Zakaria Alaoui-Ismaili, Anika Klein, J. Eifer Moeller, Tommi Bo Lindhardt, C. Hassager
Cardiac tamponade due to perforation of a cardiac chamber is a rare complication occurring in only 0.3% of patients undergoing permanent pacemaker (PM) implantation. Notably, perforation of the right coronary artery (RCA) following permanent PM implantation has only been reported twice in the literature. We report a rare case of RCA perforation leading to life-threatening cardiac tamponade with symptom onset four days after PM implantation. A 75-year-old woman underwent permanent PM implantation without any difficulties in placing pacemaker leads and with good thresholds. Four days later, the patient was readmitted in a state of shock due to cardiac tamponade. A blood gas analysis on the bloody pericardial effusion raised suspicion of ongoing arterial bleeding. A CT scan ruled out aortic dissection; instead, the source of bleeding was identified as a perforation in the RCA, which was managed surgically. This case highlights the necessity of coronary artery perforation being among the differential diagnoses of cardiac tamponade after PM implantation, and it stresses the usefulness of performing a blood gas analysis on the bloody pericardial effusion.
{"title":"Cardiac tamponade due to right coronary artery perforation following pacemaker implantation: a case report","authors":"Zakaria Alaoui-Ismaili, Anika Klein, J. Eifer Moeller, Tommi Bo Lindhardt, C. Hassager","doi":"10.1093/ehjcr/ytae343","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae343","url":null,"abstract":"\u0000 \u0000 \u0000 Cardiac tamponade due to perforation of a cardiac chamber is a rare complication occurring in only 0.3% of patients undergoing permanent pacemaker (PM) implantation. Notably, perforation of the right coronary artery (RCA) following permanent PM implantation has only been reported twice in the literature. We report a rare case of RCA perforation leading to life-threatening cardiac tamponade with symptom onset four days after PM implantation.\u0000 \u0000 \u0000 \u0000 A 75-year-old woman underwent permanent PM implantation without any difficulties in placing pacemaker leads and with good thresholds. Four days later, the patient was readmitted in a state of shock due to cardiac tamponade. A blood gas analysis on the bloody pericardial effusion raised suspicion of ongoing arterial bleeding. A CT scan ruled out aortic dissection; instead, the source of bleeding was identified as a perforation in the RCA, which was managed surgically.\u0000 \u0000 \u0000 \u0000 This case highlights the necessity of coronary artery perforation being among the differential diagnoses of cardiac tamponade after PM implantation, and it stresses the usefulness of performing a blood gas analysis on the bloody pericardial effusion.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141651413","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}
M. Tomasino, F. Valente, P. Rello Sabatè, G. M. Aguasca, B. Miranda Barrio
Aortic coarctation is a major risk factor for high blood pressure and atherosclerotic disease development. Evidence is lacking regarding the treatment of acute coronary syndrome in patients with untreated aortic coarctation. A 50-year-old male with a history of hypertension, diabetes, and haemodynamically significant untreated aortic coarctation presented to the emergency department with non-ST-elevation acute myocardial infarction. Coronary catheterization showed severe three-vessel disease. The aortic coarctation was addressed percutaneously using a covered CP stent. A quadruple coronary artery bypass surgery was conducted the following day. He was discharged home ten days after surgery. We describe a successful sequential approach involving the percutaneous repair of a native aortic coarctation followed by a surgical myocardial revascularization in the context of acute coronary syndrome. Discussion within a multidisciplinary Heart Team is key in patients with such complexity.
