JACC. Case reportsPub Date : 2026-10-21DOI: 10.1016/j.jaccas.2026.110838
Anna M Martens, Nikhil Thatte, Roger E Breitbart, Emy M Kuriakose, Edward O'Leary, Sitaram M Emani, Ryan L Kobayashi
{"title":"Multimodal Left Ventricular Rehabilitation Enabling Double-Switch Repair in Congenitally Corrected Transposition of the Great Arteries.","authors":"Anna M Martens, Nikhil Thatte, Roger E Breitbart, Emy M Kuriakose, Edward O'Leary, Sitaram M Emani, Ryan L Kobayashi","doi":"10.1016/j.jaccas.2026.110838","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110838","url":null,"abstract":"<p><strong>Background: </strong>In congenitally corrected transposition of the great arteries, pulmonary artery banding (PAB) may prepare the morphologic left ventricle (LV) for systemic work before double-switch repair; however, development of ventricular dysfunction threatens candidacy.</p><p><strong>Case summary: </strong>2-year-old boy with corrected transposition of the great arteries and Ebstein-like tricuspid valve malformation developed biventricular dysfunction after PAB tightening, atrial septal stenting, and single-site epicardial pacing for heart block. Biventricular resynchronization therapy, heart failure therapy, and PAB loosening restored ventricular function. Pressure-volume analysis demonstrated comparable ventricular contractility, preserved LV diastolic function, and loading tolerance before uncomplicated double-switch repair.</p><p><strong>Discussion: </strong>Multimodal rehabilitation and serial reassessment may preserve anatomic repair candidacy when reversible dysfunction complicates LV training.</p><p><strong>Take-home messages: </strong>Ventricular dysfunction during LV preparation warrants evaluation for reversible contributors, including pacing-associated dyssynchrony and excessive pressure loading, before abandonment of anatomic repair. Following multimodal rehabilitation, serial imaging and pressure-volume analysis can assess LV systolic recovery, diastolic reserve, and loading tolerance for systemic work.</p>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110838"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149238441","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":"Angiomatoid Fibrous Histiocytoma","authors":"Zulkifl Jafary MD, Saim Rana MD, Megan Vaughan MD, Iraj Hasan MD, Thomas Ogershok MD, Erick Trent MD, Hangyu Watson MD, Prashanti Atluri MD, Harshith Thyagaturu MD","doi":"10.1016/j.jaccas.2026.110028","DOIUrl":"10.1016/j.jaccas.2026.110028","url":null,"abstract":"<div><h3>Background</h3><div>Angiomatoid fibrous histiocytoma (AFH), a type of primary pulmonary artery tumor, is a rare pathology without well-established risk factors, making it a challenging diagnosis.</div></div><div><h3>Case Summary</h3><div>A 28-year-old man with a history of stage 3 Burkitt lymphoma in remission presented with a new systolic heart murmur. Transthoracic echocardiography noted an indeterminate structure in the main pulmonary artery. Cardiac magnetic resonance imaging and positron emission tomography-computed tomography revealed a 1.9 cm hyperintense mass attached to the pulmonic valve and main pulmonary artery wall. The patient underwent resection of the main pulmonary artery and pulmonic valve with pulmonary artery homograft implantation. Surgical pathology revealed angiomatoid fibrous histiocytoma.</div></div><div><h3>Discussion</h3><div>AFH is a rare condition with poor outcomes that is often mistaken for pulmonary embolism. Prompt diagnosis and intervention are crucial to improve prognosis.</div></div><div><h3>Take-Home Message</h3><div>AFH is a rare pathology with poor prognosis that should be considered in all patients with prior oncologic history presenting with a cardiac murmur.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 110028"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880387","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}
JACC. Case reportsPub Date : 2026-10-21Epub Date: 2026-09-02DOI: 10.1016/j.jaccas.2026.110201
Sarah Noorani MD, Tyson Burnham MD, Eric Zuniga MD, MBA, Antonio H. Frangieh MD, MPH, Andy Y. Lee MD
