http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2013 , Hindawi Publishing Corporation . All rights reserved. Thu, 16 May 2013 17:59:11 +0000 http://www.hindawi.com/crim/cardiology/2013/397063/ Anatomical variations in relation to coronary artery and its branches will help cardiac surgeons for refining imaging techniques and coronary artery bypass grafting. A heart was detected with multiple anomalies of coronary arteries in a cadaver. The anomalies of coronary arteries in terms of origin, number of ostia, courses, and presence of myocardial bridges were described, and related clinical implications were highlighted in the present study. The knowledge of variant anatomy may be of paramount importance to anatomists for variant anatomy and to cardiac surgeon for proper diagnosis and treatment of cardiac ailments including radiologists to refine image interpretation. Rajani Singh Copyright © 2013 Rajani Singh. All rights reserved. Mon, 13 May 2013 18:13:52 +0000 http://www.hindawi.com/crim/cardiology/2013/250808/ A 26-year-old man presenting with a transient episode of dysarthria and dizziness, 3 weeks prior to admission, was referred to our center to be evaluated for transient ischemic attack (TIA). The patient had been previously admitted to a different hospital and echocardiography was reported normal at that center, but upon presenting to our institution strand-like masses in the left ventricle (LV) were detected. Transesophageal echocardiography (TEE) revealed two distinct mobile LV masses suggesting a diagnosis of papillary fibroelastoma. CT angiography and histopathological studies confirmed this diagnosis. Ahmad Mirdamadi, Mohsen MirmohammadSadeghi, Mahfar Arasteh, and Mojgan Gharipour Copyright © 2013 Ahmad Mirdamadi et al. All rights reserved. Sun, 12 May 2013 18:20:58 +0000 http://www.hindawi.com/crim/cardiology/2013/748241/ The current report describes a rare case of a caseous necrosis presenting as a pseudotumor in ventricle, revealed by stroke. Cerebral MRI, showing multiples lacunes, evocates a cardioembolic mechanism. Transthoracic and transesophageal echocardiography demonstrate a large hyperechogenic mass fixed to the posterior mitral valve and annulus while thoracic tomography revealed a fully calcified lesion, at the mitral annulus, evocative of caseus necrosis. Medical therapy was preferred (anticoagulation), because of her age and the decaying nature of surgery. Jérôme Corre, Lionel Leroux, and Pierre Coste Copyright © 2013 Jérôme Corre et al. All rights reserved. Tue, 23 Apr 2013 13:10:15 +0000 http://www.hindawi.com/crim/cardiology/2013/641348/ Prinzmetal angina or vasospastic angina is a clinical phenomenon that is often transient and self-resolving. Clinically it is associated with ST elevations on the electrocardiogram, and initially it may be difficult to differentiate from an acute myocardial infarction. The vasospasm induced in this setting occurs in normal or mildly to moderately diseased vessels and can be triggered by a number of etiologies including smoking, changes in autonomic activity, or drug ingestion. While the ischemia induced is usually transient, myocardial infarction and life-threatening arrhythmias can occur in 25% of cases. We present the case of a 65-year-old female where repetitive intermittent coronary vasospasm culminated in transmural infarction in the setting of gastrointestinal bleeding. This case highlights the mortality associated with prinzmetal angina and the importance of recognizing the underlying etiology. Michael Ruisi, Phillip Ruisi, Hugo Rosero, and Paul Schweitzer Copyright © 2013 Michael Ruisi et al. All rights reserved. Mon, 22 Apr 2013 10:24:54 +0000 http://www.hindawi.com/crim/cardiology/2013/407242/ We report the case of a 53-years-old patient, known to have coronary artery disease, presenting with typical angina at rest with normal ECG and laboratory findings. His angina is relieved by sublingual nitroglycerin. He had undergone a cardiac catheterisation two weeks prior to his presentation for the same complaints. It showed nonsignificant coronary lesions. Another catheterisation was performed during his current admission. He developed coronary spasm during the procedure, still with no ECG changes. The spasm was reversed by administration of 2 mg of intracoronary isosorbide dinitrate. Variant (Prinzmetal's) angina was diagnosed in the absence of electrical ECG changes during pain episodes. Ghassan Nakad and Hamid Bayeh