Chest X-ray in cardiac illness: a tale of four decades

Nikhil Prakash Patil, Alexander Weymann, Aron F. Popov, André Rüdiger Simon
2014 European Heart Journal  
A chest X-ray (Panel 1) indicates the tale of four decades of intervention for cardiac illness. A 46-year-old gentleman had Starr-Edwards balland-cage (1) mechanical mitral valve replacement (MVR) (36 years ago) following failed tissue-MVR (38 years ago) for infective endocarditis secondary to vertebral osteomyelitis that also resulted in scoliosis (2) requiring Harrington rods (3). An attempted-redo MVR 13 years ago failed due to left-atrial calcification (4), with atrial fibrillation
more » ... brillation necessitating AVNode-ablation and cardiacresynchronization-therapy/pacemaker (CRT-P) device (5). Subsequent superior vena cava obstruction required a 4th time sternotomy (6-6 ′ ) for surgical patch correction. He eventually developed end-stage heart failure and diuretic-resistant fluid-overload, treated with trans-lumbar inferiorvena-caval Tesio-line (7) insertion (4 months ago) for hemofiltration. The patient ultimately required venoarterial extracorporeal membrane oxygenation (ECMO) support, effectuated via rightsuclavian access (8-8 ′ ) for arterial cannula (9) and trans-femoral venous cannula (10). After 3 weeks on ECMO support (mandating systemic anticoagulation), the patient developed uncontrollable bleeding from his tracheostomy (11) and into his left lung (12), with obstructive clots despite multiple bronchoscopies. This obviated any feasibility of weaning from ECMO or escalating therapy to longer-term mechanical circulatory support. Coroner's office recommended 'natural cause of death following maximum therapy for severe chronic illness'. Panel 1. Chest X-ray, anteroposterior supine film. Published on behalf of the
doi:10.1093/eurheartj/ehu472 pmid:25538092 fatcat:gq4n3negxbdsrbgg5kr4pui3iu