We are presenting a case of severe dilated cardiomyopathy (DCM) post-mRNA-based coronavirus disease-2019 (COVID-19) vaccine (Pfizer-BioNTech) in a young healthy man. After the second dose of the vaccine, his health rapidly declined, and he developed severe DCM with reduced ejection fraction. Investigations for other causes of DCM were unremarkable. Severe DCM following COVID-19 vaccine injection is a rare but serious condition. It also highlights the importance of close follow-up of pericarditis and perimyocarditis cases post-COVID-19 vaccine and we recommend clinicians have a low threshold for using echocardiography for early diagnosis and management.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Rheumatic heart disease and its impact on cardiac health is still a concern in developing countries. Percutaneous trans-mitral commissurotomy (PTMC) is the standard of care in managing severe rheumatic mitral stenosis (MS). This article reports a single-center, 10-year real-world experience in Qatar. Methods: In this retrospective study, we reviewed all the patients who underwent PTMC in Qatar between January 1, 2012, and January 1, 2022. Periprocedural data were collected at baseline, postprocedural, 1 year, and during the last follow-up. The primary outcome was procedural success (improvement in valve area by 50%, final valve area >1.5 cm², and freedom from > moderate mitral regurgitation, stroke, or pericardial effusion). Safety endpoints were freedom from death, periprocedural cardiogenic shock and cardiac arrest, stroke urgent mitral valve replacement (MVR), or pericardiocentesis. Long-term outcomes included the requirement of redo PTMC or MVR, in addition to rehospitalization due to arrhythmias, heart failure, or stroke. Results: Sixty-five patients were included in the review (age 42 ± 10, female 38 [58.5%]). Sixty-two patients (95.4%) had a successful procedure. One patient developed a hemorrhagic pericardial tamponade and cardiogenic shock, for which he underwent pericardiocentesis and emergency aortic root repair. One patient developed acute stroke 8 h after the procedure, and one patient had tamponade resolved with emergency pericardiocentesis. Two patients required MVR after 1 and 4 years, respectively. Conclusion: PTMC is the mainstay of rheumatic MS management in patients with suitable anatomy as most patients have excellent outcomes with long-term freedom from surgery, which has been the case in our single-center experience.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Coronary artery bypass grafting is the standard of care for patients with obstructive left main (LM) coronary disease. In poor surgical candidates, high-risk percutaneous coronary artery intervention (PCI) is an alternative. Methods: We investigated a retrospective cohort of patients who underwent LM PCI from January 2010 to March 2014 (n = 89). Obstructive LM disease was defined as 50% angiographic obstruction of luminal flow, and the primary endpoint was inhospital mortality. Ventricular assist device (VAD) was defined as the use of either intra-aortic balloon pump (IABP) or Impella 2.5 devices before, during, or following PCI. Results: A total of 89 patients with LM PCI were divided into those with (n = 39) and without (n = 50) VAD support. The former group was further divided into those with support from either Impella 2.5 (n = 28) or IABP (n = 11). Age, race, and gender did not differ between patients who received unassisted LM-PCI from those with VAD support (P = 0.142, 1.0, and 0.776, respectively). The angiographic stenosis of atherosclerotic lesions in LM, proximal left anterior descending artery, and other native/surgical coronary vessels was similar between the groups. The duration of hospitalization was significantly longer for patients with VAD support compared to those without (7.19 ± 6.89 vs. 2.78 ± 3.39, P < 0.001). The incidence of cardiogenic shock and inhospital mortality was significantly higher in the VAD group (P = 0.009 and 0.001, respectively). Overall, inhospital mortality was 9% (8/89). The IABP and Impella 2.5 groups had mortality proportions of 46% (5/11) and 11% (3/28), respectively; P = 0.028. For all patients, inhospital mortality was higher for those with versus without cardiogenic shock (56% or 5/9 vs. 4% or 3/80; P < 0.001), and for those with versus without left ventricular systolic function <40% (17% vs. 2%;P < 0.025). Conclusion: In a selected group of patients with LM disease, unsupported PCI appears to be a feasible and safe procedure. In high-risk patients, the use of Impella 2.5 appears to be superior to IABP in LM PCI resulting in favorable short-term outcomes.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial ischemia. SCAD complicated by coronary artery aneurysm (CAA) is rare and seldom reported. Coronary angiography is the gold standard for the diagnosis of SCAD. However, an obscure intimal flap may not be recognized with a conventional coronary angiogram, and intravascular imaging modalities are important in the diagnosis of SCAD. Optical coherence tomography contributes to providing information about the size, shape, and location of CAAs. Herein, we are presenting a challenging and unique case of a woman presenting with SCAD complicated by a CAA.