[Use of transjugular intrahepatic portosystemic shunt (TIPS) in an 84 year-old patient during acute variceal bleeding]. / Utilizacion del shunt portosistemico intrahepatico transyugular (TIPS) en un paciente 84 años durante un episodio de hemorragia aguda por varices esofagicas.

The transjugular intrahepatic protosystemic shunt (TIPS) is a nonsurgical method with low mortality which does not interfere with subsequent liver transplantation. We describe the case of an old male patient with chronic hepatopathy who was admitted because of an episode of variceal bleeding. Due to the failure of the medical treatment and sclerotherapy, coronarian stomachic vein was embolized with a coil and a TIPS was performed during the acute episode of variceal bleeding. He evolved favorably and after a year of the procedure remains asymptomatic.

Percutaneous balloon mitral valvuloplasty: early and late results according to surgical risk and echocardiographic score.

OBJECTIVE AND DESIGN: Early results, complications and follow-up of 70 patients undergoing percutaneous balloon mitral valvuloplasty (BMV) were retrospectively analyzed to establish whether an increased surgical risk or an unfavourable echocardiographic score influenced the results. PATIENTS: The patients were divided into two groups according to the presence (group A, n = 31) or absence (group B, n = 38) of high surgical risk factors. The patients were also divided into two other groups according to the presence (group C, n = 46) or absence (group D, n = 20) of favourable mitral valve anatomy. Group A (high surgical risk) included patients fulfilling at least one of the following criteria: 65 years of age or older; previous surgical commissurotomy; depressed left ventricular function; respiratory or hepatic insufficiency; or previous aortic valve replacement. Mitral valve anatomy was classified as 4 to 16, according to the echocardiographic score established by Abascal et al. Group C patients had echocardiographic score below 8 and group D had echocardiographic scores of 8 or greater. INTERVENTIONS: Mean mitral valve gradient (MVG) and area (MVA) were Doppler-estimated immediately before and 48 h after the BMV. MAIN RESULTS: There were no differences in the early results and complications between groups A and B (MVA 1.8 +/- 0.5 versus 1.9 +/- 0.4 cm2). Final MVA was significantly greater in group C than in group D (MVA 1.9 +/- 0.4 versus 1.6 +/- 0.4 cm2; P = 0.03). There was no difference in the incidence of complications. Over a follow-up period averaging 19.1 months (range 1 to 55), 90.7% of the patients were in New York Heart Association functional class I or II. Four patients had a mitral valve replacement, one had a surgical commissurotomy and one had a second BMV. Two unrelated deaths occurred. There were no differences in the characteristics of the study population and the incidence of events in the follow-up period between groups. CONCLUSIONS: The results and outcome of BMV were unrelated to the general surgical risk, suggesting that this procedure may be used with particular benefit in this group of patients. In contrast, mitral valve anatomy must be considered as an important determinant of the results.