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Djokovic A, Krljanac G, Matic P, Zivic R, Djulejic V, Marjanovic Haljilji M, Popovic D, Filipovic B, Apostolovic S. Pathophysiology of spontaneous coronary artery dissection: hematoma, not thrombus. Front Cardiovasc Med 2023; 10:1260478. [PMID: 37928766 PMCID: PMC10623160 DOI: 10.3389/fcvm.2023.1260478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) accounts for 1.7%-4% of all acute coronary syndrome presentations, particularly among young women with an emerging awareness of its importance. The demarcation of acute SCAD from coronary atherothrombosis and the proper therapeutic approach still represents a major clinical challenge. Certain arteriopathies and triggers are related to SCAD, with high variability in their prevalence, and often, the cause remains unknown. The objective of this review is to provide contemporary knowledge of the pathophysiology of SCAD and possible therapeutic solutions.
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Affiliation(s)
- Aleksandra Djokovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Predrag Matic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinic for Vascular Surgery, Institute for Cardiovascular Diseases “Dedinje”, Belgrade, Serbia
| | - Rastko Zivic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Surgery, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Vuk Djulejic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Faculty of Medicine, Institute of Anatomy, Belgrade, Serbia
| | | | - Dusan Popovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Gastroenterology, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Branka Filipovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department for Gastroenterology, Clinical Hospital Center Dr Dragisa Misovic “Dedinje”, BelgradeSerbia
| | - Svetlana Apostolovic
- Coronary Care Unit, Cardiology Clinic, University Clinical Center of Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
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Javed S, Mei Y, Zhang Y, Liu C, Liu S. Multi-slice CT analysis of the length of left main coronary artery: its relation to sex, age, diameter and branching pattern of left main coronary artery, and coronary dominance. Surg Radiol Anat 2023:10.1007/s00276-023-03193-w. [PMID: 37402958 DOI: 10.1007/s00276-023-03193-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE The objective of this research was to analyze and correlate the length of the left main coronary artery (LMCA) with significant clinical parameters using multi-slice CT (MSCT). MATERIALS AND METHODS 1500 patients (851 males and 649 females; mean age 57.38 ± 11.03 [SD]; age range: 5-85 years) who underwent MSCT scans from September 2020 to March 2022 were retrospectively included. The data were applied to generate three-dimensional (3D) simulations of a coronary tree using the syngo.via post-processing workstation. The reconstructed images were then interpreted, and the collected data were subjected to statistical analysis. RESULTS The results showed 1206 (80.4%) cases with medium LMCA, 133 (8.9%) with long LMCA, and 161 (10.7%) with short LMCA. The average diameter of LMCA at its midpoint was 4.69 ± 0.74 mm. The most frequent type of division of LMCA was bifurcation in 1076 (71.7%) cases; in 424 (28.3%) cases, the LMCA was divided into three or more branches. The dominance was right in 1339 (89.3%), left in 78 (5.2%), and co-dominant in 83 (5.5%) cases. There was a positive correlation between the length and branching patterns of LMCA, χ2 = 113.993, P = 0.000 (< 0.05). Other variables like age, sex, diameter of LMCA, and coronary dominance did not show any significant correlation. CONCLUSION This study has demonstrated a significant association between the length and the branching pattern of LMCA, which may be essential in diagnosing and treating coronary artery patients.
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Affiliation(s)
- Saeed Javed
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
| | - Yixuan Mei
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China
- Department of Medical Imaging, Dongying People's Hospital, Dongying, 257091, China
| | - Yi Zhang
- Department of Medical Imaging, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China
- Shandong Provincial Maternal and Child Health Care Hospital Affiliated to Qingdao University, Jinan, 250014, Shandong, China
| | - Cheng Liu
- Department of Medical Imaging, Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Shuwei Liu
- Research Center for Sectional and Imaging Anatomy, Shandong Key Laboratory of Digital Human and Clinical Anatomy, Department of Anatomy and Neurobiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, China.
- Shandong University School of Medicine, 44#, Wenhua Xi Road, Jinan, 250012, Shandong, China.
