The mortality rate after the development of postinfarction ventricular septal defect (VSD) remains high, despite progress in pharmacologic therapy, invasive cardiology, and surgical techniques. We present three cases of preoperative venoarterial extracorporeal membrane oxygenation as a bridge to reparative surgical repair in patients with cardiogenic shock who would otherwise require emergent cardiac surgery with an associated risk. Two patients were discharged, whereas the third patient died due to pulmonary artery rupture after a right ventricular assist device implantation, despite the fact that he had a successful bridge to reparative surgery and VSD repair. Finally, a review of the current literature concerning the use of preoperative venoarterial extracorporeal membrane oxygenation as a bridge to reparative surgery is provided.

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AIM: Asymptomatic atrial fi brillation (AF) detection and pulmonary veins isolation (PVI) outcome prediction remain challenging. Our aim was to study the association between apelin and paroxysmal AF in patients undergoing radiofrequency catheter PVI. METHODS: Sixty-three consecutive patients (55 ± 8years, 12 females) with paroxysmal AF without a structural heart disease and implanted ECG loop recorders undergoing PVI and healthy control group of 34 persons (41 ± 9.5years, 21 females) were included. Apelin plasmatic concentrations were measured before and three months after PVI. AF burden was continually assessed for three years. RESULTS: Apelin was signifi cantly decreased in AF patients compared to the healthy controls (0.79 ± 0.09 vs 0.98 ± 0.06 ng/ml; p < 0.00001). Apelin plasmatic concentration of 0.89 ng/ml had 94 % specifi city and 89 % sensitivity for AF prediction with the area under the curve (AUC) of 0.96. After propensity matching to sex, age and comorbidities, apelin concentration was signifi cantly lower in AF group (0.78 ± 0.1 vs 0.99 ± 0.06 ng/ml; p < 0.0001; AUC: 0.97). There was a signifi cant inverse correlation between apelin concentration and AF burden both before and after PVI (Rho =-0.22; p = 0.05) and (Rho =-0.51; p = 0.006), respecti vely. There was no signifi cant association between pre-PVI apelin and PVI long-term outcome. CONCLUSION: In patients without a structural heart disease apelin showed a signifi cant specifi city and sensitivity for AF prediction and inversely correlated with AF burden (Tab.