10 research outputs found

    Dedicated Bifurcation Stents

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    Bifurcations still remain one of the most challenging lesions to be treated in the modern PCI era. They are associated with lower procedural success rates, higher rates of periprocedural complications, and complicated long-term outcomes. Their incidence is assessed to be approximately 15–20%. There is still debate on how should they be treatedβ€”one-stent versus two-stent techniques, whether there is a need for obligatory proximal optimization or kissing balloons. Multiple clinical trials have tested different PCI strategies. We will cover theoretical basics of treating bifurcations and describe different types of dedicated bifurcation stentsβ€”Nile PAX, Nile SIR, BiOSS Expert, BiOSS LIM, Stentys Tryton, and Axxess Plus. We will discuss the data from studies comparing these bifurcation devices and will show our own experience and results working with these devices. There will be a discussion, tips, and tricks treating bifurcation lesions with dedicated devicesβ€”most common pitfalls and how to deal with them

    Vena cava superior syndrome. Analisis of interventional and medical treatment options

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    ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²ΡΠΌΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ случай Π½Π° 72-годишСн мъТ с Π°Ρ€Ρ‚Π΅Ρ€ΠΈΠ°Π»Π½Π° хипСртония ΠΈ прСТивяна SARS-CoV-2 инфСкция, хоспитализиран ΠΏΠΎ ΡΠΏΠ΅ΡˆΠ½ΠΎΡΡ‚ Π² ΠΈΠ½Ρ‚Π΅Π½Π·ΠΈΠ²Π΅Π½ ΠΊΠ°Ρ€Π΄ΠΈΠΎΠ»ΠΎΠ³ΠΈΡ‡Π΅Π½ сСктор, ΠΏΠΎ ΠΏΠΎΠ²ΠΎΠ΄ Π½Π° диспнСя Π² ΠΏΠΎΠΊΠΎΠΉ, зачСрвяванС ΠΈ ΠΏΠΎΠ΄ΡƒΠ²Π°Π½Π΅ Π½Π° Π²Ρ€Π°Ρ‚Π° ΠΈ Π»ΠΈΡ†Π΅Ρ‚ΠΎ, Π³Π»Π°Π²ΠΎΠ±ΠΎΠ»ΠΈΠ΅ ΠΈ Π΄Π²ΡƒΠΊΡ€Π°Ρ‚Π½Π° Π·Π°Π³ΡƒΠ±Π° Π½Π° съзнаниС. Болният Π΅ с Π΅Ρ…ΠΎ-ΠšΠ“ Π΄Π°Π½Π½ΠΈ Π·Π° Π·Π°ΠΏΠ°Π·Π΅Π½Π° Π›Πš ΠΈ Π”Πš систолна функция, Π±Π΅Π· Ρ…Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡ‡Π½ΠΎ Π·Π½Π°Ρ‡ΠΈΠΌΠΈ ΠΊΠ»Π°ΠΏΠ½ΠΈ Π»Π΅Π·ΠΈΠΈ ΠΈ Π½ΠΎΡ€ΠΌΠ°Π»Π½Π° Π•ΠšΠ“. На слСдващият Π΄Π΅Π½ ΠΎΡ‚ хоспитализацията Π΅ ΠΎΡΡŠΡ‰Π΅ΡΡ‚Π²Π΅Π½Π° ΠΊΠΎΠΌΠΏΡŽΡ‚ΡŠΡ€Π½Π° томография Π½Π° бял Π΄Ρ€ΠΎΠ±, ΠΎΠ±Π΅ΠΊΡ‚ΠΈΠ²ΠΈΠ·ΠΈΡ€Π°Π»Π° солидСн ΠŸΠ—ΠŸ ΠΎΡ‚ Ρ†Π΅Π½Ρ‚Ρ€Π°Π»Π΅Π½ Ρ‚ΠΈΠΏ Π½Π° дСсния бял Π΄Ρ€ΠΎΠ±, компрСсиращ Π² Π·Π½Π°Ρ‡ΠΈΡ‚Π΅Π»Π½Π° стСпСн Π²Π΅Π½Π° ΠΊΠ°Π²Π° супСриор. ΠŸΡ€ΠΎΠ²Π΅Π΄Π΅Π½Π° Π΅ вСнография, която дСмонстрира субтотална Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·Π° Π½Π° Π²Π΅Π½Π° ΠΊΠ°Π²Π° супСриор ΠΈ Π΅ ΠΎΡΡŠΡ‰Π΅ΡΡ‚Π²Π΅Π½ΠΎ стСнтиранС с Wallstent 16/60 mm. ΠžΡ‰Π΅ Π½Π° 6-ия час ΠΎΡ‚ интСрвСнцията сС наблюдава ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π½ΠΎ ΠΏΠΎΠ΄ΠΎΠ±Ρ€Π΅Π½ΠΈΠ΅ – Π·Π½Π°Ρ‡ΠΈΡ‚Π΅Π»Π½ΠΎ намаляванС Π½Π° ΠΎΡ‚ΠΎΠΊΠ° ΠΈ ΠΎΠ±Π»Π΅ΠΊΡ‡Π°Π²Π°Π½Π΅ Π½Π° симптоматиката. We present a clinical case of a 72-year-old man with a history of hypertension and SARS-CoV-2 infection, urgently hospitalized in the intensive care unit due to dyspnea at rest, blushes and swelling of the neck and face, headache, and syncope. Echocardiography was performed and revealed preserved ejection fraction of left and right ventricle (EF – 57%, TAPSE – 21 mm), without hemodynamically significant valve lesions and normal ECG. On the next day of hospitalization, we performed a computer tomography (CT) scan of the lungs and it showed a tumor in right lung, compressing vena cava superior. Venography was performed and revealed subtotal thrombosis of vena cava superior and stenting with Wallstent 16/60 mm was performed. Six hours after the intervention a clinical improvement was achieved – reducing of the swelling and relieving of the symptoms

