Case Reports in Cardiology The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Acute Coronary Syndrome: An Unusual Consequence of GERD Tue, 24 Nov 2015 08:27:06 +0000 We report a case of an 83-year-old man with history of coronary artery disease and gastroesophageal reflux disease (GERD) who presented with sudden onset nocturnal dyspnea. He was diagnosed with non-ST elevation myocardial infarction based on the electrocardiographic changes and cardiac biomarker elevation. Cardiac catheterization revealed chronic three-vessel coronary artery disease, with 2 patent grafts and 2 chronically occluded grafts. While at the hospital, the patient experienced a similar episode of nocturnal dyspnea, prompting a barium esophagram, which was suggestive of a stricture in the distal esophagus from long-standing GERD. We hypothesized that he had myocardial ischemia due to increased oxygen demand from uncontrolled GERD symptoms. He had no further ischemic episodes after increasing the dose of antireflux medication over a 6-month follow-up. After presenting our case, we review the literature on this atypical presentation of GERD causing acute coronary syndrome and discuss potential mechanisms. Chui Man Carmen Hui, Santosh K. Padala, Michael Lavelle, Mikhail T. Torosoff, Xinjun Cindy Zhu, and Mandeep S. Sidhu Copyright © 2015 Chui Man Carmen Hui et al. All rights reserved. Recurrent Postmyocardial Infarction Ventricular Tachycardia: An Unusual Culprit Sun, 22 Nov 2015 11:09:36 +0000 Although temporary transvenous pacing is life-saving in patients with myocardial infarction who develop bradyarrhythmias, the electrical complications resulting from it can be fatal and are rarely reported. We report here a patient with acute inferior wall myocardial infarction who required temporary transvenous pacing due to second-degree atrioventricular block accompanied with hypotension. Following coronary angiography and successful revascularisation, the patient developed multiple episodes of monomorphic and polymorphic ventricular tachycardia as well as ventricular fibrillation which on careful inspection were found to be initiated by fusion of the intrinsic and paced complexes. The problem of malignant ventricular tachycardia was solved by simple removal of the pacing lead. To the best of our knowledge, malignant ventricular tachycardia of both monomorphic and polymorphic types initiated by fusion complexes in a paced patient has not been reported in literature. Akhil Kumar Sharma, Nirdesh Jain, Safal Safal, Vikas Kumar, and Sudhanshu Kumar Dwivedi Copyright © 2015 Akhil Kumar Sharma et al. All rights reserved. Left Ventricular Thrombus as a Complication of Clozapine-Induced Cardiomyopathy: A Case Report and Brief Literature Review Wed, 18 Nov 2015 07:11:11 +0000 A 48-year-old male with history of schizoaffective disorder on clozapine presented with chest pain, dyspnea, and new left bundle branch block. He underwent coronary angiography, which revealed no atherosclerosis. The patient’s workup was unrevealing for a cause for the cardiomyopathy and thus it was thought that clozapine was the offending agent. The patient was taken off clozapine and started on guideline directed heart failure therapy. During the course of hospitalization, he was also discovered to have a left ventricular (LV) thrombus for which he received anticoagulation. To our knowledge, this is the first case report of clozapine-induced cardiomyopathy complicated by a LV thrombus. Shahbaz A. Malik, Sarah Malik, Taylor F. Dowsley, and Balwinder Singh Copyright © 2015 Shahbaz A. Malik et al. All rights reserved. Valvular Excrescences: A Possible Transient Phenomenon Mon, 16 Nov 2015 14:29:22 +0000 The thrombogenic potential of Lambl excrescences (LE) is minimal unlike the benign tumour fibroelastoma wherefrom thrombi often originate. We present a patient with multiple strokes within a six-year period. A possible locus on the aortic valve was found and diagnosed as fibroelastoma. Before aortic valve substitution prior finding could not be visualized and surgery was aborted. Due to