European Heart Journal: Case Reports最新文献

{"title":"First case of isolated persistence of the fifth aortic arch observed on magnetic resonance imaging.","authors":"Karine Warin-Fresse, Patrice Guérin","doi":"10.1093/ehjcr/ytaf390","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf390","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf390"},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112159","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":"Bilateral carcinoid heart disease secondary to a massive right-to-left shunt through a patent foramen ovale: a case report.","authors":"Javier Bertolín Boronat, Begoña Muñoz Giner, María Teresa Tuzón Segarra, David Tejada Ponce, Juan Cosin-Sales","doi":"10.1093/ehjcr/ytaf444","DOIUrl":"10.1093/ehjcr/ytaf444","url":null,"abstract":"<p><strong>Background: </strong>Carcinoid heart disease (CHD) is a rare complication of neuroendocrine tumours (NET). It typically involves the right-sided heart valves due to the effect of vasoactive substances. Bilateral involvement is uncommon and usually requires a significant right-to-left shunt through a patent foramen ovale (PFO).</p><p><strong>Case summary: </strong>A 75-year-old woman with metastatic well-differentiated NET presented with progressive dyspnoea. Transthoracic echocardiography showed multivalvular involvement, including the tricuspid, mitral, and aortic valves, secondary to CHD. During preoperative assessment for valve replacement, the patient developed refractory hypoxaemia. A large right-to-left shunt through a high-risk PFO was confirmed by transoesophageal echocardiography. Percutaneous PFO closure was performed, which resulted in immediate normalization of oxygen saturation. Unfortunately, a few days later, the patient developed aspiration pneumonia and died of cardiorespiratory arrest.</p><p><strong>Discussion: </strong>To our knowledge, this is the first reported case of bilateral CHD due to a massive right-to-left shunt through a PFO, driven by elevated right atrial pressure and a tricuspid regurgitation jet. This case highlights the importance of assessing for a PFO in patients with carcinoid syndrome and left-sided valvular involvement or unexplained hypoxia. Early recognition and PFO closure may represent a key therapeutic step in selected patients.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf444"},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12461251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145184907","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":"Cardioneuroablation for coronary artery vasospasm: a case report.","authors":"Di Fan, Zhen Guo, Bo He, Yingying Hu, Zhibing Lu","doi":"10.1093/ehjcr/ytaf456","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf456","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery spasm (CAS) occurring at night may be caused by excessive vagal tone. In patients with CAS related to high vagal tone, cardioneuroablation (CNA) may offer a promising alternative for the radical treatment of medication-refractory CAS.</p><p><strong>Case summary: </strong>We report a case of a 66-year-old male with frequent and uncontrolled coronary artery spasms, usually occurring during sleep at night. Despite treatment with multiple antispasmodic medications including calcium channel blockers and long-acting nitrates, the patient still experienced severe symptomatic chest pain with ST-segment elevation. Ergonovine challenge testing confirmed the diagnosis of CAS with multiple spasms in the right coronary artery. Cardioneuroablation targeting four main ganglionated plexi on the left atrium was performed, resulting in complete resolution of nocturnal angina pectoris for six-month follow-up without antispasmodic medications. Post-ablation autonomic parameters showed decreased parasympathetic tone, and repeat ergonovine challenge demonstrated reduced vasomotor response.</p><p><strong>Discussion: </strong>This case provides preliminary evidence for the potential of CNA in treating refractory CAS by modulating autonomic tone. Cardioneuroablation may provide a novel alternative for patients whose CAS is unresponsive to conventional medical therapy, though larger studies with longer follow-up are needed to validate this approach's efficacy and safety.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf456"},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12492480/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231910","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 case report of delayed onset of severe aortic regurgitation due to commissural detachment after low-energy blunt chest trauma: timing is key.","authors":"Emiyo Sugiura, Masaki Ishiyama, Hisato Ito, Shiro Nakamori, Kaoru Dohi","doi":"10.1093/ehjcr/ytaf446","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf446","url":null,"abstract":"<p><strong>Background: </strong>Valve injury is a rare complication of blunt chest trauma (BCT). Although many cases result from high-energy BCT, it is important to recognize that low-energy trauma can also lead to serious cardiac complications, depending on the timing of the applied force. Herein, we present a case of delayed traumatic aortic regurgitation (AR) following low-energy BCT.