2), RVF post cardiac surgery (1), RVF post LVAD implantation (2) and RVF post acute myocardial infarction (1). All patients were in cardiogenic shock prior to Impella RP implant.The percutaneous implant of the device was feasible and successful in 100% of the patients. The support time ranged from 1 to 9 days, with more than 60% of the patients being supported for longer than 4 days (median of 6.5 days) and explanted upon RV recovery. The average flow was 3.9 L/min. Overall thirty-day survival was 83%. Conclusions: A novel percutaneous right ventricular assist device has been developed. The design was enhanced after the first implant to improve torque-ability and push-ability which resulted in an ease of placement for the subsequent patients. The preliminary clinical experience is very encouraging and further evaluation is ongoing. TCT-372Coronary artery disease in patients with reduced left ventricular systolic function treated with medicine, surgery, or percutaneous coronary intervention: a retrospective review of outcomes within a multicenter healthcare system

A patent foramen ovale (PFO) can act as a conduit between the venous and arterial circulations, allowing right-to-left shunting and bypass of the pulmonary circulation. Brain abscess may develop as a result of paradoxical embolism of organisms through a PFO. In this small series, we report on the closure of PFO for the prevention of recurrent brain abscess. Only prospective, randomized trials comparing PFO closure to conservative therapy could provide a definitive answer as to the optimal strategy for preventing recurrent cerebral abscess.

Invasive aspergillosis is an often fatal disease that usually occurs in immunocompromised patients. We report a case of invasive aspergillosis presenting as a febrile respiratory infection with a cardiac mass in an immunocompetent patient. Invasive aspergillosis should be considered in the differential diagnosis of an otherwise undiagnosed invasive febrile respiratory illness, even in immunocompetent patients. Echocardio graphy should be performed to evaluate for endocarditis in such cases. Prompt initiation of appropriate antifungal therapy is warranted, even before the diagnosis of invasive aspergillosis is confirmed. Brief ReportA generally healthy 53 year-old male plumber with suboptimally-controlled noninsulin dependent diabetes mellitus (Hb A1c 8) and coronary artery disease s/p CABG 10 years earlier presents to the ED with 10 days of fever and cough. Physical exam reveals a temperature of 36.6°C, blood pressure of 111/70 mmHg, pulse of 108 bpm, respiratory rate of 30, and pulse oxygen saturation of 80% on room air which rises to 95% on 4 liter nasal cannula. There is a regular tachycardia without murmur; rales are present one-quarter up the lung fields bilaterally. Labs are notable for a wbc 15.2 with 73% neutrophils and 8% bands. Electrocardiogram demonstrates sinus tachycardia at 110 beats per minute with an incomplete right bundle branch block pattern. Chest radiography reveals bilateral interstitial infiltrates with small nodules in the right upper and left lower lobes. Moxifloxacin is started for treatment of community-acquired pneumonia. On HD #2 CT angiogram of the pulmonary arteries reveals a small left upper lobe pulmonary embolism and extensive bilateral ground-glass opacities. Lower extremity venous Doppler ultrasound study reveals bilateral DVTs below the knee. Therapeutic enoxaparin injections are started. On HD #3 a bronchoalveolar lavage is performed with washings sent for Gram stain, and bacterial, fungal, AFB, and viral cultures, all of which are negative. Serum human immunodeficiency virus test is negative.Transthoracic echocardiogram performed on HD #3 to assess pulmonary artery pressures and cardiac function reveals normal left ventricular systolic function, an estimated right ventricular systolic pressure of 58 mmHg,

A 39-year-old man presented with dyspnea on exertion and was found on ausculation to have a continuous machinery-like murmur. A computed tomographic (CT) angiogram with 3-dimensional reconstruction showed a tubular patent ductus arteriosus (PDA) that measured 1.7 × 1.3 cm in diameter (Figs. 1 and 2). Given the large size of the defect, we entered the PDA with a peripheral intravascular ultrasound catheter (Volcano Corporation; San Diego, Calif ) to obtain ultrasonographic images (Fig. 3), which precisely confirmed the dimensions shown on the CT scan. Because of the defect's large size, we used an Amplatzer 20-mm vascular plug II (St. Jude Medical, Inc.; St. Paul, Minn) for closure (Fig. 4). Multiple aortograms verified cessation of left-to-right flow across the PDA, consistent with occlusion of the PDA (Fig. 5).

Invasive aspergillosis is an often fatal disease that usually occurs in immunocompromised patients. We report a case of invasive aspergillosis presenting as a febrile respiratory infection with a cardiac mass in an immunocompetent patient. Invasive asper-gillosis should be considered in the differential diagnosis of an otherwise undiagnosed invasive febrile respiratory illness, even in immunocompetent patients. Echocardiography should be performed to evaluate for endocarditis in such cases. Prompt initiation of appropriate antifungal therapy is warranted, even before the diagnosis of invasive aspergillosis is confirmed.