Journal of Cardiology Cases最新文献_第6页

Endocardial ablation-resistant ivabradine-sensitive atrial tachycardia suggestive of an epicardial origin in the left atrial appendage 心内膜抗消融性伊伐布雷定敏感房性心动过速提示心外膜起源于左心房附件

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.05.006

Kohki Nakamura MD, PhD, FJCC , Takehito Sasaki MD , Kentaro Minami MD, PhD , Taiki Masuyama MD, PhD , Shingo Yoshimura MD , Keiji Hoshino MD , Akiko Kodama MD , Yuji Matsuo MD , Kenichi Kaseno MD, PhD , Suguru Nishiuchi MD, PhD , Shigeto Naito MD, PhD

A 23-year-old woman presented with 200,409 heart beats/day due to an atrial tachycardia (AT) lasting one year and tachycardia-induced cardiomyopathy. None of the antiarrhythmic or rate control drugs terminated the AT or sufficiently reduced the heart rate during the AT. Thus, she underwent radiofrequency catheter ablation of the AT. Ultra-high-resolution mapping suggested that the AT originated from the epicardial left atrial appendage (LAA), and endocardial radiofrequency ablation failed to eliminate the AT, although acceleration and transient termination of the AT during ongoing ablation in the endocardial LAA were observed. After the ablation, ivabradine monotherapy achieved both an optimal heart rate control during the AT and termination of the AT. Some ATs refractory to conventional antiarrhythmic drug therapy can be treated by ivabradine and are called ivabradine sensitive-ATs (ISATs). Left atrial ISATs often originate from the vicinity of the LAA and have been reported to be treated by endocardial radiofrequency ablation. This case report describes that a subset of ISATs originating from the LAA may be associated with epicardial abnormal automaticity and refractory to conventional endocardial radiofrequency ablation.

Learning objective

Some focal atrial tachycardias (ATs) refractory to conventional antiarrhythmic drug therapy are successfully treated by ivabradine and are called ivabradine sensitive-ATs (ISATs). ISATs originating from the left atrial appendage (LAA) have been reported to be eliminated by endocardial radiofrequency ablation, but a subset of LAA-ISATs may be associated with epicardial abnormal automaticity and may be refractory to endocardial radiofrequency ablation.

一名23岁女性因持续一年的房性心动过速（AT）和心动过速引起的心肌病而出现200,409次/天的心跳。抗心律失常或控制心率的药物均不能终止AT或充分降低AT期间的心率。因此，她接受了射频导管消融AT。超高分辨率定位提示AT起源于心外膜左心耳（LAA），心内膜射频消融术未能消除AT，尽管在心内膜LAA持续消融术中观察到AT的加速和短暂终止。消融后，伊伐布雷定单药治疗获得了AT期间和AT终止时的最佳心率控制。一些对常规抗心律失常药物治疗难治的ATs可以用伊伐布雷定治疗，被称为伊伐布雷定敏感型ATs （ISATs）。左房isat通常起源于LAA附近，据报道可通过心内膜射频消融术治疗。本病例报告描述了起源于LAA的isat的一个亚群可能与心外膜异常自动性和传统的心内膜射频消融难治性有关。学习目的：一些常规抗心律失常药物治疗难治性局灶性房性心动过速（ATs）被伊伐布雷定成功治疗，称为伊伐布雷定敏感型心房过速（ISATs）。据报道，起源于左心耳（LAA）的isat可以通过心内膜射频消融术消除，但LAA- isat的一部分可能与心外膜异常自动性有关，并且可能对心内膜射频消融术无效。

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引用次数: 0

Symptomatic esophagogastric hypomotility a year after cryoablation for atrial fibrillation: a case report 房颤冷冻消融后1年出现症状性食管胃动力低下1例

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.05.001

Shinya Sugiura MD PhD , Naoki Fujimoto MD PhD, FJCC , Kazuki Fujioka , Takashi Tanigawa MD PhD, FJCC , Kaoru Dohi MD PhD, FJCC

Background

Cryoballoon (CB) ablation is a safe and effective treatment for atrial fibrillation (AF). However, complications, such as esophagogastric hypomotility (EGH) secondary to vagal nerve injury (VNI), have been reported.