{"title":"Catheter-Based Ventricular Assist Device–Induced Severe Hyperthermia","authors":"Sarah Noorani MD, Tyson Burnham MD, Eric Zuniga MD, MBA, Antonio H. Frangieh MD, MPH, Andy Y. Lee MD","doi":"10.1016/j.jaccas.2026.110201","DOIUrl":"10.1016/j.jaccas.2026.110201","url":null,"abstract":"<div><h3>Background</h3><div>Hemolysis is a potential complication of catheter-based ventricular assist devices (CVADs), but severe hyperthermia is a rare occurrence that significantly affects further management and outcomes.</div></div><div><h3>Case Summary</h3><div>A young man with toxic methamphetamine-associated cardiomyopathy presented with cardiogenic shock, prompting placement of a CVAD. He soon developed severe hyperthermia unresponsive to cooling measures. The hyperthermia ultimately subsided with removal of the device.</div></div><div><h3>Discussion</h3><div>Hemolysis and renal failure are known complications of CVAD placement. The hyperthermia in this patient was likely related to erythrocytosis, highly viscous blood, and resulting hemolysis. The patient returned to normothermia only after removal of the device, supporting the idea that the CVAD was a cause of hyperthermic episode.</div></div><div><h3>Take-Home Messages</h3><div>The use of CVADs in cardiogenic shock offers favorable outcomes but has potential complications. This unique case of severe hyperthermia resulting from massive hemolysis that required prompt removal of the device supports a rare, high-morbidity potential complication.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 110201"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148880390","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 Myocarditis Presenting as Neck Pain With Severe Systemic Inflammation","authors":"Ayesha Fayyaz MBBS, Sher Wali Khan MBBS, EECC, Mariam Azam MD, Madiha Rabbani MD, Valaine Hewitt MD","doi":"10.1016/j.jaccas.2026.109796","DOIUrl":"10.1016/j.jaccas.2026.109796","url":null,"abstract":"<div><h3>Background</h3><div>Acute myocarditis classically presents with chest pain, dyspnea, and arrhythmias; however, atypical and extracardiac presentations may delay recognition. We describe an unusual presentation characterized by unilateral neck pain, dysphagia, profound systemic inflammation, and reversible cardiogenic shock.</div></div><div><h3>Case Summary</h3><div>A 35-year-old previously healthy woman initially presented with unilateral neck pain, dysphagia, and constitutional symptoms without chest pain or dyspnea. She developed hypotension requiring vasopressors, marked leukocytosis, thrombocytopenia, transaminitis, elevated cardiac biomarkers, and severe left ventricular dysfunction (ejection fraction 30%). Cardiac magnetic resonance showed elevated native T1 values and extracellular volume suggestive of diffuse myocardial injury. After infectious causes were excluded, corticosteroid therapy resulted in complete recovery within 1 week.</div></div><div><h3>Discussion</h3><div>Extracardiac symptoms initially obscured the diagnosis; parametric cardiac magnetic resonance mapping proved diagnostically valuable.</div></div><div><h3>Take-Home Messages</h3><div>Myocarditis may present with atypical extracardiac inflammatory symptoms. Parametric cardiac magnetic resonance mapping can support diagnosis when conventional imaging findings are limited or absent.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 109796"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148759723","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}
JACC. Case reportsPub Date : 2026-10-21Epub Date: 2026-08-22DOI: 10.1016/j.jaccas.2026.109927
Pierre-Léo Laporte MD, Gauthier Giordano MD, Géraldine Vedrenne MD, Anne Messali MD, Fabrice Extramiana MD, PhD, Vincent Algalarrondo MD, PhD
{"title":"Dual Rare Lead-Related Complications","authors":"Pierre-Léo Laporte MD, Gauthier Giordano MD, Géraldine Vedrenne MD, Anne Messali MD, Fabrice Extramiana MD, PhD, Vincent Algalarrondo MD, PhD","doi":"10.1016/j.jaccas.2026.109927","DOIUrl":"10.1016/j.jaccas.2026.109927","url":null,"abstract":"<div><h3>Background</h3><div><em>LMNA</em>-related dilated cardiomyopathy is associated with ventricular remodeling and a high arrhythmic risk, frequently requiring implantable cardioverter-defibrillator (ICD) implantation. Although transvenous systems are generally safe, rare lead-related complications may occur.