Coil Embolization for Management of Brachiocephalic Artery Perforation and Mediastinal Hematoma Following Percutaneous Coronary Intervention.

In this clinical image vignette, we illustrate the presentation and management of an extremely rare and lethal complica- tion of radial access percutaneous coronary intervention. We present a case of perforation of a small collateral branch of the brachiocephalic artery with subsequent mediastinal hematoma formation and stridor presentation. We suspect the perforation was probably caused by the hydrophilic-coated guidewire. After a multidisciplinary heart team discussion, a percutaneous approach was recommended. We performed the procedure with a single coil embolization of the collateral branch perforation, achieving complete resolution of the hemorrhage.

Acute Myocardial Infarction with Non-Obstructive Coronary Arteries - Stratifying the Risk of a "new" Clinical Entity using an "Old" Tool

Abstract Background Some of the patients admitted for acute myocardial infarction have non-obstructive coronary artery disease (MINOCA). Their prognosis is not always benign, making it necessary the development of tools for risk stratification of these patients. Objectives To describe the characteristics of a sample of patients admitted for suspected MINOCA and to evaluate the prognostic value of GRACE score in this population. Methods This was a retrospective, observational, single-center, cohort study involving 56 consecutive patients with MINOCA. During one-year follow-up, patients were assessed for mortality and major adverse cardiovascular events (MACE) - a composite of all-cause mortality and hospitalization due to acute myocardial infarction, heart failure, ischemic stroke, and acute limb ischemia. Statistical analysis was performed using a non-parametric approach, with the Mann-Whitney U test for quantitative variables and ROC curves for assessing the discriminatory power of the Grace score in predicting cardiovascular events. The level of significance was set at 5%. Results Of the 56 MINOCA patients included in the study (median age 67 years), 55.4% were female. During the one-year follow-up, mortality rate was 5.5% and 9.1% of patients had MACE. A higher GRACE score was associated with mortality (p = 0.019; AUC 0.907; 95%CI 0.812-1.000; cut off 138) and MACE (p =0.034; AUC 0.790; 95%CI 0.632-0.948; cutoff 114). Conclusion The definition of MINOCA includes various diagnoses and prognoses, and the GRACE score is useful for risk stratification of patients with this condition.

Surgical treatment of concomitant severe heart disease and lung cancer.

The concomitant presentation of lung cancer and severe heart disease requiring intervention is a scenario that many clinicians have to face. Its common physiopathological substratum is unknown and it is believed that tobacco plays a role. From a surgical point of view, these patients pose various technical challenges and medical literature is scarce in providing solid answers. The aim of this report is to review our experience with cases undergoing combined surgical treatment of both heart disease and lung cancer, aiming to analyse patients' characteristics, operative technical considerations and related outcomes. A total of five patients were included, with two synchronous procedures, two cases with lung surgery being performed first and one case commenced with cardiac surgery. All cancers were non-small-cell lung carcinoma or carcinoid tumors and cardiac disease was mostly represented by severe aortic stenosis. Lobectomy was performed in two thirds of patients and minimally invasive techniques were used in 60% of the procedures. All valvular patients received a bioprosthesis. There was one immediate complication, with good recovery on follow-up, and there were no late events (median follow-up of 1,8 ±1,1 months). The analysis of these cases highlights the complex nature of these challenging patients and reinforces the importance of devoting efforts to offer the most suitable solutions for each scenario.

