Case Reports in Cardiology The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Recurrent Pericarditis, an Unexpected Effect of Adjuvant Interferon Chemotherapy for Malignant Melanoma Wed, 22 Jun 2016 09:33:28 +0000 Drug-induced pericarditis is a well-described cardiac pathology that can result from a variety of medications; however, interferon-mediated pericarditis is extremely rare. We present a case of a young female with recurrent pericarditis due to interferon therapy. The role of interferon in adjuvant chemotherapy is well known and yields good effect, but this case highlights the very uncommon phenomena of interferon induced pericarditis and the significant distress it can cause. Farhan Ashraf, Fady Marmoush, Muhammad Ismail Shafi, and Ashish Shah Copyright © 2016 Farhan Ashraf et al. All rights reserved. Left Main Percutaneous Coronary Intervention and Transcatheter Aortic Valve Replacement in a Young Male with Rheumatic Heart Disease and Porcelain Aorta Wed, 22 Jun 2016 09:32:28 +0000 We highlight the presence of a calcified mass in the left main coronary artery without significant atherosclerosis seen in the other coronary arteries or in the peripheral large arteries. In our view, the calcified character of the obstruction and the calcification of the aortic valve are characteristic of a variant type of coronary artery disease (CAD) not associated with the same risk factors as diffuse coronary atherosclerosis, but, in this case, with rheumatic heart disease. This case report also emphasizes the interventional approach for patients with aortic valve stenosis secondary to rheumatic heart disease. Vinod Chainani, Osman Perez, Ram Hanno, Patrick Hourani, Pablo Rengifo-Moreno, Pedro Martinez-Clark, and Carlos E. Alfonso Copyright © 2016 Vinod Chainani et al. All rights reserved. Accidental Entrapment of Electrical Mapping Catheter by Chiari’s Network in Right Atrium during Catheter Ablation Procedure Sun, 05 Jun 2016 12:25:07 +0000 A 78-year-old male was admitted to our hospital due to frequent palpitation. His electrocardiogram (ECG) presented regular narrow QRS tachycardia with 170 bpm, and catheter ablation was planned. During electroanatomical mapping of the right atrium (RA) with a multiloop mapping catheter, the catheter head was entrapped nearby the ostium of inferior vena cava. Rotation and traction of the catheter failed to detach the catheter head from the RA wall. Exfoliation of connective tissue twined around catheter tip by forceps, which were designed for endomyocardial biopsy, succeeded to retract and remove the catheter. Postprocedural echocardiography and pathologic examination proved the existence of Chiari’s network. The handling of complex catheters in the RA has a potential risk of entrapment with Chiari’s network. Atsushi Sakamoto, Tsuyoshi Urushida, Tomoaki Sakakibara, Makoto Sano, Kenichiro Suwa, Takeji Saitoh, Masao Saotome, Hideki Katoh, Hiroshi Satoh, and Hideharu Hayashi Copyright © 2016 Atsushi Sakamoto et al. All rights reserved. Progressed Multivessel Spontaneous Coronary Artery Dissection That Naturally Healed in a Male Patient with Non-ST Segment Elevation Myocardial Infarction Mon, 30 May 2016 06:45:48 +0000 Spontaneous coronary artery dissection (SCAD) is a rare condition that may have a serious outcome because of acute coronary syndrome. The condition especially affects young women. We evaluated a middle-aged male patient with a non-ST segment elevation myocardial infarction caused by multivessel SCAD. The SCAD had occurred in the distal right coronary artery (RCA), the mid left anterior descending artery (LAD), and the distal LAD at the same time. His culprit lesion was in the distal RCA, but the SCAD had progressed more proximally within the RCA 12 days later with no clinical symptoms. We treated the mid LAD with implantation of a drug-eluting stent on admission and the SCAD had not progressed 12 days later. Moreover, the SCAD in the distal RCA and distal LAD healed spontaneously 12 days later. He had no recurrent attack, and all SCAD lesions of the RCA and LAD had completely