RESUMO
No-reflow phenomenon is frequent in patients with ST-segment elevation myocardial infarction (STEMI) and has proven to be a strong predictor of mortality. Local fibrinolytic infusion with distal coronary occlusion (previously described as "marinade technique") can be useful in patients with acute myocardial infarction and intraluminal thrombus refractory to aspiration enabling the local effect of the drug, directly applied inside the thrombus, while protecting the microvasculature with prolonged inflation of a distal balloon. We present the early experience of four patients with inferior acute myocardial infarction and high thrombus burden successfully treated with marinade technique in one center.
RESUMO
Percutaneous intervention in anomalous coronary arteries originating from the opposite sinus of Valsalva is complicated by their unusual location and course, which makes selective cannulation difficult. The GuideLiner (Vascular Solutions, Inc.) is a monorail guide extension catheter designed to advance beyond the tip of a mother guide catheter to enable deep intubation of a coronary artery, provide extra support, and improve coaxial alignment. We describe the cases of 4 patients with an anomalous coronary artery originating from the opposite sinus of Valsalva-including 2 with acute myocardial infarction-who underwent successful percutaneous coronary intervention with use of a GuideLiner catheter.
Assuntos
Anomalias dos Vasos Coronários , Intervenção Coronária Percutânea , Seio Aórtico , Cateterismo Cardíaco , Cateteres , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/cirurgia , Humanos , Seio Aórtico/anormalidades , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , StentsAssuntos
Apêndice Atrial , Fibrilação Atrial , Acidente Vascular Cerebral , Anticoagulantes/efeitos adversos , Apêndice Atrial/diagnóstico por imagem , Apêndice Atrial/cirurgia , Fibrilação Atrial/complicações , Fibrilação Atrial/cirurgia , Hemorragia/induzido quimicamente , Humanos , Resultado do TratamentoRESUMO
BACKGROUND: Coronary artery fistulae are rare vascular anomalies. Although they are usually asymptomatic, the presence of symptoms might present a challenge in the diagnostic and therapeutic management. CASE SUMMARY: We present a patient with chest pain whose initial tests were normal, but coronary artery fistulae were found. Single-photon emission computed tomography test showed ischaemia due to coronary artery fistulae and cardiac computed tomography helped in the planning of the percutaneous closure. DISCUSSION: CCT is emerging as an optimal non-invasive tool to characterise the morphology and course of coronary artery fistulae and may be essential for its accurate diagnosis and planning for percutaneous closure.
RESUMO
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is a rare condition that can cause acute coronary syndrome, typically in young patients without classical cardiovascular risk factors. Although in SCAD the conservative management is preferable, in cases with complete occlusion of the artery an invasive treatment may be required. In such cases, the goal of the percutaneous intervention should be to restore the connection between the true and false lumen recovering the distal flow of the vessel. CASE SUMMARY: A young man was admitted with acute chest pain and ST segment elevation in precordial v3-v6 leads. An emergent coronary angiogram showed an abrupt occlusion of middle left anterior descending artery compatible with SCAD. A microcatheter was advanced distally into the artery and pulled back with continuous contrast injection through the catheter, restoring the distal flow with a residual spiroid intimal flap and with relief of the chest discomfort. A computed tomography performed during admission showed complete resolution of the lesion. DISCUSSION: In SCAD with complete occlusion of the vessel, the 'pull-back technique' with continuous vigorous injection of contrast through a distal microcatheter may be effective to restore the distal flow enabling the healing of the artery at follow-up and avoiding the stent implant.
Assuntos
Aneurisma Aórtico/cirurgia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/etiologia , Trombose Coronária/diagnóstico por imagem , Trombose Coronária/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Aneurisma Coronário/cirurgia , Angiografia Coronária , Trombose Coronária/cirurgia , Ecocardiografia , Feminino , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgiaAssuntos
Humanos , Idoso , Falso Aneurisma , Aneurisma Aórtico , Dor no Peito , Valva Aórtica , Aorta TorácicaRESUMO
Percutaneous intervention in the context of coronary artery ectasia (CAE) is penalized with no-reflow phenomenon. The glycoprotein-IIb/IIIa-inhibitor abciximab was the most accepted method for pharmacology thrombus resolution in this scenario, nevertheless, this agent was recently withdrawn. We describe 5 patients treated with local intracoronary fibrinolysis administrated through predesigned catheters in the setting of AMI and CAE.
