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2. Abstracts

Author

Doulaptsis, C, Masci, PG, Goetschalckx, K, Janssens, S, Bogaert, J, Ferreira, VM, Piechnik, SK, DallArmellina, E, Karamitsos, TD, Francis, JM, Ntusi, N, Holloway, C, Choudhury, RP, Kardos, A, Robson, MD, Friedrich, MG, Neubauer, S, Miszalski-Jamka, T, Sokolowska, B, Szczeklik, W, Karwat, K, Miszalski-Jamka, K, Belzak, K, Malek, L, Mazur, W, Kereiakes, DJ, Jazwiec, P, Musial, J, Pedrotti, P, Masciocco, G, DAngelo, L, Milazzo, A, Quattrocchi, G, Zanotti, F, Frigerio, M, Roghi, A, Rimoldi, O, Kaasalainen, T, Kivistö, S, Holmström, M, Pakarinen, S, Hänninen, H, Sipilä, O, Lauerma, K, Banypersad, S.M, Fontana, M, Maestrini, V, Sado, D.M, Pinney, J, Wechalekar, A.D, Gillmore, J.D, Lachmann, H, Hawkins, P.N, Moon, J.C, Barone-Rochette, G, Pierard, S, Seldrum, S, de Ravensteen, CM, Melchior, J, Maes, F, Pouleur, A-C, Vancraeynest, D, Pasquet, A, Vanoverschelde, J-L, L Gerber, B, Captur, G, Muthurangu, V, Flett, AS, Wilson, R, Barison, A, Anderson, S, Cook, C, Sado, DM, McKenna, WJ, Mohun, TJ, Elliott, PM, Moon, JC, Pepe, A, Meloni, A, Gulino, L, Rossi, G, Paci, C, Spasisno, A, keilberg, P, Restaino, G, Resta, MC, Positano, V, lombardi, M, Reiter, U, Reiter, G, Kovacs, G, Schmidt, A, Olschewski, H, Fuchsjäger, M, Macmillan, A, Dabir, D, Rogers, T, Monaghan, M, Nagel, E, Puntmann, V, Semaan, E, Spottiswoode, B, Freed, B, Carr, M, Wasielewski, M, Fortney-Campione, K, Shah, S, Carr, J, Markl, M, Collins, J, Sung, YM, Hinojar, R, Ucar, EA, Dabir, D, Voigt, T, Gaddum, N, Schaeffter, T, Nagel, E, Puntmann, VO, Dabir, D, Rogers, T, Ucar, EA, Kidambi, A, Plein, S, Gebker, R, Schnackenburg, B, Voigt, T, Schaeffter, T, Nagel, E, Puntmann, VO, McAlindon, E, Bucciarelli-Ducci, C, Sado, D, Maestrini, V, Piechnik, S, Porter, J, Yamamura, J, Fischer, R, Moon, J, Symons, R, Doulaptsis, C, Masci, P.G, Goetschalckx, K, Dymarkowski, S, Janssens, S, Bogaert, J, Yalin, K, Golcuk, E, Ozer, CS, Buyukbayrak, H, Yilmaz, R, Dursun, M, Bilge, AK, Adalet, K, Reinstadler, SJ, Klug, G, Feistritzer, HJ, Mayr, A, Harrasser, B, Krauter, L, Mair, J, Schocke, MF, Pachinger, O, Metzler, B, Rigolli, M, To, A, Edwards, C, Ding, P, Christiansen, J, Rodríguez-Palomares, JF, Ortiz, JT, Bucciarelli, C, Lee, D, Wu, E, Bonow, RO, Karwat, K, Tomala, M, Miszalski-Jamka, K, Licholaj, S, Mazur, W, Kereiakes, DJ, Nessler, J, Zmudka, K, Jazwiec, P, Miszalski-Jamka, T, Peltonen, J, Kaasalainen, T, Kivistö, S, Holmström, M, Lauerma, K, Rutz, T, Meierhofer, C, Martinoff, S, Ewert, P, Hess, J, Stern, H, Fratz, S, Groarke, JD, Waller, AH, Blankstein, R, Kwong, RY, Steigner, M, Alizadeh, Z, Alizadeh, A, Khajali, Z, Mohammadzadeh, A, Kaykhavani, A, Heidarali, M, Singh, A, Bekele, S, Gunarathne, A, Khan, J, Nazir, SN, Steadman, CD, Kanagala, P, Horsfield, MA, McCann, GP, Duncan, RF, Dundon, BK, Nelson, AJ, Williams, K, Carbone, A, Worthley, MI, Zaman, A, Worthley, SG, Monney, P, Piccini, D, Rutz, T, Vincenti, G, Koestner, S, Stuber, M, Schwitter, J, Gripari, P, Maffessanti, F, Pontone, G, Andreini, D, Bertella, E, Mushtaq, S, Caiani, EG, Pepi, M, El ghannudi, S, Nghiem, A, Germain, P, Jeung, M-J, Roy, C, Gangi, A, Nucifora, G, Muser, D, Masci, PG, Barison, A, Piccoli, G, Rebellato, L, Puppato, M, Gasparini, D, Lombardi, M, Proclemer, A, Nucifora, G, Muser, D, Masci, PG, Barison, A, Piccoli, G, Rebellato, L, Puppato, M, Gasparini, D, Lombardi, M, Proclemer, A, Pöyhönen, P, Kivistö, S, Holmströn, M, Hänninen, H, Thorning, C, Bickelhaupt, S, Kampmann, C, Wentz, KU, Widmer, U, Juli, CF, Miszalski-Jamka, K, Klys, J, Glowacki, J, Kijas, M, Miszalski-Jamka, T, Adamczyk, T, Kwiecinski, R, Bogucka-Czapska, J, Ozaist, M, Mazur, W, Kluczewska, E, Kalarus, Z, Kukulski, T, Karakus, G, Marzluf, B, Bonderman, D, Tufaro, C, Pfaffenberger, S, Babyev, J, Maurer, G, Mascherbauer, J, Kockova, R, Tintera, J, Kautznerova, D, Cerna, D, Sedlacek, K, Kryze, L, El-Husseini, W, Sikula, V, Segetova, M, Kautzner, J, Vasconcelos, M, Lebreiro, A, Martins, E, Cardoso, JS, Madureira, AJ, Ramos, I, Maciel, MJ, Florian, A, Ludwig, A, Rösch, S, Sechtem, U, Yilmaz, A, Monmeneu, J.V, López-Lereu, M.P, Bonanad, C, Sanchis, J, Chaustre, F, Merlos, P, Valero, E, Bodí, V, Chorro, F.J, Yalin, K, Golcuk, E, Ozer, CS, Buyukbayrak, H, Yilmaz, R, Dursun, M, Bilge, AK, Adalet, K, Klug, G, Reinstadler, SJ, Feistritzer, HJ, Mayr, A, Riegler, N, Schocke, M, Esterhammer, R, Kremser, C, Pachinger, O, Metzler, B, Siddiqi, N, Cameron, D, Neil, C, Jagpal, B, Singh, S, Schwarz, K, Papadopoulou, S, Frenneaux, MP, Dawson, D, Robbers, LFHJ, Eerenberg, ES, Teunissen, PFA, Jansen, MF, Hollander, MR, Horrevoets, AJG, Knaapen, P, Nijveldt, R, Levi, MM, van Rossum, AC, Niessen, HWM, Marcu, CB, Beek, AM, van Royen, N, Everaars, H, Robbers, LFHJ, Nijveldt, R, Beek, AM, Teunissen, PFA, Hirsch, A, van Royen, N, Zijlstra, F, Piek, JJ, van