Pub Date : 2025-10-10DOI: 10.1016/j.crmic.2025.100113
Miguel Gonzalez Toribio , Johan Antonio De la Rosa Laureano , Jean Paul Fernandez
Central venous catheter malposition can signal a thoracic venous anomaly. We report a 56-year-old man whose LIJ catheter tracked left paramediastinally; on-table venography and CT confirmed an isolated persistent left superior vena cava draining to a dilated coronary sinus. Recognition prevented futile repositioning and permitted safe therapy. While CT/MR delineate anatomy, bedside transthoracic echocardiography, specifically adding the suprasternal notch view, with optional left-arm agitated saline, usually suffices to screen for LSVC and related variants. Operators should suspect LSVC when a left-sided catheter fails to cross midline and use targeted imaging to guide management.
{"title":"Left-sided superior vena cava mimicking catheter malposition","authors":"Miguel Gonzalez Toribio , Johan Antonio De la Rosa Laureano , Jean Paul Fernandez","doi":"10.1016/j.crmic.2025.100113","DOIUrl":"10.1016/j.crmic.2025.100113","url":null,"abstract":"<div><div>Central venous catheter malposition can signal a thoracic venous anomaly. We report a 56-year-old man whose LIJ catheter tracked left paramediastinally; on-table venography and CT confirmed an isolated persistent left superior vena cava draining to a dilated coronary sinus. Recognition prevented futile repositioning and permitted safe therapy. While CT/MR delineate anatomy, bedside transthoracic echocardiography, specifically adding the suprasternal notch view, with optional left-arm agitated saline, usually suffices to screen for LSVC and related variants. Operators should suspect LSVC when a left-sided catheter fails to cross midline and use targeted imaging to guide management.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100113"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145321625","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 : 2025-10-03DOI: 10.1016/j.crmic.2025.100109
Nail Kahraman , Nöfel Ahmet Binicier , Deniz Demir
A 67-year-old female patient with a history of mechanical mitral and aortic valve replacement developed Enterococcus faecalis Prosthetic valve endocarditis (PVE). In this patient, who had negative serial blood cultures and had completed an eight-week course of intravenous antibiotic therapy with discharge planned, acute pulmonary edema developed unexpectedly. Transesophageal Echocardiography (TEE), Cinefluoroscopy, and intraoperative findings revealed complete detachment of the posterior mitral annulus, severe paravalvular regurgitation, and pronounced rocking motion of the prosthetic mitral valve. Additionally, moderate-to-severe functional tricuspid regurgitation was identified. An urgent mitral valve replacement using a bioprosthesis was performed in conjunction with tricuspid valve repair. The postoperative recovery was uneventful. Complete posterior annular detachment of the prosthetic mitral valve and pronounced rocking motion following prosthetic mitral valve endocarditis is an extremely rare mechanical complication. These complications, which are rarely observed after mitral PVE, may lead to acute heart failure and circulatory collapse and pose life-threatening risks. We report a rare case of successful revision surgery in a patient who developed paravalvular leak (PVL), posterior annular detachment, and rocking motion of a prosthetic mitral valve following infective endocarditis caused by Enterococcus faecalis.
