Case Reports in Cardiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Late Diagnosed Left Coronary to the Pulmonary Artery Large Fistulae: An Interesting and Incidental Cath Lab Finding Wed, 07 Dec 2016 09:57:06 +0000 http://www.hindawi.com/journals/cric/2016/1459607/ Coronary artery anomalies are congenital changes in their origin, course, and/or structure. Most of them are discovered as incidental findings during coronary angiographic studies or at autopsies. A coronary artery fistulae involve a communication between a coronary artery and a chamber of the heart or any segment of the systemic or pulmonary circulation. We present herein the case of a 67-year-old man with a recent history of exertional angina and dyspnea to usual daily activities whose coronary angiogram revealed an interesting and incidental coronary-pulmonary artery large fistulae. Marcos Danillo P. Oliveira, Pedro H. M. Craveiro de Melo, Érlon O. Abreu-Silva, Fernando Barbiero Coura, Gleyson Moraes Rios, and Daniel Izzet Potério Copyright © 2016 Marcos Danillo P. Oliveira et al. All rights reserved. Primary Cardiac Lymphoma: Lessons Learned from a Long Survivor Wed, 07 Dec 2016 07:47:10 +0000 http://www.hindawi.com/journals/cric/2016/7164829/ Primary cardiac lymphoma (PCL) is a rare neoplasm that involves the heart, pericardium, or both. Patients with PCL have median survival of approximately 7 months. We report a 63-year-old woman with PCL treated with chemoimmunotherapy but relapsed 7 years later. She received automated implantable cardioverter-defibrillator (AICD) prophylactically shortly after the diagnosis. She presented with a breast recidive 7 years after initial diagnosis and died of relapsed small cell lung cancer. As many patients with PCL die early in the disease course due to life-threatening arrhythmias, preemptive implantation of AICD may improve mortality and prevent early death. Chemoimmunotherapy is effective in inducing remission in patients with PCL. Late and unusual pattern of relapse may be more frequent in patients with PCL and should be explored further. This case presents one of the longest surviving patients with PCL reported in the literature. Baljit Singh, Randy Ip, Ahmed Ibrahim Al-Rajjal, Zyad Kafri, Ayad Al-Katib, and Tarik Hadid Copyright © 2016 Baljit Singh et al. All rights reserved. Addison’s Disease and Dilated Cardiomyopathy: A Case Report and Review of the Literature Mon, 28 Nov 2016 13:37:55 +0000 http://www.hindawi.com/journals/cric/2016/4362514/ Addison’s disease is often accompanied by a number of cardiovascular manifestations. We report the case of a 30-year-old man who presented with a new onset dilated cardiomyopathy due to Addison’s disease. The clinical presentation, treatment, and outcomes of this rare hormone mediated cardiac disorder are reviewed. Viktoriya Mozolevska, Anna Schwartz, David Cheung, Bilal Shaikh, Kapil M. Bhagirath, and Davinder S. Jassal Copyright © 2016 Viktoriya Mozolevska et al. All rights reserved. A Rare Case of Primary Meningococcal Myopericarditis in a 71-Year-Old Male Mon, 28 Nov 2016 12:38:51 +0000 http://www.hindawi.com/journals/cric/2016/1297869/ We describe a case of primary meningococcal C pericarditis with myocardial involvement in a 71-year-old male that is thus far the oldest patient with isolated meningococcal pericardial disease and only the third patient with primary meningococcal myopericarditis described in English literature. Our patient was successfully treated by full sternotomy and surgical drainage combined with intravenous ceftriaxone. Mild symptoms unresponsive to anti-inflammatory treatment and leukocytosis may guide clinicians towards the correct diagnosis. It is important to recognize this cause of pericarditis as the relatively mild clinical presentation may rapidly progress into tamponade and right-sided heart failure. Odilia I. Woudstra, Gerard J. J. Boink, Jacobus A. Winkelman, and Ron van Stralen Copyright © 2016 Odilia I. Woudstra et al. All rights reserved. Inflammatory Pseudotumor Originating from the Right Ventricular Outflow Tract Sun, 27 Nov 2016 14:27:33 +0000 http://www.hindawi.com/journals/cric/2016/6527479/ Introduction. Inflammatory