European Heart Journal: Case Reports最新文献

{"title":"IgG4-related disease as an uncommon cause of myocarditis: a case report.","authors":"Emily Ellis, Sarah Grebennikov, Rodolfo Jose Denadai Benatti","doi":"10.1093/ehjcr/ytag274","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag274","url":null,"abstract":"<p><strong>Background: </strong>IgG-4-related disease (IgG4-RD) is a systemic fibroinflammatory disease that can affect any organ system. Myocarditis is a rare manifestation.</p><p><strong>Case summary: </strong>A 65-year-old woman with clinically diagnosed IgG4-RD, who had recently completed corticosteroid taper, presented with multiple admissions for recurrent chest pain and myocardial injury. Coronary angiography repeatedly showed preserved coronary anatomy, and initial transthoracic echocardiography showed preserved left ventricular systolic function. Subsequent transthoracic echocardiography showed rapid decline in ejection fraction, and cardiac magnetic resonance imaging (MRI) showed myocardial oedema, infarct scar, and patchy non-ischaemic fibrosis. A probable diagnosis of IgG4-RD myocarditis was made clinically based on medical history, multimodal imaging findings, and exclusion of alternative diagnoses, although tissue confirmation was not obtained. The patient improved clinically and radiographically with corticosteroid re-initiation followed by maintenance with mycophenolate mofetil (MMF).</p><p><strong>Conclusion: </strong>This case underscores the importance of considering IgG4-RD in the differential diagnosis of unexplained myocardial inflammation and highlights the potential reversibility of cardiac injury with early immunosuppression.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 5","pages":"ytag274"},"PeriodicalIF":0.8,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132405/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812626","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":"Posterior mitral leaflet hypoplasia in adults: diagnostic value of three-dimensional transoesophageal echocardiography: a case series.","authors":"Dylan Young, Edward Dababneh, Vivek Kulkarni, Rowena Solayar, Ian Agahari, Kuljit Singh, Maria Gabriela Matta","doi":"10.1093/ehjcr/ytag160","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag160","url":null,"abstract":"<p><strong>Background: </strong>Posterior mitral leaflet (PML) hypoplasia is a rare and frequently under-recognized condition in adults, as transthoracic echocardiography (TTE) findings may be subtle. Transoesophageal echocardiography (TOE), particularly with three-dimensional (3D) imaging, is invaluable in confirming leaflet morphology and identifying associated anomalies.</p><p><strong>Case summary: </strong>We describe three adult patients with PML hypoplasia confirmed by 3D TOE. Common features included rudimentary posterior leaflet, elongated anterior leaflet, and frequent association with congenital anomalies including bicuspid aortic valve and interatrial communications. Mitral regurgitation severity varied from mild to severe. Management was individualized based on symptoms and MR severity, ranging from conservative follow-up to surgical intervention.</p><p><strong>Discussion: </strong>This series underscores the practical role of 3D TOE when TTE is equivocal: it defines leaflet morphology, distinguishes hypoplastic PML from rheumatic pathology, and detects associated anomalies that influence management. A pragmatic pathway is to suspect PML hypoplasia when MR lacks an obvious mechanism on TTE, proceed to targeted TOE/3D imaging, and tailor treatment to symptoms and MR severity.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag160"},"PeriodicalIF":0.8,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107961/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766267","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":"Rethinking small vessel CTOs: collateral channels as a bridge to subsequent complex intervention-a case report.","authors":"Zizhuo Su, Jiajie Li, Woliang Yuan, Jingfeng Wang, Maohuan Lin","doi":"10.1093/ehjcr/ytag241","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag241","url":null,"abstract":"<p><strong>Background: </strong>The retrograde approach has been integrated into global practice for managing challenging chronic total occlusion (CTO). A fundamental limitation of this technique is the requisite presence of navigable collateral channels. Thus, the incomplete exposure of collateral pathways renders complete interventional revascularisation of multi-vessel CTOs a persistent challenge.</p><p><strong>Case summary: </strong>A 53-year-old man was admitted for unstable angina. Coronary angiography demonstrated three-vessel CTOs, with a long right coronary artery (RCA) CTO, a proximal left anterior descending artery (LAD) CTO, and a CTO in a small-calibre left circumflex (LCX). A staged percutaneous coronary intervention (PCI) approach was adopted. The LAD and LCX CTOs were sequentially revascularized via an antegrade approach. Leveraging optimal visualisation of the collateral channels, particularly an interventional channel from the distal LCX to the RCA, a more challenging RCA CTO was successfully revascularized using a retrograde approach. The patient was symptom-free and was discharged 3 days later.</p><p><strong>Discussion: </strong>This case highlights the presence of potential interventional collateral channels in a small vessel CTO, which may enhance the success rate of subsequent, more complex CTO interventions via a retrograde approach.