Wajeeha Saeed

Management strategies and possible risk factors for ventricular septal defects after transcatheter aortic valve replacement: Case series from a single center and review of literature☆

Development of membranous ventricular septal defects (VSD) is a rare complication of transcatheter aortic valve replacements (TAVR), and is recognized using intraoperative and postoperative imaging. We present two cases of this rare but serious complication; one was successfully managed conservatively and the other with valve-in-valve therapy. Management strategies for post-TAVR VSDs varies, but should be individualized to the clinical scenario. We performed a literature search and sought to identify various risk factors which may predispose patients to the development of VSD after TAVR.

When we should say no to TAVR—Defining the line between utility and futility☆

History of prior coronary artery bypass surgery (CABG) is a frequent scenario encountered in patients with severe symptomatic aortic stenosis deemed inoperable and referred for transcatheter aortic valve replacement (TAVR). Aside from indices of frailty and other comorbidities, these patients remain at higher risk for peri-operative mortality and morbidity compared to their counterparts without prior CABG. Presence of concomitant peripheral arterial disease and patent left internal mammary artery (LIMA) graft pose further access related challenges. We present a case of an 84-year-old female with prior CABG and severe PAD who underwent transapical TAVR for severe symptomatic AS sustaining an acute myocardial injury from damage to her apical epicardial collateral circulation. The case entails the importance of recognition of epicardial coronary collateralization where a transapical approach is best avoided or further aided by utilization of peri-procedural angiographic/fluoroscopy guidance to avoid epicardial vascular injury.

Long-term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America

Objective: To evaluate the long term clinical results of percutaneous mitral balloon valvuloplasty in patients with rheumatic mitral stenosis in Colombia, South America. Background: In 1993, Colombia, South America began a National Mitral Balloon Valvuloplasty Registry. This multicenter database was designed to establish the longterm safety and efficacy of percutaneous mitral valvuloplasty, as well as rate of restenosis. Methods: Between January 1993 and December 2011, 182 patients >18 years old were treated for rheumatic mitral stenosis with percutaneous valvuloplasty in two centers in Colombia, South America. Clinical, echocardiographic and hemodynamic data were stored in an electronic database. The Inoue Balloon technique was used in 99% of patients. The longest follow-up period was 15 years. Results: 182 patients were included; women (89%), hypertension (19%), dyslipidemia (1.6%), smoking (8.8%), diabetes (5.5%) and renal failure (1%). Forty-six patients (25.7%) were NYHA functional class III-IV. Procedure related mortality was 1.09% (2 patients). Fourteen patients (7.69%) had significant post procedure mitral insufficiency (grades III-IV); 4 patients (2.19%) had cardiac tamponade and 6 patients (3.3%) had vascular site related complications. The survival rate at 12 months was 96%. At 50 months, 60.7% of patients were alive and free of mitral surgery and repeated mitral valvuloplasty. The percentage of severe restenosis of mitral valve was 4.8%, 19.2%, 15.2% at one, five and 10 years of follow-up. Conclusions: Percutaneous mitral valvuloplasty using the Inoue balloon technique improves the hemodynamic profile of severe mitral stenosis. Long-term follow-up suggest that it is a safe alternative to mitral valve surgery in well selected patients. *Corresponding Author: Wajeeha Saeed, Department of Medicine, Albert Einstein College of Medicine, 1650 Grand Concourse, Bronx, New York, NY 10457. Tel: +1 347-327-2736; E-mail: wajsaeed@yahoo.com Citation: Saeed, W., et al. Long-term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America. (2015) J Heart Cardiol 1(3): 1-5. Long-Term Outcomes after Percutaneous Mitral Valvuloplasty in Colombia, South America Carlos Uribe1, Wajeeha Saeed2*, Carlos Tenorio1, Carlos Eusse Carlos1, Carlos Rubio1, Julián A Ochoa3, Roland Njoh4, Muhammad Rizwan Sardar4, Bernardo Lombo5, John K Forrest5 Received date: July 07, 2015 Accepted date: Aug 31, 2015 Published date: Sep 10, 2015 Abbreviations: SD: Standard Deviation; NYHA: New York Heart Association; TAVI= Transcatheter Aortic-Valve Implantation; PMBV= Percutaneous Mitral balloon Valvuloplasty; MS= Mitral Stenosis DOI: 10.15436/2378-6914.15.012 2 for mitral stenosis. The treatment of mitral stenosis depends on the postulated cause. Rheumatic fever is the most prevalent cause of mitral stenosis (MS)[1]. Cardiac rheumatic disease is a chronic manifestation of rheumatic carditis, which occurs between 60 and 90% of cases in rheumatic fever[2-4]. Rheumatic mitral valvular disease continues to be an important public health problem, especially because it is a preventable disease; furthermore its incidence continues to grow in many developing third world countries. In Colombia, it is estimated that between 0.1 and 0.2% of deaths occur as a result of rheumatic disease[5]. Delay in the treatment of MS leads to complications like atrial fibrillation and pulmonary hypertension[6-8]. In 1984, Inoue et al described the first percutaneous mitral balloon valvuloplasty (PMBV) and since then, the Inoue technique has been shown to produce excellent hemodynamic results in patients with severe rheumatic mitral stenosis[9]. Multiple trials have been done comparing PMBV to surgical mitral valvotomy with follow-up ranging from one to seven years[10-21]. A recent meta-analysis showed comparable clinical outcomes between the two approaches[22]. The external validity of the clinical trials are one of the most important aspect which are often ignored in the current cardiovascular literature and expert guidelines[23,24]. The long-term follow-up data in mitral stenosis patients undergoing PMBV is not available for a country like Colombia, which is a third world country[3]. To address this, in 1993 the Colombian Mitral Balloon Valvuloplasty registry was created to collect baseline, post-procedural as well as long-term follow-up data of patients undergoing PMBV. We therefore seek to analyze the long-term clinical results of PMBV in patients.

PREVALENCE OF INTERNET USE FOR CONGESTIVE HEART FAILURE EDUCATION: A PILOT STUDY

Online patient-education has been shown to be an effective tool in managing several chronic medical problems. We sought to examine the frequency of the use of internet education in heart failure patients in 3 different communities and the factors that impede patient access to internet education.