pseudotumor is an uncommon entity, and its cardiac origin is exceedingly rare. Case History. A previously healthy 27-year-old man was found to have a systolic murmur during preemployment screening evaluation. A transthoracic echocardiogram revealed a 4 × 2.5 cm mass originating from the right ventricle (RV) outflow tract extending into the aortic root. A computed tomography guided biopsy confirmed an IgG4-related inflammatory pseudotumor. Patient was started on oral prednisone with subsequent reduction in mass size. Conclusion. Cardiac inflammatory pseudotumors are markedly rare tumors that should be considered in the differential of intracardiac tumors which otherwise includes cardiac fibromas, myxomas, and sarcomas. Mohita Singh, Umair Khalid, Nasser Lakkis, and Rashed Tabbaa Copyright © 2016 Mohita Singh et al. All rights reserved. Bradycardia Associated with Steroid Use for Laryngeal Edema in an Adult: A Case Report and Literature Review Thu, 24 Nov 2016 14:31:30 +0000 http://www.hindawi.com/journals/cric/2016/9785467/ Steroids are used for specific indications in the perioperative period to reduce laryngeal or spinal cord edema, or for prophylaxis and treatment of postoperative nausea and vomiting. Given the other potential causes for hemodynamic alterations in the perioperative setting, it is important for physicians to be aware of cardiovascular side effects of short term steroids. Changes in blood pressure and heart rate, cardiac dysrhythmias, and even death have been described in patients receiving short term intravenous steroids. Bradycardia has been reported following short term methylprednisolone and dexamethasone therapy in both adult and pediatric patients. There are only two case reports in the literature of bradycardia following short term intravenous dexamethasone use in adult patients. This is the first case report that describes bradycardia following the use of dexamethasone in the postoperative setting for management of laryngeal edema in an adult. Telemetry and twelve lead electrocardiograms revealed sinus bradycardia and correlated directly with administration of dexamethasone in our patient. Bradycardia resolved following discontinuation of dexamethasone. We advocate for hemodynamic monitoring in patients receiving more than one dose of intravenous steroid therapy in the perioperative period, especially those with known cardiac and hepatic comorbidities and those taking medications with negative chronotropic effects. Preeti R. John, Ariana Khaladj-Ghom, and Kimberly L. Still Copyright © 2016 Preeti R. John et al. All rights reserved. Percutaneous Coronary Intervention for the Anomalous Left Coronary Artery Originating from the Noncoronary Cusp Thu, 24 Nov 2016 07:18:37 +0000 http://www.hindawi.com/journals/cric/2016/2097174/ Percutaneous coronary intervention (PCI) for anomalous left coronary artery (LCA) originating from the noncoronary cusp (NCC) is challenging, as it poses difficulties with the engagement of the guiding catheter and the establishment of backup support. This report examines the case of a 69-year-old woman with unstable angina of anomalous LCA origin. The computed tomography showed a diffuse plaque in the middle of the left anterior descending (LAD) artery and an anomalous LCA originating from the NCC. After successful engagement of a straightened Judkins-Left diagnostic catheter, the angiography revealed a diffuse plaque in the middle of the LAD artery. We then engaged a Judkins-Right guiding catheter. Due to the weak backup support of the guiding catheter, we used another wire to stabilize it, and the stent was then implanted successfully. To our knowledge, this is the first case report of PCI for an anomalous LCA originating from the NCC. Toshiki Kuno, Yohei Numasawa, and Toshiyuki Takahsashi Copyright © 2016 Toshiki Kuno et al. All rights reserved. Acute Myocardial Infarction in a Patient with Two-Vessel Occlusion and a Large Lambl’s Excrescence Tue, 22 Nov 2016 11:32:35 +0000 http://www.hindawi.com/journals/cric/2016/8370212/ A 59-year-old man underwent an echocardiography study after myocardial infarction and it showed a thin, mobile mass attached to the aortic