RESUMO
Chest pain is the most common symptom of coronary artery disease (CAD) and diabetes mellitus (DM) is a well-known single strongest risk factor for cardiovascular diseases. Thus, the impact of CAD nor DM on long-term clinical effects is reported widely, but the prognostic factors of non-DM patients presenting with chest pain without significant CAD are limited. A total of 1,046 patients with chest pain without DM and significant CAD who underwent coronary angiography (CAG) and acetylcholine (ACH) provocation tests were finally enrolled. Propensity score matching and multivariate Cox-proportional hazard ratio analysis were performed to adjust for baseline potential confounders. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of total death, myocardial infarction (MI), revascularization, stroke, and recurrent angina. This study aimed to evaluate the long-term prognostic factors for MACCE in patients with chest pain without DM and CAD up to 5 years. Coronary artery spasm (CAS) was the most common cause of chest pain. However, long-term MACCE of CAS was not worse than those of patients with chest pain without CAS when patients with CAS had subsequent optimal antianginal medication therapy. However, a recurrent chest pain remains a problem even with continuous antianginal medication therapy. Up to 5 years, the incidence of MACCE was in 7.3%, including recurrent angina 6.9%. Dyslipidemia (HR: 2.010, 95% CI 1.166-3.466, P = 0.012), mild-moderate (30-70%) coronary stenosis (HR: 2.369, 95% CI 1.118-5.018, P = 0.024), the use of aspirin (HR: 2.885, 95% CI 1.588-5.238, P < 0.001), and the use of nitrates (HR: 1.938, 95% CI 1.094-3.433, P = 0.023) were independent risk factors for MACCE. Among the patients with chest pain without DM and significant CAD, the incidence of MACE were rare, but recurrent angina was still a challenging problem who had treated with antianginal medications.
Assuntos
Fármacos Cardiovasculares , Doença da Artéria Coronariana , Estenose Coronária , Vasoespasmo Coronário , Diabetes Mellitus , Humanos , Prognóstico , Doença da Artéria Coronariana/complicações , Angina Pectoris/diagnóstico , Angina Pectoris/epidemiologia , Angina Pectoris/etiologia , Vasoespasmo Coronário/complicações , Vasoespasmo Coronário/diagnóstico , Vasoespasmo Coronário/epidemiologia , Estenose Coronária/diagnóstico , Estenose Coronária/diagnóstico por imagem , Dor no Peito/diagnóstico , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Diabetes Mellitus/epidemiologia , Fatores de Risco , Angiografia Coronária/efeitos adversosRESUMO
We report the case of a 79-year-old male patient who benefited from the implantation of a coronary sinus reducer (CSR) (Reducer; Neovasc, Inc.) in the management of typical angina with mild exertion with optimal medical treatment.
Assuntos
Seio Coronário , Artéria Pulmonar , Masculino , Humanos , Idoso , Seio Coronário/diagnóstico por imagem , Seio Coronário/cirurgia , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Angina Pectoris/terapiaRESUMO
INTRODUCTION: In this study, we aimed to evaluate the most common causes of recurrent angina after coronary artery bypass grafting (CABG) and our treatment approaches applied in these patients. METHODS: We included all patients who underwent CABG, with or without percutaneous coronary intervention after CABG, at our hospital from September 2013 to December 2019. Patients were divided into two groups according to the time of onset of anginal pain after CABG. Forty-five patients (58.16 ± 8.78 years) had recurrent angina in the first postoperative year after CABG and were specified as group I (early recurrence). Group II (late recurrence) comprised 82 patients (58.05 ± 8.95 years) with angina after the first year of CABG. RESULTS: The mean preoperative left ventricular ejection fraction was 53.22 ± 8.87% in group I, and 54.7 ± 8.58% in group II (P=0.38). No significant difference was registered between groups I and II regarding preoperative angiographic findings (P>0.05). Failed grafts were found in 27.7% (n=28/101) of the grafts in group I as compared to 26.8% (n=51/190) in group II (P>0.05). Twenty-four (53.3%) patients were treated medically in group I, compared with 54 (65.8%) patients in group II (P=0.098). There was a need for intervention in 46.6% (n=21) of group I patients, and in 34.1% (n=28) of group II patients. CONCLUSION: Recurrent angina is a complaint that should not be neglected because most of the patients with recurrent angina are diagnosed with either native coronary or graft pathology in coronary angiography performed.
