Journal of Cardiology Cases最新文献

{"title":"Successful superior vena cava isolation using point-by-point cryothermal ablation after failed radiofrequency ablation","authors":"Shimpei Seiki MD,&nbsp;Takeshi Matsuura MD,&nbsp;Satoshi Yamamoto MD","doi":"10.1016/j.jccase.2026.06.009","DOIUrl":"10.1016/j.jccase.2026.06.009","url":null,"abstract":"<div><div>Pulmonary vein isolation is the cornerstone of catheter ablation for atrial fibrillation (AF), but non–pulmonary vein (non-PV) triggers such as the superior vena cava (SVC) also play an important role. Electrical isolation of the SVC (SVCI) can be limited by anatomical complexity and the risk of phrenic nerve or sinus node injury, particularly with radiofrequency or cryoballoon techniques. We report a 76-year-old woman with recurrent paroxysmal AF after cryoballoon pulmonary vein isolation. During repeat ablation, AF was initially induced from the left atrial posterior wall and successfully treated with radiofrequency ablation. Subsequent provocation revealed AF triggers from the SVC. Despite careful radiofrequency ablation under phrenic nerve pacing, complete SVCI could not be achieved. Point-by-point cryothermal ablation was then performed under continuous phrenic nerve monitoring, resulting in successful SVCI without complications. This case suggests that focal cryothermal ablation may be a practical and safer alternative when SVCI cannot be achieved with radiofrequency energy.</div></div><div><h3>Learning objective</h3><div>To understand that superior vena cava isolation (SVCI) may be challenging with radiofrequency ablation due to anatomical complexity and safety limitations related to phrenic nerve injury. This case highlights point-by-point cryothermal ablation as a feasible alternative strategy, enabling stable catheter contact, precise lesion delivery, and continuous phrenic nerve monitoring, particularly in regions where point-by-point pulsed-field ablation is not yet available.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 169-172"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078566","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":"Dual cardiac amyloidosis with AL cardiomyopathy and ATTR cardiomyopathy in systemic AL amyloidosis: Recommendation for a myocardial histology-based diagnosis","authors":"Kazuki Fujioka MD,&nbsp;Tetsuji Kitano MD, PhD,&nbsp;Naoki Fujimoto MD, PhD, FJCC,&nbsp;Kazuaki Maruyama MD, PhD,&nbsp;Kai Miyazaki MD,&nbsp;Yukako Shintani-Domoto MD, PhD,&nbsp;Kyoko Imanaka-Yoshida MD, PhD,&nbsp;Kaoru Dohi MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.06.013","DOIUrl":"10.1016/j.jccase.2026.06.013","url":null,"abstract":"<div><div>Accurate amyloid typing in cardiac amyloidosis is clinically important for determining treatment strategies. A 73-year-old man underwent a renal biopsy due to renal dysfunction and was diagnosed with systemic λ-type light chain (AL) amyloidosis. Echocardiography and cardiac magnetic resonance revealed cardiac involvement, leading to a clinical diagnosis of λ-type AL-cardiomyopathy (CM). However, the clinical course and findings were inconsistent with AL-CM. Technetium-99m-pyrophosphate scintigraphy showed intense myocardial uptake corresponding to Grade 3 on visual assessment. Further examination through an endomyocardial biopsy and protein mass spectrometry revealed the patient had both AL-CM and transthyretin amyloid (ATTR)-CM. In addition to chemotherapy for systemic AL amyloidosis, transthyretin stabilizing therapy was initiated for wild-type ATTR-CM. Initially, this patient was diagnosed with AL-CM complicated by systemic AL amyloidosis; however, it was subsequently determined that the cardiac involvement was a coexistence of both AL-CM and ATTR-CM.</div></div><div><h3>Learning objective</h3><div>Even though multimodality imaging approaches have been established with recent advances in imaging technology, it is still challenging to noninvasively and accurately determine specific amyloid subtypes or to predict the presence of multiple types of amyloids. Accurate amyloidosis typing is critically important for determining treatment strategies. When clinical course and imaging findings conflict with the diagnosis, diagnosis based on myocardial tissue should not be deferred. Furthermore, proteomic analysis is highly useful for accurate amyloid typing.