Novel management options for tricuspid endocarditis
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- Tricuspid valve endocarditis is managed either surgically or percutaneously depending on factors like resistant infection, recurrent infection showers, or resistant heart failure. - Surgical options include excision with bicuspidization or patch repair, while percutaneous options include aspiration of vegetations using the AngioVac system or the newer Flow Triever system. - The AngioVac system uses a self-expanding nitinol funnel tip and cardiopulmonary bypass to aspirate vegetations, showing technical success in 90% of cases and resolution of bacteremia in 75% within 48 hours.
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Ventricular septal rupture .pptx
Ventricular septal rupture (VSR) is a devastating complication following myocardial infarction. It occurs in 0.17-0.31% of cases post-primary PCI, usually 2-8 days post-MI. Risk factors include older age, female sex, late presentation, extensive MI, hypertension, and lytic therapy. Diagnosis involves acute deterioration, auscultation findings, echocardiogram, and CT scan. Management uses a hybrid approach of primary PCI of the culprit vessel followed by transient mechanical support like IABP, then definitive surgical or percutaneous repair. Without treatment, mortality is over 90% at 1 year. Challenges include friable tissue that cannot hold sutures early on and
Cardiovascular sequelae of Covid-19 (ACC consensus 2022)
Summary of the recently published ACC consensus 2022 about the cardiovascular sequalae of Covid-19 infection
Lecture link: https://youtu.be/7JBG2v8YLpA
Temporary pacemaker
This document discusses how to insert a temporary pacemaker. It begins by providing historical context, noting the first patient to be kept alive for months using a pacemaker device. It then outlines the key steps for inserting a temporary pacemaker, including obtaining venous access, positioning the pacing lead under fluoroscopy or echocardiography guidance, and setting up the pacemaker device. Potential complications are addressed, as well as troubleshooting loss of capture or sensing. Special situations like externalized batteries or congenital vascular anomalies are also covered.
Pericardiocentesis
1) Pericardiocentesis is performed to drain fluid from the pericardial sac surrounding the heart. It was first done in 1840 by Franz Schuh in Vienna on a patient with a mediastinal tumor.
2) There are several potential access sites for the procedure including sub-xiphoid, left and right parasternal, and apical approaches. Ultrasound is typically used to guide needle placement and confirm proper positioning within the pericardial sac.
3) After fluid is drained, samples are obtained for analysis. The drainage catheter is then sutured in place and connected to a drainage system. Complications can include laceration of nearby organs or vessels,
How to read coronary angiography
Simple approach to interpret coronary angiography views.
Youtube lecture link:
https://youtu.be/Xb8BSJsSJq4
Focused bedside Echocardiography
How to perform rapid focused bedside Echocardiography
Youtube lecture link:
https://youtu.be/_AHiQDfMo7k
SGLT2 inhibitors
SGLT-2 inhibitors have shown promising cardiovascular and renal benefits:
1) Trials have found SGLT-2 inhibitors reduce the risk of cardiovascular death in patients with type 2 diabetes and established cardiovascular disease, as well as reducing heart failure hospitalizations in those with diabetes and cardiovascular risk factors.
2) Studies also show SGLT-2 inhibitors improve outcomes for patients with heart failure with reduced ejection fraction, reducing rates of heart failure hospitalization and mortality regardless of diabetes status or background heart failure therapies.
3) SGLT-2 inhibitors were also found to reduce the risk of renal death or progression to end-stage kidney disease in patients with type 2 diabetes and macroalbuminuria.
Coronary bifurcations
1) Two-stent strategies can be used either as bail-out during provisional stenting if the side branch is compromised, or electively for complex bifurcation anatomies with predictors of side branch compromise.
2) Common two-stent techniques discussed include T/TAP stenting, mini-crush, culotte, and DK crush. Factors such as vessel diameters, angles, and lesion lengths help determine the appropriate technique.
3) Key steps discussed include optimal kissing balloon inflation, proximal optimization of the main vessel stent, and respecting the bifurcation anatomy. Being familiar with one or two techniques and using intravascular imaging is recommended.
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Novel management options for tricuspid endocarditis
- 1. Tricuspid valve endocarditis Management options Ahmed Elborae, MSc, MD, PhD, MRCP UK (London) Lecturer of Cardiology, Cairo University
- 2. Agenda • Introduction • When to intervene? • How?
- 3. Introduction • Right-sided IE accounts for 10% of IE cases • Incidence ↑ x12 folds in the last decade due to ↑ “IVDA” • S. aureus is the predominant organism (60–90% of cases), mostly MRSA • The usual presentation is multiple septic pulmonary emboli • Less commonly present with right HF “severe TR or obstruction” • Vegetation length 20 mm and fungal etiology are the main predictors of death(~ 7%) Expectations Reality
- 5. When to intervene? Resistant infection Recurrent showers Resistant HF
- 6. Challenges… • High recurrence rate of IE due to continued drug abuse (25%) • Mechanical prosthesis thrombosis is (x 20 times) left-sided one “Low flow” • Tricuspid valve replacement usually with bioprosthesis “Durability?” Shrestha NK, et al.. Ann Thorac Surg. 2015;100:875–882. doi: 10.1016/j.athoracsur.2015.03.019 More conservative approach
- 7. Surgical repair options Gottardi R, et al. Midterm follow-up of tricuspid valve reconstruction due to active infective endocarditis. Ann Thorac Surg 2007;84:1943–1948. Excision+bicuspidization Excision+patch repair
- 8. Percutaneous solutions for isolated vegetation? • Lessen the microbial burden • Disruption of fibrotic vegetation > more surface area for antimicrobials • Decrease the chance of showering • Improve valve leaflets dynamics (+/-) Giulio Russo, et al. Challenges and future perspectives of transcatheter tricuspid valve interventions. European journal of heart failure.2021 Remove the nest ! Aspiration vegectomy x x
- 9. AngioVac aspiration system The third generation: Self-expanding nitinol funnel-shaped tip ( 20 and 180 degree angle) Veno-venous bypass circuit Bangalore S, et al. Catheter Cardiovasc Interv. 2021;98: E475–E477 26 F
- 10. Angio Vac reperfusion options At (2000-3000) RPM
- 11. Technical points SVC Vegetation • Angle calculation (TEE) is very important • Clockwise torque of the AngioVac catheter produces counterclockwise turn on TEE image Meyer et al. J A C C : C A S E R E P O R T S , V O L . 1 , N O . 5 , 2 0 1 9 • Technical success reaching 90% • Resolution of bacteremia within 48 hours in 75 % of cases • Tricuspid regurgitation was stationary in 60%, improved in 20%, and worsened in 20%
- 12. TV IE Angio Vac Case Stoker et al. Cardiovascular Imaging Case Reports-2022
- 13. Flow Triever system (Inari) • Less invasive • Does not require cardiopulmonary bypass • The curved catheter has an adjustable tip capable of 260 angulation Almanfi et al. JACC case reports. Vol.4 no 18. 2022
- 14. Percutaneous solutions for regurge? Giulio Russo, et al. Challenges and future perspectives of transcatheter tricuspid valve interventions. European journal of heart failure.2021 Future options
- 15. Take home message When? Surgical options Percutaneous solutions Resistant How? MDT Psychiatry
- 16. Thank You !