{"title":"Reoperation for complete posterior annular detachment and rocking motion of a prosthetic mitral valve after infective endocarditis","authors":"Nail Kahraman , Nöfel Ahmet Binicier , Deniz Demir","doi":"10.1016/j.crmic.2025.100109","DOIUrl":"10.1016/j.crmic.2025.100109","url":null,"abstract":"<div><div>A 67-year-old female patient with a history of mechanical mitral and aortic valve replacement developed <em>Enterococcus faecalis</em> Prosthetic valve endocarditis (PVE). In this patient, who had negative serial blood cultures and had completed an eight-week course of intravenous antibiotic therapy with discharge planned, acute pulmonary edema developed unexpectedly. Transesophageal Echocardiography (TEE), Cinefluoroscopy, and intraoperative findings revealed complete detachment of the posterior mitral annulus, severe paravalvular regurgitation, and pronounced rocking motion of the prosthetic mitral valve. Additionally, moderate-to-severe functional tricuspid regurgitation was identified. An urgent mitral valve replacement using a bioprosthesis was performed in conjunction with tricuspid valve repair. The postoperative recovery was uneventful. Complete posterior annular detachment of the prosthetic mitral valve and pronounced rocking motion following prosthetic mitral valve endocarditis is an extremely rare mechanical complication. These complications, which are rarely observed after mitral PVE, may lead to acute heart failure and circulatory collapse and pose life-threatening risks. We report a rare case of successful revision surgery in a patient who developed paravalvular leak (PVL), posterior annular detachment, and rocking motion of a prosthetic mitral valve following infective endocarditis caused by <em>Enterococcus faecalis</em>.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100109"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269896","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}
Iatrogenic aortocoronary dissection is a rare but life-threatening complication during coronary angiography or percutaneous coronary intervention. We report two cases illustrating distinct clinical outcomes. The first case involved a right coronary artery dissection managed conservatively, followed by successful delayed stenting. The second case involved extensive dissection of the left main coronary artery, leading to vessel occlusion and fatal cardiac arrest despite emergent intervention. These cases highlight the critical importance of early recognition, careful procedural technique, and individualized management strategies. They also emphasize the need for strict adherence to guideline-directed decision-making to optimize patient safety and outcomes in complex coronary interventions.
{"title":"Clinical insights into iatrogenic aortocoronary dissection: a case series of conservative and fatal outcomes","authors":"Saroj Kumar Sahoo, Sai Karthik Kowtarapu, Ramachandra Barik, Dibya Sundar Mahanta, Debasis Acharya, Sindhu Rao Malla, Debasis Panda, Prabhat Kumar Singh","doi":"10.1016/j.crmic.2025.100110","DOIUrl":"10.1016/j.crmic.2025.100110","url":null,"abstract":"<div><div>Iatrogenic aortocoronary dissection is a rare but life-threatening complication during coronary angiography or percutaneous coronary intervention. We report two cases illustrating distinct clinical outcomes. The first case involved a right coronary artery dissection managed conservatively, followed by successful delayed stenting. The second case involved extensive dissection of the left main coronary artery, leading to vessel occlusion and fatal cardiac arrest despite emergent intervention. These cases highlight the critical importance of early recognition, careful procedural technique, and individualized management strategies. They also emphasize the need for strict adherence to guideline-directed decision-making to optimize patient safety and outcomes in complex coronary interventions.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100110"},"PeriodicalIF":0.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145269895","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 : 2025-09-19DOI: 10.1016/j.crmic.2025.100108
Huseyin Kandemir , Mustafa Karakurt , Selcuk Ozturk
Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, with left main coronary artery (LMCA) involvement being particularly uncommon and life-threatening. We report the case of a 39-year-old previously healthy female who presented with recurrent chest pain and syncope. Initial investigations were inconclusive, but she later developed hypotension and ischemic electrocardiography changes, prompting emergent coronary angiography. A dissection of the LMCA extending into the left anterior descending artery and first diagonal artery was identified, with likely circumflex artery occlusion. Given the patient's instability, immediate percutaneous coronary intervention was performed using a stepwise bifurcation stenting approach, culminating in the culotte technique. The patient made a full recovery with normalization of cardiac function and remained asymptomatic during long-term follow-up. This case highlights the clinical challenges of diagnosing and managing SCAD involving the LMCA and demonstrates that timely intervention with structured bifurcation strategies can result in excellent outcomes, even in high-risk scenarios.
