JACC. Case reports最新文献_第10页

Success Today, Options Tomorrow: Lifetime Management of Aortic Valve Disease. 今天的成功，明天的选择：主动脉瓣疾病的终生管理。

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110762

Tetsuro Shimura, Masanori Yamamoto

引用次数: 0

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110621

Wenqi Han, Haichao Chen, Yi Wang, Ju Yan, Lei Shi, Zhenyu Wang, Baoguo Song, Qiling Gou

{"title":"Pregnancy-Related Right Atrial Appendage Tachycardia Requiring ECMO and Hybrid Ablation.","authors":"Wenqi Han, Haichao Chen, Yi Wang, Ju Yan, Lei Shi, Zhenyu Wang, Baoguo Song, Qiling Gou","doi":"10.1016/j.jaccas.2026.110621","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110621","url":null,"abstract":"Background: Right atrial appendage atrial tachycardia (AT) during pregnancy is rare and can progress to tachycardia-induced cardiomyopathy and shock.Case summary: A 22-year-old woman at 36 weeks and 5 days of gestation presented with fatigue, dyspnea, and narrow-complex tachycardia at 190-210 beats/min. Echocardiography showed an ejection fraction of 18%. After failed medical therapy, cardioversion, and esophageal pacing, she underwent emergency cesarean delivery and venoarterial extracorporeal membrane oxygenation. Mapping localized the AT to the base of the right atrial appendage; endocardial radiofrequency (RF) and pulsed field ablation produced only transient sinus rhythm. Thoracoscopic bipolar RF ablation with surgical clamping restored durable sinus rhythm.Conclusions: Appendage-origin AT in pregnancy can progress rapidly to tachycardia-induced cardiomyopathy, and timely venoarterial extracorporeal membrane oxygenation support improves the prognosis. RF and pulsed field ablation may be insufficient for deep or possibly epicardial substrates; surgical ablation should be considered when catheter ablation fails.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110621"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194000","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}

引用次数: 0

Argatroban Anticoagulation for Transcarotid TAVR Under Conscious Sedation in a Patient With Heparin-Induced Thrombocytopenia. 阿加曲班抗凝治疗肝素诱导的血小板减少症患者清醒镇静下经颈动脉TAVR。

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110764

Augustin Delcampe, Rémi Sabatier, Charline Lacôte, Yohan Repessé, Richard Descamps

{"title":"Argatroban Anticoagulation for Transcarotid TAVR Under Conscious Sedation in a Patient With Heparin-Induced Thrombocytopenia.","authors":"Augustin Delcampe, Rémi Sabatier, Charline Lacôte, Yohan Repessé, Richard Descamps","doi":"10.1016/j.jaccas.2026.110764","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110764","url":null,"abstract":"Objectives: To describe argatroban anticoagulation in a patient with heparin-induced thrombocytopenia undergoing transcarotid transcatheter aortic valve replacement under conscious sedation.Key steps: Vitamin K antagonist therapy was discontinued and intravenous argatroban initiated, with anti-factor IIa monitoring. Procedural anticoagulation consisted of an argatroban bolus followed by continuous infusion guided by activated clotting time. An ultrasound-guided intermediate cervical plexus block with remifentanil sedation maintained consciousness for neurological assessment. Argatroban was resumed postoperatively before transition to vitamin K antagonist therapy.Potential pitfalls: Surgical carotid access under argatroban requires careful balancing of thrombotic and bleeding risks. Maintaining consciousness for neurological monitoring adds an anesthetic challenge, requiring adequate anesthesia for carotid exposure while avoiding excessive sedation; an intermediate cervical plexus block may cause dysphagia.Take-home message: Integrating argatroban anticoagulation with locoregional anesthesia may address the competing requirements of surgical carotid access and continuous neurological monitoring in patients with heparin-induced thrombocytopenia undergoing transcarotid transcatheter aortic valve implantation.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110764"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194089","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}

引用次数: 0

Occult Penetrating Trauma: A STEMI Mimic Hiding in Plain Sight. 隐蔽性穿透性创伤：隐藏在视线中的STEMI模拟物。

