Spontaneous coronary dissection is a rare event occurring particularly in women during the peripartum and postpartum period. Two cases related to the early postpartum period with a successful outcome are described, together with a comprehensive review of all the previously published cases. Diagnostic and therapeutic considerations of this unique clinical entity are discussed and reviewed.

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Arterial puncture sites after cardiac catheterization are a troublesome cause of complications. Closure devices have been developed to improve on patient comfort and safety. We evaluated a suture-mediated closure device, the Prostar-Plus device, in a consecutive population of over 10,001 diagnostic and interventional catheterizations. A significantly higher complication rate was noted for both major and minor complications in the diagnostic catheterization patients treated with the Prostar-Plus device compared to diagnostic catheterization patients treated with manual compression (2.6% major and 4.6% minor complication rate for the Prostar-Plus treatment group vs. 0.2% major and 1.8% minor complication rate for the manual compression treatment group). For the interventional patients, there were no statistical differences noted for both major and minor complications between patients treated with the Prostar-Plus device vs. manual compression. Subgroup analysis showed that older, thinner women were more likely to have complications related to the Prostar-Plus device.

The AFFIRM Study enrolled 4060 predominantly elderly patients with atrial fibrillation to compare ventricular rate control with rhythm control. The patients in the AFFIRM Study were representative of patients at high risk for complications from atrial fibrillation, which indicates that the results of this large clinical trial will be relevant to patient care.

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