We report the first case of the use of an Amplatzer septal occluder device to close a large ascending aortic pseudoaneurysm. The patient had a complex cardiac history with redo coronary artery bypass graft surgery, severe left ventricular dysfunction, and end-stage renal disease requiring hemodialysis. The procedure was successfully performed under fluoroscopic and 2D/3D transthoracic echocardiographic guidance. Six-week follow-up with both transthoracic echocardiography and MRI showed the device was in proper position with complete closure of the pseudoaneurysm.
Postinfarct VSD (PIVSD) carries a grim prognosis. The mainstay of management has been surgical repair. The advent of septal occluder devices has offered an attractive alternative to surgical repair. Most PIVSD have serpiginous tracts with necrotic tissue, which makes assessing the defect challenging. 3D computer printing has become useful in preprocedure planning of complex surgical procedures in multiple subspecialties.
Infective endocarditis is a rare cause of coronary embolism. This can result in myocardial infarction. Prompt identification is necessary as management is different from a regular myocardial infarction. Unlike in regular myocardial infarction, use of thrombolytics in this scenario could result in life-threatening complications and hence not indicated. In a patient who appears to be septic, embolic myocardial infarction should always be in the working differential diagnosis. An early transesophageal echocardiogram and cardiac catheterization could assist in diagnosis and management. We present an interesting case of a 45-year-old man who was admitted with vision loss, fevers and was found to have a non-ST segment elevation myocardial infarction. He had persistent bacteremia and developed systemic emboli. Investigation revealed mitral valve vegetation and a cardiac catheterization showed an interesting “snake”-shaped embolic vegetation in right coronary artery. He was treated with surgery to the mitral valve and antibiotics. In a septic patient with myocardial infarction, possibility of coronary embolism from vegetation should be kept in mind.
Figure 1. Single arrow points to the tongue shaped vegetation on AICD in right atrium, double arrows point to the grape shaped vegetations on AICD in right ventricle.
Case detailsA 46 year old female with cirrhosis, hepatitis C, intravenous heroin use, automatic implantable cardioverter defi brillator (AICD), presented with methicillin sensitive Staphylococcus aureus sepsis. Transthoracic echocardiogram was unrevealing but a transesophageal echocardiogram (TEE) showed a cluster of ' grape ' like vegetations attached to AICD lead in right ventricle and ' tongue ' shaped vegetation on the lead in right atrium (Figure 1). She was treated by AICD extraction and intravenous oxacillin for six weeks.
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