Moon-Kyung Jung, Hwan Wook Kim, K. S. Beck, Y. Sung, M. Jung
Pulmonary thromboembolism and active hemoptysis represent distinct yet critical emergencies necessitating immediate intervention. However, the treatment protocols for these conditions—anticoagulation therapy and hemostatic therapy—often pose a dilemma. We present the case of a 25-year-old female who presented to our emergency room with hemoptysis and a concurrent diagnosis of pulmonary thromboembolism. Due to persistent active hemoptysis, we temporarily paused anticoagulation and opted for surgical pulmonary thrombectomy, enabling the safe resumption of anticoagulation therapy. Hemoptysis occurring in pulmonary thromboembolism is infrequently reported in the literature, and established treatment guidelines for such cases are lacking. This case could provide guidance on how to handle the intricate treatment challenges posed by concurrent hemoptysis and pulmonary thromboembolism.
{"title":"Managing a Patient with Pulmonary Thromboembolic Disease Presenting with Active Hemoptysis: A Case Report","authors":"Moon-Kyung Jung, Hwan Wook Kim, K. S. Beck, Y. Sung, M. Jung","doi":"10.1093/ehjcr/ytae353","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae353","url":null,"abstract":"\u0000 \u0000 \u0000 Pulmonary thromboembolism and active hemoptysis represent distinct yet critical emergencies necessitating immediate intervention. However, the treatment protocols for these conditions—anticoagulation therapy and hemostatic therapy—often pose a dilemma.\u0000 \u0000 \u0000 \u0000 We present the case of a 25-year-old female who presented to our emergency room with hemoptysis and a concurrent diagnosis of pulmonary thromboembolism. Due to persistent active hemoptysis, we temporarily paused anticoagulation and opted for surgical pulmonary thrombectomy, enabling the safe resumption of anticoagulation therapy.\u0000 \u0000 \u0000 \u0000 Hemoptysis occurring in pulmonary thromboembolism is infrequently reported in the literature, and established treatment guidelines for such cases are lacking. This case could provide guidance on how to handle the intricate treatment challenges posed by concurrent hemoptysis and pulmonary thromboembolism.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141824696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
In this manuscript, we present an ECG that is diagnostic of short QT syndrome and ask questions regarding arrhythmia risk and possible complications regarding management.
{"title":"Long Story Short","authors":"M. Almasri, Nirbhay Parashar, J. Orcutt","doi":"10.1093/ehjcr/ytae351","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae351","url":null,"abstract":"\u0000 In this manuscript, we present an ECG that is diagnostic of short QT syndrome and ask questions regarding arrhythmia risk and possible complications regarding management.","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141827216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Which prophylaxis is senseful after contrast-induced DRESS? The role of double prophylaxis and chemical cross-reactivity","authors":"Ingrid B Boehm","doi":"10.1093/ehjcr/ytae352","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae352","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141826321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Takayasu arteritis is a large vessel vasculitis that affects the aorta and its primary branches. Myocarditis is a rare life-threatening complication and potential diagnostic pitfall in patients with Takayasu arteritis. A previously healthy 18-year-old woman presenting with fever, back pain, and dyspnea was admitted to another hospital for acute hypertension (blood pressure, 230/106 mmHg) and congestive heart failure. Intravenous methylprednisolone pulse with antihypertensive and diuretic medications slightly improved her congestion. However, she developed acute kidney injury and was transferred to our hospital. Transthoracic echocardiography indicated a left ventricular ejection fraction of 45% and diffuse left ventricular hypokinesis. Doppler ultrasound test and magnetic resonance angiography revealed severe bilateral renal-artery stenosis. Her diagnosis was Takayasu arteritis and she received high-dose glucocorticoids. She required temporary hemodialysis, but two months after admission, her serum creatinine improved to 1.1 mg/dL without surgical/cardiovascular interventions. Although the pre-discharge test with 1.5- Tesla cardiac magnetic resonance initially failed to diagnose myocarditis, 3-Tesla cardiac magnetic resonance imaging revealed increased native T1 values on T1 mapping (1283–1393 ms), moderate pericardial effusion, and systolic left ventricular wall motion abnormality, indicating active myocarditis. During 6-month subcutaneous tocilizumab treatment (162 mg/week), a left ventricular ejection fraction improved to 55–60% without a relapse. This case report highlights the benefits of early multimodal imaging tests including cardiac magnetic resonance imaging for myocarditis and renal artery involvement in Takayasu arteritis. Tocilizumab might be an efficient therapeutic option for severe acute manifestations including myocarditis in young women of reproductive age.
