European Heart Journal: Case Reports最新文献

Background: Bocavirus monoinfection-related acute myocarditis is an aetiology that has rarely been described in the literature.

Case summary: A 36-year-old male, with no significant medical history, presented to the emergency department with a 4-day history of dyspnoea, haemoptysis, left-sided chest pain, and high-grade pyrexia. The initial investigations revealed a raised troponin T, raised C-reactive protein, and a normal electrocardiogram. A comprehensive microbiological and virological work-up (testing for 14 viruses and bacteria) detected human bocavirus (HBoV) DNA monoinfection. Cardiac magnetic resonance imaging showed left ventricular ejection fraction of 48%, with subepicardial late gadolinium enhancement. Other imaging modalities (chest X-ray, echocardiography, computed tomography pulmonary angiography, and bronchoscopy) revealed no other causative pathology. The patient was treated with anti-inflammatory medications and left ventricle remodelling therapy. He had a good clinical outcome. Moreover, a collateral history revealed that the patient's infant had presented with a severe respiratory illness, which was felt to be of viral aetiology, several days prior to the patient's own onset of symptoms.

Discussion: To our knowledge, this is the fourth case of HBoV-related acute myocarditis in an immunocompetent adult. This case also displays new clinical features for HBoV infection-haemoptysis, high-grade pyrexia, and a potential for vertical transmission from infants.

Background: The differential diagnosis of tricuspid masses remains challenging.

Case summary: This case involves the incidental detection of a lesion with a non-solid appearance, exhibiting the characteristic 'finger-in-glove' and 'garland-like' morphology, resembling a blind-ended protrusion of the tricuspid leaflet. This presentation is consistent with a tricuspid valve aneurysm, without significant associated stenosis or regurgitation.

Discussion: Given the lesion's morphological features, the patient's asymptomatic status, and the absence of a precipitating event suggestive of an alternative diagnosis, we concluded that the most likely diagnosis is aseptic tricuspid valve aneurysm. Following a multidisciplinary heart team discussion, surgical intervention was deemed unnecessary.

Background: Infective endocarditis (IE) predominantly involves the cardiac valves. Timely diagnosis and initiation of therapy significantly reduce morbidity and mortality. Infective endocarditis presenting as a large left ventricular outflow tract (LVOT) mass is an atypical manifestation that provides significant challenges to the treating team.

Case summary: A 19-year-young male presented with exertional shortness of breath, palpitations, and presyncope for 4 months with constitutional symptoms for the last 6 months. Two-dimensional echocardiogram showed a large LVOT mass arising from the mitral aortic intervalvular fibrosa causing dynamic severe aortic valve obstruction, moderate aortic regurgitation, and severe mitral regurgitation. He was managed on lines of IE and received intravenous antibiotics. In view of worsening heart failure and cardiogenic shock, he underwent mass excision, mechanical aortic valve replacement, and mitral valve repair. Histopathology confirmed it as vegetation. He was discharged and is doing well at 2-month follow-up.

Discussion: An atypical presentation of IE as a large LVOT mass was observed in this young male. Sound clinical judgement, judicious use of ancillary imaging, and a multidisciplinary approach ensured timely diagnosis and appropriate treatment. Management included appropriate intravenous antibiotics followed by surgery.

Background: The SGLT2 inhibitor empagliflozin has recently gained approval for treating heart failure (HF) across the entire spectrum of ejection fractions including heart failure with preserved ejection fraction (HFpEF). Bradycardia-induced HF, previously described in the literature as bradycardiomyopathy, is an uncommon cause of HFpEF.

