Aortic intervention guided by contrast-enhanced transoesophageal ultrasound while waiting for cardiac transplantation: a case report

Background: Aortic complications can occur during left ventricular assist devices (LVAD) insertion and its treatment remains challenging. Percutaneous aortic interventions can be an alternative to surgery in such high-risk cases. Case summary: We present a patient with idiopathic dilated cardiomyopathy and advanced heart failure requiring LVAD insertion as a bridge to transplant, who developed an aortic pseudoaneurysm below the anastomosis of the LVAD tube. He was treated by percutaneously coiling under contrast-enhanced transoesophageal echocardiographic (TOE) guidance and safely reached destination (heart transplantation) a year later. Discussion: LVADs provide haemodynamic support for patients with advanced heart failure waiting for heart transplantation. Although uncommon, aortic complications can develop after LVAD insertion and are life-threatening. Percutaneous aortic interventions are feasible in such cases to promote thrombosis and shrinkage of aneurysmal spaces, hence potentially reducing the risk of sudden death. Contrast-enhanced TOE can be easily and safely used to both monitor the intervention by improving anatomic target definition, guide and wire positioning, and assess early results

Diffuse Light in Hickson Compact Groups: The Dynamically Young System HCG 44

Compact groups are associations of a few galaxies in which the environment plays an important role in galaxy evolution. The low group velocity dispersion favors tidal interactions and mergers, which may bring stars from galaxies to the diffuse intragroup light. Numerical simulations of galaxy clusters in hierarchical cosmologies show that the amount of the diffuse light increases with the dynamical evolution of the cluster. We search for diffuse light in the galaxy group HCG 44 in order to determine its luminosity and luminosity fraction. Combining with literature data, we aim to constrain the dynamical status of Hickson compact groups. We use Intra Group planetary nebulae (IGPNe) as tracers of diffuse light. These are detected by the so-called on band-off band technique. We found 12 emission line objects in HCG 44, none of them associated with the galaxies of the group. 6/12 emission line objects are consistent with being IGPNe in HCG 44, but are also consistent with being Ly$\alpha$ background galaxies. Thus we derive an upper limit to the diffuse light fraction in HCG 44 of 4.7%. We find a correlation between the fraction of elliptical galaxies and the amount of diffuse light in Hickson compact groups. Those with large fraction of diffuse light are those with large fractions in number and luminosity of E/S0 galaxies. We propose an evolutionary sequence for Hickson compact groups in which the amount of diffuse light increases with the dynamical evolution of the group.Comment: 9 pages, 4 figures, accepted for publication at A&

Urgent endovascular aortic dissection repair in a Marfan patient during COVID-19 pandemic

We present a successful TEVAR procedure for acute complex type B aortic dissection in a Marfan patient during COVID-19 pandemic whilst cardiac surgery was not readily available. TEVAR procedure was performed in lieu of open redo surgery to avoid long intensive care

Transesophageal ultrasound guidance for endovascular interventions on the aorta.

Aortic pathologies in general require a multidisciplinary approach and decision-making to integrate elements of clinical acuity, vascular pathology, individual comorbidity, and risk assessment; thus, ideally it is a center with access to multiple imaging modalities and expertise in all treatment options. Besides classic open surgical options, endovascular procedures have been accepted for a variety of aortic pathologies. More recently, novel transcatheter interventions even to the proximal aorta have been introduced, particularly for patients unfit for open surgery. Nevertheless, the role of transesophageal echocardiography to guide percutaneous aortic interventions is not well established, notwithstanding the growing potential as an ancillary tool to guide the procedure and document success

Corona Virus Disease 2019 in situ arterial and venous thrombosis in critically ill patients: a case series

Background Corona Virus Disease 2019 (COVID-19) pneumonitis associated with severe respiratory failure carries a high mortality. Coagulopathy has emerged as a significant contributor to thrombotic complications. Case summary We describe two cases of severe COVID-19 pneumonitis refractory to conventional mechanical ventilation and proning position, transferred to our specialist centre for cardiorespiratory failure. Cross-sectional imaging demonstrated concurrent venous and aortic thrombosis with end-organ ischaemic changes. One patient received thrombolysis with a partial response. This could not be offered to the other patient due to a recent haemorrhagic event. Both patients died of multi-organ failure in the hospital. Discussion Concurrent aortic and venous thromboses are rare. This finding in COVID-19 cases, who were both critically ill patients, likely reflects the strongly thrombogenic nature of this illness which ultimately contributed to poor outcomes. The absence of deep vein thrombosis or a potential systemic source of embolism suggests in situ thrombosis. Further, the management of anticoagulation and thrombolysis is challenging in patients where an attendant bleeding risk exists