Journal of Cardiology Cases最新文献

Massive late device-related thrombus with watchman FLX left atrial appendage closure device two years after implantation: A case report watchman FLX左心耳关闭器植入2年后并发大量晚期器械相关血栓1例

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-09 DOI: 10.1016/j.jccase.2026.01.010

Danielle Shields MD , Bhavya Varma MD , Daniel Bamira MD , Richard Ro MD , Alexander Kushnir MD , Larry Chinitz MD , Muhamed Saric MD, PhD , Joey Junarta MBBS

Oral anticoagulation (OAC) remains the primary means of stroke prevention in patients with atrial fibrillation (AF). However, there are patients at greater risk of bleeding or who have experienced major bleeding, whereby long term OAC is relatively contraindicated. Additionally, up to 55% of eligible AF patients do not utilize OAC. Thus, transcatheter left atrial appendage occlusion devices (LAAOD) present an attractive alternative to mitigate stroke risk. Randomized trials have demonstrated the noninferiority of LAAOD to OAC in reducing stroke risk. However, treatment with LAAODs presents its own risks, including the risk of device-related thrombus (DRT). In this report, we describe an unusual case of a patient with a small DRT initially identified on transesophageal echocardiography (TEE) 6 weeks after implantation of a Watchman FLX (Boston Scientific, Marlborough, MA, USA) LAAOD that was appropriately treated and resolved on TEE 6 months after implantation. However, a massive late DRT recurred 2 years after implantation. This case highlights the importance of continued device monitoring for unfavorable evolution of DRT beyond the currently recommended 45-day to 1-year monitoring period, and especially after suspected thrombus resolution. Furthermore, it underlines the importance of developing newer generation LAAOD that reduces DRT risk.

Learning objective

Left atrial appendage occlusion devices can mitigate stroke risk in atrial fibrillation patients with contraindications to oral anticoagulation. However, these devices present with their own risks, including the risk of device-related thrombus (DRT). This case highlights the importance of continued device monitoring for unfavorable evolution of DRT beyond the recommended 45-day to 1-year monitoring period.

口服抗凝（OAC）仍然是房颤（AF）患者预防卒中的主要手段。然而，有些患者有较大的出血风险或经历过大出血，因此长期OAC是相对禁忌的。此外，多达55%的符合条件的房颤患者不使用OAC。因此，经导管左心耳闭塞装置（LAAOD）提供了一种有吸引力的替代方法来降低卒中风险。随机试验已经证明LAAOD在降低卒中风险方面与OAC相比没有劣效性。然而，laaod治疗有其自身的风险，包括器械相关血栓（DRT）的风险。在本报告中，我们描述了一个不寻常的病例，患者在Watchman FLX (Boston Scientific, Marlborough， MA， USA) LAAOD植入6 周后，经食管超声心动图（TEE）发现了一个小的DRT，并在植入后6 个月的TEE上得到了适当的治疗和解决。然而，大量晚期DRT在植入后2 年复发。该病例强调了持续设备监测的重要性，以防止DRT的不利演变超过目前推荐的45天至1年的监测期，特别是在疑似血栓消退后。此外，它强调了开发降低DRT风险的新一代LAAOD的重要性。学习目的左心耳闭塞装置可降低有口服抗凝禁忌症的心房颤动患者的卒中风险。然而，这些器械有其自身的风险，包括器械相关血栓（DRT）的风险。该病例强调了持续设备监测的重要性，以防止DRT在建议的45天至1年监测期后出现不利的演变。

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引用次数: 0

A rare case of pediatric cardiac fibroma arising from the pulmonary valve and right ventricular outflow tract presenting with obstructive hemodynamics 小儿心脏纤维瘤起源于肺动脉瓣及右心室流出道，表现为血流动力学阻塞

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-21 DOI: 10.1016/j.jccase.2026.01.013

Ryo Inoue MD , Kiyotaka Go MD, PhD , Mikiko Hashisako MD, PhD , Masaki Sato MD, PhD , Ayako Kuraoka MD, PhD , Koichi Sagawa MD

