Acute decompensated heart failure in young: Unusual causes and their management

Emergent surgery may be the only choice in certain situations of acute decompensated heart failure, despite carrying a high procedural risk of mortality. We enumerate three such cases in this series. (1) The first case is a case of rupture of sinus of valsalva complicated by fulminant infective endocarditis: The sinus of valsalva aneurysm can rupture due to several causes, including infections, trauma, or congenital abnormalities. When this happens, it can lead to a life-threatening condition called an aorto-cavitary fistula. In the case of infective endocarditis, the rupture can be accompanied by septicemia, which further complicates the situation. Emergent surgery is often required to repair the rupture, control the infection and prevent the spread of sepsis. (2) Case of ping pong giant left atrial thrombus in a patient with severe Rheumatic mitral stenosis: In rare cases of Rheumatic mitral stenosis, a massive thrombus can form in the left atrium, which is called a “ping-pong” thrombus due to its mobility within the chamber. Emergent surgery is necessary to remove the thrombus and prevent further complications. (3) Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare and severe complication of pulmonary embolism, which can lead to progressive right heart failure and death. In some cases, CTEPH can manifest for the first time with an acute pulmonary embolic event accompanied by severe cardio-respiratory failure. Emergent surgery, such as pulmonary thromboendarterectomy, is necessary to remove the thrombi from the pulmonary arteries and improve the patient’s outcome. However, this procedure carries a high risk of mortality, and careful patient selection and management are essential to ensure the best possible outcome.