Case Reports in Cardiology http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2017 , Hindawi Publishing Corporation . All rights reserved. ST-Segment Elevation Myocardial Infarction and Normal Coronary Arteries after Consuming Energy Drinks Thu, 19 Jan 2017 10:47:52 +0000 http://www.hindawi.com/journals/cric/2017/4061205/ The use of energy drinks, which often contain stimulants, is common among young persons, yet there have been few reports of adverse cardiac events. We report the case of a 27-year-old man who was admitted to our facility with an acute ST-segment elevation myocardial infarction in the setting of using energy drinks. Angiography revealed no obstructive coronary disease. The patient had elevation of cardiac troponin. Noninvasive testing with echocardiography and cardiac magnetic resonance imaging demonstrated both abnormalities in resting wall motion at the anterior apex along with late gadolinium enhancement of the anterior wall, respectively. The patient also underwent formal invasive evaluation with an intracoronary Doppler study demonstrating normal coronary flow reserve and acetylcholine provocation that excluded endothelial dysfunction and microvascular disease. The patient recovered and has abstained from consuming additional energy drinks with no reoccurrence of symptoms. A review of some of the potential cardiac risks associated with consuming energy drinks is presented. S. Michael Gharacholou, Nkechinyere Ijioma, Emma Banwart, and Freddy Del Carpio Munoz Copyright © 2017 S. Michael Gharacholou et al. All rights reserved. Ventricular Tachycardia Originating from Moderator Band: New Perspective on Catheter Ablation Wed, 18 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/3414360/ A 59-year-old woman was referred to the institution with burdens of idiopathic ventricular tachycardia (IVT). Electroanatomic mapping revealed a complex fractionated, high frequency potential with long duration preceding the QRS onset of the IVT. The real end point of ablation was the disappearance of the conduction block of Purkinje potential during the sinus rhythm besides the disappearance of the inducible tachycardia. Location of distal catheter was at the moderator band (MB) by transthoracic echocardiography (TTE). Only irrigated radiofrequency current was delivered at both insertions of the MB which can completely eliminate the IVT. Jin-yi Li, Jing-bo Jiang, Yan He, Jian-chun Luo, and Guo-qiang Zhong Copyright © 2017 Jin-yi Li et al. All rights reserved. Cardiac Calcified Amorphous Tumor of the Mitral Valve Presenting as Transient Ischemic Attack Tue, 17 Jan 2017 14:21:33 +0000 http://www.hindawi.com/journals/cric/2017/2376096/ Cardiac calcified amorphous tumors (CATs) are an extremely rare nonneoplastic intracardiac masses. They have been reported in the literature in only a few cases. Thus, the incidence, pathogenesis, and best approach to the treatment are not certain. We report a case of CATs on the atrial surface of the anterior mitral valve leaflet in a 37-year-old female who was diagnosed by histopathological examination after surgical removal. Mohammad Abbasi Teshnizi, Atefeh Ghorbanzadeh, Nahid Zirak, Babak Manafi, and Aliasghar Moeinipour Copyright © 2017 Mohammad Abbasi Teshnizi et al. All rights reserved. Coronary-Cameral Fistula Connecting the Left Anterior Descending Artery and the First Obtuse Marginal Artery to the Left Ventricle: A Rare Finding Tue, 17 Jan 2017 06:47:27 +0000 http://www.hindawi.com/journals/cric/2017/8071281/ Coronary-cameral fistulas are rare congenital malformations, often incidentally found during cardiac catheterizations. The majority of these fistulas are congenital in nature but can be acquired secondary to trauma or invasive cardiac procedures. These fistulas most commonly originate in the right coronary artery and terminate into the right ventricle and least frequently drain into the left ventricle. Depending upon their size and location, coronary-cameral fistulas can lead to congestive heart failure, myocardial infarction, and bacterial endocarditis. We describe a case of 49-year-old woman who presented with worsening exertional dyspnea and leg swelling. Transthoracic echocardiogram revealed an ejection fraction of 35%. Cardiac catheterization demonstrated