Background:

Paravalvular leaks (PVLs) are a well-recognized complication of prosthetic valve replacement Most are asymptomatic and benign, but some may cause symptoms due to a large regurgitant volume or hemolysis Medical therapy is palliative, while reoperation carries significant morbidity and mortality Percutaneous transcatheter closure techniques, now routinely applied in the management of pathological cardiac and vascular communications, may be adaptable to PVL closure, potentially offer symptomatic relief



Methods:

We reviewed our experience with attempted percutaneous closure of PVLs, using data from medical and procedural records



Results:

Between 2001 and 2004, 14 procedures were performed in 10 patients, all under general anesthesia, with transesophageal and radiographic guidance Mitral (9) and aortic (1) valve replacements were involved, both mechanical and bioprosthetic A variety of devices were used, including atrial septal occluders, patent ductus arteriosus occluders, and coils (all of label use) Six had a single procedure, which was technically successful in four: in two, the PVL could not be crossed Four underwent a second procedure, which was technically successful in three; in one the previously deployed device was dislodged necessitating urgent, but ultimately uneventful, surgical removal and leak repair One patient had transient severe hemolysis, which resolved after 1 week At 1-year follow-up (9/10 pts) three had died, five had sustained symptomatic improvement while 1 patient with a residual leak still required regular blood transfusions



Conclusions:

Percutaneous closure of PVLs is time-consuming but feasible in selected patients, with a reasonable degree of technical and clinical success A second procedure may be necessary and a variety of complications can occur © 2006 Wiley-Liss, Inc

Percutaneous closure of prosthetic paravalvular leaks: case series and review.

https://www.jvascsurg.org/article/S0741-5214(07)01767-3/pdf

Delayed presentation of aortic injury by pedicle screws: Report of two cases and review of the literature

Despite ongoing advances in percutaneous revascularization, coronary artery bypass grafting (CABG) continues to be performed in a large number of patients, with 400 000 operations reported in 2007 in the United States alone.1 Although arterial conduits are generally preferred, saphenous vein grafts (SVGs) continue to be used regularly. First described by Riahi and colleagues 2 in 1975, aneurysmal dilatation of aortocoronary SVGs remains a rare yet widely reported phenomenon. Indeed, subsequent literature on the topic consists almost exclusively of case reports and small case series. Thus, the precise incidence of aortocoronary SVG aneurysms (SVGAs) remains difficult to ascertain, although in 1 case series, an incidence of 0.07% was estimated from a review of 5500 grafts at a single institution.3 However, this likely underestimates the true number because SVGAs often remain clinically silent and no guidelines exist to screen for their development. Given the infrequent identification of SVGAs, our current understanding of the epidemiology and pathogenesis of these aneurysms remains limited. Aneurysms are generally defined as a focal dilatation of vessels 1.5 times the proximal reference diameter; however, aneurysmal dilatation of aortocoronary SVGs has led to “giant” aneurysm formation, with reports of cases exceeding 10 cm.4–6 SVGAs are often incidentally identified on imaging, but cases of rupture,7 fistula formation with neighboring anatomy,8 and hemodynamic compromise resulting from compression of adjacent cardiac and vascular structures have been reported.9 To date, 2 reviews have been published that briefly summarize 108 cases of SVGAs. 10,11 Traditionally, their management has been surgical—generally resection of the aneurysm with or without bypass of the affected territory. However, with refinement of percutaneous techniques, including the use of Amplatzer devices, covered stents, and arterial coiling, the management options for affected patients are becoming increasingly diverse, and consensus on the optimal approach to managing SVGAs remains unclear. Therefore, we performed a systematic review of published cases as has been reported for other very rare clinical conditions to determine the natural history and management of SVGAs.12,13 Details regarding the methodology, search strategy, and results can be accessed in the online-only Data

Contemporary Reviews in Cardiovascular Medicine Natural History and Management of Aortocoronary Saphenous Vein Graft Aneurysms A Systematic Review of Published Cases

