Hrvoje Jurin

Nonfatal cardiac perforation after central venous catheter insertion

Cardiac tamponade caused by perforation of the cardiac wall is a rare complication related to central venous catheter (CVC) placement. A 71-year-old female with a previous history of moderate aortic stenosis and kidney transplantation was admitted to hospital due to global heart failure and worsening of allograft function. Intensified hemodialysis was commenced through a CVC placed in the right subclavian vein. Chest radiography revealed catheter tip in the right atrium and no signs of pneumothorax. Thorough diagnostics outruled immediate life-threatening conditions, such as myocardial infarction and pulmonary embolism. However, not previously seen, 2 cm thick pericardial effusion without repercussion on the blood flow was visualized during echocardiography, predominantly reclining the free surface of the right atrium, with fibrin scar tissue covering the epicardium – it was the spot of spontaneously recovered cardiac wall perforation. Follow-up echocardiogram performed before the discharge showed regression of the previously found pericardial effusion.

Venovenous extracorporeal membrane oxygenation in a patient with acute respiratory distress syndrome caused by drowning

Case report: 32-year-old male patient with no prior medical history presented to our Emergency Department following drowning and a successful resuscitation. He was found submerged in the pool just a couple of minutes after being seen conscious and swimming. Lifeguard on duty pulled him out of the pool and started cardiopulmonary resuscitation. Upon the arrival of Emergency Medical Service, patient had a pulse and was breathing spontaneously, but was exhibiting grand mal seizures and not recovering consciousness. In the emergency department he was put on mechanical ventilation (MV) due to global RF and in the Coronary Care Unit therapeutic hypothermia (TH) was started. Urgent diagnostics was performed and no signs of stroke, coronary artery disease, pulmonary embolism or significant electrolyte imbalance were detected. 12-lead ECG and echocardiography showed no abnormal findings despite severe respiratory acidosis. Due to signs of ARDS (Figure 1) and worsening RF in Marijan Pašalić*, Boško Skorić, Maja Čikeš, Daniel Lovrić, Jana Ljubas Maček, Hrvoje Jurin, Jure Samardžić, Joško Bulum, Davor Miličić

Drug-Eluting Balloons–A New Tool in the Treatment of Cardiac Allograft Vasculopathy: A Case Series

Percutaneous coronary intervention in patients with cardiac allograft vasculopathy is burdened with a lot of difficulties. Although they have allowed significant progress in comparison with plain balloon angioplasty and bare metal stents, drug-eluting stents have not fully overcome problems of diffuse lesions and small-vessel disease that are so common in transplant coronary artery disease. There is growing evidence that drug-eluting balloons might be a better choice for patients with small vessel atherosclerotic coronary disease and yet there is no experience with this technology in patients with cardiac allograft vasculopathy. Herein we report a case series of successful percutaneous coronary interventions in patients with cardiac allograft vasculopathy.

Incidental Extraction of a Temporary Epicardial Pacemaker Wire With Right Ventricular Perforation During Endomyocardial Biopsy: A Case Report

INTRODUCTION Right ventricular perforation during endomyocardial biopsy is an unusual, although potentially life-threatening, complication caused with the tip of the bioptome. The majority of perforations in heart transplant patients can be managed without surgery owing to adhesions nearly obliterating pericardial space. CASE REPORT We report a case of heart transplant patient who suffered right ventricular perforation as a consequence of incidental extraction of a temporary epicardial pacemaker wire during a routine endomyocardial biopsy sampling. CONCLUSIONS The patient suffered no clinical consequences.