ABSTRACT The authors report on two patients whose congenital sinus of Valsalva aneurysms had ruptured into the right ventricle and were successfully occluded percutaneously. Three different devices were implanted using two different approaches. Percutaneous closure warranted that one patent ductus arteriosus occluder through a transvenous antegrade approach and that one coil plus one ventricular septal defect occluder were implanted through an arterial retrograde approach. The procedures were accomplished without complications, the devices were well positioned at angiography and echocardiography views […]
ABSTRACT Penetrating aortic ulcer is a rare entity with a poor prognosis within the spectrum of acute aortic syndrome. Even rarer are the cases located in the ascending aorta. This case demonstrates the importance of ancillary imaging methods for correct diagnosis and choice of the most appropriate management of this atypical presentation of the disease.
ABSTRACT We describe the case of a patient with multiple comorbidities scheduled to undergo intracoronary optical coherence tomography-guided percutaneous coronary intervention. Based on the images acquired, it was possible to observe the mechanism of restenosis and the anatomy of the lesion, and to optimize planning of the procedure. Our strategy was to resect the neointimal hyperplastic tissue using laser atherectomy, with great results and a successful procedure.
ABSTRACT Rupture and entrapment of a guidewire are rare complications of percutaneous coronary intervention; nevertheless, they deserve attention due to the possible outcomes. We report the case of a patient undergoing percutaneous coronary intervention for treatment of unstable angina. During the procedure, the guidewire fractured in the left main coronary artery and migrated to the left anterior descending artery. Another invasive procedure was necessary to remove the fragment retained in the coronary circulation. There are many treatment options, and the […]
ABSTRACT An 85-year-old patient with multiple comorbidities presents with severe symptomatic aortic stenosis and concomitant infrarenal abdominal aortic aneurysm with 100mm in diameter. A transcatheter aortic valve replacement was done along with concomitant percutaneous repair of the aneurysm. The therapeutic strategy was initially to implant the transcatheter aortic valve prosthesis, and then to perform the implantation of the aortic bifurcated endograft, with extensions to the right and to the left, to exclude a large fusiform aneurysm, due to the high […]
ABSTRACT Severe mitral stenosis is associated to congestive symptoms, increased pulmonary artery pressure, atrial fibrillation, and thromboembolic events. Among the treatment options, balloon mitral valve repair is the first choice in patients with favorable anatomy. We report a case of mitral valve repair using balloon in a patient with severe mitral stenosis and suprasystemic pulmonary hypertension (systolic pressure of pulmonary artery estimated at 135mmHg). Valve surgery was contraindicated due to functional class III (NYHA), after hospitalization for ischemic stroke.
ABSTRACT Optical coherence tomography is an intravascular imaging tool that has been increasingly used in the cardiac catheterization laboratory. Since its spatial resolution is approximately ten-fold greater than intracoronary ultrasound, optical coherence tomography assists in the anatomical differential diagnosis of coronary lesions with atypical presentation. In this report, we present a case of a female patient with a history of acute coronary syndrome and, currently, with a complex angiographic lesion, with the aspect of a chronic dissection in the anterior […]
ABSTRACT Entrapment and breakage of devices used in coronary interventions are rare complications, but have occurred with increasing frequency. Knowledge and mastery of techniques to rescue these materials are of paramount importance to solve these incidents. We report a successful withdrawal of a 0.014” retained guidewire in the coronary artery, by the so-called twin guidewire technique.
ABSTRACT The use of iodinated contrast media in coronary procedures may lead to contrast-induced nephropathy – particularly in older adults, diabetic individuals and patients with previous renal disease – and increase morbidity and mortality. There is no specific treatment for this condition; therefore, use of low contrast volumes and previous hydration remain the best prevention strategies. A case of percutaneous coronary intervention without contrast agent administration, involving an elderly female patient with chronic renal insufficiency and stable angina, is described. […]
ABSTRACT Spontaneous coronary dissection is an uncommon cause of acute coronary syndrome that may manifest as unstable angina, acute myocardial infarction, or sudden death. The condition occurs predominantly in women, with approximately one-third of cases reported during or after pregnancy. The etiology is unknown; however, associations with fibromuscular dysplasia and connective tissue diseases have been reported. Here, we describe a case of ST-segment elevation acute myocardial infarction in a puerperal woman due to spontaneous dissection of the left main coronary […]