Central venous access is commonly performed in the care of critically ill patients, for administration of repeated drug treatments. This routine procedure has multiple complications such as catheter malposition, migration, obstruction, infection, thrombosis and catheter fraction. We must recognize, consider and be able to manage these complications. We report a successful endovascular technique using a snare for retrieving broken venous port in a 36-year-old female.

Background: Human epidermal growth factor receptor 2(HER2) is a gene that makes proteins in the breast cell. The HER2 gene is present in about 25% - 30% of patients with breast cancers. The most common side effect of drugs is left ventricular dysfunction. Evaluation of left ventricular ejection fraction (LVEF) by 2D echocardiography cannot detect subtle changes in LV systolic function. Objectives: We want to draw a comparison between two groups of breast cancer patients (HER2 positive and negative) by advanced echocardiography. Methods: We have conducted a single center prospective study at Rajaie Cardiovascular Medical and Research Center in 2018 - 2019. Results: This analysis included 58 patients with breast cancer. 15 cases (34%) were HER2 positive. Mean left ventricular ejection fraction (2D LVEF) in HER2 positive patients was 55 % at baseline and in HER2 negative patients was 55 %. In HER2 positive patients we had 10 percent decrease in LVEF during follow-up and the final LVEF was about 45% (P value < 0.05). Mean left ventricular ejection fraction by 3D echocardiography (3D LVEF) in HER positive patients was 57 % and in HER2 negative patients was 55 % at baseline. In HER2 positive patients we had about 20% decrease in 3D LVEF and the final LVEF was 40 % (P value < 0.05). Mean circumferential strain (GCS) in HER2 positive patients was -21 and in HER2 negative patients was -21 at baseline which decreased to -18 in HER positive patients and -17 in HER2 negative patients, showing clinical significance ( P value = 0.008). Conclusions: In our study HER2 positive breast cancers showed about 10% drop in 2DEF, about 20% drop in 3DLVEF and about 5% drop in HMLVEF, which all were significant (P value < 0.05). We found that GCS is more sensitive than GLS in detecting subclinical involvement, and early changes in GCS is a good predictor of subsequent development of drugs (anthracycline-transtuzumab) induced cardiotoxicity.

Thrombus formation is an important prognostic factor in all cardiovascular diseases. Early diagnosis and treatment of intra-cardiac thrombus is critical. When a patient presents with cardiac thrombus, not only cardiac disorders but also other diseases such as malignancies, thrombophilia, rheumatologic disorders and hypercoagulable state should be considered. While regarding various hypercoagulable conditions, hyperhomocysteinemia should be evaluated. In this case report we report a case of left ventricular (LV) thrombosis in a patient with hyperhomocysteinemia.

Aortopulmonary window is a rare congenital anomaly which is commonly associated with other lesions such as patent ductus arteriosus, interrupted aortic arch, Atrial Septal Defect (ASD), and Ventricular Septal Defect (VSD). Aortic aneurysm and dissection have not been reported as an associated anomaly in AP window. A 44 -year-old male, with inoperable AortoPulmonary Window (AP window) and Eisenmenger syndrome presented to our Emergency Department with back pain and shortness of breath. Transthoracic echocardiography and aortic CT angiography depicted aneurysmal dilatation of ascending aorta with a dissection flap which was extended to main pulmonary artery. Any intervention was very high risk, due to the risk of imminent RV failure. The patient was hemodynamically stable and the symptoms seemed to be chronic, so we decided to manage him medically. AP window is a rare congenital anomaly which is commonly associated with other anomalies. In this report, we represent a rare case of AP window and Eisenmenger syndrome with aortic aneurysm and dissecting flap in ascending aorta and pulmonary artery who was managed medically.

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