{"title":"Isolated Cardiac Involvement in Rosai-Dorfman-Destombes Disease Causing Obstructive Shock","authors":"Angelina Marinkovic MD , Emily Leung MD , Collin Pryma MD , Luke Y.C. Chen MD, MMEd , Peter Tsang MD","doi":"10.1016/j.jaccas.2025.105150","DOIUrl":"10.1016/j.jaccas.2025.105150","url":null,"abstract":"<div><h3>Background</h3><div>Rosai-Dorfman-Destombes disease (RDD) is a rare histiocytic disorder that classically presents with painless massive lymphadenopathy; however, extranodal disease can occur.</div></div><div><h3>Case Summary</h3><div>A 63-year-old patient was incidentally found to have a soft tissue mass in the left atrium on computed tomography imaging during work-up for atrial flutter. After open surgery to obtain tissue diagnosis, the patient developed shock requiring venovenous extracorporeal membrane oxygenation support. The tissue biopsy revealed the diagnosis of RDD, and the patient received rituximab, which led to substantial clinical improvement.</div></div><div><h3>Discussion</h3><div>We report a case of isolated cardiac RDD resulting in severe cardiac obstruction. Cardiac RDD is very rare, and a histopathologic diagnosis is required. Expert clinicopathologic correlation is required for early recognition and diagnosis.</div></div><div><h3>Take-Home Messages</h3><div>RDD is a rare neoplastic disease with heterogeneous presentations, including cardiac involvement. Treatment can range from surgery to systemic therapy, including immunomodulatory agents and targeted therapy for patients with a mitogen-activated protein kinase mutation.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105150"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. Case reportsPub Date : 2025-09-24DOI: 10.1016/j.jaccas.2025.105142
Francis E. Ezekwueme MD , Bryan H. Goldstein MD , Carley Bright DO , Michael Mathier MD , Luciana DaSilva MD , Merritt L. Fajt MD , Anita Saraf MD, PhD
{"title":"Autoimmune Reaction and the Management of Recurrent Bioprosthetic Pulmonary Valve Dysfunction","authors":"Francis E. Ezekwueme MD , Bryan H. Goldstein MD , Carley Bright DO , Michael Mathier MD , Luciana DaSilva MD , Merritt L. Fajt MD , Anita Saraf MD, PhD","doi":"10.1016/j.jaccas.2025.105142","DOIUrl":"10.1016/j.jaccas.2025.105142","url":null,"abstract":"<div><h3>Background</h3><div>Bioprosthetic valve failure is a significant and debilitating sequela in cardiac patients caused primarily by structural changes in valve leaflets due to endocarditis, calcification, and thrombosis.</div></div><div><h3>Case Summary</h3><div>We describe a rare case of bioprosthetic pulmonary valve failure due to an allergic reaction to molybdenum within the valve cage. We describe the clinical presentation, clinical methods leading to the diagnosis, and treatment progression until we could resolve symptoms and a significant return of valvular competency.</div></div><div><h3>Discussion</h3><div>After excluding infectious etiologies as a cause, we used skin allergy testing to identify molybdenum as the allergic agent. The patient's symptoms and valve function improved and stabilized with immunosuppression and antihistamines.</div></div><div><h3>Take-Home Messages</h3><div>Allergy to a valve metal component was diagnosed with skin allergy and treated with immunosuppression and antihistamines.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105142"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. Case reportsPub Date : 2025-09-24DOI: 10.1016/j.jaccas.2025.105228
Thomas J. Mason MD, Lauren T. Lastinger MD
{"title":"Iatrogenic Reopening of a Congenital VSD After TAVR","authors":"Thomas J. Mason MD, Lauren T. Lastinger MD","doi":"10.1016/j.jaccas.2025.105228","DOIUrl":"10.1016/j.jaccas.2025.105228","url":null,"abstract":"<div><h3>Background</h3><div>Transcatheter aortic valve replacement (TAVR) has become an increasingly used technique for patients with severe aortic stenosis who are at high risk of perioperative mortality during surgical valve replacement.</div></div><div><h3>Case Summary</h3><div>Here we describe the first case to our knowledge of a patient with a congenital perimembranous ventricular septal defect with prior spontaneous closure who experienced a post-TAVR acquired intracardiac shunt (AICS) due to the reopening of her ventricular septal defect, which caused new-onset heart failure and required surgical closure.</div></div><div><h3>Discussion</h3><div>AICS is a known complication of TAVR, but its risk in patients with congenital heart disease, particularly of the intraventricular septum, is poorly understood.