Rare Case of Intracardiac Renal Cell Carcinoma Metastasis with Response to Nivolumab: Case Report and Literature Review

Intracardiac metastases in the absence of inferior vena cava involvement is a rare occurrence in patients with metastatic renal cell carcinoma (mRCC). There is limited evidence regarding the efficacy and safety of standard treatment modalities for mRCC patients with intracardiac metastases. Presence of intracardiac metastases is known to indicate poor prognosis and may potentially increase risk of treatment-related complications. Recent advances in RCC management have integrated nivolumab, a programmed death-1 (PD-1) receptor inhibitor, as a preferred treatment option in the second-line setting after failure of prior anti-angiogenic therapy; or in combination with ipilimumab, an anti-Cytotoxic T-lymphocyte antigen-4 antibody as first-line therapy for intermediate to poor risk patients with mRCC. The efficacy and toxicity of nivolumab in patients with mRCC and intracardiac metastases has never been reported previously. We herein present the first reported case of mRCC with intracardiac metastasis and a resultant excellent response to nivolumab treatment and discuss the imaging techniques and treatment options for this rare presentation

Feasibility of using ivabridine in adult congenital heart disease patients

BackgroundBeta Blockers have been the main agent to control the heart rate in Fontan patients. Ivabridine which is a selective SA node inhibitor has been used in adult cardiac patient with successful result in controlling heart rate for those who did not respond to beta blockers alone. This agent has not been reported to be used in adult congenital heart disease patients.ObjectiveTo determine the feasibility of using ivabridine in patient with adult congenital heart disease and inappropriate sinus tachycardia who failed to respond to beta blockers.Methods3 patients all with single ventricle physiology were on maximum tolerable dose of Beta Blockers, with inappropriate sinus tachycardia started on ivabridine. Average follow up was 52weeks with regular holter monitor. Pro-BNP, 6min walk test, and echocardiography at baseline and 24weeks of follow up. Physical examination and interrogation for any detected side effect was done on each visit.ResultAt baseline the average heart rate was 100±4 BPM, ivabridine started on with target dose 7.5mg BD. The mean average heart rate at 12weeks was 83 BPM, 78 BPM on 24weeks, and 85 BPM on 52weeks. There was no reported side effect by the patients or an effect on single ventricle function.Conclusionivabridine can be used in single ventricle patients to reduce the heart rate in conjunction with beta blockers. However larger study is needed to assess its isolated long term effect on a diseased sinus node

Abstract 19314: Impact of Body Mass Index on Clinical Outcomes in Complex Adult Congenital Heart Disease

Background: Obesity can adversely affect most organ systems and increases the risk of comorbidities likely to be of consequence for patients with complex adult congenital heart disease (ACHD). Conversely, several studies have demonstrated that low body mass index (BMI) is a risk factor for heart failure and adverse outcomes after cardiac surgery. However, there are currently no data regarding the impact of BMI in ACHD. Methods: We examined the charts of 87 randomly selected, complex ACHD patients whose first visit to our institution was at 18-22 years old. Patients were categorized according to BMI at initial visit: underweight (BMI &lt; 18.5 kg/m 2 ), normal (BMI 18.5 - 24.9 kg/m 2 ), overweight/obese (BMI ≥ 25 kg/m 2 ). Events occurring during follow-up were recorded. Data was censured on 1/1/2014. Cardiac events were defined as a composite of cardiac death, heart transplantation or admission for heart failure. Results: The cohort included patients with the following diagnoses: tetralogy of Fallot n=31, Mustard n=28, Fontan n=17, ccTGA n=9 and aortic coarctation n=2. The median (IQR) duration of follow-up was 8.7 (4.2 - 1.8) years. See table for distribution and outcomes by BMI category. Cardiac events occurred in 17/87 patients. After adjustment for age, sex, and underlying disease, the underweight group had increased risk of cardiac events (HR=12.9, 95% CI: 2.8-61.5, p &lt; 0.05). Kaplan-Meier curves demonstrate the poorer prognosis of underweight patients (Figure). Conclusions: Underweight was associated with increased risk of late cardiac events in ACHD patients. We were unable to demonstrate significant overweight/obesity impact. </jats:p