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  <front>
    <journal-meta>
      <journal-id journal-id-type="nlm-ta">Arq Bras Cardiol</journal-id>
      <journal-id journal-id-type="publisher-id">abc</journal-id>
      <journal-title-group>
        <journal-title>Arquivos Brasileiros de Cardiologia</journal-title>
        <abbrev-journal-title abbrev-type="publisher">Arq. Bras. Cardiol.</abbrev-journal-title>
      </journal-title-group>
      <issn pub-type="ppub">0066-782X</issn>
      <issn pub-type="epub">1678-4170</issn>
      <publisher>
        <publisher-name>Sociedade Brasileira de Cardiologia - SBC</publisher-name>
      </publisher>
    </journal-meta>
    <article-meta>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v3">V6FLdWWMBrRP3mBPtSDw6Dp</article-id>
      <article-id pub-id-type="publisher-id" specific-use="scielo-v2">S0066-782X2016000100076</article-id>
      <article-id pub-id-type="doi">10.5935/abc.20160007</article-id>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Image</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Transcatheter Valve-in-Valve Repositioning of CoreValve<sup>&#174;</sup> Evolut&#8482; Rin Aortic Prosthesis</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Azevedo</surname>
            <given-names>Ana Isabel</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Ladeiras-Lopes</surname>
            <given-names>Ricardo</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Rodrigues</surname>
            <given-names>Alberto</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Braga</surname>
            <given-names>Pedro</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Ribeiro</surname>
            <given-names>Vasco Gama</given-names>
          </name>
          <xref ref-type="aff" rid="aff1"/>
        </contrib>
        <aff id="aff1">
          <institution content-type="orgname">Vila Nova de Gaia/Espinho Hospital Centre</institution>
          <country country="PT">Portugal</country>
          <institution content-type="original">Vila Nova de Gaia/Espinho Hospital Centre - Portugal</institution>
        </aff>
      </contrib-group>
      <author-notes>
        <corresp id="c1"><bold>Mailing Address: Ana Isabel Azevedo,</bold> Vila Nova de Gaia/Espinho Hospital Centre. Rua Concei&#231;&#227;o Fernandes. Postal Code 4434-502, Vila Nova de Gaia, Porto - Portugal. E-mail:<email>ana.isabel.az@gmail.com</email>
					</corresp>
        <fn fn-type="con">
          <p>
            <bold>Author contributions</bold>
          </p>
          <p>Conception and design of the research and Writing of the manuscript: Azevedo AI; Acquisition of data: Azevedo AI, Ladeiras-Lopes R, Rodrigues A, Braga P Gama Ribeiro V; Analysis and interpretation of the data: Azevedo AI, Ladeiras-Lopes R, Rodrigues A, Braga P; Critical revision of the manuscript for intellectual content: Azevedo AI, Rodrigues A, Braga P Gama Ribeiro V.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potential Conflict of Interest</bold>
          </p>
          <p>No potential conflict of interest relevant to this article was reported.</p>
        </fn>
      </author-notes>
      <pub-date pub-type="epub-ppub">
        <month>01</month>
        <year>2016</year>
      </pub-date>
      <volume>106</volume>
      <issue>1</issue>
      <fpage>76</fpage>
      <lpage>76</lpage>
      <history>
        <date date-type="received">
          <day>04</day>
          <month>07</month>
          <year>2015</year>
        </date>
        <date date-type="rev-recd">
          <day>31</day>
          <month>08</month>
          <year>2015</year>
        </date>
        <date date-type="accepted">
          <day>10</day>
          <month>10</month>
          <year>2015</year>
        </date>
      </history>
      <permissions>
        <license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0">
          <license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
        </license>
      </permissions>
      <kwd-group xml:lang="en">
        <title>Keywords</title>
        <kwd>Aortic Vave, Bioprosthesis</kwd>
        <kwd>Heart Valve Prosthesis Implantation</kwd>
        <kwd>Heart Failure.</kwd>
      </kwd-group>
    </article-meta>
  </front>
  <body>
    <p>A 41-year-old man with history of surgical replacement of the aortic valve with a 21mm-Mitroflow bioprosthesis (1A), presented with functional class IV heart failure. Transesophageal echocardiography confirmed severe bioprosthesis obstruction (1B). We implanted a 23mm-CoreValve<sup>&#174;</sup> Evolut&#8482; R (Medtronic, Minneapolis, USA) in the aortic bioprosthesis, by transfemoral approach. The valve was recaptured and repositioned during deployment (1C-E). Immediate (1F), one (1G) and three-month (1H) transthoracic echocardiography confirmed significant reduction in transaortic gradients. The patient remained in functional class I.</p>
    <p>Our experience in repositioning the valve during a valve-in-valve procedure demonstrates the usefulness of this resource in such challenging procedures.</p>
    <fig id="f1">
      <graphic xlink:href="1678-4170-abc-106-01-0076-60007-gf01.jpg"/></fig>
