Cardiovascular Revascularization Medicine: Interesting Cases最新文献

Objectives

This is a case report describing technical challenges due to the presence of a right atrial filamentous structure during implantation of septal occluder in a patient with cryptogenic stroke and patent foramen ovale (PFO).

Background

The association of patent Foramen ovale (PFO) and cryptogenic ischemic stroke in young patients has been well described. Eustachian valve remnants (also variably and rather interchangeably referred to as Chiari network in the literature) are vestigial remnants of the sinus venosus and it is often associated with PFO and atrial septal aneurysm. Such filamentous structures can interfere during right heart procedures. Careful peri-procedural evaluation with transesophageal echocardiography (T.E.E) or Intracardiac echocardiography (I.C.E) can help identify and prevent inadvertent complications.

Conclusion

Peri-procedural intracardiac imaging is the cornerstone in identifying right atrial filamentous structures during right heart structural procedures, electrophysiology procedures etc. Such guidance and previously described “Pull-Push” technique can avoid undue complications.

A 76-year-old man with severe symptomatic aortic stenosis with low surgical risk underwent Transcatheter Aortic Valve Replacement (TAVR). This was complicated by avulsed native aortic valve leaflet posing a unique management dilemma. Following extensive multi-disciplinary valve team (MDT) discussion, TAVR valve was explanted, and surgical aortic valve replacement was performed.

The Conquest Pro 12 Sharpened Tip (CP12ST) is a novel guidewire used in intervention for coronary chronic total occlusion, with strong penetration force for hard plaques. Antegrade dissection and reentry techniques using the CP12ST have been reported, and their success and safety have been established. This report describes successful retrograde dissection and reentry using the CP12ST under intravascular ultrasound guidance in a situation in which reverse controlled antegrade and retrograde tracking was difficult to perform.

A 78-year-old man with angina and ischemic cardiomyopathy presented for LAD CTO PCI. After several failed techniques, the LAD was recanalized with subintimal tracking and reentry (STAR) with subsequent balloon angioplasty of the false lumen. No stent was deployed and the patient did not follow-up for 10-months for definitive PCI. On follow-up, IVUS findings suggested the presence of a new external elastic lamina in the false lumen (side-by-side to the true lumen), indicating favorable healing. PCI was performed with an excellent angiographic result. Our case highlights a mechanism of vascular healing following dissection and re-entry-based recanalization of an LAD CTO.

We describe a case of sub-adventitial hematoma of the ascending aorta at the level of the crown of supra-annular TAVR presenting 4 months post procedure. Acute aortic syndromes following TAVR portend grave prognosis and warrant emergent reconstructive surgery. However, the less known, chronic aortic complications may have an indolent presentation. Our patient underwent aortic reconstructive surgery with TAVR explant and bio-prosthetic AVR implantation and had a favorable outcome.

Rotational atherectomy (RA) is a necessary procedure for severely calcified lesions. We describe for the first time a case of RA through the left upper limb into LIMA to LAD in a last remaining vessel.

A 38-year-old male presented with recurrent myocardial infarction (MI). Subsequent investigations led to the diagnosis of essential thrombocytosis (ET) with a positive JAK2-V617F mutation. ET should be ruled out in young patients presenting with MI, even in the presence of typical cardiac risk factors.

Rheumatic mitral stenosis has a large patient base and a certain incidence in developing countries. Percutaneous balloon valvuloplasty is one of the main treatments for such patients, but this method is limited by the degree of mitral regurgitation. Here, we describe a 74-year-old patient with rheumatic mitral stenosis without calcification observed by transthoracic echocardiography and computed cardiac tomography, and no calcification was found in the mitral annulus. The score of Society of Thoracic Surgeons was 14.2%, with Wilkins score of 12. Under the guidance of 3-dimensional printing technology, transcatheter mitral valve replacement was successfully performed. Before discharge, the stability and function of the bioprosthesis were confirmed.

We present a case of symptomatic left anterior descending (LAD) artery to right ventricle fistula formation, following orthotopic heart transplant. Closure of the shunt with a covered stent in the LAD was a satisfactory initial management strategy, however long-term is limited by recurrent severe in-stent restenosis. The etiology, as well as the best long-term management strategy for this unusual complication is not well defined.