Unconventional treatment of a giant coronary aneurysm presenting as ST-elevation myocardial infarction: a case report.

BACKGROUND: The optimal treatment of aneurysmal or ectatic culprit vessels in the setting of acute myocardial infarction is still matter of debate, as revascularization with either percutaneous intervention or surgery is associated with low procedural success and poor outcomes. CASE SUMMARY: We report the case of a 55-year-old male patient, admitted for inferior ST-elevation myocardial infarction, who underwent successful percutaneous implantation of a micro-mesh self-expanding nitinol carotid stent in a right coronary aneurysm with intravascular ultrasonography measured diameter of 9 mm and massive thrombus apposition. DISCUSSION: The technical characteristics of the micro-mesh self-expanding nitinol carotid stent allow for adequate plaque coverage and good apposition even in large vessels, making this device particularly suitable for the treatment of coronary lesions with high thrombus burden, when severe coronary ectasia or aneurysms are present.

[Endovascular treatment of a celiac trunk aneurysm: a case report and review of the literature]. / Trattamento transradiale di aneurisma complesso del tripode celiaco: descrizione di un caso e revisione della letteratura.

Celiac trunk aneurysms are uncommon vascular lesions; treatment is usually an open surgical operation; in the medical literature, only few cases of celiac aneurysm treated with endovascular technique are reported; coil positioning or stent-graft placement are described using a femoral vascular access as first choice.Here we describe the case of a 57-year-old man with an asymptomatic large celiac trunk aneurysm involving the origin of the splenic, left gastric and hepatic arteries. The patient was treated in an elective clinical setting with a totally endovascular procedure performed through the left radial artery. First, two vascular plugs were put into splenic and gastric artery, respectively, to prevent type II endoleak, then the aneurysm was closed using a balloon expandable stent-graft into the celiac trunk-hepatic axis. The procedure was completed without any complication. The computed tomography angiography scan confirmed total occlusion of the aneurysm and normal blood flow in the visceral arteries.This case shows that endovascular technique is effective and safe also for the treatment of very complex vascular lesions, and radial access could be considered the preferred choice to minimize access-related vascular complications.

Left innominate vein aneurysm finding during pacemaker lead insertion.

Thoracic vein aneurysms are very rare vascular lesions, usually detected as incidental findings. We describe the case of a patient with an advanced atrioventricular block who underwent definitive pacemaker implantation. In order to explain the difficult advancement of a pacemaker lead, vein angiography was performed during the procedure and a large innominate vein aneurysm was observed. Successful lead placement was then performed without further complications.

Autonomic modulation of the sinus node following electrical cardioversion of persistent atrial fibrillation: relation with early recurrence.

BACKGROUND: The aim of this study was to correlate early atrial fibrillation (AF) relapses with heart rate variability (HRV) parameters immediately recorded after electrical cardioversion (EC) of persistent AF. METHODS AND RESULTS: We performed the spectral analysis of short-term HRV 30 min after EC in 25 patients with persistent AF. The numbers of patients who maintained sinus rhythm at 48 h, 7, and 30 days were 22, 16, and 14, respectively. A very low low frequency/high frequency ratio (0.93+/-0.08 vs. 1.89+/-1.30; p<0.003) significantly identified patients with AF recurrence at 48 h in comparison to patients without AF recurrence. On the contrary, HRV parameters did not identify patients with AF recurrence at 7 or 30 days. CONCLUSIONS: AF relapsed within the first 48 h more frequently in patients who presented a predominant vagal tone immediately after the restoration of sinus rhythm.

[Circumferential isolation of pulmonary veins with transcatheter radiofrequency ablation in the treatment of atrial fibrillation]. / Isolamento circonferenziale delle vene polmonari mediante ablazione transcatetere con radiofrequenza per il trattamento della fibrillazione atriale.

BACKGROUND: Circumferential anatomical isolation of the pulmonary veins by radiofrequency transcatheter ablation is a new technique for the treatment of atrial fibrillation (AF). The aim of our study was to evaluate the efficacy and the safety of circumferential radiofrequency ablation of the pulmonary veins and to analyze clinical, echocardiographic and procedural parameters as possible predictors of clinical success. METHODS: We performed circumferential isolation of the pulmonary veins in 33 patients with paroxysmal (15 patients) or persistent AF (18 patients) refractory to at least two antiarrhythmic drugs. All patients continued antiarrhythmic therapy after the procedure for at least 12 months. RESULTS: At the end of the follow-up (mean 13.7 +/- 5.1 months) 70% of the patients resulted responders to the ablation, with no differences between patients with paroxysmal and persistent AF. Complications were observed in 3% of patients. Among clinical, echocardiographic and procedural parameters analyzed none turned out to be predictor of clinical success. CONCLUSIONS: Circumferential isolation of the pulmonary veins by radiofrequency transcatheter ablation associated with antiarrhythmic drugs was efficacious in 70% of patients with either paroxysmal or persistent AF. None of the analyzed variables predicted clinical success.

Variables correlated with early relapses after external electrical cardioversion of persistent atrial fibrillation.

BACKGROUND: The aim of this study was to identify the clinical and echocardiographic variables possibly correlated with the early relapses of atrial fibrillation (AF) after external electrical cardioversion (EC) in a large cohort of patients with persistent AF. METHODS: Two hundred patients (117 males, 83 females, mean age 67.9 +/- 8.7 years) with successful EC of persistent AF (> 72 hours) were included in the present study. In order to identify the predictors of early relapses (within 7 days) of AF, 16 clinical and echocardiographic variables were compared at univariate analysis. The variables with a p value < 0.10 at univariate analysis were subsequently analyzed at multivariate analysis. RESULTS: Seventy-five patients (37.5%) had relapses of AF within 7 days of EC. By univariate analysis only a younger age (65.9 +/- 8.9 vs 69.0 +/- 8.3 years, p = 0.01) was found to be significantly correlated with a higher incidence of early relapses of AF. At multivariate analysis no variable was found to be significantly correlated with early relapses of AF. CONCLUSIONS: In patients with persistent AF, recurrences of this arrhythmia within 7 days of EC occur frequently (37.5%). Multivariate analysis did not reveal any clinical or echocardiographic variable significantly correlated with the early recurrence of AF.

Percutaneous endovascular stent-graft placement for the treatment of acute rupture of an aneurysm of the thoracic aorta.

A 68-year-old male patient presented with massive hematemesis following the acute rupture of an aneurysm of the descending thoracic aorta into the esophagus. In view of the important cardiac and pulmonary comorbidities, surgical treatment was excluded and successful percutaneous implantation of an endovascular stent-graft in the descending aorta was performed. In selected patients endovascular treatment may constitute an alternative to the surgical repair of ruptured aortic aneurysms.