  </body>
  <back>
    <fn-group>
      <fn fn-type="supported-by">
        <p>
          <bold>Sources of Funding</bold>
        </p>
        <p>There were no external funding sources for this study.</p>
      </fn>
      <fn fn-type="other">
        <p>
          <bold>Study Association</bold>
        </p>
        <p>This study is not associated with any thesis or dissertation work.</p>
      </fn>
    </fn-group>
  </back>
  <sub-article article-type="translation" id="s1" xml:lang="pt">
    <front-stub>
      <article-categories>
        <subj-group subj-group-type="heading">
          <subject>Imagem</subject>
        </subj-group>
      </article-categories>
      <title-group>
        <article-title>Reposicionamento Percut&#226;neo de uma CoreValve<sup>&#174;</sup>Evolut&#8482; R numa Biopr&#243;tese A&#243;rtica</article-title>
      </title-group>
      <contrib-group>
        <contrib contrib-type="author">
          <name>
            <surname>Azevedo</surname>
            <given-names>Ana Isabel</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Ladeiras-Lopes</surname>
            <given-names>Ricardo</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Rodrigues</surname>
            <given-names>Alberto</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Braga</surname>
            <given-names>Pedro</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <contrib contrib-type="author">
          <name>
            <surname>Ribeiro</surname>
            <given-names>Vasco Gama</given-names>
          </name>
          <xref ref-type="aff" rid="aff2"/>
        </contrib>
        <aff id="aff2">
          <institution content-type="orgname">Vila Nova de Gaia/Espinho Hospital Centre</institution>
          <country country="PT">Portugal</country>
          <institution content-type="original">Vila Nova de Gaia/Espinho Hospital Centre - Portugal</institution>
        </aff>
      </contrib-group>
      <author-notes>
        <corresp id="c2">Correspond&#234;ncia: Ana Isabel Azevedo, Vila Nova de Gaia/Espinho Hospital Centre. Rua Concei&#231;&#227;o Fernandes. C&#243;digo postal 4434-502, Vila Nova De Gaia, Porto - Portugal. E-mail: <email>ana.isabel.az@gmail.com</email>
					</corresp>
        <fn fn-type="con">
          <p>
            <bold>Contribui&#231;&#227;o dos autores</bold>
          </p>
          <p>Concep&#231;&#227;o e desenho da pesquisa e Reda&#231;&#227;o do manuscrito: Azevedo AI; Obten&#231;&#227;o de dados: Azevedo AI, Ladeiras-Lopes R, Rodrigues A, Braga P Gama Ribeiro V; An&#225;lise e interpreta&#231;&#227;o dos dados: Azevedo AI, Ladeiras-Lopes R, Rodrigues A, Braga P; Revis&#227;o cr&#237;tica do manuscrito quanto ao conte&#250;do intelectual importante: Azevedo AI, Rodrigues A, Braga P Gama Ribeiro V.</p>
        </fn>
        <fn fn-type="conflict">
          <p>
            <bold>Potencial conflito de interesse</bold>
          </p>
          <p>Declaro n&#227;o haver conflito de interesses pertinentes.</p>
        </fn>
      </author-notes>
      <kwd-group xml:lang="pt">
        <title>Palavras-chave</title>
        <kwd>Valva A&#243;rtica</kwd>
        <kwd>Biopr&#243;tese</kwd>
        <kwd>Implante de Valva Card&#237;aca</kwd>
        <kwd>Insufici&#234;ncia Card&#237;aca</kwd>
      </kwd-group>
    </front-stub>
    <body>
      <p>Um homem de 41 anos de idade, com antecedentes de cirurgia de substitui&#231;&#227;o valvular a&#243;rtica por uma biopr&#243;tese Mitroflow de 21mil&#237;metros (1A), apresentou-se no nosso Centro com insufici&#234;ncia card&#237;aca em classe funcional IV. O ecocardiograma transesof&#225;gico confirmou obstru&#231;&#227;o grave da biopr&#243;tese (1 B). Implantamos uma CoreValve<sup>&#174;</sup> Evolut&#8482; R (Medtronic, Minneapolis, EUA) de 23 mil&#237;metros na biopr&#243;tese a&#243;rtica por via transfemoral. A v&#225;lvula foi recapturada e reposicionada durante a implanta&#231;&#227;o (1C-E). O ecocardiograma transtor&#225;cico efetuado imediatamente (1F), um m&#234;s (1G) e tr&#234;s meses (1H) ap&#243;s a interven&#231;&#227;o confirmou redu&#231;&#227;o significativa dos gradientes transa&#243;rticos. O paciente permaneceu em classe funcional I.</p>
      <p>A nossa experi&#234;ncia no reposicionamento da v&#225;lvula durante um procedimento <italic>valve-in-valve</italic> demonstra que esta caracter&#237;stica pode ser &#250;til em interven&#231;&#245;es deste grau de complexidade.</p>
      <fig id="f2">
        <graphic xlink:href="1678-4170-abc-106-01-0076-60007-gf01-pt.jpg"/></fig>
    </body>
    <back>
      <fn-group>
        <fn fn-type="supported-by">
          <p>
            <bold>Fontes de financiamento</bold>
          </p>
          <p>O presente estudo n&#227;o teve fontes de financiamento externas.</p>
        </fn>
        <fn fn-type="other">
          <p>
            <bold>Vincula&#231;&#227;o acad&#234;mica</bold>
          </p>
          <p>N&#227;o h&#225; vincula&#231;&#227;o deste estudo a programas de p&#243;s-gradua&#231;&#227;o.</p>
        </fn>
      </fn-group>
    </back>
  </sub-article>
</article>
