Abdulrafee Mushaweh, Jokin Zubizarreta-Oteiza, Michael J Zellweger, Gregor Leibundgut, Philip Haaf
{"title":"Giant right coronary artery aneurysm","authors":"Abdulrafee Mushaweh, Jokin Zubizarreta-Oteiza, Michael J Zellweger, Gregor Leibundgut, Philip Haaf","doi":"10.1093/ehjcr/ytae255","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae255","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":"140967980","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 Bowles, Joshua Martin, Penni L Russell, Amy Bailey, David J Holland
Coronary artery fistula is a rare, but recognised complication of surgical myectomy. Although most communicate with the right heart, a large fistula into the left ventricular cavity may result in a shunt haemodynamically analogous to aortic regurgitation. Understanding the variable presentation of iatrogenic coronary fistulae and the optimal evaluation strategy is critical to obtaining a timely diagnosis and instituting treatment. We report the case of a 57-year-old renal transplant recipient admitted for evaluation of presyncope, one-year post-surgical myectomy for hypertrophic obstructive cardiomyopathy. An iatrogenic coronary artery fistula was suspected by transthoracic echocardiography, and later confirmed with both non-invasive and invasive coronary angiography. We highlight various cardiac imaging modalities that confirmed the diagnosis of coronary artery fistula and helped to determine the clinical significance. We report the tailored approach often required to determine the anatomic and haemodynamic characteristics of coronary fistulae and outline potential management strategies.
{"title":"Coronary Artery Fistula Following Surgical Myectomy for Hypertrophic Obstructive Cardiomyopathy – A Case Report","authors":"James Bowles, Joshua Martin, Penni L Russell, Amy Bailey, David J Holland","doi":"10.1093/ehjcr/ytae248","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae248","url":null,"abstract":"\u0000 \u0000 \u0000 Coronary artery fistula is a rare, but recognised complication of surgical myectomy. Although most communicate with the right heart, a large fistula into the left ventricular cavity may result in a shunt haemodynamically analogous to aortic regurgitation. Understanding the variable presentation of iatrogenic coronary fistulae and the optimal evaluation strategy is critical to obtaining a timely diagnosis and instituting treatment.\u0000 \u0000 \u0000 \u0000 We report the case of a 57-year-old renal transplant recipient admitted for evaluation of presyncope, one-year post-surgical myectomy for hypertrophic obstructive cardiomyopathy. An iatrogenic coronary artery fistula was suspected by transthoracic echocardiography, and later confirmed with both non-invasive and invasive coronary angiography.\u0000 \u0000 \u0000 \u0000 We highlight various cardiac imaging modalities that confirmed the diagnosis of coronary artery fistula and helped to determine the clinical significance. We report the tailored approach often required to determine the anatomic and haemodynamic characteristics of coronary fistulae and outline potential management strategies.\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":"140967100","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}
Despite previous reports indicating that in-stent tissue protrusion is not associated with worse clinical outcome, its natural history remains unclear. This is the first to describe the natural history of in-stent thrombus associated with tissue protrusion post-stenting, using multimodal imaging.
{"title":"Spontaneous Thrombus Resolution in the Right Coronary Artery Stent: Sequential Multimodal Imaging Analysis","authors":"Daigo Nishijo, M. Ikutomi, Jiro Ando","doi":"10.1093/ehjcr/ytae252","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae252","url":null,"abstract":"\u0000 Despite previous reports indicating that in-stent tissue protrusion is not associated with worse clinical outcome, its natural history remains unclear. This is the first to describe the natural history of in-stent thrombus associated with tissue protrusion post-stenting, using multimodal imaging.","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":"140969433","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}
Vincenzo Russo, Luigi Mauro Cantiello, A. Caturano
This letter discusses key points from Esposito et al.'s case report on a Brugada Syndrome (BrS) patient treated with S-ICD and later TV-ICD due to recurrent syncope. It highlights the significance of asystole in BrS-related. Additionally, it recommends dual-chamber TV-ICD systems with CLS algorithms for optimal management, citing their efficacy in reducing syncopal recurrences. Finally, it underscores the importance of considering reflex bradyarrhythmias in device selection for BrS patients at increased sudden cardiac death risk.
