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Introduction The global coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus began in Wuhan, China, in December 2019, and it has affected over 4.4 million people worldwide, with 302,169 deaths as of May 16, 2020. 1 Though respiratory symptoms are the most common presentation of COVID-19, cardiac involvement is a prominent feature of this disease, occurring in 20% to 30% of hospitalized patients and contributing to 40% of deaths. 2-4 COVID-19-related [...]

Background: The treatment for symptomatic severe aortic stenosis (AS) is the correction of valve stenosis by surgical valve replacement and more recently by transcatheter aortic valve implant (TAVI). However, in some high risk surgical patients, TAVI is not possible for technical or clinical reasons or due to the unavailability of the endoprosthesis. Objective: The aim of this study was to evaluate a mid-term follow-up of symptomatic severe AS patients who are not eligible for TAVI trials, as well as to identify the clinical features of these patients. Methods: This was an observational, retrospective study conducted with 475 symptomatic severe AS patients, evaluated by the Heart Team between 2000 and 2017. Inclusion criterias were: patients considered not to be eligible for TAVI. The Shapiro-Wilk test was applied to evaluate normality. Non-paired t and Mann-Whitney tests were applied for continuous variables, while the chi-squared and Fischer exact tests were applied for categorical variables, with a level of significance of p

Fundamentos: O implante por cateter de bioprotese valvar aortica (TAVI) consolidou-se como alternativa para o tratamento de pacientes com estenose aortica importante de alto risco cirurgico. Contudo, ha poucos dados na literatura com respeito a obstrucao coronaria que, apesar de rara, trata-se de grave complicacao do TAVI. Objetivo: Avaliar, no contexto brasileiro, a presenca dessa importante complicacao. Metodos: Foram avaliados todos os casos de obstrucao coronaria incluidos no Registro Brasileiro de TAVI. Foram coletados dados clinicos, do procedimento, do manejo e de evolucao intra-hospitalar. Resultados: Entre 418 pacientes consecutivos do registro, ocorreram tres casos de obstrucao coronaria (incidencia de 0,72%). Em sua totalidade, os pacientes eram do sexo feminino, sem cirurgia de revascularizacao miocardica (CRM) previa, com idade media de 85 ± 3 anos, EuroSCORE logistico de 15 ± 6% e STS de 9 ± 4%. Todos os casos foram realizados com a valvula balao-expansivel Sapien XT. Em um dos pacientes, com dados de tomografia computadorizada pre-procedimento, verificaram-se origem das arterias coronarias baixa e seio de Valsalva estreito. Todos os pacientes apresentaram-se clinicamente com hipotensao importante e mantida, imediatamente apos o implante da valvula, e, apesar de angioplastia com implante de stent, todos os pacientes foram a obito, sendo dois periprocedimento e um durante hospitalizacao. Conclusao: A obstrucao coronaria como complicacao do TAVI, apesar de rara, e potencialmente fatal, podendo ocorrer mais frequentemente em mulheres e com as proteses expansiveis por balao. Fatores anatomicos podem estar relacionados com sua ocorrencia, ressaltando-se a importância de boa avaliacao pre-procedimento no sentido de evitar essa grave complicacao.