Subject(s)
Humans , Female , Aged, 80 and over , Cardiac Catheterization/methods , Coronary Vessel Anomalies/surgery , Acute Coronary Syndrome/surgery , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Atherosclerosis , Acute Coronary Syndrome/complications , Acute Coronary Syndrome/diagnosis , Angina, UnstableABSTRACT
Resumen: La disección coronaria espontánea ha surgido como una causa interesante y poco reconocida de síndrome coronario agudo no aterosclerótico. Ocurre más frecuentemente en mujeres jóvenes, donde de forma importante puede asociarse a anomalías arteriales no coronarias. La clave para un tratamiento oportuno es el diagnóstico precoz que impida su evolución a cuadros más severos. Se presenta el caso de una mujer de 36 años con un síndrome coronario agudo secundario a una disección coronaria espontánea bi-arterial que evolucionó de forma grave a una insuficiencia cardíaca aguda. El objetivo es informar un cuadro poco usual y proporcionar evidencia que respalde el cómo debe enfrentarse.
Abstract: Spontaneous coronary dissection is an important cause of acute non-atherosclerotic coronary syndrome. It occurs more frequently in young women, often without significantly associated coronary arterial anomalies. Early diagnosis is a key to prompt treatment, in order to prevent severe complications. We report the case of a 36-year-old woman with an acute coronary syndrome secondary to spontaneous bi-arterial coronary dissection progressing to severe acute heart failure. A discussion of the management of this condition is included.
Subject(s)
Humans , Female , Adult , Vascular Diseases/surgery , Vascular Diseases/complications , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/complications , Myocardial Infarction/etiology , Vascular Diseases/diagnostic imaging , Stents , Coronary Vessel Anomalies/diagnostic imaging , Percutaneous Coronary InterventionSubject(s)
Humans , Female , Middle Aged , Vascular Diseases/congenital , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessels/diagnostic imaging , Acute Coronary Syndrome/diagnosis , Vascular Diseases/diagnostic imaging , Coronary Angiography/methods , Coronary Vessel Anomalies/complications , Electrocardiography/methods , Acute Coronary Syndrome/etiology , Computed Tomography Angiography , Myocardial Infarction/diagnosis , Myocardial Infarction/etiologyABSTRACT
RESUMO Os autores relatam um raro caso de uso de Suporte Avançado de Vida no contexto de uma parada cardíaca ocorrida em razão de uma origem aórtica anômala da artéria coronária direita em um paciente de 49 anos de idade. O paciente foi admitido com dor torácica e dispneia, evoluindo rapidamente para taquicardia ventricular sem pulso e parada cardiopulmonar. Considerou-se um infarto agudo do miocárdio e, na ausência de um laboratório de hemodinâmica no hospital, realizou-se trombólise. Subsequentemente, uma angiografia coronária revelou ausência de lesões angiográficas nas artérias coronárias e origem anômala da artéria coronária direita do seio de Valsalva oposto. Uma angiografia coronária por tomografia computadorizada confirmou o achado e determinou um trajeto entre a artéria pulmonar e a aorta. O paciente foi submetido à cirurgia cardíaca com realização de ponte de mamária para a artéria coronária direita, sem qualquer novo episódio de arritmia.
ABSTRACT The authors report a rare case of successful Advanced Life Support in the context of cardiac arrest due to the presence of an anomalous aortic origin of the right coronary artery in a 49-year-old patient. The patient was admitted due to chest pain and dyspnea, with rapid evolution of pulseless ventricular tachycardia and cardiopulmonary arrest. Acute myocardial infarction was considered, and in the absence of a hemodynamic laboratory in the hospital, thrombolysis was performed. Subsequently, coronary angiography revealed no angiographic lesions in the coronary arteries and an anomalous right coronary artery originating from the opposite sinus of Valsalva. Coronary computed tomography angiography confirmed this finding and determined the course between the pulmonary artery and the aorta. The patient underwent cardiac surgery with a bypass graft to the right coronary artery, with no recurrent episodes of arrythmia.
