1
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Jalalzai I, Kilic Y, Sönmez E, Çelik F, Erkut B. Giant Right Coronary Artery Aneurysm in a Patient With Multiple Coronary Artery Aneurysmatic Dilatations. Cureus 2023; 15:e51390. [PMID: 38292949 PMCID: PMC10826248 DOI: 10.7759/cureus.51390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/01/2024] Open
Abstract
One kind of coronary artery disease that is uncommon is coronary artery aneurysm (CAA). According to angiographic reports, the incidence of coronary artery aneurysms ranges from 1.5% to 4.9%, with a higher frequency in men. A patient with both coronary heart disease and an aneurysm in the right coronary artery (RCA) underwent a successful simultaneous coronary bypass together with an aneurysmal reconstruction procedure.
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Affiliation(s)
| | - Yasin Kilic
- Cardiovascular Surgery, Ataturk University Hospital, Erzurum, TUR
| | - Ebubekir Sönmez
- Cardiovascular Surgery, Ataturk University Hospital, Erzurum, TUR
| | - Furkan Çelik
- Cardiovascular Surgery, Ataturk University Hospital, Erzurum, TUR
| | - Bilgehan Erkut
- Cardiovascular Surgery, Ataturk University Hospital, Erzurum, TUR
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2
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Umar MF, Bellamy SE, Ahmad M, Mirza M, Sitara A, Benz M, Ameen AA. Staged Versus Concomitant Carotid Endarterectomy and Aortic Valve Replacement: A Case Report and Literature Review. Cureus 2023; 15:e49773. [PMID: 38161544 PMCID: PMC10757739 DOI: 10.7759/cureus.49773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Stroke is a common complication of cardiac surgery, and carotid artery stenosis is an established risk factor for stroke. Therefore, patients with carotid artery stenosis who are undergoing cardiac surgery require proper management of the former either simultaneously or before cardiac surgery. We present a challenging case of a 67-year-old male patient who presented with generalized weakness, severe aortic stenosis, and significant bilateral carotid artery stenosis. The coexistence of these findings sparked a debate about whether to perform a carotid endarterectomy first or an aortic valve replacement. Moreover, a past history of percutaneous coronary intervention and coronary artery bypass grafts made the decision more challenging. Multiple approaches have been employed for the management of coexisting carotid artery stenosis with cardiac surgery; however, no definitive guidelines exist, especially for surgeries other than coronary artery bypass grafts or where the carotid stenosis is bilateral and severe.
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Affiliation(s)
- Muhammad Faiq Umar
- Internal Medicine, Mayo Hospital, Lahore, PAK
- Cardiology, Jersey City Medical Center, Jersey City, USA
| | | | - Muhammad Ahmad
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
| | - Muhammad Mirza
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
| | - Ayesham Sitara
- Internal Medicine, Jersey City Medical Center, Jersey City, USA
| | - Michael Benz
- Interventional Cardiology, Jersey City Medical Center, Jersey City, USA
- Cardiology, Rutgers New Jersey Medical School, Newark, USA
- Cardiology, Christ Hospital, Jersey City, USA
| | - Abdul A Ameen
- Cardiology, Jersey City Medical Center, Jersey City, USA
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3
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Surve TA, Kazim MA, Sughra M, Mirza AMW, Murugan SK, Shebani KAM, Karishma F, Trada IJ, Mansour M, Asif K, Kaur L, Kamal A, Unachukwu N, Naveed A. Revascularization Modalities in Acute Coronary Syndrome: A Review of the Current State of Evidence. Cureus 2023; 15:e47207. [PMID: 38021880 PMCID: PMC10653013 DOI: 10.7759/cureus.47207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Acute coronary syndrome (ACS) stands as a leading global cause of mortality, underscoring the importance of effective prevention, early diagnosis, and timely intervention. While medications offer benefits to many patients, revascularization procedures such as coronary artery bypass grafting (CABG), percutaneous coronary intervention (PCI), and emerging hybrid approaches remain pivotal for ACS management. This review delves into the 2018 ESC/EACTS guidelines alongside an analysis of existing literature to shed light on the spectrum of revascularization methods. While both CABG and PCI demonstrate promising outcomes, the optimal choice between the two hinges on a comprehensive assessment of individual patient factors, anatomical complexity guided by advanced imaging, comorbidities, and age. The determination of whether to pursue culprit or total revascularization, as well as immediate or staged revascularization, is contingent upon various factors, including age, disease complexity, and clinical outcomes. This evidence-based decision-making process is orchestrated by a multidisciplinary heart team grounded in ongoing clinical evaluation. The primary objective of this review is to provide valuable insights into revascularization strategies and scrutinize the congruence of current guidelines with recent advancements in the field.
