RESUMO
Literature concerning transcutaneous symptomatic para valvular cardiac leaks closure (PVLC) after trans aortic valve implantation (TAVI) is relatively scarce. Hereby we present 2 clinical cases, one on an Edwards® Sapien 3 valve and the other one on a Medtronic® Evolut R valve. We present also the preliminary results of the 7 PVLC on TAVI included in our prospective FFPP registry during the 2 first years of enrolment (2017-2018), for a total of 158 inclusions for all valves. Seven procedures were performed on 8 leaks, using a majority of vascular plugs (3 Abbott® Amplatzer Vascular Plugs 2 (AVP2), 3 AVP3, 1 AVP4, and 1 muscular Ventricular Septal Defect (VSD) occluder). All procedures were successful without complication. At 1-month follow-up, all patients became asymptomatic. One-year follow-up was already available for 4 patients: 3 of them were symptoms free, and one-who had a second leak not suitable for PVLC-, underwent a « TAVI in TAVI ¼ procedure 2 months after PVLC. This short experience demonstrates the feasibility, the efficacy and the safety of PVLC on TAVI. We expect to be able to offer more in depth information at the end of our prospective ongoing study.
Assuntos
Fístula Anastomótica/cirurgia , Estenose da Valva Aórtica/cirurgia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Fístula Anastomótica/diagnóstico por imagem , Fístula Anastomótica/etiologia , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Desenho de Prótese , Dispositivo para Oclusão SeptalRESUMO
Acute coronary syndrome results in most cases of atherosclerotic plaque rupture. In a few cases, the physiopathological mechanism is different. This does not necessarily change the initial strategy but the subsequent treatments. We report three cases of clinical presentations of acute coronary syndrome whose pathophysiological mechanism is not or not mainly due to atherosclerotic lesions. Based on these cases and a review of the literature, two topics will be tackled: the diagnostic and therapeutic strategy in the management of Tako-tsubo cardiomyopathies and also acute coronary syndromes due to vasospastic angina.
Assuntos
Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Angiografia Coronária , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/terapia , Cardiomiopatia de Takotsubo/diagnóstico , Cardiomiopatia de Takotsubo/terapia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/fisiopatologia , Idoso de 80 Anos ou mais , Analgésicos Opioides/administração & dosagem , Angioplastia/métodos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anticoagulantes/administração & dosagem , Aterosclerose/complicações , Vasoespasmo Coronário/fisiopatologia , Eletrocardiografia , Feminino , Sistema de Condução Cardíaco/fisiopatologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fumar/efeitos adversos , Cardiomiopatia de Takotsubo/fisiopatologia , Resultado do TratamentoRESUMO
The authors report on 35 fractures of the humerus neck treated by "bouquet" type internal fixation. The operative technique employed is that developed by Bombard and co-workers. A few variants of this technique are described. Only fractures that were badly dislocated were internally fixated. Slight dislocations were treated for the most part by simple orthopaedic measures. This technique may be used on patients of all ages and leads to early mobilization. It might be employed to advantage in the management of slightly dislocated fractures in respiratory failure or in patients with chest injuries.
Assuntos
Fixação Intramedular de Fraturas/métodos , Fraturas do Ombro/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Luxação do Ombro/complicações , Fraturas do Ombro/complicaçõesRESUMO
A case of slow fracture of both femoral heads in a 19-year-old woman is reported. The radiological characteristics, clinical context and onset in a histologically normal skeleton were in favour of a diagnosis of fatigue fracture. Data in the literature show the rarity of this condition affecting the neck of the femur in the young woman and rarely mention the existence of morphological abnormalities as a favouring factor.