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Van den Eynde J, Rammeloo LAJ, Jongbloed MRM, Hazekamp MG, van der Palen RLF. Anomalous connection of the circumflex coronary artery to the pulmonary trunk in a patient with Taussig–Bing anomaly: a case report. EUROPEAN HEART JOURNAL: CASE REPORTS 2022; 6:ytac432. [PMCID: PMC9645565 DOI: 10.1093/ehjcr/ytac432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/27/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022]
Abstract
Background Coronary anomalies are present in one-third of all patients with transposition of the great arteries (TGA) and have been associated with increased risk of adverse outcomes after the arterial switch operation. Therefore, knowledge about coronary anatomy remains key. Case summary A 5-day-old girl with prenatal diagnosis of Taussig–Bing anomaly (double outlet right ventricle with TGA and large subpulmonary ventricular septal defect) along with aortic arch hypoplasia and coarctation of the aorta underwent the arterial switch operation with closure of the ventricular septal defect and aortic arch repair. On preoperative echocardiography, the right (R) and left coronary artery (LCx) connected both to aortic sinus 1, suggesting 1RLCx coronary anatomy according to the Leiden Convention coronary coding system. However, intraoperative inspection led to a reclassification of the coronary anatomy: the right coronary artery and left anterior descending coronary artery connected to aortic sinus 1 (1RL) as had been observed on echocardiography, but—remarkably—the circumflex coronary artery (Cx) connected to the posterior sinus of the pulmonary trunk. As a consequence, cardioplegia was administered into both the aortic and pulmonary roots, and the circumflex coronary artery could stay in its native position without having to be transferred during the arterial switch operation. Discussion Various disruptions during embryological development can lead to unusual coronary anatomy in TGA patients. While anomalous connection of a coronary artery to the pulmonary trunk remains exceedingly rare, care should be taken to identify this pattern when present as failure to do so may result in adverse outcomes.
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Affiliation(s)
- Jef Van den Eynde
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands,Department of Cardiovascular Diseases, KU Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Lukas A J Rammeloo
- Department of Pediatrics, Division of Pediatric Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands,Department of Anatomy & Embryology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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Pereira VP, Seyfert CE, Santos JML, de Morais-Pinto L. Morphological importance of coronary ostia in equine. Anat Histol Embryol 2022; 51:658-665. [PMID: 35894158 DOI: 10.1111/ahe.12844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/27/2022] [Accepted: 07/07/2022] [Indexed: 11/29/2022]
Abstract
The position of the coronary ostia was investigated in 70 segments of the aorta from young adult crossbred horses. After fixation with a 4% buffered aqueous formaldehyde solution and cautious dissection of the aortic bulb, the morphometric relationships between the coronary ostium and the aortic valvar elements were digitally analysed with the support of Image-Pro Plus® software. In horses, the left coronary ostium was near to the right valvular commissure in all cases (100%) analysed in this study. The left coronary ostium was at the level of the intercommissural line in 57.1% and below it in 42.9%. The right coronary ostium was near to the left valvular commissure in 58.6% (2.14 ± 0.32 cm) and close to the right valvular commissure in 41.4% (2.27 ± 0.40 cm). Concerning the intercommissural line, the right coronary ostia was at its level in 24.3% and below it in 75.7%. Accessory coronary ostia were observed in 8.6% of the specimens. In view of the results, it was possible to assume that the positions of the coronary ostia in equines tend towards a standard morphological disposition. Thus, perfusion of the left coronary artery occurs partly more frequently in ventricular systole and complete perfusion occurs less frequently in ventricular diastole. For the right coronary artery, perfusion is mostly complete in diastole and partially in ventricular systole.
