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Siblings With Familial Dwarfism Presenting With Acute Myocardial Infarction at Adolescence. JACC Case Rep 2021; 3:795-800. [PMID: 34317628 PMCID: PMC8311190 DOI: 10.1016/j.jaccas.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/05/2021] [Indexed: 12/02/2022]
Abstract
We encountered siblings with familial Majewski osteodysplastic primordial dwarfism type II (MOPD II) with acute myocardial infarction in adolescence and in their early 20s. We successfully performed percutaneous and surgical coronary interventions. From these cases, we were able to better understand coronary artery disease of MOPD II and provide better management. (Level of Difficulty: Intermediate.)
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Key Words
- AMI, acute myocardial infarction
- CABG, coronary artery bypass grafting
- CAD, coronary artery disease
- CAG, coronary angiography
- ECG, electrocardiogram
- HOMA-IR, homeostatic model assessment for insulin resistance
- LAD, left anterior descending artery
- LCX, left circumflex artery
- MOPD II, Majewski osteodysplastic primordial dwarfism type II
- PCNT, pericentrin gene
- coronary artery disease
- insulin resistance
- pediatric
- primordial dwarfism
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Imaizumi T, Takata K, Ike A, Idemoto Y, Shiga Y, Sugihara M, Matsunaga A, Miura SI. A Continuous Murmur as the Only Clinical Sign for Complex Coronary Artery Fistulas Diagnosis. JACC Case Rep 2021; 3:740-744. [PMID: 34317617 PMCID: PMC8311187 DOI: 10.1016/j.jaccas.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 02/08/2021] [Accepted: 03/12/2021] [Indexed: 11/24/2022]
Abstract
An asymptomatic patient presented at our hospital exhibiting a Brugada electrocardiography pattern with coronary artery fistulas. Coronary artery fistula is a congenital or acquired rare abnormal condition with increased symptoms and complications over time. In the absence of the therapeutic consensus, we discuss the association and management for this condition. (Level of Difficulty: Advanced.).
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Key Words
- BA, bronchial artery
- BrP, Brugada phenocopy
- BrS, Brugada syndrome
- CAF, coronary artery fistula
- CAG, coronary angiography
- CBF, coronary artery–to–bronchial artery fistula
- CCTA, cardiac computed tomography angiography
- ECG, electrocardiography
- IE, infectious endocarditis
- LAD, left anterior descending artery
- LMT, left main trunk
- PT, pulmonary trunk
- TTE, transthoracic echocardiography
- coronary vessel anomaly
- electrocardiogram
- murmur
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Conduits' Biology Regulates the Outcomes of Coronary Artery Bypass Grafting. JACC Basic Transl Sci 2021; 6:388-396. [PMID: 33997524 PMCID: PMC8093468 DOI: 10.1016/j.jacbts.2020.11.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/30/2020] [Accepted: 11/30/2020] [Indexed: 01/22/2023]
Abstract
Accelerated atherosclerosis is common when SVGs, but not arterial grafts, are used for myocardial revascularization during CABG. This review will provide an overview of the available data on the most commonly used conduits in CABG, highlighting the differences in their cellular biology, mechanical, biochemical, and vasoconstrictive properties. Clinical and scientific evidence support the use of arterial grafts over venous conduits at the time of CABG. These arterial conduits seem to be more protected toward the development of atherosclerosis. Exploring the molecular and cellular mechanisms, of the various cell populations within these conduits, will help unveil the pathways responsible for these protective effects.
Coronary artery bypass graft (CABG) is the gold standard for coronary surgical revascularization. Retrospective, prospective, and meta-analysis studies looking into long-term outcomes of using different conduits have pointed to the superiority of arterial grafts over veins and have placed the internal mammary artery as the standard conduit of choice for CABG. The superiority of the internal mammary artery over other conduits could be attributable to its intrinsic characteristics; however, little is known regarding the features that render some conduits atherosclerosis-prone and others atherosclerosis-resistant. Here, an overview is provided of the available data on the most commonly used conduits in CABG (internal mammary artery, saphenous vein, radial artery, gastroepiploic artery), highlighting the differences in their cellular biology, mechanical, biochemical, and vasoconstrictive properties. This information should help in furthering our understanding of the clinical outcomes observed for each of these conduits.
