European Heart Journal: Case Reports最新文献

{"title":"Ischaemic cardiomyopathy with a significant improvement in left ventricular wall motion following revascularization for a honeycomb-like structure of the left anterior descending artery: a case report.","authors":"Hiroshi Yoshikawa, Yoshihiro Hanyu, Yuko Onishi, Taishi Yonetsu, Tetsuo Sasano","doi":"10.1093/ehjcr/ytag265","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag265","url":null,"abstract":"<p><strong>Background: </strong>The honeycomb-like structure is an uncommon cause of myocardial ischaemia, detectable through high-resolution intracoronary imaging. Although percutaneous coronary intervention (PCI) for honeycomb-like structure has shown favourable outcomes, the relationship between PCI for honeycomb-like structure and subsequent improvement in cardiac function remains poorly understood.</p><p><strong>Case summary: </strong>A 58-year-old male was referred to our hospital for exertional dyspnoea. He was diagnosed with heart failure, and echocardiography revealed a reduced left ventricular ejection fraction (LVEF) of 24%, with particularly severe hypokinesis observed in the left anterior descending artery (LAD) territory. Cardiac magnetic resonance imaging showed non-transmural late gadolinium enhancement predominantly in the endocardial layer of the anterior LV wall. Coronary angiography demonstrated diffuse moderate stenosis in the LAD, with fractional flow reserve (FFR) of 0.29, and optical coherence tomography revealed a honeycomb-like structure. Two everolimus-eluting stents were implanted in the LAD. Following the PCI, significant recovery of LV wall motion including the anterior and apical segments was observed, with LVEF increasing from 24% to 46%. The 1-year follow-up showed no worsening of heart failure.</p><p><strong>Discussion: </strong>This is the first documentation of an ischaemic cardiomyopathy showing significant recovery of cardiac function after PCI targeting honeycomb-like structure. As reported in previous studies focusing on honeycomb-like structure, this case also exhibited angiographic underestimation of stenosis and low FFR value reflecting the true haemodynamic severity. The pathogenesis of honeycomb-like structure-thrombus formation and spontaneous recanalization-may have triggered ischaemic preconditioning, resulting in the development of hibernating myocardium, which could explain the viable myocardium in this case.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag265"},"PeriodicalIF":0.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128195/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812453","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 atrioventricular conduction system pacing in dextrocardia-a case report.","authors":"Catalin Pestrea, Ecaterina Cicala, Maria Pana, Florin Ortan","doi":"10.1093/ehjcr/ytag267","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag267","url":null,"abstract":"<p><strong>Background: </strong>Conduction system pacing has been proven superior to conventional myocardial pacing in both atrial and ventricular conduction abnormalities. However, in dextrocardia, physiological pacing is difficult due to a lack of dedicated delivery tools. We present the case of a patient with dextrocardia and situs inversus, in whom both Bachmann bundle pacing and left bundle branch pacing were performed for advanced interatrial and atrioventricular block.</p><p><strong>Case summary: </strong>A 76-year-old patient with dextrocardia and complete situs inversus was admitted for recurrent syncope. The electrocardiogram showed advanced interatrial block and complete atrioventricular block. With no identifiable reversible factors for conduction abnormalities, we decided on complete atrioventricular physiological pacing. Using a modified 3D delivery catheter (inversion of the distal curve), we were able to reach both the interventricular and interatrial septum, where the leads were deployed. Conduction system potentials were recorded in the Bachmann and left bundle branch area, and conduction system capture was demonstrated using the current criteria. The pacing and sensing thresholds were optimal and stable at the 1-month follow-up.</p><p><strong>Discussion: </strong>Interatrial block and right appendage pacing are associated with a higher incidence of atrial fibrillation and adverse atrial remodelling, while long-term right ventricular pacing increases the risk for pacing-induced cardiomyopathy. By engaging the conduction system, physiological pacing leads to normal myocardial depolarization, thereby reducing the risk of the aforementioned adverse outcomes. Although atrial and ventricular conduction system pacing has been described in detail, this is the first case to illustrate these procedures in the setting of dextrocardia.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag267"},"PeriodicalIF":0.