ABSTRACT: Intracardiac echocardiography (ICE) was used in a 17-year-old female with refractory symptoms and hypertrophic obstructive cardiomyopathy (HOCM) to guide alcohol septal ablation. During the procedure ICE readily identified the hypertrophied interventricular septum, the dynamic intraventricular gradient, the systolic anterior motion of the mitral valve and the associated mitral regurgitation. Notably, a perfect match was demonstrated between transthoracic echocardiography and ICE findings regarding contrast location. Potential complications related to this technique and alternative therapeutic strategies are discussed. This report highlights the potential use of ICE to guide procedures of alcohol septal ablation in patients with HOCM.

ABSTRACT: A 48-year-old female patient underwent successful complete closure of a large circumflex- coronary sinus fistula using coils. Four days later, the patient had myocardial infarction. In this article, we review coronary artery fistulae and proposed treatment plans after catheter closure.

ABSTRACT: Congenitally-corrected transposition of the great vessels (CCTGA) is a rare congenital heart defect. Patients with CCTGA have the anatomical right ventricle as their systemic pumping chamber, with ventricular dysfunction and congestive heart failure (CHF) being relatively common in older adults. The most common presenting feature is bradycardia due to high-degree atrioventricular (AV) blocks. Patients with CCTGA are increasingly subject to CHF with advancing age; this complication is extremely common by the fourth decade. The majority of patients have an inverted coronary arterial pattern.1 We report a case of a patient with CCTGA who presented with rare but life-threatening ventricular tachycardia (VT) leading to syncope, with preserved systemic ventricular function. Coincidentally, the patient also had a single coronary ostium.

ABSTRACT: It is not uncommon for patients with severe ischemic or nonischemic cardiomyopathy to have recurrent ventricular arrhythmias. Many of these arrhythmias remain asymptomatic and can be controlled with beta-blockers or amiodarone. However, for a subset of these patients, the arrhythmia is persistent and requires antitachycardic pacing, internal defibrillation, or radiofrequency ablation therapy. We present a patient with end-stage nonischemic cardiomyopathy and recurrent ventricular tachycardia (VT) who was listed for cardiac transplantation. His VT was not responsive to medical management, and standard endocardial or epicardial VT radiofrequency ablation (VTRFA) procedures. Therefore, this patient underwent successful ethanol septal ablation (ESA) to obliterate the source of arrhythmia. Five days after the ablation procedure, he underwent cardiac transplantation. Therefore, this case presents a rare opportunity to review the use of ESA for refractory VT and an excellent

ABSTRACT: In the modern surgical era, postoperative prosthetic valve endocarditis persists as a potentially devastating complication of valve replacement surgery. While generally resulting in valvular destruction and regurgitation, prosthetic valve endocarditis may also result in valvular obstruction. The diagnosis of prosthetic valve endocarditis may be difficult due to technical limitations affecting the diagnostic capability of transthoracic echocardiography in patients with prosthetic valves and the indolent nature of the infectious process. We describe the first reported case of Aspergillus endocarditis leading to obstruction of a prosthetic valve in a patient with recent aortic valve replacement.

ABSTRACT: The authors describe the case of a 51-year-old male who presented with an acute left petrous carotid dissection with neuroimaging evidence of decreased perfusion. Revascularization was accomplished with the placement of an intracranial stent (Neuroform III, Boston Scientific Corp., Natick, Massachusetts). The patient had a good clinical and radiographic outcome.

ABSTRACT: Biventricular pacing for the treatment of congestive heart failure is now one of the forefront therapies for symptomatic heart failure patients who are receiving maximal medical therapy. Recent advances in lead technology and delivery systems have improved the success rates of left ventricular (LV) lead implantation. A major difficulty in LV lead implantation, however, occurs in patients with coronary vein stenoses, insufficient coronary vein caliber, or significant variations in coronary venous anatomy, in terms of left ventricular lead implantation. We sought to examine whether cardiac vein angioplasty and/or stenting would allow for the proper placement of the LV lead in these patients.

ABSTRACT: Coronary artery fistulae are rare and usually discovered as incidentally during coronary angiography. They may be congenital or acquired secondary to trauma or cardiac intervention, and usually involve the left anterior descending or right coronary artery, with the circumflex artery much less often affected. They have been reported in transplanted hearts, usually as a secondary complication to right ventricular biopsies, and typically drain into the right ventricle. We hereby report a case of circumflex coronary artery to the great cardiac vein fistula that we believe occurred after transplantation and spontaneously closed while we were assessing the patient for percutaneous closure of the fistula.

