Pub Date : 2025-09-05DOI: 10.1016/j.crmic.2025.100103
Mustafa Alkhawam , Ali J. Ebrahimi , Akash Pandey , Rajamiyer Venkateswaran , Mustafa I. Ahmed
Here, we describe the first use of fusion imaging for percutaneous decommissioning of an LVAD. A 57-year-old male with pump thrombosis and hemolysis underwent occlusion of the outflow graft of his LVAD using three Amplater devices. Fusion imaging enabled the accurate placement and deployment of several closure devices in order to achieve immediate pump deactivation. The patient experienced a rapid improvement in hemodynamic and hemolytic parameters, making the percutaneous treatment of an LVAD a reasonable alternative to the classical open procedure.
{"title":"Advanced fusion imaging in the percutaneous decommissioning of a left ventricular assist device","authors":"Mustafa Alkhawam , Ali J. Ebrahimi , Akash Pandey , Rajamiyer Venkateswaran , Mustafa I. Ahmed","doi":"10.1016/j.crmic.2025.100103","DOIUrl":"10.1016/j.crmic.2025.100103","url":null,"abstract":"<div><div>Here, we describe the first use of fusion imaging for percutaneous decommissioning of an LVAD. A 57-year-old male with pump thrombosis and hemolysis underwent occlusion of the outflow graft of his LVAD using three Amplater devices. Fusion imaging enabled the accurate placement and deployment of several closure devices in order to achieve immediate pump deactivation. The patient experienced a rapid improvement in hemodynamic and hemolytic parameters, making the percutaneous treatment of an LVAD a reasonable alternative to the classical open procedure.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019137","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 : 2025-09-03DOI: 10.1016/j.crmic.2025.100104
Georgios E. Papadopoulos , Ilias Ninios , Sotirios Evangelou , Andreas Ioannides , Vlasis Ninios
Superior vena cava (SVC) stenosis is a rare but serious complication following surgical repair of congenital heart defects, often resulting in significant venous congestion, facial and upper extremity swelling, increased venous pressures, and impaired hemodynamics. Surgical re-intervention carries substantial risks, whereas percutaneous stenting offers a minimally invasive and effective alternative. We present two cases of symptomatic SVC stenosis following congenital heart defect repair. Both patients underwent detailed imaging with cardiac MRI and CT angiography, confirming severe SVC stenosis. Percutaneous intervention was performed using self-expanding Wallstents deployed under fluoroscopic guidance, with tailored post-dilation strategies to optimize luminal expansion. Immediate symptomatic relief was achieved in both cases, with complete resolution of venous congestion. Post-procedure anticoagulation included warfarin for six months, followed by long-term aspirin therapy. Follow-up imaging demonstrated sustained stent patency without restenosis or thrombosis. These cases highlight percutaneous stenting as a viable and effective approach for managing post-surgical SVC stenosis, offering a safe alternative to surgical re-intervention. Future research should focus on optimizing stent designs and post-procedural management strategies to further improve patient outcomes.
{"title":"Percutaneous stenting for superior vena cava stenosis following surgical repair of congenital heart defects: A two case report","authors":"Georgios E. Papadopoulos , Ilias Ninios , Sotirios Evangelou , Andreas Ioannides , Vlasis Ninios","doi":"10.1016/j.crmic.2025.100104","DOIUrl":"10.1016/j.crmic.2025.100104","url":null,"abstract":"<div><div>Superior vena cava (SVC) stenosis is a rare but serious complication following surgical repair of congenital heart defects, often resulting in significant venous congestion, facial and upper extremity swelling, increased venous pressures, and impaired hemodynamics. Surgical re-intervention carries substantial risks, whereas percutaneous stenting offers a minimally invasive and effective alternative. We present two cases of symptomatic SVC stenosis following congenital heart defect repair. Both patients underwent detailed imaging with cardiac MRI and CT angiography, confirming severe SVC stenosis. Percutaneous intervention was performed using self-expanding Wallstents deployed under fluoroscopic guidance, with tailored post-dilation strategies to optimize luminal expansion. Immediate symptomatic relief was achieved in both cases, with complete resolution of venous congestion. Post-procedure anticoagulation included warfarin for six months, followed by long-term aspirin therapy. Follow-up imaging demonstrated sustained stent patency without restenosis or thrombosis. These cases highlight percutaneous stenting as a viable and effective approach for managing post-surgical SVC stenosis, offering a safe alternative to surgical re-intervention. Future research should focus on optimizing stent designs and post-procedural management strategies to further improve patient outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010341","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}
Left ventricular free wall rupture is a rare but often fatal complication of acute myocardial infarction (MI). While typically associated with pericardial effusion and tamponade, left ventricular free wall rupture can occasionally present as a contained rupture, leading to diagnostic delays.
