Change of Peri-mitral Atrial Flutter into Single-loop Biatrial Flutter During Ablation.

Anterior line ablation for peri-mitral atrial flutter (AFL) is associated with biatrial flutter due to disruption of the electrical conduction in the left atrial septum. An AFL case with valvular disease, cardiac surgery, and prior ablation was confirmed to be counterclockwise peri-mitral flutter with isthmus on the left atrial septum. Ablation on the septum of the left atrium (LA) targeting the isthmus prolonged the tachycardia cycle length (TCL) from 266 to 286 ms.

Transcatheter interventions for severe tricuspid regurgitation: a literature review.

The prevalence of tricuspid regurgitation (TR) increases with age, affecting 65%-85% of adults. Primary TR is caused by a congenital or acquired abnormality of the tricuspid valve apparatus (leaflets, chordae, papillary muscles, or annulus). Secondary TR is due to insufficient coaptation from dilation of tricuspid valve annulus due to the right ventricle (RV) or right atrium (RA) remodeling and increased RV pressures.

Mitral Valve Prolapse: An Innocent Bystander or Proarrhythmogenic Anomaly?

Mitral valve prolapse (MVP) is a relatively common finding in the general population, and it is associated with ventricular tachycardia (VT) and sudden cardiac death (SCD). In this report, we present a case involving a 63-year-old male who had been previously diagnosed with MVP complicated by multiple admissions for episodes of ventricular arrhythmias.

Cardiac papillary fibroelastoma.

Papillary fibroelastoma (PFE) is a primary, histologically benign endocardial neoplasm. Though PFE has long been reported as the second most common primary cardiac neoplasm, it has since pulled ahead of cardiac myxomas, largely due to evolving cardiac imaging modalities. While PFEs are benign histologically, they have the potential for devastating clinical consequences, transient ischemic attack, stroke, myocardial infarction, syncope, pulmonary, and peripheral embolism.

A case report of successful intravascular shockwave lithotripsy and directional venous atherectomy of extensive chronic femoral deep venous thrombosis.

Background: Conventional treatment for chronic deep venous thrombosis (DVT) is anticoagulation. However, limited interventional endovascular options exist for patients with non-healing venous ulcers secondary to chronic DVT.

Case Summary: We present a case of 67-year-old man with severely symptomatic post-thrombotic syndrome (PTS) with persistent high-grade femoral DVT despite prior compressive therapy and chronic oral anticoagulation.

Impella-Assisted Intracoronary Lithotripsy of Severely Calcified Left Main Coronary Artery Bifurcation for NSTEMI With Cardiogenic Shock.

High calcification of coronary artery plaque is a frequent cause of suboptimal stent expansion, which can result in stent thrombosis and restenosis. Shockwave intravascular lithotripsy (S-IVL) represents a new frontier in the treatment of highly calcified coronary lesions. It can be an excellent alternative to intracoronary atherectomy in extremely high-risk lesions.

Successful resuscitation of acute cardiogenic shock presenting as ventricular fibrillation via Bipella approach: a case report.

Background: The use of mechanical circulatory support (MCS) in acute myocardial infarction and cardiogenic shock (AMICS) complicated by biventricular failure is poorly discussed in the literature.

Case Summary: We present successful treatment of a 52-year-old old man presenting with AMICS following cardiac arrest and prolonged CPR via a Bipella approach for biventricular support and restoration of haemodynamic stability.

Discussion: This case demonstrates the importance of understanding the role of MCS in the management of cardiogenic shock; the value of the cardiac power output and pulmonary artery pulsatility index as haemodynamic metrics to assess the cardiac function of a patient with cardiogenic shock; and the importance of a Bipella MCS approach in high inpatient morbidity and mortality AMICS with biventricular failure.

A Complex Ventricular Septal Defect Causing Severe Aortic Insufficiency.

We report a case of a 60-year-old male with decompensated heart failure secondary to severe aortic insufficiency in the setting of a complex ventricular septal defect. The case highlights the use of multimodality imaging, including transthoracic echocardiogram, transesophageal echocardiogram, and cardiac magnetic resonance imaging, which contributed to the findings and diagnosis of the defect noted and was confirmed during surgery. The images provide an exceptional understanding of a complex ventricular septal defect and the associated pathology, which resulted in severe aortic regurgitation leading to cardiomyopathy.

Successful Catheter-Directed Thrombolysis of Massive Bilateral Upper Extremity DVT Presenting as Superior Vena Cava Syndrome.

Superior vena cava syndrome (SVCS) is traditionally associated with malignancy. However, approximately one-third of SVCS cases are due to intravascular devices and pacemakers. No specific guidelines exist for managing catheter-associated SVCS.

Association Between Pulmonary Hypertension and Transcatheter Aortic Valve Replacement: Analysis of a Nationwide Inpatient Sample Database.

Introduction: This study was done to review the association of pulmonary hypertension (PH) with Transcatheter Aortic Valve Replacement (TAVR) procedures done in the US for years 2010 to 2012.

Methods: We used Nationwide Inpatient Sample (NIS) data to extract data for patients who were hospitalized with a primary/secondary diagnosis of TAVR as specified by International Classification of Disease (ICD-9) codes 35.05 and 35.

May-Thurner Syndrome as a Rare Cause of Paradoxical Embolism in a Patient with Patent Foramen Ovale.

May-Thurner syndrome is an underrecognized anatomical variant that can lead to increased propensity for venous thrombosis in the lower extremities. We present a case of a 67-year-old female who presented with transient ischemic attack. Initial workup including CT scan of the head, MRI scan of the head, and magnetic resonance angiogram of the head and neck was unremarkable.

Trends in Vena Cava Filter Placement: An Analysis of Nationwide Inpatient Sample Database Over an 11 Year Period.

Objectives: There have been increasing concerns regarding inappropriate usage of vena caval filters. Our study was done to analyze the current trends in vena caval filter placement.

Methods: This study used the data from Nationwide Inpatient Sample database for the years 2002- 2012 to identify patients with vena caval filter placement.

A rare cause of heart failure.

Noncompaction cardiomyopathy (NCCM) is a rare but important cause of heart failure. The reported prevalence of left ventricle NCCM based on echocardiographic criteria varies between 0.014% and 1.