Objectives The aim of the present study was to compare the incidence of periprocedural complications and short‐term outcomes between the second‐generation recapturable 34 mm Evolut‐R and its first‐generation 31 mm predecessor. Background Although already in extensive clinical use in real world patients, the periprocedural complications and clinical outcomes of the new 34 mm device have not been investigated yet. Methods Consecutive patients who had undergone transcatheter aortic valve implantation in two centers with either a 31 mm CoreValve or a 34 mm Evolut‐R device were retrospectively studied. Periprocedural complications of malpositioning, valve‐in‐valve implantation, conversion to full sternotomy or percutaneous coronary intervention and vascular complications were compared between the two groups. Short‐term outcomes at discharge were compared using Valve Academic Research Consortium (VARC‐2) criteria. Results The study group included 106 patients (35 Evolut‐R 34 mm; 71 CoreValve 31 mm). Significantly lower rates of valve‐in‐valve implantation were demonstrated for the 34 mm group compared to the first‐generation device (0% vs. 11.9%, respectively, P = 0.036). All other periprocedural complications were similar between groups. At discharge, the rates of new pacemaker implantation (5.7% vs. 26.8%, P = 0.037) and bleeding complications (2.9% vs. 19.6%, P = 0.025) were statistically significantly lower among the 34 mm group. With regards to VARC‐2 defined combined endpoints, rates of early safety were significantly improved among the 34 mm group compared to 31 mm group (0% vs. 27.9%, respectively, P = 0.004). Conclusions The recently introduced 34 mm Evolut‐R seems to demonstrate an improved safety profile, as evidenced by the reduced bleeding rates, lower rates of valve‐in‐valve implantation and lower PPM rates compared to its 31 mm predecessor.

Video-assisted thoracoscopic surgery (VATS) has been increasingly used to resect lung nodules avoiding thoracotomy thus reducing morbidity and hospitalization time. One of the main challenges is to localise the target, because very often they are not palpable and small. Various nodule localization techniques have been used to assist VATS resection including metallic marker implantation adjacent to the lesion of interest. These markers have been known to migrate, more often in the pleural space. We report an unusual case of metallic marker migration in the contralateral lung.

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The purpose of this article is to describe incidental extramammary findings identified on breast magnetic resonance imaging (MRI). Methods and materials: A retrospective review of 545 breast MRI performed between 2013e2015 was conducted across two district general hospitals. Each hospital used 1.5T MR units. Results: 542/545 (99%) were female. 37/545 (7%) patients had incidental findings. In this group, 37/37 (100%) were female with an average age of 56.5 years. 26/37 (70%) had no history of cancer. 7/37 (19%) had previous breast cancer. 4/37 (11%) were undergoing breast cancer treatment at the time of the MRI scan. Benign extramammary findings were common (33/37; 89%). The liver was major site with frequently reported simple cysts (28/37; 76%) and haemangioma (2/37; 3%). Eight MRI reports of 'high intensity focus' in the liver were not followed-up with advised ultrasonography clarification. A multi-nodular goitre was referred to the ear, nose and throat (ENT) department and monitored. A 1.2 cm focus was noted in the spleen, which was possibly a simple cyst. 3/37 (8%) findings were significant. Two new breast cancer recurrences with pulmonary metastatic spread were found (2/37; 5%). They were referred to oncology. One non-toxic multi0nodular thyroid goitre was referred to ENT and had a total thyroidectomy. Conclusion: Incidental extramammary MRI findings are, overall, uncommon. However, when found, they should warrant further follow up. Three patients in our series had significant findings, which resulted in further treatment or a new diagnosis. Two of these patients had a previous breast cancer history. Hence, careful scrutiny for additional pathology outside the breast and the axilla is important and findings should be further clarified.

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