Case Reports in Cardiology https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Mitochondrial Cardiomyopathy Presenting as Dilated Phase of Hypertrophic Cardiomyopathy Diagnosed with Histological and Genetic Analyses Tue, 23 May 2017 08:26:04 +0000 http://www.hindawi.com/journals/cric/2017/9473917/ We report a case with 46-year-old man diagnosed with mitochondrial cardiomyopathy in the dilated phase of hypertrophic cardiomyopathy. Since cardiac magnetic resonance imaging, beta-methyl-p--iodophenyl-pentadecanoic myocardial scintigraphy, and positron emission tomography/computed tomography revealed no remarkable findings, we performed electron microscopic examination, which aided in diagnosing mitochondrial cardiomyopathy. Muscle biopsy was also compatible with mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes and DNA analysis also concluded it. Since muscle biopsy is less invasive for patients compared to endomyocardial biopsy, cardiologists need to consider it. The diagnosis of mitochondrial cardiomyopathy is helpful because it is a genetic condition and also for consideration of device therapy, as well as management for acute crisis. Toshiki Kuno, Syohei Imaeda, Yohei Asakawa, Hiroshi Nakamura, Genzou Takemura, Daisuke Asahara, Akira Kanamori, Tomoyuki Kabutoya, and Yohei Numasawa Copyright © 2017 Toshiki Kuno et al. All rights reserved. Aneurysm of the Pulmonary Artery in Fallot’s Tetralogy Mon, 22 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/1384905/ Introduction. Pulmonary artery aneurysms are a rare entity. Etiologies of these findings are multiple, but they are exceptionally associated with Fallot’s Tetralogy. In this study, we present an unusual case of an important aneurysm of the left pulmonary artery associated with Fallot’s Tetralogy disease. Case Presentation. A 30-year-old woman has been admitted for dyspnea and cyanosis. The data which had been obtained from echocardiography, cardiac catheterization, and angio-magnetic resonance imaging (MRI) suggested the existence of an important aneurysm of the left pulmonary artery associated with a regular Fallot’s disease with a pulmonic stenosis. We have noticed the presence of a small restrictive patent ductus arteriosus (PDA). Therefore, the patient was referred to surgical correction. Conclusion. Pulmonary artery aneurysms associated with Fallot’s Tetralogy are rarely reported. The natural history of these rare arterial aneurysms has to be clarified. Kawtar Afrikh, Loua Hattach, Nadia Fellat, Mustapha El Bakkali, and Halima Benjelloun Copyright © 2017 Kawtar Afrikh et al. All rights reserved. Type A Quadricuspid Aortic Valve Infective Endocarditis Complicated by Multiple Aortocardiac Fistulae: Case Report and Brief Literature Review Thu, 18 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/2865305/ Aortocardiac fistulae (ACF) are exceptionally due to infective endocarditis; they are usually congenital, posttraumatic, or complicate aortic dissection. In infective endocarditis setting, their presence should prompt urgent surgery as patients can deteriorate rapidly. We report the case of a 78-year-old female patient with the first ever reported quadricuspid aortic valve infective endocarditis complicated by multiple aortocardiac fistulae. Additionally, we provide a brief review of ACF, in infective endocarditis and quadricuspid aortic valve. Amine Ghalem, Mohammed Bachrif, Anass Hbali, Mostapha Beghi, Nabila Ismaili, and Noha El Ouafi Copyright © 2017 Amine Ghalem et al. All rights reserved. Saphenovenous Graft Aneurysm: A Rare Complication of CABG Thu, 18 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/8101489/ Saphenovenous graft aneurysm is a rare complication of coronary artery bypass grafts that is likely underdiagnosed. It is typically asymptomatic, slow growing, and often diagnosed incidentally on angiography or following catastrophic rupture. There is no consensus on best management but PCI and surgery appear to have more favourable mortality outcomes relative to conservative management. We present the case of a 48-year-old male with a cardiovascular risk profile hallmarked by diabetes