Resolution of recurrent chest pain with resection of papillary fibroelastoma.

Papillary fibroelastoma (PFE) is a benign primary tumor of the heart usually originating from the heart valves. Nonvalvular fibroelastomas are rare, and reported cases have presented either incidentally or with cerebral embolic phenomena; none have reported recurrent anginal symptoms. We are reporting a case of a 53-year-old female with history of significant radiation exposure to the chest in the past, who presented with recurrent chest pain and was found to have left atrial nonvalvular PFE managed with surgical excision.

Atherectomy in Peripheral Artery Disease: A Review.

Peripheral arterial disease (PAD) is a clinical manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. The physiological force and shear stress from angioplasty and stenting have made PAD treatment challenging. Atherectomy devices have continued to emerge as a major therapy in the management of peripheral vascular disease. This article presents a review of the current literature for the atherectomy devices used in PAD.

Neutrophil lymphocyte ratio in peripheral vascular disease: a review.

Peripheral vascular disease (PVD) carries a significant morbidity and mortality. The role of inflammatory markers in cardiovascular medicine has been extensively studied. Neutrophil Lymphocyte ratio (NLR) is a novel biomarker which has been proposed as a marker of cardiovascular disease. We review the association of NLR with PVD. NLR has been shown to be an independent predictor of early and midterm amputation in patients with acute limb ischemia after embolectomy. A recent risk stratification model including NLR has emerged as a predictor of mortality and/or major amputation in critical limb ischemia. NLR appears to be an independent predictor of severity of PVD based on TransAtlantic Inter-Society Consensus classification, which classifies PVD based on the nature of the lesion and its anatomic distribution. A review of a large cohort of patients who had major vascular surgery, an NLR > 5 was found to be an independent predictor of mortality. In patients with intermediate carotid artery disease, NLR of 2.6 was found to be an independent variable for symptomatic carotid artery disease. It is a good predictor of early death in acute pulmonary embolism. NLR is inexpensive and readily available and appears to have a major role in peripheral vascular disease.

Acute complication due to impella 2.5 device (superficial femoral artery thrombosis): managed successfully with novel aspiration thrombectomy catheter (pronto v3).

The Impella recover LP 2.5 is a percutaneous left ventricular assist device (LVAD) recently approved for use in patients undergoing high risk percutaneous coronary intervention (PCI) and also in cases of cardiogenic shock. There is limited evidence available in literature about its safety, especially with regards to the incidence of local vascular complications, their management and long-term implications. We report here the first case of a serious local vascular complication-superficial femoral artery thrombus formation during Impella recover LP 2.5 use in a high risk PCI which was managed successfully with novel aspiration thrombectomy catheter (Pronto V3), which in itself is the first reported use of Pronto V3 in such a vascular complication.

Prevalence of dysglycemia among coronary artery bypass surgery patients with no previous diabetic history.

BACKGROUND: Dysglycemia is a major risk factor for atherosclerosis. In many patient populations dysglycemia is under-diagnosed. Patients with severe coronary artery disease commonly have dysglycemia and there is growing evidence that dysglycemia, irrespective of underlying history of diabetes, is associated with adverse outcome in coronary artery bypass graft (CABG) surgery patients, including longer hospital stay, wound infections, and higher mortality. As HbA1c is an easy and reliable way of checking for dysglycemia we routinely screen all patients undergoing CABG for elevations in HbA1c. Our hypothesis was that a substantial number of patients with dysglycemia that could be identified at the time of cardiothoracic surgery despite having no apparent history of diabetes. METHODS: 1045 consecutive patients undergoing CABG between 2007 and 2009 had HbA1c measured pre-operatively. The 2010 American Diabetes Association (ADA) diagnostic guidelines were used to categorize patients with no known history of diabetes as having diabetes (HbA1c ≥ 6.5%) or increased risk for diabetes (HbA1c 5.7-6.4%). RESULTS: Of the 1045 patients with pre-operative HbA1c measurements, 40% (n = 415) had a known history of diabetes and 60% (n = 630) had no known history of diabetes. For the 630 patients with no known diabetic history: 207 (32.9%) had a normal HbA1c (< 5.7%); 356 (56.5%) had an HbA1c falling in the increased risk for diabetes range (5.7-6.4%); and 67 (10.6%) had an HbA1c in the diabetes range (6.5% or higher). In this study the only conventional risk factor that was predictive of high HbA1c was BMI. We also found a high HbA1c irrespective of history of DM was associated with severe coronary artery disease as indicated by the number of vessels revascularized. CONCLUSION: Among individuals undergoing CABG with no known history of diabetes, there is a substantial amount of undiagnosed dysglycemia. Even though labeling these patients as "diabetic" or "increased risk for diabetes" remains controversial in terms of perioperative management, pre-operative screening could lead to appropriate post-operative follow up to mitigate short-term adverse outcome and provide high priority medical referrals of this at risk population.