Pub Date : 2025-12-01DOI: 10.1016/j.crmic.2025.100127
Syed F. Ahmad , Pedro E.P. Carvalho , Eleni Kladou , Emmanouil S. Brilakis
We report a rare case of extensive Stanford type B iatrogenic aortic dissection during complex percutaneous coronary intervention. This case highlights the importance of early recognition, cautious catheter and guidewire manipulation, and tailored imaging to guide management.
{"title":"Iatrogenic aortic dissection while attempting complex percutaneous coronary intervention","authors":"Syed F. Ahmad , Pedro E.P. Carvalho , Eleni Kladou , Emmanouil S. Brilakis","doi":"10.1016/j.crmic.2025.100127","DOIUrl":"10.1016/j.crmic.2025.100127","url":null,"abstract":"<div><div>We report a rare case of extensive Stanford type B iatrogenic aortic dissection during complex percutaneous coronary intervention. This case highlights the importance of early recognition, cautious catheter and guidewire manipulation, and tailored imaging to guide management.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100127"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145693904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fluoropyrimidines and platinum compounds can induce acute coronary syndrome (ACS) and significantly contribute to morbidity in patients with cancer.
Case presentation
A 32-year-old woman with supraglottic squamous cell carcinoma presented with acute chest pain after the first cycle of chemotherapy with cisplatin and 5-fluorouracil. Electrocardiography revealed ST elevation, and an echocardiogram revealed anteroseptal hypokinesia. Coronary angiography revealed a proximal left anterior descending artery thrombus without obstructive stenosis. Intravascular ultrasound confirmed plaque and thrombus with <50 % luminal narrowing, consistent with myocardial infarction with non-obstructive coronary arteries (MINOCA). The patient received dual antiplatelet therapy, anticoagulation, and intravenous glycoprotein PIIb/IIIa inhibitor for 24 h and was discharged after follow-up angiography showing thrombus resolution. Intravascular imaging guided the decision to avoid stenting in this non–obstructive thrombotic lesion.
Conclusion
This case highlights the multifactorial mechanisms of ACS in cancer and the diagnostic utility of intravascular imaging, with caution against attributing events to chemotherapy alone. Contemporary MINOCA evaluation, including intracoronary imaging and cardiac MRI, is essential for defining the underlying mechanism and guiding management.
{"title":"Myocardial infarction with non-obstructive coronary arteries following cisplatin and 5-fluorouracil therapy","authors":"Saroj Kumar Sahoo, Debasis Panda, Ramachandra Barik, Sindhu Rao Malla, Sai Karthik Kowtarapu, Saran P. Mohanan, Prabhat Kumar Singh, Muhiyyud Deen, Mohan Kumar","doi":"10.1016/j.crmic.2025.100125","DOIUrl":"10.1016/j.crmic.2025.100125","url":null,"abstract":"<div><h3>Background</h3><div>Fluoropyrimidines and platinum compounds can induce acute coronary syndrome (ACS) and significantly contribute to morbidity in patients with cancer.</div></div><div><h3>Case presentation</h3><div>A 32-year-old woman with supraglottic squamous cell carcinoma presented with acute chest pain after the first cycle of chemotherapy with cisplatin and 5-fluorouracil. Electrocardiography revealed ST elevation, and an echocardiogram revealed anteroseptal hypokinesia. Coronary angiography revealed a proximal left anterior descending artery thrombus without obstructive stenosis. Intravascular ultrasound confirmed plaque and thrombus with <50 % luminal narrowing, consistent with myocardial infarction with non-obstructive coronary arteries (MINOCA). The patient received dual antiplatelet therapy, anticoagulation, and intravenous glycoprotein PIIb/IIIa inhibitor for 24 h and was discharged after follow-up angiography showing thrombus resolution. Intravascular imaging guided the decision to avoid stenting in this non–obstructive thrombotic lesion.</div></div><div><h3>Conclusion</h3><div>This case highlights the multifactorial mechanisms of ACS in cancer and the diagnostic utility of intravascular imaging, with caution against attributing events to chemotherapy alone. Contemporary MINOCA evaluation, including intracoronary imaging and cardiac MRI, is essential for defining the underlying mechanism and guiding management.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100125"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-12-01DOI: 10.1016/j.crmic.2025.100123
