Primary Percutaneous Coronary Intervention in Chronic Type A Aortic Dissection.

This case illustrates the complexities of performing a primary percutaneous intervention in a patient with chronic Type A aortic aneurysm and dissection with contraindications for surgical management. We also discuss the significant risk that the patient had to overcome to survive an undiagnosed aortic dissection and an acute ST elevation myocardial infarction.

Mitral valve repair after a right pneumonectomy: a minimally invasive approach.

A 31-year old man was admitted to our unit with severe mitral regurgitation secondary to infective endocarditis on a background of a right pneumonectomy performed 8 years previously for a central carcinoid tumour. A previous right thoracotomy for lung resection is considered a contraindication to a minimal access approach to the mitral valve. Following the right pneumonectomy, a left-to-right displacement of the mediastinum had occurred. We report our experience on performing a mitral valve repair through a right mini-thoracotomy in a patient who had undergone a right pneumonectomy. In this case, three-dimensional computed tomography reconstructions were used to guide our surgical approach. We hope that this case presentation will help further broaden the applicability of a thru-port approach to this rare subgroup of patients.

Angiographic right heart hypermobility as a sign of non-cardiac pathology in the setting of ST elevation.

Esophageal perforation (Boerhaave's syndrome) is a severe life-threatening disorder. Diagnosis and treatment are often delayed due to the wide variety of presenting symptoms. This case report details an unusual presentation of Boerhaave's syndrome in a 48-year-old man mimicking an acute anterior myocardial infarction. We present the history, clinical, angiographic, and computed tomographic (CT) findings, as well as the subsequent management and clinical outcome. We demonstrate the rare angiographic finding of right heart hypermobility, which was strongly suggestive of a non-cardiac diagnosis in a patient with ST segment elevation and cardiovascular compromise .

A life-saving case of Dressler's syndrome.

Myocardial rupture is an uncommon and life threatening event which may occur in the setting of acute myocardial infarction. In this case report we describe a rare instance of a patient presenting with signs of ventricular rupture as a late presentation of myocardial infarction. The findings of cardiac computed tomography are demonstrated as well as intra-operative images. Despite its very high attendant mortality risk, our patient's life was saved by the earlier development of Dressler's syndrome, an intense inflammatory process in the pericardium, resulting in dense adhesions, which effectively tamponaded the leak from the ventricular free wall rupture and prevented extravasation.