Intra-pericardial thrombin injection in iatrogenic cardiac tamponade: a case report.

BACKGROUND: Nowadays, percutaneous procedures are expanding in use, and this comes with complications associated with the procedure itself. Cardiac tamponade is rare but may be life threatening since it can involve hemodynamic instability. It is known that after pleural effusion during a percutaneous procedure, pericardiocentesis should be used as drainage of the cavity. However, that does not achieve hemostasis in some cases, and in those patients who are hemodynamically unstable, a sealing agent to promote hemostasis might be useful, like thrombin. CASE PRESENTATION: We present a case report of 89-year-old patient with history of melanoma undergoing treatment with pembrolizumab, who attended the emergency department referring chest pain (intensity 5/10) and palpitations that have lasted hours. He had TnTUs 554/566 ng/L and an echocardiogram that showed dilated right chambers, hypertrophy and global hypokinesia of the left ventricle, increased filling pressures of the left ventricle and pulmonary hypertension. Myocarditis associated with pembrolizumab was suspected, so high dose steroids were initiated and endomyocardial biopsy was conducted, resulting in iatrogenic cardiac tamponade. To determine the etiology of the suspected myocarditis, an endomyocardial biopsy was performed. Unfortunately, an intraprocedural complication arose: pleural effusion resulting in iatrogenic cardiac tamponade, leading to hemodynamic instability. It required immediate pericardial drainage via subxiphoid puncture, obtaining a 550 mL hematic debit. Clinical manifestations raised suspicion of tamponade, prompting a bedside echocardiogram for a definitive diagnosis. Despite these efforts, the patient remained hemodynamically unstable, and due to the elevated surgical risk, intrapericardial thrombin was employed to achieve successful hemostasis. CONCLUSIONS: Cardiac tamponade is a life-threatening condition that can sometimes be induced iatrogenically, resulting from percutaneous interventions. Despite limited evidence regarding this therapeutic strategy, in patients experiencing iatrogenic cardiac tamponade with hemodynamic instability and high surgical risk, the administration of intra-pericardial thrombin could be contemplated.

Inteligência artificial na fisiologia coronária: onde estamos? / Artificial intelligence in coronary physiology: where do we stand?

O uso da fisiologia coronariana invasiva na seleção de indivíduos para revascularização coronariana foi estabelecido nas orientações atuais para manejo da doença arterial coronariana estável. Em comparação com a angiografia isolada, a fisiologia coronariana provou melhorar os resultados clínicos e a relação custo-efetividade no processo de revascularização. Ensaios controlados randomizados, no entanto, questionaram a eficácia do teste de isquemia na seleção de indivíduos para revascularização. Após uma intervenção coronária percutânea com sucesso angiográfico, 20 a 40% dos pacientes apresentaram angina persistente ou recorrente. A inteligência artificial é definida como o uso de vários algoritmos e conceitos computacionais para realizar tarefas complexas de maneira eficiente. Pode ser classificada em dois tipos: abordagens não supervisionadas e supervisionadas. O aprendizado supervisionado é usado principalmente nas tarefas de regressão e classificação, e nele é realizado um mapeamento otimizado entre variáveis de saída e entrada pareadas para executar as tarefas. Em contraste com isso, o aprendizado não supervisionado funciona de maneira diferente. Nesse aprendizado, os dados das variáveis de saída não estão disponíveis, e outros clusters e relações entre os dados de entrada são descobertos, usando-se vários algoritmos. Para se adquirir uma representação mais abstrata dos dados, a tecnologia de aprendizado profundo que utiliza as redes neurais multicamadas domina o aprendizado artificial atualmente.

The use of invasive coronary physiology to select individuals for coronary revascularization has been established in current guidelines for the management of stable coronary artery disease. Compared to angiography alone, coronary physiology has been proven to improve clinical outcomes and cost-effectiveness in the revascularization process. Randomized controlled trials, however, have questioned the efficacy of ischemia testing in selecting individuals for revascularization. After an angiographically successful percutaneous coronary intervention, 20 to 40% of patients experienced persistent or recurrent angina. Artificial intelligence is defined as the usage of various algorithms and computational concepts to perform the complex tasks in an efficient manner. It can be classified into two types: unsupervised and supervised approaches. Supervised learning is majorly used for the regression and classification tasks, and in this optimized mapping between output variables and paired input is carried out to perform the tasks. In contrast to this, unsupervised learning works in the different manner. In unsupervised learning, output variables data is not available and further clusters and relations between input data are found out by using the various algorithms. To acquire more abstract representation of data, deep learning technology, which uses the multilayer neural networks, dominates the artificial learning nowadays.

