RESUMO
A 26-year-old woman, a well-trained runner, had a sudden cardiac arrest just before crossing the finish line of a marathon. She was rapidly resuscitated and was later found to have an ectopic origin of the left coronary artery. This anomaly was surgically repaired by translocating the ostium from the right to the left sinus of Valsalva. Her difficult postoperative course prompted further coronary evaluation, which revealed severe stenosis of the neoostium. The patient underwent a second operation: this time, the stenosis was bypassed via a left internal mammary artery-to-left anterior descending coronary artery (LAD) graft. Hypoplasia of the LAD and spasm during manipulation caused the graft to fail, necessitating double-stent angioplasty of the left main ostium and the LAD 2 months later. At the patient's 6-month follow-up examination, she had no further evidence of functional ischemia, and she resumed jogging. Because the mode and mechanism of the patient's condition and events were documented in unusual detail, this case furthers our understanding of sudden cardiac arrest in athletes who have rare coronary anomalies. We conclude that ectopia of a coronary artery does not itself cause potentially fatal ischemia. Rather, these events are due to the ectopic artery's intramural proximal course within the aortic media, which might result in critical stenosis by means of hypoplasia or lateral compression of the artery.
Assuntos
Anomalias dos Vasos Coronários , Morte Súbita Cardíaca/etiologia , Isquemia Miocárdica , Enxerto Vascular/métodos , Vasoconstritores/uso terapêutico , Fibrilação Ventricular , Adulto , Reanimação Cardiopulmonar/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/fisiopatologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Eletrocardiografia/métodos , Circulação Extracorpórea/métodos , Feminino , Hemodinâmica/efeitos dos fármacos , Humanos , Imageamento por Ressonância Magnética/métodos , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/etiologia , Isquemia Miocárdica/fisiopatologia , Isquemia Miocárdica/cirurgia , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , Esportes , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/etiologia , Fibrilação Ventricular/fisiopatologia , Fibrilação Ventricular/terapiaRESUMO
Infective endocarditis complicated by abscess formation and coronary artery compression is a rare clinical event with a high mortality rate, and diagnosis requires a heightened degree of suspicion. We present the clinical, angiographic, and echocardiographic features of a 73-year-old woman who presented with dyspnea and was found to have right coronary artery compression that was secondary to abscess formation resulting from diffuse infectious endocarditis. We discuss the patient's case and briefly review the relevant medical literature. To our knowledge, this is the first reported case of abscess formation involving a native aortic valve and the right coronary artery.
Assuntos
Abscesso/etiologia , Estenose da Valva Aórtica/complicações , Valva Aórtica/patologia , Calcinose/complicações , Estenose Coronária/etiologia , Endocardite/complicações , Infarto do Miocárdio/etiologia , Infecções Estafilocócicas/complicações , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/microbiologia , Idoso , Antibacterianos/uso terapêutico , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/microbiologia , Estenose da Valva Aórtica/diagnóstico , Aortografia/métodos , Calcinose/diagnóstico , Angiografia Coronária , Estenose Coronária/diagnóstico , Dispneia/etiologia , Ecocardiografia Transesofagiana , Eletrocardiografia , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Evolução Fatal , Feminino , Humanos , Infarto do Miocárdio/diagnóstico , Valor Preditivo dos Testes , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Extrinsic compression of the left main coronary artery by a massively dilated pulmonary artery in patients who have severe pulmonary hypertension can lead to significant myocardial ischemia. A 58-year-old man with a large patent ductus arteriosus and Eisenmenger syndrome presented with angina at rest and worsening heart failure of 3 months' duration. The new symptoms were recognized to be secondary to extrinsic compression of the left main coronary artery ostium by a dilated main pulmonary artery and were successfully relieved by the placement of a metallic stent in the affected segment of the left main coronary artery. Multislice computed tomographic imaging after 6 months showed stent patency and the intimate relation of the stented vessel to the dilated main pulmonary trunk. We discuss diagnostic and management issues pertaining to this uncommon clinical entity.
Assuntos
Angioplastia Coronária com Balão , Estenose Coronária/terapia , Complexo de Eisenmenger/complicações , Hipertensão Pulmonar/terapia , Artéria Pulmonar/patologia , Angina Instável/etiologia , Angioplastia Coronária com Balão/instrumentação , Angiografia Coronária/métodos , Estenose Coronária/diagnóstico , Estenose Coronária/etiologia , Dilatação Patológica , Permeabilidade do Canal Arterial/complicações , Complexo de Eisenmenger/terapia , Insuficiência Cardíaca/etiologia , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Masculino , Metais , Pessoa de Meia-Idade , Desenho de Prótese , Artéria Pulmonar/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Disfunção Ventricular EsquerdaRESUMO
Aortic arch aneurysm, pseudocoarctation, and coronary artery stenosis are extremely rare in Behçet's syndrome. We present the case of a 25-year-old man with Behçet's syndrome who underwent coronary artery bypass grafting for severe stenosis in the proximal left anterior descending coronary artery and concomitant surgical correction of a saccular aneurysm that was causing pseudocoarctation of the aortic arch. The surgery was successful.