Case Reports – ABC CARDIOL

ABCIC

Case Report

Biventricular Noncompaction Cardiomyopathy Associated With Neuropathy in a Young Patient: A Case Report

Mônica de Oliveira Gonçalo et al. André Alexandre dos Santos Gomes Matheus Martins Monteiro Nicolas Babilônia Cavalcanti … Fernando Almeida Bezerra Moisés Abtibol Machado Dênison Clark Corrêa de Miranda Kátia do Nascimento Couceiro João Marcos Bemfica Barbosa Ferreira

Introduction

Ventricular hypertrabeculation, also known as ventricular noncompaction, is a myocardial phenotype characterized by excessive trabeculation and deep intertrabecular recesses caused by incomplete myocardial compaction during embryonic development. The earliest reported cases were associated with congenital heart defects, including ventricular outflow tract obstruction, complex cyanotic congenital heart disease, and coronary artery anomalies.^,

The clinical presentation is highly heterogeneous and may include heart failure (HF), arrhythmias, thromboembolic events, and sudden cardiac death. In addition to ventricular structural abnormalities, ventricular hypertrabeculation may be associated with cardiac conduction disorders, atrial arrhythmias, and functional valvular regurgitation (FVR) secondary to cardiac chamber dilatation, all of which contribute to greater clinical complexity and a poorer prognosis.

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ABC

Case Report

Use of Manually Covered Stent with Tegaderm in Vascular Perforations: Case Series Report

Alexandre Damiani Azmus et al. Antônio Carlo Klug Cogo Luis Manuel Rodriguez Oyuela João Vitor Slaviero … Andre Luiz Langer Manica Eduardo Mascarenhas Azevedo

Introduction

Coronary perforation during percutaneous coronary intervention (PCI) is a rare but potentially lethal complication, with an estimated incidence of 0.2% to 0.6% of angioplasties.

Risk factors include advanced age, previous coronary artery bypass graft (CABG) surgery, complex coronary artery disease, tortuosity, calcification, or the presence of chronic total occlusions. The Ellis classification remains widely used to define severity and guide management.

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ABC

Research Letter

Extraction of Totally Implantable Venous Access Devices Using the PISA Technique: A Small Case Series

Margarida G. Figueiredo et al. Hélder Santos Bruno Valente Mário Oliveira

Introduction

Technological progress has led to the widespread use of implantable medical devices across various conditions, significantly improving patient outcomes. In oncology, totally implantable central venous catheters (TICVCs) are commonly used to facilitate prolonged chemotherapy administration. The end of the therapy is the most common indication for removal. However, different complications associated with the use of these devices have been described, and some of them can justify their removal. Although historically performed by surgeons, removal of TICVC by interventional radiology has become much more frequent in recent decades. The removal of these devices can become technically challenging when significant fibrotic adhesion develops around the catheter tip or along its intravascular course.

The PISA technique, originally developed for extracting leads from cardiac implantable electronic devices, can be adapted for TICVC removal. It involves identification and exposure of the catheter’s proximal portion, followed by dissection to the vascular entry point. A polypropylene sheath is then advanced over the catheter using rotational motion and light traction to release adhesions and achieve complete extraction.

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ABCIC

Case Report

Aneurysm of the Suprahepatic Inferior Vena Cava: A Case Report

Gabriella Ghattas Mariano et al. Calina Araujo Thaines Gabrielle Silva Desani Letícia de Castro Gouvêa … Paulo Vítor Cabral Covilo Rogério de Paula Garcia Caravante

Introduction

Aneurysms of the inferior vena cava (IVC) are a rare occurrence in the cardiovascular system and can present with a variety of signs and symptoms. In many cases, patients remain asymptomatic, which makes diagnosis difficult. Venous aneurysms are defined as an abnormal and persistent dilation of a vein in a specific area, with a diameter at least twice that considered normal. An IVC aneurysm is a specific type of venous aneurysm. This case report is relevant because this condition is rare; by 2021, only around 70 cases had been described in literature.