Successful Left Atrial Appendage Closure with Watchman Device Implantation in Two Patients with Inferior Vena Cava Filters

Percutaneous procedures through femoral access in patients with inferior vena cava (IVC) filter may be at risk of complications. We evaluated the feasibility and safety of left atrial appendage closure (LAAC) through femoral access in patients previously implanted with IVC filter. We described the WatchmanTM device implantation in two patients with formal contraindication for oral anticoagulation. First patient had a GreenfieldTM filter and the second one an OpteaseTM filter, and in this patient an attempt to withdrawal the filter immediately before the LAAC procedure failed. A femoral approach was performed in both patients using a 14 Fr sheath. Before crossing IVC filters, venographies did not detect any thrombus. All steps of IVC filter crossing were performed under fluoroscopic guidance. No immediate or intrahospital complications related to the procedure occurred. Herein, we presented two cases of successful LAAC closure with Watchman device in patients with two different kinds of IVC filters.

Percutaneous closure of ostium secundum atrial septal defect using left internal jugular vein access in a child with situs inversus and absence of inferior caval vein.

Femoral vein access is the first choice for percutaneous atrial septal defect closure, and when it cannot be used due to anatomic reasons, the alternative sites should be considered, frequently increasing the complexity of the procedure. Here we report the case of a 3-year-old boy, with situs inversus and dextrocardia, electively referred for percutaneous closure of an ostium secundum atrial septal defect. During the procedure, agenesis of the infra-hepatic segment of the inferior caval vein was diagnosed, and no double inferior caval vein or right superior caval vein were identified by ultrasound or angiography. Therefore, we opted to perform the procedure through the left internal jugular vein, with fluoroscopy and transesophageal echocardiographic guidance. Catheters were navigated through a hydrophilic guidewire, and a Stiff guidewire was positioned in the left ventricle for better support. An Amplatzer septa occluder 19 was successfully deployed without major difficulties and the patient was discharged after 24 hours in good clinical condition. Percutaneous atrial septal defect closure through alternative access sites, especially in the presence of situs inversus, may pose significant challenges to the interventional team. In this case, the left internal jugular vein has shown to be a feasible option, allowing the navigation and manipulation of devices without complications. Provided the expertise of the interventional team, and awareness of the risks involved, alternative access sites can be successfully used for paediatric structural interventions.

Prospective comparison between three TAVR devices: ACURATE neo vs. CoreValve vs. SAPIEN XT. A single heart team experience in patients with severe aortic stenosis.

OBJECTIVE: We sought to compare the new transcatheter aortic valve replacement (TAVR) device ACURATE neo (ACT) with the already established CoreValve (MCV) and SAPIEN XT (SXT) for the treatment of severe aortic stenosis (AS). BACKGROUND: Very few data on TAVR devices are available beyond MCV and SAPIEN and there is no previous study comparing ACT with MCV and SXT. METHODS: We prospectively evaluated consecutive patients who underwent transfemoral TAVR for the treatment of severe AS. Clinical outcomes were reported following Valve Academic Research Consortium 2 (VARC-2) criteria. RESULTS: A total of 162 patients (ACT n = 49, MCV n = 56, SXT n = 57), were included. MCV group had higher valve embolization/migration rates (ACT none; MCV 9%; SXT 2%; P = 0.034) causing lower device success rates (ACT 98%; MCV 86%; SXT 95%; P = 0.043). At 30 days, there was no significant difference in all-cause mortality (P = 0.22), cardiovascular mortality (P = 0.20), periprocedural myocardial infarction (P = 0.40), stroke (P = 0.64), major vascular complications (P = 0.48), life-threatening bleeding (P = 0.29), acute kidney injury stage 2/3 (P = 0.69), or VARC-2 composite early safety endpoints (P = 0.21). MCV group had higher rates of new permanent pacemaker implantation (ACT 6%; MCV 25%; SXT 11%; P = 0.013). Follow-up echocardiography showed no significant difference in aortic valve mean pressure gradient (P = 0.73) or moderate/severe aortic regurgitation (P = 0.19) between groups. CONCLUSIONS: In a "real world" registry, ACT compared favorably against the well-studied SXT and MCV devices in both safety and efficacy. MCV implantation was associated with lower device success rates and higher rates of new permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.

