Showcasing Lessons From Around the World

In this month’s issue of the Journal of Invasive Cardiology, we continue our focus on methods to improve percutaneous aortic valve replacement, including a nice report from Bern, Switzerland on emergency procedures for decompensated aortic valve stenosis. A group of physicians from Brussels, Belgium reports on predictors of improvement in left ventricular function after balloon aortic valvuloplasty. It is great to see research in balloon valvuloplasty blossom, as this line of evidence is critical to the field of percutaneous valve replacement. Also in this issue, in the online version, is a fascinating case report from Bonn, Germany on using alcohol septal ablation to treat an intracavity pressure gradient that developed after percutaneous aortic valve replacement. Rounding out the articles on structural heart disease is an elegant review of closure of secundum atrial septal defects from Dr. Ziyad M. Hijazi’s group at Rush University in Chicago.

Cavender and colleagues from the Cleveland Clinic in Cleveland, Ohio explore the very interesting question of culprit versus multivessel intervention in patients with acute myocardial infarction complicated by shock. Investigators from Rome, Italy examine primary percutaneous coronary intervention in nonagenarians — this is an increasingly common scenario that interventionalists are facing as the worldwide population ages. Investigators from Texas Heart Institute evaluate what a high or low activated clotting time means with bivalirudin — I had often wondered about that myself in the catheterization laboratory. Dr Steven L. Goldberg from the University of Washington Medical Center in Seattle, Washington has authored a provocative piece and asks whether we should abandon femoral access for acute myocardial infarction. I imagine that viewpoint will generate a great deal of discussion among our readers.

Also in this issue of the Journal of Invasive Cardiology, a group from Monash University in Australia uses optical coherence tomography to provide insight into the role of neo-atherosclerosis in stent thrombosis. This new technology is providing clear pictures and unraveling mechanisms of disease. In this case, it turns out that stents are sometimes blamed for problems that are really due to progression of underlying atherosclerosis and not a failing of the stent, per se.

There are several other articles in this issue of the Journal of Invasive Cardiology that should be of great interest to the practicing interventionalist. We continue to try to showcase lessons learned from leading centers located around the world.