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A Bosnian woman at 20 weeks’ gestation presented with dyspnea and hypoxia. She was diagnosed with Eisenmenger physiology with severe pulmonary hypertension, ventricular septal defect, and patent ductus arteriosus. Given high maternal mortality, coordination of care with a multidisciplinary team approach may allow for best possible outcomes. (Level of Difficulty: Intermediate.), Graphical abstract, A Bosnian woman at 20 weeks’ gestation presented with dyspnea and hypoxia. She was diagnosed with Eisenmenger physiology with severe pulmonary…

A 55-year-old man underwent exercise stress echocardiography for evaluation of left inferior pulmonary vein stenosis. During exercise, ultrasound B-lines developed in the left lung only. Unilateral pulmonary congestion did not lead to forward or backward failure. The patient was followed up conservatively. (Level of Difficulty: Beginner.), Central Illustration

A large left ventricular pseudoaneurysm was discovered in a patient who presented with bacterial endophthalmitis 1 year after medically treated Staphylococcus aureus mitral valve endocarditis. After medical therapy, the patient underwent cardiac surgery uneventfully. We present a rare finding of a pseudoaneurysm complicated with a very late ocular septic event. (Level of Difficulty: Advanced.), Central Illustration

A pregnant woman presented at term with a fetus with foramen ovale restriction. We illustrate the contrast between fetal and postnatal echocardiography of this rare entity. (Level of Difficulty: Advanced.), Central Illustration

A 79-year-old woman was treated with a 23-mm balloon-expandable transcatheter heart valve (THV) that was initially complicated by an embolized THV requiring deployment in the descending aorta. She presented 13-years later with a degenerated bioprosthesis requiring redo THV. Pre-procedural computed tomography was important in highlighting underexpansion of the initial THV and open leaflets in the embolized valve. (Level of Difficulty: Advanced.), Central Illustration

Left ventricular pseudoaneurysm is a potentially life-threatening complication of acute myocardial infarction. Timely diagnosis is crucial to improve the patient’s prognosis. We describe a multimodality diagnostic approach with emphasis on cardiac magnetic resonance imaging for a left ventricular pseudoaneurysm found surreptitiously in 72-year-old man 2 weeks following an acute myocardial infarction. (Level of Difficulty: Beginner.), Graphical abstract

We describe a case of testicular teratoma with metastasis to the right ventricle. The mass nearly completely resolved with chemotherapy, obviating the need for upfront surgery. We review the workup of intracardiac metastatic tumors. (Level of Difficulty: Intermediate.), Graphical abstract

We present herein the case of a delayed covered coronary wall rupture occurring as a rare complication of rotational atherectomy performed in the subintimal space after antegrade dissection reentry for percutaneous recanalization of a long and heavily calcified left anterior descending chronic total occlusion, which was successfully managed percutaneously with the implantation of 2 covered stents. (Level of Difficulty: Intermediate.), Graphical abstract

Percutaneous coronary intervention (PCI) in patients with chronic kidney disease is associated with a high-risk of contrast-induced nephropathy. We describe a case of ultra-low contrast PCI guided using optical coherence tomography using normal saline for clearance complicated by distal wire perforation treated with embolization. (Level of Difficulty: Intermediate.), Graphical abstract

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction (ACS). We report a case of acute coronary syndrome due to SCAD of the right coronary artery. Diagnosis was based on clinical presentation and coronary angiography, and confirmed by optical coherence tomography which guided our treatment strategy. (Level of Difficulty: Beginner.), Graphical abstract

We report a rare case of crown fracture and detachment from a coronary orbital atherectomy system. During orbital atherectomy in an angulated and calcified coronary vessel, the crown was completely detached and left distal to the stenosis. It was successfully retrieved using a gooseneck snare and a guide-extension catheter. (Level of Difficulty: Advanced.), Graphical abstract

This paper presents the case of a 67-year-old female with primum atrial septal defect and congenital mitral cleft status-post surgical repair 40 years previously who was recently found to have severe mitral regurgitation. Percutaneous mitral valve repair was successfully performed using implantation of 2 MitraClips with mild residual mitral regurgitation. (Level of Difficulty: Advanced.), Graphical abstract

A man with a presumed diagnosis of hypertrophic cardiomyopathy presented after a ventricular fibrillation arrest. Review of prior cardiac magnetic resonance imaging revealed a pattern of late gadolinium enhancement that was atypical for hypertrophic cardiomyopathy and most consistent with cardiac sarcoidosis, with diagnosis confirmed by endomyocardial biopsy. (Level of Difficulty: Beginner.), Graphical abstract

