Journal of Cardiology Cases最新文献

Takotsubo syndrome with left ventricular thrombus: Prevention of systemic thromboembolism Takotsubo综合征伴左心室血栓：系统性血栓栓塞的预防

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-02-01 DOI: 10.1016/j.jccase.2025.10.003

Masato Takeuchi MD , Katsutoshi Tanioka MD , Yoshikazu Ohara MD , Nobuo Kondo MD , Kensuke Ohue MD , Hiroaki Kitaoka MD, PhD, FJCC , Yoshinori Doi MD, PhD, FJCC

Takotsubo syndrome (TTS) may at times be complicated by left ventricular (LV) thrombus with a potential risk of systemic embolism. Case 1: A 65-year-old woman presented with chest pain and electrocardiographic (ECG) features of deep T-wave inversions at leads V3-V6. A broad ballooning of mid-apical LV segments was demonstrated. Despite prophylactic anticoagulation, LV apical thrombus was detected 4 days later. She then experienced right coronary artery embolism, followed by posterior tibial artery embolism, both of which were successfully treated with thrombectomy. Case 2: A 63-year-old woman presented with consciousness disturbance and ECG features of ST-segment elevations at leads V3-V6. A broad ballooning of mid-apical LV segments and apical thrombus were demonstrated. Since LV thrombus became mobile 3 days after starting therapeutic anticoagulation, she underwent surgical removal of apical thrombus to prevent systemic embolism. An educational case series of TTS with LV thrombus is presented. In patients with TTS and LV thrombus, it is important to be prepared for systemic embolism even if prophylactic and/or therapeutic anticoagulation has already been started. In cases of highly mobile LV thrombus, surgical removal could be a reasonable option.

Learning objective

•
Takotsubo syndrome may be complicated by left ventricular (LV) thrombus, reportedly with an incidence rate of 1.3–2.3 %, with a potential risk of systemic embolism.
•
It is important to be prepared for systemic embolism even if prophylactic and/or therapeutic anticoagulation has already been started.
•
In cases of highly mobile LV thrombus, surgical removal could be a reasonable option.

Takotsubo综合征（TTS）有时可能并发左心室（LV）血栓，具有全身性栓塞的潜在风险。病例1：一名65岁女性，表现为胸痛，心电图（ECG）表现为导联V3-V6处深t波反转。可见中根尖LV节段广泛膨胀。尽管预防性抗凝，4 天后仍检测到左室根尖血栓。然后她经历了右冠状动脉栓塞，接着是胫骨后动脉栓塞，两次都成功地接受了血栓切除术。病例2:63岁女性，表现为意识障碍，心电图表现为st段V3-V6导联抬高。左室中间节段呈广泛的球囊状扩张，并有根尖血栓。由于左室血栓在开始抗凝治疗后3 天开始活动，她接受了手术切除根尖血栓以防止全身性栓塞。本文介绍了一个具有教育意义的TTS合并左室血栓病例系列。对于TTS和左室血栓患者，即使已经开始预防性和/或治疗性抗凝治疗，也要做好全身性栓塞的准备。在高流动性左室血栓的情况下，手术切除可能是一个合理的选择。学习目的•Takotsubo综合征可能并发左心室（LV）血栓，据报道发生率为1.3-2.3 %，具有全身性栓塞的潜在风险。•即使已经开始预防性和/或治疗性抗凝治疗，也要为全身性栓塞做好准备。•对于高流动性左室血栓，手术切除可能是一个合理的选择。

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引用次数: 0

Enhancing cardiac device efficacy: A case series on low atrial septal lead placement for intra-atrial conduction disturbances 提高心脏装置的功效：房间隔低位导联放置治疗房内传导障碍的病例系列

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-02-01 DOI: 10.1016/j.jccase.2025.11.001

Koji Sasaki , Satoshi Higuchi MD, PhD , Kaho Hatakeyama , Momoko Murakami , Gaku Hatayama MD , Naoyuki Tanaka MD , Satoshi Miyazawa MD , Masahiro Yagi MD, PhD , Junichi Yamaguchi MD, PhD, FJCC

This case series describes three heart failure patients with right atrial conduction disturbances, where lead placement in the lower atrium was used to optimize intra-atrial conduction. By shortening conduction delays, improving intrinsic conduction, and reducing the atrioventricular interval, this approach enabled successful left ventricular-only pacing. This strategy proved particularly beneficial for patients with prolonged intra-atrial conduction. In all cases, the intervention led to significant improvements in heart failure symptoms. These findings suggest that lower atrial lead placement may enhance the performance of cardiac implantable electronic devices and improve clinical outcomes in patients with complex conduction disorders.

