Psychosocial risk factors such as stress and psychiatric disorders are known to have negative impacts on health outcomes, but their effects on ischemic heart disease, particularly in women, remain to ...be fully understood despite contributing to one-third of the population attributable risk in acute myocardial infarction.
The impact of stress, social isolation, low socioeconomic status, hostility and anger, and stress-related psychiatric disorders on cardiovascular outcomes and the potential mechanisms that underlie their association with ischemic heart disease, with a focus on women, is evaluated. Online search of relevant terms, including the aforementioned risk factors, women, and ischemic heart disease, was utilized to find recent and pertinent trials.
Psychosocial risk factors increase cardiovascular risk in both women and men. However, current literature points to a greater degree of adverse cardiovascular events in women who experience these risk factors than in men, but the literature is not as well-defined as the data regarding traditional risk factors and cardiovascular disease.
Dedicated study of the sex differences in ischemic heart disease incidence and recurrence, including the impact of psychosocial risk factors, is warranted for the development of appropriate gender-specific diagnostic testing and treatment options in heart disease.
This case illustrates a novel percutaneous treatment of a highly vascular thoracic tumor impinging on the left atrium and right pulmonary artery by delivery of coils and alcohol ablation via a ...circumflex coronary artery feeder branch. (Level of Difficulty: Advanced.)
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This case illustrates a novel percutaneous treatment of a highly vascular thoracic tumor impinging on the left atrium and right pulmonary artery by…
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Background
This article highlights four unique cases where rotational atherectomy (RA Rotapro, Boston Scientific) was used to cut and retrieve an entrapped coronary guidewire with parts extending ...into the aorta We discuss the technique and step by step approach to the retrieval procedure.
Case Summary
Three of four cases described a guide wire entrapment in the right coronary artery (RCA), and one in the left anterior descending artery via retrograde route. In all cases the guide wire was intact within the intracoronary segment. In Case 1, the guide wire (Runthrough; Terumo) was entrapped in an acute marginal branch during chronic total occlusion (CTO) percutaneous coronary intervention. In Case 2, a whisper wire (Abbott) was entrapped during re‐wiring of the right posterolateral branch through stent struts, the traction on the wire caused severe malformation of distal and proximal stents requiring second staged procedure to complete revascularization of the RCA CTO. In Case 3, a Runthrough wire was entrapped between two layers of stents and fractured at the proximal point with filaments extending into descending aorta. And in Case 4, a Pilot 200 (Abbott) wire was entrapped retrograde in the subintimal space via saphenous vein graft connection by tying a knot at the distal tip of the wire. In all four cases RA was used to successfully cut and remove the entrapped guide wires.
Discussion
Rotablation technique appears to be a safe and effective strategy for the management of entrapped coronary guidewire when conventional strategies fail.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Complex and higher‐risk indicated percutaneous coronary interventions at times require mechanical circulatory support, most often with Impella devices. The use of such devices traditionally required ...additional arterial access site(s), increasing risk of vascular complications. The Single‐access for Hi‐risk percutaneous coronary intervention (SHiP) technique was described to overcome this issue but was limited to the use of 7F guides. Larger 8F guides often provide incremental support and space compared to 7F guides, sometimes needed in complex procedures. We described a modified SHiP technique using an 8 Fr guide delivered sheathless using Rotaglide.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Transcatheter closure of transcatheter heart valve (THV)–related paravalvular leak (PVL) is associated with a high failure rate with available devices due to the complex interaction of THV and ...aortic/mitral annulus.
This study reports on novel transcatheter techniques to treat PVL after THV.
The authors describe consecutive patients who underwent PVL closure after transcatheter aortic valve replacement (TAVR) or transcatheter mitral valve replacement (TMVR). A covered self-expanding stent (Viabahn) was deployed in the defect to create a seal between the THV and annulus. A vascular plug (Amplatzer Vascular Plug 2 AVP2 or AVP4) was then deployed inside the covered stent to obliterate PVL.
Eight patients with THV-related PVL were treated using this method (aortic 3 SAPIEN, 1 Evolut, mitral 2 SAPIEN-in-MAC (mitral annular calcification), 2 M3 TMVR). Various combinations of stents and plugs were used (5 mm × 2.5 cm Viabahn + 6 mm AVP4 n = 2, 8 mm × 2.5 cm Viabahn + 10 mm AVP2 n = 5, and 10 mm × 5.0 cm Viabahn + 12 mm AVP2 n = 1). All had technical success with immediate elimination of target PVL, without in-hospital complications. None had signs of postprocedure hemolysis. All patients were discharged alive (median 3.5 days Q1-Q3: 1.0-4.8 days). No residual PVL was seen at discharge, except for 1 patient with mild regurgitation due to another untreated PVL location. One patient died before 30 days due to complication of valve-in-MAC TMVR. In remaining patients, none had recurrence of PVL at 30 days. Symptoms decreased to NYHA functional class I/II in 6 patients. NYHA functional class III symptoms remained in 1 patient with mitral regurgitation awaiting subsequent valve replacement procedure.
The technique of sequential deployment of a covered stent and vascular plug may effectively treat THV-related PVL.
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