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Introduction: Primary percutaneous coronary intervention (PPCI) represents a timely procedure that requires speedy revascularization. Moreover, PPCI in diffuse coronary lesions remains to be challenging even in the hands of experienced operators as the use of a long stent may increase the difficulty of the procedure in terms of stent delivery, deployment, and optimization. However, the practicability and clinical outcomes of deployment of a 60-mm-long stent in the setting of PPCI remain to be determined. Methods: The study is a retrospective observational analysis in a prospective cohort. The prospectively gathered data of consecutive patients from June 2016 to December 2019, who underwent PPCI with BioMime sirolimus-eluting stents 2.5–3.0/60 mm or 3.0–3.5/60 mm were analyzed at 1 year regarding the primary outcome of major adverse cardiovascular and cerebrovascular events (MACCE) and target lesion revascularization (TLR). Results: A total of 88 cases were included in the study; 23 cases underwent PPCI, whereas 65 underwent nonPPCI. The PPCI group had a mean age of 65.7 ± 10.9 years compared with 63.3 ± 9.6 years (P = 0.34) in the nonPPCI group. Eighty-three percentage of PPCI were males compared with 94% of their nonPPCI counterparts (P = 0.20). In addition, the prevalence of hypertension was more common in the PPCI group (87% vs. 63%, P = 0.03). There was no statistically significant difference between the two groups regarding other comorbidities. The most common culprit vessel was the left anterior descending artery (57%) in the PPCI group and the right coronary artery (58%) in the nonPPCI. The use of a stent with a diameter of 2.5–3.0 mm was more common in both groups (61% in PPCI vs. 66% in nonPPCI, P = 0.8). MACCE occurred in four patients during a year of follow-up. One occurred in the PPCI group (4%) compared with three in the nonPPCI group (5%) (P = 1.00). TLR was required in two cases, one in each group (4% vs. 2%, P = 0.46). Conclusion: The use of a 60-mm-long stent in the setting of PPCI has an excellent 12-month outcome in procedural success, MACCE, and TLR. Large randomized studies are required to confirm these results.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aim: The purpose of this study is to assess the effect of the COVID-19 pandemic on the volume of ST-elevation myocardial infarction (STEMI) patients and also to assess changes in patient characteristics, door-in-to-door-out (DIDO) time, door-to-balloon time (D2B) time, and STEMI outcomes during the pandemic. Methods: Patient data were retrieved retrospectively from the electronic medical record system of King Hamad University Hospital and Mohammed Bin Khalifa Cardiac Centre in the Kingdom of Bahrain. Data were compared and analyzed for the two time periods: before the pandemic (January 2019–March 2020) and during the pandemic (April 2020June 2021). Results: There was a decline of 11.1% in patients who presented with STEMI during the pandemic. There were no major differences between the patient demographics and the baseline characteristics during the two study periods. Recommended DIDO time and D2B time could be achieved only for 7.1% and 35.7% of all STEMI cases during the pandemic. However, no significant differences were noted in the 30 days of mortality, reinfarction, cardiogenic shock, hospital length of stay, and return to the hospital within 30 days for the STEMI patients in the two time periods. Conclusions: There was a decline in patients who presented with STEMI during the pandemic. This was also associated with a lower number of STEMI cases achieving the recommended DIDO time and D2B time as compared to the prepandemic period. However, there was no significant difference in the patient outcomes in the two time periods.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Wolff–Parkinson–White (WPW) is a rare congenital arrhythmia that could result in peripartum cardiomyopathy. This condition could be managed by medical treatments or ablation treatments. In this report, we presented a 14-year-old pregnant girl with initial signs of syncope and palpitation, who was later diagnosed with WPW-induced peripartum cardiomyopathy. The baby was successfully delivered at 32 weeks gestational age, and the patient received a beta-blocker as the main treatment strategy. We recommend that a proper cardiology and gynecology care is critical in providing the best prognosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Heart failure (HF) prognosticates a death sentence, and despite recent advances in treatment, long-term outcomes for patients with advanced HF are very poor, with only a 50%–60% survival rate at 5 years. This is alarming for the approximately 26 million people worldwide living with HF. Aims and Objectives: This study aimed to investigate the relationship between HF and the risk of recurrent cardiovascular disease (CVD) events or CVD death among the national population