The prevalence of left-sided valvular heart disease (VHD) increases with age, but data on the impact of pre-existing VHD in patients with acute myocardial infarction (AMI) are limited. We aimed to define the clinical characteristics and outcomes of AMI patients with pre-existing left VHD. The analysis is based on data from three merged national registries. The dataset included 47,436 patients admitted with AMI over a 5year period at all Cath Labs nationwide. Pre-existing VHD was diagnosed in 1,445 patients (3.0%), moderate-to-severe mitral regurgitation (MR) in 510 patients (35.3%), and moderate-to-severe aortic stenosis (AS) in 869 patients (60.1%). Patients with VHD had worse baseline characteristics, pre-existing coronary artery disease, more complicated in-hospital course with higher Killip class, lower left ventricular ejection fraction, and more comorbidities. Angiographically more frequent left main stenosis, TIMI flow 3 before PCI, less frequent stent implantation. Patients with pre-existing VHD had significantly higher 7-day (10.1% vs. 4.5%, p < 0.001), 30-day (16.0% vs. 7.0%, p < 0.001) and 1-year mortality (28.7 vs. 12.7%, p < 0.001) compared to patients without. Conclusions. Patients with pre-existing VHD and AMI are characterized by complicated in-hospital course with higher Killip class, lower ejection fraction, angiographically less severe stenosis, TIMI flow 3 prior to PCI, and less frequent stent implantation. This is a high-risk group with higher short - and long-term mortality and earlier intervention should be considered.

• MeSH
• Aortic Valve Stenosis * complications   epidemiology   MeSH
• Myocardial Infarction * complications   mortality   MeSH
• Middle Aged MeSH
• Humans MeSH
• Mitral Valve Insufficiency * complications   epidemiology   MeSH
• Registries MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Infective endocarditis (IE) is a life-threatening disease, with its mortality rate varying depending on the infectious agent. Streptococci are among the most common causes of infective endocarditis. However, Streptococcus vestibularis has rarely been associated with human infections, typically affecting patients with underlying conditions such as immunosuppressive diseases, valve replacement, rheumatic heart disease, and hemodialysis. We present the case of a 26-year-old man who presented with fever, unanticipated weight loss, and fatigue. Although no typical risk factors for infective endocarditis were identified at admission, transesophageal echocardiography revealed a bicuspid aortic valve with calcification, paravalvular aortic abscess formation, and vegetations on the anterior leaflet of the mitral valve. Blood cultures grew S. vestibularis, which was initially sensitive to benzylpenicillin but developed emergent resistance on the third day of the antibiotic treatment. Subsequently, ceftriaxone therapy was initiated, and blood cultures became sterile on day 10. The patient eventually underwent aortic valve replacement. We report the first known case of native aortic and mitral valve endocarditis caused by S. vestibularis, accompanied by a paravalvular abscess around the native aortic valve, in a patient who had no typical risk factors for infective endocarditis, except for a bicuspid aortic valve.

• MeSH
• Anti-Bacterial Agents therapeutic use   MeSH
• Aortic Valve Insufficiency * microbiology   surgery   MeSH
• Endocarditis, Bacterial * complications   diagnosis   drug therapy   microbiology   MeSH
• Bicuspid Aortic Valve Disease * complications   surgery   MeSH
• Third Generation Cephalosporins therapeutic use   MeSH
• Ceftriaxone therapeutic use   MeSH
• Heart Valve Prosthesis Implantation MeSH
• Adult MeSH
• Humans MeSH
• Mitral Valve * microbiology   MeSH
• Penicillin G therapeutic use   MeSH
• Penicillin Resistance MeSH
• Streptococcal Infections * complications   diagnosis   drug therapy   microbiology   MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Male MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH

Structural, architectural, contractile, or electrophysiological alterations may occur in the left atrium (LA). The concept of LA cardiopathy is supported by accumulating scientific evidence demonstrating that LA remodelling has become a cornerstone diagnostic and prognostic marker. The structure and the function of the LA and left atrial appendage (LAA), which is an integral part of the LA, are key elements for a better understanding of multiple clinical conditions, most notably atrial fibrillation, cardioembolism, heart failure, and mitral valve diseases. Rational use of various imaging modalities is key to obtain the relevant clinical information. Accordingly, this clinical consensus document from the European Association of Cardiovascular Imaging, in collaboration with the European Heart Rhythm Association, provides comprehensive, up-to-date, and evidence-based guidance to cardiologists and cardiac imagers for the best practice of imaging LA and LAA for the diagnosis, management, and prognostication of the patients.

