European Heart Journal: Case Reports最新文献

{"title":"Accessory pathway unmasked by adenosine in a patient with unexplained cardiac arrest: a case report.","authors":"Simone Taddeucci, Luca Panchetti, Martina Nesti, Silvia Garibaldi","doi":"10.1093/ehjcr/ytaf451","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf451","url":null,"abstract":"<p><strong>Background: </strong>Survivors of sudden cardiac arrest require detailed diagnostic evaluation to identify reversible causes and guide therapy. Underlying mechanisms may include ischaemia or electrophysiological abnormalities. The conventional diagnostic workflow may fail to uncover occult arrhythmic substrates, highlighting the need for targeted testing strategies in selected cases.</p><p><strong>Case summary: </strong>A 35-year-old man, a former endurance athlete, experienced a witnessed sudden cardiac arrest during sleep. Ventricular fibrillation was terminated with direct-current shock, achieving return of spontaneous circulation. The initial 12-lead ECG showed ST-segment elevation in V1-V3 with a coved Brugada-like pattern, but reciprocal ST-segment depression. Myocardial ischaemia was ruled out with coronary angiography, and Brugada syndrome was excluded by a negative ajmaline test. No further abnormalities were found. Persistent clinical suspicion prompted an adenosine test, which revealed a left lateral accessory pathway. Electrophysiological testing demonstrated high-risk properties of the accessory pathway, with haemodynamic collapse during pre-excited atrial fibrillation. Catheter ablation successfully eliminated the accessory pathway without changes in QRS complex morphology, and the patient remained asymptomatic at follow-up, with no arrhythmic recurrence.</p><p><strong>Discussion: </strong>Unexplained cardiac arrest in patients with structurally normal hearts presents significant diagnostic challenges. In this case, adenosine testing unmasked an accessory pathway as the reversible cause of cardiac arrest. Though not routinely included in cardiac arrest evaluations, adenosine testing was crucial in this patient's diagnosis and management, preventing unnecessary implantable cardioverter-defibrillator placement. Comprehensive diagnostic strategies, including targeted use of adenosine testing, can reveal occult arrhythmic substrates, improving outcomes and avoiding overtreatment in selected cases.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf451"},"PeriodicalIF":0.8,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495035/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial tachycardia of left atrial appendage origin treated with pulsed field ablation using a linear-tip catheter: a case report.","authors":"Shaohui Wu, Guangchen Zou, Jiongchao Guo, Xu Liu, Weifeng Jiang","doi":"10.1093/ehjcr/ytaf470","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf470","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage is an unusual site of origin of atrial tachycardia and ablation used to be challenging due to fear of perforation and increased risk of thromboembolism.</p><p><strong>Case summary: </strong>A 14-year-old patient presented with frequent palpitations due to atrial tachycardia. Mapping confirmed origin of the atrial tachycardia to be the tip of the left atrial appendage. It was successfully treated with catheter ablation of the source using a linear-tip pulsed field ablation catheter.</p><p><strong>Discussion: </strong>Pulsed field ablation catheters are associated with less thermal damage to adjacent tissues, and linear tip design are suited for direct ablation of the source of atrial tachycardia of left atrial appendage origin. This can avoid the thromboembolism risk of electrical isolation of left atrial appendage and is less invasive than surgical ligation.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf470"},"PeriodicalIF":0.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495031/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pannus formation after transcatheter aortic valve implantation resulting in prosthetic valve dysfunction: a case report.","authors":"Fabian Hundertmark, Anton Tomsic, Tamer Owais, Evaldas Girdauskas","doi":"10.1093/ehjcr/ytaf440","DOIUrl":"10.1093/ehjcr/ytaf440","url":null,"abstract":"<p><strong>Background: </strong>Subaortic pannus formation (SAP) is a recognized complication following surgical aortic valve replacement (SAVR), typically manifesting around 5 years post-implantation. However, SAP occurrence after transcatheter aortic valve implantation (TAVI) remains poorly documented and investigated.</p><p><strong>Case summary: </strong>This case report presents a 79-year-old male who presented to our clinic with fatigue on exertion after having undergone TAVI with a 26-mm Edwards SAPIEN 3 valve 3 years prior to presentation. Echocardiography revealed elevated transprosthetic gradients, with no improvement after initiation of anticoagulation therapy. On cardiac tomography imaging, SAP was suspected. The patient underwent successful reoperative SAVR with concomitant mitral and tricuspid valve repair. Intraoperatively, severe pannus formation with subvalvular obstruction of the valve opening area was observed.</p><p><strong>Discussion: </strong>This case highlights the risk of early SAP formation following TAVI, underscoring the need for long-term follow-up and a more thorough understanding of the underlying pathophysiology.