Journal of Interventional Cardiac Electrophysiology, 2010
Transesophageal echocardiography (TEE) is the gold standard in the evaluation for left atrial app... more Transesophageal echocardiography (TEE) is the gold standard in the evaluation for left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and is often performed prior to AF ablation. We routinely use intracardiac echocardiography (ICE) to assist in AF ablation; however, standard right atrial views do not provide adequate visualization of the LAA. As the incidence of thrombus in this population is relatively low, TEE incurs additional risk, cost, and patient discomfort. Novel views of the LAA with ICE may obviate the need for TEE in this population. We tested the hypothesis that due to their proximity, imaging the LAA from the pulmonary artery (PA) would provide equivalent sensitivity and specificity to TEE in detecting LAA thrombus in a swine model. Five domestic swine were utilized. Baseline images of the LAA with TEE were obtained. An 8Fr ICE catheter was placed in the left main PA, and imaging of the LAA was repeated. After transseptal puncture, an admixture of 2 cm(3) blood and 1,000 IU of thrombin was injected into the LAA, and imaging of the LAA was repeated. Two blinded, independent reviewers experienced in ICE assessed the images and adjudicated both the presence of thrombus and the subjective image quality. The presence or absence of thrombus was correctly identified in all cases by both reviewers. Both reviewers rated the subjective quality of ICE images superior to TEE. ICE is equivalent to TEE in imaging LAA thrombus in a porcine model. Whether ICE can provide similar diagnostic accuracy and safety for detecting LAA thrombus in humans remains unproven.
Left main coronary artery compression by the pulmonary artery may be seen in patients with pulmon... more Left main coronary artery compression by the pulmonary artery may be seen in patients with pulmonary hypertension who are undergoing cardiac catheterization. Cardiac magnetic resonance imaging is useful in these patients to document extrinsic compression, which might otherwise be mistaken for intrinsic atherosclerotic disease.
Journal of the American College of Cardiology, Jan 29, 2015
In EVEREST II (Endovascular Valve Edge-to-Edge Repair Study), treatment of mitral regurgitation (... more In EVEREST II (Endovascular Valve Edge-to-Edge Repair Study), treatment of mitral regurgitation (MR) with a novel percutaneous device showed superior safety compared with surgery, but less effective reduction in MR at 1 year. This study sought to evaluate the final 5-year clinical outcomes and durability of percutaneous mitral valve (MV) repair with the MitraClip device compared with conventional MV surgery. Patients with grade 3+ or 4+ MR were randomly assigned to percutaneous repair with the device or conventional MV surgery in a 2:1 ratio (178:80). Patients prospectively consented to 5 years of follow-up. At 5 years, the rate of the composite endpoint of freedom from death, surgery, or 3+ or 4+ MR in the as-treated population was 44.2% versus 64.3% in the percutaneous repair and surgical groups, respectively (p = 0.01). The difference was driven by increased rates of 3+ to 4+ MR (12.3% vs. 1.8%; p = 0.02) and surgery (27.9% vs. 8.9%; p = 0.003) with percutaneous repair. After per...
Intracardiac echocardiography (ICE) has become an accepted imaging modality to guide device closu... more Intracardiac echocardiography (ICE) has become an accepted imaging modality to guide device closure of atrial septal defect (ASD) and patent foramen ovale (PFO). The use of ICE to guide device closure of ASDs in small children (< 20 kg) has been very limited. We report on the use of a new, 8 Fr ICE catheter that possesses full color Doppler capabilities to guide device closure of ASDs in small children as well as to guide device closure of ASDs and PFOs in adult patients.
A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented... more A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion. Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography. She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure. A transcatheter 26 mm Edwards SAPIEN valve was placed in the tricuspid position, resulting in near normalisation of tricuspid valve gradient. This represents the first report of a combined valve-in-ring (VIR) and valve in a homograft valve (VIV) SAPIEN implantation.
