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1.
Tex Heart Inst J ; 46(3): 189-194, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708701

RESUMO

Patients with anomalous origin of a coronary artery during aortic valve replacement (AVR) are at risk of coronary compromise. Large case series are lacking. In this retrospective study, we review our experience with this condition. From August 2014 through June 2016, 8 adult patients (mean age, 74 ± 17.5 yr; age range, 33-86 yr; 5 men) with anomalous aortic origin of a coronary artery underwent surgical or transcatheter AVR at our institution. Six patients had aortic stenosis; 2 had aortic insufficiency, one of whom had an associated aortic root aneurysm. In 7 patients, the left anomalous coronary artery originated from the right aortic sinus, and in one, the right coronary artery arose from the left cusp. The anatomic course was revealed by means of 3-dimensional computed tomographic angiography. No patient underwent primary aortic reimplantation of the anomalous artery. Two had the artery mobilized from encircling the annulus too closely and then underwent coronary artery bypass grafting. Two high-risk patients underwent transcatheter AVR. After surgical AVR, 2 patients had perioperative myocardial infarction caused by coronary compression, so percutaneous coronary intervention was performed. One patient died of sepsis 3 months after discharge from the hospital. In our patients, AVR sometimes led to severe perioperative complications. Successful AVR depended on 3-dimensional computed tomographic angiographic findings, individual anatomic variations, and appropriate treatment choices.


Assuntos
Valva Aórtica/cirurgia , Anomalias dos Vasos Coronários/diagnóstico , Doenças das Valvas Cardíacas/cirurgia , Substituição da Valva Aórtica Transcateter/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Valva Aórtica/diagnóstico por imagem , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/cirurgia , Ecocardiografia Doppler em Cores , Feminino , Seguimentos , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico , Humanos , Imagem Tridimensional , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Resultado do Tratamento
2.
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
3.
Tex Heart Inst J ; 46(3): 225-228, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31708710

RESUMO

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. Four months after corrective surgery, she was doing well. We discuss the reperfusion phenomenon in our patient's case, as well as other considerations in this combination of congenital defects.


Assuntos
Anormalidades Múltiplas , Aorta Torácica/anormalidades , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Artéria Pulmonar/anormalidades , Síndrome de Turner/diagnóstico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Implante de Prótese Vascular/métodos , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Ecocardiografia , Feminino , Fluoroscopia , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia
4.
Rev Port Cardiol ; 38(8): 609.e1-609.e7, 2019 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31694785

RESUMO

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome that typically occurs in relatively young patients without classical cardiovascular risk factors for coronary artery disease. The etiology appears to be multifactorial and optimal management is not clearly established, so the treatment strategy is often selected based on clinical presentation and coronary anatomy. We present two cases of spontaneous coronary artery dissection with different initial approaches, highlighting the importance of a case-by-case assessment.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Tomada de Decisões , Stents , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Humanos , Masculino , Ultrassonografia de Intervenção , Doenças Vasculares/diagnóstico , Doenças Vasculares/cirurgia
5.
J Assoc Physicians India ; 67(8): 85-86, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31562729

RESUMO

Congenital coronary anomalies are uncommon with rarest being absent left circumflex artery (LCX) having prevalence of 0.003%. We report a case of a 68 year old male having acute coronary syndrome and left ventricular dysfunction whose coronary angiogram showed an absent LCX with super dominant right coronary artery (RCA). Precise morphological evaluation is needed for best suited management strategy.


Assuntos
Síndrome Coronariana Aguda/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Idoso , Angiografia Coronária , Humanos , Masculino
6.
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
7.
Int Heart J ; 60(5): 1226-1229, 2019 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-31484871

RESUMO

This paper presents two cases of human hearts (a 75-year-old woman and an 88-year-old man) with double posterior descending arteries (PDA) of various sizes originating from the right coronary artery, mainly supplying the interventricular septum as well as the posterior walls of both heart ventricles in a different scope. In the analysis of the arterial vasculature, a range of aspects were considered, such as the point of exit of the right coronary artery, the course of the vessel, the range of the blood supply of the interventricular septum and both ventricles, as well as selected morphometric parameters that were simultaneously compared with one another. These atypical changes presented based on the example of the analyzed cases will certainly constitute a valuable source of information for cardiac surgeons and interventional cardiologists in planning operations.


