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Background: Transcatheter aortic valve implantation (TAVI) has become a standard therapeutic option for patients with severe aortic stenosis (AS) at high cardiac surgical risk. The aim of the NAUTILUS study was to investigate the safety and performance of the New Valve Technology (NVT) Allegra bioprosthesis in high-risk patients undergoing TAVI. Methods: Twenty seven patients with severe, symptomatic AS at high surgical risk were prospectively enrolled, who underwent treatment using the novel self-expanding NVT Allegra bioprosthesis via transfemoral approach (TF-TAVI). The primary end-point was all-cause mortality at 30 days. Results: Patients were elderly (83 years, range 75–89 years), and predominantly female (70.4%, n = 19). All patients were deemed to be at high surgical risk, with a mean logistic EuroSCORE of 12.4% (range, 2.8–31.8%). The bioprosthesis was successfully implanted in 96% of the cases (n = 25). The echocardiographic assessment confirmed good hemodynamic profile after implantation of the NVT Allegra bioprosthesis. Complications included cardiac tamponade (4%, n = 1) and the need for permanent pacemaker implantation (8%, n = 2). The analysis of procedural aspects showed a short learning effect related to the precise placement of the valve. A significant improvement in clinical symptoms were observed, and no patients died in-hospital or within 30 days of post-discharge observation. Conclusions: This prospective observation shows that the NVT Allegra bioprosthesis was associated with a satisfactory safety profile and a remarkable hemodynamic performance after implantation.

Background Data regarding the efficacy of the percutaneous coronary intervention (PCI) with new-designed drug-eluting stent (new-DES) vs. bare metal stent (BMS) of saphenous vein grafts (SVG) stenosis is scarce. The primary objective was to compare one-year clinical outcomes of PCI in stenosis of SVG using new-DES vs. BMS in a real-world population. Methods and results We carried out a multi-center registry comparing new-DES with BMS in all consecutive patients undergoing PCI of SVG. The primary composite endpoint was major adverse cardiac and cerebrovascular events (MACCE) at 1 year. This observation included 792 consecutive patients (mean age 69 ± 8.9y), treated with either new-DES (n = 379, 47.9%) or BMS (n = 413, 52.1%). Among patients treated with new-DES compared with BMS, there was a lower risk of MACCE (21.4% vs. 28.3%, HR = 0.69, 95% CI 0.50–0.95, p = 0.025) as well as myocardial infarction (MI) (6.3% vs. 12.1%; HR 0.49, 95% CI 0.30–0.82, p = 0.005) at 1 year. After propensity score adjustment, the similar, significant reduction in MACCE and MI was observed in favor of new-DES (HR 0.66, 95% CI 0.46–0.96, p = 0.030; and HR 0.53, 95% CI 0.31–0.92, p = 0.020, respectively). Conclusion In patients undergoing PCI of SVG, the use of new-DES is associated with a reduced 1-year rate of MACCE and MI compared to BMS.

Background: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen­tial coronary stenosis without balloon inflation is hereby proposed. Methods: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu­la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls’ formula. FFR of the remaining lesion was finally recorded (measured FFR). Results: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls’ formula showed virtually absolute agreement (ICCa 0.999, R 2 = 0.997 for the proximal lesion, R 2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640–0.909, R 2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. Conclusions: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.

Cerebral embolic protection (CEP) devices aim to reduce the risk of periprocedural cerebrovascular events during transcatheter aortic valve implantation (TAVI). Here, the authors describe the first-in-human experience with the ProtEmbo Cerebral Protection System (Protembis), a next-generation CEP device, during TAVI. This case is part of a larger European trial evaluating the safety and performance of this device. After deployment of the ProtEmbo in the aortic arch, a first transcatheter heart valve was implanted. Despite postdilatation, moderate to severe aortic regurgitation persisted. The operating team decided to perform a valve-in-valve procedure using a second transcatheter heart valve. The ProtEmbo demonstrated good coverage of all three head vessels and no interaction with TAVI catheters in the aortic arch throughout the entire procedure. No adverse events were observed during hospitalisation or follow-up, and there was a significant reduction in aortic regurgitation at follow-up echocardiography. Despite a challenging overall procedure with presumably high embolic burden, diffusion-weighted MRI at follow-up showed a low number (n=3) and volume (156 mm3) of new hyperintense lesions. The first-in-human use of the ProtEmbo was safe and feasible, despite a challenging TAVI valve-in-valve procedure.