Case summary: Herein, we describe a case of a young, 32-year-old woman with no prior medical history who was referred to the hospital due to progressive fatigue and exercise intolerance. She exhibited junctional bradycardia and sinus node dysfunction on electrocardiographic examination, was hypotensive, and had significantly elevated NT-proBNP levels at admission. Transthoracic echocardiographic examination (TTE) revealed preserved systolic function of the left ventricle with segmental abnormalities of contractility and reduced global longitudinal strain, indicative of HFpEF. Cardiac magnetic resonance imaging showed hypertrabeculations, suggesting noncompaction cardiomyopathy (NCCM), even though the definitive diagnostic criteria for NCCM were not met. The patient reported no recent episodes of fever and no chest pain. A comprehensive panel for cardiotropic viruses and Lyme disease were negative while infiltrative diseases such as sarcoidosis were clinically ruled out. Coronary angiography excluded coronary artery disease. Due to profound hypotension and bradycardia, we prescribed empagliflozin and theophylline. At the subsequent follow-up visit within 1 month, the patient reported that she was asymptomatic, with restored sinus rhythm, and complete normalization of NT-proBNP values.

Discussion: Bradycardia-induced HFpEF is a rare entity that can limit the use of most cardiovascular pharmacotherapies but can be successfully treated with empagliflozin and theophylline as demonstrated in our case.

Background: Takayasu arteritis (TAK) is a systemic non-inflammatory vasculitis that primarily affects large- and medium-sized arteries.

Case summary: We report the case of a 57-year-old woman with a history of coronary artery bypass grafting (CABG) 7 years prior, who was referred for a stress echo due to chest pain. Transthoracic echocardiography revealed the left ventricle at the upper limits of normal with preserved contractility, as well as circumferential thickening of the aortic root, causing severe aortic regurgitation (AR). Cardiac computed tomography and angiography demonstrated diffuse thickening of the aortic wall from the aortic root to the descending thoracic aorta, extending to the left carotid artery and significant stenosis of the left subclavian artery. Coronary angiography showed severe narrowing of the left main coronary ostium with ostial stenosis and total occlusion of the right coronary and left internal mammary arteries. Magnetic angiography highlighted thickening of the aortic wall, while no active inflammation was detected on positron emission tomography. These findings suggested Takayasu aortitis with chronic inflammation.

Discussion: In young patients, particularly women, who present with angina and coronary ostial stenosis, Takayasu arteritis should be considered in the differential diagnosis. Aortic regurgitation (AR) is a serious complication, and its surgical management can be challenging.

Background: Behçet's disease is an inflammatory condition, caused by vasculitis of big and small veins and arteries in which, although vascular inflammation is the basis of disease, cardiac involvement is rare. We present a rare case of a man, affected by Behçet's disease, with pulmonary embolism due to a floating thrombus in the right ventricle.

Case summary: We report a case of a 36-year-old man admitted to emergency department due to dyspnoea and haemoptysis. He had already been diagnosed with Behçet's disease, and he was in therapy with low doses of azathioprine and prednisone from three months. Thorax CT scan detected pulmonary embolism with pulmonary infraction. No evidence of deep vein thrombosis was found. The echocardiogram pointed out a floating mass of at least 30 mm in the right ventricle. Cardiac magnetic resonance confirmed the diagnosis of right ventricle thrombosis. On the hypothesis of an inflammatory genesis of the thrombosis, immunosuppressive drugs and anticoagulation with vitamin K antagonist were prescribed. The patient underwent echocardiograms every 3 weeks, and the mass disappeared 5 months later.

Discussion: Behçet's disease is a systemic inflammatory disorder that often affects vessels and rarely the heart. Thrombosis can be the only clinical feature of primary or relapsing events with also atypical origin site. Thrombosis suggests a high inflammatory status that needs to be balanced with the right immunosuppressive therapy, associated to anticoagulation.

Background: Blood culture-negative endocarditis (BCNE) is a significant condition associated with cardiac vegetation. It often occurs alongside sepsis, auto-immune diseases, or malignancies, posing a risk of vegetation and embolization. Notable pathogens include Haemophilus species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species.

