Publications by authors named "Leire Unzué"

37 Publications

Local intracoronary fibrinolysis in acute myocardial infarction of ectatic coronary arteries in the post-abciximab era.

Cardiovasc Revasc Med 2021 Jan 14. Epub 2021 Jan 14.

Clinical Cardiology, Hospital Universitario HM Sanchinarro, HM Hospitales, Madrid, Spain.

Percutaneous intervention in the context of coronary artery ectasia (CAE) is penalized with no-reflow phenomenon. The glycoprotein-IIb/IIIa-inhibitor abciximab was the most accepted method for pharmacology thrombus resolution in this scenario, nevertheless, this agent was recently withdrawn. We describe 5 patients treated with local intracoronary fibrinolysis administrated through predesigned catheters in the setting of AMI and CAE.
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http://dx.doi.org/10.1016/j.carrev.2021.01.005DOI Listing
January 2021

Percutaneous repair of TAVI induced aortic pseudoaneurysm.

Rev Esp Cardiol (Engl Ed) 2020 Nov 21. Epub 2020 Nov 21.

Unidad de Imagen Cardiaca, HM CIEC-Centro Integral de Enfermedades Cardiovasculares, HM Hospitales, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2020.10.005DOI Listing
November 2020

Transradial Secondary Approach During Transfemoral TAVI: Usefulness of Placing a Wire Before Femoral Puncture for Management and Treatment of Vascular Complications.

Cardiovasc Revasc Med 2021 Feb 3;23:94-99. Epub 2020 Aug 3.

Clinical Cardiology, HM Hospitales-Centro Integral de enfermedades Cardiovasculares HM-CIEC, Madrid, Spain.

Vascular complications during transcatheter aortic valve implantation (TAVI) are relatively common, and some of them related to the transfemoral secondary access. The use of the transradial access (TRA) as an alternative vascular approach for transfemoral TAVI could reduce these complications, however, the treatment of potential vascular peripheral issues from this access has been scarcely described. The advance of a wire from the TRA to the primary transfemoral access at the beginning of the procedure could help the management of eventual vascular complications. A new TRA technique during transfemoral TAVI procedures is described, reporting the results in the first forty-two patients in one center.
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http://dx.doi.org/10.1016/j.carrev.2020.07.024DOI Listing
February 2021

Percutaneous closure of an atrial septal defect in a patient with Ebstein anomaly and right-to-left shunt.

Rev Port Cardiol 2020 Aug 3;39(8):475.e1-475.e3. Epub 2020 Aug 3.

Clinical Cardiology Unit, HM CIEC, Hospital Universitario HM Montepríncipe, Hospital Universitario HM Sanchinarro, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.

Ebstein anomaly is a congenital disease frequently associated with atrial septal defects, which can generate a right-to-left shunt, leading to systemic desaturation and right ventricular failure. We describe the case of a 68-year-old man with central cyanosis due to Ebstein anomaly and a patent foramen ovale. An atrial septal occluder was initially implanted after having performed prolonged test occlusion of the interatrial communication. In this case, device embolization occurred due to high right pressure. Percutaneous closure of atrial septal defects in the presence of a right-to-left shunt can offer a significant clinical improvement in selected cases. In patients with Ebstein anomaly, the implantation of atrial septal defect closure devices may be desirable, due to the larger size of the waist, which may provide better stability in the event of an increase in right pressure.
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http://dx.doi.org/10.1016/j.repc.2019.01.010DOI Listing
August 2020

Coronary arterial segmental stenosis quantified by MDCT: correlation with quantitative coronary analyses by invasive angiography.

Rev Esp Cardiol (Engl Ed) 2020 12 18;73(12):1068-1070. Epub 2020 Jul 18.

Unidad de Imagen Cardiaca, Hospital Universitario HM Montepríncipe-CIEC, HM Hospitales, Madrid, Spain; Servicio de Cardiología, Hospital Universitario HM Montepríncipe-CIEC, HM Hospitales, Madrid, Spain; Universidad CEU San Pablo, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain. Electronic address:

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http://dx.doi.org/10.1016/j.rec.2020.04.029DOI Listing
December 2020

Diagnostic and Prognostic Value of Coronary Computed Tomography Angiography in Patients with Severe Calcification.

J Cardiovasc Transl Res 2021 Feb 1;14(1):131-139. Epub 2020 Apr 1.

Unidad de Imagen Cardiaca, Departamento de Cardiología, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Madrid, Spain.

