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Senel M, Schlensak C, Gawaz MP, Krumm P, Mueller KAL. Myocardial Abscess After Myocarditis: Advantages of Multimodal Imaging Detecting the Rare Case of Fungal Abscess. JACC Case Rep 2022; 6:101694. [PMID: 36704065 PMCID: PMC9871202 DOI: 10.1016/j.jaccas.2022.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/07/2022] [Accepted: 10/31/2022] [Indexed: 12/13/2022]
Abstract
We discuss the rare case of a myocardial abscess of the left ventricle in a 42-year-old man on immunosuppressive therapy after fulminant myocarditis. Multimodal imaging detected the myocardial abscess along with other septic emboli caused by infection with aspergillus fumigatus, which could be treated effectively with antimycotic strategies. (Level of Difficulty: Intermediate.).
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Higashimoto N, Ota S, Murata S, Nishimura Y, Tanaka A. Pericardial Lipoma With Fat Necrosis. JACC Case Rep 2022; 4:101677. [PMID: 36438433 PMCID: PMC9681664 DOI: 10.1016/j.jaccas.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 06/16/2023]
Abstract
A pericardial lipoma is a rare benign cardiac tumor, and fat necrosis is an uncommon clinical condition. This is the first reported case of pericardial lipoma with fat necrosis, which showed clinical presentations of a malignant tumor despite imaging findings consistent with benign lipoma. (Level of Difficulty: Advanced.).
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Chandra VM, Norton EL, Khaja MS, Herrera DG, Williams DM, Yang B. Surgical and endovascular repair for type B aortic dissections with mesenteric malperfusion syndrome: A systematic review of in-hospital mortality. JTCVS OPEN 2022; 12:37-50. [PMID: 36590716 PMCID: PMC9801243 DOI: 10.1016/j.xjon.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 07/06/2022] [Accepted: 07/20/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES Mesenteric malperfusion is a feared complication of aortic dissection, with high mortality. The purpose of this study was to systematically review in-hospital mortality (IHM) of endovascular and surgical management of acute and chronic Stanford type B aortic dissections (TBAD) complicated by mesenteric malperfusion (MesMP). METHODS A systematic search of English language articles was conducted in relevant databases. Data on patient demographics, procedure details, and survival outcomes were collected. Reports were classified by type of intervention performed. Studies that failed to report patient-level outcomes based on specific intervention performed or IHM were excluded. Retrospective chart review of previously published data from a single institution was also performed to further identify cases of TBAD that were managed endovascularly. The Fisher exact test was performed to determine statistical significance. RESULTS In total, 37 articles were suitable for inclusion in this systematic review, which yielded 149 patients with a median age 55.0 years (interquartile range, 46.5-65 years) and 79% being male. Overall, in-hospital mortality was 12.8% (19/149) and was similar between endovascular and open surgical interventions (13% vs 11%, P = .99). Among endovascular strategies, IHM was greater, although not statistically significant in the thoracic endovascular aortic repair group compared with the fenestration/stenting without thoracic endovascular aortic repair group (24% vs 11%, P = .15). CONCLUSIONS Multiple strategies exist for the management of TBAD with MesMP; however, a majority of cases were managed endovascularly. Despite advances in therapies, mortality remains high at 13%.
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Liu H, Qian SC, Zhang YY, Wu Y, Hong L, Yang JN, Zhong JS, Wang YQ, Wu DK, Fan GL, Chen JQ, Zhang SQ, Peng XX, Shao YF, Li HY, Zhang HJ. A Novel Inflammation-Based Risk Score Predicts Mortality in Acute Type A Aortic Dissection Surgery: The Additive Anti-inflammatory Action for Aortopathy and Arteriopathy Score. Mayo Clin Proc Innov Qual Outcomes 2022; 6:497-510. [PMID: 36185465 PMCID: PMC9519496 DOI: 10.1016/j.mayocpiqo.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 08/22/2022] [Accepted: 08/31/2022] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To develop an inflammation-based risk stratification tool for operative mortality in patients with acute type A aortic dissection. METHODS Between January 1, 2016 and December 31, 2021, 3124 patients from Beijing Anzhen Hospital were included for derivation, 571 patients from the same hospital were included for internal validation, and 1319 patients from other 12 hospitals were included for external validation. The primary outcome was operative mortality according to the Society of Thoracic Surgeons criteria. Least absolute shrinkage and selection operator regression were used to identify clinical risk factors. A model was developed using different machine learning algorithms. The performance of the model was determined using the area under the receiver operating characteristic curve (AUC) for discrimination, calibration curves, and Brier score for calibration. The final model (5A score) was tested with respect to the existing clinical scores. RESULTS Extreme gradient boosting was selected for model training (5A score) using 12 variables for prediction-the ratio of platelet to leukocyte count, creatinine level, age, hemoglobin level, prior cardiac surgery, extent of dissection extension, cerebral perfusion, aortic regurgitation, sex, pericardial effusion, shock, and coronary perfusion-which yields the highest AUC (0.873 [95% confidence interval (CI) 0.845-0.901]). The AUC of 5A score was 0.875 (95% CI 0.814-0.936), 0.845 (95% CI 0.811-0.878), and 0.852 (95% CI 0.821-0.883) in the internal, external, and total cohort, respectively, which outperformed the best existing risk score (German Registry for Acute Type A Aortic Dissection score AUC 0.709 [95% CI 0.669-0.749]). CONCLUSION The 5A score is a novel, internally and externally validated inflammation-based tool for risk stratification of patients before surgical repair, potentially advancing individualized treatment. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT04918108.
