Journal of Cardiology Cases最新文献

{"title":"Successful endovascular therapy with “Direct tip injection in occlusive lesions (DIOL)” fashion for persistent sciatic artery aneurysmal occlusion: A case report","authors":"Masanaga Tsujimoto MD,&nbsp;Takuya Haraguchi MD,&nbsp;Yoshifumi Kashima MD,&nbsp;Katsuhiko Sato MD,&nbsp;Tsutomu Fujita MD","doi":"10.1016/j.jccase.2024.08.006","DOIUrl":"10.1016/j.jccase.2024.08.006","url":null,"abstract":"<div><div>Persistent sciatic artery (PSA) is a rare congenital anomaly that may involve aneurysmal formations. During endovascular treatment for PSA aneurysm (PSAA) occlusion, guidewire crossing can be challenging due to complex anatomy. We report successful endovascular intervention for PSAA occlusion using the “direct tip injection in occlusive lesions (DIOL)” fashion, in which hydraulic pressure with contrast facilitates guidewire crossing by visualizing the vessel course and expanding the microchannel and vessel lumen. An 80-year-old woman presented with severe intermittent left calf claudication due to PSA occlusion with PSAA. Endovascular treatment was attempted for the occlusion; however, bidirectional wiring in the PSAA was unsuccessful. Therefore, bidirectional DIOL was applied; antegrade-DIOL visualized and enlarged the subintimal plane of the proximal PSAA, while retrograde-DIOL showed intramedial lumen enlargement in the middle and distal PSAA. Consequently, bidirectional guidewires were successfully advanced into the expanded lumen, achieving guidewire externalization. After balloon angioplasty, a self-expandable stent and three stent-grafts were implanted throughout the PSA occlusion, with stent-grafts overlapping around the hip joint to overcome chronic external compression. The final angiogram revealed sufficient blood flow, and the symptoms improved. A 2-year follow-up computed tomography angiography indicated no restenosis. Thus, the DIOL fashion facilitates guidewire crossing in complex occlusions.</div></div><div><h3>Learning objective</h3><div>This case report highlights the successful guidewire crossing for the treatment of a persistent sciatic artery aneurysm (PSAA) occlusion, which can be challenging. The “direct tip injection in occlusive lesions” fashion, using hydraulic pressure with a contrast medium to facilitate guidewire crossing with visualization of the vessel course and expansion of the lesion lumen, is a valuable and safe method for guidewire crossing in PSAA occlusion.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 185-188"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757450","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":"Modest dilation using rotational atherectomy and drug-coated balloon for native coronary proximal lesion with patent internal thoracic artery graft","authors":"Jun Shiraishi MD, FJCC ,&nbsp;Takashi Mabuchi MD ,&nbsp;Takashi Kajihara MD ,&nbsp;Rikuya Ukawa MD ,&nbsp;Tetsuro Nishimura MD ,&nbsp;Takashi Ohkura MD ,&nbsp;Shunta Taminishi MD ,&nbsp;Yumika Tsuji MD ,&nbsp;Makoto Saburi MD ,&nbsp;Masao Takigami MD ,&nbsp;Yoshinori Tsubakimoto MD ,&nbsp;Keiji Inoue MD ,&nbsp;Kazuya Ishibashi MD","doi":"10.1016/j.jccase.2024.08.005","DOIUrl":"10.1016/j.jccase.2024.08.005","url":null,"abstract":"<div><div>Intervention to proximal lesions should be avoided in graft-protected native coronary arteries in general, because there might be a risk for bypass-graft failure. An 81-year-old man with coronary artery bypass grafting surgery due to 3-vessel disease 17 years previously complained of worsening angina. Coronary angiography (CAG) revealed a diseased saphenous vein graft (SVG) and a probable functional occlusion in the mid left anterior descending coronary artery (LAD) concomitant with calcified severe stenosis in the left main (LM)-proximal LAD, and patent right internal thoracic artery (RITA)-LAD graft. After the first percutaneous coronary intervention (PCI) against the SVG lesion, we performed second PCI against the LM-proximal LAD lesions to release angina symptom and prevent LM occlusion. After rotational atherectomy (RA) with 1.5/1.75 mm burrs and balloon dilations, we detected a slight antegrade flow to distal LAD. To preclude possibility of graft failure in the RITA, we did not add further large-balloon dilations and stent implantations, and finally dilated with 3.0-mm drug-coated balloons (DCBs), leading to angina-free condition. Six-month follow-up CAG revealed no further vessel narrowing in both target vessels without RITA-graft failure. Stent-less PCI using relatively small-sized RA/DCB might be feasible for native proximal calcified lesions with patent bypass graft.