• MeSH
• Echocardiography methods   MeSH
• Atrial Fibrillation diagnostic imaging   MeSH
• Cardiac Imaging Techniques MeSH
• Cardiology MeSH
• Consensus * MeSH
• Humans MeSH
• Multimodal Imaging * methods   MeSH
• Prognosis MeSH
• Atrial Appendage * diagnostic imaging   MeSH
• Societies, Medical * MeSH
• Heart Atria * diagnostic imaging   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Practice Guideline MeSH
• Geographicals
• Europe MeSH

BACKGROUND: Management of recurrent mitral regurgitation (MR) or relevant iatrogenic mitral valve (MV) stenosis after mitral transcatheter edge-to-edge repair (M-TEER) emerges as an increasingly relevant clinical issue. Surgery after M-TEER is associated with higher morbidity and mortality. Electrosurgical leaflet laceration and stabilization of the implant (ELASTA-Clip) followed by transcatheter mitral valve replacement (TMVR) is an innovative, less-invasive treatment option for patients with TEER failure. OBJECTIVES: The authors sought to evaluate the early results of ELASTA-Clip followed by transapical TMVR in patients with symptomatic failed M-TEER (defined as persistent or recurrent MR, or iatrogenic MV stenosis). METHODS: Data from symptomatic patients with failed M-TEER who underwent ELASTA-Clip followed by compassionate use or commercial transapical TMVR using the Abbott Tendyne system were retrospectively collected from 8 tertiary care centers in 4 countries. Safety and efficacy of the procedure were assessed up to 1 year according to Mitral Valve Academic Research Consortium (MVARC) criteria. RESULTS: A total of 22 patients (mean age 77.8 ± 9.2 years, 40.9% [9/22] female) at high surgical risk (EuroSCORE II 8.0 ± 0.4, STS score 7.2% ± 1.1%) with symptomatic residual MR ≥3+ (n = 21) or iatrogenic MV stenosis (n = 1) after failed M-TEER were followed for a median period of 8.5 [Q1-Q3: 2.6-11.6] months. The ELASTA-Clip procedure (90.9% [20/22] transseptal, 9.1% [2/22] transapical) followed by TMVR were successful in all patients (22/22). Technical success according to MVARC was achieved in 21 patients (21/22, 95.4%) without left ventricular outflow tract obstruction or conversion to sternotomy. At 30 days, 3 patients had paravalvular leak progression, ischemic stroke occurred in 3 patients (3/20, 15.0%). Baseline MR (≥3+ in 95.5% [21/22]) was reduced to grade 1+ or less in all patients with durable results in 89.5% (17/19) (P < 0.001). NYHA functional class significantly improved to ≤II in 81.3% (13/16) at discharge (P < 0.001) and 72.2% (13/18) at last follow-up (P < 0.001). At 30 days, all patients (20/20) were alive. Three patients (3/20, 15.0%) were rehospitalized for heart failure (uncontrolled atrial fibrillation in 2 cases) and 1 of them (1/22, 4.5%) underwent a reintervention (valve retensioning). CONCLUSIONS: Transapical TMVR after ELASTA-Clip is a feasible and less invasive option for the management of failed M-TEER that can be performed with acceptable results in a carefully selected patient population. Particular attention is required to avoid paravalvular leakage and measures to minimize the risk of periprocedural cerebrovascular events need to be implemented in future larger-scale prospective studies with longer-term follow-up.

