European Heart Journal: Case Reports最新文献

Background: Temporary pacemaker lead implantation is a common low-risk procedure, but can occasionally get complicated by infections, arrhythmias, thromboembolic events, and perforation of the vessel or the heart. However, intracardiac knotting of the temporary pacemaker lead has been rarely reported. This could lead to vascular or valvular injury, pneumothorax, symptomatic loss of pacing or haemodynamic compromise, and difficult lead removal.

Case summary: We are reporting a case of twice twice-knotted temporary pacemaker lead, which to our knowledge has not been reported before. The two knots in the transjugularly inserted temporary pacemaker lead, via a 6F venous sheath made it difficult to retrieve it.

Discussion: We decided to snare the knotted TPI into the inferior vena cava, and then retrieve it via a large-size femoral sheath, thus avoiding the need for a venotomy or any surgical intervention.

Background: Respiratory muscle function can be affected in patients with heart failure. Ultrasound can be used to assess diaphragm, the main inspiratory muscle. Speckle tracking imaging is an imaging technology providing the evaluation of tissue deformation during contraction. We aimed to evaluate the contribution of traditional echography and 2D speckle tracking imaging in the evaluation and monitoring of patients with acute heart failure (AHF).

Case summary: We report a series of four cases of AHF. Diaphragm ultrasound coupled with diaphragm 2D speckle tracking imaging was performed at admission and after decongestive therapy, in cardiac intensive care unit. Patients, at admission, disclosed higher diaphragm 2D strain value and higher diaphragm inspiratory motion value in the context of higher cardiac loading that significantly decrease after decongestive therapy, except for one patient. Diaphragm motion remained less than 10 mm (weakness), despite medical therapy in Cases 2, 3, and 4. Among them, 3 months later, one patient (Case 3) experienced an episode of AHF.

Discussion: Diaphragm ultrasound coupled with diaphragm 2D speckle tracking imaging is feasible and may be used to monitor respiratory status patients with AHF.

Background: The quadricuspid pulmonary valve (QPV) is a relatively rare heart congenital anomaly. It is usually asymptomatic and incidentally detected.

Case summary: A 52-year-old woman presented with paroxysmal palpitations and chest tightness after exertion. After a series of examinations, we finally diagnosed her with QPV and pulmonary hypertension. The symptoms have improved significantly with medications, and subsequently, the patient was discharged.

Discussion: This case demonstrated the crucial role of multimodality imaging in evaluating the non-invasive depiction of pulmonary valve disease.

Background: Drug-eluting therapies remarkably reduce the incidence of restenosis and have revolutionized endovascular strategies for femoropopliteal lesions in patients with peripheral artery disease, nevertheless, concerns have arisen over the risk of aneurysmal degeneration after using an Eluvia polymer-based drug-eluting stent (DES).

Case summary: We present a case of an 80-year-old male who developed a giant aneurysm long-term after Eluvia implantation. He noticed a pulsatile mass in his thigh without any decrease in the ankle-brachial index 27 months after subintimal DES placement for superficial femoral artery (SFA) chronic total occlusion. Duplex ultrasonography (DUS) showed a giant cavity outside the vessel and a to-and-fro flow between the cavity and the SFA at the Elvia stents overlapped in the subintimal space. Endovascular-covered stents successfully sealed the cavity and reduced the size of the aneurysm at follow-up DUS.

Discussion: The aneurysmal degeneration, the so-called 'low echoic area' around the stent by ultrasound, is a relatively common finding after Eluvia DES implantation. It is thought to have little association with clinical events up to 2 years, however, the nature of this phenomenon remains unclear, and some cases present with clinical worsening. In this case, the development of a giant aneurysm could be induced by the overlapping stent not only by the local drug and polymer overdose but also by the increased mechanical force exerted against the fragile outer wall of the subintimal structure.

