European Heart Journal: Case Reports最新文献

{"title":"Intraprocedural tail-first pulmonary artery migration of a leadless pacemaker: a protective sleeve-assisted helix-side retrieval strategy-a case report.","authors":"Ryobun Yasuoka, Motohide Tanaka, Takashi Noda, Gaku Nakazawa, Takashi Kurita","doi":"10.1093/ehjcr/ytag657","DOIUrl":"10.1093/ehjcr/ytag657","url":null,"abstract":"<p><strong>Background: </strong>Leadless pacemaker migration into the pulmonary artery is an exceptionally rare but potentially serious complication. Tail-first (proximal helix-oriented) migration poses additional risk, as traction on the exposed helix may cause vascular injury.</p><p><strong>Case summary: </strong>A 72-year-old woman with bradycardic atrial fibrillation underwent implantation of an Aveir™ VR leadless pacemaker. Immediately after device release, fluoroscopy revealed a tail-down shift suggesting inadequate mechanical engagement, accompanied by frequent premature ventricular contractions and non-sustained ventricular tachycardia, prompting immediate retrieval. During the retrieval procedure, the device became completely dislodged and migrated into the left pulmonary artery with the helix oriented proximally.In this orientation, standard docking button retrieval was not feasible. The Aveir™ retrieval catheter was advanced into the pulmonary artery, the helix was captured, and the device was enclosed within the protective sleeve before successful extraction.The new device was subsequently re-implanted at a more apical septal site, and stable fixation was achieved.</p><p><strong>Discussion: </strong>In previously reported cases of pulmonary artery migration of the Aveir™ pacemaker, retrieval was performed using non-dedicated flexible sheaths and snare catheters. In contrast, this case demonstrates that advancing the dedicated retrieval system to enclose the grasped helix enabled controlled retrieval while minimizing direct contact between the exposed helix and the pulmonary arterial wall. This case also highlights that satisfactory electrical parameters alone may not guarantee adequate mechanical fixation. Although this technique may represent a practical bailout strategy when engagement of the docking button is not feasible, further clinical experience is required to establish its safety and reproducibility.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag657"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988716","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":"Long intramural left coronary artery confined to the left sinus of Valsalva with diastolic deformation: a case report.","authors":"Takuya Kawabata, Junya Nabeshima, Taku Ishii, Taishi Yonetsu, Tomoyuki Fujita","doi":"10.1093/ehjcr/ytag661","DOIUrl":"10.1093/ehjcr/ytag661","url":null,"abstract":"<p><strong>Background: </strong>Anomalous aortic origin of a coronary artery (AAOCA) is a rare congenital anomaly. The most frequently reported and surgically treated form involves origin of a coronary artery from the opposite sinus that follows an interarterial course, often termed 'malignant'. In contrast, AAOCA arising from the appropriate sinus without an interarterial course is uncommon, and its clinical significance and optimal management remain poorly defined.</p><p><strong>Case summary: </strong>A 12-year-old girl with exertional syncope during physical activity was referred to our hospital. Contrast-enhanced computed tomography revealed an anomalous origin of the left coronary artery from the left sinus of Valsalva with an acute-angle take-off and an intramural segment. Intravascular ultrasound (IVUS) confirmed an intramural course within the aortic wall and demonstrated luminal deformation, with the lumen appearing more elliptical at end-diastole. Because of exertional syncope and a substantial intramural segment, surgical unroofing was performed without postoperative aortic valve dysfunction.</p><p><strong>Conclusion: </strong>This report describes a rare variant of AAOCA characterized by a long intramural course confined to the left sinus of Valsalva without an interarterial course. Despite the absence of a typical malignant course, the patient had symptoms suggestive of myocardial ischaemia. Multimodality imaging played a key role in diagnosis and surgical planning, while IVUS provided complementary structural and dynamic information by demonstrating luminal changes. Surgical unroofing may therefore be considered for symptomatic paediatric patients with a substantial intramural segment even without an interarterial course.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag661"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13551615/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148911164","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":"Cardinal lessons in cardiac amyloidosis: diagnostic pitfalls across three cases-a case report.","authors":"Ghasaq Saleh, Omar Abou Ezzeddine, Fadi Adel","doi":"10.1093/ehjcr/ytag654","DOIUrl":"10.1093/ehjcr/ytag654","url":null,"abstract":"<p><strong>Background: </strong>Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy caused by extracellular deposition of misfolded amyloid fibrils within the myocardium, resulting in progressive ventricular wall thickening and heart failure. Transthyretin (ATTR) and immunoglobulin light-chain (AL) amyloidosis account for ∼95% of cases. Despite advances in diagnostic imaging and laboratory testing, CA remains underrecognized, often leading to misdiagnosis or delayed diagnosis. Timely and accurate diagnosis, including amyloid subtyping, is critical to guide appropriate therapy and improve clinical outcomes, as prognosis and management vary substantially among amyloid subtypes.