Annular Rupture During Transcatheter Aortic Valve Implantation: Predictors, Management and Outcomes.
KeywordsTranscatheter aortic valve implantation (TAVI)
aortic annular rupture
balloon aortic valvuloplasty (BAV)
multislice computed tomography (MSCT)
transcatheter heart valve (THV)
transoesophageal echocardiography (TEE)
transthoracic echocardiography (TTE)
MetadataShow full item record
PublisherInternational Cardiology Review
JournalInternational Cardiology Review
AbstractTranscatheter aortic valve implantation (TAVI) is the treatment of choice in patients with symptomatic severe aortic stenosis who are either inoperable or at high risk for conventional surgical aortic valve replacement. Recent data have also shown favourable outcomes in patients deemed to be at intermediate operative risk, which expands the application of this novel technology. Despite its success, TAVI has been associated with rare life-threatening complications. Of these, aortic annular rupture is considered to be the most devastating. Advances in pre-procedural screening and patient selection have reduced the incidence of annular rupture. When this complication occurs, early recognition and prompt management are essential. This article is intended to provide a comprehensive review of the predictors, management and clinical outcomes of aortic annular rupture.
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Daily diurnal variation in admissions for ruptured abdominal aortic aneurysms.Killeen, Shane; Neary, Peter; O'Sullivan, Martin; Redmond, H P; Fulton, Gregory; Department of Surgery, Cork University Hospital, Cork, Ireland., email@example.com (2012-02-03)BACKGROUND: Many vascular events, such as myocardial infarction and cerebrovascular accident, demonstrate a circadian pattern of presentation. Blood pressure is intimately related to these pathologies and is the one physiological variable consistently associated with abdominal aortic aneurysm rupture. It also demonstrates a diurnal variation. The purpose of this study was to determine if rupture of an abdominal aortic aneurysm (RAAA) exhibits a diurnal variation. METHODS: A retrospective cohort-based study was performed to determine the timing of presentation of RAAA to the vascular unit of Cork University Hospital over a 15-year period. Time of admission, symptom onset, and co-morbidities such as hypertension were noted. Fournier's analysis and chi-squared analysis were performed. To ameliorate possible confounding factors, patients admitted with perforated peptic ulcers were examined in the same manner. RESULTS: A total of 148 cases of RAAA were identified, with a male preponderance (71.7%  male versus 29.3%  female patients) and a mean age of 74.4 +/- 7.2 years at presentation. 70.9% (105) were known to have hypertension, 52.2% (77) were current smokers, and 46.8% (69) were being treated for chronic obstructive airway disease (COAD). Time of symptom onset was recorded in 88.5% (131) of patients. There was a marked early morning peak in RAAA admissions, with the highest number of RAAA being admitted between 08.00 and 09.59. A second, smaller peak was observed at 14.00-15.59. These findings were suggestive of diurnal variation. [chi(2) =16.75, p < 0.003]. Some 40% (59) of patients were admitted between 00.00 and 06.00, an incidence significantly higher than for other time periods (06.00-12.00, 12.00-18.00, and 18.00-24.00) [chi(2) = 18.72; df = 3; p < 0.0003]. A significantly higher number of patients admitted between 00.00 and 06.00 were known hypertensives (chi(2) = 7.94; p < 0.05). CONCLUSIONS: The findings of this study suggest a distinct circadian pattern of presentation for RAAA. Systolic blood pressure has a circadian rhythm that mirrors this pattern of presentation. Our results further support the association between RAAA and hypertension, and they may also indicate that chronotropic blood pressure control combating the early-morning peak in systolic blood pressure may assist in the management of abdominal aortic aneurysms.
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Acute aortic occlusion in a patient with heparin-induced thrombocytopenia treated by thrombectomy.Collins, D; Moloney, M A; O'Donnell, D; Brophy, D; Sheehan, S J; Department of Vascular Surgery, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland. firstname.lastname@example.org (2012-09)Heparin-induced thrombocytopenia syndrome (HITS) is an infrequent complication of heparin anticoagulation.