    Acute coronary syndrome and ischemic stroke in the course of COVID-19 infection

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    ΠŸΠ°Π½Π΄Π΅ΠΌΠΈΡΡ‚Π° ΠΎΡ‚ Β Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) сС разпространи Π±ΡŠΡ€Π·ΠΎ ΠΏΠΎ свСта с 314 ΠΌΠΈΠ»ΠΈΠΎΠ½Π° Π·Π°Ρ€Π°Π·Π΅Π½ΠΈ ΠΈ 5 ΠΌΠΈΠ»ΠΈΠΎΠ½Π° ΠΆΠ΅Ρ€Ρ‚Π²ΠΈ (към Π΄Π΅ΠΊΠ΅ΠΌΠ²Ρ€ΠΈ 2021 Π³.) Π² свСтовСн ΠΌΠ°Ρ‰Π°Π±. SARS-CoV-2 сС ΠΎΠΊΠ°Π·Π° Π½Π΅ само причиняващ вирусна пнСвмония, Π½ΠΎ ΠΈ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π° Π·Π° сСриозни послСдици Π·Π° ΡΡŠΡ€Π΄Π΅Ρ‡Π½ΠΎ-ΡΡŠΠ΄ΠΎΠ²Π°Ρ‚Π° систСма. Π”ΠΎΠΊΠ°Π·Π°Π½ΠΎ Π΅, Ρ‡Π΅ COVID-19 Β ΠΌΠΎΠΆΠ΅ Π΄Π° сС услоТни с ΠΎΡΡ‚ΡŠΡ€ ΠΊΠΎΡ€ΠΎΠ½Π°Ρ€Π΅Π½ синдром посрСдством Ρ€ΡƒΠΏΡ‚ΡƒΡ€Π° Π½Π° ΠΏΠ»Π°ΠΊΠ°, вазоспазъм ΠΈΠ»ΠΈ ΠΌΠΈΠΊΡ€ΠΎΡ‚Ρ€ΠΎΠΌΠ±ΠΈ вслСдствиС Π½Π° систСмното възпалСниС ΠΈΠ»ΠΈ Ρ†ΠΈΡ‚ΠΎΠΊΠΈΠ½ΠΎΠ²Π°Ρ‚Π° буря. Π”ΠΎΠΏΡŠΠ»Π½ΠΈΡ‚Π΅Π»Π½Π° роля към Ρ‚ΠΎΠ²Π° играят хипСримунният ΠΎΡ‚Π³ΠΎΠ²ΠΎΡ€, ΠΊΠ°ΠΊΡ‚ΠΎ ΠΈ Π΅Π½Π΄ΠΎΡ‚Π΅Π»Π½Π°Ρ‚Π° дисфункция, ΠΊΠΎΠΈΡ‚ΠΎ допринасят Π·Π° Ρ…ΠΈΠΏΠ΅Ρ€ΠΊΠΎΠ°Π³ΡƒΠ»Π°-Ρ†ΠΈΠΎΠ½ΠΎΡ‚ΠΎ ΡΡŠΡΡ‚ΠΎΡΠ½ΠΈΠ΅. Π‘ΠΈΠ»Π½ΠΎ вСроятно Π΅ високият ΠΈΠ½Ρ„Π»Π°ΠΌΠ°Ρ‚ΠΎΡ€Π΅Π½ Ρ‚ΠΎΠ²Π°Ρ€ Π΄Π° Π΅ ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π° Π·Π° появата Π½Π° de novo ΠΊΠΎΡ€ΠΎΠ½Π°Ρ€Π½ΠΈ Π»Π΅Π·ΠΈΠΈ. ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²ΡΠΌΠ΅ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ случай Π½Π° 53-годишСн мъТ, ΠΏΡ€Π΅Π·Π΅Π½Ρ‚ΠΈΡ€Π°Ρ‰ сС с токси-ΠΈΠ½Ρ„Π΅ΠΊΡ†ΠΈΠΎΠ·Π΅Π½ синдром, стСнокардна симптоматика ΠΈ диспнСя. ΠŸΡ€ΠΎΠ²Π΅Π΄Π΅Π½ΠΈΡ‚Π΅ ΠΏΠ°Ρ€Π°ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π½ΠΈ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π½ΠΈ изслСдвания ΠΎΠ±Π΅ΠΊΡ‚ΠΈΠ²ΠΈΠ·ΠΈΡ€Π°Ρ…Π° ΠΎΡΡ‚ΡŠΡ€ ΠΊΠΎΡ€ΠΎΠ½Π°Ρ€Π΅Π½ синдром Π±Π΅Π· ST-СлСвация, Π»Π΅Π²ΠΎΠΊΠ°ΠΌΠ΅Ρ€Π½Π° Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·Π°, Π°ΠΊΡ‚ΠΈΠ²Π½Π° SARS-CoV-2 инфСкция ΠΈ двустранна интСрстициална пнСвмония. ΠŸΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΡŠΡ‚ бСшС Π»Π΅ΠΊΡƒΠ²Π°Π½ с ΠΏΠ΅Ρ€ΠΊΡƒΡ‚Π°Π½Π½Π° ΠΊΠΎΡ€ΠΎΠ½Π°Ρ€Π½Π° интСвСнция Π½Π° LAD с имплантация Π½Π° ΠΌΠ΅Π΄ΠΈΠΊΠ°ΠΌΠ΅Π½Ρ‚-ΠΈΠ·-Π»ΡŠΡ‡Π²Π°Ρ‰ стСнт, Π°Π½Ρ‚ΠΈΠΊΠΎΠ³ΡƒΠ»Π°Π½Ρ‚Π½Π° тСрапия, Π΄Π²ΠΎΠΉΠ½Π° Π°Π½Ρ‚ΠΈΠ°Π³Ρ€Π΅Π³Π°Π½Ρ‚Π½Π° ΠΈ ΠΏΡ€ΠΎΡ‚ΠΈΠ²ΠΎΠ²ΡŠΠ·ΠΏΠ°Π»ΠΈΡ‚Π΅Π»Π½Π° тСрапия, Π±Π΅Ρ‚Π°-Π±Π»ΠΎΠΊΠ΅Ρ€ ΠΈ АБЕ ΠΈΠ½Ρ…ΠΈΠ±ΠΈΡ‚ΠΎΡ€. На 4-ия Π΄Π΅Π½ ΠΎΡ‚ хоспитализацията Ρ€Π΅Π°Π»ΠΈΠ·ΠΈΡ€Π° исхСмичСн ΠΌΠΎΠ·ΡŠΡ‡Π΅Π½ инсулт Π² басСйна Π½Π° лявата ΡΡ€Π΅Π΄Π½ΠΎΠΌΠΎΠ·ΡŠΡ‡Π½Π° артСрия. ΠΠ°ΡˆΠΈΡΡ‚ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ случай дСмонстрира, ΡƒΠ½ΠΈΠΊΠ°Π»Π½ΠΈΡ‚Π΅ ΠΏΡ€ΠΎΡ‚Ρ€ΠΎΠΌΠ±ΠΎΡ‚ΠΈΡ‡Π½ΠΈ свойства Π½Π° SARS-CoV-2, обусловСни ΠΎΡ‚ Ρ€Π°Π·Π»ΠΈΡ‡Π½ΠΈ ΠΌΠ΅Ρ…Π°Π½ΠΈΠ·ΠΌΠΈ ΠΈ услоТ-няващи сС с Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΠ΅ΠΌΠ±ΠΎΠ»ΠΈΡ‡Π½ΠΈ ΠΈΠ½Ρ†ΠΈΠ΄Π΅Π½Ρ‚ΠΈ. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-Cov-2) pandemic has spread rapidly worldwide with 314 million infected and 5 million deceased worldwide (as of December 2021). SARS-Cov-2 has been shown to not only cause viral pneumonia, but also to lead to serious effects on the cardiovascular system. It has been proven that COVID-19 can be complicated by the Acute Coronary Syndrome through plaque rupture, vasospasm or microthrombi due to systemic inflammation or cytokine storm. An additional role is played by the hyperimmune response as well as the endothelial dysfunction, which contribute to the hypercoagulable state. Π’here is a strong possibility that the high inflammatory load is the cause of de novo coronary lesions. We present a clinical case of a 53-year-old man presenting with toxico-infectious syndrome, angina and dyspnea. Conducted paraclinical andΒ clinical studies showed acut coronary syndrome without ST-elevation, left ventricular thrombosis, active SARS-CoV-2 infection and bilateral interstitial pneumonia. The patient was treated with percutaneous coronary intervention of LAD with drug-eluting stent, anticoagulant therapy, dual antiplatelet and anti-inflamatory therapy, beta blocker and ACE-inhibitor. On the 4th day of hospitalization the patient realized Left Middle Cerebral Artery Stroke. Our clinical case demonstrates unique prothromobotic properties of SARS-CoV-2, due to different mechanisms and complicated by thromboembolic events

