Cardiovascular Revascularization Medicine: Interesting Cases最新文献

{"title":"A Rare Cardiac Complication of Chest Trauma: Right Coronary Artery – Right Atrium Fistula in a Teenager","authors":"Abdulrahman Al-Qaysi ,&nbsp;Abdelrahman Sayeh ,&nbsp;Zainab Al-Qaysi ,&nbsp;Muhammad Saad Faroogqi ,&nbsp;Naser Sayeh","doi":"10.1016/j.crmic.2025.100088","DOIUrl":"10.1016/j.crmic.2025.100088","url":null,"abstract":"<div><div>This report describes a 19-year-old male who sustained multiple chest stab wounds during a house party altercation, resulting in traumatic injury to the right coronary artery (RCA) and a fistula to the right atrium (RA). Coronary angiography showed RCA dilation with communication to the RA, coronary sinus, and right ventricle (RV), while cardiac computed tomography (CT) angiography identified an RCA pseudoaneurysm with an RA fistula, confirmed intraoperatively. The patient was stabilized and underwent successful open-heart surgery involving RCA ligation and coronary artery bypass grafting (CABG). This case emphasizes diagnostic challenges and surgical management of traumatic RCA pseudoaneurysm with fistulous communication.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100088"},"PeriodicalIF":0.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144694793","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":"Takotsubo cardiomyopathy and spontaneous coronary artery dissection association mimicking peri-partum cardiomyopathy","authors":"Arnaud Planchat ,&nbsp;Aubry Schaefer ,&nbsp;Carl Glessgen ,&nbsp;Philippe Meyer ,&nbsp;Sophie Degrauwe","doi":"10.1016/j.crmic.2025.100091","DOIUrl":"10.1016/j.crmic.2025.100091","url":null,"abstract":"<div><div>A 34-year-old woman presented with oppressive chest pain and dyspnea, later progressing to acute pulmonary edema four days after her fourth delivery. Echocardiography revealed severe left ventricular systolic dysfunction. Coronary angiography demonstrated a multivessel spontaneous coronary artery dissection (SCAD) of very small &lt; 1 mm branches of RCA and diagonal arteries that did not explain the reduction in LVEF to 35 %. Ventriculography confirmed a reversed Tako-Tsubo pattern. Cardiac MRI helped distinguish between Tako-Tsubo syndrome (TTS) and peripartum cardiomyopathy (PPCM), as both can share a similar pattern. The patient received heart failure guideline-directed medical therapy, resulting in rapid clinical improvement. This case highlights the diagnostic challenge not only in identifying SCAD, TTS, and PPCM in the peripartum period, but also in recognizing the potential overlap between them. Multimodal imaging in guiding effective management of peripartum cardiovascular complications was therefore crucial.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144687367","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":"Acute aortic regurgitation following transcatheter aortic valve implantation treated with a pigtail catheter","authors":"Georgios E. Papadopoulos,&nbsp;Ilias Ninios,&nbsp;Sotirios Evangelou,&nbsp;Andreas Ioannides,&nbsp;Athinodoros Nikitopoulos,&nbsp;Vlasis Ninios","doi":"10.1016/j.crmic.2025.100090","DOIUrl":"10.1016/j.crmic.2025.100090","url":null,"abstract":"<div><div>Stuck leaflets of transcatheter aortic valves are a rare but potentially life-threatening complication. Although management often includes immediate valve-in-valve implantation, alternative catheter-based strategies may resolve leaflet immobility and avoid unnecessary interventions. A 78-year-old male with severe symptomatic aortic stenosis (mean gradient 57 mmHg, aortic valve area 0.7 cm²) and high surgical risk (EuroSCORE II 8.9 %) underwent transfemoral balloon-expandable transcatheter aortic valve implantation (TAVI). Post-deployment aortography demonstrated acute severe aortic regurgitation (AR), associated with rapid hemodynamic deterioration. With valve-in-valve implantation under consideration, gentle manipulation (rotation and withdrawal) of an aortic pigtail catheter placed via the left radial artery resulted in immediate resolution of AR, restoration of hemodynamics, and confirmation of leaflet mobility. Catheter-based troubleshooting successfully restored leaflet function without need for additional valve implantation. The patient recovered uneventfully and remained symptom-free at 3-month follow-up echocardiography, with no residual aortic regurgitation. Prosthetic leaflet immobility after TAVI may result from interference by native calcified leaflets, structural trauma during positioning, or incomplete frame expansion. Early recognition and catheter manipulation-such as gentle engagement with a pigtail catheter-can restore leaflet motion and avert emergent valve-in-valve procedures. Careful procedural technique, including precise prosthesis alignment and cautious post-dilatation, may reduce leaflet entrapment risk. In cases of acute severe AR due to stuck leaflets post-TAVI, simple pigtail catheter manipulation should be attempted as a first-line intervention before proceeding to more invasive therapies.