Bicuspid pulmonary valve is a rare echocardiographic finding, particularly if not associated with other congenital heart diseases. We report the incidental case of a severe giant pulmonary arterial aneurysm associated to bicuspid pulmonary valve in an asymptomatic 79-year-old patient. Multimodality cardiac imaging was important for the correct diagnosis and to exclude any other potential complication. (Level of Difficulty: Beginner.), Graphical abstract, Bicuspid pulmonary valve is a rare echocardiographic finding, particularly if not associated with other congenital heart diseases. We report the…

We report a case of sudden-onset pulmonary edema due to failure of a bioprosthetic mitral valve. Gross inspection revealed a leaflet tear at a stent post without calcification or pannus formation and no evidence of sutures. This case highlights the mechanical failure of a bioprosthetic mitral valve associated with missing sutures. (Level of Difficulty: Intermediate.), Graphical abstract, We report a case of sudden-onset pulmonary edema due to failure of a bioprosthetic mitral valve. Gross inspection revealed a leaflet tear at a stent…

Extensive pericardial calcification is rare in patients with chronic constrictive pericarditis (CCP). We report the case of a young man who had CCP with “eggshell” calcification of the pericardium and the classic features of CCP on echocardiography and cardiac catheterization. The patient had an uneventful recovery following surgical pericardiectomy. (Level of Difficulty: Intermediate.), Graphical abstract, Extensive pericardial calcification is rare in patients with chronic constrictive pericarditis (CCP). We report the case of a young man who had CCP with…

One of the dreaded complications of left ventricular assist device implantation is mechanical obstruction of the device secondary to pump thrombosis or mechanical outflow cannula obstruction. We describe a case of outflow cannula obstruction caused by kinking and twisting of the outflow graft after surgical manipulation of the pump. (Level of Difficulty: Beginner.), Graphical abstract, One of the dreaded complications of left ventricular assist device implantation is mechanical obstruction of the device resulting from pump thrombosis…

Using 3-dimensional speckle-tracking echocardiography-derived activation imaging system, we visualized interventricular dyssynchrony in a repaired tetralogy of Fallot case with pacing-induced left ventricular dysfunction. The activation imaging system visualized interventricular dyssynchrony and resynchronization after cardiac resynchronization therapy and may be useful to assess electromechanical disturbance in complicated congenital heart diseases. (Level of Difficulty: Intermediate.), Graphical abstract, Using 3-dimensional speckle-tracking echocardiography-derived activation imaging system, we visualized interventricular dyssynchrony in a repaired…

A 70-year-old man with severe tricuspid regurgitation and large coaptation gap (0.8 cm) was referred to transfemoral valve repair using the PASCAL system. The procedure was successful in reducing tricuspid regurgitation. The PASCAL device facilitated maximum leaflet insertion and to span large coaptation gap in severe tricuspid regurgitation without ventilation maneuvers under general anesthesia. (Level of Difficulty: Intermediate.), Graphical abstract, A 70-year-old man with severe tricuspid regurgitation and large coaptation gap (0.8 cm) was referred to transfemoral valve repair using the PASCAL…

We describe the management and clinical decision making in a cardiogenic shock patient with a free-floating left ventricular thrombus found during temporary mechanical support with an Impella CP. The management of these patients can be challenging because there are no guidelines or data to support any particular treatment strategy. (Level of Difficulty: Intermediate.), Graphical abstract, We describe the management and clinical decision making in a cardiogenic shock patient with a free-floating left ventricular thrombus found during temporary…

In patients with acute myocardial injury secondary to coronavirus disease-2019 (COVID-19), cardiovascular magnetic resonance imaging can identify the underlying pathology. We highlight a case of acute myocardial injury secondary to COVID-19, which demonstrated both epicardial vessel thrombosis and the recently described phenomenon of microvascular thrombosis. (Level of Difficulty: Advanced.), Central Illustration

A 3-dimensional printed model derived from a computed tomography dataset was obtained in a patient with tetralogy of Fallot and major aortopulmonary collaterals. The virtual and solid 3-dimensional heart models provided intuitive representation of such complex and highly individual pathologies and allowed comprehensive spatial conceptualization of the cardiac structures. (Level of Difficulty: Advanced.), Graphical abstract, A 3-dimensional printed model derived from a computed tomography dataset was obtained in a patient with tetralogy of Fallot and major aortopulmonary…

