G. De Zan, Marjolein C de Jongh, Vjeran Karloci, M. Guglielmo, I. van der Bilt
Fluoroscopy-guided catheter ablation has become the gold standard for treatment of cardiac arrhythmias. High resolution electro-anatomical mapping systems have become fundamental to perform these procedures. Recently, interventional cardiac magnetic resonance (iCMR) has been proposed as an alternative for fluoroscopy to guide atrial flutter ablations. The clinical experience with iCMR and dedicated three-dimensional mapping systems is growing. North-Star is currently the first available vendor-neutral mapping system. We performed a real-time CMR-guided cavotricuspid (CTI) catheter ablation (CA) on a 69-year-old man using a novel mapping system (NorthStar Mapping System, Imricor Medical Systems, Minnesota, USA). Starting from the CMR imaging a pre-rendered segmentation model was loaded on NorthStar and used to guide the catheters, display voltage and activation maps, show mapping and ablation points. Northstar can also take full control of the CMR scanner (i.e. start/stop sequences for anatomical information, tissue characterization and catheter visualization) and communicate with the recorder/stimulator system (Advantage-MR EP, Imricor Medical Systems, Minnesota, USA). With comparable procedural time to standard fluoroscopy-guided CA, CTI bidirectional block was achieved, without any complication. Using the NorthStar Mapping System we managed to achieve a successful CMR-guided CTI ablation without any complication. Its further use should be explored, especially in more complex arrhythmias where a substrate-guided ablation is critical, as it could significantly improve results in terms of arrhythmia recurrence.
{"title":"First Experience with a Vendor-Neutral Three-Dimensional Mapping System for Cardiac Magnetic Resonance-Guided Electrophysiological Procedures: a Case Report","authors":"G. De Zan, Marjolein C de Jongh, Vjeran Karloci, M. Guglielmo, I. van der Bilt","doi":"10.1093/ehjcr/ytae271","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae271","url":null,"abstract":"\u0000 \u0000 \u0000 Fluoroscopy-guided catheter ablation has become the gold standard for treatment of cardiac arrhythmias. High resolution electro-anatomical mapping systems have become fundamental to perform these procedures. Recently, interventional cardiac magnetic resonance (iCMR) has been proposed as an alternative for fluoroscopy to guide atrial flutter ablations. The clinical experience with iCMR and dedicated three-dimensional mapping systems is growing. North-Star is currently the first available vendor-neutral mapping system.\u0000 \u0000 \u0000 \u0000 We performed a real-time CMR-guided cavotricuspid (CTI) catheter ablation (CA) on a 69-year-old man using a novel mapping system (NorthStar Mapping System, Imricor Medical Systems, Minnesota, USA). Starting from the CMR imaging a pre-rendered segmentation model was loaded on NorthStar and used to guide the catheters, display voltage and activation maps, show mapping and ablation points. Northstar can also take full control of the CMR scanner (i.e. start/stop sequences for anatomical information, tissue characterization and catheter visualization) and communicate with the recorder/stimulator system (Advantage-MR EP, Imricor Medical Systems, Minnesota, USA). With comparable procedural time to standard fluoroscopy-guided CA, CTI bidirectional block was achieved, without any complication.\u0000 \u0000 \u0000 \u0000 Using the NorthStar Mapping System we managed to achieve a successful CMR-guided CTI ablation without any complication. Its further use should be explored, especially in more complex arrhythmias where a substrate-guided ablation is critical, as it could significantly improve results in terms of arrhythmia recurrence.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141268294","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}
F. Mohamad Yusoff, M. Kajikawa, Takumi Sakamoto, Akio Tanaka, Y. Higashi
Buerger disease, also known as Winiwarter-Buerger disease or thromboangiitis obliterans (TAO), is a non-specific inflammation of small and medium-sized arteries with thrombus obliteration and without atherosclerotic changes. Patients with TAO can develop chronic limb-threatening ischemia (CLTI) and are at risk of limb amputation despite smoking cessation and exercise therapy recommendations. A 72-year-old Japanese man presented with painful discoloration of toes and renal impairment. He was diagnosed with Rutherford-Classification stage 6 CLTI with IgA nephropathy. He refused limb amputation. Clinical symptoms improved after treatment with low-intensity pulsed ultrasound (LIPUS). LIPUS is a noninvasive option to improve peripheral arterial disease symptoms. Despite the conventional therapy measures, there was worsening of the limbs condition. The noninvasive investigational treatment option of LIPUS was initiated after the poor clinical outcomes of the conventional therapy measures. The patient’s symptoms in the bilateral lower limbs, ulcers and the blue-colored toes gradually recovered. After one year of treatment with LIPUS, he had achieved better walking independence with improved quality of life. LIPUS is a noninvasive option for therapeutic angiogenesis with the potential to improve ischemic limb conditions in patients with peripheral arterial disease and to avoid major amputation.
