Homocysteine has been implicated in promoting atherosclerotic and thrombotic vascular disease. During the last decade, the utility of homocysteine in predicting risk for atherothrombotic vascular disease has been evaluated in several observational studies in a large number of patients. These studies show that the overall risk for vascular disease is small, with prospective, longitudinal studies reporting a weaker association between homocysteine and atherothrombotic vascular disease compared to retrospective case-control and cross-sectional studies. Furthermore, randomized controlled trials of homocysteine-lowering therapy have failed to prove a causal relationship. On the basis of these results, there is currently insufficient evidence to recommend routine screening and treatment of elevated homocysteine concentrations with folic acid and other vitamins to prevent atherothrombotic vascular disease. This review outlines the metabolism and pathophysiology of homocysteine, highlights the results of homocysteine observational and interventional trials, and presents areas of uncertainty and potential future work.

establishing the diagnosis. However, the final diagnosis relied on pathological investigations. In spite of the benign nature of myxomas, they may inevitably cause valvular dysfunction and secondary pulmonary hyperten-sion and have a significant propensity to embolize the pulmonary artery (1). Pulmonary artery and pulmonary valve myxomas have the common features of right heart system, such as predilections of right ventricular obstruction, right-sided valve insufficiencies, and pulmonary embolism; however, their special characteristic is a smaller size. Pulmonary myxomas could occur isolated or in association with other congenital heart defects or acquired disorders. There were more myxomas arising from the pulmonary valve than from the pulmonary artery or from pulmonary valve and pulmonary artery. Most pulmonary valve myxomas arose from the valve leaflets, and most pulmonary artery myxomas arose from the main pulmonary artery. Because of potential hazards and occasional misdiagnosis, the patients endow an early surgical treatment upon diagnosis (5). Most patients warranted a surgical resection of the myxoma under standard cardiopulmonary bypass, while some patients were operated under normothermic cardiopulmonary bypass or deep hypothermic circulatory arrest. Concurrent procedures to myxoma resection, such as pulmonary valve repair or replacement, or right ventricular outflow tract reconstruction should be performed simultaneously. An early surgical treatment is warranted upon diagnosis because of potential hemodynamic disturbances and predilection of embolization. Most patients have a good prognosis following surgical treatment. References 1. Huang CY, Huang CH, Yang AH, Wu MH, Ding YA, Yu WC. Solitary pulmonary artery myxoma manifesting as pulmonary embolism and subacute cor pulmonale. Am J Med 2003; 115: 680-1. Crossref 2. Blodorn M. Myxoma of the pulmonary valve, respectively of the pulmonary artery. Zentralbl Allg Pathol 1955; 94: 283-9. 3. Restrepo CS, Betancourt SL, Martinez-Jimenez S, Gutierrez FR. Tumors of the pulmonary artery and veins. Semin Ultrasound CT MR 2012; 33: 580-90. Crossref 4. Barış VO, Uslu A, Gerede DM, Kılıçkap M. Rare cause of dyspnoea: pulmonary artery myxoma. Eur Heart J We report a 63-year-old patient with prior coronary artery bypass surgery and recent history of recurrent hospital admissions for refractory heart failure because of ischemic car-diomyopathy and sustained ventricular tachycardia. The patient underwent ICD implantation through left subclavian vein approach (Medtronic, single chamber, model-Maximo II VR, D284VRC, with 6947 ventricular active fixation lead). This case report describes the first patient, to our knowledge, with defi-brillator lead dislocation after manual lumbar traction for low back pain. The patient was admitted to the emergency service with severe chest pain, and electrocardiography revealed 0.5-1 mm ST-segment elevation in leads DII, DIII, and aVF. After initial evaluation, coronary angiography and percutaneous coronary intervention were immediately ...

Balloon atrial septostomy should be considered as an alternative technique for safe transseptal cannulation in select patients in the electrophysiology laboratory or other interventional procedures requiring left atrial access or delivery of large-caliber catheters or sheaths.

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