Transradial Secondary Approach During Transfemoral TAVI: Usefulness of Placing a Wire Before Femoral Puncture for Management and Treatment of Vascular Complications.

Vascular complications during transcatheter aortic valve implantation (TAVI) are relatively common, and some of them related to the transfemoral secondary access. The use of the transradial access (TRA) as an alternative vascular approach for transfemoral TAVI could reduce these complications, however, the treatment of potential vascular peripheral issues from this access has been scarcely described. The advance of a wire from the TRA to the primary transfemoral access at the beginning of the procedure could help the management of eventual vascular complications. A new TRA technique during transfemoral TAVI procedures is described, reporting the results in the first forty-two patients in one center.

Local Intracoronary Fibrinolysis in Acute Myocardial Infarction of Ectatic Coronary Arteries in the Post-Abciximab Era.

Percutaneous intervention in the context of coronary artery ectasia (CAE) is penalized with no-reflow phenomenon. The glycoprotein-IIb/IIIa-inhibitor abciximab was the most accepted method for pharmacology thrombus resolution in this scenario, nevertheless, this agent was recently withdrawn. We describe 5 patients treated with local intracoronary fibrinolysis administrated through predesigned catheters in the setting of AMI and CAE.

Percutaneous Closure of Mitral Paravalvular Leaks Generating Refractory Heart Failure in the Immediate Postoperative Period.

We present two patients with refractory heart failure due to mitral paravalvular leak (PVL) in whom percutaneous PVL closure was performed in the immediate postoperative period.

Left Bundle Branch Block after Transcatheter Aortic Valve Implantation with Edwards Sapien 3 Valve: Influence of the Valve Depth Implantation.

OBJECTIVES: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis. BACKGROUND: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3. METHODS: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed. RESULTS: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8). CONCLUSIONS: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS.

Percutaneous Closure of a Femoral Arteriovenous Fistula During Transfemoral TAVI.

Percutaneous AVF closure was performed post TAVI in a patient with severe aortic stenosis and an AVF between the right SFA and femoral vein.

Outcomes of patients at estimated low surgical risk undergoing transcatheter aortic valve implantation with balloon-expandable prostheses.

INTRODUCTION AND OBJECTIVES: Transcatheter aortic-valve implantation (TAVI) is an accepted treatment for patients with severe aortic stenosis and high surgical risk. However, there is lack in data about TAVI in low-risk patients that are already being treated with this therapy in some clinical contexts. METHODS: A retrospective analysis of patients treated with transfemoral TAVI using Edwards Sapien prosthesis in one center was performed, classifying the patients into three groups according to the surgical risk (high/intermediate/low risk for STS score>8/4-8/<4). Clinical characteristics, procedure and follow-up outcomes were collected, comparing the results between low and high surgical risk groups. RESULTS: 89 TAVIs using Edwards balloon expandable prosthesis were performed (9 Sapien XT and 80 Sapien 3 valves were implanted). 40 patients (45%) presented a STS score<4, while 33 (37%) had a STS>8. Low-risk patients were significantly younger and had lower rates of coronary artery disease, peripheral vascular disease, pulmonary lung disease and atrial fibrillation. There were no significant differences in most of the technical variables of the procedure, apart from vascular complications and complete left bundle branch block after valve implant, which were higher in the group with STS>8. Patients of low risk presented shorter hospital stay (2,91±1,6, vs 4,8±3,9 days), with lower rates of mortality at mid- and long follow-up (death from any cause 15,2% vs 0%, p 0,04). CONCLUSIONS: TAVI in low-risk patients is safe and associated with better outcome at mid and long-term follow-up compared to high-risk patients.

Percutaneous closure of a giant coronary artery fistula after surgical pericardiectomy. Review of the literature.

Coronary artery fistulae (CAF) are uncommon heart defects defined as a communication between a coronary artery and a cardiac chamber or vascular structure. They are frequently asymptomatic; nevertheless, they can produce angina, dyspnea or cardiac failure. CAF are believed to be congenital; however, isolated cases of CAF have been described as rare complications of cardiac surgery. We report the percutaneous closure of a giant CAF in an adult patient with angina and previous pericardiectomy.

Recording of high V1-V3 precordial leads may be essential to the diagnosis of Brugada syndrome during the ajmaline test.

Sodium channel-blocking agents are routinely used to unveil the Brugada syndrome in patients in whom the typical electrocardiographic pattern is absent or doubtful. In this article, the authors report a patient with syncopal episodes of unknown origin in whom the conventional electrocardiographic result was normal and a negligibly small "saddle back" type repolarization was present in lead V2 recorded 2 intercostal spaces above the conventional site. Intravenous ajmaline (50 mg) did not elicit the type 1 pattern of the Brugada syndrome in the precordial leads obtained at their usual level, but a clear-cut coved-type repolarization was apparent in high right precordial leads. These findings indicate that high precordial leads should be routinely recorded while assessing the ajmaline test in patients suspected of having the Brugada syndrome.

Treating Refractory Hypertension: Renal Denervation With High-Resolution 3D-Angiography.

A 53-year-old male was referred to our Department for refractory primary hypertension. Despite high doses of 6 anti-hypertensive drugs, ambulatory monitoring of blood pressure (BP) revealed a mean BP of 160/90 mmHg. Under local anaesthesia, renal denervation with radiofrequency was performed supported by high-resolution 3D angiography, which helped confirm the position of the applications in a spiroid fashion.

Implante percutáneo transfemoral de válvula aórtica en pacientes con enfermedad arterial periférica / Transcatheter aortic valve implantation in patients with arterial peripheral vascular disease

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Experiencia inicial con la válvula aórtica percutánea de muy bajo perfil SAPIEN 3 / Initial experience with the low-profile percutaneous aortic valve SAPIEN 3

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Bloqueo AV de alto grado transitorio por compromiso nodal y acción vagal en un deportista. ¿Es necesaria la electroestimulación cardíaca permamente? / Transient high degree AV blockade due to node engagement and vagal tone in an athlete. Is permanent cardiac electric stimulation necessary?

Un deportista de 26 años, asintomático, fue evaluado por bloqueo AV de larga data con pausas nocturnas de hasta 4,7 segundos. El estudio electrofisiológico mostró bloqueo AV suprahisiano de segundo grado tipo Mobitz I con prueba de ajmalina negativa. En el ECG Holter, el mayor grado de bloqueo AV coincidió con la frecuencia sinusal más baja. El hallazgo se interpretó como lesión crónica nodal AV, de etiología indeterminada, con paroxismos de bloqueo AV por acción vagal. No se indicó electroestimulación cardíaca permanente y se le permitió continuar con actividad física.