{"title":"Low-intensity pulse ultrasound (LIPUS) for “no-option” chronic/critical limb-threatening ischemia in a patient with Buerger disease: a case report","authors":"F. Mohamad Yusoff, M. Kajikawa, Takumi Sakamoto, Akio Tanaka, Y. Higashi","doi":"10.1093/ehjcr/ytae246","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae246","url":null,"abstract":"\u0000 \u0000 \u0000 Buerger disease, also known as Winiwarter-Buerger disease or thromboangiitis obliterans (TAO), is a non-specific inflammation of small and medium-sized arteries with thrombus obliteration and without atherosclerotic changes. Patients with TAO can develop chronic limb-threatening ischemia (CLTI) and are at risk of limb amputation despite smoking cessation and exercise therapy recommendations.\u0000 \u0000 \u0000 \u0000 A 72-year-old Japanese man presented with painful discoloration of toes and renal impairment. He was diagnosed with Rutherford-Classification stage 6 CLTI with IgA nephropathy. He refused limb amputation. Clinical symptoms improved after treatment with low-intensity pulsed ultrasound (LIPUS). LIPUS is a noninvasive option to improve peripheral arterial disease symptoms. Despite the conventional therapy measures, there was worsening of the limbs condition. The noninvasive investigational treatment option of LIPUS was initiated after the poor clinical outcomes of the conventional therapy measures. The patient’s symptoms in the bilateral lower limbs, ulcers and the blue-colored toes gradually recovered. After one year of treatment with LIPUS, he had achieved better walking independence with improved quality of life.\u0000 \u0000 \u0000 \u0000 LIPUS is a noninvasive option for therapeutic angiogenesis with the potential to improve ischemic limb conditions in patients with peripheral arterial disease and to avoid major amputation.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141102295","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}
Several reports have shown that transcatheter aortic valves are comparable in durability to surgical aortic valves. However, early structural valve deterioration (SVD) is rarely reported to occur, especially in hemodialysis patients. We present a case of rapidly progressive bioprosthetic aortic valve stenosis in a patient with end-stage renal disease (ESRD) secondary to diabetic nephropathy in an 83-year-old female admitted due to progressive dyspnea and orthopnea. A 23-mm sized SAPIEN3 bioprosthetic aortic valve showed normal function for the first year after transcatheter aortic valve implantation (TAVI), but then rapidly developed stenosis and required acute hospitalization for heart failure a year and a half after surgery. Emergent surgical aortic valve replacement (SAVR) with a 19-mm On-X valve (CryoLife, Kennesaw, GA, USA) was performed. Pathological examination of the explanted SAPIEN 3 valve demonstrated severely degenerated bioprosthetic pericardial leaflets with severe intrinsic and extrinsic nodular calcification, which could limit the leaflet motion. There is a lack of reports on the long-term procedural outcomes of TAVI in hemodialysis patients. The development of SVD in patients undergoing dialysis is multifactorial and has yet to be fully elucidated. In the presented case, the removed TAVI valve had severe extrinsic calcified nodules alongside a fibrin thrombus. Considering these pathological findings, antithrombotic therapy to prevent fibrin thrombus from adhering to the TAVI valve may be important to avoid early SVD.
