European Heart Journal[JOURNAL]
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200 papers
Idiopathic isolated pulmonary artery aneurysm: a case report.
Abdulmajid L, Jans D, Smeyers K … +1 more , Dendale P
Eur Heart J Case Rep · 2026 Jun · PMID 42326038 · Full text
BACKGROUND: Pulmonary artery aneurysms (PAAs) are rare vascular anomalies, most commonly associated with pulmonary hypertension, congenital heart disease, vasculitis, or infection. Idiopathic PAAs, lacking an identifiabl...
BACKGROUND: Pulmonary artery aneurysms (PAAs) are rare vascular anomalies, most commonly associated with pulmonary hypertension, congenital heart disease, vasculitis, or infection. Idiopathic PAAs, lacking an identifiable underlying cause, are exceptionally rare and often discovered incidentally. This case illustrates the diagnostic approach and rationale for conservative management of idiopathic PAAs in the absence of high-risk features. CASE SUMMARY: We describe a 70-year-old female with a history of asthma, obstructive sleep apnoea, and transient ischaemic attack, in whom a PAA was incidentally discovered following imaging for respiratory complaints. Contrast-enhanced computed tomography (CT) revealed a fusiform aneurysm of the left lower lobe pulmonary artery, with a maximum axial diameter of 4.6 cm, located just distal to the origin of the lower lobe branch from which also the lingula artery arises. Retrospective comparison with a chest radiograph from 10 years earlier confirmed interval growth. There were no clinical or imaging features suggestive of pulmonary hypertension, congenital shunts, or significant valvular disease, nor any clinical or biochemical evidence of infection, connective tissue disease, or vasculitis. Multidisciplinary evaluation supported the diagnosis of an idiopathic and acquired pulmonary aneurysm. A conservative approach with follow-up CT imaging at 6 months, which demonstrated stability of aneurysm size and morphology, was chosen. DISCUSSION: This case underscores the importance of recognizing rare vascular anomalies in patients with non-specific respiratory symptoms. In the absence of an identifiable underlying pathology, an idiopathic cause should be considered. Conservative management may be appropriate in selected cases lacking high-risk features, though long-term outcomes remain uncertain.
Multimodality approach to the no-entry ventricle for VT ablation: first European experience of the RA-to-LV percutaneous access-a case report.
Sanaú J, García JR, Comín-Colet J … +2 more , Anguera I, Dallaglio PD
Eur Heart J Case Rep · 2026 Jun · PMID 42326037 · Full text
BACKGROUND: Catheter ablation of ventricular tachycardia (VT) in patients with both mechanical aortic and mitral valves remains challenging, as conventional retrograde or transseptal approaches are not feasible due to th...
BACKGROUND: Catheter ablation of ventricular tachycardia (VT) in patients with both mechanical aortic and mitral valves remains challenging, as conventional retrograde or transseptal approaches are not feasible due to the risk of damaging prostheses. Alternative strategies such as thoracotomy, epicardial access, or stereotactic radiotherapy may be unsuitable due to anatomical or technical constraints. The right atrium-to-left ventricle (RA-to-LV) puncture through the inferoseptal process has recently emerged as a potential solution, yet real-world experience remains limited. CASE SUMMARY: An 81-year-old man with rheumatic heart disease, double mechanical left-sided valve replacement, chronic kidney disease, and recurrent drug-refractory VT was referred for catheter ablation. Multimodal imaging using cardiac magnetic resonance and contrast-enhanced CT processed with ADAS3D software enabled identification of the arrhythmogenic substrate in the basal lateral LV and preprocedural planning of a safe puncture trajectory. Under general anaesthesia and uninterrupted anticoagulation, a percutaneous RA-to-LV puncture was performed with real-time guidance from electroanatomical mapping, CT-fluoroscopy integration, and intracardiac echocardiography. High-density mapping revealed a basal lateral scar with areas of conduction deceleration. Targeted ablation eliminated abnormal potentials and rendered VT non-inducible. A small restrictive iatrogenic Gerbode defect was observed without haemodynamic impact at 4-month follow-up echocardiogram. The patient recovered uneventfully and remained free of VT and ICD therapies at 5-month follow-up. DISCUSSION: This case suggests that RA-to-LV access is feasible and safe in a highly selected patient when thorough multimodal planning is undertaken. This report represents the first European experience and supports the potential role of this technique in patients with no-entry ventricle.
Rescue transcatheter tricuspid valve replacement with a 56-mm expandable prosthesis following edge-to-edge repair: a case report.
Teles RC, Presume MJO, Ribeiras R … +2 more , Gonçalves PA, de Sousa Almeida M
Eur Heart J Case Rep · 2026 Jun · PMID 42326036 · Full text
BACKGROUND: Tricuspid regurgitation (TR) is a challenging condition, particularly in advanced stages. Transcatheter therapies are emerging as viable alternatives for selected patients. CASE SUMMARY: We present an 85-year...