Case summary

We present the case of a 71-year-old woman with paroxysmal AF who underwent CB ablation. The patient did not report any gastrointestinal symptoms during the procedure. Precisely 4 months later, an upper gastrointestinal endoscopy during a routine health check revealed food retention in the stomach. Eleven months after the CB ablation, the patient was admitted to the emergency room on account of chest tightness. Computed tomography showed a large amount of food residue in the esophagus. Esophagogastroscopy revealed retained food in the esophagus without any apparent obstruction.

Conclusion

EGH, particularly secondary to VNI post CB ablation, poses diagnostic and management challenges. Our case highlights the limitations of current strategies in preventing EGH, including freeze duration, frequency adjustments, and esophageal temperature monitoring. Additionally, late-onset symptomatic EGH underscores the need for long-term follow-up care post CB ablation.

Learning objective

We present a case of asymptomatic gastric hypomotility, post-ablation, which developed symptomatic esophagogastric hypomotility one year after the procedure. Late-onset symptomatic esophagogastric, especially esophageal hypomotility have not been previously reported. Freeze duration, times and esophageal temperature monitoring may not avoid esophagogastric hypomotility. Esophagogastric motility disorders may persist longer than previously reported.

低温球囊（CB）消融是治疗心房颤动（AF）安全有效的方法。然而，迷走神经损伤（VNI）继发的食管胃动力低下（EGH）等并发症也有报道。病例总结：我们报告一例71岁女性阵发性房颤患者行CB消融术。患者在手术过程中未报告任何胃肠道症状。正好4 个月后，在一次常规健康检查中，上消化道内窥镜检查发现胃里有食物潴留。CB消融11个月后，患者因胸闷被送进急诊室。计算机断层扫描显示食道内有大量食物残渣。食管胃镜检查显示食道内食物残留，无明显阻塞。结论egh，尤其是CB消融后继发的VNI，给诊断和管理带来了挑战。我们的病例强调了目前预防EGH的策略的局限性，包括冷冻时间、频率调整和食管温度监测。此外，迟发性症状性EGH强调了CB消融后长期随访护理的必要性。学习目的我们报告一例无症状的胃动力低下，消融后，一年后出现症状性食管胃动力低下。迟发性症状性食管胃，特别是食管动力低下未见报道。冷冻时间、次数和食道温度监测不能避免食管胃动力低下。食管胃运动障碍可能比以前报道的持续时间更长。

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引用次数: 0

Case of successful long-term outcome with Uhl's anomaly after total cavopulmonary connection with right ventricular exclusion 全腔室肺连接右心室排除术后Uhl异常长期预后成功1例

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.05.005

Mariko Saito MD , Hiroaki Kise MD, PhD , Minako Hoshiai MD, PhD , Shoji Suzuki MD, PhD

We report a case of Uhl's anomaly in a 24-year-old man with a hemodynamically stable condition achieved by total cavopulmonary connection (TCPC) with right ventricular (RV) exclusion. He presented with cyanosis shortly after birth. Severe RV enlargement and dysfunction were observed during early infancy. He underwent one and a half ventricular repair with partial RV resection at 9 months of age. Intraoperatively, the free wall of the right ventricle was enlarged and extremely thin. Pathological examination of the resected right ventricle revealed severe subendothelial fibrosis and a mildly degenerated myocardium, suggesting Uhl's anomaly. Following the surgery, the right ventricle was re-enlarged, accompanied by a decline in its function. The patient underwent TCPC with fenestration and RV exclusion at 6 years of age. The fenestration was surgically closed at 15 years of age due to his oxygen saturation dropping below 90 %. At the age of 24 years, the left ventricular ejection fraction was preserved without RV dilatation with New York Heart Association Class I even under univentricular circulation. In cases of Uhl's anomaly with severe RV dysfunction combined with a significantly degenerated RV myocardium, TCPC and RV exclusion should be one therapeutic option for a successful long-term outcome.

Learning objective

Uhl's anomaly is a cardiomyopathy of the right ventricle, with a poor prognosis and no treatment strategy. Appropriate surgical interventions are crucial particularly in the presence of right ventricular (RV) dysfunction, including refractory RV enlargement, worsened function, and significantly degenerated RV myocardium. In some cases, total cavopulmonary connection combined with RV exclusion contributes to reduce the impact of an enlarged right ventricle and lead to favorable long-term outcomes.

