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2.
Angiology ; 72(1): 32-43, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32787614

RESUMO

Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events (P = .029).


Assuntos
Anomalias dos Vasos Coronários/epidemiologia , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Ponte de Artéria Coronária/estatística & dados numéricos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/terapia , Terapia Antiplaquetária Dupla , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Oriente Médio/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Intervenção Coronária Percutânea/estatística & dados numéricos , Gravidez , Complicações Cardiovasculares na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/terapia , Prevalência , Sistema de Registros , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Tomografia de Coerência Óptica , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/epidemiologia , Doenças Vasculares/terapia
7.
Medicine (Baltimore) ; 99(33): e21355, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32871987

RESUMO

RATIONALE: Coronary artery abnormalities are usually of major significance in clinical cardiology and cardiac surgery departments due to associated myocardial ischemia, myocardial infarction, and sudden cardiac death. Among them, anatomical malformations account for most coronary artery abnormalities. However, hypoplasia of the coronary artery is a rare type of coronary artery without any genetic screening information. PATIENT CONCERNS: A 10-year-old boy suffered severe chest pain, and a subsequent syncope occurred. DIAGNOSIS AND INTERVENTION: The boy complained of significant chest pain with syncope. Computerized tomography (CT) angiography scanning showed that the left coronary artery was dominated by abnormal origins and dramatically narrow artery lesions. Moreover, cardiac magnetic resonance imaging (MRI) confirmed myocardial ischemia. Cardiac catheterization confirmed that this was an extremely rare hypoplastic coronary case. Finally, a mutation was identified in NOTCH1 c.1023C>A for the first time. OUTCOMES: The boy was discharged after completing all examinations and was forbidden to play any kind of sport activity while waiting for heart transplantation. LESSONS: Hypoplastic coronary artery diseases have only been reported within very limited cases. This is the only report that has identified hypoplasia in 3 epicardial major coronary arteries. In addition, this is the first case to provide evidence between NOTCH1 genetic disorder and hypoplastic coronary artery disease in the clinic.


Assuntos
Anomalias dos Vasos Coronários/genética , Receptor Notch1/genética , Criança , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Transplante de Coração , Humanos , Imagem por Ressonância Magnética , Masculino , Mutação
8.
Eur. j. anat ; 24(5): 357-361, sept. 2020. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-195272

RESUMO

Cardiac resynchronization therapy (CRT) in-volves placing a lead through the coronary sinus to pace the left ventricle. However, technical problems arise in the procedure either due to variant anatomy or due to the presence of valves. Information on coronary venous anatomy is scarce in the South Indian population. The aim of this study was to describe the coronary sinus anatomy in patients undergoing CRT implant. Coronary sinus angiograms were used to study the following parameters: (a) Dimensions of coronary sinus (b) Number and distribution of tributaries (excluding middle and great cardiac veins) (c) Diameter of major veins at the origin (d) Angulation of tributaries with CS. Measurements were made using calipers in the dicom viewer. Out of the 24 angiograms studied, only a single tributary of adequate size was noted in 70.8% (17/24) of the cases, which was most commonly a midlateral vein (76.5%). Two prominent tributaries were noted in 29.2% (7/24) of cases. The average diameter of the veins was 3.93 mm and 80.6% of the veins had an obtuse angle of drainage. Anatomical variations in the coronary venous systemin this population suggest that the majority of patients have a single suitable tributary and this is most often the midlateral vein, which is known to have the most favorable outcome. Data obtained in this study will guide clinicians in left ventricular lead placement in the South Indian population leading to greater procedural success


No disponible


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Terapia de Ressincronização Cardíaca , Anomalias dos Vasos Coronários/diagnóstico por imagem , Vasos Coronários/anatomia & histologia , Vasos Coronários/diagnóstico por imagem , Flebografia , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/fisiopatologia , Seio Coronário/anatomia & histologia , Seio Coronário/diagnóstico por imagem , Estudos Retrospectivos
9.
J Comput Assist Tomogr ; 44(4): 586-590, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32697529