mellitus, end stage renal failure, recalcitrant hyperlipidaemia, and IHD previously treated with CABG. 11 years following his CABG, he was retrieved from remote Australia to a tertiary cardiology centre with stabbing chest pain. Serial cardiac enzymes were negative. Echocardiogram identified a mass compressing the right ventricular wall. Noncontrast coronary angiogram ultimately identified a large aneurysm at the proximal end of SVG to PDA. He was managed with aggressive risk factor modification prior to planned surgical intervention once medically optimized. His case supports the role of aggressive medical management combined with surgical intervention. James Thomas Connell Copyright © 2017 James Thomas Connell. All rights reserved. Anomalous Papillary Muscle Insertion Causing Dynamic Left Ventricular Outflow Tract Obstruction without Hypertrophic Obstructive Cardiomyopathy Mon, 15 May 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/9878049/ Anomalous papillary muscle insertion directly into the surface of the mitral valve leaflet is rare, especially in a subject without apparent evidence of hypertrophic cardiomyopathy. We present a case of this isolated congenital malformation producing two hemodynamic sequelae of dynamic left ventricular outflow tract obstruction and severe mitral regurgitation. Ravi Korabathina, Katherine Chiu, Hugh M. van Gelder, and Arthur Labovitz Copyright © 2017 Ravi Korabathina et al. All rights reserved. Pyridostigmine Induced Prolonged Asystole in a Patient with Myasthenia Gravis Successfully Treated with Hyoscyamine Sun, 14 May 2017 08:10:34 +0000 http://www.hindawi.com/journals/cric/2017/6956298/ Reversible acetylcholinesterase inhibitors are used as first-line treatment for myasthenia gravis. They improve symptoms by increasing concentration of acetylcholine at the neuromuscular junction and stimulating nicotinic receptors. Serious bradyarrhythmias can occur from muscarinic stimulation in heart, which in rare cases may progress to asystole. These patients can initially be managed with hyoscyamine, a muscarinic antagonist. Persistence of bradyarrhythmias even after hyoscyamine treatment may warrant pacemaker placement. We present a case of 65-year-old female patient who presented with diplopia, dysphagia, and muscle weakness who was diagnosed with myasthenia gravis. She developed significant sinoatrial node block with prolonged asystole after starting treatment with pyridostigmine which was successfully treated with hyoscyamine, thus avoiding pacemaker placement. Mohammad Saud Khan, Abhinav Tiwari, Zubair Khan, Himani Sharma, Mohammad Taleb, and Jeffrey Hammersley Copyright © 2017 Mohammad Saud Khan et al. All rights reserved. Failed TAVI in TAVI Implantation: TAVI Dislocation Followed by Ensuing Surgical Graft Resection Sun, 30 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/5086586/ We are presenting a case report of failed valve-in-valve treatment of severe aortic stenosis. A control ultrasonography after TAVI implantation revealed a severe aortic regurgitation of the graft which was subsequently unresolved with postimplantation dilatation. Second TAVI was implanted with cranial dislocation to the aortic root. Patient underwent a CT examination to clarify the TAVI in TAVI position. Patient underwent a surgical resection of TAVI with implantation of biological aortic valve prosthesis. In situations where TAVI treatment fails or is complicated beyond the possibility of endovascular repair, surgical intervention despite its higher risks is the preferred choice. Róbert Novotný, Jaroslav Hlubocký, Tomáš Kovárník, Petr Mitáš, Zuzana Hlubocka, Jan Rulíšek, Sevim Ismihan Gulmez, Shubjiwan Kaur Ghotra, and Jaroslav Lindner Copyright © 2017 Róbert Novotný et al. All rights reserved. Sorafenib-Associated Heart Failure Complicated by Cardiogenic Shock after Treatment of Advanced Stage Hepatocellular Carcinoma: A Clinical Case Discussion Thu, 27 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/7065759/ Background. Sorafenib, an oral tyrosine kinase inhibitor (TKI), targets multiple tyrosine kinase receptors (TKRs) involved in angiogenesis