Cardiovascular Revascularization Medicine: Interesting Cases最新文献

{"title":"Stepwise bifurcation strategy in totally occluded spontaneous left main coronary artery (LMCA) dissection: Successful management with the culotte technique","authors":"Huseyin Kandemir ,&nbsp;Mustafa Karakurt ,&nbsp;Selcuk Ozturk","doi":"10.1016/j.crmic.2025.100108","DOIUrl":"10.1016/j.crmic.2025.100108","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is a rare, non-atherosclerotic cause of acute coronary syndrome, with left main coronary artery (LMCA) involvement being particularly uncommon and life-threatening. We report the case of a 39-year-old previously healthy female who presented with recurrent chest pain and syncope. Initial investigations were inconclusive, but she later developed hypotension and ischemic electrocardiography changes, prompting emergent coronary angiography. A dissection of the LMCA extending into the left anterior descending artery and first diagonal artery was identified, with likely circumflex artery occlusion. Given the patient's instability, immediate percutaneous coronary intervention was performed using a stepwise bifurcation stenting approach, culminating in the culotte technique. The patient made a full recovery with normalization of cardiac function and remained asymptomatic during long-term follow-up. This case highlights the clinical challenges of diagnosing and managing SCAD involving the LMCA and demonstrates that timely intervention with structured bifurcation strategies can result in excellent outcomes, even in high-risk scenarios.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100108"},"PeriodicalIF":0.0,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145160046","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}

{"title":"Balloon-assisted laceration and snaring technique (BLAST) of the anterior mitral leaflet to prevent LVOT obstruction during transcatheter mitral valve implantation: A novel leaflet modification technique","authors":"Khagendra Dahal ,&nbsp;Talhat Azemi ,&nbsp;Bryan Piccirillo ,&nbsp;Sean McMahon ,&nbsp;Sheelah Pousatis ,&nbsp;Jawad Haider","doi":"10.1016/j.crmic.2025.100101","DOIUrl":"10.1016/j.crmic.2025.100101","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Introduction&lt;/h3&gt;&lt;div&gt;Left ventricular outflow tract (LVOT) obstruction is a serious complication during transcatheter mitral valve implantation (TMVI) for different indications including in patients with prior mitral bioprosthetic valve replacement. Our case introduces a novel hybrid approach using &lt;strong&gt;b&lt;/strong&gt;alloon-assisted &lt;strong&gt;l&lt;/strong&gt;aceration &lt;strong&gt;a&lt;/strong&gt;nd &lt;strong&gt;s&lt;/strong&gt;naring &lt;strong&gt;t&lt;/strong&gt;echnique (&lt;strong&gt;BLAST&lt;/strong&gt;) of the anterior mitral leaflet (AML) to prevent LVOT obstruction in a high-risk patient with bioprosthetic valve dysfunction.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Case presentation&lt;/h3&gt;&lt;div&gt;A 79-year-old woman with a history of hypertension, heart Failure with preserved ejection fraction (HFpEF), atrial fibrillation (on warfarin), mitral bioprosthetic valve replacement with 29 mm Mosaic valve in 2013 for severe rheumatic mitral stenosis and TAVR (transcatheter aortic valve replacement) for severe aortic stenosis (AS), presented with severe decompensated heart failure. Echo showed severe bioprosthetic dysfunction with mitral regurgitation (MR) due to flail bioprosthetic leaflet and perforation of the neoanterior leaflet. The patient was treated with multiple vasopressors and diuretics for stabilization prior to being transferred for TMVI as she was deemed prohibitive risk for surgery.&lt;/div&gt;&lt;div&gt;Preprocedural CT imaging predicted neoLVOT area of 133 mm&lt;sup&gt;2&lt;/sup&gt; raising concerns for LVOT obstruction during valve implantation. The predicted LVOT after leaflet modification was 219 mm&lt;sup&gt;2&lt;/sup&gt;. Given the complexity of the case, to avoid possible LVOT obstruction, the decision was made to perform a balloon-assisted laceration and snaring of the neoanterior mitral leaflet. After proposed BLAST procedure through a trans-septal approach, a successful TMVI was performed. The peak LVOT gradient post procedure was 9 mmHg. Our patient was stable post-procedure, weaned from vasopressors, and showed significant hemodynamic and clinical improvement in the hospital and at short-term clinic follow-up.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;LVOT obstruction is a well-known challenge in TMVI, in patients with prior mitral valve replacement, annuloplasty or significant annular calcification. Techniques like LAMPOON have been used to prevent LVOT obstruction, but in complex cases, additional strategies may be necessary. The balloon-assisted laceration and snaring technique (proposed acronym &lt;strong&gt;BLAST&lt;/strong&gt;) provides an effective and controlled method to address neoanterior leaflet dynamics. This modification may reduce procedural complexity and improve outcomes by ensuring that the LVOT remains unobstructed during valve deployment. This technique could complement or serve as an alternative to LAMPOON, particularly in redo TMVI cases.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;The &lt;strong&gt;BLAST&lt;/strong&gt; procedure demonstrates a promising approach for patients at high risk of LVOT obstruction during TMVI. Further st","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100101"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108865","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}

