European Heart Journal: Case Reports最新文献

Background: Coronary artery aneurysm with arteriovenous fistula is extremely rare. Here we present a novel iatrogenic case of a left circumflex coronary artery (LCX) to coronary sinus fistula after mitral valve replacement (MVR).

Case summary: A 47-year-old woman with a history of MVR was diagnosed with an iatrogenic aneurysmal fistula from the LCX to the coronary sinus, causing dyspnoea. Surgical intervention included degenerated mitral and aortic valve replacement, tricuspid valve repair, and fistula ligation. Post-operative recovery was uneventful, with improved symptoms and stable cardiac function on follow-up.

Discussion: This case highlights the diagnostic and therapeutic challenges associated with arteriovenous fistula, particularly when they arise secondary to prior cardiac surgery. Given their rarity and potential for serious complications, early recognition and multidisciplinary planning are essential.

Background: Residual shunts after tetralogy of Fallot (TOF) repair are rare and can stem from residual defects, unrecognized VSDs, or, rarely, acquired coronary cameral fistulas (CCFs). Correctly distinguishing these is vital since treatments differ.

Case summary: Two paediatric cases following TOF repair are described: one shows features of an acquired CCF with continuous flow from the coronary artery into the right ventricle. Because of the low shunt fraction, asymptomatic presentation, and lack of guidelines for definitive treatment, the patient is managed conservatively with regular monitoring. The other case, though asymptomatic, demonstrates a significant residual VSD with holosystolic flow; increased pulmonary blood flow and a significant shunt on cardiac catheterization indicate the need for catheter closure.

Discussion: Acquired CCF is a rare, usually asymptomatic complication managed conservatively, while residual VSDs may cause significant haemodynamic issues requiring intervention. Echocardiography, assessing flow timing, jet origin, and haemodynamics, is key for differentiation.

[This corrects the article DOI: 10.1093/ehjcr/ytaf266.].

Background: Morquio syndrome (MPS IV) is a rare multi-systemic disorder with significant cardiovascular implications, including early-onset valvular disease. Due to the improved life expectancy, these patients could require complex interventional solutions such as TAVI-in-TAVI procedure.

Case summary: We present the first reported case of a 65-year-old woman with Morquio syndrome undergoing a TAVI-in-TAVI procedure for structural degeneration of a prior transcatheter bioprosthetic valve. The procedure was technically challenging due to complex thoracic anatomy, small aortic annulus, and intermediate-risk of coronary obstruction. A self-expanding Evolut FX + valve were successfully implanted with favourable haemodynamic outcomes and no major complications.

Conclusion: This case highlights the feasibility and importance of individualized planning in complex redo-TAVI interventions in patients with rare congenital disorders.

Background: Reninoma, a rare juxtaglomerular cell tumour, causes secondary hypertension due to renin hypersecretion. Despite characteristic biochemical features (hypertension, hypokalaemia, and elevated renin-angiotensin-aldosterone system activity), diagnostic challenges persist due to its rarity and phenotypic heterogeneity.

Case summary: We reported two young males with surgically cured hypertension secondary to renin-secreting juxtaglomerular cell tumours. Both presented with refractory hypertension and hypokalaemia. They exhibited discordant renin levels but shared concordant imaging findings. Post-operative pathological immunohistochemistry definitive confirmed reninoma.

Discussion: Our cases highlight the diagnostic challenges of reninoma. In hypertensive patients with hypokalaemia, reninoma should be considered despite its rarity. Normal plasma renin activity cannot definitively exclude reninoma. We recommend plasma renin concentration testing alongside multimodality imaging-contrast-enhanced computed tomography (CT), magnetic resonance imaging, and contrast-enhanced ultrasound to facilitate diagnosis. Both cases were ultimately confirmed by definitive immunohistochemical pathology.