European Heart Journal: Case Reports最新文献

{"title":"Novel cardiovascular magnetic resonance imaging biomarkers to track response to treatment including Sotatercept in a patient with idiopathic pulmonary arterial hypertension: a case report.","authors":"Alessandro Castiglione, Barbro Kjellström, Göran Rådegran, Ellen Ostenfeld","doi":"10.1093/ehjcr/ytag763","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag763","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary arterial hypertension (PAH) causes progressive right ventricular (RV) pressure overload and left ventricular (LV) underfilling. Sotatercept is an activin-signal inhibitor, approved by FDA in 2024 and EMA in 2025, as an add-on treatment in adult patients with PAH. Cardiovascular magnetic resonance (CMR)-derived atrioventricular plane displacement (AVPD) and left ventricular pressure-volume (PV) loops may represent non-invasive markers of treatment response, particularly important as novel therapies addressing remodelling emerge.</p><p><strong>Case summary: </strong>A 30-year-old woman was diagnosed with idiopathic PAH, after presenting with dyspnoea and peripheral oedema. Baseline CMR showed severe RV dilation, reduced RV ejection fraction, and low indexed LV stroke volume, with reduced bilateral AVPD and markedly impaired LV PV loop indices, with low stroke work, low mean external power, and high ventriculo-arterial coupling. Initial dual PAH therapy, with an endothelin receptor antagonist and a phosphodiesterase-5 inhibitor initially improved symptoms, pulmonary vascular resistance, as well as AVPD and PV loop derived indices, whereas conventional CMR indices showed only minimal change. One year later, despite triple therapy, including prostacyclin analogue, the patient deteriorated clinically and CMR showed worsening of AVPD and PV loop indices. Treatment escalation with Sotatercept immediately improved clinical status, haemodynamic, AVPD, and PV loop indices despite persistent RV remodelling.</p><p><strong>Discussion: </strong>Serial CMR-derived AVPD and LV PV loops may provide clinically useful additional information during longitudinal follow-up of PAH patients, especially in those approaching maximal available medical therapies. In the present case, both AVPD and LV PV loops reflected treatment response, and showed significant improvement after initiation of Sotatercept.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag763"},"PeriodicalIF":0.7,"publicationDate":"2026-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13715627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149295577","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":"Acute gastric dilatation and portal venous gas after pulsed field ablation for atrial fibrillation: a cautionary case report.","authors":"Masato Sakaki, Ryuta Watanabe, Koichi Nagashima, Shu Hirata, Yasuo Okumura","doi":"10.1093/ehjcr/ytag761","DOIUrl":"10.1093/ehjcr/ytag761","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) is considered to reduce collateral extracardiac injury compared with conventional thermal ablation. However, transient effects on autonomic nerves and adjacent smooth-muscle structures remain incompletely characterized.</p><p><strong>Case summary: </strong>An 80-year-old lean man underwent PFA for paroxysmal atrial fibrillation using a variable-loop circular catheter. Because stable tissue proximity was difficult to achieve around the left inferior pulmonary vein, additional ablation sets were delivered in this region. Approximately 24 h after the procedure, the patient developed acute abdominal pain. Computed tomography demonstrated marked gastric dilatation and portal venous gas with elevated lactate levels, without superior mesenteric artery occlusion or findings of irreversible bowel necrosis. Nasogastric decompression, fasting, intravenous fluids, and antibiotics resulted in rapid clinical and biochemical improvement. Portal venous gas resolved on follow-up imaging, oral intake was resumed, and the patient was discharged without surgical intervention.</p><p><strong>Discussion: </strong>The temporal relationship raises the possibility of a PFA-associated transient gastrointestinal dysmotility, although causality cannot be established from a single case. Potential mechanisms include transient effects on the periesophageal vagal plexus and/or adjacent smooth muscle. Portal venous gas was likely secondary to marked gastric dilatation rather than a direct effect of PFA.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag761"},"PeriodicalIF":0.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13705580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149264592","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":"Complete transcatheter closure of residual aortopulmonary window in an elderly patient allowing optimization of refractory pulmonary arterial hypertension therapy.","authors":"Yusuke Akazawa, Takashi Higaki, Osamu Yamaguchi","doi":"10.1093/ehjcr/ytag773","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag773","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag773"},"PeriodicalIF":0.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13715630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149295609","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":"Correction to: Minimally invasive coronary artery bypass grafting with robotic and laparoscopic-assisted artery harvesting: a case report.","authors":"","doi":"10.1093/ehjcr/ytag717","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag717","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ehjcr/ytaf495.].