Slit lamp biomicroscopy of the anterior segment of the left eye shows marginal (arrow) and peripheral (arrowheads) circumferential neovascularization of the iris.


MRA extracranial showing severe narrowing of the origin of the right brachiocephalic artery (yellow arrow) and complete occlusion of the left common carotid artery with distal reconstitution of flow near the bifurcation (red arrow).


52-year-old male with atypical chest pain. Coronary computed tomography angiography curved planar reformation image of the mid left anterior descending coronary artery. The white arrow marks an area suspicious for significant stenosis (>70%).


52-year-old male with atypical chest pain. And rest perfusion Images were acquired 150 s after injection of 1110 MBq Rb82. Total acquisition time was 270 s.


52-year-old male with atypical chest pain. Static rubidium-82 perfusion images (17 segment polar maps) demonstrates no difference between stress.


53-year-old male presenting with severe chest pain and cardiac arrest, which was successfully treated with resuscitation and cardioversion. 12-lead electrocardiogram shows massive ST-elevation consistent with anterior ST-elevation myocardial infarction.


52-year-old male with atypical chest pain. Fractional flow reserve (FFRCT = 0.52) derived from coronary computed tomography images and based on a physiologic model of coronary blood flow using three principles: (1) The total resting coronary blood flow can be quantified relative to the myocardial mass, (2) The microcirculatory vascular resistance at rest is inversely proportional to the size of the supplying coronary arteries, and (3) The vasodilatory response of the coronary microcirculation to adenosine can be predicted, allowing computational modeling of maximal hyperemia. The integration of the physiological model into 3-dimensional computational models allows computation of coronary flow and pressure under hyperemic conditions.


(a) Echo showed RV diameter 31.8 mm, the wall of the RV became thinner.


(b) CMRI showed foci of fat in right ventricular free wall.


Peripheral angiogram shows right common iliac artery stenosis of 90% at proximal and distal edges of the stent.


Right femoropolpiteal graft is thrombosed, left common iliac artery shows multifocal areas of narrowing and occlusion of 90.


Terumo wire (0.035) and exteriorized through left femoral artery (a). Right femoral artery approach was used for deploying right common iliac artery stent.


8 mm x 55 mm peripheral balloon was used and serial predilatation done (b).


8 mm x 120 mm medtronic self-. expanding stent was deployed in the right common iliac artery and 7 mm x 150 mm medtronic self-expanding stent deployed in the left common iliac artery. Postdilatation with simultaneous kissing at aortoiliac junction was done using 8 mm x 55 mm balloon in right common iliac artery and 7 mm x 40 mm balloon in left common iliac artery. Postprocedure showed good distal flow.


Computed tomography peripheral angiogram shows patent stent seen in relation to distal aorta, left common iliac artery, external right common iliac artery.


The occupational processes and tools at workplace. A. The charcoal recycler.


The occupational processes and tools at workplace. B. The on/off button of the charcoal recycler.


The occupational processes and tools at workplace. C. Handling the charcoal bowl.


The occupational processes and tools at workplace. D. Moving the charcoal to the grid pan.


The occupational processes and tools at workplace. E. After a fire is started in the charcoal with the grid pan, the burning charcoal is moved from the pan to the bowl.


The occupational processes and tools at workplace. F. Placing and stirring the burning charcoal beneath the duct for aeration.


The occupational processes and tools at workplace. G. Moving the charcoal bowl to a metal container for delivery to tables.


A hypoechoic mass with irregular borders concurrent with a thrombus based on the apical two-chamber view.


Two-dimensional.


Three-dimensional. Tomography scan with volume rendering showed large ventricular thrombus.


Computed tomography angiography preoperatively showing that there is an interruption between right sinus of Valsalva and the enlarged and tortuous right main coronary artery.


Arrow), a single left coronary ostium with a giant coronary trunk.


Arrow), a 7-mm fistula into the right ventricle (Red).


Arrow), the left and right coronary artery were connected with each other and formed a closed loop at the base of the heart.


Ascending aortic angiography preoperatively showing that the left and right coronary artery were enlarged and tortuous.


Right coronary artery was detected secondly to the left one , confirming the diagnosis of coronary artery ring with single left coronary ostium and fistula.


Intraoperative view showing that the fistula was ligated with off-pump strategy.


Transthoracic echocardiography showing that a 6.28-mm coronary fistula into the right ventricle.


Arrow) was detected preoperatively, and undetectable 1 week post-surgical ligation.


Pedigree of the family. The arrow indicates the proband. Circles indicate females, squares indicate males. The diagonal line indicates a deceased family member. Black squares/circles indicate a carrier of the FHM3 (c.4495T>C) mutation with hemiplegic migraine. White squares/circles indicate subjects that are neither patients nor mutation carriers.


Electrocardiograms before and after admission. . Notes: (A) An electrocardiogram shows bradycardia with Mobitz type II second-degree atrioventricular block and complete left bundle branch block 1 month before admission.


Electrocardiograms before and after admission. (B) An electrocardiogram shows third-degree atrioventricular block on admission.


An electrocardiogram shows biventricular pacing after CRT-D implantation. . Abbreviation: CRT-D, cardiac resynchronization therapy-defibrillator.


A: Twelve-lead ECG showing constant fusion during right ventricular apex (RVA) overdrive pacing (cycle length [CL] = 360 ms) of the ventricular tachycardia (VT; CL = 370 ms).


B: ECG showing progressive fusion during RVA overdrive pacing (CL = 340 ms) of the VT.


A: Intracardiac electrogram showing overdrive pacing from the LCC/RCC commissure during ventricular tachycardia (cycle length = 360 ms) at a paced cycle length of 340 ms.


B: Catheter position under fluoroscopy.


C: Catheter position under intracardiac ultrasonography (Soundstar, Biosense Webster, Diamond Bar, CA). The tip of the ablation catheter is positioned in the LCC/RCC commissure. ABL = ablation catheter; CS = coronary sinus; HB = His bundle; LAO = left anterior oblique; LCC = left coronary cusp; NCC = noncoronary cusp; RCC = right coronary cusp; RVOT = right ventricular outflow tract; US = ultrasonography.


Intracardiac electrogram showing that the single extrastimulus terminated the ventricular tachycardia (VT). A potential in the mid-diastolic phase during the VT is observed that persisted even after the VT terminated. However, this mid-diastolic potential more likely is a mechanical valve artifact as a result of a tiny potential, such as the mid-diastolic potential recorded, after the last QRS complex (asterisk).


Oxygen pulse (VO2/HR) at the time of the diagnosis. x-axis: VO2; left y-axis: heart rate (HR) represented by red dots; right y-axis: VO2/HR represented by blue dots.


Oxygen pulse (VO2/HR) after cardiac therapy. x-axis: VO2; left y-axis: heart rate (HR) represented by red dots; right y-axis: VO2/HR represented by blue dots.


Electrocardiography: sinus rhythm, ST-segment elevation on leads V2-V5.


Echocardiography: Four chamber view showing evidence of classic takotsubo cardiomyopathy, the apical type. Represents systole.


Echocardiography: Four chamber view showing evidence of classic takotsubo cardiomyopathy, the apical type. Represents diastole.


Petechial rash found in the distal third of the legs and the feet.


Petechial rash on buccal mucosa.


Demonstrating nail ridging.


EKG showing ST segment elevations in leads II, III, and aVF.


Four chamber(a) view shows dilated right atrium and right ventricle, dilated coronary sinus.


The terminal unroofing of the coronary sinus is demonstrated by arrow in the subxiphoid image, (b) RA-right atrium, LA-left atrium, CS-coronary sinus, RV-right ventricle, LV-left ventricle.


Chest X-ray revealing mild cardiomegaly, dilated right descending pulmonary artery, and oligemia in the right lung.


Dilation of right ventricle and pulmonary arteries (arrow).


Obstruction of pulmonary arteries from proximal portion (arrow).


Decrease in the right ventricle size (arrow).


(a) Echocardiogram, parasternal long axis view. Dilated coronary sinus is demonstrated (arrow), along with descending Aorta (head arrow). Long and short axes of CS are shown.


(b) Modified parasternal short axis. CS (arrow) and PLSVC (head arrow) are shown.


(c) Modified four chamber view. Cs (arrow) is seen entering RA (star), postero superiorly to left ventricle (triangle).


(a) CMR, cine sequence, vertical long axis (equivalent to apical two chamber echographic view), diastolic frame. The dilated CS (arrow) is shown. 1 left atrium (LA), 2 left ventricle (LV), 3 main pulmonary artery, 4 aortic arch.


(b) axial view (similar to Figure 1c). CS (arrow) is seen entering RA (star), postero superiorly to left ventricle (triangle); inferior vena cava inlet in RA is shown (point arrow).


CMR, cine sequence, coronal view, diastolic frame. Slice width 8 mm. Arrow points to the site where superior vena cava, if present, should be seen entering upper RA. PLSVC is seen forming the left mediastinal border and draining into the very dilated CS, in turn connecting to RA. 1 PLSVC, 2 dilated CS, 3 RA, 4 LA, 5 ascending aorta, 6 left pulmonary artery, 7 right innominate vein and overlapping innominate artery and common carotid artery, 8 left innominate vein, 9 inferior vena cava.


(A) Pre-operative 3D reconstruction (3Mentio Medical Imaging B. V. , Bilthoven, The Netherlands) of the 7.5-cm abdominal aortic aneurysm.


The aneurysm contains no intraluminal thrombus at all, as can be seen in the coronal.


Axial plane. Of the computed-tomography angiography.


Volume-rendering reconstruction of the aneurysm after the implantation of a modular nitinol-based endograft (Bolton Medical, Barcelona, Spain).


Coronary angiogram showing 95% stenosis in right coronary artery. (A higher resolution / colour version of this figure is available in the electronic copy of the article).


Two-dimensional transthoracic echocardiographic images. (A) Long-axis view of the left ventricle showing an echo-lucent cavity in the left-ventricular myocardium with abnormal blood flow on color Doppler (arrow).


Two-dimensional transthoracic echocardiographic images. (B) Short-axis view at the MV (mitral valve) level also showing the echo-lucent cavity with partitions in the left-ventricular myocardium and abnormal blood flow on color Doppler. AO, aorta; LA, left atrium; LV, left ventricle; RA, right atrium; RV, right ventricle; RVOT, right ventricular outflow tract.


(A,B) CT angiogram images showing the anatomical profile of IPA (white arrow) and perforation (black arrow).


(C,D) CMR LGE images showing the high signal intensity of the IPA with a distal low signal intensity ( ), and a linear high signal intensity (white arrow) of the IPA wall and partitions. LCS, left coronary sinus.


Post-operation two-dimensional transthoracic echocardiographic images. Short-axis view at the aortic valve level showing the perforation of the left sinus of Valsalva repair.


Post-operation two-dimensional transthoracic echocardiographic images. Non-standard short-axis view showing the cessation of abnormal blood flow on color Doppler.


Non-compacted myocardium measures 11.9-12.9 mm, and the compacted myocardium measures 3.7-4.2 mm in the sagittal plane.


3D image.


Printing. Of non-compaction cardiomyopathy.


