The Use of Systematic Clinical Approach in Diagnosing Rare Cases of Secondary Hypertension: A Case Report of Mid Aortic Syndrome in a Young Patient.

Mid aortic syndrome (MAS) is a rare disease that occurs in children and young adults. The most important clinical feature reflecting vascular involvement is the presence of systemic hypertension. The diagnosis is usually made during the imaging assessment of secondary hypertension when routine echocardiography fails to identify the characteristic morphological or Doppler flow patterns associated with thoracic arch coarctation in the presence of the clinical features of aortic vascular obstruction. In this report, we present a case of a 22-year-old male who presented with systemic hypertension not responding to medical treatment, and whose systematic diagnostic workup revealed the diagnosis of MAS involving both renal arteries.

The Grave Consequences of Late Presentation and Management of Rare Double Left Ventricle Chamber With Cardiomyopathy.

A double­chambered left ventricle is a rare congenital anomaly. We present the case of a 26-year-old man with such anomaly who presented with congestive heart failure. After this diagnosis was confirmed with echocardiography, surgical removal of the anomalous band and replacement of the regurgitant deformed mitral valve were performed. Postoperatively, the patient deteriorated, and no corrective response was associated with surgery. Herein we discuss what we have learned from this rare case and how it may apply to the management of similar cases in the future.

Acute Myocardial Ischemia Secondary to Embolization of Left Atrial Myxoma to Coronary Artery.

Cardiac myxoma is the most common primary cardiac tumor. Rarely it can present with systemic or coronary embolization due to fragmentation of the tumor mass. We present a case of a young male who presented with an acute myocardial ischemia secondary to embolization of a left atrial myxoma originating from the left atrium. The patient underwent successful emergency surgical management of both the myxoma and the occlusion of the coronary artery. In this scenario, the surgery is the only effective treatment. The case also highlights the significance of performing emergency echocardiography in the setting of acute myocardial ischemia to look for possible associated pathology which can inform management plan.

Combined Myocardial Bridge and Coronary Vessel Disease Requiring Coronary Artery Bypass Grafting and Myotomy of the Myocardial Bridge.

Myocardial bridging (MB) describes a band of myocardium that covers the epicardial surface of the coronary artery. This band can vary both in thickness and distance to which it covers the artery. It is broadly classified as superficial or deep, depending on the thickness of the covering muscle layer. It can be asymptomatic, or it could present with different complications. Reported complications have included ischemia and acute coronary syndromes, coronary spasm, ventricular septal rupture, and arrhythmias. MB is most commonly found in the middle segment of the left anterior descending (LAD) coronary artery. There is controversy with regard to therapy for symptomatic patients who are refractory to medical management. Percutaneous coronary intervention and surgical myotomy (unroofing) have been proposed; yet, each one has its pros and cons. MB can be associated with the development of atherosclerosis proximal to the MB segment in the involved coronary artery, and patients can present having both pathologies. We present a case series of six patients with atherosclerotic coronary lesions requiring coronary artery bypass grafting (CABG) with an accidental perioperative finding of MB, which required myotomy.