RESUMEN
We present a 70-year-old man with rheumatic mitral valve disease who had undergone 3 previous open-heart surgeries, the last of which was a new mitral valve replacement for a mechanical prosthesis due to early bioprosthetic endocarditis.
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Implantación de Prótesis de Válvulas Cardíacas , Válvula Mitral , Humanos , Masculino , Anciano , Válvula Mitral/cirugía , Válvula Mitral/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/etiología , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/terapia , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/etiología , Infecciones Relacionadas con Prótesis/terapia , Bioprótesis/efectos adversos , Cardiopatía Reumática/cirugía , Cardiopatía Reumática/diagnóstico , Resultado del Tratamiento , Endocarditis/diagnóstico , Endocarditis/etiología , Endocarditis/cirugía , Reoperación/métodos , Ecocardiografía Transesofágica/métodos , Insuficiencia de la Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/diagnósticoRESUMEN
Background: Germ cell tumours (GCT) are the most common malignancy affecting young adult men. The introduction of cisplatin-based chemotherapy in recent decades has significantly changed the prognosis of these malignant tumours into highly curable cancer, even in the setting of advanced disease. However, in the last decade, the success of these chemotherapy regimens in curing GCTs has been slowed by a growing recognition of their important late toxicities, such as cardiovascular disease. Case summary: We present the case of a 23-year-old male, recently diagnosed with a mixed non-seminomatous testicular germinal tumour, on stage IIIA (pT3 cN2 cM1a), with retroperitoneal adenopathies and pulmonary metastases. After performing a right inguinal orchiectomy, he started chemotherapy treatment with cisplatin + etoposide. Shortly after starting treatment, the patient presented an ST-elevation acute coronary syndrome. The cardiac catheterization revealed a non-occlusive thrombus in the middle segment of the right coronary artery. Intracoronary imaging techniques were used to study the arterial wall, which revealed the presence of atherosclerotic plaque that could have ruptured, with the consequent response of platelet aggregation and thrombus formation. Barely 7 months after this event, the patient was again admitted to hospital for pulmonary thromboembolism with pulmonary infarction. Discussion: To date, there are two hypotheses linking the association between cisplatin-based chemotherapy and cardiovascular disease. The direct hypothesis argues for the presence of direct chemotherapy-induced vascular damage. The indirect hypothesis, on the other hand, is based on the induction and development of cardiovascular risk factors by chemotherapy. This cardiovascular toxicity of chemotherapy is aggravated by a cancer-induced proinflammatory and prothrombotic state.
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INTRODUCTION AND OBJECTIVES: This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022. METHODS: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC. RESULTS: A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease. CONCLUSIONS: The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease.
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Cardiología , Enfermedad de la Arteria Coronaria , Intervención Coronaria Percutánea , Humanos , Cateterismo Cardíaco , Sistema de RegistrosRESUMEN
BACKGROUND: The objective of this study was to assess regional and ethnic differences in an unselected patient population treated with polymer-free sirolimus-eluting stents (PF-SES) in Asia and Europe. METHODS: Two all-comers observational studies based on the same protocol (ClinicalTrials.gov Identifiers: NCT02629575 and NCT02905214) were combined for data analysis to assure sufficient statistical power. The primary endpoint was the accumulated target lesion revascularization (TLR) rate at 9-12 months. RESULTS: Of the total population of 7243 patients, 44.0% (3186) were recruited in the Mediterranean region and 32.0% (2317) in central Europe. The most prominent Asian region was South Korea (17.6%, 1274) followed by Malaysia (5.7%, 413). Major cardiovascular risk factors varied significantly across regions. The overall rates for accumulated TLR and MACE were low with 2.2% (140/6374) and 4.4% (279/6374), respectively. In ACS patients, there were no differences in terms of MACE, TLR, MI and accumulated mortality between the investigated regions. Moreover, dual antiplatelet therapy (DAPT) regimens were substantially longer in Asian countries even in patients with stable coronary artery disease as compared to those in Europe. CONCLUSIONS: PF-SES angioplasty is associated with low clinical event rates in all regions. Further reductions in clinical event rates seem to be associated with longer DAPT regimens.