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110770

Xiaoling He, Yajie Li, Weigang Luo, Hongwei Dang

{"title":"Occult Penetrating Trauma: A STEMI Mimic Hiding in Plain Sight.","authors":"Xiaoling He, Yajie Li, Weigang Luo, Hongwei Dang","doi":"10.1016/j.jaccas.2026.110770","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110770","url":null,"abstract":"Background: We report a case of acute pericarditis caused by an occult penetrating foreign body manifesting as an ST-segment elevation myocardial infarction mimic.Case summary: The patient initially presented with chest pain, increased cardiac troponin I, and ST-segment elevation. Following emergency intravenous thrombolysis and urgent coronary angiography, an alternative etiology was suspected. Subsequent verification of the medical history and imaging examinations ultimately identified the culprit: a nail. The patient received prompt treatment, and the pericardial foreign body was successfully extracted.Discussion: Acute pericarditis and acute myocardial infarction are common causes of acute chest pain. Diagnostic confusion and treatment delays may arise due to overlapping symptoms, elevation of cardiac biomarkers, ST-segment elevation, cognitive bias, and incomplete history taking.Take-home messages: This case highlights the value of bedside echocardiography combined with chest radiography. In patients with suspected ST-segment elevation myocardial infarction, it is crucial to differentiate acute coronary occlusion from other causes, especially foreign body-induced pericarditis.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110770"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193915","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}

引用次数: 0

Successful Guidewire-Guided Ethanol Ablation for PVCs Originating From Epicardial Anterior Interventricular Groove Adjacent to LAD. 导丝引导下乙醇消融术治疗起源于LAD附近心外膜前室间沟的室性早搏

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110992

Caihong Guo, Xiong Xiong, Hongwei Yi, Yujing Yang, Caiping Han, Chenggang Deng, Jinlin Zhang

{"title":"Successful Guidewire-Guided Ethanol Ablation for PVCs Originating From Epicardial Anterior Interventricular Groove Adjacent to LAD.","authors":"Caihong Guo, Xiong Xiong, Hongwei Yi, Yujing Yang, Caiping Han, Chenggang Deng, Jinlin Zhang","doi":"10.1016/j.jaccas.2026.110992","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110992","url":null,"abstract":"Background: Premature ventricular complexes (PVCs) originating from epicardial anterior interventricular groove and closely adjacent to the left anterior descending artery (LAD) are difficult to eliminate and carry high risks of coronary damage or occlusion. We describe a successful guidewire-assisted ethanol ablation in this high -risk patient.Case summary: A 30-year-old man who presented with palpitations and high-burden PVCs was admitted to our hospital. Pace mapping performed at the epicardial anterior interventricular groove yielded QRS morphology nearly identical to the native PVCs. Coronary angiography revealed that the target site was directly adjacent to the proximal-middle segment of the LAD. Guidewire-assisted ethanol ablation via a small branch of the anterior interventricular vein successfully eliminated the PVCs. Postprocedural coronary angiography showed no coronary artery injury and the patient remained free of PVCs during the 2-month follow-up period.Discussion: Epicardial PVCs arising within the anterior interventricular groove where the LAD runs carry a high risk of coronary artery injury during ablation. Guidewire-assisted anhydrous ethanol ablation serves as an effective and safe therapeutic strategy.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110992"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194024","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}

引用次数: 0

Tachycardia Initiation by Dual-Mode PVC on Ambulatory ECG: Pattern Discovery and Invasive Electrophysiological Characteristics. 动态心电图双模PVC诱发心动过速：模式发现和侵入性电生理特征。

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110736

Deshuang Yang, Cuihong Hou, Yahui Li

{"title":"Tachycardia Initiation by Dual-Mode PVC on Ambulatory ECG: Pattern Discovery and Invasive Electrophysiological Characteristics.","authors":"Deshuang Yang, Cuihong Hou, Yahui Li","doi":"10.1016/j.jaccas.2026.110736","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110736","url":null,"abstract":"Background: Mechanisms of premature ventricular complex (PVC)-induced long-RP tachycardia warrant investigation.Case summary: A 57-year-old man with palpitations underwent 24-hour ambulatory electrocardiogram (ECG). The recording showed 4,150 monomorphic PVCs and 800 episodes of long-RP tachycardia, all triggered by the same PVC morphology. Two initiation patterns emerged. One involved direct retrograde conduction, the other showed retrograde conduction only after PR prolongation. In both patterns, induction occurred across a broad range of PVC coupling intervals. Invasive electrophysiology study (EPS) then demonstrated slow-slow atrioventricular nodal re-entrant tachycardia (SS-AVNRT) involving multiple atrioventricular nodal pathways, consistent with the dual-mode patterns seen on ambulatory ECG. Ablation succeeded, with no recurrence at 6 months.Discussion: To our knowledge, this is the first reported case of SS-AVNRT to show distinctive PVC-induced tachycardia patterns on ambulatory ECG, corroborated by EPS.Take-home message: Ambulatory ECG patterns of PVC-triggered long-RP tachycardia may suggest a dual-pathway substrate for SS-AVNRT, warranting EPS confirmation.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110736"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194059","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}