Case summary
A 69-year-old woman with prior mitral and tricuspid valve repair and atrial flutter treated with apixaban presented with cardiogenic shock following a posterior ST-elevation MI. Coronary angiography revealed thrombus in the right coronary artery and thrombotic occlusion of the left circumflex artery (LCx)- obtuse marginal (OM) branch. During evaluation for mechanical support, echocardiography suggested a large left ventricular mass. Further imaging raised suspicion of an intramural hematoma without pericardial effusion. Surgical exploration confirmed a sealed ventricular rupture contained by the parietal pericardium. Despite timely intervention, the patient succumbed to her condition.
Discussion
This case emphasizes the diagnostic challenge posed by left ventricular free wall rupture without pericardial effusion. High clinical suspicion, even in atypical presentations, and rapid multidisciplinary management are critical for improved outcomes.
{"title":"Contained ventricular free wall rupture without pericardial effusion: a diagnostic challenge in acute myocardial infarction","authors":"Ranin Hilu , Yoram Neuman , Abid Assali , Hana Vaknin Assa","doi":"10.1016/j.crmic.2025.100099","DOIUrl":"10.1016/j.crmic.2025.100099","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular free wall rupture is a rare but often fatal complication of acute myocardial infarction (MI). While typically associated with pericardial effusion and tamponade, left ventricular free wall rupture can occasionally present as a contained rupture, leading to diagnostic delays.</div></div><div><h3>Case summary</h3><div>A 69-year-old woman with prior mitral and tricuspid valve repair and atrial flutter treated with apixaban presented with cardiogenic shock following a posterior ST-elevation MI. Coronary angiography revealed thrombus in the right coronary artery and thrombotic occlusion of the left circumflex artery (LCx)- obtuse marginal (OM) branch. During evaluation for mechanical support, echocardiography suggested a large left ventricular mass. Further imaging raised suspicion of an intramural hematoma without pericardial effusion. Surgical exploration confirmed a sealed ventricular rupture contained by the parietal pericardium. Despite timely intervention, the patient succumbed to her condition.</div></div><div><h3>Discussion</h3><div>This case emphasizes the diagnostic challenge posed by left ventricular free wall rupture without pericardial effusion. High clinical suspicion, even in atypical presentations, and rapid multidisciplinary management are critical for improved outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904157","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 : 2025-08-19DOI: 10.1016/j.crmic.2025.100098
Alba Abril Molina , Manuel Villa Gil Ortega , José Eduardo López Haldón , Isabel Merino González , Carmen Federero Fernández , Almudena Aguilera Saborido , Ana López Suárez , Mónica Fernández Quero , Agustín Guisado Rasco , Rosa Cardenal Piris , José Francisco Díaz Fernández
The case of a 77-year-old male with decompensated heart failure due to multivalve disease is presented: severe primary aortic regurgitation (tissue defect, without calcification) and severe mixed mitral regurgitation (functional and ruptured chordae tendineae). Due to severe left ventricle dysfunction and high surgical risk, a combined percutaneous treatment was performed successfully although very technically demanding (TAVI in TAVI and two Mitraclip devices).
Multivalvular disease is associated with worse prognosis, difficult diagnosis and therapeutic challenges.1 Therefore, an individual assessment of each patient by a heart team, a comprehensive treatment planning and the experience and skill of the operators to handle any unforeseen issues are essential for success.