RESUMO

BACKGROUND: The clinical relevance and anatomic characteristics of intracavitary coronary arteries coursing within the right ventricle (RV) are largely unknown. OBJECTIVES: The aim of our study was to assess the clinical and computed tomographic characteristics of patients diagnosed with intracavitary coronary arteries coursing within RV (intra-RV coronaries). METHODS: Electronic records from a single high-volume cardiac center were retrospectively screened for the presence of intra-RV coronaries among consecutive patients who underwent coronary computed tomography angiography (coronary CTA) from 2008 to 2019. RESULTS: Overall, 31,748 coronary CTA reports were evaluated, and 17 subjects with intra-RV coronaries were identified. None of these patients was referred for subsequent invasive coronary angiography. One patient underwent coronary artery bypass grafting, 1 patient had a history of percutaneous coronary intervention, and 1 patient had a concomitant coronary anomaly: left circumflex coronary artery originating from the right coronary artery. All of the involved coronaries (n = 17) were the left anterior descending coronary arteries (LADs). Typical segmental coronary course within RV was along the border between free RV wall and interventricular septum (beneath interventricular groove), often within trabeculae carneae of the RV. Only the midsegment and distal segment of the LAD traversed within the RV. The mean ± SD distance from the aorta to the coronary entrance into the RV was 74.5 ± 17.1 mm, whereas the mean ± SD intra-RV coronary length was 25.1 ± 14.0 mm. CONCLUSIONS: Intra-RV course of the coronaries in an adult CTA population is an infrequent anatomical variant involving LAD. It may require additional attention during interventional and surgical interventions.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Idoso , Anomalias dos Vasos Coronários/patologia , Feminino , Ventrículos do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
11.
Asian Cardiovasc Thorac Ann ; 28(6): 333-335, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32551840

RESUMO

The introduction of the arterial switch operation has improved the surgical outcome of transposition of the great arteries. However, coronary anomalies such as intramural coronary arteries, single coronary artery, or coronary arteries originating from a single arterial sinus have been reported as independent risk factors for early mortality and late morbidity after an arterial switch operation. We performed an arterial switch operation using a unique technique for translocation of the coronary arteries originating from a single left-side arterial sinus, to prevent coronary artery distortion and subsequent coronary malperfusion.


Assuntos
Transposição das Grandes Artérias , Seio Coronário/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Transposição dos Grandes Vasos/cirurgia , Seio Coronário/anormalidades , Seio Coronário/diagnóstico por imagem , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Comunicação Interventricular/complicações , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Humanos , Lactente , Transposição dos Grandes Vasos/complicações , Transposição dos Grandes Vasos/diagnóstico por imagem , Resultado do Tratamento
12.
J Cardiothorac Surg ; 15(1): 124, 2020 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-32498681

RESUMO

BACKGROUND: Woven coronary artery (WCA) is an extremely rare congenital anomaly in which a part of epicardial coronary artery is divided into thin channels, that twist along the axis of the coronary arteries and then merge again as the main coronary lumen. This anomaly is regarded as a benign condition because the blood flow is normal. Very few cases of WCA have been reported. CASE PRESENTATION: Herein we report a case of a 44-year-old man who was admitted to our hospital due to 20 years of repeated episodes of heart palpitations, 2 years of shortness of breath after activity, and the symptoms were aggravated for 1 month. He had history of inferior myocardial infarction and atrial fibrillation. Color Doppler echocardiography revealed rheumatic heart disease, severe mitral regurgitation, mild-moderate tricuspid regurgitation, moderate pulmonary hypertension. Coronary angiography revealed 60-85% diffuse stenosis in the middle of left anterior descending artery, 60-90% diffuse stenosis in the middle of left circumflex artery, 30-40% diffuse stenosis in the proximal segment of right coronary artery, and WCA anomaly in the middle, and distal segments of right coronary artery. CONCLUSION: The patient successfully underwent prosthetic valve replacement and left anterior descending coronary artery bypass grafting, and had a good recovery after surgery. Further studies are needed to fully understand the disease and determine appropriate treatment options.


