Journal of Cardiology Cases最新文献

{"title":"Stent-less percutaneous coronary intervention using directional coronary atherectomy and drug-coated balloon angioplasty for a stenotic lesion in a patient with vasospastic angina","authors":"Koichi Sato MD, PhD,&nbsp;Mariko Shinozaki MD,&nbsp;Shohei Ikeda MD, PhD,&nbsp;Morihiko Takeda MD, PhD","doi":"10.1016/j.jccase.2025.08.001","DOIUrl":"10.1016/j.jccase.2025.08.001","url":null,"abstract":"<div><div>We report a case of vasospastic angina with clinically significant coronary stenosis, which was successfully treated with stent-less percutaneous coronary intervention (PCI). A man in his 40s with recurrent rest angina was transported to the Emergency Department. Upon arrival, his electrocardiogram showed transient ST-segment elevation. Coronary angiography showed considerable proximal left anterior descending artery stenosis without impaired flow, suggesting vasospastic involvement. Instead of proceeding directly with PCI, a vasospasm provocation test was conducted, and it confirmed severe vasospasm at the stenotic site. Initial treatment with a calcium channel blocker was initiated because of the substantial contribution of vasospasm to the patient's symptoms. However, as exertional angina became predominant, revascularization was considered necessary. Considering the potential for drug-eluting stents to exacerbate coronary vasospasm in the peri-stent region, we opted for a stent-less PCI using directional coronary atherectomy followed by drug-coated balloon angioplasty, achieving a favorable outcome. This case suggests the importance of recognizing vasospasm even in patients with considerable stenosis and highlights the role of vascular functional assessment in guiding PCI decisions. Stent-less PCI using directional coronary atherectomy and drug-coated balloon may be an effective strategy in such cases, reducing the risk of refractory vasospasm associated with drug-eluting stent implantation.</div></div><div><h3>Learning objective</h3><div>Vasospastic angina with considerable coronary artery stenosis is not rare. Drug-eluting stents may cause persistent refractory vasospasm in such cases. Careful evaluation of the patient's clinical history and appropriate vascular function tests can help avoid this complication. Stent-less percutaneous intervention using directional coronary atherectomy and drug-coated balloon angioplasty represents a viable alternative in selected cases.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 6","pages":"Pages 237-240"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625409","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":"Progressive right heart failure after transcatheter closure of patent foramen ovale in a patient with platypnea-orthodeoxia syndrome","authors":"Atsuko Furukawa MD,&nbsp;Rieko Yoshimoto MT,&nbsp;Satoshi Yamamoto MD, PhD,&nbsp;Shingo Hosogi MD, PhD","doi":"10.1016/j.jccase.2025.07.006","DOIUrl":"10.1016/j.jccase.2025.07.006","url":null,"abstract":"<div><div>Platypnea-orthodeoxia syndrome (POS) is associated with right-to-left shunting through a patent foramen ovale (PFO). There have been many reports of transcatheter PFO closure in recent years. We report a case of an 89-year-old woman with POS who developed the condition after surgery for a Stanford type A acute aortic dissection. Transthoracic echocardiography revealed severe tricuspid regurgitation. Subsequently, transesophageal echocardiography showed a right-to-left shunt via PFO. Right heart catheterization revealed no findings of elevated cardiac filling pressures or pulmonary hypertension. She underwent transcatheter PFO closure, which led to postoperative improvement in her hypoxemia. However, right heart dilatation and right ventricular dysfunction developed three months following the closure. In our case, pre-existing severe atrial functional tricuspid regurgitation likely intensified to the right-to-left shunt via PFO. The cardiac morphological deformities associated with severe kyphosis and/or previous open-heart surgery also adversely affected the pathophysiology of POS. Following PFO closure, the loss of the right-to-left shunt resulted in right heart volume overload in the presence of severe tricuspid regurgitation, leading to progressive right heart failure. This case highlights the importance of careful evaluation before PFO closure in patients with severe tricuspid regurgitation, even in the absence of preoperative pulmonary hypertension.