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Arps K, Chakravartti J, Hess CN, Rao SV. Ventricular Fibrillation Due to Aortocoronary Vein Graft Spasm During Angiography: Case Report and Literature Review. JACC Case Rep 2021; 3:388-391. [PMID: 34317543 PMCID: PMC8311046 DOI: 10.1016/j.jaccas.2020.12.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 11/03/2022]
Abstract
A 69-year-old man underwent coronary angiography 7 years after coronary artery bypass. Saphenous vein graft spasm was observed during contrast injection, resulting in ventricular fibrillation. Angiography 6 years later showed graft patency. Vein graft spasm after coronary artery bypass grafting is rarely described. Further investigation is needed regarding incidence, mechanism, and clinical outcomes. (Level of Difficulty: Beginner.).
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31
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Hartz J, Nathan M, Newburger JW, Quinonez L. Surgical Repair of Congenital Atresia of the Left Coronary Ostium. JACC Case Rep 2021; 3:198-201. [PMID: 34317502 PMCID: PMC8310967 DOI: 10.1016/j.jaccas.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 10/26/2020] [Accepted: 11/02/2020] [Indexed: 01/24/2023]
Abstract
Congenital left main coronary artery atresia is an exceedingly rare condition with potentially fatal consequences if not diagnosed in a timely fashion. We present a case series in children and adolescents, including surgical repair and outcomes. We describe the presenting symptoms and subsequent management of each patient, including surgical repair and outcomes. (Level of Difficulty: Advanced.).
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Miyagi T, Ishimine T, Nakazato J, Taniguchi N, Yagi N, Takahashi T, Tengan T, Wake M. Coronary Artery Embolism Caused by BioGlue Surgical Adhesive After Type A Acute Aortic Dissection Repair. JACC Case Rep 2021; 3:53-57. [PMID: 34317468 PMCID: PMC8305680 DOI: 10.1016/j.jaccas.2020.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022]
Abstract
Coronary artery embolism due to BioGlue surgical adhesive after repair of type A acute aortic dissection is a rare condition. We report a case of BioGlue coronary artery embolism after type A acute aortic dissection repair confirmed using intravascular ultrasound imaging and pathological examination. It was successfully treated with percutaneous coronary intervention. (Level of Difficulty: Advanced.)
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Sadouni M, Boldeanu I, Durand M, Juneau D, Blais S, Tremblay C, Chartrand-Lefebvre C. Quantification of epicardial fat using non contrast cardiac CT in an HIV population: Reproducibility and association with other body fat indices. Eur J Radiol Open 2021; 8:100317. [PMID: 33490311 PMCID: PMC7804835 DOI: 10.1016/j.ejro.2020.100317] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/20/2022] Open
Abstract
Assessment of epicardial fat volume is highly reproducible. Epicardial fat volume and epicardial fat area have a good correlation to BMI. Epicardial fat volume correlates best with DEXA-derived total body fat and trunk fat. Epicardial fat volume should be considered over other CT assessment methods when quantifying epicardial fat in HIV patients.
