No abstract

The techniques for successful pacemaker implantation via the PLSVC with the SelectSecure system (Medtronic, Minneapolis, Minnesota, USA) are unknown. Regarding the techniques, we presented a case in which we implanted a pacemaker via the PLSVC in patient with absent RSVC using the SelectSecure system.

Objectives We review our experience with 13 periprocedural aortic dissection (AD) cases caused by transcatheter aortic valve replacement (TAVR). Background AD is a potentially lethal complication of TAVR; however, only sporadic case reports have been published to date. Methods Among 1335 consecutive patients who underwent TAVR in 2013–2021, we retrospectively extracted 13 patients (1.0%) with TAVR‐related AD (Stanford type A in 6 [46%], type B in 7 [54%]). AD was defined as a new‐onset dissected layer of the aortic wall and diagnosed by aortography, computed tomography, or transesophageal echocardiography. Results Five of the six type A AD cases (83%) were detected during TAVR versus only one of the seven type B AD cases (14%). Four of the seven type B AD cases (57%) were asymptomatic and incidentally detected on computed tomography. The presumed causes of AD were injury by the delivery sheath (39%), delivery catheter (23%), valve implantation (15%), stent edge (15%), and pre‐dilation balloon (8%). Complicated AD occurred in only one patient (8%). Considering the patient's age and prohibitive surgical risk, all patients were treated conservatively and free of any aortic‐related deaths or interventions during a follow‐up of 1087 days. Conclusions TAVR‐related AD is a rare but life‐threatening condition that may be underdiagnosed. Its optimal therapy remains unclear, and conservative management might be an option for selected patients. Further studies are needed to elucidate the incidence, risk factors, effective screening, optimal therapy, and outcomes of TAVR‐related AD.

Background Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, often preceded by emotional or physical trigger. The recurrence of TTS has been investigated, however, cases of multiple recurrences are scarcely reported. Case summary A 79-year-old woman was admitted to the hospital with the complaint of dyspnoea following emotional stress. Electrocardiogram showed terminal T-wave inversion with QT interval prolongation in anterior leads. Transthoracic echocardiogram revealed severe hypokinesis of mid- and apical-anterior segments. She was diagnosed with focal TTS. After 3 months, she complained of orthopnoea subsequent to upper-respiratory infection. Coronary angiography (CAG) depicted normal coronary arteries. She had recurrence of TTS with bi-ventricular dysfunction, and complicated cardiac collapse requiring intra-aortic balloon pumping. One month after the second episode, she had dyspnoea after herpes zoster infection. She was diagnosed with recurrence of focal TTS. After 4 months, she complained of central chest pain without evident trigger factors. CAG showed no coronary artery stenosis, and left ventriculography revealed mid-inferior and apical segment akinesis. She was diagnosed with the 4th occurrence of TTS. Discussion We describe the case of an elderly female experiencing quadruple episodes of TTS with various triggers, LV dysfunctions and severities in a short period of 10 months. Although multiple recurrences of TTS is rare, it can occur with variable trigger factors and patterns of myocardial dysfunction. An analysis of multiple recurrences could aid in clarifying the pathophysiology of TTS.

ABSTRACT:Uncross-and cross-linked polyoxetanes bearing o-, m-, and p-phenolic residual groups at the terminals of moderately long pendant spacers -CH2O(CH2).-, where n = 4 and 6, were prepared. The prepolymers having the pendant O-acetylated phenols were made by the BF 3 -initiated cationic ring-opening polymerization and then the pendant phenyl acetates were hydrolyzed with 2N aqueous NaOH in methanol to give the desired phenolic polyoxetanes. The pendant phenols were subjected to the diazocoupling reaction with 3 equiv of benzenediazonium chloride to examine their reactivities in aqueous media. Model polyoxetanes with the pendant phenyl benzoates containing the azo group were also prepared to confirm the structures of the diazocoupling product polymers.