{"title":"Early Structural Valve Deterioration of Balloon Expandable Transcatheter Aortic Valve Leaflets Due to Intrinsic and Extrinsic Nodular Calcification in a Hemodialysis Patient: A Case Report","authors":"Kyohei Onishi, Kazuki Mizutani, Yu Sato, Gaku Nakazawa","doi":"10.1093/ehjcr/ytae265","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae265","url":null,"abstract":"\u0000 \u0000 \u0000 Several reports have shown that transcatheter aortic valves are comparable in durability to surgical aortic valves. However, early structural valve deterioration (SVD) is rarely reported to occur, especially in hemodialysis patients.\u0000 \u0000 \u0000 \u0000 We present a case of rapidly progressive bioprosthetic aortic valve stenosis in a patient with end-stage renal disease (ESRD) secondary to diabetic nephropathy in an 83-year-old female admitted due to progressive dyspnea and orthopnea. A 23-mm sized SAPIEN3 bioprosthetic aortic valve showed normal function for the first year after transcatheter aortic valve implantation (TAVI), but then rapidly developed stenosis and required acute hospitalization for heart failure a year and a half after surgery. Emergent surgical aortic valve replacement (SAVR) with a 19-mm On-X valve (CryoLife, Kennesaw, GA, USA) was performed. Pathological examination of the explanted SAPIEN 3 valve demonstrated severely degenerated bioprosthetic pericardial leaflets with severe intrinsic and extrinsic nodular calcification, which could limit the leaflet motion.\u0000 \u0000 \u0000 \u0000 There is a lack of reports on the long-term procedural outcomes of TAVI in hemodialysis patients. The development of SVD in patients undergoing dialysis is multifactorial and has yet to be fully elucidated. In the presented case, the removed TAVI valve had severe extrinsic calcified nodules alongside a fibrin thrombus. Considering these pathological findings, antithrombotic therapy to prevent fibrin thrombus from adhering to the TAVI valve may be important to avoid early SVD.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141100675","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}
Kawasaki disease (KD) is a pediatric multi-system vasculitis. Mainly the coronary arteries become affected due to acute inflammation and formation of coronary artery aneurysms (CAAs) may occur. As the size of the CAA increases, so does the risk of clinical complications and serious cardiac outcomes. These patients may experience life threatening thrombotic coronary artery occlusion and myocardial ischemia unless anti-platelet and anti-coagulation therapy is not initiated in a timely manner. [1] This case report presents a 12-year-old patient with Kawasaki disease who developed CAAs in two coronary arteries despite initial administration of intrave-nous immunoglobulins and acetylsalicylic acid (ASA), followed by extensive thrombosis of both coronary arteries, although antithrombotic therapy was started after the diagnosis of CAAs. Our case is notable because of the severity of the clinical manifestation de-spite the administration of antiplatelet agents and anticoagulants. It could be speculated that the development of coronary thrombosis in this case might be strongly correlated with the late initiation of oral anticoagulation. The high-quality images of the affected coronary arteries in such a young patient could be of educational value.
{"title":"Extensive coronary artery thrombosis in a pediatric patient with Kawasaki disease: A Case Report","authors":"Tilbe Kasap, Inga Voges, K. Rinne, P. Langguth","doi":"10.1093/ehjcr/ytae250","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae250","url":null,"abstract":"\u0000 \u0000 \u0000 Kawasaki disease (KD) is a pediatric multi-system vasculitis. Mainly the coronary arteries become affected due to acute inflammation and formation of coronary artery aneurysms (CAAs) may occur. As the size of the CAA increases, so does the risk of clinical complications and serious cardiac outcomes. These patients may experience life threatening thrombotic coronary artery occlusion and myocardial ischemia unless anti-platelet and anti-coagulation therapy is not initiated in a timely manner. [1]\u0000 \u0000 \u0000 \u0000 This case report presents a 12-year-old patient with Kawasaki disease who developed CAAs in two coronary arteries despite initial administration of intrave-nous immunoglobulins and acetylsalicylic acid (ASA), followed by extensive thrombosis of both coronary arteries, although antithrombotic therapy was started after the diagnosis of CAAs.\u0000 \u0000 \u0000 \u0000 Our case is notable because of the severity of the clinical manifestation de-spite the administration of antiplatelet agents and anticoagulants. It could be speculated that the development of coronary thrombosis in this case might be strongly correlated with the late initiation of oral anticoagulation. The high-quality images of the affected coronary arteries in such a young patient could be of educational value.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141101479","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}
