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Objectives The aim of this study was to evaluate the safety and effectiveness of secondary interval AngioJet rheolytic thrombectomy after localized intra-arterial catheter-directed thrombolysis (CDT) through power-pulse spray (PPS) technique in partially successful or failed primary AngioJet rheolytic thrombectomy cases of acute and subacute peripheral artery thrombosis.

We present an extremely rare case of multivalvular endocarditis in an immunocompetent host which is not observed in routine clinical practice. Multivalvular endocarditis is extremely rare to find in today's era due to the widespread use of broad-spectrum antibiotics to treat pyrexia of unknown origin (PUO). Multivalvular involvement is usually encountered in immunocompromised individuals and is most often due to staphylococcal in origin. It is scarce to find our case of a 73-year-old elderly nondiabetic female with PUO who was diagnosed to be having endocarditis of both aortic and mitral valves showing large friable vegetations. In contrast, her urine and blood culture both had grown Enterococcus species. We successfully treated the patient with parenteral ampicillin and gentamycin for eight weeks, which made the patient afebrile and resolved the vegetation.

Mature mediastinal teratomas are infrequent, slow growing, and often asymptomatic. Traditionally, they present in the fourth decade or earlier and are found in the anterior mediastinum. These teratomas are often found incidentally on imaging, and surgical resection can be a challenge due to the size and location of the tumor; however, complete surgical excision is usually curative. Our case represents an infrequent benign giant (25 cm × 18 cm × 12 cm) mature intrathoracic mediastinal teratoma with uncommon clinical presentation of congestive heart failure and cardiac cachexia. The rare location of the tumor in the mid posterior mediastinum, very large teratoma, clinical presentation with right ventricular failure and cardiac cachexia, preoperative diagnostic dilemma, perioperative surgical challenge, and management marks this case unique.

It is extremely rare to encounter primary malignant tumors of the heart. Rhabdomyoma constitutes approximately 20% of all primary malignant tumors of the heart. Rhabdomyoma commonly arises from the ventricular wall, and rarely, they arise from the atrial wall and mimic symptomatic atrioventricular valve stenosis. We describe an extremely rare case of left atrial (LA) rhabdomyosarcoma detected during the transesophageal echocardiography arising from the posterior wall of the left atrium protruding into the left ventricle causing obstruction of the mitral valve. Our case is a rare case of LA rhabdomyosarcoma presenting with mitral inflow obstruction and symptomatically mimicking severe rheumatic mitral stenosis with atrial fibrillation and fast ventricular rate with orthopnea secondary to LA failure and passive pulmonary venous congestion.

Iatrogenic femoral artery pseudoaneurysms (IFAPs) are not uncommon due to the increase in various minimally-invasive endovascular procedures. Percutaneous thrombin injection is an established technique for large pseudoaneurysms. When ultrasound-guided compression of an aneurysmal neck is not feasible, percutaneous thrombin injection can be combined with endovascular balloon occlusion to prevent leakage of thrombin into the parent artery. We describe a large IFAP following the removal of the femoral dialysis catheter after an inadvertent arterial puncture, which was managed with percutaneous ultrasound-guided (USG) thrombin injection with simultaneous balloon occlusion at the level of the aneurysmal neck without any complications. Follow-up imaging showed thrombosed IFAP without any recurrence.

The effect of horror sound on electro-cardiac activity is not yet sufficiently explored despite recommendable research on different genres of music and sound. Detecting the impact of these stimuli is a complex task. The current study intends to automatically detect the horror-sound induced cardiac changes using wavelet coefficient-based features extracted from the electrocardiograph signals and several machine learning models. The statistical comparison of these features in the two data groups suggests a significant change in different feature values after exposure to horror sound while watching a horror clip. The statistically discriminative features were employed as input to nine machine learning (ML) models, namely Naïve Bayes, Fast large margin, Logistic regression, generalized linear model, Decision tree, Random Forest, deep learning, gradient boosted tree, and Support vector machine. The performance of these ML models was compared using different performance measures, including accuracy, precision, F-measure, sensitivity, specificity, and area under the curve (AUC). The results suggest the gradient boosted tree is the best performing model in differentiating the horror sound-induced changes in the ECG signals.

Holt-Oram syndrome is a rare autosomal disorder with cardiac, vascular, and upper limb anomalies. Previous reports have described anesthetic and perioperative challenges including difficulty in arterial and venous cannulations, airway management and rhythm, and temperature abnormalities. There are no previous reports of absent right superior vena cava (SVC) in children with Holt-Oram syndrome. We present images of a case where the diagnosis of absent right SVC with persistent left SVC was made with intraoperative transesophageal echocardiography and discuss the anesthetic and perfusion implications of such findings.

Abstract Radial artery pseudoaneurysm (RAP) at the site of transradial access (TRA) for coronary angiography is rare. A clean puncture, secure bandage, and watchful follow‐up are must to prevent complete occlusion and aneurysm formation at the access site. This illustration describes surgical repair as one of the successful strategies to repair a postcatheterization RAP after TRA.