Coronary Artery Calcification and Risk of Cardiac Complication in Geriatric Trauma Population.

Background: Better means of identifying patients with increased cardiac complication (CC) risk is needed. Coronary artery calcification (CAC) is reported on routine chest CT scans. We assessed the correlation of CAC and CCs in the geriatric trauma population.

Rural versus urban outcomes following transcatheter aortic valve implantation: The importance of the heart team.

Background: Rural patients face known healthcare disparities and worse cardiovascular outcomes compared to urban residents due to inequitable access and delayed care. Few studies have assessed rural-urban differences in outcomes following Transcatheter Aortic Valve Implantation (TAVI). We compared short-term post-TAVI outcomes between rural and urban patients.

Comparison of Tricuspid Regurgitation Severity Between Cardiac Resynchronization Therapy Versus Right Ventricular Pacing in Patients With Chronic Obstructive Pulmonary Disease.

Background: Right ventricular (RV) lead placement can worsen tricuspid regurgitation (TR). TR is known to be associated with lower survival irrespective of left ventricular ejection fraction (LVEF) or pulmonary hypertension (PH). Patients with chronic obstructive pulmonary disease (COPD) often have PH and pre-existent TR with higher morbidity and mortality from worsening TR.

cardiac implantable electronic device related endocarditis.

Cases of Gram-negative, anaerobic rod bacteremia and endocarditis have been increasingly recognized in recent years. This increase has been primarily observed in patients at risk for polymicrobial infections, such as those who use injection drugs and patients with diabetes mellitus. Despite a growing incidence, there are few published case reports of cardiac implantable electronic device related endocarditis secondary to Gram negative, anaerobic organisms.

Pathophysiological factors contributing to fractional flow reserve and instantaneous wave-free ratio discordance.

The diagnostic accuracy and clinical benefits of instantaneous wave-free ratio (iFR) compared to fractional flow reserve (FFR) have been well-established in the literature. Despite the advantages of non-hyperemic pressure indices, approximately 20% of iFR and FFR measurements are discordant. Efforts have been made to establish the mechanisms as well as identify causative factors that lead to such a discordance.

Inferior Myocardial Infarction Secondary to Coronary Artery Vasospasm Following Regadenoson Stress Imaging.

Coronary artery vasospasm is a rare condition that is caused by hyperactive arterial smooth muscle vasoconstriction leading to reversible coronary artery occlusion. Patients that suffer from coronary artery vasospasm have the potential to develop life-threatening conditions such as myocardial infarction and fatal arrhythmias. ST-elevations are a rare complication that can occur in people with coronary vasospasm, and to the best of our knowledge there are no documented cases of ST-elevation myocardial infarction occurring in patients undergoing regadenoson stress test.

Very Late Aortic Endograft Infection With Listeria monocytogenes in an Elderly Man.

Endograft infection with Listeria monocytogenes is a rare, potentially devastating complication of endovascular aortic aneurysm repair. To our knowledge, only 8 cases have been reported. We describe the case of a 72-year-old man who presented with L.

Comparing Echocardiographic Modalities in Native-Valve Infective Endocarditis Due to Methicillin-Resistant Staphylococcus Aureus in People Who Inject Drugs.

Background: Methicillin-resistant (MRSA) infective endocarditis (IE) is associated with high morbidity and mortality. Current IE guidelines recommend transesophageal echocardiogram (TEE) over transthoracic echocardiogram (TTE) to diagnose infective endocarditis. Management of IE in people who inject drugs (PWID) in many medical centers is mainly conservative with prolonged intravenous antibiotics.

Subaortic stenosis secondary to pannus from a mechanical mitral valve.

A variety of conditions can lead to left ventricle outflow tract obstruction, but cases of subaortic stenosis decades following a mitral valve replacement are exceedingly rare. Any abnormal positioning of a prosthetic valve can result in continuous turbulence leading to permanent deposition of fibrous tissue. We present a case of a 56-year-old female that underwent mechanical mitral valve replacement, due to severe rheumatic mitral valve disease, with recurrent admissions for dyspnea.

Comparison of Transcatheter Aortic Valve Implantation Outcomes Between Normal-Flow, Low-Gradient Severe Aortic Stenosis and Normal-Flow, High-Gradient Severe Aortic Stenosis.

Background: Normal flow low gradient severe aortic stenosis (NFLG-AS) with preserved ejection fraction is the most prevalent form of low gradient severe aortic stenosis. Despite the increased prevalence, the clinical outcomes and management strategy of NFLG-AS remain controversial. Therefore, our study aimed to evaluate transcatheter aortic valve implantation (TAVI) outcomes of patients with NFLG-AS compared with normal flow high gradient severe aortic stenosis (NFHG-AS).

Hemodynamic outcomes after valve-in-valve transcatheter aortic valve replacement: a single-center experience.

Background: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis.

Methods: We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center.

Iatrogenic Arteriovenous Fistula Secondary to Coronary Artery Dissection Caused by Contrast Injection Into a Chronically Occluded Right Coronary Artery.

Coronary arteriovenous fistulas and coronary cameral fistulas are rare anomalies that involve the abnormal communication between a coronary artery and a venous structure, such as a coronary vein or a right-sided cardiac chamber. Iatrogenic coronary arteriovenous fistulas and coronary cameral fistulas can be uncommon complications of coronary artery angiography and intervention. Acquired coronary arteriovenous fistulas that develop during percutaneous coronary intervention of chronic total occlusions have been previously reported in the literature.

