IntroductionBecause of the unusual anatomy of an anomalous origin of the right coronary artery from the left sinus of Valsalva, selective cannulation of the guiding catheter in percutaneous coronary intervention for these cases is always challenging.Case presentationA 58-year-old Japanese man was admitted to our hospital complaining of worsening exertional chest pain. He was suspected of having unstable angina pectoris and underwent cardiac catheterization. We found a subtotal occlusive lesion in the mid-portion of his right coronary artery that originated from the left sinus of Valsalva. On the previous percutaneous coronary intervention, we failed to cannulate the guiding catheter to the anomalous orifice of the right coronary artery. Therefore, we decided to use the GuideLiner catheter for stable back-up support from the beginning. A 6Fr GuideLiner catheter was introduced into the right coronary artery by anchoring it coaxially with a semi-compliant balloon catheter. And we successfully deployed two drug-eluting stents by crossing over the posterior-descending artery. Final angiography demonstrated favorable dilatation of the target lesion, and native blood flow in the right coronary artery was completely recovered.ConclusionGuideLiner is a monorail-type “child” support catheter that facilitates coaxial guiding catheter engagement and an appropriate back-up force, achieving successful device delivery to target lesions in this kind of complex percutaneous coronary intervention.

Valacyclovir, a prodrug of acyclovir, is the first-line treatment for herpes zoster, but the renal function must be monitored, because acyclovir is metabolized by the kidneys. We herein report a case of valacyclovir-induced neurotoxicity with no preceding renal impairment. An 88-year-old man was admitted because of an impaired consciousness after the administration of valacyclovir at 3,000 mg daily for herpes zoster on the chest. His consciousness level gradually improved with hydration and valacyclovir withdrawal. It was later confirmed that the level of acyclovir on admission had been 35.45 μg/mL in the blood and 36.45 μg/mL in the cerebrospinal fluid.

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An early diastolic flow from the left ventricular apex to the base can be shown in patients with hypertrophic cardiomyopathy (HCM). This tiny flow or a diastolic paradoxic jet flow is important to detect on echocardiography because of its association with cardiovascular adverse events. We report an asymptomatic 44-year-old man with midventricular obstructive HCM, in which a diastolic paradoxic jet flow was observed not only in the left ventricle but also in the right ventricle. The diastolic paradoxic jet flow in the right ventricle started approximately 110 ms after the onset of the second heart sound, lasted for almost 95 ms, and disappeared in coincidence with the third heart sound; the onset was later and the duration was similar, compared with the diastolic paradoxic jet flow in the left ventricle. He had been doing well without any medication for months and later lost to follow-up.