In a prospective cross-sectional study of patients with advanced congestive heart failure (n=25), quantitative gated SPECT imaging was performed before and after CRT implantation. Left ventricular (LV) lead positioning at the latest activation segment, outside the scar region, correlated with a significantly improved chance of response compared to placements in other locations. A phase histogram bandwidth (PHB) value above 153, displaying 100% sensitivity and 80% specificity, was commonly observed in responders. Furthermore, responders also often had a phase standard deviation (PSD) value surpassing 33, exhibiting 866% sensitivity and 90% specificity. Quantitative gated SPECT, by employing PSD and PHB cutoff points, can aid in the selection of appropriate CRT implantation candidates and guide the positioning of the LV lead.
Cardiac resynchronization therapy (CRT) device implantation presents a technically demanding challenge, particularly when faced with complex cardiac venous anatomies, concerning left ventricular lead positioning. This case showcases the success of retrograde snaring in delivering the left ventricular lead through a persistent left superior vena cava for successful CRT implantation procedures.
The Victorian era's poetic tradition includes Christina Rossetti's Up-Hill (1862), a remarkable example crafted by a female poet among the ranks of celebrated female voices, such as Emily Brontë, Elizabeth Barrett Browning, Katherine Tynan, and Alice Meynell. Faith and love, as central subjects, were represented in allegories, a hallmark of Rossetti's Victorian era writing style and genre. With literary distinction running in her family, she came to be. Up-Hill, one of her more celebrated works, held a special place in her repertoire.
Structural interventions are critically important in the comprehensive approach to adult congenital heart disease (ACHD). This field's recent advancements in catheter-based procedures stand in contrast to the limited industrial investment and the lack of device development specifically designed for this group. Since each patient presents a unique combination of anatomy, pathophysiology, and surgical repair demands, diverse devices are employed off-label, adhering to a best-fit strategy. Hence, the imperative for constant innovation remains to adapt existing technologies for the benefit of ACHD, and to amplify collaborative efforts with the industry and regulatory bodies for the creation of purpose-built devices. These improvements will foster advancement in the field, providing this expanding population with less invasive alternatives, fewer complications, and faster recovery times. Illustrative cases from Houston Methodist are featured in this article to exemplify the current structural interventions practiced on adults with congenital deformities. We endeavor to provide a more profound insight into the subject matter and cultivate interest in this quickly expanding discipline.
Ischemic strokes, a potentially disabling consequence, are frequently associated with the widespread arrhythmia, atrial fibrillation, impacting a substantial portion of the global population. However, a substantial portion of eligible individuals remain ineligible or intolerant to oral anticoagulants. Recent transcatheter left atrial appendage closure (LAAC) techniques, developed within the last 15 years, have offered a worthwhile alternative to prolonged use of oral anticoagulants to reduce the chance of stroke and systemic emboli for patients with non-valvular atrial fibrillation. In recent years, large clinical trials have underscored the safety and effectiveness of transcatheter LAAC in patients intolerant to systemic anticoagulation, building upon the FDA approval of devices such as the Watchman FLX and Amulet. A contemporary review scrutinizes the indications for transcatheter LAAC and the evidence regarding the effectiveness of a range of device therapies currently in use or in development. Our analysis also includes an exploration of current obstacles in intraprocedural imaging and the ongoing controversies within postimplantation antithrombotic approaches. Trials are currently underway to evaluate the role of transcatheter LAAC as a safe, first-option treatment for all patients with nonvalvular atrial fibrillation.
Transcatheter mitral valve replacement (TMVR), employing the SAPIEN platform, has been applied to cases of failed bioprosthetic valves (valve-in-valve), surgical annuloplasty rings (valve-in-ring), and native valves afflicted with mitral annular calcification (MAC) (valve-in-MAC). Coloration genetics Improvements in clinical outcomes over the past ten years have been shaped by the identification of significant challenges and effective solutions. This review considers the utilization trends, unique difficulties, procedural planning, clinical outcomes, and indications pertinent to valve-in-valve, valve-in-ring, and valve-in-MAC TMVR procedures.
