Aortic root rupture and acquired intracardiac shunt after transcatheter aortic valve implantation. / Rotura de raíz aórtica con formación de shunt intracardíaco secundaria a implante valvular aórtico transcatéter.

Transcatheter aortic valve implantation (TAVI) is an alternative to surgical valve replacement in patients with high surgical risk. Although TAVI is becoming more and more common, it is not without complications. Rupture of the aortic root after implantation is an uncommon, but lethal complication; few cases have been described in the literature. Multidetector computed tomography is fundamental before TAVI to evaluate factors that predispose to complications; however, its role after the procedure is still controversial.

Síndrome coronario agudo en mujer joven: en búsqueda de la afectación arterial sistémica / Acute coronary syndrome in a young woman: The search of systemic arterial involvement

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[Failure in the implantation of drug eluting stents. Frequency and related factors]. / Fracaso en la implantación de stent liberadores de fármacos. Frecuencia y factores relacionados.

OBJECTIVE: To evaluate those procedures in which drug eluting stents DES cannot be implanted and to identify the variables related with this fact. DESIGN: Prospective observational study. PATIENTS: A total of 1.323 consecutive lesions, in which we attempted to deliver DES in our hospital, between February 2002 and March 2005. We reviewed the proportion of implantation failures and related factors. RESULTS: In 21 (1.6%) of the 1.323 lesions, it was not possible to implant the DES (1.6%, 1.5% and 2.3% with Cypher, Taxus, and Janus, respectively; p = NS). The procedure could be performed successfully in 17 cases: 9 with a bare metal stent and 8 with only balloon treatment, whereas the procedure failed in 4 patients. Those patients in whom the DES implantation failure had a greater frequency of peripheral arteriopathy (30 vs 8%; p = 0.003), calcium angiography (76 vs 42%; p = 0.002), vessel tortuosity (71 vs 20%, p < 0.01) y and B2/C lesion type (100 vs 77%; p = 0.007). The independent predictors were: peripheral arteriopathy, calcium and vessel tortuosity. There were no periprocedural mayor cardiac events in the cases with failed delivery of the DES. CONCLUSIONS: In our series, 1.6% of the DES could not be implanted. Some clinical variables, (peripheral arteriopathy) and angiographic (calcium and tortuosity), are associated to a greater risk of this occurring.

Insuficiencia mitral transitoria asociada a disección coronaria espontánea / Transient mitral insufficiency and espontaneous coronary disease

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Miocardiopatía puerperal: causa de insuficiencia cardíaca en mujeres jóvenes. A propósito de un caso / Puerperal myocardiopathy: cause of heart failure in young women

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Desinserción protésica mitral recidivante / Recurrent desinsertions of a prosthetic mitral value

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Aneurisma de arteria pulmonar izquierda / Aneurism of the left pulmonary artery

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Dolor torácico secundario a infección respiratoria / Chest pain due to infection respiratory

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