{"title":"Stepwise bifurcation strategy in totally occluded spontaneous left main coronary artery (LMCA) dissection: Successful management with the culotte technique","authors":"Huseyin Kandemir , Mustafa Karakurt , Selcuk Ozturk","doi":"10.1016/j.crmic.2025.100108","DOIUrl":"10.1016/j.crmic.2025.100108","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, with left main coronary artery (LMCA) involvement being particularly uncommon and life-threatening. We report the case of a 39-year-old previously healthy female who presented with recurrent chest pain and syncope. Initial investigations were inconclusive, but she later developed hypotension and ischemic electrocardiography changes, prompting emergent coronary angiography. A dissection of the LMCA extending into the left anterior descending artery and first diagonal artery was identified, with likely circumflex artery occlusion. Given the patient's instability, immediate percutaneous coronary intervention was performed using a stepwise bifurcation stenting approach, culminating in the culotte technique. The patient made a full recovery with normalization of cardiac function and remained asymptomatic during long-term follow-up. This case highlights the clinical challenges of diagnosing and managing SCAD involving the LMCA and demonstrates that timely intervention with structured bifurcation strategies can result in excellent outcomes, even in high-risk scenarios.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160046","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}
<div><h3>Introduction</h3><div>Left ventricular outflow tract (LVOT) obstruction is a serious complication during transcatheter mitral valve implantation (TMVI) for different indications including in patients with prior mitral bioprosthetic valve replacement. Our case introduces a novel hybrid approach using <strong>b</strong>alloon-assisted <strong>l</strong>aceration <strong>a</strong>nd <strong>s</strong>naring <strong>t</strong>echnique (<strong>BLAST</strong>) of the anterior mitral leaflet (AML) to prevent LVOT obstruction in a high-risk patient with bioprosthetic valve dysfunction.</div></div><div><h3>Case presentation</h3><div>A 79-year-old woman with a history of hypertension, heart Failure with preserved ejection fraction (HFpEF), atrial fibrillation (on warfarin), mitral bioprosthetic valve replacement with 29 mm Mosaic valve in 2013 for severe rheumatic mitral stenosis and TAVR (transcatheter aortic valve replacement) for severe aortic stenosis (AS), presented with severe decompensated heart failure. Echo showed severe bioprosthetic dysfunction with mitral regurgitation (MR) due to flail bioprosthetic leaflet and perforation of the neoanterior leaflet. The patient was treated with multiple vasopressors and diuretics for stabilization prior to being transferred for TMVI as she was deemed prohibitive risk for surgery.</div><div>Preprocedural CT imaging predicted neoLVOT area of 133 mm<sup>2</sup> raising concerns for LVOT obstruction during valve implantation. The predicted LVOT after leaflet modification was 219 mm<sup>2</sup>. Given the complexity of the case, to avoid possible LVOT obstruction, the decision was made to perform a balloon-assisted laceration and snaring of the neoanterior mitral leaflet. After proposed BLAST procedure through a trans-septal approach, a successful TMVI was performed. The peak LVOT gradient post procedure was 9 mmHg. Our patient was stable post-procedure, weaned from vasopressors, and showed significant hemodynamic and clinical improvement in the hospital and at short-term clinic follow-up.</div></div><div><h3>Discussion</h3><div>LVOT obstruction is a well-known challenge in TMVI, in patients with prior mitral valve replacement, annuloplasty or significant annular calcification. Techniques like LAMPOON have been used to prevent LVOT obstruction, but in complex cases, additional strategies may be necessary. The balloon-assisted laceration and snaring technique (proposed acronym <strong>BLAST</strong>) provides an effective and controlled method to address neoanterior leaflet dynamics. This modification may reduce procedural complexity and improve outcomes by ensuring that the LVOT remains unobstructed during valve deployment. This technique could complement or serve as an alternative to LAMPOON, particularly in redo TMVI cases.</div></div><div><h3>Conclusion</h3><div>The <strong>BLAST</strong> procedure demonstrates a promising approach for patients at high risk of LVOT obstruction during TMVI. Further st