Background: Data regarding the use of percutaneous coronary intervention with drug-eluting balloons (DEB) versus thin-strut drug-eluting stents (thin-DES) for treating DES in-stent restenosis in everyday clinical practice is scarce. Our goal was to evaluate the efficacy and safety profile of DEB versus thin-DES in DES in-stent restenosis. Methods: Consecutive patients with DES in-stent restenosis who underwent percutaneous coronary intervention between 2008 and 2019 entered the multicenter DEB-DRAGON Registry with a follow-up of 3 years. Patients who received DEB at the index procedure (n=557, 49.9%) were compared with those who received thin-DES (n=560, 50.1%). Results: Analysis of the unmatched cohort revealed lower rates of target lesion revascularization (9.1% versus 13.6%; hazard ratio [HR], 0.58 [95% CI, 0.41–0.83], P =0.003), target vessel revascularization (11.8% versus 16.7%; HR, 0.62 [95% CI, 0.45–0.84], P =0.003) and device-oriented composite end point, defined as a composite of cardiac death, target lesion revascularization, and target vessel myocardial infarction (12.7% versus 16.0%; HR, 0.69 [95% CI, 0.50–0.94], P =0.018) in the thin-DES group compared with the DEB group. The incidence of cardiac death, target vessel-myocardial infarction, and myocardial infarction were similar in both groups. However, after propensity score matching, there were no significant differences in target lesion revascularization (11.2% versus 11.2%; HR, 0.91 [95% CI, 0.55–1.51], P =0.707), target vessel revascularization (13.4% versus 14.2%; HR, 0.86 [95% CI, 0.55–1.36], P =0.523), and device-oriented composite end point (14.2% versus 14.2%; HR, 0.91 [95% CI, 0.58–1.42], P =0.667) between the thin-DES and DEB group, respectively. Conclusions: This analysis of a real-life registry revealed similar long-term outcomes of thin-DES and DEB in DES in-stent restenosis regarding target lesion revascularization, myocardial infarction, cardiac death, and device-oriented composite end point. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04415216.

Background: Evidence concerning the efficacy of the embolic protection devices (EPDs) in saphenous vein graft (SVG) percutaneous coronary intervention (PCI) is sparse. The study was designed to compare major cardiovascular events of all-comer population of SVG PCI with and without EPDs at one year of follow-up. Methods and results: A multi-center registry comparing PCI with and without EPDs in consecutive patients undergoing PCI of SVG. The group comprised 792 patients, among which 266 (33.6%) had myocardial infarction (MI). The primary composite endpoint was major adverse cardiac and cerebrovascular event (MACCE) defined as death, MI, target vessel revascularization (TVR), and stroke assessed at one year. After propensity score analysis, there were no differences in MACCE (21.9% vs. 23.9%, HR 0.91, 95% CI 0.57&ndash, 1.45, p = 0.681, respectively) nor in secondary endpoints of death, MI, TVR, target lesion revascularization (TLR) and stroke at one year in EPDs PCI group vs. no-EPDs PCI group. Similarly, there were no differences between groups in the study endpoints at 30 days follow-up. Conclusions: There were no clinical benefit for routine use of EPDs during SVG PCI in short and long-term follow-up. Further studies are warranted to explore the effect of individual types of EPDs on clinical outcomes.

