Thoracic Aortic Rupture Post Cardiopulmonary Resuscitation in a Patient With Previous Thoracic Aneurysm Repair.

Aortic dissection is characterized by a tear or rupture in the intimal layer of the aorta causing blood to flow between the layers of the arterial wall, thus separating them. While cardiopulmonary resuscitation (CPR) is a life-saving intervention, it can unintentionally contribute to the development or worsening of aortic dissection. The forceful chest compressions involved in CPR can put significant pressure on the fragile aortic wall, potentially leading to a tear or rupture. This highlights the delicate balance between life-saving measures and the potential risks they carry. Though studies have been done on the effects of CPR on the thoracic wall, few reports have studied the effects on the structures that lie in the thoracic cavity. The authors present a 63-year-old with a history of thoracic aneurysm repair who experienced a cardiac arrest while choking on food at home. The patient received CPR and a CT scan done thereafter revealed thoracic dissection and rupture. The patient received medical management in the Intensive Care Unit but eventually expired due to irreversible neurological damage. This highlights the importance of recognizing that CPR can pose a risk for aortic dissection and rupture, particularly in individuals with prior aortic repairs. It emphasizes the need for developing protocols to monitor patients who have undergone aneurysmal repair and adjusting CPR techniques to suit their specific needs. Additionally, further studies are needed to understand how often aortic complications occur after CPR and to provide guidance for follow-up care in patients who have had aortic repairs. By implementing these measures, we can improve outcomes and safety during resuscitation.

Comparison of Percutaneous Coronary Intervention-Related Adverse Cardiac Outcomes in Patients With in-stent vs de novo Chronic Total Occlusion: A Systematic Review and Meta-Analysis.

Contemporary literature reveals a range of cardiac complications in patients who receive the percutaneous coronary intervention (PCI) for chronic total occlusion (CTO). This study compared the adverse cardiac outcomes and procedural/technical success rates between the patients groups of in-stent (IS) CTO PCI and de novo CTO PCI. This systematic review and meta-analysis compared odds for primary (all-cause mortality, MACE, cardiac death post PCI, stroke) and secondary (bleeding requiring blood transfusion, ischemia-driven target-vessel revascularization, PCI procedural success, PCI technical success, and target-vessel MI) endpoints between 2734 patients who received PCI for IS CTO and 17,808 for de novo CTO. Odds ratios for outcome variables were calculated within 95% confidence intervals (CIs) via the Mantel-Haenszel method. The pooled analysis was undertaken for observational (retrospective/prospective) single- and multicentered studies published between January 2005 and December 2021. We found 57% higher, 166% higher, 129% higher, and 57% lower odds for MACE (OR: 1.57, 95% CI 1.31, 1.89, P < 0.001), ischemia-driven target-vessel revascularization (OR: 2.66, 95% CI 2.01, 3.53, P < 0.001), target-vessel myocardial infarction (MI) (OR: 2.29, 95% CI 1.70, 3.10, P < 0.001), and bleeding requiring blood transfusion (OR: 0.43, 95% CI 0.19, 1.00, P = 0.05), respectively, in patients with IS CTO PCI as compared to that of the de novo CTO PCI. No statistically significant differences between the study groups were recorded for the other primary/secondary outcome variables. The findings from this study indicated a high predisposition for MACE, ischemia-driven target-vessel revascularization, target vessel MI, and a lower incidence of bleeding episodes among IS CTO PCI patients as compared to those with de novo CTO PCI. The prognostic outcomes in CTO PCI cases require further investigation with randomized controlled trials.

Stellate Ganglion Blockade and Left Cardiac Sympathetic Denervation With Left Stellate Ganglionectomy in a Patient With Refractory Electrical Storm: A Case Report.

Electrical storm (ES) is classified as at least three episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) in any 24-hour period. Stellate ganglion blockade and left stellate ganglionectomy have shown benefit in terminating ES. A 64-year-old white male with a past medical history of atrial fibrillation, coronary artery disease requiring previous cardiac bypass surgery in 1997, and coronary artery stents in 2003 presented with syncope and refractory ventricular tachycardia/fibrillation. He eventually underwent both an ultrasound-guided left stellate ganglion block and left cardiac sympathetic denervation with left stellate ganglionectomy. In the setting of refractory ES, the left stellate ganglion block followed by left stellate ganglionectomy can be a lifesaving intervention.