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2.
Int J Rheum Dis ; 20(2): 238-244, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26012572

RESUMO

AIM: To assess left ventricular diastolic functions and serum dimethylarginine (ADMA) concentrations, as well as the effect of different treatment strategies on ADMA concentrations and diastolic function parameters, in patients with ankylosing spondylitis (AS). METHOD: Sixty AS patients and 40 control subjects without classical cardiovascular (CV) risk factors were included in the study. Baseline clinical and echocardiographic variables were obtained. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and ADMA levels were measured. Spinal mobility, disease activity and functional status were assessed using Bath Ankylosing Spondylitis Metrology Index, Bath Ankylosing Spondylitis Disease Activity Index and Bath Ankylosing Spondylitis Functional Index. RESULTS: CRP, ESR and ADMA levels were significantly higher in the AS group as compared to the control group. Two (5%) control subjects and six (10%) AS patients met the criteria for left ventricular diastolic dysfunction (DD) on conventional Doppler echocardiography, but the difference was not statistically significant (P = 0.36). However, using tissue Doppler imaging, 12 (20%) patients in the AS group and three (8%) subjects in the control group were diagnosed with left ventricular DD (P = 0.08). The anti-tumor necrosis factor (TNF)-α group, conventional therapy group and control group were compared in terms of ADMA, CRP, ESR levels and echocardiographic parameters. ADMA levels were significantly lower in anti-TNF-α group as compared to the conventional therapy group (P < 0.001). In the control group, ADMA levels were significantly lower than both treatment groups (P < 0.001). CONCLUSION: Increased ADMA levels reveal impaired nitric oxide metabolism in a relatively young group of patients with AS, who have no classical CV risk factors. Anti-TNF-α may have beneficial effect on endothelial function in AS patients by reducing ADMA levels.


Assuntos
Arginina/análogos & derivados , Espondilite Anquilosante/sangue , Espondilite Anquilosante/fisiopatologia , Função Ventricular Esquerda , Adulto , Antirreumáticos/uso terapêutico , Arginina/sangue , Produtos Biológicos/uso terapêutico , Biomarcadores/sangue , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Estudos de Casos e Controles , Estudos Transversais , Diástole , Avaliação da Deficiência , Ecocardiografia Doppler , Feminino , Humanos , Masculino , Óxido Nítrico/metabolismo , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Resultado do Tratamento , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Fator de Necrose Tumoral alfa/imunologia , Função Ventricular Esquerda/efeitos dos fármacos , Adulto Jovem
3.
Clin Rheumatol ; 35(3): 701-8, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25744156

RESUMO

The etiology of Behçet's disease (BD) has not been fully elucidated. However, immunological and environmental factors, endothelial dysfunction (ED), and genetic susceptibility have been proposed to play a role. In this study, we aimed to evaluate epicardial fat thickness (EFT) together with serum asymmetric dimethylarginine (ADMA), carotid intima media thickness (CIMT), and neutrophil-to-lymphocyte ratio (NLR) in BD patients with ocular involvement. Thirty-six ocular BD patients (17 active and 19 inactive ocular involvement), and 35 age and sex-matched healthy controls were enrolled to this cross-sectional study. All patients underwent examinations with transthoracic echocardiography and carotid Doppler ultrasound. Serum ADMA levels, CIMT, EFT, and NLR were compared between groups, and their association with disease activity was evaluated. Behçet's disease patients had higher WBC counts, neutrophil counts, NLR, CIMT, EFT values, and serum ADMA levels than do healthy controls. The other biochemical, hematological, and echocardiographic parameters were comparable between the two groups. Behçet's disease duration was positively correlated with EFT and CIMT. Multivariate logistic regression analysis revealed that increased serum ADMA concentration and CIMT are independently associated with BD. Neutrophil counts, NLR, and serum ADMA level were higher, and lymphocyte count was lower in patients with active ocular BD compared to those of inactive ocular BD group. Carotid intima media thickness, serum ADMA level, EFT, and NLR were increased in ocular BD patients compared to healthy subjects. In addition, both serum ADMA level and NLR were associated with disease activity of ocular involvement. Increase in disease duration was associated with increase in CIMT and EFT which suggests that anatomical changes occur in time during the disease course. Increased CIMT, serum ADMA level, EFT, and NLR may provide new clues about the role of ED and inflammation in the etiopathogenesis of BD.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Arginina/análogos & derivados , Síndrome de Behçet/fisiopatologia , Endotélio Vascular/fisiopatologia , Olho/fisiopatologia , Inflamação/fisiopatologia , Linfócitos , Neutrófilos , Adulto , Arginina/sangue , Síndrome de Behçet/sangue , Síndrome de Behçet/diagnóstico por imagem , Biomarcadores , Espessura Intima-Media Carotídea , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Inflamação/sangue , Inflamação/diagnóstico por imagem , Contagem de Leucócitos , Masculino , Pericárdio/diagnóstico por imagem
4.
Medicine (Baltimore) ; 94(17): e786, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25929926