and tumor growth. Studies suggest that inhibition of TKR impacts cardiomyocyte survival. Inhibition of VEGF signaling interrupts angiogenesis and is associated with the development of hypertension and compensatory hypertrophy. Compensated hypertrophy ultimately leads to heart failure. Case Description. A 76-year-old man with a past medical history of systolic heart failure due to ischemic cardiomyopathy and stage IIIC hepatocellular carcinoma (HCC) presented with symptoms of decompensated heart failure. Four months prior to admission, he was started on sorafenib. Results. Our patient was treated with intravenous furosemide and guideline directed therapy. Clinical status was complicated by the development of low cardiac output and shock requiring inotropic support. Careful titration of heart failure medication led to hemodynamic improvement and discontinuation of dobutamine. Conclusion. Greater awareness of sorafenib cardiotoxicity is essential. As TKI usage grows for treatment of cancers, heart failure-related complications will increase. In our patient, routine heart failure management and cessation of sorafenib led to clinical improvement. Future studies on the treatment of sorafenib cardiotoxicity should be explored further in this unique patient population. Candace Wu and Kamal Shemisa Copyright © 2017 Candace Wu and Kamal Shemisa. All rights reserved. A Novel, Modified Reverse Controlled Antegrade and Retrograde Subintimal Tracking Technique for Bypassing the Calcified Proximal Cap of Coronary Total Occlusions Wed, 26 Apr 2017 08:08:55 +0000 http://www.hindawi.com/journals/cric/2017/3850646/ Antegrade crossing is the most common approach to chronic total occlusions (CTOs). However, it is sometimes difficult to penetrate the proximal hard cap with guidewires, especially in the case of CTOs of anomalous coronary arteries because of a lack of support. Herein, we describe a novel, modified reverse controlled antegrade and retrograde subintimal tracking (CART) technique in which the dissection reentry was intentionally created in the proximal segment of the vessel, not within the occluded segment, using retrograde guidewire and the aid of an antegrade balloon. This technique facilitated retrograde crossing of CTOs by avoiding the proximal hard cap and may provide a viable option for patients in which conventional reverse CART is not possible. Tsuyoshi Isawa, Masahiko Ochiai, Masato Munehisa, and Tatsushi Ootomo Copyright © 2017 Tsuyoshi Isawa et al. All rights reserved. Cryoablation for Ventricular Tachycardia Originating from Anterior Papillary Muscle of Left Ventricle Guided by Intracardiac Echocardiography Thu, 20 Apr 2017 06:59:36 +0000 http://www.hindawi.com/journals/cric/2017/9734795/ Papillary muscles (PMs) were reported to be origin of ventricular arrhythmia (VA). Radiofrequency (RF) ablation was reported to be acutely effective in eliminating VA. However, the recurrence rate is high. Recently, cryoablation guided by intracardiac echocardiography, 3-dimensional mapping system, and image integration was introduced as alternative strategy for this challenging ablation. We present a case of ventricular tachycardia originating from anterior PM of left ventricle treated by cryoablation guided only by intracardiac echocardiography. Ibrahim Marai, Nizar Andria, and Osnat Gurevitz Copyright © 2017 Ibrahim Marai et al. All rights reserved. Left Atrial Myxoma in Pregnancy: Management Strategy Using Minimally Invasive Surgical Approach Sun, 16 Apr 2017 08:24:47 +0000 http://www.hindawi.com/journals/cric/2017/8510160/ This case report concerns a young woman who, during her pregnancy, suffered severe mitral regurgitation. It was discovered at the same time that she had a left atrial myxoma. During the early postpartum period she successfully underwent an anterior minithoracotomy to remove the left atrial myxoma in conjunction with repair of the mitral valve. The thoracotomy approach in this specific patient was chosen as it would give a better chance of successful mother-child bonding because the patient would be able to avoid the precautions which would have been necessary following