Matthew Hammond-Haley , Arif Khokhar , Adam Hartley , Saud Khawaja , Nearchos Hadjiloizou , Bushra Rana , Nilesh Sutaria , Ben Ariff , Edward Barden , Alessandro Viviano , Ghada Mikhail , Iqbal Malik , Neil Ruparelia
We report the case of an 85-year-old female with severe aortic stenosis, who was transferred to our centre for transcatheter aortic valve replacement (TAVR) after presenting to her local hospital in acute pulmonary oedema. Computed tomography (CT) demonstrated anomalous coronary arteries, with both the right coronary artery (RCA) and left coronary artery (LCA) arising from the right coronary cusp (RCC). The coronary heights were low for both the RCA and LCA and the simulated valve to coronary (VTC) distances narrow, suggesting high risk of coronary obstruction following TAVR. Further complicating factors were an effaced aortic root, and the presence of a previous mechanical mitral valve 6 mm below the level of the aortic annular plane. In this case we discuss the pre-procedural planning considerations and procedural steps, in this case double chimney stenting from the same aortic cusp, to successfully navigate this unusual and high-risk anatomy.
{"title":"TAVR with double chimney stenting from the same coronary cusp in anomalous and high-risk anatomy","authors":"Matthew Hammond-Haley , Arif Khokhar , Adam Hartley , Saud Khawaja , Nearchos Hadjiloizou , Bushra Rana , Nilesh Sutaria , Ben Ariff , Edward Barden , Alessandro Viviano , Ghada Mikhail , Iqbal Malik , Neil Ruparelia","doi":"10.1016/j.crmic.2025.100123","DOIUrl":"10.1016/j.crmic.2025.100123","url":null,"abstract":"<div><div>We report the case of an 85-year-old female with severe aortic stenosis, who was transferred to our centre for transcatheter aortic valve replacement (TAVR) after presenting to her local hospital in acute pulmonary oedema. Computed tomography (CT) demonstrated anomalous coronary arteries, with both the right coronary artery (RCA) and left coronary artery (LCA) arising from the right coronary cusp (RCC). The coronary heights were low for both the RCA and LCA and the simulated valve to coronary (VTC) distances narrow, suggesting high risk of coronary obstruction following TAVR. Further complicating factors were an effaced aortic root, and the presence of a previous mechanical mitral valve 6 mm below the level of the aortic annular plane. In this case we discuss the pre-procedural planning considerations and procedural steps, in this case double chimney stenting from the same aortic cusp, to successfully navigate this unusual and high-risk anatomy.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100123"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145623645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1016/j.crmic.2025.100122
Beni Rai Verma , Shaan Ahmed , Matthew Kogan , Abhishek Chaturvedi , Itsik Ben-Dor , Hayder Hashim , Ron Waksman , Brian Case
Treatment of in-stent restenosis (ISR) is based on the underlying etiology, which is defined by performing intravascular imaging. Usually, ISR is treated with implantation of a second stent layer. In cases of recurrent stenosis of the second implanted stent, management may become complex and require advanced interventional techniques. Here, we present a patient with end-stage liver and kidney disease who developed recurrent dual-layer ISR (mixed etiology: under-expansion and neoatherosclerosis) and required coronary artery revascularization. He underwent successful high-definition intravascular ultrasound guided percutaneous coronary intervention of his recurrent dual-layer ISR using an OPN high-pressure balloon followed by a drug-coated balloon. This treatment strategy addressed the mixed etiology of ISR due to underlying biologic and mechanical factors. It resulted in successful revascularization and allowed the patient to be listed for dual organ transplantation.