Long-term clinical follow-up of patients undergoing percutaneous alcohol septal reduction for symptomatic obstructive hypertrophic cardiomyopathy.

BACKGROUND: Alcohol septal ablation (ASA) is an alternative treatment for symptomatic hypertrophic obstructive cardiomyopathy (HOCM) patients refractory to pharmacological therapy. We sought to evaluate the immediate and long-term incidence of death and changes in life quality in a consecutive cohort submitted to ASA. METHODS AND RESULTS: Between October 1998 and December 2013, a total of 56 patients (mean age 53.2 ± 15.5) with symptomatic refractory HOCM were treated with ASA and followed during 15 years (mean 8 ± 4 years). There were 7 (12.5%) deaths, 2 (3.6%) being of cardiac cause. The Kaplan-Meier survival probability estimate was 96.4% at 1 year, 87.7 at 5 years and 81.0% at 12 years post-ASA. Significant improvement was observed in life quality assessed by DASI index and NYHA functional class as well as in the left ventricle outflow tract (LVOT) gradient reduction (from 92.8 ± 3.3 mm Hg to 9.37 ± 6.7 mm Hg, P < 0.001) and septum thickness (from 23.9 ± 0.6 mm to 12.9 ± 1.0 mm, P < 0.001). Only one patient (1.7%) required permanent pacemaker immediately after ASA. During follow-up, one patient had a repeated ASA, three patients underwent myectomy and other four required ICD/pacemaker. In the multivariate model only post-ASA LVOT residual gradient and left ventricle mass were associated with worse prognosis. CONCLUSIONS: In this long-term clinical follow-up without losses, ASA was effective in improving quality of life and NYHA functional class, with relatively low mortality and very low need for immediate permanent pacemaker implantation. © 2016 Wiley Periodicals, Inc.

Outcomes and predictors of mortality after transcatheter aortic valve implantation: results of the Brazilian registry.

OBJECTIVE: The study sought to evaluate outcomes and predictors of mortality after transcatheter aortic valve implantation (TAVI). BACKGROUND: TAVI registries can reliably address outcomes and issues that adversely affect results in real-life. METHODS: All endpoints and complications were analyzed according to Valve Academic Research Consortium-2 criteria. RESULTS: Between January 2008 and January 2013, 418 patients underwent TAVI in 18 centers and were included in the Brazilian registry. The transfemoral approach was used in 96.2% of the procedures. The CoreValve and Sapien XT prosthesis were used in 360 (86.1%) and 58 (13.9%) cases, respectively. All-cause mortality at 30 days and 1 year were 9.1 and 21.5%. Chronic obstructive pulmonary disease (COPD) (HR: 3.50), acute kidney injury (AKI) (HR: 3.07), stroke (HR: 2.71) and moderate/severe paravalvular regurgitation (PVR) (HR: 2.76) emerged as independent predictors of overall mortality. COPD (OR: 3.00), major vascular complications (OR: 7.99) and device malpositioning (OR: 6.97) were predictors of early (≤30 days) mortality, while COPD (HR: 2.68), NYHA class III/IV (HR: 3.04), stroke (HR: 4.15), AKI (HR: 2.44) and moderate/severe PVR (HR: 3.20) impacted late (>30 days) mortality. The use of transesophageal echocardiogram (TEE) to monitor the procedure was found to be a protective factor against overall (HR: 0.57) and late (HR: 0.47) mortality. CONCLUSION: This multicenter registry reflected a real-life national TAVI experience. Comorbidities, periprocedural complications and moderate/severe PVR were associated with increased mortality and the use of TEE to monitor the procedure acted as a protective factor.

Bloqueo aurículoventricular de alto grado que complica el infarto de miocardio con elevación ST en la era de la intervención coronaria percutánea primaria