Learning objective

This case series highlights lower atrial septal lead placement as an effective strategy for optimizing cardiac device function in patients with intra-atrial conduction disturbances. The pacing technique shortens conduction delays, improves intrinsic conduction, and reduces the atrioventricular interval, facilitating left ventricular-only pacing. This approach is particularly beneficial for patients with prolonged intra-atrial conduction, potentially improving heart failure management and patient outcomes in complex conduction disorders.

本病例系列描述了三个心力衰竭患者右心房传导障碍，其中铅放置在下心房被用来优化心房内传导。通过缩短传导延迟，改善内在传导，缩短房室间期，这种方法可以实现成功的左心室起搏。这种策略被证明对房内传导延长的患者特别有益。在所有病例中，干预导致心力衰竭症状的显著改善。这些发现表明，心房导联位置较低可以提高心脏植入式电子装置的性能，改善复杂传导障碍患者的临床结果。学习目的：本病例系列强调心房中隔下导联放置是优化心房传导障碍患者心脏装置功能的有效策略。起搏技术缩短了传导延迟，改善了内在传导，缩短了房室间期，有利于左心室起搏。这种方法对房内传导延长的患者特别有益，潜在地改善心力衰竭的管理和复杂传导障碍的患者预后。

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引用次数: 0

Percutaneous balloon pericardiotomy using the hugging balloon technique: A case series of three high-risk patients with recurrent pericardial effusion 包抱球囊技术经皮球囊心包切开术：3例复发性心包积液高危患者的病例分析

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-02-01 DOI: 10.1016/j.jccase.2025.10.007

Asaki Saijo MD, Takahide Kodama MD, PhD, FJCC, Hideomi Fujiwara MD, Chinatsu Komiyama MD, PhD, Ayako Harima MD, Yo Fujimoto MD, Tetsuo Yamaguchi MD, PhD

In patients with recurrent pericardial effusion and poor general condition, surgical intervention is often not feasible, and the establishment of a less invasive yet effective method for continuous drainage remains a clinical challenge. We performed percutaneous balloon pericardiotomy in three patients who developed cardiac tamponade or pre-tamponade due to malignant pericarditis or unexplained recurrent pericardial effusion. All patients were considered unsuitable for surgical procedures due to their poor systemic status. Following the intervention, effective drainage was achieved without recurrence of pericardial effusion, and all patients were able to be discharged home. Percutaneous balloon pericardiotomy may represent a safe and practical alternative for managing recurrent pericardial effusion in patients for whom surgery is not an option.

Learning objective

Managing recurrent pericardial effusion in patients with poor general condition remains a clinical challenge, particularly when surgery is not feasible due to advanced malignancy or frailty. Percutaneous balloon pericardiotomy using the hugging balloon technique may offer a minimally invasive and effective alternative, providing symptom relief and facilitating discharge in high-risk patients with otherwise limited treatment options.

对于复发性心包积液且一般情况较差的患者，手术干预往往是不可行的，建立一种微创但有效的持续引流方法仍然是临床的挑战。我们对3例因恶性心包炎或不明原因的复发性心包积液而出现心包填塞或心包前填塞的患者进行了经皮心包球囊切开术。所有患者均因全身状况不佳而被认为不适合手术。干预后，有效引流成功，无心包积液复发，所有患者均可出院回家。经皮球囊心包切开术可能是治疗复发性心包积液的一种安全实用的方法。学习目的一般情况较差的患者复发性心包积液的管理仍然是一个临床挑战，特别是当由于晚期恶性肿瘤或虚弱而无法进行手术时。采用拥抱球囊技术经皮球囊心包切开术是一种微创且有效的替代方法，可缓解症状并促进治疗方案有限的高危患者出院。

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引用次数: 0

Reversed paradoxical splitting of the second heart sound: A unique case report 第二心音的反向矛盾分裂：一个独特的病例报告

