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Transcatheter aortic valve implantation (TAVI) is associated with bleeding that increases mortality. Dual antiplatelet therapy (DAPT) is recommended in TAVI, however little is known about pre-procedural DAPT use and its impact on hemostasis. We sought to determine the frequency, predictors and bleeding events in patients receiving DAPT before TAVI.Three-hundred-and-three (n=303, 78.6±7.6years, 49% female, EuroScore 23.1±16.9) consecutive patients undergoing TAVI were prospectively analyzed and followed for in-hospital events. According to pre-procedural antiplatelet status study population was divided into 2 groups: patients receiving aspirin and clopidogrel (DAPT) and those on aspirin only or no antiplatelet therapy (noDAPT).Pre-procedural DAPT was used in 139 cases (46%). Previous PCI (OR 4.8, [2.8-8.3], p0.0001), implantation of self-expandable prosthesis (OR 2.2, [1.2-4], p=0.007) femoral access (OR 2.2, [1.1-4.5], p=0.029) and platelet count (OR 1.006, [1.002-1.01], p=0.002) were identified as independent predictors of pre-procedural DAPT. No difference was observed in the rates of any bleeding (23% in DAPT vs. 24.4% in noDAPT, p=0.930) or major/life-threatening bleeding (12.2% in DAPT vs. 14.7% in noDAPT, p=0.715). Propensity-score matching analysis did not alter the results. GFR30ml/min was the strongest predictor of bleeding (OR 4.3, [1.9-9.9], p=0.0005). There was a trend towards lower frequency of MI and stroke/TIA in DAPT as compared with noDAPT (3.6% vs. 9.8%, p=0.082).Pre-procedural DAPT is frequent and does not increase short-term bleeding complications or need for transfusion following TAVI. Possible impact of DAPT use before TAVI on ischemic complications needs to be investigated in larger populations.

Initially linked with gastrointestinal bleeding from angiodysplasia (Heyde syndrome), von Willebrand Factor (vWF) abnormalities are likely to underlie wider range of bleeding disorders accompanying aortic stenosis. Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve

Background: The aim of this study was to evaluate the outcomes of transcatheter aortic valve implantation (TAVI) in bicuspid aortic valve (BiAV) stenosis using a mechanically expanded Lotus™ device. The BiAV has been excluded from landmark clinical trials and is considered as relative

A 49-year-old women presented with severe chest pain typical of myocardial infarction with vomiting and sweating during emotional stress (funeral). The initial ECG revealed normal sinus rhythmwith STelevation in leadsV1–V3,T-wave inverted in I, aVL, V5–V6 (Fig. 1-1). Admission Troponin I (1.4 ng/ml — normalb0.1 ng/ml) and creatinine kinase-MB (5.4 ng/ml, normalb3.6 ng/ml) level were positive. Other laboratory tests were normal. The patient underwent emergency coronary angiography which revealed normal coronary arteries (Fig. 2-1, 2). However contrast left ventriculography demonstrated typical view of tako-tsubo cardiomyopathy with markedly reduced left ventricular ejection fraction (Fig. 2-3). This observation was confirmed in transthoracic echo. Subsequent echocardiography performed 4 days after admission revealed a normal ejection fraction of 55% with grossly normal wall motion but with a relaxation abnormality. No valvular and right ventricular dysfunctions were observed in those examinations. The patient remained clinically and hemodynamically stable during 6 days of hospitalization and was discharged home (ECG at discharge — Fig. 1-2). Discharged medications included an aspirin, beta-blocker, calcium channel antagonist and statin. After 1 month patient had signs of heart failure and the transthoracic echo showed preserved left ventricular function with normal ejection fraction (Fig. 3-1, 2) and impaired

We investigated B-type natriuretic peptide (BNP) levels in 10 consecutive patients (all women, mean age 60.4±7.8 years) with apical ballooning syndrome. Mean baseline plasma BNP level was 272.6±170.4 pg/ml and exceeded the normal range in 8 (80%) patients. When normal levels were adjusted for age and gender, all 10 patients had elevated BNP. Two patients with the highest BNP levels (630 and 423 pg/ml) presented with significant hemodynamic compromise. BNP levels correlated negatively with left ventricular ejection fraction. Increase in BNP levels in apical ballooning syndrome may support the neurohormonal etiology in these patients and requires further studies.

We present the real-time three-dimensional echocardiography in a patient who suffered a transient left apical ballooning syndrome.

Atrial septal defect transcatheter occlusion techniques have become an alternative to surgical procedures. With the increasing use of this new technology, several complications have been identified. The authors present the case of a patient who was admitted to the hospital for primary percutaneous closure of a secundum atrial septal defect. On routine follow-up examination 24 hours after implantation, transthoracic echocardiography revealed a partial dislocation of the occluder into the right atrium. The patient was referred for cardiosurgical treatment. Strict selection criteria and the choice of the device may help reduce the incidence of complications such as dislocation of the occluder into the right atrium following the percutaneous device closure of an atrial septal defect.