Image in Cardiology
Preventing coronary occlusion with a retrievable aortic valve
Prevenção da oclusão coronária com uma válvula aórtica recuperável
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5 => array:3 [ "nombre" => "José Luis" "apellidos" => "López-Sendón" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital La Paz, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "St George's Hospital, London, England, United Kingdom" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Prevenção da oclusão coronária com uma válvula aórtica recuperável" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 769 "Ancho" => 1300 "Tamanyo" => 160793 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Delivery system containing the unexpanded Lotus valve through the aortic valve; (B) the Lotus valve partially expanded.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Coronary occlusion is one of the potential complications during transcatheter aortic valve implantation. Second-generation fully retrievable and repositionable devices can theoretically prevent this complication.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 81-year-old woman with symptomatic aortic stenosis (valve area 0.52 cm<span class="elsevierStyleSup">2</span>; peak and mean gradients 118 and 70 mmHg, respectively; normal ejection fraction) was referred for transcatheter aortic valve implantation. Although her surgical risk was acceptable (logistic euroSCORE 8%), open surgery was rejected due to porcelain aorta. Preprocedural assessment included coronary angiography (normal coronary arteries) and cardiac computed tomography (aortic annulus 21 mm).</p><p id="par0015" class="elsevierStylePara elsevierViewall">A 23 mm Lotus device (Boston Scientific) was implanted. After an 18 F sheath was advanced through the right femoral artery, percutaneous aortic valvuloplasty was performed using an 18 mm balloon and a Safari guidewire. The delivery system and the unexpanded valve were advanced retrogradely to the left ventricular cavity (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>A) and manually controlled expansion of the valve was performed (<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>B).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">After complete expansion of the valve, the aortic angiogram showed apparent occlusion of the left main due to the slightly high position of the valve (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>A). Due to the possibility of resheathing the Lotus device even after it had been completely expanded, the valve was retrieved and repositioned in a lower position, without compromising the left main (<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>B), thus allowing final release of the valve (<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">This case illustrates the potential advantages of second-generation devices for transcatheter aortic valve implantation. With the Lotus device, retrieval and repositioning are possible even when the valve has been completely expanded and positioned.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical disclosures</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of human and animal subjects</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on humans or animals for this study.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Confidentiality of data</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:1 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-10-22" "fechaAceptado" => "2015-01-02" "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 769 "Ancho" => 1300 "Tamanyo" => 160793 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Delivery system containing the unexpanded Lotus valve through the aortic valve; (B) the Lotus valve partially expanded.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 718 "Ancho" => 1300 "Tamanyo" => 150571 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) The Lotus valve completely expanded, but not delivered. Contrast aortography shows that the valve, not yet released, is compromising the origin of the left main; (B) after the valve is resheathed and positioned at a lower level, the left main is no longer compromised.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 899 "Ancho" => 995 "Tamanyo" => 130851 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Lotus valve after final release.</p>" ] ] ] ] "idiomaDefecto" => "en" "url" => "/21742049/0000003400000006/v1_201506200223/S2174204915001385/v1_201506200223/en/main.assets" "Apartado" => array:4 [ "identificador" => "9915" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in cardiology" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21742049/0000003400000006/v1_201506200223/S2174204915001385/v1_201506200223/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204915001385?idApp=UINPBA00004E" ]
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