Increased trabeculation in the left ventricle, particularly in the midsections and apex with a non-compacted to compacted ratio of 2.5.


Timeline of Case 1 and Case 2.


Chest radiography showing bilateral pulmonary infiltrates.


Initial ECG demonstrating ST-segment elevation in multiple leads.


Transthoracic echocardiogram showing a calcified apical thrombus and global hypokinesis.


Computed tomography imaging showing hyperdense hemorrhagic lesion in the left temporal horn of lateral ventricle with hemorrhage in left lateral ventricle.


Contrast-enhanced angiography showing evidence of well-defined, strongly homogenous, enhancing polypoidal intraventricular mass lesion both in arterial phase and venous phase with hemorrhage in left lateral ventricle.


A cauliflower-like vascular mass in the temporal horn of lateral ventricle with an attachment to the choroid plexus.


Noncontrast computed tomography showing dilated both lateral, third and fourth ventricles suggestive of moderate communicating hydrocephalus.


(a) Papillary fronds lined by single layer of cells (H and E, x40). (b) Delicate fibrovascular connective tissue fronds covered by single layer of uniform cuboidal to columnar epithelial cells with round to oval, basally situated nuclei (H and E, x200).


Electrocardiogram (ECG) of the proband. (A) The ECG of the proband showed ventricular tachycardia onset at a cycle length of 280ms.


Electrocardiogram (ECG) of the proband. (B) Baseline ECG for proband showing a saddle-shaped ST elevation in leads V1-V3.


Prenatal US at 33 weeks' gestational age with red arrow showing dilation of the left ventricle directly under the mitral valve. Given echocardiogram and magnetic resonance imaging in the 1st week of life, this was likely aneurysmal dilation. The left atrial aneurysm is not visualized here or during prenatal US.


Echocardiogram imaging: (a) Four chamber view, day 1 of life, showing large left ventricle submitral free wall aneurysm.


(b) Parasternal short axis view, day 7 of life, showing left atrial aneurysm with hyperechoic mass at apex (arrow), presumed to be a blood clot.


(a) Sagittal plane T2 cardiac magnetic resonance imaging, day 7 of life, showing left atrial appendage aneurysm and hypoechoic blood clot at the ventral aspect. The left ventricular free wall aneurysm can be seen directly below left atrial.


(b) Sagittal oblique cardiac magnetic resonance imaging with free wall left ventricular aneurysm with free communication to the left ventricle.


Postoperative apical view echocardiogram with and without Doppler flow showing the development of new left ventricular apical pseudoaneurysm. Arrow shows apical pseudoaneurysm and color flow study shows flow into the pseudoaneurysm during cardiac systole.


Apical 4 chamber view echocardiogram performed at 6 years of age showing persistent large submitral left ventricular aneurysm marked by red arrow.


Electrocardiograph analysis showed mild ST-segment elevation and abnormal Q waves in III and aVF; sinus tachycardia and complete right bundle branch block.


Pulmonary computed tomographic angiography (CTA) showed bilateral pleural effusion and inflammation (pulmonary window and mediastinal window).


Changes in temperature and blood pressures during hospitalization.


Changes in inflammatory markers during hospitalization.


Changes in myocardial injury markers during hospitalization.


Immediate postoperative chest AP radiograph shows increased opacity in bilateral perihilar areas.


Postoperative electrocardiogram shows ST segment elevation in leads V2-4 and T-wave inversion in leads I, aVL, V2-6.


Chest X-ray of the patient, taken on the February 12, 2021.


Admission electrocardiogram shows anteroseptal and lateral ST segment elevation.


Inpatient electrocardiogram shows inferior ST segment elevation.


Inpatient electrocardiogram shows lateral ST segment elevation.


The illustration of CT angiography of acute embolism in right iliofemoral artery (arrow).


The illustration of echocardiogram of huge thrombi in left ventricle apex (arrow). LV, left ventricle; LA, left atrium.


The illustration of coronary arteriography with left anterior descending dissection (arrows).


A 35-year-old woman with recurrent attacks of palpitation since childhood. A) Transthoracic color Doppler echocardiography shows the dilated left circumflex artery (arrow) emptying into the big coronary sinus.


A 35-year-old woman with recurrent attacks of palpitation since childhood. B) Continuous turbulence flow on color Doppler at the level of coronary artery-coronary sinus connection as well as in the coronary sinus indicating a left-to-right shunts flow.


Coronary angiography (anteroposterior view) demonstrates contrast opacified left circumflex artery that is markedly dilated. CS = Coronary sinus, LCX = Left circumflex artery, LM = Left main coronary artery.


The TE echocardiogram:. X-plane vision showing a thrombus inside the appendage of the LA, and ,a limited image that comes from the posterolateral wall to the mitral valve plane without any communication with the atrial chamber.


Increased velocity of the color Doppler at the level of the mitral inflow. LV = left ventricle, LA = left atrium; Ao = ascending aorta; TE = Transesophageal.


Angio-CT: capsuled lesion of the posterolateral left atrial wall to mitral annulus with clear margins, but no contrast enhancement both in the arterial.


The late phases LV = left ventricle, LA = left atrium, CT = Computed tomography.


Cardiac MR: the intramural formation in the context of the lower lateral wall of the LA, occupying the chamber, by causing obstruction to ventricular filling but in the absence of signs of local invasiveness (a).


It was characterized by a marked hyperintensity on T2-weighted images (b). LV = left ventricle, LA = left atrium, RV = right ventricle, MR = Magnetic resonance.


Histological examination: a hematoxylin and eosin stain confirmed the presence of histiocytes, crenated red blood cells, and crystals, which are typical findings of a chronic hematoma.


Right Foot edema with peripheral Cyanosis.


Right Forefoot Gangrene.


Invasive angiogram showing right coronary artery (Blue Arrow), left circumflex artery (Yellow Arrow), left anterior descending artery (Red Arrow).


Crops of small, red-yellow dome-shaped papules of approx. 6 mm with well-defined borders located on the anterior medial thigh.


Appearance of venous blood following phlebotomy, exhibiting a thick, milky supernatant.


The main milestones of the proband's medical history. Reconstructed by the patient's reports and medical records.


The endomyocardial biopsy of the right ventricle (10-50 micron scale). Hematoxylin eosin staining showed: the endocardium is thin. Cardiomyocytes with foci of enlightenment in the perinuclear zone, disarray, with homogenization of the cytoplasm. In individual cardiomyocytes, there are foci of myolysis with the formation of voids in the cytoplasm. Microvessels with red blood cell sludge phenomenon, sclerosed walls, proliferation of endothelial cells, stenosis of the lumen and single perivascular lymphohistiocytic cells. There are minor hemorrhages, mild sclerosis. Staining of congo red (in non-polarized and polarized light), Perls reaction, the PAS reaction are a negative.


Interoperative image of arteriovenous fistula involving the radial artery and the cephalic vein in the wrist.


Coronary angiography of an essential thrombocythemia case with acute myocardial infarction. Examination results of the. First.


Coronary angiography of an essential thrombocythemia case with acute myocardial infarction. Second time admissions.


Electrocardiogram showing ST segment elevation in leads V3 and V4.


Coronary angiography showing a large thrombus in the left anterior descending artery.


Coronary angiography status post-thrombectomy with no residual lesions in the left anterior descending artery.


Echocardiography on admission. . Notes: Echocardiography showed muscular VSD of approximately 2 cm size. Ventricular septal defect (arrow).


Echocardiography on admission. . Notes: Echocardiography showed muscular VSD of approximately 2 cm size. Further delineation with use of color-flow Doppler. . Abbreviations: LV, left ventricular; RV, right ventricular; VSD, ventricular septal defect.


Coronary angiogram. . Note: Selective left coronary injection shows mid-left anterior descending total occlusion without any collateral vessels (arrow).


Emergent operation for ventricular septal defect repair by two patch technique. . Note: A ventricular septal defect (arrow).


Percutaneous transcatheter AMPLATZER. Muscular VSD Occluder device inserted across ventricular septal defect. . Note: AMPLATZER. 16 mm muscular VSD device was placed appropriately across the ventricular septal defect (arrow). . Abbreviations: VSD, ventricular septal defect; LV, left ventricular; RV, right ventricular.


Proximal left main coronary artery 99% occlusion in Case 1.


Left main coronary artery 99% occlusion in Case 2.


A 46-year-old male presented with chest pain for 1 month. Frontal chest radiograph shows a homogenous radio-opacity in the left upper zone, broad based toward aortic knuckle (large white arrow) causing superior mediastinal widening.


(a-c) A 46-year-old male presented with chest pain for 1 month. Multidetector computed tomography thoracic aortography (axial, sagittal, and coronal sections in mediastinal window) shows focal intense enhancing saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (*) just distal to origin of the left subclavian artery (small white arrow) with periaortic hypoattenuating prominent inflammatory soft tissue (large white arrow) causing subsegmental passive collapse of the left upper lobe (white arrowhead).


(a) A 46-year-old male presented with chest pain for 1 month. Multidetector computed tomography (MDCT) thoracic aortography - three-dimensional (3D) volume rendered (VR) image (axial) shows focal saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (white arrow) just distal to origin of the left subclavian artery.


(b) A 46-year-old male presented with chest pain for 1 month. MDCT thoracic aortography - 3D VR image (sagittal) shows focal saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (large white arrow) just distal to origin of the left subclavian artery (small white arrow).


(c) A 46-year-old male presented with chest pain for 1 month. MDCT thoracic aortography - 3D multidetector computed tomography image (coronal) shows focal saccular outpouching (pseudoaneurysm) in the inferolateral wall of aortic isthmus, mushroom shaped (large white arrow) just distal to origin of the left subclavian artery (small white arrow).


(a and b) A 46-year-old male presented with chest pain for 1 month. Multidetector computed tomography thoracic aortography, (axial sections in mediastinal window) shows few para-aortic necrotic lymph nodes (white arrowhead), few left lower paratracheal partially necrotic lymph nodes (small white arrow), and few aortopulmonary or subaortic partially necrotic lymph nodes (large white arrow).


A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Frontal chest radiograph shows a fairly defined inhomogeneous radio-opacity in the right upper and mid zones lung fields (large white arrow).


(a) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Multidetector computed tomography (MDCT) pulmonary arteriography - three-dimensional (3D) volume rendered (VR) image (axial) shows focal saccular outpouching (pseudoaneurysm) arising from the feeding posterior segmental branch of the right pulmonary artery (white arrow).


(b) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. MDCT pulmonary arteriography - 3D VR image (coronal) shows focal saccular outpouching (pseudoaneurysm) arising from the feeding posterior segmental branch of the right pulmonary artery (white arrow).


(c) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. MDCT pulmonary arteriography - 3D VR image (sagittal) shows focal saccular outpouching (pseudoaneurysm) arising from the feeding posterior segmental branch of the right pulmonary artery (white arrow).


(a) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Immediate postoperative follow-up frontal chest radiograph shows coils filling the pseudoaneurysm sac (small white arrow) with minimal resolution of inhomogeneous radio-opacity (white arrowhead).


