Biventricular pacing for treating heart failure in children: A case report and review of the literature

BACKGROUND Cardiac resynchronization therapy(CRT) can be used as an escalated therapy to improve heart function in patients with cardiac dysfunction due to long-term right ventricular pacing. However, guidelines are only targeted at adults. CRT is rarely used in children.CASE SUMMARY This case aimed to implement biventricular pacing in one child with heart failure who had a left ventricular ejection fraction < 35% at 4 years after implantation of an atrioventricular sequential pacemaker due to atrioventricular block.Postoperatively, echocardiography showed atrial sensing ventricular pacing and QRS wave duration of 120-130 ms, and cardiac function significantly improved after upgrading pacemaker.CONCLUSION Patients whose cardiac function is deteriorated to a level to upgrade to CRT should be upgraded to reverse myocardial remodeling as soon as possible.     

心脏再同步化治疗引起冠状窦夹层2例

病例1:男,60岁,因"劳力性呼吸困难6年,加重4个月"入院.既往无高血压和冠心病史.查体:血压130/70 mmHg,双肺底少许湿啰音,心界向左下扩大,心率92次/分,律不齐,心音低钝,双下肢轻度水肿.ECG:心房纤颤,完全性左束支传导阻滞.     

Lung adenocarcinoma metastasis to paranasal sinus: A case report

BACKGROUNDLung cancer is often metastasized to the brain, liver, kidneys, bone, bone marrow, and adrenal glands; however, metastasis of primary lung cancer to the paranasal sinuses is extremely rare.CASE SUMMARYIn this paper, we present a case of metastatic tumors of the sinus secondary to lung adenocarcinoma. The patient was a 46-year-old woman who underwent surgical removal of lung carcinoma. Four months after the surgical removal of the lung tumor, the patient presented with epistaxis, and on investigation, the diagnosis was confirmed to be nasal sinus tumors due to metastasis of lung adenocarcinoma. CONCLUSIONThorough investigation of patients with epistaxis and a history of lung cancer is necessary to diagnose metastatic sinus tumors. We reviewed relevant literature and found that there are no characteristic clinical or radiologic features for metastatic sinus tumors; however, the diagnosis can be confirmed by histopathological examination of biopsied tumor sample.     

Successful treatment of systemic sclerosis complicated by ventricular tachycardia with a cardiac resynchronization therapydefibrillator: A case report

BACKGROUND Systemic sclerosis is a rare connective tissue disease characterized by localized ordiffuse skin thickening and fibrosis,which usually accumulates in various organsthroughout the body.Tachyarrhythmia is a common clinical manifestation ofcardiovascular damage in systemic sclerosis patients.However,few studies havereported the use of catheter ablation and an implantable cardioverter defibrillatorin patients with systemic sclerosis complicated by ventricular tachycardia.CASE SUMMARY A 39-year woman with an 11-year history of systemic sclerosis was referred toour hospital due to three syncopal episodes in the past 6 mo.The results of anelectrocardiogram and a transthoracic echocardiogram revealed ventriculartachycardia and left ventricular systolic and ventricular septum segmentalmotion abnormalities,respectively.The results of an electrocardiogram showed asinus rhythm with complete blockage of the left bundle branch.In light of theprogressive nature of systemic sclerosis,the presence of a left bundle branchblock,and the decreased ejection fraction,a cardiac resynchronization therapydefibrillatorwas implanted.The patient’s clinical conditions improved,and at the3-mo follow-up,the patient was free of ventricular tachycardia and all cardiacsymptoms.CONCLUSION We report the first case of systemic sclerosis complicated by ventriculartachycardia that was successfully treated with a cardiac resynchronizationtherapy-defibrillator.     

Coronary sinus endocarditis in a hemodialysis patient: A case report and review of literature

BACKGROUNDInfective endocarditis is more common in hemodialysis patients than in the general population and is sometimes difficult to diagnose. Isolated coronary sinus (CS) vegetation is extremely rare and has a good prognosis, but complicated CS vegetation may have a poorer clinical course. We report a case of CS vegetation accidentally found via echocardiography in a hemodialysis patient with undifferentiated shock. The CS vegetation may have been caused by endocardial denudation due to tricuspid regurgitant jet and subsequent bacteremia.CASE SUMMARYA 91-year-old man with dyspnea and hypotension was transferred from a nursing hospital. He was on regular hemodialysis and had a history of severe grade of tricuspid regurgitation. There was no leukocytosis or fever upon admission. Repetitive and sequential blood cultures revealed absence of microorganism growth. Chest computed tomography showed lung consolidation and a large pleural effusion. A mobile band-like mass on the CS, suggestive of vegetation, was observed on echocardiography. We diagnosed him with infective endocarditis involving the CS, pneumonia, and septic shock based on echocardiographic, radiographic, and clinical findings. Infusion of broad-spectrum antibiotics, fluid resuscitation, inotropic support, and ventilator care were performed. However, the patient died from uncontrolled infection and septic shock. CONCLUSIONCS vegetation can be fatal in hemodialysis patients with impaired immune systems, especially when it delays the diagnosis.     

Utilization of intracardiac echocardiography to access the coronary sinus for left ventricular lead placement

This is a presentation of a case series of 10 consecutive patients undergoing implantation of cardiac resynchronization therapy defibrillator (CRT-D). Intracardiac echocardiography (ICE) is utilized to gain access to the coronary sinus. The method used is detailed with a brief discussion of observations gained from this early experience.     

