Percutaneous transluminal alcohol septal myocardial ablation after aortic valve replacement

When left ventricular outflow tract obstruction develops after aortic valve replacement, few treatment choices have been available until now. We present a patient with prior aortic valve replacement who developed left ventricle outflow tract obstruction that was successfully treated with a percutaneous transcoronary myocardial septal alcohol ablation. This technique is a useful tool for the treatment of obstructive hypertrophic cardiomyopathy, especially in those patients with prior heart surgery.

Angioplasty and stenting in acute coronary syndromes: who, when, how, and why

PTCA and stenting now form an integral part of therapy for acute coronary syndromes and are important in achieving the optimal clinical outcome.

Clinical follow-up of patients undergoing percutaneous mitral balloon valvotomy

BACKGROUND

This study is the clinical follow-up (20 +/- 12 months; range, 6 to 49 months) of 327 patients who had percutaneous mitral balloon valvotomy (PMV) at the Massachusetts General Hospital.

METHODS AND RESULTS

There were seven in-hospital deaths. Patients were divided into two groups according to their echocardiographic score; 211 patients had echocardiographic scores < or = 8 and 116, echocardiographic scores > 8. Patients with echocardiographic scores > 8 were older (64 +/- 11 versus 48 +/- 14 years, P < .01), and more had atrial fibrillation (65% versus 40%, P < .01), calcium under fluoroscopy (81% versus 29%, P < .01), and previous surgical commissurotomy (30% versus 16%, P < .01) than patients with echocardiographic scores < or = 8. With PMV, mitral valve area increased from 1.0 +/- 0.3 to 2.2 +/- 0.8 cm2 in patients with echocardiographic scores < or = 8 and from 0.8 +/- 1 to 1.7 +/- 0.7 cm2 in those with echocardiographic scores > 8. Rates of survival (98 +/- 2% versus 72 +/- 11%), survival with freedom from mitral valve replacement (91 +/- 4% versus 55 +/- 13%), and survival with freedom from combined events (79 +/- 10% versus 39 +/- 18%) at follow-up were greater in patients with echocardiographic scores < or = 8 (P < .00005). Cox regression analysis identified the echocardiographic score as the most important unfavorable intermediate long-term follow-up prediction factor after PMV.

CONCLUSIONS

The excellent intermediate long-term clinical follow-up of patients with echocardiographic score < or = 8 and no calcified mitral valves suggests that PMV may be the treatment of choice in this group of patients.