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Introduction: Endobronchial valve (EBV) placement is one technique to attain bronchoscopic lung volume reduction (BLVR). This procedure has shown clinical benefits in terms of lung function, symptoms, and quality of life. A few complications have been reported including pneumothorax, dislocation or migration of the valve, hemoptysis, COPD exacerbation, and pneumonia. However, supraventricular tachycardia (SVT) was not seen as a potential complication within 45 days of the procedure. Hypothesis: SVT is a complication of EBV placement to attain BLVR. Methods: We conducted a retrospective chart review of consecutive patients who underwent EBV placement between January 2018 and December 2021. Patients who developed SVT were compared to patient who did not get SVT. Results: A total of 94 cases were identified. The incidence of SVT was 18 (19.15%) cases post EBV placement. The patients who developed SVT were older (median [IQR]: 74 [69-76], 72.2% males and all were whites (100%). The time to develop SVT ranged between 2.5 hours and 118 hours with median 40.5 hours. 13 (72.2%, P= 0.007) of patients who developed SVT had an electrolyte imbalance post EBV placement. Electrolyte imbalance was an independent factor for predicting SVT on multiple regression after controlling for age, BMI, gender, and location of valve placement (adjusted OR, [CI 95%] 4.64, [1.41 - 15.29], P = 0.012). Placement of EBV in the lingula and left upper lobe (LUL) have higher incidence of SVT (5 (27.8%, P = 0.049) and 12 (66.7%, P = 0.071), respectively). Table 1 and Table 2 further summarizes the result from the study. Conclusion: Given the results, SVT can be recognized as a potential complication of BLVR. Additional caution must be paid to patients who have EBV placed in the LUL and patients with electrolyte imbalance post procedure. Electrolyte imbalance post procedure was the only statistically significant independent predicting factor for SVT. A larger study is needed to determine the level of association.

INTRODUCTION:The AngioVac device was designed with the purpose to percutaneously remove undesirable material from the intravascular system. AngioVac procedures have recently become popular for decreasing vegetative burden in patients with infective endocarditis who are poor surgical candidates. CASE PRESENTATION:A 26-year-old female with a previous history of intravenous drug use, MSSA bacteremia, and noncompliance presented with acute hypoxic respiratory failure and refractory septic shock. She was found to have multiple cavitary lesions on CT angiography of the chest (Figure 1A) which was consistent with septic emboli. Transesophageal echocardiogram revealed large valvular vegetations on the anterior and septal tricuspid valve leaflets measuring approximately 2cm x2cm with a component of the leaflet having independent mobility (Figure 1B). Despite directed antibiotic therapy, her clinical status continued to deteriorate. Subsequently, a decision was made to perform vegectomy with AngioVac for debulking and decreasing the disease burden. Vegectomy was performed successfully (Figure 1C and 1D) with significant improvement.DISCUSSION: Endocarditis of the right-heart circulation is most commonly managed with antimicrobial therapy. Surgical indications for complicated infective endocarditis include: large vegetations (=20 mm in diameter), recurrent septic pulmonary emboli, presence of a highly resistant organism, and/or persistent bacteremia. In certain instances, where surgical intervention is not appropriate for conditions such as unstable right heart endocarditis, AngioVac has been utilized to decrease the vegetative burden.CONCLUSIONS: AngioVac use for the purpose of right heart endocarditis is gaining attention, however, further studies needs to be done on the efficacy and safety for this new possible indication.

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Background: The American College of Cardiology (ACC) recommends intravenous iron replacement (IVIR) in patients with iron deficiency (ID) and heart failure with reduced ejection fraction (HFrEF). IVIR, in patients with HFrEF and ID, is associated with improvement in patient symptoms, functional capacity, 6-minute walk distance, and quality of life. Emerging data demonstrates IVIR can reduce hospital admissions for HFrEF. The purpose of this study is to enhance screening of ID in the HFrEF population and IVIR in the inpatient setting. Methods: This is a single-center, retrospective chart review using ICD 10 codes I50.2 and I50.42 to query the diagnosis of HFrEF in admissions from January 2018 to June 2020. Patients with recent major surgery within the last three months, use of erythropoietin stimulating agents, blood transfusions within a six-week time period, a history of cirrhosis, and/or a diagnosis of end stage renal disease receiving IVIR were excluded. ID in HFrEF is defined as ferritin <100 micrograms/L or a ferritin of 100-299 micrograms/L with transferrin saturation of <20%, per ACC guidelines. Further analysis was performed on 150 of 600 admissions pulled. Results: Of the 150 admissions analyzed, 108 of 150 were due to decompensated HFrEF and only 22 of the 150 had iron studies performed during admission. Approximately 15 of 22 patients with iron studies had a diagnosis of ID and only 1 of the 15 patients was initiated on IVIR. Additionally, 22 of the 150 total patients were on oral iron replacement and were not placed on IVIR. Discussion: Work-up of ID in patients with HFrEF is frequently omitted in the inpatient setting. In patients that have been diagnosed with ID, few receive appropriate treatment. There should be increased efforts to identify and administer IVIR to hospitalized patients with HFrEF and ID once their acute decompensation has been stabilized. This study aims to increase usage of HFrEF order sets on admissions by including iron studies within the workflow. The initiative includes administering first doses of IVIR in the hospital with subsequent transition to the outpatient setting, providing patient/provider education, and offering clinical decision support at time of ordering.