</div></div><div><h3>Learning objective</h3><div>Percutaneous patent foramen ovale (PFO) closure is a treatment option for resolving platypnea-orthodeoxia syndrome (POS). In patients with PFO, the coexistence of severe tricuspid regurgitation has been identified as a factor associated with the development of POS and with the progression of right heart failure following interventional closure. Even in the absence of preoperative pulmonary hypertension, the potential for worsening right heart failure after PFO closure should be considered.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 6","pages":"Pages 228-231"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625165","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":"Use of antibiotic loaded absorbable calcium beads in the treatment of infective endocarditis: A case report","authors":"Federico Martinelli MD,&nbsp;Silvia Mariani MD,&nbsp;Enya Di Mascio MD,&nbsp;Giovanni Marchetto MD, PhD","doi":"10.1016/j.jccase.2025.09.001","DOIUrl":"10.1016/j.jccase.2025.09.001","url":null,"abstract":"<div><div>Infective endocarditis in drug-addicted patients is a clinical condition affected by high morbidity and mortality. Valvular lesions are often destructive and can lead to cardiogenic shock for which urgent surgery is necessary before an adequate period of antibiotic therapy. Here we report the case of a 49-year-old man known for drug abuse and referred for urgent surgery due to aortic endocarditis associated with an aortic root abscess. The patient underwent aortic valve replacement. The aortic abscess was excluded using a heterologous pericardial patch after filling with an antimicrobial carrier based on a matrix of calcium sulfate (Stimulan®; Biocomposites Ltd., Keele, UK). The patient had an uneventful postoperative course and recovered well at 6-month follow-up. To our knowledge, this is the first report demonstrating the safety and feasibility of Stimulan® use in the setting of cardiac surgery and infective endocarditis.</div></div><div><h3>Learning objective</h3><div>Infective endocarditis surgery may benefit from the use of an on-site antibiotic carrier, especially when surgery is urgent, and an extended period of systemic treatment is not feasible. Drawing upon the expertise acquired from orthopedic surgery, the use of a topical antibiotic in a slow-release formulation can be safely deployed at the site of infection, close to a prosthetic aortic valve.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 6","pages":"Pages 244-246"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625167","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":"Chronic hypoxia and mediastinal mass: think about a pulmonary artery to left atrial fistula!","authors":"Antoine Fakhry AbdelMassih MD ,&nbsp;Nishant Shah MD ,&nbsp;Maitha AlMazrouei MBBS ,&nbsp;Beshr Hafez MBBS ,&nbsp;Sarah AlAbid MBBS ,&nbsp;Magdi Tofeig CABP, CCST, FRCP, FRCPCH","doi":"10.1016/j.jccase.2025.08.003","DOIUrl":"10.1016/j.jccase.2025.08.003","url":null,"abstract":"<div><div>A pulmonary artery to left atrium (PA to LA) fistula arises from incomplete degeneration of the pulmonary venous and arterial plexus during development. We present a case of a right PA to LA fistula, where the key to diagnosis was the presence of a mediastinal mass combined with mild chronic hypoxia, evidenced by concomitant polycythemia.</div></div><div><h3>Learning objectives</h3><div>Mild desaturation and polycythemia should always raise suspicion of a right-to-left shunt. When these signs are combined with the presence of a mediastinal mass, they strongly suggest a rare pulmonary artery to left atrium fistula. Two transcatheter closure approaches are available: the veno-venous approach and the antegrade approach. The antegrade approach, which employs devices with balanced discs, helps to avoid occluding the left atrial side with large discs.