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Mechanical complications after acute myocardial infarction are well-described yet catastrophic complications of acute coronary syndromes. Uniquely, we describe a rare case of left ventricular free wall rupture at the site of a septic myocardial abscess after an anterior wall myocardial infarction. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

After a ST-segment elevation inferior myocardial infarction, a patient developed multiple drug-refractory ventricular fibrillation (VF), triggered by a stereotypic premature ventricular complex. During an episode of sustained VF, catheter ablation of the moderator band terminated VF, with transition into monomorphic ventricular tachycardia. To the best of our knowledge, this is the first-in-human report of termination of VF during delivery of radiofrequency energy, which suggests that the focal area on moderator band of Purkinje system had an active role in the perpetuation of VF. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

Percutaneous ventricular assist devices have been used for high-risk ventricular tachycardia ablation when hemodynamic decompensation is expected. Utilizing a case example, we present our experience with development of a coordinated, team-based approach focused on periprocedural management of patients with high-risk ventricular tachycardia. ( Level of Difficulty: Advanced. )., Competing Interests: This work was supported by research funding from Abiomed. Dr Bharadwaj is a consultant, speaker, and proctor for Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2022 The Authors.)

A 51-year-old man with past medical history of bioprosthetic aortic valve replacement presented in cardiogenic shock secondary to acute bioprosthesis degeneration with severe aortic regurgitation. Venoarterial extracorporeal membrane oxygenation is contraindicated in patients with severe AI. Use of left atrial venoarterial extracorporeal membrane oxygenation resulted in hemodynamic improvement, allowing patient stabilization for emergency valve-in-valve transcatheter aortic valve replacement. ( Level of Difficulty: Advanced. )., Competing Interests: Dr B.P. O’Neill is a consultant to and receives research support from Edwards Lifesciences. Dr Frisoli is a proctor for Edwards Lifesciences, Abbott, Boston Scientific, and Medtronic. Dr Wang is a consultant for Edwards Lifesciences, Abbott, Neochord, and Boston Scientific and receives research grant support from Boston Scientific assigned to employer Henry Ford Health System. Dr W.W. O’Neill has served as a consultant for Abiomed, Edwards Lifesciences, Medtronic, Boston Scientific, Abbott Vascular, and St. Jude Medical and serves on the Board of Directors of Neovasc Inc. Dr Villablanca is a consultant for Edwards Lifesciences and Teleflex. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

A patient with vascular Behçet's syndrome (BS), a subtype of BS with mainly venous/arterial manifestations, presented with a left main aneurysm/thrombus and cardiogenic shock. The clinical diagnosis of BS includes mucocutaneous, vascular, and neurologic criteria. It is important to consider vascular BS as a nonatherosclerotic cause of coronary aneurysms. ( Level of Difficulty: Intermediate. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 The Authors.)

Right heart failure is a dreaded sequelae of proximal right coronary artery occlusion that can complicate an angiogram or percutaneous coronary intervention. This case illustrates the use of a percutaneous intraluminal microaxial right ventricular assist device for high-risk percutaneous coronary intervention of an ostial right coronary artery dissection in refractory right heart failure. ( Level of Difficulty: Advanced. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2021 The Authors.)

We present the challenging case of a young man with congenital heart disease who survived severe device-related infective endocarditis and new pulmonary hypertension. He required prolonged mechanical circulatory support and had multiple significant complications. His case posed a management dilemma that was successfully resolved by effective multidisciplinary, tertiary center care. ( Level of Difficulty: Beginner. )., Competing Interests: The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (Crown Copyright © 2021 Published by Elsevier on behalf of the American College of Cardiology Foundation.)

Antibody-mediated rejection is a major cause of graft failure, mortality, and morbidity among cardiac transplant recipients. We present the first reported case of TandemHeart (LivaNova, Pittsburgh, Pennsylvania) used in the management of antibody-mediated rejection associated with cardiogenic shock. ( Level of Difficulty: Advanced. )., Competing Interests: Dr. Desai is a consultant and speaker for Abbott. Dr. Rajan Patel is a speaker for LivaNova and Boston Scientific; and is on the advisory board of Abiomed. Selim Krim is a consultant for Abbott and CareDx. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2020 The Authors.)

We describe the use of a fully percutaneous, biatrial extracorporeal membrane oxygenation circuit, to provide biventricular support with left heart unloading by using a single TandemHeart (LivaNova, London, United Kingdom) circuit during high-risk percutaneous coronary intervention. ( Level of Difficulty: Advanced. )., (© 2020 The Authors.)

The use of mechanical circulatory support to maintain appropriate hemodynamics in high risk percutaneous coronary intervention cases is a new frontier. Treatment of cases that were once considered prohibitive may now be possible. Due to a paucity of data, guidelines offer no guidance about the use of mechanical circulatory support in such cases. This case, the first documented case of extracorporeal membrane oxygenation support for percutaneous coronary intervention (PCI) of a vein graft supplying the entire coronary circulation, adds to the medical literature demonstrating a likely benefit in the use of mechanical support during high risk PCI in patients without shock. ( Level of Difficulty: Intermediate. )., (© 2020 The Authors.)

We report a case of coronary perforation during high-risk percutaneous coronary intervention with Impella (Abiomed, Danvers, Massachusetts) support that resulted in cessation of pulsatile arterial flow. Maintenance of systemic perfusion due to antecedent placement of Impella 2.5 allowed for successful treatment with pericardiocentesis and covered stent placement, early discharge, and complication-free follow-up. ( Level of Difficulty: Intermediate. )., (© 2020 The Authors.)

We report the first case of a patient with a durable left ventricular assist device admitted with cardiogenic shock and managed with biventricular Impella support as a successful bridge to heart transplantation. ( Level of Difficulty: Advanced. )., (© 2020 The Authors.)

Peripartum cardiomyopathy (PPCM) is a rare but potentially fatal disease. The management of PPCM is individualized, and an early diagnosis is instrumental in the institution of an appropriate management plan. Here, we present a dramatic case of PPCM that was managed with a period of mechanical circulatory support. ( Level of Difficulty: Beginner. )., (© 2020 The Authors.)

A 74-year-old male patient who was admitted with non-ST-segment elevation myocardial infarction, severe left ventricular impairment, severe mitral regurgitation, and full viability who was turned down for surgery underwent high-risk and indicated multivessel stenting with Impella (Abiomed) support. At 6-month follow-up he was angina free, with complete resolution of the mitral regurgitation. ( Level of Difficulty: Intermediate. )., (© 2019 Published by Elsevier on behalf of the American College of Cardiology Foundation.)