Subject(s)
Humans , Middle Aged , Sinus of Valsalva , Coronary Vessel Anomalies/complications , Heart Arrest/etiology , Aorta , Coronary AngiographyABSTRACT
The anomalous origin of the coronary arteries is uncommon and the origin of the right coronary artery from the middle third of the anterior descending artery is a finding of extreme rarity. We report two patients with coronary atherosclerotic disease and with an acute coronary syndrome, in whom a single left coronary artery was found. The clinical and angiographic characteristics and the treatment of these patients are described.
Subject(s)
Humans , Male , Middle Aged , Aged , Coronary Artery Disease/diagnostic imaging , Coronary Vessel Anomalies/diagnostic imaging , Coronary Artery Disease/surgery , Coronary Artery Disease/etiology , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/complicationsSubject(s)
Adult , Humans , Male , Aortic Coarctation/complications , Coronary Vessel Anomalies/complicationsABSTRACT
Anomalies of the origin of coronary arteries are detected in 0.5-1.5% of all angiographies. Anomalous origin of the left main trunk is the most uncommon and its origin from pulmonary artery in adults is exceptional, usually because it is associated with a short survival. We report a 49-year-old female, presenting with a two months history of angina. The exercise electrocardiogram suggested ischemia. A coronary angiography was performed, showing the absence of the left main trunk in the left coronary sinus, a dilated right coronary artery, with no lesions and extensive collateral circulation to the anterior descending and circumflex arteries, with inverted flow and the left main trunk draining to the pulmonary artery. The left ventricle was mildly dilated with middle and apical anterior hypokinesia. Global systolic function was conserved. A surgical correction was decided, occluding the left main anomalous origin and performing a coronary artery bypass grafting from the left internal thoracic artery. The patient was discharged with no complications. At two years of follow-up she is symptom free and has a normal physical capacity.
Subject(s)
Humans , Female , Middle Aged , Pulmonary Artery/abnormalities , Coronary Artery Disease/complications , Coronary Vessel Anomalies/complications , Angina Pectoris/etiology , Pulmonary Artery/diagnostic imaging , Coronary Artery Disease/diagnostic imaging , Coronary Angiography , Coronary Vessel Anomalies/diagnostic imaging , Angina Pectoris/diagnostic imagingABSTRACT
No abstract available.
Subject(s)
Aged , Humans , Male , Angina Pectoris/diagnosis , Coronary Angiography , Coronary Artery Disease/complications , Coronary Stenosis/complications , Coronary Vessel Anomalies/complications , Percutaneous Coronary Intervention/instrumentation , Stents , Treatment OutcomeABSTRACT
Objective: Anomalous origin of coronary artery is uncommon. The taxonomies of anomalous origin of coronary artery are inconsistent and complex. Conceptual and therapeutic debates remain. The aim of the present study is to reappraise the concept of anomalous origin of coronary artery and to discuss the potential hazards and treatment rationale of this anomaly on basis of literature review. Methods: A comprehensive literature review was made in terms of the taxonomies including “simple”, “multiple” and “complex” types of anomalous origin of coronary artery. Results: Anomalous origin of coronary artery can be simply categorized according to the ectopically originated coronary artery. There are a couple of complex anatomical variants: “multiple” type, involving more than one coronary artery or branch, which can be subdivided into 2 subtypes, A) more than one coronary arteries or branches arising from one place; and B) two coronary arteries/branches arising from separate ectopic sites; and “complex” type, associated with acquired heart disease, or congenital heart defects. Conclusion: Sudden cardiac death in anomalous origin of coronary artery is associated with the anatomical features including abnormal coursing, acute angle take-off and ostial abnormalities. Atherosclerosis is prone to be in the right-sided ectopic and retroaortic coursing coronary artery. Surgical treatment is a definitive therapy. Simple coronary artery bypass grafting is not recommended due to the potential hazards of coronary steal phenomenon and poor patency of mammary arterial grafts, and modified maneuvers such as coronary ostial reimplantation, impinged coronary segment unroofing and coronary stent deployment are advocated instead. .