• MeSH
• Time Factors MeSH
• Heart Valve Prosthesis Implantation * instrumentation   adverse effects   MeSH
• Compassionate Use Trials MeSH
• Electrosurgery adverse effects   MeSH
• Iatrogenic Disease MeSH
• Humans MeSH
• Mitral Valve * surgery   diagnostic imaging   physiopathology   MeSH
• Mitral Valve Insufficiency * surgery   diagnostic imaging   physiopathology   etiology   MeSH
• Mitral Valve Stenosis * surgery   diagnostic imaging   physiopathology   etiology   MeSH
• Treatment Failure MeSH
• Recovery of Function MeSH
• Recurrence * MeSH
• Retrospective Studies MeSH
• Risk Factors MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Heart Valve Prosthesis * MeSH
• Cardiac Catheterization * instrumentation   adverse effects   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Geographicals
• Europe MeSH

BACKGROUND: Simulation-based training has gained distinction in cardiothoracic surgery as robotic-assisted cardiac procedures evolve. Despite the increasing use of wet lab simulators, the effectiveness of these training methods and skill acquisition rates remain poorly understood. OBJECTIVES: This study aimed to compare learning curves and assess the robotic cardiac surgical skill acquisition rate for cardiac and noncardiac surgeons who had no robotic experience in a wet lab simulation setting. METHODS: In this prospective cohort study, participants practiced 3 robotic tasks in a porcine model: left atriotomy closure, internal thoracic artery harvesting and mitral annular suturing. Participants were novice robotic cardiac and noncardiac surgeons alongside experienced robotic cardiac surgeons who established performance benchmarks. Performance was evaluated using the time-based score and modified global evaluative assessment of robotic skills (mGEARS). RESULTS: The participants were 15 novice surgeons (7 cardiac; 8 noncardiac) and 4 experienced robotic surgeons. Most novices reached mastery in 52 (±22) min for atrial closure, 32 (±18) for internal thoracic artery harvesting and 34 (±12) for mitral stitches, with no significant differences between the cardiac and noncardiac surgeons. However, for mGEARS, noncardiac novices faced more challenges in internal thoracic artery harvesting. The Thurstone learning curve model indicated no significant difference in the learning rates between the groups. CONCLUSIONS: Wet lab simulation facilitates the rapid acquisition of robotic cardiac surgical skills to expert levels, irrespective of surgeons' experience in open cardiac surgery. These findings support the use of wet lab simulators for standardized, competency-based training in robotic cardiac surgery.

• Publication type
• Journal Article MeSH

Ortnerův nebo též kardiovokální syndrom je vzácná příčina chrapotu způsobená kompresí levého zvratného nervu v důsledku patologie kardiovaskulárních struktur v mediastinu. První popis pochází od Norberta Ortnera z roku 1897, kdy syndrom spojil s mitrální stenózou. Typicky se projevuje parézou levého rekurentního laryngeálního nervu, který je mechanicky stlačen v oblasti aortálního oblouku. Kazuistika popisuje případ 81letého nekuřáka, který byl vyšetřen pro 2 měsíce trvající chrapot. Laryngoskopické vyšetření odhalilo obrnu levé hlasivky, CT krku a mediastina s kontrastní látkou prokázalo ektázii ascendentní aorty a aneurysma oblouku aorty. Pacient byl konzultován kardiochirurgem i intervenčním radiologem, ale vzhledem k věku a náhodnému nálezu nebyla doporučena chirurgická či endovaskulární léčba. Nemocný byl propuštěn domů, kde později zemřel v kruhu rodiny. Prognóza těchto pacientů závisí na rychlé diagnóze a léčbě. Včasná intervence může zlepšit nebo obnovit hlasové funkce. Neméně důležitým faktorem je pro optimální péči o pacienty i pravidelné sledování a mezioborová spolupráce.

Ortner’s syndrome, also known as cardiovocal syndrome, is a rare cause of hoarseness due to compression of the left recurrent laryngeal nerve caused by pathology of cardiovascular structures in the mediastinum. It was first described by Norbert Ortner in 1897, who associated the syndrome with mitral stenosis. It typically presents as paresis of the left recurrent laryngeal nerve, which is mechanically compressed in the area of the aortic arch. The case report describes an 81-year-old non-smoker who was examined for two months of hoarseness. Laryngoscopic examination revealed paralysis of the left vocal cord, and CT of the neck and mediastinum with contrast showed ectasia of the ascending aorta and aneurysm of the aortic arch. The patient was consulted by both a cardiothoracic surgeon and an interventional radiologist, but due to his age and the incidental nature of the finding, neither surgical nor endovascular treatment was recommended. The patient was discharged home, where he later passed away surrounded by his family. The prognosis of these patients depends on prompt diagnosis and treatment. Early intervention can improve or restore vocal function. Regular monitoring and interdisciplinary collaboration are also crucial factors for optimal patient care.

