RESUMO
Percutaneous transcatheter implantation of the aortic valve has been demonstrated as an alternative to open heart surgery in high-risk patients with symptomatic severe aortic stenosis (AS) who are not suitable for open surgery. The majority of these new devices are delivered via the transfemoral approach. However, due to the current size of delivery sheaths, the small and tortuous iliofemoral anatomy makes this approach challenging. The transapical approach provides a viable option for this patient subgroup. The first-in-Asia transcatheter aortic valve implantation via the transapical route is described. A 79-year-old Chinese woman with symptomatic severe AS and peripheral arterial disease, who was at high surgical risk, was successfully treated, and had good functional and haemodynamic results at the three-month follow-up.
Assuntos
Estenose da Valva Aórtica/cirurgia , Bioprótese , Cateterismo Cardíaco , Implante de Prótese de Valva Cardíaca/métodos , Toracotomia/métodos , Idoso , Ecocardiografia Transesofagiana , Feminino , HumanosRESUMO
Acute stroke intervention is rapidly evolving. New technologies are improving device deliverability and rates of recanalization. We describe 2 cases of acute middle cerebral artery occlusions wherein Wingspan stents could not be delivered to the occlusive site because of excessive vascular tortuosity. Merci thrombectomy was also unsuccessful. Revascularization was only achieved with deployment of the highly navigable Enterprise stent, resulting in thrombolysis in myocardial infarction 2/3 flow. Thus, all devices should be considered in the armamentarium of stroke therapy.
Assuntos
Prótese Vascular , Angiografia Cerebral/métodos , Infarto da Artéria Cerebral Média/cirurgia , Stents , Cirurgia Assistida por Computador/métodos , Doença Aguda , Adulto , Idoso de 80 Anos ou mais , Desenho de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Resultado do TratamentoRESUMO
Malaria is primarily an imported disease in Singapore. Local outbreaks are uncommon. We describe a localised outbreak of three patients with Falciparum malaria, which we believe to be locally acquired. There was one fatality due to severe disease and late presentation. Malaria should be considered as a cause of febrile illness as the likelihood of cure depends on early detection and treatment.
