C.B. Samaranayake

Pseudoaneurysm of the radial artery following coronary angiography.

An 85-year-old female patient was admitted to hospital with a non-ST-elevation myocardial infarction. After initial medical management with clopidogrel, aspirin, and enoxaparin, the patient underwent coronary angiography through the right radial artery using the standard Seldinger puncture technique and insertion of a 6-Fr Terumo Radifocus II (Terumo Medical, Japan) sheath. Unfractionated heparin 5,000 IU was administered via the sheath immediately after radial access. Percutaneous coronary intervention (PCI) of the left anterior descending artery was undertaken, with deployment of a bare-metal stent. The sheath was removed at the end of the procedure and a radial compressive device (TR band; Terumo Interventional Systems, Somerset, NJ) was applied over the arterial puncture site to achieve nonocclusive hemostasis. No complications occurred during, or immediately after, the procedure. Gradual deflation of the radial compressive device, over 90 min, was commenced after 2-h full compression as per our standard protocol. A pressure dressing was applied after removal of the TR band, as per usual practice, and kept in place for 12 h, but was repositioned because of patient discomfort. A large, painless, pulsatile mass was noticed over the volar aspect of the wrist the following morning. The hand was warm and well perfused. A clinical diagnosis of pseudoaneurysm of the radial artery was made and confirmed by an ultrasound scan, which showed a 3.7×2.6×1.3cm pseudoaneurysm arising from the radial artery (. Fig. 1). The neck measured 3 mm in diameter. Surgical repair was deemed more appropriate than thrombin injection because of the large size of the aneurysm and the associated short, but relatively wide, neck. This was performed under local anesthetic, and the patient was discharged from hospital 2 days later.

The utility of a 'non-significant' coronary angiogram.

Coronary angiography is the gold standard for assessing coronary artery disease (CAD). In many patients with chest pain, no or mild CAD (< 50% stenosis) is found. It is uncertain whether this ‘non‐significant’ result influences management and outcomes. We reviewed characteristics and outcomes in a contemporary cohort of chest pain referrals who had mild or absent CAD on coronary angiography.

A Cross-sectional Study on Employment After Heart Transplantation in New Zealand

three and 100% of patients with a CRS of 4. Primary cardiac complications included decompensated heart failure, arrhythmia (supraventricular, second degree AV block) and severe pulmonary hypertension. Two patients underwent termination of pregnancy because of deterioration in valve function. In addition, twopatients required inpatient valve replacement in the peripartum period. Conclusion:Women with rheumatic heart disease have a higher than normal risk of complications during pregnancy and the cardiac risk index provides a useful tool in risk stratifying patients. http://dx.doi.org/10.1016/j.hlc.2013.05.607 Social Aspects of Cardiovascular Disease

Giant Complex Aortic Arch Aneurysm and Dissection

A year-old man presented with a three week history of left upper back pain, and intermittent central chest pain. He also reported worsening shortness of breath, dry cough and hoarseness of voice. His past medical history included a Type A aortic dissection repair eight years previously. On examination, the only positive finding was decreased air entry in the posterior left upper zone of t a e ( 1 i c