Twitter Journal Club

Interact with your colleagues every six weeks, as ASE’s Twitter Journal Club reviews an article from a cardiology journal, cases reports, new ASE guidelines, and more! Follow @ASE360 and use the hashtag, #ASEchoJC for all tweets.

Upcoming Journal Club Dates:
December 10, January 21, March 3, and April 21

Upcoming Journal Club Article:

The Impact of Basal Septal Hypertrophy on Outcomes after Transcatheter Aortic Valve Replacement, JASE, November 2019

CME Information: 1.00 credits

Release date: December 2019

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Introduction:
Within the past decade, transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement for patients at intermediate to high surgical risk with symptomatic severe aortic stenosis.1-4 With growth in the use of TAVR, increasing attention has been given to TAVR-related complications, particularly the development of complete heart block and the need for a permanent pacemaker (PPM).5 Despite improvements in TAVR technology and increasing experience with implementation, the use of PPMs has not declined but in fact has increased. In this setting, it has been hypothesized that basal septal hypertrophy (BSH), a localized thickening of the basal portion of the left ventricular septum that associates with increased age and long-standing hypertension, could contribute to the development of conduction and mechanical complications after TAVR. The basal septum is in close proximity to both the aortic valve and the bundle of His, and localized hypertrophy at this site could contribute to procedural difficulty during TAVR and an increased risk for conduction disturbance and periprocedural complications, including PPM placement, valve pop-out, need for valve recapture, device embolization, conversion to an open procedure, or need to abort the procedure. Despite the possible concerns about BSH’s impact on outcomes, there exist few data on the outcomes of patients with BSH undergoing TAVR. We therefore conducted a retrospective chart review of individuals undergoing TAVR at Beth Israel Deaconess Medical Center (BIDMC) to evaluate the impact of BSH on periprocedural and 30-day mechanical and electrical complications.

Target Audience:
This activity is designed for all cardiac sonographers and cardiovascular physicians with a primary interest and knowledge base in the field of echocardiography; in addition, residents, researchers, clinicians, intensivists, and other medical professionals.

Learning Objectives:
After completing this activity, participants should be better able to:

  • Understand the definition of basal septal hypertrophy (BSH) and prevalence in individuals with severe aortic stenosis receiving transcatheter aortic valve replacement (TAVR).
  • Learn the anatomy of the basal interventricular septum and relationship to the cardiac conduction system.
  • Appreciate the impact of BSH on clinical outcomes after TAVR.

CME Opportunity:

Accreditation: The American Society of Echocardiography is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Designation: The American Society of Echocardiography designates this activity for a maximum of 1.0 hour of AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity enables the participant to earn up to 1 MOC point in the American Board of Internal Medicine’s Maintenance of Certification (MOC) program.

ARDMS, CCI, Sonography Canada recognize ASE’s certificates and have agreed to honor the credit hours toward their registry requirements for sonographers.

Physician Assistants:
PAs may claim credit for completing this activity. NCCPA accepts AMA PRA Category 1 Credits™ from organizations accredited by ACCME or a recognized state medical society.

Disclosures: According to ACCME policy, ASE implemented mechanisms to resolve all conflicts of interest prior to the planning and implementation of this activity.

The ASE staff and CME peer reviewers involved in the planning and content development of this activity reported no actual or potential conflicts of interest in relation to this activity.

Commercial Support: None

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