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Affiliation(s)
- Vitor P Pereira
- Laboratório de Design Anatômico/LabDA - Departamento de Morfologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - Carlos E Seyfert
- Laboratório de Modelos Anatômicos em 3D/LabMOLA - Departamento de Morfologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
| | - João M L Santos
- Laboratório de Anatomia Animal Comparada, Centro Universitário Funorte, Montes Claros, Minas Gerais, Brazil
| | - Luciano de Morais-Pinto
- Laboratório de Design Anatômico/LabDA - Departamento de Morfologia, Universidade Federal de Santa Maria, Santa Maria, Rio Grande do Sul, Brazil
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Anderson RH. Comment on Aortopulmonary Window and Anomalies of Coronary Arterial Origin. World J Pediatr Congenit Heart Surg 2022; 13:404. [PMID: 35446207 PMCID: PMC9024018 DOI: 10.1177/21501351221083987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Vallabhajosyula S, Fuchs M, Yang LT, Medina Inojosa J, Tajouri TH, Enriquez-Sarano M, Phillips SD, Gulati R, Klarich KW, Michelena H. Anomalous coronary artery origin from the opposite sinus in patients with bicuspid aortic valve: comparison with tricuspid aortic valve. Open Heart 2021. [PMCID: PMC8217920 DOI: 10.1136/openhrt-2020-001567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
ObjectiveTo compare the prevalence and patterns of anomalous coronary artery origin from the opposite sinus (ACAOS) in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV).MethodsRetrospective review of consecutive patients with surgically excised BAV and TAV was performed from 1994 to 2015. Clinical notes, echocardiograms, coronary angiograms, CT angiographies, and pathology reports were reviewed. ACAOS included right coronary artery from the left cusp, left circumflex artery from the right cusp and left main or left anterior descending artery from the right cusp.Results2371 (years 1994–2015) and 1679 (years 2009–2015) consecutive patients with pathology-confirmed BAV and TAV, respectively, and defined preoperative coronary anatomy were identified. A left dominant coronary circulation was present in 386 (18%) patients with BAV and 179 (11%) patients with TAV (p<0.001). ACAOS was identified in 43 (1.8%) patients with BAV and 15 (0.9%) patients with TAV, p=0.02. Among patients with BAV and ACAOS, the most common phenotype was right-left fusion (n=34, 79%) with present raphe (n=36, 84%), with no association between BAV phenotype and ACAOS type. On multivariate analysis, BAV status and size of the mid-ascending aorta were independently associated with ACAOS (OR 3.29; CI 1.26 to 8.6; p=0.02; OR 0.93; CI 0.87 to 0.98; p=0.01; respectively). Only two patients with ACAOS, one with BAV and one with TAV, had a perioperative coronary ischaemic event.ConclusionsThe prevalence of the potentially malignant ACAOS is significantly higher (threefold higher odds) in patients with BAV as compared with TAV, yet remains uncommon in absolute terms. Most patients with BAV and ACAOS had right-left cusp fusion and present raphe. Perioperative coronary events are rare in patients with ACAOS.
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Affiliation(s)
| | - Margaret Fuchs
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Li-Tan Yang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jose Medina Inojosa
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tanya H Tajouri
- Department of Cardiology, Sentara Healthcare Inc, Harrisonburg, Virginia, USA
| | | | - Sabrina D Phillips
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kyle W Klarich
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota, USA
| | - Hector Michelena
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Khan SM, Drury NE, Stickley J, Barron DJ, Brawn WJ, Jones TJ, Anderson RH, Crucean A. Tetralogy of Fallot: morphological variations and implications for surgical repair. Eur J Cardiothorac Surg 2020; 56:101-109. [PMID: 30657877 PMCID: PMC6580293 DOI: 10.1093/ejcts/ezy474] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/07/2018] [Accepted: 12/15/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Tetralogy of Fallot is characterized by anterocephalad deviation of the outlet septum, along with abnormal septoparietal trabeculations, which lead to subpulmonary infundibular stenosis. Archives of retained hearts are an important resource for improving our understanding of congenital heart defects and their morphological variability. This study aims to define variations in aortic override, coronary arterial patterns and ventricular septal defects in tetralogy of Fallot as observed in a morphological archive, highlighting implications for surgical management. METHODS The Birmingham Children's Hospital archive contains 211 hearts with tetralogy of Fallot, of which 164 were analysed [69 (42.1%) unrepaired and 95 (57.9%) operated specimens]. A detailed morphological and geometric analysis was performed using a rigorous 5-layer review process. RESULTS Anomalies were observed in the orifices, origins and course of the coronary arteries: 20 hearts (13.0%) had more than 2 orifices and 3 hearts (1.9%) had a single orifice. In 7 hearts (4.3%), a coronary artery crossed the right ventricular outflow tract. The extent of aortic override ranged from 31.0% to 100% (median of 59.5%). The ventricular septal defect was most often perimembranous (139, 84.8%), but we also found muscular (14, 8.5%), atrioventricular (7, 4.3%) and doubly committed juxta-arterial (2, 1.2%) variants. CONCLUSIONS Anatomical variations are common and can impact surgical management. Anomalous coronary arteries may require a conduit rather than a transannular patch. Variability in aortic override determines the size of patch used to baffle blood to the aorta. The type of ventricular septal defect affects patch closure and the risk of postoperative conduction defects.
