Chunyi Zhou, Yurong Guo, Yanchong Zeng, Honghong Ke
{"title":"Abnormal Origin of the Left Pulmonary Artery","authors":"Chunyi Zhou, Yurong Guo, Yanchong Zeng, Honghong Ke","doi":"10.1093/ehjcr/ytae280","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae280","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141358970","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":"Recurrent ventricular tachycardia in a patient with A19D mutation-associated hereditary transthyretin amyloidosis : a case report","authors":"Tanguy Bois, K. C. Lee, G. L'official, E. Donal","doi":"10.1093/ehjcr/ytae273","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae273","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141355537","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}
Sandra Zendjebil, J. Horvilleur, Victor Boilève, Vincent Millien, Philippe Garot
Left atrial appendage (LAA) thrombus is a contraindication for LAA closure (LAAC). However, in selected cases, oral anticoagulants are strictly contraindicated because of a history of life-threatening bleeding, and LAAC remains the only possible therapy to avoid systemic and especially cerebral embolization. We report a case of LAAC despite a massive proximal thrombus in a patient who had an absolute contraindication to anticoagulant therapy, with thorough pre-planning using CT-scan, device modeling and thrombus trapping techniques to reduce the risk of systemic embolic events and perform LAAC safely. Although LAAC remains at high risk in this setting, the use of cautious techniques and tools, from pre-procedure planning to systemic embolization prevention systems associated to a precise TEE-guiding throughout the procedure, allows it to be performed as safely as possible when no other option is available.
{"title":"Case report: 3 ways to mitigate the risk of embolization during left atrial appendage closure in a patient with a massive and proximal left atrial appendage thrombus","authors":"Sandra Zendjebil, J. Horvilleur, Victor Boilève, Vincent Millien, Philippe Garot","doi":"10.1093/ehjcr/ytae286","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae286","url":null,"abstract":"\u0000 \u0000 \u0000 Left atrial appendage (LAA) thrombus is a contraindication for LAA closure (LAAC). However, in selected cases, oral anticoagulants are strictly contraindicated because of a history of life-threatening bleeding, and LAAC remains the only possible therapy to avoid systemic and especially cerebral embolization.\u0000 \u0000 \u0000 \u0000 We report a case of LAAC despite a massive proximal thrombus in a patient who had an absolute contraindication to anticoagulant therapy, with thorough pre-planning using CT-scan, device modeling and thrombus trapping techniques to reduce the risk of systemic embolic events and perform LAAC safely.\u0000 \u0000 \u0000 \u0000 Although LAAC remains at high risk in this setting, the use of cautious techniques and tools, from pre-procedure planning to systemic embolization prevention systems associated to a precise TEE-guiding throughout the procedure, allows it to be performed as safely as possible when no other option is available.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141358855","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}
Stephanie Wissel, M. Drayss, Martin Christa, Rainer G Leyh, S. Frantz
Infective endocarditis (IE) is a rare disease associated with high mortality rates. Clinical presentation is highly variable with a time interval between first onset of symptoms and diagnosis > 1 month in 25% of patients. We present a case of aortic valve endocarditis with aortic root abscess with chest pain and ischemic changes on the electrocardiogram (ECG). A 59-year-old caucasian male with a known bicuspid aortic valve presented at our emergency department with a 2-week history of malaise, subfebrile temperatures and chest pain episodes. The ECG exhibited ischemic changes and laboratory workup showed elevated inflammatory markers and troponin levels. Coronary angiography revealed a one vessel coronary artery disease (CAD) with a borderline significant stenosis of the left circumflex artery. Cardiac magnetic resonance imaging (CMR) showed a large aortic valve vegetation with an aortic root abscess (ARA) expanding intramyocardially, which was not seen on bed-side echocardiography. The patient was set on intravenous (IV) antibiotics and urgently referred for surgery. The patient received a surgical aortic root and valve replacement, reconstruction of the anterior mitral leaflet and a venous bypass. After successful surgical management followed by six weeks of IV antibiotics the patient completely recovered. Diagnosing IE in atypical cases, such as those with ischemic ECG changes, remains challenging. IE should be considered as an early differential diagnosis in individuals with prosthetic or native valve disease. IE poses a significant risk for perivalvular- and aortic root abscess formation with high mortality. ARA may present with unspecific symptoms or unusual ECG changes and might be missed in standard transthoracic echocardiography in up to 30% of cases. Multimodal imaging can help in establishing a prompt and accurate diagnosis, aid in timely treatment and mitigating the risk of complications of IE.