Primary cardiac tumors in the pediatric population are rare, and reports of cardiac fibromas diagnosed during childhood are limited. We report a pediatric case of cardiac fibroma attached to the right ventricular outflow tract (RVOT) and pulmonary valve that presented with RVOT obstruction in a 15-month-old boy who was referred for evaluation of a heart murmur. Echocardiography revealed a mobile 10-mm mass attached to the pulmonary valve that caused RVOT obstruction and elevated right ventricular pressure. Because of the risk of embolization and hemodynamic significance, surgical excision was performed. A pathological examination confirmed the diagnosis of cardiac fibroma. Although rare, pediatric cardiac tumors can cause serious complications such as embolism and arrhythmias, thus highlighting the importance of careful auscultation, detailed imaging evaluation, and appropriate surgical decision-making.

Learning objective

Pediatric cardiac fibromas are rare and frequently asymptomatic; however, depending on their location and mobility, they may pose a significant risk of right ventricular outflow tract obstruction and embolic events. Careful cardiac auscultation, followed by timely echocardiographic assessment, is essential for early detection. Surgical intervention should be considered on the basis of hemodynamic impact rather than tumor size alone.

原发性心脏肿瘤在儿童人群中是罕见的，在儿童时期诊断的心脏纤维瘤的报道是有限的。我们报告一个小儿病例心脏纤维瘤附着在右心室流出道（RVOT）和肺动脉瓣，表现为RVOT阻塞在一个15个月大的男孩谁被转到评估心脏杂音。超声心动图显示一个移动的10mm肿块附着在肺动脉瓣上，引起RVOT阻塞和右心室压力升高。由于栓塞的风险和血流动力学意义，手术切除。病理检查证实了心脏纤维瘤的诊断。虽然罕见，但小儿心脏肿瘤可引起栓塞和心律失常等严重并发症，因此强调了仔细听诊、详细影像学评估和适当手术决策的重要性。学习目的：小儿心脏纤维瘤罕见且常无症状；然而，根据它们的位置和移动性，它们可能会造成右心室流出道阻塞和栓塞事件的重大风险。仔细的心脏听诊，随后及时的超声心动图评估，是必不可少的早期发现。手术干预应考虑血流动力学的影响，而不仅仅是肿瘤的大小。

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引用次数: 0

Surgical treatment for metastatic cardiac tumor originating from tongue cancer 源自舌癌的转移性心脏肿瘤的外科治疗

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-21 DOI: 10.1016/j.jccase.2026.01.020

Yuki Echie MD, Chizuo Kikuchi MD, PhD, Yasuhito Okuzono MD, Shinka Miyamoto MD, PhD, Hiroshi Niinami MD, PhD

Metastasis of malignant tumors to the heart is rare and often diagnosed posthumously. A 70-year-old man, who had undergone partial tongue resection and neck dissection for tongue cancer a year prior, was found to have bilateral lung metastases. Bilateral lung resections were planned for stage II disease. After the second lung surgery, he developed frequent ventricular arrhythmias. Echocardiography revealed a 60 mm tumor on the lateral wall of the left ventricle, diagnosed as cardiac metastasis. Given the relatively good general condition and potential for long-term survival with chemotherapy, surgery was performed to prevent embolic events. Intraoperatively, tumor invasion into the papillary muscle and chordae tendineae necessitated tumor excision and mitral valve replacement. The postoperative course was favorable, with challenges in managing pleural effusions, but no recurrence of arrhythmias. The patient was discharged on postoperative day 15 and continued systemic chemotherapy and palliative care. Pathology confirmed squamous cell carcinoma, consistent with distant metastasis of tongue cancer.

Learning objective

Cardiac tumors are extremely rare and are often discovered only after death. Even when detected during the patient's lifetime, the prognosis is generally poor. This case involved a metastatic tumor to the heart from tongue cancer, but salvage surgery was considered as a potential option to improve the outcome.

