JACC. Case reports最新文献_第5页

Ischemic Stroke as the Presenting Feature of Anterior STEMI Complicated by LV Thrombus and Pseudoaneurysm 缺血性脑卒中作为STEMI前段合并左室血栓和假性动脉瘤的表现特征。

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-08-20 DOI: 10.1016/j.jaccas.2026.109929

Ibrahim Hasan MD, Nebras Hasan MD, Pierre Sfeir MD, Noura El Sayegh MD, Marwan M. Refaat MD, Ziyad Ghazzal MD

{"title":"Ischemic Stroke as the Presenting Feature of Anterior STEMI Complicated by LV Thrombus and Pseudoaneurysm","authors":"Ibrahim Hasan MD, Nebras Hasan MD, Pierre Sfeir MD, Noura El Sayegh MD, Marwan M. Refaat MD, Ziyad Ghazzal MD","doi":"10.1016/j.jaccas.2026.109929","DOIUrl":"10.1016/j.jaccas.2026.109929","url":null,"abstract":"<div><h3>Background</h3><div>Delayed presentation of anterior ST-segment elevation myocardial infarction (STEMI) increases the risk of thromboembolic and mechanical complications.</div></div><div><h3>Case Summary</h3><div>We report a 41-year-old man who presented with transient right upper extremity weakness and dysarthria and was found to have electrocardiographic evidence of an old anterior myocardial infarction. He experienced chest pain 3 days earlier without seeking medical attention. Cardiac catheterization revealed thrombotic lesions involving the left anterior descending artery and diagonal bifurcation. Echocardiography demonstrated moderately reduced left ventricular systolic function with a large apical thrombus. Brain magnetic resonance imaging showed a small acute ischemic infarct. He was managed medically with antithrombotics and heart failure therapy. Eight weeks later, regular follow-up imaging revealed severe left ventricular dysfunction, aneurysmal remodeling, and pseudoaneurysm formation, requiring urgent surgical repair.</div></div><div><h3>Discussion</h3><div>This case highlights the dynamic progression from thromboembolic to mechanical complications following delayed-presentation STEMI and underscores the importance of early recognition, multimodality imaging, and close follow-up.</div></div><div><h3>Take-Home Messages</h3><div>Delayed-presentation anterior STEMI may first manifest as acute ischemic stroke because of left ventricular thrombus. Close follow-up and multimodality imaging are essential to detect late mechanical complications such as left ventricular pseudoaneurysm.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 109929"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793442","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}

引用次数: 0

Managing Acute STEMI in the Setting of Immune Thrombocytopenic Purpura 在免疫性血小板减少性紫癜的背景下处理急性STEMI：治疗困境。

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-08-19 DOI: 10.1016/j.jaccas.2026.109902

Khaleed Jemmieh MD, Mohamed Tawengi MD, Jawaher Baraka MD, Fathima Mahmood MD, Fatima Alzahraa Alhaj Akeel MD, Abdelkarim Alammora MD, Mhd Ghith Choura MD

{"title":"Managing Acute STEMI in the Setting of Immune Thrombocytopenic Purpura","authors":"Khaleed Jemmieh MD, Mohamed Tawengi MD, Jawaher Baraka MD, Fathima Mahmood MD, Fatima Alzahraa Alhaj Akeel MD, Abdelkarim Alammora MD, Mhd Ghith Choura MD","doi":"10.1016/j.jaccas.2026.109902","DOIUrl":"10.1016/j.jaccas.2026.109902","url":null,"abstract":"<div><h3>Background</h3><div>Immune thrombocytopenia (ITP) is an autoimmune condition characterized by thrombocytopenia. Despite bleeding tendencies, patients with ITP face thrombotic risks. Acute coronary syndrome in ITP is uncommon and poses a management dilemma between antithrombotic therapy and the high bleeding risk.</div></div><div><h3>Case summary</h3><div>A 43-year-old man with severe ITP (platelet nadir 1 × 10<sup>3</sup>/μL) treated with avatrombopag presented with inferoposterior ST-elevation myocardial infarction (STEMI). Angiography showed occlusion of the right posterolateral ventricular branch and right posterior descending artery. Plain old balloon angioplasty was performed without stenting. He remained stable without bleeding and was discharged on dual antiplatelet therapy, avatrombopag, and prednisolone.</div></div><div><h3>Discussion</h3><div>ITP presents a clinical paradox of concurrent bleeding and clotting risks. Managing STEMI requires balancing these competing mechanisms.</div></div><div><h3>Take-Home Messages</h3><div>Thrombocytopenia in ITP does not protect against acute coronary syndrome. Navigating the balance between bleeding and clotting following a STEMI event requires a tailored, flexible approach.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 109902"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793466","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}

引用次数: 0

Elongated Channels Between Surgically Excluded LAA and LA 手术排除的LAA和LA之间的通道延长：CTA检测到但TEE未发现。

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-09-02 DOI: 10.1016/j.jaccas.2026.110207

Parsa Asachi MD, Alan Vainrib MD, Didier F. Loulmet MD, Ali Hage MD, MPH, Anthony Aizer MD, Larry A. Chinitz MD, Richard Ro MD, Muhamed Saric MD, PhD