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Affiliation(s)
- Saad M Khan
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Nigel E Drury
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - John Stickley
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - David J Barron
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - William J Brawn
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Timothy J Jones
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.,Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Robert H Anderson
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK
| | - Adrian Crucean
- Department of Paediatric Cardiac Surgery, Birmingham Children's Hospital, Birmingham, UK.,Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
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Baggio TC, Sebold L, Oliveira ICD. Case Report: Surgical Treatment of High-Flow Coronary Fistulas for the Pulmonary Artery. Braz J Cardiovasc Surg 2020; 35:392-395. [PMID: 31165615 PMCID: PMC7299589 DOI: 10.21470/1678-9741-2018-0327] [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: 12/02/2022] Open
Abstract
Coronary fistulas are rare anomalies that can affect approximately 1% of the population, presenting few specific symptoms, and are often found occasionally in coronary angiography. Here we describe the case of a 61-year-old patient with complaints of precordialgia and dyspnea since adolescence, with late diagnosis of coronary fistulas with drainage to the pulmonary artery, and with unsuccessful percutaneous treatment. Therefore, she underwent open surgery for the correction of the already known fistulas, in addition to the hemangioma involving such vessels, which made the understanding and resolution of this case more complex.
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Affiliation(s)
- Thales Cantelle Baggio
- Hospital e Maternidade Jaraguá Jaraguá do Sul SC Brazil Hospital e Maternidade Jaraguá, Jaraguá do Sul, SC, Brazil
| | - Larissa Sebold
- Universidade Regional de Blumenau Ringgold Standard Institution Blumenau SC Brazil Universidade Regional de Blumenau, Ringgold Standard Institution, Blumenau, SC, Brazil
| | - Igor Cordeiro de Oliveira
- Universidade Regional de Blumenau Ringgold Standard Institution Blumenau SC Brazil Universidade Regional de Blumenau, Ringgold Standard Institution, Blumenau, SC, Brazil
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Schicchi N, Fogante M, Giuseppetti GM, Giovagnoni A. Diagnostic detection with cardiac tomography and resonance of extremely rare coronary anomaly: A case report and review of literature. World J Clin Cases 2019; 7:628-635. [PMID: 30863762 PMCID: PMC6406198 DOI: 10.12998/wjcc.v7.i5.628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 01/09/2019] [Accepted: 01/26/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The association of two congenital coronary artery anomalies (CAAs) is extremely rare but represents one of the main cause of sudden cardiac death in young athletes. Although coronary angiography (CX-A) is still widely used in childhood, cardiac magnetic resonance (C-MRI) and cardiac computed tomography (C-CT) have recently taken on an increasing diagnostic role in early detection of CAAs and concomitant congenital cardiac malformations.
CASE SUMMARY A healthy 10-year-old male patient was referred to the Radiological Department of our Institution due to no evidence of left coronary artery in echocardiographic examination. With C-MRI was detected marked myocardial trabeculation and was suspected anomalous origin and course of left circumflex (LCx) artery and of left anterior descending (LAD) artery. With third generation Dual Source C-CT 192x2-sections (SOMATOM Force, Siemens, Germany) was confirmed anomalous origin of LCx artery from right pulmonary artery associated with anomalous origin of LAD artery from right coronary artery with course in front of right ventricular outflow tract. The patient underwent surgical treatment with reimplantation of the anomalous LCX and LAD arteries into the wall of ascending aorta, with no postoperative complications. The patient remained asymptomatic and follow-up C-MRI scan four months after operation showed complete success of surgery treatment.
CONCLUSION This case highlights the diagnostic potential of C-CT and C-MRI in evaluation of CAAs and of cardiac morphology and functionality, with very low radiation dose and without the risks related to invasive procedure.
