Variations in blood supply to the anterior interventricular septum: incidence and possible clinical importance

The left anterior descending artery arising from the right sinus of Valsalva: a case report

Coronary artery anomalies occur in less than 1% of patients who undergo coronary angiography and they account for 1% to 2% of all cases of congenital heart disease. The most commonly encountered anomaly, the circumflex artery originating from the right coronary artery or the right sinus of Valsalva, is usually well tolerated. The patient in the case presented here was found to have a left anterior descending artery arising from the right sinus of Valsalva - a situation that is very rarely encountered.

Coronary stent implantation in a septal perforator artery: case report and review of the literature

Septal perforator arteries play an important role in the blood supply of the anterior interventricular septum. Their intramyocardial course makes them inaccessible for coronary bypass revascularization. Although modern catheter-based techniques might be superior to coronary bypass grafting in offering the most complete revascularization in selected patient populations, a systematic review of the literature revealed a paucity of data regarding the outcome of these patients. The present report describes coronary stent implantation in a dominant septal perforator artery and the analysis of the anatomic relationship between the stent and the intraventricular septum using a new imaging technique, catheter-based intracardiac ultrasound.

Electrocardiographic prediction of ejection fraction and site of LAD occlusion in anterior myocardial infarction

Q-wave anterior myocardial infarctions due to occlusion of the left anterior descending artery (LAD) are generally associated with the most extensive left ventricular damage. The presence of abnormal Q waves on the electrocardiogram (ECG) provides important information to localize the site of left ventricular infarction. However, the relationship between abnormalities of the QRS morphology in the precordial leads and angiographic information such as ejection fraction and the site of LAD occlusion (before or after the first septal perforator) has not been studied extensively. Seventy-three patients with single-vessel disease with complete LAD occlusion, abnormal QRS morphology in leads V1-V4 on ECG, and abnormal wall motion with contrast ventriculography were studied retrospectively. LAD occlusions were proximal to the first septal perforator in 33 patients and distal in 40 patients. Q waves were present in 59 patients, and the other 14 patients had either minimal R waves (< 0.25 mm), poor R-wave progression, or R-wave regression. A significantly higher ejection fraction was associated with the presence of R wave in V2 (0.52 +/- 0.18 vs. 0.39 +/- 0.15 in the absence of R wave, p < 0.003). LAD occlusion after and before the first septal perforator was associated with R wave in V2 in 67 and 36% of patients, respectively. Sensitivity and specificity of predicting occlusion after the first septal perforator based on R wave in V2 was 0.68 and 0.64, respectively. In patients with anterior myocardial infarctions, occluded LAD artery, and abnormal QRS morphology in the precordial leads, the presence of R wave in V2 is a useful predictor of higher ejection fraction.(ABSTRACT TRUNCATED AT 250 WORDS)