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 157-160"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078569","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":"Use of sotatercept in an adolescent patient with idiopathic pulmonary arterial hypertension","authors":"Kohei Kurosaki MD,&nbsp;Yohei Akazawa MD, PhD,&nbsp;Tomoyasu Yuki MD,&nbsp;Kohta Takei MD, PhD,&nbsp;Kiyohiro Takigiku MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.06.010","DOIUrl":"10.1016/j.jccase.2026.06.010","url":null,"abstract":"<div><div>An adolescent boy with idiopathic pulmonary arterial hypertension (iPAH) presented with persistent pulmonary hypertension with right ventricular dysfunction despite upfront oral triple combination therapy. Additional sotatercept treatment led to a striking improvement in pulmonary hemodynamics and right ventricular function without adverse side effects. Sotatercept, recently approved for use in adult patients with PAH, may be an effective and safe therapeutic option for pediatric patients with iPAH. Further studies are needed to confirm the long-term efficacy and safety of this treatment strategy.</div></div><div><h3>Learning objective</h3><div>Sotatercept may be considered as an additional therapy for pediatric patients with idiopathic pulmonary arterial hypertension. Sotatercept treatment in children with idiopathic pulmonary arterial hypertension should be evaluated further.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 173-176"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078677","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":"Managing a mavacamten non-responder in obstructive hypertrophic cardiomyopathy: A case report","authors":"Smita Scholtz MD,&nbsp;Felix Langkamp MD,&nbsp;Volker Rudolph MD,&nbsp;Jan Michael Federspiel MD,&nbsp;Vasco Sequeira PhD","doi":"10.1016/j.jccase.2026.06.011","DOIUrl":"10.1016/j.jccase.2026.06.011","url":null,"abstract":"<div><div>We report the case of a woman in her 40s with obstructive hypertrophic cardiomyopathy who remained symptomatic despite optimal medical therapy. A prior attempt of alcohol septal ablation was not performed due to unsuitable septal branch anatomy. Echocardiography demonstrated severe left ventricular outflow tract (LVOT) obstruction, systolic anterior motion (SAM) of the mitral valve (MV), and moderate-to-severe mitral regurgitation. Biomarkers indicated significant hemodynamic stress, and magnetic resonance imaging revealed myocardial fibrosis. Treatment with the cardiac myosin inhibitor mavacamten was initiated and despite stepwise escalation to 15 mg/day, LVOT gradients and symptoms persisted, classifying her as a treatment non-responder. Genetic testing detected a MYH7 variant of uncertain significance, potentially associated with reduced drug effectiveness. Given refractory obstruction, the multidisciplinary heart team recommended surgical septal myectomy. Intraoperative inspection of the mitral valve revealed not only SAM-related mitral regurgitation, but degenerative MV pathology requiring MV replacement. Postoperatively, LVOT obstruction resolved, and the patient became asymptomatic.</div></div><div><h3>Learning objective</h3><div>This case underscores the clinical importance of recognition of non-response to mavacamten therapy. It highlights the need for careful evaluation of concomitant mitral valve pathology, which may significantly contribute to persistent symptoms beside left ventricular outflow tract obstruction. In selected patients, timely consideration of surgical intervention remains essential to achieve optimal hemodynamic improvement and symptomatic relief when pharmacological treatment alone is insufficient.