BACKGROUND: Tricuspid regurgitation (TR) is a challenging condition, particularly in advanced stages. Transcatheter therapies are emerging as viable alternatives for selected patients. CASE SUMMARY: We present an 85-year-old woman with longstanding right heart failure symptoms and torrential TR who underwent edge-to-edge repair (T-TEER), complicated by single leaflet partial device attachment (SLDA). Her condition deteriorated, with readmission for decompensated heart failure. Given persistent torrential TR, clinical deterioration, and unsuitable anatomy for further leaflet-based repair due to septal leaflet plastering, she underwent successful transcatheter tricuspid valve replacement (TTVR) with a newly available 56-mm prosthesis. The patient experienced symptomatic and haemodynamic improvement. DISCUSSION: This case highlights the limitations of leaflet-based repair in anatomically complex TR and supports TTVR as an effective alternative even in SLDA cases. The availability of newer, larger valve sizes expands its feasibility, reinforcing its role in patients previously considered unsuitable for intervention.
Complete transposition of the great arteries with borderline tricuspid valve: how small is too small? A case report.
Chao C, Xing P, Pan S … +1 more , Chen R
Eur Heart J Case Rep · 2026 Jun · PMID 42326035 · Full text
BACKGROUND: Previous studies have mostly focused on the maintenance of left ventricular function after corrective surgery for transposition of the great arteries (TGA), with limited research on the recovery of postoperat...
BACKGROUND: Previous studies have mostly focused on the maintenance of left ventricular function after corrective surgery for transposition of the great arteries (TGA), with limited research on the recovery of postoperative right ventricular dysfunction. CASE SUMMARY: In April 2025, our hospital admitted a neonate with complete transposition of the great arteries complicated with ventricular septal defect (TGA/VSD) and hypoplastic right ventricle (RV). The arterial switch operation (ASO) was performed on the eighth day after birth, followed by delayed sternal closure. The neonate developed refractory right ventricular dysfunction and was treated with inotropic agents, diuretics, anti-inflammatory agents, peritoneal dialysis support, inhaled nitric oxide, and thoracic drainage. The patient recovered successfully, and follow-up echocardiography at 6 months postoperatively showed normalization of right ventricular function. DISCUSSION: We conclude that for patients with TGA/VSD, preoperative evaluation should not only focus on left ventricular development but also fully emphasize the status of right ventricular development. A borderline RV is not an absolute contraindication to ASO, although it may complicate postoperative management and necessitates long-term close follow-up of right ventricular function.
Persistent sinus node dysfunction after biatrial heart transplantation successfully managed with CT-guided leadless atrial pacing: a case report.
Pittorru R, Regany-Closa M, Eulogio-Valenzuela F … +2 more , Castel MÁ, Tolosana JM
Eur Heart J Case Rep · 2026 Jun · PMID 42326034 · Full text
BACKGROUND: Sinus node dysfunction (SND) is a well-recognized complication after orthotopic heart transplantation (OHT), particularly in recipients of biatrial anastomosis. In this setting, conventional transvenous pacin...
BACKGROUND: Sinus node dysfunction (SND) is a well-recognized complication after orthotopic heart transplantation (OHT), particularly in recipients of biatrial anastomosis. In this setting, conventional transvenous pacing may be technically challenging due to complex post-surgical anatomy and increased infection risk. CASE SUMMARY: A 36-year-old woman with restrictive cardiomyopathy underwent successful biatrial OHT. Eleven months later, she presented with persistent junctional rhythm and exertional fatigue. Electrophysiological study confirmed electrical dissociation between the donor and recipient atria with preserved atrioventricular conduction but absent sinus activity. Considering her immunosuppressed status and challenging anatomy, a leadless atrial pacemaker (Aveir AR, Abbott) was implanted under three-dimensional computed tomography (CT)-fluoroscopy fusion guidance. The device was positioned at the base of the donor right atrial appendage, achieving optimal electrical parameters. The procedure was completed without complications, and at follow-up, the patient showed complete symptom resolution and improved chronotropic response. CONCLUSION: This case demonstrates the feasibility and safety of CT-fluoroscopy-guided leadless atrial pacing in a post-transplant recipient with persistent SND, highlighting the value of advanced imaging for accurate spatial orientation and device deployment in complex post-surgical anatomy.
Takayasu arteritis with a giant ascending aortic pseudoaneurysm followed by a postoperative anastomotic pseudoaneurysm: a life-saving case report.
Inoue S, Hayatsu Y, Sai Y … +2 more , Terao N, Hata M
Eur Heart J Case Rep · 2026 Jun · PMID 42326033 · Full text
BACKGROUND: Takayasu arteritis is a rare, chronic large-vessel vasculitis that predominantly affects young women, involving the aorta and its major branches. Pseudoaneurysm formation is uncommon in this disease, particul...
