Atypical presentation and percutaneous repair of ascending aortic pseudoaneurysm: a case report.

Background: Ascending aortic pseudoaneurysms (AAPs) are an unusual complication of cardiac or aortic surgery and are associated with a high risk of complications and mortality. Guidelines recommend surgical repair. There is few data concerning percutaneous occlusion of AAP. We present a case of syncope due to vascular and heart chamber compression by a large post-surgical AAP that was filled through a focal leak. Ascending aortic pseudoaneurysm was successfully occluded percutaneously. Case summary: A 66-year-old man with a mechanical aortic prosthesis and a Dacron tube in the ascending aorta presented with syncope due to compression of the right atrium and superior vena cava by a large peritube collection. A computed tomography angiography (CTA) showed a large AAP that was filled through a small focal dehiscence of the tube proximal suture. Patient was dismissed for surgery due to high surgical risk. Then, AAP was successfully occluded percutaneously via a 6-French radial access and local anaesthesia. Discussion: In patients with syncope and previous cardiac surgery, aortic complications should be ruled out. Although transthoracic echocardiography may be useful, CTA is the recommended diagnostic test for ruling out post-surgical AAP and allows the characterization of the number, localization, and size of the leaks. In selected patients with high surgical risk and favourable anatomic characteristics, a percutaneous closure could be indicated.

Chronic chest pain after percutaneous atrial septal defect closure.

Percutaneous closure of atrial septal defect is recognised as a safe and effective procedure, however, in some patients complications may occur. Although chest pain has been sporadically reported, its exact aetiology has been poorly studied. Herein, a 14-year-old female with an atypical and long-lasting chest pain after percutaneous atrial septal defect closure is described.

Tricuspid valve in valve procedure with an Edwards S3 valve© in a 10 kg child.

A 4-year-old child of 10 kg weight, with four previous sternotomies, presented a severe right heart failure, due to a severe regurgitation of his bioprosthetic tricuspid valve. A percutaneous tricuspid valve in valve procedure with an Edwards S3 valve was offered for compassionate use, and performed, with no complications, and significant clinical condition improvement.

Sinus Superflex DS© early collapse in systemic arterial duct.

We implanted two sinus Superflex DS© stents in a systemic non-stenotic arterial duct of a newborn with hypoplastic left heart syndrome. Forty-eight hours later an important collapse of the stent was detected and treated with a balloon expandable stent. Sinus Superflex DS© has been specifically designed for systemic ducts. This complication generates doubts about its radial force in this scenario.

Valvuloplastia aórtica pediátrica: estudio de variables con influencia en los resultados a largo plazo / Pediatric balloon aortic valvuloplasty. Long-term prognostic factors

Fundamentos y objetivo: En la edad pediátrica, la valvuloplastia aórtica es considerada como una opción para el tratamiento paliativo de la estenosis aórtica congénita. Se revisaron las valvuloplastias aórticas sobre válvula nativa realizadas consecutivamente en nuestro centro desde marzo de 1994 hasta junio de 2013, con el objetivo de identificar variables asociadas a necesidad de reintervención en el seguimiento. Métodos: Análisis de pacientes sometidos a valvuloplastia aórtica, en relación a sus características clínicas, ecocardiográficas y evolutivas, de una serie de 51 individuos, dividida en dos grupos -neonatal y pediátrico- según si la valvuloplastia se hubiere realizado antes o después del mes de vida. El tiempo mediano de seguimiento fue de 5,8 años (0,5-12,3) por paciente. Resultados: De los 51 pacientes, 20 presentaban alguna malformación cardiaca asociada. Tras el procedimiento la media de los gradientes pico-pico descendió de 60 ± 18 a 25 ± 13 mmHg. Evolutivamente, la valvuloplastia inicial fue suficiente en 24 (47%) enfermos, en 12 (23,5%) pacientes se requirió revalvuloplastia por reestenosis a un tiempo mediano de 0,61 años (0,3-3,2), y en 13 (25%) se indicó cirugía a un tiempo medio de 1,62 años (0,4-10,9); en dos casos (4%) se perdió el seguimiento. Las variables: grupo neonatal, patrón diastólico restrictivo, z-score del diámetro telediastólico ventricular izquierdo < -2,5, gradiente hemodinámico pico-pico > 60 mmHg, se asociaron a necesidad de cirugía (p < 0,05) en el seguimiento. No se encontraron factores asociados a revalvuloplastia. Conclusiones:La valvuloplastia aórtica pediátrica es una opción terapéutica paliativa eficaz. En este estudio las variables descritas anteriormente se asociaron a necesidad de cirugía.

Introduction and objective: Balloon aortic valvuloplasty is regarded as a good palliative option for congenital aortic stenosis in children. Our main objective was to review the results of all consecutives balloon aortic valvuloplasties performed in children over a native valve from march 1994 until June 2013, trying to identify those variables associated with need of reintervention during follow-up. Methods: We studied the echocardiographic, clinical and evolutionary features of 51 pediatric patients who underwent a balloon aortic valvuloplasty. Two groups were recognized: neonatal (n = 11) and pediatric (n = 40) patients depending on whether valvuloplasty was performed before or after the first month of life. Median follow-up was 5.8 years (0.5-12,3). Results: There were 37 boys and 14 girls, and 20 patients had some additional cardiac malformation. The average peak to peak hemodynamic gradient fell from 60 ± 18 a 25 ± 13 mmHg. During follow-up, 12 patients needed a second valvuloplasty for reestenosis (23.5%) at 0.61 years (0.3-3.2) and 13 others needed surgery (25%) at 1.62 years (0.4-10.9); 2 cases (4%) had no follow-up. The variables neonatal group, echocardiographic restrictive diastolic pattern, z-score of end-diastolic left ventricle diameter < -2.5, and peak to peak hemodynamic gradient > 60 mmHg were associated with need of surgery during follow-up (p < 0.05). However, we did not find factors associated with repeated valvuloplasty. Conclusions: Balloon aortic valvuloplasty in children is an effective option for palliative treatment of congenital aortic stenosis. In this study the variables previously described were predictors of the need of surgery.