Lead Extraction for Treatment of Cardiac Device Infection: A 20-Year Single Centre Experience.

Background: Infection is one of the most feared complications of cardiac implantable electronic devices. We report microbiology, antimicrobial therapy and infection recurrence in patients with cardiac device infection (CDI) treated with transvenous lead extraction (TLE) at a single centre over a 20-year period.

Methods: We identified a cohort of consecutive patients undergoing TLE for CDI by a single operator at a single high volume centre.

Long-Term Outcomes Following Transvenous Lead Extraction.

Background: Complications related to a cardiac implantable electronic device sometimes require transvenous lead extraction (TLE). We report long-term follow-up of patients undergoing TLE, particularly mortality, recurrent device infection, and need for repeat procedures.

Methods And Results: Consecutive patients undergoing TLE at a high-volume center were assessed for characteristics, indications, and outcomes.

Complete Angiographic Resolution of Cocaine Induced Coronary Artery Dissection within Eight Days without Coronary Stenting--A Case Report.

Introduction: Coronary dissection is a rarely reported complication of cocaine use for which there are no specific guidelines on management despite the widespread use of the drug.

Methods: We report a case of a 26-year-old otherwise fit and healthy Caucasian male smoker who presented to our facility with an infero-lateral ST elevation myocardial infarction (STEMI) following nasal inhalation of 1 gram of cocaine. Coronary angiography showed a mid left anterior descending (LAD) artery dissection with distal occlusive embolism and another dissection of the distal right coronary artery (RCA) with embolism and occlusion of the distal posterolateral branch.

Paradoxical cardiac and cerebral arterial gas embolus during percutaneous lead extraction in a patient with a patent foramen ovale.

A 42 year-old man presented for elective percutaneous lead extraction for pacemaker redundancy. The procedure was performed supine under general anaesthesia via the right femoral vein and was complicated by acute inferior ST elevation and hypotension. Urgent transoesophageal echocardiogram showed inferior left ventricular hypokinesis, right ventricular impairment, a patent foramen ovale and air in the left ventricle.

Twenty-year experience of transvenous lead extraction at a single centre.

Aims: Indications for cardiovascular implantable electronic devices continue to evolve, which has led to an increasing requirement for transvenous lead extraction. We explore the indications, complications, and success rates involved in the removal of pacemaker and implantable cardioverter-defibrillator (ICD) leads in a high-volume centre, over 20 years.

Methods And Results: We performed a retrospective analysis of all consecutive patients undergoing transvenous lead extraction by a single operator at a single centre between 1993 and 2012.

Impending paradoxical embolism: have we lost the clot?

Impending paradoxical embolism is a rare diagnosis that requires urgent treatment. We present a case where surgical thromboembolectomy was undertaken. The thrombus vanished from view on transesophageal ultrasound and was presumed to have undergone embolisation while bypass was established.

Deleterious effect of nitric oxide inhibition in chronic hepatopulmonary syndrome.

On the basis of limited experimental and clinical studies, increased activity of the vasodilatory nitric oxide-cyclic guanosine monophosphate pathway is considered to play a key role in the pathogenesis of hepatopulmonary syndrome. We report a 46-year-old woman with Child-Pugh class C cirrhosis and progressive dyspnoea for 12 months. Investigations revealed elevated circulating concentrations of nitric oxide metabolites and exhaled nitric oxide levels, an hyperdynamic circulation with low systemic vascular resistance and mean arterial pressure, a large right to left intrapulmonary shunt fraction on radiolabelled macroaggregated albumin perfusion scanning, positive contrast-enhanced echocardiography, reduced diffusion capacity of carbon monoxide, hypoxaemia and orthodeoxyia, all in keeping with severe hepatopulmonary syndrome.

A tale of two toes.

Percutaneous closure of a patent foramen ovale (PFO) is increasingly being performed for patients with suspected paradoxical embolus. We report a rare case of a PFO occluder device related infective endocarditis.

An unusual case of partial anomalous pulmonary venous drainage.

We report a case of partial anomalous pulmonary venous drainage where the left upper and lower pulmonary veins drain into a separate posterior left atrial (LA) chamber before continuing as a vertical ascending vein. The vertical vein then joins the left innominate vein, which eventually drains into a normal right-sided superior vena cava. There was no fenestration or communication between this posterior chamber and the true LA.