Purpose To assess the reproducibility of different epicardial fat measurement and their association with other adiposity measurements in HIV-infected and non-HIV-infected patients. Methods and materials In this cross-sectional study, 167 HIV-infected and 58 non-HIV-infected consecutive participants (200 males; mean age 56 years) with low/intermediate cardiovascular risk were recruited between 2012 and 2017 from a large prospective cohort and underwent non-contrast cardiac CT. Two independent observers measured epicardial fat volume, area and thickness in all participants. For intra-observer agreement, one observer did a second assessment in a subset of 40 patients. Agreement was assessed with the intraclass correlation coefficient (ICC). Pearson's correlation was estimated to assess the association between epicardial fat, body-mass index (BMI) and dual-energy x-ray absorptiometry (DEXA) derived percentage of body fat. Results Inter-observer agreement was excellent for epicardial fat volume (ICC 0.75) and area (ICC 0.95) and good for epicardial fat thickness (ICC near the left anterior descending artery (LAD) 0.64, ICC near right coronary artery (RCA) 0.64). Intra-observer agreement was excellent for epicardial fat volume (ICC 0.97), area (ICC 0.99), thickness at LAD (ICC 0.71) and good for epicardial fat thickness at RCA (ICC 0.68). Epicardial fat volume had a better correlation to total body fat (r = 0.28, p < 0.001) and trunk fat (r = 0.37, p < 0.001), in comparison to other epicardial fat indices. Conclusion Assessment of epicardial fat volume is highly reproducible in both HIV-infected and non-HIV-infected patients and shows a superior correlation with DEXA-based body and trunk fat measurements. Epicardial fat volume should be considered over other CT assessment methods when quantifying epicardial fat in HIV patients.
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Harding SA, Mowjood T, Fairley S. Ultra-Low Contrast Percutaneous Coronary Intervention Guided by Optical Coherence Tomography Complicated by Coronary Perforation. JACC Case Rep 2020; 2:2429-2431. [PMID: 34317187 PMCID: PMC8304529 DOI: 10.1016/j.jaccas.2020.09.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/15/2020] [Accepted: 09/22/2020] [Indexed: 11/19/2022]
Abstract
Percutaneous coronary intervention (PCI) in patients with chronic kidney disease is associated with a high-risk of contrast-induced nephropathy. We describe a case of ultra-low contrast PCI guided using optical coherence tomography using normal saline for clearance complicated by distal wire perforation treated with embolization. (Level of Difficulty: Intermediate.).
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Butt AK, Almaddah N, Mirza QM, Ibebuogu UN. A Unique Case of STEMI STEALing the Flow. JACC Case Rep 2020; 2:2419-2423. [PMID: 34317185 PMCID: PMC8304535 DOI: 10.1016/j.jaccas.2020.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/16/2020] [Indexed: 11/26/2022]
Abstract
We report a case of a 55-year-old woman with previous coronary artery bypass grafting. She presented with acute ST-segment elevation myocardial infarction secondary to occlusion of the proximal left subclavian artery causing reduced flow in the left internal mammary artery to left anterior descending artery graft. (Level of Difficulty: Intermediate.)
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Alsidawi S, Campbell A, Tamene A, Garcia S. Ventricular Septal Rupture Complicating Delayed Acute Myocardial Infarction Presentation During the COVID-19 Pandemic. JACC Case Rep 2020; 2:1595-1598. [PMID: 32835258 PMCID: PMC7290201 DOI: 10.1016/j.jaccas.2020.05.049] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/04/2020] [Accepted: 05/13/2020] [Indexed: 01/27/2023]
Abstract
The rate of mechanical complications of acute myocardial infarction has declined. Recent publications raised concerns over the reduction in cardiac catheterization laboratory activation for ST-segment myocardial infarction (STEMI) during the coronavirus disease-2019 (COVID-19) pandemic. We present 2 recent cases of ventricular septal rupture in patients who presented to our institution with delayed STEMI. (Level of Difficulty: Intermediate.).
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37
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Narula N, Singh H, Krishnan U, Sciria C, Vohra A, Kim J, Lau C, Feldman D, Kim L, Friedman JL. A Challenging Case of Extensive Spontaneous Coronary Artery Dissection. JACC Case Rep 2020; 2:1437-1442. [PMID: 34316991 PMCID: PMC8302183 DOI: 10.1016/j.jaccas.2020.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/07/2020] [Accepted: 07/07/2020] [Indexed: 11/24/2022]
Abstract
The detection of spontaneous coronary artery dissection (SCAD) causing myocardial infarction is integral in pursuing the appropriate management. Our case posed a diagnostic challenge, with Takotsubo cardiomyopathy and coronary embolism among the potential differential diagnoses upon the initial presentation. Extensive propagation of spontaneous coronary artery dissection subsequently resulted in a significant challenge to management requiring surgical revascularization. (Level of Difficulty: Intermediate.).
