rare case of pulmonary artery sling with the VACTERL association in a 20-month-old infant

The VACTERL association, co-occurrence of vertebral, anorectal, cardiac, tracheoesophageal, genitourinary, and limb malformations, is a rare congenital anomaly. Several cardiac anomalies have been reported as a part of the VACTERL association, particularly ventricular and atrial septal defects. Pulmonary artery sling is a rare congenital abnormality in which the left pulmonary artery arises from the right pulmonary artery. This anomaly is not frequently observed in the VACTERL association and has been rarely reported. A 20-month-old girl was admitted to our hospital due to pneumonia in the right lung, which had pulmonary artery sling as a part of the VACTERL association. Barium meal X-ray showed pressure effects on the esophagus, and computed tomography angiography revealed pulmonary artery sling. Pneumonia management was done. However, the parents of our patient refused to give consent for the surgical correction of this vascular anomaly. Three months after discharge from the hospital, the patient was visited, at which time the parents again refused surgery and treatment for their daughter despite our recommendations

SYNTAX score can predict major adverse cardiac events following percutaneous coronary intervention

The SYNTAX score is a grading system that evaluates the complexity and prognosis of patients undergoing percutaneous coronary intervention [PCI]. We investigated the association between the incidence of major adverse cardiac events [MACE] following PCI and the SYNTAX score in patients with three-vessel disease. We consecutively enrolled 381 patients with three-vessel disease undergoing PCI and stenting. The SYNTAX score was divided into tertiles as low [22]. The endpoint was the incidence of MACE defined as cardiac death, in-hospital mortality, nonfatal myocardial infarction [MI], or target vessel revascularization. Then, the incidence of MACE was compared among the SYNTAX score tertile groups. The median follow-up was 14 months, and the rate of MACE was 12.6%. The rates of MACE were 7.5%, 9.9%, and 21.6% in patients with low, intermediate, and high SYNTAX score tertiles, respectively. Higher SYNTAX scores significantly predicted a higher risk of MACE [hazard ratio = 2.36; P = 0.02] even after adjustment for potential confounders. The main predictors of MACE were SYNTAX score, advanced age, hyperlipidemia, presentation as recent ST-elevation MI, number of total lesions, and history of renal failure. The SYNTAX score could predict major cardiac outcomes following PCI in patients with three-vessel disease

[CAM visual stimulation with conventional method of occlusion treatment in amblyopia: a randomized clinical trial]

The application of CAM visual stimulation returns to the date of more than fifty years ago. However, the reports of previous studies in this field vary from no effect to significant effects of this method in amblyopia treatment. The purpose of this study was to determine the effect of CAM visual stimulation along with conventional occlusion therapy in anisometropic amblyopic children. Forty amblyopic children aged 4 to 6 years old with no previous treatment were enrolled in this randomized clinical trial study. The subjects were randomly assigned in two different groups. The group 1 included conventional occlusion therapy and group 2 includes occlusion therapy with complementary CAM visual stimulation. In terms of visual acuity and stereopsis improvement and reduction of amblyopia severity, two groups were compared using the repeated measure ANOVA and LSD Post Hoc tests. In group 1 including conventional occlusion therapy, visual acuity improved from 0.444 +/- 0.077 logMAR to 0.138 +/- 0.023 logMAR, i.e., improvement of 0.306 logMAR [P<0.001] whereas in group 2 including complementary CAM usage, visual acuity improved from 0.398 +/- 0.075 logMAR to 0.047 +/- 0.022 logMAR, i.e., improvement of 0.351 logMAR [P<0.001]. Regarding Stereopsis, the improvements were 157 [from 258 +/- 34 to 101 +/- 13 seconds of arc, P<0.001] and 171 [from 237 +/- 33 to 66 +/- 12 seconds of arc, P<0.001] for groups 1 and 2 respectively. All subjects of group 2 gained the normal vision at the end of the treatment period, whereas only 47% of subjects of group 1 could achieve this level of vision in that time. Improvement of visual acuity in group 2 was significantly better than group 1 [P<0.05]. Using of CAM visual stimulation along with conventional occlusion will further improve visual acuity and stereopsis in amblyopic children. These findings recommended the CAM visual stimulation as an accompanying and complementary method in amblyopia treatment

Characterization of suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy

Differences in the quantity and distribution of coronary veins between patients with ischemic and non-ischemic cardiomyopathy might affect the potential for the left ventricular [LV] lead targeting in patients undergoing cardiac resynchronization therapy [CRT]. In the current study, we assessed and compared the suitability of the coronary venous system for the LV lead placement in ischemic and dilated cardiomyopathy. This single-centre study, performed at our hospital, retrospectively studied 173 patients with the New York Heart Association class III or IV who underwent CRT. The study population was comprised of 74 patients with an ischemic underlying etiology and 99 patients with a non-ischemic etiology. The distribution of the veins as well as the final lead positions was recorded. There was no significant difference between the two groups in terms of the position of the available suitable vein with the exception of the posterior position, where the ischemic group had slightly more suitable veins than did the dilated group [48.4% versus 32.1%, p value - 0.049]. There was also no significant difference with respect to the final vein, through which the LV lead was inserted. Comparative analysis showed that the patients with previous coronary artery bypass grafting surgery [CABG] had significantly fewer suitable veins in the posterolateral position than did the non-CABG group [16.3% versus 38.7%, p value = 0.029]. There was, however, no significant difference between the two subgroups regarding the final vein position in which the leads were inserted. The final coronary vein position suitable and selected for the LV lead insertion was not different between the cases with cardiomyopathy with different etiologies, and nor was it different between the ischemic cases with and without a history of CABG. Patients with a history of procedures around the coronary vessel may have an intact or recovered venous system and may, therefore, benefit from transvenous LV lead placement for CRT

Atrial standstill: a rare case

We introduce a 32-year-old man who was evaluated for a dizziness and headache of unknown origin for at least two months and was referred to our center after ECG findings. He was finally diagnosed as a case of idiopathic, familial, diffuse, persistent atrial standstill, which is a rare arrhythmogenic condition characterized by the absence of electrical and mechanical activity in the atria. He successfully received a single-chamber permanent pacemaker

Unusual treatment of pacemaker pocket infection: a case report

Pocket infection of a cardiac device is usually treated by removing the device and re-implanting it in a new site after complete treatment of the infection. This report illustrates a complicated case of pocket infection in the wake of the implantation of a permanent pacemaker [cardiac resynchronization therapy]. The patient was treated conservatively through daily irrigation and dressing, broad-spectrum antibiotics, and debridement without the device being removed; the generator was kept out of the pocket for 5 weeks and then re-implanted in the same location successfully. The method of treatment presented herein can be of value, not least in the elderly population who might experience life-threatening events following the replacement of their cardiac devices