</div></div><div><h3>Learning objectives</h3><div><ul><li><span>•</span><span><div>Full expansion of native proximal lesions should be avoided in internal thoracic artery (ITA) - protected coronary arteries in general, because it might provoke ITA-graft failure due to flow competition.</div></span></li><li><span>•</span><span><div>Stent-less modest dilation using relatively small-sized rotational atherectomy burr and drug-coated balloon might be a revascularization therapy of choice for native proximal calcified lesion with patent ITA bypass graft.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 196-200"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757452","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":"Long-term efficacy of subclavian vein stenting in a patient on hemodialysis complicated by stasis dermatitis due to subclavian vein stenosis","authors":"Shun Hashimoto MD,&nbsp;Yohei Numasawa MD, PhD,&nbsp;Tadafumi Tamura MD,&nbsp;Kei Kamata MD,&nbsp;Yuhei Shinoda MD,&nbsp;Shoya Ono MD,&nbsp;Souichi Yokokura MD,&nbsp;Hidenori Kojima MD,&nbsp;Makoto Tanaka MD","doi":"10.1016/j.jccase.2024.09.005","DOIUrl":"10.1016/j.jccase.2024.09.005","url":null,"abstract":"<div><div>Data about the long-term safety and efficacy of stent implantation for central venous stenosis in patients on dialysis are limited. We report the case of a 66-year-old man on hemodialysis for end-stage renal disease who presented with stasis dermatitis around an arteriovenous shunt with ulceration of the left forearm. Computed tomography angiography showed a tight stenosis of the proximal left subclavian vein and the development of collateral blood vessels around the stenosis. Percutaneous transluminal angioplasty (PTA) was performed and a bare nitinol stent was implanted in this lesion with intravascular ultrasound (IVUS) guidance. After PTA, the stasis dermatitis improved and the left arm circumference decreased significantly. No stent-related adverse events, such as stent occlusion, left arm swelling, and shunt failure, had occurred by 10 years after PTA. Generally, the patency rate after stenting for central vein stenosis is considered unfavorable. However, in this case, long-term patency might have been achieved by precise assessment of the vessel diameter using IVUS, implantation of a self-expandable stent of the appropriate size, and initiation of post-stenting antithrombotic therapy. This is the first report that highlights the long-term safety and efficacy of IVUS-guided stent implantation in a patient with shunt failure.</div></div><div><h3>Learning objective</h3><div>We report a 66-year-old man on hemodialysis with ulcerating stasis dermatitis around an arteriovenous shunt due to subclavian vein stenosis. We implanted an appropriately sized self-expandable stent using intravascular ultrasound. The patient's clinical course has been uneventful in the past 10 years. This case demonstrates the long-term efficacy of intravascular ultrasound-guided stent implantation for central venous stenosis in a patient with shunt failure.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 205-209"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757384","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":"A case report of pre-implantation feasibility test for combining leadless pacemaker and subcutaneous implantable cardioverter-defibrillator in adult congenital heart disease","authors":"Hibiki Mima MD,&nbsp;Takafumi Oka MD, PhD,&nbsp;Fusako Sera MD, PhD, FJCC,&nbsp;Takayuki Sekihara MD,&nbsp;Kentaro Ozu MD,&nbsp;Yasuhiro Akazawa MD, PhD,&nbsp;Daisuke Nakamura MD,&nbsp;Isamu Mizote MD, PhD,&nbsp;Tomohito Ohtani MD, PhD, FJCC,&nbsp;Yasushi Sakata MD, PhD, FJCC","doi":"10.1016/j.jccase.2024.08.007","DOIUrl":"10.1016/j.jccase.2024.08.007","url":null,"abstract":"<div><div>New cardiac implantable electronic devices (CIEDs), such as leadless pacemakers and subcutaneous implantable cardioverter defibrillators (S-ICDs), are being used in patients with adult congenital heart disease. The selection of CIEDs often requires careful consideration due to technical challenges posed by a unique heart structure. A 27-year-old man following a surgical tetralogy of Fallot (TOF) repair developed non-sustained ventricular tachycardia, sick sinus syndrome, and complete atrioventricular block. He had a history of recurrent bacteremia. We discussed the use of a combination of leadless pacemaker and S-ICD as a non-transvenous CIED after considering the infection risk and decided to select the appropriate CIED after a pre-implantation test. Ventricular tachycardia was not induced in the electrophysiological study. Although he did not need an ICD at that point, patients after TOF repair are at a high risk for ventricular tachycardia later in life. We measured the local pacing threshold and R-wave amplitude and performed an S-ICD screening for paced-QRS. Finally, we implanted a leadless pacemaker safely with the option to add an S-ICD if needed. A pre-implantation test could help future decisions regarding combinations of leadless pacemakers with S-ICDs in patients with adult congenital heart disease.