RESUMO
BACKGROUND: Balloon valvuloplasty (BAV) has been considered a mandatory step before TAVI. However, it might be related to cerebrovascular microembolizations, atrioventricular conduction disturbances, and hemodynamic instability. The aim of this study is to describe transesophageal echocardiography characteristics of patients that could benefit from direct transfemoral transcatheter aortic valve implantation (TAVI) of Edwards SAPIEN XT, without previous BAV. METHODS AND RESULTS: A total of 16 patients with direct implantation of an Edwards SAPIEN XT valve are included. Preprocedural echocardiographic findings were exhaustively analyzed and described. From 32 patients elected for transfemoral TAVI with an Edwards SAPIEN XT, 16 of them (50%) were selected for direct implantation using the Edwards SAPIEN XT valve of size 23 mm (n = 5), 26 mm (n = 8), or 29 mm (n = 3). Patients selection for direct TAVI presented three echocardiographic conditions: central effective orifice, moderate to severe calcification of the aortic valve apparatus preserving leaflets movement, and symmetric distribution of calcium with absent to moderate central aortic regurgitation. Mean age was 81.4 ± 7.4, 75% female, with a mean logistic Euroscore 18.2 ± 11.2. Preprocedural mean valve gradient was 43.6 ± 16.3. Mean effective orifice area was 0.7 ± 0.2. There was no valve embolization and the success rate was 100%. Postdilation was performed in one patient (6.25%). New permanent pacing was needed in two patients (12.5%). CONCLUSIONS: TAVI without previous BAV is feasible and safe. 2D/3D TEE is an essential tool to select the patients that could benefit from this technique.
Assuntos
Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/terapia , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/patologia , Calcinose/diagnóstico por imagem , Calcinose/terapia , Cateterismo Cardíaco , Ecocardiografia Tridimensional , Ecocardiografia Transesofagiana , Artéria Femoral , Implante de Prótese de Valva Cardíaca , Próteses Valvulares Cardíacas , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/diagnóstico por imagem , Insuficiência da Valva Aórtica/etiologia , Insuficiência da Valva Aórtica/fisiopatologia , Insuficiência da Valva Aórtica/terapia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/fisiopatologia , Calcinose/complicações , Calcinose/fisiopatologia , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/instrumentação , Cateterismo Cardíaco/métodos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/instrumentação , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Desenho de Prótese , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
The optimal percutaneous treatment strategy for coronary bifurcation lesions is still unknown. Several dedicated coronary bifurcation stents, such as the Tryton Side Branch Stent™ (Tryton Medical, Durham, NC) have been developed to improve clinical outcomes. We presented a double bifurcation lesion case treated with two Tryton sidebranch stents, with a single drug eluting stent covering the main vessel and both bifurcations.
Assuntos
Angioplastia Coronária com Balão/instrumentação , Doença da Artéria Coronariana/terapia , Stents , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico , Stents Farmacológicos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Resultado do TratamentoRESUMO
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 , Catéteres , 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 , StentsRESUMO
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.
RESUMO
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
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
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
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 TratamentoRESUMO
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
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.
Assuntos
Valva Aórtica/cirurgia , Cateterismo Cardíaco/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Comunicação Interventricular/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Valva Mitral/cirurgia , Valva Tricúspide/cirurgia , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Ecocardiografia Transesofagiana , Feminino , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Valva Mitral/diagnóstico por imagem , Desenho de Prótese , Dispositivo para Oclusão Septal , Valva Tricúspide/diagnóstico por imagemRESUMO
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
OBJECTIVES: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis. BACKGROUND: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3. METHODS: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed. RESULTS: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8). CONCLUSIONS: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Bloqueio de Ramo/epidemiologia , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/instrumentação , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/epidemiologia , Estenose da Valva Aórtica/fisiopatologia , Bloqueio de Ramo/diagnóstico , Bloqueio de Ramo/fisiopatologia , Feminino , Humanos , Incidência , Masculino , Desenho de Prótese , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espanha/epidemiologia , Resultado do TratamentoRESUMO
Percutaneous AVF closure was performed post TAVI in a patient with severe aortic stenosis and an AVF between the right SFA and femoral vein.
