Silvana Müller

Transvenous Pacemaker Lead Removal Is Safe and Effective Even in Large Vegetations: An Analysis of 53 Cases of Pacemaker Lead Endocarditis

Background: The aim of this study was to investigate whether transvenous lead removal is safe and effective in patients with lead vegetations greater than 1 cm in size.

Valvular heart disease in Parkinson's disease vs. controls: An echocardiographic study

Restrictive valvulopathy has been reported in association with dopamine agonist therapy in parkinsonian patients. The majority of reports have been related to pergolide, but anecdotal cases following treatment with bromocriptine or cabergoline have also been presented. It is presently unclear whether the potential induction of restrictive cardiac valvulopathy is a class effect of all dopamine agonists or if there is a differential risk between ergot and nonergot compounds. In this study, the frequency of a valvular regurgitation as assessed by routine transthoracic echocardiography was compared between 75 patients with Parkinsons disease (PD) treated with pergolide (n = 29), cabergoline (n = 13), pramipexole or ropinirole (n = 33), and 49 age‐matched nonparkinsonian controls. The exposure to pergolide and cabergoline was associated with higher frequencies of valvular regurgitation grades 2 and 3 (31% and 47%) compared with age‐matched controls (13%), while there was no increase of valvular regurgitation grades 2 and 3 in patients treated with nonergot compounds (10%). Evidence for restrictive valvulopathy was found in one patient treated with pergolide and cabergoline each. While this study shows similarly increased frequencies of valvular regurgitation in patients treated with the ergot agonists pergolide and cabergoline in comparison to both normal controls and patients treated with nonergot agonists, evidence for restrictive valvulopathy was only found in two cases. These results highlight the need for further prospective studies of the prevalence and underlying mechanisms of cardiac valvulopathy in PD patients treated with different dopamine agonists.

Why is intracardiac echocardiography helpful? Benefits, costs, and how to learn

Current interventional procedures in structural heart disease and cardiac arrhythmias require peri-interventional echocardiographic monitoring and guidance to become as safe, expedient, and well-tolerated for patients as possible. Intracardiac echocardiography (ICE) complements and has in part replaced transoesophageal echocardiography (TEE), including real-time three-dimensional (RT-3D) imaging. The latter is still widely accepted as a method to prepare for and to guide interventional treatments. In contrast to TEE, ICE represents a purely intraprocedural guiding and imaging tool unsuitable for diagnostic purposes. Patients tolerate ICE much better, and the method does not require general anaesthesia. Accurate imaging of the particular pathology, its anatomic features, and spatial relation to the surrounding structures is critical for catheter and wire positioning, device deployment, evaluation of the result, and for ruling out complications. This review describes the peri-interventional role of ICE, outlines current limitations, and points out future implications. Two-dimensional ICE has become a suitable guiding tool for a variety of percutaneous treatments in patients who are conscious or under monitored anaesthesia care, whereas RT-3DICE is still undergoing clinical testing. Continuous TEE monitoring under general anaesthesia remains a widely accepted alternative.

Medical three-dimensional printing opens up new opportunities in cardiology and cardiac surgery

Advanced percutaneous and surgical procedures in structural and congenital heart disease require precise pre-procedural planning and continuous quality control. Although current imaging modalities and post-processing software assists with peri-procedural guidance, their capabilities for spatial conceptualization remain limited in two- and three-dimensional representations. In contrast, 3D printing offers not only improved visualization for procedural planning, but provides substantial information on the accuracy of surgical reconstruction and device implantations. Peri-procedural 3D printing has the potential to set standards of quality assurance and individualized healthcare in cardiovascular medicine and surgery. Nowadays, a variety of clinical applications are available showing how accurate 3D computer reformatting and physical 3D printouts of native anatomy, embedded pathology, and implants are and how they may assist in the development of innovative therapies. Accurate imaging of pathology including target region for intervention, its anatomic features and spatial relation to the surrounding structures is critical for selecting optimal approach and evaluation of procedural results. This review describes clinical applications of 3D printing, outlines current limitations, and highlights future implications for quality control, advanced medical education and training.

Prognostic value of left ventricular global function index in patients after ST-segment elevation myocardial infarction

AIMS The left ventricular global function index (LVGFI) is a novel indicator of left ventricular performance. Its prognostic value in patients after ST-segment elevation myocardial infarction (STEMI) is unknown. We sought to evaluate the prognostic significance of LVGFI measured by cardiovascular magnetic resonance (CMR) imaging after STEMI. METHODS AND RESULTS Two hundred eligible STEMI patients (56 ± 11 years, 16% female) revascularized by primary percutaneous coronary intervention were followed-up for 3.1 [2-4.1] years for major adverse cardiac events (MACE). MACE was defined as a composite of death, non-fatal myocardial re-infarction, and new congestive heart failure. All patients underwent CMR imaging within 2 [2-4] days after STEMI. Late enhancement and cine images were acquired to assess myocardial injury as well as myocardial function, including LVGFI. Patients suffering a MACE event (n = 20, 10%) had a significantly lower LVGFI (P = 0.001). In Kaplan-Meier analysis, a decreased LVGFI was associated with a reduced MACE-free survival (P < 0.001). Multivariate Cox regression analysis revealed a decreased LVGFI as a predictor for MACE [hazard ratio = 4.79, 95% confidence interval (CI) 1.46-15.67, P = 0.010] after adjusting for microvascular obstruction, left ventricular mass, and multivessel disease. In receiver operating characteristic analysis, LVGFI was a strong predictor for MACE (area under the curve = 0.73, CI 0.61-0.85). However, c-statistics revealed that LVGFI does not provide incremental prognostic information over left ventricular ejection fraction (LVEF) (P = 0.38). CONCLUSION LVGFI assessed by CMR is a strong predictor of MACE within 3 years after first STEMI. A superior predictive value as compared with LVEF was not found in this study.

