Collateral Flow Reversal: Exploring Protective Role of Collateral Circulation in Acute Coronary Syndrome.

The effect of pre-existing collateral circulation on presentation of acute coronary syndrome (ACS) is not well known. We present a case of a 54-year-old male with a known history of chronic total occlusion of left circumflex artery and well-developed collaterals, who presented to the emergency department with non-STsegment elevation myocardial infarction. He underwent urgent coronary angiogram which showed an acute total thrombotic occlusion in proximal large right coronary artery with collaterals from left to right.

Current Evidence and Rationale of Percutaneous Therapy for Chronic Total Coronary Occlusions.

The prevalence of chronic total occlusion (CTO) lesions in coronary arteries is notably high in patients with significant coronary artery disease. However, only a relatively small fraction of observed CTOs classically go for revascularization. Recent advances in techniques and equipment has greatly improved the success rates of CTO revascularization while reducing complications.

Outcomes and Safety of Transcatheter Aortic Valve Implantation With and Without Routine Use of Transesophageal Echocardiography.

Transesophageal echocardiography (TEE) has been extensively used historically for Transcatheter aortic valve implantation (TAVI) but focus is shifting from routine use of TEE and general anesthesia to "as needed" use. We evaluated patients who had TAVI in our institution from September 2012 to February 2017. Decision for implantation and use of TEE during procedure was made by the structural heart team on a case-to-case basis, based on FDA approved indications.

Successful Resolution of a Large Left Ventricular Thrombus with Rivaroxaban Therapy after Acute Myocardial Infarction.

Left ventricular (LV) thrombus is a major complication of acute systolic cardiomyopathy especially after a large anterior myocardial infarction (AMI), and it poses a significant embolic risk, up to five times higher than the general population. Current guidelines for LV thrombi recommend vitamin K antagonist for anticoagulation in contrast to novel oral anticoagulants (NOACs) which have not been studied well in cases of LV thrombus. We present a case of patient with AMI, who was noted to have severe systolic dysfunction and a large LV thrombus which was successfully treated with rivaroxaban therapy with complete resolution of LV thrombus on two months follow-up.

Recurrent In-stent Restenosis in the Area of Previous Stent Fracture: A Management Dilemma.

Drug eluting stents (DES) have been increasingly being used for treatment of coronary artery disease (CAD) and have been shown to be very effective in prevention of primary in-stent restenosis (ISR). However DES have been increasingly associated with acute to subacute risk of stent fractures (SF). There is also a paucity of data about different management strategies for SF, especially in the long term.

An Unusual Presentation of Native Valve Endocarditis Caused by .

is a coagulase-negative staphylococcal (CoNS) bacterium. It is a common saprophyte on human skin, present in approximately 50% of the healthy adult population; it has emerged as a cause of serious infection in the past two decades. In most cases, there is a predisposing condition, such as a new implant or surgical procedure, before the identification of as the pathogen.

Paclitaxel Induced MDS and AML: A Case Report and Literature Review.

Therapy related acute myelogenous leukemia (AML) and myelodysplastic syndromes (MDS) have been classically linked to alkylating agents and topoisomerase inhibitors. They constitute about 1% of all AMLs. There is less evidence on association of taxanes (paclitaxel and docetaxel) with these myeloid neoplasms.

Refractory ventricular fibrillation managed by coronary revascularisation performed during ongoing manual cardiac resuscitation lasting 1½ h.

Myocardial infarction is the most common cause of ventricular arrhythmias. Although there have been several improvements and refinements in coronary catheterisation with percutaneous intervention over the years, this intervention is still rarely considered during active ongoing resuscitation of patients, especially in cases of persistent ventricular arrhythmias. We present a case of refractory ventricular fibrillations due to in-stent thrombosis that was managed by emergent coronary angiogram and stent placement during ongoing cardiopulmonary resuscitation in a code that lasted about 1½ h.