Spontaneous Coronary Artery Dissection in a Patient With Cardiogenic Shock: To Revascularize or Not to Revascularize?

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome in young patients. Supportive care is recommended for most uncomplicated cases. However, it is unclear if revascularization plays a role in treating SCAD, particularly in the setting of cardiogenic shock. We present a case of a 40-year-old female with no past medical history admitted for SCAD that was complicated by the Society for Cardiovascular Angiography & Interventions (SCAI) stage D cardiogenic shock. She was successfully managed with a percutaneous left ventricular assist device without revascularization. Repeat angiogram showed healed left anterior descending (LAD) SCAD with recovery of left ventricular (LV) systolic function. This case highlights the importance of supportive care in the treatment of SCAD, as revascularization by percutaneous coronary intervention (PCI) and coronary artery bypass graft surgery (CABG) can pose a significant perioperative risk in this patient population.

Complete Heart Block After Aortic Valve Repair and Septal Myectomy in a Patient With Rheumatic Heart Disease.

Surgical myectomy with concomitant valvular repair has been demonstrated to be safe in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). It is unclear which risk factors predispose patients to develop complete heart block (CHB). We present a unique case of a 66-year-old female with rheumatic heart disease and HOCM admitted for aortic valve (AV) repair and septal myectomy, complicated by a presentation of complete heart block. The histology slide showed fibrosis of the septum, suggesting atrioventricular conduction disease from rheumatic fever, which likely contributed to her presentation. This case highlights the importance of elucidating the etiology of HOCM before undergoing cardiac surgery to guide postsurgical management and improve clinical outcomes.

Cardiac tumor in the left ventricular outflow tract: atypical presentation of calcified amorphous tumor.

Calcified amorphous tumor (CAT) of the heart is a rare nonneoplastic tumor. A 71-year-old woman presented with a mobile mass within the left ventricular outflow tract during her elective transthoracic echocardiogram. The patient exhibited no symptoms, and intraoperative findings showed the mass originating from the anterior leaflet of the mitral valve. Transthoracic and transesophageal echo failed to diagnose and localize the origin of the tumor. The tumor origin is unclear, but CAT of the mitral valve may be associated with mitral annular calcification. Surgical excision of the mass definitively diagnoses the tumor and reduces the risk of embolization.