European Heart Journal: Case Reports最新文献

{"title":"Classic case report: concomitant pulsed field ablation, cavotricuspid isthmus ablation and percutaneous left atrial appendage occlusion in a patient with prior intracranial haemorrhage.","authors":"Rahul G Muthalaly, Sara El-Saadany, Richard Ang, Mehul B Dhinoja, Mark J Earley","doi":"10.1093/ehjcr/ytag742","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag742","url":null,"abstract":"<p><strong>Background: </strong>Concomitant atrial fibrillation (AF) ablation and percutaneous left atrial appendage occlusion (pLAAO) offers single-procedure rhythm control and stroke prevention in patients unable to tolerate long-term oral anticoagulation. Patients with prior intracranial haemorrhage (ICH) from suspected cerebral amyloid angiopathy (CAA) have among the strongest contraindications to anticoagulation yet are absent from randomized trials of concomitant procedures, and combining pulsed field ablation (PFA) with pLAAO introduces energy-specific considerations.</p><p><strong>Case summary: </strong>A 66-year-old woman with persistent AF, cavotricuspid isthmus-dependent atrial flutter and a CHA₂DS₂-VA score of 3 had been off anticoagulation for 2 years after an ICH. Brain magnetic resonance imaging showed microhaemorrhages and siderosis suggestive of CAA. Through a single transseptal puncture, four-vein PFA was performed first to avoid electrical interaction with the nitinol pLAAO frame, followed by WATCHMAN FLX deployment under transoesophageal echocardiographic and computed tomography (CT)-fluoroscopy guidance and radiofrequency cavotricuspid isthmus ablation. She received edoxaban without aspirin for three months. Cardiac CT then confirmed device seal without device-related thrombus, and all antithrombotic therapy was withdrawn.</p><p><strong>Discussion: </strong>Randomized trials show that anticoagulation after ICH prevents ischaemic stroke at the cost of a marked increase in recurrent haemorrhage, and lobar or CAA-related haemorrhage carries the least favourable balance. Concomitant ablation and pLAAO delivers rhythm control and stroke prevention with one transseptal access and one time-limited exposure to anticoagulation. Combining PFA with pLAAO requires sizing the occluder before ablation, because PFA induces acute pulmonary ridge oedema, and completing pulmonary vein isolation before deployment to avoid arcing against the nitinol frame.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag742"},"PeriodicalIF":0.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149264578","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":"Decompensated heart failure after one year of successful therapy with mavacamten: a case report.","authors":"Giulia Marchionni, Lucrezia Netti, Silvia Stavagna, Cristina Chimenti","doi":"10.1093/ehjcr/ytag741","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag741","url":null,"abstract":"<p><strong>Background: </strong>Cardiac myosin inhibition is the first disease-specific therapeutic strategy for obstructive hypertrophic cardiomyopathy. Mavacamten, the first-in-class agent, has demonstrated an excellent safety profile and sustained efficacy in both clinical trials and real-world practice. However, its safe use requires careful monitoring and thorough patient education regarding potential drug-drug interactions.</p><p><strong>Case summary: </strong>We report a case of acute heart failure occurring after long-term clinical stability on mavacamten following concomitant fluconazole administration. It is reasonable to assume that the pharmacokinetic interaction resulted in excessive mavacamten exposure, leading to transient systolic dysfunction, severe functional mitral regurgitation, and adverse left ventricular remodelling.</p><p><strong>Discussion: </strong>This case report highlights the consequences of pharmacological interactions between mavacamten and a strong CYP2C19 inhibitor. Drug-drug interaction should always be considered and systematically excluded in a patient presenting with unexplained heart failure and left ventricular remodelling during mavacamten therapy.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag741"},"PeriodicalIF":0.7,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13715631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149295628","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":"Giant cardiac hemangioma: case report and literature review.","authors":"Henrique Coutinho, Gustavo Kikuta, Marcos Filgueiras, Bruno Reznik Wajsbrot, Fabiana Resende Rodrigues","doi":"10.1093/ehjcr/ytag535","DOIUrl":"10.1093/ehjcr/ytag535","url":null,"abstract":"<p><strong>Introduction: </strong>Primary cardiac tumours are rare, with haemangiomas constituting only 2% of benign cardiac tumours. Although benign, these lesions can compress adjacent cardiac structures, leading to symptoms such as arrhythmias, heart failure, or even sudden death. This study presents a rare case of a giant cardiac haemangioma and provides a review of the current literature on its diagnosis and management.