{"title":"When the dual-chamber pacing system is the optimal choice for Brugada patients in need of ICD","authors":"Vincenzo Russo, Luigi Mauro Cantiello, A. Caturano","doi":"10.1093/ehjcr/ytae254","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae254","url":null,"abstract":"\u0000 This letter discusses key points from Esposito et al.'s case report on a Brugada Syndrome (BrS) patient treated with S-ICD and later TV-ICD due to recurrent syncope. It highlights the significance of asystole in BrS-related. Additionally, it recommends dual-chamber TV-ICD systems with CLS algorithms for optimal management, citing their efficacy in reducing syncopal recurrences. Finally, it underscores the importance of considering reflex bradyarrhythmias in device selection for BrS patients at increased sudden cardiac death risk.","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":"140967023","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}
Shigeo Godo, H. Takagi, Kohei Komaru, J. Takahashi, S. Yasuda
Hypereosinophilic syndrome (HES) is characterized by moderate to severe eosinophilia, exclusion of neoplastic or secondary origins of eosinophilia, and systemic involvement with end-organ damage. Coronary arteries can be affected to cause vasospastic angina (VSA); however, the association of the two diseases is not well recognized. A 55-year-old woman who had a history of multiple allergic disease such as bronchial asthma and chronic sinusitis with nasal polyps was hospitalized due to attacks of chest pain at rest. During a spontaneous attack of chest pain, ECG revealed ST-segment elevation in the inferior leads and emergency coronary angiography showed focal spasms of the right and left anterior descending coronary arteries, both of which were relieved after intracoronary administration of nitroglycerin. She was diagnosed with VSA according to the Japanese Circulation Society guidelines. Despite conventional vasodilator therapies, her resting angina remained refractory. Laboratory findings were notable for moderate eosinophilia. A comprehensive evaluation to uncover the underlying cause of refractory VSA led to the diagnosis of HES, concomitant with eosinophilic pneumonia and eosinophilic chronic rhinosinusitis. Pericoronary inflammation by fat attenuation index (FAI) was increased in the proximal segment of the right coronary artery. Treatment was initiated with oral prednisolone at a starting dose of 30 mg/day. The response to treatment was rapid, with her symptoms disappearing and a regression of eosinophilia observed the following day. HES manifests with refractory VSA, and eosinophil-suppressing corticosteroid therapy proves effective in improving both conditions along with reduction of the pericoronary inflammation by FAI.
嗜酸性粒细胞过多综合征（HES）的特征是中度至重度嗜酸性粒细胞增多，排除嗜酸性粒细胞增多的肿瘤性或继发性来源，全身受累并伴有内脏损害。冠状动脉受累可引起血管痉挛性心绞痛（VSA）；然而，这两种疾病的关联性尚未得到充分认识。 一名 55 岁的妇女曾患有多种过敏性疾病，如支气管哮喘和伴有鼻息肉的慢性鼻窦炎，因休息时胸痛发作而住院治疗。在一次自发性胸痛发作时，心电图显示下导联 ST 段抬高，急诊冠状动脉造影显示右冠状动脉和左前降支冠状动脉局灶性痉挛，冠状动脉内注射硝酸甘油后症状缓解。根据日本循环学会指南，她被诊断为 VSA。尽管使用了常规的血管扩张剂疗法，她的静息心绞痛仍然难治。实验室检查结果为中度嗜酸性粒细胞增多。为了找出难治性心绞痛的根本原因，医生对该患者进行了全面评估，最终确诊为 HES，同时伴有嗜酸性粒细胞肺炎和嗜酸性粒细胞慢性鼻炎。根据脂肪衰减指数（FAI），右冠状动脉近段的冠状动脉周围炎症加重。患者开始接受口服泼尼松龙治疗，起始剂量为 30 毫克/天。治疗反应很快，第二天她的症状就消失了，嗜酸性粒细胞也有所减少。 HES 表现为难治性 VSA，而抑制嗜酸性粒细胞的皮质类固醇治疗可有效改善这两种情况，同时通过 FAI 减少冠状动脉周围炎症。
{"title":"A Case Report of Refractory Multivessel Coronary Spasm Associated with Hypereosinophilic Syndrome: One Cell, One Disease?","authors":"Shigeo Godo, H. Takagi, Kohei Komaru, J. Takahashi, S. Yasuda","doi":"10.1093/ehjcr/ytae247","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae247","url":null,"abstract":"\u0000 \u0000 \u0000 Hypereosinophilic syndrome (HES) is characterized by moderate to severe eosinophilia, exclusion of neoplastic or secondary origins of eosinophilia, and systemic involvement with end-organ damage. Coronary arteries can be affected to cause vasospastic angina (VSA); however, the association of the two diseases is not well recognized.