Tips and Tricks on Paravalvular Leak Closure after Aortic Valve Replacement and Transcatheter Aortic Valve Implantation (TAVI): A Case Series | Chapter 11 | Medical Science: Trends and Innovations Vol. 3

Background: Paravalvular leak (PVL) after surgical valve replacement (AVR) and after Transcatheter Aortic Valve Implantation (TAVI) is an ominous complication with a high risk of morbidity and mortality. Approximately 1–5% of PVLs can lead to serious clinical consequences, including congestive heart failure and/or hemolytic anemia.

Aim: The aim of the study is to explore effective techniques and strategies for closing paravalvular leaks (PVLs) after Aortic Valve Replacement and after Transcatheter Aortic Valve Implantation.

Case Series: 1) A 69-year-old man with multiple comorbidities underwent surgical replacement of the aortic valve with a mechanical tilting disc prosthetic valve (Medtronic Starlight 27 mm). Several years later, recurrent episodes of congestive heart failure and hemolytic anemia developed due to a large crescent-shaped aortic PVL located at non-coronary cusp (NCC) 9–12 o’clock, with moderate-to-severe regurgitation. The huge PVL was partially closed by the first specifically designed paravalvular leak device (PLD). The procedure was complicated by transient interference of the second PLD with mechanical prosthetic valve function. This issue has however been solved with correct manipulation, orientation and downsizing of the second device implanted. 2) An 85-year-old woman suffering from long-standing atrial fibrillation and severe symptomatic aortic stenosis underwent SE TAVI (26 mm EvolutTM R®, Medtronic Inc., MN, USA). Eighteen months after TAVI, she was admitted for congestive heart failure and two-dimensional (2D) transesophageal echocardiography (TEE) color Doppler showed moderate-severe PVL regurgitation due to a long and heavily calcified leak located below the left coronary sinus. During transcatheter PVL closure (TPVLc), an extra arterio-arterial (AA) support loop and Intravascular lithotripsy (IVL) application greatly facilitates the progression of the delivery sheath and occluder resulting key to the success of the procedure.

Discussion: Surgical redo has been considered the treatment of choice for symptomatic patients with PVLs. Notwithstanding, TPVLc after AVR and after TAVI is a less invasive alternative, particularly in patients at high surgical risk, where early diagnosis and prompt interventional treatment are crucial for improving expectancy and quality of life. Dedicated devices, appropriate procedural techniques, and the close interaction between imaging modalities allowed to deal successfully with challenging cases of severe symptomatic aortic PVL regurgitation.

Conclusion: Transcatheter aortic PVL closure is a feasible, safe, less invasive and life-saving alternative to surgical repair, particularly in patients deemed at high risk for redo surgery.

 

Author (s) Details

 

Eustaquio Maria Onorato
Cardiology Department, IRCCS Galeazzi-Sant’Ambrogio Hospital, Milan, Italy.

Matteo Vercellino
Cardiology Department, IRCCS, Ospedale Policlinico San Martino, Genova, Italy.

Annamaria Costante
Cardiology Department, Azienda Ospedaliera di Alessandria, Alessandria, Italy.

 

Antonio L. Bartorelli
Cardiology Department, IRCCS Galeazzi-Sant’Ambrogio Hospital, Milan, Italy and Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Italy.

 

Salvatore Evola

Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Palermo, Italy.

 

Alessandro D’Agostino
Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Palermo, Italy.

 

Daniele Adorno
Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Palermo, Italy.

 

Oreste Fabio Triolo
Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Palermo, Italy.

 

Gioacchino Giarratana
Catheterization Laboratory, Department of Medicine and Cardiology, Azienda Ospedaliera Universitaria Policlinico “P. Giaccone”, Palermo, Italy.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/msti/v3/4055

Hematological Involvement in Pediatric Systemic Lupus Erythematosus | Chapter 4 | Highlights on Medicine and Medical Science Vol. 9

 Systemic lupus erythematosus (SLE) is a multisystemic chronic autoimmune disease with a varied clinical history. Hematological involvement is common, and it has been linked to an increase in morbidity and mortality, as well as an increased risk of infection and lower survival rates. The goal of this study was to describe the hematologic changes in paediatric SLE patients when they were first diagnosed. Methods. A retrospective descriptive analysis was undertaken on patients with SLE who were treated at the Exequiel Gonzalez Cortes Children's Hospital's Immunorheumatology Outpatients Center in Santiago, Chile. Thirty-three clinical files were examined, and demographic and clinical information was collected. Results. Thirty patients met the criteria for inclusion, 22 of them were females with an average age of 11.6 years (range 5 to 14). Hematological compromise was seen in 60% of the participants (n = 18). Lympopenia was the most common haematological abnormality, with 14 individuals, followed by autoimmune hemolytic anaemia (HA) with 11 patients. Ten individuals had leukopenia, while three had thrombocytopenia. Lympopenia was found to be associated with leukopenia in 50% of the patients (n = 9) while HA was shown to be associated with lymphopenia in 8 individuals. Skin involvement was the most common extra-hematological manifestation in patients with haematological changes (26/30), followed by kidney involvement (25), articular involvement (22), and serositis (17).

 Conclusions. In this cohort of paediatric SLE cases, haematological involvement was common, and this is accounted for in both classic and contemporary diagnostic criteria. It can be the first symptom in a group of patients, necessitating a differential diagnosis and close monitoring. In other circumstances, it could be a symptom of severe SLE that necessitates aggressive treatment.

Author(s) Details

María-Soledad Ayala
Department of Pediatrics School of Medicine University of Chile, Santiago, Chile.

Ximena Norambuena
Immunorheumatology Unit Children´s Hospital Dr. Exequiel Gonzalez Cortes, Santiago, Chile and Pediatric Rheumatology International Trials Organization (PRINTO) Member, Chile.

Alfonso Loosli
Immunorheumatology Unit Children´s Hospital Dr. Exequiel Gonzalez Cortes, Santiago, Chile.

Arnoldo Quezada
Department of Pediatrics School of Medicine University of Chile, Santiago, Chile and Pediatric Rheumatology International Trials Organization (PRINTO) Member, Chile.

View Book :- https://stm.bookpi.org/HMMS-V9/article/view/2238