BACKGROUND: Takayasu arteritis is a rare, chronic large-vessel vasculitis that predominantly affects young women, involving the aorta and its major branches. Pseudoaneurysm formation is uncommon in this disease, particularly in the ascending aorta, with only a few such cases having been reported. CASE SUMMARY: A 20-year-old Asian man presented with fever, cough, and haemoptysis. Contrast-enhanced computed tomography revealed a giant ascending aortic pseudoaneurysm (57 mm in diameter) compressing the pulmonary artery. Emergency total arch replacement was performed because the patient was in a pre-shock state and the risk of imminent rupture was high. Histopathology confirmed a diagnosis of Takayasu arteritis. The patient was discharged on postoperative Day 13 but returned 6 days later with a persistent low-grade fever, fatigue, and back pain. Repeat imaging revealed an anastomotic pseudoaneurysm between the left common carotid artery and the branch of the prosthetic graft. Emergency endovascular repair was performed using a stent graft. Corticosteroid therapy was initiated the following day, and the patient was transferred to the rheumatology department on postoperative Day 15 following the second intervention. DISCUSSION: A giant pseudoaneurysm from Takayasu arteritis can cause pulmonary artery compression and acute haemodynamic compromise, requiring prompt surgical intervention. In such cases, adequate control of vascular inflammation may be important for reducing the risk of postoperative anastomotic complications. Endovascular stent grafting may serve as a viable treatment option for arch branch anastomotic pseudoaneurysms in the postoperative setting.
True lumen stenting guided by intravascular ultrasound-confirmed wire repositioning from the subintimal space following balloon inflation during intravascular lithotripsy-induced coronary dissection: a case report.
Tokuyama H
Eur Heart J Case Rep · 2026 Jun · PMID 42326032 · Full text
BACKGROUND: Intravascular lithotripsy (IVL) is an effective modality for modifying severely calcified coronary lesions; however, IVL-induced coronary dissection may occasionally lead to inadvertent guidewire migration in...
BACKGROUND: Intravascular lithotripsy (IVL) is an effective modality for modifying severely calcified coronary lesions; however, IVL-induced coronary dissection may occasionally lead to inadvertent guidewire migration into the subintimal space. In such complex scenarios, real-time intravascular ultrasound (IVUS) is essential for identifying wire position, understanding dynamic wire-vessel interactions, and guiding safe stent deployment. CASE SUMMARY: An 80-year-old woman with unstable angina underwent percutaneous coronary intervention for a severely calcified and tortuous left anterior descending artery. Intravascular lithotripsy was performed for calcium modification, but a longitudinal medial dissection flap developed, and the guidewire migrated into the subintimal space due to tortuosity-related wire bias. Multiple rewiring attempts using a double-lumen catheter and balloon support were unsuccessful. Real-time IVUS was used to evaluate the behaviour of a semi-compliant balloon positioned on the subintimal wire. Intravascular ultrasound demonstrated that balloon inflation redirected both the balloon and wire from the subintimal space into the true lumen, facilitated by anchoring of proximal and distal wire segments that remained within the true lumen. This confirmation enabled safe and accurate deployment of a drug-eluting stent in the true lumen. DISCUSSION: Even when a guidewire migrates into the subintimal space during IVL-induced coronary dissection, balloon inflation may dynamically shift the device towards the true lumen due to anchoring by wire segments located proximally and distally within unaffected vessel segments. Real-time IVUS is indispensable for visualizing this dynamic behaviour and confirming whether balloon or stent expansion occurs within the true lumen. This IVUS-guided strategy may be valuable when conventional rewiring techniques fail.
Cardiac metastasis from a Pancoast tumour presenting with ST-segment elevation and 2:1 atrioventricular block: a case report.
Fang QY, Somma V, Sparks PB
Eur Heart J Case Rep · 2026 Jun · PMID 42326031 · Full text
BACKGROUND: Cardiac metastases are significantly more common than primary cardiac tumours. Their clinical presentation varies depending on tumour size, location, and degree of myocardial or pericardial infiltration. Comm...
BACKGROUND: Cardiac metastases are significantly more common than primary cardiac tumours. Their clinical presentation varies depending on tumour size, location, and degree of myocardial or pericardial infiltration. Common manifestations include pericardial effusion, valvular dysfunction due to inflow or outflow obstruction, and conduction disturbances. 2:1 atrioventricular (AV) block secondary to cardiac metastases is rare. CASE SUMMARY: We report a case of a 69-year-old man with a Pancoast tumour who presented with hyperacute ST-segment elevation and 2:1 AV block. Transthoracic echocardiography (TTE) and positron emission tomography (PET) revealed intracardiac metastases. A permanent dual-chamber pacemaker was implanted for symptomatic 2:1 AV block. The patient died from advanced malignancy shortly after device implantation. DISCUSSION: This case highlights 2:1 AV block as an uncommon manifestation of cardiac metastases. Multimodality imaging, particularly TTE, cardiac magnetic resonance imaging, and cardiac PET, plays a pivotal role in timely diagnosis. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. Decisions regarding permanent pacing should be shared between the patient and clinicians, incorporating balance between clinical indications, patient's comorbidities, prognosis, and preferences.