Objetivo: A origem anômala da artéria coronária é incomum. As taxonomias de origem anômala da artéria coronária são inconsistentes e complexas. Os debates conceituais e terapêuticos permanecem. O objetivo do presente estudo é reavaliar o conceito de origem anômala da artéria coronária e discutir os riscos potenciais e fundamentos para o tratamento desta anomalia, com base em revisão de literatura. Métodos: A revisão da literatura foi feita com termos das taxonomias, incluindo origem anômala da artéria coronária “simples”, “múltipla” e “complexa”. Resultados: A origem anômala da artéria coronária pode ser simplesmente classificada de acordo com a origem ectópica da artéria coronária. Há um par de variações anatômicas complexas: “múltipla”, envolvendo mais de uma artéria coronária ou ramo, que podem ser subdivididos em dois subtipos: A) mais de uma das artérias coronárias ou ramos decorrentes de um lugar; e B) duas artérias coronárias/ramos decorrentes de sítios ectópicos separados; e tipo “complexo”, associado à doença cardíaca adquirida ou defeitos cardíacos congênitos. Conclusão: A morte súbita cardíaca de origem anômala da artéria coronária está associada com as características anatômicas incluindo curso anormal, descolamento de ângulo agudo e anormalidades ostiais. A aterosclerose é propensa a ocorrer na artéria coronária ectópica e retroaórtica, do lado direito. O tratamento cirúrgico é uma terapia definitiva. Revascularização do miocárdio simples não é recomendada devido aos riscos potenciais do fenômeno de “roubo” do fluxo coronário e patência ruim dos enxertos com a artéria torácica interna. Manobras modificadas como reimplante ostial coronário, destelhamento do segmento coronário impingido e implantação de stent coronário são defendidas em seu lugar. .
Subject(s)
Humans , Coronary Vessel Anomalies/classification , Coronary Vessel Anomalies/complications , Aorta/abnormalities , Coronary Angiography , Coronary Vessel Anomalies/pathology , Death, Sudden, Cardiac/etiology , Medical Illustration , Pulmonary Artery/abnormalities , Risk FactorsABSTRACT
Anomalias coronarianas podem ser benignas ou graves, causando isquemia miocárdica, infarto e morte súbita. Relata-se o caso de paciente submetido acateterismo devido à dispneia progressiva sem precordialgia. O ecocardiograma apresentou déficitcontrátil global acentuado às custas do déficit contrátil da parede anterior. A cintilografia apresentou isquemia discreta e fibrose moderada em grandeterritório na parede anterior. A cinecoronariografia e a angio-TC mostraram artéria descendente anteriorcom porção proximal em trajeto habitual. Já seus terços médio e distal originavam-se da coronária direita.Assim, relata-se um caso de dupla-origem da artéria descendente anterior relacionada com insuficiência cardíaca sem angina.
Coronary anomalies may be benign or severe, causing myocardial ischaemia, infarction and sudden death. This case report describes a patient undergoing cardiac catheterization due to progressive dyspnea with no chest pain. The echocardiogram showed a markedglobal contractile deficit due to a contractile deficit in the anterior wall. The scintigraphy showed discreetischaemia and moderate fibrosis in a large area of the anterior wall. The cinecoronariography and angio-CTshowed the proximal portion of the anterior descending artery in a normal position, with the center and distalportions originating in the right coronary artery. This case report describes a dual-origin anterior descending artery related to heart failure without angina,
Subject(s)
Humans , Male , Middle Aged , Coronary Vessel Anomalies/complications , Heart Failure/therapy , Predictive Value of Tests , Angiography/methods , Cardiac Catheterization/methods , Echocardiography/methodsSubject(s)
Adult , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessels/pathology , Dilatation, Pathologic/diagnosis , Dilatation, Pathologic/diagnostic imaging , Echocardiography, Transesophageal , Female , Humans , Noonan Syndrome/epidemiologyABSTRACT
