- A man with severe rheumatic trivalvular disease was treated with surgical implantation of mechanical aortic and mitral prostheses at the age of 30 years and tricuspid bioprosthesis at the age of 50 years. At 61 years of age, he developed severe symptomatic tricuspid regurgitation due to bioprosthesis degeneration and was judged at very high risk for a third surgical approach. The investigators describe the successful transfemoral positioning of a 29-mm Edwards SAPIEN XT percutaneous valve inside the degenerated tricuspid prosthesis, with excellent acute results and no major complications.
- Bedside echocardiography plays an important role in the first-line diagnosis of Takotsubo cardiomyopathy (TC). Several classic imaging features could aid in the differential diagnosis in patients who have manifestation similar to that of acute coronary syndrome and potentially help in the risk stratification and management, including the decision to use coronary angiography.1,2 Right ventricular (RV) involvement in TC has been previously identified.3,4 However, these abnormal imaging features have never been well characterized and analyzed.
- The interventions aimed at patients with unprotected left main coronary disease are supported by a vast amount of data, the interpretation of which is increasingly difficult. For this purpose, studies using traditional meta-analysis1–3 and/or metaregression analysis4 are helpful, because they effectively synthesize the available information.
- Prosthetic valve thrombosis (PVT) is a serious complication after cardiac valve replacement and usually requires urgent management with either thrombolysis or surgery.1 A 38-year-old woman with history of ischemic stroke and multiple valvular surgeries including aortic St. Jude mechanical valve replacement (St. Jude Medical, St. Paul, Minnesota) presented with new-onset dyspnea on exertion. Transthoracic echocardiography and 2-dimensional transesophageal echocardiography (TEE) suggested an abnormally high gradient across the aortic valve (Figure 1) but could not determine the cause of the stenosis (Figure 2, Video 1).