Case Reports in Cardiology最新文献

We present a case of a 60-year-old man with claudication in his right foot; the patient had received stent-graft implantation for the right superficial femoral artery (SFA) 1 year ago. Computed tomography angiography suggested stent occlusion of the right SFA, and a thrombus was considered to cause occlusion. To avoid distal embolization, we performed lesion recanalization via a trans-ankle intervention. First, we performed aspiration for the lesion; however, the thrombus persisted. Second, we performed the "Super Grab a Clot and Hold ON" technique and removed several thrombi. Finally, we used drug-coated balloons as a final device for the lesion. Two years later, the right SFA was found open upon an ultrasonography.

Anomalous aortic origin of a coronary artery is a rare congenital heart defect. The detection of anomalous coronary arteries is likely to increase with increased availability and application of cardiac computed tomography and magnetic resonance imaging. Once detected, the recommendation for surgical intervention on anomalous coronary arteries depends upon patient symptoms, the presence or absence of inducible ischemia on stress imaging, and high-risk anatomic features. A 77-year-old man with a history of hypertension, hyperlipidemia, chronic kidney disease Stage III, and moderate aortic stenosis presented with a non-ST-elevation myocardial infarction and was found to have an anomalous aortic origin of the right coronary artery on cross-sectional imaging. His aortic stenosis had also progressed from moderate to severe, and it was not clear whether his myocardial infarction could be exclusively attributed to a supply-demand disparity within the context of profound aortic stenosis or if his aberrant coronary anatomy could be implicated as the culprit for his presentation. A multidisciplinary heart team decided to proceed with a transcatheter aortic valve replacement and then readdress surgical intervention on his anomalous right coronary artery if his anginal symptoms persisted following valve replacement.

Aortic dissection (AoD) is a rare fatal condition in which tearing in the intima causes a false channel in the aorta and can lead to rupture. AoD is classified as the DeBakey classification (Types I, II, III) and Stanford classification (Types A and B). Women with underlying risk factors such as hypertension, smoking, bicuspid aortic valve, and connective tissue disorders are at risk for pregnancy-related AoD. These risk factors may not be recognized until the AoD occurs during pregnancy. We describe an acute incidence of type A AoD in the second trimester of pregnancy. A multiparous woman with no previously known risk factor presented with nonspecific chest pain. She was found to have AoD and underwent successful surgical intervention. This case demonstrates the importance of vigilance in the evaluation of pregnant women with new cardiopulmonary symptoms. A multidisciplinary approach can save the mother and the fetus.

The management of spontaneous coronary artery dissection (SCAD) presents challenges and uncertainties. We present a case of a 54-year-old woman who developed SCAD in the three primary coronary artery territories including the distal left anterior descending artery (LAD), a diagonal branch, the first and second obtuse marginals (OMs), and the midright coronary artery (RCA). She was managed conservatively without procedural intervention, and follow-up coronary angiography demonstrated complete recovery.

Ebstein's anomaly is a rare congenital displacement of the tricuspid valve resulting in atrialization of the right ventricle. About half of the patients with Ebstein's anomaly also have atrial septal defects, which may lead to chronic shunting and development of Eisenmenger syndrome. We describe a case of a sexagenarian male patient with a history of Ebstein's anomaly complicated with Eisenmenger syndrome undergoing robotic laparoscopic adrenalectomy who presented hemodynamic instability, hypoxemia, and likely right-to-left shunting intraoperatively, as well as the actions taken to correct it and have a successful outcome. Perioperative management of adult patients with congenital heart defects is complex and requires careful monitoring. When available, intraoperative transesophageal echocardiography is strongly recommended. To prevent right-to-left shunting, maintaining elevated systemic vascular resistance with the use of vasopressors and low positive end-expiratory pressure (PEEP) ventilation is critical.

A 48-year-old male with a history of hyperlipidemia presented to the emergency department with chest pain. Electrocardiographic abnormalities indicated an acute coronary syndrome. Urgent coronary angiography revealed nondominant right coronary artery (RCA) occlusion. During primary percutaneous coronary intervention (PCI), a 0.014-inch floppy guidewire could not be easily advanced into the middle RCA due to poor backup support from the guiding catheter and the patient's breathing. The pressure was monitored several times after reinserting the guiding catheter. Nevertheless, the guidewire was inadvertently inserted into the false lumen from the ostium, leading to subsequent dissection during contrast injection. Intravascular ultrasound (IVUS) imaging confirmed dissection from the ostium to the middle RCA and passage of the guidewire into the false lumen. An additional guidewire was successfully inserted into the true lumen of the RCA using real-time IVUS-guided wiring. We demonstrated successful bailout stenting for catheter-induced dissection of the nondominant small RCA. Our case highlights the risk of coronary artery dissection associated with guiding catheter use, especially in a nondominant small RCA, and the importance of optimal guiding catheter selection for primary PCI. The real-time IVUS-guided wiring technique can be applied to a single 6-Fr guiding catheter and is useful for quickly inserting a guidewire into the true lumen.

This case report discusses the diagnosis and management of a 25-year-old pregnant patient presenting with persistent tachycardia. The patient, with a past medical history of thyroiditis, polycystic ovarian syndrome, and obesity, was admitted due to palpitations and was diagnosed with atrial tachycardia. Despite medical management with metoprolol, adenosine, digoxin, and flecainide, the tachycardia persisted, necessitating discussion about cardiac ablation. The report emphasizes that atrial tachycardia poses a significant clinical challenge when refractory to medical therapy. It also highlights the condition's association with tachycardia-induced cardiomyopathy and the role of catheter ablation in its management. This case underscores the need for a high index of suspicion for atrial tachycardia in pregnant patients presenting with persistent tachycardia and the importance of appropriate referral for invasive management when medical therapy fails. The case also highlights that atrial tachycardia in pregnancy can be safely managed with ablation.

Ventricular wall rupture is associated with poor outcomes subsequent to an acute myocardial infarction. We describe a case of postmyocardial infarction apical wall rupture following percutaneous coronary intervention. Our case emphasizes the importance of swift evaluation, diagnosis, and management to enhance survival in individuals confronting this critical condition.

In patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF) who are on a downward clinical trajectory, options are mostly limited to left ventricular assist device and transplantation. However, in those with factors favorable for reverse remodeling, every effort should be made to promote native myocardial recovery. We present three patients with newly diagnosed severe HFrEF, NYHA Class 3-4 symptoms, and low cardiac output with and without organ malperfusion. Ivabradine and/or home milrinone were used during their tenuous hemodynamic period as a bridge to optimize guideline-directed medical therapy (GDMT), device therapy, and eventual reverse remodeling. Evidence of structural heart improvement continued far beyond 1 year.

Although active infection is generally a contraindication before an orthotopic heart transplant, a 16-year-old man diagnosed with dilated cardiomyopathy successfully underwent an orthotopic heart transplant despite having active probable invasive pulmonary aspergillosis and bacterial pneumonia in the presence of septic and cardiogenic shock.