Heme Effects in Lowering Patient Discomfort in Radial Artery Verapamil Injection.

Background: The primary objective of this study was to evaluate whether diluting verapamil with heme as compared to normal saline reduces patient discomfort during radial artery injection. Following radial artery access, verapamil is frequently administered to reduce the incidence of radial artery spasm. The injection of verapamil via the radial artery is associated with a temporary "burning" discomfort.

Association of Echocardiographic Diastolic Dysfunction with Discordance of Invasive Intracoronary Pressure Indices.

Instantaneous wave-free ratio (iFR)-guided coronary revascularization has similar clinical outcomes compared to fractional flow reserve (FFR)-guided revascularization strategy. However, some studies have shown a discordance of around 20% between iFR and FFR. Although various factors have been reported in the literature to affect pressure indices and lead to such discordance, there is a paucity of data regarding the effect of diastolic dysfunction on functional assessment of coronary arteries.

Successful Rescue Intervention of Internal Mammary Artery Anastomotic Site Acute Graft Failure With Direct New Generation Covered Stenting.

Acute, perioperative myocardial infarction (MI) from acute left internal mammary artery (LIMA) to left anterior descending (LAD) graft failure immediately following coronary artery bypass grafting (CABG) surgery is associated with significantly increased in-hospital mortality. The leading etiology of such acute graft failure is acute thrombosis, dissection, spasm, anastomosis failure or no-reflow phenomenon. Repeat bypass surgery carries incremental risk and may not be feasible in hemodynamically unstable patients.

Successful Low-Dose tPA for Mechanical Mitral Valve Thrombosis in a Patient with Postinfarction Contained Left Ventricular Free Wall Rupture.

Prosthetic valve thrombosis is a potentially life-threatening complication diagnosed by a combination of clinical features and imaging modalities, but the optimal management in high bleeding risk patients remains controversial. Current treatment options for prosthetic valve thrombosis included surgery, thrombolytic therapy, and anticoagulation. We present a very unusual case of a patient with a recent ST-elevation myocardial infarction complicated by contained left ventricle free wall rupture and mechanical mitral valve thrombosis.

Positional changes leading to transient ischaemia in a patient with neuroendocrine carcinoma of the lung.

Coronary spasm in carcinoid heart disease has an incidence of 10%, but is rare in patients with neuroendocrine tumours without carcinoid heart disease. We present a rare case of right coronary artery spasm and ST elevations secondary to a neuroendocrine carcinoma of the lung, uniquely provoked by positional changes. Our patient is a 55-year-old man with recurrent ST-elevation myocardial infarction secondary to coronary vasospasm that was diagnosed with neuroendocrine carcinoma of the lung.

Use of the CHADS-VASc Score in Assessing Transradial Approach Failure.

Background: Radial access is now considered the preferred approach for coronary angiography and percutaneous coronary intervention because of the low risk of vascular complications. However, radial access failure is not uncommon, leading to crossover to a different access site. The CHADS-VASc score is used to estimate stroke risk in patients with atrial fibrillation.

Effect of Elevated Left Ventricular End Diastolic Pressure on Instantaneous Wave-Free Ratio and Fractional Flow Reserve Discordance.

Background: Instantaneous wave-free ratio (iFR)-guided physiological assessment has been shown to be non-inferior to fractional flow reserve (FFR)-guided assessment for deciding best treatment strategy for angiographically intermediate stenosis. The diagnostic accuracy of iFR compared to FFR reported in various studies is around 80%. Many factors can lead to iFR/FFR discordance, though underlying physiological mechanism of discordance and its associated factors have not been fully evaluated.

Transcatheter aortic valve replacement after chest radiation: A propensity-matched analysis.

Background: Chest radiation therapy (CRT) for malignant thoracic neoplasms is associated with development of valvular heart disease years later. As previous radiation exposure can complicate surgical treatment, transcatheter aortic valve replacement (TAVR) has emerged as an alternative. However, outcomes data are lacking for TAVR patients with a history of CRT.

Chylothorax and Chylopericardium: A Complication of Long-Term Central Venous Catheter Use.

The development of chylothorax and chylopericardium is an uncommon complication of the long-term use of central venous catheters. We describe a unique case of an end stage renal disease patient on hemodialysis with a left jugular tunneled catheter who developed superior vena cava syndrome. Our patient presented with both a large pleural and pericardial effusion that despite drainage continued to reaccumulate.

ST-Elevation Myocardial Infarction (STEMI) in a Patient with Moyamoya Disease.

Moyamoya disease is a rare condition that is primarily reported in Asian populations, characterized by stenoocclusive intracranial angiopathy with small, fragile, and multiple collateral vessel formation. Extracranial complications, mainly abnormalities within the renal vasculature, have been described; however, there are very few case reports of cardiovascular complications in patients with Moyamoya disease. We report a 26-year-old Caucasian female with known Moyamoya disease who presented with both typical and atypical chest pain, mimicking symptoms of a previous non-ST-elevation myocardial infarction.

Transcatheter aortic valve implantation despite challenging vascular access.

We describe transcatheter aortic valve implantation in a patient who had severe peripheral artery disease. The patient's vascular condition required additional preliminary peripheral intervention to enable adequate vascular access. A 78-year-old man with severe aortic stenosis, substantial comorbidities, and severe heart failure symptoms was referred for aortic valve replacement.