我们报告一个24岁男性的Uhl异常病例，他通过全腔肺连接（TCPC）和右心室（RV）排除实现了血流动力学稳定。他出生后不久就出现了紫绀。在婴儿期早期观察到严重的右心室增大和功能障碍。他在9 个月大时接受了一个半心室修复术和部分左心室切除术。术中，右心室游离壁扩大且极薄。切除右心室的病理检查显示严重的内皮下纤维化和轻度退化的心肌，提示Uhl异常。手术后，右心室再次扩大，同时其功能下降。患者在6 岁时接受了TCPC并开窗和RV排除。在15 岁时，由于他的血氧饱和度降至90% %以下，手术关闭了开窗。在24岁 岁时，即使在单室循环下，纽约心脏协会I级仍保留左心室射血分数，没有左室扩张。对于Uhl's异常伴有严重右室功能障碍并右室心肌明显退化的病例，TCPC和右室排除应该是一个成功的长期结果的治疗选择。学习目的uhl 's异常是一种右心室心肌病，预后差，无治疗策略。适当的手术干预是至关重要的，特别是在存在右心室功能障碍的情况下，包括难治性右心室扩大、功能恶化和右心室心肌明显变性。在某些情况下，全腔室肺连接联合右心室排除有助于减少右心室增大的影响，并导致良好的长期预后。

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引用次数: 0

Successful weaning from hemodialysis by percutaneous transluminal renal angioplasty in a patient with a solitary kidney and acute kidney injury caused by renal artery occlusion 经皮腔内肾血管成形术成功脱机血液透析患者孤立肾和急性肾损伤肾动脉闭塞

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.05.007

Kanako Yokomizo MD, Mayuko Imamura MD, Kei Yunoki MD, PhD, Ryuta Takenaka MD, PhD, Takefumi Oka MD, PhD

There is no clear consensus on the indication for percutaneous transluminal renal angioplasty (PTRA) in cases of acute kidney injury caused by renal artery stenosis or occlusion in patients with a solitary kidney. A 79-year-old man with a solitary kidney presented with right back pain and anuria and was admitted to our hospital with a diagnosis of acute kidney injury. Because of progressive renal impairment and worsening fluid overload, hemodialysis was initiated the day after admission. Magnetic resonance angiography and ultrasonography indicated severe stenosis at the right renal artery ostium, and renal scintigraphy showed markedly reduced blood flow to the right kidney. Although the outcome was uncertain, PTRA was performed on day 8 because renal viability was suspected. Abdominal aortography revealed occlusion at the origin of the right renal artery, and a bare-metal stent was placed to restore blood flow. Following PTRA, renal function gradually improved, and the patient was successfully weaned from hemodialysis 1 week later. This case demonstrates that assessing renal blood flow with multimodality imaging and performing reperfusion therapy can be effective, even when there is a delay in treatment following the onset of renal ischemia.

Learning objective

Early revascularization is typically recommended for acute renal ischemia due to renal artery stenosis or occlusion in patients with a solitary kidney because delayed intervention may lead to irreversible renal function loss. However, the present case highlights that even when revascularization is delayed, renal viability can be assessed using multimodality imaging to evaluate blood flow, and revascularization may restore renal function in select cases.

对于单肾患者肾动脉狭窄或闭塞引起的急性肾损伤，经皮腔内肾血管成形术（PTRA）的适应症尚无明确的共识。一名79岁男性单肾患者以右背部疼痛和无尿而入院，诊断为急性肾损伤。由于进行性肾功能损害和日益严重的体液超载，入院后第一天开始血液透析。磁共振血管造影及超声示右肾动脉口严重狭窄，肾显像示右肾血流量明显减少。虽然结果不确定，但由于怀疑肾脏存活，在第8天进行了PTRA。腹主动脉造影显示右肾动脉起源处闭塞，放置裸金属支架以恢复血流。经PTRA治疗后，肾功能逐渐改善，1 周后患者成功脱离血液透析。本病例表明，通过多模态成像评估肾血流并进行再灌注治疗是有效的，即使在肾缺血发作后治疗延迟。学习目的对于孤立肾患者因肾动脉狭窄或闭塞引起的急性肾缺血，通常推荐早期血运重建术，因为延迟干预可能导致不可逆的肾功能丧失。然而，本病例强调，即使血运重建术延迟，肾脏活力也可以通过多模态成像来评估血流，血运重建术可能会恢复某些病例的肾功能。

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引用次数: 0

Phase analysis with heart risk view function for cardiac resynchronization therapy: A case report 心脏再同步化治疗的期相分析与心脏风险视图功能：1例报告