Resumen Finalidades: la intervención percutánea coronaria primaria (pPCI, por sus siglas en inglés) ha reemplazado la trombolisis como tratamiento de elección para el infarto de miocardo con elevación del segmento ST (STEMI por sus siglas en inglés). Sin embargo, la incidencia y la importancia pronóstica del bloqueo aurículoventricular de alto grado (BAV-AG) en pacientes con STEMI en la era de pPCI han sido poco estudiadas. El objetivo de este estudio fue evaluar la incidencia, los predictores y la importancia pronóstica of BAV-AG en pacientes con STEMI tratados con pPCI. Métodos y resultados: este estudio incluyó 2073 pacientes con STEMI tratado con pPCI. Los pacientes fueron identificados a través de un registro hospitalario y el Registro Nacional de Pacientes de Dinamarca. Ambos registros se usaron también para establecer el diagnóstico de BAV-AG. La mortalidad por todas las causas fue la variable evaluable primaria. Durante un seguimiento con una mediana de 2,9 años [rango del intercuartil (IQR): 1,8-4,0] fallecieron 266 pacientes. Se documentó bloqueo aurículoventricular de alto grado en 67 (3,2%) pacientes, 25 de los cuales murieron. Entre los predictores independientes importantes de presentar BAV-AG, se incluyeron la oclusión de la arteria coronaria derecha, edad >65 años, género femenino, hipertensión, y diabetes. La tasa de mortalidad ajustada aumentó significativamente en pacientes con BAV-AG comparado con pacientes sin BAV-AG [cociente de riesgos instantáneos » 3,14 (intervalo de confianza 95%: 2,04-4,84), P < 0,001]. Un análisis relevante 30 días después del STEMI mostró iguales tasas de mortalidad en los dos grupos. Conclusión: la incidencia de BAV-AG en pacientes con STEMI tratado con pPCI se ha reducido comparado con los informes de la era trombolítica. Sin embargo, a pesar de esta mejora, en la era de pPCI el bloqueo AV de alto grado sigue siendo un marcador pronóstico severo. La tasa de mortalidad solo aumentó dentro de los primeros 30 días. Los pacientes con bloqueo aurículoventricular de alto grado que sobrevivieron más allá de este punto temporal tuvieron así un pronóstico igual al de los pacientes sin BAV-AG

Summary Aims: Primary percutaneous coronary intervention (pPCI) has replaced thrombolysis as treatment-of-choice for ST-segment elevation myocardial infarction (STEMI). However, the incidence and prognostic significance of high-degree atrioventricular block (HAVB) in STEMI patients in the pPCI era has been only sparsely investigated. The objective of this study was to assess the incidence, predictors and prognostic significance of HAVB in STEMI patients treated with pPCI. Methods and results: This study included 2073 STEMI patients treated with pPCI. The patients were identified through a hospital register and the Danish National Patient Register. Both registers were also used to establish the diagnosis of HAVB. All-cause mortality was the primary endpoint. During a median follow-up of 2.9 years [interquartile range (IQR) 1.8-4.0] 266 patients died. High-degree atrioventricular block was documented in 67 (3.2%) patients of whom 25 died. Significant independent predictors of HAVB included right coronary artery occlusion, age .65 years, female gender, hypertension, and diabetes. The adjusted mortality rate was significantly increased in patients with HAVB compared to patients without HAVB [hazard ratio = 3.14 (95% confidence interval 2.04-4.84), P < 0.001]. A landmark-analysis 30 days post-STEMI showed equal mortality rates in the two groups. Conclusion: The incidence of HAVB in STEMI patients treated with pPCI has been reduced compared with reports from the thrombolytic era. However, despite this improvement high-degree AV block remains a severe prognostic marker in the pPCI era. The mortality rate was only increased within the first 30 days. High-degree atrioventricular block patients who survived beyond this time-point thus had a prognosis equal to patients without HAVB

Occlusion of the perimembranous ventricular septal defect using CERA devices

Background: High incidence of atrioventricular (AV) block has been the major limitationof percutaneous closure of perimembranous ventricular septal defect (PMVSD). Methods:Prospective, multicenter, nonrandomized study including 55 patients who weresubmitted to 56 procedures from March 2010 to November 2010. Inclusion criteriawere PMVSD with diameter 5 mm or if 5 mm with hemodynamic significance andage 1 year. Exclusion criteria were fixed pulmonary arterial hypertension and associatedcongenital heart disease needing surgical repair. Procedures were performedunder general anesthesia and monitored by transthoracic echocardiography (TTE). Thedevice choice was based on left ventricle (LV) angiography and on TTE images.PMVSDs were crossed by retrograde approach. Results: Mean age was 9.3 6 7.5years, and mean weight was 29.1 6 15.9 kg. Thirty-five (63.6%) patients were females.Mean pulmonary arterial mean pressure, mean LV diastolic diameter, and mean Qp/Qswere 24.0 6 6.5 mm Hg, 43.0 6 5.9 mm, and 2.2 6 0.8, respectively. Associated nonsurgicalmalformations were present in 9 (16.3%) patients, and PMVSDs were multifenestratedin 16 (46.2%) cases. Mean PMVSDs diameter was 5.8 6 1.8 mm by angiographyand 6.8 6 2.3 mm by TTE. New rhythm disturbance without clinical significance wasobserved in 29% of the patients and was reversible in 87.5%. After procedure, trivialresidual shunt was present in 5 (8.9%) patients and moderate residual shunt in other 5(8.9%). At late FU (mean of 298.7 6 88.9 days), 91% of the patients had no residualshunts. Third-degree AV block and severe aortic regurgitation occurred in one patienteach. Conclusions: In this experience, PMVSD closure with CERAVR devices showed tobe safe and effective with low incidence of complications at immediate and mid-termFU.