</div></div><div><h3>Case Summary</h3><div>We report a 51-year-old man with <em>LMNA</em>-related dilated cardiomyopathy who experienced 2 rare and sequential ICD lead complications. An initially septal right-ventricular lead was complicated by myocardial transfixion because of anterior apical positioning, revealed by cardiac computed tomography after a rise in pacing thresholds. During reintervention, a second lead was implanted but was later found to have traversed an unrecognized sinus venosus atrial septal defect with partial anomalous pulmonary venous return, resulting in inadvertent left-ventricular lead placement. The lead was successfully repositioned under transesophageal echocardiographic guidance. Three-dimensional computed tomography reconstruction clearly demonstrated both abnormal lead positions.</div></div><div><h3>Discussion and Take-Home Message</h3><div>This case highlights the importance of systematic troubleshooting, awareness of altered anatomy, and multimodality imaging during ICD implantation.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 109927"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148793360","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}
JACC. Case reportsPub Date : 2026-10-21DOI: 10.1016/j.jaccas.2026.110353
Yu Young Kim MD, Kyoungjune Pak MD, PhD, Ji Won Lee MD, PhD, Jung Hyun Choi MD
{"title":"Extremely Severe Aortic Stenosis Mimicking Cardiac Amyloidosis on Multimodality Imaging","authors":"Yu Young Kim MD, Kyoungjune Pak MD, PhD, Ji Won Lee MD, PhD, Jung Hyun Choi MD","doi":"10.1016/j.jaccas.2026.110353","DOIUrl":"10.1016/j.jaccas.2026.110353","url":null,"abstract":"<div><h3>Background</h3><div>Cardiac amyloidosis is increasingly recognized in older patients with severe aortic stenosis, yet advanced pressure-overload remodeling can produce overlapping imaging features that confound noninvasive diagnosis.</div></div><div><h3>Case Summary</h3><div>A 70-year-old woman presented with progressive exertional dyspnea and markedly elevated cardiac biomarkers. Transthoracic echocardiography revealed extremely severe calcific aortic stenosis, increased left ventricular wall thickness, and severely reduced global longitudinal strain. Cardiac magnetic resonance imaging demonstrated elevated native T1 and extracellular volume with late gadolinium enhancement, and cardiac amyloid radionuclide imaging showed Perugini grade 1 uptake. Despite clinical suspicion of cardiac amyloidosis, noninvasive findings remained inconclusive. The patient underwent surgical aortic valve replacement with intraoperative myocardial biopsy, which demonstrated cardiomyocyte hypertrophy and interstitial fibrosis without amyloid deposition, consistent with advanced pressure-overload remodeling rather than infiltrative disease.</div></div><div><h3>Discussion</h3><div>Extremely severe aortic stenosis can mimic cardiac amyloidosis across multiple imaging modalities. Histologic confirmation remains essential when noninvasive findings are discordant or inconclusive.</div></div><div><h3>Take-Home Messages</h3><div>Severe aortic stenosis may closely mimic cardiac amyloidosis on multimodality imaging. Histological confirmation can be decisive in resolving diagnostic uncertainty.</div></div>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":"31 42","pages":"Article 110353"},"PeriodicalIF":0.0,"publicationDate":"2026-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149233788","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":"Patent Foramen Ovale and Paradoxical Embolism Complicating Postdural Puncture Headache in a Parturient.","authors":"Jiale Liu, Chang Liu, Xiang Zheng, Shenghua Li, JuanJuan Huang, Xiaonan Du, Jingli Chen","doi":"10.1016/j.jaccas.2026.110769","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110769","url":null,"abstract":"<p><strong>Background: </strong>Patent foramen ovale (PFO) is associated with migraine and cryptogenic ischemic stroke in young patients. Postdural puncture headache (PDPH) is the most likely cause of headache in a puerpera after epidural anesthesia.</p><p><strong>Case summary: </strong>A 34-year-old multipara presented with refractory postural headache, acute neurologic deficits, and elevated D-dimer following an accidental dural puncture during epidural analgesia for vaginal delivery. Investigations revealed right hemispheric infarction due to internal carotid artery occlusion, a latent PFO, and a history of migraine. Emergency thrombectomy led to full recovery.</p><p><strong>Discussion: </strong>This case suggests that PFO should be considered in postpartum women with intractable PDPH, and that strict bed rest may enhance thrombogenesis and predispose to paradoxical cerebral embolism, potentially worsening outcome.</p><p><strong>Take-home messages: </strong>The association between PDPH, PFO-related headache, and stroke is rarely documented. In puerperae with intractable PDPH refractory to standard therapy, consider PFO.</p>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110769"},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227786","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 : 2026-10-20DOI: 10.1016/j.jaccas.2026.110834
