A 61-year-old woman with a history of hypertension, glucose intolerance, hyperlipidemia, and Sjögren syndrome presented at our hospital with crescendo angina. An exercise stress test with myocardial perfusion imaging revealed a severe, medium-sized apical defect. We made several attempts under ultrasonographic guidance to enter the right distal radial artery at the anatomic snuffbox for diagnostic coronary angiography. Access was obtained on the third attempt. A subsequent coronary angiogram revealed high-grade stenosis of the proximal left anterior descending coronary artery and diagonal branch. The patient then underwent successful percutaneous coronary intervention (PCI) with use of a 6F extra backup 3.5 guide
Frequent ventricular premature complexes (VPCs) and VPC QRS duration are risk factors for left ventricular (LV) dysfunction. To determine which clinical characteristics and electrocardiographic features are associated with LV dysfunction (ejection fraction, <50%) and frequent VPCs, we retrospectively reviewed data from a single-center registry of all patients diagnosed with frequent VPCs at a Korean outpatient clinic. We identified 412 consecutive outpatients (mean age, 54.7 ± 16.8 yr; 227 women [55.1%]) who were diagnosed with frequent VPCs and had no structural heart disease from January 2010 through December 2017. Available transthoracic echocardiograms and 24-hour Holter monitoring data were evaluated to correlate the occurrence of VPCs and symptoms. Typical VPC-related symptoms (palpitations or dropped beats) were observed in 251 patients (61.1%). Electrocardiograms revealed VPCs with a left bundle branch block–like morphology in 327 patients (79.5%) and VPCs with an inferior axis in 353 (85.8%). Twenty-six patients (6.3%) were diagnosed with VPC-related LV dysfunction. The mean VPC burden did not differ significantly by LV functional status (11.06% ± 10.13% [normal] vs 14.41% ± 13.30% [impaired]; P=0.211). Patients with impaired LV function were more often men (P=0.027), had no typical VPC-related symptoms (P=0.006), and had significantly longer VPC QRS durations (mean, 157 ms vs 139 ms; P <0.01). Our findings suggest that male sex, absence of typical VPC-related symptoms, and a VPC QRS duration >157 ms are associated with LV dysfunction in patients with frequent VPCs, findings that may be useful in predicting such dysfunction.
Open surgical aortic valve replacement (SAVR) is a viable alternative to transcatheter implantation in low-risk patients. In this light, we evaluated the safety and effectiveness of SAVR performed through conventional and less invasive surgical approaches in a high-volume center. We retrospectively reviewed the records of 395 consecutive patients who underwent open SAVR from January 2019 through December 2019 in our center. We evaluated and compared the operative results and postoperative major adverse outcomes of 3 surgical approaches: full median sternotomy (n=267), upper ministernotomy (ministernotomy) (n=106), and right anterior thoracotomy (minithoracotomy) (n=22). Overall, the 30-day all-cause mortality rate was 0.8% (3 patients). Stroke occurred in 8 patients (2%), disabling stroke in 4 patients (1%), myocardial infarction in 1 (0.2%), and surgical site infection in 13 (3.2%). There was no difference in 30-day mortality rate or incidence of postoperative major adverse events among the 3 surgical groups. Stroke and surgical site infection occurred more frequently, but not significantly so, in the full-sternotomy group. The mean hospital stay was longer after full sternotomy (9.1 ± 5.5 d) than after ministernotomy (7.5 ± 2.9 d) or minithoracotomy (7.4 ± 1.9 d) (P=0.012). Our findings suggest that open SAVR performed in a high-volume center is associated with a low early mortality rate and that less invasive approaches result in faster postoperative recovery and shorter hospital stays.
Endograft infection with Listeria monocytogenes is a rare, potentially devastating complication of endovascular aortic aneurysm repair. To our knowledge, only 8 cases have been reported. We describe the case of a 72-year-old man who presented with L. monocytogenes endograft infection and a 19-cm degenerative aneurysm 9 years after having undergone endovascular repair of an abdominal aortic aneurysm. The infection was successfully treated with open surgical excision of the infected aortoiliac endograft and its replacement with a rifampin-soaked, bifurcated Dacron graft.
Phlegmasia cerulea dolens, a rare and potentially fatal complication of acute deep vein thrombosis, is characterized by substantial edema, intense pain, and cyanosis. Phlegmasia cerulea dolens may compromise limb perfusion and lead to acute ischemia, gangrene, amputation, and death. We present the case of a 61-year-old woman with a history of breast cancer who had signs and symptoms of phlegmasia cerulea dolens in her left leg. She was treated promptly with open surgical thrombectomy and sequential distal compression with use of an Esmarch bandage to ensure complete thrombus extraction. These techniques restored venous flow and saved her leg. Open surgical thrombectomy should be considered in the presence of limb-threatening acute deep vein thrombosis presenting as phlegmasia cerulea dolens.
Combining left ventricular assist device (LVAD) implantation and longitudinal sleeve gastrectomy may enable patients with morbid obesity to lose enough weight for heart transplant eligibility. In a retrospective study, we evaluated long-term outcomes of patients with body mass indexes ≥35 who underwent LVAD implantation and longitudinal sleeve gastrectomy during the same hospitalization (from January 2013 through July 2018) and then adhered to a dietary protocol. We included 22 patients (mean age, 49.9 ± 12.5 yr; mean preoperative body mass index, 43.3 ± 6.2). Eighteen months after gastrectomy, all 22 patients were alive, and 16 (73%) achieved a body mass index of less than 35. Myocardial recovery in 2 patients enabled LVAD removal. As of October 2020, 10 patients (45.5%) had undergone heart transplantation, 5 (22.3%) were waitlisted, 5 (22.3%) still had a body mass index ≥35, and 2 (9%) had died. With LVAD support, longitudinal sleeve gastrectomy, and dietary protocols, most of our patients with morbid obesity and advanced heart failure lost enough weight for transplant eligibility. Support from physicians and dietitians can maximize positive results in these patients.
In the article titled “Novel Pharmacomechanical Thrombolysis for Treating Intermediate-Risk Acute Pulmonary Embolism: The Bashir Endovascular Catheter,”1 published online 15 December 2021, the Texas Heart Institute Journal editorial staff inadvertently changed thrombotomy to thrombectomy. The following sentence on page 2 of the PDF should read as follows: “The novel Bashir Endovascular Catheter (BEC) (Thrombolex, Inc.) enables both targeted thrombolytic delivery and mechanical thrombotomy to fragment thrombus and promptly restore alveolar blood flow in the presence of acute PE.”
Louis Levy Leatherman, Jr., MD, died peacefully on 11 January 2022. Born on 17 April 1937, he was the eldest son of Gertrude Leatherman and Louis Levy Leatherman, Sr. His desire to become a physician was motivated by his father's death of heart disease when Louis Jr. was 16 years old. Dr. Leatherman studied at Louisiana College, then earned his medical degree from Louisiana State University Medical School in 1962. His internship was at Martin Army Community Hospital in Fort Benning, Georgia (1962–1963), and his internal medicine residency at Confederate Memorial Medical Center in Shreveport,
