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1.
Medicine (Baltimore) ; 99(7): e19163, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049845

RESUMO

RATIONALE: Woven coronary artery is a very rare congenital anomaly which may lead to acute coronary syndrome in previous literatures. At present, there is no consensus on the treatment of this coronary artery abnormality. PATIENT CONCERNS: A 48-year-old male was admitted to the other hospital because of persistent chest pain. The electrocardiogram showed an ST-segment elevation in the v1-v5 lead and the patient was diagnosed with acute anterior myocardial infarction. Coronary angiography revealed 2 lumens in the proximal segment of the left anterior descending artery. Then the patient was transferred to our hospital for further diagnosis and treatment. DIAGNOSES: The patient was diagnosed with acute myocardial infarction and woven coronary. Transthoracic echocardiography showed left ventricular anterior wall segmental motor abnormalities. INTERVENTIONS: Optical coherence tomography (OCT) and fractional flow reserve (FFR) guided percutaneous coronary intervention was performed successfully. OUTCOMES: During the follow-up period of 4 years, the patient remained asymptomatic and no adverse events. LESSONS: Although the significance of blood flow limitation in one of the lumens detected by FFR is unclear, this strategy of OCT and FFR-guided treatment in woven coronary artery combined with acute coronary events still shows its feasibility.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/diagnóstico , Reserva Fracionada de Fluxo Miocárdico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica
2.
Medicine (Baltimore) ; 99(7): e19176, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32049849

RESUMO

INTRODUCTION: Single coronary artery is a rare condition characterized by the origin of a coronary that supplies the entire heart from a single coronary ostium. PATIENT CONCERNS: A 45-year-old woman with an altered exercise testing was addressed to a computed tomography coronary angiography (CTCA) to rule out coronary artery disease (CAD). DIAGNOSIS: CTCA examination showed the absence of the right coronary artery (RCA). The left anterior descending artery and the left circumflex artery (LCX) presented regular origin and course and LCX provided the posterior interventricular artery and the posterolateral artery. INTERVENTIONS: As CTCA highlighted the absence of potentially life-threatening features related to coronary anomaly, no surgical treatment was advised. OUTCOMES: The patient was dismissed, kept under pharmacological control and monitored over time. CONCLUSION: CTCA is the first-choice imaging modality in patients with ECG abnormalities properly allowing the differential diagnosis between CAD and congenital heart disease.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Angiografia Coronária , Feminino , Humanos , Pessoa de Meia-Idade
3.
Zhonghua Er Ke Za Zhi ; 58(2): 113-117, 2020 Feb 02.
Artigo em Chinês | MEDLINE | ID: mdl-32102147

RESUMO

Objective: To investigate the clinical features and improve the diagnosis and treatment of anomalous origin of the left coronary artery from the right coronary sinus with an interarterial course (ALCA-R-IAC) between the ascending aorta and main pulmonary artery in children. Methods: A retrospective analysis of the clinical manifestation, laboratory test, radiological feature, treatment and prognosis were conducted in four female children presented with ALCA-R-IAC in Beijing Children's Hospital from November 2015 to June 2018. Results: The four girls with onset age of 7.5-14.7 years were diagnosed with ALCA-R-IAC by CT coronary angiography (CTCA). Four children presented with exercise-induced syncope and clinical manifestations of acute myocardial infarction including 3 patients with acute left heart failure, 1 cardiogenic shock and 1 cardiac arrest. Nervous system involvement was found in one patient. Troponin I increased significantly to 20.65-50.00 µg/L in the four patients. Electrocardiogram (ECG) developed signs of left main coronary artery involvement. Echocardiography revealed reduced left ventricular ejection fraction (LVEF) of 25%-45% in three children and suspected anomalous origin of the left coronary artery in one child. CTCA showed an anomalous left coronary artery originating from the right coronary sinus, which had an interarterial course between the aorta and pulmonary artery leading to a slim left main coronary trunk. Two children underwent unroofing procedure and the other two children in whom physical activities were restricted received conservative managements. During a regular follow-up period of 12-43 months, all the children survived without recurrent symptoms and had good prognosis. Conclusions: ALCA-R-IAC can present as exercise-related syncope and acute myocardial infarction, even sudden death in children and adolescents. CTCA is helpful to clarify the early diagnosis of ALCA-R-IAC. Surgical intervention is the main treatment for ALCA-R-IAC and strenuous physical activities should be avoided.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia , Adolescente , Criança , Angiografia Coronária , Feminino , Humanos , Estudos Retrospectivos , Volume Sistólico , Resultado do Tratamento , Função Ventricular Esquerda
4.
Medicine (Baltimore) ; 99(5): e18981, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000431

