Post-myocardial infarction ventricular septal rupture is the most catastrophic mechanical complication with high morbidity and mortality, reaching 94% in patients treated conservatively and 47% in patients undergoing cardiac surgery procedures (30-day mortality). In this review article we tried to review trans-catheter closure approach and explain elaborately device selection based on real-world patients in this fatal complication.

Background: Considering the many reports of elevated threshold levels and left ventricular dysfunction in epicardial leads, the evaluation of the short- and long-term efficacy of this type of leads is necessary in comparison with the coronary sinus (CS) leads. The present study compared left ventricular epicardial pacing via surgery and CS pacing in patients with triple-chamber pacemakers.Methods: This retrospective cohort study was performed on patients referred for cardiac resynchronization therapy. The patients were re-evaluated with ECG after pacemaker implantation and before discharge. The evaluations were performed in 2 patient groups under left ventricular epicardial pacing and CS pacing.Results: At 12 months' follow-up, the mean left ventricular pacing lead threshold was significantly higher in the patients with epicardial lead pacing than in those with endocardial lead pacing. Additionally, regarding the ECG pattern after lead pacing, the morphology of QRS at V-1 lead and also the type of the QRS axis significantly differed between epicardial pacing and CS pacing 6-12 months after pacemaker implantation. The mean left ventricular pacing lead threshold was at its highest in the posterolateral area and at its lowest in the anterolateral area, but without any significant difference.Conclusions: Comparisons between the results and the long-term effects of CS pacing and surgical epicardial lead pacing in the present study indicated that the increase and changes in the left ventricular leading threshold in the epicardial pacing lead were much more pronounced than those in CS pacing through the CS. Therefore, the use of CS leads might be preferred to pericardial leads due to the stability of left ventricular leads.

Background: It has been shown recently that a considerable burden of pulmonary embolism (PE) roots from an inflammatory response. The activated inflammatory cascade will be responsible for the final fibrotic response of pulmonary vascular bed, creating further mechanical obstruction which results in subsequent right ventricular (RV) dysfunction, influencing functional capacity and future prognosis. Although anticoagulants represent the cornerstone treatment of PE, the drug class has a minimal effect on the mentioned pathology. Study Design: The present study is a single-center randomized, double-blind, parallel group controlled trial with placebo which will evaluate the effect of high-intensity statin – rosuvastatin 20 mg daily on patients with intermediate-to-high-risk PE. Study population will be selected from patients for whom statin is not otherwise indicated. Primary end point of the present trial will be echocardiographic measures of RV function. We believe that the mentioned indexes represent an accurate surrogate for the functional capacity and prognosis. Our secondary end point will be the composites of PE recurrence and exertional capacity measured by 6-minute walk test. Conclusions: The result of the present trial might influence the complimentary treatment of acute PE.