Bryce L Phillips, Bhavya Yarlagadda, William M Yarbrough, Robert Bradley, Christopher J Huffman, Loren G Morgan
{"title":"Left Atrial Undifferentiated Pleomorphic Sarcoma: A Novel HMGA2::AVIL Fusion Presenting as Hemoptysis.","authors":"Bryce L Phillips, Bhavya Yarlagadda, William M Yarbrough, Robert Bradley, Christopher J Huffman, Loren G Morgan","doi":"10.1016/j.jaccas.2026.110834","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110834","url":null,"abstract":"<p><strong>Background: </strong>Cardiac undifferentiated pleomorphic sarcoma (UPS) is a rare primary cardiac malignancy with diagnostic difficulties.</p><p><strong>Case summary: </strong>A 22-year-old man presented with angina, hemoptysis, and dyspnea. Multimodal imaging showed an extensive intra- and extracardiac mass obliterating the left atrium. Following gross tumor resection with pulmonary vein and pericardial patch reconstruction, mouse double minute 2 homolog immunohistochemistry and comprehensive next-generation sequencing (NGS) sarcoma fusion panel testing identified a novel HMGA2::AVIL (inv[12] [q13.3; q14.3]) fusion.</p><p><strong>Discussion: </strong>To our knowledge, this is the first reported HMGA2::AVIL fusion in cardiac UPS, expanding the molecular profile of cardiac sarcomas. NGS could be useful to identify unique drivers of tumorigenesis.</p><p><strong>Take-home message: </strong>This case identifies a novel HMGA2::AVIL fusion, highlighting the utility of comprehensive NGS fusion panels in the diagnostic workup and molecular characterization of UPSs of the heart.</p>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110834"},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227828","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 : 2026-10-20DOI: 10.1016/j.jaccas.2026.110760
Ahmad Younes, Carson Oostra, Robert Roether, Donald Crescenzo, Mohamad Dabaja, Claudiu Georgescu, Stephanie Younes
{"title":"Percutaneous Multivalvular Endocarditis Debulking With a Whole-Body Embolic Protection Device.","authors":"Ahmad Younes, Carson Oostra, Robert Roether, Donald Crescenzo, Mohamad Dabaja, Claudiu Georgescu, Stephanie Younes","doi":"10.1016/j.jaccas.2026.110760","DOIUrl":"https://doi.org/10.1016/j.jaccas.2026.110760","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous debulking of left-sided endocarditis and thrombus has previously relied on cerebral-only embolic protection devices. The Emboliner is an investigational nitinol-mesh filter that provides whole-body embolic protection and has been studied in transcatheter aortic valve replacement.</p><p><strong>Summary: </strong>We describe its first reported use as an adjunct to AngioVac-based debulking in 2 patients: 1 with aortic valve endocarditis and 1 with combined tricuspid and mitral endocarditis.</p><p><strong>Discussion: </strong>The Emboliner was successfully deployed in both cases, with over 90% of vegetation removed and no periprocedural or in-hospital embolic events. Deployment technique differed by vegetation location: in the aortic valve case, the AngioVac cannula was advanced through the filter's access port; in the tricuspid/mitral case, no further interaction with the filter was required once deployed.</p><p><strong>Novelty: </strong>This represents, to our knowledge, the first reported use of whole-body embolic protection during aortic and combined tricuspid/mitral percutaneous endocarditis debulking.</p><p><strong>Take-home message: </strong>Whole-body embolic protection may offer an important adjunct to percutaneous debulking in patients at high surgical risk.</p>","PeriodicalId":14792,"journal":{"name":"JACC. Case reports","volume":" ","pages":"110760"},"PeriodicalIF":0.0,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227864","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}