Journal of Interventional Cardiac Electrophysiology, 2010
Transesophageal echocardiography (TEE) is the gold standard in the evaluation for left atrial app... more Transesophageal echocardiography (TEE) is the gold standard in the evaluation for left atrial appendage (LAA) thrombus in patients with atrial fibrillation (AF) and is often performed prior to AF ablation. We routinely use intracardiac echocardiography (ICE) to assist in AF ablation; however, standard right atrial views do not provide adequate visualization of the LAA. As the incidence of thrombus in this population is relatively low, TEE incurs additional risk, cost, and patient discomfort. Novel views of the LAA with ICE may obviate the need for TEE in this population. We tested the hypothesis that due to their proximity, imaging the LAA from the pulmonary artery (PA) would provide equivalent sensitivity and specificity to TEE in detecting LAA thrombus in a swine model. Five domestic swine were utilized. Baseline images of the LAA with TEE were obtained. An 8Fr ICE catheter was placed in the left main PA, and imaging of the LAA was repeated. After transseptal puncture, an admixture of 2 cm(3) blood and 1,000 IU of thrombin was injected into the LAA, and imaging of the LAA was repeated. Two blinded, independent reviewers experienced in ICE assessed the images and adjudicated both the presence of thrombus and the subjective image quality. The presence or absence of thrombus was correctly identified in all cases by both reviewers. Both reviewers rated the subjective quality of ICE images superior to TEE. ICE is equivalent to TEE in imaging LAA thrombus in a porcine model. Whether ICE can provide similar diagnostic accuracy and safety for detecting LAA thrombus in humans remains unproven.
Left main coronary artery compression by the pulmonary artery may be seen in patients with pulmon... more Left main coronary artery compression by the pulmonary artery may be seen in patients with pulmonary hypertension who are undergoing cardiac catheterization. Cardiac magnetic resonance imaging is useful in these patients to document extrinsic compression, which might otherwise be mistaken for intrinsic atherosclerotic disease.
Journal of the American College of Cardiology, Jan 29, 2015
In EVEREST II (Endovascular Valve Edge-to-Edge Repair Study), treatment of mitral regurgitation (... more In EVEREST II (Endovascular Valve Edge-to-Edge Repair Study), treatment of mitral regurgitation (MR) with a novel percutaneous device showed superior safety compared with surgery, but less effective reduction in MR at 1 year. This study sought to evaluate the final 5-year clinical outcomes and durability of percutaneous mitral valve (MV) repair with the MitraClip device compared with conventional MV surgery. Patients with grade 3+ or 4+ MR were randomly assigned to percutaneous repair with the device or conventional MV surgery in a 2:1 ratio (178:80). Patients prospectively consented to 5 years of follow-up. At 5 years, the rate of the composite endpoint of freedom from death, surgery, or 3+ or 4+ MR in the as-treated population was 44.2% versus 64.3% in the percutaneous repair and surgical groups, respectively (p = 0.01). The difference was driven by increased rates of 3+ to 4+ MR (12.3% vs. 1.8%; p = 0.02) and surgery (27.9% vs. 8.9%; p = 0.003) with percutaneous repair. After per...
Intracardiac echocardiography (ICE) has become an accepted imaging modality to guide device closu... more Intracardiac echocardiography (ICE) has become an accepted imaging modality to guide device closure of atrial septal defect (ASD) and patent foramen ovale (PFO). The use of ICE to guide device closure of ASDs in small children (< 20 kg) has been very limited. We report on the use of a new, 8 Fr ICE catheter that possesses full color Doppler capabilities to guide device closure of ASDs in small children as well as to guide device closure of ASDs and PFOs in adult patients.
A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented... more A 64-year-old female with rheumatic heart disease and multiple prior valve replacements presented with progressive oedema, ascites and dyspnoea on exertion. Physical examination, transthoracic echocardiography, intracardiac echocardiography, transoesophageal echocardiography, right heart cathetherisation, computed tomography. She had a mitral homograft and Physio ring in the tricuspid position, and presented with severe bioprosthetic tricuspid valve stenosis (mean gradient 16 mmHg) and right-sided heart failure. A transcatheter 26 mm Edwards SAPIEN valve was placed in the tricuspid position, resulting in near normalisation of tricuspid valve gradient. This represents the first report of a combined valve-in-ring (VIR) and valve in a homograft valve (VIV) SAPIEN implantation.
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Papers by Frank Silvestry