The latest issue of CASE is now available with intriguing reports, including “Epicardial Lead Pacer Wire Migration Causing Endocarditis in an Orthotopic Heart Transplant Patient.” CASE Editor-in-Chief Vincent Sorrell, MD, FASE, remarked, “These authors, through a carefully investigated clinical care approach, used TTE, TEE, and CT imaging to find the source of infection in a young man post-orthotopic transplant (OHT). What they found will likely surprise you – as it did me. After OHT, placement of a temporary epicardial pacing wire (TEPW) is routine; occasionally the TEPW is left in place, and the wires are cut in challenging cases where removal is considered too difficult. For such patients, the need for further monitoring and understanding of this approach to care is described. These authors demonstrate a case of TEPW migration that resulted in persistent bacteremia and endocarditis, and remind us that OHT recipients whose TEPWs are not entirely removed warrant recognition of this possibility and the importance of imaging surveillance.”
In addition to this Infections in the Heart case, Rare but Deadly Findings offers readers two impactful reports. The first depicts a patient with an iatrogenic complication that required urgent thoracic surgery to avoid a deadly outcome. Maturi et al. then present a case of chest stab wounds penetrating multiple cardiac structures, illustrating how echocardiographic imaging (with Doppler) can correlate with surgical findings. Echo Innovation rounds out this issue with two reports that will benefit your echo knowledge. Koratala et al. provide insight on venous Doppler patterns that can assist with volume assessment and guidance on ultrafiltration in dialysis patients. Wen et al. demonstrate in-situ TEE during screening for direct-current cardioversion and describe their approach to incorporating these echocardiographic findings into their anticoagulation strategies.
Be sure to check out Dr. Sorrell’s editorial as he explores spectral Doppler and related phenomena in honor of our even spookier specters appearing later this month.
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