Case Reports in Cardiology最新文献

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.

Frank's sign (FS) refers to a diagonal skin fold between the tragus and the outer edge of the earlobe. FS has been identified as an independent variable in coronary artery disease (CAD). Young patients with FS and previous myocardial infarction are still rarely reported in clinical studies. We report the case of a 49-year-old male smoker and diabetic, with a history of myocardial infarction, who presented to the emergency department due to 2 h typical cardiac chest pain. His urgent electrocardiography (ECG) showed ST elevation, and cardiac biomarkers were elevated after admission. A diagonal earlobe crease (DELC) was observed in physical tests. The preliminary diagnosis considered acute coronary syndrome (ACS). Subsequently, acute coronary artery angiography demonstrated a slit-like contrast defect in the proximal right coronary artery (RCA), with stenosis and occlusion in the distal segment. The percutaneous coronary intervention (PCI) was performed immediately. The patient's chest pain symptoms were relieved significantly after intervention. Our case indicates that FS should be highly regarded as a routine cardiovascular clinical examination, which can be effortlessly applied and be easily interpreted for screening to suspect the presence of ischemic heart disease. This may set strategies for primary screening in a younger population and prompt early diagnosis and treatment.

Percutaneous device occlusion is currently the standard of care for most cases of patent ductus arteriosus (PDA). Albeit infrequent, device-related left pulmonary artery (LPA) stenosis is a known complication of this procedure, occasionally requiring stent placement to relieve the obstruction. We present a series of four patients who required left pulmonary stenting after ductus arteriosus device closure. A review of the current evidence is presented.

Rotational atherectomy is an effective procedure for heavily calcified lesions and those that cannot be crossed using conventional percutaneous coronary intervention (PCI) devices. Here, we report a rare case of intracoronary burr entrapment in the coronary artery due to burr disconnection from the driveshaft. A 67-year-old man undergoing hemodialysis for nephrosclerosis presented with exertional chest discomfort. Coronary angiography revealed stenotic lesions in the right coronary artery, and PCI was performed using a Rotawire Floppy. During the procedure, the disconnected burr was successfully removed without surgery using the child-in-mother technique with a guide extension catheter. Notably, the patient remained hemodynamically stable throughout the procedure and his recovery was uncomplicated. He was discharged on the second postprocedural day. At the 6-month follow-up, the patient remained asymptomatic with no evidence of myocardial ischemia. This report informs clinicians of the possibility of burr disconnection and the non-surgical intervention used for its removal.

Aorto-atrial fistula is a rare and life-threatening complication of infective endocarditis, classically diagnosed by visualizing a connection between the aorta and atrium with associated continuous flow. A patient presented with bioprosthetic and native valve enterococcal endocarditis with multiple complications, including an aorto-atrial fistula that was diagnosed by color M-mode on transesophageal echocardiography. We review the features of aorto-atrial fistula and utilize this case to demonstrate how M-mode can be leveraged to provide improved temporal resolution in the setting of diagnostic uncertainty.