Daiki Toyoshima, Yasuhide Mochizuki, Hideshi Tomita, T. Shinke
{"title":"Unprecedented Hypoxemia Caused by Ventricular Septal Aneurysm Protruding into Left Ventricular Outflow Tract in An Adult with Congenitally Corrected Transposition of The Great Arteries","authors":"Daiki Toyoshima, Yasuhide Mochizuki, Hideshi Tomita, T. Shinke","doi":"10.1093/ehjcr/ytae260","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae260","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141114006","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}
Carola Griffith Brookles, Matteo Bianco, Stefano Pizzimenti, Giulia Gobello, C. Biolè, P. Destefanis, Enrico Cerrato, Alessandra Chinaglia
hypersensitivity reactions to iodinated contrast media (ICM) are frequently encountered in clinical practice. Severe manifestations, despite being infrequent, can be life-threatening and represent an issue when re-administration of ICM is required. Clear recommendations on prevention and management of relapses are still lacking. we present the cases of two patients presenting with Acute Coronary Syndrome (ACS) requiring urgent coronary angiography, with an anamnesis of ICM-induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Both patients safely underwent a coronary angiography with the use of a different ICM (Iobitridol) to the one linked to hypersensitivity manifestations, after premedication with corticosteroids and H1 antagonists. Our experience highlights that in clinical situations in which the use of ICM is urgently needed, premedication with corticosteroids and H1 antagonists together with the choice of an alternative contrast agent (when the culprit is known) represent an effective strategy to perform a potentially life-saving procedure while avoiding serious systemic allergic reactions.
{"title":"Management of Acute Coronary Syndromes requiring coronary angiography in patients with Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome induced by iodinated contrast media: two case reports and narrative review","authors":"Carola Griffith Brookles, Matteo Bianco, Stefano Pizzimenti, Giulia Gobello, C. Biolè, P. Destefanis, Enrico Cerrato, Alessandra Chinaglia","doi":"10.1093/ehjcr/ytae259","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae259","url":null,"abstract":"\u0000 \u0000 \u0000 hypersensitivity reactions to iodinated contrast media (ICM) are frequently encountered in clinical practice. Severe manifestations, despite being infrequent, can be life-threatening and represent an issue when re-administration of ICM is required. Clear recommendations on prevention and management of relapses are still lacking.\u0000 \u0000 \u0000 \u0000 we present the cases of two patients presenting with Acute Coronary Syndrome (ACS) requiring urgent coronary angiography, with an anamnesis of ICM-induced Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Both patients safely underwent a coronary angiography with the use of a different ICM (Iobitridol) to the one linked to hypersensitivity manifestations, after premedication with corticosteroids and H1 antagonists.\u0000 \u0000 \u0000 \u0000 Our experience highlights that in clinical situations in which the use of ICM is urgently needed, premedication with corticosteroids and H1 antagonists together with the choice of an alternative contrast agent (when the culprit is known) represent an effective strategy to perform a potentially life-saving procedure while avoiding serious systemic allergic reactions.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141113560","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}
Coronary guidewire entrapment is not an uncommon complication of percutaneous coronary intervention, especially in the setting of complex coronary anatomy. Core wire fracture with uncoiling of spring wire represents a catastrophic complication, posing great technical difficulty in percutaneous retrieval. The patient was a 50-year-old Asian male with ischaemic cardiomyopathy and severe left ventricular impairment. Coronary angiography showed severe left main and triple vessel disease. Coronary artery bypass graft was declined due to high surgical risk. Percutaneous coronary intervention was performed under mechanical circulatory support. However, it was complicated with guidewire entrapment and unravelling with deformity of the newly implanted stent in the left anterior descending artery. The complication was successfully bailed out by rotational atherectomy and the novel intravascular ultrasound (IVUS) and enhanced stent visualization (ESV) system guided ‘Twist-wire’ technique. Complete wire fragments retrieval was achieved with excellent final angiographic and IVUS results immediately after procedure and at 4-month follow-up angiography. This case represents a rare phenomenon of branch point protrusion (BPP) of stent causing guidewire-stent edge entanglement. A novel ‘Twist-wire’ technique with IVUS and ESV guidance was highlighted to allow successful retrieval of fluoroscopically invisible uncoiled wire filaments.