</div></div><div><h3>Learning objectives</h3><div>The appropriate selection of a cardiac implantable electronic device (CIED) in patients with adult congenital heart disease requires careful consideration. The pre-implantation feasibility test for combining a leadless pacemaker (LP) and a subcutaneous implantable cardioverter defibrillator aided decision-making in CIED selection and safe LP implantation procedure in the unique heart structure.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 189-192"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757534","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":"Dissociated rhythms between donor and recipient hearts after heart transplantation using the modified bicaval technique","authors":"Yoshitake Oshima MD ,&nbsp;Tsukasa Kamakura MD, PhD, FJCC ,&nbsp;Tetsuo Nisikawa MD ,&nbsp;Takuya Watanabe MD, PhD ,&nbsp;Yasumasa Tsukamoto MD, PhD ,&nbsp;Kengo Kusano MD, PhD, FJCC","doi":"10.1016/j.jccase.2024.07.007","DOIUrl":"10.1016/j.jccase.2024.07.007","url":null,"abstract":"<div><div>The modified bicaval anastomosis technique is an orthotopic heart transplantation technique that preserves the posterior wall of the right atrium as a bridging tissue, creating a dual structure of the recipient and donor hearts between the superior and inferior venae cavae. In this report, we present a case with unique electrophysiological findings following heart transplantation using this technique. The patient, who had persistent atrial fibrillation before the procedure, achieved a maintained sinus rhythm afterward. During an episode of cavotricuspid isthmus-dependent atrial flutter in the donor heart, an irregular rhythm suggestive of atrial fibrillation was identified in limited areas of the superior and inferior venae cavae. Atrial flutter ceased after cavotricuspid isthmus ablation; however, atrial fibrillation in the superior and inferior venae cavae persisted. The dissociated rhythms were observed probably because atrial fibrillation may have persisted entirely in the recipient's atrium, and could only be visualized through the superior and inferior venae cavae, which were accessible through the endocardium.</div></div><div><h3>Learning objective</h3><div>When two different atrial arrhythmias occur in the donor and recipient hearts in a patient after heart transplantation using the modified bicaval anastomosis technique, the recipient heart's arrhythmia may persist concurrently with the donor heart's, resulting in a “duplex arrhythmia.” Dissociated rhythms could be observed in the separated areas of the right atrium and the superior and inferior venae cavae, which are accessible through the endocardium.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 177-180"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757385","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":"Recurrent left ventricular thrombus after the direct surgical thrombectomy in Fabry disease","authors":"Takuro Makiura MD,&nbsp;Masahiro Daimon MD, PhD,&nbsp;Hiroaki Uchida MD,&nbsp;Takahiro Katsumata MD, PhD","doi":"10.1016/j.jccase.2024.09.004","DOIUrl":"10.1016/j.jccase.2024.09.004","url":null,"abstract":"<div><div>A 60-year-old woman with a recent history of presumed cardiogenic cerebral infarction was referred for surgical removal of a left ventricular mass. She was diagnosed with Fabry disease eight years before. Transthoracic echocardiography showed a mobile echogenic mass in the left ventricular apex. Emergency surgery was carried out to prevent the recurrence of embolism. On cardiopulmonary bypass, the left ventricle was opened in its apical portion and a pedunculated mass was removed from the left ventricular wall. Direct suturing closure followed. The mass was histologically a thrombus composed mainly of erythrocytes and fibrin, without a tumor component. The patient was put on a standard “heparin taken over by warfarin” anticoagulation regimen. The postoperative course was clinically uneventful, but immediate transthoracic echocardiography showed an immobile thrombus on the left ventricular suture line. The patient was followed up with intensified anticoagulation and additional antiplatelet therapy. At 7 months after surgery, the patient had not experienced recurrence of embolism. Early thrombogenesis at the surgical site against anticoagulation may feature the highly thrombogenic status in Fabry disease. Therefore, early and strong warfarinization with antiplatelet therapy may be recommended for patients who undergo cardiotomy with this pathology.