DOI: 10.3897/icf.3.e117932

Authors: N. Koleva, K. Petkov, S. Takov, K. Angelov

Abstract: We report a clinical case of a 64-year-old male with known apical hypertrophic cardiomyopathy, who presented to the hospital with new-onset persistent atrial fibrillation. An electrical cardioversion (ECV) was planned after one month of anticoagulation therapy and transesophageal echocardiogram (TEE) was performed beforehand. During the TEE thrombus in the left atrial appendage was detected, as well as a heterogeneous, hyperechoic, vascularized and non-mobile structure in the left atrium (LA). The ECV was cancelled and the patient was sent for computerized tomography (CT) chest scan. It revealed a big mass in the right lung with macromorphology of central lung carcinoma. There was tumor infiltration of the pericardium and the LA, as well as adrenal and liver metastases. The patient was sent for bronchoscopy with biopsy.

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DOI: 10.3897/icf.3.e115581

Authors: N. Ivanov

Abstract: The vertebrabasilar (VB) system plays an essential role in the circulation of main structures of nervous system. About 25% of ischemic brain strokes are located in the vertebrobasilar circulation. 20-25% of them are due to atherosclerosis, leading to formation of hemodynamically significant stenoses in both vertebral arteries. Catheter angiography proves and visualise with great accuracy vascular pathology along the course of the extracranial segments of cerebral arteries. Interventional treatment in patients with significant vertebral artery stenoses is an established and safe method of treatment, complementing optimal drug therapy, and preceding surgical treatment.

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DOI: 10.3897/icf.3.e113433

Authors: Rudolf A. de Boer, Johann Bauersachs

Abstract: The year in cardiovascular medicine 2022: the top 10 papers in heart failure and cardiomyopathies

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DOI: 10.3897/icf.3.e113431

Authors: Chiara Bucciarelli-Ducci, Nina Ajmone-Marsan

Abstract: The year in cardiovascular medicine 2022: the top 10 papers in cardiovascular imaging

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DOI: 10.3897/icf.3.e113300

Authors: N. Ivanov

Abstract: The vertebrabasilar (VB) system plays an essential role in the circulation of main structures of nervous system. As a part of Circle of Willis, it is responsible for major compensatory abilities of brain circulation in some hemodynamic disorders. On the other hand, some pathological diseases, involving VB system, could be fatal or could lead to severe injuries and functional wastes in the patient. Many variations and anomalies in VB system are common cause of hemodynamic disorders and vascular disease such as atherosclerosis. The good knowledge of variations and anatomy as well, allows us to understand pathophysiology and pathogenesis in those disorders, which in combination with specific clinical symptoms, helps us in making the fast and accurate diagnosis. This is fundamental for starting proper treatment.

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DOI: 10.3897/icf.3.e109733

Authors: E. Barbato, M. McEntegart, T. Gori

Abstract:

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DOI: 10.3897/icf.3.e108803

Authors: Plamen Gatzov

Abstract: The myocardial blood supply changes, leading to myocardial ischemia deserve deep understanding. They could be on different levels: epicardial arteries, microcirculation or both. Along with the anatomical findings, the functional assessment of coronary vessels is a key moment in making the decision for the type of treatment and the need for coronary revascularization. Together with the established methods for functional assessment of coronary circulation, new technologies nowadays have been applied in the clinical practice. The trends for future development are methods not using myocardial hyperemia, an attempt for functional assessment on the basis of invasive on noninvasive imaging technics and stronger attention to the microcirculatory dysfunction. The new achievements in that direction are on the focus of the current review.

