Nick Hiltrop

Myocarditis Associated With Campylobacter Enteritis: Report of Three Cases

Myocarditis connected with bacterial infection is rare in immunocompentent hosts.1 Campylobacter jejuni infection is a commonly recognized cause of bacterial gastroenteritis. Several case reports have suggested an association between Campylobacter enteritis and the development of myocarditis and pericarditis.2,3 Case 1. Six days after the onset of acute watery diarrhea, a 42-year-old previously healthy man was admitted with abnormal tiredness, dyspnea, and persistent watery diarrhea. Biochemical analysis showed elevated plasma creatine kinase (178 U/L; normal value 170 U/L), troponin I (3.67 μg/L; normal value <0.13), and NT-proBNP levels (1722 ng/L; normal value <115). The ECG was normal on admission. A moderately decreased systolic left ventricular (LV) function with diffuse hypokinesia was seen on echocardiography. Cardiac magnetic resonance imaging (cMR) confirmed a reduced LV systolic function (ejection fraction [EF] 40%; Supplemental Video 1 and 2; see online-only supplement) and showed patchy areas of increased signal intensity on T2-weighted images, suggesting myocardial edema (Figure 1, panel A). After administration of intravenous gadolinium, diffuse and persisting enhancement of the subepicardium and the midwall was seen (Figure 2, panel A). The next day troponin I reached a peak level of 15.6 ng/L, and new repolarization disturbances in the inferolateral leads were noticed. C jejuni , resistant to ofloxacine, …

Circumflex coronary artery injury after mitral valve surgery: A report of four cases and comprehensive review of the literature.

As the LCx is closely related to the mitral valve annulus, it is susceptible to perioperative injury. Various underlying mechanisms, predisposing factors, and therapeutic strategies have been suggested but disagreement exists. Using a MeSH terms‐based PubMed search, 44 cases of mitral valve surgery‐related LCx injury were detected, including our 4 cases. We provide a comprehensive review of current knowledge regarding mitral valve surgery‐related left circumflex coronary artery (LCx) injury. Preoperative coronary angiography was performed in 55% (n = 24). Coronary abnormalities were present in 11% (n = 5). Coronary dominance was reported in 73% (n = 32), predominantly showing left (69%, n = 22) or balanced (19%, n = 6) circulations. Right coronary dominance was present in 12% (n = 4). Ischemia was detected in the perioperative or early postoperative phase in 86% (n = 30). Delayed symptoms were present in 14% (n = 5). Echocardiography demonstrated new regional wall motion abnormalities in 80% (n = 24), but was negative in 20% (n = 6) despite coronary compromise. Electrocardiography showed myocardial ischemia in 97% (n = 34), including regional ST‐segment elevations in 68% (n = 23). Primary treatment was surgical in 42% (n = 15) and percutaneous in 58% (n = 21), reporting success ratios of 87% (n = 13) and 81% (n = 17), respectively. We confirm an augmented risk of mitral valve surgery‐related LCx injury in balanced or left‐dominant coronary circulations. Preoperative knowledge of coronary anatomy does not preclude LCx injury. An anomalous LCx arising from the right coronary cusp was identified as a possible specific high‐risk entity. Electrocardiographic monitoring and intraoperative echocardiography remain paramount to ensure a timely diagnosis and treatment.

Detailed in vivo visualization of stent fracture causing focal restenosis using 3D reconstruction software for high-resolution optical coherence tomography images

A 55-year-old female underwent repeat coronary angiography for recurrent angina, 9 months after percutaneous coronary intervention (PCI) of a mid-right coronary artery (RCA) chronic total occlusion with implantation of two overlapping Orsiro™ sirolimus-eluting stents (3.0 × 30 mm at 20 atm; 2.5 × 30 mm at 16 atm) (see Supplementary data online, Video S1 ). The distal part of the stented segment showed a focal in-stent restenosis (ISR) with the abnormal motion pattern (see Supplementary data online, Video S2 ). Optical coherence tomography (OCT) with 3D reconstruction confirmed suspected stent …

From therapeutic hypothermia towards targeted temperature management: a decade of evolution

More than a decade after the first randomised controlled trials with targeted temperature management (TTM), it remains the only treatment with proven favourable effect on postanoxemic brain damage after out-of-hospital cardiac arrest. Other well-known indications include neurotrauma, subarachnoidal haemorrhage, and intracranial hypertension. When possible pitfalls are taken into consideration when implementing TTM, the side effects are manageable. After the recent TTM trials, it seems that classic TTM (32-34°C) is as effective and safe as TTM at 36°C. This supports the belief that fever prevention is one of the pivotal mechanisms that account for the success of TTM. Uncertainty remains concerning cooling method, timing, speed of cooling and rewarming. New data indicates that TTM is safe and feasible in cardiogenic shock, one of its classic contra-indications. Moreover, there are limited indications that TTM might be considered as a therapy for cardiogenic shock per se.