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf440"},"PeriodicalIF":0.8,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456406/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pseudoaneurysm of the mitral-aortic intervalvular fibrosa and mitral valve perforation as a complication of infective endocarditis: a case report and literature review.","authors":"José Alejandro Claros Ruiz, José Ignacio Larrubia Valle, Ana María González González, Daniel Gaitán Román, Ricardo Vivancos Delgado","doi":"10.1093/ehjcr/ytaf458","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf458","url":null,"abstract":"<p><strong>Background: </strong>Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) is a rare but serious complication, most commonly associated with infective endocarditis or cardiac surgery. Early detection and appropriate timing of surgical intervention are crucial to prevent life-threatening consequences.</p><p><strong>Case summary: </strong>We present the case of a 74-year-old man with a recent history of dual-chamber pacemaker implantation who presented with atypical chest pain and low-grade fever. Initial transthoracic echocardiography raised suspicion of mitral valve pathology, but transoesophageal and 3D echocardiography revealed a pseudoaneurysm of the MAIVF and a flail posterior mitral leaflet due to leaflet perforation. Blood cultures confirmed <i>Staphylococcus epidermidis</i> infective endocarditis. The patient underwent urgent valve replacement surgery but unfortunately developed severe biventricular dysfunction and died despite maximal supportive care.</p><p><strong>Discussion: </strong>This case illustrates the critical role of multimodality imaging, especially 3D echocardiography, in diagnosing MAIVF pseudoaneurysm and assessing surgical indications in the context of infective endocarditis. Surgical timing and haemodynamic stability are essential in optimizing outcomes.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf458"},"PeriodicalIF":0.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495033/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arrhythmic mitral valve prolapse in Kohlschütter-Tönz syndrome.","authors":"Annagrazia Cecere, Agatella Barchitta, Lucia Pavan, Martina Perazzolo Marra","doi":"10.1093/ehjcr/ytaf479","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf479","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf479"},"PeriodicalIF":0.8,"publicationDate":"2025-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful mitral-transcatheter edge to edge repair in a young patient with severe primary mitral regurgitation unsuitable for surgery: a case report.","authors":"Giovanni Bellina, Salvatore Scandura, Carmelo Grasso, Placido Maria Mazzone, Davide Capodanno","doi":"10.1093/ehjcr/ytaf464","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf464","url":null,"abstract":"<p><strong>Background: </strong>Mitral transcatheter edge-to-edge repair (M-TEER) is commonly performed in elderly patients with severe mitral regurgitation (MR) who are deemed high-risk for surgery. However, its application in younger patients remains limited.</p><p><strong>Case summary: </strong>We present the case of a 45-year-old male with a history of mitral valve prolapse, who developed severe MR due to chordal rupture. Surgical mitral valve repair was not considered feasible, and the patient successfully underwent M-TEER with implantation of two MitraClips XTW (Abbott Medical, USA), resulting in mild residual regurgitation and a mean mitral valve gradient of 5 mmHg.</p><p><strong>Discussion: </strong>This case highlights the potential role of M-TEER in selected young patients, expanding its indications beyond traditional cohorts.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf464"},"PeriodicalIF":0.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495034/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inpatient cardiac rehabilitation after implantation of a total artificial heart (Aeson device CARMAT) in case of ventricular septal defect after infarction.","authors":"Raluca Fiebiger, Alexey Dashkevich, Michal Nozdrzykowski, Joanna Jozwiak-Nozdrzykowska, Erind Gjermeni","doi":"10.1093/ehjcr/ytaf478","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf478","url":null,"abstract":"<p><strong>Background: </strong>Post-infarction ventricular septal defect (VSD) is a rare but life-threatening complication of myocardial infarction, in severe cases needing heart transplantation. The Aeson Total Artificial Heart (TAH), a bioprosthetic device designed to replace both ventricles, offers an alternative for patients unsuitable for conventional therapies.</p><p><strong>Case summary: </strong>A 69-year-old male presented in cardiogenic shock following an inferior wall ST-elevation myocardial infarction complicated by a large VSD. Initial support included extracorporeal life system. Surgical repair was unfeasible due to the defect's size and proximity to the atrioventricular valve, leaving insufficient rim for septal reconstruction. Total artificial heart implantation was the only viable option, used as bridge-to-decision therapy given the patient's advanced age. Post-operative recovery was prolonged, but the patient was successfully transferred to an inpatient rehabilitation facility, where structured physiotherapy, endurance, resistance, and mobility training led to significant functional improvement. Close collaboration with a mechanical circulatory support perfusionist resolved recurring TAH alarms related to intraventricular pressure and communication issues adapting the diuretic and antihypertensive medication. The patient was discharged home in stable condition, achieving substantial physical recovery and independence in managing the device.