恶性肿瘤转移到心脏是罕见的，通常是死后才被诊断出来。一名70岁的男性，一年前因舌癌接受了部分舌切除和颈部清扫，被发现有双侧肺转移。计划对II期疾病进行双侧肺切除。第二次肺手术后，他出现频繁的室性心律失常。超声心动图显示左心室外侧壁有一个60 mm的肿瘤，诊断为心脏转移。考虑到相对良好的总体状况和化疗长期生存的潜力，我们进行了手术以防止栓塞事件。术中肿瘤侵入乳头肌和腱索，需要切除肿瘤和二尖瓣置换术。术后过程是有利的，但在处理胸腔积液方面存在挑战，但没有心律失常复发。患者术后第15天出院，继续全身化疗和姑息治疗。病理证实为鳞状细胞癌，符合舌癌远处转移。学习目的心脏肿瘤极为罕见，通常在死后才被发现。即使在患者的一生中发现，预后通常也很差。本病例涉及舌癌转移到心脏的肿瘤，但挽救性手术被认为是改善预后的潜在选择。

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引用次数: 0

Cardiac magnetic resonance findings in two cases of hypertrophic cardiomyopathy with MYH7 and MYBPC3 variants: Limitations of genotype-based phenotypic prediction 2例伴有MYH7和MYBPC3变异的肥厚性心肌病的心脏磁共振结果：基于基因型的表型预测的局限性

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-21 DOI: 10.1016/j.jccase.2026.01.018

Hidetaka Hayashi MD, PhD , Seitaro Oda MD, PhD , Masafumi Kidoh MD, PhD , Naoto Kuyama MD, PhD , Masahiro Yamamoto MD, PhD , Yasuhiro Izumiya MD, PhD, FJCC , Yuki Kuramoto MD, PhD , Yoshihiro Asano MD, PhD , Kenichi Tsujita MD, PhD, FJCC , Toshinori Hirai MD, PhD

Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy, usually caused by sarcomeric variants such as MYH7 and MYBPC3. However, genotype–phenotype correlations remain incompletely defined. We report two patients with distinct genetic backgrounds and contrasting clinical and imaging findings. Case 1, a 40-year-old man with an MYH7 variant, was incidentally diagnosed while asymptomatic, showing basal septal hypertrophy with patchy late gadolinium enhancement (LGE) at the right ventricular insertion point. Case 2, a 37-year-old woman with an MYBPC3 variant, progressed from apical HCM diagnosed in adolescence to dilated-phase HCM with extensive LGE and advanced heart failure requiring defibrillator implantation, left ventricular assist device support, and listing for transplantation. These contrasting cases highlight the phenotypic heterogeneity of sarcomeric HCM. In HCM, the predictive value of single-gene variants is inherently limited for risk stratification, and cardiac magnetic resonance imaging plays a central role in comprehensive phenotypic assessment and prognostic evaluation.

Learning objective

To recognize that hypertrophic cardiomyopathy associated with the representative sarcomeric variants MYH7 and MYBPC3 exhibits marked phenotypic heterogeneity, and that the predictive value of single-gene variants is limited in risk stratification, with cardiac magnetic resonance imaging playing a central role in comprehensive phenotypic assessment and prognostic evaluation.

肥厚性心肌病（HCM）是最常见的遗传性心肌病，通常由肌瘤变异如MYH7和MYBPC3引起。然而，基因型-表型相关性仍然不完全确定。我们报告两个不同的遗传背景和对比临床和影像学结果的病人。病例1，一名患有MYH7变异的40岁男性，在无症状的情况下偶然被诊断为基底间隔肥大，右心室插入点出现斑片状晚期钆增强（LGE）。病例2，一名37岁的MYBPC3变异女性，从青春期诊断为根尖型HCM发展为扩张期HCM，伴广泛LGE和晚期心力衰竭，需要除颤器植入，左心室辅助装置支持，并列入移植清单。这些对比鲜明的病例突出了肉瘤性HCM的表型异质性。在HCM中，单基因变异对风险分层的预测价值本身是有限的，而心脏磁共振成像在综合表型评估和预后评估中起着核心作用。学习目的认识到肥厚性心肌病与代表性肌瘤变异MYH7和MYBPC3相关表现出明显的表型异质性，单基因变异在危险分层中的预测价值有限，心脏磁共振成像在综合表型评估和预后评估中发挥核心作用。

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引用次数: 0

Management of unruptured intracranial aneurysms in atrial fibrillation: Role of ablation in anticoagulation cessation 房颤未破裂颅内动脉瘤的治疗：消融在抗凝停止中的作用