healed 6 months later. Given that SCAD appears in various forms over the clinical course, a strategy of intervention needs careful consideration. Tatsuo Haraki, Ryota Uemura, Shin-ichiro Masuda, and Takeshi Lee Copyright © 2016 Tatsuo Haraki et al. All rights reserved. Fibrinolytic Treatment after Transient Ischaemic Attack Caused by Prosthetic Mitral Valve Thrombosis Thu, 26 May 2016 08:28:54 +0000 Prosthetic valve thrombosis is one of the most severe complications after surgical valve replacement. There are many possible presentations: from asymptomatic to life-threatening complications. We report on a 61-year-old female patient with prosthetic replacement of the aortic and mitral valve in the in-house department of cardiac surgery 3 months ago. The patient was suffering from aphasia during 5 minutes in domesticity. After her presentation in the emergency room, the echocardiographic examination revealed a thrombotic formation of the prosthetic mitral valve. At presentation, the anticoagulation was outside the effective range (INR: 1.7). A successful thrombolytic therapy with the plasminogen activator urokinase was begun with complete resolution of the thrombus. Cornel Koban, Michael Neuß, Grit Tambor, Frank Hölschermann, and Christian Butter Copyright © 2016 Cornel Koban et al. All rights reserved. Idiopathic Intractable Diarrhoea Leading to Torsade de Pointes Mon, 23 May 2016 08:40:40 +0000 An 81-year-old lady was admitted to our hospital with a 3-year history of noninfective diarrhoea and recurrent syncopal events over the last 3 months. Her initial electrocardiogram (ECG) revealed trigeminy and prolonged QTc interval. She had a structurally normal heart with no coronary artery disease. Investigations revealed low potassium at 3.0 mmol/L. Sigmoidoscopy and colonoscopy suggested a possible diagnosis of diverticulitis. Soon after admission she had an unresponsive episode with spontaneous recovery. Telemetry and Holter analysis confirmed multiple episodes of polymorphic ventricular tachycardia (Torsade de Pointes). Following electrolyte supplementation the episodes of polymorphic VT improved. Due to the protracted nature of the diarrhoea, the recurrent syncopal events, and recurrent hypokalaemia documented over recent years, an Implantable Cardioverter Defibrillator (ICD) was sanctioned by the multidisciplinary team (MDT). In summary, chronic diarrhoea may result in life threatening polymorphic VT due to hypokalaemia and QTc prolongation. In these patients an ICD may be considered. Kyriacos Mouyis, Darlington Okonko, and Constantinos G. Missouris Copyright © 2016 Kyriacos Mouyis et al. All rights reserved. A Combination of Two Rare Coronary Anomalies Makes It Even Rarer: Right Sided Single Coronary Artery with Dual Left Anterior Descending Artery Wed, 18 May 2016 11:45:35 +0000 An 82-year-old female with history of hyperlipidemia and hypertension presented to the clinic with chief complaint of nonradiating chest tightness accompanied by exertional dyspnea. Cardiac catheterization showed the absence of left coronary system; the entire coronary system originated from the right aortic sinus as a common trunk which then gave off the right coronary artery and the left main coronary artery. Cardiac catheterization demonstrated also another rare coronary anomaly: dual left anterior descending artery. Patient underwent percutaneous coronary intervention and subsequent multidetector computed tomography angiography confirmed the above angiography findings. Patient was subsequently discharged home on double antiplatelet therapy with aspirin and clopidogrel and has been asymptomatic since then. Aram Barbaryan, Theodore Addai, Monahar Kola, Muhammad Wajih Raqeem, Sergey Barsamyan, and Aibek E. Mirrakhimov Copyright © 2016 Aram Barbaryan et al. All rights reserved. Percutaneous Punctured Transcatheter Device Closure of Residual Shunt after Ventricular Septal Defect Repair Tue, 17 May 2016 11:20:42 +0000 Ventricular septal defects (VSDs) are estimated to account for 20 to 30% of all congenital heart defects (CHDs). Although