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100090"},"PeriodicalIF":0.0,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144670709","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":"Hidden culprit: Hemodynamic unmasking of angiographically insignificant in-stent restenosis","authors":"Samantha L. Weller ,&nbsp;Katherine Lutz ,&nbsp;Colter Wichern ,&nbsp;Jeffrey Marbach","doi":"10.1016/j.crmic.2025.100089","DOIUrl":"10.1016/j.crmic.2025.100089","url":null,"abstract":"<div><div>A 79-year-old male with coronary artery disease (CAD) and drug-eluting stents (DES) to the right coronary artery (RCA) and left anterior descending (LAD) artery (2001). A decade later, catheterization for angina showed mid-RCA chronic total occlusion (CTO) with left-to-right collateral flow and 30 % LAD in-stent restenosis (ISR), managed medically. He re-presented with angina, and repeat angiography revealed similar LAD ISR. Functional assessment with CathWorks FFRangio and invasive instantaneous wave-free ratio (iFR) was discordant but confirmed hemodynamically significant ISR due to an under-expanded, fractured LAD stent on intravascular ultrasound (IVUS). This case illustrates angiographic-functional discordance and the value of multimodal assessment.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100089"},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144680184","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":"A case series of plug-based closure of peri-device leak after left atrial appendage occlusion","authors":"Nina S. Appareddy ,&nbsp;Gabriel Areoye ,&nbsp;Shan Tandon ,&nbsp;Divyanshi Sood ,&nbsp;Suhaib El Khatib ,&nbsp;William Charles Stout ,&nbsp;Kathleen Brown ,&nbsp;George Gibson ,&nbsp;Derar Albashaireh ,&nbsp;Bhavith Aruni","doi":"10.1016/j.crmic.2025.100087","DOIUrl":"10.1016/j.crmic.2025.100087","url":null,"abstract":"<div><div>Peri-device leak (PDL) following left atrial appendage occlusion (LAAO) is particularly problematic in patients with both high thromboembolic and bleeding risk. We present a case series of three patients with atrial fibrillation and high bleeding risk. All three patients underwent LAAO with a Watchman™ and were found to have PDL on follow-up imaging. All three patients underwent successful PDL closure with an Amplatzer™ duct occluder II device with no complications noted. These cases demonstrate that PDL closure can be safely and effectively performed via a plug-based approach. Imaging is critical in determining candidacy for and method of PDL closure.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100087"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144518485","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":"Transcatheter edge-to-edge repair of the systemic atrioventricular valve in a patient with congenitally corrected transposition of the great arteries and dextrocardia","authors":"Georgios E. Papadopoulos ,&nbsp;Ilias Ninios ,&nbsp;George Giannakoulas ,&nbsp;Sotirios Evangelou ,&nbsp;Andreas Ioannides ,&nbsp;Vlasis Ninios","doi":"10.1016/j.crmic.2025.100086","DOIUrl":"10.1016/j.crmic.2025.100086","url":null,"abstract":"<div><div>A 33-year-old male with congenitally corrected transposition of the great arteries (ccTGA), dextrocardia and situs solitus presented with dyspnea at rest, classified as New York Heart Association (NYHA) class IV, in the context of severe systemic atrioventricular valve (SAVV) regurgitation, and impaired systolic function of the systemic morphologically right ventricle. Due to high surgical risk, the Heart Team opted for a transcatheter edge-to-edge repair (TEER) using a PASCAL ACE device. The procedure successfully reduced regurgitation from severe to mild, resulting in symptomatic improvement and recovery to NYHA class I at six-month follow-up. This case highlights the feasibility of TEER as a minimally invasive alternative in selected patients with ccTGA and systemic AV valve regurgitation.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100086"},"PeriodicalIF":0.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144338742","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":"Anomalous left main coronary artery originating from the right coronary cusp: A case series and clinical implications","authors":"Ghulam Mujtaba Ghumman ,&nbsp;Adel Kanaan ,&nbsp;Sanam Farooq ,&nbsp;Abdul Baqi ,&nbsp;F.N.U. Salman ,&nbsp;Moaaz Baghal ,&nbsp;Syed Sohail Ali","doi":"10.1016/j.crmic.2025.100084","DOIUrl":"10.1016/j.crmic.2025.100084","url":null,"abstract":"<div><h3>Background</h3><div>Anomalous origin of the left main coronary artery (LMCA) from the right coronary cusp is a rare congenital anomaly with diverse clinical presentations and significant implications for patient management.</div></div><div><h3>Case summary</h3><div>This case series presents three unique cases of anomalous LMCA origin from the right coronary cusp, each with distinct clinical manifestations and management strategies. Case 1 involved an 82-year-old male presenting with heart failure symptoms, where coronary angiography revealed an anomalous LMCA with a retro-aortic course (benign), managed conservatively. Case 2 describes a 71-year-old female presenting with non-ST-segment elevation myocardial infarction (NSTEMI) due to a culprit right coronary artery (RCA) lesion, with the LMCA taking a pre-pulmonic course (benign), successfully treated with percutaneous coronary intervention (PCI) of the RCA. Case 3 details a 76-year-old male evaluated for exertional fatigue and abnormal stress test, found to have an anomalous LMCA with a malignant interarterial course, for which surgical revascularization was recommended, though the patient opted for conservative management.</div></div><div><h3>Discussion</h3><div>The series underscores the importance of recognizing LMCA anomalies and tailoring management strategies based on anatomical course and clinical presentation. Coronary computed tomography angiography (CTA) plays a pivotal role in delineating coronary anatomy and guiding management. Benign courses are managed conservatively, while malignant interarterial courses necessitate surgical consideration due to the increased risk of sudden cardiac death.