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Enfermedad de la Arteria Coronaria/terapia , Stents Liberadores de Fármacos , Etnicidad/estadística & datos numéricos , Inmunosupresores/uso terapéutico , Infarto del Miocardio/prevención & control , Intervención Coronaria Percutánea/métodos , Sirolimus/uso terapéutico , Anciano , Europa (Continente)/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Malasia/epidemiología , Masculino , Región Mediterránea/epidemiología , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Polímeros , Pronóstico , Estudios Prospectivos , República de Corea/epidemiologíaRESUMEN
AIMS: The aim of the study was to assess the safety and efficacy of percutaneous closure of paravalvular prosthetic leak (PVL) and to identify the predictors of procedural success and early complications. METHODS AND RESULTS: A total of 514 first-attempt percutaneous PVL closure in 469 patients were included at 19 centres. Technical and procedural success was achieved in 86.6% and 73.2% of the patients, respectively. In multivariate analysis, the independent predictors for procedural success in mitral lesions were the type of device used (AMPLATZER AVP III vs. others, HR 2.68 [1.29-5.54], p=0.008) and the number of procedures performed at the centre (top quartile vs. others, HR 1.93 [1.051-3.53], p=0.03). For aortic leaks the only predictor of procedural success was the leak size (≥10 mm vs. <10 mm, HR 3.077 [1.13-8.33], p=0.027). The overall major adverse events rate (death or emergency surgery or stroke) at 30 days was 5.6%; the only predictor for combined adverse events was New York Heart Association functional Class IV (HR 4.2 [1.42-12.34], p=0.009). CONCLUSIONS: Percutaneous closure of PVL can be performed with a reasonable rate of procedural success and a low rate of major complications. The type of device used, the accumulated experience and the leak size are predictors of procedural success.
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Cateterismo Cardíaco/instrumentación , Prótesis Valvulares Cardíacas , Insuficiencia de la Válvula Mitral/cirugía , Complicaciones Posoperatorias , Sistema de Registros , Dispositivo Oclusor Septal , Anciano , Anciano de 80 o más Años , Ecocardiografía Tridimensional/métodos , Femenino , Prótesis Valvulares Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Dispositivo Oclusor Septal/efectos adversos , Resultado del TratamientoRESUMEN
UNLABELLED: Percutaneous intervention of a coronary graft is the treatment of choice when the graft fails. The objective is to report the long-term results of drug-eluting stents (DES) in mammary artery grafts (MAG). Patients who had been treated with DES for MAG in 27 centers were selected. The baseline and procedural clinical data were included prospectively, and the follow-up was performed with the patients, families, and medical records. Two hundred and sixty-eight patients were included: age 65.5 ± 10.1 years, diabetes 47.8%, ejection fraction 55.5 ± 14.9%. INDICATION: stable angina 28.4%, unstable angina 38.1%, non-ST-elevation myocardial infarction 21.6%, ST-elevation myocardial infarction 5.3%, and heart failure 6.7%; 1.19 ± 0.59 stents/patient were implanted measuring 18.8 ± 8.8 mm in length and 2.68 ± 0.35 mm in diameter. Rapamycin was used in 78 cases (29.1%), paclitaxel in 77 (28.7%), everolimus in 70 (26.1%), zotarolimus in 34 (12.7%), and biolimus in 9 (3.4%). All cases were successful except for 1 in which the patient died 30 minutes after the procedure. There were no other inhospital events. After a follow-up of 41 months (Q25: 23.7 to Q75: 57.8), 24 patients (9%) died of heart-related causes and 20 (7.5%) of noncardiac causes. Repeat revascularization was necessary in 31 cases, and in 1 additional patient, there was total occlusion, which was not treated. These 32 patients represented 11.9% of the total. In conclusion, the implantation of DES in MAG shows very high procedural success and also low long-term event rates.
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Stents Liberadores de Fármacos , Inmunosupresores/administración & dosificación , Anastomosis Interna Mamario-Coronaria , Anciano , Everolimus/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Paclitaxel/administración & dosificación , Sirolimus/administración & dosificación , Sirolimus/análogos & derivados , Resultado del TratamientoRESUMEN
No disponible
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Humanos , Coartación Aórtica/cirugía , Aneurisma de la Aorta/cirugía , Angioplastia de Balón/efectos adversos , Insuficiencia de la Válvula Aórtica/cirugía , Factores de Riesgo , Complicaciones PosoperatoriasAsunto(s)
Coartación Aórtica/cirugía , Stents , Adulto , Angiografía , Coartación Aórtica/complicaciones , Coartación Aórtica/diagnóstico por imagen , Válvula Aórtica/anomalías , Enfermedad de la Válvula Aórtica Bicúspide , Cardiomiopatía Dilatada/complicaciones , Femenino , Enfermedades de las Válvulas Cardíacas/complicaciones , Humanos , Hipertensión/complicaciones , Masculino , Persona de Mediana EdadRESUMEN
No disponible
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Coartación Aórtica/cirugía , Stents , Hipertensión/complicaciones , Procedimientos Endovasculares/métodos , Grado de Desobstrucción Vascular/fisiologíaRESUMEN
No disponible
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Humanos , Masculino , Anciano , Intervención Coronaria Percutánea/métodos , Estenosis de la Válvula Aórtica/cirugía , Coartación Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Coartación Aórtica/diagnóstico por imagen , Stents , ComorbilidadAsunto(s)
Procedimientos Quirúrgicos Cardíacos/efectos adversos , Electrodos Implantados/efectos adversos , Cardiopatías Congénitas/cirugía , Marcapaso Artificial , Síndrome de la Vena Cava Superior/etiología , Síndrome de la Vena Cava Superior/cirugía , Anciano , Angioplastia Coronaria con Balón , Angiografía Coronaria , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
No disponible