Journal of Cardiology Cases最新文献

Thoracic deformity affects circulatory dynamics, and postural changes may affect hemodynamics. We report on the case of a 10-year-old girl with straight back syndrome (SBS) and funnel chest in which a right ventricular outflow tract (RVOT) obstruction was demonstrated by dynamic echocardiography. The patient occasionally experienced chest discomfort in the standing and sitting positions. Chest radiography and computed tomography showed SBS and funnel chest as well as limited anteroposterior chest space. Although she had a grade 3 systolic ejection murmur due to RVOT obstruction, it disappeared in the supine position. The cardiothoracic ratio was 56 % in the supine position but increased to 67 % in the upright position. Echocardiography showed that the RVOT was maintained in the supine (1.0 m/s) but narrowed in the sitting (1.7 m/s) position. This is the first pediatric case showing RVOT obstruction during the upright position that has been shown by dynamic echocardiography. Dynamic echocardiography in both positions may be useful for evaluating RVOT stenosis.

Learning objective

Patients with straight back syndrome and funnel chest have limited anteroposterior chest space, which may cause posture-dependent right ventricular outflow tract (RVOT) obstruction. Dynamic echocardiography in the supine and sitting position is useful to detect posture-dependent RVOT obstruction, which can be also observed in the pediatric population.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare condition; late adult presentation is extremely rare but, with modern diagnostics, more asymptomatic or mildly symptomatic elderly patients with ALCAPA are found. A 76-year-old woman was admitted to our emergency department in December 2021 with fever, fatigue, cognitive-motor slowing, and hyposthenia of left hemisoma. Cranium computed tomography (CT) was performed, with no signs of stroke. Contrast-enhanced CT, performed with electrocardiogram-gated technique, showed a dilatated left coronary artery arising directly from the main pulmonary artery; right coronary artery was markedly dilated and tortuous and characterized by multiple inter-coronary collateral arteries with left coronary artery, in particular in the retro-aortic side and along the cone artery. ALCAPA syndrome represents one of the most common causes of myocardial ischemia in children and, if left untreated, results in a mortality rate of up to 80–90 % within the first year of life. In our case, no previous history of cardiological disease was found that could have suggested this type of condition. This is extremely rare, especially if we consider that our patient reached the 8th decade of life.

Learning objectives

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  ALCAPA syndrome can present in adulthood.

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  Collaterals between coronary arteries are essential to guarantee the survival into adulthood.

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  Cardiac computed tomography imaging is essential for the diagnosis.

Left atrial calcification (LAC) has been reported in 13.8 % of patients after atrial fibrillation (AF) ablation, which is related with stiff LA physiology and increased cardiovascular events. We describe a case in which long-term persistence of atrial inflammation caused by radiofrequency catheter ablation (RFCA) resulted in LAC. A 73-year-old man who underwent three previous AF ablations presented to our institution with a chief complaint of shortness of breath upon exertion. Electrocardiography showed a normal sinus rhythm, and transthoracic echocardiography revealed mild pulmonary hypertension. A marked decrease was observed in the mitral Doppler A-wave. Right heart catheterization showed marked V-wave augmentation in the pulmonary artery wedge pressure waveform despite the absence of mitral regurgitation, leading to a diagnosis of stiff LA syndrome. Computed tomography images revealed atrial wall thickening consistent with the ablation sites 6 months after the first ablation, which reflected inflammation-induced edema. LAC occurred at the site of atrial wall edema and expanded over several years. Mitral Doppler tracing showed a decrease in the A-wave two years and nine months after the first detection of LAC. This case demonstrates inflammation-induced atrial edema can persist for months after RFCA and may adversely affect atrial function years later.

Learning objective

This case demonstrates inflammation-induced atrial edema can persist for months after radiofrequency catheter ablation and may adversely affect atrial function years later. Considering that left atrial calcification (LAC) was detected two years and nine months before atrial function declined in this case, early detection of LAC may be a predictor of future atrial function deterioration. Careful follow-up is recommended for patients with LAC.

Polymyositis (PM) and dermatomyositis (DM) are chronic inflammatory muscle disorders characterized by muscle weakness and fatigue. They are histopathologically defined by inflammatory cell infiltrates in the skeletal muscle. In a recent meta-analysis, the incidence of cardiovascular complications in patients with PM/DM ranged from 9 to 72 %, with heart failure being the most commonly reported heart disease. In cases of heart failure accompanied by severe mitral regurgitation that is refractory due to guideline-directed medical therapy, the transcatheter edge-to-edge mitral valve repair (TEER) procedure using the MitraClip (Abbott Vascular, Santa Clara, CA, USA) offers an alternative therapeutic approach. We present a pioneering case report describing the successful application of TEER in a young woman with drug-refractory heart failure due to cardiovascular involvement in PM.

Learning objective

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  In polymyositis (PM)/ dermatomyositis (DM), the most commonly reported clinical heart disorder is heart failure, with some cases attributed to mitral regurgitation.

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  Patients suffering from systemic inflammatory diseases such as PM/DM often face high surgical risk, and the MitraClip is an effective treatment modality.

