Anomalous Right Coronary Artery: Culprit or Innocent Bystander?

Anomalous aortic origin of a coronary artery is a rare congenital heart defect. The detection of anomalous coronary arteries is likely to increase with increased availability and application of cardiac computed tomography and magnetic resonance imaging. Once detected, the recommendation for surgical intervention on anomalous coronary arteries depends upon patient symptoms, the presence or absence of inducible ischemia on stress imaging, and high-risk anatomic features.

Complications of intravascular brachytherapy.

Introduction: There is some evidence of a dose-response relationship for intravascular brachytherapy (IVBT) of native vessel or first-time in-stent restenosis (ISR). It has also been shown that in-field failure predominates following intravascular brachytherapy-treated lesions. Accordingly, it may be advantageous to increase the radiation dose(s) currently used.

Increased prescription dose for large vessel intravascular brachytherapy.

Background: Most randomized studies testing the effectiveness of IVBT were limited to vessels less than 4 mm diameter. In fact, it is now common to treat vessels larger than 4 mm. Accordingly, the authors instituted a prescription dose increase to 34 Gy at 2 mm from source center for vessels greater than 4.

Outcomes of re-referrals of patients with alcohol-associated liver disease, who were previously declined for liver transplantation.

Since 2018, our program has utilized specific psychosocial criteria and a multidisciplinary approach to assess patients for liver transplant due to alcohol-associated liver disease (ALD), rather than the 6-month abstinence rule alone. If declined based on these criteria, specific recommendations are provided to patients and their providers regarding goals for re-referral to increase the potential for future transplant candidacy. Recommendations include engagement in treatment for alcohol use disorder, serial negative biomarker testing, and maintenance of abstinence from alcohol.