Case Reports in Cardiology
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Open Access journal
ISSN (Print) 2090-6404 - ISSN (Online) 2090-6412
Published by Hindawi [333 journals]
- Aborted Sudden Cardiac Death in a Female Patient Presenting with
Takotsubo-Like Cardiomyopathy due to Epicardial Coronary Vasospasm
Abstract: Takotsubo cardiomyopathy is characterized by apical ballooning of the left ventricle (LV) in the absence of relevant coronary artery stenosis, which typically occurs in elderly women after emotional stress. Catecholamine cardiotoxicity, metabolic disturbance, and coronary microvascular impairment have previously been proposed as underlying pathophysiologic mechanisms of takotsubo cardiomyopathy, whereas myocardial stunning resulting from epicardial coronary artery vasospasm is not generally accepted as a cause of takotsubo cardiomyopathy. The prognosis of takotsubo cardiomyopathy is generally more favourable compared to myocardial infarction; however, severe complications such as rupture of the LV and life-threatening arrhythmias may occur. Herein, we describe a case of an 84-year-old female, who presented with aborted sudden cardiac death due to ventricular fibrillation. Echocardiography suggested LV apical ballooning with severely impaired LV-function, so that takotsubo cardiomyopathy was suspected. However, coronary angiography revealed epicardial spasm of the left anterior ascending, which resolved after intracoronary injection of 0.2 mg nitroglycerine. Cardiac magnetic resonance exhibited subendocardial late enhancement and echocardiography showed normalization of LV dysfunction during follow-up. The patient was put on conservative treatment with nitrates and calcium inhibitors and ICD implantation were deferred.
PubDate: Sun, 19 Mar 2017 10:19:32 +000
- Adult Onset Dysphagia: Right Sided Aortic Arch, Ductus Diverticulum, and
Retroesophageal Ligamentum Arteriosum Comprising an Obstructing Vascular
Abstract: A 49-year-old African American male patient with no past medical history was admitted because of 3 months of difficulty swallowing solid and liquid foods. He had constant retrosternal discomfort and appeared malnourished. The chest radiograph revealed a right sided aortic arch with tracheal deviation to the left. A swallow study confirmed a fixed esophageal narrowing at the level of T6. Contrast enhanced Computed Tomography (CT) angiogram of the chest and neck revealed a mirror image right aortic arch with a left sided cardiac apex and a prominent ductus diverticulum (measuring 1.7 × 1.8 cm). This structure extended posterior to and indented the mid esophagus. A left posterolateral thoracotomy was performed and the ductus diverticulum was resected. A retroesophageal ligamentum arteriosum was found during surgery and divided. This rare combination of congenital anatomical aberrations led to severe dysphagia in our patient. Successful surgical correction in the form of resection of the ductus diverticulum and division of the retroesophageal ligamentum arteriosum led to complete resolution of our patient’s symptoms.
PubDate: Wed, 15 Mar 2017 07:06:31 +000
- Ventricular Septal Dissection Complicating Inferior Wall Myocardial
Abstract: Postmyocardial infarction ventricular septal defect is an increasingly rare mechanical complication of acute myocardial infarction. We present a case of acute myocardial infarction from right coronary artery occlusion that developed hypotension and systolic murmur 12 hours after successful percutaneous coronary intervention. Although preoperative imaging suggested a large ventricular septal defect and a pseudoaneurysm, intraoperative findings concluded a serpiginous dissection of the ventricular septum. The imaging technicalities are discussed.
PubDate: Wed, 15 Mar 2017 06:59:54 +000
- Takotsubo Cardiomyopathy in a Patient with Undiscovered Sigmoid Colon
Abstract: Takotsubo cardiomyopathy (TTC) is a stress-related cardiomyopathy that is characterized by reversible left systolic dysfunction, which appears to be precipitated by sudden emotional or physical stress in the absence of myocardial infarction. Here we present a rare case that clinically presented with intermittent abdominal pain, initially impressed as non-ST elevation myocardial infarction and congestive heart failure but with a normal coronary angiogram. Her symptoms relieved spontaneously without returning. Sigmoid colon cancer was diagnosed via colonoscopy later due to persistent abdominal discomfort. In the absence of detectable emotional or physical stress factors, the newly diagnosed sigmoid colon cancer was the only possible trigger factor of TTC. We offer this case as a reminder that cancer should be considered in the differential diagnosis of patients presenting with the etiology of TTC.
