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Calcific aortic stenosis is the most common valvular heart disease in the Western world. Although definitive treatment is valve replacement, many patients are not replacement candidates due to high surgical risk from older age and comorbid illness or lack of desire for a surgical or replacement procedure. Percutaneous balloon aortic valvuloplasty (BAV) is an option for palliative treatment in nonsurgical patients, although this procedure is complicated during the immediate postprocedure period by bleeding requiring transfusion for about 1 in 5 patients and subsequent restenosis. This report describes BAV using a smaller profile balloon designed to withstand higher pressures, rapidly inflated with a power injector. Twenty consecutive high-risk patients with severe aortic stenosis were treated. In all cases, New York Heart Association (NYHA) class improved from IV before BAV to I or II at 30 days follow-up. Six-month posttreatment follow-up data were available for 19 of 20 patients: 15 patients were either NYHA class I or II, 1 patient was class III, and 3 deaths occurred unrelated to aortic stenosis. One patient was lost to follow-up. Average systolic gradient peak-to-peak pressure decreased by 40.0% (range 18.0-70.0%) and mean gradient decreased by 30.0% (range 13.7-70.8%). Aortic valve area increased from 0.59 ± 0.16 cm(2) to 0.92 ± 0.23 cm(2), representing a mean increase of 30.0% (range 7.8%-58.2%). There were no significant bleeding complications. The only procedural complication was a single case of pericardial tamponade. There were no other complications during the first 24 hours post-BAV. These data support that the reported BAV technique may offer an effective alternative for patients with severe aortic stenosis who are not surgical candidates or prefer to avoid aortic valve replacement., (©2010, Wiley Periodicals, Inc.)

The management of high-grade stenosis involving the petrosal segment of the internal carotid artery has been limited to angioplasty alone in the past. However, if angioplasty fails or has less than optimum results, then endovascular stent placement should be considered. We present the first two known cases in which the Multi-Link coronary stent was used for the treatment of internal carotid disease in the petrosal segment. The first patient had symptomatic stenosis that failed angioplasty after seven months and the second patient had a symptomatic lesion that dissected upon angioplasty. The flexibility and low profile characteristics of the stent allowed it to be safely deployed with balloon expansion. No complications occurred and the patients tolerated the procedure. Patients were carefully monitored and no new neurologic events in six months of follow up occurred. These cases reveal the good clinical results of stent placement for surgically-inaccessible lesions of the internal carotid artery in the skull base.

The neuroleptic malignant syndrome (NMS), clinically manifested by hyperpyrexia, mental status changes, muscular rigidity, and autonomic dysfunction, is an idiosyncratic reaction to major neuroleptic pharmacologic agents. The reported causes of morbidity and mortality include respiratory insufficiency, cardiovascular collapse, arrhythmias, and renal failure. Coagulopathy does not seem to be a prominent component of the syndrome. We observed a case of NMS in which disseminated intravascular coagulation was a prominent feature.