Marked attenuation of shock burden by the use of antitachycardia pacing therapy in a patient with an implanted cardioverter-defibrillator.

A 76-year-old man was admitted to our institution for elective exchange of his implanted cardioverter-defibrillator generator. Nine years earlier, he had been diagnosed with nonischemic cardiomyopathy and nonsustainable ventricular tachycardia. At that time, he had received a single-chamber implanted cardioverter-defibrillator, which was upgraded to a dual-chamber implanted cardioverter-defibrillator 3 years later.

Percutaneous stenting to treat pulmonary vein stenosis after single-lung transplantation.

Pulmonary vein stenosis after lung transplantation is rare. Untreated, it can cause transplant failure and death. We describe the case of a 56-year-old man in whom pulmonary vein stenosis developed after single-lung transplantation.

Remission of chronic anthracycline-induced heart failure with support from a continuous-flow left ventricular assist device.

We report the case of a patient who had chronic anthracycline-induced cardiomyopathy that was reversed after treatment with a left ventricular assist device. A 29-year-old woman had undergone anthracycline-based chemotherapy as a teenager in 1991 and 1992 and received a diagnosis of dilated cardiomyopathy 10 years later. Optimal medical therapy had initially controlled the symptoms of heart failure.

Multiple left ventricular thrombi in a patient with left ventricular noncompaction.

The major clinical features of myocardial noncompaction are heart failure, arrhythmias, and thromboembolic events. Prominent myocardial trabeculae and deep recesses characteristic of myocardial noncompaction can cause stagnant blood flow and the formation of left ventricular clots. We describe the case of a 62-year-old woman who presented with symptoms of heart failure secondary to left ventricular noncompaction.

Continuous-flow total heart replacement device implanted in a 55-year-old man with end-stage heart failure and severe amyloidosis.

We implanted a continuous-flow total heart replacement device in a 55-year-old man who had severe end-stage heart failure due to amyloidosis and no other options for treatment. The device was composed of 2 modified HeartMate II ventricular assist pumps. After the implantation, our patient recovered normal neurologic function and was able to converse with his family and work on his computer.

Carotid artery stenting versus endarterectomy: a systematic review.

For about 2 decades, investigators have been comparing carotid endarterectomy with carotid artery stenting in regard to their effectiveness and safety in treating carotid artery stenosis. We conducted a systematic review to summarize and appraise the available evidence provided by randomized trials, meta-analyses, and registries comparing the clinical outcomes of the 2 procedures. We searched the MEDLINE, SciVerse Scopus, and Cochrane databases and the bibliographies of pertinent textbooks and articles to identify these studies.

Transthoracic echocardiography of the HeartWare left ventricular assist device.

Background: The unique findings on transthoracic echocardiography of the HeartWare left ventricular assist device (LVAD) have not been previously described.

Methods And Results: HeartWare LVADs were implanted in 19 patients from May 2009 through December 2010; 152 comprehensive transthoracic echocardiograms (TTEs) performed postoperatively on these patients were retrospectively analyzed for device component visualization, inlet cannula/outflow conduit flow velocities, and imaging artifacts. The inlet cannula was adequately visualized in 66% of studies, incompletely visualized in 14%, and not visualized in 20%.

Loss of function of hNav1.5 by a ZASP1 mutation associated with intraventricular conduction disturbances in left ventricular noncompaction.

Background: Defects of cytoarchitectural proteins can cause left ventricular noncompaction, which is often associated with conduction system diseases. We have previously identified a p.D117N mutation in the LIM domain-binding protein 3-encoding Z-band alternatively spliced PDZ motif gene (ZASP) in a patient with left ventricular noncompaction and conduction disturbances.

Advances in ablation of ventricular tachycardia in nonischemic cardiomyopathy.

