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The sociodemographic characteristics of patients undergoing intervention for aortic stenosis (AS) in England, and the impact of COVID-19, is unknown. Women and more deprived groups had lower rates of SAVR (age-standardised rates per 100 000 in 2020–2023: 17.07 for men vs women; 9.82 for men vs women; 9.55 for IMD-1 vs IMD-5).
Getty Images milla1cf Mon, 01/29/2024 - 14:24 January 29, 2024 — Despite national guidelines recommending surgical aortic valve replacement (SAVR) for patients under age 65 with severe aortic stenosis , many hospitals are still opting for a nonsurgical approach in patients under 60—possibly with poorer survival rates. for SAVR vs. 0.4%
BackgroundRecurrent pulmonary vein stenosis (PVS) following surgical repair of total anomalous pulmonary venous connection is associated with poor prognosis. Since August 2020, patients have been considered for valsartan therapy early after operation. Journal of the American Heart Association, Volume 14, Issue 4 , February 18, 2025.
American College of Cardiology/American Heart Association guideline recommendations for transcatheter aortic valve replacement (TAVR) transitioned in 2020 from decision-making based on estimated risk of surgical valve replacement (SAVR) to one based on patient age and expected longevity.
The primary safety endpoint was incidence of early onset (within seven days) primary adverse events; atrio-esophageal fistula (within 90 days); cardiac tamponade or perforation (within 30 days); and PV stenosis (within 12 months). Epub 2020 Jan 19. 2020 Jan 28;1747493020905964. 2020 June;127(1):4-20. Int J Stroke.
Below is a still image with the red arrow indicating the subtotal LMCA stenosis. Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( This Table from My Comment in the January 16, 2020 post ). The video below shows the coronary angiography.
The following day in the cath lab a borderline significant mid LAD stenosis was found. At cath the following day there was a borderline significant stenosis of the mid LAD with FFR 0,8. We review ECG findings in Takotsubo Cardiomyopathy in the March 25, 2020 post of Dr. Smith's ECG Blog. Decision was made to stent the lesion.
SCAPE is an acronym for sympathetic crash acute pulmonary edema, which can typcially occur in Pickering syndrome with renal artery stenosis [1]. Another term for transient acute pulmonary edema which occurs in renal artery stenosis is flash pulmonary edema. doi: 10.1136/bcr-2020-239421. BMJ Case Rep. 2021 Feb 9;14(2):e239421.
Methods We interrogated data collected in the UK Biobank between 1 January 2000 and 30 June 2020. VHD incidence was determined using International Classification of Disease-10 codes for aortic stenosis (AS), aortic regurgitation (AR), mitral stenosis, mitral regurgitation (MR) and mitral valve prolapse.
National Inpatient Sample (NIS) database from 2009 to 2020, evaluating patients who presented with stroke from ICAD and were treated with angioplasty and stenting and analyzed presenting co-morbidities and patient outcomes. vs 10.2%) in the 2020 patient group compared to the 2009 patients. vs 7.9%), diabetes (33.6%
EKG from triage: Here is his previous ECG: Normal ST Elevation Resident's interpretation: Reperfusion pattern/Wellens' with biphasic T waves in V2 and V3, and in comparison to an EKG in 2020 this is new. Course : Aspirin 325mg, chemistry, CBC, troponin panel all ordered. Pattern B — was the more common form in the original Wellens’ report.
These data follow the 12-month results showing superiority over DES in imaging endpoints including lower % diameter stenosis, late lumen loss, and the new measures of vessel pulsatility, compliance and adaptive blood flow by restoring hemodynamic modulation and vessel viability. JACC 2020. 3 [link] 4 Saito S, M.D. 5 Saito S, et al.
Even in patients whose moderate stenosis undergoes thrombosis, most angiograms show greater than 50% stenosis after the event. However, one can certainly imagine that many thromboses of non-obstructive lesions completely lyse and do not leave a stenosis on same day or next day angiogram. This is not the case.
TriClip has been approved for use in more than 50 countries, including in Europe and Canada, since its initial CE Mark approval in 2020. The device has already been used to treat more than 10,000 people with TR. important safety information on TriClip, visit [link]. Current state of transcatheter tricuspid valve repair.
