Asunto(s)
Síndrome Coronario Agudo/epidemiología , Síndrome Coronario Agudo/cirugía , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Brotes de Enfermedades , Intervención Coronaria Percutánea/tendencias , Neumonía Viral/epidemiología , COVID-19 , Infecciones por Coronavirus/terapia , Humanos , Pandemias , Neumonía Viral/terapia , Vigilancia de la Población , SARS-CoV-2RESUMEN
A 68-year-old man with a non-ST elevation myocardial infarction (NSTEMI) presented with a low risk profile indicating invasive revascularization within 72 h. However, left ventricular (LV) global longitudinal strain (GLS) calculated by two-dimensional speckle tracking echocardiography (2D-STE) in the Emergency Room showed substantial myocardial infarction. Therefore, urgent reperfusion therapy was decided and delivered within 30 min from hospital admission. LV GLS fully recovered after the invasive procedure and the final infarct size was 7%. This case shows that very early revascularization in NSTEMI patients can be guided by 2D-STE and might be considered for those patients with substantial LV myocardial infarction.
Asunto(s)
Revascularización Miocárdica , Infarto del Miocardio sin Elevación del ST/diagnóstico por imagen , Infarto del Miocardio sin Elevación del ST/cirugía , Anciano , Toma de Decisiones , Ecocardiografía/métodos , Electrocardiografía , Humanos , Masculino , Infarto del Miocardio , Revascularización Miocárdica/métodos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Nowadays the prognostic role of gender as a relevant factor after transcatheter aortic valve implantation (TAVI) is still unfair, since available data in the literature are few and uneven. The aim of this survey was to collect acute and 30-day safety and efficacy clinical data in high- and intermediate-risk women, who underwent TAVI with new-generation devices, in the Campania Region. METHODS: All medium and high-volume TAVI centers in Campania have been invited to fulfill an online, ad-hoc questionnaire, collecting pre-, peri- and post-procedural data concerning female patients, treated between January and December 2016. RESULTS: 331 women (representing the 61% of the overall population treated; mean age 83 ± 7 years) underwent TAVI in the participating Campania centers. Age >80 years (72%), high surgical risk score (63%) and frailty (55%) were found to be the top three reasons for the TAVI choice. Overall, 95% of the procedures were performed by transfemoral approach with local anesthesia; the remaining 5% (16 cases) were conducted via transapical (14, 4%) and transaortic (2, 1%) accesses, under general anesthesia. Edwards Sapien 3 (Edwards Lifesciences, Irvine, CA, USA) and Medtronic Evolut R (Medtronic Inc., Minneapolis, MN, USA) were the most frequently implanted valves (146, 44% and 132, 43%, respectively). The questioned Centers reported a mean length of hospital stay of 5.5 ± 1.1 days, 1.6 ± 0.37 of which in a cardiac care unit. The most prevalent in-hospital complication was pacemaker implantation (15%), followed by life-threatening vascular complications (3%). The 30-day VARC-2 composite endpoint occurred in 7% of cases, all-cause death in 4%, and stroke in 1%. CONCLUSIONS: This survey, the first representative of women undergoing TAVI in Campania, appears to confirm the good safety and efficacy profile of this procedure, also in the high- and intermediate-risk settings, probably favored by a prevalent use of new-generation devices and a low rate prevalence of significant patient comorbidities.
Asunto(s)
Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Anciano de 80 o más Años , Anestesia General/estadística & datos numéricos , Anestesia Local/estadística & datos numéricos , Diseño de Equipo , Femenino , Encuestas de Atención de la Salud , Prótesis Valvulares Cardíacas , Humanos , Italia , Tiempo de Internación/estadística & datos numéricos , Marcapaso Artificial , Selección de Paciente , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Riesgo , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Resultado del TratamientoRESUMEN
Ventricular septal defect (VSD) is a life-threatening complication of acute myocardial infarction (MI), resulting in high mortality rate even in the case of a timely approach by surgical repair. Transcatheter closure is nowadays a reliable alternative to surgery, although currently deemed challenging or unsuitable in large and complex VSD. This article reports on a successful transcatheter approach in a critically ill patient with subacute right coronary-related, complex postinfarction VSD. In this patient, two sequentially deployed Amplatzer Septal Occluder devices stabilized the clinical conditions and hemodynamic parameters.