</p><p><strong>Case summary: </strong>We present a three-case series illustrating distinct diagnostic and clinical challenges in CA, including a false-positive diagnosis of ATTR cardiomyopathy (ATTR-CM) based on planar technetium-99m pyrophosphate (PYP) scintigraphy that was subsequently ruled out by single-photon emission computed tomography (SPECT) imaging and further evaluation, a delayed diagnosis of AL amyloidosis in a patient with progressive heart failure initially attributed to non-ischaemic cardiomyopathy, and recurrent left atrial appendage thrombus despite therapeutic anticoagulation in a patient with AL amyloidosis.</p><p><strong>Discussion: </strong>These three cases demonstrate the broad spectrum of diagnostic and clinical challenges encountered in CA. The first case underscores the importance of SPECT imaging in differentiating true myocardial radiotracer uptake from blood pool activity, a common source of false-positive planar PYP studies. The second emphasizes the critical role of comprehensive monoclonal protein screening in patients with suspected amyloidosis as delayed diagnosis of AL amyloidosis may adversely affect outcomes. The third illustrates the heightened thromboembolic risk associated with CA, even in the setting of therapeutic anticoagulation, and supports consideration of transoesophageal echocardiography before cardioversion in this high-risk population.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag654"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13564386/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148955024","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: Unexpected acute kidney injury requiring dialysis after routine pulsed field pulmonary vein isolation: a case report.","authors":"","doi":"10.1093/ehjcr/ytag608","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag608","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ehjcr/ytaf669.].</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag608"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13534145/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879618","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: A case series of confirmed Neisseria gonorrhoeae native mitral valve infective endocarditis: presentation and management.","authors":"","doi":"10.1093/ehjcr/ytag643","DOIUrl":"10.1093/ehjcr/ytag643","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.1093/ehjcr/ytag531.].</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag643"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13537503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148879763","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":"Single-session combined mitral transcatheter edge-to-edge repair and left atrial appendage occlusion using a steerable introducer after a mitral repair-oriented transseptal puncture: a case report.","authors":"Michela Bonanni, Matteo Pelliccia, Giorgio Maria De Sanctis, Carmine Musto","doi":"10.1093/ehjcr/ytag622","DOIUrl":"10.1093/ehjcr/ytag622","url":null,"abstract":"<p><strong>Background: </strong>Combined mitral transcatheter edge-to-edge repair (M-TEER) and left atrial appendage occlusion (LAAO) may be considered in selected high-risk patients with severe mitral regurgitation (MR) and atrial fibrillation (AF). However, the optimal transseptal puncture site differs between procedures, potentially limiting the feasibility of a single-session approach.</p><p><strong>Case summary: </strong>An 80-year-old frail woman with severe atrial functional MR, permanent AF, chronic kidney disease, and recent severe anaemia was referred for treatment. Considering the patient's high thromboembolic and bleeding risk and overall frailty, a combined percutaneous approach was selected. A supero-posterior transseptal puncture optimized for mitral repair enabled successful M-TEER with significant MR reduction. Subsequent LAAO was challenged by suboptimal alignment with the appendage. The use of a steerable introducer restored coaxiality, allowing stable device delivery and successful deployment of a 24-mm occluder with complete sealing and no peri-device leak.</p><p><strong>Discussion: </strong>This case demonstrates the feasibility of a combined one-stop strategy in frail patients at high procedural risk. It highlights the importance of procedural planning and the role of steerable delivery systems in overcoming anatomical constraints imposed by a mitral-oriented transseptal puncture, thereby facilitating successful completion of both interventions in a single session.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag622"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13541103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148886470","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":"Transcatheter aortic valve-in-valve implantation for residual prosthetic valve dysfunction and paravalvular leak after healed Enterococcus faecalis prosthetic valve endocarditis: a case report.","authors":"Bo Fu, Qingliang Chen, Nan Jiang","doi":"10.1093/ehjcr/ytag656","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag656","url":null,"abstract":"<p><strong>Background: </strong>Prosthetic valve endocarditis (PVE) is associated with substantial morbidity and mortality, particularly when complicated by severe prosthetic valve dysfunction and paravalvular leak. Although redo surgery remains the standard treatment, some patients may be unsuitable for surgical intervention because of prohibitive operative risk.</p><p><strong>Case summary: </strong>A 64-year-old man with previous surgical bioprosthetic aortic valve replacement had a history of Enterococcus faecalis PVE and received targeted antimicrobial therapy. Following targeted antimicrobial therapy with documented microbiological control, he presented with cardiogenic shock due to severe residual prosthetic valve dysfunction, including severe prosthetic stenosis, severe central transprosthetic regurgitation, and severe paravalvular leak. Given his prohibitive surgical risk, the multidisciplinary Heart Team selected transfemoral valve-in-valve transcatheter aortic valve implantation as a rescue strategy. The procedure resulted in marked haemodynamic improvement with only mild residual regurgitation. At 1-year follow-up, the patient remained clinically stable with a well-functioning prosthetic valve and no evidence of recurrent infection.