Multiple trials have documented that myocardial blush grade (MBG) after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) has prognostic value for long-term clinical outcome. However, to the best of our knowledge, no study has determined the clinical use of MBG in routine clinical practice. We determined the prognostic value of MBG scored by the operator during primary PCI in consecutive patients with STEMI.The prognostic value of MBG scored by the operator in relation to 1-year all cause mortality was evaluated in all patients with STEMI who underwent primary PCI between January 2004 and July 2008 in our hospital. The incidence of MBG 0, 1, 2, and 3 was 12%, 14%, 36%, and 38%, respectively, in 2118 consecutive patients with STEMI. Follow-up of all 2118 patients showed a 1-year all cause mortality rate of 8% (168 of 2118): 24%, 10%, 6%, and 4%, respectively, among patients with MBG 0, 1, 2, and 3 (P<0.001). In the 1763 patients with Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 after PCI, these mortality rates were 17%, 10%, 6%, and 4%, respectively (P<0.001). MBG scored by the operator was a strong independent predictor of 1-year all cause mortality corrected for other well-known predictive variables, including TIMI flow grade.MBG scored by the operator during primary PCI has prognostic value for 1-year all cause mortality in patients with STEMI in routine clinical practice. Therefore, the MBG should be documented, in addition to the TIMI flow grade, during primary PCI in patients with STEMI in standard PCI reports in routine clinical practice.
Despite the high prevalence and adverse clinical outcomes of severe tricuspid regurgitation (TR), conventional treatment options, surgical or pharmacological, are limited. Surgery is associated with a high peri-operative risk and medical treatment has not clearly resulted in clinical improvements. Therefore, there is a high unmet need to reduce morbidity and mortality in patients with severe TR. During recent years, several transcatheter solutions have been studied. This review focuses on the transcatheter edge-to-edge repair of TR (TTVR) with respect to patient selection, the procedure, pre- and peri-procedural echocardiographic assessments and clinical outcomes. Furthermore, we highlight the current status of TTVR in the Netherlands and provide data from our initial experience at the University Medical Centre Groningen.
In selected patients, mitral valve repair using MitraClip® (Abbott, USA) is a relatively safe and well-tolerated treatment for significant mitral regurgitation [1–3]. We describe a 56-year-old female with congenitally corrected transposition of the great arteries (ccTGA) and dextrocardia (Fig. 1a) with recurrent episodes of heart failure caused by a combination of systemic (right) ventricular failure and tricuspid valve regurgitation (Fig. 1b). ccTGA is a rare congenital heart defect with discordance at both the atrioventricular and the ventriculoarterial level. In 20 % of the patients dextrocardia exists. Moderate to severe tricuspid valve regurgitation has a clear impact on cardiac prognosis [4]. We performed a percutaneous tricuspid valve repair using MitraClip® in 2014 (off-label use) (Fig. 1c). Six months after valve clipping, the tricuspid regurgitation was mild and there was an important reduction in heart failure symptoms. Mitral clipping may be feasible in selected patients with ccTGA. As far as we know, this is the first percutaneous tricuspid valve repair using MitraClip® in a patient with ccTGA and dextrocardia.
