ABSTRACT In most patients who have Ebstein anomaly (EA), neurological symptoms are either associated with thromboembolic episodes or due to arrhythmic complications. Cerebral cavernous malformation (CCM) is a vascular anomaly made up of sinusoidally dilated blood vessels, often presenting with seizure activity or intracranial bleeding. There has never been any documented report regarding coexisting EA and CCM. Herein, we have reported a 32‐year‐old female with an established history of Ebstein anomaly diagnosed in 2013 who had a history of generalized tonic‐clonic fits since 2020. Neuroimaging studies showed the presence of a right frontal lobe mass with typical “popcorn‐like” appearance and hemosiderin ring on MRI, indicative of cerebral cavernous malformation. The patient declined surgery and was managed conservatively with levetiracetam. With the occurrence of further fits in 2025, neuroimaging showed similar findings but without the presence of intratumoral bleeding. Subsequently, she underwent a left frontoparietal craniotomy for GTE of the lesion with cavernoma on histopathology. The neurological status of the patient was stable during her discharge on the fourth postoperative day. This case documents a previously unreported coexistence of Ebstein anomaly and cerebral cavernous malformation in a single patient. Given the rarity of both conditions, coexistence is coincidental. This indicates the need for genetic and molecular studies to determine whether a real biological association exists.
Background: Imaging-guided coronary intervention by intravascular lithotripsy (IVL) for severe calcification is reported to be a feasible option. In this study, we reported our experience with intravascular lithotripsy for treating severe calcific lesions in both acute and chronic coronary syndromes, comparing procedural success and clinical outcomes. Methods and results: This was a single-center, single-operator, retrospective study of all patients treated with image-guided intravascular lithotripsy (IVL) via a radial approach in Bangladesh from January 2022 to January 2024. Both ACS & CCS patients were included. Patient demographics, procedural variables for safety/efficacy, in hospital & 30-day outcomes were evaluated. The primary endpoints were an in-hospital major adverse cardiovascular event (MACE), including death, myocardial infarction (MI), and target-vessel revascularization (TVR). Secondary endpoints were a clinical success: stent expansion with <30% in-stent residual stenosis & minimum stent area more than distal reference lumen area by imaging with no in-hospital MACE. During the study period, there were 50 patients (62% male; mean age 67.58±8.38 years) (53 coronary lesions) who underwent image-guided IVL through a radial approach. Among them, 27 (54%) patients presented with ACS & the rest of the patients presented with CCS. IVUS-guided IVL was done in 48 (96%) cases. Two cases (4%) were done by OCT. Procedural-related complications such as coronary dissection occurred in 10 (20%), side branch occlusion was 3 (6%) & slow flow was observed in 1(2%). Angiographic & Imaging success (<30% residual stenosis) occurred in 26 cases (96.3%) in the ACS group & 20 cases (87%) in the CCS group, with no significant difference between them. There was no MACE in-hospital & 30 days after follow-up. Conclusions: Image-guided IVL is an effective and feasible strategy for calcium modification in both ACS & CCS groups of patients with high success rates and minimal procedural complications.
Background: Heart failure (HF) is a major public health issue. Left ventricular ejection fraction (LVEF) has been used to classify Heart Failure (HF) into phenotypes. Over the past few years, there has been more evidence that people with lower circulating magnesium concentrations have had more severe heart Failure. This study aimed to evaluate the relationship between serum magnesium levels and the severity of heart failure with reduced ejection fraction.Methods: This cross-sectional observational study was conducted at the Department of Cardiology, Dhaka Medical College Hospital, for 12 months following ethical approval. A total of 180 heart failure patients with reduced ejection fraction (<40%) were included after getting written informed consent, wherein 90 patients had Low magnesium levels (<1.8 mg/dl), and the remaining 90 patients had normal magnesium levels (>1.8 mg/dl). Data were collected in separate case record forms and analyzed by SPSS 26.0.Results: The mean age of the respondents was 63.16±12.57 years in low magnesium level and 63.67±12.96 years in normal magnesium. Among respondents with low magnesium levels, dyslipidemia was predominant (82.2%), followed by hypertension (56.7%) and diabetes mellitus (40%), with no significant difference between the two groups (p>0.05). Severe left ventricular dysfunction was observed in 78.9% of low magnesium level respondents, significantly higher than in those with normal magnesium levels (56.7%). Serum magnesium levels showed a significant negative correlation with NT-proBNP levels (rs= -0.148, p=0.048), HFrEF levels (rs= 0.205, p=0.006), and 6MWT levels (rs= 0.329, p<0.001). Conclusion: Low Serum Magnesium Level is associated with the severity of heart failure with reduced ejection fraction. However, a further larger study is recommended.
