Hyperacute Sapien Aortic Valve thrombosis in a patient with Antiphospholipid Syndrome (APS).

In this case we briefly describe the case of an old woman presenting with acute exertional dyspnea due to hyperacute Sapien Valve thrombosis.

A tricky electrocardiogram: cocaine induced Brugada type 2 phenocopy.

BACKGROUND: The pharmacological effects of cocaine have been associated with different types of cardiac dysrhythmias and with Brugada pattern on the ECG, but currently only type 1 pattern has been described. We report a case of a transient Brugada type 2 pattern in a young cocaine abuser. METHOD: We report the clinical presentation of a 32-year-old male with a history of cocaine abuse. RESULT: The treatment and the resolution of the acute phase have been described; moreover we discuss the pathophysiology of the Brugada phenocopy in this specificclinical setting. CONCLUSION: The clinical impact of our case report underscores the necessity of prompt physician awareness of any ECG abnormality besides myocardial infarction in patients with cocaine abuse, such as any Brugada pattern, which could lead to ominous ventricular arrhythmias.

Critical subaortic stenosis due to fibromuscular ridge in a 66-year-old woman: 2D-3D echocardiography findings.

Subvalvular aortic stenosis (SAS) can be either a fixed stenosis resulting from subaortic anatomical obstacle or a dynamic stenosis because of hypertrophic cardiomyopathy. Here, we report a patient with a rare subaortic circumferential fibromuscular tunnel who became unusually symptomatic in her sixth decade of life. Transthoracic and mostly transesophageal echocardiography with 3D application is the preferred diagnostic modality. Indications for surgery include symptoms and LVOT gradient of 50 mm Hg. Our purpose is an image focus on this infrequent case.

Combined venoarterial extracorporeal membrane oxygenation and transcatheter aortic valve implantation for the treatment of acute aortic prosthesis dysfunction in a high-risk patient.

We describe the case of a patient with acute bioprosthesis dysfunction in cardiogenic shock, in whom hemodynamic support was provided by venoarterial extracorporeal membrane oxygenation, and successfully treated by transcatheter aortic valve implantation.

The Strange Case of the Infarcted Myxoma.

In the setting of an acute coronary syndrome, the differential diagnosis between a thrombus and a myxoma may be cumbersome. We describe the case of a patient presenting with an acute coronary syndrome associated with an aneurysmatic apical left ventricular myxoma.

Brugada syndrome ECG pattern and fever: too warm is bad.

We describe a case of Brugada syndrome disclosed by fever and with non-significant alterations after a flecainide test.

Persistent left superior vena cava and pacemaker implantation.

Our study group read with interest the paper from Vijayvergiya et al describing the implantation of an implantable cardioverter-defibrillator lead in the presence of the persistence of the left superior vena cava. The issue of the identification a persistent left superior vena cava is of paramount importance in interventional cardiology, being the most common venous anomaly of the thoracic distribution, and because it may create some problem to any physician while performing a pacemaker lead implantation. In our letter we underscore the specific issues related to pacemaker implantation while encountering a persistent left superior vena cava (and maybe the absence of the right vena cava) and the workup that should be performed to obtain the preoperative diagnosis of the venous anomaly. More specifically, we consider avoiding any kind of defibrillator lead implantation through the coronary sinus for safety issues, and underscore the straightforward transthoracic ultrasound approach to identify the left superior vena cava.