a residual shunt is the most common complication of VSD surgery, a second operation that applies the surgical repair method is very difficult because it can increase the possibility of uncontrolled bleeding and the severity of tissue adhesion. Here, we present the first case of percutaneous punctured transcatheter device closure of a residual shunt after VSD repair as a novel method to further develop for the treatment of children with congenital heart disease. Xuming Mo, Jirong Qi, and Weisong Zuo Copyright © 2016 Xuming Mo et al. All rights reserved. A Benign Cardiac Growth but Not So Indolent Mon, 16 May 2016 12:22:13 +0000 Cardiac lipomatous hypertrophy is a rare benign condition that usually involves the interatrial septum. Due to its benign nature it rarely requires intervention. Its presence outside the interatrial septum is reported infrequently. We present a case of lipomatous hypertrophy in the intraventricular septum that was complicated by a severe, symptomatic, and disabling dynamic left ventricular outflow tract obstruction. The symptoms significantly improved following the excision of the mass. In our case transthoracic echocardiogram was used to visualize the mass and measure the severity of the obstruction; Cardiac Magnetic Resonance Imaging was used to characterize the mass and histopathology confirmed the diagnosis. Adil S. Wani, Sahadev T. Reddy, Lakshmi Harinath, and Robert W. W. Biederman Copyright © 2016 Adil S. Wani et al. All rights reserved. Severe Left Ventricular Hypertrophy, Small Pericardial Effusion, and Diffuse Late Gadolinium Enhancement by Cardiac Magnetic Resonance Suspecting Cardiac Amyloidosis: Endomyocardial Biopsy Reveals an Unexpected Diagnosis Tue, 10 May 2016 13:16:58 +0000 Left ventricular (LV) hypertrophy can be related to a multitude of cardiac disorders, such as hypertrophic cardiomyopathy (HCM), cardiac amyloidosis, and hypertensive heart disease. Although the presence of LV hypertrophy is generally associated with poorer cardiac outcomes, the early differentiation between these pathologies is crucial due to the presence of specific treatment options. The diagnostic process with LV hypertrophy requires the integration of clinical evaluation, electrocardiography (ECG), echocardiography, biochemical markers, and if required CMR and endomyocardial biopsy in order to reach the correct diagnosis. Here, we present a case of a patient with severe LV hypertrophy (septal wall thickness of 23 mm, LV mass of 264 g, and LV mass index of 147 g/m2), severely impaired longitudinal function, and preserved radial contractility (ejection fraction = 55%), accompanied by small pericardial effusion and diffuse late gadolinium enhancement (LGE) by cardiac magnetic resonance (CMR). Due to the imaging findings, an infiltrative cardiomyopathy, such as cardiac amyloidosis, was suspected. However, amyloid accumulation was excluded by endomyocardial biopsy, which revealed the presence of diffuse myocardial fibrosis in an advanced hypertensive heart disease. Nina P. Hofmann, Sorin Giusca, Karin Klingel, Peter Nunninger, and Grigorios Korosoglou Copyright © 2016 Nina P. Hofmann et al. All rights reserved. A Case of Spontaneous Multivessel Coronary Artery Spasm That Underwent Stent Implantation Accompanying ST Segment Elevation on Inferior Electrocardiographic Leads Sun, 08 May 2016 07:32:52 +0000 Coronary artery spasm is usually defined as a focal constriction of a coronary artery segment, which is reversible, and causes myocardial ischaemia by restricting coronary blood flow. A coronary spasm may rarely compromise all three epicardial arteries simultaneously. We present a case of severe coronary spasm afflicting all coronary arteries accompanying an ST segment elevation in leads D2-D3 and aVF. Nuray Kahraman Ay, Muharrem Nasifov, and Ömer Goktekin Copyright © 2016 Nuray Kahraman Ay et al. All rights reserved. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery Tue, 03 May 2016 10:04:07 +0000 Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach. Ozge Korkmaz, Osman Beton, Sabahattin Goksel, Hakkı Kaya, and Ocal Berkan Copyright © 2016 Ozge Korkmaz et al. All rights reserved. The Artery of Percheron Infarction after Coronary Angiography Tue, 26 Apr 2016 13:29:57 +0000 Coronary angiography is the golden choice for coronary artery disease evaluation and management. However, as with any invasive procedures, there is a risk of complications. We are reporting a case of 69-year-old male with past medical history of cardiac bypass surgery, CHF, hypertension, and hyperlipidemia who was admitted to the hospital to evaluate his chest pain. He had treadmill stress test that showed ischemic induced exercise. Patient underwent coronary angiography that showed proximal complete occlusion of the RCA with a patent graft. At the end of the procedure, the patient did not wake up and remained minimally responsive. An urgent brain MRI was ordered and showed infarctions consistent with an artery of Percheron infarction. Later, patient has improved slowly and was discharged home. We briefly here discuss this rare complication including the risk factor, clinical presentation, and the management. Haitham Mazek, Khaled Sherif, Jose Suarez, and Jason Wischmeyer Copyright © 2016 Haitham Mazek et al. All rights reserved. A Case of Arterial and Venous Tear during Single Lead Extraction Mon, 18 Apr 2016 09:55:54 +0000 Transcutaneous lead extraction can be associated with significant morbidity and mortality. The risk of causing concomitant arterial and venous injury is rare. We report a case of marginal artery rupture with coronary sinus rupture after a CS lead extraction. A 71-year-old male was admitted for extraction of a 6-year-old implantable cardioverter-defibrillator lead due to fracture from insulation break. During the lead extraction, blood pressure fell precipitously and echocardiographic findings were consistent with pericardial effusion. After unsuccessful pericardiocentesis, open chest sternotomy and evacuation of hematoma was performed. Subsequent surgical repair of several injuries was completed including the distal coronary sinus, a large degloving injury of posterior portion of the heart, and first obtuse marginal branch bleed. This case demonstrates that when performing transcutaneous lead extraction (TLE) with laser sheath, a degloving injury can cause arterial rupture with concomitant coronary sinus injury. A multidisciplinary team-based approach can ensure patient safety. Learning Objective. Implantable cardioverter-defibrillator leads will falter over time. With the advancement of new technology for extraction more frequent and serious complications will occur. Active fixation CS leads present unique challenges. In the presence of hemodynamic changes during extraction the occurrence of both an arterial and venous injury must be considered. Michael S. Green, Daniel Wu, Vishal Patel, and Rayhan Tariq Copyright © 2016 Michael S. Green et al. All rights reserved. Ventricular Septal Perforation after Biventricular Takotsubo Cardiomyopathy Successfully Repaired with an Amplatzer Device: First Report in the Literature Wed, 13 Apr 2016 14:20:39 +0000 A 79-year-old female was admitted with sudden onset dyspnea, mild oppressive chest pain, and severe anxiety disorder. Patient had history of hypertension, dyslipidemia, smoking, and chronic obstructive pulmonary disease. On admission blood pressure was 160/90 and heart rate was 130 bpm. Transthoracic echocardiography (TE) and contrast tomography showed a thin septum with an abnormal left and right ventricular contraction with an “apical ballooning” pattern and mild increase of cardiac enzymes. At the 4th day of admission, the patient presented symptoms and signs of congestive heart failure and developed cardiogenic shock. EKG showed an inversion of T waves in all precordial leads. In a new TE, a ventricular septal perforation (VSP) in the apical portion of the septum was seen. Coronary angiogram showed angiographically “normal” coronary arteries. With a diagnosis of VSP in takotsubo cardiomyopathy, a percutaneous procedure to repair the VSP was performed 11 days after