\u0000 \u0000 \u0000 \u0000 A 55-year-old woman who had a history of multiple allergic disease such as bronchial asthma and chronic sinusitis with nasal polyps was hospitalized due to attacks of chest pain at rest. During a spontaneous attack of chest pain, ECG revealed ST-segment elevation in the inferior leads and emergency coronary angiography showed focal spasms of the right and left anterior descending coronary arteries, both of which were relieved after intracoronary administration of nitroglycerin. She was diagnosed with VSA according to the Japanese Circulation Society guidelines. Despite conventional vasodilator therapies, her resting angina remained refractory. Laboratory findings were notable for moderate eosinophilia. A comprehensive evaluation to uncover the underlying cause of refractory VSA led to the diagnosis of HES, concomitant with eosinophilic pneumonia and eosinophilic chronic rhinosinusitis. Pericoronary inflammation by fat attenuation index (FAI) was increased in the proximal segment of the right coronary artery. Treatment was initiated with oral prednisolone at a starting dose of 30 mg/day. The response to treatment was rapid, with her symptoms disappearing and a regression of eosinophilia observed the following day.\u0000 \u0000 \u0000 \u0000 HES manifests with refractory VSA, and eosinophil-suppressing corticosteroid therapy proves effective in improving both conditions along with reduction of the pericoronary inflammation by FAI.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140976317","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}
Muhammad Usman Shah, Muhammad Anis Haider, Krishna Poudyal, Mahmoud Loubani, Syed Yaseen Naqvi
Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents. A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications. Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset ST-elevation myocardial infarction (STEMI). Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.
冠状动脉旁路移植（CABG）手术是一项重大的心血管手术，可能会因移植失败而导致术后ST段抬高型心肌梗死（STEMI）。由于植入的移植物在经皮使用药物洗脱支架治疗时容易出现并发症，因此诊断和治疗具有挑战性。 一名 60 多岁的男子接受了心血管造影术，术后虽然静脉注射了鸦片制剂，但前导联出现了新的持续 2 毫米 ST 波抬高，且无明显胸痛。经胸超声心动图无法确诊。紧急进行的有创血管造影显示，左前降支中动脉与左乳内动脉（LIMA）移植物吻合处出现血栓闭塞。通过移植物进行干预被认为并发症风险很高，因此使用了原生冠状动脉来接近闭塞处，并先后使用了半顺应性球囊和药物洗脱球囊进行了联合球囊血管成形术，成功清除了闭塞。随着 ST 波抬高的缓解，LIMA 开始恢复工作，并且没有立即出现并发症。 术后早期连续导联的 ST 波抬高不容忽视，因为这往往是新发 ST 波抬高型心肌梗死（STEMI）的唯一特征。与药物洗脱支架相比，药物洗脱球囊是治疗这些病症的可行且可能更安全的选择。
{"title":"Drug-eluting balloon to treat immediate post-coronary artery bypass grafting (CABG) ST-elevation myocardial infarction (STEMI) - A case report","authors":"Muhammad Usman Shah, Muhammad Anis Haider, Krishna Poudyal, Mahmoud Loubani, Syed Yaseen Naqvi","doi":"10.1093/ehjcr/ytae245","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae245","url":null,"abstract":"\u0000 \u0000 \u0000 Coronary artery bypass graft (CABG) surgery represents a major cardiovascular operation and may be associated with post-operative ST-elevation myocardial infarction (STEMI) due to graft failure. This is challenging to diagnose and treat as the implanted grafts may be prone to complications when treated percutaneously with drug-eluting stents.\u0000 \u0000 \u0000 \u0000 A man in his 60 s underwent CABG and developed new persistent ST elevations of 2 mm in anterior leads with no significant chest pain, although, administered with intravenous opiates post-operatively. Transthoracic echocardiography was non-diagnostic. Invasive angiography performed emergently showed a thrombotic occlusion of the mid-left anterior descending artery at the site of the anastomosis with the left internal mammary artery (LIMA) graft. Intervention via the graft was considered high risk of complications, therefore, native coronary arteries were used to approach the occlusion, which was successfully cleared with a combination balloon angioplasty with a semi-compliant and then a drug-eluting balloon. The LIMA started working again with the resolution of ST elevation and no immediate complications.\u0000 \u0000 \u0000 \u0000 Early post-operative ST elevations in continuous leads should not be ignored as they often may be the only feature of new-onset ST-elevation myocardial infarction (STEMI). Drug-eluting balloons represent a feasible and possibly safer option than drug-eluting stents to treat these conditions.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140974568","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}
Koji Takahashi, Akihiro Kodama, Shigeki Uemura, Takafumi Okura