Causes of tricuspid regurgitation (TR) encompass primary valve abnormalities or secondary regurgitation, a consequence of increased hemodynamic pressure or volume in the right side of the heart. Patients with severe tricuspid regurgitation, independent of all other variables, experience an outcome that is less favorable. TR's surgical management has been, by and large, confined to cases where left-sided cardiac surgery is also performed. Selleck Pifithrin-α Precise measurements of the success and lasting nature of surgical repair or replacement are not presently available. Transcatheter techniques could potentially benefit patients with considerable and symptomatic tricuspid regurgitation, although the development and implementation of these techniques and accompanying devices has been noticeably slow. The delay is substantially impacted by the neglect and hurdles encountered in outlining the symptoms that are associated with TR. phytoremediation efficiency Furthermore, the anatomical and physiological intricacies of the tricuspid valve apparatus pose unique difficulties. A range of devices and techniques are presently undergoing clinical investigation in different phases. This review analyzes the current situation regarding transcatheter tricuspid procedures and future potential developments. These therapies are soon to be commercially available and widely adopted, impacting the millions of neglected patients in a significant and positive way.
Prevalence-wise, mitral regurgitation tops the list of valvular heart diseases. Complex mitral valve regurgitation, due to its intricate anatomy and pathophysiology, necessitates specialized transcatheter replacement devices for those at high or prohibitive surgical risk. In the United States, transcatheter mitral valve replacement devices are the subject of ongoing clinical trials, and no commercial use is authorized at this time. Feasibility studies conducted early on have shown strong technical competence and positive immediate impacts, but a complete evaluation requires investigation into broader samples and long-term outcomes. Importantly, considerable improvements in device technology, deployment strategies, and implanting procedures are needed to avert left ventricular outflow tract obstruction, as well as valvular and paravalvular regurgitation, and also to ensure the prosthesis's robust anchoring.
Symptomatic older adults with severe aortic stenosis, irrespective of surgical risk factors, now predominantly receive transcatheter aortic valve implantation (TAVI) as the preferred treatment. Improved transcatheter aortic valve implantation (TAVI) outcomes, including reduced hospital stays, lower short- and medium-term complication rates, and increasing experience among operators, coupled with enhanced bioprosthetic design and delivery systems along with more precise preprocedural imaging, have paved the way for wider TAVI adoption among younger, lower-surgical-risk patients. The sustainability and durability of transcatheter heart valve implants are becoming increasingly significant for this younger population, given their longer projected lifespans. The absence of consistent definitions for bioprosthetic valve malfunction, coupled with conflicting approaches to evaluating coexisting hazards, made it difficult to compare transcatheter heart valves to surgical bioprosthetic valves until comparatively recently. In this analysis of the landmark TAVI trials, the authors review mid- to long-term (five-year) clinical outcomes and the corresponding long-term durability data, stressing the importance of standardized definitions in evaluating bioprosthetic valve dysfunction.
Renowned musician and artist Philip Alexander, M.D., a native Texan, has retired from his medical practice. In 2016, Dr. Phil, having practiced internal medicine for 41 years, retired from his College Station practice. He, a former music professor and lifelong devotee to music, often performs as an oboe soloist for the Brazos Valley Symphony Orchestra. Evolving from pencil sketches, including a formal portrait of President Ronald Reagan for the White House, in 1980, his visual artistic pursuits ultimately led to the computer-generated illustrations published in this journal. In the spring of 2012, his original images first appeared in this journal, demonstrating his unique artistic vision. For your art to be considered for the Humanities section of the Methodist DeBakey Cardiovascular Journal, please submit it online at journal.houstonmethodist.org.
Valvular heart disease, notably mitral regurgitation (MR), frequently affects patients, many of whom are unsuitable candidates for surgical intervention. The transcatheter edge-to-edge repair (TEER) method, rapidly evolving, secures a safe and efficient decrease in mitral regurgitation (MR) for high-risk patients. Nonetheless, critical patient selection via clinical evaluations and imaging methods is essential to secure successful procedural outcomes. The review below showcases recent breakthroughs in TEER technologies, extending patient eligibility and presenting detailed imaging of the mitral valve and surrounding structures for optimal patient selection.
Cardiac imaging is the crucial foundation for achieving safe and optimal outcomes in transcatheter structural interventions. While transthoracic echocardiography is the first imaging technique utilized to evaluate valvular diseases, transesophageal echocardiography is better suited for determining the reason for valvular regurgitation, pre-procedural assessments for transcatheter edge-to-edge repair, and intra-procedure navigation.