European Heart Journal: Case Reports最新文献

{"title":"Staged visceral revascularization prior to central aortic repair in acute type A aortic dissection complicated by mesenteric malperfusion: a case report.","authors":"Georges Abi Abdallah, Francesca Pitocco, Antoine Cazelles, Marie Corniquet, Charles Henri Gautier, Lena Ple-Nemo, Maxime Renaux, Nicolas Polge","doi":"10.1093/ehjcr/ytag693","DOIUrl":"10.1093/ehjcr/ytag693","url":null,"abstract":"<p><strong>Background: </strong>Acute type A aortic dissection (ATAAD) complicated by mesenteric malperfusion is among the most lethal cardiovascular emergencies, combining the immediate threat of aortic rupture with rapidly progressive visceral ischaemia. The optimal sequence of intervention remains controversial. Although current guidelines recommend immediate central aortic repair, this strategy may carry particularly high perioperative risk when advanced mesenteric ischaemia is already present.</p><p><strong>Case summary: </strong>A 54-year-old woman with no relevant medical history presented with ATAAD extending from the sinotubular junction to the iliac bifurcation, complicated by severe mesenteric malperfusion and haemodynamic instability. Following urgent multidisciplinary discussion, a staged strategy was adopted. On Day 0, visceral reperfusion was achieved by iliac-to-superior mesenteric artery bypass with concomitant exploratory laparotomy, combined with thoracic endovascular aortic repair. Progressive intestinal ischaemia over the next 48 h required multiple abdominal surgeries, including right colectomy, left colectomy with ileosigmoidostomy, and cholecystectomy, until bowel viability was controlled. Definitive total aortic arch replacement using a Thoraflex hybrid prosthesis was then performed on Day 6 under cardiopulmonary bypass with brief circulatory arrest. Despite a prolonged and complex postoperative course, the patient survived to hospital discharge.</p><p><strong>Discussion: </strong>This case illustrates the multidisciplinary decision-making involved in the management of a highly selected patient with ATAAD and established severe mesenteric malperfusion syndrome, in whom the immediate risk of visceral ischaemia was weighed against the substantial risk of delaying central repair.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag693"},"PeriodicalIF":0.7,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623219/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079750","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 coronary event without coronary artery disease: the hidden role of inherited thrombophilia-a case report.","authors":"Nika Kuridze, Revaz Sturua, Levan Tsaguria","doi":"10.1093/ehjcr/ytag714","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag714","url":null,"abstract":"<p><strong>Background: </strong>ST-segment elevation myocardial infarction (STEMI) in young patients without traditional cardiovascular risk factors requires evaluation beyond atherosclerotic disease. Inherited thrombophilia and cancer-related prothrombotic states represent important alternative aetiologies.</p><p><strong>Case summary: </strong>A 42-year-old man presented with an acute inferior STEMI. Coronary angiography demonstrated thrombotic occlusion of the proximal right coronary artery, treated with drug-eluting stent implantation. The patient had no cardiovascular risk factors. His medical history was significant for seminomatous testicular cancer treated with orchiectomy and cisplatin-based chemotherapy 10 months prior. Laboratory and imaging findings did not support atherosclerotic disease, and tumour markers were within normal limits. Given the absence of conventional risk factors, further evaluation was undertaken. Genetic testing revealed inherited thrombophilia. Following multidisciplinary consultation, antithrombotic therapy was optimized by adding rivaroxaban and adjusting antiplatelet therapy. At 1-year follow-up, the patient remained asymptomatic with no recurrent thrombotic events.</p><p><strong>Discussion: </strong>This case highlights the importance of a systematic and personalized diagnostic approach in young STEMI patients without evident coronary artery disease. Although inherited thrombophilia was considered a plausible underlying cause of coronary thrombosis in this case, the coexistence of prior malignancy and cisplatin-based chemotherapy may have further amplified the patient's prothrombotic state. Therefore, it is probable that multiple pathogenic mechanisms coexisted and contributed to the development of coronary thrombosis. While typically linked to venous thromboembolism, inherited thrombophilia may also contribute to arterial thrombosis in selected patients, with important implications for long-term management.