H. Yeni

Clinical and Subclinical Femoral Vascular Complications after Deployment of two Different Vascular Closure Devices or Manual Compression in the Setting of Coronary Intervention

Background: In the past two decades vascular closure devices (VCD) have been increasingly utilized as an alternative to manual compression after percutaneous femoral artery access. However, there is a lack of data confirming a significant reduction of vascular complication in a routine interventional setting. Systematic assessment of puncture sites with ultrasound was hardly performed. Methods: 620 consecutive patients undergoing elective or urgent percutaneous coronary intervention were randomly allocated to either Angioseal (AS; n = 210), or Starclose (SC; n = 196) or manual compression (MC; n = 214). As an adjunct to clinical evaluation vascular ultrasonography was used to assess the safety of each hemostatic method in terms of major and minor vascular complications. The efficacy of VCDs was assessed by achievement of puncture site hemostasis. Results: No major complications needing transfusion or vascular surgery were observed. Furthermore, the overall incidence of clinical and subclinical minor complications was similar among the three groups. There was no differences in the occurrence of pseudoaneurysmata (AS = 10; SC = 6; MC = 10), arteriovenous fistula (AS = 1; SC = 4; MC = 2) and large hematoma (AS = 11; SC = 10; MC = 14). The choice of access site treatment had no impact in the duration of hospital stay (AS = 6.7; SC = 7.4; MS = 6.4 days). Conclusions: In the setting of routine coronary intervention AS and SC provide a similar efficacy and safety as manual compression. Subclinical vascular injuries are rare and not related to VCD use.

Mitral valve disease as well as uncommon extensive epipericardial and intramyocardial calcification secondary to massive mitral annular calcification

A 71-year-old woman with a history of childhood pulmonary tuberculosis was admitted to our hospital for exertional dyspnoea (NYHA functional class II). Transthoracic and transoesophageal echocardiography demonstrated moderate to severe mixed mitral valve disease due to massive mitral annular calcification (MAC) and extensive infiltrative calcification of the atrioventricular groove. In addition, a very uncommon intramyocardial calcification of the ventricular septum and the lateral free wall was diagnosed. This case demonstrates a rare combination of mitral valve disease secondary to MAC, and a small hypertrophied left ventricle, as well as epipericardial and myocardial calcification likely due either to the massive MAC with myocardial extension or to former tuberculous perimyocarditis. The multidimensional imaging approach, which has been used in this particularly case, provided an excellent visualization and clinical evaluation of this rare finding.

Multiple cardiac metastases from a malignant melanoma causing consecutive pulmonary embolism.

A 63-year-old patient, with a history of extirpation of a right atrial myxoma 11 years ago, and a history of malignant skin melanoma surgically removed 7 years ago, was admitted to our department due to fatigue and progressive dyspnea. Transesophageal echocardiography demonstrated multiple metastases in the right atrium and the right ventricle (Figure 1a). A large mobile mass in the right atrium was prolapsing through the tricuspid valve during diastole, mimicking mechanical tricuspid valve stenosis (Figure 1b) [1–3]. Magnetic resonance imaging (MRI) demonstrated three intracardial masses with a maximum size of 3.0 × 3.1 cm (Figures 1c and 1d), which had not been detected in a previous MRI performed 5 months earlier. This rapid progression and growth of the metas1 Department of Cardiology and Angiology, Marienhospital Herne, Ruhr University Bochum, Germany.

Massive pericarditis constrictiva calcarea with compression of the right ventricle and consecutive pulmonary embolism.

A 40-year-old man was admitted with a massive pericarditis constrictiva calcarea. Transthoracic and transoesophageal echocardiography demonstrated a double-layered pericardial calcification with interspacial effusion, a massive compression of the right ventricle, and a thrombus formation in the ventricle. In addition, severe pulmonary embolism due to this right ventricular thrombus formation was diagnosed by CT. This case demonstrates the importance of a multimodal imaging approach (echocardiography, TDI, MRI, CT) in the diagnosis of constrictive pericarditis and pericardial masses. In respect to the severe pericardial calcification with the massive interspacial mass, and the compression of the right ventricle with thrombus formation and consecutive pulmonary embolism, this case appears to be a very rare and uncommon clinical finding.

Angeborenes linksventrikuläres Aneurysma bei einem 17-jährigen Leistungssportler@@@Congenital left ventricular aneurysm in a 17-year-old competitive athlete

We present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.ZusammenfassungWir berichten über einen 17-jährigen Leistungssportler mit einem asymptomatischen, kongenitalen linksventrikulären Aneurysma (LVA). Die Echokardiographie wies eine Hypoplasie des apikalen Septums und ein ausgedehntes, zipfelförmiges LVA im Bereich der Apex nach. Das MRT zeigte eine sehr dünne und fibröse Wand des LVA. Aufgrund dieses Befunds wurde bei mutmaßlich erhöhtem Risiko einer Ruptur des LVA eine chirurgische Resektion des Aneurysmas mit anschließender Patch-Plastik durchgeführt. Der postoperative Verlauf verlief komplikationslos, trotzdem wurde dem Patienten zunächst von einer Fortsetzung seines Wettkampfsports abgeraten.AbstractWe present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.

Angeborenes linksventrikuläres Aneurysma bei einem 17-jährigen Leistungssportler

We present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.ZusammenfassungWir berichten über einen 17-jährigen Leistungssportler mit einem asymptomatischen, kongenitalen linksventrikulären Aneurysma (LVA). Die Echokardiographie wies eine Hypoplasie des apikalen Septums und ein ausgedehntes, zipfelförmiges LVA im Bereich der Apex nach. Das MRT zeigte eine sehr dünne und fibröse Wand des LVA. Aufgrund dieses Befunds wurde bei mutmaßlich erhöhtem Risiko einer Ruptur des LVA eine chirurgische Resektion des Aneurysmas mit anschließender Patch-Plastik durchgeführt. Der postoperative Verlauf verlief komplikationslos, trotzdem wurde dem Patienten zunächst von einer Fortsetzung seines Wettkampfsports abgeraten.AbstractWe present the case of a 17-year-old competitive athlete with an asymptomatic left ventricular aneurysm (LVA). Echocardiography demonstrated hypoplasia of the septum and a large apical LVA. Magnetic resonance imaging (MRI) detected a very thin and fibrotic wall of the LVA. Due to the potential risk of rupture the LVA was surgically resected and the apex of the left ventricle was covered with a patch plasty. The patient had an event-free postoperative course. Because of the potential risk of arrhythmia, the patient was recommended not to participate further in competitive sport.