array:25 [
  "pii" => "S0870255117300707"
  "issn" => "08702551"
  "doi" => "10.1016/j.repc.2016.03.013"
  "estado" => "S300"
  "fechaPublicacion" => "2017-03-01"
  "aid" => "956"
  "copyright" => "Sociedade Portuguesa de Cardiologia"
  "copyrightAnyo" => "2017"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
  "subdocumento" => "sco"
  "cita" => "Rev Port Cardiol. 2017;36:221-3"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:2 [
    "total" => 2248
    "formatos" => array:3 [
      "EPUB" => 178
      "HTML" => 1651
      "PDF" => 419
    ]
  ]
  "Traduccion" => array:1 [
    "en" => array:20 [
      "pii" => "S2174204917300636"
      "issn" => "21742049"
      "doi" => "10.1016/j.repce.2016.03.013"
      "estado" => "S300"
      "fechaPublicacion" => "2017-03-01"
      "aid" => "956"
      "copyright" => "Sociedade Portuguesa de Cardiologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
      "subdocumento" => "sco"
      "cita" => "Rev Port Cardiol. 2017;36:221-3"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:2 [
        "total" => 1760
        "formatos" => array:3 [
          "EPUB" => 172
          "HTML" => 1271
          "PDF" => 317
        ]
      ]
      "en" => array:11 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
        "titulo" => "Transcatheter aortic valve implantation and transcarotid approach"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "221"
            "paginaFinal" => "223"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "pt" => array:1 [
            "titulo" => "TAVI e acesso transcarotideo"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figure 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 2205
                "Ancho" => 2501
                "Tamanyo" => 442403
              ]
            ]
            "descripcion" => array:1 [
              "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Radioscopic view of transcarotid access&#59; &#40;B&#41; positioning of the team&#59; &#40;C&#41; detail of the surgical exposure&#59; &#40;D&#41; suture result four days after the procedure&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Isaac Pascual, Pablo Avanzas, C&#233;sar Mor&#237;s"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Isaac"
                "apellidos" => "Pascual"
              ]
              1 => array:2 [
                "nombre" => "Pablo"
                "apellidos" => "Avanzas"
              ]
              2 => array:2 [
                "nombre" => "C&#233;sar"
                "apellidos" => "Mor&#237;s"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0870255117300707"
          "doi" => "10.1016/j.repc.2016.03.013"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117300707?idApp=UINPBA00004E"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300636?idApp=UINPBA00004E"
      "url" => "/21742049/0000003600000003/v1_201703240113/S2174204917300636/v1_201703240113/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:20 [
    "pii" => "S0870255117300719"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.04.018"
    "estado" => "S300"
    "fechaPublicacion" => "2017-03-01"
    "aid" => "957"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "sco"
    "cita" => "Rev Port Cardiol. 2017;36:225-6"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 2253
      "formatos" => array:3 [
        "EPUB" => 180
        "HTML" => 1645
        "PDF" => 428
      ]
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
      "titulo" => "The role of three-dimensional transesophageal echocardiography in percutaneous closure of atrial septal defects associated with aneurysm of the atrial septum"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "225"
          "paginaFinal" => "226"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "O papel da ecocardiografia transesof&#225;gica 3D no encerramento percut&#226;neo de defeitos do septo interauricular associados a aneurisma do septo interauricular"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "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" => 1203
              "Ancho" => 3333
              "Tamanyo" => 472180
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Percutaneous closure of ostium secundum atrial septal defect&#44; associated with aneurysm of the atrial septum&#44; using three-dimensional transesophageal echocardiography imaging &#40;see text for details&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "C&#225;tia Costa, Rui Anjos, Duarte Martins, Manuel Canada"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "C&#225;tia"
              "apellidos" => "Costa"
            ]
            1 => array:2 [
              "nombre" => "Rui"
              "apellidos" => "Anjos"
            ]
            2 => array:2 [
              "nombre" => "Duarte"
              "apellidos" => "Martins"
            ]
            3 => array:2 [
              "nombre" => "Manuel"
              "apellidos" => "Canada"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917300648"
        "doi" => "10.1016/j.repce.2016.04.010"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300648?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117300719?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000003/v1_201703130910/S0870255117300719/v1_201703130910/en/main.assets"