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag241"},"PeriodicalIF":0.8,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096802/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766265","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":"Percutaneous closure of ventricular septal rupture after myocardial infarction: a case report of competing timelines in multifactorial shock.","authors":"Thomas A Cook, Simone K Schumaecker, Anjani Patibandla, Nicholas J Valle, Matthew R Summers","doi":"10.1093/ehjcr/ytag253","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag253","url":null,"abstract":"<p><strong>Background: </strong>Ventricular septal rupture (VSR) following acute myocardial infarction is a rare but deadly complication with mortality rates exceeding 90% when left untreated. Coronary ischaemia leads to myocardial necrosis and friability resulting in septal rupture, most commonly 3-5 days post-infarction. The sudden development of a left-to-right shunt causes volume overload in the right ventricle, pulmonary vasculature, and left atrium, precipitating biventricular failure, and cardiogenic shock. Management requires careful consideration of timing and modality of closure along with stabilization with mechanical circulatory support in severe cases.</p><p><strong>Case summary: </strong>A 65-year-old female presented with anterior ST-segment elevation myocardial infarction complicated by VSR diagnosed the same day, cardiogenic shock, and progressive multiorgan dysfunction. Following intra-aortic balloon pump (IABP) placement and percutaneous coronary intervention to the left anterior descending artery, she experienced ventilator-associated pneumonia, ventricular fibrillation arrest, and acute renal failure requiring continuous renal replacement therapy. Despite inotropic support and IABP, the patient remained in cardiogenic shock. Given her persistent haemodynamic instability, the decision was made to proceed with delayed percutaneous VSR repair. On hospital day 11, she underwent percutaneous VSR closure with a 24-mm Amplatzer occluder device, resulting in immediate haemodynamic improvement leading to successful IABP removal. In spite of VSR repair, the patient's pulmonary sepsis worsened precipitating left ventricular dysfunction requiring Impella CP placement. Despite mechanical circulatory support, multiorgan failure ensued and the patient ultimately expired.</p><p><strong>Discussion: </strong>This case highlights the challenges of managing post-infarct VSR with delayed percutaneous device closure in the setting of mixed cardiogenic and septic shock.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag253"},"PeriodicalIF":0.8,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13096803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766205","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":"Valve-in-valve transcatheter pulmonary valve replacement in carcinoid heart disease: a case report.","authors":"Giorgio Antonelli, Valeria Cammalleri, Annamaria Tavernese, Annunziata Nusca, Gian Paolo Ussia","doi":"10.1093/ehjcr/ytag220","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag220","url":null,"abstract":"<p><strong>Background: </strong>Carcinoid heart disease (CHD) commonly affects right-sided heart valves, often leading to progressive right heart failure (RHF) and structural valve deterioration.</p><p><strong>Case summary: </strong>A 30-year-old male with CHD and prior bioprosthetic tricuspid and pulmonic valve replacements presented with New York Heart Association Class III symptoms and RHF. Imaging revealed significant degeneration of both valves. Given the high surgical risk (EuroSCORE II 9.12%), the Heart Team opted for transcatheter pulmonary valve replacement (TPVR). Despite challenging anatomy, a Melody valve (Medtronic) was successfully implanted, resulting in improved haemodynamics and no significant residual regurgitation.</p><p><strong>Discussion: </strong>Bioprosthetic failure in CHD poses significant treatment challenges. This case underscores the growing role of TPVR as a less invasive and effective alternative to surgery in high-risk patients, with advanced imaging playing a pivotal role in planning and execution.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag220"},"PeriodicalIF":0.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13089468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147722069","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 cheesy exudate: a case report on management of pericardial disease through multimodal cardiac imaging.","authors":"Aadavan Elangovan, Thomas Lewandowski, Dhaval Naik, John Spratt, Hussain Khalid","doi":"10.1093/ehjcr/ytag261","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag261","url":null,"abstract":"<p><strong>Background: </strong>Cholesterol pericardial effusion is a rare diagnosis and typically not associated with the development of pericardial constriction. However, covariate factors, such as Rheumatoid arthritis, myxoedema, and comorbid disease requiring anticoagulation, can predispose to developing dense adhesions that ultimately can cause pericardial constriction and constrictive physiology. This can develop without preceding symptoms but ultimately may declare itself with a variety of clinical presentations including syncope.</p><p><strong>Case summary: </strong>We present a patient with a pericardial mass incidentally identified during hospital evaluation after presentation with syncope. Initial suspicion based on computed tomographic angiography (CTA) appearance was of a pericardial cyst. Additional multimodal imaging consisting of transthoracic echocardiogram (TTE) and magnetic resonance imaging (MRI) supported evidence of a right ventricular-compressive effusion with constrictive physiology, findings more suggestive of a loculated pericardial effusion than a pericardial cyst without evidence of pericardial inflammation. Although transoesophageal echocardiography (TEE) guided pericardiocentesis was technically successful, it failed to produce clinical or haemodynamic improvement of the pericardial constriction. Partial local pericardiectomy and cruciate incision of the anterior aspect of the rind was essential in relieving the constrictive process. Pathologic analysis of resected pericardium demonstrated cholesterol granuloma. We discussed the role of multimodal imaging in disease classification, as well as coexisting conditions such as rheumatoid arthritis and anticoagulation for pulmonary embolism that contributed to this case's unique presentation and timeline.