{"title":"Balloon-assisted laceration and snaring technique (BLAST) of the anterior mitral leaflet to prevent LVOT obstruction during transcatheter mitral valve implantation: A novel leaflet modification technique","authors":"Khagendra Dahal , Talhat Azemi , Bryan Piccirillo , Sean McMahon , Sheelah Pousatis , Jawad Haider","doi":"10.1016/j.crmic.2025.100101","DOIUrl":"10.1016/j.crmic.2025.100101","url":null,"abstract":"<div><h3>Introduction</h3><div>Left ventricular outflow tract (LVOT) obstruction is a serious complication during transcatheter mitral valve implantation (TMVI) for different indications including in patients with prior mitral bioprosthetic valve replacement. Our case introduces a novel hybrid approach using <strong>b</strong>alloon-assisted <strong>l</strong>aceration <strong>a</strong>nd <strong>s</strong>naring <strong>t</strong>echnique (<strong>BLAST</strong>) of the anterior mitral leaflet (AML) to prevent LVOT obstruction in a high-risk patient with bioprosthetic valve dysfunction.</div></div><div><h3>Case presentation</h3><div>A 79-year-old woman with a history of hypertension, heart Failure with preserved ejection fraction (HFpEF), atrial fibrillation (on warfarin), mitral bioprosthetic valve replacement with 29 mm Mosaic valve in 2013 for severe rheumatic mitral stenosis and TAVR (transcatheter aortic valve replacement) for severe aortic stenosis (AS), presented with severe decompensated heart failure. Echo showed severe bioprosthetic dysfunction with mitral regurgitation (MR) due to flail bioprosthetic leaflet and perforation of the neoanterior leaflet. The patient was treated with multiple vasopressors and diuretics for stabilization prior to being transferred for TMVI as she was deemed prohibitive risk for surgery.</div><div>Preprocedural CT imaging predicted neoLVOT area of 133 mm<sup>2</sup> raising concerns for LVOT obstruction during valve implantation. The predicted LVOT after leaflet modification was 219 mm<sup>2</sup>. Given the complexity of the case, to avoid possible LVOT obstruction, the decision was made to perform a balloon-assisted laceration and snaring of the neoanterior mitral leaflet. After proposed BLAST procedure through a trans-septal approach, a successful TMVI was performed. The peak LVOT gradient post procedure was 9 mmHg. Our patient was stable post-procedure, weaned from vasopressors, and showed significant hemodynamic and clinical improvement in the hospital and at short-term clinic follow-up.</div></div><div><h3>Discussion</h3><div>LVOT obstruction is a well-known challenge in TMVI, in patients with prior mitral valve replacement, annuloplasty or significant annular calcification. Techniques like LAMPOON have been used to prevent LVOT obstruction, but in complex cases, additional strategies may be necessary. The balloon-assisted laceration and snaring technique (proposed acronym <strong>BLAST</strong>) provides an effective and controlled method to address neoanterior leaflet dynamics. This modification may reduce procedural complexity and improve outcomes by ensuring that the LVOT remains unobstructed during valve deployment. This technique could complement or serve as an alternative to LAMPOON, particularly in redo TMVI cases.</div></div><div><h3>Conclusion</h3><div>The <strong>BLAST</strong> procedure demonstrates a promising approach for patients at high risk of LVOT obstruction during TMVI. Further st","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108865","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 : 2025-09-13DOI: 10.1016/j.crmic.2025.100106
Nail Kahraman, Nöfel Ahmet Binicier, Deniz Demir
A 50-year-old female patient presenting with progressive dyspnea was initially diagnosed with bronchial asthma. Even after a six-month treatment period, the patient's symptoms continued to escalate. On cardiac auscultation, a diastolic murmur was noted at the apex. Transthoracic echocardiography (TTE) revealed a pedunculated mass measuring 38 × 32.5 mm, attached to the interatrial septum within the left atrium. Additionally, moderate functional mitral regurgitation was identified. With a preliminary diagnosis of atrial myxoma, urgent surgical intervention was scheduled to prevent the risk of embolism. With a transseptal atriotomy approach, the tumor was mobilized without fragmentation and resected en bloc along with its stalk. Postoperatively, the functional mitral regurgitation resolved. Histopathological examination of the resected cardiac mass confirmed the diagnosis of atrial myxoma. During the postoperative course, the patient's symptoms significantly improved, and no residual mass was detected on follow-up echocardiography at twelfth months.
Myxomas are soft, gelatinous, and highly friable tumors that pose a significant risk of intraoperative fragmentation and embolization. This case highlights a rare instance in which a left atrial myxoma, initially misdiagnosed as asthma, underscored the importance of appropriate surgical strategy to prevent embolic events and recurrence. Furthermore, the case illustrates the diverse clinical presentations of cardiac myxomas and provides valuable insights that may contribute to the existing literature.