A diagnostic pitfall of CT calcium scoring in paradoxical low-flow, low-gradient severe aortic stenosis with rheumatic morphology: a case report.
Yoshida J, Okuyama T, Yamamoto H … +2 more , Taga U, Tokuda M
Eur Heart J Case Rep · 2026 Jun · PMID 42326030 · Full text
BACKGROUND: Computed tomography (CT) calcium scoring is used to adjudicate paradoxical low-flow, low-gradient (LFLG) severe aortic stenosis (AS). However, its reliability may be limited in rheumatic disease. CASE SUMMARY...
BACKGROUND: Computed tomography (CT) calcium scoring is used to adjudicate paradoxical low-flow, low-gradient (LFLG) severe aortic stenosis (AS). However, its reliability may be limited in rheumatic disease. CASE SUMMARY: An 82-year-old woman with prior mitral valve replacement for rheumatic mitral stenosis was referred for AS. Transthoracic echocardiography revealed an aortic valve area (AVA) of 0.50 cm, mean pressure gradient of 27 mmHg, stroke volume index of 30 mL/m, and preserved systolic function, suggesting paradoxical LFLG severe AS. The CT calcium score was 889 Agatston units, below the female threshold for severe AS. Three-dimensional transoesophageal echocardiography (TEE) demonstrated commissural fusion, leaflet tip thickening, and planimetry-derived AVA of 0.69 cm, confirming severe AS. The patient underwent transcatheter aortic valve implantation, with 6-min walk distance improving from 150 to 254 m. DISCUSSION: In rheumatic morphology, low CT calcium burden may not exclude severe AS because obstruction may be driven by commissural fusion and fibrosis rather than bulky calcification. Three-dimensional TEE planimetry can serve as an anatomy-based adjudicator when echocardiographic and CT calcium findings are discordant.
Cerebral air embolism after implantation of a leadless pacemaker via the right internal jugular vein: a case report.
Ollitrault P, Al Khoury M, Champ-Rigot L … +2 more , Font J, Pellissier A
Eur Heart J Case Rep · 2026 Jun · PMID 42326029 · Full text
BACKGROUND: Leadless pacemaker (LP) implantation is associated with fewer device-related complications than conventional transvenous pacing systems. While traditionally performed via the femoral vein, the right internal...
BACKGROUND: Leadless pacemaker (LP) implantation is associated with fewer device-related complications than conventional transvenous pacing systems. While traditionally performed via the femoral vein, the right internal jugular (RIJ) approach has recently emerged as an alternative strategy, potentially improving catheter control. However, safety data for this approach remain limited. CASE SUMMARY: A 77-year-old man with precapillary pulmonary hypertension, diabetes mellitus, and recurrent traumatic syncope underwent LP implantation via the RIJ vein following documentation of infra-Hissian conduction delay (HV interval 80 ms). The procedure was uneventful, with satisfactory electrical parameters. Immediately after repositioning the patient in a 30° head-up position, he developed acute neurological deterioration (Glasgow Coma Scale 6/15). Transthoracic echocardiography (TTE) excluded pericardial effusion but revealed air bubbles in the right ventricle. Cerebral computed tomography demonstrated multiple air bubbles within the right intracerebral venous system, consistent with retrograde cerebral venous air embolism. Emergency management included Trendelenburg positioning, 100% oxygen administration, and hyperbaric oxygen therapy. Neurological status improved, although a persistent left-sided motor deficit remained. At 15-month follow-up, no further syncope occurred, and the LP functioned normally, but residual left limbs hypokinesia persisted. DISCUSSION: This case illustrates a rare but severe complication of RIJ LP implantation. Large-bore sheath use, low venous pressure in the jugular system, relative dehydration, severe pulmonary vascular disease, and early head-up positioning likely contributed to retrograde cerebral venous air migration. Strict preventive measures-including meticulous system flushing, adequate hydration, maintenance of slight Trendelenburg positioning, and post-procedural echocardiographic screening-may help mitigate this risk.
Stent-free strategy for STEMI in a retroaortic anomalous left circumflex artery: addressing elliptical vessel geometry and perioperative bleeding risk: a case report.
Kuroda S, Tsukiyama Y, Matsuo K … +2 more , Yoshida C, Takaya T
Eur Heart J Case Rep · 2026 Jun · PMID 42326028 · Full text
BACKGROUND: An anomalous left circumflex artery (LCx) arising from the right coronary sinus typically follows a retroaortic course and is considered benign regarding sudden cardiac death. However, it remains susceptible...