{"title":"From PCI to snare: A high-risk case of coronary artery disease with stent retrieval challenges","authors":"Ömer Işık ,&nbsp;Cengiz Şabanoğlu ,&nbsp;İbrahim Halil İnanç ,&nbsp;Afnan Chaudhry ,&nbsp;Mustafa Necati Dağlı","doi":"10.1016/j.crmic.2025.100100","DOIUrl":"10.1016/j.crmic.2025.100100","url":null,"abstract":"","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100100"},"PeriodicalIF":0.0,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222373","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}

{"title":"En bloc resection of a left atrial myxoma mimicking bronchial asthma: a case report","authors":"Nail Kahraman,&nbsp;Nöfel Ahmet Binicier,&nbsp;Deniz Demir","doi":"10.1016/j.crmic.2025.100106","DOIUrl":"10.1016/j.crmic.2025.100106","url":null,"abstract":"<div><div>A 50-year-old female patient presenting with progressive dyspnea was initially diagnosed with bronchial asthma. Even after a six-month treatment period, the patient's symptoms continued to escalate. On cardiac auscultation, a diastolic murmur was noted at the apex. Transthoracic echocardiography (TTE) revealed a pedunculated mass measuring 38 × 32.5 mm, attached to the interatrial septum within the left atrium. Additionally, moderate functional mitral regurgitation was identified. With a preliminary diagnosis of atrial myxoma, urgent surgical intervention was scheduled to prevent the risk of embolism. With a transseptal atriotomy approach, the tumor was mobilized without fragmentation and resected en bloc along with its stalk. Postoperatively, the functional mitral regurgitation resolved. Histopathological examination of the resected cardiac mass confirmed the diagnosis of atrial myxoma. During the postoperative course, the patient's symptoms significantly improved, and no residual mass was detected on follow-up echocardiography at twelfth months.</div><div>Myxomas are soft, gelatinous, and highly friable tumors that pose a significant risk of intraoperative fragmentation and embolization. This case highlights a rare instance in which a left atrial myxoma, initially misdiagnosed as asthma, underscored the importance of appropriate surgical strategy to prevent embolic events and recurrence. Furthermore, the case illustrates the diverse clinical presentations of cardiac myxomas and provides valuable insights that may contribute to the existing literature.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100106"},"PeriodicalIF":0.0,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145108863","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}