主动脉缩窄是导致高血压和动脉粥样硬化疾病的主要危险因素。关于未经治疗的主动脉瓣狭窄患者急性冠状动脉综合征的治疗，目前还缺乏证据。 一名 50 岁男性患者有高血压和糖尿病病史，主动脉瓣狭窄未得到治疗，血流动力学特征明显，因非 ST 段抬高型急性心肌梗死就诊于急诊科。冠状动脉导管检查显示该患者患有严重的三血管疾病。经皮使用有盖 CP 支架治疗了主动脉瓣闭塞。第二天进行了四重冠状动脉搭桥手术。术后十天，他就出院回家了。 我们描述了在急性冠状动脉综合征的情况下，先经皮修复原发性主动脉瓣闭塞，再进行心肌血管重建手术的成功序列方法。对于病情如此复杂的患者，多学科心脏团队的讨论至关重要。
{"title":"Stenting of aortic coarctation before coronary artery bypass surgery in an adult with acute myocardial infarction: a case report","authors":"M. Tomasino, F. Valente, P. Rello Sabatè, G. M. Aguasca, B. Miranda Barrio","doi":"10.1093/ehjcr/ytae330","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae330","url":null,"abstract":"\u0000 \u0000 \u0000 Aortic coarctation is a major risk factor for high blood pressure and atherosclerotic disease development. Evidence is lacking regarding the treatment of acute coronary syndrome in patients with untreated aortic coarctation.\u0000 \u0000 \u0000 \u0000 A 50-year-old male with a history of hypertension, diabetes, and haemodynamically significant untreated aortic coarctation presented to the emergency department with non-ST-elevation acute myocardial infarction. Coronary catheterization showed severe three-vessel disease. The aortic coarctation was addressed percutaneously using a covered CP stent. A quadruple coronary artery bypass surgery was conducted the following day. He was discharged home ten days after surgery.\u0000 \u0000 \u0000 \u0000 We describe a successful sequential approach involving the percutaneous repair of a native aortic coarctation followed by a surgical myocardial revascularization in the context of acute coronary syndrome. Discussion within a multidisciplinary Heart Team is key in patients with such complexity.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141651047","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}
Shaunak Mangeshkar, P. Borkowski, Aspan M Shokrekhuda, M. Barillas-Lara, M. Menegus
A rare complication of esophageal rupture or Boerhaave syndrome is myo-pericarditis due to leakage of esophageal contents. This presentation can mimic a myocardial infarction, making diagnosis and management challenging. We present the case of a middle-aged man presenting with chest pain, who was diagnosed with Boerhaave syndrome complicated by myopericarditis, although the presentation was concerning for acute coronary syndrome. Through this case, we aim to highlight an unusual alternative etiology of findings classically seen in myocardial infarction.
{"title":"Boerhaave Syndrome, An Unusual Myocardial Infarction Mimic – A Case Report","authors":"Shaunak Mangeshkar, P. Borkowski, Aspan M Shokrekhuda, M. Barillas-Lara, M. Menegus","doi":"10.1093/ehjcr/ytae310","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae310","url":null,"abstract":"\u0000 \u0000 \u0000 A rare complication of esophageal rupture or Boerhaave syndrome is myo-pericarditis due to leakage of esophageal contents. This presentation can mimic a myocardial infarction, making diagnosis and management challenging.\u0000 \u0000 \u0000 \u0000 We present the case of a middle-aged man presenting with chest pain, who was diagnosed with Boerhaave syndrome complicated by myopericarditis, although the presentation was concerning for acute coronary syndrome.\u0000 \u0000 \u0000 \u0000 Through this case, we aim to highlight an unusual alternative etiology of findings classically seen in myocardial infarction.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141651718","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}
Transcatheter mitral valve edge-to-edge repair (TEER) is now available in many countries and has achieved favourable therapeutic outcomes. However, there have been no reported cases of Clip Opening While Locked (COWL) during the acute phase using the MitraClip G4 system (Abbott, Abbott Park, Illinois, USA). We present two cases of COWL occurring at different phases: one immediately after clip release, and the other 2 days post-procedure. In both cases, the initial treatment involved the use of the XTW system. Subsequently, an additional XT system was deployed for the deterioration of mitral regurgitation caused by COWL, without any complications. The MitraClip G4 system offers four size variations, providing a larger grasping area and increased flexibility for accessing complex lesions. Furthermore, the complication rate decreased with increasing operator experience and device generation. However, it has been reported that COWL can occur after the clip is deployed during TEER. Although the mechanism of COWL is unclear, the nature and mobility of the valve leaflets and the product specificity of the MitraClip may be involved.