RESUMO

Paraoxonase-1, a high-density lipoprotein linked enzyme complex, was shown to be decreased in several cardiovascular diseases. We aimed to explore whether serum paraoxonase and arylesterase activities differ in dipper and non-dipper prehypertensive subjects compared to healthy controls.Sixty prehypertensive subjects and 30 controls were enrolled. All subjects underwent echocardiographic assessment and 24-hour ambulatory blood pressure monitoring (ABPM). According to the blood pressure (BP) course on ABPM, prehypertensive subjects were categorized into two: non-dipper prehypertensive (NDPH) and dipper prehypertensive (DPH) groups. Serum paraoxonase and arylesterase activities were detected spectrophotometrically.Paraoxonase and arylesterase activities were significantly lower in patients with NDPH compared to both DPH and control groups. Both paraoxonase and arylesterase activities showed significant negative correlations with BP and left ventricular mass index.We have demonstrated that NDPH subjects have lower paraoxonase and arylesterase activities compared to DPH subjects and normotensives. Further prospective studies are needed to clarify the role of paraoxonase and arylesterase activities in the development of overt hypertension in prehypertensive subjects.


Assuntos
Arildialquilfosfatase/sangue , Hidrolases de Éster Carboxílico/sangue , Pré-Hipertensão/enzimologia , Adulto , Monitorização Ambulatorial da Pressão Arterial , Estudos de Casos e Controles , Ecocardiografia , Feminino , Humanos , Masculino , Estresse Oxidativo , Pré-Hipertensão/diagnóstico por imagem , Estudos Prospectivos
5.
J Clin Med Res ; 4(4): 279-85, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22870176

RESUMO

BACKGROUND: The aim of this study is to investigate the frequency of metabolic syndrome (MS) in patients with rheumatoid arthritis (RA) and to determine the relationship between the clinical and laboratory parameters of RA and the components of the metabolic syndrome (MS). METHODS: Fifty-four patients with RA and 52 healthy individuals were enrolled in this study. The diagnosis of rheumatoid arthritis was based on the American College of Rheumatology criteria and the diagnosis of the metabolic syndrome was made according to the criteria set out in the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI). The functional status and disease activity were also recorded in patients with RA. RESULTS: MS was diagnosed in 42.6% of the patients with RA and in 9.6% of the healthy controls. The systolic and diastolic blood pressure values were observed to be significantly higher in the patients with RA in comparison to the controls. Also, the frequency of MS was higher in the inferior functional group in relation to the higher functional group. A positive correlation was observed between the DAS28 scores and hypertension in patients with RA. CONCLUSIONS: In this study, MS was more frequently detected in the patients with RA compared to the control group. Also, an inferior functional status in RA was also found to be associated with the presence of MS. Thus, the presence of MS in patients with RA may be associated with a higher cardiovascular risk.

6.
J Infect Dev Ctries ; 6(7): 579-83, 2012 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-22842945

RESUMO

Cardiac echinococcosis rarely mimics acute coronary syndrome. The diagnosis of cardiac hydatid cyst might be difficult on account of varying clinical presentations and nonspesific symptoms. A 75-year-old female was admitted to our hospital with typical chest pain. The patient had no history of previous cardiac symptoms or any illness leading to heart disease. Her ECG revealed ischemic changes. However, her coronary angiography revealed noncritical plaques in the left anterior descending artery. The diagnosis of cardiac echinococcosis was identified using echocardiography, computed tomography and magnetic resonance imaging. The patient was referred to cardiac surgery for resection of the cyst; however, she refused surgery. Albendezol 800 mg/day was prescribed.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Equinococose/diagnóstico , Ventrículos do Coração/patologia , Síndrome Coronariana Aguda/parasitologia , Síndrome Coronariana Aguda/patologia , Idoso , Angiografia Coronária , Diagnóstico Diferencial , Ecocardiografia , Feminino , Ventrículos do Coração/parasitologia , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X
7.
Cardiol J ; 19(1): 86-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22298174

RESUMO

Ingestion of acid-containing household products, either accidentally or as a suicide attempt, is a common form of intoxication. A clear and odorless liquid, hydrogen peroxide is an oxidizing agent found in most households and many industrial environments. Cardiovascular manifestations of hydrogen peroxide ingestion are extremely rare. Here we report a 60 year-old woman with acute inferolateral myocardial infarction (MI) after hydrogen peroxide ingestion, who had no history of coronary artery disease. Physicians dealing with hydrogen peroxide ingestion in the emergency department should be aware of the probability of MI and obtain an electrocardiogram, even if the patient has no cardiac complaint.