BACKGROUND: An anomalous left circumflex artery (LCx) arising from the right coronary sinus typically follows a retroaortic course and is considered benign regarding sudden cardiac death. However, it remains susceptible to atherosclerosis, where its unique vessel geometry may significantly influence percutaneous coronary intervention (PCI) strategies. CASE SUMMARY: A 70-year-old man with multiple risk factors and sub-obstructive rectal cancer awaiting surgery presented with inferior ST-segment elevation myocardial infarction (STEMI). Coronary angiography showed the absence of the LCx from the left coronary artery and no significant right coronary artery (RCA) stenosis. Intravascular ultrasound (IVUS) of the left main trunk confirmed the absence of a left-sided LCx ostium. Subsequent engagement of the right coronary sinus revealed a separate ostium caudad to the RCA, consistent with a retroaortic LCx. IVUS of the culprit lesion demonstrated a lipid-rich plaque with persistent elliptical vessel morphology. Following optimal lesion preparation, a drug-coated balloon (DCB) was deployed to address the atypical geometry and facilitate semi-emergent surgery. Laparoscopic rectal resection was successfully performed 6 weeks post-PCI. Six-month Computed tomography coronary angiography confirmed sustained patency, and the patient remained event-free over a 2-year follow-up. DISCUSSION: Retroaortic anomalous LCx can mimic RCA occlusion in STEMI. In such cases, persistent non-circular vessel geometry may favour a stent-free, geometry-guided strategy as a rational individualized option, especially when early surgery is required.
Acute heart failure physiology reversed by endoscopic removal of retained toothbrushes in gastro-cardiac (Roemheld) syndrome: a case report.
Jurin I, Poljak TBD, Bulum A … +1 more , Paštrović F
Eur Heart J Case Rep · 2026 Jun · PMID 42326027 · Full text
BACKGROUND: Roemheld (gastro-cardiac) syndrome describes cardiac symptoms precipitated by gastrointestinal pathology, typically gastric distension or hiatal hernia. Foreign body ingestion is common, but retention of long...
BACKGROUND: Roemheld (gastro-cardiac) syndrome describes cardiac symptoms precipitated by gastrointestinal pathology, typically gastric distension or hiatal hernia. Foreign body ingestion is common, but retention of long objects such as toothbrushes is rare and usually requires endoscopic removal. We present an unusual case of acute heart failure with restrictive filling pattern and markedly elevated NT-proBNP, in which cardiac symptoms resolved after extraction of two retained toothbrushes from the stomach. CASE SUMMARY: A 44-year-old woman was admitted for progressive dyspnoea, 6-kg weight gain, and NT-proBNP of 853 pg/mL. Echocardiography revealed restrictive diastolic dysfunction. After IV furosemide, diuresis reached 4 L in the first 24 h. Cardiac magnetic resonance showed preserved ejection fraction and no structural abnormalities; however, two foreign bodies were incidentally visualized within the stomach. Gastroscopy was performed and two toothbrushes were removed. Total diuresis reached 12 L and NT-proBNP decreased to 58 pg/mL by Day 3. Psychiatry evaluation excluded psychosis or self-harm intent; the patient denied ingestion. She reported wearing complete dentures due to early onset periodontitis at age 33. Symptoms resolved completely after extraction. CONCLUSION: This case supports that gastric retention of foreign bodies may trigger or exacerbate heart failure via gastric distension, vagal stimulation, and impaired venous return-a form of Roemheld gastro-cardiac syndrome.
Case reports of a double threat: when cancer and hidden congenital heart defects collide: malignant tamponade unveils a hidden pulmonary venous anomaly.
Rodriguez AP, Vicenty-Rivera SI
Eur Heart J Case Rep · 2026 Jun · PMID 42326026 · Full text
BACKGROUND: Malignant pericardial effusion is a life-threatening manifestation of advanced non-small-cell lung cancer (NSCLC). Cardiac tamponade as an initial presentation is uncommon, and coexistent pathologies can comp...