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.04.001

Tsuyoshi Ichihara MD , Daisuke Tomioka MD , Kazumasa Kobashi , Takuma Nishikawa MD , Yusuke Fuji MD, PhD , Tomoya Ozawa MD, PhD , Ichiro Nakae MD, PhD , Yoshihisa Nakagawa MD, PhD

Myocardial perfusion scintigraphy (MPS) is a valuable diagnostic tool for identifying stable angina and evaluating myocardial viability. In clinical practice, MPS-based analysis tools, such as the Heart Risk View (Nihon Medi-physics Co., Ltd., Tokyo, Japan), have proven effective in assessing left ventricular (LV) dyssynchrony. This case report illustrates the diagnostic utility of MPS in identifying and assessing LV dyssynchrony due to ventricular septal pacing for pacemaker implantation. Upon admission, the patient exhibited symptoms of heart failure (New York Heart Association Class II) due to a Wenckebach-type second-degree atrioventricular block, requiring dual-chamber pacemaker implantation with septal pacing. Eight months postoperatively, phase analysis using the Heart Risk View revealed a significantly reduced ejection fraction (EF: 30 %) and marked LV dyssynchrony [standard deviation width (PhSD): 86 degrees, histogram bandwidth (PhBW): 227 degrees]. Given the presentation of drug-resistant heart failure and asynchronous contraction, a cardiac resynchronization therapy (CRT) device was implanted. Immediately following CRT implantation, phase analysis demonstrated notable improvement in LV function (EF: 42 %) and LV dyssynchronous contraction (PhSD: 30 degrees, PhBW: 110 degrees).

Learning objective

This study investigated the utility of myocardial perfusion scintigraphy in diagnosing post-implantation dyssynchronous contractions and assessing treatment efficacy. This case underscores the potential for dyssynchrony due to ventricular pacing. It emphasizes the importance of regular reassessment for mechanical dyssynchrony, particularly in patients experiencing a severe decline in ejection fraction or exercise tolerance following pacemaker implantation. Early evaluation is crucial to determine the need for cardiac resynchronization therapy and prevent further deterioration.

心肌灌注显像（MPS）是一种诊断稳定型心绞痛和评估心肌活力的有价值的工具。在临床实践中，基于mps的分析工具，如Heart Risk View (Nihon Medi-physics Co., Ltd, Tokyo, Japan)，已被证明在评估左心室（LV）非同步化方面是有效的。本病例报告说明了MPS在识别和评估起搏器植入时室间隔起搏引起的左室非同步化的诊断作用。入院时，患者因wenckebach型二度房室传导阻滞而出现心力衰竭症状（纽约心脏协会II级），需要植入双室起搏器并进行间隔起搏。术后8个月，使用心脏风险视图进行期相分析，结果显示射血分数显著降低（EF: 30 %），左室非同步化明显[标准偏差宽度（PhSD）： 86度，直方图带宽（PhBW）： 227度]。鉴于耐药心衰和不同步收缩的表现，植入心脏再同步化治疗（CRT）装置。植入CRT后，相位分析显示左室功能显著改善（EF: 42 %），左室不同步收缩（PhSD: 30度，PhBW: 110度）。学习目的探讨心肌灌注显像在诊断着床后非同步性收缩及评价治疗效果中的应用价值。本病例强调了室性起搏引起的非同步化的可能性。它强调了定期重新评估机械不同步运动的重要性，特别是在起搏器植入后出现射血分数或运动耐量严重下降的患者。早期评估对于确定是否需要心脏再同步化治疗和防止进一步恶化至关重要。