</p><p><strong>Discussion: </strong>This case underscores the critical role of a multimodality imaging strategy in pericardial disease-particularly in managing rare cholesterol loculated effusions-and highlights how coexisting conditions can shape disease progression and treatment timing.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag261"},"PeriodicalIF":0.8,"publicationDate":"2026-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812157","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":"Dual atrial rhythms after heart transplantation: implications for pacemaker lead placement.","authors":"Wei-Chieh Lee, Hii Hiong-Ping","doi":"10.1093/ehjcr/ytag268","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag268","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag268"},"PeriodicalIF":0.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812366","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":"Fulminant eosinophilic myocarditis treated by venoarterial extracorporeal membrane oxygenation and adjunctive immunosuppressive therapy: a case report.","authors":"Dong Woo Suh, Sang-Hyup Lee, Chan Joo Lee, Kyung Hee Park","doi":"10.1093/ehjcr/ytag262","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag262","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic myocarditis can result from drug hypersensitivity or various systemic disorders. Although corticosteroids are effective, treatment strategies are not standardized.</p><p><strong>Case summary: </strong>A 78-year-old male presented with dyspnoea. On admission, he was febrile and hypotensive and had sinus tachycardia with a newly developed right bundle branch block. Laboratory findings showed marked eosinophilia with elevated troponin. The patient rapidly progressed to cardiogenic shock, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was applied. Eosinophilic myocarditis was suspected, and endomyocardial biopsy confirmed dense myocardial eosinophil infiltration consistent with the diagnosis. Review of history revealed recent cefaclor use for a hand injury as the probable cause. The patient's condition quickly improved after initiation of high-dose intravenous methylprednisolone, allowing weaning from VA-ECMO. However, persistent troponin elevation and myocardial inflammation on fluorodeoxyglucose positron emission tomography (FDG-PET) were observed despite 5 weeks of steroid therapy. Subcutaneous mepolizumab, an anti-interleukin-5 monoclonal antibody, was initiated as an adjunctive immunosuppressive therapy. After seven cycles, troponin levels normalized, cardiac function fully recovered, and follow-up FDG-PET demonstrated a marked reduction in myocardial inflammation.</p><p><strong>Discussion: </strong>We describe a case of fulminant eosinophilic myocarditis that was possibly associated with cefaclor use and successfully managed with VA-ECMO and adjunctive immunosuppressive therapy. Fluorodeoxyglucose positron emission tomography imaging helped detect residual inflammation and assess treatment response. Immunosuppressive therapy allowed a reduction of steroid dose, mitigating the risk of steroid-related side effects.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag262"},"PeriodicalIF":0.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13127657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812461","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":"Clinical and genetic characterization of homozygous <i>LDLR</i> variants in familial hypercholesterolaemia: insights from two case reports.","authors":"Saroj Kumar Sahoo, Prabhat Kumar Singh, Ramachandra Barik, Satya Prakash, Debananda Sahoo, Chitta Ranjan Mohanty, Sindhu Rao Malla, Rakesh Kumar Mohapatra","doi":"10.1093/ehjcr/ytag264","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag264","url":null,"abstract":"<p><strong>Background: </strong>Familial hypercholesterolaemia (FH) is an inherited lipid disorder characterized by elevated low-density lipoprotein cholesterol (LDL-C) levels and increased risk of atherosclerotic cardiovascular disease. Despite its high prevalence, FH remains underdiagnosed and undertreated in many regions, particularly in low- and middle-income countries.</p><p><strong>Case summary: </strong>We describe two patients with homozygous FH (HoFH) diagnosed at a tertiary care centre using the Dutch Lipid Clinic Network diagnostic criteria, both presented with severe hypercholesterolaemia (LDL-C > 340 mg/dL) and tendon xanthomas, whereas early cardiovascular complications were evident only in Case 1. Genetic analysis confirmed pathogenic variants in <i>LDLR</i>: c.1060+2T>G (rs774069731) in Case 1 and c.530C>T (rs121908026) in Case 2. The patients were managed with high-intensity statins, ezetimibe, PCSK9 inhibitors, inclisiran, and lipoprotein apheresis, which resulted in partial LDL-C reduction.</p><p><strong>Discussion: </strong>These cases highlight the genotypic and phenotypic heterogeneity of FH, with the c.1060+2T>G variant being reported for the first time in this region, thus expanding the known genetic spectrum of FH.</p><p><strong>Conclusion: </strong>This case series reinforces the importance of comprehensive clinical and genetic evaluation in patients with severe hypercholesterolaemia. Early diagnosis, intensified lipid-lowering strategies, and equitable access to advanced therapies are essential to improve outcomes in resource-constrained settings.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 5","pages":"ytag264"},"PeriodicalIF":0.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13135860/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835601","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":"ST segment straightening and sharp ST-T angle in acute coronary syndrome.","authors":"Yusuke Namba, Kohei Kawamura, Yusuke Kawai","doi":"10.1093/ehjcr/ytag258","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag258","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 5","pages":"ytag258"},"PeriodicalIF":0.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13143011/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147834461","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}