</div></div><div><h3>Take-Home Messages</h3><div>In patients with congenital heart disease, detailed structural imaging should be obtained to better understand the anatomy before TAVR. Additionally, any patient with new-onset heart failure post-TAVR should be promptly evaluated for AICS.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105228"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Brugada ECG Pattern in Wilson Disease","authors":"Marios G. Bantidos MD , Panagiotis Stachteas MD, PhD(c) , Athina Nasoufidou MD, PhD(c) , Efstratios Karagiannidis MD, PhD , Varvara Fyntanidou MD, PhD , Eleni Theocharidou MD, PhD , Nikolaos Fragakis MD, PhD","doi":"10.1016/j.jaccas.2025.105233","DOIUrl":"10.1016/j.jaccas.2025.105233","url":null,"abstract":"<div><h3>Background</h3><div>Wilson disease and Brugada syndrome initially appear unrelated. Although cardiac manifestations in Wilson disease are increasingly recognized, it remains controversial whether direct copper infiltration is the sole mechanism underpinning structural and electroanatomical abnormalities.</div></div><div><h3>Case Summary</h3><div>We present the case of a 40-year-old man with genetically confirmed Wilson disease who exhibited a spontaneous Brugada type 3 electrocardiographic pattern. Subsequent to a flecainide challenge, a Brugada type 1 electrocardiographic pattern was unmasked, although no prior history of arrhythmias was reported. Regular follow-up care was not accompanied by any adverse cardiac events.</div></div><div><h3>Discussion</h3><div>This is the first documented case of such a co-occurrence, to our knowledge, and it suggests a potential Wilson-induced Brugada phenocopy, possibly attributable to the mechanistic effects of copper's redox properties, which may mimic the microstructural impairment postulated in genetic Brugada syndrome.</div></div><div><h3>Take-Home Message</h3><div>Systemic metabolic disturbances variously precipitate cardiac electrical abnormalities and should be considered in atypical presentations of arrhythmia syndromes.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105233"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. Case reportsPub Date : 2025-09-24DOI: 10.1016/j.jaccas.2025.105062
Tianhao Zhang MD , Juan Du MD , Hongkai Zhang MD, PhD , Xiaoming Zhang MD , Bokang Qiao PhD , Tianlong Chen MD , Yujie Zhou MD, PhD , Lei Xu MD, PhD , Lili Pan MD, PhD , Yu Du MD, PhD
{"title":"Coronary Artery Vasculitis","authors":"Tianhao Zhang MD , Juan Du MD , Hongkai Zhang MD, PhD , Xiaoming Zhang MD , Bokang Qiao PhD , Tianlong Chen MD , Yujie Zhou MD, PhD , Lei Xu MD, PhD , Lili Pan MD, PhD , Yu Du MD, PhD","doi":"10.1016/j.jaccas.2025.105062","DOIUrl":"10.1016/j.jaccas.2025.105062","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery vasculitis (CAV) is a relatively rare etiology of coronary artery disease (CAD), which could lead to recurrent complications once treated with coronary stents. However, differentiating between CAV and atherosclerotic CAD is challenging.</div></div><div><h3>Case Summary</h3><div>Included in this case series were 10 symptomatic patients who were initially considered as having atherosclerotic CAD but were eventually diagnosed with CAV at our center from August 2021 to October 2024. We describe the clinical and imaging characteristics of these patients.</div></div><div><h3>Discussion</h3><div>This case series shows several classic CAV characteristics on coronary computed tomography angiography, raising the awareness of CAV misdiagnosis and highlighting the importance of timely order and dedicated imaging analysis for the diagnosis of CAV.</div></div><div><h3>Take-Home Message</h3><div>Coronary computed tomography angiography can provide comprehensive information on plaque characteristics, coronary artery wall abnormalities, and pericoronary inflammation, which can help cardiologists and radiologists differentiate between CAV and atherosclerotic CAD.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105062"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. Case reportsPub Date : 2025-09-24DOI: 10.1016/j.jaccas.2025.105152
Meryem Guler BS , Sudheshna Vemula BS , Matthew Hart MD , Josh Wiener MD , Darius Farzad MD , Mark DeCaro MD , Gregary D. Marhefka MD , Devin Weber MD , John Entwistle MD, PhD , Jacqueline Urtecho MD
