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Introduction: Mitral valve prolapse (MVP) is a common condition that affects up to 3% of the population. It is usually benign, but a small subset of patient has an increased risk of malignant ventricular arrhythmias and sudden cardiac death.1,2 Case report: We present a previously healthy 56 years old female patient with history of palpitations. In May 2023, she was hospitalized after out-of-hospital cardiac arrest with ventricular fibrillation (VF) as the initial rhythm. After successful resuscitation, she regained full consciousness. Serum electrolytes were within normal range at admission. Electrocardiogram was uneventful. Echocardiography revealed normally sized left ventricle with preserved ejection fraction and severe mitral regurgitation due to posterior leaflet prolapse (P2 scallop) (Figure 1). No mitral annular disjunction (MAD) was visualized. No heart rhythm disturbances were registered during monitoring. Coronary angiography found no stenosis of coronary arteries. Implantable cardioverter defibrillator (ICD) was implanted for secondary prevention of sudden cardiac death. She was discharged with metoprolol and amiodarone. On follow up visit no heart rhythm disturbances were noticed on ICD interrogation. The patient is scheduled for cardiac surgery (mitral valve repair or replacement). Conclusion: Mitral valve prolapse is becoming increasingly recognized as an important phenomenon which can lead to malignant ventricular arrhythmias and sudden cardiac death. We presented a patient who survived sudden cardiac arrest. No predisposing conditions were found other than mitral valve prolapse. The patient is scheduled for cardiac surgery following the implantation of an ICD. [ABSTRACT FROM AUTHOR]

Introduction: Transthoracic echocardiography is still the diagnostic standard procedure in pre heart transplant and advanced heart failure diagnostics. Despite continued improvements in non-contrast echocardiography, image quality is sometimes suboptimal for assessing regional and segmental wall. Case report: 22-year-old patient suffering from dilative cardiomyopathy and diabetes mellitus type I presented with signs of severe dyspnoea and was admitted to intensive coronary unit due to acute heart failure. Dilative cardiomyopathy was verified with severely reduced ejection fraction to 15% of the left ventricle, with apical left ventricular thrombus, clinically NYHA IV stage, initially INTERMACS 3. The hypertrabeculation of left ventricular wall was indicating that the aetiology could be non-compaction cardiomyopathy. He was referred to our transplant centre, where complete pre-transplant work-up was conducted. Despite optimal medical therapy, clinical condition deteriorated, NT-pro-BNP measured up to 13122.9-pg/mL and he was on inotropic support, heart failure medication and anticoagulation therapy due to left ventricular apical thrombus. Right heart catheterization showed a moderate increase of pressures in pulmonary circulation due to congestion and his cardiac index calculated from right heart catheter was 1.48 L/min/m2. Coronary artery disease was excluded by coronary angiogram. Due to deterioration, the patient needed ECMO support, and finally the multidisciplinary heart transplant team decided to implant extracorporeal left ventricular assist device (LVAD). As it is paramount to be aver of left ventricular thrombus in case of LVAD implantation, the contrast echocardiography for opacification of the left ventricle (Optison GE Healthcare) was conducted excluding the thrombus in the left ventricle and showing the extent of left ventricular trabeculation (Figure 1). Finally, patient was transplanted after three weeks of extracardiac LVAD support and was discharged from hospital in good condition. As addition, it is interesting that a patient has twin brother without diabetes mellitus, and his echocardiographic report is suggestive of dilative cardiomyopathy -noncompaction but with far better left ventricular contractility and ejection fraction of LV of 35%. Conclusion: Use of contrast echocardiography to guide urgent treatment decisions in critically ill patients and making treatment decisions as in device therapy provides a valuable option for improving endocardial border resolution and outcome in these patients. [ABSTRACT FROM AUTHOR]

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cardiologia Croatica is the property of Croatian Cardiac Society and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: The aim was to determine soluble vascular adhesion molecule 1 (sVCAM-1) before and 24 hours after the percutaneous coronary intervention (PCI) between the group of patients treated with balloon dilatation with stent implantation, with drug-eluting balloon (DEB) and the control group, to compare the obtained differences and their relationship with clinical and procedural parameters. Patients and Methods: The study included 15 patients treated with predilatation and stenting (group A), 15 patients treated with DEB (group B) and 24 patients in the control group. We measured sVCAM-1 before the procedure and 24 hours after the procedure. We compared sVCAM-1 between groups, and their relationship with clinical and procedural parameters. Results: Group A had significantly higher sVCAM-1 in the first measurement in relation to both other groups (p < 0.05). There was a significant decrease between two measurements in the group A (p = 0.041), increase in the group B (p = 0.017), and no changes in the control group. There were no significant differences in demographic and clinical characteristics, except for a significantly smaller proportion of patients with previous myocardial infarction (MI) in control group and significantly lower average time elapsed from myocardial infarction in group B. There was positive correlation between the number of balloon inflations and the total duration of inflation and sVCAM-1 24 hours after the procedure, but not statistically significant. In the subanalysis we found no statistically significant difference in the dynamics of sVCAM-1 depending on history of earlier MI, PCI and history of statin therapy, and we noted statistically significant (p = 0.024) increase of sVCAM-124 h after the procedure among nondiabetic patients in group B. Conclusion: 1 significant increase in sVCAM-124 hours after the procedure in patients of group B could be caused by procedural differences done in groups A and B, but possible reason is in some of the characteristics of the DEB. 2. significantly higher value sVCAM-1 before the procedure in group A is because we included patients who have had a myocardial infarction less than 3 months before the intervention. 3. results of this study rejected the hypothesis on the expected lower inflammatory response in patients treated with DEB, but they provide useful information for future studies1'3 which should clarify the mechanisms of endothelial damage during PCI. [ABSTRACT FROM AUTHOR]

