Cardiovascular Revascularization Medicine: Interesting Cases最新文献

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.

A 90-year-old male was admitted for heart failure (HF) in the setting of severe aortic stenosis (AS). He underwent transcatheter aortic valve replacement (TAVR) with a 23 mm Edwards Sapien 3 Ultra valve complicated by acute aortic insufficiency (AI) due to prosthetic leaflet immobility. It was successfully treated with valve-in-valve TAVR during the same procedure.

Sometimes secondary vascular access during transfemoral transcatheter aortic valve replacement (TAVR) may be challenging due to hostile vascular anatomy, representing a further source of vascular complications. In such cases, a minimalist approach with single femoral access (“all-in-one” technique) may be performed. Here we describe how to successfully perform the “all-in-one” technique, reporting 3 cases of transfemoral TAVR for which a single-access approach was used to overcome challenges in obtaining secondary arterial access and minimize sources of vascular complications, according to patients' characteristics and procedural aspects.

The Pierced Balloon Assist Technique is a simple, easy-to-use technique for delivery a second guidewire through the true lumen with additional support in the absence of a dual-lumen microcatheter.

In this case report, the successful surgical implantation of a valve separated from the distribution system during percutaneous pulmonary valve implantation in a patient with a history of total surgical correction of tetralogy of Fallot using a transannular patch in childhood and who developed advanced pulmonary valve insufficiency during. This case was shared because it is very rare in the literature.

Spontaneous coronary artery dissection (SCAD) is a non-traumatic spontaneous separation of a coronary wall that can present as acute myocardial infarction. Here, we present a 60-year-old female with sudden onset of retrosternal chest pain and ST-segment elevation myocardial infarction (STEMI) secondary to spontaneous dissection of the left anterior descending (LAD) coronary artery. The patient was successfully managed with primary percutaneous coronary angioplasty (PPCI) with advanced coronary intervention techniques including intravascular coronary imaging technology and microcatheter assisted luminal wiring.

Chronic total occlusion percutaneous coronary intervention has lower success rates in patients with prior coronary artery bypass graft surgery. Patent or occluded bypass grafts serve as conduits for retrograde recanalization, but a common cause of failure is the acute angulated graft insertion making wiring difficult, with recurrent wire and microcatheter prolapse, if not impossible. We present a case with difficult retrograde wiring and tracking around a retroflexed graft insertion site that was successfully addressed using a strategic balloon to anchor the microcatheter – the “microcatheter anchor technique (MAT)”.

We present an interesting case of a 73 years-old male who was referred for mid-right coronary artery (RCA) chronic total occlusion (CTO) intervention given continuous angina symptoms with coronary angiogram revealing mid-RCA CTO with a left to right collaterals from LAD and concomitant moderate stenosis in the mid-LAD. Hemodynamic assessment of this lesion pre-PCI using non-invasive angiogram-based, wireless FFR was performed. Following successful CTO revascularization, a substantial immediate improvement in non-invasive angio-FFR assessment was observed with wireless angio-based FF measurement of 0.96 (normal ≥0.80) compared to the pre-intervention value of 0.86. This suggests that angiography-based wireless FFR may be a valuable tool for assessing the hemodynamic significance of donor artery stenosis in CTO cases, potentially offering a less invasive and more accessible alternative to traditional methods.

A patient with a HeartMate 3 left ventricular assist device complicated by an extrinsic outflow graft obstruction was treated with a percutaneous approach using large covered stents in overlapping fashion from the proximal portion of the outflow graft at the bend relief into the LVAD rotor.

Balloon rupture during the course of balloon aortic valvuloplasty (BAV) is an uncommon occurrence that can potentially lead to severe complications. We describe a case in which a balloon rupture occurred during BAV, resulting in challenges in retracting the balloon into the sheath. This issue was successfully addressed through an endovascular approach, thereby avoiding the necessity for surgical intervention.

We present a case and outline key procedural considerations for bailout solutions.