Management of vascular complications remains an important component of both diagnostic cardiac catheterization and percutaneous coronary intervention. We report a unique case of extensive right subclavian artery dissection following attempted diagnostic cardiac catheterization of a right internal mammary artery (RIMA) coronary bypass graft. This resulted in complex dissection of the right subclavian artery involving the origin of the right vertebral and internal mammary arteries, as well as critical right upper limb ischemia. Therapy consisted of both conservative management of the proximal dissection and endovascular treatment at the distal site of the vessel occlusion.

Primary cardiac non-Hodgkin’s lymphoma is defined as being exclusively located in the heart and/or pericardium, and is extremely rare. This disease occurs mainly in immunocompromised patients and rarely in the immunocompetent. In a series of over 12,000 autopsies, only 7 primary tumors were identified for an incidence of less than 0.1%.¹ Primary cardiac lymphoma comprises only 2% of all cardiac tumors, and may obstruct valvular orifices and even cause hypertrophic cardiomyopathy when heavy tumorous lesions infiltrate the ventricular septum, as described by Roberts et al.² Metastatic involvement of the heart and pericardium is over 20 times more common and has been reported on autopsy series in up to 1 in 5 patients who died from cancer.^1,3–5

Obstructions of the caval veins may develop in various clinical settings in subjects with tumoral lesions, after surgery on the caval veins — as in the Mustard/Senning operation, after radiation therapy, or due to central lines, dialysis catheters and pacing wires.^1–4 In particular, patients with a history of multiple cardiac surgical procedures or with a history of infections of the pacemaker site and electrodes may easily develop an iatrogenic occlusion of the venous access.² Various kinds of interventions have been performed in these subjects, including balloon dilation and bare-metal stent implantation.^1–4
In this article, we report on 3 patients with complete interruption of the superior vena cava (SVC) in whom we used radiofrequency energy and covered stents to recanalize the SVC and to allow for implantation of endocardial pacemaker leads.

Despite newer lower-profile stent technologies, placing coronary stents may still remain challenging when vessels are extremely tortuous. We describe a case of a very large-caliber right coronary artery (RCA) with a “shepherd’s crook” configuration, which could not be stented, and for which double balloon angioplasty was successfully performed.
Case Report. A 69-year-old Caucasian male was hospitalized for an acute coronary syndrome. Diagnostic heart catheterization revealed a 90% eccentric stenosis past the genu of the right coronary artery. The vessel was large, about 7 mm in caliber, and somewhat patulous, with a prominent “shepherd’s crook” configuration (a dramatic upturn with a near-180º switchback turn) (Figure 1).

Case Report. A 30-year-old male with no previous medical history presented to an emergency department at a community hospital with left-sided, substernal chest pain. The pain was pressure-like and nonradiating. It began shortly after performing weight-lifting activity and lasted for more than 2 hours. In the emergency department, the patient was initially treated medically with aspirin and intravenous nitroglycerin, resulting in partial relief of the chest pain.

Case Report. A 66-year-old male with previous two-vessel coronary artery bypass graft surgery (CABG) presented with an acute coronary syndrome. Angiography demonstrated a critical 95% stenosis in the ostium of the saphenous vein graft (SVG) to the obtuse marginal (OM) of a dominant circumflex vessel, and another 70% thrombotic lesion in the mid portion of the same graft (Figure 1). The left internal thoracic artery (was widely patent, supplying a diffusely diseased distal left anterior descending artery not amenable to percutaneous intervention. Intervention was performed on the SVG to the OM.

The incidence of primary congenital coronary anomalies varies from 0.95–2% in the adult population undergoing coronary angiography (CAG).^1–4 The majority of these are reported to be anomalies of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery being the most common. Coronary artery anomalies are divided into those that cause and those that do not cause myocardial ischemia.^5,6 We describe a rare benign anomaly, a double right coronary artery (RCA) presenting as acute inferior wall myocardial infarction due to thrombotic occlusion of one of the two RCAs that was managed with primary percutaneous coronary intervention. This is the first case in the literature of this rare anomaly presenting with acute myocardial infarction.

Interventional catheterizations are an increasingly important component in the management of the growing population of adults with congenital heart disease (CHD). The experience of interventions on adults with CHD from some centers has been reported and the types of procedures resemble those that are common in the pediatric population.^1,2
We report a unique case of a 35-year-old female with palliated complex who underwent two unusual interventions during the same catheterization procedure. The first, patent ductus arteriosus (PDA) stent placement, is an uncommon procedure that is performed almost exclusively in newborn infants as a short-term palliation. A Gianturco- Grifka vascular occlusion device (GGVOD) was also used to occlude a residual superior vena caval-to-right atrial shunt in a classic Glenn anastomosis, an intervention that has not been previously described in the literature.