{"title":"Phase analysis with heart risk view function for cardiac resynchronization therapy: A case report","authors":"Tsuyoshi Ichihara MD , Daisuke Tomioka MD , Kazumasa Kobashi , Takuma Nishikawa MD , Yusuke Fuji MD, PhD , Tomoya Ozawa MD, PhD , Ichiro Nakae MD, PhD , Yoshihisa Nakagawa MD, PhD","doi":"10.1016/j.jccase.2025.04.001","DOIUrl":"10.1016/j.jccase.2025.04.001","url":null,"abstract":"<div><div>Myocardial perfusion scintigraphy (MPS) is a valuable diagnostic tool for identifying stable angina and evaluating myocardial viability. In clinical practice, MPS-based analysis tools, such as the Heart Risk View (Nihon Medi-physics Co., Ltd., Tokyo, Japan), have proven effective in assessing left ventricular (LV) dyssynchrony. This case report illustrates the diagnostic utility of MPS in identifying and assessing LV dyssynchrony due to ventricular septal pacing for pacemaker implantation. Upon admission, the patient exhibited symptoms of heart failure (New York Heart Association Class II) due to a Wenckebach-type second-degree atrioventricular block, requiring dual-chamber pacemaker implantation with septal pacing. Eight months postoperatively, phase analysis using the Heart Risk View revealed a significantly reduced ejection fraction (EF: 30 %) and marked LV dyssynchrony [standard deviation width (PhSD): 86 degrees, histogram bandwidth (PhBW): 227 degrees]. Given the presentation of drug-resistant heart failure and asynchronous contraction, a cardiac resynchronization therapy (CRT) device was implanted. Immediately following CRT implantation, phase analysis demonstrated notable improvement in LV function (EF: 42 %) and LV dyssynchronous contraction (PhSD: 30 degrees, PhBW: 110 degrees).</div></div><div><h3>Learning objective</h3><div>This study investigated the utility of myocardial perfusion scintigraphy in diagnosing post-implantation dyssynchronous contractions and assessing treatment efficacy. This case underscores the potential for dyssynchrony due to ventricular pacing. It emphasizes the importance of regular reassessment for mechanical dyssynchrony, particularly in patients experiencing a severe decline in ejection fraction or exercise tolerance following pacemaker implantation. Early evaluation is crucial to determine the need for cardiac resynchronization therapy and prevent further deterioration.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 2","pages":"Pages 51-54"},"PeriodicalIF":0.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144750573","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

Primary cardiac lymphoma presenting double obstruction of the right ventricle 原发性心脏淋巴瘤表现为右心室双梗阻

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.04.002

Masaru Yoshikai MD, PhD , Kazuyuki Ikeda MD , Manabu Itoh MD, PhD , Kouki Jinnouchi MD , Fumito Arima MD , Kouji Irie MD

Primary cardiac lymphoma (PCL) is an extremely rare cardiac malignancy, typically associated with a poor prognosis. We present a case of PCL causing right heart failure due to obstruction of the inflow and outflow of the right ventricle. The tumor was highly mobile, prompting an urgent debulking surgery that was successfully performed. Subsequent chemotherapy was effective, leading to remission 8 months after presentation. Although chemotherapy is the standard treatment for PCL, surgical treatment should be considered for patients with PCL leading to heart failure due to tumor-induced hemodynamic instability and/or have highly mobile tumors to prevent sudden death from tumor embolisms.

Learning objective

We describe a case where primary cardiac lymphoma (PCL) presented with right heart failure due to obstruction of the inflow and outflow of the right ventricle. The case emphasizes the role of urgent surgical intervention even before chemotherapy to prevent sudden death. It stresses the importance of cardiologists and surgeons to be well-acquainted with the conditions necessitating surgical intervention in PCL cases.

原发性心脏淋巴瘤（PCL）是一种极为罕见的心脏恶性肿瘤，通常预后较差。我们报告一例PCL因右心室流入和流出受阻而导致右心衰。肿瘤高度移动，促使紧急减体积手术成功实施。随后的化疗是有效的，导致缓解8 月后出现。虽然化疗是PCL的标准治疗方法，但对于因肿瘤引起的血流动力学不稳定和/或肿瘤高度移动而导致心力衰竭的PCL患者，应考虑手术治疗，以防止因肿瘤栓塞而猝死。学习目的我们报告一例原发性心脏淋巴瘤（PCL）因右心室流入和流出受阻而导致右心衰的病例。该病例强调了在化疗前进行紧急手术干预以防止猝死的作用。它强调了心脏科医生和外科医生熟悉PCL病例中需要手术干预的条件的重要性。

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引用次数: 0

Heart transplant in a patient with acute onset of heart failure and massive bi-ventricular thrombi: A case report 心脏移植治疗急性心力衰竭合并大量双心室血栓1例

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.05.003

Shaden Daloub MD , Rhythm Vasudeva MD , Amandeep Goyal MD , Emily Newton MD , Hirak Shah MD , Matthew Danter MD , Tyler Zorn MD , Timothy Fields MD , Tarun Dalia MD