(b) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Post-operative day 3 follow-up frontal chest radiograph shows coils filling the pseudoaneurysm sac (small white arrow) with partial resolution of inhomogeneous radio-opacity (white arrowhead).


(c) A 75-year-old male presented with dyspnea, right-sided chest pain, massive hemoptysis, and fever. Four weeks post-operative follow-up frontal chest radiograph shows coils filling the pseudoaneurysm sac (small white arrow) with near-complete resolution of inhomogeneous radio-opacity (white arrowhead).


A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Frontal chest radiograph shows no significant abnormality.


(a-c) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced computed tomography chest (axial, coronal, and sagittal sections in mediastinal window) shows a fairly defined peripherally enhancing collection in the right upper anterior chest wall epicentered in 1st costochondral junction and sternocostal joint (small white arrow). Adjacent encasement of the right internal mammary artery with pseudoaneurysm of the artery is seen (large white arrow).


(a) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced computed tomography (CT) chest - three-dimensional (3D) volume rendered (VR) image (axial) shows focal saccular outpouching (pseudoaneurysm) of the right internal mammary artery (large white arrow).


(b) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced CT chest - 3D VR image (coronal) shows focal saccular outpouching (pseudoaneurysm) of the right internal mammary artery (large white arrow).


(c) A 43-year-old male presented fever, pain, and localized swelling in the right upper anterior chest wall for 1 month. Contrast-enhanced CT chest - 3D VR image (sagittal) shows focal saccular outpouching (pseudoaneurysm) of the right internal mammary artery (large white arrow).


A; Sagittal computed tomography angiography showing a left cerebellar hemisphere hemorrhage.


B; Thrombin generation curves obtained with 5pM tissue factor and 4 muM phospholipids (final concentration) in platelet-poor plasma using calibrated automated thrombin generation assay (Stago, Asnieres, France). The area under the thrombin generation curve (or endogenous thrombin potential) is significantly higher in the patient (red) compared to another subject with afibrinogenemia (blue) or a representative normal control (grey). In this patient with combined inherited antithrombin and fibrinogen deficiency, increased thrombin generation is due to insufficient inhibition of thrombin. Thrombin generation is decreased after infusion of 30 U/kg antithrombin concentrate (pink).


C; Visualization of the left coronary artery with computed tomography coronary angiogram showing 80% stenosis in the common trunk.


D; Visualization of the left coronary artery with computed tomography coronary angiogram showing 50% stenosis in the anterior interventricular branch of left coronary artery.


This figure shows transition of blood sugar (BS) and sodium. Corrected sodium is calculated using the formula; sodium+{(BS-100)/100*1.65}. Left bar is for BS level and right bar is for sodium concentration.


Brain magnetic resonance imaging consistent with CPM. High signal intensity lesions in the posterior central pons on T2WI (arrow head).


Low signal intensity lesion on T1WI.


High signal intensity lesion and a lesion without a decrease in the apparent diffusion coefficient on DWI.


Apple watch record of the patient's heart rate.


EKG showing supraventricular tachycardia.


EKG showing normal sinus rhythm following electrical cardioversion.


The surface electrocardiogram during the onset of atrial tachycardia.


The surface electrocardiogram showing sinus rhythm after surgical ablation.


The adventitia scar after ablation of the right atrial appendage under thoracoscopic clamping.


Echocardiography of patient 1: Coronary flow pattern arising from the right-facing sinus and continuing between aorta and pulmonary artery (PA) suggesting an interarterial/intramural course of the left coronary artery.


Surgical unroofing of the left coronary artery (LCA): Identification of the slit-like ostium of the LCA in the right- facing sinus and its intramural course toward the left-facing sinus (A).


Unroofing of the LCA with a longitudinal incision into the intima from its ostium up to its off-spring from the aortic root (B).


By this, enlarging the ostium and eliminating the dynamic obstruction of the proximal main stem of the LCA (C).


Echocardiography of patient 2: Origin of the right coronary artery (RCA) from the left-facing sinus with an interarterial and intramural course between the aorta and the pulmonary artery (PA). Normal origin of the left coronary artery from the left-facing sinus.


Coronary computed tomography angiography of patient 3: AAOCA with an anomalous origin of the left coronary artery arising from the non-facing sinus without an interarterial course, but with a short intramural course. ECMO, Extracorporeal membrane oxygenation; PA, pulmonary artery.


A-D. Arteriography. Occlusion of right iliac artery.


A-D. Arteriography. ; Occlusion and aneurisms in terminal abdominal aorta and branches.


A-D. Arteriography. ; Occlusion of right subclavian artery.


A-D. Arteriography. ; Occlusion of left subclavian artery.


17-year-old boy with unruptured right sinus of Valsalva aneurysm, contrast-enhanced CT (a) Coronal image shows aneurysm (An) compressing the RVOT (arrow) with dilatation of RA and RV.


(b) Axial image shows the aneurysm extending along right atrio-ventricular groove (arrow).


(c) Oblique coronal image shows dilated right cardiac chambers, intrahepatic IVC, and hepatic veins (arrow). An = Aneurysm, LA = Left atrium, LV = Left ventricle, RA = Right atrium, RV = Right ventricle, RVOT = Right ventricular outflow tract, IVC = Inferior vena cava.


(a) Check left coronary artery angiogram done through right radial access with Tiger catheter. Left anterior descending stent is patent.


(b) Final result of transfemoral right coronary artery percutaneous coronary intervention.


(c) Check aortogram after percutaneous coronary intervention showing no major dissection or perforation.


(a) Transthoracic echo apical four-chamber view showing hematoma (arrowhead) compressing the left atrium (arrow).


(b) Transthoracic echo showing resolution of hematoma (red arrow) behind the left atrium (green arrowhead).


(a) Computed tomography thorax axial section showing posterior mediastinal hematoma (blue star) extending behind the left atrium (red asterisk).


(b) Repeat computed tomography showing resolving hematoma in the posterior mediastinum (thick arrow) with no hematoma behind the left atrium (thin arrow).


(A) Pre-hospital ECG showed ventricular tachycardia with a heart rate of 250 beats/min.


(B) Admission ECG.


(A) The left ventricular long-axis four-chamber view showed localized wall thinning of the RV apex (bold arrow) and abnormal echo in the posterior basal segment (thin arrow).


(B) The short-axis two-chamber view of the left ventricle indicated abnormal wall motion and localized dilation during diastole in RV, similar to a mini ventricular aneurysm (black arrow).


Intracardiac electrophysiological studies of right ventricular stimulation easily induced rapid ventricular tachycardia with a heart rate of 250-280 beats/min originating from the RV with various forms. (A) Body surface electrocardiogram, paper speed 25mm/s.


Intracardiac electrophysiological studies of right ventricular stimulation easily induced rapid ventricular tachycardia with a heart rate of 250-280 beats/min originating from the RV with various forms. (B) Intracardiac electrogram, paper speed 100mm/s.


Myocardial MRI showed that the segmental RV wall was locally thinned, and the abnormal signal indicated fat infiltration (bold arrow). (A) Left ventricular long-axis four-chamber view, bright blood FIESTA sequence.


Myocardial MRI showed that the segmental RV wall was locally thinned, and the abnormal signal indicated fat infiltration (bold arrow). (B) Short axis section of the left ventricle, black blood Double IR sequence.


Sequencing results of the DSG2 mutation. (A) The father of the proband did not carry the pathogenic gene.


Sequencing results of the DSG2 mutation. (B) The proband, his mother and sister carried a mutation in the DSG2 gene. Sequence chromatogram indicated a G to A transition of nucleotide 445.


Sequencing results of the PRRT2 mutation. (A) The proband and his father carried a mutation in the PRRT2 gene.


Sequencing results of the PRRT2 mutation. (B) The mother and sister of the proband did not carry the pathogenic gene. Sequence chromatogram indicated a C loss of nucleotide 641.


The pedigrees of the proband's family affected by PKD and ARVC in our study. Symbols with a slash through them indicate deceased individuals.


MR brain images showing the mismatch between positive DWI.


Negative FLAIR , consistent with hyperacute stroke of the AOP vascular territory.


Thrombus in left atrium and left ventricle.


Thrombus in right atrium, left atrium, and left ventricle.


Doppler ultrasonography with peak systolic velocities (PSV) of the right proximal.


Left proximal.


Right distal.


Left distal. Renal arteries [Normal PSV < 180 cm/s.


Computerized tomography of the right.


Left. Proximal renal arteries (arrows). Approximately 50% stenosis of the left renal artery is noted.


Percutaneous renal angiography showing the proximal left renal artery (arrows) with 50% stenosis prior to stent placement.


Improved flow post stent placement.


Left coronary angiogram showing stenotic left anterior descending coronary artery with first diagonal branch (D1) and absent left circumflex artery.


Right coronary angiogram showing a superdominant right coronary artery with double posterior descending arteries.


ECG during outpatient clinic cardiologist's consulting: inverted T waves in precordial leads (V1, V2, V3, V4, V5) and the presence of complete right bundle-branch block - minor criteria according to the 2010 revised Task Force criteria (2). . ECG - electrocardiogram.


ECG performed in emergency room: VT with right ventricular (RV) outflow configuration, left bundle-branch block morphology with inferior axis (positive QRS in leads II, III, and aVF and negative in lead aVL) - minor criterion according 2010 revised Task Force criteria (2). . ECG - electrocardiogram, RV - right ventricular, VT - ventricular tachycardia.


4 chamber LGE image. The RV local aneurysms has been reported in CMR. . CMR - cardiac magnetic resonance, LGE - late gadolinium enhancement, RV - right ventricle.


4 chamber LGE in the right and left ventricles. . LGE - late gadolinium enhancement.


Short axis LGE in the right and left ventricles. . LGE - late gadolinium enhancement.


Supraventricular tachycardia (SVT) with a long RP interval was recorded on electrocardiogram (ECG). Positive P-waves are seen in V1.


Electrocardiogram on second day post-right craniotomy for evacuation of hemorrhage and clipping of right middle cerebral artery aneurysm showing deep negative T waves in almost all leads with prolonged QTc interval (580 ms).


Left ventriculogram showing systolic anterior wall aneurysm.


Two-dimensional transthoracic echocardiography in the apical long-axis view showing anteroseptal wall aneurysm with nearly normal motion of the other segments in a) end diastole and b) mid-systole.


ECG demonstrating normal sinus rhythm at 86 bpm. No other significant abnormalities were noted.


Eletrocardiographic recordings before ventricular fibrillation in this case. The ECG shows ST segment elevation in lead V3-V5.


Coronary angiogram showing marked systolic narrowing of the left anterior descending artery. Diastole.


Systole).


ECG of the patient during hypoglycemic coma.


ECG showing ST elevation in II, I, aVL, V5, V6 with concavity upward and PR segment elevation in aVR and PR segment depression in other leads.


Electrocardiogram showing normal sinus rhythm and occasional premature ventricular complexes, right bundle branch block, and ST-segment depressions of 0.5-1 mm in leads V4-V6.


Cardiac catheterization, right anterior oblique projection with 25 degrees of caudal angulation; showing 100% left anterior descending occlusion, 90% occlusion of the circumflex, and 95% occlusion of the obtuse marginals 1 and 2.