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Key Words
- ACS, acute coronary syndrome
- CABG, coronary artery bypass graft
- CMR, cardiac magnetic resonance
- ECG, electrocardiogram
- LAD, left anterior descending artery
- LGE, late gadolinium enhancement
- LM, left main
- MI, myocardial infarction
- MINOCA, myocardial infarction with nonobstructive coronary arteries
- SCAD, spontaneous coronary artery dissection
- TTC, Takotsubo cardiomyopathy
- Takotsubo cardiomyopathy
- spontaneous coronary artery dissection
- women’s health
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Santangelo G, Buono A, Silvestro A, Giglio M, Tespili M, Ielasi A. Multimodal Imaging of Post-Stenting Mycotic Coronary Pseudoaneurysm Complicated by Device Fracture and Myocardial Abscess. JACC Case Rep 2020; 2:1667-1670. [PMID: 34317030 PMCID: PMC8312001 DOI: 10.1016/j.jaccas.2020.05.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 05/11/2020] [Indexed: 11/17/2022]
Abstract
Mycotic coronary aneurysm and pseudoaneurysm are rare infective complications of percutaneous coronary interventions, associated with poor prognosis. Multimodality imaging is recommended to achieve a correct diagnosis. We present a case of post-stenting mycotic coronary pseudoaneurysm complicated by myocardial abscess in which we used different imaging tools, each carrying additional information. (Level of Difficulty: Advanced.)
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Schaikewitz MF, Nnaoma CB, Meredith RD, Uretsky S, Blitz LR, Klein AL, Rosenthal MS. Acute Myocardial Infarction With Cardiogenic Shock Due to Pericardial Constriction and Multivessel Coronary Obstruction. JACC Case Rep 2020; 2:1708-1712. [PMID: 34317040 PMCID: PMC8312038 DOI: 10.1016/j.jaccas.2020.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 04/25/2020] [Accepted: 05/06/2020] [Indexed: 11/11/2022]
Abstract
We present a rare case of cardiogenic shock and multivessel coronary compression due to focal pericardial inflammation and constriction. The patient was treated in the acute phase with coronary stenting and temporary mechanical support. Multimodality imaging was essential in elucidating the diagnosis. (Level of Difficulty: Beginner.)
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Intracoronary Lithoplasty in Percutaneous Treatment of Challenging Calcified Coronary Lesions. JACC Case Rep 2020; 2:1679-1683. [PMID: 34317033 PMCID: PMC8312044 DOI: 10.1016/j.jaccas.2020.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Unexpanded stents in calcified coronary stenosis is a problem where intravascular lithotripsy could be effectively employed. In these 2 cases, we report possible issues associated with the use of this technology. (Level of Difficulty: Intermediate.)
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41
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Badlani JT, Poornima IG, Thosani A, Biederman RW. Cardiac Sarcoidosis Causing Ventricular Tachycardia After Myocardial Infarction: A Shocking Diagnosis. JACC Case Rep 2020; 2:1056-1061. [PMID: 34317414 PMCID: PMC8302109 DOI: 10.1016/j.jaccas.2020.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/17/2020] [Accepted: 04/20/2020] [Indexed: 11/29/2022]
Abstract
Scar-mediated ventricular tachycardia (VT) commonly results from ischemic heart disease. We present a case of recurrent VT, which was initially attributed to ischemic disease; however, the scar location pointed to an alternate pathology. This case demonstrates the utility of multimodality imaging in diagnosing sarcoidosis as a cause of VT. (Level of Difficulty: Intermediate.)