</p><p><strong>Case report: </strong>A 58-year-old female presented with progressive abdominal pain and dyspnoea. Imaging revealed a large, heterogeneous mass in the pericardial sac measuring 11.9 × 11.7 × 6.7 cm. Complete surgical resection was performed without complications. Histopathological analysis confirmed the diagnosis of a cavernous haemangioma. Postoperative recovery was uneventful, and follow-up imaging showed no residual mass or functional impairment.</p><p><strong>Discussion: </strong>Cardiac haemangiomas are rare and pose significant diagnostic challenges. Advanced imaging modalities, such as magnetic resonance imaging (MRI) and computed tomography (CT), are essential for accurate diagnosis and surgical planning. Complete tumour resection remains the treatment of choice, ensuring a favourable prognosis and minimal risk of recurrence.</p><p><strong>Conclusion: </strong>Effective management of giant cardiac haemangiomas requires early diagnosis, precise imaging, and complete surgical resection. Long-term follow-up is necessary to monitor for recurrence and ensure optimal outcomes.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag535"},"PeriodicalIF":0.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13640959/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106039","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 TriArtic procedure: TRIcuspid annular reduction by TEER in the commissure-a transcatheter annuloplasty enabling EVOQUE tricuspid valve replacement: a case report.","authors":"Raphael Phinicarides, Fabian Voß, Tobias Zeus, Amin Polzin","doi":"10.1093/ehjcr/ytag729","DOIUrl":"10.1093/ehjcr/ytag729","url":null,"abstract":"<p><strong>Background: </strong>Transcatheter tricuspid valve replacement (TTVR) with the EVOQUE system has expanded therapeutic options for severe tricuspid regurgitation (TR), but a prohibitively dilated tricuspid annulus may exceed the device-sizing matrix and preclude implantation. No transcatheter strategy has been described to mechanically pre-condition such an annulus.</p><p><strong>Case summary: </strong>A 71-year-old woman with heart failure with reduced ejection fraction (left ventricular ejection fraction 38%, suspected premature-ventricular-complex-induced cardiomyopathy), permanent atrial fibrillation, and class III obesity presented with torrential atrial functional TR refractory to fully optimized guideline-directed medical therapy. Screening cardiac computed tomography (CT) classified the native annulus as 'outside parameters' for the 56 mm EVOQUE (Edwards Lifesciences); the Heart Team also deemed standalone tricuspid edge-to-edge repair (T-TEER) inadequate owing to the massively dilated annulus. We performed the TriArtic procedure-a single TriClip XTW (Abbott) deployed in the septo-anterior position as a transcatheter annuloplasty step. Repeat CT after 27 days demonstrated an ∼11% reduction in tricuspid annular area and conversion of projected-derived-diameter oversizing from -2.9% to +3.3% (within parameters). Transfemoral EVOQUE 56 mm was implanted 48 days after the TriClip; postprocedural imaging confirmed no residual regurgitation and a mean transtricuspid gradient of 1 mm Hg, with rapid recovery of cardiorenal function.</p><p><strong>Discussion: </strong>Transcatheter tricuspid annuloplasty by a strategically placed commissural TEER device may convert a prohibitively dilated annulus into one within EVOQUE-implantable parameters. In carefully selected patients ineligible for either standalone strategy, sequential transcatheter annuloplasty followed by valve replacement-the TriArtic procedure-may offer a feasible pathway, conceptually analogous to the mitral ARCTIC technique. This single case demonstrates feasibility only and does not establish general applicability.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag729"},"PeriodicalIF":0.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149223573","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":"Constrictive pericarditis in cystic fibrosis: a case report of an emerging cardiovascular complication successfully managed with off-pump pericardiectomy.","authors":"Defne Elif Alev, Andrea D'Alessio, Rana Ahmed Sayeed","doi":"10.1093/ehjcr/ytag734","DOIUrl":"10.1093/ehjcr/ytag734","url":null,"abstract":"<p><strong>Background: </strong>Constrictive pericarditis (CP) is rarely reported in people with cystic fibrosis (CF) and may be overlooked because dyspnoea, fatigue, oedema, and reduced exercise tolerance overlap with pulmonary exacerbation. As survival improves with highly effective CF transmembrane conductance regulator modulator therapy, cardiovascular causes of cardiorespiratory symptoms may become increasingly relevant in adults with CF. This case highlights the importance of recognizing CP in this population and individualizing surgical decision-making.