Purpose: Uninterrupted sustained oxygenation is paramount in neonates and infants with cyanotic/acyanotic congenital heart diseases (CHD) undergoing closed or open heart surgeries and tracheostomy tube decannulation to avoid hypoxic events. Description: We describe here-in a new device, permitting uninterrupted delivery of oxygen through the tracheostomy stoma, allowing continuation of enteral feeds and suctioning of the endotracheal secretions through the tracheostomy stoma. Evaluation: Eighty-four neonates and infants with a median age of four months (IQR:23 days-9 months) undergoing different closed and open heart surgeries for cyanotic/acyanotic CHD with or without pulmonary arterial hypertension were treated with a device permitting uninterrupted oxygenation following tracheostomy tube decannulation. There were 11 (13.1%) deaths due to multifactorial etiologies, and one was lost to follow-up. Seventy-two children were successfully decannulated using this protocol. At a median follow-up of 166(IQR:82.5-216) months, the actuarial survival was 86.61% (SE±0.04%; 95% CI: 77.1-92.3). Conclusions: Transtracheal oxygenation through the tracheostomy stoma via a thin catheter allows uninterrupted oxygenation following tracheostomy tube decannulation, continuation of enteral feeds, and allows intermittent endotracheal suctioning, thus avoiding post decannulation hypoxic events.

Cannabis is the most abused psychoactive drug in the world. Delta 9-tetrahydrocannibol, the main psychoactive compound in marijuana, acts via the endocannabinoid system to elicit various cardiovascular physiological effects, and has been associated with many adverse cardiovascular effects such as acute coronary syndrome, arrhythmias, and sudden cardiac death. It is important to consider cannabis use as a significant risk factor of myocardial infarction, particularly in individuals with no cardiac risk factors, as delay in management can result in fatal outcomes. Coronary angiography as the main exam to definitively diagnose or rule out coronary artery disease is usually safe, but complications also occur. Coronary dissection, despite rare, can be extremely difficult to manage and even be fatal. Iatrogenic causes of coronary dissection include catheter tip or guidewire trauma, vigorous contrast injection and angioplasty balloon overinflation. We present the case of a 41 years old Caucasian woman admitted to cardiology department after an episode of myocardial infarction due to cannabis induced vasospasm. However, the angiography was complicated by iatrogenic coronary artery dissection.

Transcatheter valve in valve (ViV) implantation actually represents a valid alternative to surgical reinterventions in patients with previous surgical aortic valve replacement (AVR). In patients less than 80 years old, it is crucial to correctly position the new valve leaving a feasible and easy access to coronary ostia, both for future percutaneous coronary intervention (PCI) than for a future possible TAVinTAV procedure. We report a 71 year old man with prior AVR presented with structural valve deterioration (SVD) leading to severe aortic stenosis. In order to guarantee comfortable coronary access we aligned, the commissures of the new percutaneous valve with the ones of the surgical bioprothesis by reconstructing the headframes of the surgical bioprosthesis with computer tomography (CT) and fluoro-CT.

Treatment of acute myocardial infarction (AMI) has been with tissue plasminogen activator (tPA) alone since 1987, at an original cost of $2,000 which has risen to $5,000. Over the past decade tPA has been replaced by percutaneous coronary intervention (PCI), an invasive, more time-consuming hospital procedure. The mortality results of the two treatments were similar, but the PCI cost and reimbursement are at least 5-fold higher. At the time, another fibrinolytic regimen was developed which is more effective, but it was ignored, and PCI continued to be the treatment choice and major source of revenue.