a sternotomy, especially the limitation of her ability to hold her child during the first 4–6 weeks postoperatively. Noppon Taksaudom, Kuntharee Traisrisilp, and Rungsrit Kanjanavanit Copyright © 2017 Noppon Taksaudom et al. All rights reserved. Retrieval of Embolized Amplatzer Patent Foramen Ovale Occlusion Device: Issues Related to Late Recognition Sun, 16 Apr 2017 08:12:31 +0000 http://www.hindawi.com/journals/cric/2017/9894215/ Embolization of a percutaneous patent foramen ovale (PFO) closure device is a rare but serious complication. While early, periprocedural device embolization can normally be managed with snare and percutaneous retrieval, late embolization requires a different management strategy due to inability of the device to deform to allow passage into a large caliber sheath. We present a case of asymptomatic device embolization recognized six months following implantation and discuss the challenges encountered in successfully retrieving the device. Allan J. Davies, Nicholas Collins, and Nicole Organ Copyright © 2017 Allan J. Davies et al. All rights reserved. Absence of Left Circumflex Artery: A Rare Congenital Disorder of Coronary Arteries Sun, 16 Apr 2017 07:50:50 +0000 http://www.hindawi.com/journals/cric/2017/8710135/ Congenital absence of left circumflex artery is a rare occurrence and very few cases have been reported in literature. It is a benign incidental finding; however some patients present with sudden onset chest pain mimicking acute coronary syndrome often resulting in detection of this rare anatomy on coronary angiography. Coronary computed tomography angiography is a relatively new noninvasive imaging modality which can be used to confirm this suspicion and diagnose this unique morphology reliably. Saad Ullah, Muzammil Khan, Noman Ahmed Jang Khan, Hassan Zeb, and Roshan Patel Copyright © 2017 Saad Ullah et al. All rights reserved. Severe Dilatation of Coronary Artery Ostium Complicating Sinus of Valsalva Aneurysm: Differential Diagnosis and Review of the Literature Thu, 13 Apr 2017 10:13:49 +0000 http://www.hindawi.com/journals/cric/2017/8694652/ Coronary artery dilatation may be due to various aetiologies including congenital anomalies, atherosclerotic coronary disease, and Kawasakis disease. We describe a case characterised by apparent severe dilatation of the right coronary artery ostium in an asymptomatic male. Subsequent imaging and surgical intervention documented the presence of a sinus of Valsalva aneurysm extending into the ostium of the right coronary artery. This represents an unusual manifestation of a sinus of Valsalva aneurysm. The underlying pathophysiology, differential diagnosis, role of surgical management, and outcomes are discussed. Paul Bamford and Nicholas Collins Copyright © 2017 Paul Bamford and Nicholas Collins. All rights reserved. Reversible Myocardial Injury and Intraventricular Thrombus Associated with Aluminium Phosphide Poisoning Sun, 09 Apr 2017 10:45:14 +0000 http://www.hindawi.com/journals/cric/2017/6287015/ Aluminium phosphide (ALP) is widely used as a fumigant pesticide. In case of ALP poisoning, it is responsible for myocardial dysfunction, related to toxic myocarditis, and hemodynamic disorders. We report a case of a 28-year-old female who had intentionally ingested ALP and was admitted with cardiogenic shock. The transthoracic echocardiography (TTE) at the time of admission showed severe global myocardial hypokinesia with the presence of a giant left ventricular thrombus. Cardiovascular magnetic resonance (CMR) revealed extensive toxic myocarditis with a left ventricular systolic dysfunction. All cardiac lesions were reversible after symptomatic treatment, within 6 months. We aim, by reporting this case, to evidence the complete reversibility of cardiac injury due to aluminium phosphide poisoning documented by transthoracic echocardiography and cardiovascular magnetic resonance. Abdelkader Jalil El Hangouche, Hala Fennich, Oumaima Alaika, Taoufiq Dakka, Zaineb Raissouni, Latifa Oukerraj, Nawal Doghmi, and Mohamed Cherti Copyright © 2017 Abdelkader Jalil El Hangouche et al. All rights reserved. Surgical Repair