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A single coronary artery is a rare congenital anomaly, estimated to occur in 0.024% of the population, where all 3 coronary vessels arise from a single ostium. These patients can have a wide range of symptoms, from asymptomatic to angina and sudden cardiac arrest. In this patient, cardiac computed tomography angiography (CCTA) confirmed anomalous common origin anterior to the sinus of Valsalva and the course was prepulmonic. Given the benign prognosis associated with prepulmonic course, the patient was managed conservatively. Ischemic work-up is important in this group of patients, with coronary angiography being the gold standard. As demonstrated here, CCTA is an essential tool to define artery course and provide further risk stratification.

Magnetic resonance guided laser induced thermal therapy (LITT) is a minimally invasive method to treat a wide range of intracranial pathologies. The Arrhenius model is used to generate a thermal damage estimate (TDE) predicting ablation extent.Evaluation and correlation of the TDE to magnetic resonance imaging (MRI)-estimated ablation extent in human cases.The Medtronic Visualase system (Medtronic Inc, Dublin, Ireland) was utilized. Postablation axial T1-contrast enhanced images were acquired and intraoperative TDE image was obtained from the Visualase console. OsiriX DICOM Viewer (Pixmeo Inc, Bernex, Switzerland) was utilized to calculate cross-sectional area on MRI. ImageJ (National Institutes of Health, Bethesda, Maryland) was utilized for TDE area. Two blinded raters performed all measures. Statistical testing included Pearson correlation and the Student's t-test.Twenty-two cases including tumor and epilepsy were evaluated. Average MRI predicted tumor ablation area was 4.72 ± 2.22 cm2 and average predicted epilepsy ablation area was 4.12 ± 1.89 cm2. Average tumor TDE was 4.02 ± 1.95 cm2 and average epilepsy TDE was 4.36 ± 2.21 cm2. Rater 1's ablation areas and TDEs correlated with r = 0.89 (P.0001) and no significant difference (P.5). Rater 2's ablation areas and TDEs correlated with r = 0.91 (P.0001) and no significant difference (P.7). Rater 1 vs Rater 2 showed a strong correlation for TDE (r = 0.98, P.000001) and ablation area (r = 0.96, P.0001) and no significant difference (P.5).The TDE is an accurate and reliable measure of ablated area in LITT in human cases as assessed on postoperative MRI. Future studies should be larger and assess reliability of the TDE when multiple lasers and planes are used.

Functional tricuspid regurgitation (FTR) is a maker increased mortality and is frequently associated with left-sided heart disease, RV failure and annulus dilation. However, FTR surgical interventions may not change patient outcomes. A single center, retrospective chart review of 32 patients who

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiomyopathy associated with sudden cardiac arrest. It has been attributed to over a dozen mutations, principally in desmosomes, characterized by progressive fibrous-fatty tissue displacement of ventricular myocardium. Right

Rapid diagnosis of Brugada syndrome is critical to therapy, which is aimed at reversing provoking factors to suppress/terminate malignant arrhythmias.…, Rapid diagnosis of Brugada syndrome is critical to therapy, which is aimed at reversing provoking factors to suppress/terminate malignant arrhythmias. This case highlights the diagnosis and peri-operative management of patients with Brugada syndrome at high risk for sudden cardiac death. (Level of Difficulty: Beginner.), Graphical abstract

Background: Promise Clinic, a student-run continuity-based free health clinic affiliated with Rutgers Robert Wood Johnson Medical School, serves the uninsured and low-income population in New Brunswick, New Jersey. Though it has been operating for over ten years, Promise Clinic does not yet have a formalized system for evaluating quality of care from a patient’s perspective. The purpose of this study was to investigate patient satisfaction and expectations at Promise Clinic. Methods: Over a two-month span, we interviewed 21 patients at Promise Clinic. The interview addressed a variety of factors, including patient satisfaction with student doctors, health education and awareness, and understanding of and access to community health options. Furthermore, we elicited open-ended feedback from patients, allowing them to express opinions regarding their healthcare and reasons for attending Promise Clinic over other low-income healthcare providers. Results: We found that while patients were highly satisfied with their overall experience and student doctor teams, there were some concerns about wait times, the timing of clinic, and student doctor preparedness. Patient health education was strong in many, but not all, areas. Of eligible patients, 40.0% reported receiving regular cancer screenings and 33.3% were unaware of other healthcare options. Conclusions: Overall, this study provides a patient-centered assessment of the clinic. Insight obtained has helped medical students and faculty administrators at Promise Clinic address chief patient concerns and improve upon the patient experience. We hope that patient interviews will continue to be a part of quality improvement processes at Promise Clinic and other similar clinics.

Brugada syndrome is an inherited channelopathy that conveys an increased risk of sudden cardiac death (SCD). Baseline ECG may be normal, confounding the diagnosis. Provoking factors may be required to unmask the Brugada ECG pattern. A 50 year old woman with HTN and HLD presented with fever and

Many patients take non-prescription substances which are considered benign. It is essential to ask about non-FDA regulated substances when obtaining a patient history and to be familiar with their side effects. A 79 year old man presented to the emergency room after four episodes of syncope with

We present a case of transfusion dependent anemia with secondary hemochromatosis and resultant heart failure. A 44 year old woman receiving blood transfusions monthly for 20 years presented to the hospital with 1 week of progressive chest heaviness and abdominal discomfort. Labs were notable for a

Background Debate over revascularization of asymptomatic carotid stenosis before cardiac surgery is ongoing. In this study, we analyze cardiac surgery outcomes in patients with asymptomatic carotid stenosis at a single hospital. Methods In this study, 1,781 patients underwent cardiac surgery from January 2012 to June 2013; 1,357 with preoperative screening carotid duplex were included. Patient demographics, comorbidities, degree of stenosis, postoperative complications, and mortality were evaluated. Chi-square test and logistic regression analysis were performed. Results Asymptomatic stenosis was found in 403/1,357 patients (29.7%; 355 moderate and 48 severe). Patients with stenosis, compared with those without, were older (71.7 ± 11 vs. 66.3 ± 12 years; p Conclusion This study suggests that patients with asymptomatic carotid stenosis undergoing cardiac surgery are not at increased risk of postoperative complications and mortality; thus, prophylactic carotid revascularization may not be indicated.