PubDate: Thu, 09 Mar 2017 09:03:27 +000
- Premature Ventricular Complex Causing Ice-Pick Headache
Abstract: Ice pick headache is a momentary, transient, repetitive headache disorder and manifests with the stabbing pains and jolts. The exact mechanism causing this disease is unknown. Premature ventricular contractions are early depolarization of the ventricular myocardium and in the absence of a structural heart disease, it is considered to be a benign disease. In this report, we describe a male patient presenting with the symptom of momentary headache attacks accompanied with instant chest pain which is associated with premature ventricular contraction.
PubDate: Tue, 07 Mar 2017 08:16:10 +000
- FOLFOX Induced Takotsubo Cardiomyopathy Treated with Impella Assist Device
Abstract: Chemotherapy induced cardiotoxicity is becoming increasingly prevalent with several new agents being used recently. The incidence of Takotsubo cardiomyopathy due to 5-fluorouracil based chemotherapeutic regimens like FOLFOX is not uncommon. It is also seen with platinum based chemotherapy. Most of these patients have reversible cardiotoxicity and the cardiac function recovers within a short period with supportive treatment. Here we have a patient who presented with cardiogenic shock after 5 days of receiving FOLFOX regimen for colorectal adenocarcinoma. She was treated with a percutaneous left ventricular assist device, Impella CP, for hemodynamic support with excellent outcome.
PubDate: Tue, 07 Mar 2017 00:00:00 +000
- Transcatheter Aortic Valve Implantation in an Extremely Tortuous S-Shaped
Abstract: Transcatheter aortic valve implantation (TAVI) has emerged as an alternative technique to treating aortic stenosis in patients with high surgical risk. We present a case of a successful transfemoral TAVI in a high-risk patient with an extremely tortuous iliofemoral system and a significant S-type bend in the descending aorta. With careful preprocedure planning and using all the techniques available, TAVI can be performed in the most challenging patients.
PubDate: Thu, 02 Mar 2017 09:10:29 +000
- Conventional Coronary Angiography Induced Takotsubo Cardiomyopathy
Complicated with Cardiac Tamponade
Abstract: Takotsubo cardiomyopathy (TCM) is a transient left ventricular dysfunction that typically occurs after emotional or physical stress. TCM has a benign prognosis and serious complications are uncommon. However, though very rarely reported, cardiac tamponade has occurred on some occasions. We hereby report the case of a 70-year-old woman who underwent coronary angiography with an ergonovine provocation test to evaluate recurrent chest pain and was readmitted 7 days later presenting with TCM, followed by left ventricular outflow tract obstruction and cardiac tamponade.
PubDate: Wed, 01 Mar 2017 07:23:35 +000
- ACE Inhibitor-Induced Angioedema following Cervical Spine Surgery
Abstract: Angioedema is a well-known side effect of angiotensin converting enzyme inhibitors (ACEi). However, ACE inhibitors induced angioedema after cervical surgery is a rare condition. They result in increased levels of circulating bradykinins. Rare cases of angioedema following local trauma in patients using ACE inhibitors have been published. We present such a case. A 54-year-old Caucasian female with a history significant for hypertension, controlled with lisinopril, was admitted for routine cervical spine surgery. She has severe degenerative cervical disc disease and was admitted to the hospital for an elective cervical diskectomy. The patient failed weaning off the ventilator on multiple attempts postoperatively. There were no observed symptoms of an allergic reaction. A CT scan of the neck showed extensive soft tissue edema at the level of the arytenoids. Dexamethasone was given to reduce the edema without successful resolution. On review of her medications, it was found that the patient was resumed on lisinopril following the procedure. It was subsequently discontinued. By the following day the patient had a positive leak around the ET tube cuff and patient was successfully extubated.
PubDate: Tue, 28 Feb 2017 00:00:00 +000
- Myocardial Infarction after Endoscopic Removal of Foreign Body
Abstract: The development of cardiac complications during or after endoscopic procedures is rare. However, mortality from myocardial ischemia, particularly in the elderly population, is elevated. We illustrate the rare case of a 79-year-old man with multiple cardiovascular risk factors who developed a non-ST elevation myocardial infarction (NSTEMI) after endoscopic removal of a foreign body. This case report summarizes a rare complication of a low-risk procedure and highlights the importance of considering this potential adverse event, particularly in patients with significant cardiovascular risk factors, to promote early diagnosis and proper treatment.
