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Acta Medica Iranica، جلد ۵۱، شماره ۸، صفحات ۵۷۷-۵۸۲
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عنوان انگلیسی Safety and effectiveness of combined percutaneous coronary angioplasty and aortic valvuloplasty in an elderly patient with cardiogenic shock: effect on concomitant severe mitral regurgitation.
چکیده انگلیسی مقاله An 80-year-old diabetic man with severe aortic stenosis was admitted to our hospital for cardiogenic shock complicating non-ST-elevation myocardial infarction. Echocardiographic evaluation showed also a severe degree of both left ventricular dysfunction and mitral regurgitation. The patient was initially stabilized with inotropes and mechanical ventilation was necessary because of concurrent pulmonary edema. The day after, he was submitted to coronary angiography showing bivessel coronary disease. Given the high estimated operative risk, the patient was treated with angioplasty and bare metal stent implantation on both right coronary and circumflex artery; contemporarily, balloon aortic valvuloplasty (BAV) was performed with anterograde technique, obtaining a significant increase in planimetric valve area and reduction in transvalvular peak gradient. Few days after the procedure echocardiogram showed an increase in left ventricular ejection fraction, moderate aortic stenosis with mild regurgitation and moderate mitral regurgitation. Hemodynamic and clinical stabilization were also obtained, allowing amine support discontinuation and weaning from mechanical ventilation. At three months follow-up, the patient reported a further clinical improvement from discharge, and echocardiographic evaluation showed moderate aortic stenosis and an additional increase in left ventricular function and decrease in mitral regurgitation degree. In conclusion, combined BAV and coronary angioplasty were associated in our patient with hemodynamic and clinical stabilization as well as with a significant reduction in transvalvular aortic gradient and mitral regurgitation and an increase in left ventricular ejection fraction both in-hospital and at three month follow-up; this case suggests that these procedures are feasible even in hemodynamically unstable patients and are associated with a significant improvement in quality of life.
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نویسندگان مقاله emanuele cecchi | emanuele cecchi
department of internal medicine, azienda ospedaliero universitaria careggi, florence, italy. and department of heart and vessels, azienda ospedaliero universitaria careggi, florence, italy.


cristina giglioli | cristina giglioli
department of internal medicine, azienda ospedaliero universitaria careggi, florence, italy. and department of heart and vessels, azienda ospedaliero universitaria careggi, florence, italy.


cecilia agostini | cecilia agostini
department of internal medicine, azienda ospedaliero universitaria careggi, florence, italy. and department of heart and vessels, azienda ospedaliero universitaria careggi, florence, italy.


gian فرانکو gensini | gian franco gensini
department of internal medicine, azienda ospedaliero universitaria careggi, florence, italy. and department of heart and vessels, azienda ospedaliero universitaria careggi, florence, italy.


gennaro santoro | gennaro santoro
department of internal medicine, azienda ospedaliero universitaria careggi, florence, italy. and department of heart and vessels, azienda ospedaliero universitaria careggi, florence, italy.
نشانی اینترنتی http://acta.tums.ac.ir/index.php/acta/article/view/4389
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