Between 2016 and 2020, 395 patients with mitral valvular disease were discussed at MDT. Of those discussed at MDT the pathology was: DMR 65%; mitral stenosis 14%; functional mitral regurgitation (MR) 5%; rheumatic MR 4%; endocarditis 4%; ischaemic MR 4%; and other pathologies 4%. Of these, 310 patients underwent surgery.
Objectives To understand the patient and hospital level drivers of the variation in surgical versus trascatheter aortic valve replacement (SAVR vs TAVR) for patients with aortic stenosis (AS) and to explore whether this variation translates into differences in clinical outcomes. Background Adoption of TAVR has grown exponentially worldwide.
To standardize (2), aspiration was to be initiated just before PTA balloon deflation during pre- and post-dilatation.Methods:From June 2020 to the present, CAS cases using the Filter protection device were enrolled and divided into two groups before and after the introduction of the POWER technique. Symptomatic stenosis (63.9%
Objectives Lipoprotein(a) (Lp(a)) is associated with an increased incidence of native aortic stenosis, which shares similar pathological mechanisms with bioprosthetic aortic valve (bAV) degeneration. However, evidence regarding the role of Lp(a) concentrations in bAV degeneration is lacking.
Introduction Severe aortic stenosis is a major cause of morbidity and mortality. Data were collected retrospectively for all outpatients referred for consideration of TAVI to a Heart Valve Centre from November 2020 to November 2021. Methods The centre performing local workup implemented a novel TAVI referral pathway.
ml/h, P = 0.04), a higher likelihood of parent artery stenosis (65% vs. 20.8%, P < 0.001), and increased need for angioplasty or stenting (50% vs. 17%, P < 0.001). Follow-up lesion volumes and functional outcomes were similar; however, the mismatch group showed a slower infarct growth rate (3.8 ml/h vs. 7.5 vs. 21.2%, P = 0.02).Conclusions:DWI-ADC
Angiogram findings included: 95% mid RCA stenosis with occluded distal right PDA secondary to thrombus (peristent OMI). Successful drug-eluting stent placement opening up 95% mid RCA stenosis to 0% residual Nonobstructive left system disease. Queen of Hearts: The initial troponin (high sensitivity troponin I) returned less than 6 ng/L.
1 These included one pseudoaneurysm, one PV stenosis and one hematoma.1 2020 June;127(1):4-20. 1 Study success was defined by meeting both safety and acute effectiveness performance goals.1 1 Results from the analysis reaffirmed the safety and effectiveness of low/zero fluoroscopy procedures.1 Int J Stroke. 2021 Feb;16(2):217-221.
Lesion on Dist RCA: 90% stenosis reduced to 0%. On occasion — the intermittent conduction defect may show random alternation between normal and impaired conduction, with no "fixed" interval between narrow and wider beats ( See My Comment in the June 25, 2020 post in Dr. Smith's ECG Blog ). Pre procedure TIMI III flow was noted.
The PREMIER study first demonstrated high rates of complete occlusion without parent vessel stenosis or permanent neurological complications after the treatment of wide-necked small and medium-sized intracranial ICA aneurysms with the 48-wire pipeline. Successful implantation was encountered in 99% (128/129) of the cases. At a median 10.1
Fetal aortic valvuloplasty is considered for fetuses with severe valvar aortic stenosis and echocardiographic features suggesting a risk of progression to hypoplastic left heart syndrome. Though surgical options are available for infants with hypoplastic left heart syndrome, morbidity and mortality are high.
We aimed to describe diagnoses in hospital encounters within 7 days and 30 days before a first-ever stroke.Methods:We used a statewide (Tasmania, ~500,000 population) linked dataset comprising emergency department [ED] presentations, hospital admissions and deaths in Australia from 2007-2020. migraine) and respiratory diseases (Table 1).
First high sensitivity troponin I = 4 ng/L (nearly below the limit of detection) Angiogram: --Culprit is 99 % stenosis in the proximal ostial LAD --LCX is a large OM with a large lateral segment, the lateral segement has a diffuse 90% disease in the ostial proximal segment of it. This is FAR LESS than all other studies of shockable arrest.