Absorb Bioresorbable Vascular Scaffold in Complex Coronary Bifurcation Interventions: Insights From an In Vivo Multimodality Imaging Study

Background—Although bioresorbable scaffolds offer potential advantages compared with metallic drug-eluting stents in the treatment of complex coronary bifurcation lesions, there are concerns that the polymeric scaffold integrity may be compromised. This in vivo study sought to provide insights about the feasibility of performing complex bifurcation stenting with Absorb bioresorbable vascular scaffolds (Abbott Vascular, Santa Clara, CA). Methods and Results—Twenty New Zealand white rabbits underwent stenting of the nondiseased aortoiliac bifurcation with bioresorbable vascular scaffolds using provisional (PS, n=5), culotte (n=5), modified-T (n=5), or T-and protrusion (n=5) stenting techniques. Angiography, optical coherence tomography, and microcomputed tomography were performed. Angiographic results were excellent without evidence of dissection or side branch (SB) compromise. PS optimally opened the SB ostium without deforming the main vessel (MV) bioresorbable vascular scaffolds, avoiding malapposition, and revealing a single connector fracture in 1 of 5 cases on microcomputed tomography. Culotte stenting resulted in complete bifurcation coverage with extensive segments of double-layered struts and inappropriately apposed struts at the bifurcation level in 3 of 5 cases. On microcomputed tomography, there was MV and SB scaffold distortion at the bifurcation with single strut fractures in 4 of 5 and double fractures in 1 of 5. Modified-T and T-and protrusion resulted in complete bifurcation coverage and in minimal double-strut layers at the neocarina. On microcomputed tomography, no strut fractures were present after modified-T, whereas in 3 of 5 T-and protrusion procedures single strut fractures were noted. Conclusions—Bifurcation stenting using bioresorbable vascular scaffolds is feasible with excellent angiographic results. PS with additional T-and protrusion whenever needed seems a reasonable approach. Whenever a 2-stent technique is planned, modified T-stenting appears the most promising.

Functional performance and quality of life in high-risk comorbid patients undergoing transcatheter aortic valve implantation for symptomatic aortic valve stenosis

Aims We assessed the impact of transcatheter aortic valve implantation (TAVI) on functional performance and quality of life (QoL) in a high-risk patient population with multiple comorbidities. Methods and results Between January 2009 and December 2014, 145 high-risk patients (EuroSCORE II 7.3% [4.9; 14.9]) with severe symptomatic aortic valve stenosis (AS) underwent TAVI in a single centre. We prospectively evaluated New York Heart Association (NYHA) functional class, 6-minute walking distance (6MWD), and QoL using the validated Dutch version of the EuroQol-5D (EQ-5D) descriptive assessment and a visual analogue scale (EQ-VAS) at baseline, 30 days, as well as 6, 12, and 24 months after TAVI. All patients were eligible for analysis. New York Heart Association functional class improved significantly at 30-day, 6-, 12-, and 24-month follow-up (P < 0.001 for all). The absolute 6MWD improved significantly at 30 days (+19.3 ± 8.2 m; P= 0.0499) and at 6 months (+23.3 ± 8.1 m; P = 0.0194). A favourable trend was maintained at 12 months (+17.1 ± 8.8 m; P = 0.1879), whereas at 24 months 6MWD was similar to baseline values. No significant change in the descriptive assessment of QoL (EQ5D) was observed, whereas the EQ-VAS showed a significant improvement in QoL up to 24 months (P < 0.0180 for all time-points). Conclusion In high-risk comorbid patients with symptomatic AS, TAVI results in a significant but temporary improvement of functional performance when assessed with objective measures of 6MWD but not of EQ-5D. Moreover, TAVI has a significant and sustained impact on subjective well-being and exercise capacity assessed with the EQ-VAS and NYHA score.

Unusual stent fracture: diagnosis with optical coherence tomography

: We report an unusual case of new-generation drug-eluting stent fracture, diagnosed and managed with aid of optical coherence tomography.

Cancer in the Left Anterior Descending Artery: A Therapeutic Aspect of Thrombus Aspiration?

A 49-year-old male was admitted for surgical resection of a solitary pulmonary metastasis. A mixed germ cell testis tumor (mature teratoma and seminoma) was diagnosed 1 year before and treated with orchidectomy and adjuvant chemotherapy. Surgical resection of regional retroperitoneal disease

Heart failure with preserved ejection fraction: blame the veins….

A 59-year-old female with heart failure with preserved ejection fraction (HFpEF), NYHA class III, with eccentric left ventricle (LV) hypertrophy and anterior inverted T waves on the ECG ( Panel A ), underwent a coronary angiography that excluded coronary artery disease. However, an unusual venous circulation pattern was incidentally observed: persistent embryonic coronary arterial fistulas (CAF) from the left and right coronaries to both ventricular cavities (see Supplementary material online, Videos S2 …