{"title":"Purulent Pericarditis","authors":"Meryem Guler BS , Sudheshna Vemula BS , Matthew Hart MD , Josh Wiener MD , Darius Farzad MD , Mark DeCaro MD , Gregary D. Marhefka MD , Devin Weber MD , John Entwistle MD, PhD , Jacqueline Urtecho MD","doi":"10.1016/j.jaccas.2025.105152","DOIUrl":"10.1016/j.jaccas.2025.105152","url":null,"abstract":"<div><h3>Objective</h3><div>Purulent pericarditis is a rare, lethal complication of a bacterial pericardial infection. This case report outlines the protocol for instilling intrapericardial antibiotics for methicillin-sensitive <em>Staphylococcus aureus</em> (MSSA) pericarditis without fibrinolytics in a 51-year-old man.</div></div><div><h3>Key Steps</h3><div>An appropriately sized percutaneous pericardial drain was placed. Then, a 3-day course of intrapericardial infusions of 50 mL vancomycin was begun. Drainage of all accessible fluid was performed before each infusion. The daily infusions each had an 8-hour dwell time. The prior drainage protocol continued after each infusion.</div></div><div><h3>Potential Pitfalls</h3><div>Strict dosage and infusion length management are required to prevent direct toxicity. Potential complications include local inflammatory responses and constrictive pericarditis.</div></div><div><h3>Take-Home Messages</h3><div>The use of simultaneous intravenous and intrapericardial antibiotics were used for treating MSSA purulent pericarditis without using intrapericardial fibrinolytics in an adult. This was noted to favorably improve the purulent output and relative safety without untoward complications.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105152"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. Case reportsPub Date : 2025-09-24DOI: 10.1016/j.jaccas.2025.105068
Ravi Sankar Tulluru DM, Karthik Gopinath DM, Viji Samuel Thomson DM, John Jose E DM, Ommen K. George DM
{"title":"Coronary Artery Perforation During PCI","authors":"Ravi Sankar Tulluru DM, Karthik Gopinath DM, Viji Samuel Thomson DM, John Jose E DM, Ommen K. George DM","doi":"10.1016/j.jaccas.2025.105068","DOIUrl":"10.1016/j.jaccas.2025.105068","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery perforation (CAP) is an uncommon but serious complication of percutaneous coronary intervention, with a mortality rate of 10% to 20%. Its relevance is increasing with procedural complexity and expanded device use.</div></div><div><h3>Case Summary</h3><div>We present a 10-year, single-center case series of 21 CAP cases, highlighting 5 key cases: type III CAP treated with a covered stent complicated by side branch occlusion; calcified perforation complicated by stent thrombosis; distal wire perforation with fatal outcome; chronic total occlusion-related CAP managed with coiling and surgery; and type IV CAP with delayed deterioration. Overall, type III CAP was most common (52%), and the left anterior descending artery was most frequently involved (57%). Management included covered stent in 71%, coiling in 14%, and surgery in 2 cases. Four patients died, and 2 patients developed stent thrombosis or in-stent restenosis.</div></div><div><h3>Discussion</h3><div>This series emphasizes CAP mechanisms; treatment strategies; and the importance of timely recognition, imaging guidance, and institutional preparedness.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105068"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Left Main Vasospasm Masquerading as Critical Stenosis Leading to Unnecessary Surgery","authors":"Francesca Di Lenarda MD , Riccardo Terzi MD, BSc , Michele Gallazzi MD , Giovanni Monizzi MD , Emanuele Gallinoro MD, PhD , Pasquale Paolisso MD, PhD , Davide Marchetti MD , Edoardo Conte MD, PhD , Antonio L. Bartorelli MD , Daniele Andreini MD, PhD","doi":"10.1016/j.jaccas.2025.105231","DOIUrl":"10.1016/j.jaccas.2025.105231","url":null,"abstract":"<div><h3>Background</h3><div>Vasospastic angina is a condition determined by epicardial coronary artery spasm, which is usually diagnosed from resting angina.</div></div><div><h3>Case Summary</h3><div>A 62-year-old man was admitted for recurrent rest angina despite previous coronary artery bypass grafting and plain-old balloon angioplasty for multivessel disease. Coronary computed tomography angiography revealed occluded bypass grafts but nonsignificant coronary atherosclerosis, along with diffuse coronary ectasia and myocardial bridging. During invasive re-evaluation, intravascular ultrasound confirmed positive remodeling and intimal thickening, suggestive of vasospastic pathology. Critical, focal epicardial vasospasm during angiography triggered ventricular fibrillation, reversed by defibrillation. A transient right coronary artery occlusion with ST-elevation resolved with nitrates, highlighting the dynamic nature of the vasospasm.