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  • 1
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    Abstract 17147: Multidisciplinary-team Management Of A Severely-ill Pregnant Covid-19 Patient With A Newly Diagnosed Severe Mitral Stenosis
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: A 30-year-old female who was 26 weeks pregnant, presented to an outside facility with acute hypoxic respiratory failure and was initially treated as an asthma exacerbation. Her chest X-ray and CT revealed extensive bilateral airspace disease of ground glass opacities (Figure 1A) and a main pulmonary artery diameter of 3.5 cm. Transesophageal echocardiogram revealed severe mitral stenosis (MS) with a high Wilkins-Abascal score of 11/16, a mean mitral gradient of 19 mmHg, and a right ventricular systolic pressure of 94 mmHg consistent with severe pulmonary hypertension (Figure 1B, 1C). Rapid COVID test was positive, patient clinically deteriorated and was emergently transferred to our facility. She rapidly required intubation and vasopressor support. Our multi-disciplinary team (MDT) decided to perform an emergent rescue percutaneous balloon mitral valvuloplasty, which led to an improvement of mitral stenosis, but with a resultant significant MR. Intraoperative decision was taken to proceed with an emergency cesarean section and a live male was delivered. Postoperatively, she was treated supportively for COVID pneumonia with rapid improvement in clinical status. She was extubated on the 3 rd postoperative day (POD), and was ambulating without any need for oxygen by the 7 th POD, and discharged home on the 11 th POD. Her infant continued to improve and was discharged 1 month later. Discussion: Rheumatic MS constitutes a major cause of acquired heart disease complicating pregnancy in the developing world. This case report features some of the challenges in the diagnosis and management of a complex condition in the pandemic environment and highlights the importance of MDT approach.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.17147
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 2
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    Spontaneous coronary artery dissection of the proximal left circumflex artery: a case report
    Oxford University Press (OUP) ; 2019
    In:  European Heart Journal - Case Reports Vol. 3, No. 3 ( 2019-09-01)
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 3, No. 3 ( 2019-09-01)
    Abstract: Spontaneous coronary artery dissection (SCAD) has gained attention as an important cause of acute coronary syndrome and sudden cardiac death (SCD) among women. Management strategies of SCAD differ from those of atherosclerotic disease. There is an elevated risk of complications and suboptimal outcomes in patients with SCAD undergoing percutaneous coronary interventions (PCIs). Case summary A 48-year-old woman without any traditional cardiovascular risk factors was admitted with severe central chest pain with associated dyspnoea and diaphoresis. The patient had a strong family history of SCD, affecting three female members in their 40s and 50s. Cardiac troponins were elevated. Coronary angiogram showed moderate to severe stenosis of the proximal circumflex coronary artery. Optical coherence tomography confirmed SCAD with sub-intimal haematoma. Despite significant stenosis in the proximal segment of a relatively large artery, a decision was made not to proceed with PCI. The follow-up angiogram demonstrated normal coronaries. Magnetic resonance imaging of renal arteries showed features suggestive of fibromuscular dysplasia affecting the right renal artery. Subsequent genetic counselling and gene testing were unremarkable. Discussion Conservative management of SCAD is recommended because the large majority of SCAD lesions heal naturally, whereas PCI is associated with increased risk of complications and adverse outcomes. Whether SCAD is associated with the sudden death events in our patient’s family remains unclear. It certainly raises concerns as to an inheritable condition. In the absence of post-mortem findings in her family members, we can only speculate about this representing a possible inheritable form of SCAD.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytz112
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 3
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    Surgical outcome of isolated congenital supravalvular pulmonary stenosis: a case series
    Oxford University Press (OUP) ; 2019
    In:  European Heart Journal - Case Reports Vol. 3, No. 2 ( 2019-06-01)
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 3, No. 2 ( 2019-06-01)
