DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

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The Methodist Hospital chosen for percutaneous valve replacement study Study evaluates replacing heart valve through tiny puncture hole MetHodist de Bakey Heart & VasCular Center update HOuSTON (Jan. 24, 2011) — The Methodist DeBakey Heart & vascular Center was chosen today as a site for a critical percutaneous heart valve study. As part of the research study, Methodist physicians will replace diseased cardiac valves through a single, tiny puncture hole in the research subject’s groin. “using this new technique in the study, we will be able to replace severely calcified and damaged aortic valves without open heart surgery or removal of the original diseased valve,” said Dr. Neal Kleiman, director of the catheterization labs at the Methodist DeBakey Heart & vascular Center and cardiology principal investigator for the trial. “This study is the only way individuals have access to this technique in the united States.” The Medtronic Corevalve ® System, which is delivered into the individual’s heart via catheter, has been implanted in more than 12,000 patients worldwide and is available in 34 countries outside the united States. The trial incorporates expertise of both cardiac surgeons and cardiologists. using this technique, physicians make a tiny puncture hole in the individual’s groin and In the news thread a catheter through the femoral artery into the heart. The valve is delivered to the site of the diseased aortic valve through the catheter, and then the new valve is deployed inside the individual’s original valve, thus providing the individual with a functioning valve to allow for effective blood flow. “We routinely perform surgical valve replacement for diseased aortic valves, but many individuals are too high a risk for open-heart surgery due to age or other illness, said Dr. Michael Reardon, cardiac surgeon at Methodist and surgical principal investigator for the trial. “In this trial, we will evaluate whether catheter based aortic valve replacement will help extend the lives of this group of individuals.” Worldwide, approximately 300,000 people have been diagnosed with this condition (100,000 in the united States), and approximately one-third of these patients are deemed at too high a risk for open-heart surgery,[i] the only therapy with significant clinical effect that is currently available in the united States. Traditionally, a valve is replaced with a tissue or mechanical valve during open-heart surgery, which requires a surgical incision and a one month recovery period. Transcatheter valve replacement is being studied in part to evaluate recovery times and exposure to side affects of major surgery. In July, Methodist opened a new hybrid, robotic operating suite that integrates advanced robotics, imaging and navigation with surgery to offer patients the least invasive and safest surgical and interventional treatments for cardiovascular disease. “The new suite is perfectly designed for advanced procedures like the percutaneous valve,” said Dr. Alan Lumsden, medical director of the Methodist DeBakey Heart & vascular Center in Houston. “The clear 3-D imaging we have in this new room enables us to maneuver the valve into place and position it much more accurately and precisely than ever before. This is vitally important in such an advanced technique.” Methodist will be one of 40 sites in the country studying this new technique. The study investigators are currently screening subjects for enrollment. Methodist will enroll approximately 100 patients over the course of the trial. The Medtronic Corevalve u.S. Pivotal Clinical Trial will enroll a total of more than 1,300 patients in the united States. Outside the united States, Corevalve received CE (Conformité Européenne) Mark in Europe in 2007. For more information on the Methodist DeBakey Heart & vascular Center, visit www. debakeyheartcenter.com. [i] Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J. 2003;26:2714-2720. 56 vII (1) 2011 | MDCvJ
Introduction CT Coronary Angiography: When Should It Be Performed? Selim R. Krim, M.D. a ; Rey P. Vivo, M.D. a ; Su Min Chang, M.D. b a University of Texas Medical Branch, Galveston, Texas; and b Methodist DeBakey Heart & Vascular Center, Houston, Texas Over the past decade, technological advances in multidetector computed tomography (CT) with submillimeter spatial resolution and almost heart-freezing temporal resolution have enabled the accurate noninvasive assessment of coronary arteries. Multiple studies have shown that CT coronary angiography (CTCA) has a high sensitivity, good specificity and, in particular, an extremely high negative predictive value, making it an attractive imaging modality to rule out the presence of coronary artery disease (CAD). Furthermore, CTCA depicts the presence of nonobstructive coronary plaques and has been used for prognosticating future coronary events. CTCA is now considered by many as a noninvasive imaging modality of choice that supplants invasive angiography for assessing obstructive CAD in selected patient populations. It is also now recognized as an “appropriate” procedure in several selected clinical scenarios, including: 1) evaluation of chest pain syndrome with uninterpretable or equivocal stress test; 2) evaluation of chest pain syndrome in patients with intermediate pre-test probability of CAD; and 3) acute chest pain with intermediate pre-test probability of CAD, no ECG changes, and negative serial enzymes. Other applications of CTCA include the diagnosis of coronary anomalies. Despite its many advantages and promising clinical results, many concerns related to inappropriate use have been raised due to radiation exposure and use of iodinated contrast material. It is considered inappropriate to use CTCA as a screening tool in asymptomatic patients. In addition, it is recom- aBstraCts The following abstracts were selected from those presented at the conference on Multimodality Cardiovascular Imaging for the Clinician: Update in Echocardiography, Nuclear, CT and CMR held in Houston, Texas, October 2–3, 2010 under the direction of Dr. William Zoghbi and co-chaired by Drs. Miguel Quiñones, John Mahmarian, and Dipan Shah. This conference was designed to address the conundrum of clinicians in choosing the best imaging procedure from the many now available choices for a particular clinical problem thus avoiding the time and expense of multiple imaging procedures. mended that CTCA use be avoided in patients who have chronic kidney disease, a severe reaction to contrast material, and a rapid or irregular heart rate. Live 3-D Imaging Facilitates Percutaneous Paravalvular Repair Stephen H. Little, M.D. a ; Neal Kleiman, M.D. a ; Sasidhar Guthikonda, M.D. b aThe Methodist DeBakey Heart & Vascular Center, Houston, Texas; and bPiedmont Heart Institute, Piedmont Hospital, Atlanta, Georgia Overview: Our initial experience using live threedimensional transesophageal echocardiography (3-D TEE) during percutaneous paravalvular repair (PPvR) is described. We report that 3-D TEE enables real-time catheter visualization and facilitates occluder device placement across regurgitant mitral paravalvular defects (PD). Purpose: 3-D TEE (Philips, uSA) was employed during four consecutive PPvR procedures. Image guidance by 2-D TEE and 3-D TEE was qualitatively compared for 1) assessment of the structural defect location and geometry, 2) continuous catheter visualization, and 3) evaluation of closure device position and function. Methods: Five occluder devices (Amplatzer PDA, uSA) were successfully positioned across large PDs in three patients. Patient 1 — single occluder deployed for mechanical mitral PD; patient 2 — 2 occluders deployed for mechanical mitral PD, a third adjacent occluder deployed 5 months later (Figure 1); patient 3 — single occluder deployed for bioprosthetic mitral PD. Compared to 2-D TEE, supplemental imaging by 3-D TEE was of immediate value. Live 3-D/color Doppler imaging clearly identified the size, location, and crescent-like geometry of significant mitral paravalvular MDCvJ | vII (1) 2011 57
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DeBAKEy CARDIOvASCuLAR JOuRNAL - Methodist Hospital

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