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Background: Transcatheter Aortic Valve Implantation (TAVI) is beneficial in patients with symptomatic severe Aortic Stenosis (AS). There is no consensus about the best anticoagulation strategy for patients with a recent TAVI and with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) are effective to prevent embolic events with a significant lower incidence of bleeding. There is scarce evidence about the use of these drugs in patients undergoing TAVI., Aim: To assess the management of anticoagulation at the moment of discharge of patients with AF and TAVI., Material and Methods: A four question survey was sent to cardiologists involved in TAVI programs in different international centers., Results: The survey was answered by 72 interventional cardiologists. Even with the lack of randomized evidence, in most of the scenarios DOACs are prescribed at discharge in patients with indication for anticoagulation. Also, in patients with high bleeding risk, most cardiologists would perform a left atrial appendage closure. In patients with concomitant coronary artery disease, if a stent was recently implanted, prescription of the combination of a DOAC and one antiplatelet drug was the most common answer. In patients with a former coronary angioplasty, DOAC or Warfarin was the therapy of choice., Conclusions: In the absence of randomized data, interventional cardiologists prescribe DOACs at discharge to patients with AF and TAVI, without following current guidelines in most cases.

COVID-19 pandemic generated multiple challenges for the health system. Cardiovascular disease is associated with a worse prognosis of infections. Moreover, most hospital resources and operative rooms were destined to patients with COVID-19 infection, deferring the treatment of most valvular patients requiring surgery. We report seven patients with symptomatic severe aortic stenosis who underwent transcatheter aortic valve implantation (TAVI) with conscious sedation and early discharge. No patient required intensive care unit admission or mechanical ventilation. After a 90-day follow-up, there were no complications or unplanned readmissions.

Quadricuspid aortic valve is rare and requires surgery when symptomatic severe regurgitation/stenosis is present. Associated anomalous coronary ostia location demands accurate diagnosis to avoid intraoperative complications, and several imaging techniques have been used, with drawbacks of low sensitivity, radiation and contrast exposure. We report a pre-operative assessment using 3-dimensional echocardiography. ( Level of Difficulty: Intermediate. )., Competing Interests: This work was partially supported by “Agencia Nacional de Investigacion y Desarrollo” (ANID), Chile, grant FONDAP 15130011 (Dr. Gabrielli). The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 The Authors.)

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.

Spontaneous coronary artery dissection is a rare condition that usually causes a coronary syndrome, but may also cause sudden death. It is more common in women and is associated with factors such as the peripartum period and oral contraceptive use. We report two cases. A 45-year-old woman with hepatitis C, presenting in the emergency room with angina. An intravascular ultrasound showed a dissecting hematoma involving the left, anterior descending and circumflex coronary arteries. She was initially managed with nitroglycerin, anticoagulation and anti-platelet drugs but due to persistence of symptoms, she required surgical revascularization. A 32-year-old woman presenting in the emergency room with angina. A coronary angiogram revealed a dissection of the anterior descending coronary artery. Eight days later an intravenous ultrasound showed a retrograde progression of the dissection and she was subjected to a surgical revascularization.

Performing complex cardiac interventions that need atrial septal crossing in patients with a previously implanted inferior vena cava filter (ICVF) has proven difficult. Accordingly, some authors have chosen accesses different from the traditional femoral vein approach. Here, we report two cases of complex cardiac procedures performed via the femoral vein and through an IVCF. In the first case, a percutaneous mitral valvuloplasty was performed in an elderly woman after crossing the IVCF with a large sheath. In the second case, simultaneous left atrial appendage and patent foramen ovale closures were performed. In both experiences, the key step was to secure the access by positioning a long sheath with its tip above the IVCF and not removing it until the procedure had finished. These cases further support the use of traditional femoral vein access in patients with IVCF and confirm the possibility of performing complex cardiac interventions in these scenarios.