Early neurological complications after transcatheter closure of atrial septal defect with nitinol wire mesh occluder.

Atrial septal defect (ASD) was closed percutaneously in an 18-year-old boy with a 27 mm nitinol wire mesh occluder according to standard procedures. Three hours after the procedure, he presented anxiety attacks, aggression, a vacant stare and a verbal/speaking disorder. Small ischaemic stroke localised in the right temporal/parietal region of the central nervous system was confirmed by computed tomography examination. Activated partial thromboplastin time was then 54 s despite continuous heparin infusion. Heparin dose was increased and symptomatic treatment was introduced (mannitol, furosemide, propofol, haloperidol). The next day, all symptoms disappeared. He remained in good clinical condition, without neurological disorders 1.5 months after the procedure. Complications related to transcatheter ASD closure still exist despite the fulfillment of standard procedural criteria. Frequent coagulogical examinations during and after the procedure are necessary. Close observation and follow-up of treated patients is mandatory.

[Rapidly evolving techniques for structural heart disease interventions]. / Técnicas de rápido desarrollo en intervencionismo estructural.

Structural heart disease interventions are the transcatheter techniques used for treating non-coronary heart disease. In recent years, these techniques have generated considerable interest even though they still comprise only a small percentage of the total volume of interventions performed in interventional cardiology departments. The level of interest in these techniques is high probably because their application is characterized by a number of special features: a) the need for multidisciplinary teams; b) the need for specialized education and training; c) the requirement for special skills developed through education and experience, and d) the limited number of referral centers at present. This article describes four specific techniques: a) percutaneous closure of perivalvular leaks; b) percutaneous left atrial appendage obliteration; c) percutaneous treatment of mitral regurgitation, and d) transcatheter implantation of prosthetic aortic valves. We explore the rationale for using the technique, the specific procedures involved and the results obtained.

Resultados de un programa mixto de implantación de prótesis aórtica por vía transfemoral con los dispositivos de Edwards y CoreValve / Findings of a mixed transfemoral aortic valve implantation program using edwards and CoreValve devices

Introducción y objetivos. La implantación de prótesis valvular aórtica por vía transfemoral con los dispositivos Edwards-SAPIEN (ES) y Medtronic-CoreValve (MCV) es una alternativa al reemplazo quirúrgico en pacientes con estenosis aórtica severa y alto riesgo quirúrgico. Nuestro objetivo es comparar los resultados obtenidos con uno y otro dispositivo. Métodos. Estudio prospectivo de las prótesis implantadas por vía transfemoral en nuestro centro. Resultados. De los 76 pacientes (edad, 83±6 años; el 63% mujeres; EuroSCORE logístico, 18±9), Se seleccionó a 50 para ES y a 26 para MCV. No se observaron diferencias entre grupos en edad, sexo, clase funcional, área valvular, enfermedades asociadas o EuroSCORE. Se consiguió implantar la prótesis en el 84% del grupo ES y el 100% del grupo MCV (p=0,04); hubo 3 casos de taponamiento, 2 disecciones aórticas y 1 malposición en la serie ES. Las complicaciones vasculares fueron similares (el 26 frente al 23%), pero la necesidad de marcapasos fue mayor con la MCV (el 10 frente al 39%; p=0,003). Las mortalidades totales a 30 días fueron del 12 y el 20% (sin diferencia significativa) y a 1 año, del 24 y el 20% en los grupos ES y MCV respectivamente. Tras un seguimiento de 367±266 días para ES y 172±159 para MCV, 3 pacientes fallecieron; los demás mantienen la mejoría clínica y no se observan cambios ecocardiográficos. Conclusiones. La mortalidad hospitalaria, la tasa de complicaciones y la evolución a medio plazo han sido similares con ambos dispositivos; las únicas diferencias encontradas han sido una tasa de implantación con éxito mayor con la MCV, aunque a expensas de una mayor frecuencia de bloqueo auriculoventricular (AU)

Introduction and objectives: Transfemoral implantation of an Edwards SAPIEN (ES) or Medtronic CoreValve (MCV) aortic valve prosthesis is an alternative to surgical replacement for patients with severe aortic stenosis and a high surgical risk. The study’s aim was to compare results obtained with these two devices. Methods: Prospective observational study of transfemoral prosthesis implantation performed at our center. Results: Of the 76 patients (age 83 +/- 6 years, 63% female, logistic EuroSCORE 18 +/- 9) included, 50 were assigned the ES and 26 the MCV device. There was no difference between the groups in age, sex, functional class, valve area, associated conditions, or EuroSCORE. Implantation was successful in 84% of the ES group and 100% of the MCV group (P = .04). There were three cases of tamponade, two aortic dissections and one valve malposition in the ES group. The two groups had similar vascular access complication rates (26% vs. 23%; P = NS), but pacemaker need was greater with the MCV (10% vs. 39%; P = .003). Mortality rates at 30 days were 12% and 20% (P = NS) in the ES and MCV groups, respectively, and at 1 year, 24% and 20% (P = NS), respectively. After a follow-up of 367 +/- 266 days in the ES group and 172 +/- 159 days in the MCV group, three patients died. Clinical improvement was maintained in other patients and no echocardiographic changes were observed. Conclusions: In-hospital mortality, the complication rate and medium-term outcomes were similar with the two devices. The only difference observed was a higher implantation success rate with the MCV, although at the expense of a greater frequency of atrioventricular block (AU)

Findings of a mixed transfemoral aortic valve implantation program using Edwards and CoreValve devices.