引用次数: 0

Ablation in Dextrocardia With Interrupted Inferior Vena Cava and Azygos Continuation to Coronary Sinus. 右心伴下腔静脉中断和奇静脉延续冠状窦的消融。

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110744

Xiaobo Liao, Longjiang Hu, Lan Ren, Xin Su, Changsheng Ma, Xueyuan Guo

{"title":"Ablation in Dextrocardia With Interrupted Inferior Vena Cava and Azygos Continuation to Coronary Sinus.","authors":"Xiaobo Liao, Longjiang Hu, Lan Ren, Xin Su, Changsheng Ma, Xueyuan Guo","doi":"10.1016/j.jaccas.2026.110744","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110744","url":null,"abstract":"Background: Atrial fibrillation ablation in dextrocardia with interrupted inferior vena cava presents formidable technical challenges, particularly when anomalous systemic venous return distorts interatrial septal relationships.Case summary: A 58-year-old man with drug-refractory paroxysmal atrial fibrillation, situs inversus totalis with dextrocardia, and inferior vena cava interruption with azygos continuation to the coronary sinus underwent catheter ablation. Lacking an inferior route, a superior approach through the left internal jugular vein was selected. Under intracardiac echocardiography (ICE) guidance, transseptal access was obtained using a dedicated wire-based system. Pulmonary vein isolation and roofline ablation were safely completed using radiofrequency energy.Discussion: Azygos continuation to the coronary sinus drastically distorts interatrial geometry. ICE-guided, wire-based transseptal access via a superior route is a safe, practical alternative when conventional inferior access is unavailable and needle-based puncture poses high risks.Take-home messages: In situs inversus, the left internal jugular vein offers an optimal trajectory for transseptal puncture via a superior approach. Using a dedicated transseptal guidewire instead of a rigid needle, strictly guided by ICE, reduces the risk of mechanical complications during atypical transseptal punctures in complex congenital heart disease.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110744"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194108","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}

引用次数: 0

Severe Bioprosthetic Mitral Valve Dysfunction: Multimodality Imaging Identifies Structural Valve Degeneration and Guides Valve-in-Valve TMVR. 重度生物假体二尖瓣功能障碍：多模态成像识别结构性瓣膜变性并指导瓣内TMVR。

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110750

Michael J McKenna, Conor McCaughey, Greg L Douglas, Charles McCreery, Niall T Mulvihill, Martin Quinn, James A Shand

{"title":"Severe Bioprosthetic Mitral Valve Dysfunction: Multimodality Imaging Identifies Structural Valve Degeneration and Guides Valve-in-Valve TMVR.","authors":"Michael J McKenna, Conor McCaughey, Greg L Douglas, Charles McCreery, Niall T Mulvihill, Martin Quinn, James A Shand","doi":"10.1016/j.jaccas.2026.110750","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110750","url":null,"abstract":"Background: Severe bioprosthetic valve dysfunction presents a diagnostic challenge because distinguishing reversible leaflet thrombosis from structural valve degeneration may not be possible using echocardiography alone.Case summary: A patient with end-stage renal disease, previous bioprosthetic mitral and aortic valve replacement, and prior valve-in-valve transcatheter aortic valve replacement presented with heart failure and cardiogenic shock. Multimodality imaging demonstrated severe bioprosthetic mitral valve dysfunction with restricted leaflet motion, raising suspicion for leaflet thrombosis. Empiric intravenous unfractionated heparin was commenced while cardiac computed tomography was arranged. Computed tomography excluded hypoattenuated leaflet thickening and demonstrated severe leaflet calcification, confirming structural valve degeneration. After heart team discussion, transseptal valve-in-valve mitral replacement resulted in rapid hemodynamic and clinical recovery.Discussion: Serial multimodality imaging guided escalation from anticoagulation to definitive valve intervention.Take-home messages: Persistent prosthetic valve dysfunction after anticoagulation should prompt reassessment for structural valve degeneration. Transseptal valve-in-valve transcatheter mitral valve replacement is an effective treatment for selected high-surgical-risk patients.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110750"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193987","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}

