Mitral valve-in-valve and valve-in-ring for failing surgical bioprosthetic valves and rings.

The transcatheter valve-in-valve (VIV) procedure for failed aortic bioprostheses is recognized as an alternative treatment to conventional surgery in high-risk patients. This less invasive option has now been applied to failed mitral bioprostheses (VIV) or failed repairs i.e. valve-in-ring (VIR). In this emerging field, to get an optimal result, a good understanding of the design features of the failed surgical heart valve/ring, the transcatheter heart valve being used and their compatibility, is of paramount importance. Although similar in many ways to the aortic counterpart, a mitral VIV/VIR procedure can pose certain different challenges such as delayed migration and left ventricular outflow tract obstruction. This review describes the features of bioprostheses, rings and THVs relevant to a VIV/VIR procedure, and also provides guidance regarding sizing, positioning and how to avoid some of the major complications therefore improving the chances of a successful outcome.

Transaortic transcatheter aortic valve implantation using the Lotus valve: first-in-man experience.

AIMS: To demonstrate the feasibility of implanting the Lotus second-generation transcatheter heart valve (THV) (designed for a transfemoral procedure) via a transaortic approach. METHODS AND RESULTS: We describe a case with severe aortic stenosis in the presence of small calibre and calcified femoral access and severe chronic obstructive pulmonary disease. The transaortic approach was the ideal approach for this patient and we successfully implanted a 25 mm Lotus valve without any complication. CONCLUSIONS: The transaortic access is a feasible and safe alternative in patients who have suboptimal iliofemoral conduits and who will benefit from the unique features of the Lotus THV.

Traumatic aortic injury score (TRAINS): an easy and simple score for early detection of traumatic aortic injuries in major trauma patients with associated blunt chest trauma.

PURPOSE: To develop a risk score based on physical examination and chest X-ray findings to rapidly identify major trauma patients at risk of acute traumatic aortic injury (ATAI). METHODS: A multicenter retrospective study was conducted with 640 major trauma patients with associated blunt chest trauma classified into ATAI (aortic injury) and NATAI (no aortic injury) groups. The score data set included 76 consecutive ATAI and 304 NATAI patients from a single center, whereas the validation data set included 52 consecutive ATAI and 208 NATAI patients from three independent institutions. Bivariate analysis identified variables potentially influencing the presentation of aortic injury. Confirmed variables by logistic regression were assigned a score according to their corresponding beta coefficient which was rounded to the closest integer value (1-4). RESULTS: Predictors of aortic injury included widened mediastinum, hypotension less than 90 mmHg, long bone fracture, pulmonary contusion, left scapula fracture, hemothorax, and pelvic fracture. Area under receiver operating characteristic curve was 0.96. In the score data set, sensitivity was 93.42 %, specificity 85.85 %, Youden's index 0.79, positive likelihood ratio 6.60, and negative likelihood ratio 0.08. In the validation data set, sensitivity was 92.31 % and specificity 85.1 %. CONCLUSIONS: Given the relative infrequency of traumatic aortic injury, which often leads to missed or delayed diagnosis, application of our score has the potential to draw necessary clinical attention to the possibility of aortic injury, thus providing the chance of a prompt specific diagnostic and therapeutic management.

Aortoesophageal fistula after thoracic stent grafting.

Aortoesophageal fistula after thoracic stent grafting is rare and usually fatal. A 66-year-old woman developed an aortoesophageal fistula 1 month after endovascular stent grafting of the thoracic aorta for a complicated type B dissection. She had a fatal episode of massive bleeding before she could be treated. The limited treatment options are discussed.

Endovascular stent grafting for acute thoracic aortic pathology.

BACKGROUND: Endovascular repair of the thoracic aorta has shown reduced morbidity and mortality compared with open surgery. We describe our experience with endovascular stent grafting in the treatment of acute thoracic aortic pathology. METHODS: From October 2003 to January 2008, 25 patients underwent endovascular stent graft repair of the thoracic aorta. The underlying pathology was a complicated Stanford type B dissection (n = 13), a symptomatic or ruptured thoracic aorta aneurysm (n = 6), a symptomatic penetrating atherosclerotic ulcer (n = 5), or a traumatic aortic injury (n = 1). There were 21 males and four female patients with a mean age of 61.3 years (30-91 years). Routine surveillance included clinical evaluation and contrast-enhanced spiral computed tomography scans before discharge and at 3, 6, and 12 months after the procedure and yearly thereafter. RESULTS: Stent graft placement was technically successful in all patients. There was no intraoperative mortality. Hospital mortality was of two patients (8%). Paraparesis occurred in one patient (4%). Average intensive care unit and hospital stay was 1 and 10 days, respectively. The mean follow-up was 30 months (range, 7-53). Late mortality was in one patient (4%), due to a type A dissection. During the follow-up, four patients (16%) required a second procedure for type I endoleak. CONCLUSIONS: Mortality and morbidity in our small series were low. Close follow-up is mandatory and long-term results have to be awaited.