{"title":"Takayasu Arteritis Manifesting as Acute Kidney Injury and Congestion Due to Renal-Artery Stenosis and Myocarditis: A Case Report","authors":"Misato Hara, Shintaro Mandai, Takayasu Mori, Yasuhiro Maejima, Shinichi Uchida","doi":"10.1093/ehjcr/ytae347","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae347","url":null,"abstract":"\u0000 \u0000 \u0000 Takayasu arteritis is a large vessel vasculitis that affects the aorta and its primary branches. Myocarditis is a rare life-threatening complication and potential diagnostic pitfall in patients with Takayasu arteritis.\u0000 \u0000 \u0000 \u0000 A previously healthy 18-year-old woman presenting with fever, back pain, and dyspnea was admitted to another hospital for acute hypertension (blood pressure, 230/106 mmHg) and congestive heart failure. Intravenous methylprednisolone pulse with antihypertensive and diuretic medications slightly improved her congestion. However, she developed acute kidney injury and was transferred to our hospital. Transthoracic echocardiography indicated a left ventricular ejection fraction of 45% and diffuse left ventricular hypokinesis. Doppler ultrasound test and magnetic resonance angiography revealed severe bilateral renal-artery stenosis. Her diagnosis was Takayasu arteritis and she received high-dose glucocorticoids. She required temporary hemodialysis, but two months after admission, her serum creatinine improved to 1.1 mg/dL without surgical/cardiovascular interventions. Although the pre-discharge test with 1.5- Tesla cardiac magnetic resonance initially failed to diagnose myocarditis, 3-Tesla cardiac magnetic resonance imaging revealed increased native T1 values on T1 mapping (1283–1393 ms), moderate pericardial effusion, and systolic left ventricular wall motion abnormality, indicating active myocarditis. During 6-month subcutaneous tocilizumab treatment (162 mg/week), a left ventricular ejection fraction improved to 55–60% without a relapse.\u0000 \u0000 \u0000 \u0000 This case report highlights the benefits of early multimodal imaging tests including cardiac magnetic resonance imaging for myocarditis and renal artery involvement in Takayasu arteritis. Tocilizumab might be an efficient therapeutic option for severe acute manifestations including myocarditis in young women of reproductive age.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141825345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patients with atrial fibrillation (AF) are at increased risk for thromboembolic events including stroke. The primary source for thromboembolism in these patients is thrombus formation in the left atrial appendage (LAA). Depending on the individual thromboembolic risk, long-term anticoagulation is recommended. In certain patients however, long-term anticoagulation is contraindicated and interventional closure of the LAA (LAAC) represents an alternative approach to lower the thromboembolic risk and avoid oral anticoagulation. An 83-year-old male underwent LAAC at our center in November 2022. Prior to the procedure, a thrombus in the left atrium (LA) or LAA was excluded by transoesophageal echocardiography (TOE) and the anatomy of the LAA was assessed as eligible for LAAC with no evidence of anatomical irregularities. After contrast medium injection, angiography revealed an atypical anatomic variant of the LAA with a substantially long, elephant-trunk-like course. We present a previously not described unique anatomic variant of the LAA: the elephant trunk morphology. LAA anatomy is very heterogeneous and detailed knowledge of LAA morphology is important for endovascular LAA procedures as well as for predicting the risk of thromboembolic events. Despite thorough preprocedural imaging, anatomic variants may remain obscured.