Assuntos
Estenose Coronária/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Insuficiência da Valva Mitral/diagnóstico por imagem , Infarto do Miocárdio/etiologia , Cardiopatia Reumática/diagnóstico por imagem , Adulto , Angiografia Coronária , Ponte de Artéria Coronária , Estenose Coronária/complicações , Estenose Coronária/cirurgia , Anomalias dos Vasos Coronários/complicações , Ecocardiografia Doppler em Cores , Implante de Prótese de Valva Cardíaca , Humanos , Hipertensão Pulmonar/complicações , Masculino , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/cirurgia , Cardiopatia Reumática/complicações , Cardiopatia Reumática/cirurgia , Insuficiência da Valva Tricúspide/complicações , Insuficiência da Valva Tricúspide/diagnóstico por imagem
17.
J Cardiothorac Surg ; 15(1): 90, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398101

RESUMO

BACKGROUND: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare but potentially fatal congenital coronary anomaly associated with early infant mortality and sudden adult death. By the development or lack of coronary collateral, it can be classified as infantile or adult type. However, even with the compensatory mechanism in adult patients, there is an estimated 80 to 90% incidence of sudden death at the mean age of 35 years. METHODS: We enrolled 9 patients with ALCAPA within the age group 5 to 16 years. RESULTS: Only one patient developed symptoms (apsychia), whereas other patients were asymptomatic, and there was no evident left ventricular dysfunction found in any of the cases. CONCLUSION: With the development of imaging techniques, asymptomatic adult-type ALCAPA patients could be identified and diagnosed in childhood or adolescence. As a potential cause of sudden death, ALCAPA should be surgically repaired soon after the diagnosis.


Assuntos
Síndrome de Bland-White-Garland/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/diagnóstico por imagem , Adolescente , Doenças Assintomáticas , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Artéria Pulmonar/anormalidades
18.
Int J Cardiovasc Imaging ; 36(10): 1855-1885, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32462448

RESUMO

Exclusion of cardiac abnormalities should be performed at the beginning of the athlete's career. Myocarditis, right ventricular remodeling and coronary anomalies are well-known causes of life-threatening events of athletes, major cardiovascular events and sudden cardiac death. The feasibility of an extended comprehensive echocardiographic protocol for the detection of structural cardiac abnormalities in athletes should be tested. This standardized protocol of transthoracic echocardiography includes two- and three-dimensional imaging, tissue Doppler imaging, and coronary artery scanning. Post processing was performed for deformation analysis of all compounds including layer strain. During 2017 and 2018, the feasibility of successful image acquisition and post processing analysis was retrospectively analyzed in 54 male elite athletes. In addition, noticeable findings inside the analyzed cohort are described. The extended image acquisition and data analyzing was feasible from 74 to 100%, depending on the used modalities. One case of myocarditis was detected in the present cohort. Coronary anomalies were not found. Right ventricular size and function were within normal ranges. Isovolumetric right ventricular relaxation time showed significant regional differences. One case of hypertrophic cardiomyopathy and two subjects with bicuspid aortic valves were found. Due to the excessive cardiac stress in highly competitive sports, high-quality and precise screening modalities are necessary, especially with respect to acquired cardiac diseases like acute myocarditis and pathological changes of left ventricular and RV geometry. The documented feasibility of the proposed extended protocol underlines the suitability to detect distinct morphological and functional cardiac alterations and documents the potential added value of a comprehensive echocardiography.


Assuntos
Atletas , Cardiomiopatia Hipertrófica/diagnóstico por imagem , Anomalias dos Vasos Coronários/diagnóstico por imagem , Ecocardiografia Doppler , Ecocardiografia Tridimensional , Miocardite/diagnóstico por imagem , Função Ventricular Direita , Remodelação Ventricular , Adulto , Cardiomiopatia Hipertrófica/complicações , Cardiomiopatia Hipertrófica/fisiopatologia , Anomalias dos Vasos Coronários/complicações , Morte Súbita Cardíaca/etiologia , Estudos de Viabilidade , Humanos , Masculino , Miocardite/complicações , Miocardite/fisiopatologia , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Adulto Jovem
19.
BMC Cardiovasc Disord ; 20(1): 192, 2020 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321432

