A case series of novel technique of coronary protection for patients with low coronary height undergoing transcatheter aortic valve implantation.

OBJECTIVE: Coronary artery occlusion (CAO) in patients undergoing transcatheter aortic valve implantation (TAVI) is rare but is associated with up to 50% mortality risk. We report a case series of a novel technique of coronary protection for patients undergoing TAVI at high risk of CAO. METHODS: Patients with symptomatic severe aortic stenosis scheduled for TAVI and at high risk of CAO were included. A noncompliant coronary angioplasty balloon was placed between the left coronary artery and the transcatheter heart valve. The distal "nose" of the balloon was positioned at the ostium of the left main and its main body "hanging" in the aorta. The coronary balloon was sized 1:1 to the left main, and simultaneous kissing balloon inflation was performed during valve deployment. RESULTS: Eight patients were included in this series. Five patients had previous isolated surgical bioprosthetic valves. The median left coronary height was 7.1 (6.0-8.4) mm with a median valve-to-coronary (VTC) distance of 3.3 (2.9-3.6) mm. There were no procedural complications, but one patient had a stroke during their in-hospital stay. After a median follow up of 12 (5.8-16.8) months, there were no mortality or rehospitalization events. CONCLUSION: Simultaneous kissing balloon is a novel technique of coronary protection in patients undergoing TAVI at high risk of CAO. Further studies are required to establish the safety of this novel technique.

Delayed, Unprovoked, Hemodynamic Collapse with Following Asystole in a Pediatric Patient Following a High-Voltage Injury: A Case Report and Literature Review.

Electrical incidents are common and mostly uneventful, though can be severe and sometimes lethal. Aside from skin, muscle and soft tissue damage, electrical injuries can cause cardiac arrhythmias, the most common cardiac complication. The case of a 14-year-old girl who sustained 48.5% TBSA burns following a high-voltage electrical injury is described. She suffered five episodes of asystole 78 h following the injury, requiring extracorporeal membrane oxygenation. The cause of the delayed asystole was investigated and a PubMed literature search was conducted to explore late presenting cardiac sequelae following electrical injuries. This yielded fifteen studies, identified as relevant, of high quality and in the English language. These studies included a total of 1411 patients of whom only 3 were found to have had late potentially lethal arrhythmias, all manifesting within the first 24 h after the injury. Of these patients, 32 suffered cardiac arrests shortly after the electrical injury, 11 of which were documented as asystolic arrests though these were all from a single study with the rural locale and prolonged delay in arrival to the hospital setting contributing to this finding. To our knowledge, this is the only pediatric cardiac arrest developing in a stable patient over 72 h following the initial electrical injury. No other patient has suffered any significant cardiac complications first presenting outside the initial 24-h period following the electrical injury. Guidelines and recommendations on post electrical injury observation of patient vary and further research into this field is required to allow for guidance unification.

Chronotropic incompetence could negatively influence post-operative risk assessment in patients before lung cancer surgery.

BACKGROUND: Cardiopulmonary exercise testing (CPET) is a standard part of preoperative evaluation in patients before lung surgical resection. According to current guidelines the risk of such a procedure is estimated according to maximum oxygen consumption (VO2max). Chronotropic incompetence (CI) is a prevalent condition which could possibly influence cardiopulmonary fitness. The aim of this study was to assess the prevalence of CI in patients before surgical lung resections and its influence on CPET results. METHODS: This study enrolled 154 patients (97 men) of average age 66.4±8.3 with newly diagnosed lung cancer indicated for surgical lung resections. All patients underwent CPET (cycle ergometry). Age predicted maximal HR was calculated using the traditional equation (220 - age). Three levels of CI were defined as, 85% HRpred, 80% HRpred and 70% HRpred. The influence of CI on CPET results was evaluated. RESULTS: CI was present in the following ratios: 85% HRpred-48.7%; 80% HRpred-39.6% and 70% HRpred-16.9%. A significant negative correlation was also found between VO2max, maximal heart rate (HR) and maximal work load among all CI groups (P<0.0001). The presence of CI significantly correlated with beta-blocker treatment (P<0.0001). CONCLUSIONS: CI significantly decreases VO2max in patients before lung cancer surgery. It is strongly associated with beta-blocker treatment which could negatively influence risk assessment. It is thus a matter for future discussion, as to whether the evaluation of CI should be part of preoperative care guidelines.

Neurogenic pulmonary oedema as a rare complication of epileptic seizures.

INTRODUCTION: Neurogenic pulmonary oedema (NPE) is avery rare complication of epileptic seizures, which could potentially increase mortality. MATERIAL AND METHODS: The case of a66-year-old male patient with NPE caused by repeated epileptic seizures is reported. Rapid resolution of pulmonary oedema is well documented by X-ray and computed tomography images. CONCLUSIONS: Neurogenic pulmonary oedema could potentially increase mortality, and thus, it is important to perform achest X-ray in all patients presenting with seizures and dyspnoea.