1,720,972 research outputs found
[Mitral valvuloplasty in a patient with congenital kyphoscoliosis: case report and literature review]
No full textPercutaneous transluminal mitral commissurotomy (PTMC) is the procedure of choice for the treatment of severe mitral stenosis in symptomatic patients. In recent years, epidemiological changes among these patients are observed, since they more frequently are older, with several comorbidities and unfavorable mitral anatomy, all features that may contraindicate PTMC. Notwithstanding this, high rates of success and safety are achieved, following improvements in the learning curve and technique. We report the case of a 68-year-old Caucasian male, affected by chronic obstructive pulmonary disease and congenital kyphoscoliosis, admitted for acute pulmonary edema in severe mitral valve stenosis and moderate mitral regurgitation. PTMC was performed successfully, without any complications, using few simple tricks
An Amulet to Say "Big is Not Enough"
No full textWe report the case of a man affected by non-valvular atrial fibrillation in whom a severely enlarged left atrial appendage with a narrow neck was successfully closed with a 34 mm Amplatzer Amulet device (St. Jude Medical). In the presence of a huge appendage with a narrow neck, as in this case, the Amulet should be considered an available option to ensure the feasibility of percutaneous closure
Mechanical interference between a closure device and the rigid stent of mitral bioprosthesis: a mechanism for closure device late dislodgement.
No full textWe report here the mechanical interference between mitral bioprostheses and devices currently adopted for percutaneous paravalvular leak closure as a possible cause for late dislodgement and embolization of successfully implanted and apparently stable closure devices.The images included in this study demonstrate that the topographical relationship of the target leak with the bioprosthetic valve posts may be a major obstacle for device stability after percutaneous paravalvular leak closure procedures
The SAPIEN 3 valve: lights and shadows.
No full textTranscatheter aortic valve implantation (TAVI) has become an accepted alternative treatment option for high-risk or inoperable patients with symptomatic severe aortic stenosis. The future challenge for TAVI devices is to ensure results in terms of safety and efficacy that may justify an eligibility extension for this procedure to patients at intermediate and low risk for surgery. The ideal aortic valve prosthesis should be durable, with optimal hemodynamic performance and able to reduce the current major complications of TAVI procedure, in particular vascular complications (not infrequent with the transfemoral access route), paravalvular leaks, stroke and atrioventricular block requiring a permanent pacemaker. The SAPIEN 3 (TM) (S3) (Edwards Lifesciences, Irvine, CA, USA) is the last Edwards family's transcatheter heart valves and incorporates a number of new and enhanced features intended to reduce the risk of vascular injury and paravalvular regurgitation, and to facilitate rapid and accurate positioning and implantation. The first data on S3 (SAPIEN3 trial) were presented at the EuroPCR 2014 and confirmed the advantage of the S3 compared with the previous Edwards valves (SAPIEN and SAPIEN XT) in terms of prevention of vascular complications and of moderate-severe paravalvular leaks, but showed an increase in the need of a permanent pacemaker post-TAVR. The S3 is certainly a promising evolution of transcatheter valves which may effectively reduce the risk of vascular complications and paravalvular leak. However, the S3 seems to be related to an increased risk of atrioventricular block, even if this complication could be due to the need to implant the valve in a higher position compared to previous models
Atrial fibrillation in patients undergoing transcatheter aortic valve implantation: epidemiology, timing, predictors, and outcome
No full textAtrial fibrillation (AF) is a common arrhythmia in patients with aortic stenosis. When these patients are treated medically or by surgical aortic valve replacement, AF is associated with increased risk of adverse events including death. Growing evidence suggests a significant impact of AF on outcomes also in patients with aortic valve stenosis undergoing transcatheter aortic valve implantation (TAVI). Conversely, limited evidence is available regarding the optimal management of this condition. This review aims to summarize prevalence, pathophysiology, prognosis, and treatment of AF in patients undergoing TAVI
Left atrial appendage closure: beyond the artifact.
No full textTransesophageal echocardiography (TEE) represents the gold standard technique to detect left atrial appendage (LAA) thrombosis. Several conditions may be erroneously interpreted as LAA thrombus at TEE, including artifacts mimicking thrombi. We report a case of a 78-year-old man with atrial fibrillation and contraindication to anticoagulation who was referred to our institution for percutaneous left appendage closure with a transcatheter trans-septal approach. Intraoperative transesophageal echocardiography revealed a thrombus-mimicking image, related to reverberations of left upper pulmonary vein ridge, located at twice the distance of the ridge from the transducer
Blood oozing: A cause of life-threatening bleeding without overt source after transcatheter aortic valve replacement
No full textBACKGROUND:
Post-procedure non-access site-related bleedings have a significant impact on mortality in patients treated by transcatheter aortic valve replacement (TAVR). Notwithstanding, the source of these bleedings is frequently indeterminate, with potentially serious clinical implications related to lack of diagnosis and treatment.
METHODS:
Out of 513 TAVR performed between June 2007 and January 2016 in the Interventional Cardiology Laboratory of the Department of Cardiac, Thoracic and Vascular Sciences, University Hospital of Padua, we identified few proven cases of concealed bleeding after TAVR due to blood oozing.
RESULTS:
We report three cases of angiographically confirmed post-TAVR non-access bleedings related to spontaneous blood oozing, a life-threatening condition consisting of diffuse capillary hemorrhage developing from vessels not directly involved by the procedure. We hypothesize that spontaneous post-procedural blood oozing may account for a substantial proportion of non-overt, non-access site-related bleeding after TAVR.
CONCLUSION:
The possibility of post-TAVR blood oozing is largely neglected in the literature, and comprehensive categorization of non-access site bleedings in current standardized endpoints of TAVR studies is missing. Early assessment with arterial and venous contrast phase angio-MDCT scans in case of post-TAVR unexplained and persistent anemia may allow diagnosis and treatment of this subtle condition
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