Assuntos
Peróxido de Hidrogênio/intoxicação , Infarto do Miocárdio/induzido quimicamente , Oxidantes/intoxicação , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico
8.
Clin Appl Thromb Hemost ; 18(6): 650-3, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-22327822

RESUMO

AIM: To investigate the relationship between mean platelet volume (MPV) and in-hospital deep venous thrombosis (DVT). MATERIAL AND METHODS: 147 patients with the diagnosis of DVT and 149 control participants were included in the study. For all participants, clinical risk factors, smoking status, and other demographic data were recorded from hospital registries. The data of patients with DVT were compared with the control participants. RESULTS: Mean MPV was significantly higher in patients with DVT than the control group (8.91 ± 1.86 vs 7.86 ± 0.9; P < .001). Body mass index, smoking frequency, hematocrit, and platelet count were significantly correlated with MPV. Independent predictors of in-hospital DVT were MPV (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2-1.87; P ≤ .001), body mass index (OR = 1.17; 95% CI = 1.04-1.34; P = .012), and smoking (OR = 1.83; 95% CI = 1.09-3.08; P = .023). CONCLUSION: Mean platelet volume was significantly higher in patients with DVT, and it is an independent predictor of in-hospital DVT.


Assuntos
Plaquetas , Trombose Venosa/sangue , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Estudos Retrospectivos
9.
Blood Press ; 21(3): 202-8, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22229446

RESUMO

OBJECTIVE: Epicardial fat has been proposed as a new cardiometabolic risk factor. Although epicardial fat thickness (EFT) is associated with hypertension, the relationship between diurnal blood pressure profiles and EFT is still unknown. The purpose of this study is to investigate the association between the echocardiographic EFT and diurnal blood pressure profiles in hypertensive patients. METHODS: After the ambulatory blood pressures of 123 patients were monitored, they were divided into three groups according to the clinical diagnoses: 41 patients (33.3%) were in the normotensive group, 40 patients (32.5%) were in the dipper hypertensive group and 42 patients (34.1%) were in the non-dipper hypertensive group. All participants underwent transthoracic echocardiography and ambulatory blood pressure monitoring to measure the EFT and blood pressure responses. RESULTS: The mean EFT measurements of the dipper group were significantly higher than the normotensive group (6.5 ± 0.6 vs 5.8 ± 0.6; p < 0.0001). On the other hand, the mean EFTs of the non-dipper group were also significantly higher than the dipper group (7.4 ± 0.7 vs 6.5 ± 0.6, p < 0.0001). An EFT of ≥ 7 mm predicted the non-dipper profile in hypertensive patients with 74% sensitivity and 71% specificity (receiving operator characteristic area under the curve: 0.826, 95% CI 0.738-0.913; p < 0.0001). EFT was associated with both dipper (OR 8.9, 95% CI 3.03-26.3; p < 0.0001) and non-dipper blood pressure profiles (OR 12.3, 95% CI 1.75-86.31; p < 0.0001), and this relationship was also independent from all the risk factors. CONCLUSION: Echocardiographic EFT assessment is independently associated with impaired diurnal blood pressure profiles in the hypertensive individuals. Thus, the echocardiographic assessment of the EFT may be helpful in cardiometabolic risk stratification and therapeutic interventions.