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-03-06 DOI: 10.1016/j.jccase.2026.01.014

Yuriko Hiruma MD , Masateru Takigawa MD, PhD , Shinsuke Miyazaki MD, PhD, FJCC , Satoru Takahashi MD, PhD , Sakyo Hirai MD, PhD , Kazutaka Sumita MD, PhD , Tetsuo Sasano MD, PhD, FJCC

Flow diverters (FDs) are increasingly used for unruptured intracranial aneurysms and require postprocedural dual antiplatelet therapy. In patients receiving oral anticoagulation, such as those with atrial fibrillation (AF), antithrombotic management remains challenging because anticoagulation may impair intra-aneurysmal thrombosis and reduce occlusion rates. We report three AF patients treated with FDs for unruptured intracranial aneurysms. Complete aneurysm occlusion was achieved only in one patient in whom anticoagulation was discontinued after successful catheter ablation combined with ethanol infusion into the vein of Marshall and antiarrhythmic therapy for persistent AF of more than five years. This case series highlights that anticoagulation withdrawal enabled by individualized rhythm-control strategies may facilitate successful FD treatment even in very long-standing persistent AF.

Learning objective

To recognize that successful flow diversion in patients with atrial fibrillation may require careful selection of treatment strategies that permit temporary or permanent discontinuation of oral anticoagulation, and to emphasize the importance of individualized, goal-oriented antithrombotic management rather than a fixed anticoagulation approach.

血流分流器（FDs）越来越多地用于未破裂的颅内动脉瘤，需要术后双重抗血小板治疗。在接受口服抗凝治疗的患者中，如房颤（AF）患者，抗血栓管理仍然具有挑战性，因为抗凝可能会损害动脉瘤内血栓形成并降低闭塞率。我们报告了3例房颤患者使用FDs治疗未破裂的颅内动脉瘤。只有1例患者在成功的导管消融联合Marshall静脉乙醇输注和抗心律失常治疗5年以上的持续性房颤后停止抗凝治疗，实现了完全的动脉瘤闭塞。本病例系列强调了个体化心律控制策略下的抗凝停药可能有助于即使是非常长期的持续性房颤的成功治疗。学习目的认识到房颤患者成功的血流转移可能需要仔细选择允许暂时或永久停止口服抗凝的治疗策略，并强调个体化治疗的重要性。目标导向的抗血栓管理，而不是固定的抗凝方法。

{"title":"Management of unruptured intracranial aneurysms in atrial fibrillation: Role of ablation in anticoagulation cessation","authors":"Yuriko Hiruma MD , Masateru Takigawa MD, PhD , Shinsuke Miyazaki MD, PhD, FJCC , Satoru Takahashi MD, PhD , Sakyo Hirai MD, PhD , Kazutaka Sumita MD, PhD , Tetsuo Sasano MD, PhD, FJCC","doi":"10.1016/j.jccase.2026.01.014","DOIUrl":"10.1016/j.jccase.2026.01.014","url":null,"abstract":"<div><div>Flow diverters (FDs) are increasingly used for unruptured intracranial aneurysms and require postprocedural dual antiplatelet therapy. In patients receiving oral anticoagulation, such as those with atrial fibrillation (AF), antithrombotic management remains challenging because anticoagulation may impair intra-aneurysmal thrombosis and reduce occlusion rates. We report three AF patients treated with FDs for unruptured intracranial aneurysms. Complete aneurysm occlusion was achieved only in one patient in whom anticoagulation was discontinued after successful catheter ablation combined with ethanol infusion into the vein of Marshall and antiarrhythmic therapy for persistent AF of more than five years. This case series highlights that anticoagulation withdrawal enabled by individualized rhythm-control strategies may facilitate successful FD treatment even in very long-standing persistent AF.</div></div><div><h3>Learning objective</h3><div>To recognize that successful flow diversion in patients with atrial fibrillation may require careful selection of treatment strategies that permit temporary or permanent discontinuation of oral anticoagulation, and to emphasize the importance of individualized, goal-oriented antithrombotic management rather than a fixed anticoagulation approach.</div></div>","PeriodicalId":52092,"journal":{"name":"Journal of Cardiology Cases","volume":"33 5","pages":"Pages 164-167"},"PeriodicalIF":0.0,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147757102","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}

