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  • ISSN: 2573-1297
    Volume 2, Issue 1
    Research Article
    Claudius Jacobshagen*, Corinne Mucha, Stefan Wagner, Bettina Sobisiak, Mark Hünlich, Tim Seidler, Gerd Hasenfuss, Wolfgang Schillinger, and Miriam Puls
    Background: The number of transcatheter aortic-valve implantations (TAVI) is increasing tremendously, whereas the post-procedural antithrombotic management after TAVI is undetermined. Aim of this study is to identify predictors of post-procedural stroke after TAVI with respect to the antithrombotic regimen.
    Methods and results: Data from 300 consecutive patients who underwent TAVI at our institution between August 2008 and February 2012 were included in this observational study. The mean age was 82.1 ± 0.3, the logistic EuroScore I was 24.34 ± 0,8. The decision on the post-procedural antithrombotic therapy was left to the operator. From 255 patients that were discharged alive 13 were re-hospitalized due to an ischemic stroke (5.1%). There were no significant differences in the baseline characteristics between patients with stroke and without stroke. In particular diabetes, renal insufficiency, prior cerebral ischemic events, peripheral vascular disease and coronary artery disease were not predictive for the occurrence of strokes. Importantly, the prevalence of atrial fibrillation was 61.5% in the stroke group and 43.4% in the no-stroke group (P=0.19). The CHAD2DS2-VASc scores in the two groups were similar (stroke: 5,68; no-stroke: 5.92). Patients with post-procedural stroke received significantly more often a single antithrombotic therapy (either single antiplatelet or single anticoagulation) than patients without stroke (61.5% vs. 27.3%; P=0.02). In the no-stroke group patients received more often dual antiplatelet therapy (41.3% vs. 15.4%) or a combination of antiplatelet and anticoagulative therapy (27.7% vs. 15.4%).
    Conclusion: TAVI patients treated with a combinated antithrombotic therapy may be better protected against stroke than patients with a single antithrombotic therapy.
    Case Report
    Erik Green, Viet Q. Tran*, Ulrika Birgersdotter-Green, and Victor Pretorius
    A 47 year old female with a history of non-ischemic cardiomyopathy and a defibrillator system presented for an infected ICD pocket site, two months after an elective generator change out. The patient was transferred to our institution after a failed lead extraction. During the index procedure, it was discovered she had the RV defibrillation lead implanted via a persistent left-sided SVC. During our preoperative workup, a CT chest was performed which revealed she had a persistent left sided SVC and an absent right-side SVC. Given her infected device, we proceeded with an extraction procedure using a 16 Fr Spectranetics laser sheath. Notably, we did not use the outer sheath in order to allow the laser sheath to traverse around the acute angles of the lead. The procedure was successful without any complications. After completion of antibiotics, the patient underwent re-implantation of a defibrillator system from the right subclavian vein, across to the left subclavian and down the left-sided SVC, and on clinic follow up, the patient has been doing well with normal device parameters.
    Denise Marin*, Carole Hamilton, Albert Schuetz, and Stephen Hohe
    Mitral valve repair is the surgery of choice in patients with mitral valve regurgitation. Reoperations are becoming more frequent and more complex over the past four decades. There are limited reports describing multiple time redo mitral valve surgery in particular mitral valve repair.
    We report on a 36 year old female in NYHA class II – III preoperatively, who underwent successful re-redo mitral valve repair. In 1997 and 2005, the patient underwent mitral valve repair through an anterolateral thoracotomy. The patient refused mechanical valve implantation as she is still in child-bearing years. The third operation involved a complex repair with resection of cords class I and II at A2 and implantation of three artificial cords at A1, A2 and A3 with implantation of Cosgrove Edwards ring. The post-operative course was uneventful. Postoperative echocardiography revealed only a mild regurgitation and a mild to moderate stenosis. The last transthoracal echocardiography 3 years after operation showed no further changes. The patient is doing well in NYHA class I without medical therapy. This case report shows that the approach of mitral valve repair, even in re-operations, is a safe and excellent option and mitral valve replacement can be avoided.
    Hector A. Mazzetti*and Jorge Gonzalez-Zuelgaray
    Persistent left superior vena cava (PLSVC) is caused by an abnormal embryologic development, with a prevalence in the general population of 0.1-0.3% [1]. The presence of a PLSVC associated with absence of its right-sided counterpart is seen approximately in 10% of all cases of PLSVC, as a consequence of the persistence of the left anterior cardinal vein and the obliteration both of the common cardinal vein and of the proximal portion of the anterior cardinal vein (on the right) [1-3].
    Alfredo D. Guerron and Daniel P. Raymond*
    The patient is a 63-year-old with a history of histoplasmosis who has undergone two prior thoracotomies for diag-nostic wedge resection revealing granulomatous lesions. She presented with hemoptysis and underwent two embo-lization procedures providing temporary control of her hemoptysis. Radiologic examinations revealed a large cavitary partially calcified mass in the right lower lobe.
    Due to high risk of recurrent bleeding she underwent right lower lobectomy which ultimately revealed an inflamma-tory, cavitary mass surrounding surgical felt. The material had been placed to buttress a parenchymal suture line and had eroded into the pulmonary parenchyma and hilar vasculature resulting in hemoptysis. Retained surgical material is a rare cause of hemoptysis. We present a case of massive hemoptysis due to retained surgical material resembling a cavitary lesion.
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