Blood flow analysis using the intravascular Doppler

Inside view of an artery with intravascular sonogram.

Diseased artery: partial occlusion before treatment		After angioplasty: the artery is open

	Treatment of Aortic Valve with a percutaneous approach - TAVI Percutaneous Aortic Valve Replacement for patients not considered good candidates for the traditional surgical procedure and affected by severe stenosis of the aortic valve TAVI: Trancatheter Aortic Valve Implantation is a procedure which can save lives. The results of the PARTNER Trial recently presented at TCT in Washington have shown a significant reduction in mortality at 1 year for the patients treated with TAVI compared to patients treated with medical therapy and with aortic balloon valvuloplasty. The advantage for TAVI was quite impressive with only 5 patients needed to be treated in order to save one live. The progress of the TAVI valve delivery systems have been quite remarkable since the completion of PARTNER. In Europe the Edwards Sapien valve is available with a smaller femoral introducer of 18/19 French and the Medtronic CoreValve has now a new delivery catheter which gives a more precise positioning. The experience of the Milan Team working at San Raffaele Hospital and at Columbus Hospital is now over 250 patients treated with a 30 day mortality below 5%. The procedure is performed with percutaneous transfemoral access in most of the patients. For individuals with poor peripheral vascular access the implantation of the CoreValve utilizing the transaxillary approach is now an alternative. Most of the procedures are performed without general anesthesia and on the average patients are discharged within 3 days from the procedure. Screening to evaluate the feasibility of the procedure includes a Multislice Computer Tomography of the vascular system, transthoracic echo and if needed transesophageal echo. If nor available at the time of Hospital admission these test can be performed in the Hospital in one or two days and the procedure can be performed on day 3. Suggested links: http://www.medtronic.com/corevalve/ous/education.html http://www.theheart.org/article/1012909.do http://www.oxfordradcliffe.nhs.uk/forpatients/090427patientinfoleaflets/100208tavi.pdf
	Treatment of mitral insufficency width a percutaneous approach - Mitraclip Treatment of mitral insufficency width a percutaneous approach: e-valve system MitraClip: the percutaneous solution for mitral regurgitation Although surgical therapy is the gold standard treatment for mitral regurgitation, in a number of cases the risk associated to the surgical operation is too high. The low-risk solution is a percutaneous procedure using the MitraClip system. The MitraClip is a device that reproduces the surgical Alfieri technique procedure: to correct the regurgitation, the leaflets are joined at the site of regurgitation using a clip, delivered by a sophisticated system, under 3D echocardiographic guidance. The results of the EVEREST trial, presented at the American College of Cardiology in March 2010, showed that the MitraClip therapy is safer than surgery and has similar efficacy in selected patients. In Europe, the procedure is performed in selected centers, by specialized operators. Our team has been involved in the very early stage of the development of the procedure and is now one of the leaders in Europe. The experience of the Milan Team working at San Raffaele Hospital and at Columbus Hospital is now over 50 patients treated with a 30 day mortality below 2%. The procedure is performed with percutaneous transfemoral access in all patients, under general anesthesia to facilitate transesophageal echocardiography. The MitraClip is mostly performed in individuals with "functional" mitral regurgitation, secondary to heart failure; however, also patients with prolapse can be treated efficiently. Depending on the underlying conditions, the hospital stay is as low as 3 days. Screening is based on transesophageal echo unless other exams are deemed necessary to complete the diagnosis. In most cases, the patients are discharged within 2 days from the procedure. http://www.abbottvascular.com/int/mitraclip.html http://eurheartj.oxfordjournals.org/content/31/11/1382.full.pdf+html http://www.slideshare.net/drmaisano/percutaneous-mitral-repair-the-truth	click Image to see video