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-02-01 DOI: 10.1016/j.jccase.2025.11.003

Megumi Takahashi MS, Takashi Muro MD, FJCC, Kazumasa Adachi MD, Rio Shiraki MD, Tomoko Tohda MD, Takeo Nakai MD, Yukikatsu Okada MD, PhD, FJCC

A 73-year-old female presented with split second heart sound (S2) and ejection systolic murmur. The S2 split only during expiration (paradoxical splitting) with a softer second component (pulmonary component), which was in reverse order compared to typical paradoxical splitting (termed reversed paradoxical splitting). Furthermore, the murmur increased during expiration and decreased during inspiration (reversed Rivero-Carvallo's sign). Transthoracic echocardiography revealed a mass adherent to the free wall of the right ventricular outflow tract. Open-heart surgery was performed, and the tumor was surgically resected. Histopathological examination confirmed the diagnosis of a capillary hemangioma. The patient's recovery was smooth and uneventful.

Learning objective

Splitting of the second heart sound (S2) sometimes provides significant clinical clues for cardiopulmonary disease. Paradoxical splitting of S2 typically features a softer pulmonary component (P2) followed by a clearer aortic component (A2) during expiration. We encountered a case of paradoxical splitting in which A2 preceded P2 (termed reversed paradoxical splitting) in a patient with right ventricular outflow tract obstruction due to cardiac hemangioma. Auscultation findings were definitive in this case.

73岁女性，以秒心音（S2）和射血性收缩期杂音表现。S2仅在呼气时分裂（矛盾分裂），第二组分（肺组分）较软，与典型的矛盾分裂（称为反向矛盾分裂）相反。此外，呼气时杂音增加，吸气时杂音减少（与Rivero-Carvallo标志相反）。经胸超声心动图显示一个肿块附着在右心室流出道的游离壁上。进行了心脏直视手术，并手术切除了肿瘤。组织病理学检查证实了毛细血管瘤的诊断。病人的康复很顺利。学习目的第二心音（S2）的分离有时为心肺疾病的诊断提供重要的临床线索。S2的矛盾分裂通常表现为呼气时较软的肺部分（P2），随后是较清晰的主动脉部分（A2）。我们遇到了一个病例的矛盾分裂，其中A2先于P2（称为反向矛盾分裂）的患者右心室流出道阻塞由于心脏血管瘤。本病例的听诊结果是明确的。

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引用次数: 0

SGLT2 inhibitor-associated euglycemic ketoacidosis after percutaneous coronary intervention for ST-segment elevation myocardial infarction st段抬高型心肌梗死经皮冠状动脉介入治疗后SGLT2抑制剂相关的血糖酮症酸中毒

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-02-01 DOI: 10.1016/j.jccase.2025.10.002

Takahiro Kuno MD, Shiro Amanai MD, Noriaki Takama MD, PhD, Hideki Ishii MD, PhD

While sodium-glucose cotransporter-2 (SGLT2) inhibitors improve cardiovascular outcomes after myocardial infarction (MI), they carry the risk of euglycemic diabetic ketoacidosis (euDKA). We report the case of a 60-year-old male with type 2 diabetes mellitus who developed euDKA after a primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Despite exhibiting hemodynamic stability, the patient developed persistent metabolic acidosis. The diagnosis of SGLT2 inhibitor-associated euDKA was significantly delayed, as it was obscured by a combination of the patient's clinical stability, an initial normal anion gap acidosis from diarrhea, and the administration of sodium bicarbonate. This case highlights the fact that clinical stability after primary PCI might mask SGLT2 inhibitor-associated euDKA. This report also emphasizes that euDKA should be a critical diagnostic consideration in the face of persistent acidosis in STEMI patients treated with PCI and receiving SGLT2 inhibitors, even when they appear clinically stable.

Learning objectives

This case highlights that euglycemic diabetic ketoacidosis (euDKA) might be a critical and missed diagnosis in SGLT2 inhibitor-treated diabetic patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). SGLT2 inhibitor-associated euDKA should be considered in diabetic patients presenting with unexplained metabolic acidosis, even if they are hemodynamically stable and their blood glucose levels are normal. Routine ketone monitoring should be considered in this setting.