{"title":"Unprecedented Guidewire Entrapment Salvaged by Combined Rotational Atherectomy and ‘Twist-wire’ Technique: a case report","authors":"Siu-Fung Wong, H. Chow, T. Chung","doi":"10.1093/ehjcr/ytae258","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae258","url":null,"abstract":"\u0000 \u0000 \u0000 Coronary guidewire entrapment is not an uncommon complication of percutaneous coronary intervention, especially in the setting of complex coronary anatomy. Core wire fracture with uncoiling of spring wire represents a catastrophic complication, posing great technical difficulty in percutaneous retrieval.\u0000 \u0000 \u0000 \u0000 The patient was a 50-year-old Asian male with ischaemic cardiomyopathy and severe left ventricular impairment. Coronary angiography showed severe left main and triple vessel disease. Coronary artery bypass graft was declined due to high surgical risk. Percutaneous coronary intervention was performed under mechanical circulatory support. However, it was complicated with guidewire entrapment and unravelling with deformity of the newly implanted stent in the left anterior descending artery. The complication was successfully bailed out by rotational atherectomy and the novel intravascular ultrasound (IVUS) and enhanced stent visualization (ESV) system guided ‘Twist-wire’ technique. Complete wire fragments retrieval was achieved with excellent final angiographic and IVUS results immediately after procedure and at 4-month follow-up angiography.\u0000 \u0000 \u0000 \u0000 This case represents a rare phenomenon of branch point protrusion (BPP) of stent causing guidewire-stent edge entanglement. A novel ‘Twist-wire’ technique with IVUS and ESV guidance was highlighted to allow successful retrieval of fluoroscopically invisible uncoiled wire filaments.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141121220","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}
Samah El-Mhadi, Hind Hibatouallah, Zakia Touati, Mohammed Cherti
We report a rare case of unoperated D-transposition of the great arteries (d-TGA) in a 55-year-old homeless patient presenting with exertional dyspnea and cyanosis. Echocardiographic findings revealed d-TGA with an outlet ventricular septal defect and concurrent subvalvular and valvular pulmonary stenosis. Due to delayed age of diagnosis, limited data on adult d-TGA outcomes, and socioeconomic factors, surgical intervention was not pursued. Instead, palliative care measures were implemented, underscoring the importance of early diagnosis, tailored care plans, and comprehensive support structures to optimize outcomes.
我们报告了一例罕见的未经手术的 D 型大动脉横跨（d-TGA）病例，患者 55 岁，无家可归，出现劳力性呼吸困难和紫绀。超声心动图检查结果显示，d-TGA伴有室间隔出口缺损，并发瓣下和瓣膜性肺动脉狭窄。由于确诊年龄较晚、有关成人d-TGA预后的数据有限以及社会经济因素，该患者没有接受手术治疗。相反，他们采取了姑息治疗措施，强调了早期诊断、量身定制的护理计划和全面的支持结构对优化预后的重要性。
{"title":"Balanced chaos: A 55-year journey with unrepaired D-transposition of great arteries, ventricular septal defect, subvalvular and valvular pulmonary stenosis","authors":"Samah El-Mhadi, Hind Hibatouallah, Zakia Touati, Mohammed Cherti","doi":"10.1093/ehjcr/ytae257","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae257","url":null,"abstract":"\u0000 We report a rare case of unoperated D-transposition of the great arteries (d-TGA) in a 55-year-old homeless patient presenting with exertional dyspnea and cyanosis. Echocardiographic findings revealed d-TGA with an outlet ventricular septal defect and concurrent subvalvular and valvular pulmonary stenosis. Due to delayed age of diagnosis, limited data on adult d-TGA outcomes, and socioeconomic factors, surgical intervention was not pursued. Instead, palliative care measures were implemented, underscoring the importance of early diagnosis, tailored care plans, and comprehensive support structures to optimize outcomes.","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140965431","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}
Andrea Papa, U. Fisch, Stefano Bassetti, P. Badertscher, P. Krisai
