A ventricular septal defect is the most common congenital cardiac abnormality encountered in infants and children. Many of them survive through adulthood before diagnosis. Two-thirds of the cases involve the membranous part of the septum. In the absence of an interventricular shunt or concomitant cardiac surgery, guidelines for surgical intervention or resection of isolated aneurysms of the membranous septum are not well established. In this report, we discuss a multi-imaging modality approach for the diagnosis and assessment of membranous ventricular septal aneurysms and review the experts' consensuses for follow-up and treatment strategies.

W e report an amazing case of a 69-year-old man who accidently shot himself with a power-driven nail gun and ended up having 16 finishing nails (2.5-inch) in his left chest. Panel A is a computed tomography (CT) scan of his chest showing the multiple nails embedded in the heart. The patient managed to drive to the hospital and was admitted in moderate distress. An emergent median sternotomy with cardiopulmonary bypass was performed, and 15 nails were removed from the chest wall and the heart. Due to the patient's critical condition, 1 nail from the left ventricle (LV) could not be removed. Panel B is a CT scan of the chest with the single retained nail in the heart. The patient later underwent coronary angiography for anginal symptoms, which revealed the retained intracardiac nail along with diffuse nonobstructive coronary artery disease. Panel C displays the right coronary angiogram, right anterior oblique view, showing the intracardiac nail crossing the plane of the atrioventricular groove.A repeat CT scan was conducted that demonstrated the retained nail in the LV cavity and crossing the coronary sinus posteriorly (D). Seven years later, the patient remains asymptomatic with the nail still in his heart. LA ϭ left atrium.

Syncope is defined as a transient loss of consciousness due to cerebral hypoperfusion characterized by rapid onset, short duration, and spontaneous complete recovery. Numerous causes of syncope have been described. Vasovagal syncope is the most common with a number of precipitants. We report a case of post herpetic trigeminal neuralgia leading to neurocardiogenic syncope. These episodes were preceded by severe stabbing left frontal headaches followed by significant sinus bradycardia, asystole, and syncope requiring pacemaker implantation. To our knowledge only one previous case of post herpetic trigeminal neuralgia leading to syncope has been reported.