Complex lesions interventions are technically demanding and associated with higher rates of adverse events. In left main stenting, ostial lesions and bifurcation procedures, precise stent position, complete lesion coverage and full stent deployment (apposition) are mandatory. These procedures should be guided with other imaging modalities. Intravascular ultrasound (IVUS) is a gold standard for all these indications, but it is expensive, time consuming and carries some added per procedural risk. Clear stent imaging or stent boost is an enhancement of the radiological edge of the stent by digital management of regular X-ray images. It is a simple and fast method especially useful for proper stent positioning, control of stent deployment and apposition. During bifurcation stenting it also allows correct balloon positioning for proximal optimizing technique and correct positioning of side branch stenting in T-stenting and small protrusion technique. Recent studies investigated the accuracy of stent positioning and deployment guided with CLEARstent, compared it and also controlled it with IVUS. The results show sufficient specificity for conventional use in every day practice.1-2 We routinely started to use CLEARstent imaging in December 2015. The procedures were carried out on a Siemens Artis zee floor-mounted angiography system integrated with CLEARstent software. We present some clinical cases where we were guided with CLEARstent imaging which definitely improved success of our procedures. The method is simple and quick, and as a center without IVUS, we now routinely use it in every complex lesion intervention. [ABSTRACT FROM AUTHOR]

Background: Current evidence clearly show that patients with ST-segment elevation myocardial infarction (STEMI) should be pretreated with dual antiplatelet therapy (DAPT) and anticoagulation therapy immediately after confirmed diagnosis, and that pretreatment can be even performed safely prehospitally.1 In non ST-segment elevation myocardial infarction (NSTEMI), recommendations are not so clear, with data showing that pretreatment depends on what combination of DAPT is used and what is the risk profile of the patient. Also, less than 70% of all patients with NSTEMI undergo stenting after coronary angiography whereas the rest continue medical treatment or are scheduled for coronary artery bypass graft surgery. We present our data on anticoagulation and platelet antiaggregation therapy selection and timing in patients with STEMI and NSTEMI scheduled for early invasive approach, that were collected using our acute coronary syndrome flow chart, and compare them to current guidelines. Patients and Methods: Standardized prospective flow chart was utilized to collect data on medical and interventional treatment of patients with STEMI and NSTEMI scheduled for early coronary angiography in 2016. Registry data from 2014 and 2015 were used as comparison. Results: Data showed that all patients with STEMI received pretreatment with either clopidogrel (in 2014) or ticagrelor (in 2015 and 2016) and unfractionated heparin, but only in-hospital. Only aspirin was administered prehospitally. Patients with NSTEMI received enoxaparine, fondaparinux or unfractionated heparin, mostly before coronary angiography. Clopidogrel was administered before coronary angiography in all patients with NSTEMI in 2014 and 2015, whereas patients with NSTEMI in 2016 received ticagrelor, mostly before angiography. In 2016 there were nearly 10% of patients that were treated with ticagrelor after early coronary angiography, with no thrombotic complications. Conclusions: STEMI pretreatment should be done as early as possible, and standardized protocols should encourage early detection and prehospital administration. NSTEMI protocols are however unclear, there are cases with unsupported mixing of anticoagulants before and during invasive treatment. Choice of antiplatelets and their timing of administration is still unclear in NSTEMI and requires further investigation. [ABSTRACT FROM AUTHOR]

