Previous studies have shown a higher prevalence of patent foramen ovale (PFO) in patients with obstructive sleep apnea syndrome (OSAS). Right to left shunting through a PFO may be encouraged by the ...respiratory physiology of OSAS, contributing to the disease pathophysiology. We assessed whether PFO closure would improve respiratory polygraphy parameters compared with baseline measurements in patients with OSAS.
Twenty-six patients with newly diagnosed OSAS and a moderate-large PFO (prevalence, 18% of 143 patients screened) were referred for PFO closure. The oxygen desaturation index (ODI), apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), 6-minute walk test (6MWT), and Sleep Apnea Quality of Life Index (SAQLI) results were compared in these patients at baseline (before continuous positive pressure ventilation CPAP) and at 6-month follow-up (after interrupting CPAP for 1 week).
All PFOs were safely sealed at 6 months, as confirmed by repeated transthoracic echocardiography. The ODI (44.8 interquartile range (IQR), 31.2-63.5) vs 42.3 IQR, 34.0-60.8; P = 0.89) and AHI (47.9 IQR, 31.5-65.2 vs 42.3 IQR, 32.1-63; P = 0.99) did not change after PFO closure nor did the 6MWT, although the ESS (13.0 IQR, 12.0-16.8 vs 6.0 IQR, 4.0-8.8; P < 0.001) and the SAQLI (3.4 IQR, 2.8-4.3 vs 4.4 IQR, 3.9-5.3; P < 0.001) did improve.
The prevalence of PFO in OSAS appears to be no higher than that in the general population. Although PFO closure is safe and effective, it did not improve respiratory polygraphy measures of OSAS severity. The improvement in the ESS and SAQLI likely reflect residual benefits from CPAP.
Les études antérieures ont démontré une prévalence plus élevée du foramen ovale perméable (FOP) chez les patients atteints du syndrome de l’apnée obstructive du sommeil (SAOS). Le shunt droite-gauche à travers un foramen ovale perméable peut être favorisé par la physiologie respiratoire du SAOS, ce qui contribue à la physiopathologie de la maladie. Nous avons évalué si la fermeture du FOP pouvait améliorer les paramètres de la polygraphie respiratoire en les comparant aux mesures initiales chez les patients atteints du SAOS.
Nous avons orienté 26 patients ayant récemment reçu un diagnostic de SAOS et de FOP de taille modérée ou grande (prévalence, 18 % des 143 patients dépistés) pour la fermeture du FOP. Nous avons comparé les résultats de l’indice de désaturation en oxygène (IDO), de l’indice d’apnées-hypopnées (IAH), de l’échelle de somnolence d’Epworth (ESE), du test de marche de 6 minutes (TM6) et du SAQLI (de l’anglais, Sleep Apnea Quality of Life Index) chez ces patients au début (avant la ventilation en pression positive permanente CPAP) et au suivi après 6 mois (après l’interruption du CPAP durant 1 semaine).
Tous les FOP s’étaient bien refermés après 6 mois, ce que la nouvelle échocardiographie transthoracique a permis de confirmer. Il n’y a pas eu de changement dans l’IDO (44,8 intervalle interquartile (IIQ), 31,2-63,5) vs 42,3 IIQ, 34,0-60,8 ; P = 0,89) et l’IAH (47,9 IIQ, 31,5-65,2 vs 42,3 IIQ, 32,1-63 ; P = 0,99) après la fermeture du FOP ni après le TM6 bien que l’ESE (13,0 IIQ, 12,0-16,8 vs 6,0 IIQ, 4,0-8,8 ; P < 0,001) et le SAQLI (3,4 IIQ, 2,8-4,3 vs 4,4 IIQ, 3,9-5,3 ; P < 0,001) s’étaient améliorés.
La prévalence du FOP lors du SAOS ne semble pas plus élevée que cela dans la population générale. Bien que la fermeture du FOP soit sûre et efficace, elle n’améliore pas les mesures de la gravité du SAOS à la polygraphie respiratoire. L’amélioration de l’ESE et du SAQLI reflète vraisemblablement les avantages résiduels de la CPAP.