Assuntos
Angina Pectoris , Ponte de Artéria Coronária , Recidiva , Humanos , Ponte de Artéria Coronária/efeitos adversos , Pessoa de Meia-Idade , Masculino , Feminino , Angina Pectoris/etiologia , Angina Pectoris/cirurgia , Idoso , Estudos Retrospectivos , Angiografia Coronária , Complicações Pós-Operatórias/etiologia , Intervenção Coronária Percutânea , Resultado do Tratamento , Fatores de Tempo , Volume Sistólico/fisiologiaRESUMO
BACKGROUND: Sinus of Valsalva aneurysm (SVA) is a rare cardiac anomaly which can be congenital or acquired. Patients with SVA are commonly asymptomatic when the occupying effect of SVA is insignificant, while ruptured SVA usually causes severe symptoms including heart failure and myocardial ischemia. CASE PRESENTATION: We present an unusual case of a 64-year-old female manifesting with exertional dyspnea as well as angina pectoris for three months. Echocardiography and cardiac computed tomographic angiography confirmed unruptured left-coronary and non-coronary SVAs. The left anterior descending artery and left circumflex artery were stretched and compressed by the SVA which causing myocardial ischemia. The patient finally received aortic root replacement (Bentall procedure) and got symptom relieved. CONCLUSIONS: Giant unruptured SVA originating from left coronary sinus is extremely rare. Our case highlights that giant SVA should be considered in cases with angina pectoris. Echocardiography and coronary computed tomographic angiography are useful and important for diagnosis. Surgery is highly recommended in patients with SVA.
Assuntos
Aneurisma Aórtico , Seio Aórtico , Feminino , Humanos , Pessoa de Meia-Idade , Seio Aórtico/diagnóstico por imagem , Seio Aórtico/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/cirurgia , Ecocardiografia , Tomografia Computadorizada por Raios X , Angina Pectoris/etiologia , Angina Pectoris/cirurgiaRESUMO
BACKGROUND: ST-elevation myocardial infarction (STEMI) systems of care have reduced inter-hospital transfer times and facilitated timely reperfusion goals. Helicopters may be an option when land transportation is not feasible; however, the safety of air transport in patients with acute coronary syndrome (ACS) is a factor to consider. OBJETIVES: The aim of this study was to evaluate the safety of helicopter transport for patients with ACS. METHODS: Prospective, observational, and descriptive study including patients diagnosed with ACS within the STEMI network of a metropolitan city transferred by helicopter to a large cardiovascular center to undergo percutaneous coronary intervention. The primary outcome of the study was the incidence of air-travel-related complications defined as IV dislodgement, hypoxia, arrhythmia, angina, anxiety, bleeding, and hypothermia. Secondary outcomes included the individual components of the primary outcome. RESULTS: A total of 106 patients were included in the study; the mean age was 54 years and 84.9% were male. The most frequent diagnosis was STEMI after successful fibrinolysis (51.8%), followed by STEMI with failed fibrinolysis (23.7%) and non-reperfused STEMI (9.4%). Five patients (4.7%) developed at least one complication: IV dislodgement (1.8%) and hypoxemia (1.8%) in two patients and an episode of angina during flight (0.9%). A flight altitude of > 10,000 ft was not associated with complications. CONCLUSIONS: The results of this study suggest that helicopter transportation is safe in patients undergoing acute coronary syndrome, despite the altitude of a metropolitan area.
ANTECEDENTES: Los sistemas de atención de IAMCEST han reducido los tiempos de transferencia interhospitalaria y han facilitado las metas de reperfusión oportuna. Los helicópteros pueden ser una opción cuando el transporte terrestre no es factible; sin embargo, la seguridad del transporte aéreo en pacientes con síndrome coronario agudo (SICA) es un factor a considerar. OBJETIVOS: Evaluar la seguridad del transporte en helicóptero para pacientes con SICA. MÉTODOS: Estudio prospectivo, observacional, descriptivo. Se incluyeron pacientes con diagnóstico de SICA dentro de la red IAMCEST en metrópolis extensa, trasladados en helicóptero a un centro cardiovascular. El resultado primario del estudio fue la incidencia de complicaciones relacionadas con los viajes aéreos definidas cómo desalojo de catéter intravenoso, hipoxia, arritmia, angina, ansiedad, sangrado e hipotermia. RESULTADOS: Total de 106 pacientes; la edad media fue de 54 años y 84,9% eran hombres. La altitud media de vuelo fue de 10,100 pies y la distancia media de vuelo fue de 50,0 km. El diagnóstico más frecuente fue IAMCEST tras fibrinolisis exitosa (51,8%), seguido de IAMCEST con fibrinolisis fallida (23,7%). Cinco pacientes (4,7%) desarrollaron una complicación: desalojo IV (1,8%) e hipoxemia (1,8%) en dos pacientes y un episodio de angina durante el vuelo (0,9%). Una altitud de vuelo mayor de 10,000 pies no se asoció a complicaciones. CONCLUSIONES: Los resultados de este estudio sugieren que el transporte en helicóptero es seguro en pacientes con SICA, incluso en altitudes > 10,000 pies.
