The aim of this study was to evaluate the efficacy and safety of the stepwise mechanical transvenous lead extraction approach in a patient population with chronically implanted transvenous leads... Show moreThe aim of this study was to evaluate the efficacy and safety of the stepwise mechanical transvenous lead extraction approach in a patient population with chronically implanted transvenous leads with a long dwell time.From January 2014 till December 2018, all lead extractions with lead dwell time >= 5 years performed at our tertiary centre were retrospectively analysed. A total of 173 leads, from 78 patients (median age 68 years; 81% male) with a median dwell time of 9 years (interquartile range [IQR] 5) were extracted, with three or more leads in 42% of the patients. Right atrial leads: 41%; right ventricular pacing leads: 16%; implantable cardioverter-defibrillator (ICD) leads: 31% (72% dual coil); coronary sinus leads: 12%. The majority (75%) of the leads had an active fixation. Most frequent indication for extraction was pocket infection/erosion (76%). Overall clinical success was 97%, and complete procedural success was 93%. Venous patency, assessed with venous angiography, was well preserved in 93% of the cases. The overall procedural complication rate was 3.8% (2.6% major and 1.3% minor).Despite the complexity of the population and a very long dwell time (median 9 years), a clinical success rate of 97% was achieved with the stepwise mechanical approach. Analysis of impeding progression of pectoral extraction suggests that dense fibrosis and sharp lead curvature in the transvenous trajectory pose a challenge. Complication rate was low, and acute venous patency was generally well preserved. Show less
A 53-year-old man presented with symptomatic severe pulmonary valve regurgitation. He underwent a diagnostic catheterization. A heavily calcified pericardium and the pressure tracings illustrate... Show moreA 53-year-old man presented with symptomatic severe pulmonary valve regurgitation. He underwent a diagnostic catheterization. A heavily calcified pericardium and the pressure tracings illustrate typical features of constrictive pericarditis physiology, including the "square root sign." This condition is important to recognize given the progressive nature and poor prognosis if untreated. Show less
Meijer, F.M.M.; Hendriks, S.V.; Huisman, M.V.; Hulle, T. van der; Swenne, C.A.; Kies, P.; ... ; Klok, F.A. 2020
Introduction: The YEARS algorithm was successfully developed to reduce the number of computed tomography pulmonary angiography (CTPA) investigations in the diagnostic management of patients with... Show moreIntroduction: The YEARS algorithm was successfully developed to reduce the number of computed tomography pulmonary angiography (CTPA) investigations in the diagnostic management of patients with suspected pulmonary embolism (PE), although half of patients still needed to be referred for CTPA. We hypothesized that ECG derived ventricular gradient optimized for right ventricular pressure overload (VG-RVPO), an easy to use tool for detecting PE-induced pulmonary hypertension (PH), may further improve the efficiency of the YEARS algorithm.Methods: In this post-hoc analysis of the Years study, ECGs of 479 patients with suspected PE managed according to the YEARS algorithm were available for analysis. The diagnostic performance of VG-RVPO was assessed and likelihood ratios were calculated.Results: PE was diagnosed in 88 patients (18%). In patients with confirmed PE, 34% had an abnormal VG-RVPO versus 24% of those without PE (odds ratio 1.6; 95%CI 0.94-2.6). The mean VG-RVPO was -22 +/- 13 and did not differ between the two patient groups (-22 versus-20; mean difference - 2, 95% CI -4.8 to 1.3). The sensitivity of VG-RVPO for PE was 24% (95%CI 34-45), the specificity 76% (95%CI 71-80) and the c-statistic 0.45 (95% CI 0.38-0.51). When combined with the YEARS algorithm, the likelihood ratios of VG-RVPO remained close to 1.0. Ruling out PE in patients with an indication for CTPA based on a normal VG-RVPO would have resulted in 58 missed cases.Conclusions: The VG-RVPO has no diagnostic value for suspected acute PE, either as stand-alone diagnostic test or combined with the YEARS algorithm.Condensed abstract: This post-hoc analysis of the YEARS study failed to demonstrate incremental diagnostic value of VG-RVPO for acute PE, either as stand-alone diagnostic test or combined with the YEARS algorithm. Nevertheless, the role of VG-RVPO recorded on admission could potentially be valuable in the risk stratification of PE during hospitalization, although this remains to be studied. (C) 2020 Published by Elsevier Inc. Show less
Ventricular assist device (VAD) implantation is an established treatment modality for patients with end-stage heart failure, and improves symptoms and survival. In the Netherlands, it is not yet... Show moreVentricular assist device (VAD) implantation is an established treatment modality for patients with end-stage heart failure, and improves symptoms and survival. In the Netherlands, it is not yet routinely considered in patients with congenital heart disease and failing systemic right ventricle (SRV). Recently, a VAD was implanted in 2 SRV patients, one who underwent a Mustard procedure during infancy for transposition of the great arteries (male, 47 years old) and one with a congenitally corrected transposition of the great arteries (male, 54 years old). The first patient is doing well >1 year after implantation; the second patient will be discharged home soon. These examples and other reports demonstrate the feasibility of adopting VAD implantation into routine care for SRV failure. In conclusion, patients with SRV failure may be suitable candidates for VAD implantation: they are relatively young, usually have a preserved subpulmonary left ventricular function, and their specific anatomical and physiological characteristics often make them unsuitable for cardiac transplantation. Therefore it is important to recognise the possibility of VAD implantation early in the process of SRV failure, and to timely refer these patients to a heart failure clinic with experience in VAD implantation in this group of patients for optimisation, screening, and implantation. Show less