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag714"},"PeriodicalIF":0.7,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13625939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106046","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":"Case report: aortic root thrombus presenting with syncope and embolic events.","authors":"Ai Phi Thuy Ho, Eirik Brekka Tjønnfjord, Ole-Christian Walter Rutherford","doi":"10.1093/ehjcr/ytag715","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag715","url":null,"abstract":"<p><strong>Background: </strong>Aortic root thrombus is a rare but potentially life-threatening condition, often associated with systemic embolization or obstruction of coronary arteries (myocardial infarction). The most common reason is a complication of left ventricular assist device (LVAD) implantation, but it may occur in the absence of LVAD, for instance in structural valve disease or prothrombotic disorders (antiphospholipid syndrome, haemolytic diseases, and myeloproliferative disease, making diagnosis challenging.</p><p><strong>Case summary: </strong>We report the case of a 47-year-old man with a history of deep venous thrombosis who presented with syncope, anaemia, and new-onset atrial fibrillation. Initial evaluation revealed elevated troponin, cerebral and splenic embolic lesions, and a mobile aortic root mass measuring 2.3 × 1.3 cm. Despite extensive work-up, no autoimmune or haematological disorder was identified. Surgical removal of the thrombus was performed. His postoperative course was complicated by pericardial tamponade requiring drainage but was otherwise favourable. He was discharged on long-term anticoagulation with preserved cardiac function.</p><p><strong>Discussion: </strong>Aortic root thrombus may present with systemic embolization in otherwise healthy individuals without identifiable thrombophilia. Early recognition and surgical intervention are essential when thrombus size, mobility, and embolic risk are high.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag715"},"PeriodicalIF":0.7,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624277/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106092","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 lone lifeline-a rare case report of a single right coronary circulation with hypoplastic left coronary system.","authors":"Ani Abhishek Sharma, Deepanjan Bhattacharya, Sanjeev S Mukherjee, Saurav Banerjee, Kalyan Kumar Saha","doi":"10.1093/ehjcr/ytag705","DOIUrl":"10.1093/ehjcr/ytag705","url":null,"abstract":"<p><strong>Background: </strong>Single coronary artery is an exceptionally rare congenital anomaly, occurring in ∼0.02% of patients undergoing coronary angiography. Hypoplastic coronary artery disease represents another uncommon congenital abnormality characterized by underdevelopment of epicardial coronary arteries. The coexistence of these anomalies resulting in a functionally single coronary circulation is extremely rare and has important diagnostic and clinical implications.</p><p><strong>Case summary: </strong>A woman in her late 60s presented with atypical chest pain. Electrocardiography and transthoracic echocardiography demonstrated normal findings with preserved biventricular function. Coronary angiography revealed an atretic left coronary ostium with retrograde filling of the left coronary system from the right coronary artery. Computed tomography coronary angiography confirmed a dominant right coronary artery supplying the entire myocardium with a hypoplastic left coronary system. The left anterior descending artery was opacified via collateralization through Vieussens' arterial ring. No obstructive coronary disease was identified. The patient was managed conservatively and remained clinically stable on follow-up.</p><p><strong>Discussion: </strong>Rare coronary artery anomalies may present with non-specific symptoms and require multimodality imaging for definitive diagnosis. Early recognition is crucial for appropriate risk stratification, management, and surveillance.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag705"},"PeriodicalIF":0.7,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079774","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":"Beyond iron deficiency: unmasking right-sided subclavian steal syndrome in a patient with chronic anaemia.","authors":"Mohamad Bahrou, Rami Al-Ayyubi, Karthik Missula, Ahmad Al-Turk","doi":"10.1093/ehjcr/ytag706","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag706","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag706"},"PeriodicalIF":0.