Left main compression syndrome by idiopathic pulmonary artery aneurysm caused by medial necrosis Erdheim-Gsell combined with bicuspid pulmonary valve.

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N-terminal pro-B-type natriuretic peptide is associated with aortic stiffness in patients presenting with acute myocardial infarction

Background: Aortic stiffness is associated with increased left ventricular (LV) afterload, a process which is accompanied by a release of natriuretic peptides. Aortic pulse wave velocity (PWV) has been demonstrated to be the functional surrogate of aortic stiffness. We sought to investigate the impact of aortic PWV on N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations in patients with acute myocardial infarction (AMI). Methods: This prospective observational study included 86 consecutive patients undergoing percutaneous coronary intervention for AMI. Aortic PWV was determined 47 h (interquartile range (IQR) 27–64 h) after AMI using an established oscillometric device. NT-proBNP values were measured using a commercially available immunoassay. Results: The mean age of the study cohort was 60±11 years; 19% were female. Median aortic PWV was 7.8 m/s (IQR 6.8–9.4 m/s). Patients with a PWV above the median showed significantly higher NT-proBNP peak concentrations (median=1330 ng/l, IQR: 729–3180 ng/l vs median=498 ng/l, IQR: 124–1575 ng/l, p=0.001). Aortic PWV (beta=0.373, p=0.014) was independently associated with NT-proBNP peak concentrations even after correction for LV function, cardiac troponin T levels, heart rate, blood pressure, body mass index and the primary prevention European Society of Cardiology (ESC) SCORE (model: R=0.542, p=0.014). Conclusion: In patients with AMI, aortic PWV is independently associated with NT-proBNP concentrations. This finding suggests an impact of aortic PWV on myocardial wall stress after AMI.

Left ventricular global function index: Relation with infarct characteristics and left ventricular ejection fraction after STEMI

Mikkel Schoos, Roxana Mehran, Usman Baber, Ke Xu, Frederick Feit, Bernard j Gersh, E. Magnus Ohman, Bernhard Witzenbichler, Gregg W. Stone Mount Sinai Medical Center, New York, NY, USA, Copenhagen, Denmark, Mount Sinai Hospital, New York, United States, Mount Sinai Hospital, New York, New York, Cardiovascular Research Foundation, New York, NY, NYU, New York, United States, Mayo Clinic College of Medicine, Rochester, United States, Duke University Medical Center, Durham, North Carolina, Charité Campus Benjamin Franklin, Berlin, Germany, Cardiovascular Research Foundation, NY, NY

The Bentall procedure – an attractive option for the aortic root

SummaryBACKGROUND: The Bentall operation is a favorable technique of aortic root replacement and can be applied to most cases in adult aortic root pathology. The operative procedure is highly standardized. METHODS: We present the main indications, general and special technical aspects of the procedure, and results according to literature data and own experience. RESULTS: Perioperative mortality of the Bentall operation, especially as an elective treatment, is comparable to elective isolated aortic valve replacement. CONCLUSIONS: It is the low rate of adverse events during long-term follow-up which makes Bentall operations highly attractive as a replacement of pathologic aortic roots.ZusammenfassungGRUNDLAGEN: Die Bentall-Operation stellt eine attraktive Variante des Aortenwurzelersatzes dar und kann in den meisten Fällen von Aortenwurzel-Pathologie beim Erwachsenen indiziert werden. Das operative Vorgehen ist hochstandardisiert. METHODIK: Anhand von Literatur und eigenen Erfahrungen werden Hauptindikationen, allgemeine und spezielle technische Aspekte der Operation und Ergebnisse dargestellt. ERGEBNISSE: Die perioperative Mortalität ist besonders bei der elektiv durchgeführten Bentall-Operation vergleichbar mit jener des elektiven, isolierten Aortenklappenersatzes. SCHLUSSFOLGERUNGEN: Niedrige Raten von Komplikationen im Langzeitverlauf machen die Bentall-Operation zu einer sehr attraktiven Option für die pathologisch veränderte Aortenwurzel.

A solid mass trapped in the right atrium

A 63-year-old woman with a history of breast cancer in 2005 and a synovial carcinoma of the left lung with resection of the lingula in November 2013 and the upper left lobe in January 2014 was transferred to our coronary care unit from a secondary regional hospital after systemic thrombolysis for a massive pulmonary embolism. …