valve. A diagnosis of Lambl’s excrescence (LE) was suspected. Coronary occlusion as a consequence of embolism of LE’s material could not be excluded and the patient underwent surgical excision. Histology confirmed the diagnosis; however a differential diagnosis with papillary fibroelastoma could not be established because both of these structures are histologically indistinguishable. A brief survey of the literature is presented. Evidence-based recommendations for treatment have not been established yet. Alfredo Pizzuti, Francesco Parisi, Luciano Mosso, Francesca Cali’ Quaglia, and Antonino Tomasello Copyright © 2016 Alfredo Pizzuti et al. All rights reserved. Novel Use of an Orbital Atherectomy Device for In-Stent Restenosis: Lessons Learned Tue, 15 Nov 2016 09:53:24 +0000 http://www.hindawi.com/journals/cric/2016/5047981/ We present a case of a 67-year-old man with stage III chronic kidney disease, uncontrolled diabetes mellitus, coronary artery disease, and high surgical risk who presented with two episodes of acute coronary syndrome attributed to in-stent restenosis (ISR) associated with heavily calcified lesions. In this case, we were able to improve luminal patency with orbital atherectomy system (OAS); however, withdrawal of the device resulted in a device/stent interaction, causing failure of the device. Given limitations in current evidence and therapies, managing ISR can be a technical and cognitive challenge. Balloon expansion of the affected region often provides unsatisfactory results, possibly related to significant calcium burden. OAS could be an efficacious way of reestablishing luminal patency in ISR lesions, as these lesions are often heavily calcified. K. Shaikh, S. Kelly, M. Gedela, V. Kumar, A. Stys, and T. Stys Copyright © 2016 K. Shaikh et al. All rights reserved. Sinus Venosus Atrial Septal Defect Complicated by Eisenmenger Syndrome and the Role of Vasodilator Therapy Mon, 14 Nov 2016 13:24:17 +0000 http://www.hindawi.com/journals/cric/2016/8164923/ Sinus venosus atrial septal defect is a rare congenital, interatrial communication defect at the junction of the right atrium and the vena cava. It accounts for 5–10% of cases of all atrial septal defects. Due to the rare prevalence and anatomical complexity, diagnosing sinus venous atrial septal defects poses clinical challenges which may delay diagnosis and treatment. Advanced cardiac imaging studies are useful tools to diagnose this clinical entity and to delineate the anatomy and any associated communications. Surgical correction of the anomaly is the primary treatment. We discuss a 43-year-old Hispanic female patient who presented with dyspnea and hypoxia following a laparoscopic myomectomy. She had been diagnosed with peripartum cardiomyopathy nine years ago at another hospital. Transesophageal echocardiography and computed tomographic angiography of the chest confirmed a diagnosis of sinus venosus atrial septal defect. She was also found to have pulmonary arterial hypertension and Eisenmenger syndrome. During a hemodynamic study, she responded to vasodilator and she was treated with Ambrisentan and Tadalafil. After six months, her symptoms improved and her pulmonary arterial hypertension decreased. We also observed progressive reversal of the right-to-left shunt. This case illustrates the potential benefit of vasodilator therapy in reversing Eisenmenger physiology, which may lead to surgical repair of the atrial septal defect as the primary treatment. Amornpol Anuwatworn, Maheedhar Gedela, Edgard Bendaly, Julia A. Prescott-Focht, Jimmy Yee, Richard Clark, and Orvar Jonsson Copyright © 2016 Amornpol Anuwatworn et al. All rights reserved. Exercise-Stress Echocardiography Reveals Systolic Anterior Motion of the Mitral Valve as a Cause of Syncopes in a Cardiac Amyloidosis Patient Thu, 10 Nov 2016 07:51:43 +0000 http://www.hindawi.com/journals/cric/2016/3198715/ Patients with cardiac amyloidosis are at increased AV-block and syncope risk. Therefore, a prophylactic pacemaker is often implanted. However, this case illustrates that other mechanisms should be ruled out prior to pacemaker implantation. The patient studied had mitral valve thickening