Background: Optimal results of primary percutaneous coronary intervention (PCI) in acute ST-segment elevation myocardial infarction (STEMI) are sometimes challenged by large thrombotic burden. TAPAS (Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial Infarction Study) trial in 2008 first showed that thrombus aspiration in STEMI patients with large thrombotic burden improved overall survival after 1 year.1 Later on in 2013, Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia (TASTE) trial, a prospective national registry showed no benefit of routine thrombectomy in STEMI.2 2012 European Society of Cardiology (ESC) Guidelines for the management of STEMI, that are currently available, gave a strong recommendation (IlaB) for manual thrombectomy in STEMI.3 However, that recommendation was downgraded to IlbA after TASTE trial in 2014 ESC Guidelines on myocardial revascularization.4 Here, we present the data on thrombus aspiration utilization within the Western Slavonia Primary PCI network, and compare the results between pre-TASTE and post-TASTE era. Patients and Methods: Data on primary PCI techniques to achieve Thrombolysis in Myocardial Infarction (TIMI) 3 flow, on utilization of the glycoprotein Ilb/IIIa inhibitors, and on clinical outcomes in STEMI were collected in 2012 and 2013, and compared to data from 2014 and 2015. Results: In 2012 and 2013, out of 114 patients that underwent primary PCI in STEMI 32% received thrombus aspiration, out of whom 61% had thrombus aspiration in the right coronary artery. Overall TIMI 3 rate was 88%, and overall in-hospital mortality was 6.1%. In 2014 and 2015 there were 253 patients with primary PCI in STEMI, with only 17% of thrombectomy cases (68% of cases were done in the right coronary artery). Overall TIMI 3 rate was 91%, and in-hospital mortality 5.9%. Conclusion: Thrombectomy penetration dropped significantly, together with the glycoprotein Ilb/IIIa inhibitors use after publication of TASTE trial. Patients that received thrombectomy in 2014 and 2015 had mainly high thrombotic burden in the right coronary artery, or had embolic myocardial infarction. There were no changes in TIMI 3 achievement and in-hospital mortality. Manual thromboaspiration remains a useful tool only in selected population of patients with highly thrombotic lesions, aneurysmal coronary artery disease or embolic myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: Current ESC/EACTS Guidelines on myocardial revascularization emphasized benefit of radial access over femoral access in ST-segment elevation myocardial infarction (STEMI) if performed by an experienced radial operator. There are several definitions of an experienced radial operator. One of them is less than 10% of conversions from radial to femoral approach, and is often used in practice. The other is certainly volume, with 100 procedures as a primary operator needed to be securely on the upslope of the learning curve.1'2 We present our experience of long transition from femoral to radial access for primary percutaneous coronary intervention (PCI) in STEMI, mostly due to technical limitations and practical and organizational issues. Patients and Results: Data from catheterization laboratory registries in Slavonski Brod from 2004 to 2016 were analyzed. Radial approach was first introduced systematically in mid 2012 after a 3-day radial access workshop in Slavonski Brod. Proportions of patients with radial access in 2012,2013,2014, and 2015 were 5%, 22%, 15%, and 18%, respectively. In 2012 70% of radial access was right radial, but in 2013 right radial access was used in only 25% of radial cases. In 2014 and 2015 right radial was used again in most patients (86% and 83% of all radial, respectively). From 2012 to 2015, proportions of radial access in STEMI were small, varying between 3% and 6%, and were mostly driven by impossible femoral access. In first two moths of 2016, after the installation of new coronary angiography suite with adequate room and table options for radial access, and additional education in a high volume radial center in University Hospital Centre Rijeka, Croatia, routine right radial access climbed suddenly to 76%, with 4% of left radial access reserved mainly for left internal mammary artery bypass graft coronary angiography. Conversion to femoral access varied among operators from 6% to 14% during first two months in 2016, that led to routine introduction of radial access in STEMI by the end of January 2016 for 2 out of 5 operators. In first two months of 2016,40% of STEMI patients had right radial access, with no prolongation of door to balloon time noted. Conclusion: Very long transition from femoral to radial access in STEMI, expected to reach a maximum of 90% of STEMI cases by June 2016, was mainly driven by technical limitations of catheterization laboratory suite, and organizational issues with varying approaches and equipment used in the learning curve. [ABSTRACT FROM AUTHOR]

Enhanced fibrinolysis or hyperfibrinolysis may lead to life-threatening blood loss, while reduced activity may contribute to thrombosis. Euglobulin clot lysis time (ECLT) is a manual method that measures plasma fibrinolytic activity and is considered the gold standard. However, the data on reference interval is scarce and outdated. We have employed one-sided reference interval (>3 h) since the implementation of ECLT in our laboratory; therefore, we aimed to establish reliable ECLT reference interval and to explore the possible preanalytical influence of different blood collection tubes on the established ECLT reference interval. Establishing a reference interval for fibrinolysis was performed according to CLSI EP28-A3c guidelines by employing a posteriori direct sampling technique. The predefined exclusion criteria included a history of malignant or hepatobiliary disease, a history of deep vein thrombosis/pulmonary embolism (DVT/PE), an acute inflammatory state at the time of the venipuncture. We collected vein blood samples in Vacutest plastic coagulation tubes (Kima, Italy) and Vacutainer glass coagulation tubes (Beckton Dickinson, USA) containing 0.109 mol/l buffered trisodium citrate as an anticoagulant at a blood-to-anticoagulant ratio 9 : 1. We calculated two-sided reference interval and presented as 2.5th and 97.5th percentiles. ECLT values did not differ between sexes or the types of tubes enrolled in the study (P = 0.8979). The established reference interval ranged from 130 to 297 min for the KIMA Vacutest tube and from 120 to 292 min for the BD Vacutainer tube. The established ECLT reference interval differed significantly from the currently used cut-off value in our laboratory, thus enabling the assessment of hyperfibrinolysis by employing double-sided reference interval., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)