Assuntos
Tecido Adiposo/diagnóstico por imagem , Pressão Sanguínea/fisiologia , Obesidade/patologia , Pericárdio/diagnóstico por imagem , Tecido Adiposo/patologia , Ritmo Circadiano , Ecocardiografia/métodos , Ecocardiografia Doppler , Gorduras , Humanos , Masculino , Pessoa de Meia-Idade , Obesidade/diagnóstico por imagem , Obesidade/fisiopatologia , Pericárdio/anatomia & histologia , Fatores de Risco
11.
Wien Klin Wochenschr ; 124(1-2): 3-10, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22183816

RESUMO

UNLABELLED: Pulmonary Veins are one of the major structures of circulation. In the last decade, pulmonary veins have been known to play an important role as the triggering focus of the electrical activity in atrial fibrillation. Primary treatment method of AF is RF ablation of the focus. For the best ablation, the anatomy of PVs should be well established before the procedure. MATERIAL AND METHODS: In our radiology department, 783 patients underwent computed tomography angiography between January 2008 and May 2010. Patients were referred for coronary CTA because of known or suspected coronary artery disease or computed tomography pulmonary angiography (CTPA) because of known or suspect pulmonary embolism. All scanning was performed on Philips Brilliance 64 slice Multidetector CT. The group consisted of 402 male and 381 female patients with the average age of 48 (range 14-89). CT data of patients were retrospectively reviewed to identify the PV anatomy and to determine anatomic variants and anomalies. RESULTS: In the majority of cases, two pulmonary veins drain into the left atrium on each side. Eighteen and eight variations were found in the right and left sides, respectively. Most frequent combined variations were 2R-4L (32.3%) and 4L was the more frequent single variation type (76%). In addition to that one Situs inversus totalis (0.12%), two partial anomalous pulmonary venous returns (0.25%) and one scimitar syndrome (0.12%) were found. CONCLUSION: This study showed that multiple types of variations of PVs can be found with increasing patient number. Therefore, for the successful ablation and surgery without any complications, the anatomy of PVs should be known before the procedure. MDCT is a reliable imaging method for the detailed cross-sectional and 3D anatomy.


Assuntos
Flebografia/estatística & dados numéricos , Veias Pulmonares/anormalidades , Veias Pulmonares/diagnóstico por imagem , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Turquia/epidemiologia , Adulto Jovem
12.
Blood Coagul Fibrinolysis ; 23(1): 91-3, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22024793

RESUMO

The mean platelet volume (MPV) values reflect platelet size and are accepted as marker of platelet activation. We sought to test the hypothesis that platelet activation occurs independently from presence or absence of thrombus in prosthetic mitral valve. A total of 168 patients were included in the study. Study participants were divided in three groups: group 1 (n = 62) - patients with normal prosthetic mitral valve; group 2 (n = 37) - patients with prosthetic mitral valve thrombosis; and group 3 (n = 69) - healthy individuals. MPV values were significantly higher in normal and thrombotic prosthetic mitral valve patients than in healthy individuals (P = 0.008 and P = 0.01, respectively). MPV values were not different between normal prosthetic mitral valve and thrombotic prosthetic mitral valve. This is the first study indicating that increased MPV is present in normal and thrombotic prosthetic mitral valve, implying that platelet reactivity occurs in prosthetic mitral valve irrespective of development of thrombus formation.


Assuntos
Plaquetas/citologia , Próteses Valvulares Cardíacas , Valva Mitral/fisiologia , Trombose/sangue , Ecocardiografia Doppler/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valva Mitral/diagnóstico por imagem , Ativação Plaquetária , Trombose/diagnóstico por imagem
14.
Scand J Clin Lab Invest ; 71(7): 613-9, 2011 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21859357

RESUMO

Mean platelet volume (MPV) is a marker of platelet activation. An increased MPV is associated with acute myocardial infarction (AMI) and long-term mortality. The aim of this study was to compare MPV in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). Also, we investigated the value of MPV on in-hospital mortality and long-term prognosis of patients with STEMI and NSTEMI. We studied 429 patients with AMI (70.4% male, 61.9 ± 12.4 years; 279 patients with STEMI, 150 patients with NSTEMI). MPV and platelet count were similar in both groups. Elevated MPV increased the risk of death by 3.1-fold (p < 0.001) in STEMI group during the hospitalization. However, increased MPV was not associated with in-hospital mortality in NSTEMI group. The area under the receiver operating characteristic curve of MPV was 0.868 (95% CI, 0.830-0.907) for predicting two-year mortality. A cut-off point of 11.1 fL showed a sensitivity of 81% and a specifity of 77% for prediction of two-year mortality. Kaplan-Meier survival curve showed two-year mortality rate of 12.5% in patients with MPV >11.1 fL versus 9.9% in patients with MPV <11.1 fL (p < 0.001). Cox regression analysis showed MPV to be an independent predictor of two-year mortality (Hazard ratio 1.7; 95% CI 1.5-1.9; p < 0.001). An increased MPV is an independent predictor of in-hospital mortality in patients with STEMI. However, elevated levels of MPV did not predict in hospital mortality in NSTEMI group. The increase in MPV values was independently correlated with two-year mortality in all study patients.


