Rotational atherectomy device entrapment is a rare but challenging complication of peripheral vascular interventions. This case report details a novel dual-access endovascular technique for retrieving an entrapped atherectomy burr from the posterior tibial artery of a 70-year-old man with severe peripheral arterial and chronic kidney disease. When conventional retrieval methods failed, retrograde posterior tibial access was established as an adjunct to the existing femoral access, enabling sequential balloon angioplasty with progressively larger balloons (1.5-2.5 mm) around the entrapped device. This dual-access approach successfully liberated the burr without requiring surgical extraction or arteriotomy. Following device retrieval, definitive treatment with balloon angioplasty and stent placement was completed immediately, achieving excellent restoration of flow. This minimally invasive technique offers several advantages over traditional surgical approaches, including vessel patency preservation, reduced procedural morbidity, avoidance of general anesthesia, and protection of potential future bypass targets. The described methodology expands the endovascular options for managing complex device-related complications and demonstrates particular value in high-risk patients with significant comorbidities.

Evolocumab is a human monoclonal antibody that effectively reduces low-density lipoprotein (LDL) cholesterol levels by inhibiting proprotein convertase subtilisin-kexin type 9 (PCSK9). Although generally well tolerated, evolocumab may rarely lead to severe hypersensitivity reactions, including angioedema. To the best of our knowledge, severe angioedema requiring airway intervention has not been reported previously in the US population. A 64-year-old woman with hypertension, hypothyroidism, hyperlipidemia, and active tobacco use presented with acute chest pain and was diagnosed with ST-segment elevation myocardial infarction. She underwent percutaneous coronary intervention with two stents placed in the right coronary artery. Despite maximum lipid-lowering therapy, her LDL level remained elevated at 125 mg/dL, prompting the addition of evolocumab (Repatha). Within 24 hours, she experienced progressive tongue and facial swelling, with oropharyngeal edema threatening airway obstruction. Urgent laryngoscopy confirmed early oropharyngeal involvement, which necessitated endotracheal intubation. She received intravenous corticosteroids and antihistamines in the intensive care unit, with symptoms resolving within 48 hours, allowing for extubation and discharge after three days. This case highlights a rare but potentially life-threatening adverse effect of evolocumab.

Data on the impact of chronic thrombocytopenia (CT) on outcomes following chronic total occlusion (CTO) percutaneous coronary interventions (PCI) is limited. Most studies are case reports and focused on postprocedural thrombocytopenia. The purpose of this present study is to assess the impact of CT (> one year) on health resource utilization (HRU), in-hospital outcomes, and cost following CTO PCI. We used discharge data from the 2016-2018 National Inpatient Sample and propensity score-weighted approach to examine the association between CT and HRU among patients undergoing CTO PCI. HRU was measured as a binary indicator defined as a length of stay greater than seven days and/or discharge to a non-home setting. The cost was measured as total charges standardized to 2018 dollars. Both outcomes were assessed using generalized linear models adjusted for survey year, and baseline characteristics. Relative to its absence, the presence of CT following CTO PCI was associated with a 4.8% increased probability of high HRU (Population Average Treatment Effect (PATE) estimate = 0.048; 95% Confidence Interval (CI) = 0.041-0.055; P<0.001) and approximately $18,000 more in total hospital charges (PATE estimate = +$18,297.98; 95% CI = $15,101.33-$21,494.63, P<0.001). Among chronic total occlusion patients undergoing percutaneous coronary intervention, those with chronic thrombocytopenia had higher resource use, including total hospital charges, and worse in-hospital outcomes when compared with those without chronic thrombocytopenia.

A lower blood ALB concentration contributed to a greater risk of hospital death and long-term death in HF patients admitted to the ICU, further suggesting that nutritional support in the ICU is highly important for improving the short-term and long-term mortality of HF patients. However, in HF patients without hypoproteinaemia (>3.5 g/dL), the impact of increased serum ALB on patient prognosis still needs to be demonstrated.

Supraventricular tachycardia (SVT) is the most prevalent arrhythmia observed in infants, impacting individuals with or without congenital cardiac dysfunction. Infantile-onset SVT typically manifests within the initial one to two months of life. A variety of anti-arrhythmic medications are employed to treat SVT in infants during their first year of life. Nevertheless, a consensus has yet to be reached on the most efficacious drug, and treatment approaches continue to vary considerably As SVT remains a frequent problem around the world, with different management approaches and no obvious optimal option, we conducted a systematic review of the new update of antiarrhythmic drugs for managing SVT in infants under one year old.

