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Volume 18, Number 2 - 2017

Volume 18, Number 2 - 2017

Table of Contents

Percutaneous Coronary Intervention for Coronary Bifurcation Lesions Treatment Update
Percutaneous coronary intervention (PCI) of lesions at coronary bifurcations poses a technical challenge. Short-term complications, including periprocedural myocardial infarction, and long-term complications such as in-stent restenosis and stent thrombosis, are higher in patients with bifurcation lesions. Techniques for PCI of bifurcation lesions include stenting of the main branch alone, and the use of two or more stents to cover the main and side branches. Two- or three-stent techniques include T-stenting, crush, culotte, simultaneous kissing stents, V-stenting, and Y-stenting. The goal of these techniques is to minimize areas of vessel that are not covered by stent. Dedicated bifurcation stents exist, including stents with apertures that allow standard stents to be placed within the aperture. Simultaneous kissing balloon angioplasty in the two branches should be performed to optimize angiographic results. Many studies exist comparing the different techniques; however, no consensus exists on the preferred method. [Rev Cardiovasc Med. 2017;18(2):59–66 doi: 10.3909/ricm0868] © 2017 MedReviews®, LLC
Timing of Percutaneous Coronary Intervention and Therapeutic Hypothermia in Patients With ST-Elevation Myocardial Infarction and Out-of-hospital Cardiac Arrest Management Update
The American College of Cardiology/American Heart Association guidelines include a Class 1 recommendation to initiate therapeutic hypothermia (TH) in comatose patients with out-of-hospital cardiac arrest (OHCA) with an initial shockable rhythm who have achieved return of spontaneous circulation. There is also a Class 1 recommendation for immediate angiography in these patients whose initial electrocardiography shows ST-elevation myocardial infarction (STEMI). However, due to a lack of clinical trials evaluating these patients who have received both percutaneous coronary intervention (PCI) and TH, controversy remains regarding whether the two can be safely combined. Furthermore, in patients who receive TH and PCI, another question to address is which therapy to initiate first. This article focuses on how best to manage comatose OHCA survivors who have an initial shockable rhythm and STEMI. [Rev Cardiovasc Med. 2017;18(2):67–72 doi: 10.3909/ricm0876] © 2017 MedReviews®, LLC
Two Perspectives of the Appropriate Use Criteria in Cardiology Practice: Advantageous and Useful or Limiting and Harmful? Views in Cardiology
The appropriate use criteria (AUC) has become an integral part of the cardiologist’s daily practice and have evolved greatly since their inception over a decade ago. However, as health care costs continue to rise, the AUC has come to play an even more pivotal role in the way medicine—specifically cardiology—is practiced today. This editorial describes two opposing viewpoints commonly held by practicing clinicians of the AUC. Written from the perspective of two fellows-in-training looking ahead at the challenges and opportunities of clinical practice (under the auspices of several experienced clinicians and leaders of the American College of Cardiology), this article provides a fresh perspective on the impact AUC has on our patients, clinicians, and the health care system. [ Rev Cardiovasc Med. 2017;18(2):73–77 doi: 10.3909/ricm0884] ©2017 MedReviews®, LLC
Cardiac Metastasis of Nonvisceral Soft-tissue Leiomyosarcoma
Metastasis of a nonvisceral leiomyosarcoma to the heart is rare. We present the case of a man with a history of an upper extremity cancerous lesion that was completely resected with appropriate surveillance monitoring, which then metastasized to the heart 14 years later, presenting as superior vena cava syndrome. Full evaluation found no other metastatic lesions, including no residual sarcoma at the former primary site. We include transthoracic echocardiography and computed tomography images of unusual presentation of the large mass extending from the caudal superior vena cava to the right atrium and into the right ventricle across the tricuspid valve. [Rev Cardiovasc Med. 2017;18(2):78–81 doi: 10.3909/ricm0859] © 2017 MedReviews®, LLC
Role of Exogenous Phosphocreatine in Chemotherapy-induced Cardiomyopathy
The 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) regimen is widely used in the management of breast cancer. The common cardiotoxic effects of doxorubicin include congestive heart failure and left ventricular dysfunction, and those of cyclophosphamide include pericarditis, myocarditis, and congestive heart failure. It has been postulated that cardiotoxicity of 5-fluorouracil presents as coronary artery diseases (eg, angina). Cardiomyopathy is a common outcome following treatment with the FAC regimen. We report on a 52-year-old woman with cardiomyopathy following chemotherapy and radiation therapy. The patient did not respond well to b-blockers and angiotensin-converting enzyme inhibitors. After the addition of exogenous phosphocreatine, the patient’s cardiac condition improved significantly. [Rev Cardiovasc Med. 2017;18(2):82–87 doi: 10.3909/ricm0867] © 2017 MedReviews®, LLC
Two Reports of Quadricuspid Aortic Valve With Aortic Insufficiency
We report two cases of a quadricuspid aortic valve with severe aortic incompetence. Both patients presented with dyspnea on exertion. Their physical examinations demonstrated wide pulse pressures with diastolic murmurs. Bedside transthoracic Doppler echocardiography revealed preserved left ventricular systolic function and possible quadricuspid aortic valve with severe aortic incompetence in both patients. We proceeded with transesophageal echocardiography that confirmed a quadricuspid aortic valve with severe aortic incompetence in both patients. Left ventricular systolic function was preserved in both cases. Both patients had a preoperative cardiac catheterization, which showed normal coronary arteries. They were referred to cardiothoracic surgery and underwent successful aortic valve replacement with bioprosthetic valves. [Rev Cardiovasc Med. 2017;18(2):88–91 doi: 10.3909/ricm0874] © 2017 MedReviews®, LLC