</p><p><strong>Case summary: </strong>A 77-year-old man presented with acute heart failure due to severe AR 2 months after a minor fall. Echocardiography revealed commissural detachment between the left and noncoronary cusps (NCC). He underwent aortic valve replacement owing to uncontrolled heart failure and severe AR.</p><p><strong>Discussion: </strong>This case demonstrates delayed traumatic AR following low-energy BCT, a presentation less common than its typical association with high-energy trauma. However, AR can occur after minor trauma, particularly if the impact takes place during early diastole. The NCC is most frequently involved. In this case, detachment occurred at the commissure between the NCC and the left coronary cusp. Patients with acute and severe AR require prompt surgical intervention. This case emphasizes the importance of considering follow-up echocardiography in patients with persistent or progressive cardiac symptoms, even after minor chest trauma.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf446"},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495032/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231813","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":"Severe aortic insufficiency after catheter ablation of refractory ventricular tachycardias via retrograde aortic approach in a patient with left ventricular assist device: a case report.","authors":"Komei Mizokami, Susumu Takase, Takeo Fujino, Akira Shiose, Kazuo Sakamoto","doi":"10.1093/ehjcr/ytaf448","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf448","url":null,"abstract":"<p><strong>Background: </strong>Severe aortic insufficiency (AI) after catheter ablation (CA) for ventricular tachycardias (VTs) via a retrograde aortic (RA) approach in patients with left ventricular assist devices (LVADs) has not been reported and is not well recognized.</p><p><strong>Case summary: </strong>A 59-year-old man with dilated cardiomyopathy underwent LVAD implantation as a bridge to transplantation. After 6 months, the drug-resistant VTs increased, and CA was performed via the RA approach since echocardiography showed that the aortic valve was still occasionally open with only trivial AI. After mapping and ablation of the left ventricle (LV), the VTs were acutely suppressed. However, the patient was readmitted to our hospital 8 days later with worsening heart failure. The AI had progressed from trivial to severe and did not improve despite medical therapy; therefore, a surgical aortic valvuloplasty was performed. Since then, the heart failure has resolved for 12 months without AI.</p><p><strong>Discussion: </strong>This is the first report of a patient with an LVAD who underwent CA via an RA approach for VTs and subsequently developed heart failure due to severe AI that required open-heart surgery. In patients with LVADs, aortic valves may be prone to catheter-induced deformation or injury, and continuous aspiration of the LV by LVADs can lead to significant AI, requiring open-heart surgery. This study demonstrated a real case in which it was important to consider these potential risks when selecting the LV approach as well as during and after the procedures via an RA approach, especially in patients with LVADs.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf448"},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495030/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231912","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":"Chronic active myocarditis presenting as an isolated atrioventricular block: a case report.","authors":"Kazuhiro Asano, Masahiko Noguchi, Kisaki Amemiya, Yoshihiko Ikeda, Kotaro Obunai","doi":"10.1093/ehjcr/ytaf454","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf454","url":null,"abstract":"<p><strong>Background: </strong>Although atrioventricular (AV) block is frequently observed in acute myocarditis, its occurrence as an isolated finding in chronic myocarditis is rare. Chronic active myocarditis represents an uncommon subset of myocarditis with a potentially poor prognosis. Herein, we report a rare case of chronic active myocarditis presenting solely as an isolated AV block.