Ralph Wessel

Two-dimensional echocardiography in double orifice mitral valve

In a patient with endocarditis and significant aortic insufficiency, two-dimensional echocardiography revealed an abnormal mitral valve configuration with division of the valve into two separate orifices. At autopsy, a double orifice mitral valve with two sets of valve leaflets was observed. Appreciation of this echocardiographic abnormality is important because double orifice mitral valve is associated with other congenital anomalies and this echocardiographic configuration may be confused with other cardiac abnormalities.

Femoral Micropuncture or Routine Introducer Study (FEMORIS)

Objectives: The Micropuncture® 21-gauge needle may reduce complications related to vessel trauma from inadvertent venous or posterior arterial wall puncture. Methods: This was a single-center, multiple-user trial. Four hundred and two patients undergoing possible or definite percutaneous coronary intervention (PCI) were randomized 1:1 to an 18-gauge versus a 21-gauge needle. Patients and personnel pulling the sheaths and performing the follow-up were blinded. The primary end point was a composite of access bleeding. Events were tabulated following sheath removal, ≤24 h after the procedure and at the follow-up (at 1-2 weeks). End points were blindly adjudicated. Results: The event rate overall was 12.4% and did not differ significantly between groups, although the 21-gauge needle was found to reduce events by more than one third. An exploratory subgroup analysis of prespecified variables indicated that: patients who did not undergo PCI or elective procedures, female patients and those with a final sheath size of ≤6 Fr all had a significant or near-significant reduction of complications with Micropuncture. Conclusions: Although no significant differences between the use of the 18- and 21-gauge needles were observed, there was a 50-75% reduction with Micropuncture in several subgroups. The study was terminated prematurely. Access site complications may be reduced by the use of the 21-gauge needle, particularly when the risk of bleeding is not high. Further multicenter data will be required to confirm these hypothesis-generating observations.

When Should Ablation Be Considered in the Treatment of Atrial Fibrillation – A Clinician’s View

Catheter ablation is a relatively recent and evolving modality for the maintenance of sinus rhythm in patients with atrial fibrillation. What its role is in the management of the general patient population with atrial fibrillation remains unclear. In order to understand the role of catheter ablation for treatment of atrial fibrillation, an overview of the problem of atrial fibrillation will be discussed. Management strategies will be considered. The mechanisms of atrial fibrillation along with a history of ablation and a rationale for atrial fibrillation ablation will be presented. Data on the outcomes, efficacy and complications of catheter ablation will be reviewed. Finally, patient selection will be discussed.