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 6","pages":"Pages 241-243"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625410","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":"Isolated unilateral absence of the right proximal pulmonary artery diagnosed in a neonate: A case report and review of the literature","authors":"Naoya Fukushima MD, PhD ,&nbsp;Jun Maeda MD, PhD ,&nbsp;Yukihiro Yoshimura MD, PhD ,&nbsp;Kazuhiko Shibuya MD, PhD","doi":"10.1016/j.jccase.2025.08.002","DOIUrl":"10.1016/j.jccase.2025.08.002","url":null,"abstract":"<div><div>Isolated unilateral absence of the proximal pulmonary artery is a rare, vascular anomaly that is difficult to diagnose and treat in a timely manner because its symptoms are often not evident in the neonatal period. Failure to treat this condition in its early stages may lead to catastrophic complications later in life. Perinatal fetal echocardiography may be helpful in enabling early intervention by alerting the physician to this anomaly in the neonatal period. We herein report two cases that were diagnosed in the neonatal period; the first case was initially suspected on the basis of fetal echocardiographic findings, while the second case was incidentally diagnosed after the patient was admitted for pneumothorax. Prostaglandin E1 was ineffective in both cases. Staged surgery, initially in the neonatal period and later after the patient's condition stabilized, led to a favorable outcome. The present report also contains a review of seven, previous studies of cases which were diagnosed and treated with prostaglandin E1 during the neonatal period.</div></div><div><h3>Learning objective</h3><div>Fetal echocardiography enables isolated unilateral absence of the right proximal pulmonary artery to be diagnosed in the neonatal period, thereby allowing timely intervention. Initial prostaglandin E1 administration tends to be ineffective, and urgent intervention is usually required. Staged surgery may be a reasonable option for optimizing vascular and alveolar growth.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 6","pages":"Pages 232-236"},"PeriodicalIF":0.0,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145625166","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":"Angioedema presumably caused by hypersensitivity reactions to pacemaker implantation","authors":"Naoshi Ito MD ,&nbsp;Shusuke Yagi MD, PhD, FJCC ,&nbsp;Tomoko Takahashi MD ,&nbsp;Yutaka Kawabata MD, PhD ,&nbsp;Kazuki Tezuka MD ,&nbsp;Tomomi Matsuura MD, PhD ,&nbsp;Muneyuki Kadota MD, PhD ,&nbsp;Takayuki Ise MD, PhD, FJCC ,&nbsp;Koji Yamaguchi MD, PhD ,&nbsp;Hirotsugu Yamada MD, PhD, FJCC ,&nbsp;Takeshi Soeki MD, PhD, FJCC ,&nbsp;Masataka Sata MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.06.017","DOIUrl":"10.1016/j.jccase.2025.06.017","url":null,"abstract":"<div><div><span>Metal allergies, including hypersensitivity to </span>medical devices<span>, are thought to have decreased with the increasing number of medical devices made of titanium. However, cases of angioedema<span> as well as local reactions have been reported after implantation of cardiovascular implantable electronic devices in patients. We report the case of a man in his 80s who experienced left arm swelling after pacemaker implantation 10 years previously, experienced recurrence of left arm swelling, and was diagnosed with angioedema after pacemaker battery exchange. Angioedema should be listed as a differential diagnosis for edema of the arm in patients implanted with implantable cardiovascular electronic devices.</span></span></div></div><div><h3>Learning objective</h3><div>Angioedema due to metal allergies should be listed as a differential diagnosis for edema of the arm in patients implanted with implantable cardiovascular electronic devices even in a pacemaker implanted 10 years previously.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 5","pages":"Pages 191-193"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420339","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":"Hybrid imaging approach for guidance of transcatheter tricuspid valve replacement with Evoque system for lead-associated type B atrial tricuspid valve regurgitation","authors":"Marco Guerrini MD,&nbsp;Mihail Celeski MD,&nbsp;Antonio Popolo Rubbio MD,&nbsp;Nedy Brambilla MD,&nbsp;Maurizio Tusa MD,&nbsp;Marta Barletta MD,&nbsp;Antonio Sisinni MD,&nbsp;Chiara Mainardi MD,&nbsp;Luca Testa MD, PhD,&nbsp;Francesco Bedogni MD","doi":"10.1016/j.jccase.2025.06.020","DOIUrl":"10.1016/j.jccase.2025.06.020","url":null,"abstract":"<div><div><span><span><span>Tricuspid regurgitation (TR) continues to provide a substantial clinical challenge, especially in high-risk patients with severe symptoms. Transcatheter </span>tricuspid valve replacement (TTVR) has recently emerged as a potential and novel therapy option for individuals with at least severe TR. However, the success of TTVR depends heavily on appropriate imaging guidance, with </span>transesophageal echocardiography<span> (TEE) serving as the gold standard for evaluating tricuspid valve morphology and directing device location. Here we present a rare case of a 74-year-old female with lead-associated type B atrial TR who had successful TTVR utilizing the EVOQUE device (Edwards Lifesciences, Irvine, CA, USA). Because TEE image quality was unsatisfactory throughout the procedure, we demonstrate the use of a hybrid imaging technique combining TEE with </span></span>transthoracic echocardiography and multiplanar reconstruction to guide EVOQUE implantation.