BackgroundAtrial fibrillation (AF) is a cardiac arrhythmia with high risk for thromboembolic events, specially stroke.ObjectiveTo assess the safety of left atrial appendage closure (LAAC) with the Amplatzer Cardiac Plug for the prevention of thromboembolic events in patients with nonvalvular AF.MethodsThis study included 15 patients with nonvalvular AF referred for LAAC, 6 older than 75 years (mean age, 69.4 ± 9.3 years; 60% of the male sex).ResultsThe mean CHADS2 score was 3.4 ± 0.1, and mean CHA2DS2VASc , 4.8 ± 1.8, evidencing a high risk for thromboembolic events. All patients had a HAS-BLED score > 3 (mean, 4.5 ± 1.2) with a high risk for major bleeding within 1 year. The device was successfully implanted in all patients, with correct positioning in the first attempt in most of them (n = 11; 73.3%).ConclusionThere was no periprocedural complication, such as device migration, pericardial tamponade, vascular complications and major bleeding. All patients had an uneventful in-hospital course, being discharged in 2 days. The echocardiographic assessments at 6 and 12 months showed neither device migration, nor thrombus formation, nor peridevice leak. On clinical assessment at 12 months, no patient had thromboembolic events or bleeding related to the device or risk factors. In this small series, LAAC with Amplatzer Cardiac Plug proved to be safe, with high procedural success rate and favorable outcome at the 12-month follow-up.

Severe tricuspid commitment is no longer understood as merely a marker of disease but is now widely thought of as a significant contributor to cardiac morbidity and mortality. However, isolated tricuspid valve surgery remains rare and to this day continues to be associated with the highest surgical risk among all valve procedures and high operative mortality rates, especially in reoperations. Therefore, the development of tricuspid transcatheter procedures is as necessary as it was for the other valves a couple of years ago. Recently, multiple percutaneous therapies have been developed for the management of severe tricuspid disease, initially only repair and more recently replacement, thus creating a new branch for the management of patients who have already undergone surgery and who present with dysfunctional bioprostheses. The purpose of this review and report is to demonstrate current and possible future challenges, and to show that the valve-in-valve procedure of the tricuspid valve is feasible and safe, and now can be performed in all its range, in the smallest to the largest sizes of presentation, without incurring the untoward risks of conventional surgery.

The Gerbode defect is defined as an abnormal communication between the left ventricle and the right atrium, and is etiologically classified as congenital or acquired (iatrogenic or not). The typical treatment consists of surgical repair of the shunt, but transcatheter occlusion of this condition has proven to be a safe and effective therapeutic alternative for such patients, especially for those with prior surgeries. The aim of this study was to report a case of transcatheter closure of an acquired Gerbode defect, using the Amplatzer™ Septal Occluder device, in a 58-year-old patient, with two prior mitral valve replacements, and the consequent post-procedure mechanical hemolysis.

Transcatheter aortic valve implantation is considered a standard treatment for many symptomatic patients with severe aortic stenosis. Coronary artery occlusion after transcatheter aortic valve implantation is associated with a mortality rate of up to 50%. In this case report we described a patient with severe aortic bioprosthesis dysfunction, at high risk of coronary obstruction after transcatheter aortic valve implantation. This patient underwent Basilica procedure followed by valve-in-valve transcatheter aortic valve implantation. The patient demonstrated good improvement and was discharged from hospital after 2 days, without any symptoms. The patient remained asymptomatic at 6 months of follow-up.

A nefropatia por contraste iodado (NCI) consiste numa complicação importante e freqüente nos centros de hemodinâmica. Objetivo: Definir a prevalência de NCI nos pacientes diabéticos que passaram por procedimentos que utilizaram contraste iodado no laboratório de Hemodinâmica do HUSF, no período de Junho a Agosto, de 2009. Metodologia: Preenchimento de ficha de identificação dos pacientes admitidos no setor, coleta de amostra sanguínea para detecção de glicemia e creatinina sérica, e aferição da pressão arterial. Resultados: Durante o período pesquisado, foram estudados 245 pacientes com idade entre 33 a 90 anos. Dos 150 indivíduos que foram acompanhados, sendo que 35 pacientes desenvolveram NCI (27%). Evidenciou-se 38 eram portadores de DM (29,23%), e destes, 8 indivíduos (21,05%) desenvolveram NCI. Conclusão: Como visto nos resultados expostos, 21,05% dos pacientes diabéticos desenvolveram NCI, configurando incidência média 11 vezes maior quando comparado à população geral.