Ipsilateral Protection and Bailout for Large-Bore Access.

This manuscript describes the refinements of ipsilateral wire protection and bailout strategy for large-bore femoral access and especially transcatheter aortic valve replacement. This ipsilateral wire protection requires no additional expenses and can provide effective arteriotomy site protection without the need for contralateral femoral access, especially in cases when contralateral wiring and crossover are not feasible. Ipsilateral wiring can be done both as prophylactic protection and as bailout strategy. The exact steps required for ipsilateral protection and bailout are described. A comparison between ipsilateral wiring with conventional contralateral femoral and transradial wire protection is delineated.

Angioplasty Balloon Entrapped Fully Inflated and Detached Within the Left Main Coronary Artery.

Described is a complication of rescue left main coronary stenting due to threatened left main closure following a "valve in valve" TAVR procedure. Left main stent post dilatation with a NC Trek balloon was complicated by a failure to deflate the balloon. The patient spiraled into cardiogenic shock and was stabilized by an intra-aortic balloon pump. Attempts to withdraw the balloon resulted in shearing of the balloon off the shaft. Parallel wiring and sequential balloon dilatations allowed left main bifurcation stenting while crushing the inflated balloon underneath the stent's struts. Follow up of 13 months was uneventful. The management of entrapped inflated coronary balloon is reviewed.

Coumadin ridge: An incidental finding of a left atrial pseudotumor on transthoracic echocardiography.

Coumadin ridge is a normal anatomic variant that is occasionally found in the left atrium. It can present as a linear or nodular mass which can undulate with cardiac motion and if particularly prominent, can easily be mistaken for a tumor or thrombus. Careful evaluation and consideration of the common variants discussed in this review can help limit misdiagnosis, as well as unnecessary workup and treatment. We present a case of coumadin ridge that was found on a patient using two-dimensional transthoracic echocardiography.

Atrium of stone: A case of confined left atrial calcification without hemodynamic compromise.

Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present, is usually extensive, often encompassing multiple cardiac chambers and valves. We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography. Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve, and no hemodynamic effects.