Journal of Cardiology Cases最新文献_第10页

Simultaneous transcatheter aortic valve replacement and thoracic endovascular aortic repair by the transcarotid approach for aortic stenosis with chronic type-A aortic dissection 经颈动脉入路同步经导管主动脉瓣置换术和胸腔内主动脉瓣修复治疗主动脉狭窄合并慢性a型主动脉夹层

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-05-01 DOI: 10.1016/j.jccase.2025.01.009

Suguru Hirose MD, PhD , Yusuke Takei MD, PhD , Masahiro Tezuka MD , Takahisa Nasuno MD, PhD , Michiaki Tokura MD, PhD , Masashi Sakuma MD, PhD , Ikuko Shibasaki MD, PhD , Shigeru Toyoda MD, PhD, FJCC , Hirotsugu Fukuda MD, PhD, FJCC

Frail patients presenting with ascending aortic dissection and aortic stenosis (AS) are usually treated with a minimally invasive approach. Although transcatheter aortic valve replacement (TAVR) is becoming the standard treatment for AS, reports of catheter-only treatment for patients with AS complicated by chronic type-A aortic dissection (TAAD) are scarce. We present a case of a patient who underwent simultaneous TAVR and thoracic endovascular aortic repair (TEVAR) using a transcarotid approach. An 86-year-old woman was hospitalized for syncope due to severe AS. Computed tomography revealed chronic TAAD. We considered TAVR appropriate because of the invasive nature of open thoracic surgery; however, TAVR was associated with a risk of chronic TAAD exacerbation due to catheter manipulation. Our heart team decided to simultaneously perform TAVR and TEVAR using the transcarotid approach. The procedure involved using a short stent graft Excluder cuff to cover the dissection entry, followed by the placement of a CoreValve Evolut R 26-mm valve. The operation was successfully completed without complications. The patient was discharged on postoperative day 16. TAVR and TEVAR, using the transcarotid approach, can be performed depending on the anatomic conditions and device selection.

Learning objective

Reports on the catheter-only treatment of severe aortic stenosis complicated by chronic type-A aortic dissection are limited. We herein report a case in which transcatheter aortic valve replacement and thoracic endovascular aortic repair were simultaneously performed. Depending on anatomical conditions, this technique is beneficial, particularly for elderly patients who cannot undergo open thoracic surgery.

以升主动脉夹层和主动脉狭窄（AS）为表现的体弱患者通常采用微创方法治疗。尽管经导管主动脉瓣置换术（TAVR）正在成为AS的标准治疗方法，但关于AS合并慢性a型主动脉夹层（TAAD）患者仅经导管治疗的报道很少。我们提出一个病例的病人谁接受了同时TAVR和胸椎血管内主动脉修复（TEVAR）经颈动脉入路。一名86岁妇女因严重AS引起的晕厥住院。计算机断层扫描显示慢性TAAD。我们认为TAVR是合适的，因为开放性胸外科手术具有侵入性；然而，由于导管操作，TAVR与慢性TAAD恶化的风险相关。我们的心脏团队决定采用经颈动脉入路同时进行TAVR和TEVAR。手术过程包括使用短支架移植排斥袖带覆盖夹层入口，随后放置CoreValve Evolut R 26毫米瓣膜。手术顺利完成，无并发症。患者术后第16天出院。TAVR和TEVAR采用经颈动脉入路，可根据解剖条件和设备选择进行。学习目的单纯置管治疗严重主动脉狭窄合并慢性a型主动脉夹层的报道有限。我们在此报告一例经导管主动脉瓣置换术和胸椎血管内主动脉瓣修复术同时进行的病例。根据解剖条件，这种技术是有益的，特别是对于不能进行开胸手术的老年患者。

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引用次数: 0

Clinical implication of catheter ablation for atrial fibrillation in patients with cardiac amyloidosis 导管消融治疗心脏淀粉样变性心房颤动的临床意义

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-05-01 DOI: 10.1016/j.jccase.2025.02.002

Naoya Kataoka MD, Teruhiko Imamura MD, FJCC

引用次数: 0

An infantile case of myocardial ischemia associated with hypoplastic left coronary cusp 小儿心肌缺血合并左冠状动脉尖发育不全1例

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-05-01 DOI: 10.1016/j.jccase.2025.02.001

Hiroyuki Yamada MD , Jun Maeda MD, PhD , Masaru Miura MD, PhD , Yukihiro Yoshimura MD, PhD , Kazuhiko Shibuya MD, PhD

We report a fatal case of myocardial ischemia in a 1-month-old infant caused by a hypoplastic left coronary cusp, a rare, congenital anomaly. The infant presented with acute respiratory failure and hemodynamic instability. Transpericardial echocardiography revealed occlusion of the left coronary ostium by a hypoplastic left cusp. Despite emergency aortic valvuloplasty, refractory cardiogenic shock developed, resulting in death. The present case highlights the importance of considering hypoplastic coronary cusp in the differential diagnosis of infantile myocardial ischemia and the need for careful echocardiographic evaluation of suspected cases.

