RESUMO
INTRODUCTION: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an emerging complication. There are incomplete and disparate data on its incidence. We present the experience of a single-centre of incidence, mortality and associated factors of IE after TAVI. METHODS: A retrospective observational study of IE cases in people who received a TAVI, between 06/01/2009 and 11/01/2017, in a university hospital, during a median follow-up period of 15.3months (interquartile range [IQR] 9.1-36.2). Incidence, clinical, microbiological and prognostic data, and factors associated with IE after TAVI were analysed. RESULTS: Eleven patients with IE of 200 TAVI were detected. Global incidence: 5.5% (2.77 cases per 100 patient-year). The median of days from TAVI to IE was 112 (IQR 36-578), the in-hospital mortality rate was 36.4%, and the one-year mortality rate was 54.5%. All the organisms identified were gram-positive (4 Enterococcus faecalis, 3 coagulase-negative Staphylococcus). The patients with IE after TAVI were significantly younger (median 78years, IQR 73-80, versus 82 years, IQR 79-84, P=.002), they had a higher EuroSCORE (5.1±2.4 versus 3.2±1.2, P<.001), and they more frequently had a history of neoplasia (18.2% versus 4.2%, P<.03) CONCLUSIONS: In our area, IE after TAVI has an incidence greater than that described in multicentre series, this is in line with the trend published in the literature. It leads to high mortality and is associated with a worse baseline clinical situation.
Assuntos
Infecção Hospitalar/etiologia , Endocardite Bacteriana/etiologia , Infecções por Bactérias Gram-Positivas/etiologia , Infecção da Ferida Cirúrgica/etiologia , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Estenose da Valva Aórtica/cirurgia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Endocardite Bacteriana/epidemiologia , Endocardite Bacteriana/microbiologia , Enterococcus , Enterococcus faecalis/isolamento & purificação , Feminino , Seguimentos , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais Universitários , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/microbiologiaAssuntos
Apêndice Atrial/lesões , Fibrilação Atrial/terapia , Cateterismo Cardíaco/efeitos adversos , Traumatismos Cardíacos/etiologia , Derrame Pericárdico/prevenção & controle , Veias Pulmonares/lesões , Idoso de 80 Anos ou mais , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/diagnóstico por imagem , Cateterismo Cardíaco/instrumentação , Traumatismos Cardíacos/diagnóstico por imagem , Humanos , Masculino , Derrame Pericárdico/etiologia , Veias Pulmonares/diagnóstico por imagem , Resultado do TratamentoAssuntos
Apêndice Atrial/cirurgia , Fibrilação Atrial/cirurgia , Erros de Diagnóstico , Cardiopatias/etiologia , Complicações Pós-Operatórias , Dispositivo para Oclusão Septal/efeitos adversos , Trombose/etiologia , Idoso , Apêndice Atrial/diagnóstico por imagem , Fibrilação Atrial/complicações , Ecocardiografia , Seguimentos , Cardiopatias/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Raras , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/prevenção & controle , Trombose/diagnósticoRESUMO
Six-month PCI follow-up results of left anterior descending (LAD) and circumflex (CX) drug-eluting stent implantation are presented. Angiography showed patent LAD and CX stents. However, OCT revealed almost all abluminal cavities were completely filled, which the authors surmise was due to a neointimal healing process.
Assuntos
Trombose Coronária/cirurgia , Vasos Coronários/diagnóstico por imagem , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tomografia de Coerência Óptica/métodos , Angiografia Coronária , Trombose Coronária/complicações , Trombose Coronária/diagnóstico , Vasos Coronários/cirurgia , Stents Farmacológicos , Humanos , Imunossupressores/farmacologia , Masculino , Pessoa de Meia-Idade , Neointima/patologia , Desenho de Prótese , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Sirolimo/farmacologiaRESUMO
We present a case of a 52 year old female who suffered from a sudden syncope. A coronariography was performed and spontaneous coronary dissection was diagnosed in the posterior descending artery after an optical coherence tomography (OCT) was performed. A conservative management was decided. During hospitalization the patient presented with an episode of chest pain with an anterior ST elevation on ECG. Coronariography showed total occlusion of the left descending artery and again a dissection was diagnosed by OCT. This time, 2 stents were implanted in the affected artery. The hypothesis that the coronary adventitial volume of vasa vasorum is higher in patients with spontaneous coronary artery dissection has been demonstrated in a recent small study and it was observed in this patient. Conservative management is preferred in most cases, proceeding to revascularization for patients with ongoing chest pain, hemodynamic instability and ST elevation, mostly if it affects major arteries.