HEART INTERNATIONAL – VOLUME 14 ISSUE 2 – WINTER 2020

Welcome to the latest edition of Heart International. I would like to begin by paying tribute to all the victims of the coronavirus pandemic. I know of very few people who have not lost a family member, friend, colleague or a neighbour with COVID-19. Such deaths are not simply statistics, for behind each death is a […]

Moderate-to-severe congenital heart disease, which requires specialist cardiology care, is present in around 6/1,000 live births.1 Patients born with congenital heart defects often require surgery in early life and a consequence of this initial surgical repair is pulmonary regurgitation. The severity of pulmonary regurgitation can worsen over time and present more frequent symptoms, and may […]

Technical approaches to left main (LM) revascularisation by percutaneous techniques continues to be in evolution. This manuscript will attempt to summarise the current best practices for LM percutaneous coronary intervention (PCI). Following a clinical decision for PCI of left main bifurcation (LMB) stenosis, based on angiographic, imaging and functional severity, and supported by current guidelines […]

More than half of acute coronary syndromes (ACS) occur in subjects with no significant coronary stenosis.1 In view of the number of patients dying each year from a heart attack, the question of identifying these patients is of primary importance. A large body of evidence currently exists, indicating that total coronary atheroma burden (TOCAB) – the […]

Cardiovascular disease (CVD) represents the prevailing cause of death in the United States.1 Cancer, accidents and other prevalent causes of death, have a multitude of pathophysiologic and mechanistic underpinnings leading to mortality. Meanwhile, the majority of CVD is primarily attributable to atherosclerosis.2 Moreover, the degree of coronary calcification strongly correlates with the magnitude of atherosclerotic plaque burden, […]

Reperfusion of infarct-related artery (IRA) in acute ST-elevation myocardial infarction (STEMI) is the procedure with the most clinical benefit in interventional cardiology. However, in around 50% of patients presenting with STEMI, other significant lesions are present, a finding which is associated to a worse prognosis.1,2 Most physicians performing primary percutaneous coronary intervention (PCI) have been trained […]

Aortic stenosis is a common degenerative valve disease and its prevalence increases with age.1 If untreated, severe symptomatic aortic stenosis leads to significant morbidity and mortality.2 Although surgical aortic valve replacement (SAVR) is a well-established treatment option for this condition, more than 30% of patients are not suitable candidates for SAVR due to increased operative risks; advanced […]

Percutaneous coronary intervention (PCI) has evolved over recent years, with increasingly more complex, high-risk procedures being performed, including in patients with multivessel coronary artery disease with or without left main disease, often complicated by severe left ventricular (LV) dysfunction.1 In addition, decisions about coronary bypass surgery or PCI often focus not only on coronary anatomy, […]

Coronary artery disease is the leading cause of morbidity and mortality globally.1 Dual antiplatelet therapy (DAPT), in the form of aspirin and a P2Y12 inhibitor, is the mainstay of pharmacotherapeutic treatment for acute coronary syndrome and prevention of stent thrombosis after percutaneous coronary intervention (PCI) for acute coronary syndrome or stable coronary disease. DAPT with ticlopidine plus […]

Anomalous coronary arteries originating from the opposite sinus of Valsalva (ACAOS) is one of the most clinically relevant abnormalities among the wide spectrum of coronary artery anomalies.1 Sudden cardiac death has been related to myocardial bridges, ectopic origin of the pulmonary artery, a single coronary artery and ACAOS with an intramural course (ACAOS-IM), especially in young […]

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe cutaneous adverse drug reaction. Symptoms comprise fever, lymphadenopathy, rash, and eosinophilia, with or without visceral organ involvement. The extent of internal organ involvement, including hepatitis, myocarditis, pneumonitis, thyroiditis, and pancreatitis, determines the morbidity and mortality associated with the disease.1–3 We report a case of […]

Perioperative management of a mediastinal tumour is an anaesthetic challenge. Echocardiography is not considered as a primary diagnostic modality in the evaluation of a mediastinal mass; however, it can provide valuable information in patients with clinical and diagnostic evidence of cardiac compression or encroachment. Judicious interpretation of perioperative transthoracic or transoesophageal echocardiographic images may be […]

Bicuspid aortic valve (BAV) represents the most common congenital cardiac anomaly, with a prevalence ranging between 1% and 2% in the general population.1 BAV is known to be associated with dilation and dissection of the ascending aorta, and the significantly higher shear forces seem to have a pivotal role on the development of such complications.2 Nowadays, patients […]

Spontaneously recanalized coronary thrombus (SRCT), informally known as Swiss-cheese, honeycomb, lotus root or spiderweb lesion, is an increasingly recognised pathology in patients undergoing coronary angiography. Most patients with SRCT present with angina or angina equivalent.1 We describe a case of SRCT in a patient who presented with ventricular tachycardia (VT) without a previous history of ischaemic […]