Aneurysm of coronary artery.


Coronary angiogram done from 2010 demonstrating 2 aneuryms in the right coronary artery.


Coronary angiogram done in 2008 demonstrating aneurysms in the Right coronary artery.


Abdominal and pelvic non-contrast CT revealing a 36 x 31-mm, well-demarcated, ellipsoid and hypodense mass with a CT value of about 27 Hounsfield units (HU) in the external branch of the right adrenal region. Hypodense lesions with a diameter of 15 mm.


Abdominal and pelvic non-contrast CT revealing a 36 x 31-mm, well-demarcated, ellipsoid and hypodense mass with a CT value of about 27 Hounsfield units (HU) in the external branch of the right adrenal region. 39 mm discovered in the upper.


Abdominal and pelvic non-contrast CT revealing a 36 x 31-mm, well-demarcated, ellipsoid and hypodense mass with a CT value of about 27 Hounsfield units (HU) in the external branch of the right adrenal region. Lower. Poles of the right kidney, respectively.


Abdominal and pelvic non-contrast CT revealing a 36 x 31-mm, well-demarcated, ellipsoid and hypodense mass with a CT value of about 27 Hounsfield units (HU) in the external branch of the right adrenal region. Non-contract CT of the chest suggesting lung metastasis: multiple nodules in both lungs, the largest one being located in middle lobe of the right lung (D).


TTE revealing a 23.9 x 13.4-mm, hyperechoic mass with a smooth surface in the left atrium, close to the posterior leaflet of the mitral valve, and moving without extension to the outflow tract during the cardiac cycle; the mass was suspected to be a myxoma (A).


Repeat TTE showing a 27.7 x 16-mm isoechoic mass attached to the posterior leaflet annulus of the mitral valve in the enlarged left atrium (B).


Immunohistochemical staining showing positivity for CAIX, CD10, and Vimentin. (A) CAIX (x200).


Immunohistochemical staining showing positivity for CAIX, CD10, and Vimentin. (B) CD10 (x200).


Immunohistochemical staining showing positivity for CAIX, CD10, and Vimentin. (C) Vimentin (x200).


Immunohistochemical staining showing positivity for CAIX, CD10, and Vimentin. (D) Histological examination of the tumor using Hematoxylin & Eosin stain.


Genetic results for case 2.


ECG shows concave ST elevation over lead I, II, V2, V5 and V6.


CT Brain shows subacute infarct of right corona radiata.


Penal A and B show the diastolic and systolic phase of ventriculogram which showing ventricular apical ballooning.


Case 1. (A) Digital subtraction angiography (DSA) oblique view demonstrating small unruptured aneurysm (red arrow) in the transition between the cavernous and clinoidal segments of the right internal carotid artery (ICA).


Case 1. (B) Intraoperative photograph of direct injection of fibrin glue into the cavernous sinus posterior to the ICA.


Case 1. Indocyanine green (ICG) videoangiography demonstrating patency of the right ICA, darkened by the presence of atheroma in the center of the vessel, and ,patency of the right posterior communicating artery (PCoA).


Case 1. Companion intraoperative photograph.


Case 1. Postoperative axial computed tomography angiography (CTA).


Case 1. 3-dimensional CTA, superior skull base view, obtained 2 h after surgery, demonstrating complete occlusion of the right ICA.


Case 1. (G) Postoperative oblique-lateral DSA after several thrombectomies showing patency of the right ICA and contrast stagnation caused by poor collateral flow. Used with permission from Henan Provincial People's Hospital, Juha Hernesniemi International Center for Neurosurgery.


Case 2. Intraoperative photographs demonstrating. Direct injection of fibrin glue into the cavernous sinus.


Case 2. Subsequent visualization of the patent internal carotid artery (ICA) during resection.


Case 2. 90 min later, the thrombosed middle cerebral artery, which has turned blue.


Case 2. (D) Postoperative posteroanterior angiography via the right common carotid artery demonstrating occlusion of the distal ICA.


Case 2. (E) Postoperative axial computed tomography of the head after decompressive hemicraniectomy and resection of ischemic territory. Used with permission from Barrow Neurological Institute, Phoenix, Arizona.


(a) Diastolic flow from the pulmonary trunk directed upward.


(b) Pulsed-wave Doppler confirming typical coronary flow pattern.


(c) Coronary-pulmonary fistula from the mid segment of the left anterior descending coronary artery (arrow).


(d) Coronary-pulmonary fistula from the right coronary artery (arrow).


Right ventricular systolic phase.


Right ventricular diastolic phase.


Left ventricular systolic phase.


Left ventricular diastolic phase.


A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Coronary computed tomography (CT) angiography curved multiprojection reconstructions of the right (right coronary artery), the left anterior descending, the left circumflex, and the left main coronary arteries as well as the ramus. Red arrow: Coronary stenosis; blue arrow: CT-derived fractional flow reserve reading [cf. Figure 2].


A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Computed tomography-derived fractional flow reserve (FFRct) report. Numbers indicate FFRct readings 15 mm distal to the stenoses in the left main (LM) coronary artery and right coronary artery (RCA), respectively, corresponding to the blue arrows in Figure 1. The FFRct value was <=0.75 in the distal LM, proximal left anterior descending coronary artery, and proximal left circumflex coronary artery, whereas it was 0.86 in the ramus. The FFRct value in the RCA was normal.


A 76-year-old man with dyspnea subsequently diagnosed with coronary artery disease. Invasive coronary angiography. Left: Right coronary artery which is without coronary stenosis. Right top: Left anterior descending coronary artery with moderate elongated stenosis (red arrow). The ramus and left circumflex coronary artery are without coronary stenosis. Right bottom: Left main coronary artery with distal moderate stenosis (red arrow). Blue arrow: Points of FFR measurements.


(A) Transabdominal scan performed at 25 weeks 4 days in coronal plane: the cleft lip appeared as an anhecogenic area at the level of the left upper lip.


(B) Transverse section of fetal chest at 25 weeks 4 days: the red arrow pointed to the defect between the left atrium (LA) and the coronary sinus (CS).


(C) The three-vessel and tracheal (3VT) view at the upper mediastinum showed a supernumerary vessel to the left of the pulmonary trunk and arterial duct. The red arrow pointed to the persistent left superior vena cava (PLSVC) draining into the right atrium.


Single nucleotide polymorphism (SNP) array results of the fetus: the red rectangle showed the deletion region of 1q23.3q31.2.


A chest computed tomographic image in the axial plane demonstrates ground-glass opacities of the lung parenchyma with bilateral and sub-pleural distribution admixed with areas of focal consolidation.


A cardiac catheterization image evidences the progression of the dissection until the circumflex artery after percutaneous coronary intervention (PCI).


Coronary angiography and cerebral CT. Coronary angiography showed a total occlusion at the mid-left anterior descending branch (red arrow). (A) Cranial view.


Coronary angiography and cerebral CT. Coronary angiography showed a total occlusion at the mid-left anterior descending branch (red arrow). (B) Left cranial view.


Coronary angiography and cerebral CT. Coronary angiography showed a total occlusion at the mid-left anterior descending branch (red arrow). (C) Axial cerebral CT showed hypodensity in the right parietooccipital lobe, with two spotted hyperdense areas.


(a) Photomicrograph of the tumor showing distinctly two populations of cells, one of a high-grade glial cell types showing marked nuclear pleomorphism and multinucleated tumor giant cells merging with bundles of malignant spindle-shaped cells (H and E, x250). (b) Photomicrograph showing selective cells stained positive for glial fibrillary acidic protein (PAP, x450). (c) Photomicrograph showing vimentin positivity by both types of tumor cells ie, spindle-shaped cells and malignant glial cells with bizarre nuclei (PAP, x450).


EKG showing early repolarization in anterior leads and diffuse T wave depression in multiple leads.


Coronary CTA showing a filling defect at the right coronary sinus (black arrow) at the level of the right coronary artery ostium suggesting thrombus occluding the proximal right coronary artery.


Normal left coronaries.


Left heart catheterization showing normal left coronary artery.


Sub-total occlusion of right coronary artery with filling defect at proximal segment (white arrow) consistent with acute thrombus.


The lesion was treated with balloon angioplasty and stenting with excellent results (D).


CTA of lungs showed moderate-sized filling defects in the left lower lobe consistent with pulmonary embolism (asterisk *).


Electrocardiogram findings in the studied case. (a) Before treatment.


Electrocardiogram findings in the studied case. (b) After treatment.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. B; The distal end of the PED was deployed proximal to the distal end of the previous Enterprise stent. C Dyna-CT indicated that the entire PED was deployed within the Enterprise.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. D; Adjunctive coiling was performed to secure the aneurysm.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. Right anterior oblique.


A CTA on admission suggested the recurrence of the aneurysm with fusiform morphology. Lateral view. Of DSA indicated complete occlusion of the aneurysm on follow-up 6 months later.


Serial ECGs recorded during hospitalisation.


(A) In chest X-ray, permeability was reduced in bilateral lower lung field and butterfly shadow was observed. Cardio-thoracic ratio (CTR) was 59.8% and both costophrenic angles (CPA) were blunt.


(B) Abdominal contrast-enhanced computed tomography revealed a 50-mm hyper-vascularized tumor with calcification in the right adrenal gland and multiple hyper-vascularized tumors in the liver. The right adrenal gland showed round shape and a mixture of high- and low-density area. In addition, since there was thin adipose tissue between the right adrenal gland and the kidney and inferior vena cava, there seemed to be no infiltration into surrounding organs.


(C) In 131I MIBG scintigraphy, there was high accumulation in the right adrenal gland and multiple accumulation in the liver, and there was small hot spot in the sternum and right rib.


Intimal dissection (arrow) in proximal left anterior descending artery (LAD) by coronary angiography.


Entry (arrow) of intimal tear of the proximal to dissection site in the LAD by intravascular ultrasonography (IVUS).


Intimal flap (arrow) dividing between true lumen, and ,false lumen in the dissection site by IVUS.


Re-entry (arrow) of intimal tear of the distal to dissection site by IVUS.


Coronary angiography revealing intimal dissection (arrow) in mid left anterior descending artery.


Immediate poststenting coronary angiography.


Intimal flap (arrow) dividing between true lumen, and ,false lumen in the dissection site by intravascular ultrasonography (IVUS).


Entry (arrow) of false lumen site in the dissection site by IVUS.


(a) Two-dimensional transthoracic apical four-chamber zoom view focusing the posterobasal ventricular septal defect.


(b) Two-dimensional transthoracic apical four-chamber view on color Doppler shows the left-to-right shunt.


(c) Three-dimensional transthoracic apical four-chamber view images show ventricular septal defect and allow its sizing.


Fluoroscopic images before.


After. Implantation of a 26-mm Amplatzer atrial septal occluder.


Two-dimensional transthoracic apical four-chamber view images acquired 6 days after percutaneous closure: a 26-mm Amplatzer atrial septal occluder correctly placed.


Mild residual interventricular shunt on color Doppler.


