Experience using drug-coated balloon venoplasty for acquired pulmonary vein stenosis after radiofrequency ablation.

Pulmonary vein stenosis is a rare but severe complication of catheter ablation for arterial fibrillation (AF). Symptoms include dyspnea, hemoptysis, recurrent pneumonia, and pulmonary hypertension. We herein discuss a 27-year-old male patient who presented with hemoptysis and dyspnea three months after catheter ablation for AF. Computed tomography demonstrated an occluded left inferior pulmonary vein (LIPV) and left lower lung edema secondary to severe stenosis of the LIPV. The patient underwent treatment, including drug-coated balloon (DCB) venoplasty. Treatment of pulmonary vein stenosis involving percutaneous interventions with balloon angioplasty and stenting carry a high risk of restenosis. DCB therapy may be used to prevent stenosis. .

Epicardial pacemaker implantation for sick sinus syndrome in a patient with supra vena cava obstructed by a primary cardiac lymphoma.

Primary cardiac lymphoma (PCL) involves the heart and pericardium. Symptoms may vary according to the cardiac site involved. The most frequent cardiac manifestations associated with PCL are pericardial effusion, heart failure, and atrioventricular block. PCL can be diagnosed using transesophageal echocardiography, computed tomography (CT), or magnetic resonance imaging. We herein discuss a 67-year-old male patient who presented with sick sinus syndrome. CT demonstrated a tumor in the right atrium obstructing the superior vena cava. The patient underwent a diagnostic lateral thoracotomy with concomitant epicardial pacemaker insertion. Histological examination revealed a diffuse large B cell lymphoma, and chemotherapy, including rituximab, was begun. A diagnostic thoracotomy is crucial for a definitive diagnosis of PCL, and the most effective treatment is chemotherapy. .

Effect of carperitide on in-hospital mortality of patients admitted for heart failure: propensity score analyses.

Although a previous randomized study showed that the use of atrial natriuretic peptide (carperitide) improved the long-term prognosis of patients with heart failure, its effect on short-term prognosis remains unclear. We retrospectively identified patients who were admitted to our tertiary-care center with acute decompensated heart failure (ADHF) between April 2009 and December 2013.We divided the eligible patients into two groups: patients who started receiving carperitide on the day of admission (carperitide group) and those who did not receive carperitide during hospitalization (control group). We compared the in-hospital mortality between the two groups using propensity scores derived from 40 baseline variables. We identified 879 eligible patients (mean age, 75.2 years; male, 56.7%), including 336 (38.2%) in the carperitide group and 543 (61.8%) in the control group. One-to-one propensity score matching created 177 pairs. Although the unmatched analysis found a significantly lower in-hospital mortality in the carperitide group than in the control group (3.3% vs. 7.9%, respectively, p = 0.005), the propensity score-matched analysis found no significant difference in in-hospital mortality between the two groups [4.0% vs. 5.1%, p = 0.609; risk difference, -1.1%, 95% confidence interval (CI), -5.5-3.2%]. Logistic regression analysis with adjustment for propensity scores also found no significant association between carperitide use and in-hospital mortality (adjusted odds ratio, 0.61; 95% CI, 0.29 to 1.28; p = 0.605). The present retrospective study showed that carperitide use as the initial treatment was not significantly associated with lower in-hospital mortality in patients with ADHF.