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Takahashi K, Kodama A, Uemura S, Okura T. Bilateral isolated coronary ostial stenosis in a middle-aged premenopausal woman with vasospastic angina: a case report. Eur Heart J Case Rep 2024; 8:ytae249. [PMID: 38817315 PMCID: PMC11139352 DOI: 10.1093/ehjcr/ytae249] [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: 10/25/2023] [Revised: 04/29/2024] [Accepted: 05/13/2024] [Indexed: 06/01/2024]
Abstract
Background Vasospastic angina (VSA) is uncommon in premenopausal women who have less chronic endothelial injury causing vascular remodelling, considered to play a primary role in the pathogenesis for coronary vasospasms. Furthermore, vasospasms rarely occur in the bilateral coronary ostia. Isolated coronary ostial stenosis (ICOS), which often causes severe effort angina and requires surgical intervention, is more commonly reported in middle-aged women, with causes including fibromuscular dysplasia (FMD) and large-vessel vasculitis. However, ICOS associated with VSA is extremely rare. Case summary A 50-year-old premenopausal Japanese woman presented with a complaint of typical chest pain due to angina during light exertion daily in the early morning hours since 3 years. Coronary angiography (CAG) revealed bilateral mild-to-moderate ICOS in addition to multi-vessel spasms involving the bilateral coronary ostia confirmed by the vasospasm provocation test using intracoronary acetylcholine injection. Tests to determine the cause of ICOS did not identify FMD or any other disease. The angina attacks alleviated after calcium channel blocker (CCB) administration without intervention for bilateral ICOS for 24 years since the first presentation. Moreover, coronary computed tomography angiography (CTA) performed 24 years after the first presentation showed no ICOS. Discussion In our patient with typical and frequent VSA symptoms, CAG revealed both mild-to-moderate ICOS and the vasospasms in the bilateral coronary ostia. Fibromuscular dysplasia or large-vessel vasculitis was ruled out as the causes of ICOS. Vasospastic angina rarely occurred after the prescription of CCB, and coronary CTA 24 years after the first presentation showed no ICOS. Bilateral ICOS in our patient might be VSA related.
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Affiliation(s)
- Koji Takahashi
- Department of Community Emergency Medicine, Ehime University Graduate School of Medicine, 454 Shitsukawa, Toon, Ehime 791-0295, Japan
- Department of Cardiology, Yawatahama City General Hospital, 1-638 Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Akihiro Kodama
- Department of Internal Medicine, Seiyo Municipal Hospital, 147-1 Nagaosa, Seiyo, Ehime 797-0029, Japan
| | - Shigeki Uemura
- Department of Cardiology, Yawatahama City General Hospital, 1-638 Ohira, Yawatahama, Ehime 796-8502, Japan
| | - Takafumi Okura
- Department of Cardiology, Yawatahama City General Hospital, 1-638 Ohira, Yawatahama, Ehime 796-8502, Japan
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Seco M, Paterson HS, Gaudino M, Vallely MP. Selecting the optimal treatment for left main coronary disease: The importance of identifying subgroups of patients. J Card Surg 2022; 37:4190-4195. [PMID: 36168863 DOI: 10.1111/jocs.16565] [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: 04/14/2022] [Accepted: 04/17/2022] [Indexed: 01/06/2023]
Abstract
Randomized trials of stenting versus surgery for patients with unprotected left main (LM) coronary stenosis have largely shown similar survival between the two interventions. However, patients with LM stenosis represent a heterogeneous group in which subgroups likely to benefit from one therapy more than another are difficult to identify. Increasing coronary disease burden is the most accepted subgrouping for identifying optimal therapy but this can be defined in more detail allowing greater discrimination. Competitive flow reduces bypass graft patency in patients with isolated LM stenosis and complex bifurcation stenoses reduce the effectiveness of coronary stenting. The evidence for LM stenosis subgroupings is presented.
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Affiliation(s)
- Michael Seco
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia.,Department of Cardiothoracic Surgery, Royal North Shore Hospital, Sydney, Australia
| | - Hugh S Paterson
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Michael P Vallely
- Division of Cardiac Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Yin T, Zhong X, Tao L, Hu T. Revascularization by percutaneous coronary intervention in a case of left main coronary artery atresia. Catheter Cardiovasc Interv 2021; 98:1343-1348. [PMID: 34410028 DOI: 10.1002/ccd.29931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022]
Abstract
Left main coronary artery atresia (LMCAA) is a rare congenital anomaly of the coronary artery that may have an unfavorable prognosis if left untreated. Surgical revascularization by either coronary artery bypass grafting or coronary reconstruction osteoplasty is unanimously recognized as the treatment of choice for this condition. Here, we first report a case of LMCAA treated with revascularization by percutaneous coronary intervention (PCI) through a retrograde approach. Intravascular ultrasound revealed an unusual coronary structure for the left main artery. PCI appears to be a feasible and effective alternative to surgery for the treatment of LMCAA, particularly if a minimally invasive method is desired.
