Abdominal aortic aneurysms (AAA) localize in the infrarenal aorta in humans, while they are found in the suprarenal aorta in mouse models. It has been shown previously that humans experience a reversal of flow during early diastole in the infrarenal aorta during each cardiac cycle. This flow reversal causes oscillatory wall shear stress (OWSS) to be present in the infrarenal aorta of humans. OWSS has been linked to a variety of proatherogenic and proinflammatory factors. The presence of reverse flow in the mouse aorta is unknown. In this study we investigated blood flow in mice, using phase-contrast magnetic resonance (PCMR) imaging. We measured blood flow in the suprarenal and infrarenal abdominal aorta of 18 wild-type C57BL/6J mice and 15 apolipoprotein E (apoE)-/- mice. Although OWSS was not directly evaluated, results indicate that, unlike humans, there is no reversal of flow in the infrarenal aorta of wild-type or apoE-/- mice. Distensibility of the mouse aortic wall in both the suprarenal and infrarenal segments is higher than reported values for the human aorta. We conclude that normal mice do not experience the reverse flow in the infrarenal aorta that is observed in humans.

Supracristal ventricular septal defect (SCVSD), a defect of the infundibular portion of the interventricular septum just below the right aortic cusp, occurs more frequently in Eastern Asian populations. SCVSD may be complicated by right sinus of Valsalva aneurysm (SoVA). We present the case of a 26-year-old male of Korean descent with a history of a childhood murmur who was referred to our institution for progressive heart failure symptoms. He was diagnosed with SCVSD and ruptured right SoVA based on history, physical exam, and echocardiography including three-dimensional transesophageal echocardiography with reconstructed surgical views. The patient underwent SCVSD closure, SoVA excision, and valve-sparing aortic root replacement. We reviewed the echocardiography literature regarding SCVSD and SoVA, and analyzed contemporary literature of SoVA and its relationship with SCVSD. We conclude that a higher prevalence of ruptured SoVA in Eastern Asians is likely related to a higher prevalence of underlying SCVSD in this population.

The beneficial effect of placement of intra-aortic balloon (IAB) pump before revascularization in patients with high-risk coronary anatomy and impaired left ventricular systolic function is documented. However, the conventional insertion of IAB pump via the common femoral artery may be contraindicated or may be even impossible in patients with severe vascular disease. Recently, the percutaneous insertion of IAB via the brachial artery has been shown to be effective and safe in small series of patients with vascular disease undergoing coronary artery bypass surgery. The authors report their experience with a patient with aortobifemoral bypass grafts who underwent successful stenting of a trifurcating distal left main stenosis after placement of a 7.5-Fr IAB pump via the left brachial artery.

INTRODUCTION: Primary lung cancer usually presents in older adults with a smoking history. However, there is an estimated incidence of 15 to 20 percent of cases in men who have never smoked (1). We present an adult male with progressively worsening shortness of breath and a large pericardial effusion complicated by cardiac tamponade requiring urgent intervention. CASE PRESENTATION:A 54-year-old Caucasian male non-smoker who presented with a history of progressively worsening shortness of breath of two weeks and bilateral leg swelling. On admission, he was tachycardic to 129 beats/minute, tachypneic to 28 cycles/minute with oxygen saturation of 91% on 3 L of oxygen. Blood pressure was 99/73 mmHg. COVID-19 PCR test was persistently positive two weeks after initial diagnosis. CXR revealed cardiomegaly, bilateral lower lobe opacities and small right pleural effusion. CT angiogram of the chest revealed bilateral acute pulmonary emboli with right ventricular strain and large pericardial effusion. Lower extremity ultrasound showed bilateral DVT. EKG showed atrial fibrillation with electrical alternans. Echocardiogram revealed large circumferential pericardial effusion with evidence of tamponade. 2000 cc of grossly bloody fluid was aspirated from the pericardial space. A pericardial drain was subsequently placed with drainage of sanguineous fluid. A pericardial window was placed. Cytology of pericardial fluid showed malignant cells consistent with adenocarcinoma and pericardial tissue biopsy confirmed lung adenocarcinoma. Immuno-stains demonstrated the cells were positive for BER-EP4 and TTF-1 (patchy) with high expression for PD-L1 and negative for PAX-8 and calretinin. Atrial fibrillation was initially managed with digoxin and metoprolol and later with amiodarone. For his COVID-19 infection, he did not receive remdesivir or plasma. Given the metastases to the bone, he received palliative radiation treatment. Patient opted to proceed with alectinib since his NGS testing demonstrated presence of a targetable ALK mutation.DISCUSSION: There are various etiologies attributable to pericardial effusion including viral pericarditis, autoimmune disorders, metastasis particularly lung breast, melanoma, leukemia, non-Hodgkin's lymphoma and Hodgkin's disease. Malignant pericardial effusion (MPE) is a rare presentation of advanced cancer. It is associated with high morbidity and mortality with a median survival of 2 -3 months after it is diagnosed and a mean survival of 5 months for solid tumors (2,3).CONCLUSIONS: Patients presenting with inflammatory cardiovascular syndromes with respiratory symptoms should inspire an index of suspicion for a primary lung pathology, especially a malignancy. This case elucidates the need for more awareness of an atypical presentation of lung adenocarcinoma.