review of earlier Transesophageal Echocardiography (TEE) and the transient component, LE was accepted as the most plausible diagnosis. This illustrates the need for TEE just before surgery. Peter Marstrand, Maiken Brit Jensen, and Nikolaj Ihlemann Copyright © 2015 Peter Marstrand et al. All rights reserved. Giant Saphenous Venous Graft Aneurysm with Compression of the Pulmonary Artery: A Rare Cause of Heart Failure Mon, 16 Nov 2015 13:58:20 +0000 We report a case of a 74-year-old man who presented with dyspnea on exertion and pedal edema. He had five-vessel coronary artery bypass graft (CABG) surgery twenty-six years ago and redo three-vessel CABG done thirteen years later. Computed tomographic angiography (CTA) of the heart and coronary vessels demonstrated a giant aneurysm arising from the saphenous venous graft (SVG) to the first obtuse marginal of the left circumflex artery compressing the pulmonary artery (PA). He underwent coronary angiography, confirming the CTA findings. Surgical and percutaneous interventions were offered, but the patient opted for conservative management due to the high risk of morbidity and mortality. Jagadeesh K. Kalavakunta, Yashwant Agrawal, Alicia Williams, Jerry W. Pratt, and Frank Saltiel Copyright © 2015 Jagadeesh K. Kalavakunta et al. All rights reserved. Cushing’s Disease Presented by Reversible Dilated Cardiomyopathy Mon, 16 Nov 2015 13:14:10 +0000 Introduction. Dilated cardiomyopathy is rarely reported among CS patients especially without hypertension and left ventricular hypertrophy. Materials and Methods. We hereby report a Cushing’s syndrome case presenting with dilated cardiomyopathy. Results. A 48-year-old female patient was admitted to our clinic with severe proximal myopathy and dilated cardiomyopathy without ventricular hypertrophy. Cushing’s disease was diagnosed and magnetic-resonance imaging of the pituitary gland revealed a microadenoma. Under diuretic and ketoconazole treatments, she underwent a successful transnasal/transsphenoidal adenomectomy procedure. Full recovery of symptoms and echocardiographic features was achieved after six months of surgery. Conclusion. Cushing’s syndrome must be kept in mind as a reversible cause of dilated cardiomyopathy. Recovery of cardiomyopathy is achieved with successful surgery. Berna İmge Aydoğan, Demet Menekşe Gerede, Asena Gökçay Canpolat, and Murat Faik Erdoğan Copyright © 2015 Berna İmge Aydoğan et al. All rights reserved. Insights into the Mechanism of Severe Mitral Regurgitation: RT-3D TEE Guided Management with Pathological Correlation Thu, 12 Nov 2015 09:53:26 +0000 Mitral valve perforation is an uncommon but important complication of infective endocarditis. We report a case of a 65-year-old man who was diagnosed to have infective endocarditis of his mitral valve. Through the course of his admission he had a rapid development of hemodynamic instability and pulmonary edema secondary to acutely worsening mitral regurgitation. While the TEE demonstrated an increase in the size of his bacterial vegetation, Real Time 3D TEE was ultimately the imaging modality through which the valve perforation was identified. Through this case report we discuss the advantages that RT-3D TEE has over traditional 2D TEE in the management of valve perforation. Senthil Anand, Naktal Hamoud, Jess Thompson, and Rajesh Janardhanan Copyright © 2015 Senthil Anand et al. All rights reserved. Multiple Coronary Artery Microfistulas Associated with Apical Hypertrophic Cardiomyopathy: Left and Right Coronary Artery to the Left Ventricle Wed, 11 Nov 2015 12:04:32 +0000 A 76-year-old woman underwent coronary angiography for chest pain. On the coronary angiogram, no significant coronary artery atherosclerotic stenosis was observed. Multiple coronary artery microfistulas, draining from the left anterior descending artery to the left ventricle and from the posterior descending artery of the right coronary artery to the left ventricle, were observed. Apical wall thickening and fistula flow from the left anterior descending artery were demonstrated by using transthoracic