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https://www.readbyqxmd.com/read/28895294/pathology-of-self-expanding-transcatheter-aortic-valves-findings-from-the-corevalve-us-pivotal-trials
#1
Kazuyuki Yahagi, Sho Torii, Elena Ladich, Robert Kutys, Maria E Romero, Hiroyoshi Mori, Frank D Kolodgie, Jeffrey J Popma, Renu Virmani, Aloke V Finn
BACKGROUND: Transcatheter aortic valve replacement (TAVR) has recently become an alternative to surgical aortic valve replacement for patients with severe aortic stenosis. However, paravalvular leaks, possible leaflet thrombosis, and device durability following TAVR remain unresolved issues. METHODS AND RESULTS: We conducted the first systematic microscopic and macroscopic pathologic analysis of self-expanding CoreValve transcatheter aortic valves removed at autopsy or surgically from the U...
September 12, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28893450/emergency-medicine-evaluation-and-management-of-the-end-stage-renal-disease-patient
#2
REVIEW
Brit Long, Alex Koyfman, Courtney M Lee
BACKGROUND: End stage renal disease (ESRD) is increasing in the U.S., and these patients demonstrate greater all-cause mortality, cardiovascular events, and hospitalization rates when compared to those with normal renal function. These patients may experience significant complications associated with loss of renal function and dialysis. OBJECTIVE: This review evaluates complications of ESRD including cardiopulmonary, neurologic, infectious disease, vascular, and access site complications, as well as medication use in this population...
September 5, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28885112/management-of-failing-bioprosthesis-in-elderly-patients-who-have-undergone-transcatheter-aortic-valve-replacement
#3
Ozan M Demir, Neil Ruparelia, Angela Frame, Sayan Sen, Ghada W Mikhail, Michael Fertleman, Iqbal S Malik
Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of symptomatic aortic stenosis. The number of TAVR procedures is expected to increase exponentially in the next decade. Therefore, patients will inevitably present with signs and symptoms attributable to TAVR bioprosthesis failure many years after an acutely successful procedure. Their management will become increasing important moving forward. Areas covered: The aim of this article is to review the causes of bioprosthesis failure and outline optimal management strategies in elderly patients...
September 15, 2017: Expert Review of Medical Devices
https://www.readbyqxmd.com/read/28880010/chronic-pancreatitis
#4
REVIEW
Jorg Kleeff, David C Whitcomb, Tooru Shimosegawa, Irene Esposito, Markus M Lerch, Thomas Gress, Julia Mayerle, Asbjørn Mohr Drewes, Vinciane Rebours, Fatih Akisik, J Enrique Domínguez Muñoz, John P Neoptolemos
Chronic pancreatitis is defined as a pathological fibro-inflammatory syndrome of the pancreas in individuals with genetic, environmental and/or other risk factors who develop persistent pathological responses to parenchymal injury or stress. Potential causes can include toxic factors (such as alcohol or smoking), metabolic abnormalities, idiopathic mechanisms, genetics, autoimmune responses and obstructive mechanisms. The pathophysiology of chronic pancreatitis is fairly complex and includes acinar cell injury, acinar stress responses, duct dysfunction, persistent or altered inflammation, and/or neuro-immune crosstalk, but these mechanisms are not completely understood...
September 7, 2017: Nature Reviews. Disease Primers
https://www.readbyqxmd.com/read/28878012/synthetic-oligosaccharides-can-replace-animal-sourced-low-molecular-weight-heparins
#5
Yongmei Xu, Kasemsiri Chandarajoti, Xing Zhang, Vijayakanth Pagadala, Wenfang Dou, Debra Moorman Hoppensteadt, Erica M Sparkenbaugh, Brian Cooley, Sharon Daily, Nigel S Key, Diana Severynse-Stevens, Jawed Fareed, Robert J Linhardt, Rafal Pawlinski, Jian Liu
Low-molecular weight heparin (LMWH) is used clinically to treat clotting disorders. As an animal-sourced product, LMWH is a highly heterogeneous mixture, and its anticoagulant activity is not fully reversible by protamine. Furthermore, the reliability of the LMWH supply chain is a concern for regulatory agencies. We demonstrate the synthesis of heparin dodecasaccharides (12-mers) at the gram scale. In vitro experiments demonstrate that the anticoagulant activity of the 12-mers could be reversed using protamine...