Learning objective

Hypoplastic aortic valve cusp should be borne in mind as a potential cause of myocardial ischemia in children.

Meticulous echocardiographic assessment should be performed for any coronary artery of anomalous origin and for the morphology of the aortic valve cusp.

我们报告一个致命的病例心肌缺血在1个月大的婴儿引起的发育不良的左冠状动脉尖，一种罕见的，先天性异常。婴儿表现为急性呼吸衰竭和血流动力学不稳定。经心包超声心动图显示左冠状动脉口被左尖发育不全阻塞。尽管紧急主动脉瓣成形术，难治性心源性休克发生，导致死亡。本病例强调考虑冠状动脉尖发育不全在婴幼儿心肌缺血鉴别诊断中的重要性，以及对疑似病例进行仔细超声心动图评估的必要性。学习目的：儿童主动脉瓣尖发育不全是引起心肌缺血的潜在原因。对于任何异常起源的冠状动脉和主动脉瓣尖的形态，应进行细致的超声心动图评估。

引用次数: 0

Amyloid and Anderson-Fabry disease: Can there be a CMR phenotypic overlap? 淀粉样蛋白和安德森-法布里病：是否存在CMR表型重叠？

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-04-01 DOI: 10.1016/j.jccase.2024.12.005

Saed Alnaimat MD , Mariah Mascara MD , Srijana Maharjan MD , Abdallah Naser MD , Valentyna Ivanova MD , Moneal Shah MD , Robert W.W. Biederman MD

A 53-year-old female had an atypical presentation of cardiac amyloidosis on cardiac magnetic resonance imaging. As opposed to the usual diffuse heterogenous late gadolinium enhancement (LGE) seen in cases of cardiac amyloidosis, the patient had localized LGE in the inferolateral left ventricular wall classically resembling Anderson Fabry's disease. However, other cardiac magnetic resonance features raised the suspicion for cardiac amyloidosis which was later confirmed by endomyocardial biopsy. This case highlights that cardiac amyloidosis can have atypical imaging features that may lead to incorrect diagnosis. Clinicians should maintain a high index of suspicion and pay attention to certain supportive findings such as atrial wall thickening, valve leaflet thickening, pericardial effusion, as well as abnormal strain pattern.

Learning objectives

•
Cardiac amyloidosis can have atypical imaging features and strain pattern that may lead to incorrect diagnosis.
•
Clinicians should maintain a high index of suspicion and pay attention to certain supportive findings such as atrial wall thickening, valve leaflet thickening, pericardial effusion, as well as abnormal strain pattern.

一位53岁的女性在心脏磁共振成像上表现为不典型的心脏淀粉样变性。与心脏淀粉样变性患者常见的弥漫性非均质晚期钆增强（LGE）相反，该患者的LGE位于左心室外壁内，典型地类似安德森法布里病。然而，其他心脏磁共振特征引起了对心脏淀粉样变的怀疑，后来通过心内膜肌活检证实了这一点。本病例强调心脏淀粉样变具有不典型的影像学特征，可能导致误诊。临床医生应保持高度的怀疑指数，并注意某些支持性发现，如心房壁增厚、瓣膜小叶增厚、心包积液以及异常应变模式。•心脏淀粉样变性可能具有不典型的影像学特征和应变模式，可能导致错误的诊断。•临床医生应保持高度的怀疑指数，并注意某些支持性发现，如心房壁增厚、瓣膜小叶增厚、心包积液以及异常应变模式。

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引用次数: 0

Left atrial appendage occlusion devices: one size doesn't fit all? The turning point of a custom-made device 左心耳闭塞装置：一种尺寸不适合所有人？定制设备的转折点

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-04-01 DOI: 10.1016/j.jccase.2024.12.001