Paravalvular leak (PVL) is an uncommon yet serious complication associated with the implantation of mechanical or bioprosthetic surgical valves and more recently recognized with transcatheter aortic ...valves implantation (TAVI). A significant number of patients will present with symptoms of congestive heart failure or haemolytic anaemia due to PVL and need further surgical or percutaneous treatment. Until recently, surgery has been the only available therapy for the treatment of clinically significant PVLs despite the significant morbidity and mortality associated with re‐operation. Percutaneous treatment of PVLs has emerged as a safe and less invasive alternative, with low complication rates and high technical and clinical success rates. However, it is a complex procedure, which needs to be performed by an experienced team of interventional cardiologists and echocardiographers. This review discusses the current understanding of PVLs, including the utility of imaging techniques in PVL diagnosis and treatment, and the principles, outcomes and complications of transcatheter therapy of PVLs.
A 45-year-old man presented after an episode of central chest pain. Catheter angiography revealed an aberrant circumflex artery and high-grade stenosis in the mid RCA and proximal CX arteries. ...Previous case series have suggested that the retroaortic portion of aberrant circumflex arteries may be particularly prone to the development of atherosclerosis.
The Eustachian Ridge: Not an Innocent Bystander Kydd, Anna C., MD; McNab, Duncan, MD; Calvert, Patrick A., MD, PhD ...
JACC. Cardiovascular imaging,
10/2014, Letnik:
7, Številka:
10
Journal Article
Virtual histology intravascular ultrasound (VH-IVUS) and optical coherence tomography (OCT) are invasive imaging techniques that may permit in vivo plaque classification through identification of ...individual plaque components.
We describe the first report of an Edwards SAPIEN valve implanted in a tricuspid bioprosthesis from the femoral vein. We highlight the feasibility of this previously avoided approach and the ...techniques involved.
A 61-year-old woman with multiple valve replacements for rheumatic heart disease presented with NHYA IV dyspnoea secondary to a severely stenosed tricuspid bioprosthesis. After failed aggressive medical therapy and surgical turn down, an Edwards SAPIEN XT valve was deployed in the tricuspid bioprosthesis via the right femoral vein. Adaptations to the standard transfemoral transcatheter aortic valve implantation (TAVI) technique included: (1) crossing the tricuspid bioprosthesis with a balloon floatation catheter; (2) temporary pacing wire in the coronary sinus rather than the right ventricle; (3) mounting of the SAPIEN XT valve in the reverse orientation to transfemoral TAVI; and (4) fine positioning of the final valve position pre-deployment by 3D transoesophageal echocardiography (3D TOE) alone due to complete radiolucency of the tricuspid bioprosthesis. The procedure was completed without complication and resulted in significant symptomatic improvement.
Deployment of an Edwards SAPIEN valve in a tricuspid bioprosthesis via the femoral vein is feasible and, with careful adaptations to established TAVI techniques, can be performed without complications and with good clinical response.
Recent studies show that virtual histology intravascular ultrasound (VH-IVUS) can identify plaques at high risk of rupture, such as thin-capped fibroatheromata, raising the possibility of immediate ...targeted intervention. However, plaque classification entails border recognition and subjective assessment of plaque architecture, introducing inter-observer variability without confirmation by core-labs. Furthermore, the accuracy of local versus core-laboratory VH-IVUS plaque classification and effects of different plaque definitions have not been examined.
Local observers classified 100 VH-IVUS-defined coronary plaques to determine single center inter-observer variability; multi-center variability was determined by comparison with VH-IVUS core-laboratory analysis, and compared with gray-scale IVUS. Frequency of plaque types using different published plaque definitions also was determined. Single-center VH-IVUS inter-observer agreement was strong (kappa=0.86), but lower for thin-capped fibroatheromatas (k=0.59) because of observer judgments on presence and location of confluent necrotic core. Multi-center inter-observer agreement for plaque classification was lower again (k=0.71), particularly for thin-capped fibroatheromatas (k=0.56). Different plaque definitions further reduced VH-IVUS-defined thin-capped fibroatheromata numbers by 44%. The diagnostic accuracy of gray-scale IVUS to identify thin-capped fibroatheromata was poor for both observers (21 and 29% correct), with low inter-observer agreement (k=0.14).
VH-IVUS plaque classification, and particularly VH-IVUS-defined thin-capped fibroatheromata identification, varies significantly between local observers, and particularly in comparison with core-laboratory analysis. Differences in VH-IVUS plaque definitions introduce further variability between studies. These factors reduce the use of VH-IVUS plaque classification to guide intervention in a "live" clinical setting, and also affect comparison of diagnostic accuracy and natural history of plaques between studies.
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