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Vol. 69. Issue 4.
Pages 457-458 (April 2016)
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Vol. 69. Issue 4.
Pages 457-458 (April 2016)
Letter to the Editor
DOI: 10.1016/j.rec.2016.01.007
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Coronary Obstruction During Transcatheter Aortic Valve Replacement: Related to Calcification or Thrombus? Response
Obstrucción coronaria durante el implante percutáneo de válvula aórtica: ¿relacionada con calcificación o con trombo? Respuesta
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Ricardo Mori Juncoa,
Corresponding author
ricardomori22@gmail.com

Corresponding author:
, Francisco Domínguez Melcónb, Mar Moreno Yangüelab
a Servicio de Cardiología. Hospital Universitario La Paz, Madrid, Spain
b Unidad de Imagen Cardiaca, Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain
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Rev Esp Cardiol. 2016;69:456-710.1016/j.rec.2015.12.012
Cengiz Ozturk, Ali Osman Yildirim, Mustafa Demir, Sevket Balta
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To the Editor,

We appreciate the comments of Ozturk et al on our publication entitled, “Coronary Thromboembolism During Transcatheter Aortic Valve Replacement”.1

The case in question concerned a patient with high thromboembolic risk who received 2 drug-eluting stents in the anterior descending artery during coronary angiography 1 month before the valve replacement procedure. The patient received dual antiplatelet therapy after the angioplasty and, later, unfractionated heparin during the transcatheter aortic valve implantation to maintain an activated clotting time between 200 and 250 s. Thus, the patient received complete antithrombotic therapy despite a high risk of bleeding (hypertension, diabetic nephropathy, and chronic alcoholic liver disease). We do not know if there were fluctuations in the anticoagulation level during the procedure. After the implant, the patient continued to receive dual antiplatelet therapy. Although coronary thromboembolic complications during aortic valve implantation are infrequent (around 1%2), they can be catastrophic3 and thus require urgent treatment.

Calcifications in the left ventricular outflow tract, the native aortic valve itself, and the ascending aorta can lead to certain complications.4–6 Another possible complication to bear in mind is coronary embolism of calcified material. In our patient, the presence of an intracoronary thrombus was revealed using a thromboaspiration device. Because this device is designed to remove intravascular thrombi, it helped to achieve optimal myocardial perfusion.

Cases such as this one reinforce the need for adequate procedure-related antithrombotic therapy, in addition to transesophageal echocardiography monitoring to permit early detection of complications requiring urgent management, as well as for other uses.

References
[1]
R. Mori Junco, F. Domínguez Melcon, M. Moreno Yangüela.
Tromboembolia coronaria durante implante percutáneo de prótesis aórtica.
Rev Esp Cardiol., 68 (2015), pp. 893
[2]
M. Seiffert, L. Conradi, S. Baldus, J. Schirmer, S. Blankenberg, H. Reichenspurner, et al.
Severe intraprocedural complications after transcatheter aortic valve implantation: calling for a heart team approach.
Eur J Cardiothorac., 44 (2013), pp. 478-484
[3]
M. Seiffert, R. Schnabel, L. Conradi, P. Diemert, J. Schirmer, D. Koschyk.
Predictors and outcomes after transcatheter aortic valve implantation using different approaches according to the valve academic research consortium definitions.
Catheter Cardiovasc Interv., 82 (2013), pp. 640-652
[4]
N. Montarello, B. Copus, R. Prakash, S.G. Worthley.
Peripheral embolization of aortic valve calcium following trans-femoral Sapien XT valve implantation requiring emergency surgical embolectomy.
Int J Cardiol., 181 (2015), pp. 17-18
[5]
A. Colli, R. D’Amico, S. Sci, J. Kempfert, M.A. Borger, F. Mohr, et al.
Transesophageal echocardiographic scoring for transcatheter aortic valve implantation: Impact of aortic cusp calcification on postoperative aortic regurgitation.
J Thorac Cardiovasc Surg., 142 (2011), pp. 1229-1235
[6]
C. Ozturk, S. Demirkol, M. Demir, A.O. Yildirim, S. Balta, T. Celik, et al.
Mobile mass lesion in the aorta after transcatheter aortic valve implantation: Thrombus or residue calcification.
Int J Cardiol., 198 (2015), pp. 45-46
Copyright © 2016. Sociedad Española de Cardiología
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