a fistula connecting the left anterior descending artery and the first obtuse marginal artery to the left ventricle. In this report, the authors provide a concise review on coronary fistulas, complications, and management options. Abdul Mannan Khan Minhas, Ehtesham Ul Haq, Ahmed Arslan Yousuf Awan, Arshad Ameer Khan, Ghazanfar Qureshi, and Pragathi Balakrishna Copyright © 2017 Abdul Mannan Khan Minhas et al. All rights reserved. Could Externalized St. Jude Medical Riata® Lead Be a Culture Medium of a Polymicrobial Endocarditis? A Clinical Case Sun, 15 Jan 2017 10:03:59 +0000 http://www.hindawi.com/journals/cric/2017/8967234/ We report the case of a man affected by polymicrobial endocarditis developed on a St. Jude Medical Riata lead with a malfunction because of the outsourcing of conductors. The patient was treated with antibiotic targeted therapy and showed different bacteria at the blood cultures and then underwent transvenous leads extraction. Vegetations were highlighted on the caval, atrial, and ventricular tracts of the Riata lead, but the cultures were all negative. The externalization of Riata lead may cause the malfunction but it could also promote bacterial colonies and vegetations. In conclusion, looking for early signs of infection is mandatory during Riata leads follow-up checks. Zefferino Palamà, Roberta Trotta, Cosimo Mandurino, Mariangela Pinto, Giovanni Luzzi, and Stefano Favale Copyright © 2017 Zefferino Palamà et al. All rights reserved. A Rare Case of Angina Pectoris with the Longest Ectopic Left Main Coronary Artery Arising from Right Sinus of Valsalva and a Prepulmonic Course Sun, 15 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cric/2017/5483257/ Knowledge of the morphoanatomical characteristics of the main trunk of the left coronary artery as well as its variations is cornerstone of hemodynamic, correct interpretation of coronary angiogram and for revascularization purpose. The left main coronary artery (LMCA) ranges from 3 to 6 mm in diameter and may be up to 10 to 15 mm in length in humans. We here report a case of the longest anomalous LMCA (56 mm) reported so far in a 35-year-old man with chronic stable angina arising from right sinus of valsalva as seen on conventional angiogram and multidetector computerized tomogram (MDCT). Santosh Kumar Sinha, Vikas Mishra, Nasar Abdali, Karandeep Singh, Mukesh Jitendra Jha, and Ashutosh Kumar Copyright © 2017 Santosh Kumar Sinha et al. All rights reserved. Undilatable Stent Neoatherosclerosis Treated with Ad Hoc Rotational Atherectomy Tue, 10 Jan 2017 10:16:38 +0000 http://www.hindawi.com/journals/cric/2017/3168067/ A middle age woman with known ischemic heart disease and old stents in proximal left anterior descending coronary artery (LAD) was admitted to Coronary Care Unit with acute coronary syndrome. The coronary angiography showed one vessel disease with significant restenosis within the previously implanted stents. The lesion was tough and remained undilatable despite high pressure balloon inflation. Eventually, the balloon ruptured creating a massive dissection of the LAD beginning immediately after the distal part of the undilatable lesion. We proceeded with a challenging ad hoc rotational atherectomy of the lesion and finally stenting of the lesion. In-stent restenosis many years after stent implantation is considered to be mainly due to neoatheromatosis compared to intimal hyperplasia, making lesion treatment more difficult and unpredictable. Michael Koutouzis, Maria Agelaki, Christos Maniotis, Ioannis Tsiafoutis, Vasileios Patris, and Mihalis Argyriou Copyright © 2017 Michael Koutouzis et al. All rights reserved. QT Prolongation due to Graves’ Disease Thu, 05 Jan 2017 06:46:14 +0000 http://www.hindawi.com/journals/cric/2017/7612748/ Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status. Zain Kulairi, Nisha Deol, Renee Tolly, Rohan Manocha, and Maliha Naseer Copyright © 2017 Zain Kulairi et al. All rights reserved. Large Left Ventricular Thrombus in a Patient with Systemic and Venous Thromboembolism Secondary to Protein C and S Deficiency Wed, 04 Jan 2017 06:52:27 +0000 http://www.hindawi.com/journals/cric/2017/7576801/ 58-year-old Hispanic female presented with an altered mental status. A CT scan of the head demonstrated