Background Coronary artery disease (CAD) and degenerative aortic stenosis often coexist. However, the impact of CAD and its management on the prognosis after transcatheter aortic valve implantation (TAVI) remains uncertain. We sought to evaluate the impact of obstructive CAD, SYNTAX score (Ss), and percutaneous coronary intervention (PCI) prior to TAVI on short-term outcome. Methods Overall, 896 patients who underwent TAVI after heart team decision was included. Pre-procedural angiograms were analysed to calculate baseline Ss (bSs) and residual Ss (rSs). Baseline, procedural and follow-up data up to 30 days was acquired from the national POL-TAVI registry. Results Patients with obstructive CAD at baseline (n = 462, 52%) had higher mortality as compared with the remaining (8.7 vs. 5.1%, log-rank P = 0.039). Also, after correction for confounding factors obstructive CAD was identified as independent predictor of mortality (hazard ratio [HR] 1.74, 95% confidence intervals [CIs] 1.03–2.94, P = 0.037). In obstructive CAD, neither bSs (AUC 0.47, CI 0.38–0.56, P = 0.47) nor rSs (AUC 0.47, CI 0.30–0.64, P = 0.72 for those undergoing PCI and AUC 0.48, CI 0.37–0.59, P = 0.75 for the remaining) was predictive of mortality. When revascularization status was considered, patients with PCI prior to TAVI had similar outcome as those without obstructive CAD at baseline (7.7 vs. 5.1%, log-rank P = 0.23) with no negative impact on mortality (HR 1.13, CI 0.62–2.09, P = 0.69). Conclusions In conclusion, obstructive CAD at baseline evaluation for TAVI has independent negative impact on short-term prognosis. However, neither baseline nor residual Ss values have prognostic ability in patients undergoing TAVI. Revascularization prior to TAVI seems to improve survival to levels comparable with patients without obstructive CAD at baseline.

Fractional flow reserve (FFR) is an evidence-based diagnostic tool of physiological significance of coronary artery stenosis in patients with stable coronary artery disease (CAD). Due to microvascular dysfunction in acute coronary syndrome (ACS), information obtained from FFR assessment could be less reliable and, thus, its clinical role remains controversial. Indeed, results of currently published studies are essentially discrepant. Only a few randomized clinical trials have been performed showing the efficacy of FFR-guided percutaneous coronary intervention in ACS. Consequently, its role in acute scenarios remains substantially understudied. Herein, is presented the current state of knowledge re-garding FFR use in ACS setting. (Cardiol J 2017; 24, 4: 426-435).

Background: Despite adequate heparinization, formation of fresh intracardiac thrombi during the MitraClip procedure was reported. Aims: We aimed to evaluate the incidence and clinical consequences of intracardiac thrombus formation during the MitraClip device implantation. Methods: Clinical data and transesophageal echocardiography findings obtained during MitraClip procedures in 100 consecutive patients (81 men; mean [SD] age, 67.8 [8.3] years) were reviewed. In all patients, a heparin bolus was given immediately after a successful transseptal puncture, and the activated clotting time above 250 seconds was maintained throughout the procedure. Results: Thrombus formation was documented in 9 patients (9%). In 6 patients, thrombi formed on a transseptal needle/sheath (2 attached to the sheath in the right atrium and 4 on the sheath immediately after the puncture in the left atrium), and in 3 patients, on the MitraClip device in the left atrium (2 on a steerable guiding catheter and 1 on the clip delivery system). Overall, 6 thrombi (67%) formed prior to and 3 (33%) after heparin administration. All thrombi were transient and disappeared within minutes. No periprocedural ischemic stroke, transient ischemic attack, or other embolic complications were reported. Clinical characteristics were similar in patients with and without thrombi, except for lower left ventricular ejection fraction (LVEF; mean [SD], 23% [10%] and 30% [10%], respectively; P = 0.03). In­-­hospital death was reported in 6 patients: 2 with a visible thrombus and 4 without (P = 0.09). Conclusions: Transient thrombus formation is relatively common during the MitraClip procedure, especially in patients with low LVEF; however, acute clinical consequences are benign.