admission. The VSP was closed with an Amplatzer device. TE performed 24 hours after showed significant improvement of ventricular function and good apposition of the Amplatzer device. Three days later she was discharged from the hospital. To our knowledge, this is the first reported case of a VSP in a TCM repaired percutaneously with an occluder device. Alfredo E. Rodríguez, Carlos Fernandez-Pereira, Juan Mieres, Diego Ascarrunz, Eduardo Gabe, Alfredo Matías Rodríguez-Granillo, Romina Frattini, and Pablo Stuzbach Copyright © 2016 Alfredo E. Rodríguez et al. All rights reserved. A Case of Isolated Celiac Artery Dissection Accompanied by Splenic Infarction Detected by Ultrasonography in the Emergency Department Mon, 11 Apr 2016 09:49:36 +0000 A 46-year-old male with a history of hypertension visited the emergency department (ED) by ambulance complaining of sudden pain in the left side of his back. Ultrasonography (USG) performed at ED revealed splenic infarction along with occlusion and dissection of the celiac and splenic arteries without abdominal artery dissection. Contrast enhanced computed tomography (CT) revealed the same result. Consequently, spontaneous isolated celiac artery dissection (SICAD) was diagnosed. Because his blood pressure was high (159/70 mmHg), antihypertensive medicine was administered (nicardipine and carvedilol). After his blood reached optimal levels (130/80 mmHg), symptoms disappeared. Follow-up USG and contrast enhanced CT performed 8 days and 4 months after onset revealed amelioration of splenic infarction and improvement of the narrowed artery. Here, we report a case of SICAD with splenic infarction presenting with severe left-sided back pain and discuss the relevance of USG in an emergency setting. Kazumasa Emori, Nobuhiro Takeuchi, and Junichi Soneda Copyright © 2016 Kazumasa Emori et al. All rights reserved. Torsade de Pointes Triggered by Early Ventricular Escape Beats in a Patient with Complete Atrioventricular Block Wed, 06 Apr 2016 09:33:56 +0000 Torsade de pointes is an uncommon and malignant form of polymorphic ventricular tachycardia and associated with a prolonged QT interval, which may be congenital or acquired. Complete atrioventricular block may cause QT interval prolongation and torsade de pointes. In this paper, we present a case with complete atrioventricular block complicated with frequent episodes of torsade de pointes triggered by early premature ventricular contractions despite normal QT intervals. Erkan Yildirim, Baris Bugan, Suat Gormel, Uygar Cagdas Yuksel, Murat Celik, Yalcin Gokoglan, Serdar Firtina, Sinan Iscen, Emre Yalcinkaya, Ugur Kucuk, and Hasan Kutsi Kabul Copyright © 2016 Erkan Yildirim et al. All rights reserved. Tirofiban-Induced Thrombocytopenia Occurring with Crohn’s Disease Wed, 06 Apr 2016 08:10:17 +0000 A 69-year-old man, with severe refractory Crohn’s disease, presented with acute coronary syndrome that required angioplasty. He developed severe tirofiban-induced thrombocytopenia (TIT) heralded by type I allergic reaction that required steroids and a combination of antihistamine H1 and antihistamine H2 for symptomatic management. The thrombocytopenia spontaneously resolved uneventfully in 48 hours thereafter. This case report suggests a possible association between TIT and inflammatory bowel disease. Therefore, strict monitoring of the platelet count is required in patients who develop allergic reactions to tirofiban. Toni Ibrahim, Fady El Karak, Assem Araji, and Elie El Rassy Copyright © 2016 Toni Ibrahim et al. All rights reserved. Eosinophilic Myocarditis due to Toxocariasis: Not a Rare Cause Thu, 31 Mar 2016 11:32:10 +0000 Myocarditis is a clinically important disease because of the high mortality. From the perspective of treatment strategy, eosinophilic myocarditis should be distinguished from other types of myocarditis. Toxocariasis, caused by Toxocara canis or Toxocara cati, is known as a cause of eosinophilic myocarditis but is considered rare. As it is an unpopular disease, eosinophilic myocarditis due to toxocariasis may be underdiagnosed. We