September 6, 2017: Science Translational Medicine
https://www.readbyqxmd.com/read/28876686/management-of-failed-mitral-valve-replacement-the-durban-experience
#6
D Kistan, M Booysen, G Alexander, T E Madiba
BACKGROUND: Mitral valve replacement is the procedure of choice in patients with severe mitral valve disease. However, these patients are surviving longer and are thus at an increased risk of prosthesis failure or valve-related complications. METHOD: Study setting: Inkosi Albert Luthuli Central Hospital, a tertiary referral Hospital in Durban. Study population: All patients undergoing redo mechanical mitral valve replacement surgery between January 2005 and December 2014...
June 2017: South African Journal of Surgery. Suid-Afrikaanse Tydskrif Vir Chirurgie
https://www.readbyqxmd.com/read/28866159/biomimetic-modification-of-polyurethane-based-nanofibrous-vascular-grafts-a-promising-approach-towards-stable-endothelial-lining
#7
Parivash Davoudi, Shiva Assadpour, Mohammad Ali Derakhshan, Jafar Ai, Atefeh Solouk, Hossein Ghanbari
The emerging demand for small caliber vascular grafts to replace damaged vessels has attracted research attention. However, there is no perfect replacement in clinical use yet, mainly due to low patency rate of synthetic small caliber grafts. The main pathology behind low patency rate include thrombosis and graft/vessel hemodynamic mismatch, leading to intimal hyperplasia. Rapid in-situ endothelialization of vascular grafts is considered as one of the best strategies to overcome these complications. In the present study, Heparin and VEGF were immobilized via self-polymerization and deposition of polydopamine (PDA) on polyurethane (PU) nanofibrous scaffolds to improve endothelialization...
November 1, 2017: Materials Science & Engineering. C, Materials for Biological Applications
https://www.readbyqxmd.com/read/28863787/venous-thromboembolism-and-hyperhomocysteinemia-as-first-manifestation-of-pernicious-anemia-a-case-series
#8
W Ammouri, Z Mezalek Tazi, H Harmouche, M Maamar, M Adnaoui
BACKGROUND: Hyperhomocysteinemia has been suspected of favoring thrombosis. Several case-control studies and even a meta-analysis have confirmed a link between venous thrombosis and hyperhomocysteinemia. Homocysteine is due to genetic and acquired factors (poor diet in folate and vitamin B12, older age, renal impairment, thyroid diseases, and malignancies) induced by the intake and the concentrations of vitamin B9 or B12 in the majority of cases. CASES PRESENTATION: We report the cases of four Moroccan patients who presented with acute vein thrombosis of different sites: a 34-year-old man, a 60-year-old man, a 58-year-old man, and a 47-year-old woman...
September 2, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28857797/a-comparison-of-3-frailty-indices-in-predicting-morbidity-and-mortality-after-on-pump-aortic-valve-replacement
#9
Gary Esses, Evie Andreopoulos, Hung-Mo Lin, Shipra Arya, Stacie Deiner
BACKGROUND: Aortic valve replacement is a high-risk surgery (3%-5%, 30-day mortality) performed on approximately 30,000 elderly patients a year in the United States. Currently, preoperative risk assessment is based on a composite of medical examination and a subjective evaluation for frailty ("eyeball test"). Objective frailty assessment using validated indices has the potential to improve risk stratification. The purpose of this study was to (1) establish whether frailty can predict 30-day mortality and composite morbidity in patients undergoing aortic valve replacement and (2) compare the predictive ability of 3 frailty indices in this population...
August 29, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28856946/spontaneous-hit-syndrome-post-knee-replacement-surgery-with-delayed-recovery-of-thrombocytopenia-a-case-report-and-literature-review
#10
Dilli Ram Poudel, Sushil Ghimire, Rashmi Dhital, Daniel A Forman, Theodore E Warkentin
Recently published reports have established a heparin-induced thrombocytopenia (HIT)-mimicking thromboembolic disorder without proximate heparin exposure, called spontaneous HIT syndrome. Although the pathophysiology remains unclear, anti-platelet factor 4 (PF4)/heparin antibodies possibly triggered by exposure to knee cartilage glycosaminoglycans or other non-heparin polyanions found on bacterial surfaces and nucleic acids have been postulated. We present a 53-year-old female receiving antithrombotic prophylaxis with aspirin following right total knee replacement surgery (without perioperative or any previous lifetime heparin exposure) who acutely presented with high-risk pulmonary embolism (PE) and right great saphenous vein thrombophlebitis on postoperative day (POD) 14; her platelet count at presentation was 13 × 10(9)/L...