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Key Words
- 5A, Additive Anti-inflammatory Action for Aortopathy & Arteriopathy
- ATAAD, acute type A aortic dissection
- AUC, area under the receiver operating characteristics curve
- AVR, aortic valve regurgitation
- CT, computed tomography
- GERAADA, German Registry for Acute Type A Aortic Dissection
- ICU, intensive care unit
- KNN, K-nearest neighbor
- LASSO, least absolute shrinkage and selection operator
- NB, naïve Bayes
- RF, random forest
- STI, systemic thrombo-inflammatory
- SVM, support vector machine
- WBC, white blood cell
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Qian J, Li JN, Rose EK, Vandergriff T, Khosama L, Beg MS, Mauskar MM, Wang RC. Fibroblast growth factor receptor inhibitor therapy induced calcinosis cutis treated with sodium thiosulfate. JAAD Case Rep 2022; 31:128-132. [PMID: 36583143 PMCID: PMC9792732 DOI: 10.1016/j.jdcr.2022.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Fujita T, Takeya A, Miyata H, Ninomiya F, Nonoyama Y, Nakazawa T, Furuya Y, Enoki Y, Fujii T, Fukao S. Thoracic spinal metastasis as recurrence of borderline Brenner tumor without local recurrence: A case report. Gynecol Oncol Rep 2022; 44:101108. [PMID: 36506037 PMCID: PMC9731387 DOI: 10.1016/j.gore.2022.101108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Background Brenner tumor is a rare epithelial ovarian neoplasm that accounts for 2-3% of all ovarian neoplasms. Herein, we report the first case of thoracic spinal metastasis of recurrent Brenner tumor without local recurrence.Case Description.A 70-year-old female presented with a feeling of abdominal distension. Computed tomography revealed cystic lesions in her bilateral ovaries. Blood examination revealed high CA-125 [74.9 U/ml]. We excised bilateral ovaries, uterus, and omentum. Borderline Brenner tumor was diagnosed [Ki-67 labeling index: 10 %]. Follow-up abdominal echo and CA-125 examination revealed no local recurrence. 26 months later she developed paraplegia. Magnetic resonance imaging revealed tumor in the 5th-9th thoracic vertebra and compression of spinal cord at the 6th thoracic vertebra level. Her paraplegia was progressive. We performed semi-urgent partial resection of tumor and release of spinal cord compression. Spinal metastasis from Brenner tumor was diagnosed [Ki-67 labeling index: 50-60 %]. She received adjuvant radiation of 30 Gy in 10 fractions to the 4th-10th thoracic vertebra. After radiation and rehabilitation, she was discharged home on foot. She received adjuvant radiation and chemotherapy but died 11 months after spinal surgery. An autopsy has not been performed on her, and the cause of death is unknown. Conclusion We report the first case of thoracic metastasis of recurrent Brenner tumor without local recurrence.
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Kawakami Y, Shichijo S, Takeuchi Y, Kubo C, Omori T, Uedo N. Underwater EMR for the diagnosis of diffuse infiltrative gastric cancer. VIDEOGIE : AN OFFICIAL VIDEO JOURNAL OF THE AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY 2022; 8:68-69. [PMID: 36820250 PMCID: PMC9938288 DOI: 10.1016/j.vgie.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Video 1Underwater EMR for establishing diagnosis of diffuse infiltrative gastric cancer.
