Iatrogenic ventricular septal defects following transcatheter aortic valve implantation.

Ventricular septal defect (VSD) rarely occurs following transcatheter aortic valve implantation (TAVI). We report two patients who developed VSD following TAVI. One case was a Gerbode defect treated by percutaneous closure, and the second was a restrictive perimembranous VSD managed conservatively.

Operative approach for right coronary artery to coronary sinus fistula.

Coronary artery fistula is a rare congenital heart disease that is defined as an abnormal connection between a coronary artery and a cardiac vessel or cardiac chamber. Most coronary artery fistulas involve the right coronary artery draining into the right-sided heart structures. We present a patient with right coronary artery to coronary sinus fistula diagnosed by coronary angiography. The surgical approach of retrograde cardioplegia and transatrial resection allowed for protection of the myocardium and definitive visualization and closure of the abnormal fistula.

Angiosarcoma of the right atrium presenting as hemoptysis.

This case report describes a previously healthy 32-year-old man who presented with several weeks of hemoptysis. Initially he was treated with antibiotics with a preliminary diagnosis of pneumonia. With increasing hemoptysis and additional symptoms, he was referred to our institution. Cardiac magnetic resonance imaging suggested a diagnosis of right atrial angiosarcoma with extensive pulmonary metastases. His extensive pulmonary tumor burden caused the hemoptysis. Pulmonary biopsy was well tolerated, and he was referred to medical oncology for adjuvant therapy. Following the first cycle of chemotherapy, his hemoptysis lessened.

Temporary left ventricular assist device through an axillary access is a promising approach to improve outcomes in refractory cardiogenic shock patients.

Cardiogenic shock (CS) causes significant morbidity and mortality and such patients can deteriorate rapidly. Temporary left ventricular assist devices (LVADs) are a promising approach to manage these patients. The following is a case series in which patients stabilized with a temporary LVAD for CS improvement were analyzed retrospectively. Between June 2011 and January 2014, 15 patients received temporary devices through an axillary approach (mean age: 53 ± 15, 93% male). Mean survival time was 317.8 ± 359.5 days (range: 6-936 days). During support there were no major bleeding events, infectious complications at the axillary access site, upper extremity edema, or emboli. The most of the patients recovered from CS (93%) were mobilized (67%) and were extubated (73%) while on temporary device support. Median times to extubation, intensive care unit discharge, and discontinuation of inotropic medications were: 1.63, 18, and 15 days, respectively. Four patients recovered to no device support and five received a long-term LVAD, all of whom remain alive. Therefore, implantation of a temporary LVAD through an axillary approach is a promising therapy for improving outcomes in patients needing mechanical circulatory support as a bridge to recovery or a definitive LVAD.

Consequence of patient substitution of nattokinase for warfarin after aortic valve replacement with a mechanical prosthesis.

This report describes a patient's self-substitution of nattokinase for the vitamin K antagonist warfarin after aortic valve replacement with a mechanical prosthesis. Nattokinase is an enzyme derived from a popular fermented soybean preparation in Japan (natto), which has fibrinolytic properties and is gaining popularity in nontraditional health journals and nonmedical health websites as an over-the-counter thrombolytic. After nearly a year of use of nattokinase without warfarin, the patient developed thrombus on the mechanical valve and underwent successful repeat valve replacement. We believe this is the first documented case of nattokinase being used as a substitute for warfarin after valve replacement, and we strongly discourage its use for this purpose.

Iatrogenic retained foreign body in the right atrium. Lessons to Learn.

INTRODUCTION: We report a case of a retained foreign body in the right atrium and the review of the literature discussing several cases where the poor attention and management of medical staff has led to worsening consequences to patient's health. PRESENTATION OF CASE: In our case the mass demonstrated on MRI scan turned out to be an inflammatory process and organized clotted blood built around a broken piece of a plastic cannula protruding out of the right atrium. This caused debilitating pleuritic pain to the patient on presentation. DISCUSSION: The cause of this iatrogenic retained piece of cannula may well be from the patients prior diagnostic investigations. CONCLUSION: Algorithm managed indications for surgical removal of such foreign bodies in symptomatic patients lead to better patient's outcomes and decreases the chances of infection, embolization, or erosions within the heart. Keeping this in view, we managed our patient with success.

Radiofrequency maze ablation for atrial fibrillation in a patient undergoing atrial septal defect repair.

Chronic atrial fibrillation affects over 2.2 million people and is associated with complications including heart failure, stroke, and exercise intolerance. Since drug therapy and cardioversion have been only partially successful in restoring sinus rhythm, surgical procedures were developed for medically refractory atrial fibrillation (1). We report a case of successful left atrial radiofrequency ablation for chronic atrial fibrillation in a patient who had a large secundum atrial septal defect.