{"title":"Clip opening while locked after transcatheter edge-to-edge mitral valve repair with different onset times: A case series","authors":"Hiroki Matsuzoe, Kazuki Mizutani, Naoko Soejima Onishi, Ayano Yoshida, Takayuki Kawamura, Masafumi Ueno, Genichi Sakaguchi, Gaku Nakazawa","doi":"10.1093/ehjcr/ytae322","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae322","url":null,"abstract":"\u0000 \u0000 \u0000 Transcatheter mitral valve edge-to-edge repair (TEER) is now available in many countries and has achieved favourable therapeutic outcomes. However, there have been no reported cases of Clip Opening While Locked (COWL) during the acute phase using the MitraClip G4 system (Abbott, Abbott Park, Illinois, USA).\u0000 \u0000 \u0000 \u0000 We present two cases of COWL occurring at different phases: one immediately after clip release, and the other 2 days post-procedure. In both cases, the initial treatment involved the use of the XTW system. Subsequently, an additional XT system was deployed for the deterioration of mitral regurgitation caused by COWL, without any complications.\u0000 \u0000 \u0000 \u0000 The MitraClip G4 system offers four size variations, providing a larger grasping area and increased flexibility for accessing complex lesions. Furthermore, the complication rate decreased with increasing operator experience and device generation. However, it has been reported that COWL can occur after the clip is deployed during TEER. Although the mechanism of COWL is unclear, the nature and mobility of the valve leaflets and the product specificity of the MitraClip may be involved.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653728","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}
Felipe Israel López-Trejo, E. Andrade-Cuellar, Edil Rosalio Argueta Machado
{"title":"Giant left atrium in a patient with Marfan syndrome","authors":"Felipe Israel López-Trejo, E. Andrade-Cuellar, Edil Rosalio Argueta Machado","doi":"10.1093/ehjcr/ytae350","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae350","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653859","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}
Cardiac blunt trauma clinically presents as a spectrum of injuries of varying severity. However, the diagnosis of complications of remote myocardial trauma is often challenging, especially if the patient forgets to mention a remote history of chest trauma. Here, we present a patient who recently experienced traumatic myocardial dissection and interventricular septal rupture, alongside three patients exhibiting a mimic double-chambered left ventricle, indicative of prior remote myocardial trauma potentially associated with the myocardial dissecting tear. Patients with recent severe myocardial injury are detectable through cardiac imaging. However, forgotten remote myocardial trauma can lead to adverse myocardial remodeling, heart failure, and arrhythmias. Long-term myocardial remodeling can obscure initial myocardial imaging characteristics, posing challenges in interpretation. Our case series suggests remote myocardial trauma may be more prevalent than commonly thought in clinical practice.
{"title":"Recent and Speculative Remote Myocardial Trauma: A Case Series","authors":"Zhijuang Lu, Xiaocong Zhang, Yanling Huang, Jia Song, Chaoqun Zhang, Qiang Wang, Handong Wu, Xinsheng Huang","doi":"10.1093/ehjcr/ytae349","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae349","url":null,"abstract":"\u0000 \u0000 \u0000 Cardiac blunt trauma clinically presents as a spectrum of injuries of varying severity. However, the diagnosis of complications of remote myocardial trauma is often challenging, especially if the patient forgets to mention a remote history of chest trauma.\u0000 \u0000 \u0000 \u0000 Here, we present a patient who recently experienced traumatic myocardial dissection and interventricular septal rupture, alongside three patients exhibiting a mimic double-chambered left ventricle, indicative of prior remote myocardial trauma potentially associated with the myocardial dissecting tear.\u0000 \u0000 \u0000 \u0000 Patients with recent severe myocardial injury are detectable through cardiac imaging. However, forgotten remote myocardial trauma can lead to adverse myocardial remodeling, heart failure, and arrhythmias. Long-term myocardial remodeling can obscure initial myocardial imaging characteristics, posing challenges in interpretation. Our case series suggests remote myocardial trauma may be more prevalent than commonly thought in clinical practice.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141654554","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}
Shota Iseki, Shogo Yamaguchi, Yuta Ozaki, Yusuke Uemura
Mushroom poisoning caused by the ingestion of Russula subnigricans has been reported to cause rhabdomyolysis and cardiac dysfunction, leading to death. There have been few reports of cardiogenic shock induced by mushroom poisoning that was successfully treated using mechanical circulatory support devices. A 38-year-old man presented with gastrointestinal symptoms a day after consuming a curry made with forest-collected mushrooms and was admitted with a diagnosis of rhabdomyolysis. Despite appropriate fluid management for severe rhabdomyolysis, the patient experienced anuria and cardiogenic shock with a remarkably reduced left ventricular ejection function, followed by the development of ventricular fibrillation. Mechanical support using Impella CP, veno-arterial extracorporeal membranous oxygenation (VA-ECMO), and continuous haemodiafiltration were administered for cardiogenic shock and severe rhabdomyolysis. His cardiac and renal function gradually improved, and the patient was successfully weaned off VA-ECMO on day 4, Impella CP on day 5, and renal replacement therapy on day 23. The left ventricular ejection fraction returned to normal without any neurological, respiratory, or renal sequelae. The remaining mushroom samples were identified as R. subnigricans by polymerase chain reaction testing. This is the first reported case of cardiogenic shock caused by R. subnigricans poisoning, successfully treated with Impella CP and VA-ECMO. The optimal use of mechanical circulatory support devices plays an important role in the treatment of cardiogenic shock caused by mushroom toxicity.