Copyright © 2013 Ghassan Nakad and Hamid Bayeh. All rights reserved. Tue, 16 Apr 2013 17:20:14 +0000 http://www.hindawi.com/crim/cardiology/2013/246891/ We report a case of Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) which illustrates the natural progression of disease in the absence of availability of an implanted cardiac defibrillator (ICD). Electrocardiograms and cardiac imaging show the progress of ARVC and these clinical milestones of disease are presented herein. Wenling Liu, Xiaoliang Qiu, Wen Liu, Dayi Hu, Tiangang Zhu, Chunling Wang, Dominik Beer, and Li Zhang Copyright © 2013 Wenling Liu et al. All rights reserved. Thu, 11 Apr 2013 11:51:18 +0000 http://www.hindawi.com/crim/cardiology/2013/418565/ A 14-year-old boy after balloon valvuloplasty of severe aortic valve stenosis in the neonatal period was referred for heart-lung transplantation because of high grade pulmonary hypertension and left heart dysfunction due to endocardial fibroelastosis with severe mitral insufficiency. After heart catheterization, hemodynamic parameters were invasively monitored: a course of levosimendan and initiation of diuretics led to a decrease of pulmonary capillary wedge pressure (from maximum 35 to 24 mmHg). Instead of an expected decrease, mean pulmonary artery pressures (mPAP) increased up to 80 mmHg with increasing transpulmonary pressure gradient (TPG) up to 55 mmHg. Oral bosentan and intravenous epoprostenol then led to a ~50% decrease of mPAP (TPG between 16 and 22 mmHg). The boy was listed solely for heart transplantation which was successfully accomplished 1 month later. Martin Schwienbacher, Ulrich Schweigmann, Nikolaus Neu, Elisabeth Schermer, Corinna Velik-Salchner, Ina Michel-Behnke, Erentraud Irnberger, Christina Maria Steger, Jörg Ingolf Stein, and Ralf Geiger Copyright © 2013 Martin Schwienbacher et al. All rights reserved. Wed, 10 Apr 2013 09:36:13 +0000 http://www.hindawi.com/crim/cardiology/2013/897813/ Coronary artery spasm has been reported during adenosine stress testing. Herein, we describe a transient ST-segment elevation following adenosine therapy for supraventricular tachycardia. A 38-year-old male presented to the emergency department with palpitations. Electrocardiogram showed supraventricular tachycardia with short RP interval. Vagal maneuvers were unsuccessful. Adenosine was then administered in two successive injections of 6 and 12 mg dosages, respectively. A subsequent 12-lead electrocardiogram revealed ST-segment elevation in inferior leads with reciprocal changes. Coronary angiography disclosed nonobstructive coronary disease. A postprocedure electrocardiogram exhibited normal sinus rhythm with nonspecific T wave abnormalities. Cardiac biomarkers were elevated with a peak troponin I of 0.32. Echocardiogram depicted bicuspid aortic valve and normal systolic function. Electrophysiological study revealed a concealed left accessory pathway and successful radiofrequency ablation was performed. Given the dynamic changes in the electrocardiogram, we hypothesize that this event was most likely a coronary vasospasm. The mechanism of coronary spasm following adenosine injection remains uncertain. Potential mediators include channels and adenosine-2 receptors. Henry C. Quevedo, Jerson Munoz-Mendoza, Veronica Pinto Miranda, and Rafael F. Sequeira Copyright © 2013 Henry C. Quevedo et al. All rights reserved. Wed, 03 Apr 2013 08:40:26 +0000 http://www.hindawi.com/crim/cardiology/2013/842606/ Calcium channel blockers (CCBs) are prescribed in a wide variety of cardiovascular conditions. Nevertheless, they remain a major cause of cardiovascular drug overdose that often leads to a lethal outcome. We report the case of an intoxication with amlodipine, which caused severe hypotension, in a young woman. The patient was initially treated with fluids, calcium gluconate, and Dobutamine without effect. She then received hyperinsulinemia euglycemia therapy. A rise in blood pressure (BP) was observed two hours after insulin was started. The next day, the insulin infusion was stopped and seven days later the patient was discharged from the hospital after psychiatric consultation. The positive inotropic effect of insulin therapy in our patient supports previous findings that suggest its use as a first-line therapy in the management of CCBs overdose. T. El Houari, I. Haddiya, N. El Ouafi, and Z. Bazid Copyright © 2013 T. El Houari et al. All rights reserved. Mon, 18 Mar 2013 16:49:31 +0000 http://www.hindawi.com/crim/cardiology/2013/767541/ Cardiogenic shock and myocardial rupture can complicate an acute myocardial infarction (AMI). A case is reported in which a 58-year-old male with an acute inferior myocardial infarction required placement of biventricular assist device for hemodynamic support eight days after the onset of his AMI; eleven days after his AMI, the patient developed abrupt onset of hemodynamic instability with massive bleeding from his chest tube due to delayed free wall myocardial rupture that was discovered when he was taking emergently to the operating room. Myocardial rupture in patients with a ventricular assist device should be considered in the differential diagnosis in the event of acute hemodynamic compromise. A high level of suspicion for such a complication should prompt aggressive and emergent actions including surgery. We present a case of delayed free wall myocardial rupture following an acute inferior wall myocardial infarction in a patient with biventricular mechanical circulatory support. Yazhini Ravi, Emily P. Sudhakar, Pratima Nayak, Chittoor B. Sai-Sudhakar, and Konstantinos Dean Boudoulas Copyright © 2013 Yazhini Ravi et al. All rights reserved. Wed, 13 Mar 2013 11:22:32 +0000 http://www.hindawi.com/crim/cardiology/2013/343027/ In a 61-year-old woman with well controlled arterial hypertension, hypercholesterolemia, and smoke and suffering from recurrent angina pectoris despite angiographically normal epicardial coronary vessels and maximal therapy, the replacement of nitrates with novel antiangina drug ranolazine, after 6-month therapy, induced a complete relief of angina and a relevant rising of the transthoracic Doppler-derived coronary flow reserve (CFR). The present clinical case underlines therefore how in patients with chronic ischemic heart disease without epicardial coronary stenosis ranolazine can induce an improvement till the complete solution of the angina symptoms and a substantial increase of CFR as expression of the enhancement of the microvascular coronary function. The improvement of both symptoms and coronary microvascular function is strictly linked to the mechanism of action of the drug. Ranolazine induces in fact a reduction of the intracellular late sodium current that leads to a reduction of the intracellular calcium concentration thus producing a better myocardial diastolic relaxation process which in its turns enhances the myocardial perfusion. The ranolazine acts therefore as a lusitropic drug that improves the diastolic dysfunction and the segmental ischemia thus affecting one of the first steps of the ischemic cascade. Alessandro Santoro, Vincenzo Schiano Lomoriello, Ciro Santoro, Riccardo Muscariello, and Maurizio Galderisi Copyright © 2013 Alessandro Santoro et al. All rights reserved. Sun, 10 Mar 2013 10:52:09 +0000 http://www.hindawi.com/crim/cardiology/2013/976379/ Infiltrative heart diseases are caused by a heterogeneous group of disorders; amyloidosis and sarcoidosis are two frequent causes of myocardial infiltration, which differ in clinical and biological outcome and treatment issues. The presence of high levels of angiotensin-converting enzyme (ACE) in a patient with infiltrative heart disease may increase suspicion of sarcoidosis. Nevertheless, no mention about increased ACE levels in extracerebral primary systemic amyloidosis is available. We present two cases of primary systemic amyloidosis, which are cardiac involvement and elevated ACE levels. J. Praena-Segovia, A. Sanchez-Gastaldo, M. Bernabeu-Wittel, R. Ocete-Pérez, R. Ávila-Polo, and M. L. Martino Copyright © 2013 J. Praena-Segovia et al. All rights reserved. Wed, 06 Mar 2013 09:36:13 +0000 http://www.hindawi.com/crim/cardiology/2013/473979/ Trastuzumab is a monoclonal antibody highly effective in the treatment of several cancers, but its use is associated with cardiac toxicity which usually responds to cessation of the drug and/or medical therapy. We present an unusual case of acute cardiac toxicity temporally related to administration of trastuzumab in which the clinical presentation suggested an acute coronary syndrome. Coronary angiography, however, demonstrated minimal epicardial disease, but new wall motion abnormalities. Furthermore, the patient did not respond to withdrawal of the drug or medical therapy for heart failure. Sylvana Hidalgo, Carol A. Albright, and Gretchen L. Wells Copyright © 2013 Sylvana Hidalgo et al. All rights