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812188","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":"Superior venous use of bridge balloon for percutaneous lead extraction in a patient with an interrupted inferior vena cava: a case report.","authors":"Rea Ganatra, Curtis Page, Rebecca Preston, Christopher Aldo Rinaldi, Jonathan M Behar","doi":"10.1093/ehjcr/ytag252","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag252","url":null,"abstract":"<p><strong>Background: </strong>Transvenous lead extraction (TLE) is the gold-standard treatment for cardiac implantable electronic device removal but carries a small risk of major complications, including superior vena cava (SVC) injury. The prompt use of endovascular occlusion devices can provide temporary haemostasis and haemodynamic stability in the rare event of SVC laceration. The presence of congenital heart disease and venous anomalies introduces additional technical complexity and necessitates careful procedural planning.</p><p><strong>Case summary: </strong>A 52-year-old gentleman with dextrocardia and situs inversus totalis was referred to our centre for transvenous lead extraction after having presented with pacemaker pocket erosion. A CT venogram confirmed a completely interrupted inferior vena cava (IVC) with azygos continuation. A Bridge Balloon was pre-emptively placed via a superior venous approach through the right internal jugular vein as the IVC interruption precluded conventional approach through the femoral vein. TLE was performed under general anaesthesia using laser and mechanical sheaths, with successful extraction of all three leads and no major complications. The patient underwent reimplantation of a dual-chamber ICD on the right side after completing antibiotic therapy and was discharged in good condition.</p><p><strong>Discussion: </strong>In IVC interruption, a superior approach for Bridge Balloon placement can provide effective protection against SVC injury. As survival of patients with congenital heart disease improves, awareness of anatomical variants and procedural adaptation is crucial for safe and successful lead extraction.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag252"},"PeriodicalIF":0.8,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13128198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812662","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 'bystander' stenosis dilemma: a case against revascularization in a territory of extensive myocardial scar-a case report.","authors":"Samson S Badalyan, Syune V Markosyan","doi":"10.1093/ehjcr/ytag153","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag153","url":null,"abstract":"<p><strong>Background: </strong>Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a working diagnosis that requires careful exclusion of alternative ischaemic mechanisms. This case highlights a MINOCA mimic: a silently evolved, spontaneously reperfused transmural infarction, where cardiac magnetic resonance (CMR) was decisive for clarifying the mechanism and guiding management.</p><p><strong>Case summary: </strong>A 38-year-old man with heavy smoking as his sole cardiovascular risk factor underwent a routine evaluation. ECG demonstrated features of a large anterior infarction, while cardiac biomarkers were negative. Echocardiography showed severe left ventricular dysfunction and a large apical thrombus. Angiography revealed a partially recanalized mid-left anterior descending (LAD) and a severe diagonal stenosis without an obvious culprit lesion. CMR demonstrated a large transmural, non-viable LAD territory infarction with microvascular obstruction. A genetic panel revealed polymorphisms potentially contributing to a prothrombotic condition. Given the absence of viability, revascularization was deferred. At 6-month follow-up, the patient remained asymptomatic, with persistent apical thrombus despite anticoagulation.</p><p><strong>Discussion: </strong>Silent, spontaneously reperfused infarction may mimic MINOCA when angiography reveals only mild or intermediate lesions. CMR is essential for identifying non-viable myocardium, avoiding misclassification, and guiding management. Young patients with extensive infarction may benefit from targeted thrombophilia evaluation.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag153"},"PeriodicalIF":0.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688839","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":"Sarcoid aortitis presenting as an ascending aortic mass mimicking intramural haematoma and complicated by retrograde aortic dissection: a case report.","authors":"Mohamed Salah Shehata, Abdalla Elagha","doi":"10.1093/ehjcr/ytag180","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag180","url":null,"abstract":"<p><strong>Background: </strong>Sarcoidosis is a multi-system disorder characterized by non-caseating granulomatous infiltration, commonly affecting the lungs. Cardiac involvement is rare but potentially life-threatening. Aortitis in sarcoidosis is extremely rare and scarcely reported in the literature.