Aims The effectiveness of revascularization of chronic total occlusion (CTO) remains intriguing. Thus, we sought to investigate whether a successful PCI for single CTO improves outcomes in a setting of stable angina and chronic occlusion of single coronary artery. Methods and Results Of 11 957 consecutive patients referred for nonurgent PCI between 2003 and 2010, 1110 displayed single CTO and were enrolled to the central CTO-registry database. The primary end-point included all-cause mortality, the secondary end-point a composite of safety outcome measure of all-cause death, nonfatal-MI, the need for urgent revascularization and stroke. The major adverse cardiovascular event (MACE) records were extracted from the national administrative database and all patients were linked to the long-term follow-up. Since the patient assignment was not random, we performed the propensity scoring to minimize selection bias; 734 patients (66%) had a successful PCI-CTO. Compared with successful procedures, unsuccessful procedures had similar rates of all-cause death both in crude (HR, 0.78; 95%CI, 0.49–1.25; P = 0.30) and adjusted analysis (HR, 0.80; 95%CI, 0.50-1.28; P = 0.34). A similar, significant reduction in overall MACE was noted with successful PCI-CTO compared with unsuccessful procedure in unadjusted (HR, 0.74; 95%CI, 0.56–0.96; P = 0.020) and adjusted calculation (HR, 0.73; 95%CI, 0.56–0.96; P = 0.019). Patients after successful PCI-CTO as compared with failed recanalization less frequently underwent surgical revascularization. The benefit was sustained at 3 years follow-up. Conclusions Successful PCI for single CTO does not improve long-term survival, nonetheless, is associated with reduced overall MACE and the need for surgical revascularization. © 2015 Wiley Periodicals, Inc.

We present the case of 58-year-old male patient hospitalized due to stenocardial pain (CCS Class IV). Cardiac markers and ECG met the criteria for ST-segment elevation myocardial infarction. Urgent coronary angiography revealed a thrombus in intermediate branch of the left coronary artery; the other coronary arteries were normal. The patient underwent successful treatment. Further diagnostics revealed that the cause of paradoxical embolization was a patent foramen ovale (PFO), which has been successfully closed with percutaneously implanted closure device.

A 74-year-old man presented with ST elevation myocardial infarction (STEMI) on the 15th day of antibiotic therapy due to aortic valve staphylococcal endocarditis. The coronary angiography revealed occlusion of the left anterior descending artery (LAD) (Figure 1 A). Initial aspiration thrombectomy (AT) with an Export AP (Medtronic Vascular) catheter reestablished TIMI 3 flow. No trace of ruptured plaque was detected. However, the final contrast injection revealed occlusion of the left circumflex artery (LCx) (Figure 1 B), presumably by material translocated during withdrawal of the AT device. Since AT using the Export AP catheter was ineffective in the LCx, a guide extension mother-and-child catheter was applied as an aspiration device [1]. First a 2.0 × 20 mm balloon catheter was inflated beyond the site of the occlusion in order to ensure protection from distal embolism and facilitate the guide extension catheter advancement (Figure 1 C). Subsequently, the Heartrail II-ST01 5 Fr (Terumo Medical) catheter was positioned proximal to the site of the occlusion (Figure 1 C). Aspiration was performed with suction pressure generated by a 20 cc syringe attached to the proximal tip of the guide extension catheter via a y-connector, while the guide wire and balloon catheter remained at their positions. The large body of the embolus was pulled into the syringe (Figure 1 E), which resulted in TIMI 3 flow restoration (Figure 1 D). The patient's further clinical course was uneventful. Histological examination of the aspirated material revealed thrombus with purulent foci, the picture suggestive of bacterial vegetation (Figure 1 F). Figure 1 A – Initial angiography, the site of the LAD occlusion (thin arrow) and the patent LCx. B – The site of the LCx occlusion by the material translocated from the LAD during aspiration thrombectomy using the Export AP (thin arrow). C – ... The greatest shortcoming of the dedicated aspiration catheters is their small inner cross-sectional area (CSA). The suction power is often insufficient to evacuate occlusive material, but intracoronary maneuvers may fragment it; therefore, distal embolization of the infarct related artery is a frequently reported complication [2]. Furthermore, a large thrombus or bacterial vegetation may get stuck at the tip of an aspiration device and be released during its withdrawal, causing embolic stroke or occlusion of another artery. Frequently, the radial artery may not accommodate guide catheters larger than 6 Fr, which precludes the use of larger dedicated AT devices. Previously, in selected cases of STEMI, wherein a large thrombus not amenable to routine AT was identified, aspiration using a deeply advanced guide catheter or a ‘Fogarty type’ balloon embolectomy has been attempted. These approaches provide the potential for coronary dissections and prolonged ischemic times [3, 4]. Mechanical thrombectomy might also be considered; however, these devices are rarely available “off the shelf”. Therefore, AT with guide extension catheters seems the reasonable option. Beside the Heartrail II-STO1 catheter, the GuideLiner (Vascular Solutions) and the Guidezilla (Boston Scientific) catheters may be similarly used for aspiration [5]. The Heartrail II-STO1 catheter is a 120 cm straight tip 5 Fr catheter that extends throughout the length of the 6 Fr guide catheter, unlike the other two guide extension catheters. Distal protection by balloon occlusion does compromise the inner CSA, possibly limiting the efficacy of AT. An optional approach for distal protection would be a filter wire basket, less likely to compromise the inner CSA of the AT device.