Differentiation of syncope from seizure is challenging and has therapeutic implications. Cardioinhibitory reflex syncope typically affects young patients where permanent pacing should be avoided whenever possible. Cardioneuroablation may obviate the need for a pacemaker in well-selected patients. A previously healthy 24-year-old woman was referred to the emergency department after recurrent episodes of transient loss of consciousness (TLOC). The electrocardiogram (ECG) and the echocardiogram were normal. An electroencephalogram (EEG) showed intermittent, generalized pathological activity. During EEG under photostimulation, the patient developed a short-term TLOC followed by brachial myocloni, while the concurrent ECG registered a progressive bradycardia, which turned into a complete atrioventricular block and sinus arrest with asystole for 14 seconds. Immediately after, the patient regained consciousness without sequelae. The episode was interpreted as cardioinhibitory convulsive syncope. However, due to the pathological EEG findings, an underlying epilepsy with ictal asystole could not be fully excluded. Therefore, an antiseizure therapy was also started. After discussing the consequences of pacemaker implantation, the patient agreed to undergo a cardioneuroablation and after 72-hours without complications she was discharged home. At 10 months the patient autonomously discontinued the antiepileptics. The follow-up EEG displayed unspecific activities without clinical correlations. An implantable loop recorder didn’t show any relevant bradyarrhythmia. At 1-year follow-up, the patient remained asymptomatic and without syncopal episodes. Reflex syncope must be considered in the differential diagnosis of seizures. The cardioneuroablation obviated the need for a pacemaker and allowed for the withdrawal of anticonvulsants, originally started on the premise of seizure.
{"title":"Syncope or seizure, that is the question: case report of a young patient with convulsive cardioinhibitory syncope treated with cardioneuroablation","authors":"Andrea Papa, U. Fisch, Stefano Bassetti, P. Badertscher, P. Krisai","doi":"10.1093/ehjcr/ytae256","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae256","url":null,"abstract":"\u0000 \u0000 \u0000 Differentiation of syncope from seizure is challenging and has therapeutic implications. Cardioinhibitory reflex syncope typically affects young patients where permanent pacing should be avoided whenever possible. Cardioneuroablation may obviate the need for a pacemaker in well-selected patients.\u0000 \u0000 \u0000 \u0000 A previously healthy 24-year-old woman was referred to the emergency department after recurrent episodes of transient loss of consciousness (TLOC). The electrocardiogram (ECG) and the echocardiogram were normal. An electroencephalogram (EEG) showed intermittent, generalized pathological activity. During EEG under photostimulation, the patient developed a short-term TLOC followed by brachial myocloni, while the concurrent ECG registered a progressive bradycardia, which turned into a complete atrioventricular block and sinus arrest with asystole for 14 seconds. Immediately after, the patient regained consciousness without sequelae. The episode was interpreted as cardioinhibitory convulsive syncope. However, due to the pathological EEG findings, an underlying epilepsy with ictal asystole could not be fully excluded. Therefore, an antiseizure therapy was also started. After discussing the consequences of pacemaker implantation, the patient agreed to undergo a cardioneuroablation and after 72-hours without complications she was discharged home. At 10 months the patient autonomously discontinued the antiepileptics. The follow-up EEG displayed unspecific activities without clinical correlations. An implantable loop recorder didn’t show any relevant bradyarrhythmia. At 1-year follow-up, the patient remained asymptomatic and without syncopal episodes.\u0000 \u0000 \u0000 \u0000 Reflex syncope must be considered in the differential diagnosis of seizures. The cardioneuroablation obviated the need for a pacemaker and allowed for the withdrawal of anticonvulsants, originally started on the premise of seizure.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966770","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}
Takahito Kohara, K. Yoneda, Takehumi Takahashi, Koichi Kishi
{"title":"Acute Myocardial Infarction due to Compression by a Left Sinus of Valsalva Aneurysm Complicated by Septic Shock","authors":"Takahito Kohara, K. Yoneda, Takehumi Takahashi, Koichi Kishi","doi":"10.1093/ehjcr/ytae253","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae253","url":null,"abstract":"","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140966870","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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