• Keywords
• Ortnerův syndrom,
• MeSH
• Aneurysm, Aortic Arch * diagnostic imaging   therapy   MeSH
• Aortic Aneurysm, Thoracic diagnostic imaging   therapy   MeSH
• Hoarseness etiology   MeSH
• Fatal Outcome MeSH
• Humans MeSH
• Vocal Cord Paralysis * diagnostic imaging   etiology   therapy   MeSH
• Aged, 80 and over MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged, 80 and over MeSH
• Publication type
• Case Reports MeSH

• About
• Ortner, Norbert, 1865-1935 Authority

Medzirebrová herniácia pľúc je definovaná ako protrúzia pľúcneho tkaniva za normálne hranice hrudnej steny. Prvý prípad pľúcnej hernie opísal v roku 1499 Roland. Pomer získaných a vrodených pľúcnych hernií je 4 : 1. Na základe anatomickej lokalizácie sú známe cervikálne, medzirebrové (interkostálne) a diafragmatické formy pľúcnej herniácie. Rizikovou zónou posttraumatickej a pooperačnej medzirebrovej pľúcnej hernie je v dôsledku slabého svalového krytu predná stena hrudníka. Kazuistika prezentuje 71-ročného muža, ktorý pred 9 rokmi podstúpil aortokoronárny bypass, náhradu mitrálnej chlopne, plastiku trikuspidálnej chlopne a zákrok MAZE. Pred pol rokom ďalej podstúpil transapikálnu implantáciu mitrálnej chlopne. Po implantácii chlopne pacient podstúpil opakovanú pleurálnu punkciu z dôvodu pleurálneho výpotku. Pacient prišiel do nemocnice pre bolestivú rezistenciu v mieste jazvy po torakotómii, ktorá sa zväčšila počas Valsalvovho manévru. Ultrasonografia a počítačová tomografia potvrdili diagnózu medzirebrovej pľúcnej hernie. Bola vykonaná resekcia herniálneho vaku a defekt bol uzavretý implantáciou polypropylénovej sieťky. Pacient bol prepustený v dobrom stave. Transapikálna implantácia chlopne predstavuje unikátnu kombináciu rizikových faktorov pre vznik medzirebrovej pľúcnej hernie ako zo strany pacienta, tak aj zo strany operačného prístupu. Dôsledné sledovanie pacientov za účelom včasnej identifikácie prítomnosti medzirebrovej pľúcnej hernie by malo byť bezpodmienečnou súčasťou pooperačného sledovania pacientov po transapikálnej implantácii chlopne.

Intercostal lung herniation is defined as a protrusion of lung tissue beyond the normal limits of the chest wall. The first case of pulmonary hernia was described in 1499 by Roland. The ratio of acquired to congenital lung hernias is 4 : 1. Based on anatomical localisation, cervical, intercostal, and diaphragmatic forms of lung herniation are known. The risk zone for posttraumatic and postoperative intercostal lung hernia is the front wall of the chest due to the poor muscular cover. The case report presents a 71-year-old man who underwent aortocoronary bypass, replacement of the mitral valve, repair of the tricuspid valve, and the MAZE procedure 9 years ago, as well as transapical implantation of the mitral valve through thoracotomy half a year ago. Repeat pleural puncture due to pleural effusion after valve implantation was needed. The pa- tient came to the hospital because of a painful resistance at the site of the thoracotomy scar which increased during the Valsalva manoeuvre. Ultrasonography and computed tomography confirmed the diagnosis of an intercostal lung hernia. A resection of the hernial sac was performed, and the defect was closed by implant- ing a polypropylene mesh. The patient was discharged in a good condition. Transapical valve implantation represents a unique combination of risk factors for the formation of an intercostal lung hernia, both from the patient's side and from the operative approach. Consistent monitoring of patients for the purpose of early identification of the presence of an intercostal lung hernia should be an unconditional part of the postoperative monitoring of patients after transapical valve implantation.

