Congenital absence of the left circumflex artery: Case series and review.

Congenital absence of the left circumflex artery (CALCx) or an anomalous origin of the left circumflex artery from the right coronary artery is a unique anomaly in the literature that has been incidentally diagnosed with coronary angiography. CALCx is characterized by an angiographical absence of the left circumflex artery, with a super-dominant right coronary artery that provides the postero-lateral wall of the left ventricle. We present a review of the literature of a total of 52 CALCx cases reported so far including our case. In our study, the average age of patients was 52.83 years (median - 55 years; standard deviation - 13.05 years; range 12-76 years) with a male to female ratio of 1.93:1. The chronic coronary syndrome was the most common clinical presentation followed by the acute coronary syndrome. In 45.5% of cases, the associated coronary artery disease was documented. A comprehensive anatomical and functional assessment is required for the appropriate management strategy.

Resolution of Primary Aortic Thrombosis after Dabigatran therapy-A New Hope for the Rare and Old Disease.

The primary aortic thrombosis (PAT) is an uncommon noncardiac cause of distal peripheral embolization to lower extremities. Also, this condition develops in the absence of extensive atherosclerosis of aorta or abnormal dilatation like aneurysm of the aorta. In most of the cases, there was either no or minimal atherosclerosis of the aorta. The disease can involve any part of the aorta, but in most of the cases, the thoracic aorta below the origin of the left subclavian artery followed by the infrarenal portion of the abdominal aorta was the most common site of involvement. In our case, there was extensive thrombosis starting from the lower part of the thoracic aorta extending across both the renal arteries up to the aortic bifurcation without any underlying aortic pathology or hypercoagulable disease. There are no guidelines for the management of the PAT, but our experience is based on few case series, case reports, and meta-analysis where there are variable success rate using conservative medical management, endovascular procedure, or surgical thrombectomy. Vitamin K antagonist was the drug of choice in all the cases as a part of conservative medical management or used to prevent recurrence after the endovascular or surgical procedure. We present a case of PAT where the use of dabigatran leads to complete resolution and prevented the recurrence of the disease during two-year follow-up, which is the first and unique case report of the literature.

Tetralogy of Fallot, left ventricular clot, aortic dissection: rare association.

Cases of uncorrected adult tetralogy of Fallot are rare and mostly manifest secondary to complications. A 30-year-old man presented with progressive breathlessness and severe chest discomfort. Echocardiography revealed tetralogy of Fallot with a left ventricular apical clot and DeBakey type I dissection of the aorta. The patient underwent successful surgical correction. The combination of preoperative complications in the setting of uncorrected tetralogy of Fallot, such as a left ventricular clot and DeBakey type I dissection of the aorta, is very rare.

CD20 negative B-cell lymphoma presenting as constrictive pericarditis: Rare etiology of acute heart failure.

We describe a case report of a young girl, who presented with symptoms and signs of acute decompensated heart failure not responding to decongestive therapy. Routine 2D echocardiography revealed a diagnosis of constrictive pericarditis. She underwent pericardiectomy, and etiology of it turned out to be CD20 negative B-cell lymphoblastic primary cardiac lymphoma (PCL). Despite intensive medical and surgical management, it was fatal. PCL is uncommon among cardiac tumors and extremely rare in immunocompetent patients. Constrictive pericarditis is a rare clinical diagnosis and manifestation of pericardial involvement in PCL.