Rossum, AC, Goitein, O, Grupper, A, Hamdan, A, Eshet, Y, Beigel, R, Medvedofsky, D, Herscovici, R, Konen, E, Hod, H, Matetzky, S, Cadenas, R, Iniesta, AM, Refoyo, E, Antorrena, I, Guzman, G, Cuesta, E, Salvador, O, López, T, Moreno, M, López-Sendon, JL, Alam, SR, Spath, N, Richards, J, Dweck, M, Shah, A, Lang, N, Semple, S, MacGillivray, T, Mckillop, G, Mirsadraee, S, Pessotto, R, Zamvar, V, Newby, DE, Henriksen, P, Reiter, G, Reiter, U, Kovacs, G, Olschewski, H, Fuchsjäger, M, Ahmad, S, Raza, U, Malik, A, Sun, JP, Eisner, R, Mazur, W, ODonnell, R, Positano, V, Meloni, A, Santarelli, MF, Landini, L, Tassi, C, Grimaldi, S, Gulino, L, De Marchi, D, Chiodi, E, Renne, S, Lombardi, M, Pepe, A, Wu, L, Germans, T, Güçlü, A, Allaart, CP, van Rossum, AC, Kalisz, K, Lehenbauer, K, Katz, D, Bi, X, Cordts, M, Guetter, C, Jolly, M-P, Freed, B, Shah, S, Markl, M, Flukiger, J, Carr, J, Collins, J, Osiak, A, Tyrankiewicz, U, Jablonska, M, Jasinski, K, Jochym, PT, Chlopicki), S, Skorka, T, Kalisz, K, Semaan, E, Katz, D, Bi, X, Cordts, M, Guetter, C, Jolly, MP, Freed, B, Flukiger, J, Lee, D, Kansal, P, Shah, S, Markl, M, Carr, J, Collins, J, Groarke, JD, Shah, RV, Waller, AH, Abbasi, SA, Kwong, RY, Blankstein, R, Steigner, M, Chin, CWL, Semple, S, Malley, T, White, A, Prasad, S, Newby, DE, Dweck, M, Pepe, A, Meloni, A, Lai, ME, Vaquer, S, Gulino, L, De Marchi, D, Cuccia, L, Midiri, M, Vallone, A, Positano, V, Lombardi, M, Pedrotti, P, Milazzo, A, Quattrocchi, G, Roghi, A, Rimoldi, O, Barison, A, De Marchi, D, Masci, P, Milanesi, M, Aquaro, GD, Keilberg, P, Positano, V, Lombardi, M, Positano, Vincenzo, Barison, Andrea, Pugliese, Nicola Riccardo, Masci, Piergiorgio, Del Franco, Annamaria, Aquaro, Giovanni Donato, Landini, Luigi, Lombardi, Massimo, Dieringer, MA, Deimling, M, Fuchs, K, Winter, L, Kraus, O, Knobelsdorff-Brenkenhoff, FV, Schulz-Menger, J, Niendorf, T, Hinojar, R, Ucar, EA, DCruz, D, Sangle, S, Dabir, D, Voigt, T, Gaddum, N, Schaeffter, T, Nagel, E, Puntmann, VO, Sung, YM, Pontone, G, Andreini, D, Bertella, E, Mushtaq, S, Gripari, P, Cortinovis, S, Loguercio, M, Baggiano, A, Conte, E, Pepi, M, El ghannudi, S, Hop, O, Germain, P, Jeung, M-J, De Cesare, A, Roy, C, Gangi, A, Barone-Rochette, G, Pierard, S, Seldrum, S, De Meester de Ravensteen, C, Melchior, J, Maes, F, Pouleur, A-C, Vancraeynest, D, Pasquet, A, Vanoverschelde, J-L, L Gerber, B, Bekele, S, Singh, A, Khan, JN, Nazir, SA, Kanagala, P, McCann, GP, Singh, A, Steadman, CD, Bekele, S, Khan, JN, Nazir, SA, Kanagala, P, McCann, GP, Paelinck, BP, Vandendriessche, T, De Bock, D, De Maeyer, C, Parizel, PM, Christiaan, J, Trauzeddel, RF, Gelsinger, C, Butter, C, Barker, A, Markl, M, Schulz-Menger, J, von