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DOI: 10.3897/icf.3.e104187

Authors: Susanna Price, Juan Carlos Kaski, Rasha Al-Lamee, William Boden, Kurt Huber, Jason Katz, Konstantin Krychtiuk

Abstract: The year in cardiovascular medicine 2022: the top 10 papers in acute cardiac care and ischaemic heart disease

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DOI: 10.3897/icf.3.e104121

Authors: Jean-Jacques Monsuez, Plamen Gatzov, Ignacio Ferreira-Gonzalez, Fernando Alfonso

Abstract: Coronary interventions 2021: insights from the National Societies of Cardiology Journals of the European Society of Cardiology

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DOI: 10.3897/icf.3.e102468

Authors: Helmut Baumgartner, Bernard Iung, David Messika-Zeitoun

Abstract: The year in cardiovascular medicine 2022: the top 10 papers in valvular heart disease

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DOI: 10.3897/icf.2.e98590

Authors: I. Petrov, Z. Stankov, P. Polomski, D. Boychev

Abstract: The first TAVI implantation was performed in 2002 by Cribier and colleagues. From then, we have seen significant progress in technology, with the appearance of new generations – lower-profile, longer-lasting and more stable during positioning TAVI prostheses. The present publication presents single-center results and experience with TAVI procedures over an eight-year period. During the period 2013 – November 2022 a total of 354 TAVI procedures were performed in Acibadem City Clinical Cardiovascular Center. Two operating strategies are used – standard and minimalist approach. From the first procedure in 2013 until mid-2018 the standard approach (surgical vascular access, general anesthesia, direct valve implantation where possible) was mostly used. Then, the minimalist approach (percutaneous access, no intubation anesthesia, mandatory valve predilation and use of rapid pacing) was introduced as a standard approach in the center.

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DOI: 10.3897/icf.2.e94644

Authors: N. Ivanov

Abstract: Bow Hunter‘s Syndrome (BHS) is a mechanical compression of the vertebral artery during head rotation, leading to partial disruption or complete interruption of the blood flow of the affected artery, causing vertebrobasilar vascular insufficiency. There are no established precise diagnostic and therapeutic behavioral algorithms in patients with BHS. I present a case of an 80-year-old woman with syncopal symptoms, in which a dynamic stenosis of the dominant left vertebral artery was diagnosed, and the same artery originates from the aortic arch with a separate ostium.

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DOI: 10.3897/icf.2.e95002

Authors: Pl. Gatzov

Abstract: To solve any problem, first of all we need to know it in details. The entity of myocardial ischemia is a deep deterioration in metabolic processes and function of cardiomyocytes, because of lack of oxygen supply. The diagnostic process of patients with chronic coronary syndrome includes myocardial ischemia provocation with stress tests. Next steps are the ischemic myocardium amount estimation, the exact cause оf ischemia revealing: the epicardial coronary arteries, micro vessels or both. The last step is the decision of method of treatment and its implementation. The realization of all that steps takes time and efforts, but is absolutely obligatory for exact assessment of patient with myocardial ischemia. The description and details of every one of those steps are the aims of this review.

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DOI: 10.3897/icf.2.e89266

Authors: Z. Stankov, S. Vasilev, I. Petrov

Abstract: Pulmonary artery aneurysms (PAAs) are rare with non-specific clinical presentation but may lead to serious complications such as pulmonary artery dissection, rupture and compression of the left main coronary artery (LMCA). Their complications and PAA association with pulmonary hypertension lead to significant morbidity and mortality. The standard treatment strategy is surgical correction of the aneurysm, however percutaneous coronary intervention in patients with clinically significant compression of the LMCA, due to PAA should be considered as a possible treatment approach. In this article, we present a case report of a 73-year-old with polymorbidity, presenting with an acute coronary syndrome, caused by extrinsic compression of the LMCA by PAA. Due to the high surgical risk, we adopted an endovascular approach with stenting of the compressed LMCA with successful restoration of the blood flow and clinical stabilization. In this case, a percutaneous coronary intervention proved to be a safe and effective treatment option for selected patients, who are at high operative risk.

