European Heart Journal: Case Reports最新文献

{"title":"Coronary stent infection causing perforation and thrombotic occlusion after early post-PCI methicillin-resistant <i>Staphylococcus aureus</i> bacteraemia: an autopsy case report.","authors":"Shota Hirai, Goro Fujiki, Atsushi Nakagawa, Taichi Okabe","doi":"10.1093/ehjcr/ytag671","DOIUrl":"10.1093/ehjcr/ytag671","url":null,"abstract":"<p><strong>Background: </strong>Coronary stent infection (CSI) is rare but can be fatal. In <i>Staphylococcus aureus</i> bacteraemia (SAB), treatment duration is guided by classification as uncomplicated or complicated SAB. However, whether a recently implanted drug-eluting stent (DES) should be regarded as intravascular prosthetic material remains unclear.</p><p><strong>Case summary: </strong>An 83-year-old woman underwent percutaneous coronary intervention (PCI) for a severely calcified right coronary ostial lesion. After rotational atherectomy, a DES was implanted, and final angiography showed adequate expansion. On hospital day 7, cellulitis developed at a peripheral intravenous catheter site. Blood and skin cultures grew methicillin-resistant <i>Staphylococcus aureus</i> (MRSA). Intravenous linezolid was started because of renal dysfunction. The episode was considered to be uncomplicated SAB because follow-up blood cultures were negative, fever resolved, transthoracic echocardiography showed no vegetation, and no metastatic infection was identified. Antimicrobial therapy was stopped after 14 days. Fever and inflammatory markers did not recur, but nonspecific chest symptoms persisted. Follow-up coronary angiography showed no clear abnormalities. After discharge, MRSA bacteraemia recurred. The patient developed shock with inferior ST-segment elevation, followed by pulseless electrical activity and death. Autopsy revealed coronary wall disruption, surrounding haemorrhage, ostial thrombotic occlusion, gram-positive cocci, and neutrophilic infiltration near the right coronary ostial stent, leading to the diagnosis of CSI.</p><p><strong>Discussion: </strong>This case raises the possibility that a recently implanted DES may serve as an occult endovascular focus during SAB. Negative follow-up blood cultures, defervescence, normalized inflammatory markers, and unrevealing imaging may not exclude CSI; persistent or recurrent chest symptoms after recent PCI should prompt targeted reassessment.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag671"},"PeriodicalIF":0.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584215/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988693","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 stenosis in Fabry disease with optical coherence tomography imaging presentation: a case report.","authors":"Zesheng Peng, Bo Zheng, Yawen Zhao, Wei Zhang, Wei Ma","doi":"10.1093/ehjcr/ytag652","DOIUrl":"10.1093/ehjcr/ytag652","url":null,"abstract":"<p><strong>Background: </strong>Fabry disease (FD) is a rare X-linked lysosomal storage disorder and also a rare cause of coronary stenosis. We present a case of coronary stenosis in a 39-year-old man with FD, including optical coherence tomography (OCT) imaging findings.</p><p><strong>Case summary: </strong>A 39-year-old man was admitted with unstable angina. He had been previously diagnosed with FD through α-galactosidase A enzyme activity testing and genetic analysis. Coronary angiography (CAG) revealed 90% stenosis in the proximal left anterior descending artery (pLAD). The pre-procedural CAG-based fractional flow reserve (caFFR) was 0.57, and the CAG-based index of microcirculatory resistance (caIMR) was 14.4. Drug-coated balloon angioplasty was performed, achieving post-procedural stenosis of 0%, with caFFR improving to 0.86 and caIMR decreasing to 9.4. He had no traditional atherosclerotic cardiovascular disease risk factors. Although CAG indicated 90% stenosis of the pLAD, OCT imaging did not demonstrate typical atherosclerotic or fibrocalcific plaques. However, based on the patient's clinical features, OCT findings, and previous literature, we could not definitively determine the specific aetiology of the coronary stenosis (FD, coronary atherosclerosis, or both). During a 2-year follow-up, he remained angina-free.</p><p><strong>Discussion: </strong>Although OCT may aid in differentiating FD-related coronary involvement due to its high resolution and ability to detect FD-compatible changes, it cannot reliably determine whether the fibrous plaque morphology and loss of layered architecture are attributable to FD-related coronary pathology or premature atherosclerosis, representing a fundamental imaging limitation.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag652"},"PeriodicalIF":0.