Humans , Female , Middle Aged , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/diagnosis , Coronary Angiography/methods , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/diagnosis , Vascular Diseases/congenital , Vascular Diseases/diagnostic imaging , Vascular Diseases/diagnosis
Injury to coronary arteries during mitral surgery is a rare but life-threatening procedural complication, an anomalous origin and course of the left circumflex artery (LCx) increase this risk. Recognizing the anomaly by the characteristic angiographic pattern and identifying its relationship with the surrounding anatomical structure using imaging techniques, mainly transesophageal echocardiography (TOE) or coronary computed tomography angiography (CCTA), is of crucial importance in setting up the best surgical strategy. We report a case of anomalous origin of a circumflex artery (LCx) from the proximal portion of the right coronary artery (RCA) with a pathway running retroaortically through the mitro-aortic space. An integrated diagnostic approach using a multidisciplinary team with a cardiologist and an imaging radiologist allowed us to decide the surgical strategy. We successfully performed a mitral valvular repair using a minimally invasive minithoracotomic approach and implanting a complete semirigid ring.
Aortic Valve , Coronary Vessel Anomalies , Echocardiography, Transesophageal , Mitral Valve , Humans , Mitral Valve/surgery , Mitral Valve/diagnostic imaging , Mitral Valve/abnormalities , Aortic Valve/surgery , Aortic Valve/diagnostic imaging , Aortic Valve/abnormalities , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/diagnostic imaging , Coronary Angiography , Computed Tomography Angiography , Male , Mitral Valve Insufficiency/surgery , Mitral Valve Insufficiency/diagnostic imaging , Female , Coronary Vessels/surgery , Coronary Vessels/diagnostic imaging
BACKGROUND: Spontaneous coronary artery dissection (SCAD) is an underdiagnosed cause of acute coronary syndrome, particularly in younger women. Due to limited information about SCAD, case reports and case series can provide valuable insights into its features and management. This study aimed to comprehensively evaluate the features of SCAD patients who experienced psychophysical stress before the SCAD event. METHODS: We conducted an electronic search of PubMed, Scopus, and Web of Science from inception until January 7, 2023. We included case reports or series that described patients with SCAD who had experienced psychophysical stress before SCAD. Patients with pregnancy-associated SCAD were excluded from our analysis. RESULTS: In total, we included 93 case reports or series describing 105 patients with SCAD. The average patient age was 44.29 ± 13.05 years and a total of 44 (41.9%) of patients were male. Among the included SCAD patients the most prevalent comorbidities were fibromuscular dysplasia (FMD) and hypertension with the prevalence of 36.4 and 21.9%, respectively. Preceding physical stress was more frequently reported in men than in women; 38 out of 44 (86.4%) men reported physical stress, while 36 out of 61 (59.1%) females reported physical stress (p value = 0.009). On the other hand, the opposite was true for emotional stress (men: 6 (13.6%)), women: 29 (47.6%), p value < 0.001). Coronary angiography was the main diagnostic tool. The most frequently involved artery was the left anterior descending (LAD) (62.9%). In our study, recurrence of SCAD due to either the progression of a previous lesion or new SCAD in another coronary location occurred more frequently in those treated conservatively, however the observed difference was not statistically significant (p value = 0.138). CONCLUSION: While physical stress seems to precede SCAD in most cases, emotional stress is implicated in females more than males.
Coronary Vessel Anomalies , Stress, Psychological , Vascular Diseases , Vascular Diseases/congenital , Humans , Female , Stress, Psychological/epidemiology , Stress, Psychological/diagnosis , Coronary Vessel Anomalies/epidemiology , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/complications , Male , Adult , Middle Aged , Vascular Diseases/epidemiology , Vascular Diseases/diagnostic imaging , Vascular Diseases/psychology , Vascular Diseases/physiopathology , Vascular Diseases/diagnosis , Risk Factors , Prevalence , Risk Assessment , Sex Factors , Prognosis , Comorbidity , Aged
Coronary artery fistula (CAF) is characterized as a congenital or acquired abnormal communication between a coronary artery and any of the four chambers of the heart (coronary-cameral fistula) or great vessels (coronary arteriovenous fistula) bypassing the capillaries within myocardium. CAF is a rare disease, challenging to diagnose and treat depending on the anatomical location and type of the fistula and accompanying diseases. This study aims to report a case with multiple coronary artery to coronary sinus (CS) fistulas with giant left circumflex artery and multivalvular infective endocarditis.
