Case Reports in Cardiology最新文献

The AngioVac mechanical aspiration system has emerged in the literature as a viable treatment option for patients with intracardiac masses and thrombi and who are deemed high risk for cardiac surgery. Notably, it has been shown to be an effective treatment modality for the debulking of thrombi in the setting of malignancy. We present a case of repeat AngioVac debulking of a large right atrial thrombus with extension from the hepatic vein in the setting of advanced malignancy complicated by Enterococcus faecium endocarditis.

By 2030, the United States will have over 12 million people with atrial fibrillation, which carries a five-fold increase in risk of stroke. Watchman device is an alternative in patients who are poor candidates for anticoagulation. Here, we present a rare case of Watchman device implantation related to left atrial appendage (LAA) perforation noted intraoperatively with portion of the device in the pericardial space. A 93-year-old female with high fall risk and on Coumadin presented for Watchman device placement. During implantation, LAA perforation was noted with exudation of contract in the pericardium during deployment, and decision to deploy the device was made, hoping it would help seal the leak. Retrieving the device was thought to put the patient at risk of bigger perforation. Following which successful pericardial window with temporary drain placement avoided sternotomy and overall had a good outcome. A Watchman device with self-expanding frame covering the left atrial facing surface was deployed, after which a rare but potential complication of perforation was noted during delivery. The device left in place sealed the leak and prevented potential worsening incase device was retrieved. Eventually, this decision improved the outcome of the patient.

Patients on hemodialysis with concomitant severe aortic stenosis (AS) and multivessel coronary artery disease (CAD) are at high risk for surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG). Transsubclavian-transcatheter aortic valve implantation (TSc-TAVI) is a well-established alternative approach to transfemoral TAVI for patients with unfavorable femoral access. Herein, we report a case in which minimally invasive surgical treatment and TSc-TAVI were performed simultaneously in a patient with severe AS and multivessel CAD undergoing hemodialysis. An 85-year-old man undergoing hemodialysis for end-stage renal disease owing to severe AS (mean pressure gradient, 46 mmHg; aortic valve area, 0.75 cm²; and left ventricular ejection fraction, 59%) presented to our hospital with chest pain on exertion. Preoperative coronary angiography revealed significant stenosis of the left anterior descending (LAD) coronary artery and right coronary artery (RCA), requiring revascularization. However, the patient was not a good candidate for transfemoral TAVI because of a porcelain ascending aorta and a shaggy descending aorta observed on computed tomography. He was scheduled for concomitant right TSc-TAVI and minimally invasive cardiac surgery (MICS)-CABG after percutaneous coronary intervention (PCI) for the RCA. The treatment was successful. Simultaneous TSc-TAVI and MICS-CABG with PCI may be applied as a minimally invasive surgical treatment modality for patients with AS and CAD undergoing hemodialysis.

Background: The clinical course of cardiac sarcoidosis is typically subacute, and fulminant cases requiring mechanical circulatory support are rare. Here, we report the case of a patient with pathologically diagnosed cardiac sarcoidosis who presented with fulminant myocarditis and whose cardiac function was improved by aggressive immunosuppressive therapy based on the treatment of giant cell myocarditis. Case Presentation: A 55-year-old woman presented with progressive dyspnoea and nausea that persisted for 1 month and was eventually diagnosed with acute heart failure. Echocardiography showed a reduced left ventricular ejection fraction with thinning of the basal septal wall. During hospitalisation, she experienced ventricular tachycardia and fibrillation attacks, and bradycardia due to a complete atrioventricular block and sinus dysfunction was observed after starting amiodarone. Subsequently, she underwent intra-aortic balloon pump insertion in addition to inotropic agent administration; however, venoarterial extracorporeal membrane oxygenation and Impella 5.0 were needed because biventricular dysfunction progressed. We diagnosed our patient with cardiac sarcoidosis based on the pathological findings revealing inflammatory cell infiltration, including giant cells with extensive fibrosis and granulomas. However, the possibility of giant cell myocarditis could not be ruled out because of the fulminant clinical course; therefore, aggressive immunosuppressive therapy with corticosteroids and cyclosporine was started. Her cardiac function improved, and all mechanical circulatory support and inotropic agents were discontinued. Conclusion: Cardiac sarcoidosis is difficult to differentiate from giant cell myocarditis because they have many similarities in terms of myocardial histopathology and clinical manifestations. While whether the two diagnoses are parts of a single-disease continuum remains debatable, aggressive combination immunosuppressive therapy may contribute to favourable outcomes.

Hydralazine, a commonly used arterial vasodilator for managing congestive heart failure and hypertension, is known to be associated with drug-induced lupus and, less frequently, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Drug-induced AAV typically carries a favorable long-term prognosis and is not commonly linked to cardiovascular or ocular involvement. Pericarditis cases associated with hydralazine have not been previously reported. We present a rare case involving an 85-year-old woman on long-term hydralazine therapy, initially presenting with acute lobar pneumonia. During her hospitalization, she developed pericarditis, chemosis, and conjunctivitis in her eyes, along with cutaneous lesions described as a maculopapular rash on her face, tender bullae on her digits, and a petechial rash on her back. Laboratory findings were consistent with drug-induced AAV, showing positive myeloperoxidase and proteinase 3 antibodies. An attempted diagnostic pericardiocentesis was unsuccessful. Hydralazine was discontinued, and she was successfully treated with corticosteroids and tolerated immunosuppression well. Subsequently, she recovered and was discharged from the hospital.

Background: Ivabradine is a novel drug with the ability to reduce heart rate without compromising myocardial contractility or blood pressure. Studies on this drug exist mainly for heart failure and coronary artery disease; for arrhythmia, the studies are limited to small sample trials and case series, mostly unrandomized. Additionally, its evidence for arrhythmia in pediatric patients is limited. Here, we present a case of successful ivabradine administration for incessant atrial tachycardia in a 1-year-old child following tetralogy of Fallot (TOF) repair. Case: A 1-year-old child experienced incessant tachyarrhythmia episodes after TOF repair. Multiple standard therapies, including adenosine, amiodarone, multiple cardioversions, beta-blockers, and digoxin, failed to convert the rhythm. Considering the limited therapy options and existing case reports, ivabradine was administered at a dose of 0.1 mg/kg. Subsequently, sinus rhythm was restored 8 h after its administration, with the heart rate significantly decreased, and the patient returned to a stable hemodynamic status. Discussion: Ivabradine may be an option for incessant atrial tachycardia in pediatric patients. Although most tachyarrhythmias following TOF repair occur due to a reentry mechanism, focal mechanisms can also occur, suggested by timing, gradual acceleration after cardioversion and its response to ivabradine. Future studies are needed to further understand the safety and efficacy of ivabradine for atrial tachycardia in pediatric patients.

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.