Treatment of Inferior Vena Cava Thrombosis by Endovascular Stenting: A Case Report.

Optimal treatment of inferior vena cava (IVC) thrombosis remains unclear, especially given the contraindications to anticoagulation use and because interventional options remain limited. We present a case of a 62-year-old man with advanced liver cirrhosis who developed IVC thrombosis with symptoms of severe abdominal pain and leg swelling. IVC flow was restored via successful recanalization with a transjugular and common femoral approach after deploying a 22 × 70 mm Wallstent. On follow-up, the patient had a resolution of his symptoms.

Aerococcus urinae: A Rare Cause of Endocarditis Presenting With Acute Stroke.

Aerococcus urinae is a rare organism infrequently isolated from cultures. Mostly known to cause urinary tract infection, it can cause bacteremia leading to severe urosepsis and infective endocarditis. Embolization is frequently reported with Aerococcus urinae endocarditis (AUE); hence, the presentation is highly variable. Sequelae such as various central nervous system manifestations, sepsis, valvular regurgitation with heart failure and even coronary artery involvement have been reported. We report a case of a 58-year-old man with AUE of the aortic valve, severe aortic regurgitation and embolic stroke as a result of embolization from AUE and ultimately required aortic valve replacement. Our case highlights this rare cause of endocarditis and offers insight into the variability of patient presentation and risk factors to consider.

Trastuzumab-Induced Cardiomyopathy and Intermittent Left Bundle Branch Block.

Trastuzumab-induced cardiomyopathy is a known complication of its use in breast cancer treatment, but it remains mostly asymptomatic and often reversible. Non-myopathic cardiac complications have been rarely reported with trastuzumab. These include left and right bundle branch block, arrhythmias and sinus node dysfunction. We report a case of a 52-year-old female breast cancer patient with trastuzumab-induced asymptomatic intermittent left bundle branch block recurring nearly a year after the initial diagnosis and resolution of trastuzumab-related cardiomyopathy.

Myocardial Stunning After Electrocution With Complete Reversibility Within 24 Hours: Role of Repeat Transthoracic Echocardiograms in Potential Cardiac Transplant Donors.

Despite the development of ventricular assist devices, cardiac transplantation remains an important procedure for patients with advanced heart failure. The number of transplants done annually has remained stable because of lack of of donors. Left ventricular systolic dysfunction remains one of the most important reasons for seeking a donor heart. Myocardial stunning is an important cause of reversible systolic dysfunction. Electrical injury is a recognized cause of myocardial stunning with variable duration ranging from days to weeks. Repeating the transthoracic echocardiogram to look for reversibility of left ventricular dysfunction can be a cost-effective method to improve the selection of heart donors. This can significantly help to decrease critical organ shortage. We present a case of myocardial stunning after electrocution which was completely reversible within a few hours, thus meeting cardiac transplant donor criteria.

Bioprosthetic Valve Thrombosis.

Degenerative valve disease is on the rise with greater than 100,000 valve operations performed in the US alone per year. The majority of those procedures employ tissue bioprostheses to avoid the attendant risk of anticoagulation, especially in the elderly. Though traditionally this approach has been considered a superior option to avoid anticoagulation, more recent analyses have demonstrated a significant incidence of previously unrecognized thrombosis associated with bioprosthetic valves, especially with the more recent advent of the transcatheter aortic valve replacement implantations. Bioprosthetic valve thrombosis is a major cause of either acute or indolent bioprosthetic valve degeneration, and often has an elusive presentation causing delayed recognition and treatment. The literature has extensively addressed the risks and benefits of anticoagulation following bioprosthetic valve replacement to prevent bioprosthetic valve thrombosis (BPVT), without conclusive evidence-based recommendations. The duration of anticoagulation following an episode of BPVT is unclear, and lifelong anticoagulation has been suggested. The increasing use of transcatheter aortic valve replacement as an alternative to surgical aortic valve replacement in various risk groups has introduced new challenges with regards to valve thrombosis, which have been poorly studied with regards to optimal treatment and prevention. The increasing use of valve-in-valve procedures is expected to bring on further uncharted challenges.