Cardiovascular Revascularization Medicine: Interesting Cases最新文献

Spontaneous coronary vasospasm (SCV) can present as coronary stenosis on angiography. Undiagnosed thyrotoxicosis is a rare cause of SCV and patients with unclear history and workup presenting with unstable angina should have thyroid function tested.

Percutaneous coronary interventions (PCI) in patients with prior coronary artery bypass grafting (CABG) could present significant challenges, especially when the navigation of arterial conduits is necessary. The selective cannulation of internal mammary artery (IMA) is the first step of these high-risk procedures, in which technical complexities and ischemic complications are frequently faced. Acknowledging the lack of pre-shaped guiding catheter alternatives, IMA cannulation is time and contrast–consuming and potentially dangerous, as both catheter probing and wiring attempts may threaten vessel integrity.

To address this unmet need we developed a novel, easy-to-use technique to achieve selective internal mammary artery (IMA) graft cannulation. Our method proposes to first engage the arterial graft by means of any diagnostic catheter, whose shape can be chosen according to the specific features of the graft. Afterwards, a 0.014-inch workhorse guidewire is advanced to the distal segment of the graft. A 5- or 6-French IM guiding catheter is finally tracked over the wire rail into the ostium to reach stable engagement, ensuring procedural success. This approach is applicable irrespective of access route (ipsilateral or contralateral, transradial or transfemoral), and ultimately reduces procedural complexities and ischemic risks associated with traditional practice. This method also promotes the adoption of smaller guide catheters, thus reducing the ischemic triggers during selective cannulation. Furthermore, it offers versatility in catheter selection and guidewire support, enhancing personalization to diverse patient anatomies and clinical scenarios.

By streamlining procedures and improving success rates, our technique represents a significant advancement in PCI via IMA grafts, promising safer and more efficient interventions for CABG patients.

Procedure-related stroke represents a major complication of transcatheter aortic valve replacement (TAVR). The Sentinel Cerebral Protection System is the only FDA-approved embolic protection device for TAVR and is intended for use via right radial access. As TAVR has become the preferred modality for aortic valve replacement, protection devices like Sentinel have been developed to reduce procedural complications; however, its use in aberrant aortic arch anatomy has not been previously reported. We present a case of successful Sentinel deployment and embolic protection via alternative left radial artery access in a patient with an aberrant right subclavian artery.

Hemolytic anemia following surgical mitral valve repair is rare, and the role of mitral transcatheter edge-to-edge repair (TEER) in its treatment is unknown. We present three cases of hemolytic anemia following surgical mitral valve repair treated with mitral TEER. All three patients experienced resolution of hemolysis after mitral TEER.

A 59-year-old male with incompletely treated aortic valve endocarditis from complicated methicillin-sensitive Staphylococcus aureus bacteremia presented with acute left lower-extremity osteomyelitis. He was found to have new large infected coronary artery aneurysms, which were confirmed by multimodality imaging. This case highlights key decision-making by the multidisciplinary team.

Coronary stent dislodgement (CSD) during percutaneous coronary intervention is a rare complication nowadays, thanks to equipment design and stent technology improvements. Coronary calcification, inadequate lesion preparation and suboptimal stent expansion are some of the risk factors for the occurrence of CSD. On the other hand, complete dislodgement of a deployed coronary stent is extraordinarily rare and infrequently reported in the literature. Herein, we describe a complete CSD case after deployment in a severely calcified right coronary artery lesion and discuss strategies to prevent this severe complication.

Transcatheter valve-in-valve implantation has emerged as a viable alternative for treating degenerated bioprosthetic tricuspid valves. However, patients with Ebstein's anomaly, characterized by an enlarged right atrium, pose challenges due to difficulties in correct positioning and deployment of transcatheter valves, stemming from inadequate support and coaxial alignment. In our presented case report, we describe a tricuspid valve-in-valve procedure performed on a patient with Ebstein's anomaly and a significantly enlarged right atrium. A novel technique was employed to facilitate the advancement of the transcatheter heart valve within the degenerated bioprosthesis, ultimately ensuring the success of the intervention.

Background

Pregnancy in women with mechanical valves has a high risk of both valve thrombosis and bleeding.

Case summary

We describe the case of a pregnant woman developing thrombosis of a mechanical aortic valve causing severe aortic stenosis without heart failure symptoms. The pregnancy was managed with heparin, and a high dose of warfarin was restarted soon after delivery. One month later transesophageal echocardiogram showed dissolution of the thrombosis, with restoration of the transvalvular gradients present after implantation.

Conclusion

The management of pregnant patients with mechanical valves is complex and a multidisciplinary approach is essential.

Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital heart disease due to the abnormal origin of the left coronary artery from the pulmonary artery. When this condition is not diagnosed nor surgically corrected on time, most patients do not survive childhood. We report a 58-year-old woman who presented with angina and new-onset atrial fibrillation as a delayed manifestation of ALCAPA syndrome. Following surgical intervention, the patient has experienced a satisfactory long-term survival.

Transcaval transcatheter aortic valve replacement (TAVR) is a well-documented alternative access valve implantation method, wherein a large-bore vascular sheath is inserted into the abdominal aorta through the femoral vein and inferior vena cava, resulting in an aorto-caval tract. Closure of this tract is typically accomplished using nitinol occluder devices. In the rare instance that hemostasis is not achieved with a nitinol occluder, covered stents in the aorta are used for bailout. We present a case in which an aortic covered stent was placed as the primary closure strategy in a patient with a very small abdominal aorta that could not accommodate a nitinol occluder device after transcaval TAVR.