Asymptomatic Coarctation of the Aorta in Adults with Preserved Exercise Capacity.

We herein report a case of coarctation of the aorta (CoA) in an asymptomatic adult who had a preserved exercise capacity. A 56-year-old man with mild hypertension exhibited left ventricular hypertrophy on an electrocardiogram during an annual medical checkup. Echocardiography showed a bicuspid aortic valve and cor triatriatum sinister, and subsequent computed tomography revealed CoA with developed collaterals. Cardiopulmonary exercise testing showed a good exercise capacity. He refused surgical repair and has been asymptomatic for five years. This case is of special interest, as CoA is usually rarely noticed during adulthood if there are no severe congenital anomalies, and in addition, this patient had good exercise capacity.

Sudden and severe cardiotoxicity induced with pembrolizumab, its clinical course, therapeutic intervention, and outcome.

Immune checkpoint inhibitors (ICIs), including cytotoxic T-lymphocyte associated antigen-4 inhibitors, and inhibitors of programmed cell death 1 and its ligand, are widely used in the treatment of several malignant tumors. Immune-related adverse events occur in two-thirds of recipients. Among them, cardiotoxicities are very rare (about 1%), albeit fatal. Pembrolizumab-induced cardiotoxicity in a patient was successfully treated with high-dose corticosteroids, and his cardiac function was maintained by adrenergic drugs and intra-aortic balloon pumping in the intensive care unit for 1 week. Cardiotoxicity with ICIs is an oncologic emergency, and should be managed in a pluridisciplinary setting involving cardiologists.

Thrombosed sinus of Valsalva aneurysm masquer ading as a cardiac tumour: a case report.

BACKGROUND: An aortic sinus of Valsalva aneurysm (SVA) often remains undiagnosed until it ruptures. An SVA filled with thrombus can be challenging to diagnose accurately. CASE SUMMARY: A 70-year-old man was admitted with a clinical diagnosis of well-tolerated complete atrioventricular block (AVB). Transthoracic echocardiography revealed a spherical mass (43 × 49 mm) at the interatrial septum. Enhanced computed tomography (CT) showed a well-defined, hollow, and non-enhanced mass suggesting a cardiac tumour. However, 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) showed no uptake in the mass. After implantation of a permanent pacemaker, anticoagulant therapy was started for paroxysmal atrial fibrillation. Two months later, follow-up evaluation by echocardiography and enhanced CT revealed an increase in size of the hollow interior cavity, suggesting thrombolysis by the anticoagulant. We diagnosed a non-coronary SVA filled with thrombus, which masqueraded as a cardiac tumour and may have caused complete AVB. CONCLUSIONS: We describe a rare case of a giant thrombosed SVA masquerading as a cardiac tumour. Initial 18F-FDG PET/CT and serial imaging studies were helpful in distinguishing it from a cardiac tumour.

Clinical implications of antegrade diastolic pulmonary artery flow in adults.

BACKGROUND: End-diastolic opening of the pulmonary valve and subsequent antegrade diastolic pulmonary artery flow (ADPAF) reflect restrictive right ventricular (RV) physiology in children. However, this has attracted little attention in adults. PURPOSE: To clarify the clinical implications of ADPAF in adults. METHODS AND RESULTS: The study population consisted of 23,049 consecutive adult patients who underwent echocardiography in our hospital between 2008 and 2015. ADPAF was found in 17 patients (0.07%). The simultaneous recording of RV and pulmonary artery pressures revealed marked elevation of RV diastolic pressure, which exceeded pulmonary artery pressure at the time of atrial contraction. These results suggested that ADPAF implies RV restriction. Based on the level of tricuspid annular plane systolic excursion (TAPSE), we classified these patients into two groups: reduced RV function (R-RVF) group (12 patients with TAPSE <17 mm) and preserved RV function (P-RVF) group (5 patients with TAPSE ≥17 mm). In the R-RVF group, four patients died, one patient underwent left ventricular assist device implantation, and two patients underwent unplanned hospitalization for heart failure during follow-up. The R-RVF group had poorer prognosis and higher mortality rate compared with the P-RVF group. CONCLUSIONS: ADPAF reflects RV restriction in adults. ADPAF suggests a less favorable prognosis in patients with R-RVF.