</p><p><strong>Case summary: </strong>A 51-year-old female with ulcerative colitis and bipolar disorder presented with complete AV block. Echocardiography revealed preserved cardiac function, whereas laboratory findings revealed persistently elevated troponin I levels. Despite extensive investigations, no definitive cause of conduction disturbance was identified, leading to pacemaker implantation. Ten months later, 18-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) revealed diffuse cardiac uptake; endomyocardial biopsy demonstrated inflammatory infiltrates adjacent to the cardiomyocyte necrosis and fibrosis. These findings were consistent with those of chronic active myocarditis. As the patient's symptoms were mild and cardiac function was preserved, a conservative approach was adopted. Over the next 2 years, the patient's symptoms improved, cardiac function was preserved, and the FDG-PET/CT findings markedly diminished. However, high-uptake areas remained on FDG-PET/CT and re-elevation of troponin I was observed, indicating the persistence of subclinical inflammation within the myocardium.</p><p><strong>Discussion: </strong>AV block may be a clinical sequela of chronic active myocarditis and should not be considered idiopathic, even in the absence of inflammatory symptoms or systolic dysfunction. Such cases may carry a risk of poor long-term outcomes due to ongoing inflammation. Endomyocardial biopsy should therefore be considered to establish an accurate diagnosis, and long-term follow-up is essential.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 10","pages":"ytaf454"},"PeriodicalIF":0.8,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12495037/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231824","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":"Pulsed field ablation as a bailout for ventricular tachycardia ablation: a case report.","authors":"Laurens Verhaeghe, Geoffroy Ditac, Romain Tixier, Pierre Jaïs, Frédéric Sacher","doi":"10.1093/ehjcr/ytaf437","DOIUrl":"10.1093/ehjcr/ytaf437","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation of ventricular tachycardia (VT) using radiofrequency energy has proven to be an effective therapy. The outcome in patients presenting with an intramural septal substrate has however been disappointing. New tools and energy such as pulsed field ablation (PFA) might improve our efficacy to treat arrhythmia in this setting.</p><p><strong>Case summary: </strong>A 64-year-old patient with valvular and ischaemic cardiomyopathy had recurrence of arrhythmic storm despite previous endocardial ablation and stereotactic body radiation therapy targeting the interventricular septum. A new attempt using PFA via a novel large footprint 9 mm lattice-tip catheter allowed to achieve non-inducibility. Early recurrence of VT however occurred, necessitating a second procedure targeting zones that were ablated in the previous procedure. Careful analyses of the first procedure highlighted three possible technical reasons for this recurrence, which were taken into account during the redo ablation. At 7-month follow-up, the patient remained free from VT.</p><p><strong>Discussion: </strong>Endocardial ablation applying pulsed field energy through a lattice-tip catheter was capable of successfully treating an intramural septal substrate in a patient with multiple prior failed ablation procedures. Extra attention should be paid to specific properties of PFA for VT to avoid recurrences.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf437"},"PeriodicalIF":0.8,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12445646/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112193","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 closure of aorto-right atrial fistula.","authors":"Denizhan Ozdemir, Jair Basantes de la Calle, Hasan Jilaihawi, Moody Makar, Raj Makkar","doi":"10.1093/ehjcr/ytaf445","DOIUrl":"10.1093/ehjcr/ytaf445","url":null,"abstract":"<p><strong>Background: </strong>Aorto-right atrial fistulas are rare complications of cardiac surgery that can result in heart failure due to continuous left-to-right shunting. In patients with recent sternotomy, reoperation carries significant risk, making transcatheter closure a compelling alternative.</p><p><strong>Case summary: </strong>A 64-year-old man with a history of diabetes, cerebrovascular disease, and recent coronary artery bypass grafting complicated by ascending aortic dissection and repair presented with progressive dyspnoea. Prior to transfer, echocardiography suggested a cardiovascular fistula. On admission, multimodality imaging-including transthoracic and transoesophageal echocardiography and computed tomography-confirmed an aorto-right atrial fistula with elevated pulmonary artery pressures. Given the recent surgery and comorbidities, the heart team deemed the patient high risk for repeat operation and opted for percutaneous closure. Under general anaesthesia with transoesophageal echocardiographic guidance, the fistula was percutaneously occluded with a 10 mm × 7 mm Amplatzer Vascular Plug II. Post-procedural imaging confirmed successful closure without impingement on aortic valve structures. The patient was discharged in stable condition to a rehabilitation facility on dual antiplatelet therapy.