of Subacute Right Ventricular Perforation after Pacemaker Implantation Thu, 06 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/3242891/ We report an 84-year-old woman who presented with right ventricular perforation 4 days after pacemaker implantation for syncope due to sick sinus syndrome. Median sternotomy revealed no pericardial effusion, but the pacing lead had penetrated the right ventricle and pericardium. When the pleura was opened, the tip of the lead was seen in the visceral pleura. The lead was cut in the pericardial cavity and extracted from the left subclavian wound together with the generator. The right ventricular perforation was sutured and a temporary pacing lead was placed on the right ventricular wall intraoperatively. Ten days after the surgery, a new pacemaker lead was placed in the ventricular septum via the right axillary vein. Right ventricular perforation is a rare complication after pacemaker implantation. Typically, it occurs at the time of implantation or within 24 hours after implantation. In the present case, the perforation of the right ventricle which needed urgent surgery occurred 4 days after implanting the pacing lead at the right ventricular apex. Great care should have been taken not to overlook this life-threatening complication even more than 24 hours after pacemaker implantation. Takeshi Oda, Takanori Kono, Keiichi Akaiwa, Yasushi Takahara, Chie Yasuoka, and Katsuhiko Nakamura Copyright © 2017 Takeshi Oda et al. All rights reserved. Life-Threatening Hemopericardium Associated with Rivaroxaban Wed, 05 Apr 2017 07:32:09 +0000 http://www.hindawi.com/journals/cric/2017/4691325/ Rivaroxaban is a novel oral anticoagulant used in the treatment of venous thromboembolism. The use of this medication has expanded over the recent years with resultant expansion of side effect profile. We present a case of a 56-year-old female who presented with shortness of breath and chest pain 12 weeks after starting rivaroxaban for left upper extremity deep vein thrombosis. She was later diagnosed with spontaneous hemopericardium requiring pericardial fluid drainage. Rarer side effects like this will be encountered more often with the increasing use of novel oral anticoagulants. The clinicians should be cognizant of this entity among patients with shortness of breath and chest pain for timely diagnosis and intervention. Sijan Basnet, Niranjan Tachamo, Biswaraj Tharu, Rashmi Dhital, Sushil Ghimire, and Dilli Ram Poudel Copyright © 2017 Sijan Basnet et al. All rights reserved. Peeled Guidewire Coating with Debulked Plaque Obtained by Directional Coronary Atherectomy Wed, 05 Apr 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/2397183/ Percutaneous directional coronary atherectomy (DCA) is a plaque debulking method performed in Japan, and recently a renewed DCA device has been launched. We present a case with a tight left anterior descending lesion undergoing percutaneous coronary intervention with application of DCA. After several sessions of DCA, white plaques accompanied by green, stringed materials were obtained from the device; some materials were considerably long (approximately 15 mm in length). A drug-eluting stent was subsequently implanted, and the procedure was completed successfully without any complications. The extracted plaques and artificial materials were pathologically examined, and no inflammatory changes were detected on plaques adjacent to the material. Assessing pathological findings and structure of the DCA catheter, the obtained artificial materials were considered as peeled guidewire, possibly resulting from the friction between the guidewire and metallic bearing in the housing of DCA catheter. Of note, this phenomenon has been recognized even in other DCA cases in which guidewires of the other kind are used. We report this phenomenon for the first time, warning of theoretically possible distal embolization of artificial materials caused by any debulking devices. Rikuta Hamaya, Taishi Yonetsu, Sadamitsu Ichijo, Makoto Araki, Tadashi Murai, Yoshihisa Kanaji, Eisuke Usui, Junji Matsuda, Masahiro Hoshino, Masahiro Hada, Takayuki