引用次数: 0

Improvement of acute hemolysis after mechanical valve replacement by prosthesis rotation without redo replacement 无重做机械瓣膜置换术后机械瓣膜旋转后急性溶血的改善

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-10 DOI: 10.1016/j.jccase.2026.01.009

Ryusuke Hosoda MD , Takaya Hoashi MD, PhD , Koichi Toda MD , Akinori Hirano MD, PhD , Yuji Fuchigami MD , Yukino Iijima MD , Takaaki Suzuki MD, PhD

A1-year-old female with a partial atrioventricular septal defect and a borderline left ventricular size underwent a left-sided atrioventricular valve plasty at four months. Due to persistent regurgitation, a reoperation was performed at one year for left-sided atrioventricular valve replacement. The valve was implanted in an anti-anatomical position and the side of the posterior wall translocated toward the left atrium because of a narrow annulus. Postoperative course was initially good, but lactate dehydrogenase levels significantly rose to 2262 U/L by postoperative day 14. Echocardiography revealed mild paravalvular leakage on the septal and left atrial sides. A greater regurgitant jet was observed from the posterior left atrial hinge compared to the septal side. Reoperation was performed for mechanical valve adjustment on postoperative day 17. The left atrial wall side, suspected of paravalvular leakage, was broadly reinforced with felt strips. Intraoperative transesophageal echocardiography still showed significant regurgitation from the left atrial hinge. The mechanical valve was rotated 40 degrees counterclockwise. Post-rotation, the regurgitant jet significantly decreased. Lactate dehydrogenase normalized, and resolution of transvalvular leakage and associated hemolysis was confirmed. This case highlights the complexity of mechanical valve implantation in challenging anatomies and the importance of addressing subtle leaks.

Learning objective

A1-year-old female with a partial atrioventricular septal defect and borderline left ventricular size underwent a left-sided atrioventricular valve replacement. Postoperatively, she developed hemolysis, which was suspected to be caused by transvalvular leakage. A reoperation involving valve rotation and paravalvular leakage repair resolved the hemolysis. It is possible that the specific structure of the mechanical valve contributed to the hemolysis, warranting further investigation.

一位患有部分房室间隔缺损和边缘性左心室大小的11岁女性在4个月时接受了左侧房室瓣膜成形术。由于持续返流，一年后再次行左房室瓣膜置换术。瓣膜在反解剖位置植入，由于瓣膜环狭窄，后壁侧向左心房移位。术后初期病程良好，但术后第14天乳酸脱氢酶水平显著上升至2262 U/L。超声心动图显示轻度瓣旁渗漏在室间隔和左心房。左心房后部的反流较中隔侧多。术后第17天再次手术进行机械瓣膜调节。左心房壁疑似瓣旁漏，用毛毡条广泛加固。术中经食管超声心动图仍显示左心房铰链返流明显。机械阀逆时针旋转40度。旋转后，反流射流明显减小。乳酸脱氢酶恢复正常，经瓣膜漏血和相关溶血的解决得到证实。这个病例强调了机械瓣膜植入在具有挑战性的解剖结构中的复杂性，以及解决细微泄漏的重要性。学习目的：一名患有部分房室间隔缺损和左心室边缘大小的11岁女性接受了左侧房室瓣膜置换术。术后患者出现溶血，怀疑是经瓣膜渗漏所致。再次手术包括瓣膜旋转和瓣旁渗漏修复，解决了溶血。可能是机械瓣膜的特殊结构导致了溶血，需要进一步的研究。

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引用次数: 0

Thrombocytosis-associated ticagrelor non-responder status after ECMO-supported primary PCI in STEMI STEMI患者在ecmo支持的初级PCI治疗后血小板增多相关替格瑞洛无应答状态

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-26 DOI: 10.1016/j.jccase.2026.01.015

