Burkholderia cepacia complex as a cause of community acquired bacteremia in a young immuncompetent male.

Burkholderia cepacia complex (BCC) is a well-recognized cause of nosocomial infections. We describe here a young healthy male who presented with fever and chest pain with ECG changes of acute pericarditis. Two sets of blood cultures at separate timings grew gram negative bacilli identified as BCC by molecular methods. The patient responded to intravenous ceftazidime despite high ceftazidime MIC's. The source of infection was probably contaminated nasal spray/nasal saline wash which he used after a balloon sinoplasty procedure one month ago. Issues related to accurate identification and susceptibility testing of BCC are also discussed.

Amplatzer Septal Occluder to treat iatrogenic cardiac perforations.

BACKGROUND: Iatrogenic free wall cardiac perforation is a rare but serious complication encountered during percutaneous cardiac procedures, which usually leads to tamponade and death. Septal occluder devices have been developed for sealing intracardiac shunts but may be also used in this emergency setting. METHODS AND RESULTS: We report a small series of five consecutive cases of iatrogenic heart perforations that were treated with implantation of Amplatzer Septal Occluders (ASO). In the first case, iatrogenic left ventricle (LV) perforation occurred during LV biopsy and could be closed up with a 4 mm ASO. In the second case, a 4 mm ASO was used for sealing of a right atrial perforation allocated to Port-a-Cath dislodgment. The third case happened during transseptal puncture for implantation of a TandemHeart bVAD device in a patient suffering cardiogenic shock and was treated by implantation of a 5 mm ASO. The fourth patient was transferred to our facilities for percutaneous closure of an acute post-infarct VSD after anteroseptal myocardial infarction. This procedure was complicated by perforation of the posterolateral free wall and led to the deployment of 12 mm ASO. The last patient suffered from free LV wall perforation during investigation of a severe aortic stenosis and was treated by implantation of 4 mm ASO. All patients were alive after 24 hrs but the last patient died during the in-hospital stay of a right ventricular infarction complicated by multiple organ failure. CONCLUSIONS: Percutaneous device occlusion of iatrogenic heart perforation seems to be a safe and efficient method to treat iatrogenic heart perforation. In order to perform this elegant method, it is however imperative not to prematurely withdraw the perforating catheter to maintain access to the hole for closure.

A novel technique for retrieval of a drug-eluting stent after catheter break and stent loss.

Break of a stent delivery catheter and subsequent stent loss (SL) has been a rare event in the drug-eluting stent (DES) era. We here report a case of successful retrieval of a stent after a break if the delivery catheter and SL from a balloon catheter at a culprit lesion. We finally resolved this situation using a simple balloon technique for both the broken stent catheter inside of the guide catheter and the unexpanded stent in the culprit lesion. Thus balloons are an important weapon in our armamentarium in the cardiac catheterization laboratory for urgent retrieval of a lost stent. Their apt use definitely allowed our patient to avoid undergoing emergency cardiovascular thoracic surgery.

Entrapment of a drug-eluting stent in left anterior descending artery and left main artery leading to a life-threatening complication.

Sudden stent loss after stent entrapment in a tight coronary lesion is an unexpected and devastating complication. Proper and timely steps without pressing the panic button are necessary. We describe a case of entrapment of a sirolimus-eluting stent into the left coronary artery system. Although the entrapped drug-eluting stent was successfully removed using a snare device, excessive guide manipulation under this life-threatening condition led to extensive left main and left circumflex artery dissection. This was immediately rescued by direct stenting to the left main and circumflex arteries. The usage of snare device in this bail-out situation was successful, safe and prevented emergency bypass surgery.

"Apical ballooning" - what is the cause?

The pathophysiology of takotsubo cardiomyopathy remains enigmatic. Here we attempted to define the link between the coronary arteries and the histopathological involvement of the left ventricle. We observed similarities and discrepancies between patients. All patients experienced stress prior to the event. We found a reduced coronary flow reserve in all patients and signs of hibernating myocardium on biopsy specimen. This raises a strong suspicion of stress-induced endothelial dysfunction with hibernating myocardium in the pathogenesis of this cardiomyopathy.

Port-a-Cath perforation of the right atrium closed with an amplatzer ASD occluder.

Right atrial perforation can lead to tamponade and death. Closure devices are used for sealing of shunts in the heart. We describe an indwelling catheter that caused perforation of the right atrium and was treated with a percutaneous closure device.

Coronary stent fracture and restenosis in the drug-eluting stent era: do we have clues of management?

Despite the fact that the drug-eluting stents (DES) have markedly reduced neointimal proliferation, restenosis is still an open subject. Although DES fracture is very rare, it has been considered as one of the reasons for DES restenosis, however, the mechanism and proper management are not clearly elucidated yet. We describe two cases of sirolimus-eluting stent fracture combined with significant restenosis and suggest the possible revascularization strategies for successful management.