Journal of Cardiology Cases最新文献

{"title":"Complete atrial screw lead penetration and contralateral pneumothorax post-pacemaker implantation","authors":"Satoko Shiomi MD,&nbsp;Michifumi Tokuda MD, PhD,&nbsp;Hidenori Sato MD, PhD,&nbsp;Kenichi Tokutake MD, PhD,&nbsp;Seigo Yamashita MD, PhD,&nbsp;Michihiro Yoshimura MD, PhD, FJCC,&nbsp;Teiichi Yamane MD, PhD","doi":"10.1016/j.jccase.2024.09.002","DOIUrl":"10.1016/j.jccase.2024.09.002","url":null,"abstract":"<div><div>There are some reports of atrial screw-in lead perforation, but the entire lead body is rarely exposed outside the right atrium at an early stage of the procedure. A man in his 80s had undergone catheter ablation for atrial fibrillation (AF) and had recurrent AF and tachycardia-bradycardia syndrome with 8.8 s of sinus arrest, which caused presyncope. The day after the dual-chamber pacemaker was implanted, atrial screw-in lead perforation caused an elevated threshold, a right pneumothorax, bloody pleural effusion, and pneumomediastinum. A small right thoracotomy with thoracoscopy was performed. The lead that completely penetrated the right atrial appendage and was exposed was safely retracted into the heart and removed thoracoscopically. Early surgery is essential when complete lead perforation with elevated threshold is suspected.</div></div><div><h3>Learning objectives</h3><div><ul><li><span>1.</span><span><div>Perforation of the right atrium by the screw-in lead causes contralateral pneumothorax and chest hemorrhage.</div></span></li><li><span>2.</span><span><div>Elevated lead threshold suggests lead perforation outside the myocardium.</div></span></li><li><span>3.</span><span><div>Treatment was possible with a small right thoracotomy combined with thoracoscopy.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 1","pages":"Pages 1-4"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069603","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":"Alcohol septal ablation in drug-refractory hypertrophic obstructive cardiomyopathy patient with multiple comorbidities","authors":"Ryota Sato MD, PhD ,&nbsp;Atsushi Sakamoto MD, PhD ,&nbsp;Kenichiro Suwa MD, PhD ,&nbsp;Keisuke Iguchi MD, PhD ,&nbsp;Makoto Sano MD, PhD ,&nbsp;Keitaro Akita MD, PhD ,&nbsp;Terumori Satoh MD, PhD ,&nbsp;Hiroe Tsukui MD ,&nbsp;Takenori Ikoma MD, PhD ,&nbsp;Yuichiro Maekawa MD, PhD, FJCC","doi":"10.1016/j.jccase.2024.09.003","DOIUrl":"10.1016/j.jccase.2024.09.003","url":null,"abstract":"<div><div>Septal reduction therapy is an effective treatment for hypertrophic obstructive cardiomyopathy (HOCM). Alcohol septal ablation (ASA) is indicated for HOCM patients who are ineligible for surgical myectomy, but several tips exist for the management of high-risk patients with ASA. Here, we present a case of successful ASA in a HOCM patient with multiple comorbidities, including severe obesity, drug-refractory bronchial asthma, poorly controlled diabetes, and steroid-induced immunosuppression. Pre-procedural strict glycemic control, pre-treatment with corticosteroids for bronchospasm prevention, minimal puncture sites for device insertion, and myocardial contrast echocardiography-guided procedure contributed to the achievement of successful ASA. With careful periprocedural management, ASA is a safe and effective treatment option for drug-refractory HOCM, even in high-risk patients with multiple comorbidities.</div></div><div><h3>Learning objective</h3><div>Alcohol septal ablation can be a beneficial and safe treatment option for hypertrophic obstructive cardiomyopathy patients with multiple comorbidities, including severe obesity, drug-refractory bronchial asthma, poorly controlled diabetes, and steroid-induced immunosuppression. Detailed periprocedural management, including myocardial contrast echocardiography-guided procedure, is the key for achievement.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 1","pages":"Pages 5-8"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016207","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 surgical case of right ventricular outpouching","authors":"Tsukasa Miyatake MD, PhD ,&nbsp;Yuki Tanaka MD ,&nbsp;Koji Sato MD, PhD ,&nbsp;Noriyuki Otsuka MD, PhD ,&nbsp;Akihiko Yotsukura MD, PhD ,&nbsp;Noriyoshi Kato MD, PhD ,&nbsp;Masayuki Sakurai MD, PhD","doi":"10.1016/j.jccase.2024.09.007","DOIUrl":"10.1016/j.jccase.2024.09.007","url":null,"abstract":"<div><div>Outpouching of the heart ventricles, especially of the right ventricle, is rare. Here, we report the case of a 60-year-old male, referred to our institution with an outpouched structure at the right ventricular apex. The patient had no cardiac events. The outpouching was detected incidentally on computed tomography. The structure communicated with the right ventricle through a narrow pedicle. It did not contract, but showed dyskinetic movement with a thin wall. We safely resected it using off-pump coronary bypass apparatuses without cardiopulmonary bypass. Histopathological examination revealed muscular tissues only on the base of the structure, and certain parts of the wall were extremely thin. The treatment of ventricular outpouching, especially of the right ventricle, is controversial. The surgical indications could be decided by comparing the actual risk of rupture with that of surgery if we could accumulate the data from more cases.