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Affiliation(s)
- Tahoora A Surve
- Internal Medicine, K. J. Somaiya Medical College, Mumbai, IND
| | | | - Mehak Sughra
- Internal Medicine, Gujranwala Teaching Hospital, Gujranwala, PAK
| | | | - Siva Kumar Murugan
- Internal Medicine, Meenakshi Medical College and Research Institute, Chennai, IND
| | | | - Fnu Karishma
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Khairpur, PAK
| | | | - Mohammad Mansour
- General Medicine, University of Debrecen, Debrecen, HUN
- General Medicine, Jordan University Hospital, Amman, JOR
| | - Kainat Asif
- Medicine and Surgery, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Karachi, PAK
| | - Loveneet Kaur
- Medicine and Surgery, Government Medical College, Patiala, IND
| | - Amer Kamal
- Medicine, School of Medicine, The University of Jordan, Amman, JOR
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4
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Jimenez-Hernandez R, Vazquez-Fuster J, Rivera P. From the Heart to the Gut: A Case Report of a Rare Complication After Coronary Artery Bypass Graft Surgery. Cureus 2023; 15:e46372. [PMID: 37790870 PMCID: PMC10545265 DOI: 10.7759/cureus.46372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2023] [Indexed: 10/05/2023] Open
Abstract
Coronary artery bypass graft (CABG) surgery has a major role in the management of obstructive coronary artery disease, especially in patients with diabetes or multiple vessel disease. Currently, in the USA, the annual incidence rate of CABG has been reported to be approximately 400,000. Overall, gastrointestinal (GI) complications occur in less than 2% of patients undergoing open-heart surgery. Acute colonic pseudo-obstruction, also known as Ogilvie's syndrome, is a disorder characterized by dilatation of the colon in the absence of an anatomic lesion that obstructs the flow of intestinal contents. This condition occurs in 0.06% of patients following cardiac surgery, and in CABG patients, the reported incidence is approximately 0.046%. In this report, we discuss a case of a patient who developed Ogilvie's syndrome after undergoing CABG.
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Affiliation(s)
| | | | - Patricia Rivera
- Internal Medicine, VA Caribbean Healthcare System, San Juan, PRI
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5
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Karedath J, Nazly S, Murtaza SF, Bhandari S, Sharma A, Talpur S, Vistro MM, Palleti SK. Comparison of Early and Long-Term Mortality in Patients With Reduced and Preserved Ejection Fraction Undergoing Coronary Artery Bypass Graft: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e43245. [PMID: 37692708 PMCID: PMC10491923 DOI: 10.7759/cureus.43245] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
The aim of this study was to compare early and long-term mortality in patients with reduced and preserved ejection fraction (EF) undergoing coronary artery bypass graft (CABG). This meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Two investigators independently conducted a systematic and comprehensive search of PubMed, EMBASE, and Scopus from inception to July 15, 2023, using the search terms "reduced ejection fraction," "preserved ejection fraction," "coronary artery bypass surgery," and "mortality." Boolean operators (AND, OR) were used with medical subject heading (MeSH) terms to refine the search. The reference lists of all included articles were manually searched to identify potentially relevant studies. We restricted our search to studies published in the English language. The outcomes assessed in this meta-analysis included short-term mortality (including in-hospital and 30-day mortality) and long-term mortality. A total of five studies were included in this meta-analysis. The pooled sample size is 94,399 participants. Pooled analysis showed that the risk of early mortality was significantly higher in patients with reduced EF compared to patients with preserved EF (risk ratio, RR: 2.14, 95% CI: 1.50 to 3.06). The pooled analysis also reported that late mortality was significantly higher in patients with reduced EF compared to patients with preserved EF (RR: 1.67, 95% CI: 1.35 to 2.08). The pooled analysis of studies demonstrated a significantly higher rate of both early and late mortality in patients with reduced EF, emphasizing the importance of EF assessment in risk stratification for CABG patients.