</p><p><strong>Discussion: </strong>The Aeson TAH proved to be a safe and effective therapy, in particular, as bridge-to-decision therapy in this complex case of post-infarction VSD. Inpatient cardiac rehabilitation played a pivotal role in optimizing physical recovery, managing device-related challenges, and preparing the early transition to an independent living. This case highlights the potential of advanced bioprosthetic solutions and the benefits of a structured rehabilitation system in managing severe cardiac conditions. Further research is needed to evaluate the long-term outcomes and broader applicability of the Aeson TAH.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf478"},"PeriodicalIF":0.8,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Myocarditis or 'hot phase' of arrhythmogenic cardiomyopathy? A case series.","authors":"André Ferreira, Rita Teixeira, Pedro Brás, José Viegas, Inês Almeida, Diana Antunes, Rui Cruz Ferreira, Sílvia Aguiar Rosa","doi":"10.1093/ehjcr/ytaf460","DOIUrl":"10.1093/ehjcr/ytaf460","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic cardiomyopathy (ACM) is a genetic condition characterized by fibrofatty replacement of myocardial tissue, leading to arrhythmias and structural heart changes. Recent studies have identified an acute inflammatory phase, or 'hot phase', within the progression of ACM that presents with clinical features similar to myocarditis. This phase complicates the differentiation between ACM and myocarditis, posing a diagnostic challenge.</p><p><strong>Case summary: </strong>We present two cases of young male patients, both with mutations in the DSP and LMNA genes, who initially presented with symptoms of myocardial inflammation. Patient 1, a 23-year-old male, presented with pleuritic chest pain, elevated troponin, and imaging findings suggesting myocarditis. Cardiac magnetic resonance (CMR) revealed extensive subepicardial late gadolinium enhancement (LGE) in a non-ischaemic pattern. Genetic testing confirmed a likely pathogenic (LP) LMNA mutation. Patient 2, a 26-year-old male with family history of sudden cardiac death, presented similarly with chest pain and elevated biomarkers. His CMR showed intramural LGE, and genetic testing identified a LP DSP mutation. He underwent implantation of a subcutaneous defibrillator (ICD) due to arrhythmic risk.</p><p><strong>Discussion: </strong>This case series underscores the importance of recognizing the 'hot phase' of ACM, which can clinically mimic myocarditis. Cardiac magnetic resonance is crucial for differentiating these entities, while genetic testing confirms the diagnosis, offering prognostic information. Mutations in the LMNA and DSP genes, particularly associated with inflammation in ACM, require consideration of arrhythmia prevention strategies, such as ICD implantation. Multidisciplinary management and advanced imaging play essential roles in the care of these patients.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf460"},"PeriodicalIF":0.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The 'reverse loop' technique for difficult left ventricular access during percutaneous balloon mitral valvuloplasty.","authors":"Milind S Phadke, Saurabh V Limaye, Pratap J Nathani","doi":"10.1093/ehjcr/ytaf457","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf457","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf457"},"PeriodicalIF":0.8,"publicationDate":"2025-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495038/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report of an aggressive cardiac myxofibrosarcoma with rapid disease progression.","authors":"Koichi Nakamura, Osamu Kurihara, Nobuaki Kobayashi, Yasuhiro Kawase, Kuniya Asai","doi":"10.1093/ehjcr/ytaf447","DOIUrl":"10.1093/ehjcr/ytaf447","url":null,"abstract":"<p><strong>Background: </strong>Primary cardiac myxofibrosarcoma is an exceptionally rare malignant tumour, often asymptomatic until local invasion or distant metastasis occurs. Early diagnosis is challenging, and the prognosis is generally poor owing to high local recurrence and metastasis rates.</p><p><strong>Case summary: </strong>We report the case of a 79-year-old woman who presented with neurological symptoms and multiple brain metastases. Imaging showed a broad-based exophytic mass obstructing the left pulmonary vein and extending into the left atrium. Surgical resection was conducted, and the diagnosis of myxofibrosarcoma was confirmed from histology. Despite surgery, the tumour recurred locally within days, and the brain metastases progressed. Considering the patient's deteriorating condition, no further treatment was initiated. She was then transferred to hospice care and died shortly thereafter.</p><p><strong>Discussion: </strong>Primary cardiac myxofibrosarcoma is an extremely rare malignancy with non-specific symptoms and poor prognosis owing to its aggressive biological behaviour. In this case, multimodal imaging showed features suggestive of malignancy, including an exophytic mass with a broad attachment base and heterogeneous signal intensity. Despite surgical resection, the tumour recurred rapidly, and brain metastases progressed. The tumour size, high histological grade, and delayed intervention are likely to contribute to poor clinical outcomes. Owing to their rarity, there are no standardized treatment guidelines for primary cardiac sarcomas. In this case, we reconfirmed the high-grade malignancy of the cardiac sarcoma through multiple computerized tomography scans conducted over a short period. Currently, the only method for prompt evaluation using multiple imaging modalities involves early surgical resection combined with adjuvant therapy to improve clinical outcomes.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf447"},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12487779/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}