Assuntos
Biomarcadores/análise , Plaquetas/patologia , Infarto do Miocárdio/diagnóstico , Idoso , Tamanho Celular , Eletrocardiografia , Feminino , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Morbidade , Infarto do Miocárdio/classificação , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Ativação Plaquetária , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Sensibilidade e Especificidade , Turquia/epidemiologia
17.
Biol Trace Elem Res ; 144(1-3): 436-44, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21720784

RESUMO

The essential trace elements play important roles in the maintainance of the normal structure and physiology of cells. Several research groups have demonstrated that they also play important roles in states of cardiovascular diseases. Our aim is to investigate whether there is a relationship between trace elements (Zn and Cu) and the degree of atherosclerosis. The sample consisted of 67 patients with coronary artery disease and 26 clinically healthy individuals. Ninety-three subjects were separated into four groups according to their Gensini scores, the number of diseased vessels, the presence of acute coronary syndrome, and ejection fraction. Each group was divided into three subgroups, and serum zinc and copper levels were measured for each individual. The serum levels of zinc and copper were found to be significantly lower in patients with atherosclerosis than in the control group, but there were no significant differences in the serum levels of Cu and Zn between severe atherosclerosis and mild atherosclerosis. In Spearman's rank correlation, the zinc and copper levels were correlated with the Gensini score and the number of diseased vessels. The present study revealed a relationship between the serum levels of zinc and copper and atherosclerosis, but not between these levels and the severity of the disease.


Assuntos
Cobre/sangue , Doença da Artéria Coronariana/sangue , Zinco/sangue , Síndrome Coronariana Aguda/sangue , Síndrome Coronariana Aguda/diagnóstico por imagem , Idoso , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/patologia , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Espectrofotometria Atômica , Ultrassonografia
18.
Ann Nucl Med ; 25(2): 125-31, 2011 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-21104169

RESUMO

OBJECTIVE: ECG-gated myocardial perfusion scintigraphy (MPS) can be used to determine several cardiac functional parameters (e.g., left ventricular ejection fraction (LVEF), end-diastolic volume (EDV), and end-systolic volume (ESV)). In this study, we aimed to compare these cardiac functional parameters calculated by the following cardiac quantification programs: Emory Cardiac Toolbox (ECTb), Quantitative Gated SPECT (QGS), and Myometrix. We also evaluated reproducibility of the cardiac programs. METHODS: Fifty-seven patients (27 male, 30 female) at Elazig Research and Training Hospital from 2008 to 2009 were included in this study. In all patients, (99m)Tc-MIBI ECG-Gated (8-bin frame mode) myocardial perfusion scintigraphies were performed. By using 3 different cardiac quantification programs (ECTb, QGS, and Myometrix); LVEF, EDV, and ESV were calculated. The same raw data of MPS images were reprocessed at different time periods, and these 3 parameters were recalculated. LVEF, EDV, and ESV yielded by 3 different programs were compared for interprogram variability assessment, and parameters calculated at two different time periods were compared to evaluate intraprogram reproducibility. RESULTS: There were statistically significant differences between ECTb, QGS, and Myometrix programs for LVEF, EDV, and ESV (p < 0.001). There was also a statistically significant correlation between LVEF and EDV (p < 0.001, r = 0.546; p < 0.001, r = 0.45, respectively), but no statistically significant correlation was present between the ESV values (p > 0.05, r = 0.09). Statistically significant differences were not found between the values of LVEF, EDV, and ESV obtained from the first and second reconstruction analysis of 3 cardiac quantification programs. DISCUSSION: Different MPS cardiac software programs give variable (but correlated) LVEF and left ventricular volumetric measures. Those obtained from different cardiac softwares cannot be used interchangeably. Our findings have shown that ECTb, QGS, and Myometrix programs are reproducible, with respect to LVEF, EDV, and ESV.


Assuntos
Coração/diagnóstico por imagem , Coração/fisiologia , Software , Função Ventricular Esquerda , Adulto , Idoso , Automação , Eletrocardiografia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Imagem de Perfusão do Miocárdio , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Volume Sistólico
19.
Int J Angiol ; 20(2): 101-2, 2011 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22654472

RESUMO

Coronary artery anomalies are not uncommon. The importance of coronary anomalies varies from unimportant to life threatening. Herein, we report for the first time twin circumflex coronary arteries originating separately from the left sinus of Valsalva.

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