{"title":"The elephant trunk: A rare morphology of the left atrial appendage – a case report","authors":"P. Fischer, F. Mahfoud, M. Böhm, Christian Ukena","doi":"10.1093/ehjcr/ytae334","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae334","url":null,"abstract":"\u0000 \u0000 \u0000 Patients with atrial fibrillation (AF) are at increased risk for thromboembolic events including stroke. The primary source for thromboembolism in these patients is thrombus formation in the left atrial appendage (LAA). Depending on the individual thromboembolic risk, long-term anticoagulation is recommended. In certain patients however, long-term anticoagulation is contraindicated and interventional closure of the LAA (LAAC) represents an alternative approach to lower the thromboembolic risk and avoid oral anticoagulation.\u0000 \u0000 \u0000 \u0000 An 83-year-old male underwent LAAC at our center in November 2022. Prior to the procedure, a thrombus in the left atrium (LA) or LAA was excluded by transoesophageal echocardiography (TOE) and the anatomy of the LAA was assessed as eligible for LAAC with no evidence of anatomical irregularities. After contrast medium injection, angiography revealed an atypical anatomic variant of the LAA with a substantially long, elephant-trunk-like course.\u0000 \u0000 \u0000 \u0000 We present a previously not described unique anatomic variant of the LAA: the elephant trunk morphology. LAA anatomy is very heterogeneous and detailed knowledge of LAA morphology is important for endovascular LAA procedures as well as for predicting the risk of thromboembolic events. Despite thorough preprocedural imaging, anatomic variants may remain obscured.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141827198","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jens Trøan, K. Hansen, Manijeh Noori, J. Lassen, L. O. Jensen
Bioresorbable scaffolds (BRS) have been proposed as an alternative to drug-eluting stents (DES), offering radial support during the early phases of healing, while potentially reducing the risk of long-term complications. A magnesium-based BRS (MgBRS) have shown promising results after implantation. However, there is a lack of knowledge regarding the long-term outcomes. A 62-year old man with hypertension, dyslipidemia, family history of ischemic heart disease, and previous myocardial infarction, presented with Non ST-elevation myocardial infarction (NSTEMI). Six years prior he also had a NSTEMI and a mid left anterior descending artery (LAD) lesion was treated with a 3.0/25mm MgBRS. Post-implantation optical coherence tomography (OCT) revealed proximal edge dissection, and a second MgBRS 3.0/15mm was implanted. OCT of the scaffold-treated segment was performed after 6 and 12 months with no sign of restenosis. The current angiogram showed a restenosis in the previously MgBRS treated segment in LAD. OCT showed a plaque rupture in a thin cap fibro-atheroma and scaffold remnants. The lesion was pre-dilated and stented with a 3.0/20mm DES and post-dilated with a 3.5mm non-compliant balloon. Most cases of late scaffold failure showed acquired malapposition, which also can be related to the degrading process, or uncovered struts, none of which were seen in our case at 6 or 12 months. This case represents an insight into the vascular healing and potential mechanisms for failure of the MgBRS, with serial OCT recording at implantation, and after 6 months, 12 months and 6 years.
{"title":"Very Late Magmaris Scaffold Restenosis: A 6-year Serial Optical Coherence Tomography Case Report","authors":"Jens Trøan, K. Hansen, Manijeh Noori, J. Lassen, L. O. Jensen","doi":"10.1093/ehjcr/ytae344","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae344","url":null,"abstract":"\u0000 \u0000 \u0000 Bioresorbable scaffolds (BRS) have been proposed as an alternative to drug-eluting stents (DES), offering radial support during the early phases of healing, while potentially reducing the risk of long-term complications. A magnesium-based BRS (MgBRS) have shown promising results after implantation. However, there is a lack of knowledge regarding the long-term outcomes.\u0000 \u0000 \u0000 \u0000 A 62-year old man with hypertension, dyslipidemia, family history of ischemic heart disease, and previous myocardial infarction, presented with Non ST-elevation myocardial infarction (NSTEMI).\u0000 Six years prior he also had a NSTEMI and a mid left anterior descending artery (LAD) lesion was treated with a 3.0/25mm MgBRS. Post-implantation optical coherence tomography (OCT) revealed proximal edge dissection, and a second MgBRS 3.0/15mm was implanted. OCT of the scaffold-treated segment was performed after 6 and 12 months with no sign of restenosis.\u0000 The current angiogram showed a restenosis in the previously MgBRS treated segment in LAD. OCT showed a plaque rupture in a thin cap fibro-atheroma and scaffold remnants. The lesion was pre-dilated and stented with a 3.0/20mm DES and post-dilated with a 3.5mm non-compliant balloon.\u0000 \u0000 \u0000 \u0000 Most cases of late scaffold failure showed acquired malapposition, which also can be related to the degrading process, or uncovered struts, none of which were seen in our case at 6 or 12 months. This case represents an insight into the vascular healing and potential mechanisms for failure of the MgBRS, with serial OCT recording at implantation, and after 6 months, 12 months and 6 years.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141639787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Schmidt, Karl-Heinz Kuck, C. Marquetand, Ingo Eitel, C. Frerker
Besides transcatheter edge-to-edge repair (TEER) there are new interventional treatment options for mitral and tricuspid regurgitation in evaluation, such as a complete replacement of the valve through a prosthesis. A 78-years-old previous coronary artery bypass graft-operated patient with symptomatic severe mitral regurgitation and tricuspid regurgitation was sequentially treated by a transfemoral transcatheter mitral and tricuspid valve prosthesis (Cardiovalve; Cardiovalve Ltd, Israel) due to unfavorable mitral valve anatomy. The transcatheter mitral valve implantation (TMVI) was performed first and after progression of the tricuspid regurgitation, a second transcatheter valve prosthesis was implanted in tricuspid position (TTVI) 1.5 years later. Imaging showed a twin look-alike picture of a mitral and tricuspid prosthesis and showing the possibility of a complete transcatheter based replacement of the mitral and tricuspid valve. This case shows the possibility of a Cardiovalve prosthesis being used for TMVI and TTVI in a single patient. Especially in TEER ineligible patients it might be a good treatment option after device approval. A Cardiovalve prothesis can be used for TMVI and TTVI, especially in TEER ineligible patients and with one device for both anatomies, which might be a good treatment option after device approval.