Assuntos
Vasos Coronários , Infarto do Miocárdio , Abciximab , Anticorpos Monoclonais , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Fibrinólise , Humanos , Fragmentos Fab das Imunoglobulinas , Infarto do Miocárdio/tratamento farmacológico , Inibidores da Agregação Plaquetária , Complexo Glicoproteico GPIIb-IIIa de Plaquetas , Resultado do TratamentoAssuntos
Falso Aneurisma , Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Falso Aneurisma/diagnóstico , Falso Aneurisma/etiologia , Falso Aneurisma/cirurgia , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
Our aim was to analyze its diagnostic and prognostic value in patients with high coronary calcium score (CCS). A total of 113 patients with CCS > 400 were included. Significant coronary artery disease (CAD) was defined as stenosis ≥ 50%. Invasive coronary angiography and major cardiovascular events were recorded. The CCS and heart rate during the acquisition were significantly lower in the diagnostic coronary computed tomography angiography (CCTA) group. The cut-off value of CCS to establish the diagnostic utility of CCTA was 878. The rate of cardiovascular events was 9.3%. The positive predictive value of CCTA to detect significant CAD was 73.5% and the negative predictive value for predicting cardiovascular events was 96%. In patients with high CCS, CCTA is useful to evaluate CAD, especially when the CCS is lower or equal to 878; moreover, the prognostic value of CCTA is better in patients where significant CAD has been ruled out.
Assuntos
Calcinose/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Doença da Artéria Coronariana/diagnóstico , Vasos Coronários/diagnóstico por imagem , Sistema de Registros , Idoso , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de RiscoRESUMO
Vascular complications during transcatheter aortic valve implantation (TAVI) are relatively common, and some of them related to the transfemoral secondary access. The use of the transradial access (TRA) as an alternative vascular approach for transfemoral TAVI could reduce these complications, however, the treatment of potential vascular peripheral issues from this access has been scarcely described. The advance of a wire from the TRA to the primary transfemoral access at the beginning of the procedure could help the management of eventual vascular complications. A new TRA technique during transfemoral TAVI procedures is described, reporting the results in the first forty-two patients in one center.
Assuntos
Estenose da Valva Aórtica , Substituição da Valva Aórtica Transcateter , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Artéria Femoral/diagnóstico por imagem , Artéria Femoral/cirurgia , Humanos , Punções , Estudos Retrospectivos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do TratamentoRESUMO
No disponible
Assuntos
Humanos , Masculino , Feminino , Idoso , Estenose Coronária/diagnóstico por imagem , Constrição Patológica , Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Tomografia Computadorizada por Raios XRESUMO
Ebstein anomaly is a congenital disease frequently associated with atrial septal defects, which can generate a right-to-left shunt, leading to systemic desaturation and right ventricular failure. We describe the case of a 68-year-old man with central cyanosis due to Ebstein anomaly and a patent foramen ovale. An atrial septal occluder was initially implanted after having performed prolonged test occlusion of the interatrial communication. In this case, device embolization occurred due to high right pressure. Percutaneous closure of atrial septal defects in the presence of a right-to-left shunt can offer a significant clinical improvement in selected cases. In patients with Ebstein anomaly, the implantation of atrial septal defect closure devices may be desirable, due to the larger size of the waist, which may provide better stability in the event of an increase in right pressure.
Assuntos
Anormalidades Cardiovasculares , Anomalia de Ebstein , Forame Oval Patente , Dispositivo para Oclusão Septal , Idoso , Anomalia de Ebstein/complicações , Forame Oval Patente/complicações , Humanos , Hipóxia , MasculinoRESUMO
No disponible
Assuntos
Humanos , Masculino , Idoso de 80 Anos ou mais , Próteses Valvulares Cardíacas/efeitos adversos , Estenose da Valva Mitral/terapia , Dabigatrana/uso terapêutico , Trombose/tratamento farmacológico , Falha de Prótese/efeitos adversos , Reoperação/métodos , Procedimentos Endovasculares/métodosRESUMO
We present two patients with refractory heart failure due to mitral paravalvular leak (PVL) in whom percutaneous PVL closure was performed in the immediate postoperative period.
Assuntos
Insuficiência Cardíaca/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Insuficiência da Valva Mitral/cirurgia , Valva Mitral/cirurgia , Complicações Pós-Operatórias/cirurgia , Dispositivo para Oclusão Septal , Idoso , Procedimentos Cirúrgicos Cardíacos/métodos , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , ReoperaçãoRESUMO
We describe the case of an 81-year-old woman with three biological prostheses at the aortic valve, mitral valve, and tricuspid valve with recurrent hospitalizations due to heart failure. To the best of our knowledge, this is the first percutaneous closure of ventricular septal defect in the presence of three valvular prostheses.