Assuntos
Anormalidades Múltiplas/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Cardiopatias Congênitas/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Cadáver , Dissecação , Feminino , Humanos , Masculino , Doenças Raras , Septo Interventricular/patologia
8.
Rev Port Cir Cardiotorac Vasc ; 26(2): 159-162, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31476820

RESUMO

Pulmonary sequestration (PS) is a rare congenital malformation, even more when its arterial supply is a coronary artery. We present a case of a 68-year-old man admitted in the emergency room with an acute coronary syndrome and no evidence of significant coronary disease. Instead, he had an abnormal branch from the circumflex coronary artery nourishing a mass in the left lower pulmonary lobe. A coronary steal phenomenon was proposed to explain the clinical presentation. An anterior left thoracotomy with ligation of the abnormal branch and atypical resection of the lung segment comprising the sequestration was performed.


Assuntos
Síndrome Coronariana Aguda/etiologia , Sequestro Broncopulmonar/cirurgia , Anomalias dos Vasos Coronários/cirurgia , Pulmão/irrigação sanguínea , Idoso , Sequestro Broncopulmonar/complicações , Sequestro Broncopulmonar/diagnóstico , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Humanos , Masculino , Toracotomia
10.
World J Pediatr Congenit Heart Surg ; 10(4): 515-517, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307295

RESUMO

Anatomic single coronary arteries are quite rare but can be a potential cause of sudden cardiac death. We present the first case of a pediatric patient with an anatomic single right coronary artery (Lipton type R1 or Shirani-Roberts type IIA), of a type which has been associated with adult-onset ischemic cardiac disease. We review the evaluation and management of this young patient.


Assuntos
Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Criança , Angiografia por Tomografia Computadorizada , Ecocardiografia , Humanos , Masculino
11.
World J Pediatr Congenit Heart Surg ; 10(4): 502-503, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31307300

RESUMO

Cardiovascular computed tomographic angiography (CCTA) 3-D thoracic reconstruction can serve as a "virtual patient avatar" providing surgical views for approach to complex anomalous coronary artery anatomy. Images demonstrated a single coronary artery ostium arising from the right aortic sinus with trifurcation into a prepulmonic left anterior descending coronary artery (LAD), an interarterial circumflex with a subsequent intraseptal course, and normal course of the right coronary artery. Virtual 3-D CCTA reconstructions were important to planning an incisional plane for surgical correction.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Angiografia por Tomografia Computadorizada/métodos , Angiografia Coronária/métodos , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Imagem Tridimensional , Realidade Virtual , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/cirurgia , Humanos , Valor Preditivo dos Testes , Seio Aórtico/anormalidades
12.
Int Heart J ; 60(4): 1003-1005, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31308327

RESUMO

A 14-year-old boy collapsed suddenly after a basketball game and was transported to our hospital after recovering from ventricular fibrillation by an automated external defibrillator. He had experienced loss of consciousness twice and has been examined for suspected long-QT syndrome at another hospital. The 12-lead electrocardiogram on admission revealed a prolonged QTc interval of 480 milliseconds. After the patient recovered without any sequelae, computed tomography revealed an anomalous left coronary artery arising from the opposite sinus of Valsalva and coursing between the aorta and the pulmonary artery. Furthermore, genetic testing identified a KCNE1-D85N abnormality. An anomalous coronary artery is one of the major causes of sudden death in young people; therefore, surgical revascularization is recommended for left coronary arteries arising from the contralateral sinus and coursing between the aorta and the pulmonary artery, regardless of myocardial ischemia. Transient myocardial ischemia may have exaggerated the instability from the arrhythmic substrate, even though KCNE1-D85N abnormalities alone are not thought to cause fatal arrhythmias. Besides routine electrocardiography, further examinations, including imaging and genetic testing, can characterize the pathophysiology of fatal cardiac disease.