Assuntos
Síndrome Coronariana Aguda , Infarto do Miocárdio , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Síndrome Coronariana Aguda/terapia , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio/etiologia , Estudos Prospectivos , Viagem , Doença Relacionada a Viagens , Aeronaves , Intervenção Coronária Percutânea/métodos , Angina Pectoris/etiologiaRESUMO
This case report discusses a 74-year-old man presenting with angina pectoris. Coronary computed tomography angiography suggested only mild stenosis in the mid left anterior descending artery (LAD), with fractional flow reserve based on computed tomography images (FFRct) value of 0.87. However, coronary angiography revealed slit-like stenosis in the mid LAD, and the invasive fractional flow reserve (FFR) was measured at 0.72, demonstrating a deviation from the FFRct value.
Assuntos
Angina Pectoris , Angiografia por Tomografia Computadorizada , Angiografia Coronária , Estenose Coronária , Vasos Coronários , Reserva Fracionada de Fluxo Miocárdico , Valor Preditivo dos Testes , Humanos , Idoso , Masculino , Estenose Coronária/fisiopatologia , Estenose Coronária/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Angina Pectoris/fisiopatologia , Angina Pectoris/diagnóstico por imagem , Angina Pectoris/etiologia , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Invasive CFT is the gold standard for diagnosing coronary vasomotor dysfunction in patients with ANOCA. Most institutions recommend only testing the left coronary circulation. Therefore, it is unknown whether testing multiple coronary territories would increase diagnostic yield. OBJECTIVES: The aim of this study was to evaluate the diagnostic yield of multivessel, compared with single-vessel, invasive coronary function testing (CFT) in patients with angina and nonobstructive coronary arteries (ANOCA). METHODS: Multivessel CFT was systematically performed in patients with suspected ANOCA. Vasoreactivity testing was performed using acetylcholine provocation in the left (20 to 200 µg) and right (20 to 80µg) coronary arteries. A pressure-temperature sensor guidewire was used for coronary physiology assessment in all three epicardial vessels. RESULTS: This multicenter study included a total of 228 vessels from 80 patients (57.8 ± 11.8 years of age, 60% women). Compared with single-vessel CFT, multivessel testing resulted in more patients diagnosed with coronary vasomotor dysfunction (86.3% vs 68.8%; P = 0.0005), coronary artery spasm (60.0% vs 47.5%; P = 0.004), and CMD (62.5% vs 36.3%; P < 0.001). Coronary artery spasm (n = 48) predominated in the left coronary system (n = 38), though isolated right coronary spasm was noted in 20.8% (n = 10). Coronary microvascular dysfunction (CMD), defined by abnormal index of microcirculatory resistance and/or coronary flow reserve, was present 62.5% of the cohort (n = 50). Among the cohort with CMD, 27 patients (33.8%) had 1-vessel CMD, 15 patients (18.8%) had 2-vessel CMD, and 8 patients (10%) had 3-vessel CMD. CMD was observed at a similar rate in the territories supplied by all 3 major coronary vessels (left anterior descending coronary artery = 36.3%, left circumflex coronary artery = 33.8%, right coronary artery = 31.3%; P = 0.486). CONCLUSIONS: Multivessel CFT resulted in an increased diagnostic yield in patients with ANOCA compared with single-vessel testing. The results of this study suggest that multivessel CFT has a role in the management of patients with ANOCA.