To our knowledge, there is no clear consensus on a definitive cardiac rehabilitation method for patients undergoing Coronary Artery Bypass Graft (CABG). We conducted this systematic review to compare and evaluate the effects of two of the most frequent cardiac rehabilitation modalities, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), on cardiopulmonary variables. We carried out a systematic search of the databases PubMed, Web of Science, Embase, Scopus, and Google Scholar. Following the removal of duplicate results, the original search yielded 385 citations. We identified four randomized clinical trials after reviewing titles, abstracts, and potential full-text studies. We utilized the Cochrane Risk of Bias Tool (RoB2) to assess the risk of bias. We included four randomized clinical trials involving 143 people. All trials included individuals who had CABG and completed HIIT or MICT sessions for at least four weeks. The findings indicated that HIIT programs may improve functional capacity, heart rate variability indices, and blood pressure management while lowering brain natriuretic peptide (BNP1-32) and N-terminal pro-b-type natriuretic peptide (NT-proBNP1-76) levels. Given the findings, it appeared that supervised high-intensity exercise regimens could be more useful to patients. Following the surgery, HIIT therapy improves exercise capacity, the autonomic nervous system, volume overload, and blood pressure regulation.

The left atrium (LA) size can change due to cardiac pathologies like heart failure and aging. While the link between LA enlargement and left ventricular (LV) dysfunction is acknowledged, this study aims to assess the negative predictive value of normal LA size concerning the severity of LV systolic function in a large cohort undergoing diagnostic echocardiography. This retrospective cohort study, conducted at the University of California, Irvine Medical Center from 1984 to 1998, aimed to elucidate the negative predictive value of normal LA size measured by M-mode and two-dimensional echocardiography in a large cohort undergoing diagnostic assessment. In the analysis of 22,390 echocardiograms, 55.1% exhibited normal LA size (<40 mm), while 44.9% showed abnormal LA size (≥40 mm). Within the normal LA size group, only 2.4% demonstrated abnormal LV systolic function, with 1.1% mildly depressed, 0.7% moderately depressed, and 0.6% severely depressed LV function. The negative predictive value of normal LA size for abnormal LV systolic function was calculated at 97.5%, rising to 99.3% and 99.4% for moderate or severely decreased LV systolic function, respectively. In patients with small LA size (<35 mm), moderate to severely depressed LV systolic function was observed in only 0.8%, with severe LV systolic dysfunction in 0.3%, yielding an overall prevalence of 1.5% for all systolic dysfunction in the small LA size group. Our findings underscore the clinical significance of normal LA size as a reliable indicator of preserved LV function.

This systematic review aimed to review existing evidence to evaluate the effects of physical cardiac rehabilitation on cardio-pulmonary outcomes in the patients with hypertrophic cardiomyopathy (HCM). We conducted a systematic search of the databases PubMed, Web of Science, Embase, Scopus, and Google Scholar. The initial search led to 1222 citations after removing duplicate results. We included only English-written studies published since 2013 (2013-2023). Ultimately, we retrieved five studies, involving 235 participants. We used the Cochrane Risk of Bias Tool for randomized trials (RoB2) and risk of bias in non-randomized studies of intervention (ROBINS-I) for evaluating the risk of bias in randomized and non-randomized studies, respectively. Results showed that four training programs improved participants' functional capacity by up to 46%. Improvements in weight, BMI, echocardiography, and remodeling parameters (left atrium volume index, premature ventricular contraction burden, pulmonary artery systolic pressure), exercise test results (minute ventilation/carbon dioxide production, peak workload, heart rate reserve, exercise duration, peak heart rate, peak systolic pressure, and blood pressure response to exercise normalization), and a decrease in N- Terminal Pro-Brain Natriuretic Peptide (NT-pro BNP) were reported in these studies. No major adverse events, including sustained tachyarrhythmia, implantable cardioverter-defibrillator discharge, and sudden cardiac death were reported. Supervised exercise training is safe and helpful for patients diagnosed with HCM. It can improve exercise capacity and is considered an adjunctive therapeutic option.

Early CRT implantation in LMNA cardiomyopathy patients, with an indication for pacemaker or ICD, may reduce heart failure deterioration and life-threatening heart failure complications.

Pulmonary artery catheterization is a diagnostic procedure in which a catheter is inserted through a central vein and advanced toward the pulmonary artery to measure right atrial, right ventricular, and pulmonary artery pressures, estimate cardiac output, identify intracardiac shunts, and measure pulmonary vascular resistance. Hemodynamic measurements can provide a better understanding of the pathophysiology of heart failure and pulmonary hypertension, but their proper assessment and optimal use can be challenging due to differences in techniques that can lead to differences in conclusions and therapeutic management strategies. In this review, we will discuss right heart catheterization and its role in clinical practice (e.g., shunt evaluation, management of cardiogenic shock) and summarize important concerns related to measurement and interpretation.