</div></div><div><h3>Conclusion</h3><div>Anomalous origin of the LMCA from the right coronary cusp presents diagnostic and therapeutic challenges, requiring a multidisciplinary approach for optimal management. Early identification and accurate characterization of the coronary course are critical for guiding intervention and improving outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100084"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144271038","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":"When complications become opportunities: Guide catheter-induced dissection facilitating an unplanned investment strategy in chronic total occlusion PCI of the RCA","authors":"Ghulam Mujtaba Ghumman,&nbsp;Sidra Kalsoom,&nbsp;Mohammed Taleb,&nbsp;Syed Sohail Ali,&nbsp;Zaid Al-Jebaje","doi":"10.1016/j.crmic.2025.100085","DOIUrl":"10.1016/j.crmic.2025.100085","url":null,"abstract":"<div><h3>Background</h3><div>Percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) of the right coronary artery (RCA) remains technically challenging. Guide catheter-induced dissection is typically considered a serious complication. However, in rare cases, such events may paradoxically aid in successful revascularization.</div></div><div><h3>Case Summary</h3><div>We report the case of a 43-year-old male with prior coronary artery bypass grafting (CABG) and RCA CTO, who underwent unplanned investment PCI procedure. Immediately after guide catheter engagement, contrast injection revealed a proximal RCA dissection. Instead of terminating the procedure, this unintentional dissection enabled entry into the subintimal space and facilitated guidewire passage to the distal branches. Intravascular ultrasound (IVUS) confirmed entry into the false lumen. Serial balloon angioplasty was performed, restoring TIMI-III flow to the right posterior descending artery (RPDA) and right posterolateral artery (RPLA). Remarkably, the dissection did not extend to the aortic cusp, nor did it result in perforation or pericardial effusion. The case was deemed a successful investment procedure, with staged completion in 10 weeks when patient returned for definitive revascularization. Four overlapping stents were placed from ostial RCA to RPLA with excellent results.</div></div><div><h3>Conclusion</h3><div>While coronary dissection during CTO-PCI is conventionally viewed as a complication, in select scenarios it may facilitate revascularization. Recognizing and managing such outcomes requires careful intraprocedural assessment and expertise in complex PCI.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100085"},"PeriodicalIF":0.0,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144263887","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":"“Atrialized” minimally invasive transcatheter mitral valve-in-MAC replacement to prevent outflow tract obstruction","authors":"Luai Madanat,&nbsp;Richard Bloomingdale,&nbsp;Ahmad Jabri,&nbsp;Michael Gallagher,&nbsp;Vishal Birk,&nbsp;Amr E. Abbas,&nbsp;John Young,&nbsp;Rakesh M. Suri","doi":"10.1016/j.crmic.2025.100081","DOIUrl":"10.1016/j.crmic.2025.100081","url":null,"abstract":"<div><div>Mitral valve replacement in the setting of severe mitral annular calcification remains a high-risk intervention, often complicated by poor outcomes with both conventional surgical and transcatheter techniques. A hybrid open transcatheter mitral valve-in-MAC procedure utilizing an atrialized implantation strategy offers a promising alternative to minimize the risk of left ventricular outflow tract obstruction. Meticulous preoperative planning with cardiac CT is essential to guide procedural strategy and optimize outcomes.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100081"},"PeriodicalIF":0.0,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144231128","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":"TRI-umphant recovery: A case series of transcatheter tricuspid valve-in-valve replacement for bioprosthetic tricuspid valve stenosis","authors":"Nina S. Appareddy ,&nbsp;Bradley Casey ,&nbsp;Divyanshi Sood ,&nbsp;Renuka Singh ,&nbsp;Syed R. Zaidi ,&nbsp;Manaquibb Khan ,&nbsp;George Gibson ,&nbsp;Bhavith Aruni ,&nbsp;Derar Albashaireh","doi":"10.1016/j.crmic.2025.100082","DOIUrl":"10.1016/j.crmic.2025.100082","url":null,"abstract":"<div><div>Transcatheter tricuspid valve-in-valve (TViV) replacement is an emerging alternative to repeat surgical intervention for patients with bioprosthetic tricuspid valve stenosis. We present two patients with a history of severe tricuspid regurgitation and bioprosthetic tricuspid valve replacement, one with a history of Ebstein's anomaly and the other with a history of blunt chest trauma. Both patients presented several years later with severe bioprosthetic tricuspid valve stenosis symptomatic with progressive lifestyle limiting dyspnea. Following multi-disciplinary discussion, they were both determined to be of high surgical risk and ultimately managed via a transcatheter approach with TViV replacement.</div></div>","PeriodicalId":100217,"journal":{"name":"Cardiovascular Revascularization Medicine: Interesting Cases","volume":"8 ","pages":"Article 100082"},"PeriodicalIF":0.0,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144241992","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}