    Abstract: Supravalvular stenosis of main pulmonary artery is a rare anomaly characterized by the presence of constriction band just above the pulmonary valve. It is mostly acquired after intervention on the pulmonary trunk or less commonly is congenital in origin associated with complex congenital cardiac malformations and very rarely can present as an isolated native congenital supravalvular pulmonary stenosis (SPS). Case summary We present a series of four cases of isolated congenital SPS who underwent surgical correction at our tertiary care institute over 8 years. Mean age of the patients was 2.25 ± 0.96 years with all of them being males. Mean peak systolic gradient across the stenosis was 82 ± 21.48 mmHg ranging from 60 mmHg to 110 mmHg. There was no early and medium-term mortality with 100% survival at mean follow-up of 31 months (range 7–85 months). Discussion Surgical correction of congenital SPS carries excellent early and mid-term results with almost no mortality and very low risk of re-intervention for restenosis.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytz012
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 4
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    Drug-coated balloon angioplasty, intraoperatively through left anterior descending arteriotomy access, a novel hybrid revascularization strategy: a case report
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal - Case Reports Vol. 7, No. 1 ( 2022-12-27)
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 7, No. 1 ( 2022-12-27)
    Abstract: Patients undergoing coronary artery bypass graft (CABG) sometimes have critical proximal lesion in left anterior descending (LAD) artery or chronic total occlusion followed by either skip lesions or diffuse disease of late mid-to-distal LAD artery. Such lesions require endarterectomy or atheroma bridging via long venous or arterial patch (patch-plasty), for which clinical outcomes are conflicting in studies due to a more thrombogenic milieu created by patch-plasty as well as incomplete endarterectomy. We present a hybrid approach with drug-coated balloon (DCB) angioplasty of mid-to-distal LAD through LAD arteriotomy followed by left internal mammary artery (LIMA) insertion to LAD. Case summary A 35-year-old man who was thrombolyzed for anterior wall myocardial infarction in another city, reported to our hospital four weeks later with persistent angina. Coronary angiography showed severe multivessel coronary artery disease. There was diffuse disease in LAD distal to potential site of LIMA insertion and needed patch-plasty. We carried out a hybrid procedure by performing DCB angioplasty of mid-to-distal LAD through the LAD arteriotomy site during CABG followed by LIMA insertion to the LAD. The patient remained asymptomatic post procedure with a 6-month follow-up computerized tomography scan showing patent LIMA and mid-to-distal LAD. Discussion This case shows a novel technique, first in the world, of performing angioplasty during CABG through arteriotomy followed by graft insertion.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytad014
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 5
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    Online Resource
    A case report: delayed right ventricular pericardial fistula and aneurysm following penetrating traumatic injury—a controversial aetiology
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Case Reports Vol. 4, No. 4 ( 2020-08-01), p. 1-5
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 4, No. 4 ( 2020-08-01), p. 1-5
    Abstract: Right ventricular aneurysms (RVAs) are rare. We present a case with a combined RVA and right ventricular pericardial fistula resulting in a pericardial effusion and cardiac tamponade. The RVA was detected 47 days after the patient suffered a gunshot wound. This report adds to the body of scarce literature on RVA aetiology, diagnoses, and treatment. Case summary A 30-year-old male patient presented with worsening respiratory distress over a 7-day period with clinical signs of cardiac tamponade following a history of a gunshot (with associated liver laceration, pulmonary embolism, right nephrectomy, and sepsis) 47 days prior. Transthoracic echocardiography showed a large circumferential pericardial effusion and an RVA. The patient was emergently taken for surgical repair of the RVA. Discussion Our case presents a delayed presentation of a gunshot heart and an aetiology with indications of and against a true aneurysm. It brings attention to possible complications of penetrating precordial injuries, with the need for consideration and possible evaluation at follow-up. The literature on the operative excision of RVA is reviewed and various aetiological factors and consequences are discussed.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytaa183