Christoph Strohhofer MD , Hannes Alber MD , Jakob Dörler MD

Despite established treatment pathways for ST-elevation myocardial infarction (STEMI), complications range from adverse events such as malignant cardiac arrhythmias to more elusive risks such as thrombocytosis compromising antiplatelet efficacy. We describe a case of ticagrelor non-responsiveness in a patient who developed critical reactive thrombocytosis after veno-arterial extracorporeal membrane oxygenation–supported percutaneous coronary intervention for inferior STEMI. High on-treatment platelet reactivity was detected by Multiplate (Roche Diagnostics, Mannheim, Germany) testing at a time when the platelet count exceeded 1.1 × 10⁶/μl. Given the absence of alternative platelet function platforms at the treatment center, prasugrel was introduced based on the available test results, with subsequent normalization of platelet function. Unlike clopidogrel and prasugrel, resistance to ticagrelor has rarely been reported. This case highlights the need for individualized antiplatelet strategies in high-risk profiles.

Learning objective

Ticagrelor may present a pharmacodynamic challenge in patients with thrombocytosis. In very high-risk patients, particularly those with atypical hematologic profiles, verifying the efficacy of platelet aggregation inhibition through laboratory testing is essential.

尽管st段抬高型心肌梗死（STEMI）有既定的治疗途径，但并发症的范围从恶性心律失常等不良事件到更难以捉摸的风险，如血小板增多症影响抗血小板疗效。我们描述了一例替格瑞洛无反应性的患者，他在静脉-动脉体外膜氧合支持的经皮冠状动脉介入治疗后出现了严重的反应性血小板增多。当血小板计数超过1.1 × 106/μl时，通过Multiplate（罗氏诊断公司，曼海姆，德国）检测检测到高治疗时血小板反应性。鉴于治疗中心缺乏替代的血小板功能平台，根据现有的检测结果引入普拉格雷，随后将血小板功能正常化。与氯吡格雷和普拉格雷不同，替格瑞的耐药性很少有报道。该病例强调了在高危人群中个体化抗血小板策略的必要性。学习目标替格瑞洛在血小板增多患者中可能存在药效学挑战。在高危患者中，特别是那些具有非典型血液学特征的患者，通过实验室检测验证血小板聚集抑制的有效性是必不可少的。

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引用次数: 0

Intracoronary urokinase infusion during prolonged perfusion balloon inflation for massive thrombus in acute myocardial infarction: case series 急性心肌梗死大面积血栓的长时间灌注球囊膨胀时冠状动脉内尿激酶输注：病例系列

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-21 DOI: 10.1016/j.jccase.2026.01.016

Sae Ujiro MD , Hiroyuki Yamamoto MD, PhD , Hiroto Kinutani MD, PhD , Tomofumi Takaya MD, PhD

Primary percutaneous coronary intervention remains the cornerstone of management in ST-segment elevation myocardial infarction (STEMI). However, thrombus-rich lesions frequently impede optimal reperfusion, increasing the risk of procedural complications and limiting the achievement of Thrombolysis in Myocardial Infarction grade 3 flow. Various adjunctive techniques—including thrombus aspiration, prolonged balloon inflation, excimer laser coronary angioplasty, and intracoronary thrombolysis—have been employed in such scenarios. This case series describes two STEMI patients treated with a novel approach: intracoronary infusion of low-dose urokinase (60,000 units) during prolonged (10-min) inflation with a perfusion balloon (Ryusei, Kaneka, Osaka, Japan), which maintains distal perfusion during dilation. This strategy effectively achieved reperfusion and thrombus resolution while minimizing myocardial ischemia and reducing stent length. In contrast to conventional high-dose thrombolysis, this method enables localized low-dose delivery (60,000 units), potentially enhancing drug retention and tissue penetration. These cases suggest that intracoronary infusion of low-dose urokinase during perfusion balloon inflation may represent a safe and effective adjunctive strategy for managing thrombus-rich lesions in STEMI.

Learning objective

To present an innovative technique involving intracoronary infusion of urokinase during prolonged perfusion balloon inflation. This strategy enables simultaneous compression of the culprit plaque and thrombolysis, potentially leading to improved outcomes in STEMI with a high thrombus burden. Additionally, lesion-selective infusion of urokinase through perfusion balloon microholes allows effective thrombolysis with a lower urokinase dose compared to standard administration.