Coronary artery bypass graft (CABG) surgery is the standard of care in the treatment of advanced coronary artery disease. It is well known that the long-term clinical outcome after myocardial revascularization depends on the patency of the bypass grafts. In the past, invasive coronary angiography was used to assess the status of the grafts and check for graft occlusion. Recently, computed tomography (CT), particularly multidetector CT with electrocardiographic gating, has emerged as an important diagnostic tool for evaluation of CABGs in both the early ( 1 month) postoperative settings. A variety of postoperative complications may manifest as dyspnea and chest pain, thereby mimicking recurrent angina secondary to graft occlusion. Owing to its improved spatial resolution compared with that of earlier-generation CT scanners and its ability to produce three-dimensional and multiplanar images, multidetector CT has assumed an integral role in characterization of graft patency while allowing investigation of alternative postoperative complications. In addition, the expanded capabilities of volumetric imaging may provide valuable information in preoperative planning for repeat CABG surgery.

Coronary artery bypass grafts: assessment with multidetector CT in the early and late postoperative settings.

The optimal intensity of vitamin K antagonists in patients with mechanical heart valves: a meta-analysis.

Saphenous Vein Graft Pseudoaneurysm Rupture After Coronary Artery Bypass Grafting

Clinical experience with the Omnicarbon prosthetic heart valve

Objective: We diseuss the clinical aspects related to mechanical valve dysfunction based upon 20 years' experience of our cases.Methods: Between January 1982 and December 2001, 21 patients underwent surgical interventions because of mechanical valve dysfunction. Thirteen men and 8 women (mean age 47±20, range 3–75 years-old), were included.Results: Mitral valve dysfunction was observed in 12 patients. Prosthetic valve stenosis occurred in 6 patients between 2 and 224 months, and paravalvular leaks in 4 between 1 and 71 months after surgery. The other 2 patients suffered from hemolytic anemia with mild paravalvular leaks between 102 and 104 months after surgery. Aortic valve dysfunction was observed in 8 patients including 3 stenotic lesions between 48 and 97 months and 5 paravalvular leaks between 3 and 150 months after surgery. Tricuspid regurgitation was seen in 1 patient with a huge right atrium at 42 months after surgery. Early death was seen in 1 patient. Late death occurred in 1 patient, 17 years after operation. Survival, including early death, was 95.2% at 10 and 15 years. One valve-related complication of bioprosthetic valve endocarditis at the mitral and tricuspid positions occurred 12 years after a reoperation. The freedom from complications was 95.2% at 10 years, and 76.2% at 15 years.Conclusions: Paravalvular leaks without overt endocarditis had latency periods of up to 12 years, and pannus formation was observed 20 years after surgery. Early and late clincal results after surgery for mechanical valve dysfunction were excellent.

When and how does nonstructural mechanical prosthetic heart valve dysfunction occur

Organized thrombus of the tricuspid valve mimicking valvular tumor

We report herein the case of a 61-year-old man with myelodysplastic syndrome causing pancytopenia who underwent successful coronary artery bypass grafting (CABG). Preoperatively, his hemoglobin (Hb) value was 10.4 g/dl while receiving transfusions of 1 or 2 units of red blood cells (RBC) every 2 weeks, his white blood cell (WBC) count was 8200/μl with injections of 100 μg granulocyte colony-stimulating factor (G-SCF) every 5 days, and his platelet count was 4.5×104/μl without platelet transfusion. From the time the pancytopenia was diagnosed in his peripheral blood, he had received a total of 104 units of RBC and 472 units of platelets, following which he developed an antiplatelet antibody, not for a platelet-specific antigen, but for an HLA antigen. Thus, HLA-matched platelets were prepared to prevent bleeding caused by thrombocytopenia, and the WBC count was elevated preoperatively by G-CSF injections. Thereafter, CABG was performed on three vessels. The HLA-matched platelets were transfused as the patient was weaned from the extracorporeal circulation. As a result of these preparations, we were able to protect the patient against bleeding and infection.

Successful coronary artery bypass grafting for a patient with myelodysplastic syndrome: report of a case.

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