Knobelsdorff, F, Florian, A, Schäufele, T, Ludwig, A, Rösch, S, Wenzelburger, I, Yilmaz, A, Sechtem, U, López-Lereu, M.P, Bonanad, C, Monmeneu, J.V, Sanchís, J, Estornell, J, Igual, B, Maceira, A, Chorro, F.J, Focardi, M, Cameli, M, Bennati, E, Massoni, A, Solari, M, Carbone, F, Banchi, B, Mondillo, S, Miia, H, Kirsi, L, Helena, H, Tiina, H, Jyri, L, Pauli, P, Sari, K, Schumm, J, Greulich, S, Grün, S, Ong, P, Klingel, K, Kandolf, R, Sechtem, U, Mahrholdt, H, Raimondi, F, Ou, P, Boudjemline, Y, Bajolle, F, Iserin, F, Bonnet, D, Collins, J, Kalisz, K, Benefield, B, Sarnari, R, Katz, D, Bi, X, Cordts, M, Guetter, C, Jolly, M-P, Freed, B, Flukiger, J, Kansal, P, Lee, D, Shah, S, Markl, M, Carr, J, Sokolowska, B, Miszalski-Jamka, T, Szczeklik, W, Karwat, K, Miszalski-Jamka, K, Belzak, K, Mazur, W, Kereiakes, DJ, Jazwiec, P, Musial, J, Silva, G, Almeida, AG, Resende, C, Marques, JS, Silva, D, David, C, Amaro, C, Costa, P, Silva, JAP, Diogo, AN, Tsokolov, AV, Senchilo, VG, Vertelkin, AV, Hoffmann, P, Mykjåland, G, Wangberg, H, Tønnessen, T, Sjaastad, I, Nordsletten, L, Hjørnholm, U, Løset, A, Rostrup, M, Meloni, A, Gulino, L, Keilberg, P, Palazzi, G, Maddaloni, D, Ascioti, C, Missere, M, Salvatori, C, Positano, V, Lombardi, M, Pepe, A, Meloni, A, Filosa, A, Gulino, L, Pulini, S, Salvatori, C, Chiodi, E, Ascioti, C, Keilberg, P, Positano, V, Lombardi, M, Pepe, A, Meloni, A, Gulino, L, Pietrapertosa, A, Izzi, G, De Marchi, D, Valeri, G, Preziosi, P, Positano, V, Lombardi, M, Pepe, A, Meloni, A, Ruffo, GB, Keilberg, P, Gulino, L, Gerardi, C, Sallustio, G, Tudisca, C, Positano, V, Lombardi, M, Pepe, A, Greulich, S, Backes, M, Schumm, J, Grün, S, Sechtem, U, Mahrholdt, H, Dorniak, K, MSc, AS, Szurowska, E, Fijalkowski, M, Rawicz-Zegrzda, D, Dudziak, M, Raczak, G, Hamdan, A, Baker, FA, Klein, M, Di Segni, E, Goitein, O, Fibisch, G, Konen, E, Müller-Bierl, B, Tanaka, K, Buls, N, Fierens, Y, van Cauteren, T, Willekens, I, van Laere, S, Luypaert, R, de Mey, J, Muzzarelli, S, Faragasso, E, Pedrazzini, G, Sürder, D, Pasotti, E, Moccetti, T, Faletra, F, Qayyum, AA, Hasbak, P, Larsson, HB, Mathiasen, AB, Vejlstrup, NG, Kjaer, A, Kastrup, J, Moschetti, K, Favre, D, Pinget, C, Pilz, G, Petersen, S, Wagner, A, Wasserfallen, JB, Schwitter, J, Ghosh Dastidar, A, Cengarle, M, McAlindon, E, Augustine, D, Nightingale, AK, Bucciarelli-Ducci, C, Dandekar, VK, Ertel, AW, Dickens, C, Gonzalez, RC, Farzaneh-Far, A, Ripley, DP, Higgins, D, McDiarmid, AK, Bainbridge, GJ, Uddin, A, Kidambi, A, Herzog, B, Greenwood, JP, Plein, S, Khanji, M, Newton, T, Westwood, M, Sekhri, N, and Petersen, SE