Vasospastic angina (VSA) is uncommon in premenopausal women who have less chronic endothelial injury causing vascular remodelling considered a primary role in the pathogenesis for coronary vasospasms. Furthermore, vasospasms rarely occur in the bilateral coronary ostia. Isolated coronary ostial stenosis (ICOS), which often causes severe effort angina and requires surgical intervention, is more commonly reported in middle-aged women, with causes including fibromuscular dysplasia (FMD) and large-vessel vasculitis. However, ICOS associated with VSA is extremely rare. A 50-year-old premenopausal Japanese woman presented with a complaint of typical chest pain due to angina during light exertion daily in the early morning hours since 3 years. Coronary angiography revealed bilateral mild-to-moderate ICOS in addition to multivessel spasms involving the bilateral coronary ostia confirmed by the vasospasm provocation test using intracoronary acetylcholine injection. Tests to determine the cause of ICOS did not identify FMD or any other disease. The angina attacks alleviated after calcium channel blocker (CCB) administration without intervention for bilateral ICOS for 24 years since the first presentation. Moreover, coronary computed tomography angiography (CTA) performed 24 years after the first presentation showed no ICOS. In our patient with typical and frequent VSA symptoms, coronary angiography revealed both mild-to-moderate ICOS and the vasospasms in the bilateral coronary ostia. FMD or large-vessel vasculitis were ruled out as the causes of ICOS. VSA rarely occurred after the prescription of CCB, and coronary CTA 24 years after the first presentation showed no ICOS. Bilateral ICOS in our patient might be VSA-related.
{"title":"Bilateral Isolated Coronary Ostial Stenosis in a Middle-Aged Premenopausal Woman with Vasospastic Angina: A Case Report","authors":"Koji Takahashi, Akihiro Kodama, Shigeki Uemura, Takafumi Okura","doi":"10.1093/ehjcr/ytae249","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae249","url":null,"abstract":"\u0000 \u0000 \u0000 Vasospastic angina (VSA) is uncommon in premenopausal women who have less chronic endothelial injury causing vascular remodelling considered a primary role in the pathogenesis for coronary vasospasms. Furthermore, vasospasms rarely occur in the bilateral coronary ostia. Isolated coronary ostial stenosis (ICOS), which often causes severe effort angina and requires surgical intervention, is more commonly reported in middle-aged women, with causes including fibromuscular dysplasia (FMD) and large-vessel vasculitis. However, ICOS associated with VSA is extremely rare.\u0000 \u0000 \u0000 \u0000 A 50-year-old premenopausal Japanese woman presented with a complaint of typical chest pain due to angina during light exertion daily in the early morning hours since 3 years. Coronary angiography revealed bilateral mild-to-moderate ICOS in addition to multivessel spasms involving the bilateral coronary ostia confirmed by the vasospasm provocation test using intracoronary acetylcholine injection. Tests to determine the cause of ICOS did not identify FMD or any other disease. The angina attacks alleviated after calcium channel blocker (CCB) administration without intervention for bilateral ICOS for 24 years since the first presentation. Moreover, coronary computed tomography angiography (CTA) performed 24 years after the first presentation showed no ICOS.\u0000 \u0000 \u0000 \u0000 In our patient with typical and frequent VSA symptoms, coronary angiography revealed both mild-to-moderate ICOS and the vasospasms in the bilateral coronary ostia. FMD or large-vessel vasculitis were ruled out as the causes of ICOS. VSA rarely occurred after the prescription of CCB, and coronary CTA 24 years after the first presentation showed no ICOS. Bilateral ICOS in our patient might be VSA-related.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140974717","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}
Michaela D Kiel, Sruti Prathivadhi-Bhayankaram, Arun K Singhal, Mahi L Ashwath
Coronary arteriovenous fistulas present an abnormal connection between the coronary arteries and an adjacent systemic or pulmonary vessel. They are rare, representing 0.002% of the general population.1 The majority are congenital but may additionally occur related to trauma or interventional cardiac procedures. We present the case of a 48-year-old male with a history of untreated bacterial endocarditis developing a right coronary/superior vena cava fistula. We detail the imaging findings of this rare phenomenon to arrive at this diagnosis. We describe his clinical course and the interventions considered, including surgical extraction. Unfortunately, this patient left against medical advice before completing recommended treatment. We present the first documentation of a right coronary/superior vena cava fistula secondary to chronic untreated bacterial endocarditis. Clinicians should be aware of this rare complication.