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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  • 6
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    Epicardial mesothelial cyst originating from the roof of the left atrium: a case report
    Oxford University Press (OUP) ; 2022
    In:  European Heart Journal - Case Reports Vol. 6, No. 5 ( 2022-05-04)
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 6, No. 5 ( 2022-05-04)
    Abstract: Epicardial mesothelial cysts are cysts that are attached to the epicardium within the pericardial cavity. Reports on epicardial mesothelial cysts are rare, and limited studies have investigated their surgical management. Here, we report the rare case of an epicardial cyst originating from the roof of the left atrium. Case summary A 73-year-old man with dyspnoea on exertion and lower limb oedema was diagnosed with a giant cyst (diameter, 7 cm × 4.5 cm) in the pericardial cavity using computed tomography. Off-pump surgery was performed with successful resection of the cyst with a pedicle connected to the roof of the left atrium. Histological examination confirmed the mesothelial origin of the tumour cells. Conclusion Cysts rarely develop within the pericardial cavity, especially an epicardial cyst. The few studies exploring this disease have suggested that patients with this condition may be asymptomatic or have mild breathlessness or cardiac tamponade, which might be occasionally or incidentally diagnosed. Sufficient preoperative evaluation, particularly involving the coronary artery, is essential, and a rational way of surgery should be planned considering all factors.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytac157
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 7
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    Abstract 16935: A Rare Case Of COVID-19 Induced Thrombus-in-Transit Going Through A PFO In A Pregnant Patient
    Ovid Technologies (Wolters Kluwer Health) ; 2021
    In:  Circulation Vol. 144, No. Suppl_2 ( 2021-11-16)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 144, No. Suppl_2 ( 2021-11-16)
    Abstract: Case Presentation: A 42-year-old female in her 24 th week of pregnancy was admitted to an outside hospital with respiratory failure due to COVID-19 pneumonia and was managed with Remdesivir, Dexamethasone, and pharmacological DVT prophylaxis. Her chest CT showed a massive PE. Due to instability, a cesarean section was necessitated, which resulted in delivering a stillborn baby. Two days later, she developed a severe circulatory shock with acute renal failure, not responding to conventional vasopressors/inotropic therapy. VA-ECMO was inserted for hemodynamic stabilization and the patient was transferred to our advanced ICU for further management. Upon arrival, the clinical picture was suggestive of COVID-19- induced thrombotic storm. Furthermore, the patient underwent several imaging studies which showed additional de-novo thromboembolic events in the brain (stroke), pulmonary circuit (PE), and portal circuit (hepatic thrombosis), which were managed medically. A transesophageal echocardiogram was done and revealed a large highly mobile echogenic structure, measuring up to 40 mm, crossing a patent foramen ovale (PFO) highly suggestive of thrombus in transit, in addition to the findings of significantly dilated RA and RV cavities (Figure 1 A, B). The team decided to perform an urgent surgical excision of that highly mobile thrombus accompanied by PFO closure to prevent catastrophic strokes. The thrombus in transit was extracted and was consistent with prior obtained imaging (Figure 1 C, D). Her postoperative course was uncomplicated. With advanced ICU and multidisciplinary care, she was finally discharged home hemodynamically stable on anticoagulation with Apixaban. Discussion: COVID-19 induced thrombus in-transit crossing a PFO is a rare finding and carries a high risk of paradoxical embolism. Multidisciplinary approach in integrating clinical and imaging findings can further help in a timely-manner decision making which improves patient's outcome.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.144.suppl_2.16935
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2021
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  • 8
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    Post-operative myocardial infarction following aortic root surgery with coronary reimplantation: a case series treated with percutaneous coronary intervention
    Oxford University Press (OUP) ; 2019
    In:  European Heart Journal - Case Reports ( 2019-10-22)
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), ( 2019-10-22)
