18F-FDG PET/CT-imaging of left ventricular assist device infection: a retrospective quantitative intrapatient analysis.

BACKGROUND: Despite the use of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT), diagnosis of a driveline infection in ventricular assist device (LVAD) recipients remains challenging. Our aim was to evaluate the potential of a baseline 18F-FDG PET/CT (prior to an infection) for the diagnosis of an LVAD-related infection. METHODS: We retrospectively selected all LVAD recipients who had undergone two consecutive whole-body 18F-FDG PET/CT examinations between January 2010 and December 2016. PET/CT was analyzed qualitatively (uptake pattern) and semi-quantitatively (SUVmax and ∆SUVmax). SUVmax was measured and compared in five distinctive volumes of interest along the LVAD driveline. An SUVmax threshold was calculated. Final diagnosis was made by clinical examination, microbiological parameters, and molecular imaging. RESULTS: Thirty patients were enrolled (mean age 54 ± 12 years; 26 male). Mean difference in SUVmax for all five positions between the first and the second PET/CT along the driveline was significantly higher in patients with an LVAD-related infection (mean ∆SUVmax = 4.38 ± 1.44) compared to those without a driveline infection (mean ∆SUVmax = 0.03 ± 0.43), P < 0.05. Applying ROC analysis, an SUVmax threshold of 3.88 resulted in a sensitivity and specificity of 100%, respectively. There were three distinctive uptake patterns in patients with a driveline infection. CONCLUSION: PET/CT diagnosis in the context of an LVAD-related infection can be improved by comparison to a baseline examination using a distinctive SUVmax threshold.

Pre-operative risk factors for driveline infection in left ventricular-assist device patients.

AIMS: Implantation of left ventricular-assist devices (LVAD) to treat end-stage heart failure is of increasing relevance due to donor shortage. Infections of the driveline are common adverse events. LVAD infections can lead to high urgency listings for transplantation. However, transplantation in patients with infection leads to worse post-transplantation outcomes. This study aims to evaluate specific risk factors for driveline infections at the time of implantation. METHODS AND RESULTS: Four hundred forty-one patients receiving either Heartmate II or Heartware system from August 2009 to October 2013 were assessed. An expert committee sorted patients into four different groups concerning the likeliness of infection. Twenty-eight (6%) of discussed infection cases were judged as secured, 33 (7%) as likely, 18 (4%) as possible, and 20 (4%) as unlikely. The remaining 342 (78%) subjects showed either no signs of infection at all times (329 [75%]) or developed signs of infection in a second observation period within 1 year after ending of the first observation period (13 [3%]). For a better discriminatory power, cases of secured and likely infections were tested against the group with no infection at all times in a Cox proportional hazard model. Among all variables tested by univariate analysis (significance level P < 0.15), only age (P = 0.07), LVAD-type (P = 0.12), need for another thoracic operation (P = 0.02), and serum creatinine value (P = 0.02) reached statistical significance. These were subsequently subjected to multivariate analysis to calculate the cumulative risk of developing a drive infection. The multivariate analysis showed that of all the potential risk factors tested, only the necessity of re-thoracotomy or secondary thoracic closure had a significant, protective effect (hazard ratio [95% CI] = 0.45 [0.21-0.95]; P = 0.04). CONCLUSION: This single-centre cohort study shows that driveline infections are common adverse events. The duration of support represents the major risk factor for LVAD driveline infections.

Hemoptysis as a side effect of cryoballoon pulmonary vein isolation in atrial fibrillation: a retrospective case-control study.

PURPOSE: Hemoptysis and pulmonary hemorrhage are rarely described as complications of cryoballoon ablation for pulmonary vein isolation (CB PVI). This study evaluated a large cohort to determine the frequency and risk factors for manifestation of these complications and assess the clinical relevance of hemoptysis after CB PVI. METHODS: Seven hundred fifteen consecutive patients (351 female) from a single-center database were evaluated to identify those who developed hemoptysis after CB PVI. RESULTS: A total of 31 patients with hemoptysis (4.3%; 2 female, age 60.5 ± 11.5 years) were matched with a control group (n = 31). Hemoptysis developed within 72 h after CB PVI. Cases versus controls had significantly lower ablation temperatures in the right inferior pulmonary vein (PV) (- 56.2 ± 26.6 vs - 49.1 ± 13.2 °C; p = 0.004) and left inferior PV (- 56.4 ± 11.9 vs - 47.2 ± 7.6 °C; p = 0.001). A trend to lower temperatures not reaching the level of significance was also found for the superior PV. All other procedural parameters were not significantly different between cases and controls. Although pre-procedural hemoglobin levels were comparable, post-procedural hemoglobin was lower in cases versus controls (12.9 ± 1.6 vs 13.7 ± 1.5 g/dL; p < 0.05). Twenty-six patients presenting with hemoptysis underwent chest CT scan, which showed perivenous infiltration at either the right (n = 23) or left inferior PV (n = 2) or no infiltrate (n = 1). No negative long-term effects were reported after 3, 6, and 12 months' follow-up. CONCLUSIONS: Post-procedural hemoptysis after CB PVI is a relatively frequent finding and was associated with low freezing temperatures and pulmonary tissue infiltration predominantly located at the right inferior PV. Hemoptysis resolved without long-term sequelae.

Uncommon intraventricular thrombus formation between the posterior mitral leaflet and the lateral left ventricular wall.

Transthoracic echocardiography demonstrated an intraventricular mass between the posterior mitral leaflet and the lateral left ventricular (LV) free wall in a 61-year-old man. Because of this uncommon localization an intracardial tumor, an endocarditis of the mitral valve or an intraventricular thrombus was suspected. Magnetic resonance imaging (MRI) ruled out an intracardial tumor and revealed a myocardial scarring of the LV free wall covered by an intraventricular thrombus by late gadolinium enhancement. MRI can distinguish subacute clots-which do not enhance after contrast material injection-from organized thrombi. The characterization of thrombi can be used to predict the risk of embolism, which is higher for subacute clots than for organized thrombi.

Successful correction of a total anomalous venous connection in a 63-year-old male--case report and review of the literature.

Total anomalous pulmonary venous connection is a rare variant of cyanotic congenital heart disease and usually requires surgical correction within the first few months of life. We report midterm results of a 63-year-old male with intracardiac total anomalous venous return into the coronary sinus who presented with congestive predominantly right heart failure and underwent corrective surgery with unroofing of the coronary sinus and patch closure of the secundum atrial septal defect.

Primary malignant pericardial mesothelioma - a rare cause of pericardial effusion and consecutive constrictive pericarditis: a case report.

INTRODUCTION: Primary malignant pericardial mesothelioma is a very rare pericardial tumor of unknown etiology. CASE PRESENTATION: A 61-year-old Caucasian woman was admitted to our hospital complaining of exertional dyspnea due to a large pericardial effusion. Intrapericardial fluid volume declined after repeated pericardiocentesis, but the patient progressively developed a hemodynamically relevant pericardial constriction. Pericardiectomy revealed a pericardial mesothelioma. Subsequently, four cycles of chemotherapy (dosage according to recently published trials) were administered. The patient remained asymptomatic, and there was no recurrence of the tumor after three years. CONCLUSION: Pericardial mesothelioma should be considered and managed appropriately in non-responders to pericardiocentesis, and in patients who develop constrictive pericarditis late in their clinical course.