European Heart Journal: Case Reports最新文献

{"title":"Exploring the cardiac burden of high-flow arteriovenous fistulas in end-stage renal disease.","authors":"Huan Dat Pham, Gulana Khan, Muhammad Hamza Saad Shaukat","doi":"10.1093/ehjcr/ytaf221","DOIUrl":"10.1093/ehjcr/ytaf221","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf221"},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090053/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110188","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":"Left ventricular outflow tract obstruction in transthyretin amyloid cardiomyopathy: a case report on diagnostic and treatment challenges and role of alcohol septal ablation.","authors":"Ali Hussein Jaber Mejren, Sie Kronborg Fensman, Steen Hvitfeldt Poulsen","doi":"10.1093/ehjcr/ytaf233","DOIUrl":"10.1093/ehjcr/ytaf233","url":null,"abstract":"<p><strong>Background: </strong>Transthyretin amyloid cardiomyopathy (ATTR-CM) is a restrictive cardiomyopathy caused by amyloid deposition in the myocardium. Its phenotypical overlap with hypertrophic cardiomyopathy, particularly in cases involving left ventricular outflow tract obstruction (LVOTO), challenges accurate diagnosis. Medical management of LVOTO in ATTR-CM is challenged by the opposing effects of beta-blockers and diuretics.</p><p><strong>Case summary: </strong>A 79-year-old male with left ventricular hypertrophy and LVOTO presented with worsening dyspnoea. Full diagnostic work-up confirmed wild-type ATTR-CM. A conservative medical approach with diuretics and beta-blockers proved challenging. Alcohol septal ablation was successfully performed without major complication, resolving the LVOTO and improving symptoms.</p><p><strong>Discussion: </strong>The diagnosis and management of ATTR-CM with LVOTO are complex. A thorough diagnostic approach is needed to avoid mismanagement. Diuretics and beta-blockers must be carefully balanced to achieve optimal clinical results. Alcohol septal ablation may be considered in patients with persistent symptoms and high LVOT gradients despite optimal medical therapy.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf233"},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12100115/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144141726","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":"Voltage threshold adjustments for a novel pulsed-field ablation catheter with integrated mapping capabilities: lessons from a case series.","authors":"Thomas Kueffer, Ajay Panakal, Claudia Herrera, Hildegard Tanner, Helge Servatius, Laurent Roten, Tobias Reichlin","doi":"10.1093/ehjcr/ytaf231","DOIUrl":"10.1093/ehjcr/ytaf231","url":null,"abstract":"<p><strong>Background: </strong>Accurate electroanatomical mapping relies on voltage thresholds to differentiate electrically inactive areas, fibrotic scar, and healthy myocardium. These thresholds have been well established for high-density mapping catheters with small, closely spaced electrodes. However, the optimal voltage thresholds for a novel pulsed-field ablation catheter with integrated mapping capabilities remain unclear. This case series evaluates different voltage thresholds for the variable-loop circular catheter (VLCC, Varipulse, Biosense Webster) compared with a dedicated high-density mapping catheter (Octaray, Biosense Webster).</p><p><strong>Case summary: </strong>Four patients undergoing left atrial catheter ablation-including pulmonary vein isolation (PVI), posterior wall ablation, and ablation for scar-related atrial flutter-were mapped using both the VLCC and Octaray catheter. The key findings include: (i) standard voltage thresholds for high-density catheters overestimate voltage in scarred and ablated tissue when applied to the VLCC, necessitating adjusted voltage settings; (ii) the VLCC effectively identified PVI and reconnections, posterior wall isolation, anterior wall scarring, and atrial flutter circuits; and (iii) while the VLCC identified areas of scar, its representation remained less precise compared with high-density mapping.</p><p><strong>Discussion: </strong>This case series demonstrates that the VLCC provides satisfactory mapping performance in common use cases but requires voltage threshold adjustments for accurate visualization. Despite its ability to detect ablation endpoints, scar characterization remains less accurate. Further quantitative analysis of electrogram differences and a prospective evaluation in a larger patient population are necessary to determine the optimal voltage thresholds for this catheter.