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Vincent LL, Wan SH, Steinberg ZL, Kapnadak S, Nishimura RA, Cheng RK. Constrictive Pericarditis After Lung Transplantation. JACC Case Rep 2020; 2:938-942. [PMID: 34317386 PMCID: PMC8302063 DOI: 10.1016/j.jaccas.2020.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 03/11/2020] [Indexed: 11/15/2022]
Abstract
As a rare complication after lung transplant, cardiac constriction should not be missed. Physical exam, echocardiography, and catheterization are essential for diagnosis A 65-year-old man with previous coronary artery disease and idiopathic pulmonary fibrosis underwent bilateral lung transplant and subsequently presented for progressive dyspnea and volume overload. Cardiac imaging and cardiac catheterization confirmed constriction, and complete pericardiectomy was performed. The patient had rapid resolution of heart failure symptoms. Pericardial constriction is a rare complication following lung transplant, and we provide a review of the literature and discussion of potential contributing factors. (Level of Difficulty: Intermediate.)
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Kolominsky J, Tushak Z, Patel J, Schatz A, Pillai A, Potfay J. Eosinophilic Granulomatosis With Polyangiitis Presenting as an Acute Coronary Syndrome. JACC Case Rep 2020; 2:1062-1065. [PMID: 34317415 PMCID: PMC8302115 DOI: 10.1016/j.jaccas.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/01/2020] [Accepted: 05/06/2020] [Indexed: 12/26/2022]
Abstract
Eosinophilic granulomatosis with polyangiitis, formerly Churg-Strauss Syndrome, is an uncommon disorder that carries a high mortality when coronary artery disease develops. Early recognition and treatment is crucial. We highlight an unusual presentation of acute coronary syndrome not associated with atherosclerotic coronary disease. (Level of Difficulty: Intermediate.)
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Key Words
- ANCA, antineutrophilic cytoplasmic antibody
- CA, coronary angiograph
- CABG, coronary artery bypass graft
- CRP, C-reactive protein
- DES, drug-eluting stent
- EGPA
- EGPA, eosinophilic granulomatosis with polyangiitis
- ESR, erythrocyte sedimentation rate
- LAD, left anterior descending artery
- LCx, left circumflex artery
- LMCA, left main coronary artery
- OM1, obtuse marginal artery
- R-PLB, right posterior-lateral branch
- RCA, right coronary artery
- acute coronary syndrome
- eosinophilia
- ischemic heart disease
- premature coronary artery disease
- vasculitis
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Egred M, Bagnall A, Spyridopoulos I, Purcell IF, Das R, Palmer N, Grech ED, Jain A, Stone GW, Nijveldt R, McAndrew T, Zaman A. Effect of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size in anterior STEMI: PiCSO in ACS study. IJC HEART & VASCULATURE 2020; 28:100526. [PMID: 32435689 PMCID: PMC7229496 DOI: 10.1016/j.ijcha.2020.100526] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 02/08/2023]
Abstract
STEMI patients treated with PiCSO were propensity matched to INFUSE-AMI controls. Infarct size at day 5 was significantly lower in the PiCSO group. There were no major adverse cardiac events (MACE) related to the PiCSO.
Background The aim of this clinical research was to investigate the effects of Pressure-controlled intermittent Coronary Sinus Occlusion (PiCSO) on infarct size at 5 days after primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results This comparative study was carried out in four UK hospitals. Forty-five patients with anterior STEMI presenting within 12 h of symptom onset received pPCI plus PiCSO (initiated after reperfusion; n = 45) and were compared with a propensity score-matched control cohort from INFUSE-AMI (n = 80). Infarct size (% of LV mass, median [interquartile range]) measured by cardiac magnetic resonance (CMR) at day 5 was significantly lower in the PiCSO group (14.3% [95% CI 9.2–19.4%] vs. 21.2% [95% CI 18.0–24.4%]; p = 0.023). There were no major adverse cardiac events (MACE) related to the PiCSO intervention. Conclusions PiCSO, as an adjunct to pPCI, was associated with a lower infarct size at 5 days after anterior STEMI in a propensity score-matched population.