{"title":"CardioTwins: Case report of a transcatheter mitral and tricuspid valve implantation in one patient","authors":"T. Schmidt, Karl-Heinz Kuck, C. Marquetand, Ingo Eitel, C. Frerker","doi":"10.1093/ehjcr/ytae336","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae336","url":null,"abstract":"\u0000 \u0000 \u0000 Besides transcatheter edge-to-edge repair (TEER) there are new interventional treatment options for mitral and tricuspid regurgitation in evaluation, such as a complete replacement of the valve through a prosthesis.\u0000 \u0000 \u0000 \u0000 A 78-years-old previous coronary artery bypass graft-operated patient with symptomatic severe mitral regurgitation and tricuspid regurgitation was sequentially treated by a transfemoral transcatheter mitral and tricuspid valve prosthesis (Cardiovalve; Cardiovalve Ltd, Israel) due to unfavorable mitral valve anatomy. The transcatheter mitral valve implantation (TMVI) was performed first and after progression of the tricuspid regurgitation, a second transcatheter valve prosthesis was implanted in tricuspid position (TTVI) 1.5 years later. Imaging showed a twin look-alike picture of a mitral and tricuspid prosthesis and showing the possibility of a complete transcatheter based replacement of the mitral and tricuspid valve.\u0000 \u0000 \u0000 \u0000 This case shows the possibility of a Cardiovalve prosthesis being used for TMVI and TTVI in a single patient. Especially in TEER ineligible patients it might be a good treatment option after device approval.\u0000 \u0000 \u0000 \u0000 A Cardiovalve prothesis can be used for TMVI and TTVI, especially in TEER ineligible patients and with one device for both anatomies, which might be a good treatment option after device approval.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141640136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giovanni Civieri, Davide Betta, Carlo Cernetti, N. Gasparetto
Cardiac tamponade is a life-threatening compression of the heart caused by the accumulation of fluid in the pericardial sac. Although central venous catheters (CVCs) are essential in modern medicine, they carry a certain risk of complications including cardiac tamponade. A 12 year-old female was involved in a road accident reporting multiple severe traumatic injuries, including a left humerus fracture and subdural hemorrhage. After 2 days in the intensive care unit, she suddenly developed hypotension and cardiac tamponade was diagnosed. Analysis of the pericardial fluid showed high glucose levels comparable to the parenteral nutrition that she was receiving. Retraction of the CVC allowed resolution of the effusion. Cardiac tamponade is a rare but serious adverse event after CVCs insertion, mostly among younger patients. Awareness of this risk allows physicians to promptly recognize and treat this dangerous complication.
{"title":"A Case Report Of Cardiac Tamponade After A Road Accident: Think Beyond Trauma","authors":"Giovanni Civieri, Davide Betta, Carlo Cernetti, N. Gasparetto","doi":"10.1093/ehjcr/ytae324","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae324","url":null,"abstract":"\u0000 \u0000 \u0000 Cardiac tamponade is a life-threatening compression of the heart caused by the accumulation of fluid in the pericardial sac. Although central venous catheters (CVCs) are essential in modern medicine, they carry a certain risk of complications including cardiac tamponade.\u0000 \u0000 \u0000 \u0000 A 12 year-old female was involved in a road accident reporting multiple severe traumatic injuries, including a left humerus fracture and subdural hemorrhage. After 2 days in the intensive care unit, she suddenly developed hypotension and cardiac tamponade was diagnosed. Analysis of the pericardial fluid showed high glucose levels comparable to the parenteral nutrition that she was receiving. Retraction of the CVC allowed resolution of the effusion.\u0000 \u0000 \u0000 \u0000 Cardiac tamponade is a rare but serious adverse event after CVCs insertion, mostly among younger patients. Awareness of this risk allows physicians to promptly recognize and treat this dangerous complication.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141642582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Patrascu, D. Binder, Peter Schnabel, K. Weinmann, I. Ott
Transcatheter edge-to-edge repair (TEER) for the systemic atrioventricular valve has been anecdotally reported as a viable treatment option in symptomatic inoperable adult patients born with congenitally corrected transposition of the great arteries (ccTGA) . However, to date, case reports on TEER treatment of both atrioventricular valves are lacking, especially when considering the present availability of specific mitral and tricuspid valve TEER devices. We present the case of an 84-year-old man with recurrent admissions for acute heart failure due to high-grade regurgitation of both atrioventricular valves. The patient was first diagnosed with ccTGA at this advanced age and underwent a thorough multimodality imaging approach, including transthoracic and transesophageal echocardiography, cardiac MRI, cardiac CT, and ventriculography of the systemic ventricle. Due to the high symptom burden despite optimal medical therapy and high doses of diuretics, the Heart Team recommended TEER, first for the systemic tricuspid valve, and later on for the non-sytemic mitral valve. Both complex procedures were uneventful and led to considerable improvement in quality of life. ccTGA mostly manifests itself in adulthood and affects both ventricles and atrioventricular valves. In case of anatomical doubts on transthoracic echocardiography, a thorough multimodality imaging work-up is recommended. Transcatheter treatment of both atrioventricular valves seems to be a safe and effective therapeutic option in these often-inoperable patients.
