Con: Contrast-induced nephropathy-should we try to avoid contrast media in patients with chronic kidney disease?

The incidence of acute kidney injury (AKI) attributed to iodinated contrast has been over-estimated and this has led clinicians to withhold potentially life-saving diagnostic and therapeutic interventions. There is mounting evidence that iodinated contrast plays only a minor role in the development of AKI in comparison with more significant risk factors such as pre-existing renal dysfunction, hemodynamic instability and exposure to nephrotoxic drugs. We will present data which challenge the dogma of avoiding iodinated contrast in patients with reduced renal function. Based on a rational and individualized risk-benefit analysis, we believe it is preferable to utilize iodinated contrast if alternate diagnostic or therapeutic options are comparatively ineffective or hazardous.

One problem two issues! Left ventricular systolic and diastolic dysfunction in aortic stenosis.

Reports suggested that immediate post-aortic valve replacement (AVR); left ventricular (LV) dysfunction may be an important risk for morbidity and mortality in patients requiring positive inotropic support. Several factors have been identified as significant prognostic factors i.e., LV systolic dysfunction, LV diastolic dysfunction (LV-DD), heart failure and myocardial infarction (MI). Specific to pathophysiological changes associated with AS, markers of systolic LV function (e.g., LVEF) have been extensively studied in management, yet only a few studies have analysed the association between LV-DD and immediate post-operative LV dysfunction This review brings together the current body of evidence on this issue.

Large lymphaticovenous malformation resection.

We report a case of a giant cardiac lymphaticovenous malformation arising from the atrioventricular groove in a 38-year old Caucasian female. Cardiac vascular lesions are rare and tend to be poorly described in the literature. Lymphaticovenous malformations are present at birth and develop due to errors in venolymphatic development. As the tumour enlarged, the patient experienced significant shortness of breath on exertion. At resection, the mass measured 6.0 cm anterior-posterior ×10.4 cm craniocaudal. The mass was found to be adhered tightly to the coronary sinus. Histologically, the lesion was composed of dilated vascular and lymphatic channels within a fatty stroma. The mass was resected without complications.

Mycotic pseudoaneurysm of the aortic arch with purulent pericardial effusion.

A 67-year-old woman presented with dyspnea on exertion and a diminished left radial pulse in comparison with the right. She had signs and symptoms of cardiac tamponade. A computed tomographic (CT) angiogram of the chest revealed an aortic arch pseudoaneurysm along the lesser curvature and a large pericardial effusion with the density of blood. Upon pericardiotomy, a nonhemorrhagic thick purulent effusion (Streptococcus milleri) was discovered in the pericardial space. Replacement of the aortic arch was performed with a rifampin-soaked Dacron tube graft, with the patient under hypothermic circulatory arrest.