INTRODUCTION AND OBJECTIVES: Transfemoral implantation of an Edwards SAPIEN (ES) or Medtronic CoreValve (MCV) aortic valve prosthesis is an alternative to surgical replacement for patients with severe aortic stenosis and a high surgical risk. The study's aim was to compare results obtained with these two devices. METHODS: Prospective observational study of transfemoral prosthesis implantation performed at our center. RESULTS: Of the 76 patients (age 83 ± 6 years, 63% female, logistic EuroSCORE 18 ± 9) included, 50 were assigned the ES and 26 the MCV device. There was no difference between the groups in age, sex, functional class, valve area, associated conditions, or EuroSCORE. Implantation was successful in 84% of the ES group and 100% of the MCV group (P = .04). There were three cases of tamponade, two aortic dissections and one valve malposition in the ES group. The two groups had similar vascular access complication rates (26% vs. 23%; P=NS), but pacemaker need was greater with the MCV (10% vs. 39%; P = .003). Mortality rates at 30 days were 12% and 20% (P = NS) in the ES and MCV groups, respectively, and at 1 year, 24% and 20% (P = NS), respectively. After a follow-up of 367 ± 266 days in the ES group and 172 ± 159 days in the MCV group, three patients died. Clinical improvement was maintained in other patients and no echocardiographic changes were observed. CONCLUSIONS: In-hospital mortality, the complication rate and medium-term outcomes were similar with the two devices. The only difference observed was a higher implantation success rate with the MCV, although at the expense of a greater frequency of atrioventricular block.

Técnicas de rápido desarrollo en intervencionismo estructural / Rapidly evolving techniques for structural heart disease interventions

El intervencionismo estructural se refiere a las técnicas intervencionistas que van dirigidas a enfermedades cardiacas no coronarias. En los últimos años está teniendo un interés muy considerable, aunque todavía representa un porcentaje muy pequeño del volumen total de intervencionismo de un departamento de terapia endovascular. A pesar del pequeño volumen relativo, el interés es muy grande, probablemente debido a las características peculiares que rodean a estas técnicas: a) necesidad de equipos multidisciplinarios; b) formación y entrenamiento específicos; c) requiere habilidades especiales derivadas de la formación y experiencia, y d) escaso volumen en el momento actual que aconseja centros dereferencia. En este capítulo desarrollamos cuatro apartados específicos: a) cierre percutáneo del leak perivalvular (LP);b) obliteración percutánea de la orejuela; c) tratamiento percutáneo de la insuficiencia mitral, y d)implantación transcatéter de prótesis valvulares aórticas. Exploramos las razones de la técnica, los procedimientos específicos y los resultados obtenidos (AU)

Structural heart disease interventions are the transcatheter techniques used for treating non-coronary heart disease. In recent years, these techniques have generated considerable interest even though they still comprise only a small percentage of the total volume of interventions performed in interventional cardiology departments. The level of interest in these techniques is high probably because their application is characterized by a number of special features: a) the need for multidisciplinary teams; b) the need for specialized education and training; c) the requirement for special skills developed through education and experience, and d) the limited number of referral centers at present. This article describes four specific techniques: a) percutaneous closure of perivalvular leaks; b) percutaneous left atrial appendage obliteration;c) percutaneous treatment of mitral regurgitation, and d) transcatheter implantation of prosthetic aorticvalves. We explore the rationale for using the technique, the specific procedures involved and the results obtained (AU)

Hipertensión arterial refractaria y apnea del sueño / Refractory Hypertension and Obstructive Sleep Apnea

El síndrome de apnea obstructiva del sueño (SAOS) tiene un papel importante en la morbimortalidad cardiovascular. Se han sugerido muchos mecanismos para explicar la asociación mórbida entre el SAOS y la enfermedad cardiovascular, especialmente la hipertensión arterial (HTA). Alrededor de la mitad de los pacientes con SAOS padecen hipertensión arterial y la prevalencia de SAOS en pacientes hipertensos es mayor que la existente en la población general. En el presente caso se describe a un paciente con HTA refractaria al tratamiento farmacológico que evolucionó favorablemente luego del diagnóstico y el tratamiento del SAOS.

Obstructive sleep apnea syndrome (OSAS) plays an important role in cardiovascular morbidity and mortality. Several mechanisms have been suggested to explain the morbid association between OSAS and cardiovascular disease, especially with hypertension (HT). About half of the patients with OSAS have hypertension, and the prevalence of OSAS is greater in hypertensive patients than in general population. The current case report describes a patient with hypertension refractory to pharmacological treatment which presented favorable outcomes after OSAS was diagnosed and properly treated.