{"title":"Two Balloons Can Save Stent(s): Treating Recurrent In-Stent Restenosis","authors":"Beni Rai Verma , Shaan Ahmed , Matthew Kogan , Abhishek Chaturvedi , Itsik Ben-Dor , Hayder Hashim , Ron Waksman , Brian Case","doi":"10.1016/j.crmic.2025.100122","DOIUrl":"10.1016/j.crmic.2025.100122","url":null,"abstract":"<div><div>Treatment of in-stent restenosis (ISR) is based on the underlying etiology, which is defined by performing intravascular imaging. Usually, ISR is treated with implantation of a second stent layer. In cases of recurrent stenosis of the second implanted stent, management may become complex and require advanced interventional techniques. Here, we present a patient with end-stage liver and kidney disease who developed recurrent dual-layer ISR (mixed etiology: under-expansion and neoatherosclerosis) and required coronary artery revascularization. He underwent successful high-definition intravascular ultrasound guided percutaneous coronary intervention of his recurrent dual-layer ISR using an OPN high-pressure balloon followed by a drug-coated balloon. This treatment strategy addressed the mixed etiology of ISR due to underlying biologic and mechanical factors. It resulted in successful revascularization and allowed the patient to be listed for dual organ transplantation.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100122"},"PeriodicalIF":0.0,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takayasu's arteritis (TA) is a rare large-vessel vasculitis that can involve the coronary arteries, most often the ostial left main, and may present with acute coronary syndrome (ACS). Its diagnosis is challenging due to nonspecific clinical features and the rarity of coronary involvement.
Case summary
We report a 32-year-old female with a history of sarcoidosis and prior provoked pulmonary embolism who presented in severe distress with chest pain, hypoxemia, and shock. Initial investigations demonstrated diffuse ST depressions with aVR elevation, elevated cardiac biomarkers, and reduced ejection fraction with moderate aortic regurgitation. Coronary angiography revealed critical (90 %) ostial left main coronary artery (LMCA) stenosis. A real time heart team discussion was undertaken, and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) with mechanical circulatory support was performed successfully. Multimodality imaging demonstrated diffuse aortic wall thickening and left subclavian artery stenosis, consistent with Takayasu's arteritis. Rheumatology consultation confirmed the diagnosis, and the patient was initiated on high-dose corticosteroids and disease-modifying therapy. Over follow-up, she was transitioned to tocilizumab with normalization of inflammatory markers, resolution of aortic wall thickening, and stable moderate aortic regurgitation.
Conclusion
This case highlights the importance of considering vasculitis as an etiology of ACS in young patients and demonstrates the feasibility of IVUS-guided PCI for LMCA involvement in Takayasu's arteritis.
{"title":"A twisted tale of Takayasu and left main stenosis","authors":"Manaquibb Khan , Nina Shyama Appareddy , Divyanshi Sood , Adam Strunk , Fadi Alattar , Derar Albashaireh","doi":"10.1016/j.crmic.2025.100111","DOIUrl":"10.1016/j.crmic.2025.100111","url":null,"abstract":"<div><h3>Background</h3><div>Takayasu's arteritis (TA) is a rare large-vessel vasculitis that can involve the coronary arteries, most often the ostial left main, and may present with acute coronary syndrome (ACS). Its diagnosis is challenging due to nonspecific clinical features and the rarity of coronary involvement.</div></div><div><h3>Case summary</h3><div>We report a 32-year-old female with a history of sarcoidosis and prior provoked pulmonary embolism who presented in severe distress with chest pain, hypoxemia, and shock. Initial investigations demonstrated diffuse ST depressions with aVR elevation, elevated cardiac biomarkers, and reduced ejection fraction with moderate aortic regurgitation. Coronary angiography revealed critical (90 %) ostial left main coronary artery (LMCA) stenosis. A real time heart team discussion was undertaken, and intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) with mechanical circulatory support was performed successfully. Multimodality imaging demonstrated diffuse aortic wall thickening and left subclavian artery stenosis, consistent with Takayasu's arteritis. Rheumatology consultation confirmed the diagnosis, and the patient was initiated on high-dose corticosteroids and disease-modifying therapy. Over follow-up, she was transitioned to tocilizumab with normalization of inflammatory markers, resolution of aortic wall thickening, and stable moderate aortic regurgitation.</div></div><div><h3>Conclusion</h3><div>This case highlights the importance of considering vasculitis as an etiology of ACS in young patients and demonstrates the feasibility of IVUS-guided PCI for LMCA involvement in Takayasu's arteritis.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100111"},"PeriodicalIF":0.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-08DOI: 10.1016/j.crmic.2025.100121
Ata Firouzi , Sedigheh Saedi , Sohiela Salari , Hamidreza Pouraliakbar , Hossein Ghorbanzadeh , Hossein Hakimi , Mohammadbagher Asgari
Background
Coronary artery fistulas (CAFs) are rare coronary anomalies that are often incidental findings but may cause significant hemodynamic consequences when large or symptomatic.