Arteriovenous Fistula , Coronary Artery Disease , Coronary Sinus , Coronary Vessel Anomalies , Endocarditis, Bacterial , Endocarditis , Humans , Coronary Sinus/diagnostic imaging , Coronary Sinus/surgery , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/surgery , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/surgery , Coronary Artery Disease/complications , Endocarditis/complications , Arteriovenous Fistula/diagnostic imaging , Arteriovenous Fistula/surgery
INTRODUCTION: Anomalous origin of the right coronary artery from the left sinus of Valsalva (R-ACAOS) is a relatively rare condition that can potentially lead to devastating outcomes. The current study aims to investigate the cardiac-related disorders among patients with incidental R-ACAOS diagnosis through computed tomography angiography (CTA). METHODS: The current cross-sectional study has been conducted on 50 patients diagnosed with R-ACAOS who underwent CTA. Based on CTA, the patients' were categorized as R-ACAOS with interarterial course and non-interarterial course. The demographic and medical characteristics, any history of cardiac intervention and New York Heart Association (NYHA) Functional Classification at the time of diagnosis were recruited. Patients were revisited to assess cardiac-associated variables, including symptoms, the presence of heart failure and current NYHA function class. RESULTS: The variables including the history of cardiac intervention (P-value<0.001), the presence of heart failure (P-value = 0.010) and NYHA function class at the time of diagnosis (P-value = 0.006) were remarkably higher among those with interarterial course of R-ACAOS; while, the other variables including chest pain at rest (P-value = 0.55) or on exertion (P-value = 0.12), current NYHA function class, current cardiac-associated symptoms except for dyspnea at rest (P-value = 0.012), mortality and coronary calium score did not differ (P-value>0.05). coronary interventions led to significantly improved NYHA function class (P-value<0.05). CONCLUSION: Based on the findings of the current study, R-ACAOS with interarterial course leads to significantly higher rates of atherosclerotic-related symptoms and events compared with the other types of RCA anomalies. Moreover, coronary interventions led to significantly improved NYHA functional class regardless of R-ACAOS category.
Computed Tomography Angiography , Coronary Vessel Anomalies , Incidental Findings , Sinus of Valsalva , Humans , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/diagnosis , Male , Female , Sinus of Valsalva/abnormalities , Sinus of Valsalva/diagnostic imaging , Middle Aged , Cross-Sectional Studies , Computed Tomography Angiography/methods , Adult , Aged , Coronary Angiography/methods
This case report discusses a diagnosis of spontaneous coronary artery dissection in an otherwise healthy man with nonST elevation myocardial infarction.
Coronary Angiography , Coronary Vessel Anomalies , Non-ST Elevated Myocardial Infarction , Vascular Diseases , Humans , Male , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/complications , Vascular Diseases/congenital , Vascular Diseases/diagnostic imaging , Vascular Diseases/diagnosis , Vascular Diseases/complications , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/diagnostic imaging , Electrocardiography , Middle Aged
Coronary artery anomalies are rare but potentially fatal abnormalities with occasional striking imaging findings radiologists should recognize.
Computed Tomography Angiography , Coronary Angiography , Coronary Vessel Anomalies , Predictive Value of Tests , Pulmonary Artery , Female , Humans , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/complications , Coronary Vessels/diagnostic imaging , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/physiopathology , Aged
Coronary Angiography , Humans , Coronary Angiography/methods , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/diagnosis , Male , Coronary Vessels/diagnostic imaging , Myocardial Infarction/therapy , Myocardial Infarction/diagnosis , Myocardial Infarction/complications , Middle Aged , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/therapy
Coronary Vessel Anomalies , Perioperative Care , Humans , Aorta, Thoracic/abnormalities , Aorta, Thoracic/surgery , Aorta, Thoracic/diagnostic imaging , Coronary Vessel Anomalies/surgery , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessels/surgery , Coronary Vessels/diagnostic imaging , Perioperative Care/methods
Coronary Vessel Anomalies , Vascular Diseases , Vascular Diseases/congenital , Humans , Female , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Vascular Diseases/diagnosis , Vascular Diseases/etiology , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/complications , Coronary Angiography/adverse effects
Coronary Artery Disease , Coronary Vessel Anomalies , Fistula , Heart Defects, Congenital , Humans , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Pulmonary Artery/abnormalities , Heart Defects, Congenital/complications , Heart Defects, Congenital/diagnostic imaging , Heart Defects, Congenital/surgery , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/surgery , Coronary Angiography
We describe herein a case of a 16 years-old female patient referred to our department for further exploration of a chest pain. Color Doppler echocardiography revealed an abnormal flow at the level of the pulmonary artery. Exercise testing was abnormal leading to further imaging including computed cardiac tomography followed by coronary angiography which showed anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) associated with mid shaft left main stenosis. We discuss this uncommon association and therapeutic options.