without increased left ventricular outflow track (LVOT) velocity. However, bicycle exercise-stress test with simultaneous echocardiography revealed a stepwise decrease in blood pressure, a substantial increase in the LVOT velocity, and severe systolic anterior motion of the mitral valve. The patients’ symptoms were likely explained by these findings. Therefore, a comprehensive clinical evaluation is warranted prior to pacemaker implantation in cardiac amyloidosis patients. Tor Skibsted Clemmensen, Henning Mølgaard, Niels Frost Andersen, Steen Baerentzen, and Steen Hvitfeldt Poulsen Copyright © 2016 Tor Skibsted Clemmensen et al. All rights reserved. Neurocardiogenic Syncope and Supraventricular Tachycardia in Association with a Rare Congenital Aortic Valve Abnormality Mon, 07 Nov 2016 14:07:20 +0000 http://www.hindawi.com/journals/cric/2016/8136079/ We report a case of a 26-year-old woman who presented with multiple episodes of syncope over a five-months period of time. Transthoracic echocardiogram had shown a normal functioning quadricuspid aortic valve (QAV) which was also confirmed on a transesophageal echocardiogram. Computed tomographic angiography of heart and coronary arteries showed the QAV with equal size of all aortic cusps and normal coronary arteries. Intermittent chest pain and palpitations warranted an exercise stress test. The stress test revealed normal aerobic exertion, with achievement of 101% of maximal peak heart rate. However, during peak stress, we noted a drop in her blood pressure significantly resulting in dizziness. No arrhythmias were noted during the stress test. With recurrent syncope episodes and palpitations, Holter monitoring was done, revealing supraventricular tachycardia (SVT). We discuss current available literature and coassociations with QAV. New association of QAV with SVT needs further analysis. Yashwant Agrawal, Jagadeesh K. Kalavakunta, Vishal Gupta, and William Lapenna Copyright © 2016 Yashwant Agrawal et al. All rights reserved. MELAS Syndrome with Cardiac Involvement: A Multimodality Imaging Approach Mon, 07 Nov 2016 10:33:04 +0000 http://www.hindawi.com/journals/cric/2016/1490181/ A 49-year-old man presented with chest pain, dyspnea, and lactic acidosis. Left ventricular hypertrophy and myocardial fibrosis were detected. The sequencing of mitochondrial genome (mtDNA) revealed the presence of A to G mtDNA point mutation at position 3243 (m.3243A>G) in gene. Diagnosis of cardiac involvement in a patient with Mitochondrial Encephalomyopathy, Lactic Acidosis, and Stroke-like episodes syndrome (MELAS) was made. Due to increased risk of sudden cardiac death, cardioverter defibrillator was implanted. Sara Seitun, Laura Massobrio, Anna Rubegni, Claudia Nesti, Margherita Castiglione Morelli, Sara Boccalini, Athena Galletto Pregliasco, Irilda Budaj, Luca Deferrari, Gian Marco Rosa, Fabrizio Montecucco, and Alberto Valbusa Copyright © 2016 Sara Seitun et al. All rights reserved. Lyme Carditis: An Interesting Trip to Third-Degree Heart Block and Back Sun, 06 Nov 2016 13:39:27 +0000 http://www.hindawi.com/journals/cric/2016/5454160/ Carditis is an uncommon presentation of the early disseminated phase of Lyme disease. We present the case of a young female who presented with erythema migrans and was found to have first-degree heart block which progressed to complete heart block within hours. After receiving ceftriaxone, there was complete resolution of the heart block in sequential fashion. Our case illustrates the importance of early recognition and anticipation of progressive cardiac conduction abnormalities in patients presenting with Lyme disease. Maxwell Eyram Afari, Fady Marmoush, Mobeen Ur Rehman, Umama Gorsi, and Joseph F. Yammine Copyright © 2016 Maxwell Eyram Afari et al. All rights reserved. Surviving All Odds: A Unique Case of Multiple Congenital Unruptured Sinus of Valsalva Aneurysms Involving Both Left and Right Coronary Sinuses with Biventricular Dysfunction and Heart Block Wed, 02 Nov 2016 09:05:48 +0000 http://www.hindawi.com/journals/cric/2016/4654031/ Aneurysms of the sinus of Valsalva are very uncommon, with an incidence ranging from 0.1 to 3.5% of all congenital