The transcatheter mitral valve-in-ring (VIR) procedure can trigger more than just left ventricular outflow tract obstruction from permanent displacement of the native anterior mitral leaflet [(1)][1]. A 74-year-old man was referred for VIR after pulmonary edema due to severe mitral regurgitation.

Transcatheter aortic valve replacement has become a standard therapeutic option for patients with severe aortic stenosis (AS) with high cardiac surgical risk. The aim of the NAUTILUS study was to investigate the safety and performance of the New Valve Technology (NVT) Allegra bioprosthesis in high

Background and aim: The long-term benefit of percutaneous recanalisation of chronic total occlusion (CTO) is still unclear. Given advances in interventional cardiology over the last two decades, we sought to investigate whether a successful percutaneous coronary intervention for CTO (PCI-CTO) improves outcomes in an age- and gender-matched single-centre cohort of stable angina patients. Methods: Out of 401 consecutive patients enrolled to the CTO-Registry database, 276 patients were included in the final analysis. Patients with unsuccessful PCI-CTO (n = 138) were age- and gender-matched in a 1:1 ratio with patients who underwent a successful procedure. The primary end-points included hard end-points comprising death and nonfatal myocardial infarction (MI) and a composite safety outcome measure of death, nonfatal MI and ischaemia-driven revascularisation. The secondary end-point was improvement in angina status or complete resolution of angina symptoms. Patients were followed up for six months and at two years. Results: Patients who underwent a successful recanalisation of CTO, compared to those who underwent an unsuccessful procedure, revealed similar rates of composite death and MI at six months (0.7% vs. 1.4%; hazard ratio [HR], 0.50; 95% confidence interval ratio [CI], 0.05–4.80; p = 0.56) and two years (1.4% vs. 5.8%; HR 0.24; 95% CI 0.07–0.85; p = 0.053). A significant difference in composite safety end-points between subsets, although not recorded after six months of observation (8.7% vs. 15.2%; HR 0.54; 95% CI 0.27–1.07; p = 0.095), was noted at two years follow-up (15.2% vs. 29.7%; HR 0.47; 95% CI 0.29–0.77; p = 0.004). A greater improvement in symptom burden or resolution of angina symptoms was documented after a successful PCI at both six months (68.1% vs. 23.2%, p < 0.001; 80.4% vs. 34.8%, p < 0.001, respectively) and two years (52.2% and 8.0%, p < 0.001; 68.1% vs. 22.5%, p < 0.001, respectively). Conclusions: Successful recanalisation of CTO improves outcomes in long-term observation.

Adherence to medication is one of the most significant challenges of secondary prevention in patients after an acute myocardial infarction (AMI). Indeed, it has been well established that higher adherence is associated with better cardiovascular outcomes. Research pertaining to secondary prevention after AMI treated with percutaneous coronary intervention (PCI) focuses mainly on the adherence to antiplatelet therapy. Adherence levels have been found to be particularly poor and thus, insufficient with regards to prevention; with a high rate of discontinuation of therapy occurring during the 12-month follow-up. There are numerous predicting factors associated with non-adherence to antiplatelet therapy in patients after PCI. These include, but are not limited to, a lack of education on antiplatelet treatment, various comorbidities, depression, or even, unmarried status. Financial limitations of the patient also play a relevant role, however, the nature of this impediment is problematic and requires further investigation. It would seem beneficial to carry out advanced research based on a randomized and double-blind protocol, however, large-cohort, real-world observations are also essential to investigate non-adherence across a broad array of treatment settings above and beyond the scope of prospective clinical trials. Research about adherence under the context of invasive treatment of AMI has a tremendous practical impact and should be considered a matter of importance concerning both clinicians and scientists. Close collaboration between not only researchers, health practitioners, i.e. physicians and pharmacists, but also politicians, is strongly recommended to aid in designing an intervention that might improve patient adherence.