Background: Computed tomography (CT) assessment is the standard for predicting coronary obstruction (CO) caused by sinus sequestration (SS) during transcatheter aortic valve (TAV) implantation in degenerated TAV (TAV-in-TAV) procedure, but it may not always be accurate. This report describes a prediction method for CO by using balloon aortic valvuloplasty (BAV) during TAV-in-TAV.

Case summary: An 87-year-old woman with a history of balloon-expandable transcatheter heart valve (BE-THV) implantation 7 years prior was admitted with worsening dyspnoea. Echocardiography revealed severe THV deterioration, and CT confirmed calcium proliferation in the THV. Our heart team decided to perform a TAV-in-TAV procedure using a 23-mm BE-THV. Preoperative CT imaging indicated an intermediate risk of CO. To evaluate CO risk more precisely, the top of a 20-mm balloon was positioned near the top of a BE-THV stent and inflated, followed by simultaneous aortic root injection (SARI). During SARI, contrast flowed into both coronary arteries, predicting a low risk of CO. Based on these findings, TAV-in-TAV was performed without coronary protection. The procedure was completed successfully without CO. After the procedure, the patient's symptoms improved, and echocardiography showed normal valve function. She was discharged without complications and remains under outpatient follow-up care.

Discussion: The diagnostic method for predicting CO using BAV with SARI could serve as a valuable adjunctive diagnostic tool in patients with an intermediate or high risk of SS anatomy after TAV-in-TAV. In such cases, this method may provide additional insights concerning precise CO risk and the indication of leaflet modification technique during TAV-in-TAV.

Background: Coronary artery pseudoaneurysm (PSA) is a rare occurrence linked to percutaneous coronary interventions (PCIs), infection, or chest trauma, lacking established management guidelines due to its low incidence.

Case summary: A 78-year-old male with a medical history of triple vessel disease, post coronary artery bypass grafting, heart failure, and chronic obstructive pulmonary disease, presented with intractable left-sided chest pain following a mechanical fall. The initial workup was positive for mildly elevated high-sensitivity troponin and brain natriuretic peptide raising suspicion for a pulmonary embolism; but chest computed tomography angiography revealed an enlarging pericardial haematoma. Further computed tomographic coronary angiography exposed a mid-left anterior descending (LAD) interrupted segment concerning for a contained ruptured PSA. Left heart catheterization confirmed the suspicion, showing a collection of contrast at the haematoma site following injection of contrast into the saphenous vein graft to the diagonal artery. The patient underwent percutaneous PSA coiling, successfully occluding blood inflows from both the first diagonal and distal LAD. There were no subsequent electrocardiogram changes or further elevation in troponin levels ensuring the integrity of the LAD vital branches.

Discussion: Coronary PSA results from the dissection of at least one layer of the vessel wall leading to blood extravasation. Although they are usually associated with PCI complications, the absence of haemopericardium in prior imaging makes the recent blunt chest trauma the most likely cause of this patient's presentation. Percutaneous coiling of inflow vessels to PSAs proved to be a suitable option in this case of a patient with a history of sternotomy and an expanding pericardial haematoma.

Background: Heterophile antibody presence confounds troponin assay results, causing falsely elevated troponin levels. This rare phenomenon is an important differential to consider when evaluating patients with suspected acute coronary syndrome. We present a case series of three patients with similar clinical presentations where the presence of heterophile antibodies was confirmed.

Case summary: We reviewed three patients from our hospital who presented with chest pain in a 12-month period. All patients were males aged 50-70. All patients had elevated troponin, and there was clinical concern for acute coronary syndrome in two patients. Two patients underwent coronary angiography during admission, and the third had a recent angiogram within the last 6 months. No obstructive lesions were found, and no alternative diagnoses were identified. Ultimately, the presence of heterophile antibodies was confirmed in all three patients.

Discussion: Heterophile antibody presence is an important differential to consider in patients with unexplained troponin elevation. Once the presence of heterophile antibodies is confirmed, this aids in clinician decision-making and helps to guide investigations and treatment in future.