Transcatheter Aortic Valve Replacement: Role of Multimodality Imaging in Common and Complex Clinical Scenarios.
- 作者列表："Bax JJ","Delgado V","Hahn RT","Leipsic J","Min JK","Grayburn P","Sondergaard L","Yoon SH","Windecker S
:Transcatheter aortic valve replacement (TAVR) is an established therapy for patients with symptomatic severe aortic stenosis. Technological advances and the learning curve have resulted in better procedural results in terms of hemodynamic valve performance and intermediate-term clinical outcomes. The integration of anatomical and functional information provided by multimodality imaging has improved size selection of TAVR prostheses, permitted better patient selection, and provided new insights in the performance of the TAVR prostheses at follow-up. Furthermore, the field of TAVR continues to develop and expand the technique to younger patients with lower risk on the one hand, and more complex clinical scenarios, on the other hand, such as degenerated aortic bioprostheses, bicuspid aortic valves, or pure native aortic regurgitation. The present review article summarizes how multimodality imaging can be integrated in TAVR in clinical (sometimes complex) scenarios that have not been included in the landmark randomized clinical trials.
: 经导管主动脉瓣置换术 (TAVR) 是症状性重度主动脉瓣狭窄患者的既定治疗方法。技术进步和学习曲线在血流动力学瓣膜性能和中期临床结果方面产生了更好的程序结果。多模态成像提供的解剖和功能信息的整合改善了TAVR假体的尺寸选择，允许更好的患者选择，并在随访中对TAVR假体的性能提供了新的见解。此外，TAVR领域继续发展并将技术扩展到一方面风险较低的年轻患者，另一方面更复杂的临床场景，例如退化的主动脉生物假体、二叶式主动脉瓣或纯天然主动脉瓣反流。本综述文章总结了在临床 (有时是复杂的) 情况下，如何将多模态成像整合到TAVR中，这些情况尚未纳入具有里程碑意义的随机临床试验。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.