Removal of a Hickman catheter using a laser sheath.

A 31-year-old female with 10 years indwelled Hickman catheter for idiopathic pulmonary hypertension presented infectious findings. We decided to remove it but simple traction did not work. Although it was an off labeled use, we could remove it using a laser sheath and snare technique without any complication.

Complete detachment of cardiac myxoma causing aortic saddle embolization and cerebral infarction.

A 30-year-old previously healthy male was brought to our emergency room with loss of consciousness and convulsion. Physical examination showed that the femoral arterial pulses were absent. Two-dimensional transthoracic and transesophageal echocardiography showed no evidence of intracardiac thrombus or tumor or of aortic dissection. Brain magnetic resonance imaging study showed cerebral infarction involving anterior and bilateral hemispheres. He died of multiple organ failure after admission. Autopsy showed aortic saddle embolization caused by a myxomatous-like material. Histological examination of the embolic material confirmed the diagnosis of myxoma. There was a stalk on the left atrial septum which might possibly represent the site of attachment of the myxoma. This case suggested that a cardiac myxoma completely detached from the left atrial septum and caused aortic saddle embolization.

Complete fracture and restenosis of sirolimus-eluting stent in ostial saphenous vein graft.

Although the use of a sirolimus-eluting stents (SES) have markedly reduced neointimal proliferation, in-stent restenosis still occurs in some cases. SES fracture was recently suggested as a new potential mechanism of restenosis. We described a rare case of complete SES fracture combined with significant restenosis, due to failure of drug delivery to the vessel wall, in the ostial saphenous vein graft (SVG). The curvature of the SVG during cardiac contractions with perivascular adhesion and fibrosis in the limited intra-thoracic space may induce high mechanical stresses at the ostial SVG. The cause of complete SES fracture in the present case was most likely mechanical stresses resulting from cardiac contractions.

Acute and chronic management in patients with Brugada syndrome associated with electrical storm of ventricular fibrillation.

BACKGROUND: Some patients with Brugada syndrome experience an electrical storm of ventricular fibrillation (VF). OBJECTIVE: The purpose of this study was to investigate the clinical, laboratory, electrocardiographic, and electrophysiologic characteristics, acute and subsequent chronic treatment, and follow-up data of patients with Brugada syndrome associated with electrical storm of VF. METHODS: Sixty-seven patients with Brugada syndrome (65 men and 2 women, age 46 +/- 14 years) were divided into three groups: 7 patients with a history of electrical storm of VF (group I), 39 symptomatic patients with documented VF and/or syncope (group II), and 21 asymptomatic patients (group III). Electrical storm was defined as three or more episodes of VF per day recorded by the memory of an implantable cardioverter-defibrillator. RESULTS: No significant differences were observed among the three groups with regard to clinical (age at diagnosis, familial history of sudden cardiac death), laboratory (SCN5A mutation and serum potassium level), electrocardiographic and electrophysiologic characteristics, and follow-up duration after diagnosis. However, arrhythmic events during follow-up after diagnosis and number of arrhythmic events per patient were significantly higher in group I compared with groups II and III. Isoproterenol infusion (0.003 +/- 0.003 microg/kg/min for 24 +/- 13 days) completely suppressed electrical storm of VF in all five patients treated and was successfully replaced with oral medications, including denopamine, quinidine, isoproterenol, cilostazol, and bepridil alone or in combination. CONCLUSION: No specifically clinical, laboratory, electrocardiographic, and electrophysiologic characteristics were recognized in patients with Brugada syndrome associated with electrical storm of VF. Isoproterenol infusion was effective as an acute treatment in suppressing electrical storm of VF and was successfully replaced with chronic oral medications.