</p><p><strong>Discussion: </strong>This case demonstrates that valve-in-valve transcatheter implantation may be considered as a rescue option in carefully selected patients with controlled prosthetic valve endocarditis and residual prosthetic valve dysfunction who are unsuitable for redo surgery. Multimodality imaging and multidisciplinary Heart Team evaluation are essential for individualized decision-making in this challenging clinical scenario.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag656"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600609/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149036962","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":"ECG challenge: a narrow clue in a wide QRS tachycardia.","authors":"Akihiko Nogami, Ryuichi Usui, Kikuya Uno","doi":"10.1093/ehjcr/ytag653","DOIUrl":"10.1093/ehjcr/ytag653","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag653"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988666","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":"Retrograde transaortic percutaneous retrieval of a left-ventricularly embolized LAmbre occluder followed by same-session redo left atrial appendage closure: a case report.","authors":"Dengke Ou, Jie Song, Mingyang Tang","doi":"10.1093/ehjcr/ytag634","DOIUrl":"10.1093/ehjcr/ytag634","url":null,"abstract":"<p><strong>Background: </strong>Left atrial appendage closure (LAAC) is an established stroke-prevention strategy for selected patients with atrial fibrillation who are unsuitable for long-term oral anticoagulation. Device embolization is rare but potentially life-threatening, particularly when the occluder migrates into the left ventricle, where it may interfere with the mitral or aortic valve apparatus or provoke ventricular arrhythmia.</p><p><strong>Case summary: </strong>A 68-year-old woman with permanent atrial fibrillation, recurrent gross haematuria during anticoagulant therapy, chronic heart failure, and a high thromboembolic risk underwent LAAC under transoesophageal echocardiographic guidance. Pre-procedural imaging showed a left atrial appendage ostium of 30 mm, a landing-zone diameter of 28 mm, and a depth of 32 mm. During the first deployment attempt with a 28-/34-mm LAmbre occluder, the device showed insufficient anchoring and was not released. During attempted recapture and exchange, the partially deployed device embolized across the mitral valve into the left ventricular cavity, with a short self-terminating episode of ventricular tachycardia. Because the patient remained haemodynamically stable and real-time imaging showed no valvular entrapment or structural injury, retrograde transaortic percutaneous retrieval was performed using a 14-Fr steerable sheath and grasping forceps. After successful retrieval and immediate confirmation of valve integrity, a larger 32-/36-mm LAmbre occluder was implanted in the same session with stable position and no residual peri-device leak.</p><p><strong>Discussion: </strong>This case illustrated that, in carefully selected haemodynamically stable patients without valvular entrapment, left ventricular outflow tract obstruction, or structural injury, retrograde transaortic percutaneous retrieval of a left-ventricularly embolized LAAC device may be feasible. The same-session redo LAAC can be considered after successful retrieval when valve integrity is confirmed and the left atrial appendage anatomy remains suitable.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag634"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988708","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":"Ischaemic strokes as an initial manifestation of eosinophilic granulomatosis with polyangiitis with eosinophilic myocarditis: a case report.","authors":"Lukas Ley, Christian Kirsch, Dirk Bandorski","doi":"10.1093/ehjcr/ytag650","DOIUrl":"10.1093/ehjcr/ytag650","url":null,"abstract":"<p><strong>Background: </strong>Eosinophilic myocarditis (EM) is a rare form of myocarditis which may be caused by eosinophilic granulomatosis with polyangiitis (EGPA), a rare disease which frequently affects the heart. The case of a young woman with a rare initial manifestation of EGPA as a cause of EM is reported.</p><p><strong>Case summary: </strong>A 39-year-old woman presented with diffuse neurological symptoms. She was diagnosed with multiple, bilateral, simultaneous ischaemic strokes. No obvious stroke origin was detectable. However, significantly elevated troponin levels and eosinophilia were noted. Cardiac computed tomography ruled out coronary artery disease. Cardiac magnetic resonance imaging (CMR) proved myocarditis. However, endomyocardial biopsy, did not confirm EM. Nevertheless, EGPA with primary cardiac involvement was diagnosed due to eosinophilia, history of asthma, evidence of pANCA and matching CMR findings. Treatment with benralizumab was initiated. Follow-up CMR after about 6 months showed a significant reduction in inflammatory activity.</p><p><strong>Discussion: </strong>Eosinophilic granulomatosis with polyangiitis and EM associated with EGPA are rare but in patients with EGPA, cardiac involvement is frequent. Ischaemic strokes as an initial manifestation of EGPA is particularly rare. Other potential causes of stroke were ruled out. In the presence of CMR-proven myocarditis associated with peripheral eosinophilia, EM may be diagnosed without histological confirmation. Endomyocardial biopsy may be false negative in a relevant number of cases but CMR is usually abnormal. However, there are no specific CMR findings that occur exclusively in EM.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag650"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575684/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148975867","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}