Unexpectedly detected air bubbles in left ventricle during off-pump coronary artery bypass grafting: a case report.

Background: Unlike on-pump beating coronary artery bypass grafting, off-pump coronary artery bypass grafting (OPCAB) rarely causes intracardiac air embolisms. However, there have been several reports of air embolisms that occurred during OPCAB using a CO blower, which is commonly used to facilitate visualization of the anastomotic site. Herein, we describe a rare case of air bubbles detected only in the left ventricle during OPCAB.

Right Ventricular Myocardial Infarctions.

Acute isolated right ventricular (RV) myocardial infarctions are relatively uncommon in clinical practice; more frequently, RV infarctions occur in association with inferior ST-segment elevation myocardial infarctions. Recent advances in diagnostic tools and methods have significantly improved our ability to detect RV infarctions in both scenarios. For this reason, it is critical for physicians to understand the pathophysiology, clinical presentation, and diagnostic criteria for RV infarctions to initiate treatment and optimize the outcomes of patients.

[Metastatic Lung Tumor with Bronchial Cast Shadow in Which Intraoperative Bronchoscopy Was Useful During Robotic Surgery].

A man in his 60s, who had undergone surgery for rectal cancer, liver metastases, and lung metastasis, had a past history of myocardial infarction and ventricular fibrillation with reduced cardiac functions. He was referred to our department because of a pulmonary nodule shadow in the S2 right upper lobe and a bronchial cast shadow along the B2 bronchus. Robot-assisted thoracoscopic right S2 segmentectomy was performed and intraoperative bronchoscopy revealed a polyp-like tumor within B2a.

Phaeochromocytoma mimicking acute ST-elevation myocardial infarction.

Phaeochromocytomas are rare catecholamine-secreting tumours, usually benign, originating from chromaffin cells of the adrenal glands. Their typical presentation includes the triad of headaches, sweating and tachycardia due to excessive catecholamine release. However, many patients do not exhibit all three symptoms, making diagnosis challenging.

Temporary microaxial transvalvular left ventricular assist device for post-myocardial infarction ventricular septal rupture: Bridging a paradigm shift.

Objective: To characterize the clinical courses and outcomes of patients presenting with post-myocardial infarction (MI) ventricular septal rupture (VSR) receiving temporary microaxial transvalvular left ventricular assist device (tVAD) support.

Methods: Between December 2019 and July 2023, 10 consecutive patients presented with a post-MI VSR. All 10 patients received a tVAD.

Adverse Events and Failure Modes Related to Impella RP/RP Flex: Insights From FDA MAUDE Database.

Background: Impella RP and RP Flex can provide right ventricular (RV) support in numerous clinical situations. Notably, the redesigned RP Flex allows for an internal jugular approach compared to the femoral venous approach with RP.

Aims: We investigated the type and frequency of device-related complications as reported in the US Food and Drug Administration (FDA) Manufacturer and User Facility Experience (MAUDE) for both Impella RP and RP Flex to see if there are any differences.

Concomitant myocardial infarction and systemic embolism associated with thrombosis of the right coronary ostium: a case report.

Background: Sequential occurrences of acute ischaemic stroke in patients with acute myocardial infarction (MI) and vice versa have been reported, but not the simultaneous occurrence of both conditions. We report a case of simultaneous occurrence of MI and systemic embolism caused by a mechanism not reported to date.

Case Summary: A 52-year-old female patient presented with concurrent chest pain, right arm weakness, and dysphasia.

Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis-Study of Treatment's Echocardiographic Mechanisms (CLOVERS-STEM).

Importance: Receipt of fluid and vasopressors, common treatments in septic shock, may affect cardiac function.

Objectives: We sought to determine whether a liberal or restrictive fluid resuscitation strategy was associated with changes in cardiac function.

Design: We prospectively studied a subset of patients enrolled in the Crystalloid Liberal or Vasopressors Early Resuscitation in Sepsis (CLOVERS) trial, performing echocardiography at baseline and at 24 hours after randomization.

Extended Duration Bridge to Orthotopic Heart Transplant Utilizing the Impella RP Flex.