Niida, Yoshinori Kanno, and Tsunekazu Kakuta Copyright © 2017 Rikuta Hamaya et al. All rights reserved. Pulmonary Embolism and Intracardiac Type A Thrombus with an Unexpected Outcome Sun, 02 Apr 2017 08:04:56 +0000 http://www.hindawi.com/journals/cric/2017/9092576/ Detection of right heart thrombi (RHT) in the context of pulmonary thromboembolism (PE) is uncommon (4–18%) and increases the risk of mortality beyond the presence of PE alone. Type A thrombi are serpiginous and highly mobile and are thought to be originated from large veins and captured in-transit within the right heart. Optimal management of RHT is still uncertain. A 79-year-old woman, with a history of recent total hysterectomy with adnexectomy and a Wells procedure, presented to the emergency department following an episode of syncope. Computed tomography revealed bilateral PE and the presence of a right atrial thrombus. Transthoracic echocardiography demonstrated a free-floating type A thrombus in the right atrium, protruding into the right ventricle, and signs of pulmonary hypertension and right ventricle dysfunction. Considering the recent surgery and clinical stability, treatment with heparin alone was decided. Subsequent clinical improvement was observed and echocardiographic follow-up revealed complete thrombus dissolution and complete recovery of right ventricle function. Most authors recommend treatment of PE with RHT with thrombolysis or embolectomy followed by anticoagulation, although evidence is scarce. Individual risk of hemorrhage and operatory-related mortality should be taken into account when defining the treatment strategy especially when benefit is not firmly established. João Português, Lucy Calvo, Margarida Oliveira, Vítor Hugo Pereira, Joana Guardado, Mário Rui Lourenço, Olga Azevedo, Francisco Ferreira, Filipa Canário-Almeida, and António Lourenço Copyright © 2017 João Português et al. All rights reserved. Papillary Fibroelastoma as a Cause of Cardiogenic Embolic Stroke in a β-Thalassemia Patient: Case Report and Literature Review Sun, 26 Mar 2017 07:40:39 +0000 http://www.hindawi.com/journals/cric/2017/8185601/ We describe a case of a young male without stroke risk factors who presented with a sudden onset of left-sided weakness, left hand numbness, and left eye blurriness. CT scan of the head without contrast and diffusion-weighted MRI of the brain with contrast revealed an ischemic stroke in the right middle cerebral artery distribution. Transesophageal echocardiography (TEE) revealed a mobile pedunculated mass on the posterior surface of the mitral valve. This mass was resected and pathology showed a cardiac papillary fibroelastoma (CPFE), which was determined to be the cause of the patient’s cardioembolic stroke. Further workup also found that patient had microcytic anemia secondary to β-thalassemia intermedia, a rare hematologic disorder due to defective hemoglobin synthesis. Recently, another case report suggested β-thalassemia major may underlie the pathogenesis of CPFE. β-Thalassemia major causes a state of chronic inflammation and endothelial damage, which can mediate CPFE formation. Based on literature review, this is the first case report of a CPFE in a patient with β-thalassemia intermedia. This hypothesis-generating case report calls attention to the need for elucidating the relationship between CPFE and β-thalassemia in future studies to better understand the diagnosis and management of a rare cardiac tumor. Re-I Chin, John J. Monda, Maulik Sheth, William Ogle, Gloria Merenda, and Debapriya De Copyright © 2017 Re-I Chin et al. All rights reserved. Aborted Sudden Cardiac Death in a Female Patient Presenting with Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm Sun, 19 Mar 2017 10:19:32 +0000 http://www.hindawi.com/journals/cric/2017/7875240/ Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV) in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred. Sorin Giusca, Tom Eisele, Peter Nunninger, Benedikt Münz, and Grigorios Korosoglou Copyright © 2017 Sorin Giusca et al. All rights reserved. Adult Onset Dysphagia: Right Sided Aortic Arch, Ductus Diverticulum, and Retroesophageal