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Interventricular interactions may be responsible for the decline in ventricular performance observed in various disease states that primarily affect the contralateral ventricle.

Surgery remains the only recommended intervention for patients with native aortic regurgitation. A transcatheter therapy to treat patients at high risk for mortality and complications with surgical aortic valve replacement represents an unmet need. Commercial transcatheter heart valves in pure aortic regurgitation are hampered by unacceptable rates of embolisation and paravalvular regurgitation. The Trilogy transcatheter heart valve (JenaValve Technology, Irvine, CA, USA) provides a treatment option for these patients. We report outcomes with transfemoral transcatheter aortic valve implantation (TAVI) in patients with pure aortic regurgitation using this dedicated transcatheter heart valve.

ABSTRACTThe concurrence of transthyretic cardiac amyloidosis (ATTR-CA) and severe aortic stenosis (AS) is being increasingly identified, however the long-term trajectory of these patients remains unclear. In this comprehensive review, we discuss what is known about the prevalence of dual diagnosis, the impact of new imaging modalities on diagnosis of ATTR-CA, and outcomes for patients with concomitant disease. We discuss emerging medical therapies for ATTR-CA, which may be considered in appropriate patients with ATTR-CA and severe AS.

Three-dimensional (3D) echocardiographic (3DE) imaging is an alternative to multi–detector row computed tomography (MDCT) for aortic annular measurement before transcatheter aortic valve replacement (TAVR). A commonly used direct planimetry from a reconstructed short-axis view has not been compared with semiautomated 3DE methods. Typically accepted optimal cutoffs for percent prosthesis-area oversizing of the balloon-expandable SAPIEN or SAPIEN XT valve to native annular size are approximately 5% to 15%. The aim of this study was to compare semiautomated and direct planimetric 3DE methods for aortic annular sizing with a gold standard of MDCT to determine predictive value for paravalvular regurgitation (PVR) and balloon postdilatation.

Cardiac computed tomography angiography was used to identify anatomical characteristics of the aortic root in patients with severe aortic regurgitation (AR) as compared to those with aortic stenosis (AS) to judge feasibility of transcatheter aortic valve replacement (TAVR) with the JenaValve Trilogy system.

Echocardiographic calculation of effective orifice area (EOA) after transcatheter aortic valve replacement is integral to the assessment of transcatheter heart valve (THV) function. The aim of this study was to determine the most accurate method for calculating the EOA of the Edwards SAPIEN and SAPIEN XT THVs.

Advances in cardiovascular interventional techniques have enabled percutaneous treatment for a wide spectrum of non-coronary cardiovascular diseases, also known as ‘structural heart diseases (SHD)’. As these therapies are performed without an open-heart surgery, the use of echocardiography is crucial for detailed visualisation of cardiac anatomy, and to provide guidance for optimal success of these catheter-based interventions. This review will describe the key role of the echocardiographic techniques and imaging protocols that are currently used in different catheter-based SHD interventions.

Introduction:Advanced tricuspid regurgitation (TR) is associated with adverse cardiovascular outcomes. Herein, we report demographics of patients presenting to a tertiary valve center and characterize measures of TR severity and right ventricular (RV) function.Methods:We conducted a single center retrospective analysis of patients referred to a specialty valve clinic from January 2016 to September 2020 with a primary or secondary diagnosis of tricuspid regurgitation. Baseline clinical, echocardiographic, and hemodynamic variables were evaluated.Results:A total of 348 patients were included. Median age was 79 years (IQR 70, 84), and 54% were female. Torrential TR was present in 41% (n = 146), massive in 11% (n = 40), severe 34% (n = 120), and moderate or less in 9% (n = 31). Increase in TR severity was associated with RV, right atrial, and annular dilatation. There was no difference in RV function between groups assessed by TAPSE or S’. Right atrial pressure v-wave was higher with increase in TR severity. Pulmonary arterial (PA) pressures were significantly different between groups, as was pulmonary vascular resistance (PVR): lower PA pressures and PVR were seen with increase in TR severity. There were no differences in cardiac output across groups, though a numeric trend in decreasing cardiac output was noted with increase in TR severity from severe to torrential. There was increase in S’/PASP and decrease in pulmonary artery pulsatility index seen with increasing TR severity.Conclusion:Patients referred for TR are frequently advanced in age with massive or torrential tricuspid regurgitation and evidence of adverse right ventricular remodeling. Increasing severity of advanced TR was associated with RV hemodynamic decompensation. Preservation of two-dimensional measures of right ventricular function in the setting of progressive TR, as well as markers of right ventricular-vascular coupling, may suggest these are late markers of right ventricular compromise.

Supplemental Digital Content is available in the text.The experience with transcatheter aortic valve replacement is increasing worldwide; however, the incidence of potentially catastrophic cardiac or aortic complications has not decreased. In most cases, significant injuries to the aorta, aortic valve annulus, and left ventricle require open surgical repair. However, the transcatheter aortic valve replacement patient presents a unique challenge as many patients are at high or prohibitive surgical risk and, therefore, an open surgical procedure may not be feasible or appropriate. Consequently, prevention of these potentially catastrophic injuries is vital, and practitioners need to understand when open surgical repair is required and when alternative management strategies can be used. The goal of this article is to provide an overview of current management and prevention strategies for major complications involving the aorta, aortic valve annulus, and left ventricle.

Introduction: The objective of this case report is to illustrate a case of idiopathic left ventricular tachycardia (ILVT). It is important to distinguish key features to differentiate ILVT from other types of ventricular tachycardias.Clinical picture: A 33-year-old male presented with palpitations. Clinical examination was unremarkable, except a heart rate of 170 beats/min. ECG showed a right bundle branch morphology, left superior frontal plane and a relatively narrow QRS duration. A diagnosis of ILVT was made.Treatment: Intravenous verapamil was given and the ILVT was terminated.Conclusion: ILVT differs from other types of VT, such as right ventricular outflow tract (RVOT), in terms of mechanisms, site of origin and management. Overall, ILVT has a good prognosis, compared to VTs seen in ischaemic cardiomyopathy.