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Affiliation(s)
- Nicolò Schicchi
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
| | - Marco Fogante
- Department of Radiology, Università Politecnica delle Marche, Ancona 60126, Italy
| | - Gian Marco Giuseppetti
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
| | - Andrea Giovagnoni
- Department of Radiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona 60126, Italy
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Visualising the Cardiovascular System of Embryos of Biomedical Model Organisms with High Resolution Episcopic Microscopy (HREM). J Cardiovasc Dev Dis 2018; 5:jcdd5040058. [PMID: 30558275 PMCID: PMC6306920 DOI: 10.3390/jcdd5040058] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 12/09/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022] Open
Abstract
The article will briefly introduce the high-resolution episcopic microscopy (HREM) technique and will focus on its potential for researching cardiovascular development and remodelling in embryos of biomedical model organisms. It will demonstrate the capacity of HREM for analysing the cardiovascular system of normally developed and genetically or experimentally malformed zebrafish, frog, chick and mouse embryos in the context of the whole specimen and will exemplarily show the possibilities HREM offers for comprehensive visualisation of the vasculature of adult human skin. Finally, it will provide examples of the successful application of HREM for identifying cardiovascular malformations in genetically altered mouse embryos produced in the deciphering the mechanisms of developmental disorders (DMDD) program.
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Kolesová H, Bartoš M, Hsieh WC, Olejníčková V, Sedmera D. Novel approaches to study coronary vasculature development in mice. Dev Dyn 2018; 247:1018-1027. [DOI: 10.1002/dvdy.24637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Hana Kolesová
- Institute of Anatomy, First Faculty of Medicine; Charles University in Prague; Czech Republic
- Institute of Physiology; Czech Academy of Sciences; Prague Czech Republic
| | - Martin Bartoš
- Institute of Anatomy, First Faculty of Medicine; Charles University in Prague; Czech Republic
- Institute of Dental Medicine, First Faculty of Medicine; Charles University in Prague; Czech Republic
| | - Wan Chin Hsieh
- Institute of Anatomy, First Faculty of Medicine; Charles University in Prague; Czech Republic
| | - Veronika Olejníčková
- Institute of Anatomy, First Faculty of Medicine; Charles University in Prague; Czech Republic
- Institute of Physiology; Czech Academy of Sciences; Prague Czech Republic
| | - David Sedmera
- Institute of Anatomy, First Faculty of Medicine; Charles University in Prague; Czech Republic
- Institute of Physiology; Czech Academy of Sciences; Prague Czech Republic
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Silva A, Baptista MJ, Araújo E. Congenital coronary artery anomalies. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Silva A, Baptista MJ, Araújo E. Congenital anomalies of the coronary arteries. Rev Port Cardiol 2018; 37:341-350. [PMID: 29496389 DOI: 10.1016/j.repc.2017.09.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/05/2017] [Accepted: 09/24/2017] [Indexed: 02/07/2023] Open
Abstract
Congenital coronary artery anomalies are modifications of their origin, course or structure and its incidence varies between 0,2 and 5,6% of the general population. Although the majority is asymptomatic, they are the second leading cause of sudden cardiac death in young athletes. The aim of this study is to highlight the main anomalies with hemodynamic significance, including the anomalous origin of a coronary artery from the opposite sinus and anomalous origin of the left coronary artery from pulmonary artery. The anomalous aortic origin of a coronary artery from the opposite sinus accounts for 14-16% of all cardiac deaths, that unexpectedly occur in healthy children or young athletes during or immediately after exercise. The mechanism responsible for the compression/occlusion of the coronary artery originating from the opposite sinus is still unclear and there are several proposed mechanisms. The clinical presentation of these patients is variable and physical examination is normal in most individuals. Transthoracic echocardiogram is the diagnostic test most commonly used. Treatment and management are controversial topic. The anomalous origin of the left coronary artery from pulmonary artery is a very rare condition and without surgery, most infants die within the first 12 months of life. The echocardiogram is also the method of choice for diagnostic confirmation. The diagnosis of this congenital anomaly in an infant, usually seriously ill, is an indication for urgent surgery. Because these anomalies produce hemodynamic changes, it is important an early diagnosis and treatment.
