Trombectomía tras fibrinolisis fallida en trombosis protésica tricuspídea / Thrombectomy after failed fibrinolysis in prosthetic tricuspid valve thrombosis

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Percutaneous treatment of mitral valve periprosthetic leakage. An alternative to high-risk surgery?

Periprosthetic mitral valve regurgitation due to paravalvular leakage is one of the complications of valve replacement surgery. We report a series of eight patients with severe symptomatic periprosthetic mitral regurgitation in whom surgery could not be performed because of the high risk. All patients were assigned to percutaneous closure of periprosthetic mitral valve leaks using an Amplatzer duct occluder. The procedure was successful in five patients. A significant reduction in periprosthetic regurgitation and a clinical improvement were observed in four of the patients. The procedure was unsuccessful in three patients: in two due to interference with the prosthesis discs; in the other, because it was not possible to pass through the leak. One of these three patients died a few hours after the procedure due to severe stroke. Percutaneous closure of paravalvular leakage in patients at a high surgical risk is technically feasible and has an acceptable clinical success rate.

Cierre percutáneo de las dehiscencias periprotésicas mitrales. ¿La alternativa a una cirugía de alto riesgo? / Percutaneous treatment of mitral valve periprosthetic leakage. An alternative to high-risk surgery?

La insuficiencia mitral periprotésica secundaria a fugas perivalvulares es una complicación de la cirugía de reemplazo valvular. Presentamos una serie de 8 casos con insuficiencia mitral periprotésica severa y sintomática, rechazados para cirugía por alto riesgo y en los que se decidió el cierre percutáneo de la fuga periprotésica mitral. En todos se utilizó dispositivo Amplatzer de cierre ductal. El procedimiento fue exitoso en 5 de los pacientes. Se objetivó disminución significativa de la insuficiencia periprotésica y mejoría clínica en el seguimiento en 4 pacientes. Se fracasó en 3 (2 por interferencia con los discos de la prótesis y 1 por no poder atravesar la fuga), de los que 1 falleció a las pocas horas del procedimiento por ictus masivo. El cierre percutáneo de dehiscencias perivalvulares en pacientes con alto riesgo quirúrgico es un procedimiento técnicamente posible y con una tasa de éxito clínico aceptable (AU)

Periprosthetic mitral valve regurgitation due to paravalvular leakage is one of the complications of valve replacement surgery. We report a series of 8 patients with severe symptomatic periprosthetic mitral regurgitation in whom surgery could not be performed because of the high risk. All patients were assigned to percutaneous closure of periprosthetic mitral valve leaks using an Amplatzer duct occluder. The procedure was successful in 5 patients. A significant reduction in periprosthetic regurgitation and a clinical improvement were observed in 4 of the patients. The procedure was unsuccessful in 3 patients: in 2 due to interference with the prosthesis discs; in the other, because it was not possible to pass through the leak. One of these 3 patients died a few hours after the procedure due to severe stroke. Percutaneous closure of paravalvular leakage in patients at a high surgical risk is technically feasible and has an acceptable clinical success rate. and has an acceptable clinical success rate (AU)

Tromboembolismo pulmonar masivo en paciente previamente anticoagulado y con antecedente de intervención de Fontan / Massive pulmonary thromboembolism in patient treaty with anticoagulant previously and with intervention of Fontan

Presentamos el caso de un varón de 18 años sometido a los tres años de vida a la intervención de Fontan por atresia tricuspídea, que ingresó en nuestro servicio de Cardiología por descompensación de insuficiencia cardíaca. Tras estudio exhaustivo se diagnosticó de tromboembolismo pulmonar masivo pese a estar anticoagulado. Hemos realizado una búsqueda bibliográfica de casos similares y aportamos nuestra opinión sobre las recomendaciones sobre anticoagulación en estos pacientes

We present the case of a 18 years-old male subjected to at the age of three years old to the Fontan operation for tricuspid atresia, that entered in our Cardiology Unit for descompensated heart failure. After exhaustive study, a massive pulmonary thromboembolism was diagnosed in spite of the patient was treated with anticoagulant drugs previously. We have carried out a bibliographical search of similar cases and we contribute our opinion on the recommendations about anticoagulation in these patients