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Key Words
- ACS, acute coronary syndrome
- AMI, acute myocardial infarction
- BARC, Bleeding Academic Research Consortium
- CI, Confidence interval
- CMR, Cardiac magnetic resonance
- CRT, Cardiac Resynchronization Therapy
- IMR, Index of microcirculatory resistance
- Infarct size reduction
- LAD, left anterior descending artery
- LV, Left ventricle
- MACE, Major adverse cardiac events
- PiCSO, Pressure-controlled intermittent coronary sinus occlusion
- Pressure-controlled intermittent coronary sinus occlusion (PICSO)
- SD, Standard deviation
- ST-segment elevation myocardial infarction (STEMI)
- STEMI, ST-segment elevation myocardial infarction
- TIMI, Thrombosis in myocardial infarction
- pPCI, Primary percutaneous coronary intervention
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Moroni F, Gramegna M, Ajello S, Beneduce A, Baldetti L, Vilca LM, Cappelletti A, Scandroglio AM, Azzalini L. Collateral Damage: Medical Care Avoidance Behavior Among Patients With Myocardial Infarction During the COVID-19 Pandemic. JACC Case Rep 2020; 2:1620-1624. [PMID: 32835261 PMCID: PMC7252183 DOI: 10.1016/j.jaccas.2020.04.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 12/15/2022]
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has caused an enormous strain on healthcare systems and society on a global scale. We report a new phenomenon of medical care avoidance among patients with acute coronary syndrome, which is due to concerns about contracting severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection during hospital stay, ultimately leading to dire clinical outcomes. (Level of Difficulty: Beginner.)
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Key Words
- COVID-19, coronavirus disease-2019
- ECG, electrocardiography
- EMS, emergency medical services
- ICU, intensive care unit
- LAD, left anterior descending artery
- LV, left ventricular
- MI, myocardial infarction
- PCI, percutaneous coronary intervention
- SARS-CoV-2, severe acute respiratory syndrome-coronavirus-2
- STEMI, ST-segment elevation myocardial infarction
- acute coronary syndrome
- complication
- myocardial infarction
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Martínez Pereyra V, Seitz A, Hubert A, Mahrholdt H, Bekeredjian R, Sechtem U, Ong P. Coronary Microvascular Spasm as the Underlying Cause of the Angiographic Slow Flow Phenomenon. JACC Case Rep 2020; 2:35-39. [PMID: 34316961 PMCID: PMC8301693 DOI: 10.1016/j.jaccas.2019.11.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 05/04/2023]
Abstract
Slow coronary flow is frequently seen during angiography in patients with angina and unobstructed coronary arteries. However, the pathophysiology of this finding remains largely unclear. We report a case of a 52-year-old woman with slow coronary flow caused by acetylcholine-induced microvascular spasm, as confirmed by intracoronary flow measurements. (Level of Difficulty: Beginner.).
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Chang CT, Lee WH, Kuo HF, Chen MZ, Hsu PC, Chu CS, Su HM, Lin TH, Yen HW, Chiu CA. Ping-Pong Guide Catheters to Facilitate Real-Time Intravascular Ultrasound-Guided Recanalization of Stumpless Chronic Total Occlusion. JACC Case Rep 2019; 1:792-795. [PMID: 34316933 PMCID: PMC8288592 DOI: 10.1016/j.jaccas.2019.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/01/2019] [Accepted: 11/02/2019] [Indexed: 06/13/2023]
Abstract
Stumpless chronic total occlusion is associated with a higher failure rate of recanalization. Intravascular ultrasound (IVUS) is useful for identifying the entry point; however, 8-F guide catheters are necessary for real-time IVUS-guided wiring. This case reports the novel use of the "ping-pong" guide catheter technique to facilitate real-time IVUS-guided wiring for a stumpless chronic total occlusion. (Level of Difficulty: Advanced.).
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Sawami K, Natsuaki M, Hongo H, Kajiwara M, Kaneko T, Inoue Y, Komatsu A, Kotooka N, Hikichi Y, Node K. Spontaneous Internal Mammary Artery Graft Dissection Triggered by Emotional Stress. JACC Case Rep 2019; 1:732-736. [PMID: 34316921 PMCID: PMC8288662 DOI: 10.1016/j.jaccas.2019.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 09/23/2019] [Accepted: 09/25/2019] [Indexed: 10/31/2022]
Abstract
Internal mammary artery graft dissection is a rare condition and is usually caused by iatrogenic complications or mechanical stress. We experienced a case of acute myocardial infarction due to spontaneous internal mammary artery graft dissection that was triggered by emotional stress and was successfully treated by percutaneous intervention using drug-eluting stents. (Level of Difficulty: Beginner.).