heart defects. Very few cases have been reported in the literature that presented with involvement of two or more sinuses. We report a case of 27-year-old male with a history of exertional breathlessness of one-month duration. After complete evaluation using transesophageal echocardiography (TEE) and multiple detector computed tomography (MDCT) scanning, the patient was diagnosed to have large congenital unruptured sinus of Valsalva aneurysms involving both left and right coronary sinuses with extension into the interventricular septum. The patient also displayed second-degree heart block (Mobitz type 2) and biventricular dysfunction. The patient was managed successfully. We present the case with an aim to highlight the management challenges including intraoperative and postoperative complications that are associated with unruptured sinus of Valsalva aneurysms of ≥2 sinuses. Aniketh Vijay B, Vikrant Vijan, and Navin Mathew Copyright © 2016 Aniketh Vijay B et al. All rights reserved. Successful Interventional Management for Pulmonary Arterial Injury Secondary to Pacemaker Implantation Wed, 02 Nov 2016 07:55:33 +0000 http://www.hindawi.com/journals/cric/2016/4340193/ Subclavian vein puncture is a relatively fast and safe technique to access the right heart for placement of pacemaker leads. Hemothorax related to injury of the pulmonary artery (PA) is a rare complication of subclavian vein access but can be life-threatening. We report a case of hemothorax occurring after subclavian vein puncture for pacemaker implantation. No cases of transcatheter arterial embolization for PA injury secondary to pacemaker implantation have been reported. Understanding of this rare complication after pacemaker implantation along with its specific clinical presentation may lead to early diagnosis and intervention. Hiroyuki Tokue, Azusa Tokue, Hideo Morita, and Yoshito Tsushima Copyright © 2016 Hiroyuki Tokue et al. All rights reserved. Spontaneous Renal Artery Dissection in a Patient with Neurofibromatosis Type I Thu, 27 Oct 2016 10:00:13 +0000 http://www.hindawi.com/journals/cric/2016/4593932/ We present a case of spontaneous renal artery dissection (SRAD) in a 28-year-old female with history of neurofibromatosis type I (NF-1) treated successfully with endovascular stenting. The clinical presentation, diagnostic testing, and treatment options are discussed. An endovascular approach with stenting was successfully performed after failure of medical treatment with subcutaneous low molecular weight heparin. Patient’s blood pressure and symptoms improved significantly. This may be the first reported case of SRAD in a patient with NF-1 successfully treated with endovascular stenting. Nicolas W. Shammas, Majid Z. Chammas, Jon Robken, and Edmund Coyne Copyright © 2016 Nicolas W. Shammas et al. All rights reserved. Massive Thrombosis of the Right Atrium Extended to the Superior Vena Cava at the Diagnosis of Acute Myeloid Leukemia Wed, 26 Oct 2016 09:52:34 +0000 http://www.hindawi.com/journals/cric/2016/6802429/ Introduction. Venous thromboembolic disease is a common complication found in 8% of patients with acute myeloid leukemia. The location at the right atrium is exceptional. These last fifty years, only 6 cases of thrombosis of the atrium in the diagnosis of acute myeloid leukemia were published on PubMed search engine. Case Presentation. 35-year-old farmer, who had been admitted by emergency department for superior vena cava syndrome and had a hyperleukocytic AML with complex karyotype associated with a significant thrombosis of the right atrium, extended all along the superior vena cava. He has been treated by the 2011 AML protocol using low molecular weight heparin and died from respiratory distress. Conclusions. If thrombosis is common in AML, the location in right atrium is rare. Its management requires surgery that is sometimes difficult to achieve. Bienvenu Houssou, Gnon Gourou Orou-Guiwa, Rachida Habbal, Meryem Qachouh, and Asmaa Quessar Copyright © 2016 Bienvenu Houssou et al. All rights reserved. Successful Ablation for Atrial Tachycardia Originated from Sinus Venosa with Tachycardia-Induced Cardiomyopathy Thu, 20 Oct 2016 