Case presentation
We report the case of a 24-year-old man in whom a congenital CAF originating from the proximal left circumflex artery (LCX) and draining into the right atrium (RA) was incidentally detected during a routine occupational health evaluation. Transthoracic echocardiography demonstrated left-sided chamber enlargement consistent with volume overload, while coronary computed tomography angiography and invasive angiography delineated the large, tortuous fistulous tract. Based on these findings, percutaneous transcatheter closure was performed using a 14 × 18 mm Amplatzer™ patent ductus arteriosus (PDA) occluder device under transesophageal echocardiographic guidance.
Outcome
Immediate and follow-up imaging confirmed near-complete occlusion with minimal residual flow and no complications.
Conclusion
This case highlights the role of multimodality imaging in guiding diagnosis and treatment planning, and demonstrates that transcatheter closure is a safe and effective therapeutic option for hemodynamically significant CAFs.
背景冠状动脉瘘管（CAFs）是一种罕见的冠状动脉异常，通常是偶然发现的，但当较大或有症状时可能会引起严重的血流动力学后果。病例介绍：我们报告一例24岁的男性，其先天性CAF起源于左旋动脉近端（LCX）并流入右心房（RA），在常规职业健康评估中偶然发现。经胸超声心动图显示左侧心室增大与容量过载一致，而冠状动脉计算机断层血管造影和侵入性血管造影显示大而弯曲的瘘管。基于这些发现，在经食管超声心动图引导下，使用14 × 18 mm Amplatzer™动脉导管未闭（PDA）封堵器进行经皮导管闭合。结果：即时和随访成像证实接近完全闭塞，残余血流最小，无并发症。结论本病例强调了多模态成像在指导诊断和治疗计划中的作用，并表明经导管闭合是一种安全有效的治疗方法。
{"title":"Transcatheter closure of a large congenital LCX–RA coronary fistula using a PDA occluder: Case insights and literature review","authors":"Ata Firouzi , Sedigheh Saedi , Sohiela Salari , Hamidreza Pouraliakbar , Hossein Ghorbanzadeh , Hossein Hakimi , Mohammadbagher Asgari","doi":"10.1016/j.crmic.2025.100121","DOIUrl":"10.1016/j.crmic.2025.100121","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery fistulas (CAFs) are rare coronary anomalies that are often incidental findings but may cause significant hemodynamic consequences when large or symptomatic.</div></div><div><h3>Case presentation</h3><div>We report the case of a 24-year-old man in whom a congenital CAF originating from the proximal left circumflex artery (LCX) and draining into the right atrium (RA) was incidentally detected during a routine occupational health evaluation. Transthoracic echocardiography demonstrated left-sided chamber enlargement consistent with volume overload, while coronary computed tomography angiography and invasive angiography delineated the large, tortuous fistulous tract. Based on these findings, percutaneous transcatheter closure was performed using a 14 × 18 mm Amplatzer™ patent ductus arteriosus (PDA) occluder device under transesophageal echocardiographic guidance.</div></div><div><h3>Outcome</h3><div>Immediate and follow-up imaging confirmed near-complete occlusion with minimal residual flow and no complications.</div></div><div><h3>Conclusion</h3><div>This case highlights the role of multimodality imaging in guiding diagnosis and treatment planning, and demonstrates that transcatheter closure is a safe and effective therapeutic option for hemodynamically significant CAFs.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100121"},"PeriodicalIF":0.0,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145578639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.crmic.2025.100120
Omar Jafar , Nicholas Valle , Rupinder Bahniwal , Matthew Summers
Left ventricular pseudoaneurysm (LVPA) is a rare, life-threatening complication that may arise after cardiac surgery, myocardial infarctions, or infective endocarditis. We present a case of a 55-year-old woman with complex surgical history and prior infective endocarditis who developed an incidental LVPA. Due to lack of surgical repair options, a percutaneous approach was pursued using a post-infarct ventricular septal defect device (PIVSD) under guidance of fluoroscopy and intracardiac echocardiography (ICE) guidance with successful exclusion of LVPA. This case highlights the utility of multimodal imaging in the percutaneous management of complex left ventricular lesions.