    Abstract: Coronary ostial stenosis is an uncommon but potentially lethal complication following aortic root replacement with or without aortic valve replacement (including Bentall and David procedures). This manifests clinically as acute myocardial ischaemia in the early or late post-operative period. Traditionally, this might be managed with redo open-heart surgery. Case summary  This case series describes two presentations where urgent percutaneous coronary intervention was used to manage myocardial infarction complicating aortic root surgery with coronary reimplantation. Discussion  This series highlights the risk of acute myocardial infarction after cardiac surgery involving coronary reimplantation. Emergency percutaneous coronary intervention is feasible and illustrates the importance of shared post-operative care involving the cardiac surgeons and the cardiology team.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytz181
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 9
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    Recurrent myocardial infarction due to coronary artery aneurysm in Behçet’s syndrome: a case report
    Oxford University Press (OUP) ; 2019
    In:  European Heart Journal - Case Reports Vol. 3, No. 4 ( 2019-12-01), p. 1-4
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 3, No. 4 ( 2019-12-01), p. 1-4
    Abstract: Behçet’s syndrome (BS) is a multisystemic vasculitis of unknown aetiology. Coronary involvement is extremely uncommon in BS, with a reported prevalence of 0.5%. The mortality of cardiovascular manifestation in BS is 20%, while there are still considerable challenges in the management of these patients. Case summary We report the case of a 30-year-old young man with a 12-year history of BS complicated by left anterior descending coronary (LAD) aneurysms, stenosis, and recurrent myocardial infarction. Percutaneous coronary intervention treated the stenosis and aneurysms of the LAD, but the coronary angiography clearly revealed an acute stent thrombosis after 7 months. This unusual coronary complication of BS treated successfully is presented. Discussion Our case demonstrated the feasibility of covered stent, immunosuppressive therapy, and escalated antithrombotic regimen in the treatment of BS patients with coronary artery aneurysm (CAA). We also demonstrated that drug-eluting stents may aggravate aneurysmal dilatation of the CAA under inefficient immunosuppressive therapy.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytz204
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 10
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    Late atrioventricular groove disruption presenting 7 years after mitral valve replacement: a case report
    Oxford University Press (OUP) ; 2020
    In:  European Heart Journal - Case Reports Vol. 4, No. 3 ( 2020-06-01), p. 1-5
    Details
    In: European Heart Journal - Case Reports, Oxford University Press (OUP), Vol. 4, No. 3 ( 2020-06-01), p. 1-5
    Abstract: Left ventricular rupture is the most feared complication in mitral valve surgery. Despite its low incidence, mortality rates can reach up to 75%. It usually presents on the operating room with a dissecting haematoma followed by massive bleeding after discontinuing cardiopulmomary bypass. However, cardiac rupture may be contained by adherent pericardium or scar tissue leading to chronic formation of a pseudoaneurysm (PSA). Case summary A 44-year-old man came to our institution with acute heart failure triggered by community-acquired pneumonia. He underwent mitral valve replacement with a mechanical prosthesis 7 years before and reported suffering from chronic worsening dyspnoea for 18 months. He underwent chest computed tomography scan and cardiac magnetic resonance imaging (CMRI), which showed two extensive left ventricular (LV) multilobulated PSAs. An operative approach was chosen and a tear was found on the posterior atrioventricular groove (AVG), communicating left ventricle with the PSA, which was closed with bovine pericardium patch. After weaning from cardiopulmonary bypass, he presented a diffuse life-threatening bleeding. The surgeons packed his chest with compresses before closing the sternum and he was operatively revised after 48 h. Post-operative CMRI showed that one of the PSAs remained connected with the LV. Despite of all, 1 year after hospital discharge, he remains asymptomatic without signs of heart failure. Discussion This case illustrates PSAs' potential to grow for a long period before causing symptoms, the complexity and risks of chronic AVG disruption surgery and the importance of careful annular manipulation and debridement as preventive measures in mitral valve surgery.
    Type of Medium: Online Resource
    ISSN: 2514-2119
    URL: Article
    DOI: 10.1093/ehjcr/ytaa091
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
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