multiple scattered infarcts and a large right temporal lobe infarct. We also diagnosed the patient with right popliteal and femoral vein thrombosis, bilateral pulmonary embolism, and a transient right radial artery occlusion. Her 12-lead EKG showed lateral ST elevation. Emergent coronary angiogram revealed normal coronaries. Echocardiogram demonstrated a large mobile mass attached to the anterolateral free wall with overall normal contractility of the left ventricle. The patient underwent surgical embolectomy to prevent further systemic embolization. Coagulability workup returned positive for protein C and S deficiency. The patient did well after surgery. Following her surgery, we initiated chronic oral anticoagulation. The presentation with intracardiac thrombus in a normal heart should raise a concern of a probable thrombophilia. Mohit Pahuja, Bujji Ainapurapu, and Aiden Abidov Copyright © 2017 Mohit Pahuja et al. All rights reserved. GuideLiner Balloon Assisted Tracking (GBAT): A New Addition to the Interventional Toolbox Wed, 28 Dec 2016 09:13:59 +0000 http://www.hindawi.com/journals/cric/2016/6715630/ The use of guide extension catheters, such as GuideLiner, allows for increased guide support and facilitates device delivery in tortuous vessels. In cases which the GuideLiner catheter cannot be advanced even with balloon anchoring technique, we inflate a noncompliant balloon protruding from the GuideLiner catheter at nominal pressure and both the GuideLiner and the balloon are advanced over the coronary guidewire through the tortuous segments. This technique can be applied to 5.5 Fr., 6 Fr., and 7 Fr. GuideLiner catheters. This technique is termed GuideLiner Balloon Assisted Tracking (GBAT). Basem Elbarouni, Motaz Moussa, Malek Kass, Olga Toleva, Minh Vo, and Amir Ravandi Copyright © 2016 Basem Elbarouni et al. All rights reserved. Successful Percutaneous Retrieval of Embolized Septal Occluder Device from Aortic Arch and Placement of a Newer Septal Occluder Device in Combined Procedure Tue, 27 Dec 2016 08:13:32 +0000 http://www.hindawi.com/journals/cric/2016/1032801/ Embolization of the Amplatzer Septal Occluder (ASO) device (St. Jude Medical, Minnesota) after percutaneous closure of atrial septal defect (ASD) is a rare and potentially catastrophic complication. Percutaneous retrieval of the embolized device is gaining ground as an acceptable method, although these patients are usually subsequently referred for open surgical closure of the ASD. We present a unique case of percutaneous retrieval embolized ASO device and placement of newer larger ASO device in a single procedure. Natraj Katta, Sandeep Gautam, and Richard Webel Copyright © 2016 Natraj Katta et al. All rights reserved. Asymptomatic Pulmonary Vein Stenosis: Hemodynamic Adaptation and Successful Ablation Sun, 25 Dec 2016 07:37:32 +0000 http://www.hindawi.com/journals/cric/2016/4979182/ Pulmonary vein stenosis is a well-established possible complication following an atrial fibrillation ablation of pulmonary veins. Symptoms of pulmonary vein stenosis range from asymptomatic to severe exertional dyspnea. The number of asymptomatic patients with pulmonary vein stenosis is greater than originally estimated; moreover, only about 22% of severe pulmonary vein stenosis requires intervention. We present a patient with severe postatrial fibrillation (AF) ablation pulmonary vein (PV) stenosis, which was seen on multiple imaging modalities including cardiac computed tomography (CT) angiogram, lung perfusion scan, and pulmonary angiogram. This patient did not have any pulmonary symptoms. Hemodynamic changes within a stenosed pulmonary vein might not reflect the clinical severity of the obstruction if redistribution of pulmonary artery flow occurs. Our patient had an abnormal lung perfusion and ventilation (V/Q) scan, suggesting pulmonary artery blood flow redistribution. The patient ultimately underwent safe repeat atrial fibrillation ablation with successful elimination of arrhythmia. John J. Lee, Denis Weinberg, and Rishi Anand Copyright © 2016 John J. Lee et al. All rights reserved. Complete Resolution of Tumor Burden of Primary Cardiac Non-Hodgkin’s Lymphoma Thu, 22 Dec 2016 13:37:38 +0000 http://www.hindawi.com/journals/cric/2016/2124975/ Primary cardiac