</div></div><div><h3>Learning objectives</h3><div><ul><li><span>1.</span><span><div>The terminology of heart ventricular outpouched structures is obscure and the structure presented in our patient may be termed a diverticulum, aneurysm, pseudoaneurysm, epicardial cyst, or an outpouching.</div></span></li><li><span>2.</span><span><div>Some right ventricular outpouchings can be resected safely using off-pump coronary bypass apparatuses without cardiopulmonary bypass.</div></span></li><li><span>3.</span><span><div>The surgical indications for right ventricular outpouching refer to those for left ventricular outpouching. More data are expected in the future.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 1","pages":"Pages 17-19"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016204","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 aortic valve implantation: A feasible and a therapeutic procedure for cardiogenic shock in severe aortic stenosis","authors":"Georgios Chalikias MD, PhD,&nbsp;Dimitrios Stakos MD, PhD,&nbsp;Dimitrios Tziakas MD, PhD","doi":"10.1016/j.jccase.2024.09.001","DOIUrl":"10.1016/j.jccase.2024.09.001","url":null,"abstract":"<div><div>Transcatheter aortic valve implantation (TAVI) procedure is a well-established therapeutic measure for severe aortic stenosis with expanding indications. We present a case of a patient who had undergone a TAVI procedure during cardiopulmonary resuscitation on the grounds of cardiogenic shock.</div></div><div><h3>Learning objectives</h3><div>During the past decade, as platform and delivery technology regarding the implementation of transcatheter aortic valve implantation (TAVI) have improved, procedure indications expanded both to low and very high-risk patients. Patients presenting with cardiogenic shock on the grounds of severe aortic stenosis identifies yet another sub-group of patients that could benefit from TAVI.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 1","pages":"Pages 9-11"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143015535","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 of cardiac amyloidosis presenting stiff left atrial syndrome with severe calcification after first AF ablation","authors":"Takuya Nishimura MD,&nbsp;Yuri Ochi MD,&nbsp;Naoki Arima MD,&nbsp;Kenta Sugiura MD,&nbsp;Takayoshi Hirota MD,&nbsp;Toru Kubo MD, FJCC ,&nbsp;Naohito Yamasaki MD,&nbsp;Hiroaki Kitaoka MD, FJCC","doi":"10.1016/j.jccase.2024.09.010","DOIUrl":"10.1016/j.jccase.2024.09.010","url":null,"abstract":"<div><div>Scarring of the left atrial (LA) wall from atrial ablation (AF) leads to the development of stiff LA syndrome. Multiple ablation treatments have been considered to be associated with the development of LA calcification (LAC). We report a case of wild-type transthyretin cardiac amyloidosis (CA) who presented with worsening heart failure due to stiff LA syndrome despite the condition after initial ablation for AF. The case had LAC along the ablation point, a reduced LA reservoir strain by echocardiography, and a characteristic pulmonary artery wedge pressure waveform with markedly elevated v wave by right cardiac catheter examination consistent with stiff LA syndrome. Notably, in patients with CA, there may be a causal relationship between ablation for AF and LAC and development of stiff LA syndrome. When we encounter patients with worsening heart failure with CA after AF ablation, we should pay additional attention to stiff LA syndrome.</div></div><div><h3>Learning objectives</h3><div><ul><li><span>•</span><span><div>In the case of worsening heart failure in patients who have undergone left atrial (LA) catheter ablation, the possibility of stiff LA syndrome due to calcification of the LA should be considered.</div></span></li><li><span>•</span><span><div>A detailed assessment of hemodynamics by echocardiography and right heart catheterization is useful for diagnosis of stiff LA syndrome.</div></span></li><li><span>•</span><span><div>In patients with cardiac amyloidosis treated with radiofrequency catheter ablation for atrial fibrillation, additional attention should be given to calcification of the LA and stiff LA syndrome.</div></span></li></ul></div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"31 1","pages":"Pages 20-23"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11745783/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016201","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 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":"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}