Raewyn Fisher

Transcatheter Aortic Valve Implantation Complicated By Acute Structural Valve Failure Requiring Immediate Valve In Valve Implantation

The first percutaneous transcatheter aortic valve implantation (TAVI) was performed in 2002 by Alain Cribier with over 10,000 valve implants since. Despite this, as with all new technologies we remain on a learning curve and continue to encounter new challenges and complications. We report a case of acute structural valve failure treated successfully with a second valve in valve implantation of transcatheter aortic valve in a patient who had severe aortic stenosis (AS) complicated by a severely unfolded aorta.

Enterococcus gallinarum causing native valve endocarditis and aorto-atrial fistula: a case report and literature review.

Case Report: A 16-year-old female from Samoa with no known prior illness presented with a fever. She had a 4-week history of lethargy, malaise, poor appetite, and pyrexia, and had received two intramuscular injections of ceftriaxone in Samoa 2 weeks previously. She failed to improve and presented to our institution on arrival to New Zealand. She was febrile, tachycardic with mild hypotension, visible carotid neck pulsations, and had a long early diastolic murmur, with no signs of left ventricular failure. A chest x-ray showed pulmonary venous congestion and marked cardiomegaly. Her electrocardiogram (Vivid 7, GE Healthcare, Chalfont St Giles, United Kingdom) showed persistent sinus tachycardia with a normal PR interval, and no conduction abnormalities. White cell count and inflammatory markers were elevated. A transthoracic echocardiogram (TTE) showed a severely dilated left ventricle, severe aortic regurgitation, and two oscillating masses on the noncoronary and left coronary aortic valve cusps (Fig. 1; Movie clip 1). Serial blood cultures were positive for Enterococcus gallinarum and antibiotics (gentamycin and amoxicillin) were commenced. Transesophageal echocardiography (TEE) (Vivid 7) confirmed TTE findings and also demonstrated vegetations on the interventricular septum and the mitral-aortic intervalvular fibrosa, and a possible paravalvular abscess (Fig. 2; Movie clips 2a, 2b, 2c). A communication between the aorta and the right atrium was also noted, with color flow demonstrated between the two (Fig. 2; Movie clip 2d). Aortic

Dual life-threatening pathologies presenting simultaneously

A 70-year-old male presented to hospital with both anterior ST elevation myocardial infarction and spontaneous oesophageal rupture (Boerhaave’s syndrome). He underwent primary angioplasty and stenting for a lesion of the left anterior descending in addition to cardiothoracic surgery for the oesophageal rupture. This combination of pathologies is a rare entity and often difficult to diagnose. To date, only a few cases have been reported.