BACKGROUND: Malignant pericardial effusion is a life-threatening manifestation of advanced non-small-cell lung cancer (NSCLC). Cardiac tamponade as an initial presentation is uncommon, and coexistent pathologies can complicate diagnosis and management. CASE SUMMARY: A 72-year-old man with mild chronic obstructive pulmonary disease (COPD) and a remote 2-pack-year smoking history was admitted with COVID-19 infection and possible superimposed pneumonia. Initial imaging revealed pericardial inflammation and a small effusion, raising concern for pericarditis. Subsequent echocardiography demonstrated a large pericardial effusion with tamponade physiology requiring pericardiocentesis, while cardiac magnetic resonance and computed tomography suggested possible malignancy. Cytology from pericardial and pleural fluid confirmed adenocarcinoma and bronchoscopy established stage IV epidermal growth factor-mutant NSCLC with cerebellar metastases. The patient experienced recurrent malignant effusions, managed successfully with balloon pericardiotomy and was treated with Osimertinib, resulting in sustained remission of effusions and clinical recovery. Careful review of multimodality imaging also revealed partial anomalous pulmonary venous return with significant left-to-right shunting, which may have exerted a protective hemodynamic effect on tamponade physiology. This may suggest a potential, though speculative, contribution of the anomalous pulmonary venous return to the observed tamponade physiology. At 2-year follow-up, the patient remains clinically and hemodynamically stable. DISCUSSION: This case illustrates the interesting duality of how multiple concurrent pathologies-including COVID-19 pneumonia, pericarditis, malignant pleuro-pericardial effusions, metastatic lung adenocarcinoma, and PAPVR-can coexist and probably shape the clinical course. The case underscores the indispensable role of multimodality imaging, molecular profiling, and minimally invasive pericardial interventions in guiding diagnosis, therapy, and prognosis in complex cardio-oncology presentations.
Fulminant prosthetic valve endocarditis after transcatheter aortic valve implantation caused by non-typeable with central nervous system involvement: a case report.
Bando R, Yagi S, Kadota M … +2 more , Ise T, Sata M
Eur Heart J Case Rep · 2026 Jun · PMID 42326025 · Full text
BACKGROUND: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an uncommon but life-threatening complication, often associated with diagnostic challenges. (GBS) is increasingly recognize...
BACKGROUND: Infective endocarditis (IE) after transcatheter aortic valve implantation (TAVI) is an uncommon but life-threatening complication, often associated with diagnostic challenges. (GBS) is increasingly recognized as a cause of invasive infection in older adults and may exhibit a rapidly progressive clinical course with central nervous system involvement. CASE SUMMARY: An 85-year-old woman with a history of TAVI presented with acute-onset fever and was diagnosed with GBS bacteraemia. Initial transthoracic echocardiography (TTE) showed no vegetations. On hospital Day 3, she developed delirium and neck stiffness suggestive of meningitis, with intracranial haemorrhage on computed tomography. Repeat TTE demonstrated newly developed vegetations on the prosthetic aortic valve and anterior mitral leaflet, with worsening mitral regurgitation, leading to a diagnosis of IE. The causative organism was identified as non-typeable GBS. Despite intensive antimicrobial therapy, her condition rapidly deteriorated with shock and multiorgan failure, and she died on hospital Day 7. DISCUSSION: This case highlights the fulminant nature of invasive GBS infection in elderly patients, particularly when associated with prosthetic valve IE after TAVI. Notably, this case was characterized by multivalvular involvement and possible central nervous system involvement. These features may reflect a severe disease phenotype driven by highly invasive bacteraemia and structural vulnerability related to the transcatheter valve system. Initial echocardiographic findings may be inconclusive, necessitating repeated evaluation. In addition to embolic complications, central nervous system involvement should be considered in cases of neurological deterioration. Early recognition is critical; however, prognosis remains poor once severe complications develop.
Native-valve endocarditis complicated by destructive pseudoaneurysm of the mitral-aortic intervalvular fibrosa: a case report and review of the literature.
Ohev Shalom R, Avedikian S, Dev V
Eur Heart J Case Rep · 2026 Jun · PMID 42326024 · Full text
BACKGROUND: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) represents a rare but severe complication of infective endocarditis, classically associated with highly virulent organisms such as . , a coagu...
BACKGROUND: Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF) represents a rare but severe complication of infective endocarditis, classically associated with highly virulent organisms such as . , a coagulase-negative staphylococcus traditionally considered a low-virulence commensal, is increasingly recognized as a cause of clinically significant native-valve endocarditis. CASE SUMMARY: We report a 72-year-old man with native bicuspid aortic valve who presented with syncope and was found to have bacteraemia. Transthoracic echocardiography demonstrated an aortic valve mass, but transoesophageal echocardiography (TEE) revealed extensive periannular destruction including MAIVF pseudoaneurysm, posterior aortic annular abscess, and a large mitral valve vegetation with associated thrombus. Neuroimaging confirmed multiple embolic cerebral infarcts. Despite aggressive medical therapy, the patient's clinical trajectory precluded surgical intervention, and he ultimately transitioned to comfort-focused care. CONCLUSION: To our knowledge, this represents one of the first reported cases of native-valve endocarditis complicated by destructive MAIVF involvement in the absence of prosthetic material. This case underscores the underappreciated pathogenic potential of coagulase-negative staphylococci and highlights the critical role of TEE in detecting periannular complications that may be missed on transthoracic imaging.
Case report: diaphragmatic hernia after epicardial catheter ablation.