{"title":"Percutaneous closure of a left ventricular pseudoaneurysm using a post-infarct VSD Device guided by intracardiac echocardiography","authors":"Omar Jafar , Nicholas Valle , Rupinder Bahniwal , Matthew Summers","doi":"10.1016/j.crmic.2025.100120","DOIUrl":"10.1016/j.crmic.2025.100120","url":null,"abstract":"<div><div>Left ventricular pseudoaneurysm (LVPA) is a rare, life-threatening complication that may arise after cardiac surgery, myocardial infarctions, or infective endocarditis. We present a case of a 55-year-old woman with complex surgical history and prior infective endocarditis who developed an incidental LVPA. Due to lack of surgical repair options, a percutaneous approach was pursued using a post-infarct ventricular septal defect device (PIVSD) under guidance of fluoroscopy and intracardiac echocardiography (ICE) guidance with successful exclusion of LVPA. This case highlights the utility of multimodal imaging in the percutaneous management of complex left ventricular lesions.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100120"},"PeriodicalIF":0.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1016/j.crmic.2025.100119
Jeremy Wells , Vijay Iyer , Mohamed Abdel-Aal Ahmed , Dany Cheikh-Debs
We present the case of a 76-year-old man with a past medical history significant for atrial fibrillation on anticoagulation, CVA, and GI bleed requiring cautery and transfusion who underwent successful placement of a Watchman left atrial appendage occlusion device. He was asymptomatic at his 45-day follow up but on routine TEE imaging it was revealed that his device had partially dislodged into the left atrium. During attempted transcatheter retrieval, the device was ultimately repositioned and left in place and has been stable on follow-up imaging. To our knowledge, this is the first case of a LAAO device that was dislodged and repositioned rather than retrieved and removed via a percutaneous or surgical approach.
{"title":"Endovascular repositioning of dislodged left atrial appendage occlusion device","authors":"Jeremy Wells , Vijay Iyer , Mohamed Abdel-Aal Ahmed , Dany Cheikh-Debs","doi":"10.1016/j.crmic.2025.100119","DOIUrl":"10.1016/j.crmic.2025.100119","url":null,"abstract":"<div><div>We present the case of a 76-year-old man with a past medical history significant for atrial fibrillation on anticoagulation, CVA, and GI bleed requiring cautery and transfusion who underwent successful placement of a Watchman left atrial appendage occlusion device. He was asymptomatic at his 45-day follow up but on routine TEE imaging it was revealed that his device had partially dislodged into the left atrium. During attempted transcatheter retrieval, the device was ultimately repositioned and left in place and has been stable on follow-up imaging. To our knowledge, this is the first case of a LAAO device that was dislodged and repositioned rather than retrieved and removed via a percutaneous or surgical approach.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"11 ","pages":"Article 100119"},"PeriodicalIF":0.0,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145801992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-04DOI: 10.1016/j.crmic.2025.100118
Nail Kahraman , Nöfel Ahmet Binicier
A 27-year-old woman with prior subaortic membrane resection presented with recurrent tunnel-type subaortic stenosis, severe aortic regurgitation, and a small annulus. She underwent a Konno–Rastan procedure with aortic root enlargement and mechanical valve implantation. Postoperative complete Atrioventricular (AV) block required pacemaker insertion. This rare adult case highlights the strategic use of preoperative indexed Effective Orifice Area (iEOA) calculations to guide surgical planning and avoid patient–prosthesis mismatch (PPM). Additionally, it underscores the feasibility and relevance of the Konno–Rastan technique in adult reoperations, contributing valuable insight into decision-making for anatomically complex Left Ventricular Outflow Tract (LVOT) pathologies.
