Implante de válvula aórtica percutánea por acceso transcarotídeo: reporte del primer caso realizado en Chile / Percutaneous aortic valve replacement by trans-carotid approach: First case in Chile

La indicación en el implante de la válvula aortica percutánea (TAVI) se ha incrementado considerablemente en los últimos años, utilizando de preferencia el acceso transfemoral (TF), sin embargo, no queda claro cual debería ser la 2 vía de preferencia ante contraindicaciones a esta última. Presentamos un paciente de 81 años con alto riesgo quirúrgico en quien luego de discusión con heart team se decidió realizar TAVI y posterior a la identificación de obstrucción de la luz aortica descendente de 50%, se decidido realizar acceso transcarotideo izquierdo. Numerosos abordajes alternativos a la vía TF han sido descriptos en los últimos años. La vía transcarotidea ha sido la de mejores resultados en distintas revisiones clínicas y la que se ha presentado como 2° alternativa a la TF en algoritmos establecidos. Reportamos el primer implante de TAVI por vía transcarotidea en el hospital las Higueras, Chile.

The indication for percutaneous aortic valve implantation (TAVI) has increased considerably in recent years, preferably using transfemoral access (TF); however, it is not clear which should be the preferred access in the event of contraindications to the latter. We present an 81-year-old patient with high surgical risk in whom a 50% obstruction of the descending aortic lumen was identified and so, a left transcarotid access was chosen. Numerous alternative approaches to the TF approach have been described in recent years. The transcarotid approach has been the one with the best results in different clinical reviews and the one that has been presented as the second alternative to TF in established algorithms. We report the first transcarotid TAVI implantation in Las Higueras Hospital, Talcahuano, Chile.

Estrategia fármaco-invasiva en el manejo del infarto agudo al miocardio con supradesnivel del ST / Pharmaco-invasive approach in the management of acute myocardial infarction. Analysis of 144 cases

BACKGROUND: In those patients who do not have timely access to primary angioplasty, the pharmaco-invasive approach, that is, the use of thrombolysis as a bridging measure prior to the coronary angiography, is a safe alternative. AIM: To describe the features of patients with an acute ST-elevation myocardial infarction (STEMI) treated with a pharmaco-invasive strategy. MATERIAL AND METHODS: Descriptive observational study of 144 patients with mean age of 46 years with STEMI who received a dose of thrombolytic prior to their referral for primary angioplasty at a public hospital between 2018 and 2021. RESULTS: There were no differences the clinical presentation according to the Killip score at admission between thrombolyzed and non-thrombolyzed patients (p = ns). Fifty-three percent of non-thrombolyzed patients were admitted with an occluded vessel (TIMI 0) compared with 27% of thrombolyzed patients (p < 0.001). The thrombolyzed group required significantly less use of thromboaspiration (3.5 and 8.4% respectively; p = 0.014). Despite this, 91 and 92% of non-thrombolyzed and thrombolyzed patients achieved a post-angioplasty TIMI 3 flow. Long-term survival was 91 and 86% in thrombolyzed and non-thrombolyzed patients, respectively (p = ns). CONCLUSIONS: The pharmaco-invasive strategy is a safe alternative when compared to primary angioplasty in centers that don't have timely access to Interventional Cardiology.

Implante de válvula aórtica percutánea con técnica de sedación consciente / Transfemoral transcatheter aortic valve implantation under conscious sedation: experience in 15 patients

Background: Transfemoral transcatheter aortic valve implantation (TAVI) is the standard of treatment for patients with symptomatic severe aortic stenosis (AE) and intermediate or high surgical risk. The use of conscious sedation (CS) could reduce complications and allow an early discharge of these patients. Aim: To report our experience with TAVI under conscious sedation. Material and Methods: Review of medical records of 15 patients aged 79 ± 6 years (53% women) undergoing a transfemoral TAVI implant under conscious sedation. Results: The indications for the procedure were severe AE in 13 patients and biological prosthetic dysfunction in two. The mean Thoracic Surgeons predicted risk of mortality score was 7.3. The valves used were Edwards Sapien 3 in three patients, Medtronic Evolut in five, Boston Acurate Neo in four and Meril Myval in three. A successful implant was achieved in all cases and there were no hospital mortality or pacemaker requirements. One patient had a stroke, and one patient had a vascular access complication. Early discharge (< 72 h) was achieved in 80% of patients. Conclusions: TAVI under conscious sedation was a safe procedure and associated with a complication rate similar to previous reports, allowing for an early hospital discharge in most patients.

Implante de válvula aórtica percutánea en paciente con prótesis mitral previa: riesgos y consideraciones técnicas / Successful deployment of a percutaneous aortic valve in a patient with a mitral prosthesis: risks and technical considerations

The deployment of a percutaneous aortic valve is challenging in patients with a mitral prosthesis. The risk of prosthetic deformation, embolization or dysfunction is higher in this group of patients, which requires a series of technical considerations. We report a successful implantation of an Evolut Pro # 29 self-expanding valve in a 67-year-old female with a previous Starr-Edwards caged-ball mitral prosthesis.

ECMELLA: Uso combinado de dispositivos de asistencia ventricular izquierda en el manejo del shock cardiogénico postinfarto agudo al miocardio / Combined use of left ventricular assist devices in cardiogenic shock. Report of one case

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.

Efecto del tratamiento prolongado con metformina sobre la densidad mineral ósea en las mujeres postmenopáusicas con diabetes tipo 2 / Effect of long term metformin treatment on bone mineral density in postmenopausal women with type 2 diabetes

The aim of this study was to determine whether there is a relationship between prolonged use of metformine on bone mineral density, comparing a group of patients receiving prolonged treatment with metformine and a control group with similar characteristics biodemographic. Material and Methods: A case-control study was conducted in a population of 225 postmenopausal women between 51 and 62 years of age, were divided into 2 groups, one of type 2 diabetic patients treated with 1,000-2,000 mg. of metformine for at least 5 years (n = 75) and they had an acceptable metabolic control (HbA1c < 7.5 percent), and a control group of non diabetic women (n = 150). BMD at the lumbar spine (L1-L4) and both hips were measured with DEXA. Results: The group of type 2 diabetes treated with metfornine was associated with a significantly increased bone mineral density at the lumbar spine compared with the control group (L1-L4 g/cm2 1.07 +/- 0.15 vs 0.16 +/- 0.975) (L1-L4 T score-0.68 +/- 1.06 vs -1.73 +/- 1,07) (p = 0.05).Conclusion: Prolonged therapy metformine could have an effect on the preservation of bone mineral density at the lumbar spine in women with diabetes type 2, suggesting an effect of metfornine osteoprotective in trabecular bone.

Osteopoiquilia: comunicación de un caso clínico / Osteopoikilosis: report of one case

Osteopoikilosis is an infrequent sclerotic bone dysplasia with discrete spherical areas of increased bone density. It has an autosomal, dominant inheritance with variable penetrance. It a diagnosed by the observation of characteristic images on x-ray films. Despite its lack of pathological importance, it must be distinguished from osteoblastic bone metastases, tuberose sclerosis, mastocytosis or sarcoidosis. We report a 23 years old male who presented a right ankle sprain. X-ray films showed important lesions in the trabecular bone of the tarsus, metatarsus and phalanges, as numerous small foci of osteosclerosis. The study was complemented with a pelvis, femur and a hand radiological study with similar findings. These findings led to the diagnosis of osteopoikilosis. Among his family members, x-ray films showed that the mother also carried the disease.