Sylvie Bilodeau

Comparison of hemodynamic performance of the balloon-expandable SAPIEN 3 versus SAPIEN XT transcatheter valve.

The SAPIEN 3 valve (S3V) is a new-generation transcatheter valve with enhanced anti-paravalvular leak properties, but no data comparing with earlier transcatheter valve systems are available. We aimed to compare the hemodynamic performance of the S3V and the SAPIEN XT valve (SXTV) in a case-matched study with echo core laboratory analysis. A total of 27 patients who underwent transcatheter aortic valve replacement (TAVR) with the S3V were matched for prosthesis size (26 mm), aortic annulus area, and mean diameter measured by computed tomography, left ventricular ejection fraction, body surface area, and body mass index with 50 patients treated with the SXTV. The prosthesis size was determined by oversizing of 1% to 15% of annulus area. Doppler echocardiographic images collected at baseline and 1-month follow-up were analyzed in a central echocardiography core laboratory. The need for postdilation was higher in the SXTV group (20% vs 4%, p=0.047), and mean residual gradient and effective orifice area were similar in both groups (p>0.05). The incidence of paravalvular aortic regurgitation was greater with the SXTV (≥mild: 42%, moderate: 8%) than with the S3V (≥mild: 7%, moderate: 0%; p=0.002 for ≥mild vs SXTV). The implantation of an S3V was the only factor associated with trace or no paravalvular leak after TAVR (p=0.007). In conclusion, TAVR with the S3V was associated with a very low rate of paravalvular leaks and need for balloon postdilation, much lower than that observed with the earlier generation of balloon-expandable valve (SXTV). The confirmation of these results in a larger cohort of patients will represent a major step forward in using transcatheter valves for the treatment of aortic stenosis.

Coronary ostia stenosis after transcatheter aortic valve implantation.

A frail 85-year-old woman with symptomatic severe aortic stenosis was evaluated for transcatheter aortic valve implantation (TAVI). The Society of Thoracic Surgeons (STS) risk score and the logistic EuroSCORE were 7.2% and 13.3%, respectively. Based on extreme frailty and severe chronic kidney

Transapical mitral implantation of a balloon-expandable valve in native mitral valve stenosis in a patient with previous transcatheter aortic valve replacement.

55-year-old woman, with a previous trans-catheter aortic valve replacement (TAVR)performed 5 years earlier by the transapicalapproach because of porcelain aorta (radiotherapyfor a Hodgkin lymphoma), developed progressiveheart failure (New York Heart Association func-tional class III). Echocardiography revealed a normo-functioning aortic bioprosthesis (mean gradient15 mm Hg; valve area 1.1 cm

The ‘what, when, where, who and how?’ of cardiac computed tomography in 2009: Guidelines for the clinician

DISCLOSURES: Benjamin Chow is supported by the Canadian Institutes of Health Research New Investigator Award #MSH-83718. He receives research and fellowship support from GE Healthcare, and education support from TeraRecon, Inc. Arun Abraham is supported by the Heather and Whit Tucker Research Fellowship in Cardiology. The remaining authors have no conflicts of interest to disclose.

Percutaneous mitral valve annuloplasty for functional mitral regurgitation: acute results of the first patient treated with the Viacor permanent device and future perspectives

BACKGROUND There is a need to develop less invasive techniques to manage moderate or severe functional mitral regurgitation in patients at high surgical risk. OBJECTIVE We report the acute results of the first patient treated with the permanent Viacor percutaneous transvenous mitral annuloplasty (PTMA) device in North America, introduce the PTOLEMY-2 protocol, and briefly discuss the current status of transvenous mitral valve techniques. CASE REPORT After several episodes of pulmonary edema, an 87-year-old woman was referred for hemodynamic evaluation. Angiography revealed normal coronary arteries and severe mitral regurgitation. Baseline echocardiography showed severe (4+) functional mitral regurgitation. The coronary sinus was cannulated with a 9.5-Fr introducer from a left subclavian approach. After distal positioning of a coronary wire, the 7-Fr PTMA Viacor catheter was advanced to the anterior interventricular vein. Two 130 g/cm rods were then inserted resulting in an acute and dramatic reduction in mitral regurgitation as assessed by continuous transoesophageal echocardiography and which was associated with a sudden rise in arterial blood pressure. The next day, transthoracic echocardiogram showed a significant reduction in effective regurgitant orifice area (EROA) from 41 to 10 mm(2). The patient was discharged home the day following the procedure without complication. In accordance with the PTOLEMY-2 protocol, she will undergo 3-D transthoracic echocardiograms, quality of life assessments, and 6-min walk tests at regular intervals for the next 5 years. CONCLUSION PTMA is a promising technique for the treatment of severe mitral regurgitation in selected patients. Further ongoing research will determine the predictors of success and long-term safety and performance of this technique.

Right coronary artery from the left sinus of valsalva: Multislice CT and transradial PCI

A 42-year-old-woman presented with de novo crescendo angina. Thallium-scintigraphy showed inferior ischemia. Coronary angiogram revealed a right coronary artery (RCA), originating from the left sinus of Valsalva with a severe proximal systolic compression. She underwent successful transradial percutaneous coronary intervention with stent implantation. Multislice-computed tomography (MSCT) is usually used to evaluate coronary artery anomalies and can effectively show the anomalous RCA and the inter-arterial trajectory between the aorta and pulmonary arteries. Anomalies of the origin of the coronary arteries are rare, but can produce specific clinicopathological entities that should be diagnosed with accuracy. This case report illustrates the role of MSCT in the detailed description of an abnormal coronary artery and the use of stenting for symptoms relief.

Left main mycotic aneurysm causing myocardial infarction

Mycotic coronary aneurysms are rare, and simultaneous involvement of the left main, left anterior descending and circumflex arteries has never been described. In the present case, multislice computed tomography was an invaluable tool to adequately delineate the aneurysm from the surrounding structures and to plan cardiac surgery accordingly.

Transcatheter aortic valve replacement with a balloon-expandable valve for the treatment of noncalcified bicuspid aortic valve disease.

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