{"title":"Percutaneous treatment of multivalve disease: severe aortic and mitral regurgitation. Complex patient, complex solution","authors":"Alba Abril Molina , Manuel Villa Gil Ortega , José Eduardo López Haldón , Isabel Merino González , Carmen Federero Fernández , Almudena Aguilera Saborido , Ana López Suárez , Mónica Fernández Quero , Agustín Guisado Rasco , Rosa Cardenal Piris , José Francisco Díaz Fernández","doi":"10.1016/j.crmic.2025.100098","DOIUrl":"10.1016/j.crmic.2025.100098","url":null,"abstract":"<div><div>The case of a 77-year-old male with decompensated heart failure due to multivalve disease is presented: severe primary aortic regurgitation (tissue defect, without calcification) and severe mixed mitral regurgitation (functional and ruptured chordae tendineae). Due to severe left ventricle dysfunction and high surgical risk, a combined percutaneous treatment was performed successfully although very technically demanding (TAVI in TAVI and two Mitraclip devices).</div><div>Multivalvular disease is associated with worse prognosis, difficult diagnosis and therapeutic challenges.<sup>1</sup> Therefore, an individual assessment of each patient by a heart team, a comprehensive treatment planning and the experience and skill of the operators to handle any unforeseen issues are essential for success.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100098"},"PeriodicalIF":0.0,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864345","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 : 2025-08-08DOI: 10.1016/j.crmic.2025.100096
Mark Sonbol , Mark Vesely
Patients with torrential tricuspid regurgitation (TR) and large leaflet gaps pose technical challenges for tricuspid valve transcatheter edge-to-edge repair (t-TEER). We report the novel use of inhaled nitric oxide (iNO) as a hemodynamic adjunct in t-TEER in a 59-year-old female with torrential TR and NYHA Class IV heart failure. After an unsuccessful initial TEER attempt with the TriClip device due to a large leaflet gap, iNO was initiated at the repeat t-TEER attempt for the intraoperative reduction of pulmonary vascular resistance (PVR) and right ventricle (RV) afterload. This decreased intraoperative TR severity and optimized valve geometry for easier leaflet grasping, allowing for successful deployment of two TriClips.
{"title":"Use of inhaled nitric oxide in facilitating tricuspid TEER: A novel approach","authors":"Mark Sonbol , Mark Vesely","doi":"10.1016/j.crmic.2025.100096","DOIUrl":"10.1016/j.crmic.2025.100096","url":null,"abstract":"<div><div>Patients with torrential tricuspid regurgitation (TR) and large leaflet gaps pose technical challenges for tricuspid valve transcatheter edge-to-edge repair (t-TEER). We report the novel use of inhaled nitric oxide (iNO) as a hemodynamic adjunct in t-TEER in a 59-year-old female with torrential TR and NYHA Class IV heart failure. After an unsuccessful initial TEER attempt with the TriClip device due to a large leaflet gap, iNO was initiated at the repeat t-TEER attempt for the intraoperative reduction of pulmonary vascular resistance (PVR) and right ventricle (RV) afterload. This decreased intraoperative TR severity and optimized valve geometry for easier leaflet grasping, allowing for successful deployment of two TriClips.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100096"},"PeriodicalIF":0.0,"publicationDate":"2025-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144864346","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}
We report the case of a 64-year-old male patient, symptomatic for crescendo angina, admitted for elective coronary angiography with a finding of significant In-Stent Restenosis (ISR) of the mid Left Anterior Descending (LAD). Optical Coherence Tomography (OCT) imaging analysis confirmed the fibrotic nature of the ISR (biological mechanism) determined by intimal hyperplasia (biological mechanism). Following this findings, Knob balloon (GRIP TT, Acrostak, Switzerland) was used followed by non-compliant (NC) balloon at high atmosphere and final Drug Coated Balloon elution with optimal lumen gain.