</p><p><strong>Case summary: </strong>We report a unique case of a 51-year-old female patient with multi-system extra-cardiac sarcoidosis who was referred for cardiac magnetic resonance imaging (CMR) to exclude cardiac sarcoid involvement. Imaging revealed a retrograde Stanford Type A aortic dissection with an infiltrative mass engulfing the ascending aorta, initially presumed to represent an intramural haematoma (IMH). However, detailed CMR tissue characterization demonstrated findings inconsistent with IMH and more indicative of inflammatory activity of the ascending aortic wall.</p><p><strong>Discussion: </strong>This case highlights the rare presentation of sarcoid aortitis masquerading as IMH on initial imaging, underscoring the importance of advanced tissue characterization in atypical aortic pathology and the potentially catastrophic complications of granulomatous vascular involvement.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag180"},"PeriodicalIF":0.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688902","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":"Creative surgical solution for mechanical circulatory support in adult congenital heart disease: case report.","authors":"Maria Grandinetti, Alessandro Olimpieri, Rachele Adorisio, Gianluca Brancaccio, Antonio Amodeo","doi":"10.1093/ehjcr/ytaf597","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf597","url":null,"abstract":"<p><strong>Background: </strong>Advances in surgical and medical care have led to an increasing number of patients with congenital heart disease (CHD) surviving into adulthood. As a result, we must address the long-term consequences of palliative or corrective surgery, with heart failure being one of the most common and challenging issues faced by adult CHD (ACHD) surgeons.</p><p><strong>Case summary: </strong>We present a multidisciplinary perspective on the use of ventricular assist device support in a young patient with ACHD.</p><p><strong>Discussion: </strong>While heart transplantation remains the gold-standard treatment for end-stage heart failure, the shortage of donors necessitates alternative solutions such as mechanical circulatory support. Despite significant advancements in this field, surgical interventions in ACHD patients remain complex and are not without complications.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytaf597"},"PeriodicalIF":0.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688857","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":"Early pannus after transcatheter heart valve implantation leading to delayed coronary obstruction: a case report.","authors":"Louis Perrard, Alexandre Lafont, Mariama Akodad, Patrick Nataf, Emmanuel Gall","doi":"10.1093/ehjcr/ytag243","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag243","url":null,"abstract":"<p><strong>Background: </strong>Coronary obstruction after transcatheter aortic valve implantation (TAVI) is a rare complication typically occurring acutely. Delayed coronary obstruction (DCO) due to early pannus formation is exceptionally uncommon.</p><p><strong>Case summary: </strong>A 74-year-old woman with no coronary artery disease underwent TAVI with a self-expandable 26-mm Evolut Pro + (Medtronic) transcatheter heart valve (THV) six months prior. She presented with recurrent non-ST-segment elevation myocardial infarctions (NSTEMI), despite no angiographic evidence of acute coronary lesions. Multimodality imaging revealed early pannus overgrowth around the THV, causing mechanical obstruction of the left main ostium. Following Heart Team discussion, she underwent successful coronary artery bypass grafting without the need for surgical THV intervention.</p><p><strong>Discussion: </strong>This case highlights a rare cause of DCO post-TAVI. Both orthotopic chimney stenting and THV explant with surgical valve replacement were deemed unsuitable in this context.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag243"},"PeriodicalIF":0.8,"publicationDate":"2026-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13075941/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147688890","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":"Retrieval of stuck burr by pullback orbital atherectomy with RESCUE technique: a case report.","authors":"Sho Nakao, Takayuki Ishihara, Takuya Tsujimura, Wataru Ariyasu, Toshiaki Mano","doi":"10.1093/ehjcr/ytag259","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag259","url":null,"abstract":"<p><strong>Background: </strong>Rotational atherectomy (RA) burr entrapment is an uncommon but potentially life-threatening complication. Additional percutaneous bailout is necessary when conventional percutaneous bailout strategies are unsuccessful in patients with prohibitive surgical risk.