Postnatal cranial ultrasound images showing bilateral intraventricular hemorrhage with extensive hemorrhagic infarction of the left hemisphere and ventricular dilatation in coronal view.


Parasagittal left plane view.


Blood clot in the 4th ventricle.


Dilatation of the 4th ventricle (*) with dysplastic cerebellar hemispheres.


Postmortem magnetic resonance imaging showing extensive ventricular dilatation and blood in the 4th ventricle in T2-weighted midsagittal plane , intraventricular blood in the right ventricle.


Ventricular dilatation of the left ventricle in T2-weighted axial plane.


Blood in the 4th ventricle with cerebellar dysplasia in T2-weighted axial plane.


Susceptibility weighted image axial plane. Of the posterior fossa.


Histologic presentation of case 1. Endomyocardial biopsy shows interstitial fibrosis with some interstitial lymphocytes. Signs of hypertrophy are detectable.


EKG showing sinus tachycardia with q waves and ST segment elevations of almost 2 mm in leads III and aVF (arrow) along with ST segment depressions in I and aVL leads. This implies that there is possible inferior wall infarction. Left atrial enlargement also noted.


Echocardiogram with color Doppler displaying a ventricular septal defect postmyocardial infarction (arrow).


Transesophageal echocardiogram showing ventricular septal defect (arrow) with size.


3D echocardiogram showing ventricular septal defect (red arrow) and necrosis (black arrow).


(A) Electrocardiogram on admission showing ST-segment elevation in the precordial leads.


(B) Electrocardiogram after percutaneous coronary intervention showing significantly improved ST-segment elevation resolution.


(A) Coronary angiogram revealing patent right coronary artery (RCA).


(B) Coronary angiogram revealing minimal stenosis of <30% near proximal left anterior descending coronary artery (LAD) and occlusive thrombus in distal LAD.


(C) Recovery of antegrade flow into distal LAD after manual thrombus aspiration.


(D) Index echocardiogram revealing left ventricular (LV) apical thrombus.


(E) Computed tomography scan revealing right adrenal mass which is of soft tissue attenuation with heterogeneous contrast enhancement.


(F) Echocardiogram performed at the 2-month follow-up revealing left ventricular (LV) apical aneurysm.


Baseline electrocardiogram showing pre-excitation.


Echocardiography before ablation showing dilation of left ventricle and dysynchrony between septal and lateral wall on the apical four chamber view.


Electrocardiogram after ablation showing normal PR segment.


Echocardiography post ablation showing synchrony between the septal and lateral wall in the apical four chamber view.


A venacavagram performed during IVC filter placement demonstrating filling defect near the confluence of the common iliac veins.


With delayed reconstitution of contrast flow into the right, but not left, common iliac vein Findings are consistent with an occlusive thrombus in the left common iliac vein with extension into the proximal IVC which is near-occlusive in nature.


(a) Sagittal T1-weighted MR sequence revealing a lesion in the L5-S1 anterior epidural space that is heterogeneously hypointense (arrow).


(b) Sagittal T2-weighted MR sequence with anterior spinal epidural lesion that is mixed iso- and hyperintense centrally with a rim of hypointensity peripherally (arrows), most prominently seen at L4-S1 but also present at T12-L3 levels. There is evidence of mass effect with compression of the thecal sac.


Sagittal.


Axial. Images of gadolinium-enhanced T1 MR sequence. Arrows depict heterogeneous contrast-enhancing lesions in the anterior epidural space that have serpiginous fill void centrally.


Electrocardiogram after admission to our hospital.


12 lead electrocardiogram showing ST-segment elevation at V3-V4 with reciprocal changes at lead II and III.


Coronary angiography at the time of her presentation at the outline hospital. (a) Severe stenosis at mid right coronary artery.


Coronary angiography at the time of her presentation at the outline hospital. (b) Repeat angiography after nitroglycerin infusion with near complete resolution of the right coronary artery stenosis.


Coronary angiography at the time of her presentation at the outline hospital. (c) Moderate-severe stenosis at proximal left anterior descending artery.


Coronary angiography at the time of her presentation at the outline hospital. (d) Repeat angiography after nitroglycerin infusion with near complete resolution of the left anterior descending coronary stenosis.


Cardiac magnetic resonance imaging, (a) Mid ventricular short axis slice demonstrating transmural infarct (red arrows) of the anterior septum with evidence of microvascular obstruction (white arrows) on delayed gadolinium.


(b) Two-chambers view showing transmural infarction (red arrows) of the anterior septum with evidence of microvascular obstruction (white arrows) delayed gadolinium.


Electrocardiogram on admission shows sinus rhythm, complete right bundle branch block, pathological Q waves in leads V1-V3, and T wave changes in some leads.


Color Doppler echocardiography shows left ventricular apical aneurysm formation and left ventricular systolic and diastolic dysfunction.


Left ventricular angiography using a pigtail catheter shows ventricular aneurysm formation.


Timeline showing the clinical course in this patient.


Electrocardiogram at admission.


Electrocardiogram at 24 hours after admissionn.


Electrocardiogram at 2-months follow-up.


Coronary angiography at 2-months follow-up - normal left coronary artery.


Magnetic resonance imaging at 2-months follow-up - dynamic postcontrast T1 sequence with moderate focal capture in the septal myocardium (arrows).


A pre-operative electrocardiogram showed sinus rhythm with a heart rate of 75 beats per minute and p mitrale (noted by the negative q wave deflection of more than 1 mm in the lead V1, suggestive of left atrial enlargement).


Computed tomography angiography. A. Compression of the left common iliac vein between the right common iliac artery and lumbar spine.


Computed tomography angiography. B. Normal left common iliac vein.


Initial venography, a. MTS. Synechias endoluminal of the left common iliac vein.


B. Normal left common iliac vein.


Dissection of the right internal carotid artery, which was the etiology for amaurosis fugax. This is noted as a string sign, representing the extent of the dissection.


Dissection of the right internal carotid artery is noted in a transverse view.


Heart, anterior surface - cardiomegaly, aneurysmal dilatation A distal to the left subclavian artery, anomalous collaterals (arrow) distal to aneurysm.


Heart, posterior surface -constriction beyond aneurysm A. Descending thoracic aorta DTA is supplied by bunch of anomalous collateral arteries (arrows). The ductus is closed. AA: Ascending aorta, LCCA: Left common carotid artery, LA: Left atrium, LPA: Left pulmonary artery, LV: Left ventricle, PT: Pulmonary trunk, RAA: Right atrial appendage, RBCA: Right brachiocephalic artery, RPA: Right pulmonary artery, RV: Right ventricle.


Heart ultrasound showing right coronary artery aneurism (RCA).


Summary of main data regarding the whole clinical history.


Summary of main inflammatory markers tested during the disease course and how they have been influenced by the different therapies.


Computed Tomography and Histological Images of the Pheochromocytoma. A: Abdominal computed tomography showing a left adrenal mass of 50 mm in diameter with rounded, well-defined edges, and hyperdense areas of cystic necrosis inside (asterisk).


Computed Tomography and Histological Images of the Pheochromocytoma. B: Histological panoramic view of the pheochromocitoma. On the left side of the picture there is a normal adrenal gland on which sits the tumor with a large nodule with areas of hemorrhagic aspect, especially in the tumor periphery.


Coronary angiogram in the left anterior oblique caudal view showing in-stent restenosis in the left anterior descending stent.


Coronary angiogram in the right anterior oblique caudal view showing in-stent restenosis in the left anterior descending stent.


Final result poststenting in the left anterior oblique caudal view.


The CAG showed the severely dilated left sinus of Valsalva and the contrast agent was preserved and rotated in a circle (A).


The aneurysm compressed the LMCA (yellow arrow) in the upward direction with significant LMCA seriously narrowing (B). No critical stenosis was observed in LAD. Red stars, the outline of the SoVA; CAG, coronary artery angiography; LMCA, left main coronary artery; LAD, left anterior descending coronary artery, black arrow; white arrow, left circumflex coronary artery.


Angiography showing total occlusion of the three vessels with distal flow in dorsalis pedis artery from collaterals.


Intravenous cannula at the dorsum of the foot.


Guidewire inside the dorsalis pedis artery.


Medical image.


Final angiogram.


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (A) 2D-TTE parasternal long axis view with indicating the prolapsed left atrial myxoma during systole (enveloped by the white, elliptical border).


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (B) Transesophageal view of the atrial myxoma (subtended by the white curvilinear line).


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (C) 2D-TTE parasternal long axis view illustrating the pseudo-stenotic, obstructive effect of the atrial myxoma (subtended by the white curvilinear) of both the mitral valve orifice and left ventricular outflow tract.


2-dimensional transthoracic (TTE) and transesophageal series (TEE). (D) 2D-TTE short axis view of the atrial myxoma at the level of the mitral valve and its subvalvular apparatus (enveloped by the white, elliptical border).


Cineangiography series. (A) Left coronary angiography revealing patent left anterior descending and left circumflex arteries (indicated by the black arrows) with thrombolysis in myocardial infarction (TIMI 3) antegrade flow.


Cineangiography series. (B) Right coronary angiography revealing a dominant and patent right coronary with TIMI 3 antegrade flow (indicated by the black arrow).


Resected gross specimen. Histopathology examination of the specimen confirmed the diagnosis of myxoma.


Chest X-ray upon first admission. . Cardio-mediastinal silhouette is within normal limits with the heart being normal in size. . No pleural effusion / pneumothorax/consolidative patches identified.


Chest X-ray upon his most recent admission. . Mildly prominent hilar vascular markings identified (red arrows) with minimal blunting of the left costophrenic angle (blue arrows) and mild elevation of the left hemidiaphragm. But Cardio-mediastinal silhouette.


Chest CT upon recent admission. . Congestive pulmonary changes in the form of ground glass opacities and pleural effusion at the posterior inferior aspects of both lungs, more on the left. (Arrow heads) Circumferential pericardial effusion (red arrow).


Pleural and Pericardial Biopsy Histopathology report. . A. Light microscopic view showing well-defined epithelioid granuloma engulfing parasitic egg (H&E x400).


Pleural and Pericardial Biopsy Histopathology report. . B. The cuticle of the parasitic egg is polarizable (H&E x400 with polarizer/analyzer lens).


Contrast CT scan of the chest. Right apical tumour, with mediastinal extension.


Inferior regional pericarditis.


Severely stenosed coronary arteries in an HoFH patient. (A) Calcified plaques (black arrow) in the middle of the left descending artery in the heart of the patient. Stenosis (red arrow) in the middle of the left descending artery.


Severely stenosed coronary arteries in an HoFH patient. (B) Calcified plaques (black arrow) in the initial ramus. Stenosis (red arrow) in the initial ramus.


Timeline of the patient's entire diagnosis and treatment.


Angiogram showing unobstructed coronary arteries.


Echocardiogram showing single ventricle (arrow) with double inlet etiology.


Invasive Angiography identifying Circumflex Artery Disease.


Electrocardiogram of the patient showing sinus tachycardia and a prolonged QTc.


Electrocardiogram of the patient showing frequent ventricular ectopics and a run of nonsustained ventricular tachycardia.


Computed tomography picture showing renal mass lesion.


Histopathology consistent with Reninoma.