RESUMO

BACKGROUND: The condition of anomalous aortic origin of the right coronary artery (AAORCA) with an interarterial course leads to few, if any, clinical problems. Malignant presentation of the often non-significant AAORCA associated with conduction system abnormalities is a rare finding. Surgical repair, even for highly symptomatic patients, is still controversial. However, in this case, the surgery brought a paradigm shift in treatment modality, improving the symptoms of this patient. CASE PRESENTATION: We report a case of a 52-year-old man with severe chest pain and recurrent electrical storms with an implanted cardiac resynchronization therapy defibrillator (CRT-D) device. Coronary angiography and computed tomography (CT) revealed the rare anomalous aortic origin of the right coronary artery (AAORCA) with a high interarterial course between the aorta and the pulmonary trunk. As symptoms typically develop on exertion, placing the patient at an increased risk of ischemic distress, a stress myocardial perfusion imaging study helped to identify his high-risk status. Although patient-specific, a surgical repair was the only concrete step agreed upon after multiple collaborative discussions with the cardiac surgeons. Surgery significantly improved the symptoms, with the patient reporting resolution of his chest pain, as well as no documented inappropriate defibrillator activity on follow-up appointments. CONCLUSION: One purpose of reporting the case study was to underscore the risk factors associated with AAORCA, challenging claims of its benign nature. This case complements existing findings demonstrating that ischemic distress consequent to the right coronary artery (RCA) compression may precede the rare incidence of an electrical storm. Importantly, the case-study emphasizes the significance of integrated multimodality imaging in clinical practice as well as providing real-world evidence for the efficacy of surgical repair in highly symptomatic patients with AAORCA with an interarterial course.


Assuntos
Anomalias dos Vasos Coronários/complicações , Taquicardia Ventricular/etiologia , Terapia de Ressincronização Cardíaca , Dispositivos de Terapia de Ressincronização Cardíaca , Procedimentos Cirúrgicos Cardíacos , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Desfibriladores Implantáveis , Cardioversão Elétrica/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/terapia , Resultado do Tratamento
20.
JACC Cardiovasc Interv ; 13(8): 921-932, 2020 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-32327089

RESUMO

OBJECTIVES: The aim of this study was to investigate the impact of spontaneous coronary artery dissection (SCAD) on 30-day readmission rates following hospitalization with acute myocardial infarction (AMI) using a national database. BACKGROUND: AMI in the setting of SCAD represents an uncommon type of myocardial infarction with limited data on short-term outcomes. METHODS: All hospitalizations with primary or index diagnoses of AMI from 2010 to 2015 in the Nationwide Readmissions Database were queried. The primary outcome was overall 30-day readmission rates in both SCAD and non-SCAD cohorts. Propensity score matching (1:2) was conducted. RESULTS: A total of 2,654,087 patients with AMI were included in the final analysis, of whom 1,386 (0.052%) were diagnosed with SCAD. SCAD was associated with a higher readmission rate in the SCAD cohort (12.3% vs. 9.9%; p = 0.022). The main causes of readmissions in the SCAD cohort were cardiac causes (80.6%), and AMI was the most common cardiac cause (44.8%), followed by chest pain (20.1%) and arrhythmia (12.7%). Among the SCAD readmissions, 50.6% patients were readmitted in the first week post-discharge, with 54.5% of AMI readmissions occurring in the first 2 days post-discharge. CONCLUSIONS: The incidence of 30-day readmission following AMI and SCAD is nontrivial and occurs early post-discharge. Most readmissions are due to cardiac causes, especially AMI. Targeted management approaches are needed to diminish the high rates of readmission and early recurrent AMI.


Assuntos
Anomalias dos Vasos Coronários/terapia , Infarto do Miocárdio/terapia , Admissão do Paciente , Readmissão do Paciente , Doenças Vasculares/congênito , Idoso , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/mortalidade , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/mortalidade , Recidiva , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/mortalidade , Doenças Vasculares/terapia
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