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Affiliation(s)
- Jithin Karedath
- Internal Medicine, King's College Hospital NHS Foundation Trust, London, GBR
| | - Sumreen Nazly
- Internal Medicine, University Medical and Dental College Faisalabad, Faisalabad, PAK
| | - Syeda Fatima Murtaza
- Internal Medicine, Mayo Clinic, Jacksonville, USA
- Internal Medicine, Allama Iqbal Medical College, Lahore, PAK
| | | | - Anmol Sharma
- Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, NPL
| | - Saifullah Talpur
- Psychiatry, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Muhammad Moiz Vistro
- Internal Medicine, United Medical and Dental College, Creek General Hospital, Karachi, PAK
| | - Sujith K Palleti
- Nephrology, Edward Hines Jr. Veterans Administration Hospital, Hines, USA
- Nephrology, Loyola University Medical Center, Maywood, USA
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6
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Peña C, Kalara N, Velagapudi P, Poli F. Takayasu Arteritis: A Difficult Diagnosis in a Patient With an Extensive Cardiovascular History. Cureus 2023; 15:e41256. [PMID: 37396146 PMCID: PMC10314794 DOI: 10.7759/cureus.41256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 07/04/2023] Open
Abstract
Large vessel vasculitides, such as Takayasu arteritis (TAK), are rare inflammatory conditions primarily affecting the aorta and its major branches. Its nonspecific symptoms and potential resemblance to atherosclerotic disease often pose diagnostic challenges. We present a case of a 57-year-old male with a history of extensive cardiovascular disease, initially attributed to atherosclerosis, resulting in several interventions, such as catheterization and major cardiac surgery, which didn't help improve his symptoms. Further evaluation revealed diffuse wall thickening of the aorta and its roots, as well as labs that suggested elevated inflammatory markers, comprehensive review of his chart and previous admissions, revealed that he had a well-documented aortitis for which he underwent a biopsy, which at the time was unrevealing. Furthermore, as he had significant aortic aneurysmal dilation, a thoracic cardiovascular surgeon remitted him to the rheumatology clinic, where he was placed on a prednisone taper and methotrexate regimen. Unfortunately, he redeveloped symptoms, and plans were made to transition to a tumor necrosis alpha (TNF-alpha) inhibitor. Our case highlights the importance of an accurate diagnosis and the prompt initiation of appropriate treatment in challenging cases of large vessel vasculitides. This case also underscores the need for heightened clinical awareness and interdisciplinary collaboration to ensure optimal patient care.
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Affiliation(s)
- Carlos Peña
- Internal Medicine, Mount Sinai Medical Center, Miami Beach, USA
| | - Niketa Kalara
- Internal Medicine, Mount Sinai Medical Center, Miami Beach, USA
| | | | - Fernando Poli
- Internal Medicine, Mount Sinai Medical Center, Miami Beach, USA
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7
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Ahlawat Y, Vegunta R, Sanghavi N, Nelson J. Coronary Artery Bypass Grafting in a Patient With Severe Factor VII Deficiency. Cureus 2023; 15:e37815. [PMID: 37091489 PMCID: PMC10114005 DOI: 10.7759/cureus.37815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 04/25/2023] Open
Abstract
Factor VII deficiency is a rare bleeding disorder. Clinical presentation is highly variable and can range from mild symptoms like mucosal bleeding to life-threatening hemorrhages in early infancy. Some people remain asymptomatic and are only diagnosed incidentally on laboratory tests. Given the low incidence in the population and variable phenotypes, there are no official guidelines on the management of such patients perioperatively to minimize bleeding risk. We present a case of a man with inherited severe factor VII deficiency who underwent successful coronary artery bypass grafting.