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13623236/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079731","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":"Connection of right coronary and left circumflex arteries terminating in the left ventricle with intramyocardial aneurysm: a rare coronary fistula.","authors":"Shi-Qin Yu, Wei-Feng Yan, Zhi-Gang Yang","doi":"10.1093/ehjcr/ytag675","DOIUrl":"10.1093/ehjcr/ytag675","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag675"},"PeriodicalIF":0.7,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584208/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988730","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":"Capturing coronary plaque healing in transition: a case report.","authors":"Horea-Laurentiu Onea, Florin-Leontin Lazar","doi":"10.1093/ehjcr/ytag667","DOIUrl":"10.1093/ehjcr/ytag667","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag667"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13582020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988738","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":"Cryoballoon left atrial posterior wall isolation using the cross-over technique in situs inversus with dextrocardia: a case report.","authors":"Fuminori Odagiri, Takashi Tokano, Tetsuro Miyazaki, Kai Ishii, Tohru Minamino","doi":"10.1093/ehjcr/ytag674","DOIUrl":"10.1093/ehjcr/ytag674","url":null,"abstract":"<p><strong>Background: </strong>Situs inversus with dextrocardia (SID) is a rare congenital condition with fully mirrored cardiac anatomy, posing unique technical challenges for catheter ablation of atrial fibrillation (AF). Although cryoballoon (CB)-based left atrial posterior wall isolation (LAPWI) has recently been reported in a patient with SID, adjunctive radiofrequency catheter ablation was required to complete posterior wall isolation. We present a case in which complete LAPWI was achieved exclusively using CB applications, employing the previously described cross-over technique.</p><p><strong>Case summary: </strong>A 69-year-old woman with SID and drug-refractory persistent AF underwent catheter ablation using a fourth-generation CB system. To accommodate mirrored anatomy, the procedure was performed using mirror-image fluoroscopy and intentionally reversed catheter manipulation to restore conventional spatial orientation. Pulmonary vein isolation was achieved, followed by LAPWI using the cross-over technique, in which overlapping CB applications were delivered from both left- and right-sided pulmonary vein anchor positions to improve lesion continuity across the left atrial posterior wall. Complete LAPWI was confirmed by voltage mapping and pacing manoeuvres demonstrating both entrance and exit block. No periprocedural complications occurred. The patient remained free from AF recurrence for 48 months without antiarrhythmic therapy.</p><p><strong>Discussion: </strong>This case demonstrates that complete CB-based LAPWI using the cross-over technique is feasible even in anatomically mirrored hearts. The successful use of mirror-image fluoroscopy and intentionally reversed catheter manipulation provides practical technical insights and highlights the importance of deliberate spatial adaptation when performing complex left atrial ablation in patients with SID.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag674"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13584201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988760","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":"Aortopathy: limitations of diameter-based decision-making: a case report.","authors":"Juliana Senftinger, Michael Stiefel, Robert Manka, Mark Haykowsky, David Niederseer","doi":"10.1093/ehjcr/ytag672","DOIUrl":"10.1093/ehjcr/ytag672","url":null,"abstract":"<p><strong>Background: </strong>Thoracic aortic aneurysms are often incidental findings that require close follow-up monitoring and eventual surgical or endovascular treatment to prevent life-threatening dissection. Their complex relationship with physical activity requires further research to balance cardiovascular risk reduction against the dangers of acute blood pressure peaks.</p><p><strong>Case summary: </strong>A 75-year-old male endurance athlete was evaluated in a sports cardiology clinic to assess the safety of intensive exercise with a known ascending thoracic aortic aneurysm (ATAA). He had adopted an active lifestyle at 65 and completed over thirty 70.3 Ironman races. In 2019, at the age of 75, echocardiography revealed an ATAA measuring 52 mm, along with a bicuspid aortic valve and moderate regurgitation. The patient declined surgery and wished to continue endurance training. After shared decision-making, continued training and racing were allowed under predefined limits for blood pressure and heart rate, with regular imaging surveillance. Over 6 years of follow-up using magnetic resonance imaging, computed tomography, and echocardiography, aneurysm size remained stable, with an aortic wall thickness of 2.5 mm. Based on Laplace's law, the calculated circumferential wall stress stayed below rupture thresholds during exercise. Exercise counselling should consider not only aneurysm diameter but also blood pressure, wall thickness, and wall stress.</p><p><strong>Discussion: </strong>In accordance with current guidelines, watchful waiting and a temporary restriction of physical activity are recommended in this case of aortic dilatation. However, because factors such as increased aortic wall thickness may allow for a more favourable distribution of wall stress, an individualized risk assessment can refine these recommendations. In the present case, a shared decision-making approach revealed that controlled physical exertion did not critically increase wall stress and potentially conferred a long-term protective effect against aneurysm progression, underscoring the value of individualized therapeutic strategies.