Successful percutaneous transvenous approach for pinch-off syndrome: a case report.

Background: Pinch-off syndrome is a rare late complication characterized by the occurrence of spontaneous fracture and embolization of a port-a-cath implanted via subclavian venous access. It may lead to serious cardiovascular outcomes. Case presentation: We report a successful percutaneous transvenous removal of intravascular fractured port catheter embolized into the right ventricle by using the 'lasso' technique in an 85-year-old man with type B non-Hodgkin lymphoma undergoing chemotherapy and long estimated life expectancy. Discussion: Knowledge of pinch-off syndrome among physicians is essential for early intervention, thereby preventing adverse events. Percutaneous approach seems an effective, safe, and simple procedure.

Vitamin D deficiency related to physical capacity during cardiac rehabilitation.

BACKGROUND: Vitamin D deficiency is a frequent pathology associated with cardiovascular diseases and physical performance. OBJECTIVE: To study the link between 25-hydroxyvitamin D (25OHD) level and physical performance and gain in physical performance after cardiovascular rehabilitation (CVR) with vitamin D deficiency. METHODS: 25OHD level was assessed in a retrospective cohort of patients admitted for CVR. Data were collected on physical fitness [6-min walk test distance (6MWD) in percentage of predicted, maximal power (Pmax)]. The threshold of vitamin D deficiency was 20ng/ml chosen according to the literature. RESULTS: Among the 131 patients included, as compared with those with nondeficiency (n=83; 63%), patients with vitamin D deficiency (n=48, 37%) had lower initial 6MWD (82±18 vs 89±12% predicted, P=0.009) and Pmax (100±58 vs 120±39W, P=0.006). After CVR, this difference was maintained. The improvement in 6MWD and Pmax was significantly lower with deficiency than nondeficiency, for an increase of 11±8% versus 14±9% predicted (P=0.048) and 10±30 versus 32±30W (P=0.00001), respectively. CONCLUSION: Vitamin D deficiency may be associated with impaired physical fitness before CVR and a smaller gain in physical fitness with CVR, probably related to the action of vitamin D on the muscle.

Cardiac rehabilitation and 5-year mortality after acute coronary syndromes: The 2005 French FAST-MI study.

BACKGROUND: Clinical studies have shown a beneficial effect of cardiac rehabilitation (CR) on mortality. OBJECTIVE: To study the effect of CR prescription at discharge on 5-year mortality in patients with acute myocardial infarction (AMI). METHODS: Participants, from the 2005 French FAST-MI hospital registry, were 2894 survivors at discharge, divided according to AMI type: ST-segment elevation myocardial infarction (STEMI; n=1523) and non-STEMI (NSTEMI; n=1371). The effect of CR prescription on mortality was analysed using a Cox proportional hazards model. RESULTS: At discharge, 22.1% of patients had a CR prescription. Patients referred to CR were younger (62.4 vs. 67.5years), were more frequently men and more had presented with STEMI (67.8% vs. 48.3%) than non-referred patients. Ninety-four (14.7%) deaths occurred among patients referred to CR and 585 (25.9%) among non-referred patients (P<0.001). After multivariable adjustment, the association between CR and mortality remained significant (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.60-0.96). Analyses stratified by sex, age (<60 vs.≥60years) and AMI type showed that the inverse association was stronger in men (HR 0.64, 95% CI 0.48-0.87) than in women (HR 0.95, 95% CI 0.64-1.39), in younger (HR 0.34, 95% CI 0.15-0.77) than in older patients (HR 0.84, 95% CI 0.65-1.07) and in NSTEMI (HR 0.63, 95% CI 0.46-0.88) than in STEMI (HR 0.99, 95% CI 0.69-1.40). CONCLUSION: After hospitalization for AMI, referral to CR remains a significant predictor of improved patient survival; some subgroups seem to gain greater benefit.