虽然钠-葡萄糖共转运蛋白-2 （SGLT2）抑制剂可改善心肌梗死（MI）后的心血管预后，但它们具有血糖型糖尿病酮症酸中毒（euDKA）的风险。我们报告一例60岁男性2型糖尿病患者，因st段抬高型心肌梗死（STEMI）接受经皮冠状动脉介入治疗（PCI）后发生euDKA。尽管血流动力学稳定，但患者出现了持续性代谢性酸中毒。SGLT2抑制剂相关euDKA的诊断被显著延迟，因为患者的临床稳定性、腹泻引起的初始正常阴离子间隙酸中毒和碳酸氢钠的使用掩盖了这一诊断。该病例强调了一个事实，即原发性PCI术后的临床稳定性可能掩盖了SGLT2抑制剂相关的euDKA。该报告还强调，对于接受PCI和SGLT2抑制剂治疗的STEMI患者，即使临床表现稳定，euDKA也应作为持续酸中毒的关键诊断考虑因素。本病例强调了在SGLT2抑制剂治疗的st段抬高型心肌梗死（STEMI）的糖尿病患者接受初级经皮冠状动脉介入治疗（PCI）时，正常血糖型糖尿病酮症酸中毒（euDKA）可能是一个关键的漏诊。出现不明原因代谢性酸中毒的糖尿病患者，即使血液动力学稳定且血糖水平正常，也应考虑SGLT2抑制剂相关的euDKA。在这种情况下应考虑常规酮监测。

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引用次数: 0

Bailout intravascular lithotripsy after rotational atherectomy for chronic total occlusion of the right coronary artery with severe calcification: A case report 右冠状动脉慢性全闭塞伴严重钙化的旋转动脉粥样硬化切除术后紧急血管内碎石术1例报告

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-02-01 DOI: 10.1016/j.jccase.2025.10.006

Yoichiro Naito MD , Kazufumi Nakamura MD, FJCC , Yoshimasa Morimoto MD , Yasunori Arai MD , Akihiro Oka MD , Yuichi Kato MD , Takaaki Saito MD , Ryunosuke Takechi MD , Michihide Okada MD , Shinsuke Yuasa MD, FJCC , Masaki Yoshikawa MD

Coronary artery calcification (CAC) is recognized as an independent predictor for major cardiovascular events. Rotational atherectomy (RA), orbital atherectomy system, and intravascular lithotripsy (IVL) are used to treat severe CAC. Among these, IVL is associated with a notably low risk of complications, such as slow flow and coronary artery perforation. A 70-year-old man with exertional angina underwent percutaneous coronary intervention for chronic total occlusion of the right coronary artery. RA was performed on a severely calcified lesion; however, the RA could not be advanced through the lesion, resulting in guidewire rupture and slow coronary flow. Due to the difficulty in proceeding with RA, IVL was attempted as a bailout strategy. Good stent expansion was achieved using IVL for residual calcified lesions, and the ruptured guidewire was secured beneath the stent. In cases where safe treatment cannot be accomplished with RA alone, the use of IVL following RA may be considered desirable.

Learning objective

Intravascular lithotripsy (IVL) is associated with a low risk of complications, such as slow flow and coronary artery perforation.

IVL serves as a useful bailout strategy when rotational atherectomy cannot be continued due to complications such as slow coronary flow and perforation.

冠状动脉钙化（CAC）被认为是主要心血管事件的独立预测因子。旋转动脉粥样硬化切除术（RA）、眼眶动脉粥样硬化切除术系统和血管内碎石术（IVL）用于治疗严重的CAC。其中，IVL的并发症风险明显较低，如血流缓慢和冠状动脉穿孔。一个70岁的男人劳累心绞痛接受经皮冠状动脉介入治疗慢性全闭塞右冠状动脉。RA对严重钙化病变进行；然而，RA不能通过病变推进，导致导丝破裂，冠状动脉血流缓慢。由于进行RA的困难，IVL被尝试作为救助策略。使用IVL对残余钙化病变进行良好的支架扩张，并将破裂的导丝固定在支架下方。如果单靠类风湿性关节炎无法实现安全治疗，那么在类风湿性关节炎后使用IVL可能是可取的。学习目的血管内碎石术（IVL）并发症的风险较低，如血流缓慢和冠状动脉穿孔。当由于冠状动脉血流缓慢和穿孔等并发症不能继续进行旋转动脉粥样硬化切除术时，IVL是一种有用的救助策略。

