Post-introduction observation of transcatheter aortic valve implantation in Galicia (Spain).

RATIONALE, AIMS AND OBJECTIVES: Transcatheter aortic valve implantation constitutes an example of a technology introduced into the Galician Health Care System basket and subjected to a post-introduction observational study after coverage. This paper aims to describe the process and results of this experience, illustrating the main challenges and opportunities in using these studies for supporting decision making. METHODS: The study protocol was developed by a multidisciplinary team consisting of experts from the Galician HTA Agency (avalia-t), interventional cardiologists and cardiac surgeons. Together they agreed on the information that was relevant and feasible for collection, and planned the study design, data collection and analysis of results. RESULTS: During the 1-year recruitment period, 94 patients underwent percutaneous aortic valve replacement in the three authorized centres. Implantation rate and prosthesis models differed substantially across the centres. Overall, procedural success rate was 96.8% and hospital mortality was 7.4%. Complications during post-surgical admission were recorded in 40.4% of patients. Moderate residual aortic regurgitation was observed in 10% of patients, and the procedure was associated with a stroke rate of 3.3% at 30 days and 5.3% at 1 year. CONCLUSIONS: Post-introduction observation has made it feasible to determine the use of this procedure within the SERGAS context and has enabled the assessment of performance in real-life conditions. The proposed strategic actions and interventions have been drawn up based upon the collective judgement of a group of experienced professionals, and have served to establish recommendations on further research that would be required to optimize health benefits.

Rapid growth of left atrial myxoma after radiofrequency ablation.

Atrial myxoma is the most common benign tumor of the heart, but its appearance after radiofrequency ablation is very rare. We report a case in which an asymptomatic, rapidly growing cardiac myxoma arose in the left atrium after radiofrequency ablation. Two months after the procedure, cardiovascular magnetic resonance, performed to evaluate the right ventricular anatomy, revealed a 10 × 10-mm mass (assumed to be a thrombus) attached to the patient's left atrial septum. Three months later, transthoracic echocardiography revealed a larger mass, and the patient was diagnosed with myxoma. Two days later, a 20 × 20-mm myxoma weighing 37 g was excised. To our knowledge, the appearance of an atrial myxoma after radiofrequency ablation has been reported only once before. Whether tumor development is related to such ablation or is merely a coincidence is uncertain, but myxomas have developed after other instances of cardiac trauma.

Imaging of nonthrombotic pulmonary embolism: biological materials, nonbiological materials, and foreign bodies.

Nonthrombotic pulmonary embolism is defined as embolization to the pulmonary circulation caused by a wide range of substances of endogenous and exogenous biological and nonbiological origin and foreign bodies. It is an underestimated cause of acute and chronic embolism. Symptoms cover the entire spectrum from asymptomatic patients to sudden death. In addition to obstruction of the pulmonary vasculature there may be an inflammatory cascade that deteriorates vascular, pulmonary and cardiac function. In most cases the patient history and radiological imaging reveals the true nature of the patient's condition. The purpose of this article is to give the reader a survey on pathophysiology, typical clinical and radiological findings in different forms of nonthrombotic pulmonary embolism. The spectrum of forms presented here includes pulmonary embolism with biological materials (amniotic fluid, trophoblast material, endogenous tissue like bone and brain, fat, Echinococcus granulosus, septic emboli and tumor cells); nonbiological materials (cement, gas, iodinated oil, glue, metallic mercury, radiotracer, silicone, talc, cotton, and hyaluronic acid); and foreign bodies (lost intravascular objects, bullets, catheter fragments, intraoperative material, radioactive seeds, and ventriculoperitoneal shunts).

Caseous calcification of the mitral annulus: a rare cause of intracardiac mass.

Caseous calcification of the mitral annulus is a rare form of periannular calcification with a mass-like appearance, that has to be in the differential of the cardiologist and radiologist. It classically looks like a round or semilunar hyperdense mass with an even denser peripheral rim, located in the posterior mitral annulus and having in general no clinical significance.

Pulmonary embolism due to biological glue after repair of type A aortic dissection.

Biological glue is increasingly used in cardiac surgery. We report a case of type A aortic dissection repair that was complicated by subsequent pulmonary embolism due to BioGlue(®) (Cryolife Inc, Hennesaw, GA, USA). To our knowledge this is the first report of a case with this complication.

Up to twenty-five-year survival after aortic valve replacement with size 19 mm valves.

Long-term survival was investigated in 202 patients who underwent isolated aortic valve replacement (AVR) with 19 mm valves. There were 171 women with a mean age of 69+/-9 years and 31 men with a mean age of 64+/-13 years. Patients had a mean body surface area of 1.61+/-0.13 m(2). Patient-prosthesis mismatch was moderate in 196 and severe in six patients. The mean follow-up for all patients was 78 months. There were 79 late deaths. The actuarial survival rates for all patients were 95+/-1% at 1 year, 75+/-2% at 5 years, 56+/-2% at 10 years, 41+/-2% at 15 years, 34+/-3% at 20 years and 34+/-2% at 25 years. Patients over 70 years old had a lower survival rate (P=0.0001). There were significant differences between ejection fraction (EF) >55% and EF <55% (P=0.0305). AVR with 19 mm valves appeared to provide satisfactory mid-term survival. Age and low EF were risk factors for shorter survival.

Cardiac Aspergillosis with pedunculated mass in the left ventricle.

Immunosuppression can allow organisms that are not usually pathogenetic to cause disease; under such circumstances, Aspergillus species frequently form large masses of fungal elements. We describe the case of a 12-year-old girl with hematologic remission of leukemia. She had a left ventricular pedunculated mass that was detected by echocardiographic study; at surgery, the presence of Aspergillus terreus was confirmed.