    A clinical case of a patient after COVID 19 infection and a thrombus in the right atrium, deep phlebothrombosis, and pulmonary embolism

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    Π’ΡŠΠ²Π΅Π΄Π΅Π½ΠΈΠ΅: ЗаболяванСто ΠΎΡ‚ COVID-19 Π²ΠΎΠ΄ΠΈ Π΄ΠΎ ΠΌΡƒΠ»Ρ‚ΠΈΠΎΡ€Π³Π°Π½Π½ΠΎ засяганС, Π΅Π½Π΄ΠΎΡ‚Π΅Π»Π½ΠΎ възпалСниС ΠΈ ΠΌΠΈΠΊΡ€ΠΎ- ΠΈ макроваскулит, ΠΏΡ€ΠΈ ΠΊΠΎΠΈΡ‚ΠΎ ΠΌΠΎΠΆΠ΅ Π΄Π° Π½Π°ΡΡ‚ΡŠΠΏΠΈ Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·Π° Π² ΠΌΠ°Π»ΠΊΠΈΡ‚Π΅ съдовС, Π² съдовС Π² Ρ€Π°Π·Π»ΠΈΡ‡Π½ΠΈ ΠΎΡ€Π³Π°Π½ΠΈ, ΠΊΠ°ΠΊΡ‚ΠΎ ΠΈ Π² ΡΡŠΡ€Π΄Π΅Ρ‡Π½ΠΈΡ‚Π΅ ΠΊΡƒΡ…ΠΈΠ½ΠΈ. Някои ΠΎΡ‚ услоТнСнията ΠΌΠΎΠΆΠ΅ Π΄Π° пСрсистират, ΠΊΠΎΠ΅Ρ‚ΠΎ сС наблюдава Π² нашия ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ случай ΠΈ Ρ‚ΠΎΠ²Π° Π³ΠΎ ΠΏΡ€Π°Π²ΠΈ особСно интСрСсСн. ΠšΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ случай: ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²ΡΠΌΠ΅ 73-годишСн ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ с извСстно ΠΏΠ΅Ρ€ΠΌΠ°Π½Π΅Π½Ρ‚Π½ΠΎ ΠΏΡ€Π΅Π΄ΡΡŠΡ€Π΄Π½ΠΎ мъТдСнС ΠΈ прояви Π½Π° Ρ…Ρ€ΠΎΠ½ΠΈΡ‡Π½Π° ΡΡŠΡ€Π΄Π΅Ρ‡Π½Π° Π½Π΅Π΄ΠΎΡΡ‚Π°Ρ‚ΡŠΡ‡Π½ΠΎΡΡ‚, ΠΏΠΎΠΏΠ»ΠΈΡ‚Π΅Π°Π»Π½Π° Ρ„Π»Π΅Π±ΠΎΡ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ опСрация Π½Π° лява Ρ‚Π°Π·ΠΎΠ±Π΅Π΄Ρ€Π΅Π½Π° става. 53 Π΄Π½ΠΈ слСд Π΄ΠΎΠΊΠ°Π·Π°Π½ ΠΏΠΎΠ»ΠΎΠΆΠΈΡ‚Π΅Π»Π΅Π½ тСст Π·Π° COVID-19 ΠΏΠΎΡ€Π°Π΄ΠΈ оплаквания ΠΎΡ‚ Ρ„Π΅Π±Ρ€ΠΈΠ»ΠΈΡ‚Π΅Ρ‚ ΠΈ ΠΊΠ°ΡˆΠ»ΠΈΡ†Π° Π½Π° Ρ„ΠΎΠ½Π° Π½Π° Π½Π΅Π³Π°Ρ‚ΠΈΠ²Π΅Π½ ваксинационСн статус ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΡŠΡ‚ Π΅ хоспитализиран с ΠΊΠ»ΠΈΠ½ΠΈΠΊΠ° Π½Π° Π»Π΅ΠΊΠ° Π΄ΠΈΡ…Π°Ρ‚Π΅Π»Π½Π° Π½Π΅Π΄ΠΎΡΡ‚Π°Ρ‚ΡŠΡ‡Π½ΠΎΡΡ‚ ΠΈ ΠΊΠ°Ρ€Π΄ΠΈΠΎΠ³Π΅Π½Π΅Π½ шок. ΠžΡ‚ Π½Π°ΠΏΡ€Π°Π²Π΅Π½ΠΈΡ‚Π΅ Π»Π°Π±ΠΎΡ€Π°Ρ‚ΠΎΡ€Π½ΠΈ изслСдвания сС установиха повишСни ΠΌΠ°Ρ€ΠΊΠ΅Ρ€ΠΈ Π·Π° възпалСниС. Π•ΠšΠ“ ΠΏΠΎΠΊΠ°Π·Π° тахиаритмия (170 ΡƒΠ΄./min) ΠΈ ΠΏΡ€Π΅Π΄ΡΡŠΡ€Π΄Π½ΠΎ мъТдСнС. Π•Ρ…ΠΎΠšΠ“ Ρ€Π°Π·ΠΊΡ€ΠΈ Π½Π°Π»ΠΈΡ‡ΠΈΠ΅Ρ‚ΠΎ Π½Π° Π”Πš-систолна дисфункция, ΠΏΡƒΠ»ΠΌΠΎΠ½Π°Π»Π½Π° хипСртония ΠΈ масивСн Ρ‚Ρ€ΠΎΠΌΠ± Π² дясното ΠΏΡ€Π΅Π΄ΡΡŠΡ€Π΄ΠΈΠ΅. Π‘ ΠΏΠΎΠΌΠΎΡ‰Ρ‚Π° Π½Π° Π”ΠΎΠΏΠ»Π΅Ρ€ сС Π΄ΠΎΠΊΠ°Π·Π° Ρ„Π΅ΠΌΠΎΡ€ΠΎΠΏΠΎΠΏΠ»ΠΈΡ‚Π΅Π°Π»Π½Π° Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·Π° вдясно, Π° CT-пулмоангиографията ΠΏΠΎΠΊΠ°Π·Π° Π΄Π°Π½Π½ΠΈ Π·Π° масивна двустранна Π‘Π’Π•. Π’Π·Π΅ сС Ρ€Π΅ΡˆΠ΅Π½ΠΈΠ΅ Π·Π° ΠΏΡ€ΠΎΠ²Π΅ΠΆΠ΄Π°Π½Π΅ Π½Π° систСмна Ρ„ΠΈΠ±Ρ€ΠΈΠ½ΠΎΠ»ΠΈΠ·Π°, която сС понСсС Π±Π΅Π· услоТнСния. По Π²Ρ€Π΅ΠΌΠ΅ Π½Π° хоспитализацията Π½Π΅ сС установи Π½Π°Π»ΠΈΡ‡ΠΈΠ΅ Π½Π° нСопластично заболяванС. Π—Π°ΠΊΠ»ΡŽΡ‡Π΅Π½ΠΈΠ΅: Π’ΠΎΠ·ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ случай ΠΏΠΎΡ‚Π²ΡŠΡ€ΠΆΠ΄Π°Π²Π° високия риск ΠΎΡ‚ Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·ΠΈ вслСдствиС Π½Π° Ковид инфСкция (Ρ„Π»Π΅Π±ΠΎΡ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·Π°, ΠΏΡ€Π΅Π΄ΡΡŠΡ€Π΄Π½Π° Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΠ·Π° ΠΈ масивна двустранна Π‘Π’Π•) Π±Π΅Π· ΠΎΠΏΡ‚ΠΈΠΌΠ°Π»Π½Π° Π°Π½Ρ‚ΠΈΠΊΠΎΠ°Π³ΡƒΠ»Π°Π½Ρ‚Π½Π° тСрапия ΠΈ ΠΏΡ€ΠΈ ΠΏΡ€ΠΈΠ΅ΠΌ Π½Π° Π°Π½Ρ‚ΠΈΠ°Π³Ρ€Π΅Π³Π°Π½Ρ‚ ΠΎΠΊΠΎΠ»ΠΎ 2 мСсСца слСд Π½Π°Ρ‡Π°Π»ΠΎΡ‚ΠΎ Π½Π° симптомитС. Background: The coronavirus disease (COVID-19 disease) leads to multiple organ disease, inflammation of the endothelium, and micro- or macrovasculitis that may result in thrombosis of the small vessels, and thrombosis of vessels in various organs, as well as intracardiac thrombosis. Some of the complications may be long-lasting, as in our case, which makes it particularly interesting to discuss. Case report: We present a 73-year-old male patient with a history of permanent atrial fibrillation and chronic heart failure (II NYHA class), popliteal phlebothrombosis, and surgery of the left hip joint. 53 days after a positive rapid test for Covid 19 performed because of fever and coughing, the patient, who is not vaccinated for Covid 19, was hospitalised at our Department with clinical signs of mild respiratory failure and cardiogenic shock.Β  The laboratory tests revealed elevated markers of inflammation. The ECG showed tachyarrhythmia (170/min) and atrial fibrillation. The EchoCG displayed evidence of right systolic dysfunction, pulmonary hypertension, and a massive thrombus in the right atrium. The Doppler ultrasonography revealed the presence of right femoropopliteal thrombosis, while the CT-pulmoangiography showed evidence of massive bilateral PE. A decision was made to perform systemic fibrinolysis, which the patient tolerated without complications. During the hospitalisation, the examinations revealed no evidence of an oncological disease. Conclusion: The reported clinical case confirms the high risk of thrombosis due to a COVID-19 infection, such as phlebothrombosis, atrial thrombosis, and massive bilateral PE, in the absence of optimal anticoagulant therapy and against the backdrop of the administration of antiplatelet therapy roughly 2 months after the onset of the COVID-19 symptoms