Valor de la tomografía computada en la predicacción de los abscesos pancreáticos / Value of computed tomography in the prognosis of pancreatic abscesses

Se estudiaron 70 pacientes con pancreatitis aguda mediante tomografía computada con el objeto de evaluar la relación entre los hallazgos tomográficos iniciales y la posterior aparición de abscesos pancreáticos. El 70% de los pacientes con pancreatitis aguda grave que presentaron estadio inicial 3 y colección líquida asociada, evolucionaron al absceso pancreático. Se comprueba el valor pronóstico de la tomografía computada con respecto a la aparición de abscesos en pacientes graves que presentaron importante compromiso inflamatorio retroperitoneal en las imagens radiológicas iniciales (AU)

Valor de la tomografía computada en la predicacción de los abscesos pancreáticos / Value of computed tomography in the prognosis of pancreatic abscesses

Se estudiaron 70 pacientes con pancreatitis aguda mediante tomografía computada con el objeto de evaluar la relación entre los hallazgos tomográficos iniciales y la posterior aparición de abscesos pancreáticos. El 70% de los pacientes con pancreatitis aguda grave que presentaron estadio inicial 3 y colección líquida asociada, evolucionaron al absceso pancreático. Se comprueba el valor pronóstico de la tomografía computada con respecto a la aparición de abscesos en pacientes graves que presentaron importante compromiso inflamatorio retroperitoneal en las imagens radiológicas iniciales

Leiomioma del duodeno / Duodenal leiomyoma

Se presenta el cuarto caso mundial y el primero nacional de leiomioma del duodeno. Se trata de un hombre de 78 años de edad cuyo síntoma fundamental fue una hemorragia digestiva alta. Se describen los métodos diagnósticos y terapéuticos utilizados, enfatizando el papel decisivo de la biopsia por inclusión (AU)

Leiomioma del duodeno / Duodenal leiomyoma

Se presenta el cuarto caso mundial y el primero nacional de leiomioma del duodeno. Se trata de un hombre de 78 años de edad cuyo síntoma fundamental fue una hemorragia digestiva alta. Se describen los métodos diagnósticos y terapéuticos utilizados, enfatizando el papel decisivo de la biopsia por inclusión

Tumores insulares no funcionantes de la cabeza del páncreas / Insular non-functioning tumors of the head of the pancreas

Se presentan 2 pacientes con tumores no funcionantes de los islotes del páncreas. En uno de ellos la resección se efetuó por enucleación, mientras que el tamaño y la localización del segundo, requirió efectuar una duodenopancreatectomía cefálica. Los estudios anatomopatológicos y la inmunohistoquímica no permitieron demostrar la secreción de hormonas en las células neoplásicas (AU)

Tumores insulares no funcionantes de la cabeza del páncreas / Insular non-functioning tumors of the head of the pancreas

Se presentan 2 pacientes con tumores no funcionantes de los islotes del páncreas. En uno de ellos la resección se efetuó por enucleación, mientras que el tamaño y la localización del segundo, requirió efectuar una duodenopancreatectomía cefálica. Los estudios anatomopatológicos y la inmunohistoquímica no permitieron demostrar la secreción de hormonas en las células neoplásicas

Valor de la tomografía computada en la pancreatitis aguda: correlación con los signos pronósticos / Value of the computed tomography in acute pancreatitis: correlaction with the prognostic signs

Los autores han relacionado los hallazgos en la tomografía axial computada con los signos pronósticos de Ranson en 61 pacientes con pancreatitis aguda. Existe correlación significativa tanto en la valoración al inicio de la dolencia, como durante el transcurso evolutivo para el diagnóstico oportuno de las complicaiones, tales como seudoquiste, abscesos, secuestros, etc (AU)

Valor de la tomografía computada en la pancreatitis aguda: correlación con los signos pronósticos / Value of the computed tomography in acute pancreatitis: correlaction with the prognostic signs

Los autores han relacionado los hallazgos en la tomografía axial computada con los signos pronósticos de Ranson en 61 pacientes con pancreatitis aguda. Existe correlación significativa tanto en la valoración al inicio de la dolencia, como durante el transcurso evolutivo para el diagnóstico oportuno de las complicaiones, tales como seudoquiste, abscesos, secuestros, etc