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引用次数: 0

Absent left atrial appendage in a patient with mitral stenosis 二尖瓣狭窄患者左心房附件缺失

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-02-01 DOI: 10.1016/j.jccase.2025.11.002

Neeta Bachani MBBS , Rashmi Rao DNB Medicine , Alpa Bharati MD , Kunal Sinkar DNB Medicine, DNB Cardiology , Gopi Krishna Panicker MBA , Jaipal Jadwani MD

A 50-year-old woman, diagnosed with severe rheumatic mitral stenosis, was referred for transesophageal echocardiography (TEE) study to confirm suitability for percutaneous balloon valvotomy and to look for evidence of thrombus in the left atrial appendage (LAA). TEE evaluation followed by computed tomography scan and magnetic resonance imaging confirmed congenital absence of LAA – a rare occurrence with fewer than 25 reports in the literature.

Learning objective

To evaluate the diagnostic process and clinical implications of absent left atrial appendage in the context of severe rheumatic mitral stenosis, emphasizing the utility of transesophageal echocardiography, contrast-enhanced computed tomography scan, and cardiac magnetic resonance imaging in identifying this rare anomaly with its impact on therapeutic decision-making.

一名50岁女性，诊断为严重风湿性二尖瓣狭窄，经食管超声心动图（TEE）研究，以确认经皮球囊瓣膜切开术的适用性，并寻找左心房附件血栓的证据。TEE评估后进行计算机断层扫描和磁共振成像证实先天性LAA缺失，这是一种罕见的情况，文献报道少于25例。学习目的评估严重风湿性二尖瓣狭窄患者左心耳缺失的诊断过程和临床意义，强调经食管超声心动图、增强计算机断层扫描和心脏磁共振成像在识别这种罕见异常及其对治疗决策的影响方面的应用。

引用次数: 0

Takotsubo syndrome presenting as ventricular fibrillation cardiopulmonary arrest coupled with complete heart block Takotsubo综合征表现为心室颤动、心肺骤停并完全性心脏传导阻滞

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-01-01 DOI: 10.1016/j.jccase.2025.10.001

Atsuko Hashimoto MD , Yuki Nishimura MD , Junya Komatsu MD , Hiroki Nakayama MD , Hiroki Sugane MD , Hayato Hosoda MD , Koji Nishida MD , Yoko Nakaoka MD , Shinji Mito MD , Ryu-ichiro Imai MD , Shu-ichi Seki MD , Sho-ichi Kubokawa MD , Kazuya Kawai MD, PhD, FJCC , Naohisa Hamashige MD, PhD , Yoshinori Doi MD, PhD, FJCC

Life-threatening arrhythmia can occur in patients with takotsubo syndrome (TTS). However, it is unusual for a TTS patient to present with ventricular fibrillation cardiopulmonary arrest (VF-CPA) coupled with complete heart block at the initial presentation. An 83-year-old woman underwent a VF-CPA. After she was successfully defibrillated, her electrocardiogram showed deep T-wave inversions with unusually prolonged QT-intervals (QTc = 0.493) at leads V1-V6 together with complete heart block. Echocardiogram and left ventriculogram showed broad ballooning from the mid left ventricle (LV) to the apex, consistent with TTS. A repeated echocardiogram 11 days after the VF-CPA event showed total recovery of the LV wall motion. She later testified that she had experienced slow pulse rate 3 days prior to the event. In conclusion, TTS presenting as VF-CPA as well as complete heart block is most unusual. As a possible sequence of events, it is postulated that TTS triggered by complete heart block was followed by VF-CPA. Prominent post-TTS QT prolongation, partly influenced by complete heart block, is considered as a possible mechanism for the VF-CPA event in this TTS patient.