10:07:01 +0000 http://www.hindawi.com/journals/cric/2016/4865034/ A 74-year-old male suffering from congestive heart failure with atrial tachycardia (AT) with 2 : 1 atrioventricular conduction was admitted to our hospital. After the therapy with diuretics and β-blocker, his rapid AT was still sustained. He took the catheter ablation for his AT. Postpacing interval mapping from entrainment and noncontact mapping system revealed the mechanism of his AT, originated from sinus venosa. His AT was successfully terminated and eliminated by radiofrequency catheter ablation. After the successful ablation, he has been free from any AT, and his cardiac function was also improved. Sou Takenaka, Hideaki Sato, Mikio Yuhara, and Takashi Uchiyama Copyright © 2016 Sou Takenaka et al. All rights reserved. An Endomyocardial Biopsy of the Left Ventricle in an Anorexia Nervosa Patient with Sinus Bradycardia and Left Ventricular Systolic Dysfunction Wed, 19 Oct 2016 08:37:03 +0000 http://www.hindawi.com/journals/cric/2016/9805291/ Anorexia nervosa (AN) is an eating disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted perception of body weight. AN is a life-threatening condition that significantly increases the risk of death due to cardiac complications, such that at least one-third of all deaths in patients with AN are associated with cardiac causes including sudden death. In many reports, sudden death has been linked to reduced left ventricular function, structural changes, and QT abnormalities. However, the mechanistic details connecting AN to cardiac abnormalities remain unknown. Here we present an endomyocardial biopsy of the left ventricle in a case of AN with a reversible left ventricular systolic dysfunction. Satoshi Takahashi and Takanao Mine Copyright © 2016 Satoshi Takahashi and Takanao Mine. All rights reserved. Corrigendum to “A Striking Coronary Artery Pattern in a Grown-Up Congenital Heart Disease Patient” Mon, 17 Oct 2016 12:32:33 +0000 http://www.hindawi.com/journals/cric/2016/8393704/ Fortunato Iacovelli, Martino Pepe, Gaetano Contegiacomo, Vito Alberotanza, Filippo Masi, Alessandro Santo Bortone, and Stefano Favale Copyright © 2016 Fortunato Iacovelli et al. All rights reserved. A Sizable Aortic Root Paravalvular Mycotic Pseudoaneurysm Tue, 11 Oct 2016 11:42:50 +0000 http://www.hindawi.com/journals/cric/2016/7924631/ Mycotic aneurysm is an established condition first identified in 1885 by Sir William Osler. It is linked to malignant endocarditis. With prevalence of 0.7–2.6% of all cases of aortic aneurysms, it is associated with a significant rate of mortality and morbidity. Physicians should be highly cautious, as diagnosis and effective treatment for this condition are difficult. The following is a case report of a 13-year-old pediatric patient diagnosed with mycotic aneurysm. Before an adequate treatment plan could be developed and implemented, patient’s status worsened swiftly and was ultimately terminal. This case is the sole instance of this condition evidenced in the last ten years in Saudi Arabia. Ahmad Saeed Azhar and Noran M. Abu-Ouf Copyright © 2016 Ahmad Saeed Azhar and Noran M. Abu-Ouf. All rights reserved. A Case of Haemorrhagic Constrictive Pericarditis with Bilateral Pleural Effusions Tue, 11 Oct 2016 08:58:11 +0000 http://www.hindawi.com/journals/cric/2016/8142134/ Presentation of pericardial disease is diverse, with the viral aetiology being the most common cause; however, when haemorrhagic pericardial effusion is present, these causes are narrowed to few aetiologies. We present a case of a young female of African descent who presented with diffuse abdominal pain and vomiting. Initial work-up showed pericardial effusion with impending echocardiographic findings of cardiac tamponade and bilateral pleural effusions. Procedures included a left video-assisted thoracoscopic surgery (VATS) with pericardial window. We consider that it is important for all physicians to be aware of not only typical presentation but also atypical and unusual clinical picture of pericardial disease. Hans A. Reyes, Julie Islam, Soheila Talebi, Eder Cativo, Savi Mushiyev, Gerald Pekler, and Ferdinand Visco Copyright © 2016 