{"title":"Angina pectoris? Fake News. A case report of infective endocarditis with giant aortic root abscess detected by cardiac MRI","authors":"Stephanie Wissel, M. Drayss, Martin Christa, Rainer G Leyh, S. Frantz","doi":"10.1093/ehjcr/ytae297","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae297","url":null,"abstract":"\u0000 \u0000 \u0000 Infective endocarditis (IE) is a rare disease associated with high mortality rates. Clinical presentation is highly variable with a time interval between first onset of symptoms and diagnosis > 1 month in 25% of patients. We present a case of aortic valve endocarditis with aortic root abscess with chest pain and ischemic changes on the electrocardiogram (ECG).\u0000 \u0000 \u0000 \u0000 A 59-year-old caucasian male with a known bicuspid aortic valve presented at our emergency department with a 2-week history of malaise, subfebrile temperatures and chest pain episodes. The ECG exhibited ischemic changes and laboratory workup showed elevated inflammatory markers and troponin levels. Coronary angiography revealed a one vessel coronary artery disease (CAD) with a borderline significant stenosis of the left circumflex artery. Cardiac magnetic resonance imaging (CMR) showed a large aortic valve vegetation with an aortic root abscess (ARA) expanding intramyocardially, which was not seen on bed-side echocardiography. The patient was set on intravenous (IV) antibiotics and urgently referred for surgery. The patient received a surgical aortic root and valve replacement, reconstruction of the anterior mitral leaflet and a venous bypass. After successful surgical management followed by six weeks of IV antibiotics the patient completely recovered.\u0000 \u0000 \u0000 \u0000 Diagnosing IE in atypical cases, such as those with ischemic ECG changes, remains challenging. IE should be considered as an early differential diagnosis in individuals with prosthetic or native valve disease. IE poses a significant risk for perivalvular- and aortic root abscess formation with high mortality. ARA may present with unspecific symptoms or unusual ECG changes and might be missed in standard transthoracic echocardiography in up to 30% of cases.\u0000 Multimodal imaging can help in establishing a prompt and accurate diagnosis, aid in timely treatment and mitigating the risk of complications of IE.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141355845","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}
Tomohiro Yoshino, Kei Yunoki, Katsunori Miyahara, Jun Ida, Takefumi Oka
Type I variant Kounis syndrome is characterized by coronary spasm following an allergic or anaphylactic reaction. Coronary spasm is also recognized as a contributing factor in spontaneous coronary artery dissection (SCAD). A 46-year-old woman presented to the emergency room with a chief complaint of chest discomfort following the ingestion of a steamed bun. A marked decrease in systolic blood pressure and a prominent rash on her forearms and groin suggested anaphylactic shock. Upon stabilization of vital signs, acute coronary syndrome (ACS) was suspected based on electrocardiogram findings and symptoms, prompting an emergency coronary angiography (CAG). The CAG revealed severe stenosis with coronary artery dissection in the right coronary artery, and a stent implantation was performed. Given the suspicion of type I variant Kounis syndrome, a spasm provocation test was performed, yielding a positive result. Six years later, she experienced chest discomfort while sleeping and was admitted to our emergency department. An electrocardiogram showed ST-segment elevation in leads II, III, and aVF. An emergency CAG identified a severely stenotic lesion with coronary artery dissection in the right coronary artery, leading to a diagnosis of SCAD. Direct stenting was performed at the stenotic site. The patient was discharged following intensification of medication. This report describes a rare case of a middle-aged woman with two episodes of ACS caused by both allergic and nonallergic coronary artery dissection. These episodes suggest that a shared underlying coronary vasospasm in both conditions may be a common trigger for coronary artery dissection.