A female patient presented with severe, symptomatic aortic stenosis after distant surgical aortic valve replacement and subsequent transcatheter aortic valve implantation 6 years prior. A 23-mm CoreValve Evolut (Medtronic, Dublin, Ireland) was implanted with excellent symptomatic and hemodynamic results. (Level of Difficulty: Advanced.), Graphical abstract, A female patient presented with severe, symptomatic aortic stenosis after distant surgical aortic valve replacement and subsequent transcatheter…

Delayed perforation of the coronary artery and extraluminal migration of coronary stent is a rare phenomenon. We report a case in which the stent was documented to perforate the coronary artery at least 1 year after the intervention and migrated within the pericardium without any symptom. (Level of Difficulty: Intermediate.), Central Illustration

A 68-year-old man with a biventricular implantable cardioverter-defibrillator who was pacemaker dependent was admitted for percutaneous coronary intervention. The patient had an asystolic cardiac arrest as a result of electromagnetic interference during an orbital atherectomy. We should keep electromagnetic interference from the machine in mind when performing orbital atherectomy. (Level of Difficulty: Beginner.), Graphical abstract

Thrombus embolization is a rare consequence of ultrasonographic examination of the vessels of the lower limbs. We present a case of a 77-year-old woman with lung cancer who developed pulmonary embolism originating from the right femoral deep vein thrombus during the compression maneuver of the ultrasonographic examination of the lower limbs. (Level of Difficulty: Beginner.).

Woven coronary artery anomaly is a rare congenital anomaly, and intravascular ultrasound and optical coherence tomography are useful for the diagnosis. We performed both imaging techniques for woven coronary artery anomaly and evaluated which was superior. We concluded that optical coherence tomography was the preferred imaging modality in this case. (Level of Difficulty: Intermediate.), Graphical abstract, Woven coronary artery anomaly is a rare congenital anomaly, and intravascular ultrasound and optical coherence tomography are useful for the diagnosis…

Transcatheter aortic valve replacement within a degenerated surgical bioprosthetic aortic valve is increasing in frequency. We present a rare case of a patient requiring a second TAVR placed within a previous placed degenerated transcatheter aortic valve, which was implanted in a degenerated surgical bioprosthetic aortic valve. (Level of Difficulty: Advanced.), Graphical abstract, Transcatheter aortic valve replacement within a degenerated surgical bioprosthetic aortic valve is increasing in frequency. We present a rare case…

We performed orbital atherectomy in the left circumflex artery through a stent that jailed the circumflex artery ostium. The orbital atherectomy catheter was entrapped within the stent and the stent was avulsed during catheter withdrawal. We should consider this potential complication when performing orbital atherectomy in a jailed side branch. (Level of Difficulty: Advanced.), Graphical abstract, We performed orbital atherectomy in the left circumflex artery through a stent that jailed the circumflex artery ostium. The orbital atherectomy catheter…

A 15-year-old female who was 1-month post-partum presented with shortness of breath and hemoptysis. Echocardiography revealed findings suspicious for spontaneous papillary muscle rupture. We illustrate the evaluation, differential diagnosis, and management of spontaneous papillary muscle rupture. (Level of Difficulty: Beginner.), Graphical abstract, A 15-year old female who was 1-month post-partum presented with shortness of breath and hemoptysis. Echocardiography revealed findings suspicious…

We describe a case of platypnea-orthodeoxia syndrome in an 88-year-old man who presented with progressive dyspnea. Right-to-left shunting through a patent foramen ovale (PFO) was seen in the setting of normal right-sided heart pressures. He was successfully treated with percutaneous transcatheter PFO closure. (Level of Difficulty: Beginner.), Graphical abstract, This study describes a case of platypnea-orthodeoxia syndrome in an 88-year-old man who presented with progressive dyspnea. Right-to-left shunting…

We present a case of a 20-year-old man with tetralogy of Fallot status post-repair with a transannular patch and left pulmonary artery reconstruction at age 1 and subsequent pulmonary valve replacement with bioprosthetic valve 3 years ago. A transthoracic echocardiogram revealed severe bioprosthetic valve insufficiency. Cardiac magnetic resonance with 4-dimensional flow revealed a paravalvular leak. (Level of Difficulty: Intermediate.), The authors present a case of a 20-year-old man with tetralogy of Fallot status post-repair with a transannular patch and left pulmonary artery…

Aortic wall injury during transcatheter aortic valve replacement (TAVR) is a rare and life-threatening complication. Annular rupture can be classified…, The authors report the case of an 87-year-old man undergoing transcatheter aortic valve replacement via transfemoral approach who developed a life-threatening complication, i.e., fistulization between the aortic root and the left atrium, which was successfully treated by surgery. At 6-month follow-up, the clinical course was uneventful. (Level of Difficulty: Beginner.), Graphical abstract