Aneurysms may arise due to fragility in the vessel wall and can be triggered by various factors, including hypertension, trauma, infection, and genetic conditions. Smoking, atherosclerosis, and chronic obstructive pulmonary disease are also considered risk factors for aneurysm development. Although they can occur in different regions of the body, they most frequently affect the cerebral arteries, the aorta, and the peripheral arteries.

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Chatterjee Phenomenon: The Heart Remembers What the Mind Forgets

Miguel Vicente et al. Eric Monteiro Domingos Ramos Lino Gonçalves

Introduction

The Chatterjee phenomenon, also known as cardiac memory (CM), is defined as persistent changes in the T wave on the electrocardiogram after episodes of stimulated rhythms. These changes become evident when the normal pattern of ventricular activation is reestablished, which is often confused with pathological conditions such as myocarditis, hypertrophy, and ventricular pre-excitation, hydroelectrolytic disorders, and intracranial hypertension, where the most serious scenario is acute myocardial ischemia.^–

This nosological entity, observed in about one-third of patients with pacemakers and with a prevalence of around 80% in cases with a high percentage of ventricular stimulation, was first reported exactly 110 years ago by White, who described transient T wave inversion (TWI) after premature ventricular beats. Twenty-five years later, abnormal T waves of varying duration were described after periods of intermittent ventricular pre-excitation, post-ventricular tachycardia syndrome, and ventricular complexes augmented by sodium channel blocker toxicity.

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ABCIC

Case Report

Intramyocardial Cardiac Tumor: A Case Report

Luisa Latado et al. Fabio Figueiredo Costa Carlos Frederico Lopes Benevides Jorge Andion Torreão … Adna Keyne Lima Adelina Sanches de Melo Adriana Lopes Latado

Introduction

Primary cardiac tumors are rare entities, approximately 75% of which are benign, with myxoma as the most common type.^, Only about 15% of primary cardiac tumors are malignant, predominantly sarcomas. In contrast, metastatic cardiac involvement is relatively frequent and has been identified in up to 9% of patients who died from cancer.

Clinical manifestations are more closely related to tumor location than to histopathological classification. They may result from embolic phenomena, intracardiac obstruction with signs of heart failure (HF), valvular involvement, myocardial invasion with alterations in contractile function and electrical conduction, and pericardial involvement with the risk of effusion and cardiac tamponade, among other presentations.

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Case Report

Hypocalcemia and Reversible Cardiomyopathy Assessed by Magnetic Resonance Imaging

Bruno Lenzi et al. Gustavo Tortajada Victoria Rabaza Ernesto Cairoli Gabriel Parma

Introduction

Calcium is a fundamental component of biological systems and plays a key role in excitation-contraction coupling in cardiac myocytes. Calcium entry triggers a mechanism known as calcium-induced calcium release, in which calcium released from the sarcoplasmic reticulum is modulated by the influx of calcium from the extracellular space. Muscle contraction subsequently occurs through the interaction between calcium and the troponin-tropomyosin complex. In the heart, intracellular calcium is the primary regulator of contractile force (inotropism).

Hypocalcemia-induced cardiomyopathy is a rare condition with few reports in the scientific literature. We present a clinical case associated with hypoparathyroidism, one of the main causes of chronic hypocalcemia. This case report includes a novel element: the use of cardiac Magnetic Resonance Imaging (cMRI), which, to our knowledge, has not been previously described in the literature.

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IJCS

Case Report

Intermittent Left Bundle Branch Block and Cardiac Memory in a Patient with Dengue Fever: A Case Report and Literature Review

Muchtar Nora Ismail Siregar et al. Jasmine Ibtisamah Alkatiri

Abstract

Background:

Arrhythmias and Electrocardiography changes in Dengue Fever (DF) cases can mimic electrocardiogram (ECG) appearance of threatening clinical conditions such as myocardial ischemia, albeit no significant ischemic injury at the heart muscle.