RESUMO

RATIONALE: Congenital absence of the right coronary artery with acute myocardial infarction (AMI) is a rare clinical situation that may lead to death. We report a case of successful percutaneous coronary intervention for congenital absence of the right coronary artery with AMI. PATIENT CONCERNS: A 53-year-old woman had a 7-day history of chest discomfort that had worsened over 10 hours. She was diagnosed as having myocardial infarction and was admitted to hospital. DIAGNOSIS: Coronary angiography showed absence of the right coronary artery; the left anterior descending (LAD) branch sent out the right ventricular branch and the posterior descending branch. The LAD branch was occluded and there was diffuse stenosis of the middle right ventricular branch and severe stenosis of the distal circumflex branch. INTERVENTIONS: Percutaneous coronary intervention was performed. One stent was implanted in the LAD branch and another implanted in the right ventricular branch. OUTCOMES: The patient was discharged 3 weeks after surgery. The follow-up showed that the patient was asymptomatic without recurrence. LESSONS: Although absence of the right coronary artery with AMI is a fatal condition, percutaneous coronary intervention remains an effective treatment.


Assuntos
Anomalias dos Vasos Coronários/cirurgia , Infarto do Miocárdio/cirurgia , Intervenção Coronária Percutânea , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Stents
6.
BMC Cardiovasc Disord ; 20(1): 37, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996146

RESUMO

BACKGROUND: The Starr-Edwards ball valve prosthesis was successfully introduced in 1961-62 and largely used for aortic and mitral valve replacement. Even if Starr-Edwards valves have been widely replaced in clinical practice by other mechanical valves, they define a standard concerning long-term durability. CASE PRESENTATION: We describe the case of a 55-year-old man referred to our Department to perform a cardiac computed tomography (CCT), to better evaluate a severe dilation of ascending aorta discovered at echocardiography. The patient had been surgically treated 46 years earlier to correct a supra-cristal type ventricular septal defect. Both mitral and aortic valves were replaced, respectively due to bacterial mitral endocarditis and a fibrous sub-valvular aortic stenosis. In addition, the right coronary artery (RCA) was found to arise from the left coronary sinus. CONCLUSION: We report the longest lasting durability (46 years) of aortic and mitral Starr-Edwards valves successfully implanted in a patient simultaneously carrying a malignant anomalous origin of RCA.


Assuntos
Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/complicações , Comunicação Interventricular/cirurgia , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Valva Mitral/cirurgia , Aneurisma Aórtico/complicações , Aneurisma Aórtico/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Comunicação Interventricular/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento
8.
Braz J Cardiovasc Surg ; 34(6): 779-782, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31793257

RESUMO

Spontaneous coronary artery dissection (SCAD) is characterized by tear of the inner layer in the coronary artery, creating a false lumen between the inner and central layer. Its infrequent incidence often leads to delay in diagnosis posing challenges in management. There are currently no guidelines for the treatment of this condition. We describe an adult patient who presented with multiple episodes of ventricular fibrillation, in whom cardiac catheterization showed SCAD, treated by off-pump coronary artery bypass.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Doenças Vasculares/congênito , Adulto , Cateterismo Cardíaco , Angiografia Coronária , Vasos Coronários , Ecocardiografia , Eletrocardiografia , Feminino , Humanos , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
9.
Rev Med Liege ; 74(12): 625-626, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31833270

RESUMO

Congenital coronary artery fistulas are infrequent but sometimes hemodynamically important anomalies depending on their magnitude and the cardiac chamber or vascular site involved. Fistula from left circumflex artery to coronary sinus are potentially curable causes of ischemic heart disease.


Assuntos
Doença da Artéria Coronariana , Anomalias dos Vasos Coronários , Fístula Vascular , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/cirurgia , Seio Coronário , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Humanos , Fístula Vascular/diagnóstico por imagem , Fístula Vascular/cirurgia
10.
Methodist Debakey Cardiovasc J ; 15(3): 223-225, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31687103

RESUMO

Anomalous origin of the right coronary artery (ARCA) is an extremely rare cardiac pathology. The coronary artery can potentially course between the aorta and the pulmonary artery, putting the patient at risk for sudden cardiac death. Even rarer is an ARCA that arises from the left main coronary artery (LMCA). To our knowledge, this is the first case where an ARCA arising entirely from the LMCA is associated with critical bicuspid aortic valve stenosis.