    Balloon aortic valvuloplasty in degenerative aortic stenosis

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    Π‘Π°Π»ΠΎΠ½Π½Π°Ρ‚Π° валвулопластика Π½Π° Π°ΠΎΡ€Ρ‚Π½Π° ΠΊΠ»Π°ΠΏΠ° (BAV) ΠΏΡ€ΠΈ Π°ΠΎΡ€Ρ‚Π½Π° стСноза сС ΠΏΡ€Π°ΠΊΡ‚ΠΈΠΊΡƒΠ²Π° ΠΎΡ‚ Π½Π°Π΄ 35 Π³ΠΎΠ΄ΠΈΠ½ΠΈ. ΠŸΡŠΡ€Π²ΠΎΠ½Π°Ρ‡Π°Π»Π½ΠΈΡ Π΅Π½Ρ‚ΡƒΡΠΈΠ°Π·ΡŠΠΌ, ΠΏΠΎΡ€ΠΎΠ΄Π΅Π½ ΠΎΡ‚ отличния нСпосрСдствСн Ρ…Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡ‡Π΅Π½ Π΅Ρ„Π΅ΠΊΡ‚ ΠΎΡ‚ ΠΏΡ€ΠΎΡ†Π΅Π΄ΡƒΡ€Π°Ρ‚Π°, ΠΈΠ·Ρ‡Π΅Π·Π²Π° ΠΏΠΎΡ€Π°Π΄ΠΈ Π±ΡŠΡ€Π·Π°Ρ‚Π° рСстСноза Π½Π° Π°ΠΎΡ€Ρ‚Π½Π°Ρ‚Π° ΠΊΠ»Π°ΠΏΠ° слСд интСрвСнция. Π Π΅Π·ΡƒΠ»Ρ‚Π°Ρ‚ΠΈΡ‚Π΅ ΠΎΡ‚ ΡΡŠΠ²Ρ€Π΅ΠΌΠ΅Π½Π½ΠΈΡ‚Π΅ ΠΌΠ΅Ρ‚ΠΎΠ΄ΠΈ Π·Π° Π΄Π΅Ρ„ΠΈΠ½ΠΈΡ‚ΠΈΠ²Π½ΠΎ Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ Π½Π° Π°ΠΎΡ€Ρ‚Π½Π°Ρ‚Π° ΠΊΠ»Π°ΠΏΠ½Π° стСноза – sAVR ΠΈ TAVI, са ΠΎΡ‚Π»ΠΈΡ‡Π½ΠΈ, Π±Π»Π°Π³ΠΎΠ΄Π°Ρ€Π΅Π½ΠΈΠ΅ Π½Π° ΠΊΠΎΠ΅Ρ‚ΠΎ са Π·Π΄Ρ€Π°Π²ΠΎ Π·Π°Π»Π΅Π³Π½Π°Π»ΠΈ Π² Ρ€ΡŠΠΊΠΎΠ²ΠΎΠ΄ΡΡ‚Π²Π°Ρ‚Π° Π·Π° Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅. Π’ΡŠΠΏΡ€Π΅ΠΊΠΈ Ρ‚ΠΎΠ²Π° BAV ΠΈΠΌΠ° своитС ΠΈΠ½Π΄ΠΈΠΊΠ°Ρ†ΠΈΠΈ ΠΏΡ€ΠΈ симптомни ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ, ΠΊΠΎΠΈΡ‚ΠΎ Π½Π΅ са подходящи Π·Π° Π΄Π΅Ρ„ΠΈΠ½ΠΈΡ‚ΠΈΠ²Π½ΠΈΡ‚Π΅ ΠΈΠ½Ρ‚Π΅Ρ€Π²Π΅Π½Ρ†ΠΈΠΈ. Настоящата публикация Ρ€Π°Π·Π³Π»Π΅ΠΆΠ΄Π° ΡΡŠΠ²Ρ€Π΅ΠΌΠ΅Π½Π½ΠΈΡ‚Π΅ ΠΈΠ½Π΄ΠΈΠΊΠ°Ρ†ΠΈΠΈ Π·Π° BAV, основнитС Π΅Ρ‚Π°ΠΏΠΈ ΠΎΡ‚ ΠΏΡ€ΠΎΡ†Π΅Π΄ΡƒΡ€Π°Ρ‚Π°, Π²ΡŠΠ·ΠΌΠΎΠΆΠ½ΠΈΡ‚Π΅ услоТнСния, ΠΊΠ°ΠΊΡ‚ΠΎ ΠΈ Ρ€Π΅Π·ΡƒΠ»Ρ‚Π°Ρ‚ΠΈΡ‚Π΅ ΠΎΡ‚ Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅Ρ‚ΠΎ. Balloon valvuloplasty of the aortic valve (BAV) in aortic stenosis has been practiced for over 35 years. The initial enthusiasm caused by the excellent immediate hemodynamic effect of the procedure disappears due to the rapid restenosis of the aortic valve after intervention. The results of modern methods for defi nitive treatment of aortic valve stenosis – AVR and TAVI are excellent, thanks to which they are fi rmly rooted in treatment guidelines. However, BAV has its indications in symptomatic patients who are not suitable for defi nitive interventions. This publication discusses current indications for BAV, the main stages of the procedure, possible complications, and treatment outcomes

    Interventional treatment of pulmonary embolism - where do we currently stand?