echocardiography. We describe a rare case of multiple coronary artery microfistulas from the left and right coronary artery to the left ventricle combined with apical hypertrophic cardiomyopathy. Jeong-Woo Choi, Kyehwan Kim, Min Gyu Kang, Jin-Sin Koh, Jeong Rang Park, and Jin-Yong Hwang Copyright © 2015 Jeong-Woo Choi et al. All rights reserved. Mitral Subvalvular Aneurysm in a Patient with Chagas Disease and Recurrent Episodes of Ventricular Tachycardia Sun, 08 Nov 2015 13:16:20 +0000 Subvalvular left ventricular aneurysm is a rare disease of obscure origin suggesting unique causes such as congenital, traumatic, and inflammatory or infectious diseases. Its mortality is closely related to heart failure, mitral insufficiency, thromboembolic phenomena, and cardiac arrhythmias. Although association with coronary artery disease is not described, the compression of epicardial vessels by the aneurysm may lead to ischemic manifestations. We report here a case of mitral subvalvular left ventricular aneurysm of probable chagasic origin, in a patient with normal left ventricular function evolving with repeated episodes of monomorphic ventricular tachycardia, despite noninducible electrophysiological testing and the use of optimal medical treatment, including amiodarone. The indication for implantable cardioverter-defibrillator in patients with Chagas cardiomyopathy and segmental wall motion abnormalities but without global systolic dysfunction remains unclear in literature, even in the presence of complex ventricular arrhythmias. A brief review of the literature on morphological features, diagnosis, prognosis, and treatment will be also discussed. Tereza Augusta Grillo, Guilherme Rafael S. Athayde, Ana Flávia L. Belfort, Reynaldo C. Miranda, Andrea Z. Beaton, and Bruno R. Nascimento Copyright © 2015 Tereza Augusta Grillo et al. All rights reserved. Influenza Induced Cardiomyopathy: An Unusual Cause of Hypoxemia Thu, 05 Nov 2015 07:37:31 +0000 Influenza has considerable burden on public health funds. The complications of influenza can be devastating. We present a case of a 42-year-old woman with history of asthma who presented to the emergency room in winter with shortness of breath and general malaise and was found to be in hypoxemic respiratory failure. She was diagnosed with influenza and workup revealed severely depressed systolic cardiac function (ejection fraction of 25%). She was treated with oseltamivir and diuresis and regained cardiac function within a week. We review the pathophysiology and management of influenza induced cardiomyopathy. Abdullah Quddus, Maxwell Eyram Afari, and Taro Minami Copyright © 2015 Abdullah Quddus et al. All rights reserved. Serratia marcescens: A Rare Cause of Recurrent Implantable Cardioverter Defibrillator Site Infection Thu, 29 Oct 2015 08:04:01 +0000 We present a unique case of a patient who experienced recurrent infections of his implantable cardioverter defibrillator (ICD) site with the bacterium Serratia marcescens. This report highlights the virulence of this bacterium, its resistance to antibiotic therapy, and its ability to remain latent for prolonged periods between episodes of sepsis. It also demonstrates the merits of reimplanting devices at different sites in the context of Serratia marcescens infection. S. Hawkey and AM. Choy Copyright © 2015 S. Hawkey and AM. Choy. All rights reserved. Small Bowel Obstruction Masquerading as Acute ST Elevation Myocardial Infarction Mon, 26 Oct 2015 11:29:53 +0000 ST segment elevation on EKG remains among the most important presentations of acute myocardial infarction. Due to the urgency of intervention for this finding, other clinical scenarios causing ST elevations on EKG may sometimes go unaddressed and can lead to fatal complications. We present a case of an 86-year-old male presenting with small bowel obstruction leading to EKG findings of ST segment elevation in the absence of critical coronary obstruction. The EKG finding resolved after the improvement of small bowel obstruction reflecting the reversible cause of the changes. Manan