</p><p><strong>Discussion: </strong>This case highlights the role of transcatheter closure in managing post-surgical aorto-right atrial fistulas. Comprehensive imaging and echocardiographic guidance were essential for procedural success. In select patients with high operative risk, percutaneous approaches provide a safe and effective alternative to repeat surgery.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf445"},"PeriodicalIF":0.8,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12477471/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198722","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":"Paddling through palpitations: when genes, myocardial inflammation and exercise collide-a case report of arrhythmogenic cardiomyopathy in a young competitive rower.","authors":"Boris Delpire, Olivier Ghekiere, Dagmara Dilling-Boer, Pieter Koopman, Guido Claessen","doi":"10.1093/ehjcr/ytaf442","DOIUrl":"10.1093/ehjcr/ytaf442","url":null,"abstract":"<p><strong>Background: </strong>Arrhythmogenic cardiomyopathy (ACM) is characterized by fibrofatty replacement of myocardium, predisposing to ventricular arrhythmias and sudden cardiac death. Arrhythmogenic cardiomyopathy is often linked to desmosomal gene mutations, particularly PKP2, which encodes plakophilin-2, a key structural protein in cardiac intercalated discs. In individuals with PKP2 mutations, exercise has been shown to accelerate disease progression.</p><p><strong>Case summary: </strong>A 22-year-old male semi-professional rower presented with palpitations, pre-syncope, and a history of presumed myocarditis with subepicardial fibrosis on cardiac magnetic resonance (CMR). Workup revealed anterior T-wave inversions on resting ECG and sustained monomorphic right ventricular (RV) outflow tract tachycardia, induced during exercise testing. Repeat CMR showed RV dysfunction and non-ischaemic RV and LV fibrosis with fibrofatty replacement. The patient met diagnostic criteria for biventricular ACM and underwent catheter ablation targeting the arrhythmic substrate. A multidisciplinary team carefully considered ICD therapy. However, due to the limited extent of the arrhythmic substrate, the exercise-induced nature of the ventricular tachycardia, and the successful ablation, ICD implantation was deferred at this stage. An ILR was implanted for continuous rhythm monitoring, with a low threshold for future ICD placement. High-intensity sports restriction, pharmacological therapy, and genetic counselling were initiated. Genetic testing identified a pathogenic PKP2 mutation.</p><p><strong>Discussion: </strong>This case highlights the complex interplay of genetic predisposition, myocardial inflammation, and exercise in ACM expression. The presumed myocarditis likely represented a 'hot phase' of ACM, accelerating structural cardiac changes. High-intensity exercise then acted as a 'second hit,' triggering phenotypic expression. Multidisciplinary evaluation combining rhythm monitoring, imaging, and genetic testing was key to diagnosis and management.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf442"},"PeriodicalIF":0.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12456407/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145136946","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":"Combined transapical transcatheter aortic valve implantation and premature ventricular contraction ablation in a high-risk cardiomyopathy patient: a case report.","authors":"Yu-Bin Li, Yang Wu, Chen Su, Zhong-Kai Wu, Li-Chun Wang","doi":"10.1093/ehjcr/ytaf441","DOIUrl":"10.1093/ehjcr/ytaf441","url":null,"abstract":"<p><strong>Background: </strong>Frequent premature ventricular contractions (PVCs) and valvular dysfunction are established contributors to worsening heart failure.</p><p><strong>Case summary: </strong>We present a 67-year-old male with dilated cardiomyopathy, severe aortic regurgitation, and unifocal left ventricle-originated PVCs (37.8% burden) refractory to guideline-directed medical therapy and cardiac devices. Due to high surgical risk, a combined transapical transcatheter aortic valve implantation and PVC ablation was performed. Postoperatively, PVCs were eliminated, left ventricular ejection fraction improved from 35% to 55%, and cardiac dimensions normalized significantly.</p><p><strong>Discussion: </strong>This case highlights the feasibility of a single apical approach for addressing both valvular and arrhythmic pathologies in high-risk patients, offering a novel strategy to mitigate heart failure progression.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 9","pages":"ytaf441"},"PeriodicalIF":0.8,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12448879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145112209","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}