Assuntos
Anomalias dos Vasos Coronários/genética , Parada Cardíaca/etiologia , Polimorfismo Genético , Canais de Potássio de Abertura Dependente da Tensão da Membrana/genética , Adolescente , Angiografia Coronária , Ponte de Artéria Coronária/métodos , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Eletrocardiografia , Testes Genéticos , Parada Cardíaca/diagnóstico , Humanos , Masculino , Canais de Potássio de Abertura Dependente da Tensão da Membrana/metabolismo , Tomografia Computadorizada por Raios X
13.
S Afr Med J ; 109(7): 477-479, 2019 Jun 28.
Artigo em Inglês | MEDLINE | ID: mdl-31266572

RESUMO

Spontaneous coronary artery dissection (SCAD) is a relatively rare cause of acute coronary syndrome and sudden cardiac death, which frequently affect young women in the absence of established cardiovascular risk factors. Advancements in cardiovascular imaging account for the increasing recognition of this diagnosis and associated diagnoses, although classic diagnostic modalities such as electrocardiography remain of paramount importance. We present a young woman with recurrent SCAD and briefly discuss her management and its outcome.


Assuntos
Anomalias dos Vasos Coronários/diagnóstico , Doenças Vasculares/congênito , Adulto , Angiografia Coronária , Anomalias dos Vasos Coronários/terapia , Eletrocardiografia , Feminino , Humanos , Náusea/etiologia , Recidiva , Sudorese , Troponina T/sangue , Doenças Vasculares/diagnóstico , Doenças Vasculares/terapia
14.
Expert Rev Cardiovasc Ther ; 17(7): 497-510, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31232618

RESUMO

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.


Assuntos
Anomalias dos Vasos Coronários/etiologia , Doenças Vasculares/congênito , Adulto , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico , Anomalias dos Vasos Coronários/fisiopatologia , Gerenciamento Clínico , Feminino , Humanos , Pessoa de Meia-Idade , Infarto do Miocárdio/etiologia , Recidiva , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico , Doenças Vasculares/etiologia , Doenças Vasculares/fisiopatologia
16.
World J Pediatr Congenit Heart Surg ; 10(3): 360-363, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31084306

RESUMO

Anomalous origin of a coronary artery from the opposite aortic sinus of Valsalva can present in various ways, ranging from a benign and incidental finding to sudden cardiac death. The variant with an intraseptal subpulmonary course (sometimes referred to as intraconal), is widely perceived to carry a low risk of ischemia and has been considered to be a benign variant, not requiring surgical treatment. In one of our recent patients, however, nuclear scintigraphy highlighted a myocardial perfusion deficit in the territory supplied by the allegedly benign anomalous coronary artery, prompting the need for a more aggressive surgical approach.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Circulação Coronária/fisiologia , Anomalias dos Vasos Coronários/cirurgia , Vasos Coronários/diagnóstico por imagem , Imagem de Perfusão do Miocárdio/métodos , Criança , Anomalias dos Vasos Coronários/diagnóstico , Vasos Coronários/cirurgia , Ecocardiografia , Humanos , Masculino , Tomografia Computadorizada por Raios X
18.
Cardiol Young ; 29(5): 727-729, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31133077

RESUMO

We report the case of a 14-year-old female who had tetralogy of Fallot along with anomalous origin of the left pulmonary artery from the ascending aorta with co-dominant double aortic arch forming a complete vascular ring compressing the oesophagus along with a left main coronary artery to right ventricular outflow tract fistula. She underwent surgical correction without conduit placement.


Assuntos
Aorta/anormalidades , Fístula Artério-Arterial/diagnóstico , Anomalias dos Vasos Coronários/diagnóstico , Artéria Pulmonar/anormalidades , Tetralogia de Fallot/diagnóstico , Adolescente , Fístula Artério-Arterial/congênito , Fístula Artério-Arterial/cirurgia , Procedimentos Cirúrgicos Cardíacos , Angiografia por Tomografia Computadorizada , Anomalias dos Vasos Coronários/cirurgia , Feminino , Humanos , Imagem Tridimensional , Tetralogia de Fallot/cirurgia , Procedimentos Cirúrgicos Vasculares
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