Parikh, Martin Miguel Amor, Isha Verma, Jeffrey Osofsky, and Madhu Paladugu Copyright © 2015 Manan Parikh et al. All rights reserved. Pacing and Sensing of Human Heart for over 31 Years with the Same Apparatus (Generator and Lead) Mon, 26 Oct 2015 09:53:23 +0000 Several patients receive a permanent pacemaker in a relatively young age, with multiple subsequent reoperations for pacemaker replacement. Pulse generator replacement is an invasive procedure, associated with the risk of various complications, mainly infection and skin erosion. A case of an extremely long-lasting pacemaker with a totally uneventful longevity period over 31 years is presented. The explanation for this quite rare pacemaker longevity (possibly unique) is analyzed and discussed. Evangelos Papasteriadis and Panagiotis Margos Copyright © 2015 Evangelos Papasteriadis and Panagiotis Margos. All rights reserved. A Spiral in the Heart: Mitral Valve Endocarditis with Unusual Vegetation Shape Potentially Affecting Effectiveness of Antibiotic Therapy Sun, 25 Oct 2015 06:59:29 +0000 We report an unusual case of infective endocarditis (IE) in an 88-year-old woman, occurring on a prolapsing mitral valve and characterized by an atypical vegetation shape resembling a spiral-like appearance. After the patient refused surgical correction, persistent IE despite prolonged antibiotic therapy was observed, resulting in an ischemic stroke probably secondary to septic embolus. The importance of vegetation shape in the management of patients with IE was classically related to the increased risk of embolization associated with pedunculated, irregular, and multilobed masses. We hypothesize that the unusual spiral-like vegetation shape in our patient may have favored IE persistence by two mechanisms, namely, a decrease of the exposed vegetation surface with creation of an internal core where the penetration of antimicrobial agents was obstacled and the creation of blood turbulence within the vegetation preventing a prolonged contact with circulating antibiotics. These considerations suggest that vegetation shape might be considered of importance in patients with IE not only because of its classical association with embolization risk, but also because of its potential effect on the efficacy of antibiotic therapy. Veronica Fibbi, Piercarlo Ballo, Alessandro Abbondanti, Marco Nannini, and Antonio Fazi Copyright © 2015 Veronica Fibbi et al. All rights reserved. Spontaneous Coronary Artery Dissection/Intramural Haematoma in Young Women with ST-Elevation Myocardial Infarction: “It Is Not Always a Plaque Rupture Event” Wed, 21 Oct 2015 13:01:48 +0000 Spontaneous coronary artery dissection (SCAD) is an unusual, but increasingly recognized, cause of ST-elevation myocardial infarction (STEMI), especially among younger patients without conventional risk factors for coronary artery disease (CAD). Although dissection of the coronary intima or media is a hallmark finding, hematoma formation within the vessel wall is often present. It remains unclear whether dissection or hematoma is the primary event, but both may cause luminal stenosis and occlusion. The diagnosis of SCAD is made principally with invasive coronary angiography, although adjunctive intracoronary imaging modalities may increase the diagnostic yield. In STEMI patients, the decision whether to pursue primary percutaneous coronary intervention (PCI) or appropriate conservative medical therapy is based on clinical presentation, the extent of the dissection, the critical anatomy involvement, and the amount of ischaemic myocardium at risk. In this case report, we present two cases of young women with SCAD and STEMI, successfully treated with primary PCI. We briefly illustrate the characteristic aspects of the angiographic presentation and intravascular ultrasound-guided treatment. SCAD should always be considered in young STEMI patients without conventional risk factors for CAD with primary angioplasty to be required in patients with ongoing myocardial ischemia. George Kassimis, Athanasios Manolis, and Jonathan N. Townend