Anfinsen OG, Fink TS, Øye A … +2 more , Johansen RB, Fasting MH
Eur Heart J Case Rep · 2026 Jun · PMID 42326023 · Full text
BACKGROUND: Catheter ablation from the epicardial space is increasingly utilized to treat ventricular tachycardias (VTs). We report a rare complication. CASE SUMMARY: A 67-year-old male with dilated cardiomyopathy and fr...
BACKGROUND: Catheter ablation from the epicardial space is increasingly utilized to treat ventricular tachycardias (VTs). We report a rare complication. CASE SUMMARY: A 67-year-old male with dilated cardiomyopathy and frequent, exercise-induced VTs had been ablated once with endocardial and twice with epicardial access. Six weeks after the last procedure, he was hospitalized with abdominal and back pain due to an iatrogenic diaphragmatic hernia with displacement of the stomach and spleen into the left thoracic cavity. Following an acute exacerbation with cardiac arrest and splenic bleeding, he underwent successful surgery with splenectomy, reposition of the stomach, and direct suture of the diaphragmatic hernia. DISCUSSION: This is a rare complication, but notable for its delayed clinical manifestation several weeks after the procedure and necessitates urgent surgical treatment.
Machine learning for prediction of key haemodynamic parameters in pulmonary arterial hypertension.
Kramer T, Weis H, Kramer M … +3 more , Baldus S, Rosenkranz S, Spinler S
Eur Heart J Digit Health · 2026 Jun · PMID 42325947 · Full text
AIMS: Machine learning (ML) is increasingly recognized for its ability to identify and structure variables for predictive tasks. Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated me...
AIMS: Machine learning (ML) is increasingly recognized for its ability to identify and structure variables for predictive tasks. Pulmonary arterial hypertension (PAH) is a progressive disease characterized by elevated mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR) with normal pulmonary arterial wedge pressure (PAWP), as assessed by right heart catheterization (RHC). Despite increased awareness, delays between onset of non-specific symptoms and diagnosis continue to hinder early initiation of targeted therapies, leading to poorer outcomes. To develop and evaluate ML models for predicting key haemodynamic parameters in PAH, based on routinely available non-invasive data collected within 8 weeks prior to RHC, as a proof of concept. METHODS AND RESULTS: We analysed data from 181 patients with invasively confirmed PAH, incorporating 56 variables, including demographics, echocardiography, blood gas analyses, 6-min walk distances, laboratory tests, and WHO functional class. An 80/20 train-test split and fivefold cross-validation were applied across multiple ML models, including least absolute shrinkage and selection operator (lasso) regression, ridge regression, k-nearest neighbours, decision trees, random forest, and gradient boosting machine. Lasso achieved best performance for predicting mPAP ( = 0.80, ² = 0.64, RMSE = 8.49). For PVR, ridge performed best ( = 0.71, ² = 0.51, RMSE = 3.60). Random forest and gradient boosting machines achieved modest but consistent performance for cardiac index ( = 0.38 and 0.37), while PAWP prediction remained limited across all models. CONCLUSION: Machine learning models can estimate mPAP and PVR from routine clinical data obtained prior to RHC in patients with confirmed PAH. External validation is required to confirm generalizability and clinical applicability.
ECG-GPT: considerations for advancing toward clinical implementation.
Yu Z, Qin F
Eur Heart J Digit Health · 2026 Jun · PMID 42325946 · Full text
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Intra-coronary imaging and transcriptomics of calcified nodules before and after intensive lipid-lowering therapy: a YELLOW III substudy.
Revaiah PC, Vengrenyuk Y, Liu J … +15 more , Yasumura K, Santosh VK, Karki M, Bansal I, Hooda A, Sweeny JK, Khera S, Kapur V, Krishnan P, Moreno PR, Mehran R, Zhou X, Narula J, Sharma SK, Kini AS
Eur Heart J Imaging Methods Pract · 2026 Jan · PMID 42325865 · Full text
AIMS: Calcified nodules (CNs) contribute to 3-5% of acute coronary syndromes (ACS). Identifying peri-calcific lipid-rich areas is challenging with conventional imaging but feasible using near-infrared spectroscopy (NIRS)...
