Matin Goldooz

Ablating Left Atrial (LA) fibrotic tissue (a substrate for Atrial Fibrillation [AF]) emerged as a complementary method for AF management. Despite these efforts, degree of LA fibrosis often continues to increase after ablation and likely affects maintenance of sinus rhythm. We examined how regression and progression of LA fibrosis affected AF recurrence.

Immediate postoperative complications in renal transplants include renal artery thrombosis and dissection both of which carry significant risk for loss of the graft. We present an unusual case in which apparent devascularization of the upper pole of the transplant kidney was due to reversible vasospasm as a result of a drug interaction. Tacrolimus, a calcineurin inhibitor, is used for post-transplant immunosuppression. The antihypertensive medication nicardipine impairs liver metabolism of tactolimus and, in this case, the combination of drugs resulted in supratherapeutic levels of tacrolimus causing acute nephrotoxicity as well as profound vasoconstriction which was most pronounced in the upper pole branch renal artery and simulated devascularization of almost half of the transplant kidney. This case highlights the fact that not all abnormal post-transplant Doppler findings are due to surgical technique or embolic events and illustrates the importance of drug interactions in this group of patients with complex medical conditions.

Umbilical cord hemangiomas are rare tumors of the umbilical cord. Doppler ultrasound has been shown to be useful in the diagnosis of cord hemangioma and evaluation of arterial blood flow through the mass. In this study, we present a 28-year-old pregnant woman with an umbilical cord mass with solid and cystic components. She was followed with weekly umbilical artery (UA) Doppler ultrasound, but the fact that the umbilical vein (UV) ran in the wall of the mass was not noted prospectively. At the time of placental delivery, the cystic component of the mass ruptured tearing the UV causing significant bleeding. The case illustrates the importance of using Doppler ultrasound to both look for UA compromise and to map the UV location through the entirety of the cord.