Case summary: A 60-year-old white male Belgian patient presented with worsening dyspnoea. His recent medical history included chronic infections over the past 6 months. Transthoracic echocardiography revealed severe aortic stenosis with an 18 × 12 mm vegetation. Despite normal inflammatory markers and negative blood tests, 18F-fluorodeoxyglucose positron emission tomography with computed tomography excluded malignancy but identified multiple bilateral septic lung emboli. Sputum cultures and tuberculosis polymerase chain reaction (PCR) were negative. Facing the high risk of cardiac embolization and the need for aortic valve replacement, surgery was scheduled with an intraoperative bronchoalveolar lavage (BAL) to investigate the lung lesions. Intraoperative findings confirmed valvular lesions, and a biological aortic valve was successfully implanted. The post-operative course was uneventful. Aortic valve cultures and eubacterial PCR results were negative, but BAL cultures were positive for Haemophilus influenzae, indicating a chronic infection. The patient showed favourable progress at 6 months post-surgery with ongoing antibiotherapy.

Discussion: This case illustrates a rare BCNE associated with large vegetation and symptomatic H. influenzae chronic respiratory tract colonization (CRTC). For BCNE cases with negative sputum cultures and suspected bacterial CRTC, we recommend performing BAL cultures for accurate diagnosis.

Background: Coronary artery aneurysms (CAAs) are uncommon and can cause complications such as thrombosis, vessel rupture, or distal embolization. Rarely, CAAs are classified as 'giant', although the defining diameter is debated. The predominant cause of CAAs is atherosclerotic disease. Independently, CAAs constitute an estimated 5-year survival of 71%.

Case summary: We report the case of a 56-year-old female who presented 20 years ago with a chest infection when a murmur was auscultated on examination. Subsequently, a coronary angiogram was performed, demonstrating an extensive aneurysm of the right coronary artery (RCA). The aneurysmal segment of the RCA was resected, and a length of saphenous vein was utilized in its reconstruction. Twenty years later, the patient re-presented with dyspnoea, indicating repeat investigations; coronary angiography demonstrated a vein graft 20 years post-reconstruction that is almost indistinguishable from a native RCA.

Discussion: The optimal management strategy for CAAs is debatable, and there are no clear guidelines. However, surgical management is generally preferred in cases of GCAAs, which was also the case for this patient. This reconstruction procedure, involving resection of the aneurysmal segment of the RCA and reconstruction with a saphenous vein graft, proved to be a durable and reliable approach, with the saphenous vein graft remaining patent for over 20 years. The 20-year follow-up provides valuable insight into the long-term durability of surgical intervention, allowing for comprehensive assessment of the durability and reliability of this procedure.

Background: The coexistence of aortic stenosis (AS) and neoplastic pathology are common due to shared risk factors with atherosclerotic disease, such as diabetes, inflammatory conditions, and smoking. Severe AS in patients with cancer requires careful assessment in order to select the appropriate therapeutic choices and their timing (i.e. valve treatment first vs. cancer treatment first).

Case summary: A 66-year-old woman with a history of smoking was admitted to our centre due to heart failure (HF). During her hospitalization, severe AS with severe ventricular dysfunction and cancer were documented. Because of her severe heart disease, she was unable to receive antineoplastic treatment. Therefore, she underwent percutaneous surgery to treat the aortic valve. After that, the management of cancer became possible, which included bilateral radical mastectomy and chemotherapy.We are presenting a case of cancer coexisting with aortic stenosis and reduced left ventricle ejection fraction. In this case, we performed Transcatheter Aortic Valve Replacement (TAVR) with the aim of improving the ejection fraction, followed by chemotherapy.

Discussion: Cancer patients may be further disadvantaged by AS if it interferes with their treatment by increasing the risk associated with oncologic surgery and compounding the risks associated with cardiotoxicity and HF. Clinical trials and guidelines on TAVR exclude cohorts with limited life expectancy. Hence, the correct and optimal care for cancer patients with severe AS is complex. The TAVR, for cancer patients with severe AS, can more frequently be the best clinical choice by avoiding cardiopulmonary bypass, minimal invasiveness, and therefore, shorter recovery time.