RESUMO
One of the most common complications of tricuspid valve replacement is atrioventricular block (AVB), often requiring permanent pacing. The endocardial pacemaker lead, placed in the right ventricle, may sometimes interfere with the implanted prosthesis, causing its early dysfunction and the need for alternative sites of pacing. To the best of our knowledge, we present the first case of a successful combined percutaneous procedure consisting of the implantation of two leads in the coronary sinus for univentricular bifocal pacing and a transcatheter tricuspid valve-in-valve implantation in a young patient with severe dysfunction of the tricuspid bioprosthesis, requiring permanent pacing for a postsurgical complete atrioventricular block.
Tricuspid valve replacement with surgery can often lead to cardiac rhythm disorders requiring a permanent pacemaker. This device may occasionally damage the tricuspid prosthesis. We present the first case of a combined procedure of tricuspid valve replacement and device implantation distant from the prosthesis without the need for a surgical approach in a young patient with severe tricuspid prosthesis malfunctioning and permanent pacing.
Assuntos
Cateterismo Cardíaco , Estimulação Cardíaca Artificial , Seio Coronário , Implante de Prótese de Valva Cardíaca , Valva Tricúspide , Humanos , Valva Tricúspide/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Seio Coronário/cirurgia , Cateterismo Cardíaco/métodos , Estimulação Cardíaca Artificial/métodos , Bloqueio Atrioventricular/terapia , Bloqueio Atrioventricular/etiologia , Bioprótese , Próteses Valvulares Cardíacas , Insuficiência da Valva Tricúspide/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico , Marca-Passo Artificial , Feminino , Masculino , AdultoRESUMO
Hereditary hemorrhagic telangiectasia is regarded as a high hemorrhagic risk condition, and the management of anticoagulation and heart surgery in these patients can be challenging. The authors describe a combined percutaneous treatment of mitral regurgitation and left atrial appendage occlusion in a patient affected by hereditary hemorrhagic telangiectasia and atrial fibrillation, supporting the safety and feasibility of the procedure and the optimal short-term outcome.
Hereditary hemorrhagic telangiectasia is a disease that carries a high risk of bleeding because of the growth of blood vessels with weak walls. The authors describe the case of a patient with hereditary hemorrhagic telangiectasia needing an intervention for mitral valve regurgitation and anticoagulation therapy for atrial fibrillation. To reduce the bleeding risk, two innovative techniques were used: the mitral valve disease was treated with the percutaneous implantation of stitches without open chest surgery and the left atrial appendage was contextually occluded thanks to another mini-invasive procedure to avoid the need for anticoagulation.