Coarctation of the aorta in adults: what is the best treatment? Case report and literature review.

Coarctation of the aorta is a congenital cardiac malformation that can go undiagnosed until old age with only hypertension as a marker of its presence because clinical signs can be subtle and overlooked if a complete physical exam is not performed. We report the case of a 45 year-old women, diagnosed with severe coarctation of the aorta just distal to the left subclavian artery, with poststenotic dilatation of the descending aorta and difficult control of blood pressure values. The patient was successfully treated interventionally, by balloon angioplasty with deployment of a covered stent. We review here the different methods employed for the treatment of coarctation of the aorta in adults, including surgical or percutaneous balloon angioplasty with or without stent placement, underlying their complications and the factors that influence the choice of the best coarctation repair method.

Characterization of refractory port-related blood stream infections in intestinal failure patients on parenteral nutrition.

BACKGROUND AND AIMS: Parenteral nutrition is life-saving for patients with severe intestinal failure. Line-related blood stream infection is the most frequent complication and strategies have been developed to sterilize central lines. Nevertheless, failures of attempted sterilization are not well understood. METHODS: 19 ports were explanted from 19 patients receiving parenteral nutrition because of port-related blood stream infection and failed sterilization, defined as a) recurrence of the same organism after a recent sterilization attempt <90 days), b) recovery of the causative organism after 10 days of proper antibiotic therapy or c) insufficient clinical improvement. Port chambers were opened and swabs were examined by culture. RESULTS: Pathogens resembled those typically found in successfully treated line-related blood stream infection. Despite proper therapy for a median of 6.5 days the same pathogen was recovered from 18/19 chambers. In 9/19 chambers visible debris were found, from which the pathogen could be cultured. CONCLUSIONS: Infected debris or infected biofilms in the chamber are the reason for failure to sterilize a port. Lock techniques, single lumen tunneled catheters or in certain settings the exchange of only the port chamber may be approaches to prevent, circumvent or treat failures of attempted sterilization of an infected port system.