Recai Alemdar

Successful percutaneous mitral valve repair with the MitraClip system of acute mitral regurgitation due to papillary muscle rupture as complication of acute myocardial infarction.

Percutaneous mitral valve repair with the MitraClip is a new promising therapeutic option for symptomatic severe mitral regurgitation (MR). Acute myocardial infarction (MI) is a well recognized cause of papillary muscle rupture (PMR). If PMR is untreated, the prognosis is poor and the mortality could be as high as 80% during the first week of post MI. For patients with PMR, the standard therapy for MR is open surgical repair or replacement. However, in our case, percutaneous mitral valve repair with the MitraClip was chosen technique because of the metastatic colon cancer. We report the case of a 60‐year‐old woman who underwent successful percutaneous mitral valve repair with the MitraClip system for the treatment of acute MI complicated by PMR.© 2013 Wiley Periodicals, Inc.

Transcatheter aortic valve implantation with the CoreValve for the treatment of rheumatic aortic stenosis.

Transcatheter aortic valve implantation (TAVI) is a new therapeutic option for inoperable/high risk patients with severe symptomatic calcific aortic stenosis (AS). The only admitted indication for TAVI is the treatment of patients with symptomatic severe calcific AS. However, some reports suggested feasibility and good short-term results with ‘‘off-label’’ uses of TAVI in patients with degenerated aortic bioprostheses and aortic regurgitation (1-3). Rheumatic AS is characterized by fusion of the commissures of the valve leaflets with little or no calcification. There is no information about TAVI in rheumatic AS. TAVI could be difficult in this population as the lack of calcium might increase the risks of misplacement and migration of the prosthesis. To the best of our knowledge, it is the first time TAVI was used for rheumatic AS in the literature. Here we present two cases with severe symptomatic rheumatic AS who underwent successful TAVI with CoreValve because of contraindication to surgery.

Association between admission mean platelet volume and ST segment resolution after thrombolytic therapy for acute myocardial infarction.

OBJECTIVEnMean platelet volume (MPV), one of the indices of platelet reactivity has been shown to be related to impaired angiographic reperfusion in ST-segment elevation myocardial infarction (STEMI) patients treated with primary angioplasty or thrombolytics. However data regarding MPV and its association with ST-segment resolution; an indicator of epicardial and tissue level reperfusion in the setting of STEMI are limited. In this study, we aimed to investigate whether MPV on admission is associated with ST-segment resolution in STEMI patients treated with thrombolytics.nnnMETHODSnWe retrospectively evaluated 232 consecutive patients with a diagnosis of first STEMI who were administered thrombolytic therapy within 12 hours of onset of chest pain. ST segment resolution based on baseline and 90 minute electrocardiographies were measured. Patients were grouped into two as with <50% and ≥50% ST-segment resolution. Admission MPV was measured and compared between two groups.nnnRESULTSnAdmission MPV was higher in patients with <50% ST-segment resolution than patients with ≥50% ST-segment resolution (9.9±1.3 fL vs. 8.5±1.1 fL respectively, p<0.001). The receiver operating characteristic analysis yielded a cut-off value of 9.3 fL to predict ST-segment resolution, with sensivity and specifity being 66.7% and 77.9%, respectively. In-hospital mortality rate was high in patients with <50% ST -segment resolution (p=0.002).nnnCONCLUSIONnHigh MPV on admission in STEMI patients treated with thrombolytics is associated with impaired ST segment resolution.

First experience with the jailed pressure wire technique in the provisional side branch stenting of coronary bifurcation lesions.

AIMSnThe provisional strategy (PS) is an accepted modality of treatment in coronary bifurcation interventions, though, after main vessel (MV) stenting, the assessment of the side branch (SB) becomes more difficult. In bifurcation interventions, the major advantage of fractional flow reserve (FFR) is the avoidance of the need for SB intervention. However, SB access with a pressure wire after MV stenting may be difficult, sometimes impossible. The objective of this paper was to evaluate the feasibility and safety of physiologic assessment of SB lesions using FFR with the jailed pressure wire (JPW) in patients undergoing the PS. Although the JPW technique is theoretically possible in the PS, there is no information available on the use of this technique.nnnMETHODS AND RESULTSnWe retrospectively evaluated 11 patients who were treated with the JPW technique at a single centre. Procedures were successfully accomplished in all cases without complications, such as damage of the pressure sensor, failure to measure FFR value, removing the polymer coating, and entrapment or fracture of the JPW.nnnCONCLUSIONSnIn conclusion, our limited experience suggests that the JPW technique in the PS may be a safe and technically feasible approach. This technical report details the JPW technique in patients undergoing the PS.

Left atrial spontaneous echo contrast and thrombus formation at septal puncture during percutaneous mitral valve repair with the MitraClip system of severe mitral regurgitation: a report of two cases

Percutaneous mitral valve repair with the MitraClip is a new promising therapeutic option for symptomatic severe mitral regurgitation (MR) for patients being at high risk for conventional surgery. In spite of its beneficial effect, theoretically, Mitraclip may have an acute, harmful effect on left atrial spontaneous echo contrast (LASEC) and thrombus formation especially in severe MR patients with atrial fibrillation (AF). However, to the best of our knowledge, LASEC and thrombus formation during percutaneous mitral valve repair with the MitraClip of severe MR has not been well documented in the literature. Here we present, two unique cases, a thrombus formation at the septal puncture site, and LASEC formation during percutaneous mitral valve repair with the MitraClip system of severe MR.

Percutaneous mitral valve repair with the MitraClip system in a patient with subacute severe mitral regurgitation caused by papillary muscle rupture.

Papillary muscle rupture (PMR) is usually associated with acute myocardial infarction (MI) and rarely seen as the only clinical and echocardiographic finding (1). If PMR is treated medically, the prognosis is very poor (2). However, even with surgery, it carries a high mortality (3). We report, to the best of our knowledge, the first case of mitral valve repair with the MitraClip system of subacute severe MR with flail anterior mitral valve leaflet caused by PMR.

Safety of Transesophageal Echocardiography-Guided Atrial Septostomy: Outcomes of the Largest series of TEE-guided Atrial Septostomy in Turkey

PP-375nnAtrial septostomy (AS) is a complex technique used during interventions such as; mitral balloon valvotomy, electrophysiological procedures, left atrial appendage closure and MitraClip. Cardiac perforation occurs in 1-5% of cases even in experienced hands. In daily practice, although AS is

Carotid Artery Back Pressure and Cerebral Intolerance During the Occlusion in Carotid Stenting with the Mo.Ma Proximal Embolic Protection Device

OP-173nnThe Mo.Ma proximal embolic protection system provide neuroprotection during all phases of the carotid artery stenting (CAS) procedure. However, cerebral intolerance is not an infrequent occurrence with this approach. In most of the cases, intolerance is a benign phenomenon which resolves