Copyright © 2015 George Kassimis et al. All rights reserved. Corrigendum to “Acute Amiodarone Pulmonary Toxicity after Drug Holiday: A Case Report and Review of the Literature” Mon, 19 Oct 2015 05:50:51 +0000 Ahmed Abuzaid, Marwan Saad, Mohamed Ayan, Amjad Kabach, Toufik Mahfood Haddad, Aiman Smer, and Amy Arouni Copyright © 2015 Ahmed Abuzaid et al. All rights reserved. A Rare Case of Complete Stent Fracture, Coronary Arterial Transection, and Pseudoaneurysm Formation Induced by Repeated Stenting Mon, 12 Oct 2015 09:05:04 +0000 This report describes a rare asymptomatic case of complete stent fracture, coronary arterial transection, and pseudoaneurysm formation in response to repeated stenting. The proximal and distal ends of transected coronary artery were closed, and distal bypass was performed. Coronary arterial transection can occur in patients with repeated stenting as a long-term adverse event. Fumiaki Nakao, Masashi Kanemoto, Jutaro Yamada, Kazuhiro Suzuki, Hidetoshi Tsuboi, and Takashi Fujii Copyright © 2015 Fumiaki Nakao et al. All rights reserved. Comment on “Takotsubo Cardiomyopathy: A New Perspective in Asthma” Mon, 12 Oct 2015 08:00:49 +0000 John E. Madias Copyright © 2015 John E. Madias. All rights reserved. Right Ventricular Outflow Tract Tachycardia with Structural Abnormalities of the Right Ventricle and Left Ventricular Diverticulum Mon, 05 Oct 2015 13:05:06 +0000 A 43-year-old woman presented to the emergency room with a sustained ventricular tachycardia (VT). ECG showed a QRS in left bundle branch block morphology with inferior axis. Echocardiography, ventricular angiography, and cardiac magnetic resonance imaging (CMRI) revealed a normal right ventricle and a left ventricular diverticulum. Electrophysiology studies with epicardial voltage mapping identified a large fibrotic area in the inferolateral layer of the right ventricular wall and a small area of fibrotic tissue at the anterior right ventricular outflow tract. VT ablation was successfully performed with combined epicardial and endocardial approaches. Bortolo Martini, Nicola Trevisi, Nicolò Martini, and Li Zhang Copyright © 2015 Bortolo Martini et al. All rights reserved. Reversible Myocarditis and Pericarditis after Black Widow Spider Bite or Kounis Syndrome? Mon, 05 Oct 2015 11:36:48 +0000 Clinical manifestation of black widow spider bite is variable and occasionally leads to death in rural areas. Cases of myocarditis and pericarditis after black widow spider bite are rare and the associated prognostic significance is unknown. Kounis syndrome has been defined as an acute coronary syndrome in the setting of allergic or hypersensitivity and anaphylactic or anaphylactoid insults that manifests as vasospastic angina or acute myocardial infarction or stent thrombosis. Allergic myocarditis is caused by myocardial inflammation triggered by infectious pathogens, toxic, ischemic, or mechanical injuries, such as drug-related inflammation and other immune reactions. A 15-year-old child was admitted to the emergency department with pulmonary edema after spider bite. ST segment depression on ECG, elevated cardiac enzymes and global left ventricular hypokinesia (with ejection fraction of 22%), and local pericardial effusion findings confirmed the diagnosis of myopericarditis. After heart failure and pulmonary edema oriented medical therapy, clinical status improved. Patient showed a progressive improvement and LV functions returned to normal on the sixth day. Myopericarditis complicating spider bite is rare and sometimes fatal. The mechanism is not clearly known. Alpha-latrotoxin of the black widow spider is mostly convicted in these cases. But allergy or hypersensitivity may play a role in myocardial damage. Mehmet Yaman, Turkan Mete, Ismail Ozer, Elif Yaman, and Osman Beton Copyright © 2015 Mehmet Yaman et al. All rights reserved. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report Wed, 30 Sep 2015 09:44:58 +0000 Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication. Yakup Alsancak, Burak Sezenoz, Sedat Turkoglu, and Adnan Abacı Copyright © 2015 Yakup Alsancak et al. All rights reserved. Double Ventricular Responses Leading to Reversible Cardiomyopathy as Late Complication after Slow-Pathway Ablation Wed, 30 Sep 2015 08:01:01 +0000 Double ventricular response is a rare arrhythmia that results from simultaneous antegrade conduction over the fast and slow pathways of AV node. Double ventricular responses may lead to arrhythmia-related cardiomyopathy. As far as we know, there is not any reported reversible cardiomyopathy development that resulted from double ventricular responses to one atrial impulse after slow pathway ablation. We report a unique case of double ventricular response cardiomyopathy that has been developed 5 years after slow pathway ablation. Umut Celikyurt, Meinrad Gawaz, Juergen Schreieck, and Peter Seizer Copyright © 2015 Umut Celikyurt et al. All rights reserved. Pulmonary Vein Stenosis in a Newborn: A Commonly Overlooked Diagnosis Sun, 20 Sep 2015 14:19:07 +0000 The diagnosis of primary pulmonary vein stenosis is often overlooked because its symptoms overlap lung diseases and pulmonary arterial hypertension. Its diagnosis may be difficult because the condition is progressive and associated with other defects. We present a case of pulmonary vein stenosis in a newborn with stenosis of the left-sided common pulmonary vein, diffuse hypoplasia of the superior right pulmonary vein, and atresia of the inferior right pulmonary vein. Nathalie Jeanne Magioli Bravo-valenzuela, Guilherme Ricardo Nunes Silva, and Marcela Pinto Varella Copyright © 2015 Nathalie Jeanne Magioli Bravo-valenzuela et al. All rights reserved. Primary Cardiac Fibroma in an Adult Sun, 20 Sep 2015 07:26:07 +0000 Cardiac fibromas are benign primary tumors composed of connective tissue and fibroblasts. These uncommon tumors are primarily found in the pediatric population, and their prevalence among the adult population is exceedingly rare. We report a case of an adult with nonspecific symptoms, who was subsequently found to have a solitary mass located in the left ventricle. This case highlights an unusual finding in an adult who through various imaging modalities, surgical excision, and immunohistological analysis was found to have a cardiac fibroma. Samuel H. Cho, Timothy Fritz, Lynn J. Cronin, and Stephen D. Cohle Copyright © 2015 Samuel H. Cho et al. All rights reserved. A Case of Aortopulmonary Window: Asymptomatic until the First Pregnancy Thu, 17 Sep 2015 08:50:29 +0000 The aortopulmonary window (APW) is an abnormal communication between the ascending aorta and the pulmonary trunk in the presence of two separate semilunar valves. It is a rare congenital malformation which represents 0.1% of all congenital cardiac diseases. Herein, we report a very rare case of 27-year-old patient with unrepaired APW causing Eisenmenger syndrome and pulmonary hypertension who was asymptomatic until her first pregnancy. The median survival of uncorrected APW is 33 years. Aortopulmonary window is a very rare congenital anomaly. To our knowledge, asymptomatic adult case has not been reported until now. APW should be considered in the differential diagnosis of the severe pulmonary hypertension also in adult patients. Murat Kose, Serra Ucar, Samim Emet, Timur Selcuk Akpinar, and Kıvanc Yalin Copyright © 2015 Murat Kose et al. All rights reserved. Left Main Compression by a Giant Aneurysm of the Left Sinus of Valsalva: An Extremely Rare Reason for Myocardial Infarction and Cardiogenic Shock Tue, 15 Sep 2015 09:54:03 +0000 Aneurysms of the sinus of Valsalva are very rare and mostly located in the right coronary sinus. They might course with dyspnea, fatigue, and acute coronary syndromes. We present herein an extremely rare case report of a 61-year-old woman diagnosed with external left main coronary compression by a giant aneurysm of the left sinus of Valsalva, which was successfully managed with percutaneous coronary intervention. Bruno L. R. Faillace, Micheli Z. Galon, Marcos Danillo P. Oliveira, Guy F. A. Prado Jr., Adriano A. M. Truffa, Expedito E. Ribeiro, and Pedro A. Lemos Copyright © 