Giant Right Coronary Artery Aneurysm Incidentally Found During Stroke Evaluation Through Echocardiography.

Giant coronary artery aneurysms (CAAs) are rare forms of coronary artery disease. An 82-year-old man presented to the hospital with generalized weakness, arm numbness, and dizziness and was found to have a multi-infarct stroke. A transthoracic echocardiogram was obtained to determine a possible cardiovascular etiology of his stroke. However, it did not reveal thrombi or vegetation; instead, it showed a ring-like structure adjacent to the tricuspid valve that appeared to be a large right atrial cyst. A transesophageal echocardiogram was performed localizing the ring-like mass near the tricuspid annulus. Cardiac catheterization revealed aneurysms of the coronary arteries with complete distal occlusion of the left anterior descending artery (LAD), an aneurysmal left circumflex, and a right coronary artery with a very large aneurysm without signs of thrombus or flow-limiting lesion. CAAs are usually found through cardiac catheterization. Echocardiography may be a novel way of identifying CAAs.

Burkholderia cepacia: A Rare Source of Endocarditis.

A 37-year-old male with a past medical history of previous mitral valve replacement due to bacterial endocarditis and intravenous (IV) drug use was found to have Burkholderia cepacia bacteremia. Transesophageal echocardiogram revealed large mitral and tricuspid valve vegetations. Medical management was initially attempted but his bacteremia persisted, and he required urgent prosthetic mitral valve replacement and native tricuspid valve replacement. Prosthetic valve endocarditis has been associated with surgery in 48.9% of patients and a mortality of 22.8%. In patients with prosthetic valve endocarditis due to B. cepacia, valve replacement occurred in approximately 61.5% of patients and mortality is estimated to be 33.3%. To our knowledge, this is one of only a few prosthetic valve endocarditis cases caused solely by B. cepacia and our case is the first to affect multiple valves including prosthetic and native valves.

Triple Threat: Triple Pathogen Endocarditis.

Polymicrobial endocarditis is rare but is seen in those with risk factors like diabetes mellitus, structural heart disease, congenital heart defects, prosthetic devices, and intravenous drug use. We report the case of a 30-year-old woman with a past medical history of chronic Hepatitis C and IV drug use who presented with a one-week history of generalized weakness, subjective fevers, lower extremity abscesses, and occasional chest pain. Blood cultures were positive for Streptococcus anginosus, Gemella hemolysans, and Pseudomonas aeruginosa. A transthoracic echocardiogram revealed a very large tricuspid valve vegetation and severe tricuspid regurgitation. Her course was complicated by a complete heart block, septic pulmonary emboli, acute hypoxic respiratory failure, and cardiogenic shock meeting the criteria for early surgical intervention. She underwent an emergency tricuspid valve replacement and pacemaker implantation. During the operation, it became evident that her valve was destroyed with vegetation. A week after the operation, her ejection fraction had improved to 50% and she only exhibited mild tricuspid valve regurgitation. Six weeks later, she was in a stable condition and presented for follow-up. Surgery is necessitated in nearly 50% of Gemella endocarditis cases, 62% of cases with S. anginosus group, and approximately 56% of P. aeruginosa cases. To our knowledge, this is the only case of polymicrobial endocarditis caused by G. hemolysans, S. anginosus, and P. aeruginosa.

CAUSE: Learning Granger Causality from Event Sequences using Attribution Methods.

We study the problem of learning Granger causality between event types from asynchronous, interdependent, multi-type event sequences. Existing work suffers from either limited model flexibility or poor model explainability and thus fails to uncover Granger causality across a wide variety of event sequences with diverse event interdependency. To address these weaknesses, we propose CAUSE (Causality from AttribUtions on Sequence of Events), a novel framework for the studied task. The key idea of CAUSE is to first implicitly capture the underlying event interdependency by fitting a neural point process, and then extract from the process a Granger causality statistic using an axiomatic attribution method. Across multiple datasets riddled with diverse event interdependency, we demonstrate that CAUSE achieves superior performance on correctly inferring the inter-type Granger causality over a range of state-of-the-art methods.

Left ventricular puncture during thoracentesis.

Left ventricular puncture during a thoracentesis is a rare and unusual complication that has yet to be reported. We report a case in which a 74-year-old woman with dilated ischaemic heart disease suffered from puncture of the left ventricle during a routine ultrasound-guided thoracentesis despite following the recommended protocol and procedures. She became haemodynamically unstable and underwent an emergent thoracotomy for removal of the catheter and repair of the left ventricular wall.

Successful Obliteration of a Pseudoaneurysm from Post-CEA Repair Secondary to a Pruitt-Inahara Shunt Using a Stent Graft.

Pseudoaneurysms of the carotid artery are very uncommon complications following carotid endarterectomy. Pseudoaneurysms are usually caused by any kind of blunt injury or trauma during carotid artery surgery. CEA has become an increasingly more common vascular surgery performed in the United States. The standard of treatment for a carotid PA has been open surgical repair with excision of the defect and then a graft reconstruction of the artery. Advancements in endovascular intervention have helped to make it a more popular choice in treatment because of the positive results and less invasive approach. This case report describes the successful obliteration of a large post-CEA PA using a stent graft. The PA was likely secondary to the use of a Pruitt-lnahara Shunt because it was found to be distal to the endarterectomized area of the carotid artery which means that the defect was likely caused by the balloon portion of the shunt. This case demonstrates the feasibility of using endovascular interventional techniques to treat a PA using a stent graft.