引用次数: 0

Perioperative B-Cell-Targeted Therapy for High-Risk Valve Surgery in Active Primary Sjögren's Disease. 活动性原发性Sjögren疾病高危瓣膜手术围手术期b细胞靶向治疗

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110573

Bing Li, Lili Pan, Hua Liao

{"title":"Perioperative B-Cell-Targeted Therapy for High-Risk Valve Surgery in Active Primary Sjögren's Disease.","authors":"Bing Li, Lili Pan, Hua Liao","doi":"10.1016/j.jaccas.2026.110573","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110573","url":null,"abstract":"Background: Primary Sjögren's disease (SjD) is a systemic autoimmune disease driven by B-cell dysregulation. Clinically significant valvular involvement is uncommon, and evidence guiding perioperative immunomodulation remains limited.Case summary: A 59-year-old woman with SjD and severe aortic stenosis required valve replacement. Preoperative evaluation demonstrated active SjD with elevated inflammatory markers and hypergammaglobulinemia. Following multidisciplinary discussion, telitacicept, corticosteroids, and hydroxychloroquine were initiated before surgery. After improvement in inflammatory activity, the patient underwent aortic valve and ascending aorta replacement. Histopathologic examination showed degenerative valvular changes with focal inflammatory cell infiltration. The postoperative course was uneventful, with normal prosthetic valve function at 1-year follow-up.Discussion: This case highlights the challenges of managing severe valvular heart disease in patients with active primary SjD and a multidisciplinary perioperative strategy incorporating B-cell-targeted therapy. Although preoperative immunomodulation may have attenuated the histopathologic evidence of immune-mediated valvular involvement, the case offers insights when guidance is limited.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110573"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149193916","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}

引用次数: 0

Vascular Plug Closure of Delayed Leaflet Perforation Post-TEER in Patient With Multiple Implantable Devices. 多植入器械患者teer后延迟小叶穿孔的血管栓闭合。

JACC. Case reports Pub Date : 2026-10-16 DOI: 10.1016/j.jaccas.2026.110745

Guanzhong Chen, Zhenyu Xiong, Menghui Liu, Ziwei Zhou, Jiantong Shen, Min Ye, Fengjuan Yao, Xinxue Liao, Xiaodong Zhuang

{"title":"Vascular Plug Closure of Delayed Leaflet Perforation Post-TEER in Patient With Multiple Implantable Devices.","authors":"Guanzhong Chen, Zhenyu Xiong, Menghui Liu, Ziwei Zhou, Jiantong Shen, Min Ye, Fengjuan Yao, Xinxue Liao, Xiaodong Zhuang","doi":"10.1016/j.jaccas.2026.110745","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110745","url":null,"abstract":"Background: Transcatheter edge-to-edge repair (TEER) is the main minimally invasive therapy for severe mitral regurgitation (MR) in patients at high surgical risk. Roughly 10% of patients develop recurrent MR within 1 year postoperatively. Postprocedural mitral anatomical distortion complicates reintervention, rendering recurrent MR management a common clinical challenge.Case summary: A 63-year-old man with multivalvular heart disease, chronic heart failure, multiple implantable devices and dialysis-dependent end-stage renal disease presented with symptomatic severe recurrent MR secondary to delayed anterior mitral leaflet perforation after TEER. Under combined fluoroscopic and 3-dimensional transesophageal echocardiographic guidance, our multidisciplinary team performed transcatheter closure of the perforation using a vascular plug. MR was markedly alleviated, heart failure symptoms resolved, and the patient recovered uneventfully before discharge.Discussion: TEER-related leaflet perforation caused severe recurrent MR. Percutaneous plug closure successfully downgraded MR to trivial, confirming the feasibility of this approach for mitral leaflet perforation.","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110745"},"PeriodicalIF":0.0,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149194026","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}

引用次数: 0