Management of patients with nonischemic cardiomyopathy (NICM) and ventricular tachycardia (VT) remains challenging. The role of catheter ablation for VT continues to evolve for these patients. Prior reports have described the location of the arrhythmogenic substrate for patients with NICM to be frequently located along the basal left ventricle, with an epicardial predilection.

Human molecular genetic and functional studies identify TRIM63, encoding Muscle RING Finger Protein 1, as a novel gene for human hypertrophic cardiomyopathy.

Rationale: A delicate balance between protein synthesis and degradation maintains cardiac size and function. TRIM63 encoding Muscle RING Finger 1 (MuRF1) maintains muscle protein homeostasis by tagging the sarcomere proteins with ubiquitin for subsequent degradation by the ubiquitin-proteasome system (UPS).

Objective: To determine the pathogenic role of TRIM63 in human hypertrophic cardiomyopathy (HCM).

Remission of chronic, advanced heart failure after left ventricular unloading with an implantable left ventricular assist device.

We describe the case of a 35-year-old man with severe, dilated idiopathic cardiomyopathy who was placed on the waiting list for cardiac transplantation. While awaiting transplantation, his heart failure decompensated to such a degree that left ventricular assist device support was necessary. He did well on device support until a pump-pocket infection (methicillin-resistant coagulase-negative staphylococci) developed at 10 months.

Adenocarcinoma of the parotid gland metastatic to the ventricular septum and right ventricular wall.

Adenocarcinoma of the parotid gland metastatic to the right ventricle has rarely been reported in the medical literature. We describe the case of a 51-year-old man who had a right ventricular adenocarcinoma that metastasized from his right parotid gland. He had undergone incomplete resection of the parotid tumor, followed by radiotherapy, 5 years earlier.

Isolated left ventricular noncompaction in a 90-year-old man.

Isolated ventricular myocardial noncompaction is a cardiomyopathy that is being diagnosed more frequently in patients of all ages because of increased awareness and improvements in imaging methods. It is an extremely rare cause of heart failure in nonagenarians. We describe the case of a man who presented with heart failure for the first time at 90 years of age.

An evidence-based guide for coronary calcium scoring in asymptomatic patients without coronary heart disease.

As public awareness and clinical use of CAC screening increases, physicians should, at a minimum, know the following information: 1) The presence of CAC indicates underlying CHD but does not predict luminal obstruction. 2) Non-contrast, prospectively ECG-gated cardiac EBCT and MDCT are sensitive, reproducible, rapid, and essentially equivalent imaging techniques commonly used to screen for CAC. 3) Currently, CAC screening is appropriate for all intermediate- risk patients and low-risk patients with a family history of premature CHD, and might be appropriate for all low-risk women.

Identify and treat depression for reduced cardiac risk and improved outcomes.

Why do we stay in prison when the door is wide open? - Jalal ad-Din Rumi. Depression is an independent risk factor for the development of CAD. Patients with CAD have a high rate of depression, which worsens their prognosis.

Closure of post-myocardial infarction ventricular septal defect with use of intracardiac echocardiographic imaging and percutaneous left ventricular assistance.

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Infected right atrial thrombus after explantation of a left ventricular assist device.

Finding the source of a fungal infection and selecting the most appropriate treatment for candidemia is often challenging for physicians, especially when the patient has a complex medical history. We describe the case of a 48-year-old woman who had persistent candidemia after undergoing explantation of a left ventricular assist device. The source of the infection was found to be a right atrial thrombus.

Differential local spasticity in myocardial bridges.

To illustrate the effect of myocardial bridges on coronary vascular tone, we describe the cases of 2 patients with different clinical presentations in the context of reproducible increased spasticity at the site of myocardial bridging. One had an episode of takotsubo cardiomyopathy, and one developed typical Prinzmetal angina while receiving desmopressin treatment for pituitary insufficiency. In both patients, acetylcholine challenge clearly revealed both the presence and the severity of myocardial bridging while producing several recognizable degrees of abnormal spastic tendency.