experienced two cases of eosinophilic myocarditis due to toxocariasis from different geographical areas in quick succession between 2013 and 2014. Case 1 is 32-year-old man. Case 2 is 66-year-old woman. In both cases, diagnosis was done by endomyocardial biopsy and IgG-ELISA against Toxocara excretory-secretory antigen. Only a corticosteroid was used in Case  1, whereas a corticosteroid and albendazole were used in Case  2 as induction therapy. Both patients recovered. Albendazole was also used in Case  1 to prevent recurrence after induction therapy. Eosinophilic myocarditis by toxocariasis may in actuality not be a rare disease, and corticosteroid is an effective drug as induction therapy even before use of albendazole. Shunichi Shibazaki, Shunsuke Eguchi, Takashi Endo, Tadamasa Wakabayashi, Makoto Araki, Yoshiaki Gu, Taku Imai, Kouji Asano, and Norihide Taniuchi Copyright © 2016 Shunichi Shibazaki et al. All rights reserved. Solid Right Ventricular Compression by Intraventricular Septum-Hematoma Induced after Percutaneous Coronary Intervention Mon, 28 Mar 2016 07:17:53 +0000 Intraventricular septum-hematoma is a rare complication following percutaneous coronary intervention (PCI). This complication may represent a challenge for accurate diagnosis and treatment. This case report is about a 60-year-old male patient being admitted with an acute coronary syndrome. Despite successful PCI with drug eluting stent implantation into the right coronary artery (RCA) the patient complained about recurrent angina pectoris according to Canadian Cardiovascular Society (CCS) class IV. Cardiac magnetic resonance imaging and transthoracic echocardiography revealed a massive  cm sized end-diastolic septum-hematoma, which compromised right ventricular cavity. Emergent recoronary angiography ruled out further contrast extravasation from the RCA. Conservative treatment was intended after discussion in the “heart-team.” The patient completely recovered with nearly complete resolution of the hematoma after 6 months. Ibrahim El-Battrawy, Ibrahim Akin, Benedikt Münz, David Manuel Leistner, Michael Behnes, Thomas Henzler, Holger Haubenreisser, Theano Papavassiliu, Martin Borggrefe, and Ralf Lehmann Copyright © 2016 Ibrahim El-Battrawy et al. All rights reserved. Synthetic Marijuana Induced Acute Nonischemic Left Ventricular Dysfunction Mon, 28 Mar 2016 06:40:38 +0000 Synthetic marijuana is an uptrending designer drug currently widely spread in the US. We report a case of acute deterioration of nonischemic left ventricular dysfunction after exposure to synthetic marijuana. This case illustrates the importance of history taking in cardiac patients and identifies a negative cardiovascular effect of synthetic marijuana known as K2, not yet well detected by urine toxicology screening tools. Moustafa Elsheshtawy, Priatharsini Sriganesh, Vasudev Virparia, Falgun Patel, and Ashok Khanna Copyright © 2016 Moustafa Elsheshtawy et al. All rights reserved. Treatment of Iatrogenic Aortocoronary Arteriovenous Fistula with Coronary Covered Stent Sun, 27 Mar 2016 14:00:15 +0000 An 83-year-old man, who underwent coronary artery bypass operation of left internal mammary artery (LIMA) to left anterior descending (LAD) artery, with sequential saphenous vein to the first and second obtuse marginal (OM) branches of circumflex artery 5 years ago and coronary artery stent implantation to right coronary artery 2 months ago, was admitted to the hospital with syncope and chest pain. Aortosaphenous graft selective angiography revealed that first sequential side to side ligation was inadvertently anastomosed to left posterolateral coronary vein with resultant flow into the coronary sinus and distal end to side sequential anastomosis to OM 2 coronary artery which was filling very weakly. In order to close this iatrogenic coronary arteriovenous fistula and to supply saphenous vein flow to OM artery, we decided to implant a graft covered stent into the saphenous vein at the same session. Ender Ornek, Harun Kundi, Emrullah Kiziltunc, and Mustafa Cetin Copyright © 2016 Ender Ornek et al. All rights reserved. 