Severe PPM and elevated gradients after aortic ViV are very common but were not associated with short-term survival and clinical outcomes. The long-term effect of poor post-ViV haemodynamics on clinical outcomes requires further evaluation.

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In patients with an ICD and ventricular arrhythmias, dofetilide decreases the frequency of VT/VF and ICD therapies even when other antiarrhythmic agents, including amiodarone, have previously been ineffective. Recurrences still occur in some patients requiring catheter ablation, mechanical support, or heart transplantation.

Paragangliomas are extraadrenal tumors that arise from chromaffin cells of the sympathetic ganglia. Cardiac paraganglia are exceptionally rare and because of paucity of cohort data, raises dilemmas about management when encountered. Some of them are metabolically active and may present with symptoms of catecholamine excess, whereas some may be incidentally diagnosed. In this report, we discuss the challenges surrounding the diagnosis and management of a cardiac paraganglioma at each stage. Case PresentationA 73-year-old woman is referred by her cardiologist for an elective coronary angiography because of an abnormal stress test in the setting of dyspnea on exertion. The dyspnea started ≈6 months ago and has been slowly progressive. She continues to try to exercise through this and is currently able to walk 1 mile in 30 minutes, a pace that is slower than usual. The medical history is significant for mild edema (hydrochlorothiazide 25 mg/d), dyslipidemia (diet controlled); there is no history of smoking, hypertension, diabetes mellitus, coronary artery disease, or peripheral atherosclerosis. Her family history is notable for coronary artery disease.On physical examination, the patient's body mass index is 35 (5 ft 0 in; 81.6 kg), blood pressure is 140/70 mm Hg with a pulse of 60 bpm. Jugular venous pulse is normal. Carotid upstroke is brisk, and there are no bruits. Lungs are clear to auscultation. The first and the second heart sounds are normal; there are no murmurs, rubs, or gallops. There is no lower extremity edema, and rest of the examination is unremarkable. An ECG demonstrates normal sinus rhythm with possible anteroseptal infarct. A chest radiograph is normal.The stress echocardiography report shows that the patient exercised for 7:30 minutes on a Bruce protocol achieving a peak heart rate of 146 bpm (99% maximum predicted heart rate) and blood pressure of 180/60 mm Hg. The resting heart rate and blood pressure were 71 bpm and 118/60 mm , respectively. The resting ECG showed normal sinus rhythm with possible anteroseptal infarct, and the stress ECG showed sinus tachycardia with nonspecific ST-T wave changes. The resting part of stress echocardiography showed normal wall motion, and with exercise, the left ventricle became smaller and more vigorous, but the anterior septum and septum failed to become hyperkinetic, and therefore the study was read as an abnormal study. The patient was then referred to a cardiologist for further evaluation. Certainly, the stress test abnormality was not high risk, and a trial of medical therapy with investigation of alternate pathogenesis for dyspnea versus diagnostic coronary angiography was discussed. However, the patient's symptoms were out of proportion to the degree of stress test abnormality, with no other obvious pathogenesis. The patient was concerned about ischemic heart disease in light of not a normal stress test, and decision was made to proceed with a diagnostic coronary angiography.At this time, the patient undergoes coronary angiography via transradial access...

Electroconvulsive therapy (ECT) is recommended by the American Psychiatric Association Task Force on ECT as a safe and effective treatment of depression throughout pregnancy. We report here administration of ECT in the third trimester of pregnancy in a 33-year-old patient with severe bipolar depression. The patient had a good antidepressant response to ECT. She experienced, however, delayed onset premature uterine contractions at home after her sixth session of ECT (10 hours post-ECT administration). After receiving tocolytics, the patient's contractions did not progress to premature labor. In consultation with the obstetrics team, it was decided to terminate the ECT course earlier than planned. The patient is delivered of a healthy female newborn infant spontaneously at 37 weeks' gestational age. Four months after delivery, the baby's development is progressing normally. This case illustrates that premature contractions in association with ECT during the third trimester of pregnancy may be delayed in onset. Patients and treatment team need to be aware of this possibility, particularly when ECT is conducted on an outpatient basis.

Increased TR following CRMD implantation is relatively common (33%) and correlated with subsequent risk of hospitalization for heart failure. A preventive strategy and close monitoring for development or worsening of CHF after CRMD implantation may help prevent hospital admissions.

Background and Aim of Study The treatment of inoperable patients with concomitant complex coronary artery disease and severe aortic stenosis unsuitable for conventional transcatheter aortic valve replacement (TAVR) poses a significant challenge. Effective treatment is even more difficult in those patients with complex coronary anatomy unamenable to percutaneous revascularization. Our manuscript aims to enlighten clinicians on the management of this complex patient. Methods We conducted a contemporary review of the literature of combined off‐pump coronary artery bypass grafting and transaortic TAVR in this patient population and describe our own successful experience in an inoperable patient with a porcelain aorta. Results Including our report, 17 cases have been described in the literature. All patients had multiple comorbidities with elevated STS (range, 2.6‐25; 6%) and EuroScore I (range, 13.7‐83; 7%) and were not considered candidates for conventional CABG and SAVR. Most had severe, complex, multivessel CAD deemed unsuitable for PCI and structural findings precluding them from other standard percutaneous or alternative TAVR approaches (transfemoral/subclavian/transcaval/transapical). Out of the 17 cases, 5 (29%) had porcelain aortas. Most reports specify the decision‐making process is driven by a multidisciplinary team. Conclusion This report demonstrates that hybrid off‐pump CABG surgery and transaortic TAVR can be successfully performed in high‐risk patients with porcelain aortas who are not candidates for percutaneous methods, on‐pump revascularization, transfemoral, subclavian, or transcaval valve implantations. It also highlights that careful study of the CTA scan could predict adequate access for a transaortic approach even in the presence of porcelain aorta in selected patients.

D should be considered a pharmacologic alternative when adult patients with CHD develop AT. D does not depress conduction, sinus node, or ventricular function but needs close monitoring for potential ventricular pro-arrhythmia.