Cardiac arrest in type II Kounis syndrome after oral intake of amoxicilline.

BACKGROUND: Kounis syndrome (KS) is defined as the occurrence of an acute coronary syndrome related to allergic or hypersensitivity reaction. KS is currently classified into three variants, based on coronary arteries status. This syndrome is often neglected or misdiagnosed in clinical practice. METHODS AND RESULTS: We described a type II KS case. This acute coronary syndrome (ACS) began with cardiac arrest (an uncommon clinical expression for KS) immediately after oral intake of amoxicilline. Coronary angiography revealed coronary arteries stenoses which were considered unsuitable for revascularization. Optimization of medical therapies was the goal of the management for this patient. Follow-up visits revealed normal echocardiographic findings and no malignant arrhythmias at ECG Holter monitoring. CONCLUSIONS: KS can be a rare case for ACS, sometimes occurring with sudden cardiac arrest. Physicians should pay attention to the history of the patients in order to identify the correct cause of ACSs.

Ultrasound-guided venipuncture for implantation of cardiac implantable electronic devices: A single-center, retrospective study.

BACKGROUND: The venous access for the insertion of permanent leads of cardiac implantable electronic devices is often achieved by venous cutdown of the cephalic vein, or by "blind" puncture of the subclavian vein using anatomical landmarks, or by fluoroscopy-assisted methods. METHODS: We have retrospectively analyzed our clinical experience to verify the feasibility, the safety, and efficacy of the adoption of ultrasound-guided puncture/cannulation of the axillary vein for this purpose. RESULTS: Nine hundred eighty-seven leads were placed during 548 consecutive procedures, accessing the axillary vein in the infraclavicular area using real-time ultrasound guidance. Venipuncture was successful in 99.8% of cases. The access time was 11 seconds (range 4-580). We recorded three cases of pneumothorax (0.5%), but no hemothorax and no hemo-mediastinum. The incidence of local hematoma was 2.1% (12 cases). No injury to the brachial plexus or to the phrenic nerve was recorded. In a follow-up of 33 months (range 16-39), we observed no cases of "subclavian crush syndrome" (damage of the leads at the level of the thoracic inlet), and the rate of pocket infection/infective endocarditis was 0.7%. CONCLUSION: In our experience, ultrasound-guided puncture/cannulation of the axillary vein for implantation of permanent leads is feasible, effective, and safe. It might be considered as a first option for this procedure.

[Conservative treatment of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa: 9 years of follow-up]. / Trattamento conservativo di pseudoaneurisma della fibrosa mitro-aortica: 9 anni di follow-up.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF-P) is one of the rare complications of endocarditis or, more rarely, of surgical trauma. This condition is characterized by a pseudoaneurysm in the intra-annular area between the mitral valve and the aortic valve communicating with the outflow tract of the left ventricle, between the coronary or noncoronary left aortic valve and the front flap of the mitral valve. Nowadays, surgery is recommended to avoid further growth and complications. We hereby describe the case of a patient with MAIVF-P as a consequence of a surgical trauma and early appearance of MAIVF-P. During the long echocardiographic and clinical follow-up, the patients showed stable clinical and hemodynamic conditions despite the increase in size of the MAIVF-P. A conservative treatment based on a medical follow-up can represent an alternative in patients refusing surgery, in high-risk surgical patients as well as in patients showing a stable echocardiographic and clinical picture regardless of the MAIVF-P size.

Isolated Congenital Left Ventricular Diverticulum: A Case Report and Differential Diagnosis.

We describe a case of an incidental finding of diverticulum in a patient presented to the Emergency Department for atypical chest pain, and we analyze the challenging differential diagnosis with aneurysm, pseudoaneurysm, and ventricular cleft.

[Isolated pulmonary valve endocarditis]. / Endocardite isolata della valvola polmonare.

We report a case of isolated pulmonary valve endocarditis evaluated with real-time three-dimensional echocardiography in a previous intravenous drug user. Although right-sided infective endocarditis is common in this population, the involvement of the pulmonary valve without infection of the tricuspid valve is a rare condition.