Coronary Stenosis , Coronary Vessel Anomalies , Humans , Female , Adolescent , Pulmonary Artery/diagnostic imaging , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnostic imaging , Tomography, X-Ray Computed , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/etiology
BACKGROUND: Coronary artery complications (CACs) in patients who undergoing prosthetic pulmonary valve implantation for congenital heart disease can lead to fetal outcomes. However, the incidence of and risk factors for CACs in these patients remain unknown.MethodsâandâResults: A retrospective cohort study was conducted on patients who underwent cardiac computed tomography or invasive coronary angiography after prosthetic pulmonary valve implantation at Seoul National University Hospital from June 1986 to May 2021. Among 341 patients, 25 (7.3%) were identified with CACs, and 2 of them died. Among the patients with CACs, congenital coronary anomalies and an interarterial course of the coronary artery were identified in 11 (44%) and 18 (72%) patients, respectively. Interarterial and intramural courses of the coronary artery were associated with a 4.4- and 10.6-fold increased risk of CACs, respectively. Among patients with tetralogy of Fallot and pulmonary atresia, the aortic root was rotated further clockwise in patients with coronary artery compression compared to those without it (mean [±SD] 128.0±19.9° vs. 113.5±23.7°; P=0.024). The cut-off rotation angle of the aorta for predicting the occurrence of coronary artery compression was 133°. CONCLUSIONS: Perioperative coronary artery evaluation and prevention of CACs are required in patients undergoing prosthetic pulmonary valve implantation, particularly in those with coronary artery anomalies or severe clockwise rotation of the aortic root.
Pulmonary Valve , Humans , Retrospective Studies , Female , Male , Risk Factors , Adult , Pulmonary Valve/surgery , Pulmonary Valve/diagnostic imaging , Heart Valve Prosthesis Implantation/adverse effects , Heart Defects, Congenital/surgery , Coronary Artery Disease/etiology , Coronary Artery Disease/surgery , Coronary Artery Disease/diagnostic imaging , Coronary Angiography , Adolescent , Young Adult , Heart Valve Prosthesis/adverse effects , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/complications , Incidence , Child , Middle Aged , Tetralogy of Fallot/surgery
An asymptomatic 17-month-old, 18.5-kg, male Staffordshire bull terrier was referred due to a heart murmur. Examination revealed a grade 3/6 left apical systolic and right apical 3/6 heart murmur. Echocardiography showed volume overload of the left ventricle and mild systolic dysfunction with a left-right flow over the interventricular septal region. Cardiac gated computed tomography revealed anomalous origin of the right coronary artery from the pulmonary artery, an extensive network of collateral blood vessels connected the right and left coronary arteries, with bronchial and left intercostal arteries also connected to the network of collateral blood vessels, markedly enlarged right and left coronary arteries and left coronary sinus. With varied presentation, coronary anomalies are difficult to recognise and classify and to the best of our knowledge this is the first case of anomalous origin of the right coronary artery from the pulmonary artery diagnosis in the dog.
Coronary Vessel Anomalies , Dog Diseases , Pulmonary Artery , Dogs/abnormalities , Animals , Coronary Vessel Anomalies/veterinary , Coronary Vessel Anomalies/diagnostic imaging , Male , Pulmonary Artery/abnormalities , Pulmonary Artery/diagnostic imaging , Dog Diseases/congenital , Dog Diseases/diagnostic imaging , Dog Diseases/diagnosis , Echocardiography/veterinary , Tomography, X-Ray Computed/veterinary