</p><p><strong>Case summary: </strong>A 33-year-old woman with homozygous F508del CF, stable on elexacaftor/tezacaftor/ivacaftor, presented with chest pain, left scapular discomfort, breathlessness, night sweats, and signs of systemic venous congestion. Computed tomography pulmonary angiography excluded pulmonary embolism but demonstrated pericardial calcification, thickening, bilateral pleural effusions, and a small pericardial effusion. Transthoracic echocardiography, cardiac magnetic resonance imaging, and invasive haemodynamic assessment confirmed chronic CP. Following treatment of an acute infective/inflammatory episode and recovery from congestive hepatopathy, she underwent off-pump complete pericardiectomy via median sternotomy with phrenic-to-phrenic resection. She was extubated within 1 h, received immediate chest physiotherapy, and was discharged on postoperative day 4. A reactive pleural effusion on day 28 resolved with drainage and antibiotics. At 4 months, oedema had resolved, exercise tolerance had improved, quality-of-life scores improved, and echocardiography showed no recurrent constriction.</p><p><strong>Discussion: </strong>CP should be considered in people with CF when symptoms are disproportionate to pulmonary disease severity. CF should not automatically preclude pericardiectomy; in selected patients, CF-specific perioperative planning may enable definitive surgery with clinical and quality-of-life benefit.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag734"},"PeriodicalIF":0.7,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215366","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":"LAA occluder device impeding pulsed field ablation of an anterior mitral line: a case report about the role of a dual energy source.","authors":"Stefano Bordignon, Sara Würfel, Ulrich Hink, Boris Rudic","doi":"10.1093/ehjcr/ytag711","DOIUrl":"10.1093/ehjcr/ytag711","url":null,"abstract":"<p><strong>Background: </strong>Pulsed field ablation (PFA) and percutaneous closure of the left atrial appendage are increasingly used in patients with atrial fibrillation. An interaction between this form of energy and metallic structures in the heart is an emerging problem. We first report a left atrial appendage closure (LAAC)-limiting PFA using a novel dual energy ablation catheter, solved by switching to the classic radiofrequency ablation.</p><p><strong>Case summary: </strong>An 85-year-old woman with heart failure with preserved ejection fraction and a history of persistent atrial fibrillation (status post pulmonary vein isolation in 2019, with a 25 mm Abbott Amulet LAAC implanted in 2023) presented with recurrent atrial tachycardia. During redo ablation, mapping revealed a macroreentrant circuit through an anterior left atrial low-voltage area. While extending a linear PFA lesion towards the LAAC, the generator repeatedly aborted applications due to invalid impedance values near the device-despite the device having been in place for 3 years. Switching to radiofrequency energy on the same catheter allowed the line to be completed successfully, achieving bidirectional block and tachycardia non-inducibility.</p><p><strong>Discussion: </strong>The interaction between PFA and metallic cardiac devices may limit catheter ablation, a problem that can be solved by technologies that allow for the switch to radiofrequency sources. Dual energy technologies may be therefore preferred in patients with LAAC devices.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag711"},"PeriodicalIF":0.7,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655610/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167381","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":"Coral reef aorta demonstrated by serial computed tomography: a case report.","authors":"Tsuneaki Kawashima, Masaki Harada","doi":"10.1093/ehjcr/ytag732","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag732","url":null,"abstract":"<p><strong>Background: </strong>Coral reef aorta (CRA) is a rare vascular disorder characterized by dense, protruding calcified plaques within the abdominal aorta, often resulting in ischaemic symptoms. Because of its rarity and atypical presentation, CRA is frequently diagnosed at an advanced stage.