18F-FDG-PET Scanning Confirmed Infected Intracardiac Device-Leads with Abiotrophia defectiva Sun, 27 Mar 2016 11:48:47 +0000 Abiotrophia species are relatively slow growing pathogens, which may be present as commensal flora. However, invasive infections are frequently reported, like endocarditis, septic arthritis, osteomyelitis, and many other types of infection. In this case report we describe a 65-year-old male patient with an intracardiac device- (ICD-) lead infection caused by Abiotrophia defectiva. Diagnosis was confirmed by 18F-FDG-PET scanning. This is remarkable, since Abiotrophia defectiva is a slow growing pathogen causing low-grade infections. This case demonstrates that although infection of ICD-leads cannot be excluded in case of 18F-FDG-PET-negative findings, positive findings are highly suggestive for infection. Sonja van Roeden, Hans Hartog, Vivian Bongers, Steven Thijsen, and Sanjay Sankatsing Copyright © 2016 Sonja van Roeden et al. All rights reserved. Angiosarcoma of the Right Atrium with Extension to SVC and IVC Presenting with Complete Heart Block and Significant Pericardial Effusion Sun, 27 Mar 2016 08:58:29 +0000 Primary cardiac neoplasms are particularly unusual. Angiosarcoma is the most frequently seen histological subtype and is described by its infiltrating and damaging nature. Inappropriately, primary cardiac angiosarcoma is often missed as a preliminary diagnosis because of its scarcity. We present a 29-year-old previously healthy man with complete heart block and pericardial effusion who was finally diagnosed with angiosarcoma of the right atrium with extension to SVC and IVC. Hossein Vakili, Isa Khaheshi, Mehdi Memaryan, and Shooka Esmaeeli Copyright © 2016 Hossein Vakili et al. All rights reserved. Spontaneous, Postpartum Coronary Artery Dissection and Cardiogenic Shock with Extracorporeal Membrane Oxygenation Assisted Recovery in a 30-Year-Old Patient Thu, 24 Mar 2016 13:10:02 +0000 Coronary artery dissection is an infrequent cause of acute coronary syndrome in the general population. There is, however, a greater incidence of spontaneous coronary artery dissection (SCAD) in young women, especially in the peripartum period. However, the majority of cases have favorable outcomes with medical management or percutaneous coronary intervention; coronary artery bypass grafting (CABG) and transplantation are utilized in severe cases. This case is a one of a 30-year-old postpartum female with multivessel SCAD requiring CABG with subsequent biventricular failure and inability to wean from bypass. We believe this is the first reported case in which venoarterial extracorporeal membrane oxygenation (VA-ECMO) was used in the management of biventricular heart failure in a postpartum patient with SCAD. Kathleen E. Knapp, Ricardo A. Weis, Efrain I. Cubillo, Alyssa B. Chapital, and Harish Ramakrishna Copyright © 2016 Kathleen E. Knapp et al. All rights reserved. Carcinoid Syndrome-Induced Ventricular Tachycardia Mon, 21 Mar 2016 14:27:17 +0000 Introduction. Carcinoid tumors are rare neuroendocrine malignancies that secrete multiple bioactive substances. These bioactive substances are responsible for the carcinoid syndrome characterized by diarrhea, flushing, syncope, and right-sided valvular heart disease. Previous case reports have described carcinoid syndrome associated with coronary vasospasm and the well-characterized carcinoid heart disease. Case. Our patient is a 73-year-old female with complex past medical history most notable for metastatic carcinoid tumors diagnosed in 2013-05. She initially presented in 2014-09 with syncope and dizziness associated with sinus pause on an event monitor. She received a pacemaker given normal left ventricular function and was discharged. However, she was readmitted with similar symptoms corresponding to multiple episodes of ventricular tachycardia. She was started on high-dose beta blockade and has had no recurrence of arrhythmia over a follow-up period of 12 months. Conclusion. We hypothesize that the patient’s ventricular