A 24-year-old man with systemic lupus erythematosus and antiphospholipid syndrome complicated by lupus nephritis presented with acute limb ischaemia secondary to an embolus. Following embolectomy, the patient underwent a transthoracic echocardiogram which revealed a large vegetation on all three cusps of the aortic valve. The patient was taken for an urgent aortic valve replacement with a mechanical valve. Cultures of one cusp remained sterile. Histopathological examination of the remaining two cusps revealed sterile fibrin-rich thrombotic vegetations characteristic of non-bacterial thrombotic endocarditis.

We describe the intraoperative non-invasive use of an infrared (IR) camera to monitor Del Nido cardioplegia delivery in patients undergoing cardiac surgery. Thermal pictures were taken pre- and post-cardioplegia and at timed points after arrest, and compared to readings from a transseptal temperature probe. There was good concordance between the transseptal probe and the IR camera temperature readings. This non-invasive technique, which assesses cardioplegic distribution, may help to determine when additional doses of Del Nido cardioplegia are required during periods of cardioplegic arrest.

A 64-year-old man experienced a driveline infection that was treated with serial debridements and antibiotics. When the wound clinically appeared ready for closure, a handheld fluorescence imaging device still revealed a margin of red fluorescence around the wound edges consistent with a subclinical infection. Therefore, a wider margin was made and additional specimens for wound culture were taken, which demonstrated a vancomycin-resistant enterococcal infection. The autofluorescence signals of common bacteria can be detected with a fluorescence camera in subclinical wound infections without clinical signs. Here we describe the first use of this technology to diagnose ventricular assist device driveline infections after left ventricular assist device implantation.

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Total artificial heart is a durable option for severe biventricular failure and multiple valvular dysfunction as a bridge to transplant in a young patient with Marfan syndrome.