Abstract

Background-Aims: Early post-infarction pericardial injury is a common finding but its diagnosis remains elusive. Though C-reactive protein (CRP) is considered a marker of myocardial damage, reflecting myocardial inflammation at the infarcted area, we sought to assess the relationship between CRP and pericardial injury depicted by cardiovascular magnetic resonance (CMR) imaging in patients with ST elevation myocardial infarction (MI). Methods and results: 181 MI patients (84% male) were studied with CMR in the first week and at 4 months post-infarction to assess infarct characteristics, left ventricular volumes/function and pericardial injury. The latter was defined as pericardial fluid >4mm and/or enhancement on late gadolinium enhancement CMR. The CRP-value at day 2 (according to previous literature) was used for correlation with CMR and clinical parameters. Pericardial injury was noted in 87 patients, i.e. effusion (n = 30), inflammation (n = 46), both (n = 11). Patients with pericardial injury had significantly higher peak values of cardiac biomarkers (p<0.001) and higher peak CRP-values than patients with normal pericardium (median 13 vs 43 mg/dl, p<0.001). A strong correlation was found between peak CRP-values and a) left venticular ejection fraction and infarct size both at 1 week and 4 months, b) myocardial hemorrhage, microvascular obstruction (MVO) and pericardial injury at 1 week, c) cardiac biomarkers values and time to PCI. However in a multiple regression model only pericardial injury (p = 0.003) and less importantly time to PCI (p = 0.022) were the independent predictors of CRP values. Conclusion: Pericardial damage described by cardiac MRI occurs often after acute ST elevation MI. CRP-values at the acute phase of MI reflect not only inflammation at the infarcted area but even more the inflammation of the surrounding pericardial tissue. Table 1 Comparison of baseline clinical and biochemical parameters of patients with or without evidence of early post-infarct pericardial damage on CMR Normal Group (n = 94)Pericardial injury group (n = 87)p-valueAgem, years59±1160±120.48Male, n(%)83 (88)69 (79)0.10Diabets, n(%)12 (13)9 (10)0.61Smoker, n(%)52 (55)44 (51)0.52Hyperlipidemia, n(%)56 (60)55 (63)0.62BSA m22.0 ± 0.22.0 ± 0.20.20Time to PCI, min195 (155 − 274)223 (160 − 335)0.20Troponin I, μ/l44 (19 − 92)90 (44 − 149)>0.001CK-MB, U/L128 (77 − 216)250 (143 − 443)>0.001CRP, mg/dL13 (7 − 28)43 (16 − 96)>0.001Day of peak CRP2 (1 − 3)2 (1 − 3)0.39 Table 2 Significant correlations between CRP Values and corresponding CMR measurements, cardic biomarkers and clinical related parameters VariblesSpearmanscorrelations rp-valueCMR parameters 1 weekLV EF−0.28>0,001Infractsize(%ofLV)0.40>0,001Microvasular obstruction0.27>0,001Hemorrhage0.33>0,001Size of area atrisk0.31>0,001Transmurality0.30>0,001Pericaldial damage0.43>0,001CMR parameters 4 monthsLVEF−0.43>0,001Infarctsize(%ofLV)0.46>0,001Cardiac BiomarkersPeak TnI0.34>0,001Peak CK-MB0.32>0,001OtherTime to PCI0,1820,007

Published
2013
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3. Accuracy of predicted orthogonal projection angles for valve deployment during transcatheter aortic valve replacement.

Author

Steinvil A, Weissman G, Ertel AW, Weigold G, Rogers T, Koifman E, Buchanan KD, Shults C, Torguson R, Okubagzi PG, Satler LF, Ben-Dor I, and Waksman R

Subjects
Aged, Aged, 80 and over, Aortic Valve physiopathology, Aortic Valve Stenosis physiopathology, Female, Heart Valve Prosthesis, Humans, Male, Predictive Value of Tests, Reproducibility of Results, Retrospective Studies, Aortic Valve diagnostic imaging, Aortic Valve surgery, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis surgery, Computed Tomography Angiography methods, Coronary Angiography methods, Multidetector Computed Tomography methods, Radiographic Image Interpretation, Computer-Assisted methods, Transcatheter Aortic Valve Replacement instrumentation
Abstract