September 2017: Platelets
https://www.readbyqxmd.com/read/28856722/the-doppler-paradox
#11
Ioannis Ntalas, Júlia Karády, Stam Kapetanakis, Ronak Rajani
Obstructive prosthetic valve thrombosis (PVT) is a rare but severe complication that usually occurs in the presence of suboptimal anticoagulation. Although fluoroscopy is commonly used to detect abnormal leaflet motion as a surrogate marker for PVT, its inability to directly visualize adjacent tissue and valve physiology leaves it susceptible to miss clinically important PVT. In this manuscript, we report the case of a 54-year-old woman with a mechanical mitral valve who was admitted to our institute with exertional dyspnea...
August 30, 2017: Echocardiography
https://www.readbyqxmd.com/read/28854521/substitution-rate-based-screening-model-to-assess-stenosis-progression-in-experimental-stenotic-arteriovenous-grafts
#12
Chung-Dann Kan, Wei-Ling Chen, Chia-Hung Lin, Ming-Jui Wu, Yi-Chen Mai
An arteriovenous graft (AVG) has a higher patency rate in stenosis progression at the venous anastomosis site, which causes coexisting inflow and outflow stenoses. This leads to increases in blood pressure, flow velocity, and flow resistance, resulting in hemodialysis (HD) vascular access dysfunction from early clots and thrombosis to the progression of coexisting stenoses. To prevent vascular access complications such as inflow or outflow stenoses, this study proposes a novel examination method in an experimental AVG system using a substitution-rate based screening model...
August 15, 2017: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
https://www.readbyqxmd.com/read/28847146/on-x-versus-st-jude-medical-mechanical-prosthesis-in-mitral-position-are-we-moving-forward-in-design-technology
#13
Ezzeldin A Mostafa, Ashraf A El Midany, Ahmed S Taha, Saeed R El Aasy, Ayman A Doghish, Ahmed Helmy, Sherif A Mansour, Ramy Khorshid, Hosam E Ashor, Yaser Elnahas, Mohammed Saffan
BACKGROUND: Continuous effort is still provided in designing optimal artificial heart valves with better hemodynamic function and reduced thromboembolic potential. The question is do we have moved forward toward this goal or not. METHODS: A prospective, randomized comparative study was done on 360 patients scheduled for elective mitral valve replacement. Patients were grouped into On-X group (n=180) who received On-X mechanical valve and SJM (n=180) who received St Jude mechanical valve...
July 28, 2017: Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28843859/aortic-pseudoaneurysm-after-endarterectomy-for-small-aorta-syndrome
#14
M Domanin, D Bissacco, S Romagnoli, A Buora
INTRODUCTION: Small Aorta Syndrome (SAS) or hypoplastic aorto-iliac syndrome is a rare pathology of the aorta that affects almost exclusively young or middle-aged women and is characterized by smaller dimension of the aorta and iliac axes. Etiopathogenesis is unclear and many factors have been invoked. The smaller caliber of the aorta and iliac arteries may predispose to aorto-iliac occlusive disease development. In the past aorto-iliac endarterectomy (AE) with patch closure was utilized as an alternative to surgical bypass in order to correct steno-obstructive syndromes affecting carriers of SAS...
August 10, 2017: International Journal of Surgery Case Reports
https://www.readbyqxmd.com/read/28839992/optical-coherence-tomography-in-imaging-of-peripheral-pulmonary-arteries
#15
Cheng Hong, Nan-Shan Zhong, Chun-Li Liu, Nuo-Fu Zhang, Shi-Yue Li, Wei Wang
BACKGROUND: To establish an optical coherence tomography (OCT)-based method for imaging peripheral pulmonary arteries. METHODS: We recruited eight patients (five men; average age, 48±12 years; peripheral pulmonary artery thrombosis, three patients; idiopathic pulmonary hypertension, three patients; interstitial lung disease, two patients) who underwent OCT of the peripheral pulmonary arteries in the First Affiliated Hospital of Guangzhou Medical University and Guangzhou Institute of Respiratory Diseases, between September 2009 and September 2010...