Assuntos
Estenose da Valva Aórtica/cirurgia , Fístula Arteriovenosa/cirurgia , Cateterismo Periférico/efeitos adversos , Substituição da Valva Aórtica Transcateter , Idoso , Angiografia , Fístula Arteriovenosa/diagnóstico , Fístula Arteriovenosa/etiologia , Feminino , Artéria Femoral , Veia Femoral , Humanos , Período IntraoperatórioRESUMO
Anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) is a rare malformation traditionally considered "malignant" in cases of interarterial course. Recently, a protective effect of the low interarterial subtype (between the aorta and the right ventricle outflow tract) has been described. We present an IVUS-guided percutaneous intervention in a patient with anomalous origin of the left coronary artery from the right coronary sinus presenting with anterior ischemia. In patients with ACAOS, the integration of complementary image techniques is recommended, defining the anomalous course of the vessel and providing an accurate assessment of the individual risk for each patient. The use of IVUS may be advisable, emerging as a really useful tool to complete the study and guide the treatment.
Assuntos
Seio Coronário/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Intervenção Coronária Percutânea , Idoso , Angiografia por Tomografia Computadorizada , Angiografia Coronária/métodos , Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Stents Farmacológicos , Humanos , Imageamento por Ressonância Magnética , Masculino , Tomografia Computadorizada Multidetectores , Intervenção Coronária Percutânea/instrumentação , Resultado do Tratamento , Ultrassonografia de IntervençãoRESUMO
INTRODUCTION AND OBJECTIVES: Transcatheter aortic-valve implantation (TAVI) is an accepted treatment for patients with severe aortic stenosis and high surgical risk. However, there is lack in data about TAVI in low-risk patients that are already being treated with this therapy in some clinical contexts. METHODS: A retrospective analysis of patients treated with transfemoral TAVI using Edwards Sapien prosthesis in one center was performed, classifying the patients into three groups according to the surgical risk (high/intermediate/low risk for STS score>8/4-8/<4). Clinical characteristics, procedure and follow-up outcomes were collected, comparing the results between low and high surgical risk groups. RESULTS: 89 TAVIs using Edwards balloon expandable prosthesis were performed (9 Sapien XT and 80 Sapien 3 valves were implanted). 40 patients (45%) presented a STS score<4, while 33 (37%) had a STS>8. Low-risk patients were significantly younger and had lower rates of coronary artery disease, peripheral vascular disease, pulmonary lung disease and atrial fibrillation. There were no significant differences in most of the technical variables of the procedure, apart from vascular complications and complete left bundle branch block after valve implant, which were higher in the group with STS>8. Patients of low risk presented shorter hospital stay (2,91±1,6, vs 4,8±3,9 days), with lower rates of mortality at mid- and long follow-up (death from any cause 15,2% vs 0%, p 0,04). CONCLUSIONS: TAVI in low-risk patients is safe and associated with better outcome at mid and long-term follow-up compared to high-risk patients.
Assuntos
Estenose da Valva Aórtica/cirurgia , Valva Aórtica/cirurgia , Valvuloplastia com Balão , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter/instrumentação , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/fisiopatologia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/fisiopatologia , Valvuloplastia com Balão/efeitos adversos , Valvuloplastia com Balão/mortalidade , Feminino , Hemodinâmica , Humanos , Masculino , Desenho de Prótese , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/mortalidade , Resultado do TratamentoRESUMO
Coronary artery fistulae (CAF) are uncommon heart defects defined as a communication between a coronary artery and a cardiac chamber or vascular structure. They are frequently asymptomatic; nevertheless, they can produce angina, dyspnea or cardiac failure. CAF are believed to be congenital; however, isolated cases of CAF have been described as rare complications of cardiac surgery. We report the percutaneous closure of a giant CAF in an adult patient with angina and previous pericardiectomy.