IHJ Cardiovascular Case Reports (CVCR)最新文献

Brugada-type electrocardiographic pattern (BTEP) is caused by inherited sodium channelopathy of the cardiomyocyte which can be augmented in fever. We are reporting the first case series of BTEP unmasked by dengue fever in Malaysia. Detecting BTEP is crucial in regions where both dengue fever and Brugada syndrome is prevalent.

Sudden cardiac death is the final event caused in several cases by ventricular arrhythmias. Transvenous implantable cardioverter-defibrillators have been the standard therapy for the prevention of sudden cardiac death. The most frequent complications associated with TV-ICD is related to intracavitary electrodes. S-ICD has been developed as an alternative system. Novel S-ICD device in prevention of SCA was implanted in 8 patients with an average follow up period of 2.5 years. Bleeding and inappropriate shock was reported in one patient. Appropriate shock for ventricular tachycardia was observed in 5 patients. There was no death reported in any of the patients.

A 30-year-old lady with severe Rheumatic Mitral stenosis underwent PTMC. Despite a good result, echocardiogram on post-op day one showed a mobile mass attached to the mitral chordae causing diagnostic dilemma between a thrombus and damaged chordae, despite undergoing a cardiac MR to assess the nature of the mass. However, the mass disappeared after 4 weeks of receiving oral anticoagulation, favouring the diagnosis of a thrombus on MV apparatus.

Push up induced brachial artery pseudo aneurysm (BAPA) in the antecubital fossa is rare. When there is involvement of the ulnar and radial artery, percutaneous closure using thrombin is preferred to surgery or covered stent. A 52-year-old man, known hypertensive on angiotensin receptor blocker, presented with a giant right antecubital fossa pseudo aneurysm after a push-up exercise. The neck of the aneurysm was located where the brachial artery was dividing into UA and RA. Ultrasound guided neck compression had no effect. A staged direct thrombin injection thrombosed the sac. A follow period of 15 months showed normal flow in the BA, RA, and UA.

Wellen's sign occurs due to either critical stenosis in the proximal left anterior descending artery (LAD) or coronary steal phenomenon. Here we report a case of a 57-year-old gentleman with anomalous origin of the right coronary artery from mid LAD, where both these phenomena contributed together leading to Wellen's sign.

We present the case of a 23 year old male, marijuana smoker, who suffered acute anterior wall MI. OCT study revealed red thrombus with adequate minimum lumen area in LAD, which was managed with DAPT. Repeat OCT study revealed complete resolution of thrombus with underlying plaque erosion.

Electrical alternans i.e., beat to beat of variation of QRS amplitude has been classically described in pericardial tamponade. Rarely, alternative causes are found in patients with QRS alternans. We report a case of atypical electrical alternans in a middle-aged female in the absence of pericardial effusion. A careful analysis of QRS complexes in our case suggested a unique pattern of alternans varying with respiratory movements instead. On evaluation, we found large left sided pleural effusion as the key underlying mechanism of the atypical alternans.

Iatrogenic aortocoronary dissection is a scarcely reported complication of cardiac catheterization, which can be fatal if not managed promptly. We present a case of extensive aortocoronary dissection extending into aortic arch in a patient undergoing primary percutaneous coronary intervention (PCI) of right coronary artery (RCA) and its successful percutaneous management.

Transcatheter aortic valve replacement (TAVR) is now the standard of therapy for elderly population with severe aortic stenosis. Several studies have established that the outcomes of TAVR are superior when compared with Surgical aortic valve replacement (SAVR), especially when the access route is transfemoral arterial approach. In the elderly population with advanced age and numerous comorbidities, iliofemoral arterial disease (IAD) is not uncommon and it precludes the use of this route for TAVR. Peripheral Intravascular lithotripsy (IVL) has been previously established as an excellent safe and efficient modality to treat symptomatic occlusive calcific iliofemoral artery disease. The same principle of IVL has been recently used successfully to modify the vascular compliance of heavily calcified iliofemoral arteries thereby enabling large bore sheath advancement and safe passage of TAVR delivery catheter systems.

We report the first case of Intravascular lithotripsy facilitated Transfemoral TAVR (TF-TAVR) in India. This case was done in December 2020 by the “femoral route” in order to keep the TAVR procedure simple straightforward and discharge the patient back home quickly in Covid times. The use of Intravascular Lithotripsy (IVL)was based on evidence of good outcomes in trials of peripheral vascular disease of lower limbs as well as from the good outcomes of few registries on IVL facilitated TAVR.^{1,2,3,4,5,6,8} The second case was done in August 2021 by us for another patient successfully.

Left main coronary artery atresia (LMCAA) is a rare coronary anomaly. Usually they present with myocardial ischemia/infarction, heart failure, syncope due to ventricular arrhythmias or sudden death. Diagnosis is confirmed by CT or invasive coronary angiography. We are presenting two cases of LMCAA, who underwent off-pump coronary artery bypass surgery.