Post-operative simultaneous very late two-vessel drug eluting stent thrombosis with sparing of bare metal stent in a Jehovah's witness after clopidogrel withdrawal.

Very late stent thrombosis is a feared complication after drug-eluting stent (DES) implantation. Several factors related to the patient, generation and type of the deployed stent, procedure, and premature antiplatelet withdrawal are known to contribute to this complication. Herein, we describe a case of a Jehovah's witness patient who developed simultaneous two-vessel 1st generation DES thrombosis 5.4 and 3.5 years after deployment [with sparing of the bare metal stent (BMS)] in the immediate post-operative period secondary to clopidogrel withdrawal. The case was complicated by ST-segment elevation myocardial infarction, cardiogenic shock, and a ventricular fibrillation cardiac arrest requiring urgent percutaneous coronary intervention. The acute thrombosis of DESs with sparing of the BMS exemplify how they are more prone to this complication due to delayed endothelialization of stent struts and neoinitimal coverage. .

Approach to percutaneous closure in patients with multiple atrial septal defects.

In most patients with an atrial septal defect or patent foramen ovale, a single defect of the interatrial septum may be closed with a single device. However, patients with multiple defects of the interatrial septum may require the use of multiple devices, which involves some technical challenges. We present 5 cases requiring 2 closure devices with clinical and echocardiographic follow up ranging from 3 months to 4 years, demonstrating a high success and low complication rates.

Percutaneous closure of atrial septal defect via transjugular approach with the Amplatzer septal occluder after unsuccessful attempt using the CardioSEAL device.

Percutaneous closure of a secundum atrial septal defect was performed successfully via the jugular approach in a 77-year-old patient with heparin-induced thrombocytopenia and total occlusion of the inferior vena cava using the Amplatzer septal occluder after an unsuccessful attempt using the CardioSEAL septal occluder. This case demonstrates the advantages of the jugular approach in the patient with difficult anatomy and the advantage of the Amplatzer over the CardioSEAL device in this situation.

Percutaneous coronary intervention for myocardial infarction during pregnancy: a new trend?

Recent studies report that American women are increasingly delaying their first births. While the proportion of births in older women has been increasing, there is also increased prevalence of cardiovascular risk factors and complications of pregnancy with increasing maternal age. We present 2 cases of acute myocardial infarction occurring during pregnancy. The mothers were both over 35 years old, and had significant risk factors for coronary disease. Both were found to have atherosclerotic coronary lesions, and were managed with coronary intervention with successful reperfusion. One woman successfully delivered a healthy infant at term. The other had a spontaneous abortion shortly after discharge from the hospital. Given current demographic trends, it is likely that such cases will be more commonly seen.

Transcatheter closure of residual atrial septal defect after cardiac transplantation.

A 55-year-old male patient experienced 2 acute neurologic events 3 weeks after orthotopic cardiac transplantation. Transesophageal echocardiography demonstrated a patent foramen ovale in the native portion of the interatrial septum with bidirectional shunting by Doppler and microbubble contrast. The defect was closed successfully with a CardioSeal transcatheter septal closure device. This case demonstrates the advantages of the percutaneous approach for closure of residual defects in the post-operative patient.

Transjugular percutaneous inoue balloon mitral commissurotomy in a patient with inferior vena cava obstruction after liver transplantation.

Percutaneous transvenous mitral commissurotomy was performed successfully via the transjugular approach in a patient with severe rheumatic mitral stenosis and obstruction of the inferior vena cava due to prior liver transplantation. This case demonstrates the advantage of the jugular approach in patients with difficult anatomy.