初级经皮冠状动脉介入治疗仍然是st段抬高型心肌梗死（STEMI）治疗的基石。然而，富含血栓的病变经常阻碍最佳再灌注，增加了手术并发症的风险，并限制了心肌梗死3级血流溶栓的实现。各种辅助技术——包括血栓抽吸、延长球囊膨胀、准分子激光冠状动脉成形术和冠状动脉内溶栓——已被用于这种情况。本病例系列描述了两名STEMI患者采用一种新方法治疗：冠状动脉内输注低剂量尿激酶（60,000 单位），在长时间（10分钟）膨胀期间使用灌注球囊（Ryusei, Kaneka, Osaka, Japan），在扩张期间维持远端灌注。该策略有效地实现了再灌注和血栓溶解，同时最大限度地减少心肌缺血和缩短支架长度。与传统的高剂量溶栓相比，该方法能够局部低剂量递送（60,000 单位），潜在地增强药物保留和组织渗透。这些病例表明，在灌注球囊膨胀期间，冠状动脉内输注低剂量尿激酶可能是治疗STEMI中富含血栓病变的一种安全有效的辅助策略。学习目的介绍一种在长时间灌注球囊充气过程中冠脉内输注尿激酶的创新技术。这种策略可以同时压缩罪魁祸首斑块和溶栓，可能改善STEMI高血栓负担患者的预后。此外，通过灌注球囊微孔的病变选择性输注尿激酶，与标准给药相比，可以用更低的尿激酶剂量进行有效的溶栓。

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引用次数: 0

A unique infective etiology for cardiomyopathy in a South Asian patient 南亚患者心肌病的独特感染病因学

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-21 DOI: 10.1016/j.jccase.2026.01.017

Gulbadin Mufti MD, DM, A. Shaheer Ahmed MD, DM, DNB

Left ventricular (LV) dysfunction can occur due to various causes. In order to provide appropriate treatment, it is essential to establish the correct etiology of LV dysfunction. A 52-year-old male, resident of South India, presented with dyspnea on exertion for two months. Echocardiography showed global LV hypokinesia with ejection fraction of 45% and global longitudinal strain (GLS) of −12.5%. Coronary angiogram (CAG) showed single-vessel disease of right coronary artery. The CAG findings were inconsistent with distribution of LV dysfunction. There was also history of fever and migratory polyarthritis involving large joints of upper and lower limbs 2–3 months previously. Hemogram revealed mild anemia with iron deficiency. Erythrocyte sedimentation rate was elevated (100 mm/h). Lyme serology (IgM) results were positive. Fundus examination showed cotton wool spots bilaterally. Upper gastrointestinal endoscopy and biopsy indicated duodenitis. Diagnosis of Lyme cardiomyopathy was made. All the findings in our patient are explained by Lyme disease including cardiomyopathy, history of fever with polyarthritis, duodenitis, and cotton wool spots on fundus. The patient received doxycycline for 3 weeks. Subsequent follow ups for LV function showed improvement in LV ejection fraction from 45% to 52%. GLS improved from −12.5% to −15%.

Learning objective

All cases of left ventricular dysfunction should be thoroughly evaluated. Infectious diseases can also underlie left ventricular dysfunction. It is essential to confirm a history of fever and joint symptoms. In cases with migratory polyarthritis, Lyme disease should be suspected, and fundus examination together with Lyme serology testing can lead to diagnosis and appropriate treatment.

左心室功能障碍可由多种原因引起。为了提供适当的治疗，必须建立正确的左室功能障碍的病因。52岁男性，南印度居民，用力时出现呼吸困难2个月。超声心动图显示整体左室运动不足，射血分数为45%，整体纵向应变（GLS）为- 12.5%。冠状动脉造影（CAG）显示右冠状动脉单支病变。CAG结果与左室功能障碍的分布不一致。2-3个月前有发热史，上肢和下肢大关节有移动性多关节炎。血象显示轻度贫血伴缺铁。红细胞沉降率升高（100 mm/h）。莱姆病血清学（IgM）阳性。眼底检查显示双侧有棉絮斑。上消化道内窥镜和活检显示十二指肠炎。诊断为莱姆病心肌病。本例患者的所有表现均与莱姆病有关，包括心肌病、发热伴多关节炎史、十二指肠炎和眼底棉球斑。患者给予强力霉素治疗3 周。随后的左室功能随访显示左室射血分数从45%改善到52%。GLS从−12.5%提高到−15%。学习目的所有左心功能不全的病例都应进行彻底的评估。感染性疾病也可能导致左心室功能不全。确认发热史和关节症状是必要的。移动性多发性关节炎患者应怀疑患有莱姆病，眼底检查结合莱姆病血清学检测可确诊并给予适当治疗。