</div></div><div><h3>Learning objective</h3><div>This case highlights the importance of multimodality imaging<span> during pre-procedural planning in patients with complex tricuspid regurgitation and potential guiding image view obstacles. Alternative imaging modality should be selected primarily based on the anatomy. Non-invasive methods such as three-dimensional transthoracic echocardiography may serve as bailout strategies or, in selected anatomies, as complementary tools for guiding transcatheter tricuspid valve interventions when standard transesophageal echocardiography is limited or contraindicated.</span></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 5","pages":"Pages 194-198"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420340","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":"From pelvis to heart: A rare case of infective endocarditis following ASD device closure due to tubo-ovarian abscess","authors":"Anil Kumar Singhi MBBS, MD, FNB, FRCPCH, FACC ,&nbsp;Souptik Gangopadhyay MBBS, MS ,&nbsp;Soumyajit Ghosh MS, Mch ,&nbsp;Tanmay Banerjee MBBS, MD ,&nbsp;Majarul Islam MD ,&nbsp;Soumen Das MBBS ,&nbsp;Ashvini Sengupta MBBS, MD ,&nbsp;Arnab De BSc, MBA","doi":"10.1016/j.jccase.2025.07.001","DOIUrl":"10.1016/j.jccase.2025.07.001","url":null,"abstract":"<div><div>Infective endocarditis (IE) following transcatheter atrial septal defect (ASD) device closure is a rare but life-threatening complication. We report a case of a 41-year-old woman who developed device-related IE five months after ASD closure, likely secondary to an undiagnosed tubo-ovarian abscess. Initially evaluated for abnormal uterine bleeding, she was diagnosed with uterine fibroids and endometriosis. Pre-anesthetic cardiac assessment revealed a large secundum ASD, which was successfully closed with a 48-mm atrial septal occluder. Despite an uneventful early post-procedure course, her worsening uterine bleeding led to clopidogrel discontinuation. Five months later, she presented with high-grade fever and chills, and echocardiography revealed mobile vegetations on the inferior aspect of the device. A tubo-ovarian abscess was identified as a potential source of infection. Surgical abscess drainage failed to resolve symptoms, necessitating device removal and surgical ASD closure with a pericardial patch. Histopathology confirmed vegetation, although no microorganisms were isolated. This case underscores the need for vigilance in diagnosing IE post-ASD device closure, particularly in patients with distant infections. Negative blood cultures do not exclude IE, and echocardiography is crucial. A multidisciplinary approach, including prompt surgical intervention and prolonged antibiotics, ensures optimal outcomes. Long-term follow-up is essential to prevent recurrence.</div></div><div><h3>Learning objective</h3><div>This case highlights the critical learning objective of recognizing and managing rare but serious complications such as infective endocarditis following <strong>atrial septal defect</strong> device closure. It emphasizes the importance of considering distant infection sources, such as tubo-ovarian abscesses, in patients presenting with post-procedural complications. Furthermore, it underscores the necessity of multidisciplinary collaboration, and prolonged antibiotic therapy and surgical intervention for successful patient outcomes.