Case Presentation:

We report a case of subsequent cardiac memory (CM) in a 50-year-old female with DF. A 12-lead ECG on admission revealed sinus rhythm with Left Bundle Branch Block (LBBB), and it resolved on day 4 of hospitalization. However, deep symmetric T wave inversions (TWI), which were later recognized as CM, occurred. The patient received treatment with Ringer’s lactate and paracetamol infusion. A routine 12-lead ECG performed on day 7 of hospitalization revealed the resolution of TWI and normal sinus rhythm.

Conclusion:

This case report highlights one intriguing phenomenon associated with LBBB in DF, which is CM TWI, where the T wave ‘remembers’ the direction of the QRS complex during prior abnormal ventricular activation. Due to its similarity with TWI caused by myocardial ischemia, understanding of this phenomenon may prevent unnecessary interventions.

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Case Report

Coronary Artery Dissection Following Pharmacologic Stress Echocardiography and the Follow-Up of Clinical Management: A Case Report

Thiago Artioli et al. Bruno Querido Marcondes Santos Denis Cárdenas Monteiro Layane Bonfante Batista … Matheus Zavaris Lorenzoni Hsu Gwo Jen Kelvyn Melo Vital Kelvin Henrique Vilalva

Introduction

Spontaneous coronary artery dissection (SCAD) remains a diagnostic and therapeutic challenge in the evaluation of chest pain. Misinterpretation of symptom characteristics and failure to consider the patient’s epidemiological profile may lead to inappropriate diagnostic workups and treatment strategies. The case described herein represents only the second report with similar characteristics published in major medical databases. This case underscores the importance of considering uncommon causes of chest pain and acute coronary syndrome (ACS), while also providing a brief review of relevant literature. The report was prepared in accordance with the CAse REport (CARE) guidelines.

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Idiopathic Multiple Coronary Artery Aneurysms

Alberto Vera et al. Virginia Álvarez

Case presentation

A 54-year-old patient with no previous medical history was evaluated in the cardiology clinic for chest pain with atypical characteristics. Due to a pretest probability of ischemic heart disease of 20%, a coronary computed tomography scan was performed, which showed a coronary aneurysm (10 × 11 mm) from the origin of the right coronary artery (RCA) to the mid-segment (, white arrow; ). In the RCA mid-segment, there was partial circumferential thrombosis with 50% lumen stenosis ( and ; , white asterisks). The rest of the RCA showed no coronary artery obstruction. A 9 × 9 mm aneurysm was also observed in the left main coronary artery extending to the bifurcation and proximal portion of the left anterior descending coronary artery, without significant lesions ( and , white arrows; ). A 5 × 6 mm aneurysm was also observed in the proximal left circumflex artery, without significant coronary lesions (, white arrow; ). The study was completed with a regadenoson stress cardiac magnetic resonance that was negative for inducible ischemia. Serologies and autoantibodies were also requested, and they were negative. The decision was made to initiate medical treatment with acetylsalicylic acid and atorvastatin. During the 6-month follow-up, the patient did not present coronary outcomes and remained asymptomatic.

A coronary artery aneurysm (CAA) is typically defined as a focal dilation of a coronary artery that exceeds 1.5 times the diameter of an adjacent normal segment, whereas coronary ectasia refers to a diffuse dilation involving at least 50% of the artery’s length. Giant coronary aneurysms, although rare, are classified as those measuring more than 20 mm in diameter. This distinction is clinically significant, as ectasia represents a more extensive and generalized involvement of the artery, whereas aneurysms are focal and may carry a different prognosis and management approach.

