ABSTRACT
An 87-year-old man with a history of heart failure and a modified bio-Bentall Mitroflow 23-mm bioprosthesis (Sorin) was referred to our institution for critical aortic stenosis, which was confirmed by transesophageal echocardiography. Pre-procedural computed tomography revealed slightly calcified bioprosthesis leaflets, adequate coronary ostia height, and a slightly angled Bentall tube graft measuring 29 mm in diameter at the aortic anastomosis .
ABSTRACT
Dynamic road-mapping (DRM) (Dynamic Coronary Roadmap; Philips) offers a real-time, dynamic overlay of the coronary tree on fluoroscopy.
Subject(s)
Humans , Female , Aged , Nausea , Vomiting , Diuresis , Diabetes Mellitus, Type 2 , Abdominal PainABSTRACT
To the best of our knowledge, this case represents the first patient with Mitraclip, Amplatzer, and TricValve devices with a profound clinical improvement and long-term follow-up. In addition, this case illustrates how the treatment of high-risk patients with polyvalvular disease has changed in the last few years.
Subject(s)
Heart Valve Prosthesis Implantation , Mitral Valve Insufficiency , Humans , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/etiology , Cardiac Catheterization/adverse effects , Heart Valve Prosthesis Implantation/adverse effects , Treatment OutcomeSubject(s)
Aortic Valve Stenosis , Balloon Valvuloplasty , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Humans , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Treatment Outcome , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Transcatheter Aortic Valve Replacement/adverse effects , Balloon Valvuloplasty/methods , Prosthesis DesignSubject(s)
Diabetes Mellitus, Type 2 , Diabetic Ketoacidosis , Ketosis , Takotsubo Cardiomyopathy , Humans , Takotsubo Cardiomyopathy/chemically induced , Takotsubo Cardiomyopathy/diagnosis , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Ketosis/chemically induced , Ketosis/diagnosis , Glucose , Sodium , Diabetic Ketoacidosis/chemically induced , Diabetic Ketoacidosis/diagnosisSubject(s)
Myocardial Infarction , Percutaneous Coronary Intervention , Coronary Angiography , Coronary Vessels , Humans , Myocardial Infarction/diagnostic imaging , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/adverse effects , Tomography, Optical Coherence , Treatment OutcomeSubject(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
Heavily calcified coronary lesions increase the complexity of percutaneous coronary interventions (PCI) and represent a challenge for interventional cardiologists. They are an important cause of stent underexpansion and poor clinical outcome. Nowadays, there are different dedicated devices which enhance the chances of success. Rotational atherectomy is the first-line modality which permits to cross balloons or stents through severe calcified lesions. However, when circumferential deep calcium plaques exist may not be enough to achieve adequate expansion of these devices. In these cases, the complementary use of intracoronary lithotripsy ("RotaTripsy") can be an effective approach that further modifies the calcified plaque and enables optimal stent implantation. We present the first case series undergoing PCI using "RotaTripsy" technique.
Subject(s)
Atherectomy, Coronary , Coronary Artery Disease , Lithotripsy , Percutaneous Coronary Intervention , Vascular Calcification , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/therapy , Humans , Percutaneous Coronary Intervention/adverse effects , Treatment Outcome , Vascular Calcification/diagnostic imaging , Vascular Calcification/therapyABSTRACT
OBJECTIVES: The objective was to evaluate the results of valve-in-valve procedures performed with the Allegra device. BACKGROUND: Transcatheter aortic valve implantation to treat degenerated biological aortic valves (valve-in-valve) is an established procedure in most catheterization laboratories, but the results are poorer than procedures done in native aortic stenosis. The Allegra device (Biosensors, Morges, Switzerland) has an excellent design to treat these patients. METHODS: All patients with severely degenerated biological aortic valve treated with the Allegra device in centers from Spain until December 2020 were included (n = 29). Hemodynamic results and 30-day clinical outcomes were evaluated. The predominant hemodynamic failure was stenosis in 15, regurgitation in 11, and a combination of both in 3 cases. Time from aortic valve replacement to valve-in-valve procedure was 8.4 ± 3.9 years (range 3.3-22.1). RESULTS: After the procedure, maximum and mean trans-valvular gradients were 17.4 ± 12.3 and 8.4 ± 6.1 mmHg, respectively. Device success was obtained in 28 patients (96.6%). In one patient with a degenerated 19 mm prosthetic valve, mean gradient after the procedure was 22 mmHg. No patients had a para-valvular leak grade >1. There were no deaths during the hospitalization or at 30 days and one patient suffered a stroke. CONCLUSIONS: The Allegra trans-catheter aortic valve offers optimal hemodynamic results in patients with severely degenerated biological aortic valve.
Subject(s)
Aortic Valve Stenosis , Bioprosthesis , Heart Valve Prosthesis Implantation , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/surgery , Catheters , Heart Valve Prosthesis Implantation/adverse effects , Humans , Prosthesis Design , Registries , Terfenadine/analogs & derivatives , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
Percutaneous MitraClip intervention for treatment of severe mitral regurgitation in high surgical risk patients requires large-diameter transseptal sheaths that can result in iatrogenic atrial septal defect (iASD), and its prevalence is higher compared with non-MitraClip procedures. This iASD is not routinely closed because the possible consequences are still not fully understood. However, we believe it is important to identify patients who may benefit from its closure immediately after the procedure to prevent hemodynamic deterioration and long-term negative clinical outcomes. We describe our experience with 2 patients who required iASD closure after MitraClip procedure due to right-to-left shunt resulting from increase in right heart pressures.
Subject(s)
Heart Septal Defects, Atrial , Mitral Valve Insufficiency , Cardiac Catheterization/adverse effects , Heart Septal Defects, Atrial/diagnosis , Heart Septal Defects, Atrial/etiology , Heart Septal Defects, Atrial/surgery , Humans , Iatrogenic Disease , Mitral Valve/diagnostic imaging , Mitral Valve/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/surgery , Treatment OutcomeABSTRACT
We present a case in which optical coherence tomography was useful to characterize in vivo superficial calcific sheet and exclude other causes of acute coronary syndromes.
Subject(s)
Acute Coronary Syndrome , Coronary Thrombosis , Plaque, Atherosclerotic , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/surgery , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/etiology , Coronary Thrombosis/surgery , Female , Humans , Middle Aged , Percutaneous Coronary Intervention , Plaque, Atherosclerotic/diagnostic imaging , Plaque, Atherosclerotic/surgery , Tomography, Optical CoherenceSubject(s)
Aortic Valve Insufficiency/surgery , Aortic Valve/surgery , Bioprosthesis , Coronary Occlusion/prevention & control , Heart Valve Prosthesis Implantation/instrumentation , Heart Valve Prosthesis , Percutaneous Coronary Intervention/instrumentation , Prosthesis Failure , Stents , Transcatheter Aortic Valve Replacement/instrumentation , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Aortic Valve Insufficiency/physiopathology , Coronary Occlusion/etiology , Female , Heart Valve Prosthesis Implantation/adverse effects , Humans , Severity of Illness Index , Transcatheter Aortic Valve Replacement/adverse effects , Treatment OutcomeABSTRACT
Longitudinal stent deformation is a recognized complication of coronary angioplasty; however, it is difficult to detect angiographically. This case illustrates the value of OCT to identify and correctly diagnose longitudinal stent deformation.