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 177-180"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078678","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":"Localized bigeminal activity in the left atrial posterior wall preceding atrial fibrillation initiation","authors":"Ko Abe MD, PhD,&nbsp;Kazuhiro Nagaoka MD, PhD,&nbsp;Yasushi Mukai MD, PhD, FJCC,&nbsp;Hiroshi Kojima MD, PhD,&nbsp;Shunji Hayashidani MD, PhD,&nbsp;Hideki Tashiro MD, PhD","doi":"10.1016/j.jccase.2026.06.008","DOIUrl":"10.1016/j.jccase.2026.06.008","url":null,"abstract":"<div><div>Bigeminal activity of the pulmonary veins is considered an indicator of arrhythmogenic triggers of atrial fibrillation (AF). However, few reports have described localized bigeminal activity originating from non-pulmonary vein regions. We observed the phenomenon of local bigeminal activities, which did not develop into premature atrial contraction, in a restricted area of left atrial posterior wall (LAPW), preceding the initiation of the AF. Radiofrequency ablation targeting the site of these bigeminal activities transiently suppressed AF, and subsequent linear ablation connecting the site to the adjacent low-voltage region resulted in durable elimination of AF. The spatial relationship between the localized activity and the low-voltage substrate suggests that conduction abnormalities within diseased atrial myocardium may have contributed to the observed phenomenon. This case highlights the potential role of localized electrical activity arising near a low-voltage substrate of the LAPW in AF initiation and may provide insights into the electrophysiological mechanisms of non-pulmonary vein triggers.</div></div><div><h3>Learning objective</h3><div>Left atrial posterior wall (LAPW) is known to be one of the non-pulmonary vein (PV) origins triggering atrial fibrillation (AF). While bigeminal activity originating from PVs or superior vena cava has been associated with arrhythmogenic triggers, similar activity originating from non-PV origin, such as LAPW, has rarely been described. This case indicates that localized bigeminal activity occurring near a low-voltage substrate of the LAPW may precede AF initiation and provides new insights into non-PV arrhythmogenic substrates as the target of ablation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 165-168"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078676","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":"Sinus arrest during right pulmonary vein isolation related to right sinus node artery injury: a case report","authors":"Shinichi Harada MD,&nbsp;Yoshihiko Kagawa MD, PhD,&nbsp;Daiki Yamashita MD,&nbsp;Katsutoshi Nakamori BS,&nbsp;Takashi Saso BS,&nbsp;Kaoru Dohi MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.06.003","DOIUrl":"10.1016/j.jccase.2026.06.003","url":null,"abstract":"<div><div>A 50-year-old man with long-standing persistent atrial fibrillation received radiofrequency catheter ablation after electrical cardioversion. The second radiofrequency application on anterior antrum of the right superior pulmonary vein induced sinus arrest following a sinus cycle length prolongation. Sinus arrest persisted. Right ventricular pacing was required for 3 min until a sinus rhythm was restored. Preprocedural contrast-enhanced computed tomography revealed that the ablation site was near the right sinus node artery (SNA). Retrospective analysis during catheter ablation confirmed a direct anatomical relationship between the ablation site and the right SNA. In the present case, rapid recovery without coronary intervention suggests a transient and reversible mechanism, such as SNA spasm. This case highlights the importance of preprocedural anatomical assessment of the SNA and performing ablation under sinus rhythm, which may facilitate early recognition of sinus node dysfunction and help prevent irreversible injury.</div></div><div><h3>Learning objective</h3><div>A right sinus node artery might be close to the right superior pulmonary vein and can be affected by right pulmonary vein isolation. In cases of persistent atrial fibrillation, performing ablation under sinus rhythm allows immediate recognition of sinus node dysfunction and may help prevent irreversible sinus node injury.