Terapia percutánea de la persistencia del conducto arterioso (PCA):12 años de registro en el CCR-ASCARDIO: 250 casos tratados / Endovascular treatment of persistent ductus arteriosus (PDA): 12 year of registry in CCRA-Ascardio: 250 cases treated

El cierre percutáneo ha aparecido como una alternativa en el tratamiento de la persistencia del conducto arterioso. Presentamos la experiencia en un único centro (Centro Cardiovascular Regional-ASCARDIO-Lara-Venezuela) en el cierre percutáneo de 250 pacientes portadores de la persistencia del conducto arterioso desde octubre 1998 a agosto 2010. La indicación de cierre fue persistencia del conducto arterioso con soplo, sobrecarga de volumen de cavidades izquierdas, sin o con HAP leve a moderada. Se utilizaron 4 tipos de dispositivos: 190 casos con 3 tipos de Amplatzer Duct Ocludder (Tipo 1: 183 casos, Tipo Angulado: 2 casos y Tipo 2: 5 casos), 2 casos con Gianturco coil, 35 casos con Flipper Coil y 23 casos con Duct/Nit-Oclud. En forma global la tasa de éxito de cierre fue 99,6% (249/250), siendo para los 3 dispositivos Amplatzer de 99,4% (189/190), 100% para dispositivo de Gianturco coil (2/2), 100% para dispositivo de Flipper coil (35/35) y 100% para dispositivos Duct/Nit-oclud (23/23), sin shunt residual a las 24 h en 98,8% (247/250) de los casos. Hubo una embolizaciónde dispositivo de Amplatzer tipo 1(1/250=0,4%) que ameritó cirugía y tasa general de complicaciones (menores) fue por debajo del 1% (0,8%), con cero mortalidad. El cierre percutáneo de la persistencia del conducto arterioso ha resultado ser una técnica segura y eficaz con morbilidad mínima y mortalidad cero, en el CCR-Ascardio.

Percutaneous closure has been a new alternative of treatment of persistent ductus arteriosus (PDA). We present our experience in a only Center (Regional Cardiovascular Center-ASCARDIO-Lara-Venezuela) with percutaneous closure in 250 patients with this congenital pathology (isolated persistent ductus arteriosus) since October 1998 until August 2010. Indication for percutaneous closure was all persistent ductus arteriosus with murmur, Diastolic overload of left cavities, without or mild to moderate Pulmonary Hypertension. Four type of devices were used: 190 cases with three types of Amplatzer Duct Ocludder (Type 1: 183 cases, Type angulated or asymmetric: 2 cases and Type 2: 5 cases), Gianturco coil in 2 cases, Flipper coil in 35 cases and Duct/Nit Oclud were used in 23 cases. Overall successful closure rate was 99.6% (249/250), with no 24 hours residual shunt residual in 98.8% (247/250) of cases. According with three types of amplatzer devices, successful closure rate were 99.4% (189/190), 100% for Gianturco coil 2/2, 100% for Flipper Coil (35/35) and 100% for Duct/Nit Oclud (23/23). There was one embolization of amplatzer device type 1(1/250=0.4%) and patient was sent for surgery, and minor complications was less than 1% (0,8%) with no mortality. We can conclude that percutaneous closure of persistent ductus arteriosus is a very safe and secure technique with very low minor complications and with no mortality.

Os stents farmacológicos são seguros e eficazes em longo prazo? / Are drug-eluting stents safe and effective in the long term? / ¿Los stents farmacológicos son seguros y eficaces a largo plazo?