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    ΠžΡΡ‚Ρ€Π°Ρ‚Π° Π±Π΅Π»ΠΎΠ΄Ρ€ΠΎΠ±Π½Π° тромбоСмболия Π΅ Ρ‚Ρ€Π΅Ρ‚Π°Ρ‚Π° Π½Π°ΠΉ-чСста ΠΏΡ€ΠΈΡ‡ΠΈΠ½Π° Π·Π° ΡΡŠΡ€Π΄Π΅Ρ‡Π½ΠΎ-съдова ΡΠΌΡŠΡ€Ρ‚Π½ΠΎΡΡ‚ Π² свСта. Π’Π½Π΅Π·Π°ΠΏΠ½ΠΎΡ‚ΠΎ тСнсионно обрСмСняванС Π½Π° дясната ΠΊΠ°ΠΌΠ΅Ρ€Π°, ΠΏΡ€Π΅Π΄ΠΈΠ·Π²ΠΈΠΊΠ°Π½ΠΎ ΠΎΡ‚ Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΡ‚ΠΈΡ‡Π½ΠΈΡ‚Π΅ маси Π² ΠΏΡƒΠ»ΠΌΠΎΠ½Π°Π»Π½Π°Ρ‚Π° артСрия, ΠΌΠΎΠΆΠ΅ Π±ΡŠΡ€Π·ΠΎ Π΄Π° прогрСсира Π΄ΠΎ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π½Π° ΠΊΠ°Ρ€Ρ‚ΠΈΠ½Π° Π½Π° Ρ‚Π΅ΠΆΡŠΠΊ ΠΊΠ°Ρ€Π΄ΠΈΠΎΠ³Π΅Π½Π΅Π½ шок. Π’ΠΎΠ²Π° ΠΌΠΎΠΆΠ΅ Π΄Π° Π΄ΠΎΠ²Π΅Π΄Π΅ Π΄ΠΎ ΡΠΌΡŠΡ€Ρ‚Π½ΠΎΡΡ‚ Π½Π°Π΄ 50%, ΠΏΡ€ΠΈ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ с масивна Ρ„ΠΎΡ€ΠΌΠ° Π½Π° Π±Π΅Π»ΠΎΠ΄Ρ€ΠΎΠ±Π½Π° тромбоСмболия. Π’ Ρ‚Π°ΠΊΠΈΠ²Π° случаи Π΅ ΠΌΠΎΡ‚ΠΈΠ²ΠΈΡ€Π°Π½ΠΎ ΠΏΡ€ΠΎΠ²Π΅ΠΆΠ΄Π°Π½Π΅Ρ‚ΠΎ Π½Π° систСмна Ρ„ΠΈΠ±Ρ€ΠΈΠ½ΠΎΠ»ΠΈΠ·Π°, ΠΊΠΎΠ΅Ρ‚ΠΎ Π²ΠΎΠ΄ΠΈ Π΄ΠΎ Π±ΡŠΡ€Π·ΠΎ ΠΏΠΎΠ΄ΠΎΠ±Ρ€Π΅Π½ΠΈΠ΅ Π² дСснокамСрната функция ΠΈ стабилизиранС Π½Π° Ρ…Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΠΊΠ°Ρ‚Π°. Вромболитичният Π΅Ρ„Π΅ΠΊΡ‚ Π½Π° систСмната Ρ„ΠΈΠ±Ρ€ΠΈΠ½ΠΎΠ»ΠΈΠ·Π°, Π·Π° съТалСниС, e ΡΡŠΠΏΡ€ΠΎΠ²ΠΎΠ΄Π΅Π½ ΠΎΡ‚ ΠΏΠ΅Ρ‚ΠΊΡ€Π°Ρ‚Π½ΠΎ повишСн риск ΠΎΡ‚ ΠΊΡŠΡ€Π²Π΅Π½Π΅, особСно Π²ΡŠΡ‚Ρ€Π΅Ρ‡Π΅Ρ€Π΅ΠΏΠ½ΠΎ. Π‘Π»Π΅Π΄ΠΎΠ²Π°Ρ‚Π΅Π»Π½ΠΎ Π² ΠΏΠΎΠ²Π΅Ρ‡Π΅Ρ‚ΠΎ случаи Ρ…Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡ‡Π½ΠΎ стабилнитС ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ Π±ΠΈΠ²Π°Ρ‚ Ρ‚Ρ€Π΅Ρ‚ΠΈΡ€Π°Π½ΠΈ само с Π°Π½Ρ‚ΠΈΠΊΠΎΠ°Π³ΡƒΠ»Π°Π½Ρ‚Π½Π° тСрапия. Π˜Π½Ρ‚Π΅Ρ€Π²Π΅Π½Ρ†ΠΈΠΎΠ½Π°Π»Π½ΠΎΡ‚ΠΎ Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ Π½Π° острата Π±Π΅Π»ΠΎΠ΄Ρ€ΠΎΠ±Π½Π° Смболия Π²ΠΊΠ»ΡŽΡ‡Π²Π° ΡƒΠΏΠΎΡ‚Ρ€Π΅Π±Π°Ρ‚Π° Π½Π° устройства, ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Ρ‰ΠΈ ниска Π΄ΠΎΠ·Π° Ρ„ΠΈΠ±Ρ€ΠΈΠ½ΠΎΠ»ΠΈΡ‚ΠΈΠΊ ΠΈΠ»ΠΈ Ρ‚Π°ΠΊΠΈΠ²Π° Π·Π° ΠΏΠ΅Ρ€ΠΊΡƒΡ‚Π°Π½Π½Π° тромбаспирация. Π¦Π΅Π»Ρ‚Π° Π΅ Π΄Π° сС постигнС Π±ΡŠΡ€Π·ΠΎ отстраняванС Π½Π° Ρ‚Ρ€ΠΎΠΌΠ±ΠΎΡ‚ΠΈΡ‡Π½ΠΈΡ‚Π΅ маси ΠΎΡ‚ ΠΏΡƒΠ»ΠΌΠΎΠ½Π°Π»Π½Π°Ρ‚Π° артСрия, ΠΊΠ°Ρ‚ΠΎ Π΅Π΄Π½ΠΎΠ²Ρ€Π΅ΠΌΠ΅Π½Π½ΠΎ сС свСдС Π΄ΠΎ ΠΌΠΈΠ½ΠΈΠΌΡƒΠΌ хСморагичният риск. Π’ΠΎΠ·ΠΈ ΠΎΠ±Π·ΠΎΡ€ Ρ‰Π΅ сС ΠΎΠΏΠΈΡ‚Π° Π΄Π° прСдостави ΠΊΡ€Π°Ρ‚ΡŠΠΊ ΠΏΡ€Π΅Π³Π»Π΅Π΄ Π½Π° Π½Π°ΠΉ-чСсто ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°Π½ΠΈΡ‚Π΅ ΠΈ Π½Π°Π»ΠΈΡ‡Π½ΠΈ Π½Π° ΠΏΠ°Π·Π°Ρ€Π° устройства, ΠΊΠ°ΠΊΡ‚ΠΎ ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π½ΠΈΡ‚Π΅ Π΄Π°Π½Π½ΠΈ, подкрСпящи тяхната ΡƒΠΏΠΎΡ‚Ρ€Π΅Π±Π°. Π‘ΡŠΡ‰ΠΎ Ρ‚Π°ΠΊΠ°, Ρ‰Π΅ Π±ΡŠΠ΄Π°Ρ‚ Ρ€Π°Π·Π³Π»Π΅Π΄Π°Π½ΠΈ пСрспСктивитС Π² Ρ€Π°Π·Π²ΠΈΡ‚ΠΈΠ΅Ρ‚ΠΎ Π½Π° Сндоваскуларното Π»Π΅Ρ‡Π΅Π½ΠΈΠ΅ Π½Π° острата Π±Π΅Π»ΠΎΠ΄Ρ€ΠΎΠ±Π½Π° тромбоСмболия. Acute pulmonary embolism is the third most common cause of cardiovascular mortality in the world. The sudden pressure overload of the right ventricle, caused by the thrombotic masses in the pulmonary artery, may quickly progress to profound cardiogenic shock. That results in a mortality rate of more than 50% in patients with a massive form of pulmonary embolism. In such cases, systemic fibrinolysis is warranted, which leads to rapid improvement of the right ventricular function and hemodynamic stabilization. The thrombolytic effect of systemic fibrinolysis is, unfortunately, accompanied by an almost 5 times increased risk of bleeding, especially intracranial one. Therefore, in most cases, for patients with uncompromised hemodynamics, only anticoagulation treatment is offered. Interventional treatment of acute pulmonary embolism consists of the usage of very low-dose fibrinolytic devices or percutaneous thrombus aspiration devices. The goal is to provide rapid removal of the thrombotic masses from the pulmonary artery circulation while keeping the hemorrhagic risk at a minimum. This paper will try to provide a concise review of the most widely used and available devices, together with the latest clinical data, supporting their use. Also, the future perspectives in the field of endovascular treatment of acute pulmonary embolism will be presented

