Purpose of Review With increasing use of prosthetic valves to treat degenerative valvular heart disease (VHD) in an aging population, the incidence and adverse consequences of paravalvular leaks (PVL) are better recognized. The present work aims to provide a cohesive review of the available literature in order to better guide the evaluation and management of PVL. Recent Findings Despite gains in operator experience and design innovation, significant PVL remains a significant complication that may present with congestive heart failure and/or hemolytic anemia. To date, clear consensus or guidelines on the evaluation and management of PVL remain lacking. Summary Although the evolution of transcatheter valve therapies has had a tremendous impact on the management of patients with VHD, the limitations and complications of such techniques, including PVL, present further challenges. Incidence of PVL, graded as moderate or greater, ranges from 4 to 7.4% in surgical and transcatheter valve replacements, respectively. Improved imaging modalities and the advent of novel surgical and percutaneous therapies have undoubtedly yielded a better understanding of PVL including its anatomical location, mechanism, severity, and treatment options. Echocardiography, used in conjunction with cardiac computed tomography and cardiac magnetic resonance, provides essential details for diagnosis and management of PVL. Transcatheter intervention has become a favored approach in lieu of surgical intervention in select patients after previous surgical or percutaneous valve replacement. PVL treatment with vascular plugs, balloon post-dilation, and the valve-in-valve methods have shown technical success with promising clinical outcomes in appropriately selected patients.

Delayed presentation of acute appendicitis is associated with increased complications. We hypothesized that the outcomes of appendectomy in delayed presentations of acute appendicitis (>72 hours of pain) were dependent on radiologic findings rather than late presentation. We reviewed records from 2009 to 2015 and analyzed delayed presentations of acute appendicitis. We divided patients into three groups based on specific CT findings: uncomplicated appendicitis (UA), phlegmon or abscess (PA), and other perforated appendicitis (PERF, signs of perforation without abscess or phlegmon). One hundred thirty-eight patients were included in this study (58 in the UA, 67 in the PA, and 13 in the PERF groups). Overall, 78 (57%) patients underwent early appendectomy (EA) and 60 (43%) underwent initial conservative management. The incidence of adverse events was lower in EA than that in initial conservative management (17% vs 42%, P = 0.005). EA in the UA group was associated with shorter hospitalization (3.2 vs 5.6 days, P < 0.001) and less adverse events (6% vs 29%, P < 0.05). Severe adverse events (two colectomies and one fecal fistula) were observed in the PA group. In conclusion, in these late presentations of appendicitis, complicated appendicitis was common. EA was safe in selected patients, however, and associated with decreased adverse events.

Background:We sought to investigate the trajectory of cardiac catheterizations for acute coronary syndrome (ACS) and out-of-hospital cardiac arrest (OHCA) during the pre-isolation (PI), strict-isolation (SI), and relaxed-isolation (RI) periods of the coronavirus disease 2019 (COVID-19) pandemic at three hospitals in Los Angeles, CA, USA.Methods: A retrospective analysis was conducted on adult patients undergoing urgent or emergent cardiac catheterization for suspected

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Background: The COVID-19 pandemic was associated with a worrisome decrease in acute coronary syndrome (ACS) cases. We sought to investigate the trajectory of ACS following the relaxation of isolation orders and public service education. Hypothesis: We hypothesized that during the COVID-19 pandemic, ACS cases would decrease during the period of strict isolation and thereafter increase, illustrating a “rebound effect”, during the period of relaxed isolation. Methods: All adults with concern for ACS requiring cardiac catheterization at one academic center from 22 December 2019 to 13 June 2020 were included. Cases were designated as ST-elevation myocardial infarction (STEMI), STEMI activation, out-of-hospital cardiac arrest (OHCA), Non-STEMI/unstable angina (NSTEMI/UA), and/or total ACS. 18 December - 14 March, 15 March - 9 May, and 10 May - 13 June were designated as pre-isolation COVID-19 (piC), strict isolation COVID-19 (siC), and relaxed isolation COVID-19 (riC), respectively. Fisher’s exact test was used to compare average cases per week in piC vs. siC and siC vs. riC. One-way ANOVA was used to compare cases across piC, siC, and riC together. Analysis was completed with STATA/MP 16.1. Results: 315 cases concerning for ACS requiring cardiac catherization lab activation were included. When comparing piC with siC and siC with riC, there were no significant differences in STEMI, STEMI activation, OHCA, NSTEMI/UA, or total ACS. When compared across piC, siC, and riC simultaneously there were no significant differences in STEMI (p=0.426), STEMI activation (p=0.172), OHCA (p=0.167), NSTEMI/UA (p=0.362), and total ACS (p=0.219). Total ACS, STEMI activation, NSTEMI/UA, and OHCA exhibited a trend towards a rebound effect (Graph). Conclusions: There were no significant changes in the incidence of total ACS, OHCA, STEMI, STEMI activation, or NSTEMI/UA between pre-isolation, strict isolation, and relaxed isolation periods of the COVID-19 pandemic.