PubDate: Sun, 26 Feb 2017 00:00:00 +000
- Hyperkalemia Induced Brugada Phenocopy: A Rare ECG Manifestation
Abstract: Brugada syndrome (BrS) is an inherited disorder of cardiac ion channels characterized by peculiar ECG findings predisposing individuals to ventricular arrhythmias, syncope, and sudden cardiac death (SCD). Various electrolyte disturbances and ion channels blocking drugs could also provoke BrS ECG findings without genetic BrS. Clinical differentiation and recognition are essential for guiding the legitimate action. Hyperkalemia is well known to cause a wide variety of ECG manifestations. Severe hyperkalemia can even cause life threatening ventricular arrhythmias and cardiac conduction abnormalities. Most common ECG findings include peaked tall T waves with short PR interval and wide QRS complex. Since it is very commonly encountered disorder, physicians need to be aware of even its rare ECG manifestations, which include ST segment elevation and Brugada pattern ECG (BrP). We are adding a case to the limited literature about hyperkalemia induced reversible Brugada pattern ECG changes.
PubDate: Thu, 23 Feb 2017 10:02:13 +000
- Singleton Merten Syndrome: A Rare Cause of Early Onset Aortic Stenosis
Abstract: Singleton Merten syndrome (SMS) is a rare autosomal dominant genetic disorder with variable expression. Its characteristic features include abnormal aortic calcification, abnormal ossification of extremities, and dental anomalies. We present a young man with dyspnea who was noted to have aortic stenosis in the background of glaucoma, psoriasis, dental anomalies, hand and foot deformities, Achilles tendinitis, osteopenia, and nephrolithiasis. The conglomeration of features led to the diagnosis of SMS. His mother had a very similar phenotype.
PubDate: Tue, 21 Feb 2017 00:00:00 +000
- Right Ventricular Compression Mimicking Brugada-Like Electrocardiogram in
a Patient with Recurrent Pectus Excavatum
Abstract: Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS).
PubDate: Mon, 20 Feb 2017 08:46:37 +000
- Aspergillus Pericarditis with Tamponade in a Renal Transplant Patient
Abstract: Aspergillus pericarditis is a rare and life-threatening infection in immunosuppressed patients. It has nonspecific clinical manifestations that often mimic other disease entities especially in patients who have extensive comorbidities. Diagnosis is oftentimes delayed and rarely done antemortem. A high degree of suspicion in immunocompromised patients is necessary for evaluation and timely diagnosis. This is a case of Aspergillus pericarditis with cardiac tamponade in a renal transplant patient with liver cirrhosis. Two months after transplant, he developed decompensation of his cirrhosis from hepatitis C, acute cellular rejection, and Kluyvera bacteremia, followed by vancomycin-resistant Enterococcus faecium (VRE) bacteremia. Four months after transplant, the patient presented with lethargy and fluid overload. He subsequently developed shock and ventilator-dependent respiratory failure. An echocardiogram showed pericardial effusion with cardiac tamponade. He had emergent pericardiocentesis that showed purulent drainage. He was started on broad-spectrum antibiotics. Amphotericin B was initiated when the pericardial fluid grew mold that was later identified as Aspergillus fumigatus. The patient quickly decompensated and expired.
PubDate: Mon, 20 Feb 2017 00:00:00 +000
- Augmenting Function for Infarction from Infection: Impella 2.5 for
Ischemic Cardiogenic Shock Complicating Sepsis
Abstract: Cardiac dysfunction is a common complication of sepsis in individuals with preexisting coronary disease and portends a poor prognosis when progressing to ischemic cardiogenic shock. In this setting, maximal medical therapy in isolation is often inadequate to maintain cardiac output for patients who are poor candidates for immediate revascularization. Furthermore, the use of vasopressors and inotropes increases myocardial demand and may lead to further injury. Percutaneous ventricular assist devices provide a viable option for management of severe shock with multiorgan failure. The Impella is one of several novel mechanical support systems that can effectively augment cardiac output while reducing myocardial demand and serve as a bridge to recovery from severe hemodynamic compromise. This case report describes the successful utilization of the Impella 2.5 in a patient with baseline profound anemia and coronary artery disease (CAD) presenting in combined distributive and cardiogenic shock associated with a type 2 myocardial infarction complicating sepsis.
