Sudden death after valve-in-valve procedure due to delayed coronary obstruction. A case report

Background: Valve-in-valve transcatheter aortic valve implantation for degenerated aortic bioprostheses is an effective option for patients at high risk for redo surgery, even if it may be burdened by complications more common in specific settings, such as, coronary artery obstruction. Case presentation: We present the case of a Caucasic 84-year-old woman with degeneration of a previously implanted aortic Mitroflow bioprosthesis. She underwent a valve-in-valve transcatheter aortic valve implantation with a CoreValve® bioprosthesis. End-procedure coronary angiography demonstrated maintained perfusion of both coronary arteries. However, few hours later, she experienced sudden cardiac death. An autopsy showed that Mitroflow prosthesis leaflets were higher than the left main coronary ostium, and no other possible cause for the sudden death. Fatality was thus ascribed to left main coronary ostium obstruction due to apposition of the Mitroflow leaflet pushed upward by the late expansion of CoreValve®. Conclusions: Coronary artery obstruction is a frequently fatal complication which usually presents just after valve implantation, but, as reported in our case, it may also have a delayed presentation. Accurate patient's selection and intraoperative preventive measures can reduce this eventuality

Anterior mitral valve aneurysm is an uncommon complication of aortic valve infective endocarditis. A case report

Objective: Rare disease Background: Mitral valve aneurysms (MVAs) are uncommon conditions frequently associated with aortic valve endocarditis. They may be complicated by perforation and severe mitral regurgitation (MR). Optimal treatment of MVA, and in particular the best timing for surgery, are uncertain. Case Report: A 62-year-old man with a recent history of dental surgery presented to the Emergency Department complaining relapsing fever. A first echocardiogram demonstrated infective endocarditis of the aortic valve. The patient was primarily managed with specific antibiotic therapy. Despite this, a few days later he suffered from splen-ic embolization and an MVA with MR was detected. Surgical replacement of the mitral and aortic valves was therefore performed. Conclusions: MVAs are infrequent but potentially severe complications of AV endocarditis. In the absence of definite treatment indication, the correct time for surgery should depend on concomitant clinical and infective features

Cardiopulmonary assessment of patients with systemic sclerosis for hematopoietic stem cell transplantation: recommendations from the European Society for Blood and Marrow Transplantation Autoimmune Diseases Working Party and collaborating partners.

Systemic sclerosis (SSc) is a rare disabling autoimmune disease with a similar mortality to many cancers. Two randomized controlled trials of autologous hematopoietic stem cell transplantation (AHSCT) for SSc have shown significant improvement in organ function, quality of life and long-term survival compared to standard therapy. However, transplant-related mortality (TRM) ranged from 3-10% in patients undergoing HSCT. In SSc, the main cause of non-transplant and TRM is cardiac related. We therefore updated the previously published guidelines for cardiac evaluation, which should be performed in dedicated centers with expertize in HSCT for SSc. The current recommendations are based on pre-transplant cardiopulmonary evaluations combining pulmonary function tests, echocardiography, cardiac magnetic resonance imaging and invasive hemodynamic testing, initiated at Northwestern University (Chicago) and subsequently discussed and endorsed within the EBMT ADWP in 2016

Percutaneous rescue of left ventricular embolized amplatzer septal occluder device

Transcatheter atrial septal defect (ASD) closure has proven to be safe and effective, and it is rapidly becoming the standard treatment for secundum-type ASDs. However, device embolization occurs in about 0.55% of cases, regardless of ASD and device size and/or physician's expertise. Percutaneous retrieval of the embolized device is possible in about 50% of cases, and several techniques have been described, including the use of large sheaths, gooseneck snares, or bioptomes. This is the first successful and reported case of retrieval of an embolized amplatzer septal occluder (ASO) from the left ventricle that was achieved by using a modified snare technique. This was done after an unsuccessful ttempt at retrieval with a bioptome that led to a never previously reported complication. Of the 32 reported cases of ASO embolization, percutaneous retrieval was successful in 16 cases (50%) and none were obtained following left ventricular embolization. Even in experienced hands, the observed rate of embolization when using an ASO device is not negligible. Percutaneous retrieval is also possible from the left ventricle but in some cases nonstandardized devices and strategies may be required

Anorexia nervosa and heart disease: a systematic review

Anorexia nervosa (AN) is an eating disorder that most frequently afflicts females in adolescence. In these subjects, cardiovascular complications are the main cause of morbidity and mortality. Aim of this review is to analyze the hemodynamic, pro-arrhythmic and structural changes occurring during all phases of this illness, including re-feeding. A systematic literature search was performed on studies in the MEDLINE database, from its inception until September 2017, with PUBMED interface focusing on AN and cardiovascular disease. This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation. As these arrhythmias may be the substrate of sudden cardiac death (SCD), they require cardiac monitoring in hospital. In addition, reduced cardiac mass, with smaller volumes and decreased cardiac output, may be found. Furthermore, mitral prolapse and a mild pericardial effusion may occur, the latter due to protein deficiency and low levels of thyroid hormone. In anorectic patients, some cases of hypercholesterolemia may be present; however, conclusive evidence that AN is an atherogenic condition is still lacking, although a few cases of myocardial infarction have been reported. Finally, refeeding syndrome (RFS), which occurs during the first days of refeeding, may engender a critically increased risk of acute, life-threatening cardiac complications

7A.09: METABOLIC SYNDROME IS ASSOCIATED WITH LEFT VENTRICULAR DILATATION IN PRIMARY HYPERTENSION

Metabolic syndrome (MS) has been shown to predict cardiovascular events in patients with hypertension. Recently, a new four-group left ventricular (LV) hypertrophy classification based on both LV dilatation and concentricity was proposed. This classification has been shown to provide a more accurate prediction of cardiovascular events, suggesting that the presence of LV dilatation may add prognostic information. We investigated the relationship between MS and the new classification of LV geometry in patients with primary hypertension

Role of advanced oxidation protein products and Thiol ratio in patients with acute coronary syndromes

Role of advanced oxidation protein products and Thiol ratio in patients with acute coronary syndromes. Barsotti A, Fabbi P, Fedele M, Garibaldi S, Balbi M, Bezante GP, Risso D, Indiveri F, Ghigliotti G, Brunelli C. OBJECTIVES: To identify systemically detectable vascular inflammation associated to redox system unbalance, advanced oxidation protein products (AOPP), formed by HClO reaction with proteins, Thiol levels, and their ratio (AOPP/Thiol ratio) were measured in patients with acute coronary syndromes (ACS). DESIGN AND METHODS: We evaluated AOPP/Thiol ratio together with CRP and IL-1\u3b2 in 18 acute myocardial infarction (AMI) and in 16 unstable angina (UA) patients at admission, and in 16 control subjects (CTR); the measurements were repeated at 1 and at 6 months. RESULTS: At admission, AMI and UA patients displayed higher AOPP/Thiol ratio and CRP and IL-1\u3b2 compared to CTR subjects. A correlation between AOPP/Thiols and IL-1\u3b2 in AMI was found. At follow-up, in UA only, AOPP/Thiol ratio and IL-1\u3b2 levels still remained high. CONCLUSIONS: The AOPP/Thiol ratio seems to affect the inflammatory process in ACS, and may represent a reliable marker of oxidative unbalance in this setting of patients