{"title":"Mushroom poisoning with cardiogenic shock caused by Russula subnigricans successfully treated with mechanical circulatory support devices: A case report","authors":"Shota Iseki, Shogo Yamaguchi, Yuta Ozaki, Yusuke Uemura","doi":"10.1093/ehjcr/ytae337","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae337","url":null,"abstract":"\u0000 \u0000 \u0000 Mushroom poisoning caused by the ingestion of Russula subnigricans has been reported to cause rhabdomyolysis and cardiac dysfunction, leading to death. There have been few reports of cardiogenic shock induced by mushroom poisoning that was successfully treated using mechanical circulatory support devices.\u0000 \u0000 \u0000 \u0000 A 38-year-old man presented with gastrointestinal symptoms a day after consuming a curry made with forest-collected mushrooms and was admitted with a diagnosis of rhabdomyolysis. Despite appropriate fluid management for severe rhabdomyolysis, the patient experienced anuria and cardiogenic shock with a remarkably reduced left ventricular ejection function, followed by the development of ventricular fibrillation. Mechanical support using Impella CP, veno-arterial extracorporeal membranous oxygenation (VA-ECMO), and continuous haemodiafiltration were administered for cardiogenic shock and severe rhabdomyolysis. His cardiac and renal function gradually improved, and the patient was successfully weaned off VA-ECMO on day 4, Impella CP on day 5, and renal replacement therapy on day 23. The left ventricular ejection fraction returned to normal without any neurological, respiratory, or renal sequelae. The remaining mushroom samples were identified as R. subnigricans by polymerase chain reaction testing.\u0000 \u0000 \u0000 \u0000 This is the first reported case of cardiogenic shock caused by R. subnigricans poisoning, successfully treated with Impella CP and VA-ECMO. The optimal use of mechanical circulatory support devices plays an important role in the treatment of cardiogenic shock caused by mushroom toxicity.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653193","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}
James Clark, Abbas Zaidi, Peter O’Callaghan, Ulrich von Oppell, Andrew SP Sharp
When cardiac implantable electronic device infection occurs, standard therapy is usually total system extraction. Transvenous lead extraction is preferable to open heart surgical extraction, unless contraindicated because of the presence of very large vegetations on the intravenous leads according to ESC guidance. Extraction of transvenous leads with vegetations risks distal embolism resulting in obstruction and/or infection in the pulmonary arteries. Catheter aspiration of vegetations or thrombi has been performed prior to transvenous lead extraction using a partial veno-venous extracorporeal bypass circuit. We report the use of a single access aspiration system using the Inari Flowtriever 24 French system to debulk a defibrillator lead before percutaneous extraction. A 79-year-old male presented with fever 18 years after his first implantable cardioverter defibrillator implant and 9 years after his most recent pulse generator change. Two large vegetations were identified on his transvenous defibrillator lead on the atrial aspect, near the tricuspid annulus, which were aspirated using the Inari Medical 24Fr FlowTriever aspiration catheter. We describe anatomical considerations during the approach and a technique to localise the vegetations based on a combination of fluoroscopy and TEE guidance. This case demonstrates the safe and effective use of the Inari Medical 24Fr Flowtriever aspiration catheter in debulking a defibrillator lead before transvenous lead extraction. This method uses a single venous puncture and is not dependent on extracorporeal bypass. Apart from reducing complexity, this technique may be advantageous in patients where anticoagulation needs to be minimised.