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Vulvar leukemia cutis: A case report and review of the literature. JAAD Case Rep 2022; 31:97-101. [PMID: 36568892 PMCID: PMC9772607 DOI: 10.1016/j.jdcr.2022.10.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Key Words
- ATM, ataxia-telangiectasia mutated gene
- B-cell lymphoma
- BIRC3, baculoviral IAP repeat-containing protein 3
- BTK, Bruton's tyrosine kinas
- CLL
- CLL, chronic lymphocytic leukemia
- CT, computed tomography
- HPV, human papilloma virus
- IL-4, IL-5, interleukin-4, interleukin-5
- LC, leukemia cutis
- PET, positron emission tomography
- PIK3R1, phosphatidylinositol 3-kinase regulatory subunit 1
- PLC, phospholipase C
- WHO, World Health Organization
- ZAP-70, zeta-chain-associated protein kinase-70
- cGY, centigray
- chronic lymphocytic leukemia
- cutaneous lymphoma
- leukemia cutis
- ulcerative
- vulvovaginal
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Al Abri Q, El Nihum LI, Hinohara T, Chang SM, Faza NN, Goel SS, Kleiman NS, Wyler von Ballmoos MC, Atkins MD, Reardon MJ. Late Transcatheter Aortic Valve Thrombosis Leading to Cardiogenic Shock. JACC Case Rep 2022; 4:1459-1463. [PMID: 36444179 PMCID: PMC9700056 DOI: 10.1016/j.jaccas.2022.07.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/18/2022] [Accepted: 07/27/2022] [Indexed: 06/16/2023]
Abstract
A 67-year-old woman with prior transcatheter aortic valve replacement presented with worsening dyspnea. Imaging revealed transcatheter aortic valve thrombosis and aortic stenosis. Despite oral anticoagulation, she progressively deteriorated and developed cardiogenic shock. We highlight the Heart Team's role in treating this unusual late thrombosis. (Level of Difficulty: Intermediate.).
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Key Words
- CT, computed tomography
- DAPT, dual antiplatelet therapy
- HALT, hypoattenuated leaflet thrombosis
- IABP, intra-aortic balloon pump
- LVEF, left ventricular ejection fraction
- OAC, oral anticoagulation
- SAPT, single antiplatelet therapy
- SAVR, surgical aortic valve replacement
- TAV, transcatheter aortic valve
- TAVR, transcatheter aortic valve replacement
- TEE, transesophageal echocardiography
- TTE, transthoracic echocardiography
- hypoattenuated leaflet thrombosis
- transcatheter heart valve
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Gómez-Herrero J, Luis CH, Moral ET, García GM, Palacid FS, Bustamante-Munguira J, Fuentes RG. Curative Pericardiectomy in Interpheron-Resistant Severe Pericardial Erdheim-Chester Disease. JACC Case Rep 2022; 4:1534-1541. [PMID: 36444187 PMCID: PMC9700060 DOI: 10.1016/j.jaccas.2022.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 06/16/2023]
Abstract
Erdheim-Chester disease is a rare clonal non-Langerhans cell histiocytosis with multisystemic involvement. It affects bones, large vessels, and retroperitoneum. Cardiac involvement is one of the main mortality predictors.1 We present an unusual case that debuted with cardiac tamponade and pericardial constriction requiring pericardiectomy for definitive control. (Level of Difficulty: Intermediate.).
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Schafigh M, Bakhtiary F, Kolck UW, Zimmer S, Greschus S, Silaschi M. Coronary Artery Aneurysm Rupture in a Patient With Polyarteritis Nodosa. JACC Case Rep 2022; 4:1522-1528. [PMID: 36444190 PMCID: PMC9700061 DOI: 10.1016/j.jaccas.2022.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 06/12/2023]
Abstract
We present the case of a 42-year-old male patient with ST-segment elevation myocardial infarction and pericardial effusion due to rupture of the left anterior descending artery most likely secondary to polyarteritis nodosa. Successful surgery was performed under cardiopulmonary bypass using antegrade and retrograde cardioplegia combined. (Level of Difficulty: Intermediate.).
