Volume 22 - Issue 3 - March, 2010

The Impella 2.5 L for Percutaneous Mechanical Circulatory Support in Severe Humoral Allograft Rejection

Anna T. Beyer, MD, Peter Y. Hui, MD, Ernest Haeusslein, MD

ABSTRACT: Heart transplant recipients who experience humoral rejection are at risk for hemodynamic instability. We report a case of a 64-year-old male with cardiogenic shock due to allograft rejection requiring mechanical support while undergoing intense immunosuppression. He underwent implantation of a micro-axial endovascular pump (Impella). To our knowledge, this is the first reported case of successful Impella device deployment as a bridge-to-recovery strategy.


Acute allograft rejection is associated with increased morbidity and mortality i...

Left Ventricular Pseudoaneurysm Found after Mitral Valve Replacement Performed 30 Years Earlier

Elena Castilla, MD, Manuel Gato, MD*, José Ramón Ruiz, MD

ABSTRACT: Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery. Because patients frequently present with nonspecific symptoms, a high index of suspicion is needed to make the diagnosis. This report describes an unusual case demonstrating a large LV pseudoaneurysm after mitral valve replacement performed 30 years earlier.


Case Report. Pseudoaneurysm of the left ventricle (LV) is a rare cardiac disease that occurs after myocardial infarction or cardiac surgery....

Efficacy and Safety of Bivalirudin in Patients with Diabetes Mellitus (Full title below)

Luke K. Kim, MD, S. Chiu Wong, MD, Robert M. Minutello, MD, Geoffrey Bergman, MD,
Dmitriy N. Feldman, MD

Efficacy and Safety of Bivalirudin in Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention in Current Clinical Practice

ABSTRACT: Objectives. This study sought to evaluate the short- and long-term efficacy and safety of bivalirudin in diabetic patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice. Background. Early trials of platelet glycoprotein (GP) IIb/IIIa inhibitors have suggested a survival benefit in diabetic patients undergoing PCI. More recently, randomized trials have demonstrated that diabetic patients hav...

Stitched To the Heart – Till Intervention Do Us Part

Ryan D’Souza, MD and Bernhard Meier, MD

ABSTRACT: The case report describes the situation where a venous infusion catheter was inadvertently stitched to the lateral wall of the right atrium during valve replacement. A dual percutaneous approach was used to first sever the catheter at the suture and then remove both ends safely. The risk of tearing the suture which would have resulted in tamponade had to be avoided.


Entrapment of a central venous catheter to an intracardiac structure in open heart surgery is a rare but serious complication. We report a case wherein a central venous c...

Anticoagulation during Percutaneous Coronary Intervention in Diabetics — Is Simpler Always Better?

Pascal Meier, MD and Hitinder S. Gurm, MBBS

Bivalirudin is theoretically a promising alternative to unfractionated heparin (UFH). It is a direct thrombin inhibitor and has the ability to block circulating and clot-bound thrombin and prevent thrombin-mediated platelet activation.1 Glycoprotein IIb/IIIa inhibitors (GPI), such as the selective antibody abciximab or the small molecules tirofiban and eptifibatide on the other hand, are not alternatives to heparin but can, in addition to UFH, inhibit platelet aggregation by directly blocking their GPIIb/IIIa receptor. Either of these two strategies is used during most percutaneous coronary pr...

Successful Interventional Treatment of a Retrosternal Pseudoaneurysm of the Ascending Aorta with an Amplatzer Vascular Plug II

Werner Scholtz, MD, Smita Jategaonkar, MD, Nikolaus A. Haas, MD

ABSTRACT: Pseudoaneurysm of the aorta is a rare, but potentially dangerous complication after cardiac surgery, trauma or infective aortitis. Potential fatal risk of rupture with severe hemorrhage exists, so that treatment is necessary. Surgical management carries a high morbidity and mortality rate. Using an endovascular transcatheter method seems to be a promising option for treatment of aortic pseudoaneurysms. We report a case of ascending aortic pseudoaneurysm, which was diagnosed 11 years after cardiac surgery and treated successfully by implantation of an Amplatzer Vascular Plug II...

Right Coronary Artery Anatomical Variants: Where and How?

Pallavi Solanki, MD, Christine Gerula, MD, Preet Randhawa, MD, Michael Benz, MD, James Maher, MD, Bunyad Haider, MD, Marc Klapholz, MD, Jack Palmaro, MA, MPH, Diane Alfano, RN, Edo Kaluski, MD

ABSTRACT: Background. Ectopic origin of the right coronary artery (RCA) occurs in ≈1.0% of studied populations. We investigated the prevalence and location of ectopic RCAs among patients undergoing coronary angiography (CA) and assessed its effects on resource utilization. Methods. Cases of ectopic RCAs were prospectively collected over 21 months among patients undergoing cardiac catheterization at a University Hospital. “Ectopic RCA” was defined as a RCA originating outside the posterior two-thirds of the right coronary sinus. Results. The study population included 2,120 patients, of wh...

Coarctation of Distal Thoracic Aorta — The Middle Aortic Syndrome in an Elderly Female with Severe Coronary Artery Disease

Sandhya Kommana, MD, Siddharth A. Wartak, MD, MRCP, John Joelson, MD, FACC

ABSTRACT: Coarctation of the distal aorta or middle aortic syndrome is a segmental stenosis of the middle portion of the aorta, between the arch and the terminal bifurcation. Middle aortic syndrome is a rare disease of infants and young adults presenting with hypertension, lower limb claudication and renal insufficiency and is diagnosed by aortography or magnetic resonance angiography.
Our case is unique because this condition was an incidental finding diagnosed during cardiac catheterization in a 70-year-old patient with hypertension in the absence of lower limb claudication. Recognit...

Clinical Utility of B-Type Natriuretic Peptide (Full Title Below)

Joshua M. Stolker, MD and ‡Michael W. Rich, MD

ABSTRACT: Background. B-type natriuretic peptide (BNP) and echocardiographic tissue Doppler indices (TDI) predict elevated filling pressures, but few data exist comparing these methods while adjusting for clinical variables. We hypothesized that BNP would provide incremental value for estimating left ventricular end-diastolic pressure (LVEDP). Methods. Clinical data, echocardiograms, and BNP levels were obtained in 182 geriatric patients undergoing diagnostic left-heart catheterization. Patients with severe valvular disease or acute myocardial infarction were excluded. LVEDP and standard echoc...

Evaluation of Balloon Withdrawal Forces (Full Title Below)

Marvee Turk, Vishal Gupta, MD, MPH, Tim A. Fischell, MD

Evaluation of Balloon Withdrawal Forces with Bare-Metal Stents, Compared with Taxus™ and Cypher™ Drug-Eluting Coronary Stents: Balloon, Stent and Polymer Interactions

ABSTRACT: Background. There have been reports of serious complications related to difficulty removing the deflated Taxus™ stent delivery balloon after stent deployment. The purpose of this study was to determine whether the Taxus SIBS polymer was “sticky” and associated with an increase in the force required to remove the stent delivery balloon after stent deployment, using a quantitative, ex-viv...

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