reserved. Mon, 04 Mar 2013 14:55:43 +0000 http://www.hindawi.com/crim/cardiology/2013/528439/ Aortic insufficiency from iatrogenic valve perforation from nonaortic valve operations is rarely reported despite the prevalence of these procedures. Rapid diagnosis of these defects is essential to prevent deterioration of cardiac function. In this paper, we describe a young man who reported to our institution after two open cardiac surgeries with new aortic regurgitation found to be due to an iatrogenic perforation of his noncoronary aortic valve cusp. This defect was not appreciated by previous intraoperative transesophageal echocardiography and was inadequately visualized on follow-up transthoracic and transesophageal echocardiograms. In contrast, cardiac gated computed tomography clearly visualized the defect and its surrounding structures. This case highlights the utility of cardiac gated computed tomography for cases of suspected valvular perforation when echocardiography is not readily available or inadequate imaging is obtained. Luke Oakley, Kathleen Love, Alfredo Ramirez, Gilbert Boswell, and Keshav Nayak Copyright © 2013 Luke Oakley et al. All rights reserved. Sun, 17 Feb 2013 16:27:44 +0000 http://www.hindawi.com/crim/cardiology/2013/704859/ Cocaine is considered a leading cause of drug-related deaths. This is usually sudden, unwitnessed, and without prodromal features. It has been reported that in-hospital mortality is close to 2%. Cocaine has powerful central nervous system effects1 and acute cocaine overdose has been associated with hyperthermia, agitation, paranoid ideation, status epilepticus, ventricular fibrillation, ventricular tachycardia, and myocardial infarction (MI). The mechanisms of cocaine-related death remain poorly understood. We report a patient who survived massive cocaine ingestion with psychomotor agitation and generalized seizures followed by asystolic cardiac arrest and transient Brugada pattern on electrocardiogram (ECG). M. Chadi Alraies, Mohammed A. R. Chamsi-Pasha, Motaz Baibars, Abdul Hamid Alraiyes, and Khaldoon Shaheen Copyright © 2013 M. Chadi Alraies et al. All rights reserved. Wed, 06 Feb 2013 10:58:44 +0000 http://www.hindawi.com/crim/cardiology/2013/413961/ The single coronary artery, anomalous origin of the right coronary artery from the left anterior descending artery, is a benign and very rare coronary artery anomaly. We firstly present a case with this type of single coronary artery and congenital pulmonary valvular stenosis with large poststenotic dilatation. Yusuf Hoşoğlu, Cihan Örem, Oğuzhan Ekrem Turan, Mustafa Öztürk, Ömer Gedikli, Ayşe Hoşoğlu, and Mürsel Şahin Copyright © 2013 Yusuf Hoşoğlu et al. All rights reserved. Thu, 10 Jan 2013 15:25:05 +0000 http://www.hindawi.com/crim/cardiology/2013/485029/ An 80-year-old woman with a history of congestive heart failure, atrial fibrillation, and hypertension was transferred to our institution with hematemesis. Her drug regimen included 2 mg warfarin potassium/day to prevent thromboembolic events. Transthoracic echocardiography (TTE) performed at 78 years of age revealed a mass attached to the noncoronary cusp and a cardiac tumor was suspected. The patient declined surgery and was meticulously followed up with periodic TTE. Upper gastroendoscopy revealed a gastric ulcer with an exposed blood vessel; anticoagulant therapy was ceased. On day 15 of admission, acute cerebral infarction occurred. Heparin sodium and warfarin potassium were administered rapidly, and her symptoms improved. TTE revealed no alteration of the mobile, string-like mass attached to the noncoronary cusp. Cardiac tumor was considered the cause of cerebral infarction, and the patient consented to surgical therapy. Pathological examination of the resected tumor suggested papillary fibroelastoma (PFE). Although no guidelines exist for PFE management, a mobile, cardiac tumor necessitates surgical resection to prevent thromboembolic events, even when small in size. Nobuhiro Takeuchi, Masanori Takada, Koichi Fujita, Yoshiharu Nishibori, Takao Maruyama, and Kazuyoshi Naba Copyright © 2013 Nobuhiro Takeuchi et al. All rights reserved. Thu, 27 Dec 2012 09:11:45 +0000 http://www.hindawi.com/crim/cardiology/2012/420629/ Spontaneous coronary artery dissection (SCAD) is a deadly cause of myocardial infarction (MI) that mainly affects otherwise healthy, young females. Forty percent of patients die suddenly or within a few hours of symptom onset. We