This distinction is crucial to understand as most heart attacks result from plaque ruptures of less than 70% stenosis, which is the type of narrowing missed by most exercise stress tests 2. Estimates of Angiographic Stenosis of Culprit Coronary Artery Lesions in 50 Consecutive Patients Experiencing Sudden Coronary Death.
BP was recorded at frequent intervals for at least 24 hours post-CAS. Blood catecholamine concentrations were assessed in the morning of, and day immediately after, CAS in a subset of patients.
Patients were then divided into two cohorts with or without carotid-cerebral artery disease (defined as stenosis of any carotid, vertebral or intracranial artery50%). Computed tomography angiography (CTA) was performed preoperatively. vertebral artery (19.5%, 390/2004). and common carotid artery (17.3%, 347/2004).
BACKGROUNDHypertension is often codiagnosed in patients with moyamoya disease (MMD), a progressive intracranial steno‐occlusive vasculopathy; this has principally been attributed to renal artery stenosis (up to 10%). Blood pressure measurements and antihypertensive agent use were recorded pre‐ and postoperatively.
RESULTS:From 2020 through 2022, 172 patients were screened, 169 were randomized, and 162 were included in the full analysis set, receiving either aspirin plus rivaroxaban (n=80) or rivaroxaban alone (n=82) for 6 months. Secondary outcomes, including Villalta score, quality of life, and safety outcomes, were also assessed.
Angiogram Left main: Severe calcific stenosis of ostial and distal left main. LAD: large caliber vessel with severe calcific stenosis of the proximal LAD with TIMI2 flow. There are large caliber diagonal branches with no significant stenosis. Mid LAD has another area of focal moderate stenosis.
Angiogram showed no significant disease of the left main, LAD, or LCX, but acute culprit lesion of the proximal RCA with "99% stenosis" and TIMI 2 flow. KEY Point: The best way to confirm acute RV MI — is with use of right -sided leads ( See My Comment in the July 19, 2020 and July 11, 2018 posts).
Angiography revealed a 30% nonobstructive stenosis of the mid LAD. There was a 70% culprit stenosis of the first obtuse marginal branch in a right dominant system. Serial high sensitivity troponin T (URL 15 ng/L) values were negative and stagnant. Patient 1 remained in the hospital overnight.
We also compared the safety of acute carotid stenting (CAS) in TLs with low ASPECTS.Methods:This prospective multicenter study from 16 centers included patients with anterior circulation TL from 2015-2020. Patients were divided into ASPECTS 0-5 and 6-10 groups.
The primary non-inferiority endpoint was all-cause mortality, stroke, and major bleeding at 2-years between the two strategies.Results: The study enrolled 349 patients, 177 TAVR+LAAO and 172 TAVR+medical therapy, between December-2017 and November-2020 at 34 US centers. The mean age was 81 years, CHA2DS2-VASc score was 4.9 At baseline, 85.4%
We report the outcomes of a 12-hour targeted-intensity monitoring (TIM) pathway for low-risk post-IVT patients.Methods:Post-IVT patients were considered low-risk if their NIHSS < 10, blood pressure < 180/105 without medical intervention, level of consciousness was preserved, and no high-risk vessel stenosis/occlusion was present.
The first troponin I returned at 34 ng/L (URL = 35 ng/L) The HEART score (also HEART pathway) = 3 (But this is only if you were to think that the ECG is normal, as the computer does) Cath report: Findings in left circumflex: LCX: Large, but non-dominant. Supplies a very large OM1.
1-4 Surprisingly, serial angiographic studies have revealed that the plaque at the site of the culprit lesion of a future acute myocardial infarction often does not cause stenosis that, as seen on the antecedent angiogram, is sufficiently severe to limit flow. There may be a chronic tight stenosis and a non-obstructed lesion that thrombosed.
Culprit Lesion: Angiographically indeterminate 50% stenosis in the proximal OM2 was assessed further with instantaneous wave free ratio (iFR) of 0.96, which is normal (see below for description of iFR*). Instantaneous wave-free ratio is performed using high fidelity pressure wires that are passed distal to the coronary stenosis.
Cath at approximately 0945: "The LAD had a 90% proximal stenosis with TIMI 3 flow which corresponds to his ECG although LV function remains preserved. With nitroglycerin there is improvement in the 90% stenosis but still persistent stenosis consistent with the dynamic nature of his presentation.
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