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Background. The optimal timing for aortic valve replacement (AVR) in aortic stenosis (AS) is still controversial and may be guided by markers of adverse left ventricular (LV) remodeling. We aim to assess electrocardiographic (ECG) strain patterns in relation to adverse LV remodeling and myocardial fibrosis. Methods. A total of 83 symptomatic severe AS patients (age 66.5 ± 8.6, 42% male) scheduled for surgical AVR underwent preoperative cardiovascular magnetic resonance (CMR) with T1 mapping and echocardiography with global longitudinal strain (GLS) analysis. Collagen volume fraction (CVF) was measured in myocardial biopsies (71) sampled at the time of AVR. The 12-lead ECG was performed preoperatively and 3 and 12 months postoperatively. Results. ECG strain-positive patients (prevalence of 43.4%) had more severe AS, increased LV mass, higher levels of brain natriuretic peptides (BNP) and high-sensitivity troponin I, lower GLS, and lower LV ejection fraction (LVEF). Patients with ECG strain had more diffuse fibrosis, as evident by higher native T1 values (974.8 ± 33.6 ms vs 946.5 ± 28.2 ms, p

Background and Aims. Describe and present a clinical case of a patient treated with low-dose slow infusion thrombolysis after prosthetic valve thrombosis. Methods. The patient is a 75 year old women treated with low–dose slow infusion thrombolysis in the Resuscitation and Intensive Care Unit II of Vilnius University Hospital. Data was monitored since 2017 till 2020. A detailed analysis of the patient's life and medical history was made. The course and dynamics of examinations and treatment procedures / medications prescribed to the patient were analyzed in a structured way. The literature on the selected topic is examined in detail in order to compare the efficacy and outcome of low-dose slow infusion thrombolysis with the results of previous studies and in the case we presented. Permission to use patient data has been obtained with the consent of the personal data protection specialist. Patient confidentiality was guaranteed - name, surname, address and other personal data were not collected. The results of the study are published only in a summary form. Results. A 75-year-old patient had a prosthetic mitral mechanical valve in 2009 St. Jude 29 MJ. In 2015, the valve was replaced due to high thrombosis. Since 2016 the woman was hospitalized 4 times (once a year) in December for recurrent mitral valve thrombosis for a low-dose slow infusion thrombolysis procedure. Overall of 12 thrombolysis were performed. Actilyse 25 mg / 6 h was infused with heparin after each thrombolysis for aPTT 50-80 sec. The efficacy of thrombolysis was evaluated by repeated transesophageal ultrasound examinations. The mean pressure gradient dynamics was decreasing (24mmHg à4.3mmHg). A geneticist and hematologist were consulted for suspected thrombophilia that had not been diagnosed, but hyperhomocysteinemia had been identified. 2020 she was hospitalized in July for suspected recurrent MV prosthetic thrombosis, but there were insufficient data on thrombosis, so the patient was admitted to outpatient treatment, recommending a Level III cardiologist consultation twice a year. Conclusions. Low-dose, slow-infusion thrombolytic therapy is currently increasingly being used in patients with prosthetic valve thrombosis. This is because it has safety, efficacy, and a lower incidence of complications. However, this clinical case demonstrates that such treatment does not always prevent recurrence of thrombosis.

To the date efficacy and safety between surgical ans catheter-based paravalvular mitral valve leak treatment is not well investigated. Objektive of thid study was to compare efficacy and safety between two treatment methods of mitral valve paravalvular leak.

Transapical off-pump implantation of artificial mitral valve chordae using NeoChord DS1000 device is an alternative approach to treat severe mitral regurgitation

This is an observational, retrospective study of 127 patients (79 % males; mean age 52 ± 10 years [range, 23–75 years]) who underwent minimally invasive standalone surgical ablation of paroxysmal, persistent and longstanding persistent AF from 2008 to 2015. Mean follow-up was 60±21 months. Three different devices have been used for the ablation: Cardioblate® Gemini® surgical ablation system; Medtronic, Inc., Minneapolis, MN, USA; COBRA Adhere XL™ ablation system, Estech, Inc, California, CA, USA; AFx FLEX 10 microwave ablation system, Guidant, AFx, Fremont, CA, USA. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring. The mean duration of preoperative AF was 6.5 ± 5.4 years. Six (5%) patients had a paroxysmal AF, and 19 patients (15%) had a long-standing persistent AF. Mean left atrial diameter was 4.3±0.8 cm. There were two postoperative strokes (2 %) and three conversions to median sternotomy (2.4%). Permanent pacemakers were implanted in 10 (8%) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 70%, 48%, 41%, 38%, 34%, 32% of patients, respectively. The best results were achieved then bipolar ablation device (Cardioblate® Gemini® surgical ablation system;) was used (χ2 = 12,521, p = 0.0004). At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 73%, 58%, 48%, 44%, 42%, 42% of patients, respectively if bipolar ablation device was used.The failure to achieve pulmonary vein isolation (“exit” block) was the only independent predictor of long-term recurrence of AF (HR −3 [95 % CI 1,858 to 8,586], p = 0,001). Conclusions: In the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination.

This was an observational, retrospective study of 127 patients (79% males; mean age, 52±10 years [range, 23–75 years]) who underwent minimally invasive standalone surgical ablation of paroxysmal, persistent and longstanding persistent AF from 2008 to 2015. Mean follow-up was 60±21 months. Three different devices have been used for the ablation: Cardioblate® Gemini® surgical ablation system; Medtronic, Inc., Minneapolis, MN, USA; COBRA Adhere XL™ ablation system, Estech, Inc, California, CA, USA; AFx FLEX 10 microwave ablation system, Guidant, AFx, Fremont, CA, USA. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring. The mean duration of preoperative AF was 6.5±5.4 years. Six (5%) patients had a paroxysmal AF, and 19 patients (15%) had a long-standing persistent AF. Mean left atrial diameter was 4.3±0.8 cm. There were two postoperative strokes (2%) and three conversions to median sternotomy (2.4%). Permanent pacemakers were implanted in 10 (8 %) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 70%, 48%, 41%, 38%, 34%, 32% of patients, respectively. The best results were achieved then bipolar ablation device (Cardioblate® Gemini® surgical ablation system;) was used (χ2=12,521. p=0.0004). At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 73%, 58%, 48%, 44%, 42%, 42% of patients, respectively if bipolar ablation device was used.The failure to achieve pulmonary vein isolation (“exit” block) was the only independent predictor of long-term recurrence of AF (HR −3 [95%CI 1,858 to 8,586], p = 0,001). Conclusions: In the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination.