Efficacy of Cardiac Computed Tomography for Obstructive Mechanical Valve Thrombosis Under Venoarterial Extracorporeal Membrane Oxygenation.

We encountered a patient in a state of shock who required venoarterial extracorporeal membrane oxygenation in whom cardiac computed tomography was instrumental in diagnosing obstructive mechanical mitral valve thrombosis as well as in the differentiation of other probable diseases. Because the patient was on venoarterial extracorporeal membrane oxygenation support, computed tomography imaging required some ingenuity. (Level of Difficulty: Intermediate.).

Different types of Kounis syndrome caused by different episodes of bee sting anaphylaxis: Misfortunes never come singly.

We report our experience with a 69-year-old man who had different types of Kounis syndrome over a short time frame, caused by two episodes of bee sting anaphylaxis. After his first allergic reaction to a bee sting, he experienced a non-ST-segment elevation myocardial infarction; he was treated with percutaneous coronary intervention for near-occlusion of his right coronary artery. This episode was deemed type 2 Kounis syndrome. Four weeks later, we electively treated the nonculprit residual stenosis in his left anterior descending artery. Unfortunately, 2 weeks after this elective procedure, he experienced anaphylactic shock due to a second bee sting. Electrocardiography showed ST elevation in the anterior leads, and emergent coronary angiography showed thrombotic occlusion of the newly implanted stent in the left anterior descending artery. This second episode was deemed type 3 Kounis syndrome. Learning objectives: This is a rare example of different types of Kounis syndrome resulting from repeated exposures to an allergic source, an example that deepens our understanding of Kounis syndrome. This patient's experience illustrates the need for careful evaluation of the indications for revascularization of nonculprit lesions in patients with a history of Kounis syndrome.