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Affiliation(s)
- Yagya Ahlawat
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | | | - Nirali Sanghavi
- Internal Medicine, Westchester Medical Center, Valhalla, USA
| | - John Nelson
- Hematology and Oncology, Westchester Medical Center, Valhalla, USA
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8
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Muacevic A, Adler JR, Cox CJ, Ye F. Right Internal Mammary Artery Occlusion in a Patient With Failed Left Internal Mammary Artery Coronary Artery Bypass Graft Surgery Post a Laparoscopic Appendectomy for Acute Appendicitis. Cureus 2022; 14:e32343. [PMID: 36627982 PMCID: PMC9826609 DOI: 10.7759/cureus.32343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Patients who present with acute myocardial infarction are often urgently evaluated for possible revascularization via coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), or medical therapy alone. CABG has been shown to provide symptomatic relief as well as increased long-term survival for patients with multivessel coronary artery disease (CAD). Though venous grafts can be used to revascularize the ischemic territory, long-term patency is most successful when using pedicled coronary grafts such as the left internal mammary artery (LIMA) or right internal mammary artery (RIMA) graft. Only a fraction of patients who undergo a RIMA or LIMA will occlude their graft, and mid-graft lesions presumed secondary to atherosclerosis are even rare. For our case report, we evaluate a 72-year-old female who has had a very rare acute coronary occlusion of her mid-RIMA graft resulting in an acute apical left ventricular infarct. A heart catheterization confirmed a 100% thrombotic occlusion of the mid-RIMA-LAD, which was stented with a 2.5 x 20 mm drug-eluting stent.
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9
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Abdallah H, Ibrahim A, Abdelhamed MI. Aortic Coarctation Effect on Atherosclerosis of the Left Internal Mammary Artery: A Case Presentation and Literature Review. Cureus 2021; 13:e20706. [PMID: 34966626 PMCID: PMC8711118 DOI: 10.7759/cureus.20706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 11/21/2022] Open
Abstract
Atherosclerosis of the internal mammary artery (IMA) is an uncommon disease. We present a case report of a patient with stable angina who had a history of coarctation repair. After meticulous investigation and discussion, a coronary artery bypass graft (CABG) was planned. During the surgery, we found that the left internal mammary artery (LIMA) was severely atherosclerotic without any blood flow, and a fragment of LIMA was taken for histopathological examination for further insight into pathogenesis. Vein grafts were alternatively used. Furthermore, relevant literature review and management were discussed for the use of LIMA in patients with a history of aortic coarctation.
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Affiliation(s)
- Hassane Abdallah
- Cardiac Surgery, Prince Sultan Cardiac Center-Al Hassa, Al Hofuf, SAU
| | - Ahmed Ibrahim
- Faculty of Medicine and Health Sciences, University of Western Kordofan, ElNihoud, SDN.,Research and Biostatistics, Prince Sultan Cardiac Center-Al Hassa, Al Hofuf, SAU
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10
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Karikalan S, Sharma M, Chandna MK, Chandna H, Surani S. A Rare Case of Anomalous Origin of Left Anterior Descending Artery From Right Coronary Ostium. Cureus 2021; 13:e18966. [PMID: 34815907 PMCID: PMC8606039 DOI: 10.7759/cureus.18966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/05/2022] Open
Abstract
Coronary artery anomalies are rare congenital malformations, most often undiagnosed until late adolescence or adulthood when an angiogram is done for conditions such as myocardial infarction, arrhythmias, heart failure, and sudden cardiac death. Sometimes, an anomalous left coronary artery originating from the right coronary ostium might traverse between the aorta and pulmonary artery and cause chest pain, syncope, myocardial infarction, or sudden death even in younger patients. Here we present a case of an elderly female presenting with chest discomfort on exertion. The coronary angiogram revealed severe triple vessel disease and an ectopic left anterior descending artery arising from the right coronary ostium. After careful evaluation, it was determined that her symptoms were solely due to severe multivessel coronary artery disease (CAD). Thus, she underwent coronary artery bypass surgery for her CAD. It is important to consider anomalous coronary artery as an important differential diagnosis in patients with angina, ventricular arrhythmias, or even sudden cardiac death, especially in the younger population.