{"title":"Elongated Channels Between Surgically Excluded LAA and LA","authors":"Parsa Asachi MD, Alan Vainrib MD, Didier F. Loulmet MD, Ali Hage MD, MPH, Anthony Aizer MD, Larry A. Chinitz MD, Richard Ro MD, Muhamed Saric MD, PhD","doi":"10.1016/j.jaccas.2026.110207","DOIUrl":"10.1016/j.jaccas.2026.110207","url":null,"abstract":"<div><h3>Background</h3><div>Systematic left atrial appendage (LAA) exclusion during mitral valve surgery reduces thromboembolic risk in patients with pre- or postoperative atrial fibrillation. Rare residual LAA-left atrial (LA) communications may occasionally occur after surgical exclusion and increase thromboembolic risk, particularly in patients not receiving anticoagulation.</div></div><div><h3>Case Series</h3><div>Among more than 2,000 robotic mitral valve surgeries performed at NYU Langone Health from 2010 to 2025, LAA closure with LA posterior wall plication was performed using a continuous back-and-forth suture technique. We identified 4 patients with elongated residual LAA-LA communications that were occult on transesophageal echocardiography (TEE) but clearly visualized by cardiac computed tomography angiography (CCTA). TEE demonstrated persistent echolucency and color Doppler flow within the excluded LAA without a visible communication entrance. A tubular channel extending from the LAA, termed the “panhandle sign,” was consistently observed. CCTA identified the communication orifices and guided successful transcatheter vascular plug closure.</div></div><div><h3>Conclusions</h3><div>Rare elongated residual LAA-LA communications may be missed on routine TEE after LAA exclusion with LA plication. Persistent LAA flow and echolucency should prompt CCTA to detect occult communications and guide percutaneous closure. The “panhandle sign” may represent an imaging marker specific to our institutional extended-suture technique that facilitates earlier recognition.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 110207"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880376","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}

引用次数: 0

Impaired Atrioventricular Conduction System in a Postoperative Heart With Congenitally Corrected Transposition of the Great Arteries 先天性大动脉转位的心脏术后房室传导系统受损。

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-09-09 DOI: 10.1016/j.jaccas.2026.110002

Taka-aki Matsuyama MD, PhD, Yohsuke Makino MD, PhD, Eri Nakamura MD, Hatsue Ishibashi-Ueda MD, PhD, Siew Yen Ho PhD

{"title":"Impaired Atrioventricular Conduction System in a Postoperative Heart With Congenitally Corrected Transposition of the Great Arteries","authors":"Taka-aki Matsuyama MD, PhD, Yohsuke Makino MD, PhD, Eri Nakamura MD, Hatsue Ishibashi-Ueda MD, PhD, Siew Yen Ho PhD","doi":"10.1016/j.jaccas.2026.110002","DOIUrl":"10.1016/j.jaccas.2026.110002","url":null,"abstract":"<div><h3>Background</h3><div>Twin atrioventricular nodes (AVNs) occasionally occur in congenitally corrected transposition of the great arteries (ccTGA).</div></div><div><h3>Case Summary</h3><div>A 14-year-old adolescent girl with ccTGA died suddenly after cardiopulmonary arrest. The electrocardiogram showed QRS widening from age 6. At autopsy, a Rastelli conduit and a fibrotic scar from ventricular septal defect patch closure were present. Serial sections revealed isolated anterior and posterior AVNs. The posterior AVN continued into an elongated His bundle that was disrupted by fibrosis, whereas the anterior AVN was interrupted by fibrofatty tissue.</div></div><div><h3>Discussion</h3><div>QRS widening was likely caused by interruption of the elongated His bundle. Although posterior-dominant AVN is uncommon, it should be considered when planning surgery for ccTGA.</div></div><div><h3>Take-Home Message</h3><div>A posterior-dominant AVN is uncommon; however, it should be considered when planning surgery for ccTGA with usual atrial arrangement.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 110002"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148919727","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}

引用次数: 0

No Paradox, Only Anatomy 没有悖论，只有解剖

JACC. Case reports Pub Date : 2026-10-21 DOI: 10.1016/j.jaccas.2026.110672

Konstantinos N. Aronis MD, PhD

引用次数: 0

Systemic Amyloidosis After Liver Transplantation From a Donor With Hereditary Transthyretin Amyloidosis 遗传性甲状腺转蛋白淀粉样变供体肝移植后的系统性淀粉样变

JACC. Case reports Pub Date : 2026-10-21 DOI: 10.1016/j.jaccas.2026.110670

Moises Abtibol Machado MD, Matheus Martins Monteiro MSc, Denison Clark Corrêa de Miranda MD, Marcela Oliveira de Azevedo MS, Rodrigo Fernandes de Castro MD, Nayara do Carmo Santos Lima RN, Diogo Corrêa Lamberti MS, Andreza Araújo de Oliveira MS, Kátia do Nascimento Couceiro PhD, João Marcos Bemfica Barbosa Ferreira PhD

