A Rare Case of Bivalvular Infective Endocarditis With Left Atrial Mural Endocarditis.

Infective endocarditis (IE) is a life-threatening cardiac infection usually associated with cardiac valves. Left atrial (LA) mural endocarditis is rarely seen and occurs in isolation or in conjunction with mitral valve endocarditis. We present a case of a 61-year-old male with no prior cardiac history who presented with melena and fevers. Blood cultures were positive for Enterococcus faecalis. Transesophageal echocardiogram (TEE) demonstrated aortic and mitral valve vegetations with several small echo densities present on the left atrial wall. These findings were further assessed with a computed tomography angiogram of the heart and cardiac magnetic resonance imaging Ti600 sequence. The patient was treated with intravenous antibiotics and underwent aortic and mitral valve replacement with resection of numerous small fungating masses on the left atrium. There are currently no formal guidelines in place for managing mural endocarditis. However, conducting a multidisciplinary evaluation by an endocarditis team could aid in achieving earlier and more precise diagnoses of the underlying condition and its complications. This approach could also ensure consistent antibiotic therapy and appropriate timing for surgical intervention.

Contrast-Induced Acute Kidney Injury: Review and Practical Update.

Contrast-induced acute kidney injury (CI-AKI) is an important consideration in patients undergoing cardiac catheterization. There has been a continuous strive to decrease morbidity and improve procedural safety. This review will address the pathophysiology, predictors, and clinical management of CI-AKI with a concise overview of the pathophysiology and a suggested association with left atrial appendage closure. Minimizing contrast administration and intravenous fluid hydration are the cornerstones of an effective preventive strategy. A few adjunctive pharmacotherapies hold promise, but there are no consensus recommendations on prophylactic therapies.

Case Reports of Pembrolizumab-induced Acute Inflammatory Demyelinating Polyneuropathy.

Pembrolizumab is a humanized monoclonal antibody that blocks the programmed cell death 1 (PD-1) pathway, thereby enhancing antitumor immunity. As the use of immune checkpoint inhibitors becomes more prevalent, so do immune-related adverse events associated with their use. The immune-related adverse events linked with this class of drugs are commonly seen and most of the time are classified as mild adverse events. These are easily treated with steroids if recognition of symptomatology and treatment are promptly established. However, neurologic immune-related adverse events are less understood and have been infrequently cited in the medical literature, thus representing a challenge for clinicians.

Accuracy of Commonly-Used Imaging Modalities in Assessing Left Atrial Appendage for Interventional Closure: Review Article.

Periprocedural imaging assessment for percutaneous Left Atrial Appendage (LAA) transcatheter occlusion can be obtained by utilizing different imaging modalities including fluoroscopy, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound imaging. Given the complex and variable morphology of the left atrial appendage, it is crucial to obtain the most accurate LAA dimensions to prevent intra-procedural device changes, recapture maneuvers, and prolonged procedure time. We therefore sought to examine the accuracy of the most commonly utilized imaging modalities in LAA occlusion. Institutional Review Board (IRB) approval was waived as we only reviewed published data. By utilizing PUBMED which is an integrated online website to list the published literature based on its relevance, we retrieved thirty-two articles on the accuracy of most commonly used imaging modalities for pre-procedural assessment of the left atrial appendage morphology, namely, two-dimensional transesophageal echocardiography, three-dimensional transesophageal echocardiography, computed tomography, and three-dimensional printing. There is strong evidence that real-time three-dimensional transesophageal echocardiography is more accurate than two-dimensional transesophageal echocardiography. Three-dimensional computed tomography has recently emerged as an imaging modality and it showed exceptional accuracy when merged with three-dimensional printing technology. However, real time three-dimensional transesophageal echocardiography may be considered the preferred imaging modality as it can provide accurate measurements without requiring radiation exposure or contrast administration. We will present the most common imaging modality used for LAA assessment and will provide an algorithmic approach including preprocedural, periprocedural, intraprocedural, and postprocedural.