I 型变异库尼斯综合征的特点是过敏或过敏性反应后冠状动脉痉挛。冠状动脉痉挛也被认为是自发性冠状动脉夹层（SCAD）的诱因之一。 急诊室接诊了一名 46 岁的女性，主诉是吃了馒头后胸部不适。她的收缩压明显下降，前臂和腹股沟出现明显皮疹，这表明她出现了过敏性休克。生命体征稳定后，根据心电图检查结果和症状，她被怀疑患有急性冠状动脉综合征（ACS），因此急诊进行了冠状动脉造影检查（CAG）。冠状动脉造影（CAG）显示右冠状动脉严重狭窄并伴有冠状动脉夹层，于是进行了支架植入术。由于怀疑是 I 型变异库尼斯综合征，她接受了痉挛激发试验，结果呈阳性。六年后，她在睡觉时出现胸部不适，被送进了我们的急诊科。心电图显示 II、III 和 aVF 导联 ST 段抬高。急诊 CAG 检查发现右冠状动脉严重狭窄并伴有冠状动脉夹层，诊断为 SCAD。在狭窄部位进行了直接支架植入术。在加强药物治疗后，患者康复出院。 本报告描述了一例罕见病例，一名中年女性因过敏性和非过敏性冠状动脉夹层导致两次急性冠状动脉综合征发作。这些发作表明，这两种情况下共同潜在的冠状动脉血管痉挛可能是冠状动脉夹层的共同诱因。
{"title":"An unusual case of two acute coronary syndrome episodes caused by allergic and nonallergic coronary artery dissection with potential coronary vasospasm association: a case report","authors":"Tomohiro Yoshino, Kei Yunoki, Katsunori Miyahara, Jun Ida, Takefumi Oka","doi":"10.1093/ehjcr/ytae288","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae288","url":null,"abstract":"\u0000 \u0000 \u0000 Type I variant Kounis syndrome is characterized by coronary spasm following an allergic or anaphylactic reaction. Coronary spasm is also recognized as a contributing factor in spontaneous coronary artery dissection (SCAD).\u0000 \u0000 \u0000 \u0000 A 46-year-old woman presented to the emergency room with a chief complaint of chest discomfort following the ingestion of a steamed bun. A marked decrease in systolic blood pressure and a prominent rash on her forearms and groin suggested anaphylactic shock. Upon stabilization of vital signs, acute coronary syndrome (ACS) was suspected based on electrocardiogram findings and symptoms, prompting an emergency coronary angiography (CAG). The CAG revealed severe stenosis with coronary artery dissection in the right coronary artery, and a stent implantation was performed. Given the suspicion of type I variant Kounis syndrome, a spasm provocation test was performed, yielding a positive result. Six years later, she experienced chest discomfort while sleeping and was admitted to our emergency department. An electrocardiogram showed ST-segment elevation in leads II, III, and aVF. An emergency CAG identified a severely stenotic lesion with coronary artery dissection in the right coronary artery, leading to a diagnosis of SCAD. Direct stenting was performed at the stenotic site. The patient was discharged following intensification of medication.\u0000 \u0000 \u0000 \u0000 This report describes a rare case of a middle-aged woman with two episodes of ACS caused by both allergic and nonallergic coronary artery dissection. These episodes suggest that a shared underlying coronary vasospasm in both conditions may be a common trigger for coronary artery dissection.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141364215","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}
Anomalous pulmonary venous return involves the partial or complete absence of a connection between the pulmonary veins and the left atrium. The pulmonary vein potential plays a vital role in atrial fibrillation, and catheter ablation to isolate the pulmonary vein is crucial for treating this condition. However, when anomalous pulmonary venous return is present, it makes ablation more challenging and increases the risk of atrial fibrillation recurrence after the procedure. A 49-year-old man was hospitalised because he had been experiencing occasional palpitations for 2 months. He had previously undergone surgery to repair an atrial septal defect when he was 11 years old, during which an issue with the right inferior pulmonary vein was identified but left unaddressed. Electrocardiography upon admission showed atrial fibrillation. Left atrial computed tomography angiography revealed that following atrial septal repair surgery, the right inferior pulmonary vein drained into the right atrium. The patient underwent transcatheter radiofrequency Mablation to electrically isolate the pulmonary vein with anomalous return. After 12 months of follow-up, there was no atrial fibrillation recurrence. When performing catheter ablation for anomalous pulmonary venous return and atrial fibrillation, it is essential to consider ablating the irregular pulmonary vein before surgery. This helps to reduce surgical complications and the likelihood of atrial fibrillation recurrence. This case report highlights the challenges encountered during ablation in patients with atrial fibrillation and anomalous pulmonary venous return. In addition, we have reviewed the literature to offer insights into the development of ablation strategies for similar patients.
