Valve-in-Valve Implantation of a Sapien 3 Transcatheter Heart Valve for Reduction of Paravalvular Regurgitation Despite Optimal Placement of the First Transcatheter Heart Valve.

Valve-in-valve implantation is generally successful in reducing paravalvular regurgitation (PVR) in cases in which the first transcatheter heart valve is deployed in a suboptimal location. We describe a case of severe PVR 2 months after implantation of a 26-mm Sapien XT valve (Edwards Lifesciences Inc, Irvine, CA) in the optimal location. Valve-in-valve implantation of a Sapien 3 valve (Edwards Lifesciences Inc), and enough left ventricular outflow tract tissue at the inflow edge the Sapien XT to appose the sealing cuff of the Sapien 3 combined for successful PVR treatment. To our knowledge, this is the first case of PVR reduction with valve-in-valve despite the original valve being appropriately sized and placed.

Correlation between the plasma fibrinogen concentration and coronary heart disease severity in Moroccan patients with type 2 diabetes. Prospective study.

AIM: The present study aims at determining the relationship between the plasma fibrinogen concentration and the severity of coronary heart disease in type 2 diabetic patients. METHODS: Prospective analytical survey, based on a sample of 120 subjects divided in four groups: 30 non diabetic coronary patients (G1), 30 coronary diabetic patients (G2), 30 non-coronary diabetic patients (G3), and 30 healthy subjects (G4). RESULTS: The average age was 59.58±7.88 years; female gender predominated by 52.5%. The plasma fibrinogen concentration corresponded to 3.46g/L±0.86 in G1; 3.73g/L±1.11 in G2; 3.06g/L±0.98 in G3 and 2.46g/L±0.51 in G4; with a significant difference between the four groups (P=0.001). The plasma fibrinogen concentration increased in parallel with the cardiovascular risk (P=0.0001); there was also a significant correlation between the plasma fibrinogen concentration and the clinical and para-clinical coronary disease severity (respectively P=0.005 and P=0.0001). A positive correlation between the plasma fibrinogen concentration and hyperglycemia (P=0.035) was found in G4. But no correlation with the lipids parameters, except for the low density-lipoproteins in G3 (P=0.035). CONCLUSION: In the Moroccan population, the plasma fibrinogen concentration was positively and significantly correlated with the coronary heart disease severity.

Cardiac consequence of misdiagnosed vascular complication of spinal lumbar surgery: 6 years of diagnosis delay.

Ilio-caval fistula is a rare complication of lumbar disk surgery that may pose a real diagnostic challenge. We report a case of a 50-year-old woman with overlooked massive right ilio-caval fistula complicating lumbar surgery 6 years previously, and who presented with refractory right heart failure misdiagnosed as chronic pericarditis. The combination of right heart failure and a periumbilical murmur should alert clinicians to investigate with the appropriate imaging tests to confirm the diagnosis. .