ABSTRACT
BACKGROUND: Our case demonstrates a novel use of the Sentinel™ cerebral protection device (SCPD) for prevention of stroke during removal of a thrombus-adherent atrial septal occluder. CASE PRESENTATION: A 45-year-old male with multiple strokes and ostium secundum atrial septal defect closed ten years prior using an Amplatzer Septal Occluder presented with recurrent neurologic symptoms. Over the ensuing year, serial transesophageal echocardiography revealed persistent and worsening device-adherent thrombus despite trial of different anticoagulants. The device appeared to be mal-deployed, prompting the decision for surgical explant. Given concern for embolization during explant, an SCPD was placed. Excision, pericardial patch repair, and Atriclip appendage closure (AAC) were performed. The device demonstrated incomplete endothelialization and microthrombi. SCPD filtration revealed embolic debris. CONCLUSIONS: We demonstrate the first successful use of an SCPD during surgical excision of a mal-deployed occluder. With its ease of use and safety, SCPD may have utility in surgeries with high cardio-embolic risk.
Subject(s)
Embolism , Heart Septal Defects, Atrial , Septal Occluder Device , Thrombosis , Cardiac Catheterization , Echocardiography, Transesophageal , Heart Septal Defects, Atrial/surgery , Humans , Male , Middle Aged , Thrombosis/etiology , Thrombosis/prevention & control , Treatment OutcomeABSTRACT
Atrial flutter (AFL) is a macro-reentrant tachycardia that can be provoked by numerous factors, including acute pericarditis. We present a case of new-onset AFL masking acute pericarditis in a man with multiple comorbid conditions, including hypertension, chronic kidney disease, and obstructive sleep apnea. After a failed attempt of rate control, the patient underwent successful cardioversion, which revealed electrocardiographic findings consistent with acute pericarditis. Colchicine was avoided in the setting of chronic kidney disease and the patient was treated with a steroid taper. Pericarditis is a rare cause of AFL, and this case demonstrates the diagnostic and management considerations for AFL and acute pericarditis.
ABSTRACT
BACKGROUND: Coronary artery aneurysms (CAAs) are a very rare finding on coronary angiograms with multiple known aetiologies. Parry Romberg syndrome (PRS) is also a very rare disease, and the underlying aetiology remains unknown. We present a rare case of CAAs in a patient with PRS, and discuss possible implications regarding the primary pathophysiological cause for both of these diseases. CASE SUMMARY: A 48-year-old woman with a history of PRS presented with atypical and non-exertional chest pain. Initial evaluation demonstrated a rising troponin without associated electrocardiogram changes, and as such she was taken for left heart catheterization. Left heart catheterization demonstrated diffuse aneurysmal and ectatic disease of multiple coronary arteries. Further evaluation with magnetic resonance angiogram and autoantibody panel did not demonstrate other vascular anomalies or rheumatologic disease, respectively. She was treated with dual anti-platelet therapy and statin, and at 1 year follow-up, she had resolution of her symptoms. DISCUSSION: It has been postulated that the underlying mechanism causing CAA is intravascular inflammation. Parry Romberg syndrome is theorized to be a neurovasculopathy, as evidenced by cases of associated intracranial aneurysms. Intravascular inflammation may play a key pathological role in CAA, and an association between CAA and PRS may exist.
