Echogenic mobile images in intraprocedural three-dimensional transesophageal echocardiographic monitoring during percutaneous aortic valve implantation: Incidence, characteristics and clinical implications.

INTRODUCTION AND OBJECTIVES: To investigate the incidence and clinical relevance of the presence of mobile echogenic images (MEI) during transesophageal echocardiography (TEE) for monitoring of transcatheter aortic valve implantation (TAVI). METHODS: Consecutive patients referred to our center for transfemoral or transapical TAVI were included. The procedure was monitored by three-dimensional (3D) TEE and images were analyzed by two independent experts. In-hospital follow-up was carried out and correlated with imaging findings. RESULTS: A total of 104 patients were included. MEI were visualized in 11 patients during the procedure (11%) and in over 50% of cases were identified as thrombi, however no differences in periprocedural stroke were found in follow-up. CONCLUSIONS: Visualization of MEI during 3D TEE monitoring of TAVI is relatively common (11%) and in over 50% of cases they are identified as thrombi. The clinical implications of this finding are uncertain, as despite their frequency, the incidence of clinical stroke in this patient population was no higher. 3D TEE is a useful tool for diagnosis of MEI and can alert the operator to their presence.

Treatment of coronary atherosclerosis aneurysm with a combination of stent-graft and in-stent drug-eluting stent.

Coronary atherosclerotic aneurysms (CAA) are a very uncommon finding in patients presenting with coronary artery disease. In order to prevent spontaneous vessel rupture in patients presenting with large CAA, these patients are frequently treated with the implantation of a stent-graft. However, these devices have a high rate of restenosis, which limits the clinical success of this strategy at mid-term. We present a patient with a native CAA who was treated with the implantation of a stent-graft with in-stent ad- hoc implantation of a paclitaxel-eluting stent. Coronary angiography and intravascular ultrasound demonstrated absence of restenosis and persistence of the exclusion of the aneurysm at 1-year follow-up.

3D Transesophageal echocardiographic guidance and monitoring of percutaneous aortic valve replacement.

We describe a preliminary clinical experience with 3D transesophageal echocardiography (3D TEE) in an 84-year-old man with severe aortic stenosis and multiple comorbidity, who underwent percutaneous aortic valve implantation. Although 3D TEE monitoring is not a standard procedure during aortic valve replacement procedure (PAVR), when used in combination with conventional 2D-TEE contributes to improving adequate patient selection and provides more accurate information to the interventional cardiologist during positioning, deployment, and early function of the prosthesis.

Cardiogenic shock due to complete thrombotic occlusion of the left main coronary ostium in a young female.

Complete left coronary system abolition due to thrombotic occlusion of the left main coronary ostium is an unusual presentation of myocardial infarction. Delays in reaching hospital and restoring coronary blood flow are major predictors of survival in cardiogenic shock. This rare case highlights the high mortality rate of cardiogenic shock due to thrombotic occlusion of the left main coronary ostium in spite of all efforts using innovative devices to remove thrombus and achieve adequate coronary and myocardial perfusion.

[Budd-Chiari syndrome with complete occlusion of the inferior vena cava: percutaneous recanalization by angioplasty and stenting]. / Síndrome de Budd-Chiari por obstrucción completa de la vena cava inferior: recanalización percutánea mediante angioplastia e implante de stent.

A 47-year-old man was diagnosed with primary antiphospholipid syndrome and Budd-Chiari syndrome (membranous complete obstruction of the intrahepatic inferior vena cava), with edema and ascites refractory to medical treatment. The inferior vena cava membrane was punctured with a Brockenbrough needle under multidirectional fluoroscopic guidance via a transfemoral approach. The occlusion was dilated with balloons of increasing size and was subsequently stented successfully. At 1-year follow-up venography showed patency of the stent, and the patient remains asymptomatic 2 years after the procedure.