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Affiliation(s)
- Andrea Silva
- Faculdade de Medicina da Universidade do Porto, Portugal.
| | - Maria João Baptista
- Serviço da Cardiologia Pediátrica, Centro Hospital São João, Porto, Portugal; Departamento de Pediatria, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Emanuel Araújo
- Serviço de Medicina Interna, Centro Hospitalar São João, Porto, Portugal
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Coronary Artery Anomalies in Animals. Vet Sci 2017; 4:vetsci4020020. [PMID: 29056679 PMCID: PMC5606599 DOI: 10.3390/vetsci4020020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Revised: 03/02/2017] [Accepted: 04/11/2017] [Indexed: 12/22/2022] Open
Abstract
Coronary artery anomalies represent a disease spectrum from incidental to life-threatening. Anomalies of coronary artery origin and course are well-recognized in human medicine, but have received limited attention in veterinary medicine. Coronary artery anomalies are best described in the dog, hamster, and cow though reports also exist in the horse and pig. The most well-known anomaly in veterinary medicine is anomalous coronary artery origin with a prepulmonary course in dogs, which limits treatment of pulmonary valve stenosis. A categorization scheme for coronary artery anomalies in animals is suggested, dividing these anomalies into those of major or minor clinical significance. A review of coronary artery development, anatomy, and reported anomalies in domesticated species is provided and four novel canine examples of anomalous coronary artery origin are described: an English bulldog with single left coronary ostium and a retroaortic right coronary artery; an English bulldog with single right coronary ostium and transseptal left coronary artery; an English bulldog with single right coronary ostium and absent left coronary artery with a prepulmonary paraconal interventricular branch and an interarterial circumflex branch; and a mixed-breed dog with tetralogy of Fallot and anomalous origin of all coronary branches from the brachiocephalic trunk. Coronary arterial fistulae are also described including a coronary cameral fistula in a llama cria and an English bulldog with coronary artery aneurysm and anomalous shunting vessels from the right coronary artery to the pulmonary trunk. These examples are provided with the intent to raise awareness and improve understanding of such defects.
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15
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Viuff MH, Trolle C, Wen J, Jensen JM, Nørgaard BL, Gutmark EJ, Gutmark-Little I, Mortensen KH, Gravholt CH, Andersen NH. Coronary artery anomalies in Turner Syndrome. J Cardiovasc Comput Tomogr 2016; 10:480-484. [DOI: 10.1016/j.jcct.2016.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/30/2016] [Accepted: 08/03/2016] [Indexed: 01/15/2023]
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16
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Frescura C, Thiene G. The Spectrum of Congenital Heart Disease with Transposition of the Great Arteries from the Cardiac Registry of the University of Padua. Front Pediatr 2016; 4:84. [PMID: 27713877 PMCID: PMC5032087 DOI: 10.3389/fped.2016.00084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/28/2016] [Indexed: 11/13/2022] Open
Abstract
Transposition of the great arteries (TGA) is a cardiac condition in which the arterial trunks arise from the inappropriate ventricle: the aorta from the right ventricle and the pulmonary trunk from the left ventricle [discordant ventriculo-arterial (VA) connection]. In complete TGA, the discordant VA connection is associated with situs solitus or inversus and concordant atrioventricular (AV) connection. The hemodynamic consequence of these combined connections is that systemic and pulmonary circulations function in "parallel" rather than in "series". The presence of situs solitus or inversus associated with both AV and VA discordant connections characterizes a different anatomical complex known as "corrected TGA." In these hearts, the double discordance at AV and VA levels permits a normal sequence of the blood flow from the right atrium to the pulmonary artery and from the left atrium to the aorta. The systemic and pulmonary circulation in these hearts functions regularly in series, and the blood sequence is "physiologically corrected." Thus, the term transposition, either complete or corrected, identifies two precise, different anatomical complexes, both characterized by VA discordance. However, among congenital heart disease (CHD), there are other anatomical complexes with discordant VA connection in the setting of isomeric atrial situs (right or left) or of univentricular AV connections (double inlet or absent connections). In these latter conditions, the term "transposition" is still necessary to stress that the great arteries are "transposed" in relation to the ventricular septum (aorta from the right ventricle and pulmonary trunk from the left ventricle) but certainly does not figure out the anatomical complexes named complete or corrected transposition. We reviewed the hearts with discordant VA connection of our Anatomical Collection, consisting of 1,640 specimens with CHD, with the aim to discuss the anatomy and the frequency of the anatomical variants of TGA and to clarify terminology and classification. The knowledge of the precise anatomy of these malformation are really important for clinical diagnosis and surgical planning.
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Affiliation(s)
- Carla Frescura
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School , Padua , Italy
| | - Gaetano Thiene
- Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School , Padua , Italy
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