Arq. Bras. Cardiol. 2023; 120(11): e20230454
Left Atrial Appendage Occlusion and Implantation of a Bicaval System: Report of a Simultaneous Transcatheter Procedure in a Critically Ill Elderly Patient
Marcos Cherem
, Carlos Eduardo Bernini, Jamil Abdalla Saad, Dirceu Barbosa Dias Sobrinho, Marcio Sérgio Carvalho Silva, Ruthnea Aparecida Lazaro Muzzi
Case Report
We report the case of an 87-year-old male patient who presented with severe torrential tricuspid regurgitation with important hemodynamic repercussions and conditions of right heart failure, episodes of pulmonary thromboembolism, and deep vein thrombosis in the lower limbs, in follow-up at the hospital’s cardiology service since 1996.
The patient had severe comorbidities, including permanent atrial fibrillation in use of prophylactic enoxaparin and impossibility of safe oral anticoagulation due to chronic renal failure. Furthermore, he concomitantly presented stage 3 essential hypertension, left ventricular hypertrophy, hypercholesterolemia, and venous insufficiency of the lower limbs. Although he was using methyldopa, amiodarone, bisoprolol, enoxaparin, epoetin, dapagliflozin, furosemide, spironolactone, propatylnitrate, atorvastatin, and allopurinol, he progressively developed severe tricuspid insufficiency, right heart chamber dilation, and congestion in the venae cavae and right atrium, which were refractory to optimized clinical treatment, with progressive worsening of renal function. The transthoracic echocardiogram revealed severe and maladaptive concentric hypertrophy of the left ventricle, with systolic involvement of the right ventricle, important tricuspid insufficiency, important biatrial enlargement, and moderate pulmonary hypertension.
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