An 80-year-old lady was referred to our cardiology emergency department with complaints of increasing shortness of breath since 45 days earlier, which had gradually worsened over the last week. She had a history of chronic obstructive pulmonary disease, diabetes mellitus, hypertension and chronic kidney disease.

Evolocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) is a novel low-density lipoprotein (LDL) lowering agent that has been recently approved by the FDA to reduce the risk of myocardial infarction, stroke, and coronary revascularization in individuals with established atherosclerotic cardiovascular disease, alone or in combination with other lipid-lowering agents, and for treatment of patients with primary hyperlipidemia including familial hypercholesterolemia

The combination of aortic coarctation (CoA) and bicuspid aortic valve (BAV) is associated with high risk of ascending aortic dilatation and type A aortic dissection. Most of the patients having combined lesions remain asymptomatic until adulthood and are incidentally diagnosed. Several questions regarding their treatment strategies remain unanswered. Both single-and two-stage surgical procedures have been described in medical literature, to treat CoA and BAV. Lately, combined endovascular therapy (Balloon angioplasty or Stent implantation) and surgery, has become a good alternative in selected cases. Here, we describe such a asymptomatic case of BAV with massive aneurysmal root dilatation and CoA, which was managed with endovascular stenting and surgery.

Objective: There is little consensus on the indications and optimal timing of tracheostomy in the pediatric population. Our primary aim was to determine if early tracheostomy improves patient outcomes (between 10th and 15th postoperative day). Methods: A retrospective review of 84 neonates and infants requiring tracheostomy after cardiac surgery between January 1997 and December 2019 was performed. Indications and timings for tracheostomy, and risk factors for mortality were analyzed using Cox regression analysis. The receiver operating characteristic curve analysis, Youden’s index, sensitivity and specificity plot were performed to determine the optimal cut-off point of the timing of tracheostomy. Results: Twenty-five (29.76%) neonates and 59 (70.23%) infants with a median weight 7.6 kg (IQR: 3.1-9.25 kg) were studied. Extubation failure and unsuccessful weaning from ventilator occurred in 45 (53.6%) and 39 (46.4%) patients respectively. The timing of tracheostomy of 15 days as the optimal cut-off point was associated with a sensitivity of 73% and a specificity of 84% and a Youden’s index of 0.60. Early tracheostomy was associated with decreased mortality (p<0.001), morbidity (p<0.001), decreased duration of ventilation (p<0.001), ICU length of stay (p<0.001) and decreased time of decannulation (p<0.001). The hazard of death was 5.26 times (95% CI: 1.47-20.36) higher in patients undergoing late tracheostomy. At a median follow-up of 166 (IQR: 82.5-216) months, the actuarial survival was 86.61%±0.04%. Conclusions: Early tracheostomy within 15th postoperative day was associated with lower perioperative and late mortality, morbidity and ICU stay compared with tracheostomy between 15-30 days, and confers significant long-term advantages.

Partial Anomalous Pulmonary Venous Connection (PAPVC) is a remarkably unusual congenital disorder in which the venous circulation is connected with one or more pulmonary veins. Approximately 90% of all PAPVCs start from the right lung, 7% start from the left lung, and 3% of patients are found to have two-side PAPVCs. Occasionally, PAPVC can be treated percutaneously employing an occlusion device, with regard that when there is a dual drainage PAPVC. Here, we want to share our experience in 5 dual drainages PAPVC patients whose 2 right-sided PAPVCs with dual drainage closure were unsuccessful. We also reviewed all published cases which were tried to treat percutaneously to build a pathway in which percutaneous closure is more feasible in addition to inhibit futile efforts.