Circulating Tumour Cells in Patients with Malignant Lung Tumors Undergoing Radio-frequency Ablation.

Background/aim: Radiofrequency ablation (RFA) is an increasingly utilised technique in patients with surgically-untreatable lesions. The effect of this therapy on circulating tumor cells (CTCs) is unknown. As far as we are aware of, this is the first study to evaluate the effects of RFA on CTCs in patients with malignant lung tumors immediately post-treatment.

Pseudoaneurysm of a branch of left internal mammary artery: a late and potentially fatal complication after redo-sternotomy.

Post-sternotomy pseudoaneurysms of the internal mammary arteries (IMAs) and their branches are rare and often present with rupture-associated haemothorax and haemodynamic instability. In those cases, urgent surgical correction or embolization can be the treatment of choice. Traumatic chest injuries might lead to IMA branch injury as well; after cardiac surgery, injuries to these branches during sternal closure can be an extremely rare cause of pseudoaneurysm.

Utility of noninvasive arrhythmia mapping in patients with adult congenital heart disease.

Arrhythmia management in patients with adult congenital heart disease (ACHD) is a challenge on many levels, as tachycardic episodes may lead to hemodynamic impairment in otherwise compensated patients even if episodes are only transient. Recently several technical advances, including 3-dimensional (3D) image integration, 3D mapping, and remote magnetic navigation, have been introduced to facilitate curatively intended ablation procedures in patients with ACHD. This review attempts to outline the role of a novel technology of simultaneous, noninvasive mapping in this patient cohort, and gives details of the authors' single-center experience.

Transcatheter aortic valve implantation in the United Kingdom: temporal trends, predictors of outcome, and 6-year follow-up: a report from the UK Transcatheter Aortic Valve Implantation (TAVI) Registry, 2007 to 2012.

Background: We assessed trends in the performance of transcatheter aortic valve implantation in the United Kingdom from the first case in 2007 to the end of 2012. We analyzed changes in case mix, complications, outcomes to 6 years, and predictors of mortality.

Methods And Results: Annual cohorts were examined.

Phagocytosis-dependent activation of a TLR9-BTK-calcineurin-NFAT pathway co-ordinates innate immunity to Aspergillus fumigatus.

Transplant recipients on calcineurin inhibitors are at high risk of invasive fungal infection. Understanding how calcineurin inhibitors impair fungal immunity is a key priority for defining risk of infection. Here, we show that the calcineurin inhibitor tacrolimus impairs clearance of the major mould pathogen Aspergillus fumigatus from the airway, by inhibiting macrophage inflammatory responses.

Primary bacteraemia is associated with a higher mortality risk compared with pulmonary and intra-abdominal infections in patients with sepsis: a prospective observational cohort study.

Objective: To investigate whether common infection foci (pulmonary, intra-abdominal and primary bacteraemia) are associated with variations in mortality risk in patients with sepsis.

Design: Prospective, observational cohort study.

Setting: Three surgical intensive care units (ICUs) at a university medical centre.

The expanding role of lipoprotein apheresis in the treatment of raised lipoprotein(a) in ischaemic heart disease and refractory angina.

It is increasingly recognised that lipoprotein(a) [Lp(a)], an inherited, genetically-determined form of LDL-cholesterol, is an independent cardiovascular risk factor and predictor of adverse cardiovascular outcomes. Lp(a) is felt to increase cardiovascular risk via its pro-thrombotic effect and by enhancing intimal lipoprotein deposition. Lipoprotein apheresis is currently the most effective treatment for raised Lp(a).

Device-dependent association between paravalvar aortic regurgitation and outcome after TAVI.

Objective: The aim of the current study was to identify predictors of paraprosthetic aortic regurgitation (AR) after transcatheter aortic valve implantation (TAVI) and examine its influence on short/medium-term mortality using the UK TAVI Registry. TAVI is an effective treatment for high-risk patients with severe symptomatic aortic stenosis (AS), but paraprosthetic AR has been associated with increased in-hospital and mid-term mortality.

Methods: Between January 2007 and December 2011, 2584 TAVI procedures were performed in the UK.

Fetal aortic valvuloplasty: investigating institutional bias in surgical decision-making.

Objectives: Fetal aortic valvuloplasty may prevent the progression of aortic stenosis to hypoplastic left heart syndrome and allow biventricular rather than univentricular postnatal treatment. This study aimed to investigate whether blinded simulation of a multidisciplinary team approach aids interpretation of multicenter data to uncover institutional bias in postnatal decision-making following fetal cardiac intervention for aortic stenosis.

Methods: The study included 109 cases of prenatally diagnosed aortic stenosis from 13 European countries, of which 32 had undergone fetal cardiac intervention.

Design of the INPULSIS™ trials: two phase 3 trials of nintedanib in patients with idiopathic pulmonary fibrosis.

Background: Nintedanib is in clinical development as a treatment for idiopathic pulmonary fibrosis (IPF). Data from the Phase II TOMORROW study suggested that nintedanib 150 mg twice daily had clinical benefits with an acceptable safety profile.

Methods: The INPULSIS™ trials are replicate Phase III, randomized, double-blind, studies comparing the efficacy and safety of nintedanib 150 mg twice daily with placebo in patients with IPF.