Assuntos
Acetilcolina , Angina Pectoris , Doença da Artéria Coronariana , Circulação Coronária , Vasoespasmo Coronário , Vasos Coronários , Valor Preditivo dos Testes , Vasodilatadores , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Idoso , Vasos Coronários/fisiopatologia , Vasos Coronários/diagnóstico por imagem , Vasodilatadores/administração & dosagem , Vasoespasmo Coronário/fisiopatologia , Vasoespasmo Coronário/diagnóstico , Acetilcolina/administração & dosagem , Angina Pectoris/fisiopatologia , Angina Pectoris/diagnóstico , Angina Pectoris/etiologia , Doença da Artéria Coronariana/fisiopatologia , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Cateterismo Cardíaco , Angiografia Coronária , Reprodutibilidade dos Testes , Vasodilatação , VasoconstriçãoRESUMO
We present the case of a 60-year-old male, with active smoking and cocaine use disorder, who reported progressive chest pain. Various anatomical and functional cardiac imaging, performed to further evaluate chest pain etiology, revealed changing severity and distribution of left main artery (LMA) stenosis, raising suspicion for vasospasm. Intracoronary nitroglycerin relieved the vasospasm, with resolution of the LMA pseudostenosis. A diagnosis of vasospastic angina (VA) led to starting appropriate medical therapy with lifestyle modification counselling. This case highlights VA, a frequently underdiagnosed etiology of angina pectoris. We discuss when to suspect VA, its appropriate work-up, and management.
Assuntos
Angiografia Coronária , Estenose Coronária , Vasoespasmo Coronário , Nitroglicerina , Vasodilatadores , Humanos , Masculino , Pessoa de Meia-Idade , Estenose Coronária/diagnóstico por imagem , Estenose Coronária/terapia , Estenose Coronária/fisiopatologia , Vasoespasmo Coronário/diagnóstico por imagem , Vasoespasmo Coronário/fisiopatologia , Vasoespasmo Coronário/tratamento farmacológico , Vasoespasmo Coronário/terapia , Vasoespasmo Coronário/diagnóstico , Nitroglicerina/administração & dosagem , Resultado do Tratamento , Vasodilatadores/uso terapêutico , Vasodilatadores/administração & dosagem , Valor Preditivo dos Testes , Transtornos Relacionados ao Uso de Cocaína/complicações , Índice de Gravidade de Doença , Angina Pectoris/etiologia , Angina Pectoris/diagnóstico por imagem , Diagnóstico Diferencial , Fumar/efeitos adversosRESUMO
The internal mammary artery has become the primary conduit for the surgical revascularisation of the left anterior descending artery. Large side branches of internal mammary artery are typically ligated during cardiac surgery to avoid a potential coronary steal phenomenon. However, ligation of side branches can be unsuccessful due to the technically difficult surgical exploration of internal mammary artery branches. In this article, we present a case of a man who suffered from exertion angina pectoris despite successful surgical revascularisation of occluded left anterior descending artery by the internal mammary artery bypass. The coronary steal syndrome caused by the mighty side branch of internal mammary artery, that is, lateral costal artery was concluded as the reason of exertional angina. The endovascular procedure was performed and the lateral costal artery was successfully occluded using vascular plug. The occlusion of lateral costal artery has led to a complete disappearance of the exertional angina.
Assuntos
Doença da Artéria Coronariana , Artéria Torácica Interna , Masculino , Humanos , Angina Pectoris/etiologia , Angina Pectoris/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Doença da Artéria Coronariana/complicações , Artéria Torácica Interna/cirurgia , Anastomose de Artéria Torácica Interna-Coronária/efeitos adversosRESUMO
Abstract Congenital pulmonary stenosis (PS) can be associated with pulmonary artery (PA) dilatation. In some cases, this can cause compression of nearby structures including the left main coronary artery (LMCA). This compression causes angina and is considered an indication for surgical treatment. We present the case of a patient with PS and angina secondary to LMCA compression by the right PA and review the main indications and options for surgical treatment.