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 6","pages":"ytaf231"},"PeriodicalIF":0.8,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12127796/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208055","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":"First successful transcatheter valve-in-valve implantation into a failed mechanical prosthetic mitral valve after fracturing the discs: a case report.","authors":"Christian Butter, Michael Neuss, Tanja Kücken, Doreen Bensch, Michael Erb","doi":"10.1093/ehjcr/ytaf183","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf183","url":null,"abstract":"<p><strong>Background: </strong>Until now, dysfunctional mechanical valves had to be treated surgically. Motivated by <i>in vitro</i> fracture experiments and the first successful clinical implantation of a transcatheter valve (TAVR) into the remaining ring in aortic position, this approach was considered for the mitral position for the first time.</p><p><strong>Case summary: </strong>A 31-year-old female patient with a history of four open-heart surgeries and severe neurologic complications presented with cardiac decompensation due to a fixed tilt of her mechanical bileaflet mitral valve prosthesis, resulting in mitral stenosis with a mean gradient of above 10 mmHg. An interventional approach was discussed. Using an apical access, the tilts were cracked under cerebral protection, and a balloon-implantable TAVR was implanted uneventfully. More than 3 years later, the patient is clinically stable, the valvular function is not impaired and the embolized fragment does not cause any problems in the distal abdominal aorta.</p><p><strong>Discussion: </strong>To the best of our knowledge, this is the first case report that demonstrates the possibility to implant a biological TAVR in a failed bileaflet mechanical mitral valve after fracturing the carbon tilts.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf183"},"PeriodicalIF":0.8,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12063098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143964874","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":"Efficacy of mavacamten in patients with hypertrophic cardiomyopathy and mid-ventricular obstruction: case series.","authors":"Valeria Rella, Denisa Muraru, Lia Crotti","doi":"10.1093/ehjcr/ytaf229","DOIUrl":"10.1093/ehjcr/ytaf229","url":null,"abstract":"<p><strong>Background: </strong>Mavacamten is a cardiac-specific myosin inhibitor approved for treatment of adults with hypertrophic cardiomyopathy (HCM) symptomatic for left ventricular outflow tract (LVOT) obstruction. Since obstruction is favoured by a hyper-contractile state, it would be logical to suppose that mavacamten may also be effective in patients with mid-ventricular obstruction (MVO). We present our experience with two HCM patients having MVO effectively treated with mavacamten.</p><p><strong>Case summary: </strong>The first case is a 55-year-old woman presenting with dyspnoea and exertional fatigue, with obstructive HCM (HOCM) and mid-ventricular peak gradient of 77 mmHg associated with LVOT obstruction. The treatment with mavacamten 5 mg daily determined relief of symptoms. At 16-week follow-up, there was a significant reduction of peak gradient (11 mmHg in mid-ventricular tract) and a significant decrease in NT-proBNP levels from 1287 to 178 ng/L. The second case is a 55-year-old woman with predominant mid-ventricular HOCM (peak gradient 52 mmHg) and past history of septal myectomy, with a residual significant gradient measured at LVOT level. The patient was started on mavacamten 5 mg daily, subsequently up-titrated to 10 mg. At 16-week follow-up, there was a significant reduction of peak gradient to 10 mmHg and a significant decrease in NT-proBNP levels from 3910 to 718 ng/L.</p><p><strong>Discussion: </strong>These two cases highlight the efficacy of mavacamten in the reduction of MVO, suggesting that it may be a valid therapeutic option also in patients with isolated MVO, frequently more difficult to be adequately treated.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf229"},"PeriodicalIF":0.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090046/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110173","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 implantation for a patient with both severe aortic stenosis and membranous ventricular septal aneurysm: a case report.","authors":"Naoto Murakami, Nobuaki Kokubu, Shunsaku Otomo, Masato Furuhashi","doi":"10.1093/ehjcr/ytaf230","DOIUrl":"10.1093/ehjcr/ytaf230","url":null,"abstract":"<p><strong>Background: </strong>There have been few reports on transcatheter aortic valve implantation (TAVI) for patients with severe aortic stenosis (AS) and a membranous ventricular septal aneurysm (MSA).</p><p><strong>Case summary: </strong>A 77-year-old female complaining of dyspnoea was transferred to our hospital. Transthoracic echocardiography (TTE) showed progressive very severe AS with reduced left ventricular (LV) systolic function. The patient was scheduled for TAVI due to high surgical risk. Preoperative computed tomography showed a MSA located between the right coronary cusp and the non-coronary cusp, therefore a part of the annulus rim was lacking. We draw a virtual annulus line to assess her true annulus size and selected a 29 mm size of Evolut Pro Plus. Since the bottom end of the valve was positioned into the MSA, the valve was begun to expand with a lack of coaxiality and massive paravalvular leak (PVL) occurred. Therefore, we decided to retrieve the 29 mm valve. An up-sized 34 mm Evolut was tried, but it was too large and caused the phenomenon of stent-frame infolding. We had to retrieve the 34 mm valve again, and tried to deploy another 29 mm valve at a position as high as possible and pushed the delivery system during the final release to maintain good coaxiality. Postoperative TTE showed significant recovery of LV systolic function, and the PVL was mild.