Massive biventricular thrombi are a rare but serious complication of acute heart failure with reduced ejection fraction, presenting significant challenges in management. These thrombi can cause coronary thrombi leading to hemodynamic instability and raise the risk of systemic embolism. A 42-year-old male with a past medical history of type 2 diabetes mellitus presented with cardiogenic shock and pulmonary embolism. He was found to have new onset of heart failure with left ventricular ejection fraction of 15 % and harboring large biventricular thrombi. Stress test showed over 50 % of his myocardium was infarcted. Due to these findings, after a multidisciplinary team discussion, he was placed on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) as bridge to orthotopic heart transplant (OHT), for hemodynamic support and prevention of distal embolization. He subsequently underwent OHT as an INTERMACS category 1 a few days later. This rare and complicated case highlights the importance of a multidisciplinary team approach, and utilization of VA-ECMO in an end-stage cardiomyopathy patient with large biventricular thrombi as bridge to OHT.

Learning objective

Veno-arterial extracorporeal membrane oxygenation can be utilized to prevent systemic embolization as a bridge to orthotopic heart transplant in patients with biventricular thrombus and end-stage cardiomyopathy.

Heart transplant can be a lifesaving treatment in a patient with biventricular thrombi and extensive non-viable myocardium.

大量双心室血栓是急性心力衰竭伴射血分数降低的一种罕见但严重的并发症，对治疗提出了重大挑战。这些血栓可引起冠状动脉血栓，导致血流动力学不稳定，并增加全身栓塞的风险。42岁男性，既往有2型糖尿病病史，表现为心源性休克和肺栓塞。他被发现有新发心力衰竭，左心室射血分数为15% %，并有大的双心室血栓。压力测试显示超过50% %的心肌梗死。由于这些发现，在多学科团队讨论后，他被放置静脉-动脉体外膜氧合（VA-ECMO）作为原位心脏移植（OHT）的桥梁，以获得血流动力学支持和预防远端栓塞。几天后，他接受了INTERMACS 1类OHT治疗。这一罕见而复杂的病例强调了多学科团队方法的重要性，以及将VA-ECMO应用于有大双室血栓的终末期心肌病患者作为OHT的桥梁。学习目的动脉体外膜氧合可用于预防全身栓塞，作为双室血栓和终末期心肌病患者原位心脏移植的桥梁。心脏移植可以挽救双心室血栓和大面积无活力心肌患者的生命。

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引用次数: 0

Cardiac papillary fibroelastoma mimicking left ventricle apical thrombus 心脏乳头状纤维弹性瘤模拟左心室根尖血栓

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.04.004

Salma El Manir MD , Lionel Camilleri MD , Phuoc Nguyen Le MD , Charline Pujos MD , Yann Barthelemy MD , Etienne Geoffroy MD , Thomas Chassagne MD , Nicolas D'Ostrevy MD, PhD

Papillary fibroelastomas (PFE) are one of the most common types of primary cardiac tumors. They are a potential cause of transient ischemic attacks (TIA), strokes, myocardial infarction, and sudden death. We report the case of a 64-year-old woman who suffered from a TIA 10 years previously and a stroke a few years later. Transthoracic echocardiography (TTE) revealed a mass compatible with a thrombus in the apex of the left ventricle. The rest of the etiological assessment was negative. Anticoagulation treatment was started along with a TTE and magnetic resonance imaging (MRI) follow up. The patient presented with a new ischemic stroke two months later, and MRI revealed an increase in mass. After multidisciplinary discussion, a surgical excision was performed, and the histological study revealed PFE. The postoperative course was uneventful, and the patient was discharged 10 days after surgery.

乳头状纤维弹性瘤（PFE）是最常见的原发性心脏肿瘤之一。它们是短暂性脑缺血发作（TIA）、中风、心肌梗死和猝死的潜在原因。我们报告的情况下，64岁的妇女谁遭受了TIA 10 年前和中风几年后。经胸超声心动图（TTE）显示在左心室顶端有一个与血栓相容的肿块。其余病因评估均为阴性。抗凝治疗开始，同时进行TTE和磁共振成像（MRI）随访。两个月后，患者出现了新的缺血性中风，MRI显示肿块增加。多学科讨论后，手术切除，组织学研究显示PFE。术后过程顺利，患者术后10 天出院。

引用次数: 0

A single report tells the story: Ventricular fibrillation caused by vasospastic angina recorded from an implantable loop recorder 一个单一的报告讲述了这个故事：由血管痉挛性心绞痛引起的心室颤动记录了一个植入式环路记录器