Learning objective

Although life-threatening arrhythmia can occur in patients with takotsubo syndrome (TTS), a TTS patient presenting with ventricular fibrillation cardiopulmonary arrest (VF-CPA) together with complete heart block is most unusual. Prominent post-TTS QT prolongation, partly influenced by complete heart block, is considered as a possible mechanism for the VF-CPA event in this TTS patient. It is important to recognize that TTS may be at times triggered by complete heart block.

takotsubo综合征（TTS）患者可发生危及生命的心律失常。然而，TTS患者在最初出现心室颤动、心肺骤停（VF-CPA）并完全性心脏传导阻滞是不寻常的。一例83岁妇女行VF-CPA。除颤成功后，心电图示深t波反转，V1-V6导联qt间期异常延长（QTc = 0.493），伴完全性心脏传导阻滞。超声心动图及左心室示从左心室中部至心尖处广泛球囊，与TTS一致。VF-CPA事件11 天后复查超声心动图显示左室壁运动完全恢复。她后来作证说，在事件发生前3 天，她经历了缓慢的脉搏。总之，TTS表现为VF-CPA和完全性心脏传导阻滞是最罕见的。作为一种可能的事件顺序，假设完全性心脏传导阻滞引发的TTS之后是VF-CPA。TTS后QT间期明显延长，部分受完全性心脏传导阻滞影响，被认为是该TTS患者发生VF-CPA事件的可能机制。学习目的虽然takotsubo综合征（TTS）患者可能发生危及生命的心律失常，但TTS患者出现心室颤动、心肺骤停（VF-CPA）并完全性心脏传导阻滞是最罕见的。TTS后QT间期明显延长，部分受完全性心脏传导阻滞影响，被认为是该TTS患者发生VF-CPA事件的可能机制。认识到TTS有时可能由完全性心脏传导阻滞引起是很重要的。

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引用次数: 0

Transcatheter pulmonary valve implantation for re-intervention in recurrent right ventricular outflow tract obstruction 经导管肺动脉瓣置入术在复发性右心室流出道梗阻再干预中的应用

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-01-01 DOI: 10.1016/j.jccase.2025.09.006

Babu Ezhumalai MD, DM, FNB , Arun Arul David MD, DNB , Praveen Jeya Arulraj MD, DNB , Muthukumaran Chinnasamy Sivaprakasam MD, DM

Transcatheter pulmonary valve implantation (TPVI) has emerged as a less invasive alternative to surgical conduit replacement in patients with recurrent right ventricular outflow tract (RVOT) obstruction, particularly after repair of tetralogy of Fallot (TOF). We report a case of successful TPVI using a balloon-expandable MyVal transcatheter heart valve in a 58-year-old male with a complex cardiac history, including multiple prior surgeries and interventions for TOF and RVOT re-stenosis. The patient presented with severe symptoms, and multimodality imaging revealed severe right ventricle to pulmonary artery conduit stenosis, right-sided chamber dilation, and moderate biventricular dysfunction. Following thorough pre-procedural planning, TPVI was performed with conduit pre-dilation, deployment of a Cheatham platinum-covered stent to prevent conduit rupture, and implantation of a 23-mm MyVal valve. Post-procedural imaging confirmed optimal valve positioning, elimination of transconduit gradient, and resolution of pulmonary regurgitation. The patient was discharged on dual antiplatelet therapy with significant symptomatic improvement. This case highlights TPVI as a safe and effective re-intervention strategy in anatomically suitable high-risk patients with RVOT conduit dysfunction. While short-term outcomes are favourable, further data are warranted to assess long-term valve durability, particularly with newer valve technologies such as MyVal valve in the pulmonary position.

Learning objectives

This case report demonstrates that transcatheter pulmonary valve implantation using a balloon-expandable MyVal valve with covered-stent reinforcement provides a safe, effective, and minimally invasive re-intervention for recurrent right ventricular outflow tract conduit obstruction in complex post-tetralogy of Fallot patients. It underscores the value of meticulous preprocedural imaging, coronary compression testing, and tailored device selection to ensure optimal valve deployment, gradient elimination, and symptomatic improvement, offering a compelling alternative to high-risk redo surgical conduit replacement.