examine the case of a young female who presented with chest pain. She developed ST elevations in anterolateral leads mimicking ST elevation MI. Cardiac catheterization was done and showed a middle left anterior descending (LAD) dissection. The patient underwent primary percutaneous transluminal coronary angioplasty with coronary stent placed in the LAD. Müntecep Aşker, Selvi Aşker, and Özgür Gürsu Copyright © 2012 Müntecep Aşker et al. All rights reserved. Tue, 04 Dec 2012 14:31:35 +0000 http://www.hindawi.com/crim/cardiology/2012/126764/ Background. The congenitally corrected transposition of the great arteries (L-TGA) is a very rare congenital heart defect, which often remains undetected for several decades of life. Case Presentation. We report on a 45-year-old man without prior history of heart disease, presenting with cardiac shock related to a first episode of tachycardic atrial fibrillation. The diagnostic work-up identified a L-TGA as the underlying cause for acute heart failure. Discussion. L-TGA is a very rare congenital heart defect, which is characterized by an atrioventricular as well as a ventriculoarterial discordance. By this means, the physiological sequence of pulmonary and systemic circulation is still maintained. On the basis of an ongoing strain of the right ventricle, which has to carry the burden of the systemic blood pressure, after more than four decades without symptoms, acute heart failure was triggered by a tachycardic atrial fibrillation. M. Graf, M. Zaczkiewicz, J. Torzewski, and O. Zimmermann Copyright © 2012 M. Graf et al. All rights reserved. Tue, 04 Dec 2012 08:17:43 +0000 http://www.hindawi.com/crim/cardiology/2012/467210/ The patient is a 75-year-old man with a history significant for hypertension and congestive heart failure who underwent a bioprosthetic aortic valve replacement secondary to acute onset of aortic insufficiency. Cultures of the native valve were positive for Staphylococcus epidermidis sensitive to nafcillin and intravenous cefazolin was initiated. On postoperative day 24, he developed acute decompensated heart failure. A transesophageal echocardiogram demonstrated a structurally abnormal mitral valve with severe regurgitation, anterior and posterior leaflet vegetations, and scallop prolapse. There was also evidence of a mitral-aortic intervalvular fibrosa pseudoaneurysm (P-MAIF) with systolic expansion and flow within the aneurysm. Antibiotic treatment was changed from cefazolin to vancomycin for presumed development of methicillin-resistant Staphylococcus. He subsequently underwent a bioprosthetic mitral valve replacement and has restoration of health without sequella. This case highlights the development of a P-MAIF as a rare complication of both aortic or mitral valve replacement and infective endocarditis. Diane Elegino-Steffens, Amy Stratton, and Jone Geimer-Flanders Copyright © 2012 Diane Elegino-Steffens et al. All rights reserved. Sun, 02 Dec 2012 14:22:55 +0000 http://www.hindawi.com/crim/cardiology/2012/309576/ Cantrell syndrome is a very rare congenital disease associating five features: a midline, upper abdominal wall disorder, lower sternal abnormality, anterior diaphragmatic defect, diaphragmatic pericardial abnormality, and congenital abnormalities of the heart. In this paper, we report a case of partial Cantrell's syndrome with left ventricular diverticulum, triatrial situs solitus, ventricular septal defect, dextrorotation of the heart, an anterior pericardial diaphragmatic defect, and a midline supraumbilical abdominal wall defect with umbilical hernia. The 5-month-old patient underwent a successful cardiac surgical procedure. A PTFE membrane was placed on the apex of the heart to facilitate reopening of the patient’s chest. Postoperative course was uneventful. The patient was discharged with good clinical condition and with a normal cardiac function. Mustapha El Kouache, S. Labib, A. El Madi, A. Babakhoya, S. Atmani, Y. Abouabdilah, and M. Harandou Copyright © 2012 Mustapha El Kouache et al. All rights reserved. Thu, 29 Nov 2012 08:55:49 +0000 http://www.hindawi.com/crim/cardiology/2012/353168/ Women with valvular heart disease have an increased risk of adverse outcomes in pregnancy; however, with appropriate evaluation and treatment, most women can successfully bear healthy children. During pregnancy, pulmonary stenosis is generally well tolerated in the absence of other haemodynamically significant lesions. We present a