July 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28835886/early-experience-of-transilluminated-cryosurgery-for-varicose-vein-with-saphenofemoral-reflux-review-of-84-patients-131-limbs
#16
Kwang Yong Kim, Ji Won Kim
PURPOSE: Varicose veins with great saphenous vein (GSV) insufficiency is prevalent. Among various surgical treatments for varicose veins, cryosurgery of GSV is an alternative minimally invasive technique that could leave fewer scars and replace conventional stripping with ambulatory phlebectomy. This study sought to assess outcomes including efficacy and safety of cryosurgery for varicose veins. METHODS: One hundred thirty-one limbs in 84 patients (37 male, 47 female; mean age, 53...
August 2017: Annals of Surgical Treatment and Research
https://www.readbyqxmd.com/read/28833353/assessment-of-an-extended-interval-fondaparinux-dosing-regimen-for-venous-thromboembolism-prophylaxis-in-critically-ill-patients-with-severe-renal-dysfunction-using-antifactor-xa-levels
#17
Krista A Wahby, Lauren K Riley, Steven D Tennenberg
OBJECTIVE: Pharmacologic options for venous thromboembolism (VTE) prophylaxis are often limited in critically ill patients due to thrombocytopenia and multisystem organ dysfunction. Fondaparinux offers potential advantages in the critically ill; however, it is currently contraindicated in severe renal dysfunction (SRD). We evaluated antifactor Xa levels in critically ill patients with SRD who were receiving an extended interval dosing regimen of fondaparinux for VTE prophylaxis. METHODS: A prospective, single arm, interventional study was conducted at two academic hospitals of the Detroit Medical Center...
August 22, 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/28818223/impact-of-an-inferior-vena-cava-filter-retrieval-algorithm-on-filter-retrieval-rates-in-a-cancer-population
#18
Robert J Litwin, Steven Y Huang, Sharjeel H Sabir, Quoc B Hoang, Kamran Ahrar, Judy Ahrar, Alda L Tam, Armeen Mahvash, Joe E Ensor, Michael Kroll, Sanjay Gupta
OBJECTIVE: Our primary purpose was to assess the impact of an inferior vena cava filter retrieval algorithm in a cancer population. Because cancer patients are at persistently elevated risk for development of venous thromboembolism (VTE), our secondary purpose was to assess the incidence of recurrent VTE in patients who underwent filter retrieval. METHODS: Patients with malignant disease who had retrievable filters placed at a tertiary care cancer hospital from August 2010 to July 2014 were retrospectively studied...
September 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28816783/association-of-testosterone-replacement-therapy-and-the-incidence-of-a-composite-of-postoperative-in-hospital-mortality-and-cardiovascular-events-in-men-undergoing-noncardiac-surgery
#19
Maged Y Argalious, Jing You, Guangmei Mao, Daniel Ramos, Sandeep Khanna, Kamal Maheshwari, Carlos Trombetta
BACKGROUND: Whether patients on testosterone replacement therapy undergoing noncardiac surgery have an increased risk of postoperative in-hospital mortality and cardiovascular events remains unknown. We therefore sought to identify the impact of testosterone replacement on the incidence of a composite of postoperative in-hospital mortality and cardiovascular events in men undergoing noncardiac surgery. METHODS: Data from male American Society of Anesthesiologists I through IV patients 40 yr or older who underwent noncardiac surgery between May 2005 and December 2015 at the Cleveland Clinic (Cleveland, Ohio) main campus were included...
September 2017: Anesthesiology
https://www.readbyqxmd.com/read/28805039/unnatural-milieu-thrombus-after-transcatheter-mitral-valve-replacement
#20
EDITORIAL
Jaffar M Khan, Robert J Lederman
What the article teaches Transcatheter heart valve thrombosis in the mitral position causes increased valve gradients, valve dysfunction, and symptoms, and may be associated with lack of therapeutic anticoagulation. How it will impact practice Anticoagulation with a vitamin K antagonist should be considered in all patients undergoing transcatheter mitral valve replacement. What new research/study would help answer the question posed Efficacy, optimal duration, and safety of anticoagulation therapy, balancing reduced thrombosis against increased bleeding risk, needs to be assessed in larger cohort studies and prospective trials...
August 1, 2017: Catheterization and Cardiovascular Interventions
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