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Cardiac FBs often require surgical intervention to avoid complications.
Cardiac FBs are caused generally by penetrating wounds from direct trauma. Fewer cases have been reported regarding cardiac FB caused by ingestion from migration of the object to the heart. Signs and symptoms for cardiac FB may mimic those of cardiac masses. Cardiac FBs often require surgical intervention to avoid complications.
Cholesterol pericarditis (CP) remains a rare pericardial disease characterized by chronic pericardial effusions with high cholesterol concentrations with or without the formation of cholesterol crystals. Effusions are often large and can cause ventricular compression and subsequent pericardial adhesion formation. CP can be idiopathic but has associations with rheumatoid arthritis (RA), tuberculosis and hypothyroidism.
We present a case of a 72-year-old male with a background of seropositive RA with a finding of an incidental pericardial effusion on computed tomography thorax abdomen and pelvis. Transthoracic echocardiogram demonstrated a large effusion with echocardiographic features of tamponade. JAK/stat pathway On review, he was breathless with a raised venous pressure, bilateral ankle oedema, and pulsus paradoxus was present. Pericardial drainage was performed with fluid analysis demonstrating a cholesterol concentration of 8.3 mmol/L and numerous cholesterol crystal formation. Interval imaging demonstrated recurrencey for definitive management.
Suitability for the subcutaneous implantable cardioverter-defibrillator (S-ICD) depends on a pre-implant electrocardiogram (ECG) screening to ensure appropriate sensing of electrical cardiac signals. Screening is performed positioning electrodes guided by chest surface anatomical landmarks.
We report a case of a patient with an initially negative conventional automatic screening for S-ICD, who underwent a modified screening guided by cardiac silhouette position, as seen under fluoroscopy, resulting in eligibility for the S-ICD.
The S-ICD reduces endovascular infection risk, providing therefore a potentially safer alternative in patients with prosthetic valves. It might be reasonable to perform a pre-implant ECG screening guided by fitting the cardiac silhouette in the shock vector, as this modified screening position could increase eligibility in patients who may benefit from S-ICD therapy such as the one presented.
The S-ICD reduces endovascular infection risk, providing therefore a potentially safer alternative in patients with prosthetic valves. It might be reasonable to perform a pre-implant ECG screening guided by fitting the cardiac silhouette in the shock vector, as this modified screening position could increase eligibility in patients who may benefit from S-ICD therapy such as the one presented.
Isolated right ventricular myocardial infarction (RVMI) due to a recessive right coronary artery (RCA) occlusion is a rare presentation. It is typically caused by right ventricle (RV) branch occlusion complicating percutaneous coronary intervention. We report a case of an isolated RVMI due to flush RCA occlusion presenting via our primary percutaneous coronary intervention ST-elevation myocardial infarction pathway.
A 61-year-old female smoker with a history of hypercholesterolaemia presented via the primary percutaneous coronary intervention pathway with sudden onset of shortness of breath, dizziness, and chest pain while walking. Transradial coronary angiography revealed a normal left main coronary artery, large left anterior descending artery that wrapped around the apex and dominant left circumflex artery with the non-obstructive disease. The RCA was not selectively entered despite multiple attempts. The left ventriculogram showed normal left ventricle (LV) systolic function. She was in cardiogenic shock with a persistent ectopic atrial rhythm with retrograde p-waves and stabilized with intravenous dobutamine thus avoiding the need for a transcutaneous venous pacing system. A computed tomography pulmonary angiogram demonstrated no evidence of pulmonary embolism while an urgent cardiac gated computed tomography revealed a recessive RCA with ostial occlusive lesion. JAK/stat pathway A cardiac magnetic resonance imaging confirmed RV free wall infarction. She was managed conservatively and discharged to her local district general hospital after 5th day of hospitalization at the tertiary centre.
This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.
This case describes a relatively rare myocardial infarction presentation that can present with many disease mimics which can require as in this case, a multi-modality imaging approach to establish the diagnosis.
Apical hypertrophic cardiomyopathy provides diagnostic challenges through varying presentation, impaired visualization on echocardiography and dissent on diagnostic criteria. While hypertrophic cardiomyopathy in general requires an absolute wall thickness ≥15 mm, a threshold for relative apical hypertrophy (ratio 1.5) has been proposed.
We report the case of a 57-year-old man with newly arisen chest pain and slight T-wave inversions. Serial cardiac magnetic resonance imaging over 9 years documented the gradual evolvement of late-onset apical hypertrophy with apical fibrosis and strain abnormalities. Symptoms, electrocardiographic changes, and relative apical hypertrophy preceded the traditional imaging criteria of hypertrophic cardiomyopathy.
Relative apical hypertrophy can be an early manifestation of apical hypertrophic cardiomyopathy. Persistent cardiac signs and symptoms warrant a follow-up, as apical hypertrophic cardiomyopathy can evolve over time. link2 Cardiac magnetic resonance imaging readily visualizes apical hypertrophic cardiomyopathy and associated changes in tissue composition and function.
