Intracardiac bone cement embolism resulting in ventricular perforation: an unusual cause of sudden chest pain.

Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with new-onset chest pain and dyspnoea. He had a history of percutaneous kyphoplasty. Multimodal imaging showed intracardiac cement embolism in the right ventricle with penetration of the interventricular septum and perforation of the apex. The bone cement was successfully removed during open cardiac surgery

What does an explanted PASCAL device look like?

We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological pro We report the case of a 78-year-old female patient who had a PASCAL device implanted for severe degenerative mitral regurgitation. Intraprocedural echocardiography revealed persistent severe mitral regurgitation due to device dislocation. Implanting another device was not possible. After 8 days, the device was explanted, and the valve was replaced with a biological prosthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup. Keywords: Mitral regurgitation; PASCAL device; Transcatheter therapysthesis. The PASCAL device and resected mitral valve leaflets were sent for histopathological workup

Stenting of native right ventricular outflow tract obstructions in symptomatic infants: histological work-up of explanted specimen

BACKGROUND Stenting of stenotic right ventricular outflow tract is a palliative measure for severely impaired small babies with Tetralogy of Fallot or similar pathologies. Little is known about the histopathological fate of the stents in the right ventricular outflow tract. METHODS Eight samples of surgically removed right ventricular outflow tract stents were histologically analysed according to a predefined protocol. RESULTS The most frequent diagnosis was Tetralogy of Fallot in four patients, pulmonary atresia with ventricular septal defect in two patients, double outlet right ventricle with pulmonary obstruction in one patient, and muscular obstruction of the right ventricular outflow tract in one patient with a syndromic disease with hypertrophic cardiomyopathy. Stents mean implantation duration was 444 days ranging from 105 to 1117 days (median 305.5 days). Histology revealed a variable degree of pseudointima formation consisting of fibromuscular cells surrounded by extracellular matrix. Four of the specimen contained adjacent myocardial tissue fragments, which showed regressive changes. Neither myocardium nor pseudointima tissue or tissue parts locally related to stent struts were infiltrated by inflammatory cells. CONCLUSIONS Histological analysis after explantation of early-in-life implanted right ventricular outflow tract stents revealed predominantly pronounced neo-intimal proliferation with a visible endothelial layer, no signs of inflammation, and no prolapse of muscular tissue through the stent struts. Thus, implantation of stents in early life seems to interfere little with the hosts' immune system and might help to open up the right ventricular outflow tract by mechanical forces and regressive changes in adjacent muscular tissue

Prior intake of new oral anticoagulants adversely affects outcome following surgery for acute type A aortic dissection

Objectives: Oral anticoagulation prior to emergency surgery is associated with an increased risk of perioperative bleeding, especially when this therapy cannot be discontinued or reversed in time. The goal of this study was to analyse the impact of different oral anticoagulants on the outcome of patients who underwent emergency surgery for acute type A aortic dissection (ATAAD). Methods: This was a single-centre retrospective study of patients treated with oral anticoagulation at the time of surgery for ATAAD. Outcomes of patients on new oral anticoagulant (NOAC) therapy were compared to respective outcomes of patients on Coumadin. Additionally, a survival analysis was performed comparing these 2 groups with patients who were operated on with no prior anticoagulation. Results: Between January 2013 and April 2020, a total of 437 patients (63.8 ± 11.8 years, 68.4% male) received emergency surgery for ATAAD; 35 (8%) were taking oral anticoagulation at the time of hospital admission: 20 received phenprocoumon; 14, rivaroxaban; and 1, dabigatran. Compared to Coumadin, NOAC was associated with a greater need for blood-product transfusions and haemodynamic compromise. Operative mortality was 53% in the NOAC group and 30% in the Coumadin group. A 5-year survival analysis showed no significant difference between the NOAC and the Coumadin group (P = 0.059). Compared to 402 patients treated during the study period without anticoagulation, patients taking NOAC had significantly worse survival (P = 0.001), whereas that effect was not observed in patients undergoing surgery who were taking Coumadin (P = 0.99). Conclusions: Emergency surgery for ATAAD in patients taking NOAC is associated with high morbidity and mortality. NOAC are a major risk factor for uncontrollable bleeding and haemodynamic compromise. New treatment strategies must be defined to improve surgical outcomes in these high-risk patients. Keywords: Acute aortic syndrome; Aortic dissection; Bleeding; Coumadin; DOAC; NOAC; Oral anticoagulation; Type A dissection

Intracardiac bone cement embolism resulting in ventricular perforation: an unusual cause of sudden chest pain

Leakage of bone cement is a known complication after percutaneous kyphoplasty. In rare cases, bone cement can reach the venous system and cause life-threatening embolism. We present the case of a 73-year-old male, who was admitted to our hospital with new-onset chest pain and dyspnoea. He had a history of percutaneous kyphoplasty. Multimodal imaging showed intracardiac cement embolism in the right ventricle with penetration of the interventricular septum and perforation of the apex. The bone cement was successfully removed during open cardiac surgery

MitraClip® procedure as bridge to left ventricular assist device: Enable extracorporeal membrane oxygenation weaning and reduce perioperative risk

Secondary mitral valve regurgitation is a frequent consequence of left ventricular dysfunction in patients with severe heart failure. The management of this disease can be challenging since it often culminates in refractory pulmonary edema and multi-organ failure. We present the case of a 50-year-old male who was admitted in cardiogenic shock following myocardial infarction. After successful revascularization, percutaneous mitral valve repair using the MitraClip® device enabled weaning from extracorporeal membrane oxygenation followed by the implantation of a left ventricular assist device as bridge to transplant