</p><p><strong>Case summary: </strong>A 50-year-old male smoker with hypertension and hyperlipidaemia presented with progressive lower extremity symptoms. Four years before presentation, he developed bilateral lower limb numbness and was diagnosed with lumbar disc herniation, which likely masked the underlying vascular disease. One year before presentation, he developed intermittent claudication after ∼10 min of walking, followed by severe bilateral rest pain 1 month before presentation. The ankle-brachial index (ABI) was markedly reduced to 0.49 bilaterally. Computed tomography (CT) revealed extensive calcified plaques causing near occlusion of the infrarenal abdominal aorta. Serial CT over 6 years demonstrated progressive intraluminal calcification, facilitating diagnosis and treatment planning. Open aortic graft replacement with inferior mesenteric artery reconstruction was performed. Postoperatively, symptoms resolved completely, and the ABI improved to 1.13 (right) and 1.19 (left). At 1-year follow-up, the patient remained asymptomatic with the ABI of 1.07 bilaterally, and CT confirmed graft patency.</p><p><strong>Discussion: </strong>This case highlights the importance of considering CRA in patients with lower limb ischaemia, particularly when symptoms are initially attributed to non-vascular conditions. Serial CT is essential for detecting progression and enabling timely diagnosis. Open surgical intervention remains the most reliable treatment and can achieve excellent clinical outcomes in advanced disease.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag732"},"PeriodicalIF":0.7,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13690089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149264615","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":"Unintended right atrial lesions after monopolar biphasic lattice-tip pulsed-field ablation: a case series.","authors":"Jun Hirokami, Kenichi Hiroshima, Michio Nagashima, Masato Fukunaga, Kengo Korai, Kenji Ando","doi":"10.1093/ehjcr/ytag730","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag730","url":null,"abstract":"<p><strong>Background: </strong>Monopolar biphasic pulsed-field ablation (PFA) delivered by a lattice-tip catheter may create deeper lesions than conventional bipolar systems. The impact on adjacent right atrial structures remains poorly characterized.</p><p><strong>Case summary: </strong>We report four patients undergoing pulmonary vein isolation using a lattice-tip PFA catheter. Post-procedural electroanatomic mapping revealed unintended right atrial lesions involving the posterior right atrium, interatrial septum, or superior vena cava. In patients with short anatomical distances between right pulmonary veins and adjacent right atrial structures, lesions developed despite apparently successful pulmonary vein isolation. Catheter instability related to coughing under deep sedation appeared to contribute to broader lesion formation in two cases.</p><p><strong>Discussion: </strong>These cases suggest that monopolar biphasic lattice-tip PFA may create unintended lesions in adjacent right atrial tissue when anatomical proximity is short or catheter stability is compromised. Awareness of these mechanisms may help optimize procedural safety and lesion delivery.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag730"},"PeriodicalIF":0.7,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149166481","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":"Cardiometabolic therapy for rhythm control: a case report of refractory atrial fibrillation resolving after initiation of semaglutide for obesity.","authors":"Frederike Marie Weitkamp, Mirela Vatic, Stephan von Haehling, Constanze Schmidt, Felix Wiedmann","doi":"10.1093/ehjcr/ytag727","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag727","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a major modifiable risk factor for atrial fibrillation (AF) and has been linked to processes involved in atrial structural and electrical remodelling. Glucagon-like peptide-1 (GLP-1) receptor agonists reduce cardiovascular events in patients with type 2 diabetes at high cardiovascular risk and are increasingly regarded as cardiometabolic therapies. Whether these agents modify the trajectory of atrial cardiomyopathy or exert direct antiarrhythmic effects beyond their metabolic actions remains an area of active investigation.