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag672"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149059409","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":"Three rhythms in one presentation: atrial flutter, torsades de pointes, and complete heart block.","authors":"Nithin George","doi":"10.1093/ehjcr/ytag665","DOIUrl":"10.1093/ehjcr/ytag665","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag665"},"PeriodicalIF":0.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13590226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149012333","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":"Right internal mammary artery steal syndrome: successful percutaneous coil embolization of a collateral branch-case report.","authors":"Luca Saccarello, Giovanni Pedrazzini, Marcello Di Valentino, Andrea Demarchi, Andrea Menafoglio","doi":"10.1093/ehjcr/ytag642","DOIUrl":"10.1093/ehjcr/ytag642","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery bypass grafting (CABG) is a common revascularization strategy, yet ischaemic symptoms may persist despite patent grafts.</p><p><strong>Case summary: </strong>We describe a 60-year-old man with three-vessel coronary artery disease treated with triple CABG who presented with persistent dyspnoea and inferolateral myocardial hypoperfusion. Repeat coronary angiography demonstrated patent grafts but identified a collateral branch of the right internal mammary artery causing a steal phenomenon. Coil embolization of the collateral vessel led to complete symptom resolution and normalization of myocardial perfusion.</p><p><strong>Discussion: </strong>This case highlights a rare cause of CABG steal syndrome and emphasizes the need for careful assessment of internal mammary artery branches in patients with ongoing post-CABG ischaemia.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag642"},"PeriodicalIF":0.7,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13575683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148976107","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":"Multimodality imaging in a young patient with ST-Elevation Myocardial Infarction.","authors":"Edwin Adhi Darmawan Batubara, Celly Anantaria Atmadikoesoemah, Vidya Gilang Rejeki, Bambang Widyantoro","doi":"10.1093/ehjcr/ytag666","DOIUrl":"10.1093/ehjcr/ytag666","url":null,"abstract":"","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag666"},"PeriodicalIF":0.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149059374","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":"Acute limb ischaemia revealing AL cardiac amyloidosis despite sustained sinus rhythm: a case report.","authors":"Shuhei Osumi, Daisuke Tomioka, Naofumi Oyamada, Toshikazu Jinnai, Kazuaki Kaitani","doi":"10.1093/ehjcr/ytag662","DOIUrl":"10.1093/ehjcr/ytag662","url":null,"abstract":"<p><strong>Background: </strong>Thromboembolic complications are well recognized in cardiac amyloidosis and are traditionally attributed to atrial fibrillation (AF). However, patients with immunoglobulin light-chain (AL) cardiac amyloidosis remain at substantial thromboembolic risk, even in sinus rhythm, presumably due to atrial mechanical dysfunction. Acute limb ischaemia as the first clinical manifestation of AL cardiac amyloidosis is exceedingly rare.</p><p><strong>Case summary: </strong>A 64-year-old man presented with sudden-onset pain and coldness in the left lower limb. Computed tomography revealed acute occlusion of the left popliteal artery, and an emergency surgical thrombectomy was successfully performed. Electrocardiography showed sinus rhythm, and continuous monitoring during hospitalization detected no atrial fibrillation. Transthoracic echocardiography demonstrated concentric ventricular wall thickening and reduced transmitral A-wave velocity despite preserved sinus rhythm and generally normal left atrial size, suggesting impaired atrial mechanical function. Cardiac magnetic resonance imaging revealed diffuse subendocardial late gadolinium enhancement extending into the left atrial myocardium. Right ventricular endomyocardial biopsy confirmed AL amyloidosis. The patient was accordingly diagnosed with AL cardiac amyloidosis, complicated by systemic arterial thromboembolism. Daratumumab-based therapy and anticoagulation were initiated, resulting in no recurrence of embolic events and excellent functional recovery during follow-up.</p><p><strong>Discussion: </strong>This case highlights that AL cardiac amyloidosis can cause clinically significant systemic arterial thromboembolism, even in apparent sinus rhythm. Atrial mechanical dysfunction due to amyloid infiltration, rather than atrial fibrillation, appears to be a key mechanism. Clinicians should consider cardiac amyloidosis in patients with embolic events of unknown origin, particularly when imaging findings suggest infiltrative cardiomyopathy.</p>","PeriodicalId":11910,"journal":{"name":"European Heart Journal: Case Reports","volume":"10 9","pages":"ytag662"},"PeriodicalIF":0.7,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13560835/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148944500","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}