Abordaje y manejo del infarto agudo miocardio con elevación del ST en Costa Rica durante la pandemia por COVID-19 Documento de consenso de la Asociación Costarricense de Cardiología / Approach and management of acute ST elevation myocardial infarction in Costa Rica during the COVID-19 pandemic Consensus document of the Costa Rican Association of Cardiology

Resumen El virus SARS-CoV-2 se ha extendido a nivel mundial, rápidamente ha sobrecargado los sistemas de salud. Esta emergencia ha implicado cambios en la atención usual del infarto agudo miocardio con elevación del ST (IAMCEST) puesto que la actividad habitual de las salas de hemodinamia y las vías de traslado de los pacientes se ha visto afectada. La afectación del personal de salud también es una preocupación relevante por lo que presentamos un documento de Consenso de la Asociación Costarricense de Cardiología que pretende generar una guía de trabajo al personal que atiende esta patología y garantizar la atención adecuada del IAMCEST durante la pandemia en Costa Rica.

Abstract The current COVID-19 has spread worldwide, the outbreak is altering the usual activity of the catheterization laboratorios and the usual treatment pathways of patients with chronic diseases or emergencies, such as Acute Coronary Syndrome could be disrupted. The involvement of health personnel is a relevant concern, so we created a consensus document of the Costa Rican Association of Cardiology that aims to generate a decision-making workflow to treat this pathology and guarantee adequate and continuous care for ST elevation myocardial infarction during the COVID-19 outbreak.

Valve in Valve mitral por vía transapical en el Hospital México, reporte de dos casos y revisión de la literatura / Transapical mitral Valve in Valve in Hospital México, report of two cases and literatura review

Resumen La reoperación en pacientes con cirugía cardiaca previa en bioprótesis disfuncionantes representa una situación de alto riesgo quirúrgico, con elevada morbi-mortalidad perioperatoria. En la actualidad en casos seleccionados, el tratamiento percutáneo transcateter permite reemplazar la válvula mitral con acceso transapical o transeptal. El reemplazo percutáneo de la válvula mitral, tiene menor morbilidad y mortalidad comparado con la cirugía convencio nal, representando una alternativa terapéutica, la cual representa la única opción en pacientes de alto riesgo quirúrgico. Se presentan dos casos tratados de forma exitosa en nuestro centro con acceso transapical y válvula percutánea balón expandible Sapien XT.

Abstract Transapical mitral Valve in Valve in Hospital México, report of two cases and literatura review Surgical reintervention in patients with previous open heart surgery represents a high risk condition, with high morbidity and mortality in the perioperative period. Nowdays in selected clinical situations of patiens with failing bioprosthesis in mitral position, transcatheter percutaneous treatment allows the replacement of the mitral valve with transapical or transseptal access. The transcatheter percutaneous mitral valve replacement has lower morbidity and mortality in comparison with conventional surgery, representing a therapeutic alternative, wich migth be the only option in high risk patients. We present two cases done at our center with success using apical access and the ballon expandable device Sapien XT.

Endovascular iliac rescue technique for complete arterial avulsion after transcatheter aortic valve replacement.

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative therapy to open aortic valve repair for high-risk patients with aortic stenosis, but larger delivery sheath size is associated with vascular complications. We report 2 cases in which a minimally invasive technique was used for the hybrid repair of confirmed or suspected large-bore sheath traumatic avulsion (i.e., "iliac on a stick") after TAVR. We believe our hybrid approach to rescuing the iliac artery in suspected or confirmed complete artery avulsion could improve outcomes for patients who require TAVR.

Jetstream® atherectomy for subacutely or chronically occluded femoro-popliteal prosthetic bypass grafts: a report of three cases.

A failed infrainguinal bypass is associated with poor prognosis for the limb in question, particularly if the graft was initially placed for limb salvage. Revascularization of occluded grafts is an important but challenging issue. We present three patients with occluded femoro-popliteal graft in whom the Jetstream(®) system was used successfully to perform thromboatherectomy. The Jetstream(®) system is minimally invasive and avoids use of thrombolytic therapy and its associated costs and complications. The device seems to be highly effective in removing thrombus beyond the acute setting.

Spontaneous celiac artery dissection case report and literature review.

Symptomatic spontaneous celiac artery dissection is a rare condition that is being detected more often with the use of advanced imaging techniques. There is no consensus as to whether surgical or endovascular treatment is more appropriate.We describe the case of a 41-year-old hypertensive woman who presented with the sudden onset of sharp, persistent, right-upper-quadrant abdominal and epigastric pain. Magnetic resonance angiography of the abdomen revealed celiac artery dissection, with a flap compressing the lumen approximately 17 mm from the artery's origin at the aorta. Because of the patient's persistent epigastric pain, endovascular celiac artery stent implantation was performed with the use of 2 overlapping balloon-expandable stents. Twelve months after the procedure, the patient remained asymptomatic, and the stents were patent. This case and others in the medical literature suggest that endovascular treatment can be feasible in symptomatic patients with isolated spontaneous celiac artery dissection.