{"title":"Catheter ablation for patients with anomalous pulmonary venous return and atrial fibrillation: A case report and literature review","authors":"Zhaoyang Wei, Minghua Li, Zhenggui Wang, Zhiguo Zhang","doi":"10.1093/ehjcr/ytae292","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae292","url":null,"abstract":"\u0000 \u0000 \u0000 Anomalous pulmonary venous return involves the partial or complete absence of a connection between the pulmonary veins and the left atrium. The pulmonary vein potential plays a vital role in atrial fibrillation, and catheter ablation to isolate the pulmonary vein is crucial for treating this condition. However, when anomalous pulmonary venous return is present, it makes ablation more challenging and increases the risk of atrial fibrillation recurrence after the procedure.\u0000 \u0000 \u0000 \u0000 A 49-year-old man was hospitalised because he had been experiencing occasional palpitations for 2 months. He had previously undergone surgery to repair an atrial septal defect when he was 11 years old, during which an issue with the right inferior pulmonary vein was identified but left unaddressed. Electrocardiography upon admission showed atrial fibrillation. Left atrial computed tomography angiography revealed that following atrial septal repair surgery, the right inferior pulmonary vein drained into the right atrium. The patient underwent transcatheter radiofrequency Mablation to electrically isolate the pulmonary vein with anomalous return. After 12 months of follow-up, there was no atrial fibrillation recurrence.\u0000 \u0000 \u0000 \u0000 When performing catheter ablation for anomalous pulmonary venous return and atrial fibrillation, it is essential to consider ablating the irregular pulmonary vein before surgery. This helps to reduce surgical complications and the likelihood of atrial fibrillation recurrence. This case report highlights the challenges encountered during ablation in patients with atrial fibrillation and anomalous pulmonary venous return. In addition, we have reviewed the literature to offer insights into the development of ablation strategies for similar patients.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141365574","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. Masumoto, Hiroyuki Yamamoto, Nobuyuki Takahashi, Tomofumi Takaya
An 80-year-old female underwent transfemoral transcatheter aortic valve replacement, during which an outward bending of the transcatheter heart valve’s stent frame occurred. Because of the difficulty in fixing the deformation by balloon angioplasty, the valve delivered with balloon cushion technique was slowly deployed with underfilling, resulting in no annulus rupture.