Background: Multi-detector computed tomography (MDCT) predicted orthogonal projection angles have been introduced to guide valve deployment during transcatheter aortic valve replacement (TAVR). Our aim was to investigate the accuracy of MDCT prediction methods versus actual angiographic deployment angles., Methods: Retrospective analysis of 2 currently used MDCT methods: manual multiplanar reformations (MR) and the semiautomatic optimal angle graph (OAG). Paired analysis was used to compare the 2-dimensional distributions and means., Results: We included 101 patients with a mean (±SD) age of 81 ± 9 years. The MR and OAG methods were used in 46 and 55 patients, respectively. A ≥5% change from the predicted MDCT range in left anterior oblique/right anterior oblique (LAO/RAO) and the cranial/caudal (CRA/CAU) angle occurred in 42% and 58% of patients, respectively. The mean predicted versus actual deployment angles were significantly different (CRA/CAU: -2.6 ± 11.5 vs. -7.6 ± 10.7, p < 0.001; RAO/LAO 8.1 ± 10.9 vs. 9.5 ± 10.6, p = 0.048; respectively). The MR method resulted in a more accurate CRA/CAU angle (CRA/CAU: -4.6 ± 11.1 vs. -6.5 ± 11.8, p = 0.139; RAO/LAO 7.4 ± 11.2 vs. 10.4 ± 11.2, p = 0.008; respectively), whereas the use of the OAG resulted in a more accurate RAO/LAO angle (CRA/CAU: -0.9 ± 10.8 vs. -9±11.2, p < 0.001; RAO/LAO 9.05 ± 10.6 vs. 8.5 ± 9.9, p = 0.458; respectively). For the entire cohort, the 2-dimensional distributions and means of the predicted versus the actual angles were significantly different from each other (p < 0.001). We repeated our analysis using both MDCT methods and demonstrated similar results with each method., Conclusions: Currently used MDCT methods for TAVR implantation angles are significantly modified before actual valve deployment. Thus, further refinement of these prediction methods is required., (Copyright © 2018 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Published
2018
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4. Management and Outcome of Residual Aortic Regurgitation After Transcatheter Aortic Valve Implantation.

Author

Koifman E, Didier R, Garcia-Garcia H, Weissman G, Ertel AW, Kiramijyan S, Steinvil A, Rogers T, Patel N, Kumar S, Tavil-Shatelyan A, Ben-Dor I, Pichard AD, Torguson R, Gai J, Satler LF, and Waksman R

Subjects
Aged, 80 and over, Aortic Valve Insufficiency diagnosis, Aortic Valve Insufficiency etiology, Female, Fluoroscopy, Follow-Up Studies, Humans, Male, Reoperation, Retrospective Studies, Risk Factors, Severity of Illness Index, Aortic Valve Insufficiency surgery, Aortic Valve Stenosis surgery, Balloon Valvuloplasty methods, Heart Valve Prosthesis adverse effects, Postoperative Complications, Transcatheter Aortic Valve Replacement adverse effects
Abstract

We aimed to evaluate the success rates of balloon valvuloplasty post-dilation (BVPD) and a second-valve deployment in reducing residual aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and its impact on outcome. Residual AR immediately post-TAVI in patients with aortic stenosis is a common condition that adversely affects outcome. Patients who underwent TAVI who had more-than-mild residual AR were managed either with medical therapy, re-intervention with BVPD, or a second valve. The clinical impact of these strategies was evaluated, and the anatomical features of patients with successful and unsuccessful intervention were compared. Among 572 patients with TAVI, 110 (19%) had significant residual AR after initial device deployment. Sixty patients were treated by BVPD (n = 49) or second-device deployment (n = 11), whereas 50 patients were treated medically. Successful reduction in residual AR to mild and below was achieved in 56% of the intervention group. Eccentric and calcified annuli were present in patients in whom residual AR remained despite re-intervention (p = 0.004). Interventions to reduce residual AR were independently associated with improved survival compared with conservative medical therapy (hazard ratio 0.45, 95% confidence interval 0.94 to 0.21, p = 0.03). BVPD or a second valve were safe and were not associated with increased rate of periprocedural complications. In conclusion, both BVPD and a second-valve deployment to reduce residual AR post-TAVI are effective and safe. The success rates are inversely correlated with the annulus eccentricity and calcification. These measures should be encouraged to reduce acute residual AR as they are associated with improved long-term survival., (Copyright © 2017. Published by Elsevier Inc.)