AIMS: Calcified nodules (CNs) contribute to 3-5% of acute coronary syndromes (ACS). Identifying peri-calcific lipid-rich areas is challenging with conventional imaging but feasible using near-infrared spectroscopy (NIRS). This YELLOW III substudy investigated the impact of maximal lipid-lowering on CN morphology and lipid content over 26 weeks. METHODS AND RESULTS: Patients with stable CAD and lipid-rich, non-obstructive plaques (lipid arc >90°, FCT <120 µm on OCT) received Evolocumab (140 mg biweekly) plus maximally tolerated statins. Lesions were evaluated at baseline and 26 weeks using combined NIRS-IVUS and OCT. Exploratory endpoints were the maximum 4 mm lipid core burden index (LCBI) in segments containing CNs (maxLCBI) and morphological changes in CN. Linear mixed-effects models were used to evaluate temporal changes and group interactions. Peripheral blood mononuclear cell (PBMC) transcriptomics were analysed. Among 110 patients, 43 (39.1%) had CNs. A total of 73 paired CNs were analysed for morphology, of which 65 CNs were ≥4 mm. CNs with lipid signal (CN) demonstrated a significant reduction in maxLCBI from 176.8 to 113.3 ( = -63.51 ± 17.63; < 0.001), whereas no change was observed in dense CNs ( = 0.317). Morphological parameters remained largely unchanged in both groups. A modest increase in the surrounding calcium arc was observed in CN ( = 0.018), while depth showed a differential change between groups ( = 0.012). Transcriptomic analysis demonstrated baseline enrichment of neutrophil degranulation pathways in CN patients, which diminished at follow-up. CONCLUSION: Intensive lipid-lowering significantly reduces peri-calcific lipid burden without measurable short-term changes in CN morphology. The clinical implications of LCBI reduction in CNs warrant further investigation. SUMMARY: Calcified nodules (CNs) are high-risk coronary features responsible for a significant portion of acute coronary syndromes, yet their response to intensive medical therapy remains poorly understood. This YELLOW III substudy utilized multi-modality intravascular imaging (NIRS-IVUS and OCT) to investigate the impact of 26 weeks of Evolocumab and maximally tolerated statins on CN morphology. In 43 patients with identified CNs, intensive lipid-lowering therapy led to a significant reduction in the maxLCBI. Morphological parameters of CNs remained largely unchanged except for a modest increase in the surrounding calcium arc. Simultaneously, PBMC transcriptomic analysis revealed a marked attenuation of the neutrophil degranulation pathway, which was highly enriched at baseline. While the therapy successfully reduced the systemic inflammatory profile, a transition towards coagulation-related pathways at follow-up suggests a shift in the residual risk profile. These findings provide a novel mechanistic basis for using PCSK9 inhibitors to stabilize calcium-related high-risk plaques. Collectively, the data demonstrate that aggressive lipid-lowering not only modifies plaque architecture but also shifts the systemic biological environment from an inflammatory to a more stable one.
Wideband black- and bright-blood late gadolinium enhancement imaging in patients with implantable cardiac devices at 1.5 T for improved visualization and localization of myocardial injury.
Gut P, Cochet H, Caluori G … +9 more , Vlachos K, Antiochos P, Durand B, Masi A, Schwitter J, Sacher F, Jaïs P, Stuber M, Bustin A
Eur Heart J Imaging Methods Pract · 2026 Jan · PMID 42325864 · Full text
AIMS: Late gadolinium enhancement (LGE) imaging in patients with implantable cardiac devices is often degraded by device-related artefacts. Wideband phase-sensitive inversion recovery (PSIR) mitigates these artefacts but...
AIMS: Late gadolinium enhancement (LGE) imaging in patients with implantable cardiac devices is often degraded by device-related artefacts. Wideband phase-sensitive inversion recovery (PSIR) mitigates these artefacts but suffers from low scar-blood contrast, limiting detection of subendocardial and small focal scars. Therefore, a novel wideband SPOT (Scar-specific imaging with Preserved myOcardial visualizaTion) sequence combining co-registered wideband black- and bright-blood LGE to improve scar-blood contrast and localization, with wideband inversion recovery and wideband T2 preparation for artefact reduction, was implemented at 1.5 T. METHODS AND RESULTS: Wideband SPOT was compared with wideband PSIR, conventional PSIR, and conventional SPOT in an animal and 18 patients with devices and known myocardial lesions. Patient analyses included qualitative assessment of image quality, artefact severity, diagnostic confidence, and LGE segment detection; quantitative measurements of left ventricular (LV) volume, scar volume, and scar size; agreement analysis between wideband SPOT and wideband PSIR; and reproducibility analysis. In the animal, wideband SPOT reduced device-related artefacts and enabled accurate scar localization consistent with histology. In patients, wideband SPOT and wideband PSIR yielded similar image and artefact reduction ( > 0.05), but wideband SPOT reduced diagnostic uncertainty by 24% ( = 0.080). Inter-observer agreement for qualitative scores was moderate to good [intra-class correlation coefficient (ICC) 0.54-0.83, < 0.001]. Quantitative LV and scar measurements demonstrated excellent correlation (r > 0.9, < 0.01) and good-to-excellent reproducibility (ICC 0.85-0.98, < 0.001) between techniques. CONCLUSION: Compared with wideband PSIR, wideband SPOT showed a trend towards enhanced scar detection, identifying additional scarred segments while maintaining similar overall scar burden. It also improved inter-observer agreement, preserved anatomical reference, and reduced device artefacts, which may improve diagnostic confidence and risk stratification.
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