Silvia Maiani MD , Giulia Nardi MD , Miroslava Stolcova MD , Francesca Ristalli MD , Maria Federica Crociani MD , Niccolò Ciardetti MD , Alessio Mattesini MD , Carlo Di Mario MD, PhD , Francesco Meucci MD

Left atrial appendage occlusion (LAAO) has as a comparable efficacy and safety profile compared with oral anticoagulation therapy in patients with atrial fibrillation. The procedural success rate is high, but some challenging anatomies may preclude optimal closure with standard devices. Our patient underwent a first LAAO attempt with Amplatzer Amulet 34 mm (St. Jude Medical, Saint Paul, MN, USA) and Watchman FLX 35 mm (Boston Scientific, Marlborough, MA, USA), but device anchoring was not feasible or sub-optimal due to the oversized LAA. The procedure was postponed in order to perform a cardiac computed tomography angiography and a custom-made LAmbre Closure System 42/52 mm (Lifetech Scientific, Shenzhen, China), specifically fitted with patient's LAA anatomy, was successfully implanted. The procedure was straightforward, and the device perfectly adapted to our patient's anatomy, with no residual leak.

Learning objective

Left atrial appendage presents several morphologies and procedural success rate of left atrial appendage occlusion is high, but challenging anatomies may preclude optimal closure with standard devices. Our case emphasizes the importance of pre-procedural planning and the safety and feasibility of custom-made devices, overcoming procedural failure of a previous attempt with standard devices.

与口服抗凝治疗心房颤动患者相比，左心耳闭塞（LAAO）具有相当的疗效和安全性。手术成功率很高，但一些具有挑战性的解剖结构可能会妨碍标准装置的最佳闭合。我们的患者使用Amplatzer Amulet 34 mm （St. Jude Medical, St. Paul， MN， USA）和Watchman FLX 35 mm （Boston Scientific, Marlborough， MA， USA）进行了第一次LAAO尝试，但由于LAA过大，设备锚定不可行或不理想。为了进行心脏计算机断层血管造影，手术被推迟，并成功植入了专门适合患者LAA解剖结构的定制LAmbre闭合系统42/52 mm （Lifetech Scientific, Shenzhen, China）。手术过程很简单，而且这个装置完全适合我们病人的解剖结构，没有残留的泄漏。学习目的左心耳具有多种形态，左心耳闭塞术成功率高，但由于解剖结构复杂，使用标准装置可能无法达到最佳封闭效果。我们的案例强调了术前计划的重要性，以及定制设备的安全性和可行性，克服了先前使用标准设备尝试的程序失败。

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引用次数: 0

Dynamic ECG change from de Winter to Wellens - Rare ECG change in acute coronary syndrome 从de Winter到Wellens的动态心电图变化——急性冠状动脉综合征的罕见心电图变化

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-04-01 DOI: 10.1016/j.jccase.2024.12.004

Naoki Arima MD, Naohito Yamasaki MD, PhD, Tomoki Furushima MD, Yuya Miyamoto MD, Toshihiro Moriki MD, Kazuya Miyagawa MD, Tatsuya Noguchi MD, PhD, Toru Kubo MD, PhD, FJCC , Hiroaki Kitaoka MD, PhD, FJCC

A 70-year-old male complained of chest pain. His electrocardiogram (ECG) revealed the De Winter pattern, which indicates left anterior descending artery occlusion. His symptoms spontaneously resolved within 30 min. This time, his ECG showed Wellens's sign. It is rare to see a change from De Winter to Wellens in one patient.

Learning objectives

Recognize de Winter's and Wellens' electrocardiogram (ECG) patterns as high-risk ECG for acute coronary syndrome (ACS), specifically related to left anterior descending artery lesions. Obtain serial ECGs in ACS patients to detect newly emerging changes in the coronary artery.

一名70岁男性主诉胸痛。他的心电图显示德温特型，提示左前降支闭塞。他的症状在30分钟内自行消退 。这一次，他的心电图显示了韦伦斯症征。很少看到一个病人从德温特变成韦伦斯。学习目标认识到de Winter's和Wellens' s心电图（ECG）模式是急性冠脉综合征（ACS）的高危心电图，特别是与左前降支病变有关。获得ACS患者的连续心电图，以检测冠状动脉新出现的变化。

引用次数: 0

A rare case of cytomegalovirus myocarditis complicating rejection after heart transplantation: Case report and review of literature 心脏移植术后巨细胞病毒性心肌炎并发排斥反应1例：病例报告及文献复习

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-04-01 DOI: 10.1016/j.jccase.2024.12.007