Hans A. Reyes et al. All rights reserved. Response to: Comment on “Symptomatic Trifascicular Block in Steinert’s Disease: Is It Too Soon for a Pacemaker?” Mon, 10 Oct 2016 14:28:06 +0000 http://www.hindawi.com/journals/cric/2016/4372802/ Glenmore Lasam, Roberto Roberti, Gina LaCapra, and Roberto Ramirez Copyright © 2016 Glenmore Lasam et al. All rights reserved. Successful Left Atrial Appendage Occlusion with the New Generation Amulet® Device after Late-Occurring Embolization of an Amplatzer® Cardiac Plug in a Patient with Repetitive Strokes Sun, 09 Oct 2016 12:23:20 +0000 http://www.hindawi.com/journals/cric/2016/8438923/ The Amplatzer Cardiac Plug (ACP) is one of the most commonly used devices for percutaneous left atrial appendage (LAA) closure in order to prevent a stroke in patients with atrial fibrillation and contraindication for long-term oral anticoagulation therapy. We have previously described a patient who had experienced an embolization of the ACP device about 12 months after implantation and the device could be percutaneously retrieved. A few years later, he suffered from a posterior stroke and a stroke located in the brainstem as well as a transischemic attack (TIA). In order to protect him from further cardioembolic events a reocclusion of the LAA with the new generation of ACP device, the Amplatzer Amulet, was performed. A stable position of the device within follow-up period could be confirmed and the patient was free of additional strokes/TIA or bleeding events. This case stresses the importance of proper LAA sizing in order to prevent device embolization and notes that LAA size is not static. Moreover, it demonstrates that repeated implantation of an LAA occlusion device was still possible; one should be aware of undersizing the LAA dimensions and that the modifications of new generation LAA occlusion devices may overcome limitations of first-generation devices in order to prevent a cardioembolic stroke. Marco R. Schroeter and Wolfgang Schillinger Copyright © 2016 Marco R. Schroeter and Wolfgang Schillinger. All rights reserved. Multifactorial Etiology Pulmonary Hypertension in a Patient with Sarcoidosis Sun, 09 Oct 2016 07:47:05 +0000 http://www.hindawi.com/journals/cric/2016/2481369/ Differential diagnosis between pre- and postcapillary pulmonary hypertension (PH) in patients with diastolic heart failure (DHF) is a challenge in clinical practice. The presence of PH is implicated in worse prognosis in patients with this disease. This case report approaches the process of investigation of pulmonary hypertension in adult patient with DHF, double mitral lesion, and sarcoidosis with poor clinical outcome. Barreto Ana Terra Fonseca, Barreto Lucas Vinícius da Fonseca, Cavalcante Felipe Naze Rodrigues, Oliveira Joselina Luzia Menezes, Almeida-Santos Marcos Antônio, Garcez Juliane Dantas Seabra, Barreto-Filho José Augusto Soares, and Sousa Antônio Carlos Sobral Copyright © 2016 Barreto Ana Terra Fonseca et al. All rights reserved. Metastatic Calcinosis of Aortic Valve Secondary to Renal Failure Mimicking Infective Endocarditis Sun, 25 Sep 2016 09:01:43 +0000 http://www.hindawi.com/journals/cric/2016/3916507/ End stage renal disease has a list of consequences, cardiovascular being the most common. Inefficient dialysis can cause significant deposition of calcium all over the body, including heart valves making heart function impaired. We illustrate a case of 38-year-old female with end stage renal disease on peritoneal dialysis. The patient had been complaining of pain and swelling of the right hand for the last few months and had been seen by hand surgeon and was admitted electively for the biopsy of hand lesions. Before her planned surgery, she developed severe shortness of breath. Urgent echocardiogram revealed severe aortic regurgitation and large vegetation on the aortic valve. Infective endocarditis was suspected but blood cultures were negative for any microorganism and the patient did not meet the Duke criteria. Because of her hemodynamic instability immediate mechanical valve replacement surgery was performed. The pathology report showed extensive calcification and myxoid degeneration. No