Munksgaard Bain (kendotemple59)

Emergent Transcatheter Aortic Valve Replacement (TAVR) is a strategy that has been used for management of severely decompensated patients who are unlikely to tolerate an open procedure (Kolte et al., 2018). Recently, in the context of degenerated valve bioprosthesis, valve-in-valve (ViV) transcatheter aortic valve replacement has become an acceptable management strategy (Kalra et al., 2019 [2]). Here, we present this rare case of a 25-year-old, post-partum female with DiGeorge Syndrome, who presented with severe bioprosthetic valve stenosis leading to heart failure. She initially had received a biologic valve in order to have children; however, following delivery of her child, she developed valve failure that was severe enough to preclude her from receiving a surgical aortic valve replacement. ViV TAVR was performed emergently to improve heart failure and bridge the time to definitive treatment, when she would be able to safely receive a mechanical valve. WP1130 After valve placement, echocardiogram showed no evidence of aortic regurgitation or paravalvular leak with a mean gradient of 2 mmHg, and she was ultimately discharged. Our patient was recovering well at her two-month follow up appointment. This case highlights the need for further research in the use of ViV TAVR in younger patient populations in emergent situations. BACKGROUND Outcomes after transcatheter aortic valve implantation (TAVI) have been demonstrated to be at least equivalent in the short term compared to surgical valve implantation (SAVI). However, Conduction abnormalities are more common after TAVI than SAVI and the need for permanent pacemaker implantation is more common after TAVI with the currently commercially available self-expanding valves than after SAVI. Temporary pacemaker implantation may be associated with inability to ambulate, lead migration or perforation and infection. Depending on the monitoring system, some arrhythmias may not be detected. We examined the feasibility and safety of permanent pacemaker lead implantation connected to an external generator in patients undergoing TAVI at our institution. METHODS This is a retrospective analysis of consecutive patients (between April 1st 2014 and April 30th 2016) at a single center without permanent pacemaker at the time of TAVI who underwent implantation of a permanent pacemaker lead after TAVI co and 1 and 12 days]). Of the ten patients (9%) who required permanent pacemaker implantation, 8 had a complete atrioventricular block and two had tachy-brady arrhythmias in the context of atrial fibrillation. None of the baseline characteristics including baseline conduction abnormalities were predictors for PPI. CONCLUSION Implantation of a permanent pacemaker lead connected to an external generator is feasible and safe and could be a better option than implantation of a temporary lead connected to an external generator. It may allow earlier ambulation and facilitate monitoring. Myotonic dystrophy type 1 (DM1) is a multisystemic disorder characterized by muscle weakness and wasting and by important central nervous system-related symptoms including impairments in executive functions, spatial abilities and increased anxiety and depression. The Mbnl2 gene has been implicated in several phenotypes consistent with DM1 neuropathology. In this study, we developed a tissue-specific knockout mouse model lacking the Mbnl2 gene in forebrain glutamatergic neurons to examine its specific contribution to the neurobiological perturbations related to DM1. We found that these mice exhibit long-term cognitive deficits and a depressive-like state associated with neuronal loss, increased microglia and decreased neurogenesis, specifically in the dentate gyrus (DG). Chronic treatment with the atypical antidepressant mirtazapine (3 and 10 mg/kg) for 21 days rescued these behavioral alterations, reduced inflammatory microglial overexpression, and reversed neuronal loss in the DG. We also show that mirtazapine r