PubDate: Sun, 05 Feb 2017 10:44:46 +000
- Type 1 Kounis Syndrome in Patient with Idiopathic Anaphylaxis
Abstract: Kounis syndrome represents the concurrence of acute coronary syndromes or anginal pain with allergic, hypersensitivity, and anaphylactic reactions. It can be associated with normal coronary angiogram or preexistent coronary pathology. Idiopathic anaphylaxis is defined as anaphylaxis without any identifiable precipitating agent or event. We present a case of male who experienced attacks of dyspnoea, hypoxemia, hypotension, purple-red skin, and chest pain over several years. He was diagnosed with idiopathic anaphylaxis. Based on the pattern of chest pain of ischemic origin during the attacks he was retrospectively diagnosed with Kounis syndrome.
PubDate: Tue, 31 Jan 2017 09:05:23 +000
- Ticagrelor Associated Heart Block: The Need for Close and Continued
Abstract: Ticagrelor is an antiplatelet agent prescribed to prevent the development of adverse cardiac events after acute coronary syndrome (ACS). According to the PLATO trial, ticagrelor is associated with ventricular pauses in the first week of treatment; however, these episodes were felt to be asymptomatic and nonfatal to the patient. We present a case of ticagrelor related second-degree type II heart block causing severe dizziness and diaphoresis that resolved after discontinuation of the medication.
PubDate: Thu, 26 Jan 2017 11:10:29 +000
- Saddle Pulmonary Embolism with Thrombus in Transit across a Patent Foramen
Abstract: This is the case of a 25-year-old obese man who presented with acute shortness of breath, chest pain, and palpitations. Of note, he lives a sedentary lifestyle and was recently hospitalized for incision and drainage of a left foot abscess. On presentation he was tachypnoeic, tachycardiac, and hypoxic but blood pressure was stable. Laboratory studies were significant for elevated D-dimer and mildly increased troponin. On further investigation he was found to have a saddle pulmonary embolism with massive clot burden. Echocardiogram revealed thrombus in transit and McConnell’s sign. He underwent surgical embolectomy and closure of a patent foramen ovale. This is a particularly rare case, especially in such a young patient. Because this is a rare diagnosis, with insufficient data, there is no formally established treatment guideline. However, in patients who are good surgical candidates, studies have shown better outcome with surgical embolectomy as compared to anticoagulation alone or thrombolysis.
PubDate: Thu, 26 Jan 2017 08:04:09 +000
- ST-Segment Elevation Myocardial Infarction and Normal Coronary Arteries
after Consuming Energy Drinks
Abstract: The use of energy drinks, which often contain stimulants, is common among young persons, yet there have been few reports of adverse cardiac events. We report the case of a 27-year-old man who was admitted to our facility with an acute ST-segment elevation myocardial infarction in the setting of using energy drinks. Angiography revealed no obstructive coronary disease. The patient had elevation of cardiac troponin. Noninvasive testing with echocardiography and cardiac magnetic resonance imaging demonstrated both abnormalities in resting wall motion at the anterior apex along with late gadolinium enhancement of the anterior wall, respectively. The patient also underwent formal invasive evaluation with an intracoronary Doppler study demonstrating normal coronary flow reserve and acetylcholine provocation that excluded endothelial dysfunction and microvascular disease. The patient recovered and has abstained from consuming additional energy drinks with no reoccurrence of symptoms. A review of some of the potential cardiac risks associated with consuming energy drinks is presented.
PubDate: Thu, 19 Jan 2017 10:47:52 +000
- Ventricular Tachycardia Originating from Moderator Band: New Perspective
on Catheter Ablation
Abstract: A 59-year-old woman was referred to the institution with burdens of idiopathic ventricular tachycardia (IVT). Electroanatomic mapping revealed a complex fractionated, high frequency potential with long duration preceding the QRS onset of the IVT. The real end point of ablation was the disappearance of the conduction block of Purkinje potential during the sinus rhythm besides the disappearance of the inducible tachycardia. Location of distal catheter was at the moderator band (MB) by transthoracic echocardiography (TTE). Only irrigated radiofrequency current was delivered at both insertions of the MB which can completely eliminate the IVT.