</div></div><div><h3>Learning objective</h3><div>Fabry disease accelerates thrombogenesis in blood vessels but does so uncertainly in the cardiac chambers. We describe a patient who developed cerebral infarction from left ventricular thrombosis. After a successful surgical removal of the thrombus from the left ventricle, a new thrombus recurred over the ventricular suture line against a diligent but standard anticoagulation regimen.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 201-204"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757451","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":"SARS-CoV-2 infection-induced immune thrombocytopenia in a patient with orthotopic heart transplantation: A case report and literature review","authors":"Ryohei Ono MD, PhD ,&nbsp;Togo Iwahana MD, PhD ,&nbsp;Kaoruko Aoki MD ,&nbsp;Hirotoshi Kato MD, PhD ,&nbsp;Yuka Tsutsui MD ,&nbsp;Koji Takaishi MD, PhD ,&nbsp;Yusuke Takeda MD, PhD ,&nbsp;Emiko Sakaida MD, PhD ,&nbsp;Yoshio Kobayashi MD, PhD, FJCC","doi":"10.1016/j.jccase.2024.08.003","DOIUrl":"10.1016/j.jccase.2024.08.003","url":null,"abstract":"<div><div>Immune thrombocytopenia (ITP) is an acquired autoimmune disorder characterized by low platelet counts with increased risk of bleeding. In particular, ITP induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been increasingly reported. Since immunosuppressive regimens in organ transplantation are often the primary cause of increased risk of infection, ITP following solid organ transplantation has occasionally been observed. However, SARS-CoV-2 infection-induced ITP in a heart transplant patient has not been reported. We report the first case of ITP after SARS-CoV-2 infection in an orthotopic heart transplant patient who did not respond well to first-line ITP treatment. We also review the previously reported cases of SARS-CoV-2 infection-induced ITP on immunosuppressive therapy.</div></div><div><h3>Learning objective</h3><div>Post-transplant immune thrombocytopenia (ITP) may have different mechanisms than ordinal ITP; post-transplant ITP may be associated with donor condition such as history of ITP, autoantibodies, and use of immunosuppressants. Our literature review showed that severe acute respiratory syndrome coronavirus 2 infection-induced ITP patients with autoimmune diseases, with malignant hematologic disorders, or after organ transplantation may be refractory to prednisolone and intravenous immunoglobulin and require second-line ITP treatments.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 181-184"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757535","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":"Enhancement to effusion: Breast implant-associated anaplastic large cell lymphoma","authors":"Syed H. Ali MD,&nbsp;Akash P. Patel MD,&nbsp;Khan O. Mohammad MD,&nbsp;Neha K. Reddy MD","doi":"10.1016/j.jccase.2024.08.004","DOIUrl":"10.1016/j.jccase.2024.08.004","url":null,"abstract":"<div><div>This case is a rare presentation of breast implant-associated anaplastic large cell lymphoma (BIA-ALCL), where malignant pericardial effusion (MPE) served as the primary manifestation. A 58-year-old woman, post-breast implant removal, presented with pleuritic chest pain, fever, and chills. Clinical evaluation revealed jugular venous distention, muffled heart sounds, and hemodynamic instability. Echocardiogram with Doppler confirmed large pericardial effusion with tamponade physiology. Following a multidisciplinary discussion, a diagnostic and therapeutic pericardiocentesis was performed, resulting in immediate symptomatic relief.</div><div>Cytology studies of the pericardial fluid revealed CD30+, ALK-ALCL, confirming BIA-ALCL. Prompt initiation of brentuximab-cyclophosphamide, doxorubicin, and prednisolone therapy ensued. This case underscores the rarity of MPE as an initial presentation of BIA-ALCL and highlights the significance of early recognition and consideration of rare lymphomas in patients with breast implants.