In het proefschrift staat de respons van endotheelcellen (celpopulatie aan de binnenzijde van het hart en de bloedvaten) op verschillende hemodynamische condities centraal. In het bijzonder de... Show moreIn het proefschrift staat de respons van endotheelcellen (celpopulatie aan de binnenzijde van het hart en de bloedvaten) op verschillende hemodynamische condities centraal. In het bijzonder de bijdrage van bloedstroom ge_nduceerde endotheelcel differentiatie aan embryonale hartklep en -septum (tussenschot) ontwikkeling nader onderzocht. In de endotheelcellen is de rol van primaire cilia (haar-achtige sensors aan het celoppervlak) in de interactie tussen specifieke moleculaire signaleringcascades die betrokken zijn bij de aanleg van hartkleppen bestudeerd. Een abnormale signalering door endotheelcellen in het hart kan bijdragen aan het ontstaan van hartklep- en septum afwijkingen. Deze aangeboren hartafwijkingen hebben een belangrijk plek in de kliniek en kunnen levensbedreigend zijn. Show less
Egorova, A.D.; Heiden, K. van der; Poelmann, R.E.; Hierck, B.P. 2012
Endothelial-to-mesenchymal transition (EndoMT) is an instrumental step in the development of valves in the embryonic heart. This process is driven by activation of transforming growth factor-β (TGF... Show moreEndothelial-to-mesenchymal transition (EndoMT) is an instrumental step in the development of valves in the embryonic heart. This process is driven by activation of transforming growth factor-β (TGF-β) signaling and is characterized by the loss of endothelial and gain of mesenchymal phenotype, and by delamination of cells from the surface into the underlying endocardial cushion matrix. The endothelial cells (ECs) overlying the cushions are typically exposed to high blood flow and concomitant shear stress and do not have a primary cilium. Here, we show that shear stress activates TGF-β-Alk5 signaling in ECs, which is necessary for EndoMT in the cushions. Moreover, we show that the absence of a primary cilium is critically important for this transition process. Show less
Endothelial cells (EC) translate biomechanical forces into functional and phenotypic responses that play important roles in cardiac development. Specifically, EC in areas of high shear stress, i.e.... Show moreEndothelial cells (EC) translate biomechanical forces into functional and phenotypic responses that play important roles in cardiac development. Specifically, EC in areas of high shear stress, i.e., in the cardiac outflow tract and atrioventricular canal, are characterized by high expression of Kruppel-like factor 2 (Klf2) and by transforming growth factor-beta (Tgf beta)-driven endothelial-to-mesenchymal transition. Extraembryonic venous obstruction (venous clip model) results in congenital heart malformations, and venous clip-induced alterations in shear stress-related gene expression are suggestive for an increase in cardiac shear stress. Here, we study the effects of shear stress on Klf2 expression and Tgf beta-associated signaling in embryonic EC in vivo using the venous clip model and in vitro by subjecting cultured EC to fluid flow. Cellular responses were assessed by analysis of Klf2, Tgf beta ligands, and their downstream signaling targets. Results show that, in embryonic EC, shear stress activates Tgf beta/Alk5 signaling and that induction of Klf2 is an Alk5 dependent process. Developmental Dynamics 240: 1670-1680, 2011. (C) 2011 Wiley-Liss, Inc. Show less
Egorova, A.D.; Heiden, K. van der; Pas, S. van de; Vennemann, P.; Poelma, C.; DeRuiter, M.C.; ... ; Hierck, B.P. 2011
Rationale: Primary cilia are cellular protrusions that serve as mechanosensors for fluid flow. In endothelial cells (ECs), they function by transducing local blood flow information into functional... Show moreRationale: Primary cilia are cellular protrusions that serve as mechanosensors for fluid flow. In endothelial cells (ECs), they function by transducing local blood flow information into functional responses, such as nitric oxide production and initiation of gene expression. Cilia are present on ECs in areas of low or disturbed flow and absent in areas of high flow. In the embryonic heart, high-flow regime applies to the endocardial cushion area, and the absence of cilia here coincides with the process of endothelial-to-mesenchymal transition (EndoMT). Objective: In this study, we investigated the role of the primary cilium in defining the responses of ECs to fluid shear stress and in EndoMT. Methods and Results: Nonciliated mouse embryonic ECs with a mutation in Tg737/Ift88 were used to compare the response to fluid shear stress to that of ciliated ECs. In vitro, nonciliated ECs undergo shear-induced EndoMT, which is accompanied by downregulation of Klf4. This Tgf beta/Alk5-dependent transformation is prevented by blocking Tgf beta signaling, overexpression of Klf4, or rescue of the primary cilium. In the hearts of Tg737(orpk/orpk) embryos, Tgf beta/Alk5 signaling was activated in areas in which ECs would normally be ciliated but now lack cilia because of the mutation. In these areas, ECs show increased Smad2 phosphorylation and expression of alpha-smooth muscle actin. Conclusions: This study demonstrates the central role of primary cilia in rendering ECs prone to shear-induced activation of Tgf beta/Alk5 signaling and EndoMT and thereby provides a functional link between primary cilia and flow-related endothelial performance. (Circ Res. 2011;108:1093-1101.) Show less