2015 Bruno L. R. Faillace et al. All rights reserved. Left Ventricular Aneurysm Presenting as a Late Complication of Childhood Chemotherapy Thu, 10 Sep 2015 08:04:35 +0000 Cardiotoxicity is a well known adverse effect of chemotherapy. Multiple cardiac injuries have been reported including cardiomyopathy, pericarditis, myocarditis, angina, arrhythmias, and myocardial infarction. A left ventricular aneurysm due to chemotherapy is a rare and a dangerous complication which is particularly challenging in diagnosis requiring a high index of suspicion and periodic imaging. We present a case of a young Caucasian male with a past medical history of Acute Lymphocytic Leukemia status after chemotherapy during his childhood diagnosed with left ventricular aneurysm several years later. Braghadheeswar Thyagarajan, Lubna Bashir Munshi, and Martin Miguel Amor Copyright © 2015 Braghadheeswar Thyagarajan et al. All rights reserved. A Rare Case of Aortic Valve Thrombosis in Patient with Idiopathic Hypereosinophilic Syndrome Tue, 08 Sep 2015 09:21:26 +0000 Idiopathic hypereosinophilic syndrome (HES) is characterized by persistent eosinophilia and eosinophil-mediated organ-system damage. Cardiac thrombosis and thromboembolic complications represent common causes of morbidity and mortality and usually involve cardiac ventricles or mitral and prosthetic valves, while the involvement of the aortic valve is extremely rare in HES. Here we report peculiar multimodality images of an atypical case of extended thrombosis of the aortic valve, complicated by myocardial ischemia and asymptomatic cerebral ischemia, likely due to thrombus embolization, occurring in a 48-year-old man with HES. Prompt anticoagulant and steroid therapy lead to rapid and complete resolution of the thrombotic lesions, allowing preserving the native valve and preventing further embolic events. Elisabetta Grolla, Michele Dalla Vestra, Luca Bonanni, Ada Cutolo, and Fausto Rigo Copyright © 2015 Elisabetta Grolla et al. All rights reserved. Culture Negative Stent Infection in an Infant with Hypoplastic Left Heart and Persistent Fever Tue, 08 Sep 2015 07:02:11 +0000 We present an infant with hypoplastic left heart with persistent fever despite two courses of antibiotics and repeatedly negative blood cultures. He eventually underwent surgical extraction of two stents. The stent cultures became positive; he was treated with 4 weeks of antibiotics and the fever resolved. Kurt D. Piggott, Federico Laham, Alejandro Jordan Villegas, Harun Fakioglu, Carlos Blanco, and Sukumar Suguna Narasimhulu Copyright © 2015 Kurt D. Piggott et al. All rights reserved. A Report of Accelerated Coronary Artery Disease Associated with Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy Mon, 07 Sep 2015 05:50:52 +0000 Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common heritable form of vascular dementia and it is caused by mutations in the NOTCH3 gene. The neurologic manifestations of CADASIL syndrome have been well characterized; however, here we report one of the first de novo cases of CADASIL-associated coronary artery disease. A 45-year-old woman with a history of CADASIL and remote tobacco use presented with unstable angina. She was found to have diffuse and irregular narrowing of the left anterior descending artery and a drug eluting stent was deployed. Months later, she developed two subsequent episodes of unstable angina, requiring stent placement in the distal left anterior descending artery and the right coronary artery. Though the neurologic manifestations of CADASIL have been well described, these patients may also be predisposed to developing premature coronary artery disease. Patients with CADASIL and their physicians should be aware of this possible association because these patients may not be identified as high risk by traditional cardiovascular risk estimators. These patients may benefit from more aggressive interventions to reduce cardiac risk. Courtney B. Rubin, Virginia Hahn, Taisei Kobayashi, and Andrew Litwack Copyright © 2015 Courtney B. Rubin et al. All rights reserved.