tachycardia was mediated by the multiple bioactive substances secreted by her carcinoid tumors. Her carcinoid tumor biomarkers were elevated and other explanations for arrhythmia were investigated and ruled out. To our knowledge, this is the first case of ventricular tachycardia mediated by carcinoid syndrome and suppressed by beta-blocker. Further investigation into this relationship is needed. Austin B. Rupp, Abdulmohsin Ahmadjee, Jack H. Morshedzadeh, and Ravi Ranjan Copyright © 2016 Austin B. Rupp et al. All rights reserved. New Stenting Technique to Achieve Favorable Jailing Configuration on Side Branch Ostium: Bent Stent Technique Mon, 21 Mar 2016 09:56:27 +0000 According to data from stent-enhanced three-dimensional optical coherence tomography, incomplete stent apposition after side branch dilation in coronary bifurcation stenting can be reduced by the free carina type (no links bridged from a carina) and by distal cell rewiring. This is the first report to describe a bent stent technique that was devised to achieve the free carina type (no links bridged from a carina), as a favorable jailing configuration. Fumiaki Nakao Copyright © 2016 Fumiaki Nakao. All rights reserved. Reactive Pulmonary Capillary Hemangiomatosis and Pulmonary Veno-Occlusive Disease in a Patient with Repaired Scimitar Syndrome Wed, 16 Mar 2016 13:10:35 +0000 Pulmonary capillary hemangiomatosis (PCH) is a rare histological substrate within the spectrum of pulmonary arterial hypertension that possibly represents an unusual manifestation of pulmonary veno-occlusive disease (PVOD). One of the histological hallmarks of PCH is the proliferation of pulmonary capillaries in the alveolar septa that infiltrate adjacent structures such as bronchioles, vessels, and visceral pleura. The hyperplastic process involving the smallest vessels of the pulmonary vascular bed might reflect uncontrolled angiogenesis, but whether this vascular proliferation is idiopathic or, conversely, a reactive process remains to be elucidated. Here we discuss the pathogenesis of PCH exemplified by the first reported case of a young patient with repaired scimitar syndrome that developed unilateral PCH. Eva Güttinger, Bart Vrugt, Rudolf Speich, Silvia Ulrich, Fabienne Schwitz, Mattia Arrigo, and Lars C. Huber Copyright © 2016 Eva Güttinger et al. All rights reserved. Treatment of a Coronary Bifurcation Lesion Using One Dedicated Sirolimus Eluting Bifurcation Stent in Combination with a Bioresorbable Vascular Scaffold: A Novel Option for Coronary Bifurcation Approach Tue, 15 Mar 2016 13:25:21 +0000 We present a complex bifurcation lesion treated with a new two-stent strategy combining a dedicated sirolimus eluting bifurcation stent, BiOSS Lim, with a bioresorbable vascular scaffold (BVS). The advantages of this strategy compared with the conventional two-stent approach are as follows: the dedicated stent protects the carina from being damaged, the large cell at the middle zone of the BiOSS Lim gives possibility to enter easily into the side branch (SB) with any standard size conventional device, and, finally, the additional use of BVS in the SB could have a long-term benefit in terms of restenosis. Javier Benezet, Antonio Agarrado, and Jesús Oneto Copyright © 2016 Javier Benezet et al. All rights reserved. Neoatherosclerosis in Very Late Stenosis of Bare Metal Stent by Optical Coherence Tomography Sun, 13 Mar 2016 12:20:24 +0000 Bare metal stents (BMS) continue to be widely used in patients with coronary artery disease undergoing percutaneous revascularization. Progressive luminal renarrowing has been reported late after BMS implantation resulting in a significant rate of stent failure events. We present a case of very late BMS failure due to in-stent restenosis where optical coherence tomography (OCT) was used to demonstrate neoatherosclerosis as the underlying mechanism. We provide a brief review of neoatherosclerosis and showcase salient features on OCT evaluation. Samer Mowakeaa, Aline Iskandar, and Nikolaos Kakouros Copyright © 2016 Samer Mowakeaa et al. All rights reserved.