{"title":"En bloc resection of a left atrial myxoma mimicking bronchial asthma: a case report","authors":"Nail Kahraman, Nöfel Ahmet Binicier, Deniz Demir","doi":"10.1016/j.crmic.2025.100106","DOIUrl":"10.1016/j.crmic.2025.100106","url":null,"abstract":"<div><div>A 50-year-old female patient presenting with progressive dyspnea was initially diagnosed with bronchial asthma. Even after a six-month treatment period, the patient's symptoms continued to escalate. On cardiac auscultation, a diastolic murmur was noted at the apex. Transthoracic echocardiography (TTE) revealed a pedunculated mass measuring 38 × 32.5 mm, attached to the interatrial septum within the left atrium. Additionally, moderate functional mitral regurgitation was identified. With a preliminary diagnosis of atrial myxoma, urgent surgical intervention was scheduled to prevent the risk of embolism. With a transseptal atriotomy approach, the tumor was mobilized without fragmentation and resected en bloc along with its stalk. Postoperatively, the functional mitral regurgitation resolved. Histopathological examination of the resected cardiac mass confirmed the diagnosis of atrial myxoma. During the postoperative course, the patient's symptoms significantly improved, and no residual mass was detected on follow-up echocardiography at twelfth months.</div><div>Myxomas are soft, gelatinous, and highly friable tumors that pose a significant risk of intraoperative fragmentation and embolization. This case highlights a rare instance in which a left atrial myxoma, initially misdiagnosed as asthma, underscored the importance of appropriate surgical strategy to prevent embolic events and recurrence. Furthermore, the case illustrates the diverse clinical presentations of cardiac myxomas and provides valuable insights that may contribute to the existing literature.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108863","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 : 2025-09-11DOI: 10.1016/j.crmic.2025.100102
Magnus To , Shonit Nandakumar , Timothy Davis Ho , Harjeet Singh , Waqqas Mirza , Syed Iftikhar , Javad Savoj , Nikhil Ghatnekar , Patrick Hu
Background
Coronary artery occlusion is a rare but potentially fatal complication following transcatheter aortic valve replacement (TAVR), particularly in patients with high-risk anatomical features such as low coronary takeoff or shallow sinuses of Valsalva. Snorkel/chimney stenting has emerged as a feasible bailout or planned strategy to maintain coronary perfusion in these cases.
Objective
This case series describes the procedural approach, technical challenges, and clinical outcomes of three patients who underwent snorkel stenting of the coronary arteries following TAVR as well as one patient with concerns for coronary obstruction before TAVR.
Methods
Four high-risk patients underwent TAVR with planned or emergent snorkel stenting to prevent or manage coronary obstruction. Outcomes were assessed based on procedural success, coronary patency, and survival.
Results
Snorkel stenting was technically successful in three cases, preserving immediate coronary perfusion, while a fourth case had preparations for snorkel stenting but was not needed as the TAVR bioprosthesis did not occlude the coronary artery. Three patients survived for approximately 1–2 years post-intervention before succumbing to non-cardiac or unrelated complications and expired. Challenges included optimal stent positioning to minimize leaflet interaction and the potential for thrombotic complications.
Conclusion
This case series highlights both the feasibility and limitations of snorkel stenting as a coronary protection strategy post-TAVR. While short-term technical success was achieved, long-term survival remained limited in this high-risk population. Further research is needed to optimize patient selection, procedural strategies, and long-term management.