{"title":"A Case Report of Superior Vena Cava/Right Coronary Artery Fistula Secondary to Chronic Endocarditis","authors":"Michaela D Kiel, Sruti Prathivadhi-Bhayankaram, Arun K Singhal, Mahi L Ashwath","doi":"10.1093/ehjcr/ytae240","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae240","url":null,"abstract":"\u0000 \u0000 \u0000 Coronary arteriovenous fistulas present an abnormal connection between the coronary arteries and an adjacent systemic or pulmonary vessel. They are rare, representing 0.002% of the general population.1 The majority are congenital but may additionally occur related to trauma or interventional cardiac procedures.\u0000 \u0000 \u0000 \u0000 We present the case of a 48-year-old male with a history of untreated bacterial endocarditis developing a right coronary/superior vena cava fistula. We detail the imaging findings of this rare phenomenon to arrive at this diagnosis. We describe his clinical course and the interventions considered, including surgical extraction. Unfortunately, this patient left against medical advice before completing recommended treatment.\u0000 \u0000 \u0000 \u0000 We present the first documentation of a right coronary/superior vena cava fistula secondary to chronic untreated bacterial endocarditis. Clinicians should be aware of this rare complication.\u0000","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140972167","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}
The coronary sinus collects coronary blood flow back to the right atrium. Myocardial dysfunction might occur after the obstruction of coronary sinus, however, there is no relevant report. In this article, myocardial congestion secondary to iatrogenic obstruction of the coronary sinus was reported in a patient with coronary artery fistulae. Further research is required to investigate the mechanisms.
{"title":"Myocardial Congestion Secondary to Closure of Coronary Sinus","authors":"Ang Liu, Chaowu Yan","doi":"10.1093/ehjcr/ytae251","DOIUrl":"https://doi.org/10.1093/ehjcr/ytae251","url":null,"abstract":"\u0000 The coronary sinus collects coronary blood flow back to the right atrium. Myocardial dysfunction might occur after the obstruction of coronary sinus, however, there is no relevant report. In this article, myocardial congestion secondary to iatrogenic obstruction of the coronary sinus was reported in a patient with coronary artery fistulae. Further research is required to investigate the mechanisms.","PeriodicalId":507701,"journal":{"name":"European Heart Journal - Case Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140974798","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}
S. Naniwa, Shigeyasu Tsuda, Gaku Nakazawa, S. Yamada
In-stent restenosis (ISR) remains a significant clinical problem. It is estimated that 10-20% of patients who develop a first event of ISR will develop recurrent ISR (R-ISR). However, the pathology of R-ISR remains largely unknown, and recommendations for its optimal management are lacking. In this case report, we discuss the effectiveness of directional coronary atherectomy (DCA) as an atherectomy device and the mechanism of R-ISR based on pathological findings obtained from DCA. We report the case of a 62-year-old man with a history of ST-segment elevation myocardial infarction treated with percutaneous coronary intervention (PCI) to the mid left circumflex artery using a bare-metal stent. Even after introduction of adequate secondary prevention therapy for ISR, the patient underwent a total of six PCI sessions over 10 years following primary PCI for R-ISR. Eventually, the decision was made to institute treatment with DCA and a drug-coated balloon (DCB). No symptoms of restenosis were observed over the following four years. In this case report, we demonstrate the effectiveness of DCA treatment for debulking a wide range of collagen-rich plaques and show that DCA treatment should be considered for the treatment of R-ISR.
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