Selective right coronary angiography, early phase, the left circumflex artery (LCx) originating from the right coronary artery (RCA).


Late phase of contrast injection to the right coronary artery demonstrated retrograde filling of the left anterior descending coronary artery (LAD) via intramyocardial collaterals and shunting to pulmonary artery.


Resting 12-lead electrocardiogram (EKG) showing ST elevation in the anterior leads V2, V3 and V4.


Coronary angiogram showing coronary artery dissection that starts at the origin of Left Anterior descending artery (LAD) (See the star) and extends down to involve proximal and Mid LAD (See the white arrows).


Coronary angiogram showing occlusion of the proximal branch of the Left anterior descending artery (LAD) (See the white arrow) and an evidence of proximal and Mid LAD dissection (See the black arrows).


Coronary angiogram post percutaneous coronary angioplasty and placement of drug-eluting stent to the left anterior descending artery (See white arrows).


Myocardial biopsy. Congo red staining showed reddish amyloid material in the myocardium.


Myocardial biopsy. With apple-green birefringence under polarised light , x200.


Renal biopsy. Congo red staining showed reddish amyloid material in the renal medulla.


Renal biopsy. With apple-green birefringence under polarised light , x200.


Phenotypic characteristics of Kabuki Syndrome at 18-years-old include eversion of the lower eyekid, enlongates eyelid closurem arched eyebrows, long eyelashes and nasal tip facing down.


Brain Magnetic Resonance Imaging (MRI) in axial contrasted T1.


Medical image.


Flair.


Diffusion Note: There are some artefacts on (d and e) images due to magnetic susceptibility by the dental appliance.


Apparent Diffusion Coefficient Hyperintense T2 lesion on right posterior white matter unattended signal alteration or contrast enhancement on T1 or diffusion restriction. It is a quite unspecific, may suggesting a possible gliosis probably due to another (previous) ischemic injury. Note: There are some artefacts on (d and e) images due to magnetic susceptibility by the dental appliance.


LM and LAD, 40. cranial / 5. RAO view. Femoral approach 5 French catheter.


LM and LAD after intracoronary nitrates, 40. cranial / 5. RAO view. femoral approach 5 French catheter.


PDA of the right coronary artery after intracoronary nitrates, 25. cranial / 35. LAO view. Femoral approach 5 French catheter. The stenosis is unmodified.


PDA of the right coronary artery after stenting, 25. cranial / 35. LAO view. Femoral approach 6 Franch guider catheter.


Right atrial thrombus (center) surrounded by pulmonary thromboendarterectomy specimens.


Hypopyon and track of pus from tube at presentation with endophthalmitis.


The 12-lead electrocardiogram shows ST elevation, contextual Q waves and negative T waves in inferior leads (DII, DIII, aVF) and ST depression in V2-V6.


Preoperative transthoracic echocardiography. Apical two-chamber view shows the midbasal inferior left ventricular aneurysm (a and b).


Preoperative transthoracic echocardiography. Subcostal views show the ventricular septal rupture.


Preoperative transthoracic echocardiography. And the left to right ventricular shunt.


Left ventriculography shows the huge inferior left ventricular aneurysm (An) and the contrast enhanced in the right ventricle (arrow).


Modified apical 4-chamber view, showing the coronary aneurysm in the atrioventricular groove, in connection with the right coronary artery.


The right coronary artery aneurysm showed from subcostal view and its major diameters.


Angiography of the right coronary artery confirming the huge aneurysm; two critical stenoses are visible proximal and distal to the ectasia.


Left coronary artery angiographic image demonstrating a 90% stenosis of mid-left anterior descending artery. This was the culprit lesion responsible for patient's angina and the anteroseptal hypokinesia at echocardiography. A 70% stenosis of proximal left circumflex coronary artery was also detected; this vessel had small caliper and distribution (not showed).


The 12- lead patient's Electrocardiogram.


A) Standard 12-lead electrocardiogram (ECG) at initial presentation, showing an ST-segment elevation in the inferior leads (II, III, and aVF) and leads V3 - V5, along with an ST-segment depression in leads I and aVL.


B) Right precordial lead ECG at initial presentation, revealing an ST-segment elevation in leads V3R-V6R.


C) Posterior precordial leads at initial presentation, showing no significant ST deviation in leads V7 - V9.


Coronary angiograms of the patient: Diffuse critical stenoses (arrows) are seen in the left anterior descending (and the left circumflex arteries in the right anterior oblique (RAO) caudal view.


In the right coronary artery (RCA) in the left anterior oblique (LAO) view.


Noncritical coronary plaques after the intracoronary nitroglycerine injection are seen in the coronary arteries in the ROA views of coronary angiography (C and D).


Left ventriculography in the RAO view shows a good left ventricular size and function (E).


(A) Coronary angiogram of the completely occluded right coronary artery.


(B) Coronary angiogram showing Rentrop grade II collateral flow to the right coronary artery from the left ascending coronary artery.


(A) Coronary angiogram of the right coronary artery flow before cutting balloon dilatation.


(B) Coronary angiogram of the right coronary artery flow after cutting balloon dilatation.


Preoperative chest X-ray.


Preoperative chest computed tomography.


MRI showing the dilation of RV and transmural fibrofatty replacement in the RV free wall.


Two-dimensional echocardiogram short-axis view of the aortic valve showing an aneurysm at the non-coronary sinus of Valsalva measuring 1.94 cm x 2.57 cm. LA, left atrium; RA, right atrium; AV, aortic valve.


Two-dimensional echocardiogram short-axis view of the aortic valve.


With color flow Doppler. Showing a fistula between the non-coronary sinus of Valsalva aneurysm and the RA. LA, left atrium; RA, right atrium; AV, aortic valve; Asterix, sinus of Valsalva aneurysm; RV, right ventricle.


Image demonstrating the non-coronary sinus of Valsalva aneurysm communicating with the RA. RA, right atrium; Asterix, sinus of Valsalva aneurysm.


Panel demonstrating the non-coronary sinus of Valsalva aneurysm form the perspective of the aortic root.


The perspective of the right atrium Asterix, sinus of Valsalva aneurysm-to-right atrial fistulas.


Electrocardiograme demonstrating symmetrical T wave inversions in the anterolateral leads concerning for ischemia.


(A) Coronary angiogram showing left coronary artery circulation with a non-occlusive lesion in proximal left circumflex artery.


(B) Coronary angiogram showing right coronary artery circulation.


(A,B) Left ventriculography demonstrating apical ballooning and hypokinesis of the apex with normal functioning basal inferior and anterior segments.


ECG of the patient on presentation showing inferior ST-elevation myocardial infarction (STEMI) with a lateral extension.


Brain MRI: (A-C) T2, FLAIR and DWI showing right MCA territory infarction. A small chronic ischemic lesion seen in the white matter of the left frontal lobe.


(D) SWI image showing blooming artifacts at the site of infarction representing blood component (hemorrhagic transformation).


Brain CTA showing a Lesser extent of opacification of the cortical branches of right MCA compared to the left.


Transesophageal echocardiogram (TEE) images showing ascending aorta thrombus.


Chest CTA showing non-occlusive filling defects at the origin of the Brachiocephalic artery and in the proximal ascending aorta.


Lumbar Spine MRI:. Sagittal T2WI showing degenerative disc changes with significant thecal sac compression at levels L5-S1.


Magnification X1. Axial T2W at levels L4-L5 showing a massive AAA, Magnification X2. . Abbreviations: AAA, Abdominal Aortic Aneurysm; MRI, Magantic Resonance Imaging.


Preoperative CTA:. Axial view showing a thick-walled 10 cm infrarenal AAA.


Magnification x1 Axial (Magnification X1) and coronal (Magnification X2) views showing an aneurysmal extension into to right IIA. . Abbreviations: AAA, Abdominal Aortic Aneurysm; CTA, Computed Tomography Angiography.


Intraoperative digital subtraction angiogram:. Large infrarenal AAA with aneurysmal dilatation of right common iliac artery, and ,short ectatic left common iliac artery.


Magnification X1 successful deployment of the bifurcated graft and embolization of RIIA, Magnification X1. . Abbreviations: AAA, Abdominal Aortic Aneurysm; RIIA, Right Internal Iliac Artery.


Follow-up CTA showing: (A) patent graft with exclusion of the aneurysm from circulation and without endoleak, Magnification X1.


(B) Retrograde flow into RIIA, Magnification X1. . Abbreviations: CTA, Computed Tomography Angiography; RIIA, Right Internal Iliac Artery.


Ischemic colitis changes seen on a rectal biopsy. Magnification X4.


ECG: SR 60 bpm, negative T waves in V1-V2, QS in V3-V5.


Extensive fibrosis at biventricular level (a, b).


Electrocardiogram showing extensive anterior wall myocardial infarction (evolved).


Left coronary angiogram showing no evidence of significant coronary artery disease.


Photograph showing tendinous xanthomas on the elbow.


Photograph showing tuberous xanthomas on the buttocks.


Left coronary angiogram showing left main coronary artery-ostial 90% discrete stenosis and left anterior descending-proximal 90% discrete stenosis and mid total occlusion.


EKG initial presentation. . Note: An EKG showed a sinus rhythm with a right bundle branch block (RBBB) but without signs of ischemia. . Abbreviation: EKG, electrocardiogram.


Echocardiogram TEE PFO. . Notes: TEE showed a very minor PFO only with a Valsalva maneuver. Doppler views did not demonstrate a PFO (A).


Echocardiogram TEE PFO. . Notes: TEE showed a very minor PFO only with a Valsalva maneuver. During the Valsalva maneuver, a single bubble became apparent (blue arrow) (B). There was no aortic dissection. . Abbreviations: PFO, patent foramen ovale; TEE, transesophageal echocardiogram.


Left heart catheterization. . Note: (A) shows a thrombus in the proximal to mid LAD.


Left heart catheterization. (B) shows the dissolution of the thrombus.


Left heart catheterization. (C) shows recurrence of thrombus from the second cardiac event months later.


Left heart catheterization. (D) shows reperfusion of the vessel after stent placement. The coronary angiography shows a thrombus in the proximal to mid LAD (arrow) in otherwise normal coronary arteries. . Abbreviation: LAD, left anterior descending artery.


EKG second event. . Note: The EKG from the second event showed marked sinus bradycardia with PAC and existing T wave inversions in inferior leads. . Abbreviations: EKG, electrocardiogram; PAC, premature atrial complex.


Coronal image of CT aorta angiogram shows the pooling of contrast into a thin-walled protrusion arising from the anterolateral part of left ventricular wall (thin red arrow) abutting the proximal portion of ascending aorta (solid yellow arrow).


Contrast-enhanced axial CT shows the displacement of left aortic sinus (bold yellow arrow) and left coronary artery (thin red arrow).


Coronal-reformatted CT angiogram image demonstrates a large thrombus in the right atrium (bold red arrow) extending into the superior vena cava (bold yellow arrow).


Stent with inflated balloon along with 26 cm of snapped delivery system, Inset: Balloon in inflated stage, stuck within the stent.


Post-surgery echo of left atrial appendage.


