IHJ Cardiovascular Case Reports (CVCR)最新文献

An 84-year-old patient with St Jude Medical Endurity TM 2140 DDDR PPM presented with episodes of palpitations and syncope of 1-month duration. In the hospital, he was detected to have PMT. The tachycardia was initiated by a prolonged AV delay due to active VIP TM algorithm. The pacemaker EGMs at the time of syncope showed that the PMT was followed by a fast VT. The VT terminated spontaneously. The VIP TM algorithm was made inactive and the PVARP was increased from 275 ms to 350 ms. He has had no further episodes of PMT or VT over a 15-month period.

A congenital coronary arteriovenous fistula is a communication between a coronary artery branch and any of the four cardiac chambers or even coronary sinus, superior vena cava, pulmonary artery, or pulmonary veins as well. This anomaly can be divided into two main categories: coronary artery-ventricular multiple micro-fistulas (MMFs) and solitary small or large macro fistula. Herein, we present a case of ventricular MMFs associated with apical hypertrophic cardiomyopathy and a case of solitary macro-fistulas originated from left circumflex coronary artery to the coronary sinus.

Coronary cameral fistulas (CCFs) should be considered as a differential diagnosis in apical HCM cases presenting with chest pain and echocardiography could have a promising role in this context. Meanwhile a large solitary coronary cameral fistula can present as continuous murmur in asymptomatic adults or even babies as well.

Restrictive cardiomyopathy (RCM) is an uncommon form of cardiomyopathy and is characterized by impaired ventricular filling due to increased myocardial stiffness. In India, RCM is frequently observed in the young and endemic endomyocardial fibrosis is seen in a significant number of cases. We report a case of 15-year-old boy who presented with such a treatable cause of heart failure. On 2D Echocardiography we observed signs of restrictive cardiomyopathy (RCM) and severe mitral and tricuspid regurgitation. RCM is an uncommon form of cardiomyopathy and is usually associated with a poor prognosis. Genetic workup revealed myeloid neoplasm with eosinophilia. Eosinophilic cardiomyopathy is an infrequently reported entity.

We describe a rare surface electrocardiogram (EKG) recorded sinus beat initiation of permanent junctional reciprocating tachycardia in a 40-year old female with structurally normal heart presenting with incessant tachycardia over last 48 hours refractory to intravenous amiodarone infusion. Our case is an interesting illustration of sinus beat initiation of PJRT which has been rarely reported.

Percutaneous coronary intervention for anomalous right coronary artery arising from the left sinus of Valsalva poses technical challenges in cannulation due to its unusual location, non-circular orifice and course. We describe a series of cases here with the novel use of Ikari Left guide catheter (ILGC).

Aim

The number of patients with cardiovascular implantable electronic devices (CIEDs) attending radiation oncology department is increasing day by day. We are writing to discuss our experience and difficulties in handling this cohort of patients and our workflow, which is enabling us to handle the situation with ease.

Methods

All the patients with CIED, treated in the past three years in our radiotherapy department were included in our analysis. The data were taken from their planning images and documentation in the case sheets. The dose to the pacemaker was recorded from the planning CT scans. The cases in which the CIEDs were not included in the planning scans had an in vivo dosimetry done using EBT3 Gaffchromic films to measure the scattered dose. The patient characteristics including their dependency on the CIEDs were also recorded from the records.

Results

We have treated 15 patients with implanted pacemakers and one patient with an ICD in the past 3 years. The dose range was between 30 Gy and 66 Gy. 5 patients had in vivo measurement of the scattered dose using Gaffchromic EBT-3 films. We did either re-planning or modification, if the dose was more than 2 Gy. For the lone patient with ICD, the sensing mode was deactivated using a magnet every day and during treatment crash cart was kept stand by.

Conclusion

Radiotherapy for patients with an implanted pacemaker or an ICD can pose difficulties in small radiotherapy facilities. None of our patients had any recordable events during and after radiotherapy. There is a need for a better understanding of the CIEDs and the possible interferences during radiotherapy.

Post-transplant cardiac rehabilitation reduces major adverse cardiac events and improves long-term survival but is nonexistent in India. This case series shows that cardiac rehabilitation improves health-related behaviour, health-related quality of life and functional capacity in heart transplant recipients and could potentially be considered in the routine management of this growing population in India.

The subintimal transcatheter withdrawal (STRAW) technique is a very useful for chronic total occlusion recanalization to compress hematoma when it forms during antegrade dissection and re-entry. We describe a simple and effective technique called STRAW with sustained negative pressure. This technique may potentially address the shortcomings of the conventional STRAW.

Coronary artery fistulas are rare congenital or acquired cardiac abnormalities that are often asymptomatic. Small coronary artery fistulae are not uncommon, detected incidentally and require no treatment. Symptomatic and/or hemodynamically significant coronary artery fistulas must be considered for closure. This report describes the treatment of a proximal coronary artery fistula between the left anterior descending artery and the pulmonary artery in a 66-year-old female patient, who presented with shortness of breath on exertion. Percutaneous intervention was successfully completed with vascular coils.

The measurement of pulmonary artery pressure is critical in staged palliation of the univentricular heart. Pulmonary atresia presents various challenges in accurate measurement of pulmonary pressures. We report the application of the pressure wire and fractional flow reserve system in this subset of patients.