A introdução de stents farmacológicos em 2002 revolucionou a cardiologia invasiva através da redução de reestenoses. No final de 2006 surgiram relatos de aumento da incidência de trombose tardia de stent com esses stents em comparação com os de metal sem revestimento, provavelmente em decorrência do atraso de endotelização. No entanto, esses estudos continham sérias falhas metodológicas. Meta-análises posteriores mostraram de forma clara um risco apenas discretamente aumentado de trombose tardia de stent entre todos os grupos de pacientes. Um achado importante foi o de que os stents farmacológicos proporcionaram benefício significativo e mantido devido à redução de reestenose e, portanto, de revascularização de repetição. Vários registros obtidos na prática clínica confirmaram esses resultados e sugeriram que o uso de stents farmacológicos em situações mais complexas não está associado a resultados desfavoráveis. A trombose de stent é um problema multifatorial no qual o stent é apenas um dos elementos. Novos estudos serão necessários para determinar a técnica para o procedimento e o esquema antiplaquetário ideais. Os stents farmacológicos são seguros e eficazes em longo prazo, embora estudos intensivos continuem sendo realizados com o propósito de reduzir o risco de trombose de stent na próxima geração.

The introduction of drug-eluting stents in 2002 revolutionized interventional cardiology by minimizing restenosis. Reports of increased late stent thrombosis with these stents compared with bare metal stents, probably due to delayed endothelialization, emerged late in 2006. These studies contained serious methodological flaws, however. Subsequent meta-analyses clearly showed only a small incremental risk of late stent thrombosis across all patient groups. Importantly, a significant and sustained benefit of drug-eluting stents due to reduced restenosis and thus repeat revascularization was also shown. Several 'real-world' registries have confirmed these results and suggested that the use of these stents in more complex situations is not associated with adverse outcomes. Stent thrombosis is a multifactorial problem, in which the stent is only one element. Further research is required to determine optimal procedural technique and antiplatelet regimens. Drug-eluting stents are safe and effective in the long-term, though intensive research continues into ways to reduce the risk of stent thrombosis in the next generation.

La introducción de stents farmacológicos en 2002 revolucionó la cardiología invasiva a través de la reducción de reestenosis. En el final de 2006 surgieron relatos de aumento de la incidencia de trombosis tardía de stent con esos stents en comparación con los de metal sin revestimientos, probablemente en consecuencia del atraso de endotelización. Mientras tanto, esos estudios contenían serias fallas metodológicas. Metanálisis posteriores mostraron de forma clara un riesgo apenas discretamente aumentado de trombosis tardía de stent entre todos los grupos de pacientes. Un hallazgo importante fue el de que los stents farmacológicos proporcionaron beneficio significativo y mantenido debido a la reducción de reestenosis y, por lo tanto, de revascularización de repetición. Varios registros obtenidos en la práctica clínica confirmaron esos resultados y sugirieron que el uso de stents farmacológicos en situaciones más complejas no está asociado a resultados desfavorables. La trombosis de stent es un problema multifactorial en el cual el stent es apenas uno de los elementos. Nuevos estudios serán necesarios para determinar la técnica para el procedimiento y el esquema antiplaquetario ideales. Los stents farmacológicos son seguros y eficaces a largo plazo, aunque estudios intensivos continúen siendo realizados con el propósito de reducir el riesgo de trombosis de stent en la próxima generación.

Cuando sospechar de edema fugaz pulmonar / When suspect pulmonary oedema flash

Edema pulmonar relámpago o edema pulmonar fugaz es una condición clínica caracterizada por episodios recurrentes y súdbitos de disnea en reposo, resultado en congestión pulmonar venosa aguda pero en la presencia de función sistólica del ventrículo izquierdo normal o preservada. Está usualmente asociada a estenosis bilateral o unilateral de la arteria renal en riñón único. Relatamos un caso de una paciente femenina de 60 años de edad, con enfermedad arterial coronaria, que desarrolló estenosis de arteria renal unilateral derecha y presentó un episodio de edema fugaz pulmonar. El tratamiento consistió en intervención percutánea en la arteria renal derecha con la colocación de prótesis metálica o stent.

Flash pulmonary edema is a condition characterizaed by sudden and recurrent episodes of dyspnea at rest resulting from acute pulmonary venous congestion in the presence of normal or well-preserved LV systolic function. This is usually associated with bilateral renal artery stenosis of a single surviving kidney. We report a case of a 60-year-old woman, with coronary artery disease who later developed unilateral renal artery atenosis and presented with one episode of flash pulmonary edema. She was successfully treated with stenting of the compromised renal artery.