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DOI: 10.3897/icf.2.e82491

Authors: I. Tasheva, S. Kafalieva

Abstract: The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pandemic has spread rapidly worldwide with 314 million infected and 5 million deceased worldwide (as of December 2021). SARS-Cov-2 has been shown to not only cause viral pneumonia, but also to lead to serious effects on the cardiovascular system. It has been proven that COVID-19 can be complicated by the Acute Coronary Syndrome through plaque rupture, vasospasm or microthrombi due to systemic inflammation or cytokine storm. An additional role is played by the hyperimmune response as well as the endothelial dysfunction, which contribute to the hypercoagulable state. Тhere is a strong possibility that the high inflammatory load is the cause of de novo coronary lesions. We present a clinical case of a 53-year-old man presenting with toxico-infectious syndrome, angina and dyspnea. Conducted paraclinical and clinical studies showed acut coronary syndrome without ST-elevation, left ventricular thrombosis, active SARS-CoV-2 infection and bilateral interstitial pneumonia. The patient was treated with percutaneous coronary intervention of LAD with drug-eluting stent, anticoagulant therapy, dual antiplatelet and anti-inflamatory therapy, beta blocker and ACE-inhibitor. On the 4th day of hospitalization the patient realized Left Middle Cerebral Artery Stroke. Our clinical case demonstrates unique prothromobotic properties of SARS-CoV-2, due to different mechanisms and complicated by thromboembolic events.

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DOI: 10.3897/icf.2.e85478

Authors: P. Gatzov, V. Velchev, B. Finkov, N. Stoyanov

Abstract: We’re presenting a case of an 80-year-old woman with ischemic heart disease, who for several weeks transitioned between a state of high-grade mitral regurgitation and a state of virtually no mitral regurgitation and vice versa, with no clear link to her clinical presentation. Possible differential diagnoses and the chosen approach to the patient will be discussed.

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DOI: 10.3897/icf.2.e80540

Authors: Nikolay Ivanov

Abstract: The vertebra-basilar (VB) system plays an essential role in the circulation of main structures of nervous system. As a part of Circle of Willis, it is responsible for major compensatory abilities of brain circulation in some hemodynamic disorders. On the other hand, some pathological diseases, involving VB system, could be fatal or could lead to severe injuries and functional wastes in the patient. Many variations and anomalies in VB system are common cause of hemodynamic disorders and vascular disease such as atherosclerosis. The good knowledge of variations and anatomy as well, allows us to understand pathophysiology and pathogenesis in those disorders, which in combination with specific clinical symptoms, helps us in making the fast and accurate diagnosis. This is fundamental for starting proper treatment.

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DOI: 10.3897/icf.1.e79589

Authors: Jean-Jacques Monsuez

Abstract:

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DOI: 10.3897/icf.1.e78686

Authors: Plamen Gatzov

Abstract: The introduction of blockers of beta-adrenergic receptors (beta-blockers – BB) in the clinical practice during the second half of XX century discovered new opportunities in the treatment of cardio-vascular diseases. They rapidly have found their place in the treatment of ischemic heart disease and arterial hypertension. At the end of XX and the beginning of XXI century many new evidences have appeared favoring their use in patients with heart failure and reduced left ventricular ejection fraction (heart failure with reduced ejection fraction – HFrEF). The treatment with BB has shown a beneficial effect regarding death and hospitalization reduction, and improving their quality of life, as well. This year the new 2021 European Society of cardiology (ESC) Guidelines for the diagnosis and treatment of acute and chronic heart failure have been issued. According to them, BB again have a key role in the treatment of HF patients. The aim of this review is to address their role in details in this condition.

