Level 3 tracheal injury in acute coronary syndrome treated conservatively with extracorporeal membrane oxygenation.

Level 3 tracheal injury, characterised by complete laceration with oesophageal or mediastinal soft-tissue herniation, is conventionally indicated for surgical repair. We present the case of a woman in her 60s with level 3 tracheal injury in acute coronary syndrome who was treated successfully without surgery. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced during lung-rest management to avoid positive pressure ventilation, and percutaneous coronary angioplasty was performed. Venoarterial ECMO was switched to venovenous ECMO when the haemodynamics improved. The tracheal injury healed spontaneously in 10 days, and ECMO was withdrawn on day 15. The patient made full recovery and was discharged on day 51.

Successful endoscopic clipping management of a left atrioesophageal fistula after atrial fibrillation catheter ablation: A case report of a young male patient.

Atrioesophageal fistula (AEF) is a rare and serious complication of atrial fibrillation (AF) ablation, forming a connection between the atrium and esophagus. A systematic treatment approach for AEF has not been established to date. Herein, we report the case of a young male patient with left AEF after AF catheter ablation, which was successfully treated with the Over-the-Scope Clip (Ovesco Endoscopy AG, Tübingen, Germany) and conservative management. Despite having a double-orifice mitral valve and tricuspid valve, the patient had no symptoms or valve disease. The patient was readmitted three weeks after the procedure owing to fever, hematemesis, consciousness disturbance, hemiplegia, and systemic convulsions. Indigenous bacteria in the oral cavity were detected in blood culture. Magnetic resonance imaging of the brain showed multiple cerebral infarctions. Chest computed tomography showed mediastinal air, suggesting an AEF diagnosis. Subsequently, an endoscopic closure using the Over-the-Scope Clip was performed, leading to a successful recovery and patient discharge on day 87 after admission. This is the first case report of a successful management of AEF after radiofrequency ablation using the Over-the-Scope Clip system. Although surgery is the main treatment for AEFs, we performed nonsurgical management using the clip, demonstrating a potential treatment option for AEF. Learning objective: Surgical intervention is usually superior to endoscopic intervention and conservative management for treatment of atrioesophageal fistula. To the best of our knowledge, this is the first case to be successfully managed by endoscopic clipping and conservative management.

Heparin-induced thrombocytopenia associated with polycythemia vera during the treatment of acute coronary syndrome.

Here, we report a case of heparin-induced thrombocytopenia (HIT) associated with polycythemia vera (PV) during the treatment of acute coronary syndrome. An 84-year-old woman with pre-existing PV had an acute myocardial infarction and developed HIT after using heparin. An additional myocardial infarction was caused by HIT, and caused marked damage to her cardiac function. However, she was successfully treated with argatroban infusion and intensive care. In this case, we suspected HIT at an extremely early stage, when the decline in platelet count remained at 16%, which might have prevented further thrombosis. Subsequently, the nadir in the platelet count remained at 32%, which resulted in "intermediate possibility of HIT" according to the 4Ts score; thus, further detailed serological examination may be required for accurate diagnosis of HIT. .