Learning objective
This case highlights the value of OCT in accurately identifying the underlying mechanism of ISR, enabling a tailored, case-specific treatment strategy. Following knob balloon dilatation, effective plaque modification was obtained, allowing consequent stability during NC balloon inflation as well an improved deliverability of anti-proliferative agent and subsequent tissue retention in the restenotic area, possibly contributing to improved clinical outcomes and a reduced risk of recurrent restenosis.
{"title":"Knob balloon as a tool for intracoronary imaging guided in-stent restenosis treatment: A case report","authors":"Enrico Cerrato , Simone Zecchino , Giulia Alagna , Giulia Nardi , Hector M. Garcia-Garcia , Nieves Gonzalo , Ferdinando Varbella","doi":"10.1016/j.crmic.2025.100094","DOIUrl":"10.1016/j.crmic.2025.100094","url":null,"abstract":"<div><div>We report the case of a 64-year-old male patient, symptomatic for crescendo angina, admitted for elective coronary angiography with a finding of significant In-Stent Restenosis (ISR) of the mid Left Anterior Descending (LAD). Optical Coherence Tomography (OCT) imaging analysis confirmed the fibrotic nature of the ISR (biological mechanism) determined by intimal hyperplasia (biological mechanism). Following this findings, Knob balloon (GRIP TT, Acrostak, Switzerland) was used followed by non-compliant (NC) balloon at high atmosphere and final Drug Coated Balloon elution with optimal lumen gain.</div></div><div><h3><em>Learning objective</em></h3><div>This case highlights the value of OCT in accurately identifying the underlying mechanism of ISR, enabling a tailored, case-specific treatment strategy. Following knob balloon dilatation, effective plaque modification was obtained, allowing consequent stability during NC balloon inflation as well an improved deliverability of anti-proliferative agent and subsequent tissue retention in the restenotic area, possibly contributing to improved clinical outcomes and a reduced risk of recurrent restenosis.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100094"},"PeriodicalIF":0.0,"publicationDate":"2025-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144757602","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}
This report describes a 19-year-old male who sustained multiple chest stab wounds during a house party altercation, resulting in traumatic injury to the right coronary artery (RCA) and a fistula to the right atrium (RA). Coronary angiography showed RCA dilation with communication to the RA, coronary sinus, and right ventricle (RV), while cardiac computed tomography (CT) angiography identified an RCA pseudoaneurysm with an RA fistula, confirmed intraoperatively. The patient was stabilized and underwent successful open-heart surgery involving RCA ligation and coronary artery bypass grafting (CABG). This case emphasizes diagnostic challenges and surgical management of traumatic RCA pseudoaneurysm with fistulous communication.
{"title":"A Rare Cardiac Complication of Chest Trauma: Right Coronary Artery – Right Atrium Fistula in a Teenager","authors":"Abdulrahman Al-Qaysi , Abdelrahman Sayeh , Zainab Al-Qaysi , Muhammad Saad Faroogqi , Naser Sayeh","doi":"10.1016/j.crmic.2025.100088","DOIUrl":"10.1016/j.crmic.2025.100088","url":null,"abstract":"<div><div>This report describes a 19-year-old male who sustained multiple chest stab wounds during a house party altercation, resulting in traumatic injury to the right coronary artery (RCA) and a fistula to the right atrium (RA). Coronary angiography showed RCA dilation with communication to the RA, coronary sinus, and right ventricle (RV), while cardiac computed tomography (CT) angiography identified an RCA pseudoaneurysm with an RA fistula, confirmed intraoperatively. The patient was stabilized and underwent successful open-heart surgery involving RCA ligation and coronary artery bypass grafting (CABG). This case emphasizes diagnostic challenges and surgical management of traumatic RCA pseudoaneurysm with fistulous communication.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694793","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 : 2025-07-22DOI: 10.1016/j.crmic.2025.100091
Arnaud Planchat , Aubry Schaefer , Carl Glessgen , Philippe Meyer , Sophie Degrauwe
A 34-year-old woman presented with oppressive chest pain and dyspnea, later progressing to acute pulmonary edema four days after her fourth delivery. Echocardiography revealed severe left ventricular systolic dysfunction. Coronary angiography demonstrated a multivessel spontaneous coronary artery dissection (SCAD) of very small < 1 mm branches of RCA and diagonal arteries that did not explain the reduction in LVEF to 35 %. Ventriculography confirmed a reversed Tako-Tsubo pattern. Cardiac MRI helped distinguish between Tako-Tsubo syndrome (TTS) and peripartum cardiomyopathy (PPCM), as both can share a similar pattern. The patient received heart failure guideline-directed medical therapy, resulting in rapid clinical improvement. This case highlights the diagnostic challenge not only in identifying SCAD, TTS, and PPCM in the peripartum period, but also in recognizing the potential overlap between them. Multimodal imaging in guiding effective management of peripartum cardiovascular complications was therefore crucial.