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IJCS

Case Report

A Rare and Fatal Association With SLE: Lutembacher Syndrome With Huge Atrial Septal Defect

Muhammed Fatih Kaleli et al. Yakup Alsancak Mustafa Celik Mehmet Akif Düzenli

Introduction

Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by periods of relapse and remission, with the potential to damage multiple organs depending on disease activity and individual susceptibility. Valvular heart disease is one of the cardiac manifestations associated with SLE. Lutembacher syndrome (LS) is an exceedingly rare clinical syndrome defined by the presence of a combination of congenital or acquired ostium secundum atrial septal defect (ASD) and congenital or acquired mitral stenosis (MS). First reported by Lutembacher in 1916, this syndrome is more frequently observed in young adults, with a higher prevalence among females. In this case report, we present the case of a young pregnant woman with SLE who visited the cardiology clinic complaining of palpitations. Eventually, she was diagnosed with LS.

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ABC

Research Letter

Survival in Patients with Brugada Phenocopy. Case Series

Luis Mariano De la Torre Fonseca et al. Robert Alarcón Cedeño Lileska Andreína Hernandez Bello Juan Díaz-Heredia … Diego Milton Pulla Quezada Rubén Andrés Guamán Castro Pablo Juan-Salvadores

Introduction

Brugada phenocopy (BP) refers to a situation in which the characteristic electrocardiographic patterns of Brugada syndrome (BS) are temporarily manifested, which are indistinguishable from the type 1 (coved) and 2 (saddleback) patterns of BS. Several additional criteria must be considered for an accurate diagnosis. These include the presence of an identifiable underlying cause, regression of the pattern once this cause is corrected, low pretest probability of BS, a negative result of a pharmacological induction test, and a negative genetic test.

Currently, the true mechanism that causes BP remains unknown. However, ST-segment elevation could be explained by the transmural gradient resulting from the loss of the action potential dome in the epicardium and not in the ventricular endocardium. This phenomenon originates from the transient increase in K outward currents (Ito) or the decrease in L-type Ca inward currents and peak Na currents in phase 1 of the action potential. Various reversible clinical conditions, such as disorders of the internal environment, mechanical compression, ischemia and pulmonary embolism, myocardial and pericardial diseases, among others, constitute its main etiologies.

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IJCS

Case Report

Six-Year Follow-Up of an Octogenarian With a Left Atrial Myxoma: Case Report

Miguel Bernardino Antunes Vicente et al. Tânia Amaro Elsa Fernandes

Abstract

Myxoma is the most common primary cardiac tumour, especially in adults. However, reports on this nosological entity in patients over the age of 80 are scarce in the medical literature. Echocardiography is a useful diagnostic tool for detecting cardiac myxomas. These tumours are usually surgically removed soon after diagnosis, limiting knowledge of their natural evolution. In this report, we describe the case of an 86-year-old woman who had been followed irregularly for arterial hypertension since 2016, when an echocardiogram showed a left atrial myxoma adhered to the interatrial septum, initially without impairment of the mitral valve (MV) or obstruction of the pulmonary veins (PV). The patient refused surgical removal at the time. Six years later, she was hospitalized for urinary sepsis. A new echocardiogram revealed an increase in the size of the myxoma, which occupied around 80% of the left atrium (LA), obstructing the PV and MV. New suggestion of surgery was refused by the patient.

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Case Report

A Challenging Case Of Pulmonary Arterial Hypertension: Never Judge By Appearances

Pedro Silvério António et al. Manuel Silvério António Catarina Lopes Resende Tatiana Guimarães … Daniel Cazeiro Yolanda Sá Pereira Fausto José Pinto Rui Plácido