Assuntos
Estenose da Valva Aórtica/etiologia , Valva Aórtica/anormalidades , Anomalias dos Vasos Coronários/complicações , Doenças das Valvas Cardíacas/complicações , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca , Humanos , Achados Incidentais , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
11.
Lakartidningen ; 1162019 Sep 13.
Artigo em Sueco | MEDLINE | ID: mdl-31529421

RESUMO

Spontaneous coronary artery dissection can be caused by a tear in the intima or a bleeding in the wall of a coronary artery. It is a possible cause of acute coronary syndrome and should be suspected in patients with few risk factors for coronary artery disease. The condition is overrepresented in women particularly during the peripartum period. We present a case where a 36-year-old woman, three days after delivering her third child, presented with myocardial infarction with nonobstructive coronary arteries. She later presented again with ST-elevation myocardial infarction and coronary angiography with optical coherence tomography revealed coronary dissection that was treated with percutaneous coronary intervention.


Assuntos
Anomalias dos Vasos Coronários , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Eletrocardiografia , Feminino , Humanos , Equipe de Assistência ao Paciente , Intervenção Coronária Percutânea , Período Periparto , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/cirurgia , Fatores de Risco , Tomografia de Coerência Óptica , Doenças Vasculares/diagnóstico , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
13.
Heart Surg Forum ; 22(4): E308-E309, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31398098

RESUMO

Anomalies of the coronary arteries -- especially their abnormal origin from the pulmonary artery (ARCAPA) trunk -- are among the least common. They're also the most dangerous of congenital heart defects with an incidence of 0.002% in the general population [Williams 2006]. The diagnosis exceedingly is difficult because anatomical abnormalities of the coronary arteries are subtle. We present a case of an anomalous origin of the right coronary artery.


Assuntos
Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Angiografia por Tomografia Computadorizada , Circulação Coronária , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem
14.
Methodist Debakey Cardiovasc J ; 15(2): 111-121, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31384374

RESUMO

Anomalous aortic origin of a coronary artery (AAOCA) is the second leading cause of sudden cardiac death in young athletes. The pathophysiology leading to sudden cardiac death, the specific risks associated with the different varieties of AAOCA, and the effects of different management strategies on the risk of sudden cardiac death are all unknown. This article describes the current knowledge of AAOCA, a proposed nomenclature for the different anatomic subtypes, the different modalities used to diagnose and characterize the disease, the available management strategies, and an algorithm used by the authors to diagnose and manage these patients.


Assuntos
Técnicas de Imagem Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Morte Súbita Cardíaca/prevenção & controle , Algoritmos , Tomada de Decisão Clínica , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/fisiopatologia , Morte Súbita Cardíaca/etiologia , Técnicas de Apoio para a Decisão , Humanos , Seleção de Pacientes , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco
15.
Medicine (Baltimore) ; 98(34): e16888, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441865

RESUMO

RATIONALE: Facial nerve palsy (FNP) is one of the rare neurologic symptoms of Kawasaki disease (KD), associated with a higher incidence of coronary arteries lesions and may be an indicator of more severe disease. PATIENT CONCERNS: A 3-month-old male infant with persistent fever, irritability, and facial asymmetry. DIAGNOSES: KD with FNP. INTERVENTIONS: The infant received intravenous immunoglobulin (IVIG) (2 g/kg/16 hours) and aspirin (50 mg/kg/day) were started on the 8th day of illness. OUTCOMES: Fever and FNP resolved within 48 hours after IVIG treatment. The inflammatory markers all improved to normal or near-normal levels before discharge; all infectious studies returned negative. His left facial weakness was unappreciable at day of discharge. LESSONS: FNP associated with KD is an uncommon finding but may indicate an increased risk of coronary artery involvement. KD should always be kept in mind in the differential diagnosis of a child who presents with prolonged unexplained fever, even with incomplete diagnostic features, as well as the need to be aware of unusual manifestations, such as FNP.