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Mehta R, Tahir A, Hallak O, Gonzalez J. Collaborative Cardiac Care: A Comprehensive Heart Team Approach to Multiple Severe Vascular Conditions. JACC Case Rep 2019; 1:873-875. [PMID: 34316949 PMCID: PMC8288579 DOI: 10.1016/j.jaccas.2019.11.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/06/2019] [Accepted: 11/06/2019] [Indexed: 12/03/2022]
Abstract
Left main artery coronary disease represents the highest risk lesion of ischemic heart disease. Revascularization can be accomplished by surgery or percutaneous interventions. This study highlights the case of a patient with severe multiple peripheral vascular conditions and complex coronary anatomy treated with percutaneous coronary intervention using mechanical circulatory support. (Level of Difficulty: Intermediate.)
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Cardiotoxicity of mediastinal radiotherapy. Rep Pract Oncol Radiother 2019; 24:629-643. [PMID: 31719801 DOI: 10.1016/j.rpor.2019.09.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/21/2019] [Indexed: 12/16/2022] Open
Abstract
Aim To explore available recent literature related to cardiotoxicity following mediastinal radiation. Background Radiotherapy-related heart injury is well documented, with no apparent safety threshold dose. The number of long-term cancer survivors exposed to mediastinal radiotherapy at some point of their treatment is increasing. Heart dosimetric parameters are of great importance in developing a treatment plan, but few data are available regarding radiosensitivity and dose-volume constraints for specific heart structures. Materials and Methods In October 2018, we identified articles published after 1990 through a PubMed/MEDLINE database search. The authors examined rough search results and manuscripts not relevant for the topic were excluded. We extracted clinical outcomes following mediastinal radiotherapy of childhood cancers, lymphoma, medulloblastoma, thymic cancers and hematopoietic cell transplantation survivors and evaluated treatment planning data, whenever available. Results A total of 1311 manuscripts were identified in our first-round search. Of these manuscripts, only 115 articles, matching our selection criteria, were included. Conclusions Studies uniformly show a linear radiation dose-response relationship between mean absorbed dose to the heart (heart-Dmean) and the risk of dying as a result of cardiac disease, particularly when heart-Dmean exceeds 5 Gy. Limited data are available regarding dose-volume predictors for heart substructures and the risk of subsequent cardiac toxicity. An individual patient's cardiotoxicity risk can be modified with advanced treatment planning techniques, including deep inspiration breath hold. Proton therapy is currently showing advantages in improving treatment planning parameters when compared to advanced photon techniques in lymphoma, thymic malignancies, malignant mesothelioma and craniospinal irradiation.
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Key Words
- 2D-RT, two-dimensional radiotherapy
- 3D-CRT, three-dimensional conformal radiation therapy
- CI, confidence interval
- CSI, craniospinal irradiation
- CVD, Cardiovascular disease
- Cardiotoxicity
- Dmax, maximum absorbed dose in a specified volume
- Dmean, mean absorbed radiation dose in a specified volume
- Dose-volume predictors
- EQD2, equivalent dose in 2 Gy fractions
- G, grade
- Gy, Gray
- HR, hazard ratio
- HT, Helical tomotherapy
- IFRT, involved field radiotherapy
- IMRT, intensity modulated radiation therapy
- INRT, involved node radiotherapy
- ISRT, involved site radiotherapy
- LAD, left anterior descending artery
- Mediastinal radiotherapy
- Mediastinal tumours
- Mv, megavoltage
- NTCP, normal tissue complication probability
- Normal tissue complication probability
- OAR, organs at risk
- OR, odds ratio
- PTV, planning target volume
- RR, relative risks
- TBI, total body irradiation
- VMAT, volumetric modulated arc therapy
- Vx, receiving at last x Gy
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