</p><p><strong>Case summary: </strong>A 91-year-old man with a history of coronary artery bypass graft surgery presented with unstable angina caused by severely calcified diffuse stenosis of the right coronary artery. During lesion preparation, an RA burr became entrapped after crossing a heavily calcified segment. Multiple conventional percutaneous bailout techniques, including guide-extension catheter support, intravascular lithotripsy for the stuck site, snare retrieval, and repeat RA, failed to retrieve the stuck burr. Surgical extraction was considered extremely high risk because of advanced age and prior cardiac surgery. Intravascular ultrasound revealed that the burr was embedded within a calcified nodule along the inner curvature. Orbital atherectomy (OAS) was subsequently advanced beyond the stuck site, and a low-speed pullback manoeuver successfully freed the burr, allowing safe retrieval. Final angiography and intravascular imaging confirmed adequate plaque modification and favourable luminal enlargement without major complications.</p><p><strong>Discussion: </strong>The pullback OAS with the REtrieval of StuCk burr by pUllback orbital athErectomy (RESCUE) technique can be a rational bailout option when the stuck RA burr is located along the inner-curvature calcification. Intravascular imaging assessment is essential for selecting this treatment strategy.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag259"},"PeriodicalIF":0.8,"publicationDate":"2026-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13107967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766296","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":"From perfusion to pathology: using echocardiography to characterize a vascular, cystic atrial myxoma.","authors":"Tevin Browne, Theodore Velissaris, Eunice Onwordi","doi":"10.1093/ehjcr/ytag254","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag254","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag254"},"PeriodicalIF":0.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13130943/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812412","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":"Coronary artery bypass grafting may not be suitable in pure myocardial bridging: a case report.","authors":"Tsung-Lin Yang, Chuan-Chih Hsu","doi":"10.1093/ehjcr/ytag251","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag251","url":null,"abstract":"<p><strong>Background: </strong>Myocardial bridging (MB) is a congenital coronary artery disease. Surgical interventions are indicated if angina persists after optimization of medical treatments. Coronary artery bypass grafting (CABG) is one of the surgical options for MB.</p><p><strong>Case summary: </strong>A 66-year-old male experienced exertional angina for 10 months. Treadmill test revealed ischaemic change during exercise. Coronary angiography revealed myocardial bridging in middle part of the left anterior descending artery (LAD) with prominent squeezing during systolic phase. Medical control was advised. However, symptoms persisted after maximally tolerated non-dihydropyridine calcium channel blockers and beta-adrenergic antagonists. After discussing with the heart team, the patient underwent CABG with left internal mammalian artery canalized to distal LAD. The surgeon chose CABG due to the concern of ventricular rupture after myotomy for long MB. Nevertheless, angina recurred and persisted several months after CABG. Follow-up coronary angiography delineated to-and-fro retrograde blood flow in graft without actual feeding flow into the distal LAD.</p><p><strong>Discussion: </strong>This case demonstrates that coronary artery bypass grafting may not be an appropriate therapeutic strategy for patients with isolated myocardial bridging. Comprehensive preoperative evaluation, including stress testing and invasive haemodynamic assessment, is crucial before considering CABG. Optimization of medical therapy for myocardial bridging-related symptoms should be thoroughly pursued prior to surgical intervention and should include beta-adrenergic blockers, non-dihydropyridine calcium channel blockers, ranolazine, and ivabradine. Nitrates should be avoided in patients with myocardial bridging. For patients with isolated myocardial bridging and refractory angina despite optimal medical therapy, surgical unroofing may represent a more favourable option than CABG.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 4","pages":"ytag251"},"PeriodicalIF":0.8,"publicationDate":"2026-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13093216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147766191","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}