The Undesirable Communication: A Case of Cerebral Air Emboli in the Setting of Atrio-Esophageal Fistula Following Atrial Fibrillation Catheter Ablation

Atrial-esophageal fistula is an extremely rare condition but is often a deleterious complication following catheter ablation for atrial fibrillation. The associated iatrogenic communication acts as a conduit for air and bacterial translocation, which may lead to cerebral air embolism and polymicrobial sepsis, respectively. Coupled with a history of invasive procedures, the diagnosis is largely based on the accompanying neurological symptoms. In this report, we present the case of a 73-year-old female who presented with neurological deficits attributed to cerebral vascular emboli three weeks after catheter ablation for the treatment of chronic atrial fibrillation

The Curious Case of an Isolated Right Coronary Artery Aneurysm Complicated by Thrombosis and Distal Embolization

A 40-year-old male patient with no significant medical history was admitted with an inferior ST-segment elevation myocardial infarction. Primary percutaneous coronary intervention revealed a right coronary artery aneurysm, with no evidence of significant coronary disease. We support the hypothesis of aneurysmal thrombus formation with distal embolization

Feasible Stenting of a Large Septal Perforator Providing a Sizeable Coronary Collaterals

While coronary artery disease involving the septal perforator branches presents similar to diseases of major coronary arteries, management can present a challenge. Owing to their relatively small size, performing interventional procedures is often impractical in terms of selecting appropriate devices. Although larger septal perforator branches have been managed percutaneously, similar to major vessels, long-term sequelae and clinical effectiveness have been indeterminate. We present our experience in managing a patient with a stenosed septal perforator branch and challenging comorbidities

The Overestimation of Concentric Hypertrophy In Patients With HFpEF as Determined By 2D-Echocardiography

Background: Heart failure with preserved ejection fraction continues to pose multiple challenges in terms of accurate diagnosis, treatment, and associated morbidity. Accurate left ventricular (LV) mass calculation yields essential prognostic information relating to structural heart disease. Two-dimensional (2D) echocardiography-based calculations are solely limited to LV geometric assumptions of symmetry, whereas three-dimensional (3D) echocardiography could overcome these limitations. This study aims to compare the performance of 2D and 3D LV mass calculations. Methods: A prospective review of echocardiography findings at the University of Louisville, Kentucky, was conducted and assessed. Normal ejection fraction (EF) was defined as \u3e=52% in males and \u3e=54% in females. The following calculations were performed: relative wall thickness (RWT) = 2x posterior wall thickness/LV internal diastolic dimension (LVIDd) and 2D LV mass = 0.8{1.04([LVIDd + IVSd +PWd]3 - LVIDd3)} + 0.6. Concentric hypertrophy was RWT \u3e 0.42 and LV mass \u3e95 kg/m2 in females or \u3e 115 kg/m2 in males. The same cut-offs were used for 2D and 3D echocardiography. Results: Echocardiographic findings for a total number of 154 patients in the study were investigated. There was a weak positive correlation between 2D and 3D LV mass indices (R= 0.534, r2= 0.286, p= 0.001). Seventy patients had 3D EF \u3e=45% with clinical heart failure (HFpEF). Among HFpEF patients, LV hypertrophy (LVH) was present in 74% of patients by 2D echocardiography and 30% by 3D echocardiography (McNemar test p= 0.001). Using 3D echocardiography as the reference, 68% of normal patients were misdiagnosed with LV hypertrophy by 2D echocardiography. Two-thirds of the patients with concentric remodeling by 3D echocardiography were misclassified as having concentric hypertrophy by 2D echocardiography (p=0.001). Conclusion: Adapting necropsy-proven LV mass index cutoffs, 2D over-diagnosed LV hypertrophy through overestimation of the mass, compared to 3D echocardiography. In turn, the majority of HFpEF patients showed no structural hypertrophy of the LV on 3D imaging. This suggests that the majority of patients with HFpEF may qualify for pharmacological prevention to prevent further progression to LV remodeling or LVH

Inari Large-Bore Mechanical Thrombectomy in Intermediate-High Risk Submassive PE Patients: Case Series and Literature Review

Pulmonary embolism (PE) is one of the most common causes of cardiovascular (CV) mortality worldwide. Owing to the associated morbidity and mortality with other treatment modalities, including systemic thrombolysis, a discernible change in the era of acute pulmonary embolism management has been reported. Catheter-directed thrombectomy using the FlowTriever system (Inari Medical; Irvine, CA, USA) was shown to reduce endpoints of interest in patients with acute intermediate-high risk PE and was associated with rapid hemodynamic improvement. In this report, we describe our experience with three cases of patients presenting with submassive PE, whereby immediate pulmonary artery pressure improvement was evident in all cases after successful mechanical thrombectomy. Our experience supports the use of FlowTriever mechanical thrombectomy for the treatment of submassive PE in clinical practice, with a call for further research to establish associated benefits