  ]
  "itemAnterior" => array:20 [
    "pii" => "S0870255117300690"
    "issn" => "08702551"
    "doi" => "10.1016/j.repc.2016.05.011"
    "estado" => "S300"
    "fechaPublicacion" => "2017-03-01"
    "aid" => "955"
    "copyright" => "Sociedade Portuguesa de Cardiologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/"
    "subdocumento" => "crp"
    "cita" => "Rev Port Cardiol. 2017;36:219&#46;e1-4"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:2 [
      "total" => 3245
      "formatos" => array:3 [
        "EPUB" => 252
        "HTML" => 2518
        "PDF" => 475
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case report</span>"
      "titulo" => "Percutaneous closure of iatrogenic femoral arteriovenous fistula using a covered coronary stent"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "pt"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "219&#46;e1"
          "paginaFinal" => "219&#46;e4"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "pt" => array:1 [
          "titulo" => "Oclus&#227;o percut&#226;nea de f&#237;stula arteriovenosa femoral iatrog&#233;nica usando <span class="elsevierStyleItalic">stent</span> coron&#225;rio recoberto"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "pt" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1876
              "Ancho" => 2500
              "Tamanyo" => 367179
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Angiography obtained from the contralateral femoral artery &#40;left&#41; revealing a high-output arteriovenous fistula between the right superficial femoral artery and femoral vein &#40;white asterisk&#41;&#59; &#40;B&#41; angiography after implantation of a 26 mm&#215;4&#46;5 mm PK-Papyrus covered coronary stent &#40;white asterisk&#41; revealing complete sealing of the AV fistula&#46; DFA&#58; deep femoral artery&#59; FV&#58; femoral vein&#59; SFA&#58; superficial femoral artery&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Juan Carlos Rama-Merchan, Ignacio Cruz-Gonz&#225;lez, Javier Mart&#237;n-Moreiras, Alejandro Diego-Nieto, Javier Rodr&#237;guez-Collado, Pedro Luis S&#225;nchez"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "Juan Carlos"
              "apellidos" => "Rama-Merchan"
            ]
            1 => array:2 [
              "nombre" => "Ignacio"
              "apellidos" => "Cruz-Gonz&#225;lez"
            ]
            2 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Mart&#237;n-Moreiras"
            ]
            3 => array:2 [
              "nombre" => "Alejandro"
              "apellidos" => "Diego-Nieto"
            ]
            4 => array:2 [
              "nombre" => "Javier"
              "apellidos" => "Rodr&#237;guez-Collado"
            ]
            5 => array:2 [
              "nombre" => "Pedro Luis"
              "apellidos" => "S&#225;nchez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2174204917300624"
        "doi" => "10.1016/j.repce.2016.05.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917300624?idApp=UINPBA00004E"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117300690?idApp=UINPBA00004E"
    "url" => "/08702551/0000003600000003/v1_201703130910/S0870255117300690/v1_201703130910/en/main.assets"
  ]
  "en" => array:16 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Image in Cardiology</span>"
    "titulo" => "Transcatheter aortic valve implantation and transcarotid approach"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "221"
        "paginaFinal" => "223"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Isaac Pascual, Pablo Avanzas, C&#233;sar Mor&#237;s"
        "autores" => array:3 [
          0 => array:4 [
            "nombre" => "Isaac"
            "apellidos" => "Pascual"
            "email" => array:1 [
              0 => "ipascua&#64;live&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "Pablo"
            "apellidos" => "Avanzas"
          ]
          2 => array:2 [
            "nombre" => "C&#233;sar"
            "apellidos" => "Mor&#237;s"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "&#193;rea del Coraz&#243;n&#44; Hospital Universitario Central de Asturias&#44; Oviedo&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "pt" => array:1 [
        "titulo" => "TAVI e acesso transcarotideo"
      ]
    ]
    "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" => 923
            "Ancho" => 1800
            "Tamanyo" => 213741