Published
2017
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5. A 28-year-old man with chest and joint pains.

Author

Ertel AW, Romano S, and Farzaneh-Far A

Subjects
Adult, Anti-Bacterial Agents administration & dosage, Anti-Inflammatory Agents, Non-Steroidal administration & dosage, Drug Administration Schedule, Humans, Magnetic Resonance Imaging, Cine, Male, Penicillins administration & dosage, Pericardial Effusion microbiology, Rheumatic Heart Disease diagnostic imaging, Rheumatic Heart Disease drug therapy, Salicylates administration & dosage, Time Factors, Treatment Outcome, Arthralgia microbiology, Chest Pain microbiology, Rheumatic Heart Disease microbiology
Abstract

Clinical Introduction: A 28-year-old man with extensive travel history to developing countries was hospitalised for intermittent sharp chest pains, worst when supine and with inspiration. Two weeks prior to presentation, he had suffered a flu-like illness with a sore throat, which was resolving. Physical examination was notable for mild fever and tachycardia with cervical lymphadenopathy and painful bilateral knee and wrist effusions. Cardiac auscultation was remarkable for a soft early-peaking systolic murmur over the aortic area with a decrescendo early diastolic murmur along the left sternal edge. There was mild leucocytosis, elevation of serum troponin and acute-phase reactants with an ECG showing sinus tachycardia. Echocardiographic windows were extremely limited but suggested the presence of pericardial effusion and aortic regurgitation. Cardiac MRI was performed (figure 1). Viral, microbiological and autoimmune testing was remarkable only for significant elevation of antistreptolysin-O titres (1450 IU rising to 1940 IU, normal <200 IU). Pericardiocentesis revealed an exudative effusion, which was negative by cytology and microbiological analysis, including for tuberculosis and fungi., Question: The most appropriate next step is? Coronary angiographyEndomyocardial biopsyTreatment with colchicine for 3 monthsTreatment with corticosteroidsTreatment with high-dose salicylates and long-term penicillinFor the answer see page 808For the question see page 769., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Published
2016
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6. Myocardial infarction due to intracoronary embolization of percutaneous coronary intervention packaging.

Author

Ertel AW, Shroff AR, and Vidovich MI

Subjects
Aged, Coronary Angiography, Coronary Stenosis diagnosis, Device Removal, Embolism diagnosis, Embolism therapy, Foreign-Body Migration diagnosis, Foreign-Body Migration therapy, Humans, Male, Myocardial Infarction diagnosis, Myocardial Infarction therapy, Predictive Value of Tests, Risk Factors, Severity of Illness Index, Tomography, Optical Coherence, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Angioplasty, Balloon, Coronary instrumentation, Coronary Stenosis therapy, Embolism etiology, Foreign-Body Migration etiology, Medical Errors, Myocardial Infarction etiology, Product Packaging
Abstract

Intracoronary device loss is occasionally encountered and removal is commonly performed at the time of the procedure. We report a case of removal of a retained coronary balloon protective plastic tubing inadvertently left in the coronary artery for a month and associated with myocardial infarction. Optical coherence tomography was used to visualize the foreign body prior to removal with a snare. To our knowledge this is the first report of a removal of disposable packaging equipment after prolonged intracoronary dwell time., (Published 2014. This article is a U.S. Government work and is in the public domain in the USA.)

Published
2014
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7. Hemodynamic Consequences of Hypertrophic Cardiomyopathy with Midventricular Obstruction: Apical Aneurysm and Thrombus Formation.