Raffaele Abete MD , Attilio Iacovoni MD , Claudia Vittori MD , Roberta Sebastiani MD , Elisabetta Candiago MD , Andrea Gianatti MD , Amedeo Terzi MD , Michele Senni MD

A 49-year-old female with terminal hypertrophic cardiomyopathy underwent orthotopic heart transplantation. The patient developed early acute rejection. Intensifying therapy led to improvement, but cytomegalovirus (CMV) myocarditis emerged. Aggressive management, including high-dose ganciclovir and intravenous immunoglobulin, resulted in negativization of CMV and rejection markers. Cardiac function recovered, emphasizing the challenges and successful multidisciplinary approach in managing complex post-transplant complications.

Learning objectives

To diagnose and treat complications in heart transplantation, such as opportunistic infections and cellular and/or antibody-mediated rejection. To underline role of endomyocardial biopsy in heart transplant monitoring.

49岁女性终末期肥厚性心肌病患者行原位心脏移植手术。病人出现早期急性排斥反应。强化治疗导致改善，但巨细胞病毒（CMV）心肌炎出现。积极的治疗，包括大剂量的更昔洛韦和静脉注射免疫球蛋白，导致巨细胞病毒和排斥标志物的阴性。心脏功能恢复，强调挑战和成功的多学科方法在处理复杂的移植后并发症。学习目标诊断和治疗心脏移植并发症，如机会性感染和细胞和/或抗体介导的排斥反应。目的：强调心肌内膜活检在心脏移植监测中的作用。

引用次数: 0

Renal cell carcinoma with cardiac metastasis and near right heart obliteration: A case report 肾细胞癌合并心脏转移及近右心闭塞1例

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-04-01 DOI: 10.1016/j.jccase.2025.01.004

Maren Downing MEng , Kristen M. Quinn MD , Micheal Odle MD

Renal cell carcinoma (RCC) is the most common type of primary kidney cancer with up to 30 % of patients having metastatic disease at the time of diagnosis. Metastasis to the heart is extremely rare with only a few cases ever reported. Most patients with cardiac metastases of any origin do not develop symptoms of cardiac dysfunction. The classic triad of presentation for RCC is hematuria, flank pain, and a palpable mass. We report a rare occurrence of cardiac involvement of RCC infiltrating both the right atrium and right ventricle in an otherwise healthy female patient whose presenting symptom was dyspnea. Dyspnea, although a vague presenting symptom with a large differential diagnosis, is the most common presenting symptom of cardiac tumors and a sudden presentation of dyspnea in a patient with RCC should encourage the consideration of cardiac metastasis. The importance of repeat imaging and cross-disciplinary care in a patient with RCC with cardiac involvement is well displayed. A delay in cancer diagnosis may lead to delay in therapy and the result may be associated with significant morbidity and mortality. Quick action including evaluation and treatment for RCC is imperative to increase the chance for survival.

Learning objective

Metastasis to the heart is extremely rare and most patients do not develop cardiac symptoms. Dyspnea is a vague presenting symptom requiring a broad differential to determine underlying pathology. Here, acute dyspnea in a patient with renal cell carcinoma was the presenting symptom of cardiac metastasis and continued repeat imaging in this patient with supplemental oxygen requirements showed fast spread into the right heart.

肾细胞癌（RCC）是最常见的原发性肾癌类型，高达30% %的患者在诊断时患有转移性疾病。转移到心脏极其罕见，只有少数病例被报道过。大多数任何来源的心脏转移患者都不会出现心功能障碍的症状。肾细胞癌的典型三联征是血尿、侧腹疼痛和可触及的肿块。我们报告一例罕见的肾细胞癌累及心脏，浸润右心房和右心室，在其他方面健康的女性患者，其主要症状是呼吸困难。呼吸困难虽然是一种模糊的表现，但在鉴别诊断中很重要，它是心脏肿瘤最常见的表现，RCC患者突然出现呼吸困难应考虑心脏转移。重复成像和跨学科护理的重要性，在病人的肾细胞癌累及心脏是很好的显示。癌症诊断的延误可能导致治疗的延误，其结果可能与显著的发病率和死亡率有关。迅速采取行动，包括评估和治疗RCC是必要的，以增加生存的机会。学习目的转移到心脏是极其罕见的，大多数患者不会出现心脏症状。呼吸困难是一种模糊的症状，需要广泛的鉴别来确定潜在的病理。肾细胞癌患者的急性呼吸困难是心脏转移的主要症状，该患者在补充氧气的情况下持续重复成像显示其迅速扩散到右心。

