Endovascular treatment in patients with combined pathology

2015 ◽  
Vol 6 (3) ◽  
pp. 123-128 ◽  
Author(s):  
Evgeny Antonovich Shloydo ◽  
Igor Alexandrovich Pyaterichenko ◽  
Victoria Valentinovna Zvereva ◽  
Yuriy Romanovich Kovalev ◽  
Alexey Viktorovich Sizov

Aortic valve stenosis is one of the most common diseases from the group of acquired heart disease, especially in elderly patients. Aortic valve replacement has become the “gold standard” and gives excellent results in all age groups of patients. For aortic valve replacement is sent to only one third of patients due to high risk due to age, severity of the defect, reduced contractility of the left ventricle, pulmonary hypertension and other comorbidities. One of the attempts to reduce the frequency of complications and mortality in this group of patients, and subsequently to make it possible to perform other surgical interventions, including aortic valve replacement, which is considered inoperable patients is holding a less traumatic surgery - aortic balloon catheter valvuloplasty. In the clinical observation deals with the case of heart disease - critical aortic stenosis, ischemic heart disease complicated by pulmonary hypertension and severe heart failure, in combination with gynecological diseases (uterine fibroids, endometrial hyperplasia in postmenopausal women), complicated by uterine bleeding and hemorrhagic anemia. Consider the risks of different surgical interventions. The possibility of modern endovascular care of patients in this situation simultaneously perform operations on uterine artery embolization, coronary angioplasty with stenting and aortic catheter balloon valvuloplasty. Also shown is the nearest and remote results of operative intervention.

Choonpa Igaku ◽  
2020 ◽  
Vol 47 (5) ◽  
pp. 191-195
Author(s):  
Masayuki YAMASAKI ◽  
Yoshio TAKEUCHI ◽  
Keitaro NAKAGIRI ◽  
Rie TAKAOKA ◽  
Kimika YOSHINAGA ◽  
...  

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael I Brener ◽  
Amisha Patel ◽  
Torsten Vahl ◽  
Nadira Hamid ◽  
Melana Yuzefpolskaya ◽  
...  

Introduction: Multiple valvular heart disease (mVHD) caused by mixed stenotic and regurgitant lesions involving at least two valves is a common condition which is poorly understood and challenging to manage. Herein, we simulate the hemodynamics of a patient with mVHD before and after transcatheter aortic valve replacement (TAVR) to better understand the physiology of this complex disease. Case: A 67-year-old man with celiac enteropathy presented to a local hospital with dyspnea, hypotension, and oliguria. Echocardiography revealed a dilated left ventricle (end-diastolic diameter [LVEDD] 6.7 cm) with an ejection fraction (EF) of 20% and multiple severe valvulopathies, including aortic stenosis (AS), aortic regurgitation (AR), and mitral regurgitation (MR). Right heart catheterization revealed a low cardiac index (1.76 L/min/m 2 ) and a high wedge pressure (36 mmHg) with V-waves exceeding 50 mmHg. The patient’s severe AR precluded mechanical circulatory support, so TAVR was emergently performed in the setting of worsening cardiogenic shock (CS) with a 29 mm self-expanding bioprosthesis via transfemoral access. Valve deployment was successfully guided by fluoroscopy and transthoracic echocardiography alone. CS resolved in the subsequent 48 hours, and at 3-month follow-up, his LV EF returned to 55% and LVEDD decreased to 4.4 cm. LV pressure-volume loops pre- and post-TAVR were generated using a cardiovascular physiology simulator (Fig. 1). TAVR’s correction of the patient’s severe AS and AR produced immediate energetic benefits, with pressure-volume area declining 13% and cardiac power output increasing 2.24-fold. Conclusions: This challenging case and the accompanying pressure-volume analysis affirms the feasibility of emergent TAVR in highly selected patients, the procedure’s ability to immediately improve ventricular performance, and the LV’s capacity to remodel when operating under more physiologic loading conditions.


CHEST Journal ◽  
2020 ◽  
Vol 157 (6) ◽  
pp. 1597-1605
Author(s):  
Mercè Cladellas ◽  
Cora Garcia-Ribas ◽  
Mirea Ble ◽  
Miquel Gómez ◽  
Núria Farré ◽  
...  

2006 ◽  
Vol 53 (1) ◽  
pp. 26430-26430
Author(s):  
Juan C. Bianco ◽  
André Y Denault ◽  
Pierre Couture ◽  
Baqir Qizilbash ◽  
Michel Carrier

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