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Marcus GU, Orbach A, Fremes S, Vijayaraghavan R, Kerner A, Oikonomou A, Roifman I, Wijeysundera HC. TAVR in a Patient With Anomalous Origin and Course of the Left Main Coronary Artery. JACC Case Rep 2022; 4:1467-1471. [PMID: 36444182 PMCID: PMC9700058 DOI: 10.1016/j.jaccas.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/17/2022] [Accepted: 06/23/2022] [Indexed: 06/16/2023]
Abstract
In patients with anomalous coronary arteries with high-risk features, corrective cardiac surgery should be considered. We report the first case of transcatheter aortic valve replacement using a self-expanding Evolut valve, in a patient with a single coronary artery arising from the right coronary cusp and an intramural course of the left main. (Level of Difficulty: Intermediate.).
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63
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Chen W, Yokoi K, Yoshioka G, Kamohara K, Node K. Efficacy of Cardiac Computed Tomography for Obstructive Mechanical Valve Thrombosis Under Venoarterial Extracorporeal Membrane Oxygenation. JACC Case Rep 2022; 4:1553-1555. [PMID: 36444180 PMCID: PMC9700072 DOI: 10.1016/j.jaccas.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
We encountered a patient in a state of shock who required venoarterial extracorporeal membrane oxygenation in whom cardiac computed tomography was instrumental in diagnosing obstructive mechanical mitral valve thrombosis as well as in the differentiation of other probable diseases. Because the patient was on venoarterial extracorporeal membrane oxygenation support, computed tomography imaging required some ingenuity. (Level of Difficulty: Intermediate.).
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Rizzo M, Landra F, Gambacciani A, Lorenz V, Valente S, Ascenzi FD, Cameli M, Montesi G. From Coronary Artery Ectasia to Giant Coronary Artery Aneurysm: Is it Necessary to Follow-Up? JACC Case Rep 2022; 4:1480-1483. [PMID: 36444191 PMCID: PMC9700080 DOI: 10.1016/j.jaccas.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
Here we present a case of an asymptomatic patient with a giant coronary artery aneurysm developed in the context of diffuse coronary artery ectasia. Giant coronary artery aneurysm was complicated by the presence of a large thrombus. The heart team settled for surgical treatment of the lesion. (Level of Difficulty: Intermediate.).
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Zhan L, Zhan Y. Successful management of an intraoperative electric burn broken ureteral stent: A case report. Ann Med Surg (Lond) 2022; 84:104849. [PMID: 36582861 PMCID: PMC9793155 DOI: 10.1016/j.amsu.2022.104849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/07/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022] Open
Abstract
In the treatment of some gynecological diseases, ureteral stents (double J stents) have been generally utilized in the prevention of ureteral injury. Nevertheless, if the ureteral stent is retained as a protective reminder during gynecological surgery, severe ureteral injury can be avoided. Hence, it is very essential to be familiar with the anatomy of ureter in gynecological surgery to prevent complications and morbidity. We demonstrate a case of a 49-year-old woman who presented with an electric burn broken ureteral stent in the gynecological surgery, but the ureter is only burned but not broken. This resulted in no abnormality being found during surgery. So, ureteroscopy is necessary to extract the ureteral stent and the patient is inserted with another new ureteral stent to repair the ureteral injury. The electric burn broken ureteral stent is difficult for discovering during the operation. And ureteroscopy is very crucial for the special situation of the ureteral injury.
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Spontaneous Coronary Artery Dissection Complicated by Left Ventricular Free Wall Rupture in Turner Syndrome. JACC Case Rep 2022; 8:101654. [PMID: 36860562 PMCID: PMC9969548 DOI: 10.1016/j.jaccas.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 09/19/2022] [Accepted: 09/29/2022] [Indexed: 11/08/2022]
Abstract
A 38-year-old with Turner syndrome presented with acute myocardial infarction due to multivessel spontaneous coronary artery dissection (SCAD) complicated by left ventricular free wall rupture. Conservative management for SCAD was pursued. She underwent sutureless repair for an oozing-type left ventricular free wall rupture. SCAD has not been previously reported in Turner syndrome. (Level of Difficulty: Advanced.).
