Justiniano, Emily

Krüger, Juliana

Reich, Rejane

Romero, Paola Severo

Santos, Dulce Daise Guimarães

Portuguese

Lume 5.8

Sociedade Brasileira de CardiologiaISSN-0066-782XAbstractsVolume Number Supplement119 4 1October 2022ABSTRACTS PRESENTED ATOCTOBER 13 TO 15, 2022230YOUNG RESEARCHER - POSTER RESEARCHER - CASE REPORTArq Bras Cardiol 2022; 119(4Supl.1):1-366111221MODALITY: E-POSTER YOUNG RESEARCHER - CASE REPORT CATEGORY: ACUTE AND CHRONIC CORONARY DISEASE/ THROMBOLYSIS  TITLE: SPONTANEOUS CORONARY AND CAROTID ARTERIES DISSECTION ASSOCIATED WITH CEREBRAL ANEURYSM IN A YOUNG WOMAN  ISABELLE MENDES RODRIGUES SALOMÃO1, ALESSANDRA ARNEZ PACHECO1, DANIEL XAVIER DE BRITO SETTA1, JULIA PAULO MOURILHE ROCHA1, RICARDO MOURILHE-ROCHA1  (1) HOSPITAL PRÓ-CARDÍACOIntroduction: Spontaneous coronary artery dissection (SCAD) is an uncommon cause of myocardial infarction (AMI), reaching approximately 1% of cases and may be associated and may be rarely associated with carotid dissection. In most cases, it is underdiagnosed and may evolve to worse prognosis and even sudden death. Case report: Female, 36 years old, white, with a history of arterial hypertension, gestational diabetes and overweight. She reported stabbing chest pain, 10+/10, for 40 minutes, at rest, without irradiation, associated with sudden dyspnea, nausea and sweating. Normal electrocardiogram (ECG) and positive troponin I (TnI). Reported improvement in her symptoms after aspirin and clopidogrel and was transferred to another hospital asymptomatic. A new ECG was performed, which showed T wave inversion in the anterior and inferior walls and TnI us=3,950 ng/mL. Echocardiogram (ECO) with severe left ventricular (LV) systolic dysfunction, hypokinesia of the basal segments and akinesia of the middle and apical portions of the LV. Coronary angiography (CAT) was performed, which showed spontaneous anterior descending dissection (ADA), 1st. diagonal, septal and 1st. marginal with TIMI III flow. One day after the CAT, she evolved into a new chest pain with hemodynamic stability and ECG with a new ST elevation in the inferolateral wall, being maintained with ASA, clopidogrel, statin and associated with bisoprolol. Cardiac resonance was performed, which showed recent transmural AMI affecting the anteroseptal wall of the LV (7% infarcted mass) and subendocardial AMI in the inferolateral wall (3% infarcted mass). Coronary CT angiography with absence of atherosclerosis with images of dissections in the middle third of the ADA and moderate dissections in the distal third of the right coronary artery. Angiotomography of the neck and skull showed saccular aneurysmal dilatation in the ophthalmic segment of the right internal carotid artery (ICA) measuring 6 mm and dissection in the distal cervical segment of the left ICA. After clinical control, she was discharged from the hospital in NYHA functional class 1 with improvement in LV function by ECO. Conclusion: SCAD is more prevalent in young women with few risk factors for coronary artery disease and may be related to fibromuscular dysplasia, pregnancy and the puerperium. The association with vascular alterations in other sites must be resherched in those patients. Conservative treatment had been chosen in most cases.111234MODALITY: E-POSTER YOUNG RESEARCHER - CASE REPORT CATEGORY: PERICARDIUM/ ENDOCARDIUM/ VALVOPATHIES  TITLE: QUADRICUSPID AORTIC VALVE IN A PATIENT WITH MUCOPOLYSACCHARIDOSIS TYPE 1: A CASE REPORT  DANIEL FIORAVANTI GIMENEZ1, ELAINE DOS REIS COUTINHO1, EDUARDO HADAD CHERULLI1, MARINA ROMANO CAPELLINI1, ALOÍSIO MARCHI ROCHA1  (1) HOSPITAL DA PUC- CAMPINASINTRODUCTION: The Mucopolysaccharidosis is a group of rare autosomal recessive metabolic disorders which affects multiple systems, including cardiovascular. It´s characterized by deficiency of lysosomal enzymes (alpha-L-iduronidase) that leads to accumulation of glycosaminoglycans in tissues and in consequence, tissue dysfunction. Mucopolysaccharidosis type 1 (MPS1) has an estimated prevalence of 1:100.000 births. This case reports a patient with MPS1, Scheie phenotype, with severe aortic stenosis. CASE REPORT: A 47-year-old woman with MPS1 diagnosis since birth and with preserved ejection fraction heart failure (echocardiogram 03/21: left ventricular ejection fraction (LVEF): 51%) was admitted at emergency room with low cardiac output accompanied by pulmonary congestion due to COVID and Bacterial Pneumonia. The echocardiogram revealed: LVEF:25%, globally reduced, absence of segmental disorders, left chambers enlargement with Left Ventricular hypertrophy, malformed aortic valve (quadricuspid aspect) with mild thickening and calcification, critical stenosis and subtle insufficiency. Also, there was an severe mitral insufficiency with ring dilatation, apical systolic closure and posterior leaflet prolapse. The cardiac surgery team was opposed to an aortic valve replacement procedure due to high surgery risk. TAVI was not possible due to an unfavorable anatomy for the procedure and iodine allergy. Regarding her decreased mobility and NYHA functional class I, she was discharged and keeps her follow up in the ambulatory with optimized clinical therapy. In less severe MPS phenotypes, there may be valvular disorders independent of existing risk factors as congenital or rheumatic atherosclerosis. Therefore, the cardiological follow up is important for those patients, as pointed out in the case, in which an adult patient presents severe aortic stenosis with ventricular function loss secondary to MPS 1. CONCLUSION: The cardiovascular disease emerges