Alejandro Sánchez-Grande Flecha

Takotsubo cardiomyopathy and elderly adults: still a benign condition?

depressed. Use of antidepressants and psycholeptics was higher in whites and coloreds, and both groups reported a higher number of comorbid conditions and medication use than black Africans. Of fallers with injuries, 23 (14%) reported having sustained a fracture at baseline (78% women) and 6% at follow-up (all women), of which six (26%) and two (20%) were of the hip, respectively. The baseline fractures distribution was coloreds nine (39.1%), whites eight (34.8%), blacks four (17.4%), and Indians two (8.7%).

Ventricular septal defect as an unusual complication of percutaneous transcatheter implantation of an aortic valve prosthesis: two-year follow-up.

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Rationale and design of a multicenter, international and collaborative Coronary Artery Aneurysm Registry (CAAR)

Coronary artery aneurysm is defined as a coronary dilation that exceeds the diameter of adjacent segments or the diameter of the patients largest normal coronary vessel by 1.5×. It is an uncommon disease that has been diagnosed with increasing frequency since the widespread appearance of coronary angiography. The published incidence varies from 1.5% to 5%, suggesting male dominance and a predilection for the right coronary artery. Although several causes have been described, atherosclerosis accounts for ≥50% of coronary aneurysms in adults. Reported complications include thrombosis and distal embolization, rupture, and vasospasm, causing ischemia, heart failure, or arrhythmias. The natural history and prognosis remain unknown, as definitive data are scarce. Controversies persist regarding the use of medical management (antithrombotic therapy) or interventional/surgical procedures. Only some case reports or small case series are available about this condition. The Coronary Artery Aneurysm Registry (CAAR; http://www.ClinicalTrials.gov NCT02563626) is a multicenter international ambispective registry that aims to provide insights on anatomic, epidemiologic, and clinical aspects of this substantially unknown entity. In addition, the registry will assess management strategies (conservative, interventional, or surgical) and their short‐ and long‐term results in a large cohort of patients.

Simultaneous Transfemoral Aortic Valve Implantation and Endovascular Repair of Abdominal Aortic Aneurysm

We report a percutaneous transfemoral aortic valve implantation (TAVI) procedure in a patient with infrarenal saccular abdominal aortic aneurysm (SAAA) treated by endovascular surgery during the same procedure. We present the case of an 82-year-old man, with a history of smoking, adenocarcinoma of the colon treated by surgery and adjuvant chemotherapy in the previous 6 months, and SAAA extending to both iliac arteries with maximum diameters of 69 57 mm in multiplane reformat on computed tomography), admitted for non–ST-segment elevation acute coronary syndrome and left heart failure. Echocardiography showed a very calcified aortic valve and severe stenosis, with valve area of 0.88 cm, peak and mean gradients of 71.7 mmHg and 35 mmHg, respectively, and mild left ventricular hypertrophy with normal ejection fraction. Catheterization showed coronary artery disease with a large obstructive lesion in the proximal left anterior descending artery. The patient had a logistic EuroSCORE of 19.06%. The medicalsurgical team decided to treat the diseased artery and aortic stenosis using a percutaneous approach and the SAAA by endovascular repair. During the first procedure, a conventional stent (Stent Vision 3.5 23 mm; Abbot Vascular, Santa Clara, California, Unites States) was implanted in the proximal left anterior descending artery via the right femoral artery, without complications and with a good angiographic result. Three weeks later, a second procedure was performed with the patient under general anesthesia. After both femoral arteries were exposed, an abdominal aortic stent and the aortic valve (EdwardsSAPIEN XT 26; Life Sciences, Irvine, California, United States) were implanted. The vascular surgeon began the percutaneous procedure with exclusion of the SAAA, achieved by placing a bifurcated stent with extensions into both iliac arteries. Final angiographic control showed that there were no leaks and minimum diameters of 10 mm were obtained in both iliac arteries (Figure 1). Subsequently, TAVI was performed via the left femoral artery following standard procedures, with a good final outcome and mild residual paravalvular regurgitation (Figure 2). The procedure ended with surgical closure of both femoral arteries. Rev Esp Cardiol. 2014;67(5):408–416

Disección coronaria espontánea: papel del ultrasonido intravascular

which was normal. Elective minimally invasive valve replacement surgery was proposed, which the patient rejected. Angiodysplasia is a degenerative disease of the intestinal mucosa related to the aging process and one of the main causes of gastrointestinal bleeding in the elderly. Its association with aortic stenosis is well known.Manymechanisms have been considered to explain this syndrome; currently the most prominent is an acquired deficit of Type IIa vonWillebrand factor, characterized by a loss of the largest VWF multimers, although this causal relationship cannot always be demonstrated, as in this case. Von Willebrand factor is a high-molecular-weight multimeric protein secreted by endothelial cells that stimulates platelet adhesion and aggregation when there is vascular damage. These multimers are cleared by plasma proteases that are especially active in turbulent blood flow situations. In aortic stenosis, fragmentation of VWFmultimers is increased, which reduces their number and predisposes bleeding. Studies have reported that these coagulation anomalies are directly related to the severity of aortic stenosis and are reversible after valve replacement if successful, so that recurrence of bleeding could be an indication of persistent stenosis. Therefore, although in some cases of extensive bleeding, such as this one, intestinal resection is necessary, many authors have shown that gastrointestinal bleeding ceases after valve replacement, being even more likely to prevent recurrences than intestinal resection. Heyde’s Syndrome is an entity to be kept in mind, even more nowadays with an aging population, when assessing patients with a history of bleeding or anemia, especiallywhen the bleeding site is not found on initial examination. Based on these data, we propose the hypothesis that this association could be a new indication for valve replacement; however, gastrointestinal bleeding is not used as an indicator in current clinical practice guides.