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Key Words
- ACS, acute coronary syndrome
- CT, computed tomography
- DAPT, dual antiplatelet therapy
- DKA, diabetic ketoacidosis
- ECG, electrocardiogram
- LVFWR, left ventricular free wall rupture
- PCI, percutaneous coronary intervention
- PEA, pulseless electrical activity
- SCAD, spontaneous coronary artery dissection
- TS, Turner syndrome
- acute coronary syndrome
- cardiovascular disease
- myocardial infarction
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Franzino M, Costa F, De Ferrari T, Vizzari G, Andò G, Ceresa F, Patanè F, Di Bella G, Micari A. Chest Pain and the Dynamic Evolution of Spontaneous Coronary Artery Hematoma. JACC Case Rep 2022; 6:101673. [PMID: 36704054 PMCID: PMC9871221 DOI: 10.1016/j.jaccas.2022.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 09/23/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
Spontaneous coronary intramural hematoma (SCIH) is a rare but underdiagnosed condition, with dynamic evolution. We present a patient with acute chest pain and normal coronary angiogram undergoing work-up for myocardial infarction with nonobstructive coronary arteries. Cardiac magnetic resonance revealed an ischemic pattern, and subsequent angiography revealed coronary occlusion by SCIH. (Level of Difficulty: Intermediate.).
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Total arch replacement with extended branched stented anastomosis frozen elephant trunk repair for type A dissection improves operative outcome. JTCVS Tech 2022; 17:1-9. [PMID: 36820356 PMCID: PMC9938375 DOI: 10.1016/j.xjtc.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/25/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Objective Emergency surgical repair is the standard treatment for acute aortic dissection type A. However, the surgical risk of total arch replacement remains high. The Viabahn Open Revascularization TEChnique has been used for supra-aortic reconstruction during total arch replacement. This Cleveland Clinic technique is called "branched stented anastomosis frozen elephant trunk repair." Our total arch replacement with reconstructed extended branched stented anastomosis frozen elephant trunk repair requires no unnecessary cervical artery exposure. We compared the outcomes of extended branched stented anastomosis frozen elephant trunk repair and conventional total arch replacement in acute aortic dissection type A. Methods We compared the clinical course of patients undergoing total arch replacement using sutureless direct branch vessel stent grafting with frozen elephant trunk (extended branched stented anastomosis frozen elephant trunk repair) for acute aortic dissection type A with patients undergoing conventional total arch replacement. For the procedure, the aortic arch was transected circumferentially distal to the brachiocephalic artery origin. Frozen elephant trunk was fenestrated by heating with a cautery, and the self-expandable stent graft was delivered into the branch vessels through the fenestration. Results Of 58 cases, 21 and 37 were classified in the extended branched stented anastomosis frozen elephant trunk repair and conventional total arch replacement groups, respectively. The times (minutes) of selective antegrade cerebral perfusion (75 ± 24, 118 ± 47), total operation (313 ± 83, 470 ± 151), and cardiopulmonary bypass (195 ± 46, 277 ± 96) were significantly better in the extended branched stented anastomosis frozen elephant trunk repair group (P < .001). Six surgical deaths occurred: 2 (9%) in the extended branched stented anastomosis frozen elephant trunk repair group and 4 (10%) in the conventional total arch replacement group. In all cases, only 1 patient (2%) in the conventional total arch replacement group had a branch artery-related complication during the postoperative follow-up period. In the extended branched stented anastomosis frozen elephant trunk repair group, blood product use significantly decreased (P < .05). Conclusions Extended branched stented anastomosis frozen elephant trunk repair has shown comparable safety and efficacy to conventional total arch replacement and can be used for acute aortic dissection type A emergency repair. It optimizes true lumen perfusion and facilitates supra-aortic artery remodeling.
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Key Words
- AADA, acute aortic dissection type A
- B-SAFER, branched stented anastomosis frozen elephant trunk repair
- CT, computed tomography
- CTAR, conventional total arch replacement
- EAVR, estimated arch vessel reconstruction
- EB-SAFER
- EB-SAFER, extended branched stented anastomosis frozen elephant trunk repair
- FET, frozen elephant trunk
- FFP, fresh-frozen plasma
- HCA, hypothermic circulatory arrest
- LSCA, left subclavian artery
- RBC, red blood cells
- SACP, selective antegrade cerebral perfusion
- SAVSTEB, supra-aortic vessel anastomosis stent bridging
- TAR, total arch replacement
- acute aortic dissection type A
- frozen elephant trunk
- total arch replacement
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69
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Yoo D, Mohanty S, Natale A. Fatal Spontaneous Intercostal Artery Bleeding During Catheter Ablation for Atrial Fibrillation. JACC Case Rep 2022; 4:101614. [PMID: 36684031 PMCID: PMC9847242 DOI: 10.1016/j.jaccas.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/06/2022]
Abstract
Serious adverse events such as hemothorax are rarely seen in catheter ablation for atrial fibrillation. A recent case report discussed hemothorax from injury of the intercostal artery during atrial fibrillation ablation. Our case presents a patient with spontaneous bleeding from the intercostal artery that led to hemothorax, disseminated intravascular coagulation, and death. (Level of Difficulty: Intermediate.).
