Abstract: Current indications for transcatheter aortic valve replacement (TAVR) are limited for inoperable and high risk patients only. Meanwhile, TAVR may be successfully performed in young patients with low risk and with high technical and functional results according to short- and long-term follow-up. 54 patients underwent TAVR, 7 (12,9%) of them were younger than 65. Cause for endovascular procedure was the presence of oncological process in liver/autoimmune hepatitis/liver cirrhosis/severe bronchial asthma/atherosclerotic lesion of major vessels/severe diabetes mellitus. In 3 cases additional visualization method (intracardiac ultrasound examination) was necessary. All patients underwent implantation of CoreValve. Technical success was 100%. Function of valves was satisfactory. Light near-valve regurgitation was found in 6 cases, valve regurgitation class II was found in 1 case with decrease to class I after treatment. Intracardiac ultrasound examination is useful to attend successful results in this group of patients. References 1. 2012 ACCF/AATS/SCAi/STS Expert Consensus Document on Transcatheter Aortic Valve Replacement. JACC. 2012; 59: 1200-1254. 2. Lemos PA, Lee CH, Degertekin M, et al. Early outcome after sirolimus-eluting stent implantation in patients with acute coronary syndromes: insights from the Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. JACC. 2003; 41: 2093-2099. 3. Ong A.T., Serruys P.W., Aoki J., et al. The unrestricted use of paclitaxel versus sirolimus-eluting stents for coronary artery disease in an unselected population: one-year results of the Taxus-Stent Evaluated at 4. Hoye A., Tanabe K., Lemos P.A., et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions. JACC. 2004; 43: 1954-1958. 5. Rao S.V., Shaw R.E., Brindis R.G., Klein L.W., Weintraub W.S., Peterson E.D. On- versus off-label use of drug-eluting coronary stents in clinical practice (report from the American College of Cardiology National Cardiovascular Data Registry [NCDR]). Am. J. Cardiol. 2006; 97: 1478 -1481. 6. Beohar N., Davidson C.J., Kip K.E., et al. Outcomes and complications associated with off-label and untested use of drug-eluting stents. JAMA. 2007; 297: 1992-2000. 7. Grines C.L. Off-label use of drug-eluting stents putting it in perspective. JACC. 2008; 51: 615-617. 8. Piazza N., Otten A., Schultz C., et al. Adherence to patient selection criteria in patients undergoing transcatheter aortic valve implantation with the 9. Eltchaninoff H., Prat A., Gilard M., et al. Transcatheter aortic valve implantation: earlyresults of the FRANCE (FRench Aortic National CoreValve and Edwards) registry. Eur. Heart J. 2011; 32:19-197. 10. Zahn R., 11. Rodes-Cabau J., Webb J.G., Cheung A., et al. Transcatheter aortic valve implantation for the treatment of severe symptomatic aortic stenosis in patients at very high or prohibitive surgical risk: acute and late outcomes of the multicenter Canadian experience. JACC. 2010; 55:1080-1090. 12. Tamburino C., Capodanno D., Ramondo A., et al. incidence and predictors of early and late mortality after transcatheter aortic valve implantation in 663 patients with severe aortic stenosis. Circulation. 2011; 123: 299-308. 13. Webb J.G., Altwegg L., Boone R.H., et al. Transcatheter aortic valve implantation: impact on clinical and valve-related outcomes. Circulation. 2009; 119: 3009-3016. 14. Piazza N., Grube E., Gerckens U., et al. Procedural and 30-day outcomes following transcatheter aortic valve implantation using the third generation (18 Fr) corevalve revalving system: results from the multicentre, expanded evaluation registry 1-year following CE mark approval. EuroIntervention. 2008; 4: 242-249. 15. Leon M.B., Smith C.R., Mack M., et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 2010; 363: 1597-1607. 16. Smith C.R., Leon M.B., Mack M.J., et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 2011; 364: 2187-2198. 17. Lee D.H., Buth K.J., Martin B.J., et al. Frail patients are at increased risk for mortality and prolonged institutional care after cardiac surgery. Circulation. 2010; 121: 973-978. 18. Roques F., Nashef S.A., Michel P., et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur. J. Cardiothorac. Surg. 1999; 15: 816-822. 19. Lange R., Bleiziffer S., Mazzitelli D., et al. improvements in Transcatheter Aortic Valve implantation Outcomes in Lower Surgical Risk Patients. JACC. 2012; 59: 280-287
Abstract: Ventricular septal defect after myocardial infarction (post-MI VSD) is one of the most rare and lethal complication. We present a case report of patient with recurrent VSD, 7 months after coronary artery bypass graft with cardiosurgical correction of post-MI VSD. Due to the high risk of re-operation, it was decided to perform endovascular closure of VSD. Despite acceptable stability test, after delivery system disconnection - migration of occluder to left ventricular occurred. All efforts to retrieve device were not successful, due to strong fixation of the device in anterior leaflet chordal tendons of mitral valve (MV). The presence of 12 mm occluder didn't influence on existed MV insufficiency, so the decision to leave this device in place and to implant the bigger one to VSD was made. 14 mm occluder was successfully implanted, with immediate reduction of left-right shunt and normalization of pulmonary artery pressure. Follow-up period is 3 years - patient doesn't have any complaints. Ejection fraction 55%, mitral insufficiency 30% by volume, device is fully endothelialyzed. Endovascular VSD occlusion can be effectively used in case of post-surgery re-occurence. In cases of migration of endovascular devices, thorough functional analysis should be performed for choosing the best strategy of further actions. In this clinical case the decision to leave the device in LV didn't cause any negative outcomes for the patient. References 1. Koh A.S., Loh YJ., Lim YP., Le Tan J. Ventricular septal rupture following acute myocardial infarction. Acta Cardiol. 2011;66(2):225-30. 2. Crenshaw B.S., Granger C.B., Birnbaum Y et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect complicating acute myocardial infarction (GUSTO-I (Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries) Trial Investigators). Circulation. 2000;101:27-32. 3. Serpytis P, Karvelyte N., Serpytis R. et al. Postinfarction ventricular septal defect: risk factors and early outcomes. Hellenic J Cardiol. 2015;56(1):66-71. 4. Arnaoutakis G.J., Zhao Y, George T.J. et al. Surgical repair of ventricular septal defect after myocardial infarction: outcomes from the Society of Thoracic Surgeons National Database. Ann Thorac Surg. 2012; 94:436-443. 5. Assenza G.E., McElhinney D.B., Valente A.M. et al. Transcatheter closure of post-myocardial infarction ventricular septal rupture. Circ Cardiovasc Interv. 2013;6:59-67. 6. Calvert PA., Cockburn J., Wynne D. et al. Percutaneous closure of postinfarction ventricular septal defect: in-hospital outcomes and long-term follow-up of UK experience. Circulation. 2014;129:2395-402. 7. Deja M.A., Szostek J., Widenka K. et al. Post infarction ventricular septal defect - can we do better? Eur J Cardiothorac Surg. 2000;18:194-201. 8. Takahashi H., Arif R., Almashhoor A., et al. Longterm results after surgical treatment of postinfarction ventricular septal rupture. Eur J Cardiothorac Surg. 2015;47(4):720-724. 9. Holzer R., Balzer D., Lock Qi-Ling Cao K., Hijazi Z.M. Device closure of muscular ventricular septal defects using the Amplatzer muscular ventricular septal defect occluder. J Am Coll Cardiol. 2004;43:1257-1263.
