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To evaluate the long-term (≥2 years) outcomes following transcatheter tricuspid valve repair (TTVr) with the FORMA Transcatheter Tricuspid Valve Repair System (Edwards Lifesciences, Irvine, California).Scarce data exist on long-term outcomes following TTVr.This multicenter experience included patients with severe tricuspid regurgitation (TR) who underwent TTVr with the FORMA system at 4 centers under a compassionate clinical use program. Data were collected at baseline, 30 days, and 1 year, and yearly thereafter.Nineteen patients (76 ± 9 years of age, 74% women, mean EuroSCORE II [European System for Cardiac Operative Risk Evaluation] 9.2 ± 5.6%) with functional TR were included. Procedural success was achieved in 17 (89%) patients and there were no cases of 30-day mortality. At a median follow-up of 32 (interquartile range: 24 to 36) months, 4 (24%) patients had died (3 from terminal heart failure, 1 from sepsis) and 3 (18%) patients required rehospitalization for heart failure. There was 1 device-related thrombosis and 1 pulmonary embolism, both in the setting of subtherapeutic oral anticoagulation. Less than severe TR was observed at echocardiography in 67% of patients at the 2- to 3-year follow-up. Among 15 successfully implanted patients with at least 24-month follow-up, significant improvements in New York Heart Association functional class (p 0.001), 6-min walk test (+54 m; p = 0.016) and Kansas City Cardiomyopathy Questionnaire score (+16 points; p = 0.016) were observed, compared with baseline.TTVr using the FORMA system showed favorable long-term safety profile in high-surgical-risk patients, with sustained functional improvement and acceptable TR reduction up to 3 years.

We evaluated the clinical value of a single measurement of high-sensitivity C-reactive protein (hs- CRP) in patients presenting to the emergency department with chest pain. We screened 408 consecutive patients of whom 292 comprised the final cohort for this study. Hs-CRP measured in the emergency department (ED) in patients presenting with chest pain and admitted for evaluation of acute myocardial infarction was neither sensitive nor specific in predicting acute myocardial infarction, myocardial ischemia on SPECT imaging, need for coronary revascularization, or cardiovascular or all-cause rehospitalization at 30 days. In addition, use of a specific CRP cut off1 was not associated with an increase in all-cause rehospitalization at 30 days.

Transcatheter aortic valve implantation is emerging as a promising, effective therapy for high-risk patients not eligible to undergo surgical aortic valve replacement. Infection complications have only rarely been reported. We report a case of probable endocarditis caused by coagulase-negative Staphylococcus following repeated attempts at implantation of a CoreValve bioprosthesis.

BACKGROUND: Endocarditis complicating central venous catheter blood stream infection (CVC‐BSI) is a serious complication and is being seen with increasing frequency. METHODS: All patients discharged from our institution with International Classification of Disease (ICD‐9) codes of endocarditis and CVC‐BSI were identified. The medical records of those meeting our inclusion criteria were reviewed. RESULTS: From October 1, 1998 until December 31, 2006, 24 patients were identified with inpatient mortality of 20.8%. Nine cases were nosocomial and 15 were non‐nosocomial. The most common comorbidities were diabetes mellitus (45.8%), chronic kidney disease (58.4%), prior valvular abnormalities (37.5%), and multiple prior hospitalizations (65.2%). There were 13 external lines, 9 tunneled lines, and 2 implantable ports. Responsible microorganisms included Staphylococcus aureus in 54.6%, coagulase‐negative staphylococci in 37.5%, Candida species (spp.) in 16.6%, and enterococci in 12.5%. Five cases were polymicrobial. The line tip was within the right atrium (RA) in 37.5%, the superior vena cava (SVC)‐RA junction in 20.8%, the SVC in 33.3%, and the pulmonary artery in 4.2% of patients. Sites of endocardial involvement were the aortic valve in 6 patients, mitral valve in 7 patients, tricuspid valve in 6 patients, right atrial wall in 11 patients, and pacemaker wire in 2 patients. Isolated right‐sided involvement occurred in 50% of cases, isolated left‐sided in 33.4%, and bilateral involvement in 16.6%. Transesophageal echocardiography (TEE) was necessary for diagnosis in 10 cases (41.6%). CONCLUSIONS: Endocarditis complicating CVC‐BSI more often involves right‐sided structures, with catheter tips in or near the right atrium, frequently requires TEE for diagnosis, and has significant inpatient mortality. Copyright © 2009 Wiley Periodicals, Inc.

Noncompaction of the ventricular myocardium is a rare form of cardiomyopathy that has been described since the early 1990s. However, noncompaction remains frequently overlooked, in part due to the limited awareness of its unique clinical and imaging characteristics. Contemporary diagnosis has been facilitated by the introduction of specific morphologic criteria by echocardiography and cardiac magnetic resonance. Management issues revolve around the management of heart failure, arrhythmias, and thromboembolic events in order to prevent the significant morbidity and even mortality that has been associated with this entity. Finally, the genetics of noncompaction have been diverse and an issue of clinical importance as it relates to screening of first‐degree relatives of affected patients. Two recent cases are presented and many of the contemporary issues in diagnosis and management, based on an extensive review of the literature, are addressed. Copyright © 2007 Wiley Periodicals, Inc.

Thrombosis of intracoronary stents is a major complication associated with significant morbidity and mortality. Of concern are case reports of late (more than six months from deployment) drug-eluting stent thrombosis temporally associated with discontinuation of antiplatelet therapy and when stent endothelialization was presumed to be complete. In certain patients it appears that vascular healing at the stented segments is incomplete with increased susceptibility to late thrombosis. We report two cases of late stent thrombosis occuring more than one year after stent deployment and within weeks of discontinuation of clopidogrel. A review of the literature is presented to identify clinical and angiographic predictors of increased risk.

We sought to identify certain clinical characteristics associated with a poor clinical outcome in patients acutely infected with Influenza A.We performed a retrospective chart review of inpatients with acute Influenza A infection comparing a poor outcome group (POG; n=27), defined as patients who died and/or developed respiratory failure or shock, with a usual outcome group (UOG; n=105).Compared with the UOG, the POG had a significantly greater percentage of patients with: a history of chronic obstructive pulmonary disease (41% vs 20%), coronary artery disease (63% vs 38%), congestive heart failure (44% vs 23%), transient ischemic attack (TIA) or stroke (44% vs 21%), chronic renal insufficiency (22% vs 8%) and dialysis (11% vs 1%). Shortness of breath as a chief complaint (74% vs 44%), lower initial oxygen saturations (0.86 vs 0.92), as well as higher mean respiratory rates (28/minute vs 22/minute) occurred more frequently in the POG. The POG also had a greater frequency of CHF/ vascular congestion (26% vs 8%), and interstitial involvement (22% vs 6%) on admission chest roentgenogram. Independent predictors of poor outcome identified by multivariate analysis included low oxygen saturation on admission, history of TIA or stroke, and history of dialysis.The presence of certain comorbidities as well as clinical and radiographic evidence of respiratory compromise on admission may be helpful in identifying high-risk patients acutely infected with Influenza A.