We present a case of a 56 year old man presenting with cardiogenic shock from isolated right ventricular failure due to arrhythmogenic right ventricular cardiomyopathy who was successfully bridged to heart transplantation after 29 days on an Impella RP Flex right ventricular assist device. This represents the longest reported duration of support with the device to date and highlights the utility of this platform in the management of severe right ventricular failure.

Pulmonary Emboli Mimicking ST-Elevation Myocardial Infarction Patterns.

A pulmonary embolism (PE) is a serious condition characterized by obstruction of the pulmonary arteries, often presenting with symptoms such as sudden shortness of breath and chest pain. While pulmonary emboli and ST-segment elevation myocardial infarctions (STEMI) are distinct clinical entities, they can present with similar electrocardiogram (ECG) findings, complicating diagnosis and management. This study presents two case reports of patients who exhibited ECG changes resembling STEMI but were ultimately diagnosed with PE via CT angiography (CTA).

COMPLETE HEART BLOCK IN PATIENTS PRESENTING WITH ACUTE ANTERIOR WALL MYOCARDIAL INFARCTION.

Background: Complete heart block (CHB) is a relatively common complication in post-acute myocardial infarction (AMI) patients. Data on the incidence and consequences of CHB in patients with ST-segment elevation myocardial infarction (STEMI) are limited. Besides serving as an indicator of widespread myocardial injury, the development of CHB in STEMI is also associated with a higher risk of sudden cardiac death.

Evaluation of right ventricular systolic function in patients with acute myocardial infarction with ST-segment elevation undergoing pharmaco-invasive strategy or primary angioplasty.

Objective: To assess differences in right ventricular function between the primary angioplasty and pharmacoinvasive groups using echocardiographic parameters.

Method: Observational, retrospective, and cross-sectional study conducted on 111 patients in a cardiac care unit, where ventricular function was evaluated through transthoracic echocardiography.

Results: There were no significant differences in right ventricular function parameters (TAPSE, FAC, S' wave, RV Tei index, right V/A coupling) between both groups.

Case 331: Cardiac Sarcoidosis.

A 43-year-old male patient with no known past medical history presented to the emergency department with new-onset bitemporal headache, dizziness, and bilateral lower extremity weakness for 1 day. The patient denied chest pain, shortness of breath, cough, or recent exposure to sick individuals. He was not on any medications and denied alcohol or illicit drug use.

Electrocardiographic findings for predicting the left anterior descending artery chronic total occlusion in patients with inferior ST-segment elevation myocardial infarction.

In determining the culprit vessel responsible for inferior ST-segment elevation myocardial infarction (STEMI) as either the right coronary artery (RCA) or left circumflex (LCX), the electrocardiographic value has been validated. However, its ability to predict whether inferior STEMI is complicated by left anterior descending artery (LAD) chronic total occlusion remains uncertain. Based on the involvement of arteries other than the culprit vessels, 189 patients with inferior STEMI from our chest pain center were categorized into four groups: LAD occlusion group (n = 20), LAD stenosis > 50% group (n = 116), normal LAD group (n = 27), and other vessel stenosis > 50% group (n = 26).

Disentangled representational learning for anomaly detection in single-lead electrocardiogram signals using variational autoencoder.

Wearable technology enables the unsupervised recording of electrocardiogram (ECG) signals. Analyzing these high-dimensional ECG data poses challenges regarding statistical approaches and explainability. This work investigates the feasibility of medically explainable anomaly detection through disentangled representational learning of ECGs and personalization to mitigate inter-subject variations.

Bioelectronic block of stellate ganglia mitigates pacing-induced heterogeneous release of catecholamine and neuropeptide Y in the infarcted pig heart.

The sympathetic nervous system modulates cardiac contractile and electrophysiological function and contributes to adverse remodelling following myocardial infarction (MI). Axonal modulation therapy (AMT), directed at the sympathetic chain, blocks efferent sympathetic outflow to the heart and is a strategy to transiently and controllably mitigate chronic MI-associated sympatho-excitation. In porcine models, we evaluated scalable AMT, directed at the paravertebral chain, in blocking reflex-mediated pacing-induced sympatho-excitation post-MI.