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Bilateral fused ectopic pelvic kidneys with lateral rotation abnormality in both kidneys is a fortuitous developmental renal anomaly that to the best of our knowledge this is the first report of this rare anomaly in English literature. Due to the morphologic appearance of this anomaly it is likely it could contribute to the individual remaining asymptomatic therefore discovered incidentally. We present a 42-year-old male who presented with acute unilateral flank pain and incidentally discovered this rare renal anomaly which is an important diagnosis for management by both radiologists and urologists. © 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.Coronary spastic angina (CSA) in premenopausal women is rare, but has also been suggested to be associated with estrogen decline during the menstrual cycle. In this report, we describe the case of a young premenopausal patient with refractory CSA. She presented with ventricular fibrillation (VF) at the age of 15 years and was diagnosed as having CSA. She underwent implantation of an Implantable Cardioverter Defibrillator (ICD), and despite receiving systemic drug therapy at the maximum doses, she experienced a total of four appropriate ICD shocks over the subsequent six years. Based on careful history-taking, it was suspected that the angina episodes were closely related to the phase of the menstrual cycle. We started the patient on continuous combined estrogen-progestin hormone contraception therapy so as to prevent the reduction of the blood estrogen levels just prior to and during menstruation. After the start of this treatment, the patient became completely free of angina episodes. Although there are a few reports of the efficacy of hormone replacement therapy in premenopausal women with CSA, this is the first report of the efficacy of this therapy in a woman as young as 22 years old. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Adverse cardiovascular events have been reported in patients with multiple myeloma. We present a case of coronary spastic angina during combination therapy with bortezomib, lenalidomide, and dexamethasone for multiple myeloma. A 70-year-old man, newly diagnosed with multiple myeloma, was admitted to our hospital at his fifth therapy cycle due to exertional chest pain. Coronary angiography revealed diffuse spasm in the left coronary artery, which normalized after intracoronary injection of nitroglycerin. Calcium channel blockers were effective in treating his coronary spastic angina and the patient resumed treatment for multiple myeloma. This case highlights the importance of being aware of the possibility of coronary spastic angina when combination therapy with bortezomib, lenalidomide, and dexamethasone is initiated. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd.Sub-mitral aneurysm (SMA) is a rare cardiac malformation commonly reported in young adults of African ancestry. SMA is considered a congenital disease caused by developmental defect due to weakness at the atrioventricular junction near the posterior mitral annulus. In the past two decades, a considerable number of cases regarding this rare disease have been reported in Asians, highlighting the importance of considering SMA in differential diagnosis of young patients presenting with mitral regurgitation and chest pain. Herein, we report the case of a young male with atypical chest pain with compression of left circumflex coronary artery by a large SMA. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.We describe a successful bioprosthetic annular stretching in a patient with severe prosthetic aortic valve stenosis from a degenerated 19-mm Mitroflow valve (Sorin Group USA Inc, Arvada, CO, USA). This technique allowed for implantation of a 23-mm Evolut-R Pro valve (Medtronic, Minneapolis, MN, USA) with significant improvement in hemodynamics after prosthetic annular stretching. We have also summarized other case series and case reports which have previously described similar techniques. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.Giant cell myocarditis is a rare and frequently fatal disease that requires extensive cardiac care. Given the rarity of this condition no specific management recommendations exist. We describe a patient who presented with congestive heart failure that required a left ventricular assist device and a temporary right ventricular assist device along with immunosuppressive therapy. This case also brings to attention how undocumented immigration status can limit transplantation opportunities in the USA. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.The prognosis of pulmonary arterial hypertension (PAH) has significantly improved over the past two decades due to advances in medications, including pulmonary vasodilators. However, the side effects of these drugs remain problematic in some patients. A 51-year-old woman with chronic hepatitis C was diagnosed with PAH 7 years before presenting to our hospital. She was unable to continue her treatment with pulmonary vasodilators due to various side effects. She had a World Health Organization functional class of IV and was started on continuous infusion of prostaglandin I2 (PGI2). This therapy improved her symptoms, including dyspnea and fatigue. However, she began to complain of abdominal distension after 4 months of PGI2 therapy. Computed tomography showed significant hepatosplenomegaly. Her abdominal distension improved slightly after decreasing PGI2 treatment, but her dyspnea on exertion was exacerbated. She died 12 years after diagnosis of PAH due to uncontrollable heart failure. Here, we describe a rare case of PAH with hepatosplenomegaly after administration of PGI2. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.A 75-year-old male suffered from dyspnea on exertion. In a referring hospital, cardiac catheterization demonstrated a 25% increase in oxygen saturation between the high superior vena cava (SVC) and the right atrium, suggesting a pre-tricuspid left-to-right shunt. However, neither an intracardiac shunt nor a partial anomalous pulmonary venous connection was detected. [https://www.selleckchem.com/products/VX-745.html VX-745] Therefore, he was referred to our hospital for further evaluation. A transesophageal echocardiogram revealed a retrograde-dominant bidirectional flow in the right upper pulmonary vein (RUPV). A contrast agent injected via the left upper limb appeared in the SVC and thereafter some contrast entered into the RUPV. A three-dimensional reconstructed computed tomography showed a side-to-side communication between the RUPV and the SVC. A cavopulmonary window was definitively diagnosed, in which the RUPV not only drained into the left atrium but also connected to the SVC side-to-side. . © 2020 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.