</div></div><div><h3>Discussion</h3><div>The case emphasizes the importance of considering coronary vasospasm in patients with ambiguous angiographic findings, the diagnostic and therapeutic role of intracoronary nitroglycerin, and the value of imaging in avoiding unnecessary revascularization. Careful pharmacologic testing and physiologic assessment are essential to distinguish functional vasospasm from fixed coronary disease, especially in left main involvement.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105231"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pericardial Diffuse Large B-Cell Lymphoma Diagnosed Via Computed Tomography–Guided Biopsy","authors":"Toshiya Yoshida MD , Midori Nanamatsu MD , Shunichi Asano MD , Takuya Narita MD, PhD , Miki Terauchi MD , Akira Hirasawa MD, PhD , Yukio Kakuta MD, PhD , Kazuhiko Yumoto MD, PhD","doi":"10.1016/j.jaccas.2025.105070","DOIUrl":"10.1016/j.jaccas.2025.105070","url":null,"abstract":"<div><h3>Background</h3><div>Primary pericardial lymphomas are rare. We describe a case of pericardial diffuse large B-cell lymphoma (DLBCL) diagnosed via computed tomography (CT)–guided biopsy.</div></div><div><h3>Case Summary</h3><div>A 57-year-old man presented with chest pain and weight loss for 1 month. Multiple diagnostic modalities revealed a pericardial mass with effusion. Pericardiocentesis was performed, and cytology suggested malignant lymphoma; however, the procedure was complicated by pneumothorax owing to mediastinal distortion from the pectus excavatum and minimal effusion. After multidisciplinary discussion, CT-guided biopsy was performed, which confirmed DLBCL. Polatuzumab vedotin, rituximab/cyclophosphamide, doxorubicin, and prednisone were initiated, resulting in tumor shrinkage.</div></div><div><h3>Discussion</h3><div>Early histopathological diagnosis is essential for treating malignant lymphoma. In this case, CT-guided biopsy was selected as the safest and most effective approach and was successfully performed without complications.</div></div><div><h3>Take-Home Messages</h3><div>A multidisciplinary approach is necessary for early diagnosis of pericardial lymphoma. CT-guided biopsy can be effective in certain cases.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105070"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
JACC. Case reportsPub Date : 2025-09-24DOI: 10.1016/j.jaccas.2025.105153
Xiafeng Yu MD , Yanjun Sun MD, PhD , Lijun Fu MD, PhD , Zhuoming Xu MD, PhD , Yumin Zhong MD, PhD , Wenjing Hong MD , Yi Yan MD, PhD , Yinyu Yang MD , Hao Zhang MD, PhD
{"title":"Reversed Potts Shunt and Venopulmonary Extracorporeal Membrane Oxygenation Support in Sustained Pulmonary Hypertension Crisis","authors":"Xiafeng Yu MD , Yanjun Sun MD, PhD , Lijun Fu MD, PhD , Zhuoming Xu MD, PhD , Yumin Zhong MD, PhD , Wenjing Hong MD , Yi Yan MD, PhD , Yinyu Yang MD , Hao Zhang MD, PhD","doi":"10.1016/j.jaccas.2025.105153","DOIUrl":"10.1016/j.jaccas.2025.105153","url":null,"abstract":"<div><h3>Background</h3><div>Infantile idiopathic pulmonary arterial hypertension complicated by recurrent episodes of pulmonary hypertensive crisis is an extremely rare and critical condition with high mortality.</div></div><div><h3>Case Summary</h3><div>We present the case of a 5-month-old infant with a pulmonary hypertension crisis refractory to medical therapy, who underwent successful treatment with an emergency reversed Potts shunt (RPS), along with postoperative venopulmonary extracorporeal membrane oxygenation (V-P ECMO) support.</div></div><div><h3>Discussion</h3><div>From an imaging perspective, the mechanism by which RPS improves symptoms in patient with sustained pulmonary hypertension crises is explained. Additionally, this is the first reported case of successful postoperative use of V-P ECMO support after RPS.</div></div><div><h3>Take-Home Messages</h3><div>It is important to recognize the importance of RPS and V-P ECMO in the treatment of pulmonary hypertension crises. By comparing pre- and postoperative imaging data, the mechanism by which RPS improves cardiac function is better understood.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"30 29","pages":"Article 105153"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145128194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}