{"title":"Keeping the flow: A case series on snorkel/chimney stenting during transcatheter aortic valve replacement","authors":"Magnus To ,&nbsp;Shonit Nandakumar ,&nbsp;Timothy Davis Ho ,&nbsp;Harjeet Singh ,&nbsp;Waqqas Mirza ,&nbsp;Syed Iftikhar ,&nbsp;Javad Savoj ,&nbsp;Nikhil Ghatnekar ,&nbsp;Patrick Hu","doi":"10.1016/j.crmic.2025.100102","DOIUrl":"10.1016/j.crmic.2025.100102","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery occlusion is a rare but potentially fatal complication following transcatheter aortic valve replacement (TAVR), particularly in patients with high-risk anatomical features such as low coronary takeoff or shallow sinuses of Valsalva. Snorkel/chimney stenting has emerged as a feasible bailout or planned strategy to maintain coronary perfusion in these cases.</div></div><div><h3>Objective</h3><div>This case series describes the procedural approach, technical challenges, and clinical outcomes of three patients who underwent snorkel stenting of the coronary arteries following TAVR as well as one patient with concerns for coronary obstruction before TAVR.</div></div><div><h3>Methods</h3><div>Four high-risk patients underwent TAVR with planned or emergent snorkel stenting to prevent or manage coronary obstruction. Outcomes were assessed based on procedural success, coronary patency, and survival.</div></div><div><h3>Results</h3><div>Snorkel stenting was technically successful in three cases, preserving immediate coronary perfusion, while a fourth case had preparations for snorkel stenting but was not needed as the TAVR bioprosthesis did not occlude the coronary artery. Three patients survived for approximately 1–2 years post-intervention before succumbing to non-cardiac or unrelated complications and expired. Challenges included optimal stent positioning to minimize leaflet interaction and the potential for thrombotic complications.</div></div><div><h3>Conclusion</h3><div>This case series highlights both the feasibility and limitations of snorkel stenting as a coronary protection strategy post-TAVR. While short-term technical success was achieved, long-term survival remained limited in this high-risk population. Further research is needed to optimize patient selection, procedural strategies, and long-term management.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100102"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048775","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}

{"title":"Mitraclip in patient with prior atrial septal occlusion device: a challenging procedure","authors":"Miguel Angel Montilla Garrido,&nbsp;Elena Izaga Torralba,&nbsp;Carmen Lluch Requerey,&nbsp;Santiago Camacho Freire,&nbsp;Jessica Roa Garrido,&nbsp;Oscar Lagos De Grande,&nbsp;Antonio Gómez Menchero","doi":"10.1016/j.crmic.2025.100105","DOIUrl":"10.1016/j.crmic.2025.100105","url":null,"abstract":"","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"10 ","pages":"Article 100105"},"PeriodicalIF":0.0,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145222374","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}

{"title":"Left main stem spontaneous coronary artery dissection in a cardiogenic shock STEMI patient","authors":"George Kassimis ,&nbsp;Athanasios Samaras ,&nbsp;Athina Nasoufidou ,&nbsp;Anahita Rad ,&nbsp;Amelie De Fougeroux ,&nbsp;Carol Ojeka ,&nbsp;Pavlos Roditis ,&nbsp;Konstantinos C. Theodoropoulos ,&nbsp;Nikolaos Fragakis ,&nbsp;Antonios Ziakas","doi":"10.1016/j.crmic.2025.100107","DOIUrl":"10.1016/j.crmic.2025.100107","url":null,"abstract":"<div><div>Spontaneous coronary artery dissection (SCAD) is a rare, but well recognized cause of ST-elevation myocardial infarction (STEMI), especially in middle-aged women with few or no traditional cardiovascular risk factors. Left main stem (LMS) is the culprit coronary artery in around 13 % of STEMI-SCAD patients, and most of these patients develop cardiogenic shock (CS). LMS-SCAD represents a challenging clinical scenario where both successful revascularisation and haemodynamic support are required. Primary percutaneous coronary intervention (PPCI) in LMS-SCAD is a complex procedure, considering the risk of dissection propagation towards the left anterior descending and/or circumflex coronary arteries and in case it cannot be successfully performed, bailout emergent coronary artery bypass grafting may be needed. We herein present the case of a woman with LMS-SCAD who presented with STEMI and CS, illustrating the characteristic angiographic presentation, the treatment with a successful PPCI and the 6-month follow-up with a computed tomography coronary angiogram.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100107"},"PeriodicalIF":0.0,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145048774","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}

