Successful percutaneous retrieval of unusually knotted temporary pacemaker lead.

Implantation of temporary pacemaker lead is commonly performed procedure and is usually safe, but can sometimes develop rare and serious complication like intracardiac lead knotting which may require challenging retrieval techniques. We report a case of successful percutaneous retrieval of unusually knotted right internal jugular venous temporary pacing lead via left femoral transvenous approach using snare over a long sheath after cutting the electrode proximally and thus avoiding any surgical intervention.

Percutaneous transvenous tricuspid commissurotomy in a patient with congenitally corrected transposition of great arteries: a case report.

Percutaneous balloon tricuspid valvotomy was successfully performed in a 45-year-old female with congenitally corrected transposition of great arteries with severe rheumatic left atrioventricular (tricuspid) valve stenosis. Technical modifications in the standard procedure were made keeping in mind the left-handed ventricular loop, left and anterior aorta, wedged pulmonary valve between the interatrial septum and the mitral valve with deviation of the atrial septum away from the ventricular septum, side-by-side positioned ventricles with an added superoinferior obliquity produced by excessive tilting, and an abnormal orientation of ventricular mass in relation to the thorax, with the apex pointing slightly rightwards. A final valve area of 1.4 cm(2) and a fall in the peak/mean left atrial pressures from 37/32 mm Hg to 13/10 mm Hg were achieved without complications. This case of percutaneous transvenous commissurotomy is unique in view of the rarity of the combination of this congenital heart disease and rheumatic heart disease and successful commissurotomy in such an unusual cardiac anatomy using the Inoue technique.

Double-chambered right ventricle with pulmonary valve endocarditis.

We describe a rare case of pulmonary valve endocarditis associated with a double-chambered right ventricle in an adolescent male highlighting the two-dimensional and three-dimensional transthoracic echocardiographic findings. He was managed with aggressive antibiotic therapy followed by surgery. The echocardiographic findings were confirmed during surgery.

Acute pancreatitis complicated by ST-elevation myocardial infarction.

BACKGROUND: Electrocardiographic abnormalities mimicking myocardial ischemia have been reported in intra-abdominal conditions, including acute pancreatitis. However, the occurrence of ST-elevation myocardial infarction (STEMI) is rare. OBJECTIVES: To present a case report of a young man with acute pancreatitis subsequently complicated by acute STEMI. The diagnosis and management of STEMI in acute pancreatitis can present unique diagnostic and therapeutic challenges, which are reviewed. CASE REPORT: A 31-year-old man with no conventional coronary risk factors presented with acute abdominal pain, elevated pancreatic enzymes, and computed tomography scan findings of acute pancreatitis. The patient developed chest discomfort and presented to us on Day 2 with electrocardiographic evidence of an evolved extensive anterior wall myocardial infarction. Cardiac troponin I levels were elevated, and the electrocardiogram showed regional wall motion abnormalities in the left anterior descending territory (LAD). Coronary angiography done after stabilization showed a thrombus in the LAD, with no atherosclerotic lesions whatsoever. Hemostatic abnormalities are known in acute pancreatitis, and the development of a transient hypercoagulable state may be responsible for thrombotic complications. The overlap of some of the symptoms of the two conditions may cause diagnostic difficulty. Management issues include the choice of revascularization therapy, the safety of antiplatelet and anticoagulant therapy, intravenous fluid administration, and the use of cardiac medications that potentially can cause hypotension. CONCLUSION: The diagnosis and management of STEMI in the setting of acute pancreatitis can be challenging. In the absence of guidelines, a multidisciplinary approach individualized to the patient's clinical situation may be most appropriate.

A rare Case of "Acute Take Off" of Left Circumflex Artery Successfully Intervened using Dual-Lumen Microcatheter.

"Acute take off" of the left circumflex artery (LCX) is a rare coronary artery variant. Development of coronary artery disease in such a vessel increases technical difficulty and failure rate for percutaneous coronary intervention. We report a rare case of "acute take off" of the LCX with proximal critical stenosis successfully intervened using dual-lumen microcatheter.

Single Center 7 Year Experience of Coronary Artery Perforation: Angiographic and Procedural Characteristics, Management and Outcome.

CONTEXT: Coronary artery perforation is a rare but potentially catastrophic complication of percutaneous coronary intervention (PCI). It is infrequent complication of PCI. AIMS: The objective of the study is to report the 7-year experience of coronary artery perforation with respect to incidence, clinical and angiographic characteristics, management and outcomes. SETTINGS AND DESIGN: The study involved retrospective analysis of single centre 7 years of percutaneous coronary intervention data. Patients who had complication of coronary artery perforation during PCI were identified and included in the study. SUBJECTS AND METHODS: Retrospective analysis of clinical, angiographic and procedural characteristics as well as management and outcome of coronary artery perforation was done. STATISTICAL ANALYSIS USED: The whole data were tabulated, variables were presented as mean and percentages and comparison was done within them. RESULTS: A total of 37 cases of coronary artery perforation were identified from 4532 PCI performed. Most of the coronary artery perforation belonged to Ellis Type II and Type III (both n = 15) followed by Type III CS and Type I. Lesions belonged to AHC/AHA Type C in 31 cases. Most frequent mechanism of coronary artery perforation was related to the use of guidewire and balloon (both n = 17). The total of 8 cases presented with cardiac tamponade requiring pericardiocentesis. Eleven cases required emergency covered stent implantation. In two cases microcoil was used while one case required polyvinyl alcohol particles to seal the perforation site. There was no in-hospital mortality while 30-day mortality occurred in one patient. One case was referred for emergency surgery. CONCLUSIONS: Coronary artery perforation is rare but potentially fatal complication of percutaneous coronary intervention. Complication of coronary artery perforation can be managed effectively in the catheterization laboratory without the need of emergency of bailout surgery and in-hospital outcomes remain good in the majority of cases.

Percutaneous coronary intervention in a rare case of Type V dual LAD.

Congenital coronary anomalies are rare and reported to occur in 0.64-1.3% of patients undergoing coronary angiography. The dual left anterior descending coronary artery (LAD) is a rare coronary anomaly defined as the presence of two LADs in the anterior interventricular sulcus (AIVS). It consists of a short LAD that ends high in the AIVS and a longer LAD that enters the distal AIVS and feeds apex. Percutaneous interventions are even more uncommon in dual LAD especially Type V LAD. Thus we describe an interesting case of percutaneous transluminal coronary angioplasty (PTCA) with stenting to Type V dual LAD in a patient with chronic stable angina who was refractory to maximal anti-anginal medications. Our case was unique for these aspects - 1)Type V dual LAD is rare.2)Ramus artery is present in fewer cases of dual LAD.3)Long LAD had a myocardial bridge.4)Few cases have been reported of PTCA with stenting to short LAD. .