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 144-147"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078565","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":"Pediatric restrictive cardiomyopathy with rapid complete atrioventricular block progression","authors":"Hiromu Ukai MD,&nbsp;Takanori Suzuki MD, PhD,&nbsp;Yoji Nomura MD,&nbsp;Yuya Yamada MD,&nbsp;Ryoichi Ito MD,&nbsp;Masahiro Yasuda MD,&nbsp;Satoru Kawai MD,&nbsp;Yuki Ito MD,&nbsp;Kisaki Amemiya MD,&nbsp;Yoshihiko Ikeda MD,&nbsp;Kinta Hatakeyama MD,&nbsp;Shuichiro Yoshida MD","doi":"10.1016/j.jccase.2026.06.007","DOIUrl":"10.1016/j.jccase.2026.06.007","url":null,"abstract":"<div><div>Restrictive cardiomyopathy (RCM) is a rare pediatric cardiomyopathy characterized by ventricular diastolic dysfunction, and poor prognosis that often requires heart transplantation. We report the case of a 7-year-old boy with RCM complicated by complete atrioventricular block (CAVB) in whom pathological examination of the explanted heart demonstrated extensive fibrosis involving the cardiac conduction system. At 1 year and 9 months of age, the patient presented with arrhythmia. Echocardiography revealed marked biatrial enlargement and small ventricles. Cardiac catheterization demonstrated elevated filling pressures confirming RCM. One month after diagnosis, the patient developed severe bradycardia and circulatory collapse, requiring extracorporeal membrane oxygenation. Electrocardiography revealed complete atrioventricular (AV) block, and a permanent pacemaker (PM) was implanted. Despite recurrent heart failure episodes, cardiac function was maintained with medical therapy, including carvedilol and enalapril, without mechanical circulatory support until heart transplantation at 5 years of age. Pathology of the explanted heart revealed extensive interstitial fibrosis involving the conduction system, suggesting that conduction tissue fibrosis caused the CAVB. These findings provide pathological insight into the mechanism of advanced atrioventricular block in pediatric RCM. This case demonstrates that RCM may progress from first-degree AV block to CAVB due to conduction fibrosis.</div></div><div><h3>Learning objective</h3><div>Understanding the clinical and pathological progression of restrictive cardiomyopathy (RCM) complicated by complete atrioventricular block in children is important. This case illustrates that fibrosis of the conduction system can lead to severe bradycardia and circulatory collapse, highlighting the importance of the early detection of conduction abnormalities and timely pacemaker implantation. It has also been demonstrated that appropriate medical therapy combined with pacemaker management can effectively bridge pediatric patients with RCM to heart transplantation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 152-156"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078568","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":"Transcatheter left ventricular assist device decommissioning","authors":"Raziye E. Akdogan MD,&nbsp;Rohan Dod MD,&nbsp;Eric Batista MD,&nbsp;Matthew G. Kaye MD,&nbsp;Zachary M. Gertz MD, MBe","doi":"10.1016/j.jccase.2026.07.003","DOIUrl":"10.1016/j.jccase.2026.07.003","url":null,"abstract":"<div><div>Left ventricular assist devices (LVADs) provide mechanical circulatory support for patients with end-stage heart failure. In some patients, mechanical support may lead to adequate recovery of myocardial function. In such cases, discontinuation of LVAD support, known as decommissioning, may be appropriate. Traditionally, LVAD decommissioning required surgical explantation, a procedure associated with significant risk and surgical complexity. More recently, a less invasive approach has emerged utilizing transcatheter outflow graft occlusion and driveline transection. Here, we present seven cases of transcatheter LVAD decommissioning highlighting the procedure and potential clinical benefits.</div></div><div><h3>Learning objective</h3><div>Left ventricular assist device (LVAD) decommissioning with transcatheter outflow graft occlusion is a potential management option for patients exhibiting myocardial recovery and may be preferable to surgical explantation in carefully selected patients. More studies are needed to assess long-term outcomes after transcatheter LVAD decommissioning and define optimal anticoagulation management post-procedure.