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Three-dimensional computed tomography view of the supra-aortic vessels&#59; &#40;B and C&#41; computed tomography of the supra-aortic vessels showing absence of stenosis in the left common carotid artery &#40;black arrow&#41;&#59; &#40;D&#41; porcelain aorta&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We present a 73-year-old man with severe aortic stenosis &#40;area 0&#46;6 cm<span class="elsevierStyleSup">2</span>&#41; and left ventricular dysfunction in New York Heart Association class III&#46; He had a previous history of hypertension&#44; peripheral vascular disease&#44; chronic obstructive pulmonary disease and porcelain aorta&#46; His logistic EuroSCORE was 20&#46;01&#37; and Society of Thoracic Surgeons score was 2&#46;78&#37;&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">After careful evaluation by the heart team&#44; the patient was referred for transcatheter aortic valve implantation &#40;TAVI&#41;&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Femoral and left subclavian routes were not suitable for the procedure due to calcified and severe stenoses&#46; Other routes were also rejected&#44; the right subclavian artery due to aortic annulus angulation &#40;&#62;60&#176;&#41; and direct aortic access due to porcelain aorta &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; The minimum diameter of the left common carotid artery was 6&#46;3 mm&#44; so TAVI was scheduled&#46; Cerebral magnetic resonance angiography was carried out to confirm the presence of collateral perfusion through the circle of Willis&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The procedure was performed in the catheterization laboratory&#44; the team members being specially positioned for this approach &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; The proximal left common carotid artery was exposed under general anesthesia&#46; Thereafter&#44; sequential dilation of the carotid artery was performed and an 18F vascular access sheath was carefully advanced into the ascending aorta&#46; The valve delivery system was then advanced and a 29 mm CoreValve Evolut R self-expanding prosthetic valve was successfully deployed&#46; There was no residual gradient or significant aortic regurgitation &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Figure 3</a>&#44; <a class="elsevierStyleCrossRef" href="#sec0035">Video 1</a>&#41;&#46; The patient was discharged five days after the procedure without complications&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">A transcarotid approach represents an alternative access route for TAVI in selected cases with no other suitable vascular approach&#46;</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&#46;</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&#46;</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&#46;</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:2 [
        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"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conflicts of interest"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2016-03-10"
    "fechaAceptado" => "2016-03-14"
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0055" class="elsevierStylePara elsevierViewall"><elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary material"
            "identificador" => "sec0035"
          ]
        ]
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 923
            "Ancho" => 1800
            "Tamanyo" => 213741
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Three-dimensional computed tomography view of the supra-aortic vessels&#59; &#40;B and C&#41; computed tomography of the supra-aortic vessels showing absence of stenosis in the left common carotid artery &#40;black arrow&#41;&#59; &#40;D&#41; porcelain aorta&#46;</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" => 1323
            "Ancho" => 1500
            "Tamanyo" => 213374
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Radioscopic view of transcarotid access&#59; &#40;B&#41; positioning of the team&#59; &#40;C&#41; detail of the surgical exposure&#59; &#40;D&#41; suture result four days after the procedure&#46;</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" => 642
            "Ancho" => 1800
            "Tamanyo" => 105071
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Delivery system coming from the carotid artery&#59; &#40;B&#41; transvalvular positioning of the delivery system&#59; &#40;C&#41; deployed prosthesis&#46;</p>"
        ]
      ]
      3 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:3 [
          "fichero" => "mmc1.mp4"
          "ficheroTamanyo" => 1207839
          "Video" => array:2 [
            "flv" => array:5 [
              "fichero" => "mmc1.flv"
              "poster" => "mmc1.jpg"
              "tiempo" => 0
              "alto" => 0
              "ancho" => 0
            ]
            "mp4" => array:2 [
              "fichero" => "mmc1.m4v"
              "poster" => "mmc1.jpg"
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/08702551/0000003600000003/v1_201703130910/S0870255117300707/v1_201703130910/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "29264"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Imagens em Cardiologia"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000003/v1_201703130910/S0870255117300707/v1_201703130910/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117300707?idApp=UINPBA00004E"
]
Partilhar
Informação da revista
Vol. 36. Núm. 3.
Páginas 221-223 (março 2017)
Partilhar
Partilhar
Baixar PDF
Mais opções do artigo
Vol. 36. Núm. 3.
Páginas 221-223 (março 2017)
Image in Cardiology
Open Access
Transcatheter aortic valve implantation and transcarotid approach
TAVI e acesso transcarotideo
Visitas
5384
Isaac Pascual
Autor para correspondência
ipascua@live.com