Our aim was to analyze its diagnostic and prognostic value in patients with high coronary calcium score (CCS). A total of 113 patients with CCS > 400 were included. Significant coronary artery disease (CAD) was defined as stenosis ≥ 50%. Invasive coronary angiography and major cardiovascular events were recorded. The CCS and heart rate during the acquisition were significantly lower in the diagnostic coronary computed tomography angiography (CCTA) group. The cut-off value of CCS to establish the diagnostic utility of CCTA was 878. The rate of cardiovascular events was 9.3%. The positive predictive value of CCTA to detect significant CAD was 73.5% and the negative predictive value for predicting cardiovascular events was 96%. In patients with high CCS, CCTA is useful to evaluate CAD, especially when the CCS is lower or equal to 878; moreover, the prognostic value of CCTA is better in patients where significant CAD has been ruled out.
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http://dx.doi.org/10.1007/s12265-020-09977-4DOI Listing
February 2021

Percutaneous treatment of prosthetic mitral valve thrombosis.

Rev Esp Cardiol (Engl Ed) 2020 Jun 4;73(6):500. Epub 2019 Dec 4.

Departamento de Cardiología Clínica, HM Hospitales-Centro Integral de Enfermedades Cardiovasculares HM CIEC, Hospital Universitario HM Montepríncipe, Boadilla del Monte, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2019.09.020DOI Listing
June 2020

Percutaneous Closure of Mitral Paravalvular Leaks Generating Refractory Heart Failure in the Immediate Postoperative Period.

J Invasive Cardiol 2019 Aug;31(8):E259-E260

Unidad de Hemodinámica y Cardiología Intervencionista, HM Hospitales-Hospital Universitario HM Montepríncipe, Avenida de Montepríncipe, 25, 28668 Boadilla del Monte, Madrid, Espaņa.

We present two patients with refractory heart failure due to mitral paravalvular leak (PVL) in whom percutaneous PVL closure was performed in the immediate postoperative period.
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August 2019

Percutaneous Closure of a Poorly Tolerated Ventricular Septal Defect After Triple Valvular Prosthesis Surgery.

J Invasive Cardiol 2019 Jun;31(6):E154

Hospital Universitario HM Montepríncipe, Av. de Montepríncipe, 25, 28660 Boadilla del Monte, Madrid, Spain.

We describe the case of an 81-year-old woman with three biological prostheses at the aortic valve, mitral valve, and tricuspid valve with recurrent hospitalizations due to heart failure. To the best of our knowledge, this is the first percutaneous closure of ventricular septal defect in the presence of three valvular prostheses.
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June 2019

Left Bundle Branch Block after Transcatheter Aortic Valve Implantation with Edwards Sapien 3 Valve: Influence of the Valve Depth Implantation.

Cardiovasc Revasc Med 2019 Nov 9;20(11):949-955. Epub 2019 Jan 9.

Clinical Cardiology, Hospital Universitario HM Montepríncipe, Spain.

Objectives: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis.

Background: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3.

Methods: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed.

Results: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8).

Conclusions: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS.
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http://dx.doi.org/10.1016/j.carrev.2019.01.006DOI Listing
November 2019

Successful Percutaneous Treatment of an Acute Left Main Coronary Occlusion Due to Iatrogenic Dissection Extending Into the Ascending Aorta.

JACC Cardiovasc Interv 2018 09 29;11(18):1897-1899. Epub 2018 Aug 29.

Interventional Cardiology Unit, Hospital Universitario HM Montepríncipe, Madrid, Spain.

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http://dx.doi.org/10.1016/j.jcin.2018.06.054DOI Listing
September 2018

Percutaneous Closure of a Femoral Arteriovenous Fistula During Transfemoral TAVI.

J Invasive Cardiol 2018 08;30(8):E67-E68

Hospital Universitario, Madrid Montepríncipe, Madrid, Spain.

Percutaneous AVF closure was performed post TAVI in a patient with severe aortic stenosis and an AVF between the right SFA and femoral vein.
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August 2018

Electrocardiographic changes and conduction disturbances after transfemoral aortic valve implantation with Edwards Sapien 3 prosthesis.

J Electrocardiol 2018 May - Jun;51(3):416-421. Epub 2018 Feb 20.

Clinical Cardiology Department, Hospital Universitario HM Montepríncipe, Madrid, Spain.