case of a multiparous woman,who is pregnant with her sixth child, with a severe pulmonary stenosis. She presented with exertional chest pain and dyspnea. She was managed successfully with balloon valvuloplasty. Mustafa Oylumlu, Kazim Aykent, Hatice Ender Soydinc, Muhammed Oylumlu, Faruk Ertas, Hasan Orhan Ozer, and Ibrahim Sari Copyright © 2012 Mustafa Oylumlu et al. All rights reserved. Wed, 28 Nov 2012 10:21:31 +0000 http://www.hindawi.com/crim/cardiology/2012/314685/ A 58-year-old female with a history of Wolff-Parkinson-White syndrome presented at our institution with palpitations and chest pain. Electrocardiography revealed paroxysmal supraventricular tachycardia with a heart rate of 188 beats/min. Antiarrhythmic drugs were ineffective, and tachycardia was resolved by electrical cardioversion. Transthoracic echocardiography revealed abnormal vessels around the right coronary artery (RCA) and pulmonary artery (PA); in addition, we suspected coronary arteriovenous fistula (CAVF). Coronary angiography and coronary computed tomography revealed dilated fistula vessels, with a 1 cm saccular aneurysm around the RCA, originating from the proximal RCA and left anterior descending artery into the main trunk of PA. Therefore, we confirmed the diagnosis of CAVF with an unruptured aneurysm. We surgically ligated and clipped the fistula vessels and resected the aneurysm. The resected aneurysm measured  cm in size. Pathological examination of the resected aneurysm revealed hypertrophic walls comprising proliferating fibroblasts cells thin elastic fibers. Very few atherosclerotic changes manifested in the aneurysm walls. We report the case of a patient with CAVF and an unruptured coronary artery aneurysm who was successfully treated by surgery. Nobuhiro Takeuchi, Masanori Takada, Yoshiharu Nishibori, and Takao Maruyama Copyright © 2012 Nobuhiro Takeuchi et al. All rights reserved. Mon, 26 Nov 2012 09:09:40 +0000 http://www.hindawi.com/crim/cardiology/2012/537169/ Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks. R. Zbinden, M. Mutter, and D. Weishaupt Copyright © 2012 R. Zbinden et al. All rights reserved. Wed, 21 Nov 2012 13:30:00 +0000 http://www.hindawi.com/crim/cardiology/2012/652086/ The case of a patient who presented with angina following a coronary artery bypass (CABG) operation during which the left internal mammary artery was inadvertently anastomosed to a cardiac vein is presented. The literature concerning previously reported cases of aortocoronary arteriovenous fistulas (ACAVF) due to inadvertent grafting of a coronary vein is reviewed and the significance of this complication is discussed. ACAVF due to inadvertent grafting of a coronary vein is a rare complication of CABG and may be a more common cause of graft failure than has previously been recognized. Distortion of cardiac anatomy, the presence of epicardial fat, and an intramyocardial course of the artery intended for grafting are predisposing factors. Some patients present with angina pectoris and heart failure whereas others have no symptoms. The diagnostic test of choice is coronary angiography. Cardiac MRI and CT have a limited role due to the smaller size and the more clearly defined course of these fistulas. Asymptomatic patients are simply observed since spontaneous closure of these fistulas is reported. Symptomatic patients can be treated with combined medical management and percutaneous methods. Jonathan D. Gardner, William R. Maddox, and Joe B. Calkins Jr. Copyright © 2012 Jonathan D. Gardner et al. All rights reserved. Tue, 06 Nov 2012 08:44:45 +0000 http://www.hindawi.com/crim/cardiology/2012/396319/ Leiomyosarcoma of the pulmonary vein is rare and has poor prognosis. Its clinical features are nonspecific and mimic benign conditions. Early diagnosis is challenging. Most cases have been diagnosed only at autopsy or on postoperative histology specimens. Treatment is essentially palliative complete surgical excision. We outline the principles of management with the case of a 39-year-old man with leiomyosarcoma of the left pulmonary veins extending into the left atrium. Extensive investigation to achieve early diagnosis and determine extent of disease is essential. Frozen section guided adequate excision of all cardiac tumours and resection of involved lung tissue achieve local disease control. Adjuvant chemoradiotherapy has been shown to enhance survival. Philemon Gukop, Guido Frassetto, Georgios Karapanagiotidis, and