{"title":"Takotsubo cardiomyopathy and spontaneous coronary artery dissection association mimicking peri-partum cardiomyopathy","authors":"Arnaud Planchat , Aubry Schaefer , Carl Glessgen , Philippe Meyer , Sophie Degrauwe","doi":"10.1016/j.crmic.2025.100091","DOIUrl":"10.1016/j.crmic.2025.100091","url":null,"abstract":"<div><div>A 34-year-old woman presented with oppressive chest pain and dyspnea, later progressing to acute pulmonary edema four days after her fourth delivery. Echocardiography revealed severe left ventricular systolic dysfunction. Coronary angiography demonstrated a multivessel spontaneous coronary artery dissection (SCAD) of very small < 1 mm branches of RCA and diagonal arteries that did not explain the reduction in LVEF to 35 %. Ventriculography confirmed a reversed Tako-Tsubo pattern. Cardiac MRI helped distinguish between Tako-Tsubo syndrome (TTS) and peripartum cardiomyopathy (PPCM), as both can share a similar pattern. The patient received heart failure guideline-directed medical therapy, resulting in rapid clinical improvement. This case highlights the diagnostic challenge not only in identifying SCAD, TTS, and PPCM in the peripartum period, but also in recognizing the potential overlap between them. Multimodal imaging in guiding effective management of peripartum cardiovascular complications was therefore crucial.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687367","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 : 2025-07-17DOI: 10.1016/j.crmic.2025.100090
Georgios E. Papadopoulos, Ilias Ninios, Sotirios Evangelou, Andreas Ioannides, Athinodoros Nikitopoulos, Vlasis Ninios
Stuck leaflets of transcatheter aortic valves are a rare but potentially life-threatening complication. Although management often includes immediate valve-in-valve implantation, alternative catheter-based strategies may resolve leaflet immobility and avoid unnecessary interventions. A 78-year-old male with severe symptomatic aortic stenosis (mean gradient 57 mmHg, aortic valve area 0.7 cm2) and high surgical risk (EuroSCORE II 8.9 %) underwent transfemoral balloon-expandable transcatheter aortic valve implantation (TAVI). Post-deployment aortography demonstrated acute severe aortic regurgitation (AR), associated with rapid hemodynamic deterioration. With valve-in-valve implantation under consideration, gentle manipulation (rotation and withdrawal) of an aortic pigtail catheter placed via the left radial artery resulted in immediate resolution of AR, restoration of hemodynamics, and confirmation of leaflet mobility. Catheter-based troubleshooting successfully restored leaflet function without need for additional valve implantation. The patient recovered uneventfully and remained symptom-free at 3-month follow-up echocardiography, with no residual aortic regurgitation. Prosthetic leaflet immobility after TAVI may result from interference by native calcified leaflets, structural trauma during positioning, or incomplete frame expansion. Early recognition and catheter manipulation-such as gentle engagement with a pigtail catheter-can restore leaflet motion and avert emergent valve-in-valve procedures. Careful procedural technique, including precise prosthesis alignment and cautious post-dilatation, may reduce leaflet entrapment risk. In cases of acute severe AR due to stuck leaflets post-TAVI, simple pigtail catheter manipulation should be attempted as a first-line intervention before proceeding to more invasive therapies.