infectious agent was found. Later on, biopsy of her hand lesions showed extensive calcification with macrophages and giant cells. No atypia or malignancy was identified. This is a rare case of the metastatic calcinosis of aortic valve secondary to renal failure mimicking aortic valve infective endocarditis. Noman Ahmed Jang Khan, Masroor A. Khan, and Guillermo Juan Morell Chardon Copyright © 2016 Noman Ahmed Jang Khan et al. All rights reserved. Aortic Dissection in a Healthy Male Athlete: A Unique Case with Comprehensive Literature Review Wed, 21 Sep 2016 11:40:20 +0000 http://www.hindawi.com/journals/cric/2016/6460386/ A young otherwise healthy 27-year-old male who has been using anabolic steroids for a long time developed Type I aortic dissection associated with heavy weightlifting. The patient did not have a recent history of trauma to the chest, no history of hypertension, and no illicit drug use. He presented with severe chest pain radiating to back and syncopal event with exertion. Initial vitals were significant for blood pressure of 80/50 mmHg, pulse of 80 beats per minute, respirations of 24 per minute, and oxygen saturation of 92% on room air. Physical exam was significant for elevated jugular venous pressure, muffled heart sounds, and cold extremities with diminished pulses in upper and absent pulses in lower extremities. Bedside echocardiogram showed aortic root dilatation and cardiac tamponade. STAT computed tomography (CT) scan of chest revealed dissection of ascending aorta. Cardiothoracic surgery was consulted and patient underwent successful repair of ascending aorta. Hemodynamic stress of weightlifting can predispose to aortic dissection. Aortic dissection is a rare but often catastrophic condition if not diagnosed and managed acutely. Although rare, aortic dissection needs to be in the differential when a young weightlifter presents with chest pain as a delay in diagnosis may be fatal. Balraj Singh, Jennifer M. Treece, Ghulam Murtaza, Samit Bhatheja, Steven J. Lavine, and Timir K. Paul Copyright © 2016 Balraj Singh et al. All rights reserved. Pseudopheochromocytoma Associated with Domestic Assault Wed, 21 Sep 2016 09:45:40 +0000 http://www.hindawi.com/journals/cric/2016/6580215/ Pseudopheochromocytoma has a clinical presentation that is similar to pheochromocytoma. It manifests itself with paroxysmal hypertension crises, associated with various symptoms such as headaches, chest pain, nausea, palpitations, and dizziness. Patients are usually asymptomatic in between the crises. Unlike pheochromocytoma, there is no catecholamines overproduction in this pathology: hypertensive peaks are caused by a hyperactivation of the sympathetic nervous system, which is often triggered by a psychological trauma in the past. Treatment of pseudopheochromocytoma can be challenging due to normal blood pressure values in between the hypertensive peaks; it includes alpha- and beta-blockers for moderate crises and prevention and must be combined with psychopharmacologic agents such as anxiolytics or antidepressant drugs. Psychotherapy and dietetic treatment are also crucial in pseudopheochromocytoma management. H. M. Le, G. Carbutti, D. Ilisei, E. Bouccin, and X. Vandemergel Copyright © 2016 H. M. Le et al. All rights reserved. An Obstructed Anomalous Left Anterior Descending Coronary Artery Arising from the Right Coronary Artery Requiring Surgical Intervention Mon, 19 Sep 2016 14:16:03 +0000 http://www.hindawi.com/journals/cric/2016/3589214/ A 47-year-old female presented to our hospital with symptoms of stable angina. Cardiac catheterization revealed a rare coronary artery anomaly of the left anterior descending (LAD) artery branching off the right coronary artery ostium. Furthermore, the anomalous LAD artery exhibited significant atherosclerotic obstruction. Our review of the literature found only nine such previously described cases. Due to the unique nature of coronary artery anomalies and their complications, we would like to contribute our case to the medical literature. Alexander Mironov, Sean Galligan, Aleksandre Kakauridze, and Jonathan D. Marmur Copyright © 2016 Alexander Mironov et al. All rights reserved.