tumors are a rare set of benign and malignant neoplasms found in the heart or pericardium. We describe a patient presenting with nonspecific symptoms and ultimately diagnosed with primary cardiac non-Hodgkin’s lymphoma (PCL). Our patient had extensive tumor in the right ventricle, which extended into the right atrium and right ventricular outflow tract. The tumor also encased the right coronary artery, which manifested as ischemic changes on EKG and cardiac MRI. The patient was treated with chemotherapy and achieved complete remission, with dramatic and full resolution of the mass on repeat echocardiography in nine weeks. More studies are needed to understand the optimal management and prognosis of patients with PCL. Rina Mauricio, Ofole Mgbako, Adam Buntaine, Andre Moreira, and Albert Jung Copyright © 2016 Rina Mauricio et al. All rights reserved. A Large Left Ventricle Myxoma: Presenting with Epigastric Pain and Weight Loss Tue, 20 Dec 2016 09:12:18 +0000 http://www.hindawi.com/journals/cric/2016/9018249/ Cardiac myxomas are the most common benign tumors found in the heart. They usually appear in the left atrium. Those originating from the left ventricle (LV) are rare. Although clinical presentation may vary, dyspnea and embolism are the most commonly reported symptoms. In the present case study, a 27-year-old woman with a large myxoma originating from the left ventricular free wall is studied. She had atypical complaints, mainly epigastric discomfort, nausea, vomiting, and anorexia. She was hospitalized for acute abdomen, but subsequent investigations revealed a large myxoma that fully filled the LV and severely compromised the flow of the aortic and mitral valves. After successful emergency tumor resection, all symptoms disappeared. The uncommon presentation caused by these tumors is discussed in this study. Solmaz Fakhari and Eissa Bilehjani Copyright © 2016 Solmaz Fakhari and Eissa Bilehjani. All rights reserved. Thirty Years Later: Evolution of Treatment for Acute Left Main Coronary Artery Occlusion Mon, 19 Dec 2016 09:30:40 +0000 http://www.hindawi.com/journals/cric/2016/7360682/ Acute occlusion of left main coronary artery is a catastrophic event. We describe two patients with acute occlusion of the left main coronary artery treated thirty years apart. The first patient was treated in 1982 and survived the event without revascularization but developed severe heart failure. His survival was so unusual that it merited a case report at that time. The second patient was treated at the end of 2015. Early revascularization resulted in myocardial reperfusion and near normal left ventricular function. These patients exemplify the progress in therapeutic cardiology over the last 30 years. Moshe Y. Flugelman, Nissan Ben-Dov, Basheer Karkabi, and Ronen Jaffe Copyright © 2016 Moshe Y. Flugelman et al. All rights reserved. Kink of Subclavian Artery Mimicking Stenosis Mon, 12 Dec 2016 14:12:37 +0000 http://www.hindawi.com/journals/cric/2016/4274936/ The treatment for subclavian artery stenosis includes the more common endovascular therapy rather than surgical intervention in symptomatic patients. We present a case of a 79-year-old man with coronary artery bypass graft where subclavian artery stenosis was found incidentally. In this asymptomatic case, we have merged clinical and multiple imaging modalities to secure the diagnosis and treatment plan. Hatice S. Kemal, Aziz Gunsel, Murat Kocaoglu, Levent Cerit, and Hamza Duygu Copyright © 2016 Hatice S. Kemal et al. All rights reserved. Cardiogenic Shock due to Psychosis-Induced Inverted Takotsubo Cardiomyopathy Bridged-to-Recovery with a Percutaneous Left Ventricular Assist Device Mon, 12 Dec 2016 09:56:12 +0000 http://www.hindawi.com/journals/cric/2016/5498650/ Inverted Takotsubo cardiomyopathy, a less common variant in the spectrum of stress-induced cardiomyopathy, is increasingly being reported. This report describes an acute psychiatric illness leading to the onset of this syndrome. The patient presented here developed cardiogenic shock but successfully recovered with the use of a percutaneous left ventricular assist device. Ravi Korabathina, Warren Abel, and Arthur Labovitz Copyright © 2016 Ravi Korabathina et al. 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.