Subject(s)
Aortic Aneurysm, Abdominal , Blood Vessel Prosthesis Implantation , Coronary Aneurysm , Aortic Aneurysm, Abdominal/surgery , Blood Vessel Prosthesis , Coronary Aneurysm/diagnosis , Coronary Aneurysm/etiology , Coronary Aneurysm/surgery , Humans , Prosthesis Design , Stents/adverse effects , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Humans , Male , Middle Aged , Atherectomy , Plaque, Atherosclerotic/surgery , Angioplasty, Laser/methods , Treatment OutcomeSubject(s)
Atherectomy, Coronary/methods , Coronary Occlusion/surgery , Coronary Vessels/diagnostic imaging , Lasers, Excimer/therapeutic use , Tomography, Optical Coherence/methods , Coronary Angiography , Coronary Occlusion/diagnosis , Coronary Vessels/surgery , Humans , Male , Middle Aged , Severity of Illness IndexABSTRACT
Mitral stenosis (MS) is frequently associated with the development of atrial fibrillation (AF) as a consequence of hemodynamic and inflammatory changes in the left atrium. Both conditions predispose to thrombus formation, with frequent involvement of the left atrial appendage (LAA), and consequent increase in the incidence of systemic thromboembolic events. Percutaneous mitral valvuloplasty (PMV) reduces the risk of thromboembolism in patients with significant mitral stenosis. Percutaneous LAA closure is also associated with a reduction in thromboembolic risk in patients with AF, but there are no data regarding the use of this technique in patients with significant mitral valve disease. We report the case of a 57-year-old-woman with significant MS and permanent AF, in New York Heart Association functional class II, who despite adequate oral anticoagulation with acenocoumarol, presented several clinical episodes of systemic thromboembolism in the last four years. It was decided to perform a combined percutaneous procedure, including both PMV and percutaneous LAA closure with the Amplatzer Cardiac Plug device. No significant acute complications occurred and the patient was discharged on indefinite treatment with acenocoumarol associated with aspirin 100 mg/d for three months. After a one-year follow-up, there have been no new embolic episodes or other complications.
Subject(s)
Atrial Appendage/surgery , Atrial Fibrillation/drug therapy , Atrial Fibrillation/surgery , Mitral Valve Stenosis/surgery , Septal Occluder Device , Thromboembolism/prevention & control , Acenocoumarol/therapeutic use , Anticoagulants/therapeutic use , Atrial Fibrillation/complications , Cardiac Surgical Procedures , Combined Modality Therapy/methods , Female , Humans , Middle Aged , Mitral Valve Stenosis/complications , Mitral Valve Stenosis/diagnostic imaging , Thromboembolism/etiology , Treatment OutcomeABSTRACT
Clinical trials have shown that functional assessment of coronary stenosis by fractional flow reserve (FFR) improves clinical outcomes. Intravascular ultrasound (IVUS) complements conventional angiography, and is a powerful tool to assess atherosclerotic plaques and to guide percutaneous coronary intervention (PCI). Computational fluid dynamics (CFD) simulation represents a novel method for the functional assessment of coronary flow. A CFD simulation can be calculated from the data normally acquired by IVUS images. A case of coronary heart disease studied with FFR and IVUS, before and after PCI, is presented. A three-dimensional model was constructed based on IVUS images, to which CFD was applied. A discussion of the literature concerning the clinical utility of CFD simulation is provided.