</p><p><strong>Discussion: </strong>In patients with both MSA and severe AS, it is difficult to measure the precise annulus size for ensuring stability of the self-expanding valve and preventing PVL.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf230"},"PeriodicalIF":0.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12090047/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144110208","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":"Effective percutaneous treatment of a subacute left internal mammary artery perforation and pseudoaneurysm after coronary artery bypass grafting: a case report.","authors":"Franck Digne, Ariel Nakache, Arthur Darmon, Mohammed Nejjari, Nicolas Bonnet","doi":"10.1093/ehjcr/ytaf224","DOIUrl":"10.1093/ehjcr/ytaf224","url":null,"abstract":"<p><strong>Background: </strong>Perforation of the left internal mammary artery (LIMA) graft is a rare but severe complication of coronary artery bypass grafting (CABG).</p><p><strong>Case summary: </strong>A 75-year-old Caucasian man with hypertension, diabetes, dyslipidaemia, and a history of SARS-CoV-2 presented with exertional dyspnoea. After CABG with a Y-graft anastomosis using the right internal mammary artery, he experienced severe chest pain. A transthoracic echocardiogram revealed a haemopericardium. A computed tomography scan identified a LIMA pseudoaneurysm in contact with the haemopericardium near the anterior and anterolateral left ventricle walls. Angiography confirmed the LIMA pseudoaneurysm and left anterior descending artery (LAD) graft occlusion. The LIMA pseudoaneurysm was treated with a covered stent, and the LAD was revascularized with rotational atherectomy and drug-eluting stent. At the three-year follow-up, the patient remained asymptomatic, and the scan performed at the two-year mark indicated patent grafts with no signs of restenosis.</p><p><strong>Discussion: </strong>This case illustrates the successful percutaneous management of a rare LIMA pseudoaneurysm, preventing high-risk reoperation. It also highlights the importance of multimodal imaging and interventional strategies in managing complex post-CABG complications.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf224"},"PeriodicalIF":0.8,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144076495","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":"Congenitally corrected transposition of the great arteries and coronary artery disease: a case report in an 83-year-old male.","authors":"Ahmed Alomrani, Mohammed Alshammari, Fahad Bindakhil, Hadi Shabi, Abdullah Alkhodair","doi":"10.1093/ehjcr/ytaf161","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf161","url":null,"abstract":"<p><strong>Background: </strong>Congenitally corrected transposition of the great arteries (CCTGA), or L-loop TGA, is a rare congenital heart defect, comprising <1% of congenital heart diseases, with an incidence of ∼1 in 33 000 births. It is characterized by atrioventricular and ventriculo-arterial discordance, where the left ventricle connects to a right atrium and pumps deoxygenated blood into the pulmonary artery, while the right ventricle (RV) connects to a left atrium and pumps oxygenated blood into the aorta. Congenitally corrected transposition of the great arteries often coexists with other cardiac anomalies, although ∼10% of cases are isolated. A case report highlights a unique instance of coronary artery disease (CAD) in CCTGA.</p><p><strong>Case summary: </strong>An 83-year-old male with CCTGA presented with persistent nausea, fatigue, poor oral intake, and epigastric pain. He had a history of hypertension, Type II diabetes, dyslipidaemia, ischaemic heart disease, and chronic atrial fibrillation. On examination, he was stable but showed signs of a urinary tract infection. A cardiac workup revealed no ischaemic changes on electrocardiography, but a cardiac computed tomography identified significant CAD involving multiple vessels. A decision was made to perform percutaneous coronary intervention on the right coronary artery, successfully placing two stents.