in the United Arab Emirates (UAE). Materials and Methods: A retrospective study was conducted from April 2008 to September 2019 including 240 patients ≥18 years with a previous vascular event. Patient outcomes such as CVD death, the occurrence of a recurrent vascular event, or until the end of the study period, whichever occurred first. Results: Twenty-three patients (9.6%) had a concomitant diagnosis of HF and this doubled the risk of recurrent CVD events or death over 9 years. HF, age, lower body mass index, and atrial fibrillation were significant predictors of recurrent CVD or mortality. The mean age was 65 years and the risk of a CVD event or death increased at a rate of 3% for every increasing year of age. Patients with HF have approximately a 65% likelihood of survival at 5 years, whereas those without HF have about an 85% at 5-year survival. Conclusion: HF is a strong predictor of recurrent CVD events or mortality in UAE patients with established CVD. Thus, aggressive management of modifiable risk factors for vascular disease through multidisciplinary teams guides clinicians toward meticulous control of CVD risk factors to improve disease prognosis and premature death.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

In-stent restenosis (ISR) has always been considered a conundrum for interventional cardiologists. Despite many technical advances in the past 20 years aimed at reducing its occurrence, this area of interventional cardiology remains challenging. Here, we present a novel use of intravascular lithotripsy therapy (IVL) in a patient with repeat ISR, in whom IVL treatment has provided excellent procedural and follow-up results. Here, we present a 79-year-old man with previous ISR to a left circumflex artery (LCX) stent presenting with angina. An elective coronary angiogram confirmed recurrent ISR in the LCX. This was treated by IVL, which provided an excellent procedural result. The patient made an uneventful recovery and was discharged the same day with a follow-up 90 days postprocedure, at which point they were asymptomatic from angina. IVL is a relatively simple technique to modify ISR with a short learning curve. This case presentation highlights a novel use of IVL in a subclass of patients that remains challenging for the interventional cardiology community.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

During the current pandemic, acute coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provokes overwhelming inflammatory response leading to a wide range of clinical presentations including, a rare multisystem inflammatory syndrome and cardiac injury. Not only during the acute phase of the disease but a delayed immunologic response to SARS-CoV-2 infection among people with hyperinflammatory illness several weeks postacute phase of the infection is recently recognized. We report a young adult male who presented with acute myocarditis and heart failure associated with laboratory evidence of hyperinflammatory syndrome 5 weeks after a full recovery from COVID-19 infection. We believe that health-care providers need to be aware and recognize this syndrome as a rare sequela of COVID-19 infection.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Mitral transcatheter edge-to-edge repair (MTEER) is the first transcatheter technique for mitral valve repair (MVR) in patients with severe mitral regurgitation (MR) who are considered at high risk for surgical intervention. Mitral valve prolapse with subsequent MR is a common manifestation of Marfan syndrome. MTEER has never been reported as a treatment option in such kind of patients. We describe the case of a 30-year-old patient who was known to have Marfan syndrome which was complicated with severe symptomatic MR. The surgical risk was high, and he preferred transcatheter intervention. MTEER was complicated with an immediate single-leaflet detachment of the first deployed MitraClip XTR. Bail-out edge-to-edge MVR with two additional MitraClip XTR was performed successfully to stabilize the detached clip. The patient's symptoms and quality of life improved significantly after 10 months of follow-up.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Myocardial invasion by a neoplasm is a rare occurrence that can present identical signs and symptoms of acute coronary artery disease. We report a case of a 53-year-old man diagnosed with squamous cell lung carcinoma who presented with chest pain and ST-segment elevation on an electrocardiogram. He underwent emergent coronary angiography, which ruled out coronary artery obstruction. An echocardiogram followed by magnetic resonance imaging of the heart confirmed metastatic lung mass in the left ventricular wall. The direct compression of a metastatic tumor on a myocardial wall could lead to ST-segment elevation mimicking acute coronary syndrome. Clinicians should consider metastatic myocardial tumor as a possible cause of ST-segment elevation in patients with nonobstructive coronary arteries and lung carcinoma to prevent misdiagnosis and resultant delayed treatment.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]