(a) Intraoperative ultrasonography is showing a hypoechoic cystic lesion in left lateral ventricle with another small cystic lesion within this lesion.


(b) Hydatid cyst after excision.


Narrow complex tachycardia suggesting atrioventricular nodal re-entrant tachycardia.


Wenckebach phenomenon seen during a bout of palpitations.


Normal heart rate response during a treadmill exercise test.


The 12-lead electrocardogram (ECG) of the first patient demonstrating tachycardia with QT interval of 440 milliseconds and ST segment elevation in aVR and T wave inversion V1, V2 and V3.


The 12-lead electrocardogram (ECG) of the second patient demonstrating sinus tachycardia and prolonged QT-interval.


Erythematous rash over the left lower limb.


Twelve-lead electrocardiogram results. (A) The first electrocardiogram indicating ST-segment elevation in the II, III and aVF leads (0.5-0.7 mV) with ST-segment depression in the I and aVL leads (0.2-0.4 mV).


Twelve-lead electrocardiogram results. (B) The preoperative electrocardiogram (49 minutes after the first electrocardiogram) indicating ST-segment elevation in the II, III and aVF leads disappeared.


Electrocardiogram showing concave shaped ST- elevation in inferior and lateral leads.


contrast-enhanced computed tomography (CT) scan showed embolic cerebral infraction consisting in multiple supratentorial regions of hypodensity in a vascular distribution occurring in the white matter-gray-matter.


contrast-enhanced computed tomography (CT) scan showed in the cervicothoracic section a thrombosed dissection of left internal carotid.


Coronary angiography showed an acute thrombotic type 1 dissection of the proximal left descending artery with TIMI III blood flow.


Angiogram with right anterior oblique (RAO)-caudal projection of the saphenous vein graft bypassing the first diagonal artery revealing severe spasm (dashed arrow) of the proximal portion of the graft.


Angiogram with RAO-caudal projection depicting resolution of saphenous vein graft spasm (solid arrow) after Intracoronary (IC) administration of nitroglycerin.


Severe stenosis at mid-portion of left anterior descending artery (LAD).


Severe stenosis before last seen lesion.


Stenting of LAD lesion.


Severe stenosis at mid-portion of right coronary artery (RCA).


Severe long stenosis at proximal to mid-portion of RCA.


In the left panels, 12-lead electrocardiogram (ECG)at the age of nine (2002), depicting sinus rhythm, PR interval 160 ms, QTc 380 ms and Q-waves in leads V5, V6 with negative T-waves. In the right panel, 12-lead ECG on admission at the age of sixteen (2009), depicting sinus rhythm; PR interval 130 ms and delayed left atrial depolarization (the second vector of the P-wave is delayed, most likely by fibrosis of the interatrial septum); deep Q-waves in leads I, aVL, V5, and V6, diffuse T-wave inversion, QRS duration 130 ms and different morphologies of fQRS, including various RSR. patterns.


Parasternal large axis view.


Apical four-chamber view. Depicting global thickened of the left ventricular walls and right ventricle and interatrial septum involvement. IVS: interventricular septum; LA: left atria; LV: Left ventricle; RA: right atria; RV: right ventricle.


(A, B) Coronary computed tomography showing normal coronary arteries without stenosis.


Coronary angiography (CAG) at the time of acute coronary syndrome. (A) Complete obstruction of proximal right coronary artery (RCA).


Coronary angiography (CAG) at the time of acute coronary syndrome. (B) Restoration of RCA flow after angioplasty and thrombus suction.


Coronary angiography (CAG) at the time of acute coronary syndrome. (C, D) CAG at the time of recurred angina showing stenosis of distal right coronary artery with aneurysmal change.


Coronary angiography. A. Right anterior oblique and caudal view.


Coronary angiography. B. Left anterior oblique and cranial view. A stent thrombosis is visible (arrowheads) in the in-stent segment of the proximal left anterior descending artery.


Intravascular ultrasound. Fibrous thrombi are visible in the in-stent segment of the pLAD artery.


Aspirated thrombi. A. Several large thrombi (arrow) were aspirated during PCI and preserved in physiologic saline inside the aspiration device.


Aspirated thrombi. B. Extracted thrombi on a Petri dish.


Macroscopic and microscopic features of the ruptured heart. A; The probe passes through the rupture site at the base of the right ventricle. There is significant pericardial hemorrhage. The tricuspid valve is seen centrally.


Macroscopic and microscopic features of the ruptured heart. B; High power photomicrograph of the infarct showing myocardial necrosis and a heavy polymorphonuclear infiltrate.


Resting electrocardiography showed typical atrial flutter with 2:1 or 3:1 conduction before the radiofrequency ablation.


Ablation of atrial flutter. (A) The fluoroscopic image, left anterior oblique, showing the position of ablation and diagnostic catheters.


Ablation of atrial flutter. (B) Intracardiac electrogram showing typical counterclockwise atrial flutter. ABL, ablation; HIS, His bundle; CS, coronary sinus; RVA, right ventricular apex.


Acute occlusion of right coronary artery. (A) Coronary angiography, right anterior oblique, showing total occlusion of at the distal portion of right coronary artery (arrow).


Acute occlusion of right coronary artery. (B) Revascularization after balloon angioplasty with resultant 20% residual stenosis.


Acute occlusion of right coronary artery. (C) The fluoroscopic image, left anterior oblique, showing the position of ablation catheter tip during radiofrequency ablation (arrow).


Echo image showing large left coronary artery aneurysm opening into right ventricular outflow tract.


Angiographic view of the root of aorta showing large left coronary artery aneurysm, faintly opacifying distal left anterior descending artery and prominent right coronary artery.


Retrograde filling of the left coronary system through coronary collaterals arising from the right coronary artery.


Extracranial CTA: Diffuse severe left ICA narrowing from 0.5 cm beyond the carotid bifurcation (arrows), consistent with "Alagille vasculopathy. ".


Formal Catheter Angiography: Sagittal views following left carotid injection showed >=75% extracranial LICA stenosis (arrow). LICA was occluded in the supraclinoid segment after the left ophthalmic artery origin with moyamoya phenomenon (not shown).


AP views following left vertebral artery injection showed moyamoya phenomenon around the proximal left PCA (arrow).


Cardiac MRT before initiation of treatment.


Cardiac MRT in peripheral euthyroid state.


Abdominal computed tomography (CT) scan and duodenography. . (a) Postoperative abdominal CT scan revealed that the I-shaped graft had good patency (white arrow).


Abdominal computed tomography (CT) scan and duodenography. (b) Contrast media passed through the duodenojejunostomy without any problem.


Upper gastrointestinal endoscopy (UGE) and abdominal computed tomography (CT) scan. . (a) UGE revealed the beating hematoma on the anal side of the major papilla.


Upper gastrointestinal endoscopy (UGE) and abdominal computed tomography (CT) scan. Axial.


Operative finding. . A 1-cm perforation was found in the third part of the duodenum (white arrow).


Abdominal computed tomography (CT) scan. . Postoperative abdominal CT scan showed that endovascular aneurysm repair was performed and the superior mesenteric artery was reconstructed (white arrow).


Computed tomography head showed an acute left subdural hemorrhage with significant left-to-right midline shift.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (a) Axial T2-weighted sequence.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (b) Axial T2-FLAIR sequence.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (c) Axial 3D TOF.


MRI where we observed a serpentigenous path of the arteriovenous malformation at the parieto-occipital region. (d) Sagittal 3D TOF.


(A) Chest radiograph on the day of admission revealed pulmonary congestion bilateral, cardiothoracic ratio of 60%, and implanted pace maker.


(B) Computed tomography of the abdomen demonstrated high density throughout the liver and dilation of the hepatic veins and inferior vena cava.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (A) Displayed from left to right are the representative whole-cell inactivation recordings of WT Nav1.5 + beta1 and Nav1.5-F1571L + beta1. The INa were elicited with the pulse protocol shown underneath the traces.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (B) The time constants of channel inactivation for WT Nav1.5 (black circles, n = 5), WT Nav1.5 + beta1 (gray circles, n = 12), Nav1.5-F1571L (full red inverted triangles, n = 9), and Nav1.5-F1571L + beta1 (open red inverted triangles, n = 12). The values shown are means +- SEM.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (C) Voltage dependence of channel inactivation obtained by plotting the normalized current amplitudes at -10 mV, elicited after 500 ms of conditioning pre-pulse depolarization, as a function of the pre-pulse potential.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (D) Displayed from left to right are the representative whole-cell recordings of recovery from inactivation of WT Nav1.5 + beta1 and Nav1.5-F1571L + beta1. The protocol used is shown underneath the traces.


Inactivation properties of WT Nav1.5 and Nav1.5-F1571L alone or co-expressed with beta1. (E) Graph representing the recovery from inactivation, sampled after 500 ms from induction of inactivation.


3D CT reconstruction image of pelvis showing bilateral calcification of the vas deferens.


Occlusion of the left main.


After single ballon dilatation of the left main.


Right coronary artery.


showed normal sinus rhythm with prolonged QTc interval of 527 msec and some non-specific T wave changes over the inferior leads.


Coronary angiogram showing normal coronary artery.


Normal heart.


Tako-Tsubo sign. With apical ballooning (end-systolic view).


Resting ECG of the patient.


Original case TEE sequence in anaesthesia #4. A. Acute onset of left ventricular dysfunction/considerable hypokinesia (reduced contractility: outer circle: diastole; inner circle: systole).


Original case TEE sequence in anaesthesia #4. B. After successful therapeutic intervention: normal left ventricular function/no considerable wall motion abnormalities (normal contractility: outer circle: diastole; inner circle: systole).


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). A: Placement of catheters during ablation at the posterior aspect of right ventricular outflow tract (RVOT).


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). B: Placement of catheters during ablation at the right coronary cusp (RCC). Note the proximity of the RCC ablation site to the RVOT ablation site shown in panel A.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). C: Right coronary angiography before ablation at the RCC. The white star indicates the RCC ablation site from panel B, which was located anteriorly to the right coronary artery in right anterior oblique (RAO) view.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). D: Same images as panel C but with the ostium (white arrows) and the ostial portion (white lines) of the right coronary artery marked. Note that the ostium was located much higher than the distal tip of the ablation catheter (ABL) and the ostial portion ran inferiorly.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). E: Intracardiac electrogram recorded at the RVOT ablation site during VT. Local ventricular activation recorded at the distal (d) bipolar (Bi) electrode of the ABL showed an upright initial R wave preceding the onset of the QRS complex by 30 ms. Simultaneous recording of the unipolar (Uni) electrode of the ablation catheter displayed a QS pattern.


Fluoroscopic images of ablation sites and right coronary artery and intracardiac electrograms during ventricular tachycardia (VT). F: Intracardiac electrogram recorded at the RCC ablation site during VT. Local ventricular activation showed not an initial positive but an early activation preceding the onset of the QRS complex by 27 ms (arrow) in the distal bipolar recording and exhibited a QS pattern in unipolar recording. See text for further discussion. EPI = epicardial mapping catheter inserted via subxiphoid puncture (catheter placed only for mapping, and catheter location not related with any endocardial ablation sites); HBE = His-bundle catheter; LAO = left anterior oblique; p = proximal; RVA = right ventricular apex catheter.