</p><p><strong>Discussion: </strong>In patients with CCTGA, major factors contributing to morbidity and mortality include progressive decline in systemic RV function and systemic tricuspid valve regurgitation. A retrospective study showed that 25% of uncomplicated CCTGA patients develop heart failure by age 45, while approximately two-thirds of complicated cases do. Survival beyond age 70 is rare. Prompt management of CAD through angioplasty is critical to prevent further deterioration of RV function and worsening tricuspid regurgitation. However, the atypical positioning of the aorta and coronary arteries complicates selective coronary angiography, making a challenging diagnosis and treatment.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf161"},"PeriodicalIF":0.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056606/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979017","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":"When the heart becomes suicidal: a case report of severe left ventricular outflow tract obstruction following transcatheter aortic valve implantation.","authors":"Carl Schulz, Fabian J Brunner, Simon Pecha, Nils Sörensen, Niklas Schofer","doi":"10.1093/ehjcr/ytaf164","DOIUrl":"https://doi.org/10.1093/ehjcr/ytaf164","url":null,"abstract":"<p><strong>Background: </strong>Replacement of the aortic valve is a Class I recommendation for treatment of patients suffering from severe, symptomatic aortic stenosis. However, aortic valve replacement can occasionally lead to complications, including development of acute left ventricular outflow tract (LVOT) obstruction. This rare but severe complication is referred to as the so-called 'suicide left ventricle' phenomenon.</p><p><strong>Case summary: </strong>This case report presents an 88-year-old woman who developed severe LVOT obstruction following a successful transcatheter aortic valve implantation (TAVI), complicated by septal anterior motion of the mitral valve resulting in severe mitral regurgitation. Despite initial intensive care management, her symptoms persisted, necessitating the application of transcoronary ablation of septal hypertrophy as a bail-out procedure. Transcoronary ablation of septal hypertrophy, typically used in hypertrophic obstructive cardiomyopathy, successfully reduced the LVOT gradient and relieved symptoms.</p><p><strong>Discussion: </strong>This case emphasizes the importance of pre-operative identification of LVOT obstruction risk factors, awareness for this complication and a well-experience multidisciplinary team for the management of TAVI-associated complications.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf164"},"PeriodicalIF":0.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12056725/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143957645","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 Kounis syndrome presenting with coronary angina pectoris and coronary microcirculatory disturbance, resulting in takotsubo cardiomyopathy-like changes.","authors":"Rie Aoyama, Horie Kana, Shinichi Okino, Shigeru Fukuzawa","doi":"10.1093/ehjcr/ytaf227","DOIUrl":"10.1093/ehjcr/ytaf227","url":null,"abstract":"<p><strong>Background: </strong>Kounis syndrome is an allergic syndrome leading to acute coronary syndromes (ACS). It includes coronary spasm angina (CSA), plaque erosion or rupture, and coronary stent thrombosis. Takotsubo cardiomyopathy is a myocardial disease without significant stenosis of the coronary arteries and is said to include coronary microvascular dysfunction (CMD) and CSA in its background.</p><p><strong>Case summary: </strong>A 63-year-old woman was urgently brought to our hospital due to chest tightness and loss of consciousness after the appearance of generalized urticaria. She was in anaphylactic shock and her ECG suggested ACS. Emergency coronary angiography showed no significant stenosis and left ventriculography showed takotsubo cardiomyopathy-like wall motion. The diagnosis of Kounis syndrome type I was made. The simultaneous binuclear cardiac scintigraphy of ^99mTc-tetrofosmin and ¹²³I-BMIPP showed atypical images of takotsubo cardiomyopathy. The evaluation of coronary microvascular function showed CMD and the acetylcholine (ACh) stress test showed multivessel CSA. We started a calcium channel blocker, isosorbide mononitrate, and antihistamines. She was discharged from the hospital after cardiac function improved and has remained stable without any recurrence during one year of outpatient follow-up.</p><p><strong>Discussion: </strong>There are few reports of an invasive evaluation in the subacute phase of Takotsubo cardiomyopathy-like clinical presentation. We report a case of takotsubo-like wall motion abnormality due to CSA and CMD in a patient with Kounis syndrome. Simultaneous binuclear myocardial scintigraphy, assessment of the coronary microcirculation, and ACh stress test were useful in the diagnosis, and the coexistence of CSA and CMD suggested her clinical images similar to takotsubo cardiomyopathy.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"9 5","pages":"ytaf227"},"PeriodicalIF":0.8,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12082815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144093213","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}