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Schwarzman LS, Megowan N, Manubolu VS, Shah SU. A Rare Case of Radiation-Associated Aortic and Mitral Valve Stenosis Treated With Transcatheter Valve Replacements. JACC Case Rep 2022; 8:101672. [PMID: 36860564 PMCID: PMC9969551 DOI: 10.1016/j.jaccas.2022.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
Radiation therapy is the standard of care for achieving cure for many thoracic malignancies, but it can result in long-term cardiovascular sequelae such as valve disease. We describe a rare case of severe aortic and mitral stenosis due to prior radiation therapy for giant cell tumor treated successfully with percutaneous aortic and off-label mitral valve replacements. (Level of Difficulty: Intermediate.).
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Keeton JZ, Prasad A, Bacharach T, Dayama A, Sako E, Almomani A. Innovative Approach to Manage Transcatheter Aortic Valve Embolization. JACC Case Rep 2022; 7:101598. [PMID: 36776798 PMCID: PMC9911928 DOI: 10.1016/j.jaccas.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/06/2022]
Abstract
We describe the case of a patient with an ascending aortic aneurysm who underwent valve-in-valve transcatheter aortic valve implantation, which was complicated by valve embolization. After a multidisciplinary discussion and an innovative approach, the free-floating embolized valve was anchored securely in the aortic arch with an uncovered aortic endovascular stent. (Level of Difficulty: Intermediate.).
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Virk SA, Yiannikas J. A Caseating Tricuspid Mass in an Adult With Eisenmenger Syndrome Secondary to Aorto-Pulmonary Window. JACC Case Rep 2022; 8:101646. [PMID: 36860563 PMCID: PMC9969550 DOI: 10.1016/j.jaccas.2022.08.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/23/2022] [Indexed: 11/06/2022]
Abstract
We present the case of a 55-year old Caucasian man with Eisenmenger syndrome secondary to uncorrected aorto-pulmonary window, whose clinical course has been complicated by recurrent cerebral abscesses and dynamic tricuspid annular caseation with probable pulmonary embolization. (Level of Difficulty: Intermediate.).
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73
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Assi AEH, Tabibiazar R, Dave PR, Shemin RJ, Rafique AM. An Unusual Case of Left Ventricular Outflow Tract Pseudoaneurysm. JACC Case Rep 2022; 6:101670. [PMID: 36704061 PMCID: PMC9871057 DOI: 10.1016/j.jaccas.2022.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/28/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare condition with a wide range of causes and various clinical outcomes. The causes range from infections, trauma to the chest wall, and iatrogenic origins. We present a unique case of idiopathic LVOT pseudoaneurysm in a patient with no obvious clinical risk factors. (Level of Difficulty: Advanced.).
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74
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Grewing AJ, Furtun BY, Webb MK. Utility of Computed Tomography in Diagnosis of a Patent Ductus Arteriosus in Pulmonary Artery Endarteritis. JACC Case Rep 2022; 5:101649. [PMID: 36636506 PMCID: PMC9830465 DOI: 10.1016/j.jaccas.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 09/08/2022] [Accepted: 09/27/2022] [Indexed: 11/06/2022]
Abstract
A 15-year-old patient with infective endarteritis had a pulmonary artery vegetation but no ductus arteriosus on echocardiogram. Computed tomography scan revealed a closed ductus that became patent after antibiotics and anticoagulation. Infective endarteritis should be considered in patients with a pulmonary artery vegetation even if no ductus is seen on echocardiogram. (Level of Difficulty: Intermediate.).
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75
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Rossi Prat M, de Abreu M, Reyes G, Wolcan JD, Saenz JX, Kyle D, Antonietti L, Mariani J, Tajer CD. Intramyocardial Dissecting Hematoma: A Mechanical Complication Needing Surgical Therapy? JACC Case Rep 2022; 4:1443-1448. [PMID: 36388712 PMCID: PMC9664011 DOI: 10.1016/j.jaccas.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
Intramyocardial dissecting hematoma is a form of cardiac rupture caused by myocardial infarction, percutaneous coronary intervention, or trauma. It is a cavity between myocardial fibers caused by partial rupture of the ventricular wall. Therapeutic management, including the timing for surgical approach, has not been standardized. We present a case series describing 4 patients. (Level of Difficulty: Intermediate.).
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