当发生心脏植入式电子设备感染时，标准疗法通常是全系统拔除。根据 ESC 指南，经静脉导联拔除术优于开胸手术拔除术，除非因静脉导联上存在非常大的植被而有禁忌症。抽取带有植被的经静脉导联有可能造成远端栓塞，导致肺动脉阻塞和/或感染。在使用部分静脉-静脉体外旁路回路抽取经静脉导联之前，已对植被或血栓进行了导管抽吸。我们报告了使用 Inari Flowtriever 24 French 系统的单通道抽吸系统，在经皮抽取除颤器导联线之前对其进行清创的情况。 一名 79 岁的男性在首次植入心律转复除颤器 18 年后和最近一次更换脉冲发生器 9 年后出现发热。在他的经静脉除颤器导联线的心房侧、三尖瓣环附近发现了两个大的植被，使用 Inari Medical 24Fr FlowTriever 抽吸导管对其进行了抽吸。我们介绍了手术过程中的解剖学注意事项，以及基于透视和 TEE 引导的植物定位技术。 本病例展示了在经静脉抽取除颤器导联线之前安全有效地使用 Inari Medical 24Fr Flowtriever 抽吸导管清除导联线杂质的方法。这种方法只需一次静脉穿刺，不依赖于体外旁路。除了降低复杂性外，这种技术对于需要尽量减少抗凝治疗的患者也很有优势。
{"title":"X marks the spot - Catheter aspiration using the Inari Flowtriever device to debulk defibrillator lead vegetations prior to transvenous lead extraction- A case report","authors":"James Clark, Abbas Zaidi, Peter O’Callaghan, Ulrich von Oppell, Andrew SP Sharp","doi":"10.1093/ehjcr/ytae332","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae332","url":null,"abstract":"\u0000 \u0000 \u0000 When cardiac implantable electronic device infection occurs, standard therapy is usually total system extraction. Transvenous lead extraction is preferable to open heart surgical extraction, unless contraindicated because of the presence of very large vegetations on the intravenous leads according to ESC guidance. Extraction of transvenous leads with vegetations risks distal embolism resulting in obstruction and/or infection in the pulmonary arteries. Catheter aspiration of vegetations or thrombi has been performed prior to transvenous lead extraction using a partial veno-venous extracorporeal bypass circuit. We report the use of a single access aspiration system using the Inari Flowtriever 24 French system to debulk a defibrillator lead before percutaneous extraction.\u0000 \u0000 \u0000 \u0000 A 79-year-old male presented with fever 18 years after his first implantable cardioverter defibrillator implant and 9 years after his most recent pulse generator change. Two large vegetations were identified on his transvenous defibrillator lead on the atrial aspect, near the tricuspid annulus, which were aspirated using the Inari Medical 24Fr FlowTriever aspiration catheter. We describe anatomical considerations during the approach and a technique to localise the vegetations based on a combination of fluoroscopy and TEE guidance.\u0000 \u0000 \u0000 \u0000 This case demonstrates the safe and effective use of the Inari Medical 24Fr Flowtriever aspiration catheter in debulking a defibrillator lead before transvenous lead extraction. This method uses a single venous puncture and is not dependent on extracorporeal bypass. Apart from reducing complexity, this technique may be advantageous in patients where anticoagulation needs to be minimised.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141656483","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}
Atrial fibrillation (AF) is a prevalent cardiac condition characterized by irregular heart rhythm. Traditional non-invasive diagnostic tools, while useful, have limitations in providing comprehensive information for treatment planning. To address this gap, Electromechanical Cycle Length Mapping (ECLM), a noninvasive echocardiography-based technique, has emerged as a promising approach. ECLM offers quantitative and spatially specific insights into atrial electromechanical activation rate mapping, thereby enhancing our understanding of arrhythmia disease progression in AF patients. In this case series, we present two patient cases demonstrating the potential utility of ECLM in monitoring and evaluating treatment responses in atrial arrhythmia. The first case involved a 61-year-old male with persistent AF who underwent multiple procedures, including direct current cardioversion (DCCV) and radiofrequency ablation. Over three different DCCV encounters, pre- and post-procedure ECLM scans were performed, and the results showed the localization and incomplete elimination of arrhythmic triggers post-DCCV, which were used as early indicators of AF recurrence. The second case involved a 71-year-old male with paroxysmal AF who also underwent cardioversion and ablation procedures. ECLM imaging demonstrated a progressive reduction and elimination of arrhythmia triggers after each encounter, resulting in long-term maintenance of sinus rhythm. The findings from this case series highlight the potential of ECLM as a noninvasive imaging tool for long-term monitoring and evaluating immediate and long-term treatment responses in AF patients. The integration of ECLM with standard echocardiograms holds promise in guiding clinical decisions and improving patient outcomes in managing atrial fibrillation.