{"title":"Systemic Amyloidosis After Liver Transplantation From a Donor With Hereditary Transthyretin Amyloidosis","authors":"Moises Abtibol Machado MD, Matheus Martins Monteiro MSc, Denison Clark Corrêa de Miranda MD, Marcela Oliveira de Azevedo MS, Rodrigo Fernandes de Castro MD, Nayara do Carmo Santos Lima RN, Diogo Corrêa Lamberti MS, Andreza Araújo de Oliveira MS, Kátia do Nascimento Couceiro PhD, João Marcos Bemfica Barbosa Ferreira PhD","doi":"10.1016/j.jaccas.2026.110670","DOIUrl":"10.1016/j.jaccas.2026.110670","url":null,"abstract":"<div><h3>Background</h3><div>Acquired transthyretin (TTR) amyloidosis after domino liver transplantation is rare and may manifest years after the procedure, with neurologic involvement.</div></div><div><h3>Case Summary</h3><div>A 75-year-old man received a liver from a donor with TTR amyloid polyneuropathy. Twelve years later, he developed paresthesias, diarrhea, and blood pressure lability. Electroneuromyography showed a length-dependent, predominantly axonal sensorimotor polyneuropathy, with absent sympathetic skin responses, indicating autonomic involvement. Abdominal fat pad biopsy was Congo red positive, and TTR genetic testing was negative. Cardiac involvement was absent. He was treated with pregabalin and fludrocortisone, and patisiran was indicated as disease-modifying therapy.</div></div><div><h3>Discussion</h3><div>The association of progressive neuropathy, dysautonomia, gastrointestinal manifestations, and domino transplantation favored acquired TTR amyloidosis over diabetic neuropathy. Reported cases show onset after 5-10 years, with neuropathy preceding cardiac disease.</div></div><div><h3>Take-Home Message</h3><div>Domino transplant recipients require long-term follow-up, even with negative genetic testing and no initial cardiomyopathy, to enable early diagnosis and monitoring of systemic progression.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 110670"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149234189","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}

引用次数: 0

TEVAR as a Lifesaving Strategy in Infected Complex Aortic Graft Rupture TEVAR作为感染性复杂主动脉瓣破裂的救命策略

JACC. Case reports Pub Date : 2026-10-21 DOI: 10.1016/j.jaccas.2026.110673

Alejandro Escobar MD, Cristian Paez-Cancelado MD

引用次数: 0

Editorial Board/Officers Page 编辑委员会/官员页

JACC. Case reports Pub Date : 2026-10-21 DOI: 10.1016/S2666-0849(26)03933-1

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Full Issue PDF 完整版PDF

JACC. Case reports Pub Date : 2026-10-21 DOI: 10.1016/S2666-0849(26)03986-0

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Staged Antithrombotic Reinitiation After STEMI Complicated by LV Thrombus and Intracerebral Hemorrhage STEMI合并左室血栓和脑出血后分期抗血栓再启动。

JACC. Case reports Pub Date : 2026-10-21 Epub Date: 2026-08-20 DOI: 10.1016/j.jaccas.2026.109886

Slake Mokrytzki MBBS, Anne Yan Ting Chua MBBS, Alison Thompson MD, Miguel Mesarina DO, John F. Setaro MD

{"title":"Staged Antithrombotic Reinitiation After STEMI Complicated by LV Thrombus and Intracerebral Hemorrhage","authors":"Slake Mokrytzki MBBS, Anne Yan Ting Chua MBBS, Alison Thompson MD, Miguel Mesarina DO, John F. Setaro MD","doi":"10.1016/j.jaccas.2026.109886","DOIUrl":"10.1016/j.jaccas.2026.109886","url":null,"abstract":"<div><h3>Background</h3><div>Left ventricular thrombus after anterior ST-segment elevation myocardial infarction requires anticoagulation, and recent stenting requires dual antiplatelet therapy, but no guideline addresses antithrombotic sequencing when intracerebral hemorrhage complicates both.</div></div><div><h3>Case Summary</h3><div>A 63-year-old woman developed an apical left ventricular thrombus after left anterior descending artery percutaneous coronary intervention for late anterior ST-segment elevation myocardial infarction, then a left temporal intracerebral hemorrhage on day 2 while receiving aspirin, ticagrelor, and heparin. Declining ejection fraction and enlarging thrombi prompted staged reinitiation: cangrelor, clopidogrel, unfractionated heparin, then apixaban after serial neuroimaging confirmed stability.</div></div><div><h3>Why Beyond the Guidelines</h3><div>No guideline addresses the timing, sequence, or agent selection when these 3 indications converge.</div></div><div><h3>Discussion</h3><div>Staged reinitiation with short-acting and reversible agents may allow antithrombotic escalation guided by serial neuroimaging stability.</div></div><div><h3>Take-Home Message</h3><div>When competing thrombotic and hemorrhagic risks fall outside guideline pathways, antithrombotic therapy can be reintroduced in reassessable steps, starting with short-acting agents, guided by serial neuroimaging.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 109886"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793040","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}

引用次数: 0