    Endovascular treatment of subclavian artery stenosis

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    Най-чСстата локализация Π·Π° атСросклСрозата Π½Π° Π³ΠΎΡ€Π½ΠΈΡ‚Π΅ ΠΊΡ€Π°ΠΉΠ½ΠΈΡ†ΠΈ са артСрия субклавия ΠΈ трункус брахиоцСфаликус. Π‘ΠΈΠ³Π½ΠΈΡ„ΠΈΠΊΠ°Π½Ρ‚Π½Π°Ρ‚Π° стСноза Π½Π° артСрия субклавия сС срСща ΠΏΡ€ΠΈΠ±Ρ€ΠΈΠ»ΠΈΠ·ΠΈΡ‚Π΅Π»Π½ΠΎ ΠΏΡ€ΠΈ 2% ΠΎΡ‚ популацията ΠΈ Π² 7-11% ΠΎΡ‚ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈΡ‚Π΅ с манифСстно ΡΡŠΡ€Π΄Π΅Ρ‡Π½ΠΎ-съдово заболяванС. РСваскуларизацията Π΅ ΠΏΠΎΠΊΠ°Π·Π°Π½Π° ΠΏΡ€ΠΈ симптомни ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ ΠΈΠ»ΠΈ асимптомни с ΠΊΠΎΡ€ΠΎΠ½Π°Ρ€Π½ΠΎ заболяванС с ΠΏΠ»Π°Π½ΠΈΡ€Π°Π½Π° ΠΎΠΏΠ΅Ρ€Π°Ρ‚ΠΈΠ²Π½Π° рСваскуларизация. ОсвСн атСросклСроза Π΄Ρ€ΡƒΠ³ΠΈ ΠΏΡ€ΠΈΡ‡ΠΈΠ½ΠΈ Π·Π° изявата Π½Π° стСноза Π½Π° артСрия субклавия Π²ΠΊΠ»ΡŽΡ‡Π²Π°Ρ‚ дисСкация, ΠΏΡ€Π΅Π΄ΠΈΠ·Π²ΠΈΠΊΠ°Π½Π° ΠΎΡ‚ радиация, възпалСниС Π½Π° фибромускулатурата ΠΈ Ρ€Π°Π·Π»ΠΈΡ‡Π½ΠΈ васкулити, особСно Π°Ρ€Ρ‚Π΅Ρ€ΠΈΠΈΡ‚ Π½Π° Вакаясу. Лявата ΠΏΠΎΠ΄ΠΊΠ»ΡŽΡ‡ΠΈΡ‡Π½Π° артСрия Π΅ ΠΎΠΊΠΎΠ»ΠΎ Ρ‡Π΅Ρ‚ΠΈΡ€ΠΈ ΠΏΡŠΡ‚ΠΈ ΠΏΠΎ-вСроятно Π΄Π° бъдС засСгната, ΠΎΡ‚ΠΊΠΎΠ»ΠΊΠΎΡ‚ΠΎ дясната. Π‘Ρ€Π΅Ρ‰Π° сС ΠΎΠ±ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΎ Π½Π° Π²ΡŠΠ·Ρ€Π°ΡΡ‚ Π½Π°Π΄ 50 Π³ΠΎΠ΄ΠΈΠ½ΠΈ ΠΈ Π² 1,5-2 ΠΏΡŠΡ‚ΠΈ ΠΏΠΎ-чСсто ΠΏΡ€ΠΈ ΠΌΡŠΠΆΠ΅Ρ‚Π΅, ΠΎΡ‚ΠΊΠΎΠ»ΠΊΠΎΡ‚ΠΎ ΠΏΡ€ΠΈ ΠΆΠ΅Π½ΠΈΡ‚Π΅. ЗаболяванСто Π½Π° ΠΏΠΎΠ΄ΠΊΠ»ΡŽΡ‡ΠΈΡ‡Π½Π°Ρ‚Π° артСрия ΠΎΠ±ΠΈΠΊΠ½ΠΎΠ²Π΅Π½ΠΎ Π΅ ΠΎΠ³Π½ΠΈΡ‰Π½ΠΎ ΠΈ лСзията Π΅ ΠΏΡ€Π΅Π΄ΠΈΠΌΠ½ΠΎ Π² ΠΏΡŠΡ€Π²ΠΈΡ‚Π΅ 2 cm проксималСн сСгмСнт ΠΎΡ‚ Π½Π°Ρ‡Π°Π»ΠΎΡ‚ΠΎ Π½Π° Π°ΠΎΡ€Ρ‚Π°Ρ‚Π°. ΠœΠ΅ΠΆΠ΄Ρƒ 2016-2021 Π³. Π² ΠšΠ»ΠΈΠ½ΠΈΠΊΠ°Ρ‚Π° ΠΏΠΎ кардиология ΠΈ ангиология Π½ΠΈΠ΅ Π»Π΅ΠΊΡƒΠ²Π°Ρ…ΠΌΠ΅ Сдноваскуларно 81 ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ΠΈ (41 мъТС ΠΈ 40 ΠΆΠ΅Π½ΠΈ, срСдна Π²ΡŠΠ·Ρ€Π°ΡΡ‚ 64 Β± 11) Ρ‡Ρ€Π΅Π· Π±Π°Π»ΠΎΠ½Π½Π° дилатация ΠΈ/ΠΈΠ»ΠΈ ΠΏΡŠΡ€Π²ΠΈΡ‡Π½ΠΎ стСнтиранС послСдвано ΠΎΡ‚ Π±Π°Π»ΠΎΠ½Π½Π° постдилатация. ΠŸΠΎΡΡ‚ΠΈΠ³Π½Π°Ρ…ΠΌΠ΅ висока тСхничСска успСваСмост (93.8%) ΠΈ Π½Π΅Π·Π°Π±Π°Π²Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ успСх със само няколко ΠΌΠΈΠ½ΠΈΠΌΠ°Π»Π½ΠΈ услоТнСния. The most common localizations for upper extremity atherosclerosis are the subclavian artery and the brachiocephalic trunk. Significant stenosis of the subclavian artery occurs in 2% of the population and in 7-11% of patients with manifest cardiovascular disease. Revascularization is indicated in symptomatic or asymptomatic patients with coronary disease with planned surgical revascularization. In addition to atherosclerosis, other causes of the appearance of subclavian artery stenosis include dissection, radiation-induced inflammation of the fibromusculature, and various vasculities, especially Takayasu arteritis. The left subclavian artery is about four times more commonly affected than the right. It usually occurs over the age of 50 years and in 1.5-2 times more common in men than in women. Disease of the subclavian artery is usually focal and the lesion is predominantly in the first 2 cm proximal to the origin of the aorta. Between 2016-2021 in the clinic of cardiology and angiology we treated endovascularly 81 patients (41 men and 40 females, median age 64 Β± 11) with either intraluminal balloon dilatation and/or primary stent implantation followed by balloon post dilatation. We achieved a high technical success rate (93.8%) and immediate clinical success, with only a few minor complications.