PubDate: Wed, 18 Jan 2017 00:00:00 +000
- Cardiac Calcified Amorphous Tumor of the Mitral Valve Presenting as
Transient Ischemic Attack
Abstract: Cardiac calcified amorphous tumors (CATs) are an extremely rare nonneoplastic intracardiac masses. They have been reported in the literature in only a few cases. Thus, the incidence, pathogenesis, and best approach to the treatment are not certain. We report a case of CATs on the atrial surface of the anterior mitral valve leaflet in a 37-year-old female who was diagnosed by histopathological examination after surgical removal.
PubDate: Tue, 17 Jan 2017 14:21:33 +000
- Coronary-Cameral Fistula Connecting the Left Anterior Descending Artery
and the First Obtuse Marginal Artery to the Left Ventricle: A Rare Finding
Abstract: Coronary-cameral fistulas are rare congenital malformations, often incidentally found during cardiac catheterizations. The majority of these fistulas are congenital in nature but can be acquired secondary to trauma or invasive cardiac procedures. These fistulas most commonly originate in the right coronary artery and terminate into the right ventricle and least frequently drain into the left ventricle. Depending upon their size and location, coronary-cameral fistulas can lead to congestive heart failure, myocardial infarction, and bacterial endocarditis. We describe a case of 49-year-old woman who presented with worsening exertional dyspnea and leg swelling. Transthoracic echocardiogram revealed an ejection fraction of 35%. Cardiac catheterization demonstrated a fistula connecting the left anterior descending artery and the first obtuse marginal artery to the left ventricle. In this report, the authors provide a concise review on coronary fistulas, complications, and management options.
PubDate: Tue, 17 Jan 2017 06:47:27 +000
- Could Externalized St. Jude Medical Riata® Lead Be a Culture Medium of a
Polymicrobial Endocarditis? A Clinical Case
Abstract: We report the case of a man affected by polymicrobial endocarditis developed on a St. Jude Medical Riata lead with a malfunction because of the outsourcing of conductors. The patient was treated with antibiotic targeted therapy and showed different bacteria at the blood cultures and then underwent transvenous leads extraction. Vegetations were highlighted on the caval, atrial, and ventricular tracts of the Riata lead, but the cultures were all negative. The externalization of Riata lead may cause the malfunction but it could also promote bacterial colonies and vegetations. In conclusion, looking for early signs of infection is mandatory during Riata leads follow-up checks.
PubDate: Sun, 15 Jan 2017 10:03:59 +000
- A Rare Case of Angina Pectoris with the Longest Ectopic Left Main Coronary
Artery Arising from Right Sinus of Valsalva and a Prepulmonic Course
Abstract: Knowledge of the morphoanatomical characteristics of the main trunk of the left coronary artery as well as its variations is cornerstone of hemodynamic, correct interpretation of coronary angiogram and for revascularization purpose. The left main coronary artery (LMCA) ranges from 3 to 6 mm in diameter and may be up to 10 to 15 mm in length in humans. We here report a case of the longest anomalous LMCA (56 mm) reported so far in a 35-year-old man with chronic stable angina arising from right sinus of valsalva as seen on conventional angiogram and multidetector computerized tomogram (MDCT).
PubDate: Sun, 15 Jan 2017 00:00:00 +000
- Undilatable Stent Neoatherosclerosis Treated with Ad Hoc Rotational
Abstract: A middle age woman with known ischemic heart disease and old stents in proximal left anterior descending coronary artery (LAD) was admitted to Coronary Care Unit with acute coronary syndrome. The coronary angiography showed one vessel disease with significant restenosis within the previously implanted stents. The lesion was tough and remained undilatable despite high pressure balloon inflation. Eventually, the balloon ruptured creating a massive dissection of the LAD beginning immediately after the distal part of the undilatable lesion. We proceeded with a challenging ad hoc rotational atherectomy of the lesion and finally stenting of the lesion. In-stent restenosis many years after stent implantation is considered to be mainly due to neoatheromatosis compared to intimal hyperplasia, making lesion treatment more difficult and unpredictable.