Mycobacterium avium complex infection in non-cystic fibrosis bronchiectasis.

Background And Objective: Reliable markers of disease progression or stability to assist in management decisions are lacking in patients with non-cystic fibrosis bronchiectasis and Mycobacterium avium complex (MAC) infection.

Methods: Data from 52 adults with non-cystic fibrosis bronchiectasis and coexisting MAC infection managed at our institution over a 5-year period were retrospectively analysed. High-resolution computed tomography (HRCT) scans were scored using a scoring system that focused on findings associated with MAC infection.

Chronic hypersensitivity pneumonitis in patients diagnosed with idiopathic pulmonary fibrosis: a prospective case-cohort study.

Background: The clinical features of idiopathic pulmonary fibrosis (IPF) and chronic hypersensitivity pneumonitis can be indistinguishable; the need to eliminate occult environmental factors known to cause pulmonary fibrosis in patients suspected to have IPF during diagnostic evaluation is evident. We aimed to investigate occult, putative causes in the environments of patients diagnosed with IPF using tests beyond those conventionally used.

Methods: In this case-cohort study, 60 consecutive patients diagnosed with IPF on the basis of the 2000 American Thoracic Society (ATS) and the European Respiratory Society (ERS) criteria were prospectively followed up every 4 months for 6 years between Jan 1, 2004, and Dec 31, 2009.

Advanced ablation strategies for management of post-surgical atrial arrhythmias.

Post-surgical arrhythmias include a wide range of arrhythmias occurring late after cardiac surgery and represent a complex substrate for catheter ablation either because of extended scar and remodeling or because of limited access to the area of interest. Novel image integration and ablation tools have made the catheter ablation in this population both feasible and successful. We review a structured approach to catheter ablation of post-surgical atrial arrhythmias in various patient cohorts including the most common congenital heart defects.

Accessory pathway ablation in a 6-year-old girl using remote magnetic navigation as an alternative to cryoablation.

A 6-year-old girl with evidence of a parahisian accessory pathway on a baseline electrocardiogram underwent successful catheter ablation using magnetic navigation. Magnetic remote controlled ablation eliminated the parahisian pathway with the first radiofrequency application. A second anterolaterally located concealed pathway was successfully ablated in the same session, resulting in exclusively atrioventricular nodal conduction bidirectionally (total fluoroscopy, 4 min; 25 μGy).

Low-density lipoprotein apheresis is effective in reducing lipoprotein(a) levels and in improving symptoms in a patient with refractory angina secondary to accelerated coronary artery disease.

Coronary artery disease remains a significant cause of morbidity and mortality in the Western world. High plasma Lp(a) concentrations are related to the risk of cardiovascular disease, but Lp(a) is rarely assayed and treated. We present the case of a 50-year-old gentleman with refractory angina, whose coronary disease continued to progress despite optimal medical and surgical therapy.

[Intraoperative interruption of an accessory pathway: is it always a long-term cure for arrhythmia?].

We report the case of a male patient who had undergone successful cardiac surgery about 20 years previously for a posteroseptal accessory pathway that caused almost incessant orthodromic AV reentrant tachycardia, but presented again recently with new onset cardiac arrhythmia. 3D mapping demonstrated scar-related reentrant tachycardia in the right atrium with a critical isthmus between the atriotomy scar and terminal crest, which could be successfully treated using irrigated-tip high-frequency catheter ablation.

Left atrial tachycardia in a patient with calcified coronary aneurysms due to Kawasaki disease.

Kawasaki disease (KD) is an acute vasculitis involving all blood vessels with frequent cardiovascular complications. We describe a 28-year-old patient with childhood KD having coronary complications at the age of 17 now presenting with sustained atrial tachycardia. Electrophysiological study and catheter ablation were performed.

Anatomy of the Pericardial Space and Mediastinum: Relevance to Epicardial Mapping and Ablation.

The pericardial space is a fairly new portal for interventional cardiac electrophysiologists to access the heart and requires an understanding of its anatomic peculiarities to maneuver safely around the epicardial surfaces of the heart and great veins. Subxiphoid puncture should allow the diaphragm and fibrous pericardium to be crossed without entering the right ventricle, which is the most anteriorly situated cardiac chamber. The phrenic nerves descend on the fibrous pericardium bilaterally.

Bridging patients after salvage from bridge to decision directly to transplant by means of prolonged support with the CentriMag short-term centrifugal pump.

Objective: Optimum strategy for salvage in patients with acutely decompensated end-stage heart failure and severe multiorgan dysfunction is complex. We present our experience with prolonged CentriMag (Levitronix, Waltham, Mass) support for transitioning patients after successful salvage from bridge to decision directly to transplant.

Methods: Records of patients who underwent salvage with a CentriMag as bridge to decision and later to transplant were reviewed.

'Two-by-two' pulmonary vein isolation in the presence of a complete situs inversus and dextrocardia: use of magnetic navigation and 3D mapping with image integration.

Interventions in patients with 'abnormal' anatomy are a challenge for every invasive cardiologist. Understanding of the underlying geometry by 3D reconstruction of a pre-acquired image is facilitating the orientation of the operator. The report describes how to perform catheter ablation of atrial fibrillation in a patient with complete situs inversus using the magnetic navigation system in conjunction to electroanatomical mapping.