{"title":"Advanced fusion imaging in the percutaneous decommissioning of a left ventricular assist device","authors":"Mustafa Alkhawam ,&nbsp;Ali J. Ebrahimi ,&nbsp;Akash Pandey ,&nbsp;Rajamiyer Venkateswaran ,&nbsp;Mustafa I. Ahmed","doi":"10.1016/j.crmic.2025.100103","DOIUrl":"10.1016/j.crmic.2025.100103","url":null,"abstract":"<div><div>Here, we describe the first use of fusion imaging for percutaneous decommissioning of an LVAD. A 57-year-old male with pump thrombosis and hemolysis underwent occlusion of the outflow graft of his LVAD using three Amplater devices. Fusion imaging enabled the accurate placement and deployment of several closure devices in order to achieve immediate pump deactivation. The patient experienced a rapid improvement in hemodynamic and hemolytic parameters, making the percutaneous treatment of an LVAD a reasonable alternative to the classical open procedure.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100103"},"PeriodicalIF":0.0,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145019137","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}

{"title":"Percutaneous stenting for superior vena cava stenosis following surgical repair of congenital heart defects: A two case report","authors":"Georgios E. Papadopoulos ,&nbsp;Ilias Ninios ,&nbsp;Sotirios Evangelou ,&nbsp;Andreas Ioannides ,&nbsp;Vlasis Ninios","doi":"10.1016/j.crmic.2025.100104","DOIUrl":"10.1016/j.crmic.2025.100104","url":null,"abstract":"<div><div>Superior vena cava (SVC) stenosis is a rare but serious complication following surgical repair of congenital heart defects, often resulting in significant venous congestion, facial and upper extremity swelling, increased venous pressures, and impaired hemodynamics. Surgical re-intervention carries substantial risks, whereas percutaneous stenting offers a minimally invasive and effective alternative. We present two cases of symptomatic SVC stenosis following congenital heart defect repair. Both patients underwent detailed imaging with cardiac MRI and CT angiography, confirming severe SVC stenosis. Percutaneous intervention was performed using self-expanding Wallstents deployed under fluoroscopic guidance, with tailored post-dilation strategies to optimize luminal expansion. Immediate symptomatic relief was achieved in both cases, with complete resolution of venous congestion. Post-procedure anticoagulation included warfarin for six months, followed by long-term aspirin therapy. Follow-up imaging demonstrated sustained stent patency without restenosis or thrombosis. These cases highlight percutaneous stenting as a viable and effective approach for managing post-surgical SVC stenosis, offering a safe alternative to surgical re-intervention. Future research should focus on optimizing stent designs and post-procedural management strategies to further improve patient outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100104"},"PeriodicalIF":0.0,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145010341","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}

{"title":"Contained ventricular free wall rupture without pericardial effusion: a diagnostic challenge in acute myocardial infarction","authors":"Ranin Hilu ,&nbsp;Yoram Neuman ,&nbsp;Abid Assali ,&nbsp;Hana Vaknin Assa","doi":"10.1016/j.crmic.2025.100099","DOIUrl":"10.1016/j.crmic.2025.100099","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular free wall rupture is a rare but often fatal complication of acute myocardial infarction (MI). While typically associated with pericardial effusion and tamponade, left ventricular free wall rupture can occasionally present as a contained rupture, leading to diagnostic delays.</div></div><div><h3>Case summary</h3><div>A 69-year-old woman with prior mitral and tricuspid valve repair and atrial flutter treated with apixaban presented with cardiogenic shock following a posterior ST-elevation MI. Coronary angiography revealed thrombus in the right coronary artery and thrombotic occlusion of the left circumflex artery (LCx)- obtuse marginal (OM) branch. During evaluation for mechanical support, echocardiography suggested a large left ventricular mass. Further imaging raised suspicion of an intramural hematoma without pericardial effusion. Surgical exploration confirmed a sealed ventricular rupture contained by the parietal pericardium. Despite timely intervention, the patient succumbed to her condition.</div></div><div><h3>Discussion</h3><div>This case emphasizes the diagnostic challenge posed by left ventricular free wall rupture without pericardial effusion. High clinical suspicion, even in atypical presentations, and rapid multidisciplinary management are critical for improved outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"9 ","pages":"Article 100099"},"PeriodicalIF":0.0,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144904157","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}