A case report : black oesophagus as a possible complication of transcatheter aortic valve implantation

©The Author(s) 2019. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected]: The increasing number of transcatheter aortic valve implantation (TAVI) in the last few years has unveiled a unique set of events and complications that need prompt recognition and management in order to improve patient outcomes, often involving a multidisciplinary team. Case summary: We present a case of a 86-year-old woman with symptomatic severe aortic stenosis that underwent a TAVI and, in the post-procedure period, presented with acute abundant haematemesis, haemodynamic instability, and haemoglobin drop. The diagnosis of acute necrotizing oesophagitis (ANE) was made by upper gastrointestinal endoscopy. Discussion: Acute necrotizing oesophagitis is a rare entity caused usually by an ischaemic insult in the presence of predisposing factors; it has a high rate of complications and mortality. To the best of our knowledge, this is the first clinical case report to describe the occurrence of ANE as a possible complication of TAVI and is also an example of the importance of the multidisciplinary approach of these complex patients, which extends even beyond the concept of Heart Team.info:eu-repo/semantics/publishedVersio

Long-evolution ascites in a patient with constrictive pericarditis

Constrictive pericarditis (CP) is an uncommon disease resulting from chronic pericardial inflammation, fibrosis and calcification. Since there are atypical forms of presentation, with subtle or nonexistent cardiorespiratory symptoms, diagnosis may be challenging and difficult. Recurrent ascites in patients with congestive hepatopathy due to constrictive pericarditis is, in most cases, reversible after pericardiectomy. Nevertheless, development of persistent liver dysfunction may be a long-term complication. The present case describes a 23 years old man with growth delay, dyspnoea and long evolution ascites, whose exhaustive etiological investigation led to diagnosis. Afterwards the patient underwent elective surgery with symptom and general condition improvement. Ascites differential diagnosis and its association with constrictive pericarditis are briefly reviewed in this article

Incidence, predictive factors and clinical significance of development of portal vein thrombosis in cirrhosis: a prospective study

© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.Background and aims: The role of portal vein thrombosis (PVT) in the natural history of cirrhosis is controversial. There are few prospective studies validating risk factors for development of PVT. We analysed the incidence, factors associated with PVT development and its influence on cirrhosis decompensations and orthotopic liver transplant (OLT)-free survival. Methods: In this prospective observational study between January 2014 and March 2019, 445 consecutive patients with chronic liver disease were screened and finally 241 with cirrhosis included. Factors associated with PVT development and its influence on cirrhosis decompensations and OLT-free survival by time dependent covariate coding were analysed. Results: Majority of patients belonged to Child-Pugh class A 184 (76.3%) and the average MELD score was 10 ± 5. Previous cirrhosis decompensations occurred in 125 (52.1%), 63 (26.1%) were on NSBB and 59 (27.2%) had undergone banding for bleeding prophylaxis. Median follow-up was 29 (1-58) months. Cumulative incidence of PVT was 3.7% and 7.6% at 1 and 3 years. Previous decompensation of cirrhosis and low platelet counts but not NSBB independently predicted the development of PVT. During follow-up, 82/236 (34.7%) patients developed cirrhosis decompensations. OLT-free survival was 100% and 82.8% at 3 years, with and without PVT respectively. MELD score, but not PVT, independently predicted cirrhosis decompensations (HR 1.14; 95%CI:1.09-1.19) and OLT-free survival (HR 1.16;95%CI:1.11-1.21). Conclusion: Previous decompensations of cirrhosis and thrombocytopenia predict PVT development in cirrhosis suggesting a pathophysiologic role for severity of portal hypertension. PVT development did not independently predict cirrhosis decompensations or lower OLT-free survival.info:eu-repo/semantics/publishedVersio