Corresponding author.
, Pablo Avanzas, César Morís
Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Spain
Este item recebeu

Under a Creative Commons license
Informação do artigo
Texto Completo
Baixar PDF
Estatísticas
Figuras (3)
Mostrar maisMostrar menos
Material adicional (1)
Texto Completo

We present a 73-year-old man with severe aortic stenosis (area 0.6 cm2) and left ventricular dysfunction in New York Heart Association class III. He had a previous history of hypertension, peripheral vascular disease, chronic obstructive pulmonary disease and porcelain aorta. His logistic EuroSCORE was 20.01% and Society of Thoracic Surgeons score was 2.78%.

After careful evaluation by the heart team, the patient was referred for transcatheter aortic valve implantation (TAVI).

Femoral and left subclavian routes were not suitable for the procedure due to calcified and severe stenoses. Other routes were also rejected, the right subclavian artery due to aortic annulus angulation (>60°) and direct aortic access due to porcelain aorta (Figure 1). The minimum diameter of the left common carotid artery was 6.3 mm, so TAVI was scheduled. Cerebral magnetic resonance angiography was carried out to confirm the presence of collateral perfusion through the circle of Willis.

Figure 1.

(A) Three-dimensional computed tomography view of the supra-aortic vessels; (B and C) computed tomography of the supra-aortic vessels showing absence of stenosis in the left common carotid artery (black arrow); (D) porcelain aorta.

(0.2MB).

The procedure was performed in the catheterization laboratory, the team members being specially positioned for this approach (Figure 2). The proximal left common carotid artery was exposed under general anesthesia. Thereafter, sequential dilation of the carotid artery was performed and an 18F vascular access sheath was carefully advanced into the ascending aorta. The valve delivery system was then advanced and a 29 mm CoreValve Evolut R self-expanding prosthetic valve was successfully deployed. There was no residual gradient or significant aortic regurgitation (Figure 3, Video 1). The patient was discharged five days after the procedure without complications.

Figure 2.

(A) Radioscopic view of transcarotid access; (B) positioning of the team; (C) detail of the surgical exposure; (D) suture result four days after the procedure.

(0.2MB).
Figure 3.

(A) Delivery system coming from the carotid artery; (B) transvalvular positioning of the delivery system; (C) deployed prosthesis.

(0.1MB).

A transcarotid approach represents an alternative access route for TAVI in selected cases with no other suitable vascular approach.

Ethical disclosuresProtection of human and animal subjects

The authors declare that no experiments were performed on humans or animals for this study.

Confidentiality of data

The authors declare that no patient data appear in this article.

Right to privacy and informed consent

The authors declare that no patient data appear in this article.

Conflicts of interest

The authors have no conflicts of interest to declare.

Copyright © 2017. Sociedade Portuguesa de Cardiologia
Baixar PDF
Idiomas
Revista Portuguesa de Cardiologia
Opções de artigo
Ferramentas
Material Suplementar
en pt

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos

Ao assinalar que é «Profissional de Saúde», declara conhecer e aceitar que a responsável pelo tratamento dos dados pessoais dos utilizadores da página de internet da Revista Portuguesa de Cardiologia (RPC), é esta entidade, com sede no Campo Grande, n.º 28, 13.º, 1700-093 Lisboa, com os telefones 217 970 685 e 217 817 630, fax 217 931 095 e com o endereço de correio eletrónico revista@spc.pt. Declaro para todos os fins, que assumo inteira responsabilidade pela veracidade e exatidão da afirmação aqui fornecida.