</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag717"},"PeriodicalIF":0.7,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13688200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149264663","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":"Generalized myoclonus following dobutamine stress echocardiography: a case report.","authors":"Anastasios Bontozis, Alexandros Makris, Dimitrios Iliopoulos, Sotirios Kotoulas, Eftyhia Chamodraka","doi":"10.1093/ehjcr/ytag775","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag775","url":null,"abstract":"<p><strong>Background: </strong>Dobutamine stress echocardiography (DSE) is a widely used and generally safe non-invasive imaging modality for the assessment of myocardial ischaemia. Adverse effects are predominantly cardiovascular, whereas neurological complications are exceedingly rare. Dobutamine-induced myoclonus (DIM) has only rarely been reported, mainly in patients receiving prolonged dobutamine infusions for heart failure or cardiomyopathy.</p><p><strong>Case summary: </strong>A 47-year-old woman underwent DSE for evaluation of exertional chest pain. Following completion of a standard dobutamine protocol, she developed generalized rhythmic myoclonic jerks predominantly involving the axial musculature. The patient remained fully conscious and hemodynamically stable throughout the episode. Intravenous diazepam failed to improve symptoms, whereas complete resolution occurred after administration of intravenous valproic acid. Laboratory investigations, including electrolytes, renal function, and thyroid function tests, were normal. Electroencephalography and brain magnetic resonance imaging revealed no abnormalities. No recurrence was observed during hospitalization or follow-up.</p><p><strong>Discussion: </strong>To our knowledge, this is the first reported case of DIM occurring immediately after DSE. Unlike previously published cases, which predominantly involved patients with chronic kidney disease and developed after prolonged dobutamine exposure, our patient had normal renal function and developed symptoms immediately upon completion of the stress protocol. The pathophysiology remains uncertain, although increased central nervous system exposure to dobutamine has been proposed. Clinicians performing DSE should be aware of myoclonus as a rare but important neurological complication and should consider valproic acid when benzodiazepines fail to achieve symptom control.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag775"},"PeriodicalIF":0.7,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13715625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149295632","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":"A zero-cost 'bail-out' catheter modification strategy for anomalous coronary interventions.","authors":"Muhammed Emre Güleşir, Muhammed Esad Çekin","doi":"10.1093/ehjcr/ytag772","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag772","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag772"},"PeriodicalIF":0.7,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13718438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149295585","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":"Resolution of Lancisi's sign following bicaval TricValve implantation for torrential tricuspid regurgitation: a case report defining a novel bedside marker of haemodynamic recovery.","authors":"Mohamed Asfour, Huseyin Bozbas","doi":"10.1093/ehjcr/ytag735","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag735","url":null,"abstract":"<p><strong>Background: </strong>Caval valve implantation (CAVI) using the TricValve system is an emerging treatment option for severe tricuspid regurgitation (TR) in patients who are unsuitable for surgery or orthotopic transcatheter intervention. Lancisi's sign is a classical manifestation of severe TR; however, its resolution after CAVI has not been described.</p><p><strong>Case summary: </strong>An 85-year-old woman with recurrent right heart failure and torrential TR presented with prominent bilateral Lancisi's sign. Echocardiography revealed severe annular dilatation (48 mm), right ventricular dysfunction (TAPSE, 13 mm), and a left ventricular ejection fraction of 40%. Owing to prohibitive surgical risk (EuroSCORE II 18.4%; TRI SCORE 14), she underwent successful implantation of 29-mm superior vena cava and 35-mm inferior vena cava TricValve prostheses. At 3 months, Lancisi's sign had completely resolved, NYHA functional class improved from III-IV to I-II, NT-proBNP decreased from 25 000 to 2 000 pg/mL, TAPSE increased from 13 to 20 mm, and no rehospitalization or device-related adverse event occurred. We report a structured single-patient case using clinical examination, echocardiography, invasive hemodynamic assessment, laboratory markers, and 3-month follow-up after bicaval TricValve implantation.</p><p><strong>Discussion: </strong>Bicaval TricValve implantation resulted in marked symptomatic, biochemical, echocardiographic, and bedside clinical improvements. The resolution of Lancisi's sign may represent a simple marker of hemodynamic recovery after CAVI.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag735"},"PeriodicalIF":0.7,"publicationDate":"2026-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13715628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149295623","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":"Right internal jugular approach for transcatheter edge-to-edge mitral valve repair using the MitraClip G4 system after failed transfemoral access: a case report.","authors":"Yutaka Konami, Kazuhisa Kodama, Mika Maeda, Masahiro Yamada, Tomohiro Sakamoto","doi":"10.1093/ehjcr/ytag756","DOIUrl":"10.1093/ehjcr/ytag756","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter edge-to-edge repair of the mitral valve is conventionally performed via transfemoral venous access. When this route is not feasible, the right internal jugular vein may provide an alternative, but procedural experience remains limited.