Right coronary artery stenosis. A: Twelve-lead ECGs just before (left) and after (right,asterisks) ST elevation in the inferior leads.


Right coronary artery stenosis. B: Right coronary angiography (left anterior oblique view) showing acute stenosis just after ST-segment elevation was first observed (top) and after balloon angioplasty (bottom). White arrows indicate stenotic lesion.


Right coronary artery stenosis. C: Intravascular ultrasound showing stenosis after repeated nitroglycerin injection (top) and after balloon angioplasty (bottom). White arrow indicates eccentric intimal thickening that successfully resolved after angioplasty. Neither coronary artery dissection nor thrombus was observed. See text for further discussion.


Axial.


Coronal images of the unenhanced computed tomography (CT) scan of the brain showed an acute left middle cerebral artery (MCA) infarction, which manifested as cortical and subcortical hypodensity with loss of gray-white matter differentiation and cortical swelling involving the left frontal, parietal, and temporal regions (asterisk); hyperdense MCA signs were also noted (arrow).


Axial maximum intensity projection (MIP) images of the CT angiogram of the brain showed complete occlusion of the left supraclinoid internal carotid artery and proximal MCA (arrows).


(E) Brain CT demonstrated the presence of a malignant MCA infarction with hemorrhagic transformation, causing significant midline shifting and mass effect.


(F) Postoperative CT.


Cardiovascular magnetic resonance imaging with inversion recovery sequence using long inversion time showed area of no contrast uptake at the basal anterior and anterolateral wall.


Blue arrows) that improved on the similar sequence repeated 30 minutes later. Arrows) consistent with microvascular obstruction.


Cardiovascular magnetic resonance imaging with inversion recovery sequence using long inversion time showed area of no contrast uptake at the basal anterior and anterolateral wall (E, F) Left atrial appendage thrombus (yellow arrow) was also discovered on this sequence. Image enlarged using letsenhance. Io.


(E, F) Left atrial appendage thrombus (yellow arrow) was also discovered on this sequence. Image enlarged using letsenhance. Io.


12-lead ECG (left, posterior and right leads) performed in our emergency room showing ST-segment elevation in the inferior leads (II, III, aVF) and V5, V6.


Final image with successful PCI of the LAD artery and good coronary flow.


Balloon sizing the atrial septum through a retrograde approach.


NSR with dynamic changes in T-waves in V1 and V2 when comparing two ECGs.


Repeat ECG after second emergency department visit.


Facial dysmorphism in velocardiofacial syndrome.


Magnetic resonance imaging (MRI). (A) Magnetic resonance angiography showing a drop in signal at the 12th thoracic level.


Magnetic resonance imaging (MRI). (B) MRI showing no ischemic or demyelinating lesion.


Macroscopic view of the right side of the heart, showing downward ventricular insertion of the tricuspid valve ring ("atrialization of the right ventricle"), leaflets partially adherent to the ventricular wall and free portion dysplastic. It also shows a right ventricle with minimal chamber and a "canal" outlet chamber to the pulmonary valve, due to the mal-positioned tricuspid leaflets (source: INMLCF, I. P. , with permission).


Macroscopic view of the Quadricuspid Pulmonary Valve, with three equal-sized cusps and an extra (No. 4) smaller one (source: INMLCF, I. P. , with permission).


Case A. Transthoracic echocardiogram demonstrates an elongated and thickened anterior mitral valve leaflet. The posterior leaflet was extremely hypoplastic with just a short visible stump. A noncompaction picture of the left ventricle lateral wall is visible.


Case A. Transthoracic echocardiogram shows a marked hypoplasia of the posterior mitral leaflet and a normal sized anterior leaflet.


Case A. Transthoracic echocardiogram-4C color Doppler demonstrating an eccentric severe regurgitation jet.


Case A. Two-dimensional transesophageal echocardiography demonstrating an anterior-posterior bicuspid aortic valve (opening phase).


Case A. Two-dimensional transesophageal echocardiography demonstrating an anterior-posterior bicuspid aortic valve (closure phase).


Case A. Three-dimensional real-time transesophageal echocardiography demonstrating the lack of posterior mitral leaflet.


Case B. Transthoracic echocardiogram shows a marked hypoplasia of the posterior mitral leaflet and a normal sized anterior leaflet.


Case B. Transthoracic echocardiogram- Parasternal Long Axis (PLax) demonstrating a severe hypoplasia of mitral posterior leaflet.


Electrocardiogram (ECG) results. The pre procedural electrocardiogram revealed an ST-segment elevation in the V2-6 leads.


Electrocardiogram (ECG) results. The post-procedural electrocardiogram showed an improvement in ST-segment elevation in the V3-6 leads.


This figure (Video 1) shows the steps of the procedure; 1. Inserting the filter device (Filtrap ) and unfolding it beyond the occlusion; 2. Advancing the guide extension catheter (GuideLiner ) and capturing the huge thrombus between the tip of the GuideLiner. catheter and the filter body of the Filtrap ; 3. Pulling them back together out of the guide catheter.


Thrombus retrieved from the left anterior descending artery.


Left coronary arteriogram of a young patient with antiphospholipid syndrome and myocardial infraction on admission showing thrombotic stenosis of left descending coronary artery at the level of the proximal section.


Arteriogram of a young patient with antiphospholipid syndrome and myocardial infraction after PTCA showing evidence of successful recanalization.


Four-chamber view echocardiography of a young patient with antiphospholipid syndrome and myocardial infraction showing an apical large thrombus measuring 38x18 mm.


Presenting chest radiograph showing cardiomediastinal silhouette enlargement with mild congestion and pleural opacity on the right chest wall. Annular calcific pericardial ring later seen on echocardiogram, coronary angiography, and computed tomography scan is not well visualized.


Presenting echocardiogram showing pericardial calcification. (a) Apical four chamber and parasternal short axis.


Presenting echocardiogram showing pericardial calcification. (b) Views showing pericardial thickening (shown by arrows).


Reconstructed computed tomography scan image showing the calcific ring.


The distal first diagonal artery stent (arrow) crossing underneath the calcific band.


Autopsy gross specimens of lungs and heart. (a) Lung gross specimen showing pulmonary thromboemboli with massive right pulmonary hemorrhagic infarct and pleural hemorrhage which was thought to be the cause of death.


Autopsy gross specimens of lungs and heart. (b) Dissected specimen of left anterior groove with patent and intact recently placed first diagonal artery stent (arrow).


Autopsy gross specimens of lungs and heart. (c) Gross specimen of heart with hypertrophied left ventricle and fibrocalcific constrictive annular band in atrioventricular groove (arrow) with dense fibrosis and calcification.


CECT scan of chest showing bilateral diffuse ground glass opacities.


At onset of cerebral infarction, diffusion weighted magnetic resonance imaging (DW-MRI) revealed fresh infarctions in the left cerebral hemisphere (1-A, arrows).


MRA revealed a stenotic lesion in the cervical segment of the left ICA (1-B, arrow).


DSA (1-. Arrow).


MRA (1-. Arrows) on the second day after the onset revealed no evidence of stenosis.


Chest X - Ray Posterior - Anterior and Lateral Views Showing Dilated Main Pulmonary Artery and the Catheter.


Echocardiogram Showing the Catheter Traversing the Interatrial Septum. Abbreviations: RA, Right Atrium; LA, Left Atrium.


Intraoperative Photograph of the Entrapped Catheter in the Interatrial Septum. Abbreviations: RA, Right Atrium; SVC, Superior Venacave; IVC, Inferior Venacave (Inset-extracted catheter tip).


Intraoperative Photograph of Domed, Stenosed Bicuspid Pulmonary Valve.


Risk factors for aHUS recurrence after uDCD. Modified from Zuber et al. . uDCD = uncontrolled donation after circulatory death; cDCD = controlled donation after circulatory death; IS = immunosuppressive; IRI = ischemia-reperfusion injury.


Erect abdominal radiograph demonstrating fullness of bilateral renal fossae with obscuration of the psoas outline suggestive of renal masses. Associated mass effect evidenced by inferior displacement of adjacent bowel loops.


Sagittal ultrasound image of the right kidney depicting a large perirenal hypoechoic fluid collection with hyperechoic internal echoes compatible with complex fluid. Associated medial displacement and compression of the right kidney. Similar findings were seen on the contralateral side (not shown).


(a, b) Contrast-enhanced axial and coronal computed tomography of the abdomen demonstrating large bilateral subcapsular collections (stars) causing compression of the renal parenchyma (arrowheads).


CT scan of the brain. (A) Left side: cortico-subcortical temporo-parieto-insular hypodensity. Right side: subcortical lenticular hypodensity.


CT scan of the brain. (B) Left side: cortico-subcortical parietal hypodensity.


CT scan of the brain. (C,D) Right side: cortico-subcortical parietal hypodensity.


CT scan showing the ARSA and related pseudoaneurysm and the dissection.


3D CT reconstruction.


CT scan showing correct positioning of the endovascular stent graft.


Summative timeline showcasing key findings of the patient's evolution and detailed treatment (case 1).


Summative timeline showcasing key findings of the patient's evolution and detailed treatment (case 2).


(a-c) Para-sternal short axis views showing the non-compacted layer with numerous trabeculations. Figure 1b illustrates the two separate layers.


Cardiac MRI: four chamber view with some degree of motion artifact. Red arrow represents the non-compacted myocardium.


Echocardiography image showing large pseudoaneurysm of the posterolateral wall.


Telemetry showed ventricular tacycardia with heart rate of 149 bpm.


Pre-operative right coronary artery
angiography.


Early post-operative electrocardiogram.


Electrocardiogram at the time of chest pain 3 days after the surgery.


Non-selective aortic root injection
angiography.


Selective right coronary artery angiography after infusion of intravenous trinitroglycerine.


Electrocardiogram after transient right coronary artery spasm.


A. The electrocardiogram showed ST-segment depression in leads V3-V6 and D1-aVL.


B. Coronary angiogram in the right caudal view shows the left coronary artery, circumflex artery and intermediate artery.


C. Coronary angiogram in the left anterior oblique cranial view shows the circumflex artery and right coronary artery originating from right sinus of Valsalva. (CX: circumflex artery, IM: Intermediate artery, LAD: left anterior descending artery, LSV: Left sinus of Valsalva, RCA: Right coronary artery, RSV: Right sinus of Valsalva).


The electrocardiogram showed no ST-segment depression or elevation.


A. Coronary angiogram in the left caudal view shows the left coronary artery tree with a circumflex artery.


B. Coronary angiogram in the left anterior oblique cranial view shows the circumflex artery and right coronary artery originating from right sinus of Valsalva.


C. The significant lesion, in the left anterior oblique cranial view, shows the circumflex originating from right sinus of Valsalva.


D. After stenting the significant lesion, in left anterior oblique view shows the circumflex artery originating from right sinus of Valsalva (CX: circumflex artery, LAD: left anterior descending artery, LSV: Left sinus of Valsalva, RCA: Right coronary artery, RSV: Right sinus of Valsalva).