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Affiliation(s)
- Tao Yin
- Department of Cardiology, Xijing Hospital, Air Force Medical University, China
| | - Xin Zhong
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Ling Tao
- Department of Cardiology, Xijing Hospital, Air Force Medical University, China
| | - Tao Hu
- Department of Cardiology, Xijing Hospital, Air Force Medical University, China
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Kuo CC, Hsing CH, Chen CI, Lee CH, Cheng BC. Robotic totally endoscopic coronary artery bypass for isolated ostial stenosis of the left coronary artery. J Thorac Dis 2017; 9:E1060-E1063. [PMID: 29312766 DOI: 10.21037/jtd.2017.10.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Isolated ostial stenosis (IOS) is a rare disease that encroaches on aorto-coronary junction of uncertain etiology. All distal coronary vessels present normally. IOS occurs predominantly in premenopausal young women with few risk factors for atherosclerotic disease. Here, we report a 40-year-old woman who had experienced crescendo angina for 4 months. Surgical revascularization was achieved by robotic totally endoscopic coronary artery bypass (TECAB) with left internal thoracic artery (LITA) graft. She resumed her daily tasks without difficulties 1 week after the operation. Postoperative computed tomographic angiography disclosed good opacification of the LITA graft and distal runoff. Robotic TECAB is a potentially feasible alternative for IOS patients, particularly in premenopausal young woman, with obvious benefits of cosmetic appearance and speedy recovery.
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Affiliation(s)
- Chia-Cheng Kuo
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Medical Education, Taipei Veteran General Hospital, Taipei, Taiwan.,School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Hsi Hsing
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Anesthesiology, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-I Chen
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Chen-Hui Lee
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Bor-Chih Cheng
- Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Technology, Tainan, Taiwan
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Robinson BM, Paterson HS, Denniss AR. Composite Y-Grafting Using the Left Internal Thoracic Artery: Survival and Angiography in 198 Cases. Heart Lung Circ 2017; 26:724-729. [PMID: 28117146 DOI: 10.1016/j.hlc.2016.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/13/2016] [Accepted: 11/23/2016] [Indexed: 11/19/2022]
Abstract
BACKGROUND Extended left internal thoracic artery (LITA) harvesting allows maximal grafting to the anterior and lateral walls with a single ITA conduit. This study evaluates outcomes following the use of a LITA Y graft as the primary grafting strategy. METHODS Patients who underwent LITA composite Y-grafting (n=198) between 1995 and 2009 were identified from a cardiac surgical database. Follow-up (mean 13.1 years) was obtained by cross-reference with the state death registry and local cardiology databases. RESULTS Operative mortality was zero in the 168 patients who underwent isolated CABG and was 3.5% overall. There were no episodes of perioperative myocardial infarction. Kaplan-Meier 10-year survival was 75.9%. Independent predictors of worse late survival were age, diabetes, chronic obstructive pulmonary disease and pre-existing left ventricular dysfunction. There were 53 episodes of post-discharge angiography at an average of 5.8 years post LITA Y grafting. Twenty cases of LITA Y graft failure were identified, predominantly affecting the free limb (n=15). The ratio of symptom driven angiography to Y graft failure increased over time. Eighteen patients required revascularisation, percutaneous intervention in 15 and reoperative coronary bypass in three. CONCLUSIONS Left Internal Thoracic Artery Y grafting is a feasible revascularisation strategy with satisfactory outcomes. These are comparable to other arterial composite graft configurations. A LITA Y allows efficient conduit use without compromising the in situ LITA graft.
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Affiliation(s)
- Benjamin M Robinson
- Baird Institute of Applied Heart and Lung Surgical Research, Sydney, NSW, Australia; Department of Cardiothoracic Surgery, Bart's Heart Centre, London, United Kingdom
| | - Hugh S Paterson
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
| | - A Robert Denniss
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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Gaudino M, Massetti M, Farina P, Hanet C, Etienne PY, Mazza A, Glineur D. Chronic competitive flow from a patent arterial or venous graft to the circumflex system does not impair the long-term patency of internal thoracic artery to left anterior descending grafts in patients with isolated predivisional left main disease: Long-term angiographic results of 2 different revascularization strategies. J Thorac Cardiovasc Surg 2014; 148:1856-9. [DOI: 10.1016/j.jtcvs.2014.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/20/2014] [Accepted: 02/03/2014] [Indexed: 11/25/2022]
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Morice MC, Feldman TE, Mack M, Ståhle E, Holmes D, Colombo A, Morel MA, van den Brand M, Serruys P, Mohr F, Carrié D, Fournial G, James S, Leadley K, Dawkins K, Kappetein AP. Angiographic outcomes following stenting or coronary artery bypass surgery of the left main coronary artery: fifteen-month outcomes from the synergy between PCI with TAXUS express and cardiac surgery left main angiographic substudy (SYNTAX-LE MANS). EUROINTERVENTION 2011; 7:670-679. [DOI: 10.4244/eijv7i6a109] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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