Images of the month 1: Histoacryl glue embolisation to the right ventricle following treatment for gastric varices.

A 46-year-old woman presented with decompensated liver disease. Upper gastrointestinal endoscopy demonstrated a gastric fundal varix with stigmata of recent bleeding. She was treated with Histoacryl glue and lipiodol injection. As a part of a clinical trial, a transthoracic echocardiography was performed. This showed an echogenic mass in the right ventricle. The mass was initially assumed to be thrombus, but as the clinical story did not fit with this, she had further investigations. Computed tomography found the mass to be very radio-opaque with embolisation into the right lung. This is a rare appearance of glue embolisation, a recognised complication of treatment with Histoacryl glue.

Sex differences in transaortic flow rate and association with all-cause mortality in patients with severe aortic stenosis.

AIMS: It is not known whether transaortic flow rate (FR) in aortic stenosis (AS) differs between men and women, and whether the commonly used cut-off of 200 mL/s is prognostic in females. We aimed to explore sex differences in the determinants of FR, and determine the best sex-specific cut-offs for prediction of all-cause mortality. METHODS AND RESULTS: Between 2010 and 2017, a total of 1564 symptomatic patients (mean age 76 ± 13 years, 51% men) with severe AS were prospectively included. Mean follow-up was 35 ± 22 months. The prevalence of cardiovascular disease was significantly higher in men than women (63% vs. 42%, P < 0.001). Men had higher left ventricular mass and lower left ventricular ejection fraction compared to women (both P < 0.001). Men were more likely to undergo an aortic valve intervention (AVI) (54% vs. 45%, P = 0.001), while the death rates were similar (42.0% in men and 40.6% in women, P = 0.580). A total of 779 (49.8%) patients underwent an AVI in which 145 (18.6%) died. In a multivariate Cox regression analysis, each 10 mL/s decrease in FR was associated with a 7% increase in hazard ratio (HR) for all-cause mortality (HR 1.07; 95% CI 1.03-1.11, P < 0.001). The best cut-off value of FR for prediction of all-cause mortality was 179 mL/s in women and 209 mL/s in men. CONCLUSION: Transaortic FR was lower in women than men. In the group undergoing AVI, lower FR was associated with increased risk of all-cause mortality, and the optimal cut-off for prediction of all-cause mortality was lower in women than men.