{"title":"Keeping the flow: A case series on snorkel/chimney stenting during transcatheter aortic valve replacement","authors":"Magnus To , Shonit Nandakumar , Timothy Davis Ho , Harjeet Singh , Waqqas Mirza , Syed Iftikhar , Javad Savoj , Nikhil Ghatnekar , Patrick Hu","doi":"10.1016/j.crmic.2025.100102","DOIUrl":"10.1016/j.crmic.2025.100102","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery occlusion is a rare but potentially fatal complication following transcatheter aortic valve replacement (TAVR), particularly in patients with high-risk anatomical features such as low coronary takeoff or shallow sinuses of Valsalva. Snorkel/chimney stenting has emerged as a feasible bailout or planned strategy to maintain coronary perfusion in these cases.</div></div><div><h3>Objective</h3><div>This case series describes the procedural approach, technical challenges, and clinical outcomes of three patients who underwent snorkel stenting of the coronary arteries following TAVR as well as one patient with concerns for coronary obstruction before TAVR.</div></div><div><h3>Methods</h3><div>Four high-risk patients underwent TAVR with planned or emergent snorkel stenting to prevent or manage coronary obstruction. Outcomes were assessed based on procedural success, coronary patency, and survival.</div></div><div><h3>Results</h3><div>Snorkel stenting was technically successful in three cases, preserving immediate coronary perfusion, while a fourth case had preparations for snorkel stenting but was not needed as the TAVR bioprosthesis did not occlude the coronary artery. Three patients survived for approximately 1–2 years post-intervention before succumbing to non-cardiac or unrelated complications and expired. Challenges included optimal stent positioning to minimize leaflet interaction and the potential for thrombotic complications.</div></div><div><h3>Conclusion</h3><div>This case series highlights both the feasibility and limitations of snorkel stenting as a coronary protection strategy post-TAVR. While short-term technical success was achieved, long-term survival remained limited in this high-risk population. Further research is needed to optimize patient selection, procedural strategies, and long-term management.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048775","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 : 2025-09-11DOI: 10.1016/j.crmic.2025.100105
Miguel Angel Montilla Garrido, Elena Izaga Torralba, Carmen Lluch Requerey, Santiago Camacho Freire, Jessica Roa Garrido, Oscar Lagos De Grande, Antonio Gómez Menchero
{"title":"Mitraclip in patient with prior atrial septal occlusion device: a challenging procedure","authors":"Miguel Angel Montilla Garrido, Elena Izaga Torralba, Carmen Lluch Requerey, Santiago Camacho Freire, Jessica Roa Garrido, Oscar Lagos De Grande, Antonio Gómez Menchero","doi":"10.1016/j.crmic.2025.100105","DOIUrl":"10.1016/j.crmic.2025.100105","url":null,"abstract":"","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222374","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 : 2025-09-10DOI: 10.1016/j.crmic.2025.100107
George Kassimis , Athanasios Samaras , Athina Nasoufidou , Anahita Rad , Amelie De Fougeroux , Carol Ojeka , Pavlos Roditis , Konstantinos C. Theodoropoulos , Nikolaos Fragakis , Antonios Ziakas
Spontaneous coronary artery dissection (SCAD) is a rare, but well recognized cause of ST-elevation myocardial infarction (STEMI), especially in middle-aged women with few or no traditional cardiovascular risk factors. Left main stem (LMS) is the culprit coronary artery in around 13 % of STEMI-SCAD patients, and most of these patients develop cardiogenic shock (CS). LMS-SCAD represents a challenging clinical scenario where both successful revascularisation and haemodynamic support are required. Primary percutaneous coronary intervention (PPCI) in LMS-SCAD is a complex procedure, considering the risk of dissection propagation towards the left anterior descending and/or circumflex coronary arteries and in case it cannot be successfully performed, bailout emergent coronary artery bypass grafting may be needed. We herein present the case of a woman with LMS-SCAD who presented with STEMI and CS, illustrating the characteristic angiographic presentation, the treatment with a successful PPCI and the 6-month follow-up with a computed tomography coronary angiogram.
{"title":"Left main stem spontaneous coronary artery dissection in a cardiogenic shock STEMI patient","authors":"George Kassimis , Athanasios Samaras , Athina Nasoufidou , Anahita Rad , Amelie De Fougeroux , Carol Ojeka , Pavlos Roditis , Konstantinos C. Theodoropoulos , Nikolaos Fragakis , Antonios Ziakas","doi":"10.1016/j.crmic.2025.100107","DOIUrl":"10.1016/j.crmic.2025.100107","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is a rare, but well recognized cause of ST-elevation myocardial infarction (STEMI), especially in middle-aged women with few or no traditional cardiovascular risk factors. Left main stem (LMS) is the culprit coronary artery in around 13 % of STEMI-SCAD patients, and most of these patients develop cardiogenic shock (CS). LMS-SCAD represents a challenging clinical scenario where both successful revascularisation and haemodynamic support are required. Primary percutaneous coronary intervention (PPCI) in LMS-SCAD is a complex procedure, considering the risk of dissection propagation towards the left anterior descending and/or circumflex coronary arteries and in case it cannot be successfully performed, bailout emergent coronary artery bypass grafting may be needed. We herein present the case of a woman with LMS-SCAD who presented with STEMI and CS, illustrating the characteristic angiographic presentation, the treatment with a successful PPCI and the 6-month follow-up with a computed tomography coronary angiogram.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048774","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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