Arshad M. Safi

Fatal left main coronary artery embolism from aortic valve endocarditis following cardiac catheterization

Coronary artery embolization has been associated with sudden cardiac death. It is more commonly seen with aortic valve endocarditis. It manifests as acute myocardial ischemia or infarction, causing instability of the cardiac rhythm, which may be fatal. We report a patient with aortic valve endocarditis who had sudden cardiac death following coronary angiography. Autopsy revealed embolic occlusion of the left main coronary artery. Cathet. Cardiovasc. Intervent. 50:74–77, 2000.

Paravalvular Regurgitation: A Rare Complication Following Valve Replacement Surgery

Paravalvular regurgitation is an uncommon but important complication, usually following valve replacement surgery. Early recognition and management are important for reop erations are associated with high morbidity and mortality rates. Presently, little data are available on this topic. The authors review the subject.

Left Ventricular Intracavitary Mass and Pericarditis Secondary to Metastatic Renal Cell Carcinoma: A Case Report

Cardiac metastases from renal cell carcinoma are a well-recognized entity. However, this phenomenon is extremely rare in the absence of vena caval extension. The authors report a patient who after successful resection of renal cell carcinoma presented with left ventricular mass causing left ventricular outflow tract obstruction. There was also metastatic pericardial and intramyocardial involvement. Such a unique combination of cardiac metastasis, in the same patient, has not been reported previously.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva: disabling angina and syncope with noninterarterial courses case report of two patients.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva or the right coronary artery is a rare coronary anomaly. This anomaly has been associated with sudden cardiac death in younger patients, depending on its course relative to the pulmonary artery. The authors report this rare anomaly in two patients. It presented as unstable angina in the first patient with a septal course. In the second patient, it presented as syncope with an anterior free wall course and absent left circumflex artery. A septal course causing unstable angina has not been reported previously.

Cryptogenic ischemic stroke and paradoxical embolism: should a patent foramen ovale be closed? Case report and literature review.

Paradoxical embolism is a well-recognized cause of stroke. While the diagnosis in the majority of the cases with a patent foramen ovale is presumptive, numerous treatment strategies have been described. However, there is no single approach that has been overwhelmingly recom mended for these patients. A patient is described who presented with ischemic stroke. Transesophageal echocardiography revealed a thrombus that straddled a patent foramen ovale. Anticoagulation with intravenous heparin resulted in resolution of thrombus and neuro logic deficit. The literature regarding diagnosis and treatment of paradoxical embolism in the presence of patent foramen ovale is reviewed.

No-reflow phenomenon following percutaneous coronary intervention: an uncommon complication.

The no-reflow phenomenon has been recognized as an uncommon complication after reperfusion therapy (thrombolytic or mechanical) for acute myocardial infarction and after percutaneous coronary intervention. As management and outcomes differ, early diagnosis and angiographic exclusion of other causes of impaired blood flow are important. The authors describe a case report of a patient with no-reflow following emergent stenting of the left circumflex artery (LCX). Pathophysiology and management of the no-reflow phenomenon are described along with the case report.

Takayasu's Arteritis: An Unusual Manifestation: A Case Report

Takayasus arteritis is a rare entity. The authors describe a case of a middle-aged woman with an atypical form of Takayasus arteritis. This manifestation has not been described previously.

Anterior mitral valve aneurysm: a subaortic complication of aortic valve endocarditis: a case report and review of literature.

Mitral valve aneurysm is a rare cause of mitral regurgitation, and is usually associated with aortic valve endocarditis. Prompt diagnosis and early surgical treatment can prevent complications such as embolization and rupture of the aneurysm. The authors report a case of aortic valve endocarditis and mitral valve aneurysm in a patient who initially presented with urinary tract infection.

Coronary artery aneurysms, aortic dissection, and hypertension secondary to primary aldosteronism : A rare triad : A case report

Primary aldosteronism is a relatively uncommon etiology of hypertension. Plasma renin activity is suppressed in the majority of the cases but not always. Plasma renin activity has been associated with increased vascular injury. The occurrence of vascular complications has rarely been reported with low plasma renin activity. The authors report a case of long-standing secondary hypertension due to primary aldosteronism with coronary artery aneurysms and aortic dissection. Diagnosing is important, for therapeutic intervention can be curative.

Vasoseal® after intra-aortic balloon pump removal: A pilot study

Vascular complications after removal of an intra‐aortic balloon pump (IABP) have been reported to occur in up to 15% of patients. Vasoseal, a vascular hemostasis device (VHD), has been shown to be safe and effective in rapidly achieving hemostasis after a cardiac catheterization or percutaneous coronary intervention. We propose that similar results can be obtained with the VHD when removing an IABP. However, it is necessary to first gain first the experience of deploying the VHD without insertion of a guidewire. We studied 10 patients in whom Vasoseal was utilized after an IABP was removed. The primary endpoint was a composite of major or minor bleeding, infection, and any vascular complication at 7 days. The time to achieve hemostasis was also assessed. There was not a single episode of bleeding, infection, or vascular injury at 7 days. The time to hemostasis ranged between 8 and 17 min (mean, 12.9 min). This VHD can be utilized safely and efficaciously when removing an IABP. Cathet. Cardiovasc. Intervent. 50:495–497, 2000.