A apresentação concomitante de cancro do pulmão e doença cardíaca severa necessitando intervenção é um cenário frequente na prática clínica. O seu substrato fisiopatológico comum é desconhecido e acredita-se que o tabagismo possa ser um agente associado. Do ponto de vista cirúrgico, estes pacientes colocam vários desafios técnicos e a literatura médica é escassa em providenciar respostas robustas. O objetivo deste relato consiste em rever a nossa experiência com casos submetidos a tratamento cirúrgico combinado das patologias supracitadas, visando analisar as características dos pacientes, considerações das técnicas operatórias e eventos relacionados. Um total de cinco pacientes foram incluídos, com dois procedimentos síncronos, dois casos que tiveram a cirurgia pulmonar como primeiro procedimento e um caso iniciado com cirurgia cardíaca. Histologicamente, todos os cancros eram carcinomas pulmonares de não pequenas células ou tumores carcinóides e a patologia cardíaca mais representativa foi a estenose valvular aórtica. A lobectomia foi executada em 2/3 dos pacientes e em 60% dos casos foram utilizadas técnicas minimamente invasivas. Todos os pacientes valvulares receberam próteses biológicas. Houve uma complicação pós-operatória imediata, com recuperação favorável, e não ocorreram eventos tardios no seguimento (duração mediana de 1,8 ±1,1 meses). A análise destes casos enfatiza a complexa natureza destes pacientes desafiantes e reforça a importância em dedicar esforços para oferecer as soluções mais adequadas para cada cenário.

Are soccer matches dangerous for patients with heart disease? The HeartAtaque trial - a prospective pilot study. / Jogos de futebol impróprios para cardíacos (HeartAtaque trial) ­ Estudo piloto prospetivo.

INTRODUCTION: Behavioral and emotional factors are triggers of cardiovascular events (CVEs). It is uncertain whether soccer fans, particularly individuals with coronary artery disease (CAD), are at increased risk for CVEs. OBJECTIVES: To assess the effect of watching soccer matches in patients with known CAD on the incidence of CVEs according to the match result. METHODS: We prospectively assessed 82 male soccer fans with a history of acute coronary syndrome during 23 matches of the 2015/2016 season. Each individual was assessed by Holter monitoring on the day of their team's match and on the control day. The primary endpoint was the composite of death, stroke, reinfarction, angina or sustained arrhythmia. Secondary endpoints assessed were episodes of non-sustained supraventricular or ventricular arrhythmia and mean heart rate (HR). RESULTS: Participants' mean age was 61±10 years. Compared with the control day, despite a significant increase in HR (p<0.001) that was independent of the result (p>0.97), the number of CVEs did not differ according to the result (p>0.05). Moreover, the number of non-sustained episodes of supraventricular and ventricular arrhythmia did not differ when stratified according to the match result (p>0.05). CONCLUSIONS: The match result was not associated with a difference in incidence of CVEs in patients with a past history of CAD, with ischemic and arrhythmic substrate, who watched soccer matches on television.

Purulenta pericarditis and Pasteurella multocida: an extremely rare entity. / Pericardite purulenta e Pasteurella multocida: uma associação raríssima.

Purulent pericarditis is a rare entity, defined as the presence of neutrophilic pericardial effusion which is infected by a bacterial, fungus or parasite agent. The diagnosis can be challenging, especially if patients have taken previous antibiotic therapy; on the other hand the recognition of this pathology is often made late, with the onset of severe symptoms or signs of cardiac tamponade or even only at the autopsy. The authors describe the case of a 82-year-old woman with history of extensive laceration of the right lower limb from a dog bite in July 2016, admitted to the Cardiology Department one month later for Acute Pericarditis. During hospitalization she maintained recurrent fever peaks despite the treatment with non-steroidal anti-inflammatory drugs and colchicine. She collected blood cultures and repeated echocardiogram showed increased pericardial effusion with no signs of hemodynamic compromise. Blood cultures revealed the presence of Pasteurella multocida. Due to clinical suspicion of purulent pericarditis, pericardiocentesis was performed with drainage of liquid compatible with exudate and the patient was presented to the Cardiothoracic Surgery Department for pericardiotomy and adequate drainage of the liquid. Histological examination confirmed the diagnosis of Acute Pericarditis. It should be noted that Pasteurella is a very frequent agent (50-90%) in the gastrointestinal tract and nasopharynx of many domestic animals, namely dogs. The authors emphasize the need to aggressively treat this pathology, since untreated death is inevitable.