ABSTRACT
Percutaneous intervention in anomalous coronary arteries originating from the opposite sinus of Valsalva is complicated by their unusual location and course, which makes selective cannulation difficult. The GuideLiner (Vascular Solutions, Inc.) is a monorail guide extension catheter designed to advance beyond the tip of a mother guide catheter to enable deep intubation of a coronary artery, provide extra support, and improve coaxial alignment. We describe the cases of 4 patients with an anomalous coronary artery originating from the opposite sinus of Valsalva-including 2 with acute myocardial infarction-who underwent successful percutaneous coronary intervention with use of a GuideLiner catheter.
Subject(s)
Coronary Vessel Anomalies , Percutaneous Coronary Intervention , Sinus of Valsalva , Cardiac Catheterization , Catheters , Coronary Angiography , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Humans , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imaging , Sinus of Valsalva/surgery , StentsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Heart Valve Prosthesis/adverse effects , Mitral Valve Stenosis/therapy , Dabigatran/therapeutic use , Thrombosis/drug therapy , Prosthesis Failure/adverse effects , Reoperation/methods , Endovascular Procedures/methodsABSTRACT
No disponible
Subject(s)
Humans , Male , Aged, 80 and over , Thrombosis/diagnostic imaging , Thrombosis/surgery , Mitral Valve , Positron Emission Tomography Computed Tomography , Echocardiography, Transesophageal , ReoperationSubject(s)
Antithrombins/therapeutic use , Bioprosthesis/adverse effects , Dabigatran/therapeutic use , Heart Valve Prosthesis/adverse effects , Mitral Valve , Thrombosis/drug therapy , Aged, 80 and over , Echocardiography, Transesophageal , Humans , Male , Mitral Valve/diagnostic imaging , Prosthesis Failure , Thrombosis/diagnosis , Thrombosis/diagnostic imaging , Thrombosis/etiologyABSTRACT
OBJECTIVES: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis. BACKGROUND: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3. METHODS: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed. RESULTS: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8). CONCLUSIONS: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS.
Subject(s)
Aortic Valve Stenosis/surgery , Aortic Valve/surgery , Bundle-Branch Block/epidemiology , Heart Valve Prosthesis , Transcatheter Aortic Valve Replacement/adverse effects , Transcatheter Aortic Valve Replacement/instrumentation , Age Factors , Aged , Aged, 80 and over , Aortic Valve/diagnostic imaging , Aortic Valve/physiopathology , Aortic Valve Stenosis/diagnostic imaging , Aortic Valve Stenosis/epidemiology , Aortic Valve Stenosis/physiopathology , Bundle-Branch Block/diagnosis , Bundle-Branch Block/physiopathology , Female , Humans , Incidence , Male , Prosthesis Design , Retrospective Studies , Risk Assessment , Risk Factors , Spain/epidemiology , Treatment OutcomeABSTRACT
A left main stem bifurcation lesion (Medina 1,0,0) treated with a single Axxess stent through radial access is presented. Although the use of this stent in left main stenosis is off label, in selected cases it may simplify the technique, avoiding the use of additional overlapping stents and ensuring the bifurcation coverage with minimal amount of metal at the carina.
Subject(s)
Angioplasty, Balloon, Coronary/instrumentation , Angioplasty, Balloon, Coronary/methods , Coronary Stenosis/therapy , Drug-Eluting Stents , Sirolimus/analogs & derivatives , Aged , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Vessels/diagnostic imaging , Echocardiography , Humans , Male , Radial Artery , Treatment OutcomeABSTRACT
BACKGROUND: Coronary angiography (CA) has been the gold standard technique for studying coronary artery disease. It is based on the analysis of bidimensional orthogonal projections that may not be optimal to estimate determinate coronary segments. Rotational angiography "Xperswing" (DARCA) is a new technique that allows the visualization of the coronary arteries from multiple views, with a single contrast injection. The aim of this study is to evaluate the coronary lesions quantification with DARCA. METHODS: Quantitative coronary analysis of significant coronary stenosis (>50%) was performed. Every lesion was measured in two different projections: the "optimal projection", obtained by DARCA and defined by the operator as the one with a better lesion qualification, and the "standard projection", corresponding to the usual projection closer to the optimal one in obliquity and angulation. Measures were performed twice and by two independent operators. Intra- and inter-observer correlation was estimated by Kappa index and variables were compared with t Student test (SPSS 14.0). RESULTS: 205 lesions in 147 patients were analyzed. Kappa coefficient intra-observer was 0.80 and 0.86 respectively with an inter-observer correlation index of 0.72. Lesion length and maximal diameter of the vessel were significantly greater in the group of RA. In the segments analysis, calculated length was longer for the first diagonal branch, first marginal obtuse artery, middle circumflex, middle and distal RCA and posterior descending artery, with greater reference diameters for proximal LAD and distal RCA. There were no significant differences for coronary stenosis grade. CONCLUSIONS: RA XperSwing provides a better visualization of coronary arteries improving lesions characterization, with longer measured lesions length and greater vessel diameters, especially in coronary segments with more angulation.
Subject(s)
Coronary Angiography/methods , Coronary Stenosis/diagnostic imaging , Coronary Vessels/diagnostic imaging , Contrast Media , Humans , Ioxaglic Acid , Observer Variation , Predictive Value of Tests , Radiographic Image Interpretation, Computer-Assisted , Reproducibility of Results , Severity of Illness Index , Triiodobenzoic AcidsABSTRACT
Se presenta un paciente de 65 años de edad, con una acromegalia de larga evolución y prolapso sistólico severo de las válvulas mitral y tricúspide. Esta asociación, no descrita hasta la fecha, podría ser debida a los efectos de la hormona del crecimiento sobre el tejido conectivo valvular (AU)
No disponible