Objectives: The aim of this study is to describe electrocardiographic changes and conduction abnormalities in patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: 76 patients who underwent TAVI using Edwards Sapien 3 prosthesis were included, comparing electrocardiographic registries at admission, post-procedure and before discharge.

Results: Patients after TAVI presented a longer PR interval, a wider QRS, and a longer corrected QT, with a left deviation of QRS axis and T waves; reversible changes that tended to correct in the following days after TAVI. Complete atrioventricular block incidence was 2.9%. New-onset left bundle branch block (LBBB) incidence was 39%, although solved in almost half of patients before discharge.

Conclusions: TAVI was associated with different reversible electrocardiographic changes that suggest a transient impact on the conduction system. One of every five patients presented permanent LBBB after valve implant.
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http://dx.doi.org/10.1016/j.jelectrocard.2018.02.009DOI Listing
March 2019

Percutaneous treatment of an anomalous left main arising from the opposite sinus with subpulmonic course.

Cardiovasc Revasc Med 2018 Jul - Aug;19(5 Pt B):632-637. Epub 2018 Feb 7.

Cardiology, Hospital Universitario HM Puerta del Sur, Móstoles, Spain.

Anomalous origin of a coronary artery from the opposite sinus of Valsalva (ACAOS) is a rare malformation traditionally considered "malignant" in cases of interarterial course. Recently, a protective effect of the low interarterial subtype (between the aorta and the right ventricle outflow tract) has been described. We present an IVUS-guided percutaneous intervention in a patient with anomalous origin of the left coronary artery from the right coronary sinus presenting with anterior ischemia. In patients with ACAOS, the integration of complementary image techniques is recommended, defining the anomalous course of the vessel and providing an accurate assessment of the individual risk for each patient. The use of IVUS may be advisable, emerging as a really useful tool to complete the study and guide the treatment.
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http://dx.doi.org/10.1016/j.carrev.2018.01.008DOI Listing
July 2019

Outcomes of patients at estimated low surgical risk undergoing transcatheter aortic valve implantation with balloon-expandable prostheses.

Cardiovasc Revasc Med 2018 04 30;19(3 Pt A):251-256. Epub 2017 Aug 30.

Cardiology, Hospital Universitario Madrid Montepríncipe.

Introduction And Objectives: Transcatheter aortic-valve implantation (TAVI) is an accepted treatment for patients with severe aortic stenosis and high surgical risk. However, there is lack in data about TAVI in low-risk patients that are already being treated with this therapy in some clinical contexts.

Methods: A retrospective analysis of patients treated with transfemoral TAVI using Edwards Sapien prosthesis in one center was performed, classifying the patients into three groups according to the surgical risk (high/intermediate/low risk for STS score>8/4-8/<4). Clinical characteristics, procedure and follow-up outcomes were collected, comparing the results between low and high surgical risk groups.

Results: 89 TAVIs using Edwards balloon expandable prosthesis were performed (9 Sapien XT and 80 Sapien 3 valves were implanted). 40 patients (45%) presented a STS score<4, while 33 (37%) had a STS>8. Low-risk patients were significantly younger and had lower rates of coronary artery disease, peripheral vascular disease, pulmonary lung disease and atrial fibrillation. There were no significant differences in most of the technical variables of the procedure, apart from vascular complications and complete left bundle branch block after valve implant, which were higher in the group with STS>8. Patients of low risk presented shorter hospital stay (2,91±1,6, vs 4,8±3,9 days), with lower rates of mortality at mid- and long follow-up (death from any cause 15,2% vs 0%, p 0,04).

Conclusions: TAVI in low-risk patients is safe and associated with better outcome at mid and long-term follow-up compared to high-risk patients.
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http://dx.doi.org/10.1016/j.carrev.2017.08.012DOI Listing
April 2018

Radiation Exposure to the Pregnant Interventional Cardiologist. Is It Really Necessary? Response.

Rev Esp Cardiol (Engl Ed) 2017 07 25;70(7):614-615. Epub 2017 Apr 25.

Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario de La Princesa, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2017.01.029DOI Listing
July 2017

Percutaneous closure of a giant coronary artery fistula after surgical pericardiectomy. Review of the literature.

Cardiovasc Revasc Med 2017 Jul - Aug;18(5):384-389. Epub 2017 Mar 9.

Anesthesiology, Hospital Universitario Madrid Montepríncipe, Madrid, Spain.