{"title":"Long-term atrial arrhythmia characterization and treatment efficacy evaluation using noninvasive echocardiography-based electromechanical cycle length mapping: A case series","authors":"Melina Tourni, Rachel Weber, Angelo Biviano, Elisa Konofagou","doi":"10.1093/ehjcr/ytae303","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae303","url":null,"abstract":"\u0000 \u0000 \u0000 Atrial fibrillation (AF) is a prevalent cardiac condition characterized by irregular heart rhythm. Traditional non-invasive diagnostic tools, while useful, have limitations in providing comprehensive information for treatment planning. To address this gap, Electromechanical Cycle Length Mapping (ECLM), a noninvasive echocardiography-based technique, has emerged as a promising approach. ECLM offers quantitative and spatially specific insights into atrial electromechanical activation rate mapping, thereby enhancing our understanding of arrhythmia disease progression in AF patients.\u0000 \u0000 \u0000 \u0000 In this case series, we present two patient cases demonstrating the potential utility of ECLM in monitoring and evaluating treatment responses in atrial arrhythmia. The first case involved a 61-year-old male with persistent AF who underwent multiple procedures, including direct current cardioversion (DCCV) and radiofrequency ablation. Over three different DCCV encounters, pre- and post-procedure ECLM scans were performed, and the results showed the localization and incomplete elimination of arrhythmic triggers post-DCCV, which were used as early indicators of AF recurrence. The second case involved a 71-year-old male with paroxysmal AF who also underwent cardioversion and ablation procedures. ECLM imaging demonstrated a progressive reduction and elimination of arrhythmia triggers after each encounter, resulting in long-term maintenance of sinus rhythm.\u0000 \u0000 \u0000 \u0000 The findings from this case series highlight the potential of ECLM as a noninvasive imaging tool for long-term monitoring and evaluating immediate and long-term treatment responses in AF patients. The integration of ECLM with standard echocardiograms holds promise in guiding clinical decisions and improving patient outcomes in managing atrial fibrillation.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141657778","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}
Myocardial infarction in a patient with immune thrombocytopenia is a rare scenario which is very challenging to manage. We present a rare case of a patient with immune thrombocytopenic purpura who developed double territory ST-elevation myocardial infarction with cardiogenic shock. She had an extremely rare presentation with a fresh mobile thrombus in the aortic root which was trap-dooring the right coronary artery ostium and extending into the artery with embolism into the distal left anterior descending artery. We managed this patient conservatively with excellent recovery owing to the dangerous location of the hanging thrombus, and severe thrombocytopenia. Multidisciplinary approach is required for the management of myocardial infarction in patients with pre-existing blood disorders, with therapy tailored to the patient's presentation and treatment requirements.
免疫性血小板减少症患者发生心肌梗死是一种罕见的情况，处理起来非常具有挑战性。 我们介绍了一例罕见的免疫性血小板减少性紫癜患者，她发生了双区 ST 段抬高型心肌梗死并伴有心源性休克。她的表现极为罕见，主动脉根部有一个新鲜的移动血栓，血栓在右冠状动脉骨膜上形成陷阱，并延伸到动脉内，栓塞到左前降支动脉远端。由于悬吊血栓位置危险，且血小板严重减少，我们对该患者进行了保守治疗，患者恢复良好。 在治疗原有血液疾病患者的心肌梗死时，需要采取多学科方法，并根据患者的表现和治疗要求进行治疗。
{"title":"Double-territory STEMI with Cardiogenic shock in ITP with severe Thrombocytopenia – A Case Report","authors":"Yerramareddy Vijayachandra, Antony Wilson, Jayalakshmi Sreeram, Aishwarya Mahesh Kumar","doi":"10.1093/ehjcr/ytae345","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae345","url":null,"abstract":"\u0000 \u0000 \u0000 Myocardial infarction in a patient with immune thrombocytopenia is a rare scenario which is very challenging to manage.\u0000 \u0000 \u0000 \u0000 We present a rare case of a patient with immune thrombocytopenic purpura who developed double territory ST-elevation myocardial infarction with cardiogenic shock. She had an extremely rare presentation with a fresh mobile thrombus in the aortic root which was trap-dooring the right coronary artery ostium and extending into the artery with embolism into the distal left anterior descending artery. We managed this patient conservatively with excellent recovery owing to the dangerous location of the hanging thrombus, and severe thrombocytopenia.\u0000 \u0000 \u0000 \u0000 Multidisciplinary approach is required for the management of myocardial infarction in patients with pre-existing blood disorders, with therapy tailored to the patient's presentation and treatment requirements.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141655742","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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