Background: Transaortic (TAo) transcatheter aortic valve implantation (TAVI) is an alter­native approach in patients considered to be at high risk for classical open surgery with poor peripheral vessel access. The purpose of this study was to determine the feasibility of using TAo access for TAVI procedures employing the Edwards SAPIEN transcatheter heart valve. The primary objective was to determine overall 30-day mortality. Methods: A total of 32 patients with severe aortic valve stenosis underwent TAo-TAVI using Edwards SAPIEN bioprostheses. Postoperative results were collected according to the Registry of the Utilization Of the TAo-TAVI approach using the Edwards SAPIEN Valve (ROUTE) study protocol. Complications were assessed using Valve Academic Research Consortium- 2 (VARC-2) criteria. Results: The mean age of the population was 80.9 ± 5.2 years, with 53.1% being female. All patients received either the SAPIEN XT or the SAPIEN 3 bioprosthesis (Edwards Lifesciences). Device success was achieved in 100% of cases. One (3.25%) patient subsequently suffered an aortic dissection and required ascending aorta replacement. Paravalvular leakage was absent or mild in 26 (81%) patients, and moderate in 6 (19%) patients. Other complications included permanent pacemaker implantation in 2 (6.5%), and transient post operative delirium in 2 (6.5%) patients. The total hospital stay was 6.7 ± 2.4 days. New York Heart Association class decreased significantly on follow-up. Thirty-day mortality rate was 2 (6.5%) patients. Conclusions: Use of TAo access for TAVI procedures has a reasonable clinical outcome and is a safe alternative to the transfemoral and transapical approaches, especially for patients with high-risk peripheral vessel access.

Background: The Pl A2 allele of the gene encoding for GPIIIa subunit of the platelet membrane receptor glycoprotein (GP) IIb/IIIa has been suggested as a significant risk factor for thrombotic complications of coronary artery disease (CAD). The aim of the current investigation was to investigate the association between Pl A GPIIIa polymorphism and the extent of angiographically confirmed CAD in patients from the north region of Poland. Methods: The study was performed in 397 male Caucasian patients. All subjects had significant coronary artery stenosis confirmed by elective coronary angiography. Screening for the Pl A GPIIIa genotypes was performed by polymerase chain reaction of genomic DNA, followed by Nci I digestion and agarose gel electrophoresis. Results: The genotype distribution of the Pl A GPIIIa polymorphism in our study group was Pl A1/A1 —75%, Pl A1/A2 —24% and Pl A2/A2 —1% with Pl A1 and Pl A2 allele frequencies of 0.87 and 0.13, respectively. The prevalence of the homozygous Pl A1/A1 genotype among subjects with multiple-vessel CAD (two or three vessels with at least 50% stenosis) was significantly higher than in patients with single-vessel disease; the odds ratio of Pl A2/A2 or Pl A1/A2 patients for having multiple-vessel CAD was 0.46 (95% CI 0.27–0.77, P Pl A1/A1 patients was significantly higher in comparison to Pl A2/A2 and Pl A1/A2 patients (7.58±2.20 and 6.98±2.37, respectively, P Conclusions: Our results suggest, that the Pl A1/A1 genotype of Pl A GPIIIa polymorphism is associated with more severe CAD in male Caucasian patients from the north region of Poland.

