Background Inferior vena cava (IVC) filters are used to prevent pulmonary embolism in patients at high risk of venous thromboembolism with a contraindication to anticoagulation. IVC filters are associated with rare but significant long term complications such as filter fracture and embolisation. Case summary We report the case of a 53-year-old female with an IVC filter inserted eight years prior for the management of recurrent bilateral pulmonary embolism resistant to anticoagulation. Imaging revealed an incidental finding of IVC filter limb fracture and migration to the right heart, and the hepatic and renal vein. The patient remained asymptomatic with no impairment in cardiac, liver or renal function. Due to high operative risk, the broken IVC filter and embolised filter limbs were not retrieved. Discussion There is no consensus on management for intracardiac embolisation of IVC filters. Intravascular fragments may be removed by endovascular or surgical approaches, depending on anatomical location. Following IVC filter insertion, the appropriate follow up must be in place to ensure removal and limit clinical sequalae that is otherwise avoidable. A multidisciplinary approach to the management of IVC filter fracture and embolisation is recommended.

Background Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve‐in‐valve (TMViV) replacement has emerged as an alternative to redo surgery in high‐risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. Methods A single‐centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post‐operative trans‐thoracic echocardiogram (TTE) results. Results There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre‐operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post‐operative median length of hospital stay was 4 days with no post‐operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post‐operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow‐up of 22 months. Conclusion Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD.

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Background: Variation in size of the internal mammary artery has been demonstrated in ethnic groups, but not reported in Aboriginal patients. We hypothesised that the left internal mammary artery is smaller in Aboriginal patients compared to non-Aboriginal patients and aimed to determine the impact on survival following coronary artery bypass graft (CABG) surgery. Methods: Left internal mammary artery size was compared between Aboriginal (n = 345) and non-Aboriginal (n = 1819) in 2343 patients undergoing CABG at Flinders Medical Centre from January 2010 to June 2021. To determine the association with-survival we used Kaplan-Meier survival analysis and Cox proportional hazard models adjusted for preoperative variables.Results: There was a significant difference in left internal mammary artery (LIMA) size-Aboriginal 1.8 AE 0.4 mm; non-Aboriginal 2.1 AE 0.4 mm (P < 0.001)-and left anterior descending (LAD) artery size-Aboriginal 1.7 AE 0.3 mm; non-Aboriginal 1.9 AE 0.3 mm (P < 0.001). Aboriginal patients were more likely to have the LIMA discarded (9.3% vs. 0.4%) and to receive a LAD vein graft (17% versus 3%) (P < 0.001). There was no difference in 30-day mortality or survival <5 years. Conclusion: This study supports the hypothesis that the left internal mammary artery is smaller in Aboriginal patients compared to non-Aboriginal patients. Although Aboriginal patients were more likely to receive a venous conduit to the LAD, we observed no difference in survival up to 5 years. This data contrasts with reported outcomes of other ethnic groups.

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