ABSTRACT
Literature concerning transcutaneous symptomatic para valvular cardiac leaks closure (PVLC) after trans aortic valve implantation (TAVI) is relatively scarce. Hereby we present 2 clinical cases, one on an Edwards® Sapien 3 valve and the other one on a Medtronic® Evolut R valve. We present also the preliminary results of the 7 PVLC on TAVI included in our prospective FFPP registry during the 2 first years of enrolment (2017-2018), for a total of 158 inclusions for all valves. Seven procedures were performed on 8 leaks, using a majority of vascular plugs (3 Abbott® Amplatzer Vascular Plugs 2 (AVP2), 3 AVP3, 1 AVP4, and 1 muscular Ventricular Septal Defect (VSD) occluder). All procedures were successful without complication. At 1-month follow-up, all patients became asymptomatic. One-year follow-up was already available for 4 patients: 3 of them were symptoms free, and one-who had a second leak not suitable for PVLC-, underwent a « TAVI in TAVI ¼ procedure 2 months after PVLC. This short experience demonstrates the feasibility, the efficacy and the safety of PVLC on TAVI. We expect to be able to offer more in depth information at the end of our prospective ongoing study.
Subject(s)
Anastomotic Leak/surgery , Aortic Valve Stenosis/surgery , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement/adverse effects , Aged , Aged, 80 and over , Anastomotic Leak/diagnostic imaging , Anastomotic Leak/etiology , Female , Humans , Male , Multicenter Studies as Topic , Observational Studies as Topic , Prospective Studies , Prosthesis Design , Septal Occluder DeviceABSTRACT
Acute coronary syndrome results in most cases of atherosclerotic plaque rupture. In a few cases, the physiopathological mechanism is different. This does not necessarily change the initial strategy but the subsequent treatments. We report three cases of clinical presentations of acute coronary syndrome whose pathophysiological mechanism is not or not mainly due to atherosclerotic lesions. Based on these cases and a review of the literature, two topics will be tackled: the diagnostic and therapeutic strategy in the management of Tako-tsubo cardiomyopathies and also acute coronary syndromes due to vasospastic angina.
Subject(s)
Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/therapy , Coronary Angiography , Coronary Vasospasm/diagnosis , Coronary Vasospasm/therapy , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/therapy , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/physiopathology , Aged, 80 and over , Analgesics, Opioid/administration & dosage , Angioplasty/methods , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anticoagulants/administration & dosage , Atherosclerosis/complications , Coronary Vasospasm/physiopathology , Electrocardiography , Female , Heart Conduction System/physiopathology , Humans , Hydroxymethylglutaryl-CoA Reductase Inhibitors/administration & dosage , Male , Middle Aged , Risk Factors , Smoking/adverse effects , Takotsubo Cardiomyopathy/physiopathology , Treatment OutcomeABSTRACT
The authors report on 35 fractures of the humerus neck treated by "bouquet" type internal fixation. The operative technique employed is that developed by Bombard and co-workers. A few variants of this technique are described. Only fractures that were badly dislocated were internally fixated. Slight dislocations were treated for the most part by simple orthopaedic measures. This technique may be used on patients of all ages and leads to early mobilization. It might be employed to advantage in the management of slightly dislocated fractures in respiratory failure or in patients with chest injuries.
Subject(s)
Fracture Fixation, Intramedullary/methods , Shoulder Fractures/surgery , Female , Follow-Up Studies , Humans , Male , Middle Aged , Shoulder Dislocation/complications , Shoulder Fractures/complicationsABSTRACT
A case of slow fracture of both femoral heads in a 19-year-old woman is reported. The radiological characteristics, clinical context and onset in a histologically normal skeleton were in favour of a diagnosis of fatigue fracture. Data in the literature show the rarity of this condition affecting the neck of the femur in the young woman and rarely mention the existence of morphological abnormalities as a favouring factor.