Ligamentum Arteriosum Comprising an Obstructing Vascular Ring Wed, 15 Mar 2017 07:06:31 +0000 http://www.hindawi.com/journals/cric/2017/9614835/ A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of the ductus diverticulum and division of the retroesophageal ligamentum arteriosum led to complete resolution of our patient’s symptoms. Ankur Sinha, Hitesh Raheja, Vinod Namana, Sunil Abrol, Stephan Kamholz, and Vijay Shetty Copyright © 2017 Ankur Sinha et al. All rights reserved. Ventricular Septal Dissection Complicating Inferior Wall Myocardial Infarction Wed, 15 Mar 2017 06:59:54 +0000 http://www.hindawi.com/journals/cric/2017/9680891/ Postmyocardial infarction ventricular septal defect is an increasingly rare mechanical complication of acute myocardial infarction. We present a case of acute myocardial infarction from right coronary artery occlusion that developed hypotension and systolic murmur 12 hours after successful percutaneous coronary intervention. Although preoperative imaging suggested a large ventricular septal defect and a pseudoaneurysm, intraoperative findings concluded a serpiginous dissection of the ventricular septum. The imaging technicalities are discussed. Lindsey Kalvin, Rayan Yousefzai, Bijoy K. Khandheria, Timothy E. Paterick, and Khawaja Afzal Ammar Copyright © 2017 Lindsey Kalvin et al. All rights reserved. Takotsubo Cardiomyopathy in a Patient with Undiscovered Sigmoid Colon Cancer Thu, 09 Mar 2017 09:03:27 +0000 http://www.hindawi.com/journals/cric/2017/4563203/ Takotsubo cardiomyopathy (TTC) is a stress-related cardiomyopathy that is characterized by reversible left systolic dysfunction, which appears to be precipitated by sudden emotional or physical stress in the absence of myocardial infarction. Here we present a rare case that clinically presented with intermittent abdominal pain, initially impressed as non-ST elevation myocardial infarction and congestive heart failure but with a normal coronary angiogram. Her symptoms relieved spontaneously without returning. Sigmoid colon cancer was diagnosed via colonoscopy later due to persistent abdominal discomfort. In the absence of detectable emotional or physical stress factors, the newly diagnosed sigmoid colon cancer was the only possible trigger factor of TTC. We offer this case as a reminder that cancer should be considered in the differential diagnosis of patients presenting with the etiology of TTC. Huang Po-Yen and Ku Po-Ming Copyright © 2017 Huang Po-Yen and Ku Po-Ming. All rights reserved. Premature Ventricular Complex Causing Ice-Pick Headache Tue, 07 Mar 2017 08:16:10 +0000 http://www.hindawi.com/journals/cric/2017/3879127/ Ice pick headache is a momentary, transient, repetitive headache disorder and manifests with the stabbing pains and jolts. The exact mechanism causing this disease is unknown. Premature ventricular contractions are early depolarization of the ventricular myocardium and in the absence of a structural heart disease, it is considered to be a benign disease. In this report, we describe a male patient presenting with the symptom of momentary headache attacks accompanied with instant chest pain which is associated with premature ventricular contraction. Selcuk Ozturk and Ertan Yetkin Copyright © 2017 Selcuk Ozturk and Ertan Yetkin. All rights reserved. FOLFOX Induced Takotsubo Cardiomyopathy Treated with Impella Assist Device Tue, 07 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/8507096/ Chemotherapy induced cardiotoxicity is becoming increasingly prevalent with several new agents being used recently. The incidence of Takotsubo cardiomyopathy due to 5-fluorouracil based chemotherapeutic regimens like FOLFOX is not uncommon. It is also seen with platinum based chemotherapy. Most of these patients have reversible cardiotoxicity and the cardiac function recovers within a short period with supportive treatment. Here we have a patient who presented with cardiogenic shock after 5 days of receiving FOLFOX regimen for colorectal adenocarcinoma. She was treated with a percutaneous left ventricular assist device, Impella CP, for hemodynamic support with excellent outcome. Swethika