JUSTIFICATIVA E OBJETIVOS: O relato de caso descreve uma situação rara e potencialmente fatal associada à administração de anestesia. Nosso objetivo foi discutir as causas de parada cardíaca súbita no período perioperatório em pacientes aparentemente saudáveis e a fisiopatologia das anomalias de origem das artérias coronárias como uma causa de parada cardíaca súbita. RELATO DE CASO: Uma mulher de 44 anos, sem sintomas prévios de doença coronariana ou arritmias, apresenta parada cardíaca súbita durante a instalação de anestesia geral em duas situações distintas. No primeiro episódio, a paciente apresentava-se com quadro de abdômen agudo, porém hemodinamicamente estável. Após a indução anestésica, ocorreu bradicardia e hipotensão arterial, refratárias à reposição de volume e vasopressores. O quadro evoluiu para assistolia. A paciente foi reanimada com sucesso e recebeu alta em boas condições. No segundo episódio, um ano após o primeiro, a paciente se encontrava em boas condições clínicas para feitura de uma cirurgia eletiva. Após a indução anestésica, a paciente desenvolveu taquicardia ventricular seguida por assistolia, que foi prontamente revertida. Após extensa investigação, foi identificada uma origem anômala da artéria coronária esquerda. CONCLUSÕES: Nosso relato é ilustrativo ao enfatizar que uma investigação diagnóstica minuciosa deve ser feita nos casos de parada cardíaca súbita perioperatória, mesmo em pacientes aparentemente saudáveis.
BACKGROUND AND OBJECTIVES: This case report describes a rare and potentially fatal condition associated with anesthesia administration. Our aim was to discuss the causes of sudden cardiac arrest during the perioperative period in apparently healthy patients and the pathophysiology of anomalous origin of the coronary arteries as a cause of sudden cardiac arrest. CASE REPORT: Female patient, 44 years old, with no previous symptoms of heart disease or arrhythmias, had a sudden cardiac arrest during general anesthesia in two different situations. In the first episode, the patient presented signs of acute abdomen, but remained hemodynamically stable. Following induction of anesthesia, the patient exhibited bradycardia and hypotension refractory to volume replacement and vasopressors. The condition progressed to asystole. The patient was successfully resuscitated and discharged from the hospital in good condition. In the second episode, one year after the first, the patient was in good clinical condition to undergo an elective surgery. After induction of anesthesia, the patient developed ventricular tachycardia followed by asystole, which was promptly reversed. After extensive investigation, an anomalous origin of the left coronary artery was identified. CONCLUSIONS: Our report is illustrative as it emphasizes that a thorough diagnostic investigation should be done in cases of sudden cardiac arrest during the perioperative period, even in patients that appear to be healthy.
JUSTIFICATIVA Y OBJETIVOS: El relato de caso describe una situación rara y potencialmente fatal asociada con la administración de anestesia. Nuestro objetivo fue discutir las causas de parada cardíaca súbita en el período perioperatorio en pacientes aparentemente sanos y la fisiopatología de las anomalías de origen de las arterias coronarias como una causa de parada cardíaca súbita. RELATO DE CASO: Mujer de 44 años, sin sintomatología anterior de enfermedad coronaria o arritmias, que presenta una parada cardíaca súbita durante la aplicación de la anestesia general en dos situaciones distintas. En el primer episodio, la paciente tenía un cuadro de abdomen agudo pero hemodinámicamente estable. Después de la inducción anestésica, ocurrió una bradicardia e hipotensión arterial, refractarias a la reposición de volumen y vasopresores. El cuadro evolucionó con asistolia. La paciente fue reanimada con éxito y recibió alta en buenas condiciones. En el segundo episodio, un año después del primero, la paciente estaba en buenas condiciones clínicas para la realización de una cirugía electiva. Después de la inducción anestésica, desarrolló una taquicardia ventricular seguida por asistolia, que fue rápidamente revertida. Después de una extensa investigación, fue identificado un origen anómalo de la arteria coronaria izquierda. CONCLUSIONES: Nuestro relato es ilustrativo porque enfatiza que una investigación diagnóstica minuciosa debe ser realizada en los casos de parada cardíaca súbita perioperatoria, incluso en los pacientes aparentemente sanos.
