Prevalence and characteristics of coronary artery anomalies in an adult population undergoing multidetector-row computed tomography for the evaluation of coronary artery disease.

BACKGROUND: Congenital coronary anomalies are uncommon with an incidence ranging from 0.17 % in autopsy cases to 1.2 % in angiographically evaluated cases. The recent development of ECG-gated multi-detector row computed tomography (MDCT) coronary angiography allows accurate and noninvasive depiction of coronary artery anomalies. METHODS: This retrospective study included 2572 patients who underwent coronary 64-slice MDCT coronary angiography from January 2008 to March 2012. Coronary angiographic scans were obtained with injection of 80 ml nonionic contrast medium. Retrospective gating technique was used to synchronize data reconstruction with the ECG signal. Maximum intensity projection, multi-planar reformatted, and volume rendering images were derived from axial scans. RESULTS: Of the 2572 patients, sixty (2.33 %) were diagnosed with coronary artery anomalies (CAAs), with a mean age of 53.6 ± 11.8 years (range 29-80 years). High take-off of the RCA was seen in 16 patients (0.62 %), of the left main coronary artery (LMCA) in 2 patients (0.08 %) and both of them in 2 patients (0.08 %). Separate origin of the left anterior descending artery (LAD) and left circumflex artery (LCx) from left sinus of Valsalva (LSV) was found in 15 patients (an incidence of 0.58 %). In 9 patients (0.35 %) the right coronary artery (RCA) arose from the opposite sinus of Valsalva with a separate ostium. In 6 patients (0.23 %) an abnormal origin of LCX from the right sinus of Valsalva (RSV) was found with a further posterior course within the atrioventricular groove. A single coronary artery was seen in 3 patients (0.12 %). It originated from the right sinus of Valsalva in one patient and from LSV in two patients. In two other patients (0.08 %) the left coronary trunk originated from the RSV with separate ostium from the RCA. LCA originating from the pulmonary artery was found in one patient (0.04 %). A coronary artery fistula, which is a termination anomaly, was detected in 4 patients (0.15 %). DISCUSSION: Although these anomalies, which are remarkably different from the normal structure, exist as early as birth, they are incidentally encountered during selective angiography or at autopsy. The incidence in reported angiographic series ranges from 0.6 % to 1.3 %. Variations in the frequency of primary congenital coronary anomalies may possibly have a genetic background. The largest angiographic series of 126595 patients, by Yamanaka and Hobbs, reported a 1.3 % incidence of anomalous coronary artery. CONCLUSION: The results of this study support the use MDCT coronary angiography as a safe and effective noninvasive imaging modality for defining CAAs in an appropriate clinical setting, providing detailed three-dimensional anatomic information that may be difficult to obtain with invasive angiography.

Percutaneous treatment of spontaneous left main coronary artery dissection using drug-eluting stent.

BACKGROUND: Spontaneous coronary artery dissection is a rare cause of ischemic heart disease and sudden death. Prompt diagnosis is of paramount importance, especially in cases when it manifests with ST elevation myocardial infarction (STEMI). CASE PRESENTATION: We report a case of a 42 year-old woman, who presented with an anterior STEMI in a hospital without on-site percutaneous coronary intervention (PCI) facilities. She was transferred to our hospital and coronary angiography revealed a spontaneous dissection of the left main stem coronary artery (LM). The dissection was successfully managed with PCI. CONCLUSION: PCI appears to be a potential option, for the treatment of selected cases with spontaneous LM dissection, presenting with an acute coronary syndrome.

Eptifibatide-induced acute profound thrombocytopenia: a case report.

BACKGROUND: The interactions among cells or among cells and components of the extracellular matrix, is a crucial pathophysiological process involving some molecules collectively known as adhesion molecules (CAMs). Glycoprotein IIb / IIIa receptors are only restricted to blood platelets and they bind fibrinogen and adhesion proteins such as fibronectin, vitronectin, von Willebrand factor to form cross bridges between adjacent platelets. IIb/IIIa receptor antagonists are an object of intense research activity for target therapy worldwide during the last decades. Three GPIIb/IIIa inhibitors, abciximab, tirofiban, and eptifibatide, have been approved for clinical use. Profound thrombocytopenia is an uncommon but clinically important complication of glycoprotein IIb/IIIa inhibitors. CASE PRESENTATION: This case report discusses a forty-four-year-old male patient with acute coronary syndrome who underwent percutaneous coronary intervention and developed profound thrombocytopenia within 4 hours of first administration of eptifibatide. CONCLUSION: This report adds another case of eptifibatide-induced thrombocytopenia to the medical literature and endorses the importance of platelet count monitoring after initiating therapy with this agent.