• MeSH
• Heart Valve Prosthesis Implantation * methods   adverse effects   MeSH
• Diagnosis, Differential MeSH
• Hernia * diagnostic imaging   etiology   pathology   therapy   MeSH
• Thoracic Surgical Procedures methods   adverse effects   MeSH
• Humans MeSH
• Mitral Valve surgery   MeSH
• Pleural Effusion etiology   MeSH
• Lung Diseases surgery   diagnostic imaging   etiology   pathology   MeSH
• Tomography, X-Ray Computed MeSH
• Risk Factors MeSH
• Aged MeSH
• Thoracotomy methods   adverse effects   MeSH
• Valsalva Maneuver MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Aged MeSH
• Publication type
• Case Reports MeSH

Koarktace aorty je jednou z nejčastějších vrozených srdečních vad s obvykle dobrou středně- i dlouhodobou prognózou. Koarktace aorty je často asociována s dalšími přidruženými vrozenými vadami, zejména obstrukčními vadami levostranných srdečních struktur. Kombinace koarktace aorty s hraniční velikostí levé komory, anomálií či stenózou mitrální a/nebo aortální chlopně je asociována s vyšším rizikem reintervence či časné mortality. Třetina dětí s koarktací vyžaduje urgentní řešení vady již v novorozeneckém věku a u většiny novorozenců dochází po odstranění koarktace aorty k normálnímu růstu iniciálně menší levé komory bez progrese mitrální či aortální stenózy. Prognóza a správný postup léčby těchto pacientů závisí na několika anatomických a hemodynamických faktorech, které je potřeba stanovit již v novorozeneckém věku. Skórovací systémy založené na měření echokardiografických parametrů, které jsou využívány u novorozence s významnou valvární stenózou aorty a hraniční velikostí levé komory nejsou v případě novorozenců s koarktací aorty spolehlivé. Znalost rizikových echokardiografických parametrů u novorozenců s koarktací, které jsou přítomny před operací koarktace či časně po ní, má důležitý význam pro odhad vývoje mitrální/aortální chlopně a levé komory a také pro stanovení prognózy a správného léčebného postupu. Cílem přehledového článku je shrnout dosavadní poznatky týkající se koarktace aorty léčené v novorozeneckém věku. Článek se dále zaměřuje na problematiku této vady u novorozence s přidruženou anomálií mitrální/aortální chlopně a menší velikostí levé komory. Demonstrované pilotní výsledky mohou potenciálně posloužit jako užitečný základ pro další klinický výzkum.

Coarctation of the aorta is one of the most common congenital heart defects with usually favourable intermediate and long-term prognosis. Coarctation of the aorta is often associated with other heart congenital defects, especially obstructive lesions of the left-sided cardiac structures. The combination of aortic coarctation with a borderline left ventricle, mitral and/or aortic valve anomalies or stenosis is associated with a higher risk of reintervention or early mortality. One-third of infants with coarctation require urgent management in the neonatal period, and most infants experience normal growth of the initially smaller left ventricle after coarctation repair without progression of mitral or aortic stenosis. The prognosis and appropriate management of these patients depend on several anatomical and hemodynamic factors that should be determined in the neonatal period. Scoring systems based on the measurement of echocardiographic parameters, which are used in neonates with significant valvar aortic stenosis and borderline left ventricular size, are not reliable in neonates with aortic coarctation. Knowledge of risk echocardiographic parameters in neonates with coarctation present before or early after correction of coarctation is important for the prediction of development of the mitral/aortic valve and the left ventricle, as well as for determining prognosis and the correct therapeutic management. The aim of this review article is to summarize the current knowledge regarding neonatal aortic coarctation. The review also focuses on associated mitral/aortic valve anomaly and smaller left ventricular size. The presented pilot results may potentially serve as a useful basis for further clinical research.

• MeSH
• Survival Analysis MeSH
• Echocardiography MeSH
• Aortic Coarctation * surgery   etiology   genetics   complications   MeSH
• Humans MeSH
• Mitral Valve abnormalities   MeSH
• Heart Valve Diseases complications   congenital   MeSH
• Infant, Newborn MeSH
• Aortic Valve Disease complications   congenital   MeSH
• Prognosis MeSH
• Heart Disease Risk Factors MeSH
• Heart Ventricles abnormalities   MeSH
• Statistics as Topic MeSH
• Heart Defects, Congenital * surgery   etiology   genetics   complications   MeSH
• Check Tag
• Humans MeSH
• Infant, Newborn MeSH
• Publication type
• Research Support, Non-U.S. Gov't MeSH
• Review MeSH

