Erroneous Rapid Exchange Balloon Inflation During Coronary Angioplasty in a Male Patient in His 70s With Chronic Stable Angina.

This case report discusses an erroneous rapid exchange balloon inflation during coronary angioplasty in a patient who presented with a right coronary artery lesion on angiography.

Egg-shell calcification in Pick's disease (chronic constrictive pericarditis).

Egg-shell calcification is rare in cases with constrictive pericarditis. It leads to significant right heart failure and the only treatment is surgical excision of the pericardium. We present a case of a 22-year-old-male who was diagnosed to have severe pericardial calcification on the chest X-ray, which eventually led to a diagnosis of constrictive pericarditis and required an early surgical correction. This case shows that a common diagnostic test such as a chest X-ray does help to diagnose a severe systemic condition.

Successful use of venovenous snare to fix the wire in a collateral vein for proper placement of the left ventricular lead during cardiac resynchronization therapy: a case report.

BACKGROUND: In cardiac resynchronization therapy, left ventricular (LV) lead placement at the desired position may be difficult due to abnormal coronary sinus (CS) and lateral vein anatomy. We present a case with difficult anatomy in which we used 'an indigenous snare' made from hardware used for coronary angioplasty procedures, which is available in any cardiac catheterization laboratory. CASE SUMMARY: A 52-year-old man presented with dyspnoea due to chronic heart failure was evaluated for cardiac resynchronization therapy. The LV lead was difficult to advance into the only target lateral branch of the CS due to a combination of angulation and proximal stenosis. Balloon dilation was tried first, but we failed to track the LV lead. We formed a venovenous loop, advancing the coronary guidewire 0.014″ into the posterolateral vein; subsequently into the middle cardiac vein via a collateral. The wire was advanced into the CS and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized by using indigenous snare. Over this loop, the LV lead of the cardiac resynchronization therapy with defibrillator device was implanted successfully. DISCUSSION: We have used the snare technique, with the use of a snare prepared from a coronary guidewire. Use of such an indigenous snare has not been described before in the literature. The hardware used in this case is routinely used for coronary angioplasty procedures in all catheterization labs. The importance of our case is that no special hardware like dedicated snare was required to negotiate the LV lead at its desired location.

Changing QRS duration and morphology with A-paced and A-sensed rhythm in postcardiac resynchronization therapy (CRT) patients.

Meticulous interpretation of the ECGs of patients with cardiac resynchronization defibrillator therapy (CRT-D) device is important to ensure optimal synchronization of both the chambers. We present the ECGs of such a patient who was noted to have different morphologies of the biventricular-paced QRS depending in atrial-sensed (A-sensed) or atrial-paced (A-paced) rhythm.