{"title":"Balloon-expandable transcatheter heart valve deformation: A rare complication during transcatheter aortic valve replacement","authors":"A. Masumoto, Hiroyuki Yamamoto, Nobuyuki Takahashi, Tomofumi Takaya","doi":"10.1093/ehjcr/ytae285","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae285","url":null,"abstract":"\u0000 An 80-year-old female underwent transfemoral transcatheter aortic valve replacement, during which an outward bending of the transcatheter heart valve’s stent frame occurred. Because of the difficulty in fixing the deformation by balloon angioplasty, the valve delivered with balloon cushion technique was slowly deployed with underfilling, resulting in no annulus rupture.","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141378245","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}
Zdenek Steffek, David J Kurz, Alain M Bernheim, Matthias R Meyer
Vasospastic angina (VSA) and spontaneous coronary artery dissection (SCAD) are challenging causes of non-atherosclerotic acute coronary syndromes (ACS). Here, we report a unique ACS case with coexisting VSA and SCAD, highlighting specific strategies in diagnosis and management of these poorly studied conditions. A woman in her mid-sixties with a history of suspected microvascular angina and no atherosclerosis in a previously performed coronary computed tomography angiography presented with worsening chest pain. Invasive coronary angiography revealed a focal SCAD with a resulting high-degree stenosis of the right coronary artery. Shortly after successful percutaneous coronary intervention with stent implantation and stopping her previous vasodilator therapy with nitroglycerine and molsidomine, the patient developed recurrent anterior Non-ST-segment elevation myocardial infarction. Surprisingly, repeat coronary angiography revealed severe multifocal coronary artery spasms that were successfully treated with intracoronary nitroglycerine. VSA was subsequently managed with diltiazem, molsidomine and nitrates. Our report underscores the challenges in diagnosing and managing SCAD and VSA in ACS. The possible interplay between SCAD and VSA highlights the need for careful vasodilator therapy management, as seen in our patient, where therapy discontinuation led to severe multifocal VSA. This emphasizes the need for a comprehensive approach for optimal outcomes in complex ACS cases.
血管痉挛性心绞痛（VSA）和自发性冠状动脉夹层（SCAD）是非动脉粥样硬化性急性冠状动脉综合征（ACS）的棘手病因。在此，我们报告了一例并存 VSA 和 SCAD 的独特 ACS 病例，重点介绍了对这些研究较少的病症进行诊断和管理的具体策略。 一位六十多岁的女性患者疑似有微血管性心绞痛病史，之前进行的冠状动脉计算机断层扫描血管造影检查未发现动脉粥样硬化，她因胸痛加剧而就诊。有创冠状动脉造影显示右冠状动脉有局灶性 SCAD 和高度狭窄。在成功植入支架进行经皮冠状动脉介入治疗并停止之前使用硝酸甘油和莫西多明进行血管扩张治疗后不久，患者再次发生前非ST段抬高型心肌梗死。令人惊讶的是，重复冠状动脉造影术发现了严重的多灶性冠状动脉痉挛，冠状动脉内硝酸甘油治疗成功。随后使用地尔硫卓、莫西多明和硝酸盐治疗了 VSA。 我们的报告强调了在诊断和治疗 ACS 中 SCAD 和 VSA 时所面临的挑战。SCAD 和 VSA 之间可能存在的相互作用凸显了对血管扩张剂治疗进行谨慎管理的必要性，正如我们的患者一样，停止治疗导致了严重的多灶性 VSA。这强调了在复杂的 ACS 病例中采用综合方法以获得最佳治疗效果的必要性。
{"title":"Severe multifocal coronary artery spasms after cessation of vasodilators in a patient with a spontaneous coronary artery dissection: a case report","authors":"Zdenek Steffek, David J Kurz, Alain M Bernheim, Matthias R Meyer","doi":"10.1093/ehjcr/ytae282","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae282","url":null,"abstract":"\u0000 \u0000 \u0000 Vasospastic angina (VSA) and spontaneous coronary artery dissection (SCAD) are challenging causes of non-atherosclerotic acute coronary syndromes (ACS). Here, we report a unique ACS case with coexisting VSA and SCAD, highlighting specific strategies in diagnosis and management of these poorly studied conditions.\u0000 \u0000 \u0000 \u0000 A woman in her mid-sixties with a history of suspected microvascular angina and no atherosclerosis in a previously performed coronary computed tomography angiography presented with worsening chest pain. Invasive coronary angiography revealed a focal SCAD with a resulting high-degree stenosis of the right coronary artery. Shortly after successful percutaneous coronary intervention with stent implantation and stopping her previous vasodilator therapy with nitroglycerine and molsidomine, the patient developed recurrent anterior Non-ST-segment elevation myocardial infarction. Surprisingly, repeat coronary angiography revealed severe multifocal coronary artery spasms that were successfully treated with intracoronary nitroglycerine. VSA was subsequently managed with diltiazem, molsidomine and nitrates.\u0000 \u0000 \u0000 \u0000 Our report underscores the challenges in diagnosing and managing SCAD and VSA in ACS. The possible interplay between SCAD and VSA highlights the need for careful vasodilator therapy management, as seen in our patient, where therapy discontinuation led to severe multifocal VSA. This emphasizes the need for a comprehensive approach for optimal outcomes in complex ACS cases.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380010","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. Sareban, Gunnar Treff, Thomas Wuppinger, Daniel Zimpfer, J. Niebauer