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Affiliation(s)
- Suganya Karikalan
- Medicine, Karpaga Vinayaga Institute of Medical Sciences, Maduranthagam, IND
| | - Munish Sharma
- Pulmonary Medicine, Pulmonary Asociates, Corpus Christi, USA
| | | | | | - Salim Surani
- Anesthesiology, Mayo Clinic, Rochester, USA.,Medicine, Texas A&M University, College Station, USA.,Medicine, University of North Texas, Dallas, USA.,Internal Medicine, Pulmonary Associates, Corpus Christi, USA.,Clinical Medicine, University of Houston, Houston, USA
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11
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Zughaib MT, Patel H, Zughaib ME. Successful Medical Management of an Acute Ascending Aortic Dissection After Coronary Artery Bypass Graft Surgery. Cureus 2021; 13:e17086. [PMID: 34527473 PMCID: PMC8432422 DOI: 10.7759/cureus.17086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Aortic dissection is an acute and life-threatening disease entity. Mortality rates increase every hour after the presentation. Typical treatment includes medical management of blood pressure and heart rate control followed by prompt transfer to an operating room for surgical repair. We present a case of medically managed Stanford type A aortic dissection in a postoperative coronary artery bypass graft (CABG) patient. A 77-year-old man with a past medical history of hypertension and hyperlipidemia presented after an outpatient nuclear stress test demonstrated a reversible inferior wall defect. He was subsequently referred to a cardio-thoracic surgeon and underwent coronary artery bypass graft (CABG) surgery. Three weeks later, the patient presented to the emergency department complaining of a productive cough, nausea, vomiting, and fever. He was diagnosed with sepsis secondary to pneumonia. A CT chest demonstrated a new 3.9 cm long segment of dissection in the ascending thoracic aorta. Due to postoperative recovery from recent CABG, a decision was made to treat the ascending thoracic aortic dissection (Stanford type A) medically. He was advised to continue intensive antihypertensive medications and close follow-up with a cardiologist and cardiothoracic surgeon on an outpatient basis. Subsequent follow-up CT chest angiography at one month, four months, and 12 months later did not demonstrate the progression of the ascending aortic dissection. Decisions to deviate from the usual care should best be taken in a multidisciplinary team approach. Patients should clearly be informed about the rationale behind these complex decisions.
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Affiliation(s)
- Marc T Zughaib
- Internal Medicine, Ascension Providence Hospital/Michigan State University College of Human Medicine (MSUCHM), Southfield, USA
| | - Harshil Patel
- Cardiology, Ascension Providence Hospital, Southfield, USA
| | - Marcel E Zughaib
- Cardiology, Ascension Providence Hospital/Michigan State University College of Human Medicine (MSUCHM), Southfield, USA
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12
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Ravipati H, Rodrigues S, Rao S, Hatharaliyadda B, Junia C. The Young Heart Tears Easily Apart: A Case Report of Spontaneous Coronary Artery Dissection. Cureus 2021; 13:e15590. [PMID: 34277211 PMCID: PMC8272916 DOI: 10.7759/cureus.15590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 12/31/2022] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), seen mostly in young females. The rarity and limited knowledge of the disease make its management challenging. Prompt diagnosis of the condition is extremely important to decrease both long- and short-term complications. Treatment options depend on hemodynamic stability and the location of the dissection- with more distal lesions treated more conservatively as opposed to proximal lesions which are treated with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The following are the two cases with different presentation, management and outcomes. Our first patient was a 35-year-old woman with no medical history who presented with acute, anginal pain, diaphoresis and palpitations. She was hemodynamically stable on presentation, with work-up significant for electrocardiogram (ECG) with sinus bradycardia, ST elevation in leads V1-V6, and elevated troponin level of 4 ng/ml. There was no evidence of a pulmonary embolism on computed tomography (CT) of the chest. A coronary angiogram showed 100% dissection of the proximal to mid-left anterior descending (LAD) artery. Attempts to place a stent in the proximal to mid