    Transcatheter aortic valve implantation for severe aortic regurgitation in a patient with end-stage respiratory failure

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    ΠŸΡ€Π΅Π΄ΡΡ‚Π°Π²ΡΠΌΠ΅ случай Π½Π° 73-годишСн ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ с ΠΊΠΎΠΌΠ±ΠΈΠ½ΠΈΡ€Π°Π½ΠΎ засяганС Π½Π° Π°ΠΎΡ€Ρ‚Π½Π°Ρ‚Π° ΠΊΠ»Π°ΠΏΠ° ΠΏΡ€ΠΈ ΠΏΡ€Π΅ΠΎΠ±Π»Π°Π΄Π°Π²Π°Ρ‰Π° високостСпСнна, симптоматична Π°ΠΎΡ€Ρ‚Π½Π° рСгургитация ΠΈ ΠΏΡ€ΠΈΠ΄Ρ€ΡƒΠΆΠ°Π²Π°Ρ‰Π° Π΄ΠΈΡ…Π°Ρ‚Π΅Π»Π½Π° Π½Π΅Π΄ΠΎΡΡ‚Π°Ρ‚ΡŠΡ‡Π½ΠΎΡΡ‚ Π² Ρ‚Π΅Ρ€ΠΌΠΈΠ½Π°Π»Π΅Π½ стадий, със Π·Π°Π±Ρ€Π°Π½ΠΈΡ‚Π΅Π»Π½ΠΎ висок Ρ…ΠΈΡ€ΡƒΡ€Π³ΠΈΡ‡Π΅Π½ риск, ΠΏΡ€ΠΈ ΠΊΠΎΠΉΡ‚ΠΎ ΠΎΡΡŠΡ‰Π΅ΡΡ‚Π²ΠΈΡ…ΠΌΠ΅ ΡƒΡΠΏΠ΅ΡˆΠ½ΠΎ ΠΈΠΌΠΏΠ»Π°Π½Ρ‚ΠΈΡ€Π°Π½Π΅ Π½Π° off-label self-expandable Π°ΠΎΡ€Ρ‚Π½Π° ΠΊΠ»Π°ΠΏΠ½Π° ΠΏΡ€ΠΎΡ‚Π΅Π·Π° Medtronic Core Valve, ΠΈΠ·ΠΏΠΎΠ»Π·Π²Π°ΠΉΠΊΠΈ Ρ‚.Π½Π°Ρ€ минималистичСн ΠΏΠΎΠ΄Ρ…ΠΎΠ΄. Π’ΠΎΠ·ΠΈ ΠΊΠ»ΠΈΠ½ΠΈΡ‡Π΅Π½ случай ΠΏΠΎΠΊΠ°Π·Π²Π°, Ρ‡Π΅ ΡΠ°ΠΌΠΎΡ€Π°Π·ΡˆΠΈΡ€ΡΠ²Π°Ρ‰Π°Ρ‚Π° сС ΠΏΡ€ΠΎΡ‚Π΅Π·Π° Medtronic CoreValve Evolut R ΠΌΠΎΠΆΠ΅ Π΄Π° бъдС ΠΈΠΌΠΏΠ»Π°Π½Ρ‚ΠΈΡ€Π°Π½Π° Π±Π΅Π· Ρ‚ΡŠΠΊΠ°Π½Π½ΠΎ ΡƒΠ²Ρ€Π΅ΠΆΠ΄Π°Π½Π΅ ΠΈ миграция Π² Π΅Π΄Π½Π° ΡƒΠΌΠ΅Ρ€Π΅Π½ΠΎ ΠΊΠ°Π»Ρ†ΠΈΡ€Π°Π½Π° трикуспидна Π°ΠΎΡ€Ρ‚Π½Π° ΠΊΠ»Π°ΠΏΠ° с ΠΏΡ€Π΅ΠΎΠ±Π»Π°Π΄Π°Π²Π°Ρ‰Π° инсуфициСнция ΠΏΡ€ΠΈ нискостСпСнна стСноза ΠΈ Π΄Π° Π΄ΠΎΠ²Π΅Π΄Π΅ Π΄ΠΎ Π·Π°Π΄ΠΎΠ²ΠΎΠ»ΠΈΡ‚Π΅Π»Π½ΠΈ Ρ…Π΅ΠΌΠΎΠ΄ΠΈΠ½Π°ΠΌΠΈΡ‡Π½ΠΈ Ρ€Π΅Π·ΡƒΠ»Ρ‚Π°Ρ‚ΠΈ с подобряванС Π½Π° функционалния клас ΡΡŠΡ€Π΄Π΅Ρ‡Π½Π° Π½Π΅Π΄ΠΎΡΡ‚Π°Ρ‚ΡŠΡ‡Π½ΠΎΡΡ‚ ΠΏΡ€ΠΈ ΠΏΠ°Ρ†ΠΈΠ΅Π½Ρ‚ със ΡΡŠΠΏΡŠΡ‚ΡΡ‚Π²Π°Ρ‰Π° Ρ‚Π΅ΠΆΠΊΠ° Π΄ΠΈΡ…Π°Ρ‚Π΅Π»Π½Π° Π½Π΅Π΄ΠΎΡΡ‚Π°Ρ‚ΡŠΡ‡Π½ΠΎΡΡ‚. We report a case of a high-risk 73-year–old patient with a combined aortic valve disease with predominant severe, symptomatic aortic regurgitation and a history of an end-stage respiratory failure with prohibitive surgical risk who was successfully treated using a minimalist approach to implant off-label Π° self-expandable Medtronic Evolut R prosthesis. This case report demonstrates that the self-expandable prosthesis Medtronic Evolut R might be implanted without tissue damage and migration in a moderate-calcified tricuspid aortic valve with predominant regurgitation and mild stenosis with satisfactory hemodynamic results and improvement in functional class heart failure in a patient with concomitant severe respiratory failure

    Percutaneous coronary artery intervention after transcatheter aortic valve implantation

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    Transcatheter implantation of the aortic valve is an increasingly used method for the treatment of aortic stenosis, with a steady trend worldwide to increase the number of TAVI procedures and reduce the age of patients. In Europe, over 180,000 TAVI procedures are currently implemented annually. This review aims to evaluate the patient’s prognosis for the different approaches, the technical diffi culties during the procedure, and to offer useful tips for overcoming them. We publish our experience in transcatheter treatment of ischemic heart disease after TAVI implantation
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