Background Previous randomized trials have shown beneficial effects of coronary stenting on restenosis and event–free survival rates. However, it has not yet been fully established if routine high–pressure stenting with an antiplatelet regimen can show similar results. Methods We compared the 6-month angiographic restenosis rate and 2-year event-free survival rate in 400 patients randomly assigned to stent or angioplasty. Aspirin and ticlopidine were prescribed in both groups. Results The procedural success rate did not significantly differ between the stent and angioplasty groups (97.92% vs 97.45%, P = not significant). No stent thrombosis was found. The 6-month restenosis rate was lower in the stent group (18.18% vs 24.87%, P =.055). At 2 years target lesion revascularization rate was 17.19% in the stent group and 25.51% in the angioplasty group ( P =.02, 33% reduction). No significant differences with regard to death and myocardial infarction were observed. Event–free survival rate at 6, 12, and 24 months was 86.77% vs 78.84%, 84.13% vs 76.70%, and 83.07% vs 73.54% for stent and angioplasty groups, respectively ( P =.0172). Conclusions The 6-month angiographic and 2-year clinical outcomes were better in patients who received stent than in those after balloon angioplasty. The difference in 2-year event–free survival rate was explained by a reduction in target lesion revascularization rate in the stent group. (Am Heart J 2000;140:264-71.)

An 18-year-old female with no past cardiovascular history was admitted to the emergency room due to dyspnoea, reduced exercise tolerance, and mild systolic murmur along the right sternal border. Bedside echocardiography documented a giant polypoid tumour filling the right ventricle (RV), protruding to the right atrium and occluding tricuspid valve in systole. No tricuspid regurgitation and valve stenosis was recorded (Fig. 1A). A second mass located in the left atrium was attached to the atrial septum. With the diagnosis of myxoma, the patient was referred for computed tomography (Fig. 1B) and subsequent surgery. The masses were excised together with tricuspid valve due to extensive, irreparable damage to the anterior leaflet, and mitral biological pericardial prosthesis was implanted. Due to atrioventricular II-block, the patient required permanent pacemaker implantation. The patient remained asymptomatic and was discharged on the eighth postoperative day. Three months later, elective echocardiography revealed hyperechogenic masses in RV (1.5 × 1 cm), raising suspicion of a substantial thrombus formation (Fig. 1C). Additionally, the concomitant, moderate and centrally-located regurgitation of the valve prosthesis was recorded. A repeated echocardiogram performed after three months of anticoagulative therapy documented enlargement of the tumour diameter to 2.0 × 3.5 cm and a significant progression of prosthesis regurgitation. Second surgical inspection revealed a giant multiple myxoma which was subsequently excised (Fig. 1D, E). Leaflets of the prosthesis were thicker, stiff and shortened (Fig. 1F). Due to rapid biological valve degeneration, mechanical prosthesis was implanted. The postoperative course was uneventful. In 12 months of follow-up, no recurrence of myxoma was recorded. Herein we present a unique case of unexpected rapid biological prosthesis deterioration coupled with a giant RV multiple myxoma, early after surgical tumour excision and valve implantation. This case elucidates the requirement for short-term follow-up in patients with a primary diagnosis of multiple myxoma.

A 74-year-old female diagnosed with a non-ST elevation myocardial infarction was referred to our coronary care unit for urgent coronary angiography. Angiography revealed severe distal left main stenosis and a chronic total occlusion of the left circumflex coronary artery in its distal portion. Percutaneous coronary intervention was performed via the right femoral artery approach with a 7 Fr arterial sheath and EBU 3.0 guiding catheter (Medtronic). The Xience SBA stent was used. This device provides a good alternative to avoid multistent techniques while preserving integrity of the side branch, which results in procedural success. This dedicated bifurcation device may also be associated with shorter-duration procedures, lower contrast usage, and a reduction in total fluoroscopy time. To our knowledge, this is the first publication of this side-branch access device for the treatment of left main coronary artery disease.

The authors report case of 84-year-old male with degeneration of biological aortic prosthesis treated successfully with transapical TAVI valve in valve procedure.

We present a case of a 55 year-old female, who survived a complication of percutaneous closure of atrial septal defect never described before. Within the first day after treatment the device has dislodged and got stuck in the mitral valve apparatus. This has caused mitral insufficiency and massive haemolysis which resolved after interventional removal of the device.