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 5","pages":"Pages 199-203"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420341","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":"Spontaneous transition of double tachycardia with atrial fusion between atrioventricular reciprocating tachycardia and atrial tachycardia: a case report","authors":"Aiko Takami MD ,&nbsp;Kazuyoshi Ogura MD, PhD ,&nbsp;Toshihiko Akasaka MD, PhD ,&nbsp;Hiroshi Nasu MD ,&nbsp;Ryo Higuchi MD ,&nbsp;Kazuhiro Yamamoto MD, PhD, FJCC","doi":"10.1016/j.jccase.2025.07.003","DOIUrl":"10.1016/j.jccase.2025.07.003","url":null,"abstract":"<div><div>Direct transition between double tachycardias is rarely observed. We report successful ablation of the spontaneous transition of double tachycardia between atrioventricular reciprocating tachycardia (AVRT) and atrial tachycardia (AT). A 53-year-old female patient who complained of palpitations, and was diagnosed with drug-refractory supraventricular tachycardia (SVT), was referred for catheter ablation. Two types of SVT (AT and AVRT) were induced. The AT was sometimes sustained with a Wenckebach AV block. When the AH interval was prolonged beyond 200 ms without the jump-up phenomenon, the HA interval of the next beat stabilized at 135 ms, and there was a transition of AVRT. At an AH interval of 280 ms, spontaneous bidirectional transitions of both tachycardia types, not only AT to AVRT but also AVRT to AT, were observed with a fusion beat reproducibly. The patient underwent radiofrequency catheter ablation for double tachycardia successfully. We focused on the AH intervals and successive HA intervals during tachycardias and examined the spontaneous transition and its mechanism of AT and AVRT.</div></div><div><h3>Learning objective</h3><div>Most spontaneous transition of double tachycardias has been reported with atrioventricular nodal reentrant tachycardia. It can occur after premature atrial or ventricular activity if the cycle lengths of the two tachycardias are similar. In the present case, there was a transition between atrioventricular reciprocating tachycardia and atrial tachycardia as well as fusion of double tachycardias, and the preceding AH interval defined the next beat atrial activation.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 5","pages":"Pages 215-219"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420345","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 closure of anomalous systemic arterial supply to the left lung from the left subclavian artery: Diagnostic and procedural challenges","authors":"Anil Kumar Singhi MD, FNB, FRCPCH, FACC ,&nbsp;Manojit Lodha MD, DM ,&nbsp;Santunu De MD, DM ,&nbsp;Arpita Choraria MBBS ,&nbsp;Sandip Sardar Ms, Mch ,&nbsp;Ejaz Ahmed Bari MD ,&nbsp;Debadri Chakrabarti MBBS","doi":"10.1016/j.jccase.2025.07.007","DOIUrl":"10.1016/j.jccase.2025.07.007","url":null,"abstract":"<div><div>A 26-year-old woman with chronic effort intolerance and a continuous murmur underwent evaluation for suspected congenital heart disease. While initial assessments raised suspicion for a patent ductus arteriosus, computed tomography pulmonary angiography confirmed a rare systemic arterial collateral originating from the left subclavian artery and supplying the left lung. Due to significant left heart chamber dilatation, transcatheter closure was undertaken. A 20-mm vascular plug was successfully deployed to occlude the primary collateral. However, during attempted closure of an additional undetected collateral, sheath migration resulted in vascular dissection and intrapulmonary hemorrhage. The patient required mechanical ventilation, blood transfusion, and intercostal drainage. Hemostasis happened with clot formation at the bleeding site, and the patient gradually stabilized. She was discharged in good clinical condition after seven days. This case underscores the diagnostic and procedural challenges associated with anomalous systemic arterial supply to the lung. It highlights the potential for serious complications despite minimally invasive approaches and emphasizes the critical role of multidisciplinary collaboration in ensuring successful outcomes.</div></div><div><h3>Learning objective</h3><div>To recognize anomalous systemic arterial supply to the lung as a rare but important differential in patients with unexplained continuous murmurs and left heart dilatation, understand the role of advanced imaging in diagnosis, and appreciate the challenges and potential complications of transcatheter closure. This case also emphasizes the importance of multidisciplinary collaboration in managing complex vascular anomalies and ensuring patient safety during high-risk interventions.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"32 5","pages":"Pages 207-210"},"PeriodicalIF":0.0,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145420343","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}