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MitraClip therapy has been proposed as therapeutic option in selected patients with degenerative or functional mitral regurgitation (FMR), leading to clinical and prognostic benefits. Previous studies demonstrated the safety and the efficacy of MitraClip therapy on symptoms and left ventricular remodeling in cardiac resynchronization therapy (CRT) non-responder patients. We report a case of a CRT non-responder patient treated with MitraClip implantation followed by a new upgrading of the CRT for persistent FMR at the follow-up. The optimization of the interventricular delay, guided by echocardiographic parameters, resulted in a significant clinical and functional benefit. Echo-guided CRT upgrading can provide additive efficacy for patients in whom MitraClip implantation does not significantly improve FMR and symptoms. [ABSTRACT FROM AUTHOR]

Patent foramen ovale (PFO) is a slit or tunnel-like communication in the atrial septum occurring in approximately 25% of the population. A wide number of pathological conditions have been linked to its presence, most notably, cryptogenic stroke (CS) and migraine. However, in the setting of a neurological event, it is not often clear whether the PFO is pathogenically related to the index event or an incidental finding. Therefore, a detailed analysis of several clues is needed for understanding PFO's clinical significance, with a frequent case-by-case decision about destination therapy. Indeed, the controversy about PFO's pathogenicity prompted a paradigm shift of research interest from medical therapy with antiplatelets or anticoagulants to percutaneous transcatheter closure, in secondary prevention. Observational data and meta-analysis of observational studies had previously suggested that PFO closure with a device was a safe procedure with a low recurrence rate of stroke. To date, however, recent randomized controlled trials have not shown the superiority of PFO closure over medical therapy. Thus, the optimal strategy for secondary prevention of paradoxical embolism in patients with a PFO remains unclear. Moreover, the latest guidelines for the prevention on stroke restricted indications for PFO closure to patients with deep vein thrombosis and high-risk of its recurrence. Given these recent data, in the present review, we critically discuss current treatment options, pointing out the role of a comprehensive patient evaluation in overcoming PFO closure restrictions and planning the best management for each patient. [ABSTRACT FROM AUTHOR]

A 64-year-old man was admitted with subacute anterior ST-segment elevation myocardial infarction treated with implantation of four drug-eluting stents in proximal left anterior descending artery. Despite successful percutaneous coronary intervention, the patient developed a significant worsening of left ventricular ejection fraction because of late diagnosis. A percutaneous mechanical circulatory support device (Impella CP; Abiomed) was then required in order to preserve adequate systemic perfusion. Twelve hours later, the patient developed rapid ventricular tachycardia degenerated in ventricular fibrillation, without loss of consciousness. During the arrhythmia, lasting for 10 min, the patient was alert, with preserved mental status. After adequate sedation, a single unsynchronized 200 J DC shock converted the patient to sinus rhythm. [ABSTRACT FROM AUTHOR]