Venkatachalam Chandrasekaran Copyright © 2012 Philemon Gukop et al. All rights reserved. Thu, 01 Nov 2012 15:32:49 +0000 http://www.hindawi.com/crim/cardiology/2012/752956/ Late occurrence of atrioventricular nodal block is an extremely rare occurrence after radiofrequency catheter modification of the slow pathway and has yet to be reported after cryoablation. We report a case of late transient advanced second degree atrioventriuclar block after cryomodification of the slow pathway. Maria Malaya C. Dorotan-Guevara, Michael S. Crapanzano, and Christopher S. Snyder Copyright © 2012 Maria Malaya C. Dorotan-Guevara et al. All rights reserved. Wed, 24 Oct 2012 11:39:20 +0000 http://www.hindawi.com/crim/cardiology/2012/639284/ Background. Antibody-mediated rejection (AMR) is caused by the production of donor-specific antibodies (DSA) which lead to allograft injury in part via complement activation. The inflammatory demyelinating polyneuropathies (IDP) are inflammatory disorders of the nervous system, involving both cellular and humoral immune mechanisms directed against myelin. Case Report. A 58-year-old man five years after heart transplant presented with progressive dyspnea, imbalance, dysphagia, and weakness. Nerve conduction studies and electromyogram were consistent with IDP. Plasmapheresis and high-dose steroids resulted in improvement in neurologic symptoms. Within two weeks, he was readmitted with anasarca and acute renal failure, requiring intravenous furosemide and inotropic support. Echocardiogram and right heart catheterization revealed reduced cardiac function and elevated filling pressures. DSA was positive against HLA DR53, and endomyocardial biopsy revealed grade 1R chronic inflammation, with strong capillary endothelial immunostaining for C4d. Plasmapheresis and intravenous immunoglobulin (IVIG) were initiated. His anasarca and renal failure subsequently resolved, echocardiogram showed improved function off inotropes, and anti-DR53 MFI was reduced by 57%. Conclusions. This is an example of a single immune-mediated process causing concurrent IDP and AMR. The improvement in cardiac function and neurologic symptoms with plasmapheresis, IVIG, and high-dose steroids argues for a unifying antibody-mediated mechanism. Kathryn J. Lindley, Ashwin K. Ravichandran, Joel Schilling, and Susan M. Joseph Copyright © 2012 Kathryn J. Lindley et al. All rights reserved. Wed, 10 Oct 2012 11:23:51 +0000 http://www.hindawi.com/crim/cardiology/2012/367542/ Coronary malperfusion due to type A aortic dissection is a life-threatening condition where timely recognition and treatment are mandatory. A 77-year-old woman underwent an acute evolving type A aortic dissection mimicking acute myocardial infarction. Two pathophysiologic mechanisms are discussed: either thrombosis migrating from a previously treated giant aneurism of proximal left anterior descending or a local arterial complication due to left main stenting. Recognition of these occurrences in the catheterization laboratory is important to look immediately for surgery. Alessio Arrivi, Gaetano Tanzilli, Paolo Emilio Puddu, Giovanni Truscelli, Marcello Dominici, and Enrico Mangieri Copyright © 2012 Alessio Arrivi et al. All rights reserved. Tue, 09 Oct 2012 07:42:27 +0000 http://www.hindawi.com/crim/cardiology/2012/324326/ A ventricular septal aneurysm (VSA) is a rare cardiac anomaly, and an accurate statistic of its prevalence has not been reported in the literature. True incidence is likely underestimated as most patients are thought to be asymptomatic. As a result, most VSAs are discovered incidentally on echocardiography, during angiography, or at autopsy. Potential complications include rupture, bacterial endocarditis, right ventricular outflow tract obstruction, and thromboembolic disease. It has been proposed that VSAs occur in association with ventricular septal defects (VSDs) and other congenital cardiac abnormalities. It is uncommon for a VSA to exist in the absence of a known prior ventricular septal defect. We present two cases, each highlighting an incidental intact aneurysm involving the membranous interventricular septum. We discuss the contrast in the two patients with regard to their age, accompanying cardiac anomalies and cardiovascular fitness. Clinical implications of the condition are reviewed. Abhishek Naidu, Michelle Ricketts, Aashish Goela, Gerard Shoemaker, and Shuo Li Copyright © 2012 Abhishek Naidu et al. All rights reserved.