Resumen La estenosis pulmonar congénita se asocia a dilatación de la arteria pulmonar. En algunos casos esto puede causar compresión de las estructuras adyacentes incluyendo el tronco de la coronaria izquierda. Esta compresión causa angina y es considerada una indicación para tratamiento quirúrgico. Presentamos el caso de un paciente con estenosis pulmonar y angina secundaria a compresión del tronco de la coronaria izquierda por la arteria pulmonar derecha y revisamos las indicaciones y opciones de tratamiento quirúrgico.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/patologia , Estenose da Valva Pulmonar/complicações , Estenose Coronária/etiologia , Angina Pectoris/etiologia , Estenose da Valva Pulmonar/congênito , Estenose Coronária/complicações , Angina Pectoris/cirurgiaRESUMO
RESUMEN Introducción: las enfermedades cardiovasculares constituyen la principal causa de muerte en la mayoría de los países. Se describen los factores de riesgo para enfermedad coronaria como no modificables: edad, sexo y antecedentes familiares; y modificables relacionados al estilo de vida: tabaquismo, dislipidemia, obesidad, sedentarismo, diabetes, uso abusivo de alcohol y la enfermedad hipertensiva. Objetivo: caracterizar los factores de riesgo asociados a la cardiopatía isquémica en Atención Secundaria de Salud. Materiales y métodos: estudio observacional, descriptivo transversal en pacientes ingresados en el Hospital "Mártires del 9 de Abril" de Sagua la Grande, en el periodo comprendido entre los años 2016 y 2017. Integraron la muestra 96 pacientes que ingresaron con diagnóstico de cardiopatía isquémica. Se describieron las características demográficas de los mismos; fueron identificados los factores de riesgo y se determinó la frecuencia de asociación de otras formas clínicas de ateromatosis. Resultados: los pacientes fueron mayores de 60 años de edad; la mayoría tenían color de la piel blanca; presentaban antecedentes patológicos familiares de cardiopatía isquémica; las principales formas de cardiopatía isquémica fueron: angina e insuficiencia cardiaca; todos los pacientes presentaron uno o más factores de riesgo cardiovascular, los más significativos fueron, hipertensión arterial, tabaquismo aumento de la circunferencia abdominal y personalidad tipo "A". Conclusiones: la mayoría de los pacientes exhibieron alteraciones en el electrocardiograma: descenso del segmento ST, bloqueo de rama izquierda del haz de His y fibrilación auricular; se observó hipertrigliceridemia y se apreció asociación entre enfermedad renal crónica y angina.
ABSTRACT Introduction: cardiovascular diseases are the main cause of death in most of the countries. The risk factors for coronary disease are described as unmodifiable: age, sex and family history; and modifiable related to lifestyle: smoking, dyslipidemia, obesity, sedentary lifestyle, diabetes, abusive use of alcohol and hypertensive disease. Objective: to characterize the risk factors associated to ischemic heart disease in secondary health care. Material and methods: observational, cross-sectional, descriptive study in patients admitted in "Mártires del 9 de Abril" Hospital, Sagua la Grande, between 2016 and 2017. The sample consisted of 96 patients admitted with a diagnosis of ischemic heart disease. Their demographic characteristics were described; the risk factors were identified and the frequency of association of other clinical forms of atheromatosis was determined. Results: the patients were aged more than 60 years; most of them were white people and had family pathological antecedents of ischemic heart disease; the main forms of ischemic heart disease were angina and heart failure; all patients showed one or more cardiovascular risk factors being arterial hypertension, smoking, increase of abdominal circumference and type A personality the most significant ones. Conclusions: the majority of patients showed alterations in the electrocardiogram: ST segment decrease, His bundle left branch blockage and atrial fibrillation; hypertriglyceridemia was observed and there was an association between chronic kidney disease and angina.
Assuntos
Humanos , Idoso , Tabagismo/etiologia , Fatores de Risco , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/genética , Isquemia Miocárdica/epidemiologia , Hipertensão/etiologia , Pacientes Internados , Sistema Cardiovascular/fisiopatologia , Epidemiologia Descritiva , Estudos Transversais , Circunferência Abdominal , Estudo Observacional , Insuficiência Cardíaca/etiologia , Angina Pectoris/etiologia , Estilo de VidaRESUMO
Abstract Fistula from left internal mammary artery (LIMA) to pulmonary artery (PA) is rarely encountered in daily practice. In recent years, endovascular therapy options have emerged for the treatment of fistula formations and replaced with surgery. A 53-year-old man admitted to our outpatient clinic with symptoms of typical angina and shortness of breath despite optimal medical therapy. In his relevant history, he had a coronary artery bypass graft (CABG) operation in 2009 in which his LIMA was anastomosed to left anterior descending (LAD) and ramus artery sequentially. Coronary angiography including selective imaging of LIMA demonstrated a fistula formation originating from the proximal portion of the LIMA and draining to PA. After successful closure of fistula with transcatheter coil embolization, the patient was discharged without any complication and symptom. In conclusion, although LIMA to PA fistula is an infrequent clinical condition, it should be considered as a potential cause of persistent angina after CABG operation. Treatment options include conservative medical therapy, surgical ligation and endovascular interventions. The best therapy should be individualised for each patient in respect to patient's symptoms, surgical compatibility and anatomy of fistula.