Author

Saba SG, Ertel AW, Siegenthaler M, Bodurian E, Kellman P, Chen MY, Arai AE, and Bandettini WP

Abstract

Background: Hypertrophic cardiomyopathy (HCM) with midventricular hypertrophy is an uncommon phenotypic variant of the disease. Midventricular hypertrophy predisposes to intracavitary obstruction and downstream hemodynamic sequelae., Case Report: We present a case of HCM with midventricular hypertrophy and obstruction diagnosed after a CT scan of the abdomen incidentally revealed a filling defect in the left ventricular apex. Transthoracic echocardiography demonstrated mid left ventricular hypertrophy and obstruction, as well as an aneurysmal apex containing a large thrombus. Cardiovascular MRI showed a spade-shaped left ventricle with midcavitary obliteration, an infarcted apex and regions of myocardial fibrosis. Due to the risk of embolization and a relative contraindication to anticoagulation, the patient underwent surgery including thrombectomy, septal myectomy and aneurysmal ligation., Conclusions: Hypertrophic cardiomyopathy with midventricular hypertrophy leads to cavity obstruction, increased apical wall tension, ischemia and ultimately fibrosis. Over time, patchy apical fibrosis can develop into a confluent scar resembling a transmural myocardial infarction in the left anterior descending coronary artery distribution. Aneurysmal remodeling of the left ventricular apex potentiates thrombus formation and risk of cardioembolism. For these reasons, hypertrophic cardiomyopathy with midventricular obstruction portends a particularly poor prognosis and should be recognized early in the disease process.

Published
2014
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8. Assessment of global myocardial perfusion reserve using cardiovascular magnetic resonance of coronary sinus flow at 3 Tesla.

Author

Dandekar VK, Bauml MA, Ertel AW, Dickens C, Gonzalez RC, and Farzaneh-Far A

Subjects
Adenosine A2 Receptor Agonists, Aged, Aminophylline administration & dosage, Blood Flow Velocity, Feasibility Studies, Female, Humans, Male, Middle Aged, Myocardial Ischemia physiopathology, Predictive Value of Tests, Prospective Studies, Purinergic P1 Receptor Antagonists administration & dosage, Purines, Pyrazoles, Regional Blood Flow, Coronary Circulation, Coronary Sinus physiopathology, Magnetic Resonance Imaging, Cine, Myocardial Ischemia diagnosis, Myocardial Perfusion Imaging methods
Abstract

Background: Despite increasing clinical use, there is limited data regarding regadenoson in stress perfusion cardiovascular magnetic resonance (CMR). In particular, given its long half-life the optimal stress protocol remains unclear. Although Myocardial Perfusion Reserve (MPR) may provide additive prognostic information, current techniques for its measurement are cumbersome and challenging for routine clinical practice.The aims of this study were: 1) To determine the feasibility of MPR quantification during regadenoson stress CMR by measurement of Coronary Sinus (CS) flow; and 2) to investigate the role of aminophylline reversal during regadenoson stress-CMR., Methods: 117 consecutive patients with possible myocardial ischemia were prospectively enrolled. Perfusion imaging was performed at 1 minute and 15 minutes after administration of 0.4 mg regadenoson. A subgroup of 41 patients was given aminophylline (100 mg) after stress images were acquired. CS flow was measured using phase-contrast imaging at baseline (pre CS flow), and immediately after the stress (peak CS flow) and rest (post CS flow) perfusion images., Results: CS flow measurements were obtained in 92% of patients with no adverse events. MPR was significantly underestimated when calculated as peak CS flow/post CS flow as compared to peak CS flow/pre CS flow (2.43±0.20 vs. 3.28±0.32, p=0.03). This difference was abolished when aminophylline was administered (3.35±0.44 vs. 3.30±0.52, p=0.95). Impaired MPR (peak CS flow/pre CS flow<2) was associated with advanced age, diabetes, current smoking and higher Framingham risk score., Conclusions: Regadenoson stress CMR with MPR measurement from CS flow can be successfully performed in most patients. This measurement of MPR appears practical to perform in the clinical setting. Residual hyperemia is still present even 15 minutes after regadenoson administration, at the time of resting-perfusion acquisition, and is completely reversed by aminophylline. Our findings suggest routine aminophylline administration may be required when performing stress CMR with regadenoson.

Published
2014
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