Introduction: Data on the impact of left bundle-branch block after transcatheter aortic valve implantation (TAVI) are scarce, and treatment has been individualized. Based on this, the electrophysiological study (EPS) concomitant with TAVI may be a strategy for the early stratification of patients needing permanent pacemaker implantation (PPM). Objective: To describe the use of EPS in risk stratification of a definitive pacemaker in patients undergoing TAVI. Materials and methods: Data from seven patients with indications for TAVI due to critical aortic stenosis were retrospectively evaluated. The EPS was performed with a quadripolar diagnostic catheter in His bundle to measure the His-ventricle (HV) interval. Measurement of HV at 70 ms or above was used for discussion on PPM implant indication. Results: Four analyzed patients evolved with left bundle-branch block after TAVI. PPM implantation was indicated for one patient, and the surgery was performed uneventfully during the same hospital stay. Before TAVI, the HV interval ranged from 46 to 58 ms (mean = 53.2 ms), increasing to 52 to 84 ms (mean = 62.8 ms) immediately after valve intervention. Conclusion: The strategy of EPS during TAVI is viable to stratify patients early according to the risk of 2nd or 3rd-degree atrioventricular block, allowing adequate treatment.
Coronary anomalies are less frequent than acquired coronary diseases, such as atherosclerosis, and have been implicated as a cause of cardiovascular events. This case report describes an incidental finding on angiography of an anomalous right coronary artery with origin in the left coronary sinus and an intra-arterial course, after an episode of aborted sudden death. The Heart Team analysis indicated a percutaneous approach with drug-eluting stent implantation at the origin of the right coronary artery as the best treatment, and the procedure was successfully performed. This case report and recent studies have demonstrated percutaneous treatment of coronary anomalies is a safe option for selected patients, considering clinical presentation, anatomy study, and training of the cath lab team.
Treatment of in-stent restenosis lesions, especially calcified lesions, with stent underexpansion, generally requires more complex techniques, such as rotational atherectomy. The case reported is a male patient with a 99% in-stent focal restenosis lesion at the origin of the first diagonal branch, where two stents were implanted 14 years ago. After failure of balloon angioplasty alone, ablation of the plaque and part of the stent struts was performed using the rotational atherectomy technique, which allowed the implantation of a new stent which was totally expanded.
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