</p><p><strong>Case summary: </strong>A 50-year-old man with obesity (body mass index 34.9 kg/m²) and persistent AF presented with persistent symptomatic episodes despite four prior pulmonary vein isolation procedures and repeated electrical cardioversions. Rhythm monitoring was performed continuously using a wearable device since 2023, documenting recurrent episodes lasting 8-30 h with a modified European Heart Rhythm Association (mEHRA) class IIb-III symptom burden. Echocardiography demonstrated preserved left ventricular systolic function and left atrial enlargement. In January 2026, once-weekly subcutaneous semaglutide was initiated for weight management (0.25 mg/week with subsequent dose escalation). While a weight reduction of 14 kg was observed within 6 months, AF episodes and symptoms ceased immediately after treatment initiation and have not recurred during follow-up.</p><p><strong>Conclusion: </strong>This case describes cessation of recurrent AF episodes following initiation of semaglutide in a patient with obesity and prior ablation failure. Potential mechanisms may include cardiometabolic effects as well as direct myocardial effects on sodium and calcium handling that have been described experimentally. Although a causal relationship cannot be established from a single observation, this finding may serve as a hypothesis-generating signal and provide a rationale for prospective studies evaluating cardiometabolic therapies as potential adjuncts in rhythm control strategies.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag727"},"PeriodicalIF":0.7,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191982","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":"Pericardio-peritoneal communication following emergency subxiphoid pericardiocentesis in acute complex percutaneous coronary intervention: a case report.","authors":"Tharusan Thevathasan, Ulf Landmesser, Arbnora Magdalena Apling, Carsten Skurk, Youssef Abdelwahed","doi":"10.1093/ehjcr/ytag702","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag702","url":null,"abstract":"<p><strong>Background: </strong>Emergency pericardiocentesis represents a life-saving intervention in patients with acute cardiac tamponade. During complex percutaneous coronary intervention (PCI), abrupt haemodynamic deterioration secondary to pericardial tamponade may necessitate immediate subxiphoid drainage. Although the procedure is generally safe when performed by experienced operators, catheter malposition can result in ineffective pericardial decompression and may be associated with unexpected and potentially serious complications.</p><p><strong>Case summary: </strong>An 83-year-old patient with multiple cardiovascular risk factors and paroxysmal atrial fibrillation underwent high-risk PCI for severely calcified left main and multivessel coronary artery disease at an external institution. Owing to persistent angina, the patient was transferred directly to our tertiary referral centre. Coronary angiography revealed an iatrogenic left main coronary artery dissection, presumably related to the preceding PCI. The lesion was successfully treated using intravascular imaging guidance, adjunctive plaque modification, and drug-eluting stent implantation, resulting in complete sealing of the dissection and restoration of Thrombolysis in Myocardial Infarction 3 flow. Shortly thereafter, the patient developed acute hypotension accompanied by echocardiographic evidence of rapidly accumulating pericardial effusion with haemodynamic features of cardiac tamponade. Emergency subxiphoid pericardiocentesis led to immediate haemodynamic stabilization. However, persistent abdominal discomfort prompted further diagnostic evaluation. Computed tomography (CT) demonstrated intraperitoneal contrast distribution across multiple abdominal quadrants, consistent with peritoneal perforation by the pigtail catheter and the presence of an iatrogenic pericardio-peritoneal communication. Serial transthoracic echocardiography showed only minimal and stable residual pericardial effusion without recurrence of tamponade physiology. The drainage catheter was therefore removed at an early stage. Follow-up CT confirmed progressive resolution of intraperitoneal contrast. The patient subsequently recovered without further complications.</p><p><strong>Discussion: </strong>Peritoneal perforation during subxiphoid pericardiocentesis is a rare but clinically relevant complication. In cases in which clinical symptoms are disproportionate to echocardiographic findings, or when the effectiveness of pericardial drainage is uncertain, early cross-sectional imaging should be considered to verify catheter position and to identify abnormal extracardiac fluid communication. Prompt recognition and timely catheter removal may prevent further complications and obviate the need for surgical intervention.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag702"},"PeriodicalIF":0.7,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625651/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106099","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}