Cerebral venous sinus thrombosis following transsphenoidal surgery for craniopharyngioma: A case report

BACKGROUND Cerebral venous sinus thrombosis(CVST)is a rare condition in patients with craniopharyngioma following transsphenoidal surgery.CASE SUMMARY A 56-year-old man who underwent transsphenoidal surgery for craniopharyngioma 26 d ago presented gradual headache and cerebrospinal fluid leakage while vomiting 5 d post-discharge and required readmission to our department of neurosurgery.After admission,head imaging examination showed a hyperdense shadow in the superior sagittal sinus and right transverse sinus,edema at the bilateral parietal lobe,and hemorrhage at the left parietal lobe and right occipital lobe;the venous phase of cerebral angiography revealed CVST.The patient was treated immediately by intravenous thrombolysis,endovascular thrombolysis,and mechanical thrombectomy after the definite diagnosis.However,the neurological status of the patient continued to deteriorate and he died on the fourth day after readmission.CONCLUSION For craniopharyngioma undergoing transsphenoidal surgery,it is vital to take an effective strategy to manage the postoperative complications,such as diabetes insipidus,severe electrolyte imbalance,and cerebrospinal fluid leakage.Additionally,the early differential diagnosis of CVST is essential when it develops clinical symptoms,especially in patients following transsphenoidal surgery with a high risk of CVST.Subsequently,the timely and effective treatment of the CVST is critical for preventing neurological deterioration.     

Minimally invasive endoscopic maxillary sinus lifting and immediate implant placement: A case report

BACKGROUND This case report discusses a modified approach for maxillary sinus augmentation,in which platelet-rich fibrin,endoscope,simultaneous implant placement,and sinus floor elevation(PESS)were applied for a maxillary sinus floor lift in a 40-year-old patient.CASE SUMMARY A 40-year-old woman suffered missing upper right first molar.Implant stability quotient and cone-beam computed tomography(CBCT)were used to evaluate the diagnosis.CBCT showed insufficient posterior maxillary bone with a mean residual alveolar bone height of only 3.5 mm.The patient underwent a minimally invasive sinus floor elevation endoscopically.The sinus membrane was elevated in two stages,and a 12-mm implant was placed immediately.At 3 mo postoperatively,the final impressions were accomplished,and a full-ceramic crown was fit-placed.A 6-mo follow-up demonstrated satisfactory aesthetic and functional results.CONCLUSION This is the first report to use an endoscope for maxillary sinus floor lifting in cases with severe and insufficient bone height.This case report demonstrates the advantages of the PESS technique,which include minimal invasiveness with high precision,being applicable in cases with a residual alveolar bone height<4 mm with a promising result,and a shortened treatment period from 12 to 3 mo.     

Cardiac rehabilitation in a heart failure patient after left ventricular assist device insertion and subsequent heart transplantation: A case report

BACKGROUNDInsertion of a left ventricular assist device (LVAD) and heart transplantation (HT) improve the survival of patients with heart failure. In addition, cardiac rehabilitation (CR) further increases the functional capacity. This case report describes a successful case of CR after LVAD insertion and subsequent HT.CASE SUMMARYIn the present case, during the LVAD insertion period, peak oxygen consumption (VO₂) increased by 12.16% after CR. HT was performed 7 mo after the LVAD insertion, and the patient participated in phases I and II CR. The peak VO₂ increased from 17.24 to 22.29 mL/kg/min. This improvement was more significant than that reported in previous studies on CR after LVAD insertion or HT. The patient’s quality of life also improved. The total average score of the short form-36 questionnaire increased from 29.5 points at admission to 53.3 points 9 mo after HT.CONCLUSIONA tailored CR program after LVAD insertion or HT may improve the patients’ quality of life and increase survival.     

Perirectal epidermoid cyst in a patient with sacrococcygeal scoliosis and anal sinus: A case report

BACKGROUNDPerirectal epidermoid cysts are rare masses arising from the ectodermal germ cell layer of the hindgut and are predominantly found in middle-aged women. It is often difficult to make an accurate diagnosis of these cysts and it is equally challenging to distinguish it from other developmental cysts. CASE SUMMARYWe report the case of an 18-year-old female patient with a perirectal mass who presented to the hospital with constipation. The patient experienced sacrococcygeal falls and burns on the left buttocks during growth. Three-dimensional computed tomography scans indicated abnormal sacral vertebrae with the sacral canal partially enlarged and opened. Pelvic magnetic resonance imaging showed a 55 mm × 40 mm × 35 mm unilocular cystic mass in the perirectal space and a solitary sinus in the left ischiorectal fossa. The cyst was completely resected posteriorly using the sacrococcygeal approach. The pathology was verified to be an epidermoid cyst. The patient remained recurrence-free after 6 mo of follow-up.CONCLUSIONSuccessful treatment of perirectal epidermoid cysts depends on comprehensive evaluation. This is significant for the surgical approach and prognosis.     

COVID-19 presenting as complete heart block: A case report

Rationale: COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations. Among them, patients with cardiovascular involvement have a high mortality. Patient's concerns: A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes, myalgia, and mild respiratory symptoms. Diagnosis: Mild COVID-19 infection with complete heart block. Interventions: Temporary pacing followed by permanent pacemaker insertion 10 days after the onset. Outcomes: The patient was managed as per COVID-19 protocol in an isolation ward, and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative, after which he was shifted back to the cardiac care unit for permanent pacemaker insertion. The patient was discharged after inflammatory markers were normal and clinical condition was completely stable. Lessons: COVID-19 has a wide range of clinical presentations, and extrapulmonary manifestations, especially, cardiovascular involvement can not be ignored.