{"title":"Konno-Rastan aortic root enlargement for late tunnel-type subaortic stenosis: A case report","authors":"Nail Kahraman , Nöfel Ahmet Binicier","doi":"10.1016/j.crmic.2025.100118","DOIUrl":"10.1016/j.crmic.2025.100118","url":null,"abstract":"<div><div>A 27-year-old woman with prior subaortic membrane resection presented with recurrent tunnel-type subaortic stenosis, severe aortic regurgitation, and a small annulus. She underwent a Konno–Rastan procedure with aortic root enlargement and mechanical valve implantation. Postoperative complete Atrioventricular (AV) block required pacemaker insertion. This rare adult case highlights the strategic use of preoperative indexed Effective Orifice Area (iEOA) calculations to guide surgical planning and avoid patient–prosthesis mismatch (PPM). Additionally, it underscores the feasibility and relevance of the Konno–Rastan technique in adult reoperations, contributing valuable insight into decision-making for anatomically complex Left Ventricular Outflow Tract (LVOT) pathologies.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100118"},"PeriodicalIF":0.0,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145467018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-30DOI: 10.1016/j.crmic.2025.100116
Abubakr Ziaullah , Muhammad Taimur , Abdalaaziz Awadelkarim , Mandip Atwal , Muhammad Burhan , M. Chadi Alraies
Background
Penetrating chest trauma can disguise coronary injury; early arteriography clarifies mechanism when antithrombotic therapy must be delayed.
Case summary
A previously healthy middle-aged man sustained a left-thoracic gunshot wound. The patient underwent video-assisted thoracoscopic surgery (VATS) for hemothorax. Rising troponins, anterior ST-segment elevation and echocardiography revealed an LVEF 30–35 % with apical and anterior akinesis implied myocardial injury. Anticoagulation was withheld until bleeding resolved. Coronary angiography demonstrated a smooth, total occlusion of the proximal LAD that could not be wired. Cardiac contusion due to adjacent bullet fragments abutting the vessel and likely contributing to the obstruction. Viability imaging was planned for possible bypass outpatient.
Discussion
This staged strategy—bleeding control, echo surveillance, then defining anatomy with angiography—illustrates how catheterization guides management when coronary trauma and hemorrhage coexist.
{"title":"A second chance: Survival after gunshot wound to the heart","authors":"Abubakr Ziaullah , Muhammad Taimur , Abdalaaziz Awadelkarim , Mandip Atwal , Muhammad Burhan , M. Chadi Alraies","doi":"10.1016/j.crmic.2025.100116","DOIUrl":"10.1016/j.crmic.2025.100116","url":null,"abstract":"<div><h3>Background</h3><div>Penetrating chest trauma can disguise coronary injury; early arteriography clarifies mechanism when antithrombotic therapy must be delayed.</div></div><div><h3>Case summary</h3><div>A previously healthy middle-aged man sustained a left-thoracic gunshot wound. The patient underwent video-assisted thoracoscopic surgery (VATS) for hemothorax. Rising troponins, anterior ST-segment elevation and echocardiography revealed an LVEF 30–35 % with apical and anterior akinesis implied myocardial injury. Anticoagulation was withheld until bleeding resolved. Coronary angiography demonstrated a smooth, total occlusion of the proximal LAD that could not be wired. Cardiac contusion due to adjacent bullet fragments abutting the vessel and likely contributing to the obstruction. Viability imaging was planned for possible bypass outpatient.</div></div><div><h3>Discussion</h3><div>This staged strategy—bleeding control, echo surveillance, then defining anatomy with angiography—illustrates how catheterization guides management when coronary trauma and hemorrhage coexist.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100116"},"PeriodicalIF":0.0,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145528290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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