Atrial septal defect (ASD) is characterized by a diverse clinical presentation influenced by the type, size, and hemodynamics. Endurance athletes with ASD may exhibit higher than normal performance levels, however they face an elevated risk of exercise-induced cardiac volume and pressure strain, potentially expediting a maladaptation of the right heart. An asymptomatic 28-year-old female elite triathlete sought a pre-participation sports medical examination. Her past medical history revealed right heart enlargement. Transthoracic echocardiography and magnetic resonance imaging did not ascertain a definitive diagnosis such as shunting. The examination revealed a remarkably high maximum oxygen uptake during cardio-pulmonary exercise testing (CPET), yet an abnormal oxygen uptake/workload slope and a low, plateauing oxygen pulse. The athlete agreed to transesophageal echocardiography which demonstrated a superior sinus venosus-type ASD. Surgical intervention, conducted with minimally invasive endoscopic robotic technology and a pericardial patch was performed at a tertiary center under full cardio-pulmonary bypass. At seven-month follow-up, the patient reported engaging in swim sessions without limitations and participating in high intensity cycling sessions with performances similar to pre-surgery. CPET revealed increased maximum oxygen consumption and normalization of oxygen uptake/workload slope and maximum oxygen pulse. Endurance athletes with ASD may have abnormal hemodynamic response during CPET despite an exceptional high maximum oxygen uptake. This underscores the value of CPET in the diagnostic work-up of right heart enlargement.
{"title":"The Valuable Role of Cardio-Pulmonary Exercise Testing in the Diagnosis of Atrial Septal Defect in a Competitive Triathlete - A Case Report","authors":"M. Sareban, Gunnar Treff, Thomas Wuppinger, Daniel Zimpfer, J. Niebauer","doi":"10.1093/ehjcr/ytae278","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae278","url":null,"abstract":"\u0000 \u0000 \u0000 Atrial septal defect (ASD) is characterized by a diverse clinical presentation influenced by the type, size, and hemodynamics. Endurance athletes with ASD may exhibit higher than normal performance levels, however they face an elevated risk of exercise-induced cardiac volume and pressure strain, potentially expediting a maladaptation of the right heart.\u0000 \u0000 \u0000 \u0000 An asymptomatic 28-year-old female elite triathlete sought a pre-participation sports medical examination. Her past medical history revealed right heart enlargement. Transthoracic echocardiography and magnetic resonance imaging did not ascertain a definitive diagnosis such as shunting. The examination revealed a remarkably high maximum oxygen uptake during cardio-pulmonary exercise testing (CPET), yet an abnormal oxygen uptake/workload slope and a low, plateauing oxygen pulse. The athlete agreed to transesophageal echocardiography which demonstrated a superior sinus venosus-type ASD. Surgical intervention, conducted with minimally invasive endoscopic robotic technology and a pericardial patch was performed at a tertiary center under full cardio-pulmonary bypass. At seven-month follow-up, the patient reported engaging in swim sessions without limitations and participating in high intensity cycling sessions with performances similar to pre-surgery. CPET revealed increased maximum oxygen consumption and normalization of oxygen uptake/workload slope and maximum oxygen pulse.\u0000 \u0000 \u0000 \u0000 Endurance athletes with ASD may have abnormal hemodynamic response during CPET despite an exceptional high maximum oxygen uptake. This underscores the value of CPET in the diagnostic work-up of right heart enlargement.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141380139","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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