PubDate: Tue, 10 Jan 2017 10:16:38 +000
- QT Prolongation due to Graves’ Disease
Abstract: Hyperthyroidism is a highly prevalent disease affecting over 4 million people in the US. The disease is associated with many cardiac complications including atrial fibrillation and also less commonly with ventricular tachycardia and fibrillation. Many cardiac pathologies have been extensively studied; however, the relationship between hyperthyroidism and rate of ventricular repolarization manifesting as a prolonged QTc interval is not well known. Prolonged QTc interval regardless of thyroid status is a risk factor for cardiovascular mortality and life-threatening ventricular arrhythmia. The mechanism regarding the prolongation of the QT interval in a hyperthyroid patient has not been extensively investigated although its clinical implications are relevant. Herein, we describe a case of prolonged QTc in a patient who presented with signs of hyperthyroidism that was corrected with return to euthyroid status.
PubDate: Thu, 05 Jan 2017 06:46:14 +000
- Large Left Ventricular Thrombus in a Patient with Systemic and Venous
Thromboembolism Secondary to Protein C and S Deficiency
Abstract: 58-year-old Hispanic female presented with an altered mental status. A CT scan of the head demonstrated multiple scattered infarcts and a large right temporal lobe infarct. We also diagnosed the patient with right popliteal and femoral vein thrombosis, bilateral pulmonary embolism, and a transient right radial artery occlusion. Her 12-lead EKG showed lateral ST elevation. Emergent coronary angiogram revealed normal coronaries. Echocardiogram demonstrated a large mobile mass attached to the anterolateral free wall with overall normal contractility of the left ventricle. The patient underwent surgical embolectomy to prevent further systemic embolization. Coagulability workup returned positive for protein C and S deficiency. The patient did well after surgery. Following her surgery, we initiated chronic oral anticoagulation. The presentation with intracardiac thrombus in a normal heart should raise a concern of a probable thrombophilia.
PubDate: Wed, 04 Jan 2017 06:52:27 +000
- GuideLiner Balloon Assisted Tracking (GBAT): A New Addition to the
Abstract: The use of guide extension catheters, such as GuideLiner, allows for increased guide support and facilitates device delivery in tortuous vessels. In cases which the GuideLiner catheter cannot be advanced even with balloon anchoring technique, we inflate a noncompliant balloon protruding from the GuideLiner catheter at nominal pressure and both the GuideLiner and the balloon are advanced over the coronary guidewire through the tortuous segments. This technique can be applied to 5.5 Fr., 6 Fr., and 7 Fr. GuideLiner catheters. This technique is termed GuideLiner Balloon Assisted Tracking (GBAT).
PubDate: Wed, 28 Dec 2016 09:13:59 +000
- Successful Percutaneous Retrieval of Embolized Septal Occluder Device from
Aortic Arch and Placement of a Newer Septal Occluder Device in Combined
Abstract: Embolization of the Amplatzer Septal Occluder (ASO) device (St. Jude Medical, Minnesota) after percutaneous closure of atrial septal defect (ASD) is a rare and potentially catastrophic complication. Percutaneous retrieval of the embolized device is gaining ground as an acceptable method, although these patients are usually subsequently referred for open surgical closure of the ASD. We present a unique case of percutaneous retrieval embolized ASO device and placement of newer larger ASO device in a single procedure.
PubDate: Tue, 27 Dec 2016 08:13:32 +000
- Asymptomatic Pulmonary Vein Stenosis: Hemodynamic Adaptation and
Abstract: Pulmonary vein stenosis is a well-established possible complication following an atrial fibrillation ablation of pulmonary veins. Symptoms of pulmonary vein stenosis range from asymptomatic to severe exertional dyspnea. The number of asymptomatic patients with pulmonary vein stenosis is greater than originally estimated; moreover, only about 22% of severe pulmonary vein stenosis requires intervention. We present a patient with severe postatrial fibrillation (AF) ablation pulmonary vein (PV) stenosis, which was seen on multiple imaging modalities including cardiac computed tomography (CT) angiogram, lung perfusion scan, and pulmonary angiogram. This patient did not have any pulmonary symptoms. Hemodynamic changes within a stenosed pulmonary vein might not reflect the clinical severity of the obstruction if redistribution of pulmonary artery flow occurs. Our patient had an abnormal lung perfusion and ventilation (V/Q) scan, suggesting pulmonary artery blood flow redistribution. The patient ultimately underwent safe repeat atrial fibrillation ablation with successful elimination of arrhythmia.
PubDate: Sun, 25 Dec 2016 07:37:32 +000