{"title":"Acute aortic regurgitation following transcatheter aortic valve implantation treated with a pigtail catheter","authors":"Georgios E. Papadopoulos, Ilias Ninios, Sotirios Evangelou, Andreas Ioannides, Athinodoros Nikitopoulos, Vlasis Ninios","doi":"10.1016/j.crmic.2025.100090","DOIUrl":"10.1016/j.crmic.2025.100090","url":null,"abstract":"<div><div>Stuck leaflets of transcatheter aortic valves are a rare but potentially life-threatening complication. Although management often includes immediate valve-in-valve implantation, alternative catheter-based strategies may resolve leaflet immobility and avoid unnecessary interventions. A 78-year-old male with severe symptomatic aortic stenosis (mean gradient 57 mmHg, aortic valve area 0.7 cm<sup>2</sup>) and high surgical risk (EuroSCORE II 8.9 %) underwent transfemoral balloon-expandable transcatheter aortic valve implantation (TAVI). Post-deployment aortography demonstrated acute severe aortic regurgitation (AR), associated with rapid hemodynamic deterioration. With valve-in-valve implantation under consideration, gentle manipulation (rotation and withdrawal) of an aortic pigtail catheter placed via the left radial artery resulted in immediate resolution of AR, restoration of hemodynamics, and confirmation of leaflet mobility. Catheter-based troubleshooting successfully restored leaflet function without need for additional valve implantation. The patient recovered uneventfully and remained symptom-free at 3-month follow-up echocardiography, with no residual aortic regurgitation. Prosthetic leaflet immobility after TAVI may result from interference by native calcified leaflets, structural trauma during positioning, or incomplete frame expansion. Early recognition and catheter manipulation-such as gentle engagement with a pigtail catheter-can restore leaflet motion and avert emergent valve-in-valve procedures. Careful procedural technique, including precise prosthesis alignment and cautious post-dilatation, may reduce leaflet entrapment risk. In cases of acute severe AR due to stuck leaflets post-TAVI, simple pigtail catheter manipulation should be attempted as a first-line intervention before proceeding to more invasive therapies.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670709","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}
A 79-year-old male with coronary artery disease (CAD) and drug-eluting stents (DES) to the right coronary artery (RCA) and left anterior descending (LAD) artery (2001). A decade later, catheterization for angina showed mid-RCA chronic total occlusion (CTO) with left-to-right collateral flow and 30 % LAD in-stent restenosis (ISR), managed medically. He re-presented with angina, and repeat angiography revealed similar LAD ISR. Functional assessment with CathWorks FFRangio and invasive instantaneous wave-free ratio (iFR) was discordant but confirmed hemodynamically significant ISR due to an under-expanded, fractured LAD stent on intravascular ultrasound (IVUS). This case illustrates angiographic-functional discordance and the value of multimodal assessment.
{"title":"Hidden culprit: Hemodynamic unmasking of angiographically insignificant in-stent restenosis","authors":"Samantha L. Weller , Katherine Lutz , Colter Wichern , Jeffrey Marbach","doi":"10.1016/j.crmic.2025.100089","DOIUrl":"10.1016/j.crmic.2025.100089","url":null,"abstract":"<div><div>A 79-year-old male with coronary artery disease (CAD) and drug-eluting stents (DES) to the right coronary artery (RCA) and left anterior descending (LAD) artery (2001). A decade later, catheterization for angina showed mid-RCA chronic total occlusion (CTO) with left-to-right collateral flow and 30 % LAD in-stent restenosis (ISR), managed medically. He re-presented with angina, and repeat angiography revealed similar LAD ISR. Functional assessment with CathWorks FFRangio and invasive instantaneous wave-free ratio (iFR) was discordant but confirmed hemodynamically significant ISR due to an under-expanded, fractured LAD stent on intravascular ultrasound (IVUS). This case illustrates angiographic-functional discordance and the value of multimodal assessment.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680184","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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