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1.
Tex Heart Inst J ; 46(3): 222-224, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708709

RESUMO

Low origin of the coronary arteries, defined as an origin less than 10 mm above the functional aortic annulus, is not usually considered to be a notable anomaly because functional impairment is not intrinsic. We describe a case of severe complications after surgical aortic valve replacement in a 59-year-old woman who had symptomatic aortic valve stenosis, low origin of both main coronary arteries, and a hypoplastic aortic annulus less than 19 mm in diameter. The aortic prosthesis had to be implanted above the hypoplastic anatomic annulus. An inferior-wall myocardial infarction, hypotension, right-sided heart failure, and atrial fibrillation developed during the early perioperative period. Coronary angiograms showed occlusion of the right coronary artery ostium and critical stenosis of the left coronary ostium. During reoperation, posterior aortic patch annuloplasty enabled lower reimplantation of the prosthetic aortic valve, jointly with right coronary artery-venous grafting. To prevent potentially severe complications, we recommend that low origin of the coronary arteries be reported before patients undergo surgical aortic valve replacement. If the ostia are not seen when routine coronary angiography is used, computed tomography should be prospectively performed to characterize this anomaly.


Assuntos
Anormalidades Múltiplas , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Anuloplastia da Valva Cardíaca/métodos , Anomalias dos Vasos Coronários/diagnóstico , Implante de Prótese de Valva Cardíaca/métodos , Complicações Intraoperatórias , Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/diagnóstico , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Pessoa de Meia-Idade
2.
Curr Cardiol Rep ; 21(9): 101, 2019 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-31359160

RESUMO

PURPOSE OF REVIEW: Comprehensive discussion of alternative techniques in imaging coronary artery anomalies (CAAs) in different diagnostic scenarios. RECENT FINDINGS: At primary screening, intramural course essentially correlates with stenosis and clinical repercussion in some types of CAAs. Potential clinical aims in imaging patients with CAAs may be primary screening, severity evaluation, preoperative planning, and postoperative follow-up. Appropriate techniques are echocardiography, magnetic resonance imaging, computed tomography angiography, and intravascular ultrasound (IVUS). Rarely, IVUS may be needed in patients with potentially serious CAAs and has unique advantages and limitations. IVUS data are essential for in-depth knowledge of mechanisms of coronary dysfunction (exercise-related dynamic stenosis of variable severity) and for indicating interventional treatment. In adolescents or adults, intramural course of an anomalous coronary artery is the only important feature accompanied by stenosis of potential severity and is especially relevant in patients with a high-risk status (elite sport athletes, military recruits).

3.
J Am Heart Assoc ; 8(15): e013201, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31311390

RESUMO

See Article Cammann et al.

8.
Int J Cardiol ; 281: 28-34, 2019 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-30587416

RESUMO

OBJECTIVES: This paper reviews new findings in both embryology of coronary arteries and in clinical observations of coronary artery anomalies. FOCUS: Our presentation emphasizes studies based on: 1) newer methods of coronary development in animals and humans, and 2) intravascular ultrasonography to interpret pathophysiology and guide treatment of coronary anomalies. CONCLUSIONS: New data reveal the roles of many cellular interactions and signaling pathways involved in the normal and abnormal formation of the coronary arterial system and the consequences of their defective formation. Pathogenetic developmental mechanisms include dysfunction of the Notch and Hypo signaling pathways, angiogenic and arteriogenic molecules, and neural crest cells. We addressed numerous clinically significant coronary anomalies and their prevalence in a general population (especially those characterized by an ectopic origin with aortic intramural course), and point out the critical relevance of understanding the variable mechanisms of coronary dysfunction, especially, fixed versus phasic stenoses or intermittent spasm, and individual severity of clinical presentations.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/fisiopatologia , Desenvolvimento Embrionário/fisiologia , Ultrassonografia de Intervenção/métodos , Animais , Vasos Coronários/anatomia & histologia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/fisiopatologia , Humanos
9.
Catheter Cardiovasc Interv ; 93(3): 445-447, 2019 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-30585420

RESUMO

A 52-year-old man was referred for an anomalous right coronary artery (RCA) originating from the left sinus of Valsalva with an intramural course (R-ACAOS-IM), accompanied by progressive angina and dyspnea. He had been initially advised to have surgical treatment. Computerized axial tomographic angiography showed he had an ectopic origin from the left sinus of a small RCA, with a course between the aorta and pulmonary artery. His negative treadmill nuclear stress test was prematurely terminated because of angina and dyspnea. At our institution, intravascular ultrasound imaging indicated an intramural course and critically severe phasically changing proximal stenosis (80%-100%). The stenosis was resolved with stent-angioplasty of the intramural segment. He had no complications and returned quickly to an asymptomatic state with unrestricted physical activity.