subtly in attenuated phenotypic presentations of MPS, contributing to the premature mortality of these patients. Besides being rare, MPS 1 may present late cardiovascular implications, even in broader cases, and severe consequences that compromise the patient‘s lifestyle. The case is even more uncommon not only for its underlying disease, MPS 1, but for the aortic valve´s anatomic modification (quadricuspid), not often reported in literature in this syndrome.111223MODALITY: E-POSTER YOUNG RESEARCHER - CASE REPORT CATEGORY: NURSING  TITLE: VALVE-IN-VALVE TAVI: FIRST CASE OF BALLOON-EXPANDABLE PROSTHESIS IN SELF-EXPANDING PROSTHESIS PERFORMED AT A UNIVERSITY HOSPITAL IN SOUTHERN BRAZIL  EMILY JUSTINIANO1, REJANE REICH1, JULIANA KRUGER1, DULCE DAISE GUIMARAES1, PAOLA SEVERO ROMERO1  (1) HOSPITAL DE CLÍNICAS DE PORTO ALEGREIntroduction: Aortic stenosis is the most prevalent acquired valvular heart disease in the Brazilian population and has high morbidity and mortality. Transcatheter aortic valve implantation (TAVI) is an established procedure for the treatment of symptomatic stenosis for patients considered inoperable, at high risk and intermediate surgical risk. Objective: To report the first case of balloon-expandable prosthesis implantation in a degenerated self-expanding prosthesis performed in a public university hospital in southern Brazil. Case description: An 86-year-old female patient with a history of TAVI CoreValve prosthesis in 2012 was hospitalized with an echocardiogram showing aortic prosthesis with severe stenosis and moderate insufficiency, and a new TAVI (valve in valve) was chosen. The catheterization laboratory team previously performed combinations with the operating room team due to the possibility of conversion to a surgical approach. In addition to alignments with regard to materials, a team of professionals developed strategies to deal with intercurrences. The procedure was performed in September 2021, under general anesthesia, with transesophageal echocardiography follow-up. A balloon-expanded prosthesis, Sapien 3 23 mm, was implanted inside a previous prosthesis, by puncture in the right femoral artery (7 and 14 French introducer) and left femoral artery (7 French introducer). Passed 6 French introducer in the right femoral vein for transvenous pacemaker and in the right radial artery for catheterization of the right coronary artery. Hemostasis was performed with a suture closure device (Perclose) in the right femoral artery and by compression in the other access sites. Patient transferred to intensive care unit extubated and without vasopressor. The procedure time was 215 minutes and the room time was 337 minutes. Four medical specialties participated in the procedure, a nurse, two nursing technicians, a radiology technician, a prosthetic representative, in addition to a perfusionist and an instrumentation specialist in cardiac surgery present at the unit. The patient evolved satisfactorily and was discharged from the hospital on the tenth day after the procedure. Conclusions: The nurses of the catheterization laboratory, together with a team of professionals, actively participated in the organization of material resources and the logistics outlined for the care of a possible surgical approach. The procedure, although complex, was uneventful.111233MODALITY: E-POSTER YOUNG RESEARCHER - CASE REPORT CATEGORY: CARDIOVASCULAR INTENSIVE CARE/ CARDIOVASCULAR EMERGENCIES  TITLE: THE ROLE OF NON-INVASIVE INTRACRANIAL PRESSURE MONITORING IN HEMODYNAMIC MANAGEMENT OF CRITICAL CARE PATIENTS  AMANDA AYAKO MINEMURA ORDINOLA1, SALOMON SORIANO ORDINOLA ROJAS1, CAROLINE SPAGNOL1, VIVIANE CORDEIRO VEIGA1  (1) BENEFICÊNCIA PORTUGUESA DE SÃO PAULOIntracranial pressure (ICP) assessment is a method that can guide the hemodynamic management of patients undergoing procedures and conditions associated with neurological disturbances. In this paper, two cases were reported. The first case is a 40-year-old male with Marfan’s syndrome, admitted with aortic endocarditis which underwent valved conduit exchange with extracorporeal circulation (ECC) 182 minutes, the patient presented one episode of tonic-clonic seizure. Non-invasive ICP (NIICP) showed altered brain compliance (figure 1). The management included increase in sedation and prevention of secondary cerebral ischemia. New NIICP showed well response to the neuroprotection management (figure 2). The second is a 64-year-old female diabetic patient admitted for cytoreductive surgery due to colon adenocarcinoma. Edema and facial plethora were presented on admission, associated with high central venous pressure and high systolic volume variation.The hypothesis of superior vena cava syndrome was raised and confirmed by evidence of thrombosis related to catheter. The NIICP showed altered brain compliance (figure 3), with improvement after cerebral protection measures. In all cases reported, NIICP identified morphological changes in the ICP waveform and throughout patient management in the intensive care unit. Noninvasive method assisted in clinical decision-making regarding the optimization of protocols adapted for neuroprotection.

Valve-in-valve TAVI : first case of balloon-expandable prosthesis in self-expanding prosthesis performed at a university hospital in Southern Brazil

https://lume.ufrgs.br/bitstream/10183/250491/1/001152462.pdf

Valve-in-valve TAVI : first case of balloon-expandable prosthesis in self-expanding prosthesis performed at a university hospital in Southern Brazil

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