Despite procedural advances, recanalization of chronic total occlusions (CTOs) with percutaneous coronary intervention (PCI) remains controversial, particularly given that its long-term benefits are unclear. We assessed the association between successful PCI and symptom improvement as well as outcomes in patients with CTO and stable angina.We performed a retrospective study of 386 consecutive patients undergoing attempted PCI of an isolated CTO (i.e., no other angiographically-significant disease was present). We analyzed prospectively the change in Canadian Cardiovascular Society (CCS) classification system and occurrence of major adverse cardiovascular events (death, myocardial infarction or target vessel revascularization), after stratifying patients by procedural success. To understand which patients might benefit most from attempted PCI, multivariable models were constructed to predict: likelihood of successful PCI and symptom improvement, defined as resolution of angina or improvement of ≥ 2 CCS classes.A total of 247 (64%) patients had successful PCI. Greater symptom improvement was noted after successful PCI at both 6 months (79.8% versus 34.5% with resolution of angina or improvement of ≥ 2 CCS classes, p0.01) and 24 months (71.7% and 20.9%, respectively, p0.01). No differences were noted in MACE (11.3% vs. 10.0% at 6 months, p=0.70; and 18.6% vs. 19.4% at 24 months, p=0.84). Multivariable analysis identified several factors associated with successful PCI, but not predictive of symptom improvement. In conclusion, successful PCI of an isolated CTO improves symptom burden, but is not associated with MACE at 6 or 24 months.Several factors are associated with successful PCI, but identifying those most likely to have symptom improvement remains challenging.

A 31-year-old female was admitted to the Cardiosurgery Department, Medical University of Gdansk, with symptoms of congestive heart failure. The patient underwent aortic valve replacement (AVR) with homograft due to severe aortic insufficiency after inflammatory process 12 years previously. Echocardiography revealed severe aortic homograft regurgitation (AR). Left ventricle (LV) was enlarged and LV ejection fraction (LVEF) was 50%. Aortic valve replacement was postponed due to active endocarditis. Two weeks later, control transoesophageal echocardiography showed severe AR and new vegetations on mitral valve leaflets with torrential regurgitation, increased systolic right ventricle pressure to 55 mmHg, and decreased LVEF to 30%. Two weeks after changing the antibiotic …

Uridine (Ur) and hypoxanthine (Hx) are the major end products of ischemic nucleotide breakdown in the human heart. Hypoxanthine is further metabolized to uric acid (UA). The aim of the study was the evaluation of whether changes in nucleotide concentrations during exercise correlate with electrocardiography (ECG) changes, and the severity of coronary artery disease (CAD).Twenty-nine males with CAD and 11 controls without CAD (mean age 56.1 vs. 51.45) were subjected to treadmill exercise. The test was considered positive if ECG showed more then 1 mm ST segment depression. Venous blood samples taken before and 10 minut after the exercise were analysed by high performance liquid chromatography.Twenty-two out of 29 patients with CAD and 6 of 11 in the control group had abnormal exercise stress tests according to ECG criteria only. Mean Ur was positive in the CAD group and negative in the control group (0.45 SEM +/- 0.09 microM/L vs. -0.43 SEM +/- 0.21 microM/L, p0.0001). UA was positive in the CAD group (15.31 SEM +/- 5.52 microM/L) and negative in the control group (15.31 SEM +/- 5.52 microM/L vs. -48.18 SEM +/- 13,8 microM/L, p0.00001); Hx increased in both groups, and the change was not significantly different. Correlations of CAD-index with ST depression, Ur and UA, were: r = 0.43 (p0.005), r = 0.62 (p0.001), and r = 0.39 (p0.01), respectively. Sensitivity of any increase of uridine was superior to 1.5 mm ST depression during exercise.Blood Ur and UA concentration changes during exercise correlate with severity of CAD. We observed slightly greater accuracy of uridine change in comparison to ST changes, thus being a possible new tool in diagnosis of CAD. (Cardiol J 2007; 14: 573-579).

There is a group of rare but serious complications of acute myocardial infarction (AMI), including free wall rupture (FWR) and, less frequent, ventricular septal rupture (VSR). Urgent surgery combined with simultaneous CABG is usually a treatment of choice. We present a case of a 65-year-old male with AMI, who developed cardiogenic shock due to cardiac tamponade as a result of FWR. The patient was successfully resuscitated and operated. During postoperative treatment parasternal systolic murmur was audible and VSR diagnosis was confirmed. Three months after AMI the AMPLAZER Muscular VSD Occluder was successfully implanted. The follow-up period was uneventful.