</div></div><div><h3>Learning objective</h3><div>Recognize the importance of considering breast implant-associated anaplastic large cell lymphoma in the differential diagnoses of malignant pericardial effusion.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 6","pages":"Pages 193-195"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142757602","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":"Importance of visualizing the anatomical location of the latissimus dorsi muscle using computed tomography for a robust reimplantation of a subcutaneous implantable cardioverter-defibrillator","authors":"Yuichi Hori MD ,&nbsp;Hiroyuki Soneda MD ,&nbsp;Kouichi Yokoi MD ,&nbsp;Takashi Kurabayashi MD ,&nbsp;Yasutoshi Suzuki MD ,&nbsp;Shiro Nakahara MD, FJCC","doi":"10.1016/j.jccase.2024.07.003","DOIUrl":"10.1016/j.jccase.2024.07.003","url":null,"abstract":"<div><div>The intermuscular technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantations is a technique for implanting the device between the anterior serratus muscle and latissimus dorsi (LD) muscle. A 70-year-old hypertrophic cardiomyopathy patient underwent a surgical repositioning of an S-ICD due to a moved device with skin thinning from mechanical stress. The patient had an S-ICD implantation 4 years prior to the reimplantation and the intermuscular technique was not expected to be achieved. The locational relationship of the S-ICD and LD was visually confirmed by computed tomography (CT), which was useful for planning the reimplantation. The device was reimplanted under the LD, with a position slightly cranial to the apex, and the defibrillation test was successful at 65 J. Our case suggested that preoperative CT imaging detailing the location of the implanted device and LD was practical for an optimal repositioning of an S-ICD.</div></div><div><h3>Learning objective</h3><div>The traditional technique for subcutaneous implantable cardioverter-defibrillator (S-ICD) implantations is associated with pocket-related skin problems in patients who lack sufficient subcutaneous tissue to adequately cover the device. Therefore, the submuscular approach has been used as an alternative technique for safety. In the event of an S-ICD malposition during the long-term follow-up, computed tomography imaging is helpful in identifying the detailed anatomy of the latissimus dorsi muscle and determining the optimal device reimplantation site.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 5","pages":"Pages 147-149"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141848709","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":"Ventricular rupture during the removal of Impella 5.5 in a patient with fulminant myocarditis","authors":"Mai Katsura MD ,&nbsp;Kazuyuki Yahagi MD ,&nbsp;Shun Kitamura MD ,&nbsp;Yuya Tsuruta MD ,&nbsp;Akihiro Higashino MD ,&nbsp;Yu Horiuchi MD ,&nbsp;Masahiko Asami MD ,&nbsp;Kota Komiyama MD, PhD ,&nbsp;Hitomi Yuzawa MD, PhD ,&nbsp;Jun Tanaka MD ,&nbsp;Takayuki Ohno MD, PhD ,&nbsp;Kengo Tanabe MD, PhD","doi":"10.1016/j.jccase.2024.07.004","DOIUrl":"10.1016/j.jccase.2024.07.004","url":null,"abstract":"<div><div>Ventricular perforation or rupture caused by Impella (Abiomed Inc., Danvers, MA, USA) is extremely rare. The Japanese registry of Impella usage reported that the incidence of perforation was 0.02 % in all Impella cases. Herein, we report a rare case of fulminant myocarditis that survived cardiac insufficiency with the combination therapy of veno-arterial extracorporeal membrane oxygenation and Impella 5.5 and left ventricular free wall rupture following Impella removal with emergent surgery. It should be emphasized that the rupture occurred in an unexpected situation. The transesophageal echocardiography-guided removal led to the immediate identification of the cardiac tamponade and consequent survival.</div></div><div><h3>Learning objective</h3><div>Ventricular rupture due to Impella implantation is likely to occur under several conditions: the use of Impella 5.5, friable ventricular wall structure, and the proximity of the device tip to the wall structure. In cases with these factors, extra caution must be observed during the insertion and removal of the device as these entail a greater risk of ventricular injury.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"30 5","pages":"Pages 164-167"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142572231","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}