Relative apical hypertrophy can be an early manifestation of apical hypertrophic cardiomyopathy. Persistent cardiac signs and symptoms warrant a follow-up, as apical hypertrophic cardiomyopathy can evolve over time. Cardiac magnetic resonance imaging readily visualizes apical hypertrophic cardiomyopathy and associated changes in tissue composition and function.
Aortic complications can happen during left ventricular assist devices (LVADs) insertion and its treatment remains challenging. Percutaneous aortic interventions can be an alternative to surgery in such high-risk cases.
We present a patient with idiopatic dilated cardiomyopathy and advanced heart failure requiring LVAD insertion as a bridge to transplant, who developed an aortic pseudoaneurysm below the anastomosis of the LVAD tube. He was successfully treated with percutaneous coiling under contrast-enhanced transoesophageal echocardiography (TOE) guidance, reaching destination therapy (heart transplantation) a year later.
Left ventricular assist devices provide haemodynamic support for patients with advanced heart failure waiting for heart transplantation. Although uncommon, aortic complications can happen as a result of LVAD insertion and be life-threatening. link= JAK/stat pathway Percutaneous aortic interventions can be performed in such cases to promote thrombosis and remodelling of false lumen or aneurysmatic spaces, hence potentially reducing the risk of sudden death. Contrast-enhanced TOE can be easily and safely used to monitor the intervention in order to improve anatomic definition, guide positioning of wires and catheters and assess early results.
Left ventricular assist devices provide haemodynamic support for patients with advanced heart failure waiting for heart transplantation. link2 Although uncommon, aortic complications can happen as a result of LVAD insertion and be life-threatening. Percutaneous aortic interventions can be performed in such cases to promote thrombosis and remodelling of false lumen or aneurysmatic spaces, hence potentially reducing the risk of sudden death. Contrast-enhanced TOE can be easily and safely used to monitor the intervention in order to improve anatomic definition, guide positioning of wires and catheters and assess early results.
Persistent ductus arteriosus (PDA) is a common congenital heart defect, of which, the preferred treatment in children and adults is transcatheter occlusion. This report describes the first reported case of acute aortic dissection as a late complication of transcatheter PDA occlusion.
A 66-year-old healthy woman, with a history of transcatheter PDA closure 12 years previously, died suddenly at home. Post-mortem revealed pericardial tamponade complicating an acute aortic dissection, with a large intimal tear identified adjacent to the PDA occluder.
Transcatheter occlusion is accepted as a safe and effective treatment in older children and adults, important in preventing haemodynamic sequelae such as heart failure and pulmonary hypertension. Complications are uncommon and mostly acute, including device embolization and haemolysis. Aortic dissection has been reported as an acute complication but only in the setting of incorrect device deployment. This is the first description of aortic dissection as a late complication of transcatheter PDA occlusion and although rare has important ramifications given it is a potentially fatal outcome of a common procedure.
Transcatheter occlusion is accepted as a safe and effective treatment in older children and adults, important in preventing haemodynamic sequelae such as heart failure and pulmonary hypertension. Complications are uncommon and mostly acute, including device embolization and haemolysis. Aortic dissection has been reported as an acute complication but only in the setting of incorrect device deployment. This is the first description of aortic dissection as a late complication of transcatheter PDA occlusion and although rare has important ramifications given it is a potentially fatal outcome of a common procedure.
Extrinsic coronary compression is an extremely rare complication of aortic root abscess formation and can manifest as an acute coronary syndrome in infective endocarditis. Optimal management strategies are unknown and therefore illustrative case reports may be informative.
We describe a 63-year-old man with a background history of a mechanical aortic valve who developed sepsis due to
bacteraemia from a presumed urinary source. He suddenly deteriorated with cardiogenic shock and anterior ST-segment elevation myocardial infarction on Day 16 and received emergency percutaneous coronary intervention for severe stenoses of left anterior descending and diagonal arteries. A transoesophageal echocardiogram 2 days later demonstrated a large aortic root abscess. He was transferred for emergency surgery which revealed a large aortic abscess surrounding the left main stem confirming extrinsic coronary compression. link3 He received a redo tissue aortic valve replacement and repair of his abscess cavity.
We describe a case where percutaneous coronary intervention and emergency surgery was used to treat extrinsic compression from an aortic root abscess; a complication that is associated with a high mortality. This is also a rare case of
causing prosthetic valve endocarditis. We also explore the findings of 11 previous cases of extrinsic coronary compression from aortic root abscess.
We describe a case where percutaneous coronary intervention and emergency surgery was used to treat extrinsic compression from an aortic root abscess; a complication that is associated with a high mortality. This is also a rare case of E. link3 coli causing prosthetic valve endocarditis. We also explore the findings of 11 previous cases of extrinsic coronary compression from aortic root abscess.