ABSTRACT: Background. Treatment of unprotected left main coronar y disease by percutaneous interventions, even in the urgent setting, is still not an approved indication. However, the evolution of transcatheter technology and supporting devices, along with greater skill in high-volume centers, led the interventional community to deal with these cases. This study aimed to investigate whether the percutaneous approach in this cohort could be a viable alternative to coronary artery bypass graft (CABG) surgery in the urgent setting. Methods. We enrolled 51 acute myocardial infarction patients with left main disease as the culprit lesion and treated them by percutaneous coronary intervention. This cohort was followed for major adverse cardiac and cerebrovascular events (MACCE) in-hospital and at 30 days, 6 months and 1 year, and was compared with a population of 35 CABG patients matched for clinical and angiographic characteristics. Results. The estimated MACCE-free

ABSTRACT: Objective. We evaluated short-term prognosis and resource utilization of consecutive patients treated with percutaneous coronary intervention (PCI) as a function of fluoroscopy time. Background. Advances in interventional cardiology are reflected in the growing complexity of PCI leading to an increasing use of fluoroscopic guidance. The relationship between fluoroscopy time and in-hospital outcomes after PCI has not been addressed. Methods. In a retrospective analysis of a prospectively collected database including a total of 9,650 patients, the mean fluoroscopy time was 18.3 ± 12.2 minutes. Outcomes were stratified by fluoroscopy time. Results. Compared to patients within the 75th percentile, those with prolonged fluoroscopy time were older and had a higher prevalence of prior coronary artery bypass surgery (CABG), chronic renal insufficiency, peripheral arterial disease, type B2/C lesions, and baseline TIMI flow 0–2. Patients with prolonged fluor

ABSTRACT: Background. Trials of rescue angioplasty (rPCI) following failed fibrinolysis have excluded patients with cardiogenic shock and the benefit of rPCI in this setting is unknown. We compared the clinical, angiographic characteristics, 30-day and 1-year outcomes of cardiogenic shock patients undergoing rPCI with those undergoing primary percutaneous coronary intervention (PPCI). Methods. Of the 171 patients undergoing PCI for cardiogenic shock between 1994 and 2005 at our institution, the indication was for PPCI in 65 and rPCI in 59 patients. Clinical, procedural, 30-day and 1-year mortality data were compared. Results. There were no differences between the cohorts with regard to clinical and pre-PCI angiographic variables, except that patients who underwent rPCI were more likely to be interhospital transfers (64% vs. 43%; p = 0.02) and had a longer door-to-balloon time (median 298 [IQR 395 to 180] minutes in the rPCI group vs. 131 [IQR 215 to 90] minutes in

ABSTRACT: Background. Rotational atherectomy is associated with a high incidence of periprocedural myonecrosis. Glycoprotein (GP) IIb/IIIa inhibitors have been demonstrated to be particularly effective in this population in reducing periprocedural myocardial infarction. While bivalirudin-based therapy has emerged as an attractive alternative to heparin in patients undergoing contemporary percutaneous coronary intervention, it is unclear if such a strategy is safe in patients undergoing rotational atherectomy. Methods. We analyzed all patients undergoing rotational atherectomy at our institution from 2001 to 2004, and compared periprocedural outcome among those treated with a bivalirudin-based regimen compared to those treated with a heparin-based regimen. Results. A total of 253 patients were treated with rotational atherectomy during this period. Bivalirudin-based therapy was used in 56 patients, while the remainder were treated with a heparin-based approach. Pati

ABSTRACT: Objective. We sought to externally validate the William Beaumont Hospital (WBH) risk score for radiocontrast-induced nephropathy (RCIN) following percutaneous coronary intervention (PCI). Background. RCIN is associated with increased mortality and morbidity following PCI and accounts for increased hospital costs and length of stay. Methods. A total of 4,814 PCI procedures were used for validation of the WBH risk score, using a >1.0 mg/dl increase in serum creatinine (Cr) as the definition of RCIN. Clinical and procedural details were identified within the Mayo Clinic PCI registry. Multiple imputation was used to impute values where missing. Five imputation sets were created and averaged to compute the final estimate. Results. Follow-up Cr was available in 3,213 (67%) of procedures and RCIN occurred in 1.9% of cases. Baseline Cr clearance was missing in 13%. All other risk factors used to calculate the risk score were missing in ≤5% of the pro

ABSTRACT: Human immunodeficiency virus (HIV) infection affects multiple organs including the cardiovascular system. Postmortem studies have revealed multiple abnormalities including abnormal coronary artery pathology, arteriopathy/endothelial dysfunction, hyperlipidemia and hypercoagulability prior to the use of protease inhibitors. With the introduction of antiretroviral medications, specifically protease inhibitor therapy, patients with HIV have been further noted to have premature coronary artery disease, hypercoagulability, hyperlipidemia, insulin resistance, fat redistribution syndrome and increased tendency to myocardial infarction. In this article, we report on one patient with HIV disease on protease inhibitor therapy that presented with non-Q-wave myocardial infarction and underwent percutaneous coronary intervention, and was later found to have stent thrombosis. A review of the literature showed no other previous reports of stent thrombosis secondary to acquired hyperc