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13637581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149106033","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 'R sign' as a potential risk factor for progression of uncomplicated Type B aortic dissection: a case series.","authors":"Dan Rong, Shaofan Wang, Jianhan Yin, Yangyang Ge, Feng Liu, Wei Guo","doi":"10.1093/ehjcr/ytag707","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag707","url":null,"abstract":"<p><strong>Background: </strong>Complicated and uncomplicated Type B aortic dissection (TBAD) need distinct therapeutic pathways. While TBAD is a complex and dynamic clinical entity, ∼75% of cases present as uncomplicated initially. However, up to half of these may progress to complicated TBAD, highlighting the need for better prognostic tools. In this case series, we report a novel potential radiological risk factor for progression, the 'R sign', to contribute to a deeper understanding of this disease's behaviour.</p><p><strong>Case summary: </strong>We present two male patients with TBAD. Both cases exhibited a localized dissection at the top of the aortic arch's greater curvature on computed tomography angiography (CTA), which we term the 'R sign'. Both patients were initially admitted with uncomplicated TBAD. Patient 1: a 46-year-old man was stable on medical therapy until experiencing sudden chest tightness, at which point CTA confirmed progression to Type A dissection. Patient 2: a 54-year-old man, also managed medically for uncomplicated TBAD, suffered a sudden recurrence of back pain, with CTA confirming progression to Type A dissection.</p><p><strong>Conclusion: </strong>This case series highlights a previously unrecognized subtype of aortic dissection. In both presented cases, this specific form of TBAD progressed to Type A during the acute phase. Early identification of this high-risk uncomplicated TBAD variant is critical for patient prognosis, as it may need urgent intervention as a complicated TBAD. We present this entity to raise awareness and call for further multi-centre studies to validate our observations in larger cohorts.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag707"},"PeriodicalIF":0.7,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13652012/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149170722","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":"Aorto-mitral intervalvular fibrosa pseudoaneurysm with mitral valve perforation after manouguian aortic root enlargement.","authors":"Aby Dixon Pynadath, Tinoy Kizhakekuttu, Matthew Cox, Emmanuel Amulraj","doi":"10.1093/ehjcr/ytag704","DOIUrl":"https://doi.org/10.1093/ehjcr/ytag704","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag704"},"PeriodicalIF":0.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13662396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191954","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":"Multimodal imaging in discriminating atrial septal defect combined with mobile echoic strands in fossa ovalis: a case report.","authors":"Yi Cheng, Jing Li, Xiaojing Ma","doi":"10.1093/ehjcr/ytag701","DOIUrl":"10.1093/ehjcr/ytag701","url":null,"abstract":"<p><strong>Background: </strong>Mobile echoic structures in the fossa ovalis region represent a common diagnostic pitfall in patients with atrial septal defect (ASD). Misdiagnosis as pathological masses may lead to unnecessary invasive interventions. This case demonstrates the value of a stepwise multimodal imaging strategy for differential diagnosis.</p><p><strong>Case summary: </strong>A 48-year-old female presented with intermittent chest discomfort and was initially diagnosed with suspected patent foramen ovale (PFO) at a referring hospital. After systematic evaluation at our centre, the diagnosis was revised to secundum ASD (fossa ovalis type) accompanied by a mobile linear hyperechoic structure at the defect margin. The patient underwent transoesophageal echocardiography (TEE), transthoracic contrast echocardiography, and contrast-enhanced cardiac computed tomography, with complete laboratory workup to exclude infectious and thrombotic aetiologies.</p><p><strong>Discussion: </strong>High-resolution TEE confirmed a true anatomical septal defect rather than a PFO flap channel. Multimodal imaging stepwise excluded pathological mimics, including infective vegetation, mural thrombus, and cystic haemangioma, and the lesion was finally identified as benign residual fragments of the primary septum. Accurate differentiation directly guided clinical decision-making and avoided unnecessary invasive intervention.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 10","pages":"ytag701"},"PeriodicalIF":0.