</p><p><strong>Case summary: </strong>A 93-year-old woman with refractory heart failure had atrial functional mitral regurgitation and low-flow, low-gradient aortic stenosis. After transcatheter aortic valve implantation, moderate-to-severe mitral regurgitation persisted. Transfemoral edge-to-edge repair was unsuccessful because severe iliac venous tortuosity prevented adequate catheter control. The procedure was subsequently performed via the right internal jugular vein using the MitraClip G4 system. A pre-existing iatrogenic atrial septal defect was reused, and temporary left ventricular apical wire support facilitated advancement of the steerable guiding catheter into the left atrium. Stepwise + knob rotation increased height and working space, improved the markedly under-straddled configuration, and permitted further advancement of the clip delivery system. Subsequent M- and <i>P</i>-knob adjustments achieved an appropriate trajectory towards A2/P2, with an S-shaped fluoroscopic configuration. Leaflet grasping reduced mitral regurgitation to mild without access-site complications. Mild mitral regurgitation was maintained at 6 months without heart-failure rehospitalization.</p><p><strong>Discussion: </strong>Right internal jugular access may be a feasible alternative when transfemoral access is not possible. Successful navigation requires recognition of access-specific catheter behaviour and adaptation of steering under real-time fluoroscopy and transoesophageal echocardiography. An S-shaped fluoroscopic configuration may serve as a practical landmark of a favourable trajectory towards the mitral valve.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag756"},"PeriodicalIF":0.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13696959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149264590","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":"Intracoronary electrocardiogram and wave intensity analysis unmask functional coronary microvascular dysfunction in a middle-aged woman with 'normal' coronary arteries: a case report.","authors":"Ahmet Tas, Yaren Alan, Alp Ozcan, Erdem Cevik, Muhammed Ikbal Bayhan, Duygu Has Simsek, Sabahattin Umman, Murat Sezer","doi":"10.1093/ehjcr/ytag762","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag762","url":null,"abstract":"<p><strong>Background: </strong>Angina and/or ischaemia with nonobstructive coronary arteries (ANOCA/INOCA) is common, particularly in women, and is most frequently attributable to coronary microvascular dysfunction (CMD), rather than representing a benign finding after exclusion of epicardial stenosis.</p><p><strong>Case summary: </strong>A 55-year-old woman with cardiometabolic risk factors had recurrent angina and reversible ischaemia on stress single-photon emission computed tomography. Coronary angiography showed no obstructive disease. Doppler-based coronary function testing in the left anterior descending coronary artery demonstrated reduced coronary flow velocity reserve (1.99) with normal hyperaemic microvascular resistance (1.31 mmHg·s·cm^-1), suggesting functional CMD. Wave intensity analysis showed high resting accelerating wave energy proportion without hyperaemic augmentation, and intracoronary electrocardiogram (ECG) during adenosine hyperaemia revealed ischaemic ST-segment shifts concordant with perfusion imaging.</p><p><strong>Discussion: </strong>Multimodal invasive assessment can phenotype the INOCA endotypes and provide real-time ischaemia confirmation. This case highlights the added value of combining intracoronary ECG with wave intensity analysis for real-time ischaemia verification in INOCA, supporting a shift from anatomical exclusion to integrated physiological diagnosis of CMD. Vasoreactivity testing was not performed; therefore, a coexisting vasospastic endotype was not excluded.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag762"},"PeriodicalIF":0.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13717201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149295583","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":"Conservative management of a dislodged leadless pacemaker wedged in the pulmonary artery assessed by pulmonary perfusion scintigraphy: a case report.","authors":"Takanori Arimoto, Daisuke Kutsuzawa, Naoaki Hashimoto, Ken Watanabe, Masafumi Watanabe","doi":"10.1093/ehjcr/ytag749","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag749","url":null,"abstract":"<p><strong>Background: </strong>Leadless pacemakers reduce complications associated with conventional transvenous systems; however, device dislodgement with pulmonary artery embolization is a rare complication unique to leadless pacemakers. Although prompt retrieval is generally recommended, retrieval from the pulmonary artery may carry procedural risks, particularly in elderly or high-risk patients.</p><p><strong>Case summary: </strong>An 84-year-old woman with complete atrioventricular block underwent implantation of a leadless pacemaker. Although the pacing threshold was favourable, the R-wave amplitude was low, and unstable device movement was observed after tether release, suggesting inadequate fixation. Two hours after implantation, pacing failure occurred, and chest radiography showed migration of the device into the right pulmonary artery. The following day, the device migrated to the left posterior basal segmental pulmonary artery and remained stably wedged. Because of the risk associated with retrieval, conservative management was selected, and a transvenous pacemaker was implanted. Serial lung perfusion scintigraphy demonstrated right-to-left perfusion distributions of 60.5% vs. 39.5% at 10 days, 59.1% vs. 40.9% at 3 months, and 58.5% vs. 41.5% at 1 year, without progressive deterioration in left lung volume. The patient remained asymptomatic over 3 years of follow-up.</p><p><strong>Discussion: </strong>This case illustrates that conservative management may be feasible in carefully selected high-risk patients when an embolized leadless pacemaker is stably wedged within the pulmonary artery. Serial pulmonary perfusion scintigraphy may provide objective evidence of preserved pulmonary perfusion and support long-term follow-up after conservative management.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag749"},"PeriodicalIF":0.7,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13693475/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149264648","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}