Cardiac tumors are a very rare but heterogenous group of diseases that may reveal themselves through a variety of nonspecific cardiac symptoms that may pose a challenge to the diagnostic process. Myxofibrosarcoma is a particularly rare type of cardiac tumor that carries a poor prognosis, thus making accurate and timely diagnosis essential. A 61-year-old woman presented with fatigue and shortness of breath during mild exercise, symptoms that have progressively worsened during the previous year. Multimodality imaging consisting of transthoracic and transesophageal echocardiography (TTE and TEE), cardiac magnetic resonance (CMR), cardiac computer tomography (CCT), and fluorodeoxyglucose positron emission computer tomography (18F-FDG PET-CT) was used for the diagnosis and postoperative follow-up of a myxofibrosarcoma.

Carcinoid heart disease is a rare presentation of the carcinoid syndrome, which is caused by excessive tumoral hormone production and the abundant release of vasoactive substances with systemic expressions. A 62-year-old woman presented with flushing, diarrhea, weight loss, and right-sided heart failure symptoms. Specific carcinoid heart disease features were identified using transthoracic and transesophageal echocardiography at the tricuspid and pulmonic valves. Biomarkers, 99mTc-Tektrotyd scintigraphy, SPECT-CT, and a biopsy later confirmed the diagnosis, and the patient began treatment for the underlying condition.

Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) represents the most common cardiac arrhythmia in adults worldwide. Catheter ablation (CA) of AF provides higher efficacy with comparable safety as antiarrhythmic drug therapy. Recently, high-power short-duration (HPSD) approach has emerged as an alternative to standard-power standard-duration settings, showing reduction in ablation times and increasing patient tolerability, with similar outcomes in terms of safety and efficacy. Although the advantages of general anesthesia (GA) are well established for standard-power standard-duration settings, there are currently no studies comparing GA to mild conscious sedation (MCS) for HPSD approach CA for AF. The aim of this study was to show whether GA improves procedural outcomes compared to MCS in AF CA using HPSD approach. Methods We included patients with paroxysmal or persistent AF who underwent HPSD CA using a contact-force sensing catheter (50W, ablation index 450 on the anterior wall and 320 on the posterior wall) either under GA or MCS. Procedural characteristics and success rates were compared between the two groups, as well as mid-term outcomes. Procedural safety was evaluated by intra- and post-procedural complications. Procedural efficiency was evaluated by total procedural time, number of radiofrequency applications, fluoroscopy time and dose. Acute success was defined as confirmation of entrance block in all pulmonary veins and mid-term success as freedom of AF at 6-months follow-up visits and re-do procedures. Results A total number of 131 patients were included in the study, 47 which underwent HPSD CA for AF under GA (group 1, mean age 60.2±10.2), and 84 under MCS (group 2, mean age 58.6±10.6). CA was performed for paroxysmal AF in 34 patients in group 1 (72.3 %) and 68 patients in group 2 (80.9 %), and for persistent AF in the remaining patients. We found lower mean total procedure time in the GA group (105.7±26.4 vs. 164.4± 41.9 min, p<0.0001), as well as lower radiation exposure (1310.0±1083.2 vs. 3060.5± 2254.8 μGy, p<0.0001 and 4.9± 2.8 vs 9.4± 7.5 min, p<0.0001) and lower number of radiofrequency applications (70.4± 20.4 vs. 106.0± 30.2, p<0.01). At the 6-months follow-up AF recurrence rate was lower in GA group (21.2% vs. 33.3%), however without reaching statistical significance (p=0.14). There was one moderate pericardial effusion in the MCS group which remitted with pharmacological treatment. Conclusion This is the first study comparing GA to MCS for AF CA using HPSD approach. Our findings demonstrate that GA improves procedural efficiency and suggest lower AF mid-term recurrence when HPSD AF CA is performed under GA, compared to MCS.

Infective endocarditis (IE) is common in patients with corrected congenital heart disease (CHD) with a residual lesion, but is rarely found on surgical patches used to close atrial septal defects (ASDs). This is also reflected in the current guidelines that do not recommend antibiotic therapy for patients with a repaired ASD with no residual shunt six months after closure (percutaneous or surgical). However, the situation could be different in the case of mitral valve endocarditis, which causes leaflet disruption with severe mitral insufficiency and could seed the surgical patch. We present herein a 40-year-old male patient with a past medical history of a complete surgically corrected atrioventricular canal defect performed in childhood who presented with fever, dyspnea and severe abdominal pain. Transthoracic and transesophageal echocardiography (TTE and TEE) revealed vegetation at the level of the mitral valve and the interatrial septum. The CT scan confirmed ASD patch endocarditis and multiple septic emboli, guiding the therapeutic management. An accurate evaluation of cardiac structures should be mandatory when a systemic infection is detected in CHD patients, even if the defects were surgically corrected, because the detection and eradication of such infectious foci as well as a surgical reintervention are particularly difficult to achieve in this subpopulation.