Spontaneously ruptured aortic plaques are known to scatter frequently. Peripheral artery disease (PAD) is assumed to be exacerbated by aortic embolism besides local atherosclerosis. However, it has been challenging to show where the embolic plug came from. We estimated the embolic source of PAD in a 78-year-old male with a history of repetitive occlusion in the right peroneal artery by demonstrating and sampling using non-obstructive angioscopy (NOGA) for peripheral arteries and the aorta. Screening of the aorta, the iliac artery, and the femoral artery by computed tomography angiography, and NOGA revealed aortic dissection in the infrarenal abdominal artery. Four puff-chandelier ruptures that scattered like puffs were detected, and sampling was successful from puff-chandelier ruptures in the thoracic aorta, in the suprarenal abdominal artery, and in the dissected infrarenal abdominal artery. Among three puff-chandelier ruptures, a puff-chandelier rupture in the dissected infrarenal abdominal artery had the highest homology regarding the structure and the degree of fatty globules and cholesterol crystals. Endovascular graft replacement in the infrarenal dissected abdominal artery stopped the patient's repeated worsening of PAD.

Learning objective

The potential cause of peripheral artery disease is embolism from the upstream arteries beside local atherosclerosis. Homological comparison between materials from the occluded site and scattering plaques at the aorta and upstream arteries may suggest the embolic mechanism. In this case, repetitive occlusion in the right peritoneal artery was attributed to the embolism from the dissected infrarenal aorta because the highest homology was shown between the dissected infrarenal aorta where stent graft replacement stopped worsening of peripheral artery disease.

The optimal treatment strategy of high surgical risk patients with multivessel coronary artery disease (CAD) and functional mitral regurgitation (MR) remains controversial. We present two cases in which two-stage hybrid treatment with prior transcatheter mitral valve edge-to-edge repair (TEER) followed by off-pump coronary artery bypass grafting (OPCAB) was successfully performed in patients with CAD and functional ischemic MR. In both cases, the patient showed good hemodynamic stability during OPCAB without an increase in MR. A two-stage hybrid strategy with prior TEER followed by OPCAB may be an ideal treatment option for high surgical risk patients with multivessel CAD and functional ischemic MR.

Learning objective

To recognize the effectiveness of a two-stage hybrid approach with transcatheter edge-to-edge repair and off-pump coronary artery bypass grafting in high surgical risk patients with multivessel coronary artery disease and functional mitral regurgitation.

A 70-year-old man was referred to our hospital with a diagnosis of progressive increase in extravasation leading to an iatrogenic coronary artery (CA) pseudoaneurysm within a month of percutaneous coronary intervention (PCI). The pseudoaneurysm was located on the carina side of the proximal left descending artery (LAD) accompanied by peri-stent contrast staining around the left main trunk (LMT). After a shared decision-making process, a second PCI was performed to prevent CA pseudoaneurysm rupture owing to concerns of adhesion around the LMT and difficulty in approaching the carina side of the proximal LAD for surgery. Coil embolization with four coils was performed and kissing stents with two covered stents were implanted. After the “Double-D molding technique,” intravascular ultrasound imaging revealed only small residual spaces out of the stents. Final coronary angiography (CAG) revealed no contrast staining of the pseudoaneurysm. Four months after the PCI, follow-up CAG revealed no further pseudoaneurysm enlargement. To the best of our knowledge, this is the first case of PCI for a CA pseudoaneurysm at the LMT bifurcation treated using kissing stents with two covered stents.

Learning objective

Coil embolization and implantation of kissing stents with two covered stents with the “Double-D molding technique” is an optional method to stop further enlargement of the pseudoaneurysm at the left main trunk bifurcation.

Primary cardiac lymphoma is an extremely rare disease, with the most common being diffuse large B-cell lymphoma (DLBCL). Fibrin-associated diffuse large B-cell lymphoma (FA-DLBCL) has been classified as a rare and unusual type of lymphoma and is included in the category of DLBCL associated with chronic inflammation (DLBCL-CI). In this study, we report a case of FA-DLBCL in the aortic valve and ascending aorta of a 51-year-old-woman.

Learning objective

In this rare case of FA-DLBCL in the aortic valve and ascending aorta, we highlight the features of FA-DLBCL and its differences from DLBCL-CI.

Fusobacterium species are obligate anaerobic Gram-negative bacilli that are non-spore forming. The two most common species tied to human disease are F. nucleatum and F. necrophorum. They are commensal organisms in the oropharynx, gastrointestinal tract, and genital tract of humans, but can cause invasive infections especially in the head and neck such as periodontal disease and Lemierre's syndrome. F. necrophorum is an uncommon cause of infective endocarditis. We present a case of a previously healthy male who developed F. necrophorum endocarditis with multiple sites of pyogenic abscess formation.

Learning objective

Even among anaerobes, which account for less than 1 % of infective endocarditis (IE) cases, Fusobacterium necrophorum is rare. Specific laboratory conditions are necessary for growth, leading to delays in diagnosis. Severe disease is common given its virulence and predisposition for thrombophlebitis. While uncommon, it is crucial to maintain a degree of suspicion for Fusobacterium IE especially in individuals without prior cardiac disease whose infections were preceded by potential head and neck source.