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引用次数: 0

A case of off-pump CABG performed in a super-elderly patient with suspected metal allergy and angina 超高龄患者疑似金属过敏并发心绞痛行非体外循环冠状动脉搭桥一例

Q4 Medicine

Journal of Cardiology Cases

Pub Date : 2026-05-01 Epub Date: 2026-02-21 DOI: 10.1016/j.jccase.2026.01.019

Fumiko Yoshimachi MD , Shohei Ikeda MD, PhD , Nao Yanagisawa MD , Shuka Seto MD , Kazuki Furuyama MD , Issei Fujita MD , Keisuke Suzuki MD, PhD , Hiroshi Nakagata MD, PhD , Kosuke Aoki MD , Eiji Sato MD, PhD , Yoshihiro Yamashina MD, PhD , Takehiko Miyashita MD, PhD , Yoshiaki Mibiki MD, PhD , Akihiko Ishida MD , Tetsuo Yagi MD, PhD , Shuji Toyama MD, PhD

The patient was an 86-year-old woman who presented to our hospital with exertional chest pain as her chief complaint. Her medical history was notable for diabetes mellitus. Transthoracic echocardiography revealed reduced wall motion in the lateral and inferolateral walls, with a decreased left ventricular ejection fraction. Although her symptoms improved temporarily with nitrate administration, optimal medical therapy failed to achieve sufficient relief. Coronary angiography showed 90% stenosis in the left anterior descending artery (segments #6–7) and the left circumflex artery (segment #11), along with a chronic total occlusion in the right coronary artery (segment #2). These findings indicated a clear need for coronary revascularization. Subsequent medical history-taking suggested a suspected metal allergy. After heart team conference, off-pump coronary artery bypass grafting (CABG) without the use of metal materials was chosen and successfully performed, due to her advanced age and the allergy concern. Postoperatively, her chest pain resolved completely, and she was discharged in good condition after completing a rehabilitation program. This case highlights the feasibility of off-pump CABG without metallic implants in super-elderly patients with complex coronary artery disease and underscores the importance of individualized, heart team–based decision-making when metal allergy is a concern.

Learning objective

This case demonstrates the feasibility of metal-free off-pump coronary artery bypass grafting in a super-elderly patient with complex coronary artery disease. It emphasizes the role of multidisciplinary heart team discussions and shared decision-making when patient-specific concerns, including suspected metal allergy, influence revascularization strategies.

患者是一名86岁的女性，她以运动性胸痛为主诉来我院就诊。她的病史有糖尿病。经胸超声心动图显示外壁和内壁运动减少，左心室射血分数降低。虽然她的症状在服用硝酸盐后暂时得到改善，但最佳药物治疗未能达到充分缓解。冠状动脉造影显示左侧前降支（节段# 6-7）和左侧旋支（节段#11）90%狭窄，同时右冠状动脉（节段#2）慢性完全闭塞。这些结果表明冠状动脉血运重建术的必要性。随后的病史显示疑似金属过敏。在心脏小组会议后，考虑到她的高龄和过敏问题，我们选择了不使用金属材料的非体外循环冠状动脉旁路移植术（CABG）并成功实施。术后胸痛完全缓解，完成康复治疗后出院，病情良好。本病例强调了非体外循环冠状动脉搭桥治疗复杂冠状动脉疾病的可行性，并强调了当考虑到金属过敏时，个体化、基于心脏团队的决策的重要性。学习目的本病例证明无金属非体外循环冠状动脉旁路移植术治疗复杂冠状动脉疾病的可行性。它强调多学科心脏小组讨论和共同决策的作用，当患者的具体问题，包括疑似金属过敏，影响血运重建策略。

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