Sundaravel, Abdulah Alrifai, Mohamad Kabach, and Waqas Ghumman Copyright © 2017 Swethika Sundaravel et al. All rights reserved. Transcatheter Aortic Valve Implantation in an Extremely Tortuous S-Shaped Aorta Thu, 02 Mar 2017 09:10:29 +0000 http://www.hindawi.com/journals/cric/2017/2936513/ Transcatheter aortic valve implantation (TAVI) has emerged as an alternative technique to treating aortic stenosis in patients with high surgical risk. We present a case of a successful transfemoral TAVI in a high-risk patient with an extremely tortuous iliofemoral system and a significant S-type bend in the descending aorta. With careful preprocedure planning and using all the techniques available, TAVI can be performed in the most challenging patients. Shuangbo Liu, Olga Toleva, Amir Ravandi, Zlatko Pozeg, Alan Menkis, and Malek Kass Copyright © 2017 Shuangbo Liu et al. All rights reserved. Conventional Coronary Angiography Induced Takotsubo Cardiomyopathy Complicated with Cardiac Tamponade Wed, 01 Mar 2017 07:23:35 +0000 http://www.hindawi.com/journals/cric/2017/5631264/ Takotsubo cardiomyopathy (TCM) is a transient left ventricular dysfunction that typically occurs after emotional or physical stress. TCM has a benign prognosis and serious complications are uncommon. However, though very rarely reported, cardiac tamponade has occurred on some occasions. We hereby report the case of a 70-year-old woman who underwent coronary angiography with an ergonovine provocation test to evaluate recurrent chest pain and was readmitted 7 days later presenting with TCM, followed by left ventricular outflow tract obstruction and cardiac tamponade. Min Gyu Kang, Kye-Hwan Kim, Jin-Sin Koh, Young-Hoon Jeong, Jin-Yong Hwang, and Jeong Rang Park Copyright © 2017 Min Gyu Kang et al. All rights reserved. ACE Inhibitor-Induced Angioedema following Cervical Spine Surgery Tue, 28 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/4268962/ Angioedema is a well-known side effect of angiotensin converting enzyme inhibitors (ACEi). However, ACE inhibitors induced angioedema after cervical surgery is a rare condition. They result in increased levels of circulating bradykinins. Rare cases of angioedema following local trauma in patients using ACE inhibitors have been published. We present such a case. A 54-year-old Caucasian female with a history significant for hypertension, controlled with lisinopril, was admitted for routine cervical spine surgery. She has severe degenerative cervical disc disease and was admitted to the hospital for an elective cervical diskectomy. The patient failed weaning off the ventilator on multiple attempts postoperatively. There were no observed symptoms of an allergic reaction. A CT scan of the neck showed extensive soft tissue edema at the level of the arytenoids. Dexamethasone was given to reduce the edema without successful resolution. On review of her medications, it was found that the patient was resumed on lisinopril following the procedure. It was subsequently discontinued. By the following day the patient had a positive leak around the ET tube cuff and patient was successfully extubated. Faris Hannoodi and Hussam Sabbagh Copyright © 2017 Faris Hannoodi and Hussam Sabbagh. All rights reserved. Myocardial Infarction after Endoscopic Removal of Foreign Body Sun, 26 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/4541587/ The development of cardiac complications during or after endoscopic procedures is rare. However, mortality from myocardial ischemia, particularly in the elderly population, is elevated. We illustrate the rare case of a 79-year-old man with multiple cardiovascular risk factors who developed a non-ST elevation myocardial infarction (NSTEMI) after endoscopic removal of a foreign body. This case report summarizes a rare complication of a low-risk procedure and highlights the importance of considering this potential adverse event, particularly in patients with significant cardiovascular risk factors, to promote early diagnosis and proper treatment. Carola Maraboto, Florentino Lupercio, and Ileana L. Piña Copyright © 2017 Carola Maraboto et al. All rights reserved.