Subject(s)
Adult , Female , Humans , Anesthesia, General , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Death, Sudden, Cardiac/etiologyABSTRACT
As anomalias de coronária são, apesar de raras, importante causa de morte súbita, especialmente em atletas. Seu prognóstico está diretamente relacionado aos sintomas e, principalmente, ao seu padrão anatômico. Neste relato, descrevemos um caso raro de um subtipo incomum de origem anômala da artéria coronária esquerda do terço proximal da artéria coronária direita, associado à doença aterosclerótica obstrutiva. A utilização da angiotomografia das artérias coronárias, neste caso, foi fundamental para o correto esclarecimento anatômico dessa anomalia e para a decisão de tratamento clínico, cirúrgico ou percutâneo das lesões ateroscleróticas.
Subject(s)
Humans , Male , Middle Aged , Coronary Vessel Anomalies/complications , Atherosclerosis/complications , Atherosclerosis/diagnosis , Coronary Artery Disease/complications , Tomography/methods , TomographyABSTRACT
Anomalous origin of coronary arteries is a rare anatomical defect and its association with acute myocardial infarction is unusual. We report a 58-year-old male with ST-Segment elevation. Myocardial infarction of the inferior wall caused by a total occlusion on the proximal third of an anomalous right coronary artery, that was effectively treated with primary angioplasty with stent placement. The patient had a favorable outcome and is asymptomatic after five years of follow up.
Subject(s)
Humans , Male , Middle Aged , Angioplasty, Balloon, Coronary , Coronary Vessel Anomalies/complications , Myocardial Infarction/therapy , Coronary Angiography , Coronary Vessel Anomalies , Myocardial Infarction/complications , Myocardial Infarction , Treatment OutcomeABSTRACT
A anomalia cardíaca tipo óstio único de artéria coronária é uma entidade congênita rara, de causa desconhecida. Clinicamente apresenta-se desde a forma assintomática até casos de morte súbita, podendo associar-se a doença arterial coronária aterosclerótica. Apresentamos o caso de uma paciente de 68 anos de idade, com quadro de angina estável desde 2007, que, após três anos de seguimento, em decorrência de piora da angina, foi submetida a cinecoronariografia eletiva. A cateterização seletiva da coronária direita demonstrou anomalia tipo óstio único de artéria coronária, lesão significativa na artéria circunflexa e artéria descendente anterior ocluída no terço médio. A angiotomografia das coronárias demonstrou trajeto benigno da coronária anômala e a paciente evoluiu favoravelmente com o tratamento clínico.
Patient with Angina and Single Coronary Artery Ostium Originating from the Right Sinus of Valsalva Single coronary artery ostium is a rare congenital disease of unknown origin. Clinical manifestations range from asymptomatic disease to sudden death and it may be associated to atherosclerotic coronary artery disease. We report the case of a 68-year-old woman with stable angina since 2007, who was submitted to elective coronary angiography due to worsening of angina after three years of follow-up. Selective right coronary artery catheterization indicated the presence of single coronary artery ostium, significant lesion of the left circumflex artery, and mid left anterior descending artery occlusion. CT coronary angiography showed a benign course of the anomalous coronary artery and the patient had a favorable outcome with medical treatment.
Subject(s)
Humans , Female , Aged , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnosis , Coronary Artery Disease/complications , Sinus of Valsalva/surgery , Risk Factors , Death, SuddenABSTRACT
Coronary artery anomalies are associated often with myocardial ischemia or sudden cardiac death. A 19-year-old woman who participated in an exertive game lost consciousness upon one such exertion. She was taken to a hospital where she died on the same day. An autopsy revealed that she had bifurcated coronary arteries, which arose from one coronary ostium in the left sinus of Valsalva. The right coronary artery arose from the left sinus and traveled between the aorta and the pulmonary trunk. The heart as well as the cardiac conduction system depended exclusively on the single coronary artery ostium for oxygenated blood supply, and the unbalanced blood distribution on her exertion probably led to sudden cardiac death. The case highlights the medicolegal importance of unexpected sudden cardiac death related to an anomalous origin of the coronary arteries.