Estenosis tricuspídea de bioprótesis tratada mediante implante valvular percutáneo: una solución segura para un paciente inusual

Se comunica el caso de una mujer de 31 años quien había sido previamente sometida a reemplazo valvular aórtico, mitral y tricuspídeo en tres episodios quirúrgicos. Fue ingresada a nuestra sección de cardiologÍa con síntomas compatibles con insuficiencia cardiaca derecha. Se efectuó evaluación mediante ecocardiograma, sondeo cardíaco derecho/izquierdo, angioTAC cardíaco y cardio resonancia. Se diagnosticó una estenosis tricuspídea severa secundaria a disfunción de prótesis biológica. Debido a alto riesgo operatorio y riesgo de falla ventricular derecha post-operatorio, la paciente fue rechazada para reemplazo valvular quirúrgico. Se decidió efectuar reemplazo tricuspídeo procedimiento "valve in valve". Se logró efectuar de manera exitosa por abordeje venoso femoral, prótesis balón expansible. Se demostró corrección de la estenosis tricuspídea y la paciente evolucionó con remisión de los síntomas de falla cardíaca.

We report a 31-year-old woman who was previously subjected to aortic, mitral, and tricuspid valve replacement in three different surgical episodes. She was admitted to our cardiology section with acute right heart failure symptoms. She was studied by echocardiography, right/left heart catheterization, cardiac CT scan and cardiac magnetic resonance. A severe tricuspid stenosis due to biological prosthesis dysfunction was diagnosed. Due to high operative risk and risk of postoperative right ventricular failure, the patient was rejected for cardiovascular surgery. We decided on a percutaneous tricuspid "valve in valve replacement". The procedure was done successfully by venous femoral approach, with a balloon expandable prosthesis. Tricuspid stenosis was corrected and the patient evolved with remission of heart failure symptoms.

Complicaciones cardiovasculares en pacientes COVID-19 hospitalizados en Unidades de Pacientes Críticos en Chile. Registro COVICAR / Cardiovascular complications in COVID-19 patients admitted to intensive care units in Chilean hospitals

BACKGROUND: Patients with a cardiovascular (CV) history may be at greater risk of becoming ill and die due to SARS-CoV-2. AIM: To assess the incidence of CV complications in COVID-19 patients, the type of complication, and their association with CV history. MATERIAL AND METHODS: The clinical course of 1,314 patients with COVID-19 admitted consecutively to critical care units of 10 Chilean hospitals was registered between April and August of 2020. RESULTS: The median age of patients was 59 years and 66% were men. One hundred-four (8%) had a CV history, namely heart failure (HF) in 53 (4.1%), coronary heart disease in 50 (3.8 %), and atrial fibrillation in 36 (2.7 %). There were CV complications in 359 patients (27.3%). The most common were venous thrombosis in 10.7% and arrhythmias in 10.5%, HF in 7.2%, type 2 acute myocardial infarction in 4.2%, arterial thrombosis in 2.0% and acute coronary syndrome (ACS) in 1.6%. When adjusted by age, sex and risk factors, only HF (Odds ratio (OR) = 7.16; 95% confidence intervals (CI), 3.96-12.92) and ACS (OR = 5.44; 95% CI, 1.50-19.82) were significantly associated with CV history. There was no association with arrhythmias, type 2 acute myocardial infarction, arterial or venous thrombosis. CONCLUSIONS: Patients with a history of CV disease are at greater risk of suffering HF and ACS when hospitalized due to COVID-19. Arrhythmias, type 2 AMI, and arterial or venous thrombosis occur with the same frequency in patients with or without CV history, suggesting that these complications depend on inflammatory phenomena related to the infection.

Estenosis aórtica y lesión severa de tronco coronario: tratamiento percutáneo exitoso / Severe aortic valve stenosis with co-existing critical obstruction of the main left coronary artery

Abstracts: Successful treatment following percutaneous angioplasty (PTCA) and percutaneous trans aortic valve aortic valve stenosis and critical obstruction of the main left coronary artery is presented. Due to a very high estimated surgical risk the patient underwent PTCA of the main left trunk followed, a week later, by trans catheter implantation of an aortic valve (TAVI). The procedure was uneventful, and the clinical condition of the patient was excellent at one year (Functional class I).

Validación del test de troponinas en plasma a partir de una población sana: una experiencia local / Validation of normal values for troponin i plasma levels in a chilean population

Introducción: Las troponinas corresponden a proteínas estructurales del miocardiocito, su presencia en plasma se utiliza como marcador de injuria miocárdica. El test troponinas en plasma se utiliza actualmente para detectar daño miocárdico en pacientes en quienes se sospecha un infarto agudo al miocardio; para este propósito se toma como referencia valores de referencia validados en poblaciones de Inglaterra o Estados Unidos. Objetivo: El propósito de este estudio obtener valores de referencia para nuestra población local. Métodos y resultados: Se efectuó una determinación de troponina I en 500 sujetos sanos, se obtuvo el valor promedio de troponina I para esta población y el valor percentil 99 para esta población que se considera internacionalmente como el valor de referencia para determinar el límite normal, el valor P99 resultó significativamente menor en mujeres respecto a hombres. Conclusión: En conclusión, se han obtenido valores de referencia para aplicar el test de troponina I en nuestro medio local.

Background: Troponins are myocardiocyte proteins; their plasma level is used as a marker for myocardial injury. In the diagnosis of myocardial infarction values currently used as cut points are those validated elsewhere (USA, UK). Aim: In this study we aimed to determine normal limits of Troponin I in a sample of Chilean subjects. Methods and results: 500 healthy subjects had their troponin I levels measured, computing the mean and 99 percentile (p99) values. Both parameters were significantly lower in females compared to males (mean ± SD 0.089 +/- 0.047 vs 0.102 +/- 0.063, p<0.01; p99 0.02 vs 0.03, respectively). Conclusion: These troponin I values may be used to assess the likelihood of myocardial infarction in Chilean subjects.