Coronary artery fistulae (CAF) are uncommon heart defects defined as a communication between a coronary artery and a cardiac chamber or vascular structure. They are frequently asymptomatic; nevertheless, they can produce angina, dyspnea or cardiac failure. CAF are believed to be congenital; however, isolated cases of CAF have been described as rare complications of cardiac surgery. We report the percutaneous closure of a giant CAF in an adult patient with angina and previous pericardiectomy.
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http://dx.doi.org/10.1016/j.carrev.2017.03.002DOI Listing
May 2018

Radiation Exposure to the Pregnant Interventional Cardiologist. Does It Really Pose a Risk to the Fetus?

Rev Esp Cardiol (Engl Ed) 2017 Jul 15;70(7):606-608. Epub 2017 Feb 15.

Unidad de Hemodinámica y Cardiología Intervencionista, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.11.037DOI Listing
July 2017

Percutaneous Repair of a Complex Periprosthetic Aortic Leak.

Rev Esp Cardiol (Engl Ed) 2017 Sep 23;70(9):771. Epub 2016 Nov 23.

Unidad de Imagen Cardiaca, Hospital Universitario Madrid Montepríncipe, Boadilla del Monte, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.10.011DOI Listing
September 2017

Transcatheter Aortic Valve Implantation in Patients With Arterial Peripheral Vascular Disease.

Rev Esp Cardiol (Engl Ed) 2017 06 22;70(6):510-512. Epub 2016 Nov 22.

Servicio de Cardiología, Hospital Universitario Madrid Montepríncipe, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2016.10.008DOI Listing
June 2017

Syncopes in a Patient With a History of Radiotherapy: The Importance of a Comprehensive Assessment of Cardiac Involvement.

Rev Esp Cardiol (Engl Ed) 2016 Mar 15;69(3):352. Epub 2016 Jan 15.

Unidad de Arritmias, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2015.10.007DOI Listing
March 2016

Combined Percutaneous Mitral Valve Implantation and Paravalvular Leak Closure in a High-risk Patient With Severe Mitral Regurgitation.

Rev Esp Cardiol (Engl Ed) 2015 Dec 21;68(12):1186-8. Epub 2015 Oct 21.

Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2015.08.008DOI Listing
December 2015

Congenital atresia of the left main coronary artery in an adult: A rare anomaly with an unfavorable prognosis. Review of the literature.

Cardiovasc Revasc Med 2015 Dec 21;16(8):498-502. Epub 2015 Aug 21.

Hospital Universitario Madrid Montepríncipe.

Congenital atresia of the left main coronary artery (LMCA) is one of the rarest congenital anomalies, which may have an unfavorable prognosis leading to myocardial ischemia, ventricle dysfunction or even sudden cardiac death. There are 34 cases of LMCA in adults reported in the literature, most of them successfully treated with coronary revascularization. We report the case of an adult with LMCA who presented with terminal heart failure that required biventricular assistance and heart transplant.
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http://dx.doi.org/10.1016/j.carrev.2015.08.006DOI Listing
December 2015

Percutaneous Closure of an Ascending Aortic Pseudoaneurysm.

Rev Esp Cardiol (Engl Ed) 2015 Dec 12;68(12):1176. Epub 2015 Jun 12.

Servicio de Radiodiagnóstico, Hospital Universitario Madrid-Montepríncipe, Boadilla del Monte, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2015.03.013DOI Listing
December 2015

Percutaneous treatment of a coronary-subclavian steal syndrome.

Rev Esp Cardiol (Engl Ed) 2015 Feb 10;68(2):146. Epub 2014 Jul 10.

Servicio de Cardiología, Hospital Universitario Madrid Norte-Sanchinarro, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2014.02.023DOI Listing
February 2015

Initial experience with the low-profile percutaneous aortic valve SAPIEN 3.

Rev Esp Cardiol (Engl Ed) 2014 Nov 27;67(11):953-4. Epub 2014 Sep 27.

Servicio de Cardiología, Hospital Moncloa, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2014.04.014DOI Listing
November 2014

Vascular sealing implications in transfemoral transcatheter aortic valve implantation. Response.

Rev Esp Cardiol (Engl Ed) 2014 Oct 7;67(10):870. Epub 2014 Sep 7.

Servicio de Cardiología, Hospital Universitario Clínico San Carlos, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2014.06.005DOI Listing
October 2014

An unusual case of single coronary artery.

Rev Esp Cardiol (Engl Ed) 2014 Feb 15;67(2):147. Epub 2013 Jul 15.

Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.

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http://dx.doi.org/10.1016/j.rec.2013.04.013DOI Listing
February 2014