Assuntos
Anomalias dos Vasos Coronários/etiologia , Assimetria Facial/etiologia , Paralisia Facial/etiologia , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia , Assimetria Facial/tratamento farmacológico , Paralisia Facial/tratamento farmacológico , Humanos , Imunoglobulinas Intravenosas/administração & dosagem , Fatores Imunológicos/administração & dosagem , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/complicações
16.
Medicine (Baltimore) ; 98(35): e16612, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31464896

RESUMO

RATIONALE: Spontaneous coronary artery dissection (SCAD) is a rare, complex disease, and nowadays poorly understood. The overall incidence of SCAD ranges from 0.28% to 1.1% in angiographic studies. Therefore, the true incidence of SCAD is most likely underestimated due to asymptomatic or sudden cardiac death before diagnosis. Stent fracture (SF) is a multifactorial issue. Longer vessel remodeled by 2 stents can be more prone to have SF due to higher radial force. PATIENT CONCERNS: In this paper we report a 48-year-old man with chest pain for 2 years. DIAGNOSES: Elective coronary angiography revealed a linear dissection in obtuse marginal branch (OM). INTERVENTIONS: He underwent percutaneous coronary intervention (PCI) with the guidance of intravascular ultrasound (IVUS). OUTCOMES: Then SF was revealed 9 months later. LESSONS: This is the first case report of SF after coronary intervention therapy in SCAD patients.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Stents/efeitos adversos , Doenças Vasculares/congênito , Dor no Peito/etiologia , Angiografia Coronária , Anomalias dos Vasos Coronários/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea , Resultado do Tratamento , Ultrassonografia de Intervenção , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/cirurgia
18.
BMC Surg ; 19(1): 80, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277612

RESUMO

BACKGROUND: The combination of multiple giant coronary artery aneurysms (CAAs) and right coronary artery (RCA) to pulmonary artery (PA) fistula is extremely rare and the patients with CAAs may suffer from several fatal complications. We herein describe a 60-year-old female with hemodynamic instability who was diagnosed with multiple giant CAAs combined with RCA-PA fistula. CASE PRESENTATION: The patient, a 60-year-old female, presented to the emergency room because of progressive exertional chest distress and fatigue. The transthoracic echocardiography (TTE), coronary computed tomography angiography (CTA) and invasive coronary angiography confirmed the existence of multiple giant CAAs and RCA-PA fistula. Laboratory examinations for systemic vasculitis and infectious diseases demonstrated no abnormalities and work-up for childhood and family history were negative. We have performed a successful surgical treatment for this patient. The patient's restrictive cardiac dysfunction was improved after debriding the advanced thrombi in aneurysm sac and ligating the fistulous vessel between the native RCA and PA. The postoperative pathologic examination of the aneurysmal wall revealed loss of smooth muscle cells in the media with local mucoid degeneration, no chronic inflammation, sclerosis and IgG4 were observed. CONCLUSIONS: The treatment decision-making process should depend upon the patients' specific situations. Our case suggests the surgical intervention should be accepted as the preferred treatment for giant CAAs with restrictive cardiac dysfunction.


Assuntos
Fístula Artério-Arterial/complicações , Aneurisma Coronário/complicações , Anomalias dos Vasos Coronários/complicações , Artéria Pulmonar/anormalidades , Fístula Artério-Arterial/diagnóstico por imagem , Fístula Artério-Arterial/cirurgia , Aneurisma Coronário/diagnóstico por imagem , Aneurisma Coronário/cirurgia , Angiografia Coronária , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade
19.
BMJ Case Rep ; 12(7)2019 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-31326903

RESUMO

Coronary artery anomalies are usually an incidental finding on coronary angiogram. Most of them are benign, although few of them are malignant which may cause sudden cardiac death. A 64-year-old diabetic, hypertensive man underwent coronary angiography for evaluation of exertional dyspnoea, and angina which revealed an anomalous left main coronary artery (LMCA) arising from right coronary sinus which was unduly long (79 mm) but free from any disease. To the best of our knowledge after extensive search in literature, this is the longest LMCA to be ever reported. The patient was managed conservatively.


Assuntos
Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/patologia , Dispneia/etiologia , Anti-Hipertensivos/uso terapêutico , Angiografia Coronária , Anomalias dos Vasos Coronários/tratamento farmacológico , Diabetes Mellitus , Diagnóstico Diferencial , Humanos , Hipertensão , Achados Incidentais , Masculino , Pessoa de Meia-Idade
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