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 181-185"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078679","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":"Successful extravascular implantable cardioverter-defibrillator implantation in a patient with short QT syndrome: A case report","authors":"Nobuhisa Kodera MD,&nbsp;Nobuhiro Nishii MD, PhD,&nbsp;Akira Ueoka MD, PhD,&nbsp;Koji Nakagawa MD, PhD,&nbsp;Hiroshi Morita MD, PhD,&nbsp;Shinsuke Yuasa MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.06.002","DOIUrl":"10.1016/j.jccase.2026.06.002","url":null,"abstract":"<div><div>Short QT syndrome (SQTS) can present with life-threatening ventricular fibrillation (VF), requiring timely resuscitation and secondary prevention. A male patient in his 20s was resuscitated from VF and diagnosed with SQTS. Genetic testing may identify rare variants, such as in SLC4A3, expanding the known genetic spectrum of SQTS. Tall T waves may cause subcutaneous implantable cardioverter-defibrillator (S-ICD) screening failure in some vectors, highlighting limitations of S-ICDs in certain SQTS patients. Extravascular ICD implantation can be a feasible and effective option for patients with SQTS when transvenous or subcutaneous ICDs are suboptimal.</div></div><div><h3>Learning objectives</h3><div>Short QT syndrome (SQTS) can present with life-threatening ventricular fibrillation, requiring timely resuscitation and secondary prevention.</div><div>Genetic testing may identify rare variants, such as in SLC4A3, expanding the known genetic spectrum of SQTS.</div><div>Tall T waves may cause subcutaneous implantable cardioverter-defibrillator (S-ICD) screening failure in some vectors, highlighting limitations of S-ICDs in certain SQTS patients.</div><div>Extravascular ICD implantation can be a feasible and effective option for patients with SQTS when transvenous or subcutaneous ICDs are suboptimal.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 139-143"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078564","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":"Prenatal diagnosis of mitral–pulmonary intervalvular fibrosa pseudoaneurysm associated with TGA causing severe pulmonary stenosis: A rare case report","authors":"Aliya Kemal Ahsan MBBS, FCPS,&nbsp;Putri Yubbu MBBS,&nbsp;Anizah Aishah Rosli MBBS","doi":"10.1016/j.jccase.2026.06.006","DOIUrl":"10.1016/j.jccase.2026.06.006","url":null,"abstract":"<div><div>Pseudoaneurysm of the mitral–aortic intervalvular fibrosa is a rare and typically acquired cardiac lesion, with congenital forms being exceptionally uncommon, particularly when identified prenatally. We report the case of a 23-year-old gravida 2 woman with one previous history of miscarriage who was referred at 25 weeks' gestation for a fetal intracardiac mass. Fetal echocardiography revealed a cystic echogenic mass at the crux of the heart, consistent with a pseudoaneurysm arising from the mitral-pulmonary intervalvular fibrosa (MPIVF) associated with transposition of the great arteries, causing severe left ventricular outflow tract obstruction or subvalvular pulmonary stenosis. The cardiac lesion was also associated with a large mid-muscular ventricular septal defect alongside a small left ventricle suggestive of single-ventricle physiology. This constellation of findings pointed to a diagnosis of complex cyanotic congenital heart disease with possible ductal-dependent pulmonary circulation. Prenatal diagnosis enabled early parental counseling, planning for delivery at a tertiary cardiac center, and postnatal preparation for prostaglandin therapy and surgical evaluation. This case highlights the importance of recognizing MPIVF pseudoaneurysm in the fetal period, particularly when associated with obstructive physiology or major structural anomalies, and contributes to the limited literature on congenital variants of this condition.</div></div><div><h3>Learning objective</h3><div>Pseudoaneurysm of the mitral–pulmonary intervalvular fibrosa is an exceptionally rare congenital lesion. Its association with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction has important prognostic and surgical implications. Prenatal echocardiography is key for recognition, particularly when there is a cystic or echogenic intracardiac mass with a to-and-fro Doppler flow near the atrioventricular junction. Prenatal echocardiography is crucial for early counseling and planned delivery at a tertiary cardiac center.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"34 4","pages":"Pages 148-151"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149078567","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}