RESUMO
A few case reports and case series have documented the outcomes in patients with tricuspid bioprosthetic valvular degeneration who underwent transcatheter implantation of the Medtronic Melody and the Edwards Sapien XT and Sapien 3 valves. In this report, we describe the case of a 49-year-old woman with severe bioprosthetic tricuspid valvular stenosis and multiple comorbidities who underwent transcatheter tricuspid valve replacement with a Sapien 3 valve.
Assuntos
Bioprótese , Cateterismo Cardíaco/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Falha de Prótese , Insuficiência da Valva Tricúspide/cirurgia , Estenose da Valva Tricúspide/cirurgia , Valva Tricúspide/cirurgia , Ecocardiografia Doppler em Cores , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Valva Tricúspide/fisiopatologia , Insuficiência da Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/fisiopatologia , Estenose da Valva Tricúspide/diagnóstico por imagem , Estenose da Valva Tricúspide/etiologia , Estenose da Valva Tricúspide/fisiopatologiaRESUMO
Carcinoid heart disease presents as right-sided heart failure attributable to the dysfunction of the tricuspid and pulmonary valves. Although surgical valve replacement is the mainstay of treatment when patients become symptomatic, it is associated with substantial perioperative mortality rates. We present a case of severe pulmonary valve stenosis secondary to carcinoid heart disease, treated successfully with percutaneous valve replacement. A 67-year-old man with severe pulmonary valve stenosis was referred to our center for pulmonary valve replacement. The patient had a history of metastatic neuroendocrine tumor of the small bowel with carcinoid syndrome, carcinoid heart disease, and tricuspid valve regurgitation previously treated with surgical valve replacement. Because of the patient's severe chronic obstructive pulmonary disease and hostile chest anatomy seen on a computed tomographic scan dating from previous cardiothoracic surgery, we considered off-label percutaneous valve replacement a viable alternative to open-heart surgery. A 29-mm Edwards Sapien XT valve was successfully deployed over the native pulmonary valve. There were no adverse sequelae after the procedure, and the patient was discharged from the hospital the next day. This case report shows that percutaneous valve replacement can be a valid option in carcinoid heart disease patients who are not amenable to surgical valve replacement.
Assuntos
Doença Cardíaca Carcinoide/complicações , Cateterismo Cardíaco/métodos , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Idoso , Doença Cardíaca Carcinoide/diagnóstico por imagem , Cateterismo Cardíaco/instrumentação , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/instrumentação , Humanos , Masculino , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/diagnóstico por imagem , Estenose da Valva Pulmonar/etiologia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The use of subcutaneous implantable cardioverter-defibrillators is a novel option for preventing arrhythmia-mediated cardiac death in patients who are at risk of endovascular-device infection or in whom venous access is difficult. However, the potential for electromagnetic interference between subcutaneous defibrillators and left ventricular assist devices is largely unknown. We report the case of a 24-year-old man in whom we observed no electromagnetic interference between a subcutaneous implanted cardioverter-defibrillator and a HeartMate II Left Ventricular Assist System, at 3 different pump speeds. To our knowledge, this is the first report of such findings in this circumstance.
Assuntos
Desfibriladores Implantáveis , Coração Auxiliar , Miocardite/terapia , Taquicardia Atrial Ectópica/prevenção & controle , Eletrocardiografia , Fenômenos Eletromagnéticos , Desenho de Equipamento , Seguimentos , Humanos , Masculino , Miocardite/complicações , Miocardite/fisiopatologia , Taquicardia Atrial Ectópica/etiologia , Taquicardia Atrial Ectópica/fisiopatologia , Adulto JovemRESUMO
Electrophysiologic procedures in the young engender concern about the potential long-term effects of radiation exposure. This concern is manifold if such procedures are contemplated during pregnancy. Catheter ablations in pregnancy are indicated only in the presence of an unstable tachycardia that cannot be controlled by antiarrhythmic agents. This report describes the case of an 18-year-old pregnant woman and our stratagem to minimize irradiation of the mother and the fetus.