Off-pump transapical closure of a mitral periprosthetic leak: a new approach to a difficult problem

Off-pump transapical closure of a mitral periprosthetic leak: a new approach to a difficult problem

Author Gaia, Diego Felipe Autor UNIFESP Google Scholar
Breda, Joao Roberto Autor UNIFESP Google Scholar
Fischer, Claudio Henrique Autor UNIFESP Google Scholar
Fonseca, José Honório de Almeida Palma da Autor UNIFESP Google Scholar
Institution Universidade Federal de São Paulo (UNIFESP)
Abstract A 60-year old male patient with multiple risk factors and two previous interventions over the mitral valve was admitted to the emergency unit with symptoms of cardiac failure. Initial examination revealed a competent mitral bioprosthesis with severe perivalvular mitral insufficiency. Based on previous experiences with transapical procedures, a transapical transcatheter closure of the perivalvular leak was performed. the apex was punctured with a 7 French introducer sheath, and a hydrophilic guidewire was advanced with the aid of a right Judkins catheter and positioned across the defect in the left atrium. Fluoroscopic and tridimensional transoesophageal echocardiography was used to guide the manoeuvre. Next, a long introducer sheath was advanced through the guidewire and positioned inside the left atrium. Two Amplatzer Vascular Plug II (St Jude Medical) were deployed, resulting in a significant reduction in the perivalvular leak. the procedure was considered to be successful. the patient regained consciousness, and the orotracheal tube was removed in the operating theatre. No neurological deficits were detected, and the patient was transferred to the intensive care unit. the patient recovered well and was transferred to the ward after 1 day. Discharge was accomplished after 4 days.
Keywords Cardiac catheterization/intervention
Heart valve
Transapical
Percutaneous
Mitral valve
Language English
Date 2013-12-01
Published in Interactive Cardiovascular and Thoracic Surgery. Oxford: Oxford Univ Press, v. 17, n. 6, p. 1048-1050, 2013.
ISSN 1569-9293 (Sherpa/Romeo, impact factor)
Publisher Oxford Univ Press
Extent 1048-1050
Origin http://dx.doi.org/10.1093/icvts/ivt395
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000327456100038
URI http://repositorio.unifesp.br/handle/11600/37005

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