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DOI: 10.3897/icf.1.e76246

Authors: Ivayla Zheleva-Kyuchukova, Valeri Gelev

Abstract: Significant stenosis of the trunk of the left coronary artery (LCA) or left main (LM) stenosis is a serious injury that puts a large myocardial area at risk, being found in 4-9% of patients referred for selective coronary angiography. Revascularization in patients with severe left main stenosis significantly improves their prognosis, with bypass surgery being the standard of care. Percutaneous coronary intervention (PCI) has proven to be an effective and safe alternative, especially in patients with less complex lesions or unsuitable for surgery. The aim of this article is to review the topic and to analyze the frequency of adverse cardiovascular events in a two-year follow-up of patients with PCI of unprotected LM stenosis from real practice. Material and methods: Since March 2013, all patients with an interventional procedure for LM stenosis in the Cardiology Clinic of Acibadem City Clinic Tokuda Hospital are included in a register. For the period from 06.2013 to 06.2018, 209 PCIs of LM lesions were performed, and in the present study a series of 136 consecutive patients with PCIs of unprotected LM stenosis were analyzed. The mean Syntax Score (SS) of the study group was 26.3 ± 10.09 (11-58.5) with a median of 24.00. The mean Euro Score is 2.61 ± 4.19 (0.50-34.42) with a median of 1.22. Maximum revascularization was achieved in all subjects, and patients with STEMI and/or cardiogenic shock, previous LM PCI and protected LM PCI were excluded from the analysis. Patients were followed for 2 years for the combined indicator of adverse cardiovascular events, which included death from any cause (so-called overall mortality), cardiac mortality, stroke and revascularization. Results: 22 adverse events were registered (16.2%). The overall mortality was 9.6%, cardiac death – 8.8%, stroke – 0.7% and restenosis and revascularization – 8.1%. Conclusion: PCI of LM stenosis in patients from real clinical practice and achieving maximum revascularization is a procedure with minimal risks and favorable follow-up results, and the operator‘s experience and the capabilities of the respective medical institution to conduct such complex interventions are important.

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DOI: 10.3897/icf.1.e72386

Authors: Iveta Tasheva, Sibel Kafalieva

Abstract: We present a clinical case of a 72-year-old man with a history of hypertension and SARS-CoV-2 infection, urgently hospitalized in the intensive care unit due to dyspnea at rest, blushes and swelling of the neck and face, headache, and syncope. Echocardiography was performed and revealed preserved ejection fraction of left and right ventricle (EF – 57%, TAPSE – 21 mm), without hemodynamically significant valve lesions and normal ECG. On the next day of hospitalization, we performed a computer tomography (CT) scan of the lungs and it showed a tumor in right lung, compressing vena cava superior. Venography was performed and revealed subtotal thrombosis of vena cava superior and stenting with Wallstent 16/60 mm was performed. Six hours after the intervention a clinical improvement was achieved – reducing of the swelling and relieving of the symptoms.

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DOI: 10.3897/icf.1.e74172

Authors: Plamen Gatzov

Abstract: During the last years, following numerous trials, the need of functional assessment of stenoses before myocardial revascularization has been established. This came to replace the subjective approach based on the so-called “oculo-stenotic” reflex of the operator. Numerous methods for coronary reserve (CR) estimation as a measure of functional significance of the lesion, have been introduced in the practice. Those methods are noninvasive and invasive. A part of them are based on the measurement of coronary flow velocity before and after hyperemic medication, other are based on the difference of arterial pressure before and after the coronary stenosis. They are divided to such with or without hyperemic medication. During the last years in the diagnostic have been used methods for functional estimation of the lesions based only on standard coronary angiography or even computerized tomography (CT). The aim of this article is to present a review of modern invasive methods for coronary reserve measurement.

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DOI: 10.3897/icf.1.e72233

Authors: Plamen Gatzov

Abstract: The structure of different systems, aiming to supply a volume of definite tissue with a specific fluid, which is for example the blood in the vascular system, obeys on similar lows, which can be expressed by mathematical equations. Those systems have fractal structure, that means every small part of the system repeats the structure of entire system. Knowing those dependencies permits calculation of one particular parameter of cardiovascular system, for example, the amount of myocardium on the basis of diameter of coronary artery supplying it. This approach is extremely applicable to the patients with coronary artery disease, where the amount of ischemic myocardium is of paramount importance for the patient`s fate. The aim of the current review is to present the main interdependencies between anatomical and physiological parameters of cardiovascular system.

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DOI: 10.3897/icf.1.e73190

Authors: Plamen Gatzov

Abstract:

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