经导管肺动脉瓣植入术（TPVI）已成为复发性右心室流出道（RVOT）梗阻患者，特别是法洛四联症（TOF）修复后手术导管置换术的一种侵入性较小的替代方法。我们报告一例使用球囊可扩张的MyVal经导管心脏瓣膜进行TPVI成功的病例，患者为58岁男性，心脏病史复杂，包括多次手术和TOF和RVOT再狭窄的干预。患者表现出严重的症状，多模态成像显示严重的右心室至肺动脉导管狭窄，右侧室扩张，中度双心室功能障碍。经过周密的术前计划，TPVI手术进行导管预扩张，部署Cheatham铂覆盖支架以防止导管破裂，并植入23mm MyVal瓣膜。术后影像学证实了最佳的瓣膜定位，消除了跨导管梯度，并解决了肺反流。患者在双重抗血小板治疗后出院，症状明显改善。本病例强调TPVI是一种安全有效的再干预策略，适用于解剖结构合适的RVOT导管功能障碍高危患者。虽然短期结果是有利的，但需要进一步的数据来评估瓣膜的长期耐用性，特别是使用较新的瓣膜技术，如肺动脉位置的MyVal瓣膜。学习目的：本病例报告表明，对于复杂的法洛四联症患者复发性右心室流出道导管阻塞，经导管肺动脉瓣植入使用球囊可扩张的MyVal瓣膜和覆盖支架加固提供了一种安全、有效和微创的再干预方法。它强调了细致的术前成像、冠状动脉压缩测试和量身定制的设备选择的价值，以确保最佳的瓣膜部署、梯度消除和症状改善，为高风险的重做手术导管置换术提供了令人信服的替代方案。

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引用次数: 0

A fatal case of extensive arteriovenous malformation 广泛动静脉畸形1例死亡

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-01-01 DOI: 10.1016/j.jccase.2025.10.005

Tomoyuki Watanabe MD, PhD , Masumi Iwai-Takano MD, PhD, FJCC , Rei Sekine MD , Yuko Hashimoto MD, PhD

Arteriovenous malformation (AVM) is a rare congenital vascular anomaly that can progress to severe complications, including high-output heart failure and coagulopathy. We describe an 84-year-old woman with an extensive AVM extending from the right upper limb to the anterior chest. She was admitted with decompensated heart failure and elevated fibrin degradation products. Despite initial improvement, she experienced sudden cardiac arrest on hospital day 13. Resuscitation allowed transient electrocardiographic recording, which showed ST-segment elevation in precordial leads and aVR, suggesting acute coronary syndrome. Autopsy revealed extensive AVM with intralesional thrombi, concentric ventricular hypertrophy, and histological evidence of hyperacute ischemia, but no coronary thrombosis. The findings suggest possible mechanisms including thrombus lysis or distal embolization consistent with myocardial infarction with non-obstructive coronary artery, potentially influenced by AVM-related coagulopathy, as well as the contribution of long-standing pulmonary hypertension. This case underscores the fatal risks of extensive AVM and highlights the importance of recognizing not only heart failure progression but also thromboembolic and pulmonary hypertensive complications, along with consideration of palliative care in advanced disease.

Learning objective

Arteriovenous malformation is a rare congenital vascular anomaly that can cause progressive symptoms, including high-output heart failure depending on its size and location. In advanced stage, complications related not only to heart failure but also to coagulation abnormalities should be carefully considered.

动静脉畸形（AVM）是一种罕见的先天性血管异常，可发展为严重的并发症，包括高输出量心力衰竭和凝血功能障碍。我们描述了一位84岁的女性，从右上肢延伸到前胸的广泛AVM。她因失代偿性心力衰竭和纤维蛋白降解产物升高而入院。尽管最初有所改善，但她在住院第13天出现心脏骤停。复苏允许短暂心电图记录，显示心前导联st段升高和aVR，提示急性冠状动脉综合征。尸检显示广泛的AVM伴病灶内血栓，同心心室肥厚和超急性缺血的组织学证据，但无冠状动脉血栓形成。研究结果表明，可能的机制包括血栓溶解或远端栓塞与非阻塞性冠状动脉心肌梗死一致，可能受到avm相关凝血病变的影响，以及长期肺动脉高压的影响。该病例强调了广泛AVM的致命风险，强调了不仅要认识到心力衰竭进展，还要认识到血栓栓塞和肺动脉高压并发症的重要性，并考虑到晚期疾病的姑息治疗。学习目的动静脉畸形是一种罕见的先天性血管异常，可引起进行性症状，根据其大小和位置的不同，包括高输出量心力衰竭。在晚期，并发症不仅与心力衰竭有关，还与凝血异常有关。

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引用次数: 0