{"title":"Renal cell carcinoma with cardiac metastasis and near right heart obliteration: A case report","authors":"Maren Downing MEng , Kristen M. Quinn MD , Micheal Odle MD","doi":"10.1016/j.jccase.2025.01.004","DOIUrl":"10.1016/j.jccase.2025.01.004","url":null,"abstract":"<div><div>Renal cell carcinoma (RCC) is the most common type of primary kidney cancer with up to 30 % of patients having metastatic disease at the time of diagnosis. Metastasis to the heart is extremely rare with only a few cases ever reported. Most patients with cardiac metastases of any origin do not develop symptoms of cardiac dysfunction. The classic triad of presentation for RCC is hematuria, flank pain, and a palpable mass. We report a rare occurrence of cardiac involvement of RCC infiltrating both the right atrium and right ventricle in an otherwise healthy female patient whose presenting symptom was dyspnea. Dyspnea, although a vague presenting symptom with a large differential diagnosis, is the most common presenting symptom of cardiac tumors and a sudden presentation of dyspnea in a patient with RCC should encourage the consideration of cardiac metastasis. The importance of repeat imaging and cross-disciplinary care in a patient with RCC with cardiac involvement is well displayed. A delay in cancer diagnosis may lead to delay in therapy and the result may be associated with significant morbidity and mortality. Quick action including evaluation and treatment for RCC is imperative to increase the chance for survival.</div></div><div><h3>Learning objective</h3><div>Metastasis to the heart is extremely rare and most patients do not develop cardiac symptoms. Dyspnea is a vague presenting symptom requiring a broad differential to determine underlying pathology. Here, acute dyspnea in a patient with renal cell carcinoma was the presenting symptom of cardiac metastasis and continued repeat imaging in this patient with supplemental oxygen requirements showed fast spread into the right heart.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 4","pages":"Pages 117-120"},"PeriodicalIF":0.0,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143739183","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}

引用次数: 0

Ventricular fibrillation arrest with cardiomyopathy in the setting of exogenous T3 consumption in a previously healthy young male 室性纤颤骤停与心肌病在设定外源性T3消耗在一个以前健康的年轻男性

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-04-01 DOI: 10.1016/j.jccase.2025.01.002

Tobin Mathew MD , Kevin S. Tang MD , Fahad Gul MD , Sareen Sandhu DO , Omid Vadpey MD , Qin Yang MD , David Donaldson MD

Ventricular fibrillation (VF) is an often-fatal cardiac arrhythmia with increased prevalence in those with structural heart disease, congestive heart failure, and history of myocardial infarction. Our case describes a young adult male who presented with VF arrest and new onset cardiomyopathy in the setting of exogenous testosterone and triiodothyronine supplementation. Comprehensive work-up demonstrated a severely reduced ejection fraction, no angiographically significant coronary artery disease on invasive coronary angiography, and evidence of right ventricular mid-lateral wall scarring on electrophysiology study and cardiac magnetic resonance imaging. Exogenous thyroid hormone and testosterone supplementation have been independently associated with development of dilated cardiomyopathy; however, VF arrest has rarely been described in otherwise previously healthy individuals with concomitant use of these substances. Optimal management, risk stratification, and prognosis in this population remains unknown. Our case identifies an at-risk population of sudden cardiac death where appropriate work-up and shared clinical decision-making is essential to improved patient outcomes and quality of life.

Learning objective

Exogenous triiodothyronine (T3) intake may be a risk factor for the development of acute cardiomyopathy, as cardiac myocytes directly uptake T3 which can induce arrhythmias and cardiac arrest. This process may be separate from tachycardia-mediated cardiomyopathy. Prognosis of hyperthyroid induced ventricular fibrillation and cardiomyopathy is unclear. Reversing the hyperthyroid state may reduce the risk of repeat sudden cardiac death. The decision for secondary prevention should be a joint decision understanding patient-specific risk factors and goals.