10.
Tex Heart Inst J ; 45(4): 205-213, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-30374227

RESUMO

Improving preparticipation screening of candidates for sports necessitates establishing the prevalence of high-risk cardiovascular conditions (hr-CVC) that predispose young people to sudden cardiac death (SCD). Our accurate, novel protocol chiefly involved the use of cardiac magnetic resonance (CMR) to estimate this prevalence. Middle and high school students from a general United States population were screened by means of questionnaires, resting electrocardiograms, and CMR to determine the prevalence of 3 types of hr-CVC: electrocardiographic abnormalities, cardiomyopathies, and anomalous coronary artery origin from the opposite sinus with intramural coronary course (ACAOS-IM). We examined the range of normal left ventricular size and function in the main study cohort (schoolchildren 11-14 yr old). We defined diagnostic criteria for hr-CVC and compared the cardiac measurements of these younger participants with those of older children whom we examined (age, 15-18 yr). From 5,169 completed diagnostic studies (mean participant age, 13.06 ± 1.78 yr), CMR results revealed 76 previously undiagnosed cases of hr-CVC (1.47% of the total cohort): 11 of dilated cardiomyopathy (14.5%), 3 of nonobstructive hypertrophic cardiomyopathy (3.9%), 23 ACAOS-IM cases (30.3%; 6 left-ACAOS and 17 right-ACAOS), 4 Wolff-Parkinson-White patterns (5.3%), 34 prolonged QT intervals (44.7%), and 1 Brugada pattern (1.3%). Cardiomyopathies were significantly more prevalent in the older children. Of note, we identified 959 cases (18.5%) of left ventricular noncompaction. If our estimate is accurate, only 1.47% of school-age sports participants will need focused secondary evaluations; the rest can probably be reassured about their cardiac health after one 30-minute screening study.


Assuntos
Doenças Cardiovasculares/diagnóstico , Morte Súbita Cardíaca/epidemiologia , Imagem Cinética por Ressonância Magnética/métodos , Programas de Rastreamento/métodos , Instituições Acadêmicas , Esportes , Estudantes/estatística & dados numéricos , Adolescente , Doenças Cardiovasculares/mortalidade , Criança , Morte Súbita Cardíaca/etiologia , Eletrocardiografia , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Fatores de Risco , Inquéritos e Questionários , Taxa de Sobrevida/tendências , Estados Unidos/epidemiologia
12.
Catheter Cardiovasc Interv ; 92(2): 313-321, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-30051621

RESUMO

This is a novel re-appraisal of an understudied and misunderstood group of important coronary anomalies. The general name of the group is "anomalous origin of the left coronary artery," but several additional details should be included in this group of anomalies and the explanation of their pathophysiology. The most lethal form in young athletes or military recruits features intramural aortic proximal course. This comprehensive review is based on a large experience at a dedicated center for coronary artery anomalies, using evolving knowledge (over 20 years) while employing prospective and disciplined programs of evaluation and treatment, according to the nature and severity of each anomaly. The most common pathogenic mechanism of coronary dysfunction relates to intramural coronary course, with or without ectopic origin, leading to variable lateral compression and stenosis inside the aortic tunica media; this compression is present at rest and worsens with exertion. We propose that such variable and dynamic stenoses can be best studied by examining their specific anatomy and clinical presentation, stress testing, and, most importantly, in vivo evaluation by intravascular ultrasonography. Such methods should be used to support individual risk evaluation and selection among treatment options.


Assuntos
Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/diagnóstico por imagem , Morte Súbita Cardíaca/etiologia , Isquemia Miocárdica/etiologia , Ultrassonografia de Intervenção , Idoso , Circulação Coronária , Anomalias dos Vasos Coronários/mortalidade , Anomalias dos Vasos Coronários/fisiopatologia , Vasos Coronários/fisiopatologia , Teste de Esforço , Feminino , Humanos , Masculino , Microcirculação , Pessoa de Meia-Idade , Isquemia Miocárdica/mortalidade , Isquemia Miocárdica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Vasodilatadores/administração & dosagem , Adulto Jovem
13.
Tex Heart Inst J ; 45(1): 54, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29556157
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