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.05.008

Daiki Nakajima MD, Hitoshi Mori MD, PhD, Kazuhisa Matsumoto MD, PhD, Yoshifumi Ikeda MD, PhD, Ritsushi Kato MD, PhD

Implantable loop recorders (ILRs) are essential for diagnosing unexplained syncope, particularly when cardiogenic causes are suspected. An 80-year-old male experienced unexplained syncope following chest tightness, with no obstructive coronary findings. A comprehensive cardiac evaluation failed to identify the underlying cause, however Holter electrocardiography showed non-sustained ventricular tachycardia, suggesting cardiogenic syncope. Therefore, we proceeded with ILR implantation. Ten days post-discharge, ILR monitoring detected ventricular fibrillation (VF) preceded by ST-T elevation and triggered by a premature ventricular contraction, confirming vasospastic angina (VSA) as the cause. This is the first documented case where VF due to VSA was diagnosed via a single ILR electrogram. ILRs thus play a crucial role in managing syncope.

Learning objective

Implantable loop recorder (ILR) is useful not only for diagnosing arrhythmias in unexplained syncope, but also for identifying underlying conditions causing the arrhythmias. In this case report, ventricular arrhythmias following ST-T elevation caused by vasospastic angina were detected through a single ILR report.

植入式环路记录仪（ILRs）对于诊断不明原因的晕厥是必不可少的，特别是当怀疑心源性原因时。一位80岁男性在胸闷后出现不明原因的晕厥，无阻塞性冠状动脉发现。全面的心脏评估未能确定根本原因，然而霍尔特心电图显示非持续性室性心动过速，提示心源性晕厥。因此，我们进行了ILR植入。出院后10天，ILR监测发现室性颤动（VF）先于ST-T升高，并由室性早搏收缩触发，确认血管痉挛性心绞痛（VSA）为病因。这是第一例通过单次ILR电图诊断VSA引起的VF的病例。因此，ILRs在治疗晕厥中起着至关重要的作用。学习目的植入式循环记录仪（ILR）不仅可用于诊断不明原因晕厥的心律失常，而且可用于识别引起心律失常的潜在条件。在本病例报告中，通过单一ILR报告检测到由血管痉挛性心绞痛引起的ST-T升高后的室性心律失常。

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引用次数: 0

Pericardial drainage and continuous irrigation for a patient with purulent pericarditis caused by Streptococcus anginosus 心包引流及持续灌洗1例由心绞痛链球菌引起的化脓性心包炎

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2025-08-01 DOI: 10.1016/j.jccase.2025.04.008

Kazuki Matsumura MD , Hiroaki Kawano MD, PhD, FJCC , Takahiro Muroya MD, PhD , Shiro Hata MD, PhD , Hiroki Shinboku MD, PhD , Koichiro Sonoda MD, PhD , Kentaro Furukawa MD , Koji Maemura MD, PhD, FJCC

Pericarditis is a rare, rapidly progressing, life-threatening condition. A 49-year-old Japanese woman presented with heart failure resulting from cardiac effusion secondary to purulent pericarditis (bacterial pyogenic pericarditis) caused by Streptococcus anginosus. The patient required emergency pericardial drainage and irrigation. We report this case and discuss the available treatment options for this disease.

Learning objectives

Purulent pericarditis accounts for less than 1 % of all acute pericarditis cases because treatment methods against causative bacteria have already been established. However, purulent pericarditis continues to result in a poor prognosis and high mortality. Streptococcus anginosus, one of the normal floras can also induce purulent pericarditis, and we recommend pericardial drainage and continuous irrigation in addition to antibiotics as early as possible after the diagnosis, especially in patients with worsening of general condition.

心包炎是一种罕见、进展迅速、危及生命的疾病。一位49岁的日本女性，因心包积液继发于由心绞痛链球菌引起的化脓性心包炎（细菌性化脓性心包炎）而心力衰竭。病人需要紧急心包引流和冲洗。我们报告这个病例，并讨论这种疾病的可用治疗方案。学习目的化脓性心包炎在所有急性心包炎病例中所占的比例不到1 %，因为针对致病菌的治疗方法已经建立。然而，化脓性心包炎仍然导致预后不良和高死亡率。正常菌群之一的心绞痛链球菌也可诱发化脓性心包炎，诊断后应在抗生素治疗的基础上，尽早进行心包引流和持续灌洗，尤其是一般情况恶化的患者。

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引用次数: 0