occur during exercise and the subsequent differential exercise-induced cardiac remodeling patterns that develop will be discussed. Paradoxically, recent data have raised concern about the long-term impact of higher doses of physical activity and exercise on mortality and cardiovascular health outcomes. We will discuss important aspects of these controversial data and review the supporting evidence as well as the limitations of prior research. Specifically, we will address the association between high levels of exercise and relative reductions in overall mortality, increased risk of atrial fibrillation, arrhythmogenic cardiac remodeling, and accelerated coronary artery calcifications. For the practitioner, this review aims to detail these contemporary sports cardiology controversies and highlights the critical need to incorporate shared decision making with the athlete in dealing with the uncertainties that exist. Finally, we will discuss key “athlete-specific” variables that should be considered in the design of future important research in this arena.

The Role of Echocardiography in the Detection of Chemotherapy-Induced Cardiotoxicities

Advances in chemotherapy and radiation treatment have drastically improved mortality associated with numerous malignancies. This is counterbalanced by the short- and long-term cardiotoxic effects of cancer therapy. Given the significant morbidity and mortality associated with cardiovascular complications of cancer therapy, strategies for early detection, and prevention of cardiotoxicity are needed. While the exact timing and method of screening for cardiotoxicity remains uncertain, an ideal screening test would be widely available, radiation free, and relatively inexpensive. Echocardiography (echo) is the most widely used, noninvasive, radiation-free test of cardiac morphology and function. Advances in echocardiographic techniques, such as 3D echocardiography and speckle tracking and strain imaging, may allow for the successful detection and treatment of subclinical cardiac dysfunction prior to overt cardiomyopathy and heart failure.