Abstract

We report the case of a patient with symptomatic pulmonary hypertension (PH) associated with diffuse systemic sclerosis (SSc) whose initial assessment suggested a group 3 (clinical classification) PH. The patient had a history of drugs/toxins consumption, which contributed to the development of intrinsic pulmonary vascular disease. This changed the panorama towards the diagnosis of pulmonary arterial hypertension (PAH), with important therapeutic and prognostic implications. In fact, the excellent clinical, laboratory and hemodynamic response to therapy confirmed the hypothesis of a case of drug-associated PAH (DPAH) in a patient with diffuse SSc and lung disease. Considering the presence of DPAH, it was deemed necessary to assess acute vasoreactivity during right heart catheterization (RHC). If criteria were met, the clinical scenario may change towards a favorable and sustained clinical and hemodynamic response with oral calcium channel blockers. However, the response to inhaled nitric oxide was negative in our patient and the therapeutic strategy with dual oral combination therapy with tadalafil and ambrisentan was continued. After six-months of therapy the patient significantly improved, from a high to a low risk of one-year mortality.

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ABCIC

Case Report

Asymptomatic Pericardial Cyst: A Case Report and Brief Review of its Management

Matheus Rodrigues Barbosa et al. Henrique Turin Moreira Gustavo Jardim Volpe Danilo Tadao Wada … Minna Moreira Dias Romano Andre Schmidt

Discussion

Pericardial cyst is an uncommon clinical entity, with an estimated incidence of 1/100,000 to 1/10,000 autopsies. Its etiology is not yet completely understood, but it is believed to be due to an abnormal development of the pericardium during embryogenesis. It is necessary to differentiate the cyst from the pericardial diverticulum, which possibly have the same origin but, in the latter, there is communication with the pericardial cavity. Most cases are asymptomatic, even with large dimensions, and the lesion is often discovered incidentally during imaging exams or heart surgery. When symptomatic, the clinical presentation is variable and may include cardiorespiratory symptoms, such as chest pain, dyspnea, cough, sudden cardiac death or signs of cardiac tamponade.

The diagnosis of pericardial cyst is initially suspected by the incidental performance of a chest x-ray, which shows the mass attached to the cardiac silhouette. Doppler echocardiography, computed tomography and cardiac MRI allow the diagnosis to be confirmed, notably the last two. Chest x-ray may reveal a mediastinal mass or an area of increased density. Computed tomography (CT) scans and cardiac MRIs provide more detailed information about the location, size, and characteristics of the cyst. Transthoracic echocardiography can be useful in evaluating cardiac function and the presence of cyst-related complications, such as cardiac compression. Differential diagnosis should include neoplasms and, more rarely, migratory hydatid cysts, which may be single.

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ABCIC

Case Report

Takotsubo Syndrome After Percutaneous Mitral Valve Repair With Mitraclip®: A Case Report

Anna Luiza Souza et al. Maurício Lopes Prudente Débora Rodrigues Ana Cecília Campos Nogueira Giulliano Gardenghi

Introduction

Takotsubo syndrome (TTS), also known as stress cardiomyopathy or broken heart syndrome, is a condition whose pathophysiology is not well established, but which results from multiple factors that act synergistically in a setting of stress perception and cardiocirculatory response. It was first described in 1990, and the disproportionate and excessive increase in serum catecholamines is known to play a central role in its pathogenesis by favoring the occurrence of complications. Although rare, TTS deserves attention due to its inherent risk of decompensated heart function.^,

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ABCIC

Case Report

Acute Coronary Syndrome Followed by Pulmonary Thromboembolism and Identification of a Large Fixed Thrombus between Atria in a Patient with Severe COVID-19: A Case Report

Alice Mirane Malta Carrijo et al. Veronica Perius de Brito Gabriel Alvarenga Santos Samuel Gomes Tomaz da Silva João Lucas O’Connell

Introduction

Patent foramen ovale (PFO) is a relatively frequent congenital heart defect; however, the identification of large thrombi between the atria through a PFO is a rare condition. When visualized, they represent a major clinical challenge and require emergency treatment.

The severity of this condition becomes even more accentuated when associated with other thrombotic events, such as pulmonary embolism. In turn, these events may have their genesis in hyperinflammatory states with high thrombogenic and angiopathic potential, as in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

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