心室颤动（VF）是一种常致死性心律失常，在结构性心脏病、充血性心力衰竭和心肌梗死史患者中发病率增高。我们的病例描述了一位年轻的成年男性，他在外源性睾酮和三碘甲状腺原氨酸补充的情况下出现了VF骤停和新发心肌病。全面检查显示射血分数严重降低，有创冠状动脉造影无明显冠状动脉病变，电生理和心脏磁共振成像显示右心室中侧壁瘢痕。外源性甲状腺激素和睾酮补充与扩张型心肌病的发展独立相关；然而，在同时使用这些物质的其他方面健康的个体中，很少有心室功能停止的描述。该人群的最佳管理、风险分层和预后仍不清楚。本病例确定了心源性猝死的高危人群，其中适当的检查和共同的临床决策对于改善患者的预后和生活质量至关重要。学习目的外源性三碘甲状腺原氨酸（T3）摄入可能是急性心肌病发生的危险因素，因为心肌细胞直接摄取T3可诱发心律失常和心脏骤停。这一过程可与心动过速介导的心肌病分开。甲状腺功能亢进引起的心室颤动和心肌病的预后尚不清楚。逆转甲状腺功能亢进状态可降低再次发生心源性猝死的风险。二级预防的决定应该是一个了解患者特定风险因素和目标的共同决定。

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引用次数: 0

Surgical management of hypertrophic obstructive cardiomyopathy with anomalous papillary muscle: A case report 肥厚性梗阻性心肌病伴异常乳头肌的手术治疗：1例报告

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-04-01 DOI: 10.1016/j.jccase.2024.12.006

Katsuya Kawagoe MD , Koji Furukawa MD, PhD , Hirohito Ishi MD , Shuhei Sakaguchi MD , Tomoaki Taniguchi MD , Risa Meiri MD , Yoshimasa Yamamura MD

Anomalous papillary muscles (PMs), in which the PMs are directly attached to the anterior mitral valve (MV) leaflet, can cause obstruction of the left ventricular outflow tract (LVOT). Accurately diagnosing of anomalous PMs, understanding their pathology, and performing appropriate surgery are essential for relieving LVOT obstruction effectively.

A 71-year-old man with hypertrophic obstructive cardiomyopathy was referred to our hospital. Transthoracic echocardiography revealed LVOT obstruction with a peak outflow pressure gradient of 63 mm Hg at rest and 96 mm Hg during the Valsalva maneuver. Furthermore, an anomalous PM was suspected to be the cause of LVOT obstruction. Three- and four-dimensional cardiac computed tomography (CT) images clearly demonstrated that an anomalous PM from the anterior PMs was directly attached to the body of the anterior MV leaflet and that the anomalous PM, together with the thickened ventricular septum, caused a dynamic obstruction of the LVOT. We resected the anomalous PM from the anterior PMs and the subaortic ventricular septum using a transaortic approach.

In this case, preoperative three-dimensional and four-dimensional cardiac CT images were effective at revealing the presence of an anomalous PM and its pathology in patient with LVOT obstruction, leading to accurate and smooth surgical procedures and improved patient outcomes.

Learning objective

•
Anomalous PMs are classified by their attachment patterns and appropriate surgical methods are recommended for each type, providing valuable insights for clinical decision-making.
•
This report emphasizes the significance of 3D and 4D cardiac CT in identifying the causes of LVOTO. This imaging technique provides important information regarding the location of the anomalous PM and dynamic impact, leading to a successful surgical outcome.

异常乳头肌（pm），其中pm直接附着在前二尖瓣（MV）小叶，可引起左心室流出道阻塞（LVOT）。准确诊断异常PMs，了解其病理，并进行适当的手术治疗是有效缓解LVOT阻塞的必要条件。一位患有肥厚性阻塞性心肌病的71岁男性被转介到我院。经胸超声心动图显示LVOT梗阻，静息时流出压力梯度峰值为63 mm Hg， Valsalva操作时为96 mm Hg。此外，一个异常的PM被怀疑是LVOT阻塞的原因。三维和四维心脏计算机断层扫描（CT）图像清楚地显示，来自前心室的异常PM直接附着在前心室小叶体上，并且异常PM与增厚的室间隔一起引起LVOT的动态阻塞。我们采用经主动脉入路从前心室和腹主动脉下室间隔切除异常的心室前腔。在本例中，术前三维和四维心脏CT图像有效地揭示了LVOT梗阻患者异常PM的存在及其病理，从而导致准确和顺利的外科手术，改善了患者的预后。学习目的•根据异常pm的附着模式进行分类，并针对每种类型推荐合适的手术方法，为临床决策提供有价值的见解。•本报告强调了3D和4D心脏CT在识别LVOTO病因中的意义。这种成像技术提供了关于异常PM位置和动态影响的重要信息，导致成功的手术结果。

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引用次数: 0