Complex venous disease in transcatheter left atrial appendage closure

Abstract

20 mg. Due to severe worsening of his neurological status, he was admitted for further evaluation. After careful clinical evaluation, diagnosis of cerebellar and pyramidal syndrome in the neurosyphilis setting was achieved. Penicillin was started. During hospitalization, cerebral magnetic resonance imaging revealed the presence of a massive hernia at C4-C5 causing significant spinal cord compression. Decompressive surgery was advised. During hospitalization, he complained of chest pain. The ECG showed signs of sinus rhythm with sustained diffuse ST-segment depression and ST-segment elevation in aVR and V1. The transthoracic echocardiography showed a severely impaired left ventricular ejection fraction with severe hypokinesia of the apex, anterior, posterior, and lateral walls. The aortic root was mildly enlarged, but no flaps were seen. Due to refractory chest pain and progressively worsening hypotension, the patient was given unfractionated heparin (5000 IU) and underwent an emergency coronary angiography that revealed the presence of critical left main coronary artery ostial stenosis (videos 1 and 2 of the supplementary data). No further lesions were identified. Due to the complexity of the lesion, percutaneous angioplasty under left ventricular assist device was advised. It was necessary to make a multidisciplinary decision due to the patient’s condition.