Acute presentation of vasospastic angina induced by oral capecitabine: a case report.

INTRODUCTION: Oral capecitabine is an oral prodrug of 5-fluorouracil that has been integrated into the management of multiple cancer types because of the convenience of administration and its efficacy compared with 5-fluorouracil. Capecitabine mimics the pharmacokinetics of intravenous 5-fluorouracil. While cardiac events associated with the use of 5-fluorouracil are a well-known side effect, capecitabine-induced cardiotoxicity has only been rarely reported. CASE PRESENTATION: We present a case of a 46-year-old woman of Greek ethnicity who presented to our institution with an operated gastric sarcoma who experienced capecitabine-induced vasospastic angina. Primarily a clinical diagnosis of a possible acute coronary syndrome was proposed and the patient was admitted to the hospital for further investigation which was proved between normal limits. After a witnessed episode of angina, her prior history of capecitabine intake and an undertaken further imaging investigation we associated anginal symptoms and signs with vasospastic angina induced by capecitabine 36 hours prior to hospital admission. CONCLUSION: Cardiologists should be aware of the potential cardiac hazards of capecitabine, especially in patients with cardiovascular risk factors. Due to the increasing usage of capecitabine during the last years, patients should be warned for the possibility of chest pain, particularly during the first few days of capecitabine treatment. Specifically, patients developing acute coronary syndrome should not be retreated with capecitabine. On the other hand, due to its promising antitumoral efficacy, its use should not be discouraged.

Percutaneous coronary intervention and stenting in a single coronary artery originating from the right sinus of valsalva.

Percutaneous revascularisation in anomalous coronary arteries poses certain technical difficulties, especially in the selective cannulation of the diseased vessel and the coaxial positioning of the guiding catheter for optimum stability. We report a case of successful stent implantation in a single coronary artery (SCA) arising from the right sinus of Valsalva (SoV). The ART 4 (Boston Scientific) guiding catheter provided excellent back-up support for stent delivery in the diseased circumflex artery. We also discuss the anatomical variations of an SCA originating from the right SoV, their angiographic recognition, the clinical implications, as well as technical considerations that should be taken into account when performing percutaneous interventions in these vessels.

Congenital atresia of the left main coronary artery in an adult: an extremely rare anomaly.

Atresia of the left coronary ostium is one of the rarest congenital coronary anomalies. We describe a 50-year-old male with atypical chest pain and positive exercise stress 201-thallium myocardial scintigraphy, in which coronary angiography revealed atresia of the left main coronary artery and right coronary artery collateral to the left anterior descending and left circumflex arteries. The clinical features, diagnosis and management of the left main coronary atresia in adults are discussed.

Guideliner catheter facilitated percutaneous coronary artery intervention of an anteriorly displaced and heavily calcified right coronary artery.

Failure to deliver stents is one of the most common causes of procedural failure in contemporary percutaneous coronary intervention practice. The right coronary artery with an anomalous origin is an uncommon and challenging vessel for percutaneous intervention especially if this occurs in combination with heavy calcification. Choosing the appropriate guiding catheter is one important factor in determining procedural success. The technical difficulty of these anomalous vessels is reflected by the long procedure, fluoroscopy times, and high contrast volumes. Despite using the optimal guiding catheter, we may have difficulty advancing the stent in the distal part of the vessel due to the development of significant friction between the stent and the calcified vessel wall. We report a case of successful use of the Guideliner catheter (Vascular Solutions) for distal stent delivery in a patient with a right coronary artery with anomalous origin (anteriorly displaced) and heavy calcification.

Percutaneous coronary intervention of a totally occluded anomalous right coronary artery arising from the left sinus of valsalva with the use of multiple overlapping drug-eluting stents ("full-metal jacket" technique).

Coronary arterial anomalies occur in approximately 1% of the population, without other congenital cardiac malformations. We report our experience involving 1 patient who had a totally occluded anomalous right coronary artery arising from the left sinus of Valsalva which was successfully treated with the implantation of multiple overlapping drug-eluting stents ("full-metal jacket" technique).