Texas Heart Institute journal
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We report a case of mitral valve replacement in a patient who had previously undergone transcatheter aortic valve implantation. A transseptal approach was used to avoid displacing the aortic prosthesis. Because of the small mitral annulus, a bioprosthetic aortic valve was used in reverse position for mitral valve replacement. ⋯ To the best of our knowledge, this is the first report of mitral valve replacement in a patient who had a preceding transcatheter aortic valve implantation. We believe that the transseptal approach is promising for mitral valve replacement in such patients. Moreover, using a bioprosthetic aortic valve in reverse position is an option for mitral valve replacement when the mitral annulus is too small for placement of a standard bioprosthetic mitral valve.
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Since the implantable cardioverter-defibrillator was first used clinically in 1980, several large randomized controlled trials have shown that therapy with this device can be beneficial in various patient populations. Evidence suggests that this therapy is useful in the secondary prevention of sudden cardiac death among patients who have survived arrhythmic events. ⋯ When used with cardiac resynchronization therapy, implantable cardioverter-defibrillators have improved survival rates and quality of life in patients with severe heart failure. Further research is needed to examine the potential benefits of implantable cardioverter-defibrillators in elderly, female, and hemodialysis-dependent patients, and to determine the optimal waiting period for implantation after myocardial infarction, coronary revascularization, and initial heart-failure diagnosis.
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Citalopram is a selective serotonin reuptake inhibitor with a favorable cardiac-safety profile. Corrected QT interval (QTc) prolongation and cardiac arrhythmias have not been previously reported in association with citalopram use except in the presence of overdose, abnormal electrolyte values, or renal or liver failure. ⋯ We recommend that clinicians investigate the family history for sudden deaths and perform baseline electrocardiography before prescribing citalopram. We also recommend routine electrocardiographic testing during citalopram therapy, and that patients with long QT syndrome avoid taking citalopram.
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Case Reports
Minimally invasive retrieval of patent foramen ovale closure device after device migration to the descending aorta.
Percutaneous treatment of patent foramen ovale with a septal closure device has become a common procedure, but it is associated with various complications. Migration of the device is uncommon, and migration through the aortic valve into the aorta is rare. ⋯ We report a rare case in which a patient experienced migration of a large patent foramen ovale closure device to the descending aorta. Rarer still was its successful percutaneous management.
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Scimitar syndrome and gastrointestinal bleeding from an aberrant right subclavian artery-esophageal fistula are each extremely rare. Although scimitar syndrome and aberrant right subclavian artery are typically asymptomatic in adults, fistulous connection between the aberrant artery and the esophagus is associated with a poor prognosis. Outcomes are contingent upon timely diagnosis and prompt surgical repair. ⋯ We report the case of a 57-year-old woman in whom an aberrant right subclavian artery-esophageal fistula developed after surgical correction of symptomatic scimitar syndrome. Massive gastrointestinal bleeding resulted from prolonged nasogastric and endotracheal intubation. To our knowledge, this is the first report of aberrant right subclavian artery and scimitar syndrome in the same patient, and the 4th report of a patient's surviving a fistula between the aberrant artery and the esophagus.