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215438","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":"Assessment of readiness for return to skiing after coronary artery bypass grafting and left ventricular reconstruction using cardiopulmonary exercise testing and field-based expiratory gas analysis: a case report.","authors":"Shuhei Koyama, Takashi Murakami, Masaru Nagasaki, Takahiro Ohki, Tsutomu Ito","doi":"10.1093/ehjcr/ytag696","DOIUrl":"10.1093/ehjcr/ytag696","url":null,"abstract":"<p><strong>Background: </strong>Returning to skiing after myocardial infarction and complex cardiac surgery is challenging because cardiopulmonary exercise testing (CPET) performed in laboratory settings may not fully reflect real-world sports-specific demands.</p><p><strong>Case summary: </strong>A 63-year-old male ski instructor experienced an acute myocardial infarction while skiing and subsequently underwent coronary artery bypass grafting combined with surgical ventricular restoration. After structured outpatient cardiac rehabilitation incorporating high-intensity interval training, serial CPET demonstrated an improvement in peak oxygen uptake from 19.4 to 22.1 mL/kg/min without adverse events. To assess real-world cardiopulmonary stress, a field-based breath-by-breath expiratory gas analysis was performed during skiing using a portable metabolic analyser. Three ski techniques (skidding, long radius carving, and short radius carving) were evaluated. Peak oxygen uptake and heart rate during all ski conditions did not exceed the corresponding peak values obtained during CPET or the prescribed high-intensity interval training intensity, indicating that skiing was performed within the predefined physiological safety margin.</p><p><strong>Discussion: </strong>This case demonstrated a clinically applicable strategy for assessing readiness for return to skiing by integrating CPET-guided rehabilitation with field-based physiological assessment, thereby enabling objective evaluation of sport-specific safety.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag696"},"PeriodicalIF":0.7,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149059445","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":"Iatrogenic ventricular septal defect following papillary muscle premature ventricular contraction ablation: a case report.","authors":"Maria Luisa Benesch Vidal, Niklas Schenker, Katharina Alina Riedl, Daniel Kalbacher, Andreas Rillig","doi":"10.1093/ehjcr/ytag647","DOIUrl":"10.1093/ehjcr/ytag647","url":null,"abstract":"<p><strong>Background: </strong>Catheter ablation of monomorphic premature ventricular contractions (PVCs) in symptomatic or haemodynamically compromised patients has a Class I recommendation in cardiomyopathy and a Class IIa recommendation in patients comprising non-outflow tract PVC morphology and a physiologic anatomy according to current ESC guidelines. It is therefore widely performed and generally considered safe. Rare but clinically significant complications can occur and may present considerable diagnostic and therapeutic challenges.</p><p><strong>Case summary: </strong>A 77-year-old woman underwent radiofrequency (RF) catheter ablation for symptomatic PVCs originating from the posteromedial papillary muscle. The acute procedural course was uneventful. Two months later, she presented with progressive dyspnoea. Transthoracic echocardiography revealed a newly developed haemodynamically significant ventricular septal defect (VSD) with left-to-right shunting. Retrospective analysis demonstrated anatomical concordance between the ablation site and the septal defect, suggesting an ablation-related iatrogenic VSD. Transoesophageal echocardiography confirmed an 8 mm defect. Cardiovascular magnetic resonance imaging demonstrated a significant shunt volume (<i>Q</i> _p:<i>Q</i> _s 1.7:1) and corresponding mild-to-moderate aortic, mitral, and tricuspid valve regurgitation secondary to volume overload. Right heart catheterization corroborated haemodynamic relevance. Following multidisciplinary heart team discussion, percutaneous closure was performed using a 12 mm muscular VSD occluder. Post-procedural imaging confirmed stable device position with minimal residual shunting and clinical improvement.</p><p><strong>Discussion: </strong>Iatrogenic VSD represents a rare but potentially serious delayed complication of RF catheter ablation for PVCs. Given the possibility of insidious onset, new heart failure symptoms or murmurs after ablation should prompt timely multimodality imaging. Structured follow-up may facilitate early detection and appropriate management of this uncommon but clinically relevant complication.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag647"},"PeriodicalIF":0.7,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614262/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149059455","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}