Resumo A fístula da artéria mamária interna esquerda (AMIE) para a artéria pulmonar (AP) é raramente encontrada na prática diária. Nos últimos anos, opções de terapia endovascular surgiram para o tratamento de formações de fístula e foram substituídas por cirurgia. Um homem de 53 anos de idade, internado em nosso ambulatório com sintomas de angina típica e falta de ar, apesar da terapia clínica ideal. Em seu histórico relevante, ele teve uma cirurgia de revascularização miocárdica (CRM) em 2009, na qual sua AMIE foi anastomosada à descendente anterior esquerda (DAE) e à artéria ramus sequencialmente. A angiografia coronária, incluindo imagens seletivas da AMIE, demonstrou uma formação de fístula proveniente da porção proximal da AMIE e drenando para AP. Após o fechamento bem-sucedido da fístula com embolização transcateter com mola, o paciente recebeu alta sem qualquer complicação e sintoma. Em conclusão, embora fístula entre AMIE e AP seja uma condição clínica pouco frequente, deve ser considerada como uma causa potencial de angina persistente após a operação de revascularização do miocárdio. As opções de tratamento incluem terapia médica conservadora, ligadura cirúrgica e intervenções endovasculares. A melhor terapia deve ser individualizada para cada paciente em relação aos sintomas do paciente, compatibilidade cirúrgica e anatomia da fístula.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar , Cateterismo Periférico/métodos , Fístula Artério-Arterial/terapia , Embolização Terapêutica/métodos , Angina Pectoris/terapia , Artéria Torácica Interna , Complicações Pós-Operatórias , Prótese Vascular , Ponte de Artéria Coronária/efeitos adversos , Fístula Artério-Arterial/complicações , Fístula Artério-Arterial/etiologia , Resultado do Tratamento , Stents Metálicos Autoexpansíveis , Angina Pectoris/etiologiaRESUMO
Abstract The lateral costal artery has sometimes been identified as the culprit for the "steal phenomenon" after coronary artery bypass grafting, besides being occasionally used for myocardial revascularization. Its branches make anastomoses with the internal thoracic artery through lateral intercostal arteries. We aim to report, on three cases, the clinical significance of a well-developed lateral costal artery after coronary artery bypass grafting. Two out of three patients who underwent coronary artery bypass graft surgery in our center between June 2010 and August 2017, applied to us with stable angina pectoris, while the third one was diagnosed with acute coronary syndrome after applying to the emergency department. In coronary cineangiography, in all three cases, a well-developed accessory vessel arising from the proximal 2.5 cm segment of the left internal thoracic artery coursed as far as the 6th rib was detected, and it was confirmed to be the lateral costal artery. A stable angina pectoris in two of the patients was thought to be the result of steal phenomenon caused by the well-developed lateral costal artery. In the two cases with stable angina pectoris the lateral costal artery was obliterated via coil embolization. In the other case with the proximal left anterior descending artery stenosis, before percutaneous coronary intervention, the lateral costal artery was obliterated via coil embolization and the occluded subclavian artery was stented. Routine visualization in cineangiography and satisfactory surgical exploration of the left internal thoracic artery could be very helpful to identify any possible accessory branch of the left internal thoracic artery like the lateral costal artery.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Artérias Torácicas/anormalidades , Síndrome do Roubo Coronário-Subclávio/complicações , Anastomose de Artéria Torácica Interna-Coronária , Angina Pectoris/etiologia , Costelas/irrigação sanguínea , Artérias Torácicas/cirurgia , Cineangiografia , Síndrome do Roubo Coronário-Subclávio/cirurgia , Síndrome do Roubo Coronário-Subclávio/diagnóstico por imagem , Angina Pectoris/cirurgia , Angina Pectoris/diagnóstico por imagem , Revascularização MiocárdicaRESUMO
A 57 year-old man, smoker, with high blood pressure, presented to the emergency unit with intermittent and brief typical anginal pain in the preceding 2 days. Baseline physical examination was normal. Figure 1 depicts de EKG recorded upon admission. Biomarkers for acute coronary syndrome were negative.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Estenose Coronária/diagnóstico , Eletrocardiografia , Angina Pectoris/etiologia , Síndrome , Estenose Coronária/fisiopatologia , Estenose Coronária/terapia , Stents FarmacológicosRESUMO
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