{"title":"Transcatheter edge-to-edge repair of both atrio-ventricular valves in congenitally corrected transposition of the great arteries: a case report","authors":"A. Patrascu, D. Binder, Peter Schnabel, K. Weinmann, I. Ott","doi":"10.1093/ehjcr/ytae348","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae348","url":null,"abstract":"\u0000 \u0000 \u0000 Transcatheter edge-to-edge repair (TEER) for the systemic atrioventricular valve has been anecdotally reported as a viable treatment option in symptomatic inoperable adult patients born with congenitally corrected transposition of the great arteries (ccTGA) . However, to date, case reports on TEER treatment of both atrioventricular valves are lacking, especially when considering the present availability of specific mitral and tricuspid valve TEER devices.\u0000 \u0000 \u0000 \u0000 We present the case of an 84-year-old man with recurrent admissions for acute heart failure due to high-grade regurgitation of both atrioventricular valves. The patient was first diagnosed with ccTGA at this advanced age and underwent a thorough multimodality imaging approach, including transthoracic and transesophageal echocardiography, cardiac MRI, cardiac CT, and ventriculography of the systemic ventricle. Due to the high symptom burden despite optimal medical therapy and high doses of diuretics, the Heart Team recommended TEER, first for the systemic tricuspid valve, and later on for the non-sytemic mitral valve. Both complex procedures were uneventful and led to considerable improvement in quality of life.\u0000 \u0000 \u0000 \u0000 ccTGA mostly manifests itself in adulthood and affects both ventricles and atrioventricular valves. In case of anatomical doubts on transthoracic echocardiography, a thorough multimodality imaging work-up is recommended. Transcatheter treatment of both atrioventricular valves seems to be a safe and effective therapeutic option in these often-inoperable patients.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141643725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wide QRS tachycardia in patients with atrial fibrillation or atrial flutter treated with antiarrhythmic drugs can occur for a variety of reasons and needs careful evaluation for appropriate management of the patient. We report a case of wide QRS complex tachycardia in a patient with atrial fibrillation treated with Flecainide who received multiple external cardioversion attempts for a presumed diagnosis of ventricular tachycardia. Intravenous Diltiazem and an oral beta blocker led to the resolution of wide QRS complex tachycardia. Wide QRS tachycardia due to pro-arrhythmic effect or rate dependency phenomenon of antiarrhythmic agents should be included in the differentials. In this brief report, we discuss the differential diagnosis and outline a practical approach for acute and long-term management of these patients.
{"title":"Wide QRS Tachycardia in a Patient with Atrial Fibrillation: A Case Report and Approach to Diagnosis","authors":"Mohammad Shaikh, Hafez Golzarian, F. Hakim","doi":"10.1093/ehjcr/ytae328","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae328","url":null,"abstract":"\u0000 \u0000 \u0000 Wide QRS tachycardia in patients with atrial fibrillation or atrial flutter treated with antiarrhythmic drugs can occur for a variety of reasons and needs careful evaluation for appropriate management of the patient.\u0000 \u0000 \u0000 \u0000 We report a case of wide QRS complex tachycardia in a patient with atrial fibrillation treated with Flecainide who received multiple external cardioversion attempts for a presumed diagnosis of ventricular tachycardia. Intravenous Diltiazem and an oral beta blocker led to the resolution of wide QRS complex tachycardia.\u0000 \u0000 \u0000 \u0000 Wide QRS tachycardia due to pro-arrhythmic effect or rate dependency phenomenon of antiarrhythmic agents should be included in the differentials. In this brief report, we discuss the differential diagnosis and outline a practical approach for acute and long-term management of these patients.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141644486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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