In the 30 years since Dr Sigwart's first pioneering procedures, alcohol septal ablation (ASA) has become the standard catheterisation procedure to reduce or eliminate obstruction in the left ventricular outflow tract. This procedure reduces the pressure gradient by 70%-80%, and only 10%-20% of patients have a residual gradient > 30 mm Hg after ASA. The mortality rate of the procedure is < 1%, and ∼ 10% of patients require permanent pacemaker implantation for higher degrees of atrioventricular block. Given the potential risks, ASA should be performed only in centres with extensive experience in the treatment of hypertrophic cardiomyopathy and with comprehensive therapeutic options, including myectomy. In the future, ASA is likely to be increasingly complemented by catheter-based mitral valve repair, which will increase its efficacy.

• MeSH
• Ablation Techniques * methods   trends   MeSH
• History, 20th Century MeSH
• History, 21st Century MeSH
• Ethanol * therapeutic use   MeSH
• Cardiomyopathy, Hypertrophic * surgery   MeSH
• Catheter Ablation methods   MeSH
• Humans MeSH
• Ventricular Outflow Obstruction * surgery   MeSH
• Forecasting MeSH
• Heart Septum surgery   MeSH
• Check Tag
• History, 20th Century MeSH
• History, 21st Century MeSH
• Humans MeSH
• Publication type
• Journal Article MeSH
• Historical Article MeSH
• Review MeSH

Akutní končetinová ischemie (acute limb ischemia, ALI) představuje zásadní hrozbu pro životaschopnost končetin vyžadující urgentní revaskularizační intervence. V této kazuistice popisujeme případ 47leté Asiatky s bilaterální ALI v důsledku těžké mitrální stenózy (MS) revmatické etiologie a fibrilace síní (FS) se zanedbanou úpravou mezinárodního normalizačního poměru (INR). Pacientka byla přivezena do nemocnice s náhlou klidovou bolestí obou dolních končetin, již namodralých a naprosto bez čití. Echokardiografické vyšetření prokázalo těžkou MS revmatické etiologie spolu s trombem v oušku levé síně. CT angiogram odhalil téměř úplně obturující trombus v místě odstupu horní břišní aorty. Okamžitě byla provedena bilaterální tromboembolektomie, po níž došlo ke zlepšení stavu, a pacientka byla nakonec propuštěna z nemocnice ve stabilizovaném stavu. Pro optimální výsledek v případě ALI zahrnujících současně MS a FS jsou absolutně nezbytné vhodná antikoagulační terapie, důsledné monitorování INR a použití vhodné strategie k náhradě chlopně.

Acute limb ischemia (ALI) poses a critical threat to limb viability, necessitating urgent revascularization interventions. This case report discusses a 47-year-old Asian woman with bilateral ALI due to severe rheumatic mitral stenosis (MS) and atrial fibrillation (AF), with neglected international normalized ratio (INR) control. The patient presented with sudden bilateral leg pain at rest, accompanied by bluish discoloration and sensory loss. Echocardiographic findings indicated severe rheumatic MS along with a thrombus in the left atrial appendage. The computed tomography angiogram revealed a near-total thrombus originating from the upper abdominal aorta. Immediate bilateral thromboembolectomy was performed. Subsequent improvements were observed, and the patient was eventually discharged in stable condition. Proper anticoagulant therapy, vigilant INR monitoring, and a strategic approach to valve replacement are crucial for optimizing outcomes in cases of ALI involving concurrent MS and AF.

• MeSH
• Acute Disease therapy   MeSH
• Anticoagulants pharmacology   therapeutic use   MeSH
• Diagnostic Imaging methods   MeSH
• Lower Extremity * pathology   MeSH
• Atrial Fibrillation diagnosis   etiology   drug therapy   MeSH
• International Normalized Ratio methods   standards   MeSH
• Ischemia * surgery   etiology   drug therapy   MeSH
• Middle Aged MeSH
• Humans MeSH
• Mitral Valve Stenosis etiology   complications   MeSH
• Rheumatic Heart Disease * complications   MeSH
• Thrombectomy methods   MeSH
• Thrombotic Stroke surgery   drug therapy   MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Female MeSH
• Publication type
• Case Reports MeSH