LAD were unsuccessful as the true lumen of the LAD was not accessible. The patient became hemodynamically unstable, and an emergent CABG was done, restoring blood flow. The patient recovered during her hospital stay and was discharged with dual antiplatelet therapy (DAPT), beta-blockers, and atorvastatin. The second patient was a 28-year-old woman, with a history of hypertension who presented with anginal chest pain. Workup showed ECG with minimal ST elevations in anteroseptal leads, with elevated troponin level to 0.71 ng/ml. Coronary angiogram showed 40-50% stenosis of the mid LAD with an aneurysmal segment. An echocardiogram showed no evidence of wall motion abnormalities, and she had a normal left ventricular ejection fraction (LVEF). She was discharged home the next day, on medical management. After two days, she returned to the hospital with similar complaints, with work-up significant for ECG with non-specific ST-T abnormality, and troponin level which peaked at 2.22 ng/ml. She was started on a heparin drip, and a repeat left heart catheterization revealed type 2 dissection of the mid to distal LAD, with intravascular ultrasound showing a fractional flow reserve of 0.76. She was discharged home on DAPT, beta-blocker, calcium channel blocker (CCB), and atorvastatin, with close cardiology follow up. These two cases highlight the importance of keeping in mind the possibility of SCAD, especially when relatively healthy young women present with anginal symptoms. Early diagnosis of the condition and prompt management are extremely important to ensure favourable outcomes. The two cases also describe the coronary angiogram findings in SCAD, and the different strategies employed in the management of this condition.
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Affiliation(s)
| | | | - Swathi Rao
- Internal Medicine, MacNeal Hospital, Berwyn, USA
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13
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Ishibashi K, Motokawa M, Motomura N. Successful Percutaneous Closure of a Large Saphenous Vein Graft Aneurysm With Vascular Plug 4, Optimal Percutaneous Device Selection. Cureus 2021; 13:e14016. [PMID: 33777586 PMCID: PMC7984959 DOI: 10.7759/cureus.14016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Saphenous vein graft (SVG) aneurysm is one of the late unusual complications of coronary artery bypass grafting (CABG). We report a case of a very large SVG aneurysm successfully treated with a vascular plug 4. A 94-year-old man was referred to our hospital for an expanding aortic aneurysm. The patient had undergone CABG 24 years prior, with three SVGs to the left anterior descending (LAD) artery, left circumflex arteries (LCX) artery, and right coronary artery (RCA). A computed tomography scan of the chest demonstrated an 8.8 cm × 6.5 cm aneurysm arising from an ascending aortic wall. Coronary angiography revealed an aneurysm arising from the proximal segment of the SVG to the RCA. The distal graft anastomosis of the SVG to the RCA and LCX was occluded. Another SVG to the LAD was widely patent. From a radial approach, a 5-Fr catheter (Tempo, Cardinal Health, OH) was advanced into its cavity, and a 7-mm Amplatzer vascular plug 4 (AVP-IV, AGA Medical Corporation, MN) was successfully delivered. Contrast CT confirmed a thrombus development in the cavity. The patient was discharged home. However, interventions utilizing vascular plug insertion are limited to cases of graft occlusion. We report a case of the successful treatment of a large SVG aneurysm using the Amplatzer vascular plug 4.
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Affiliation(s)
- Kazuyuki Ishibashi
- Cardiovascular Surgery, Toho University Sakura Medical Center, Sakura, JPN
| | | | - Noboru Motomura
- Cardiovascular Surgery, Toho University Sakura Medical Center, Sakura, JPN
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14
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Iguina MM, Smithson S, Danckers M. Incessant Refractory Polymorphic Ventricular Tachycardia After Coronary Artery Bypass Graft. Cureus 2021; 13:e12752. [PMID: 33643727 PMCID: PMC7886165 DOI: 10.7759/cureus.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 01/17/2021] [Indexed: 11/08/2022] Open
Abstract
Polymorphic ventricular tachycardia (PVT) post coronary artery bypass (CABG) surgery is associated with acute myocardial ischemia, hemodynamic instability, and metabolic derangements. When acute ischemia is suspected, a comprehensive investigation for reversible causes is justified to improve patient outcomes. We present a curious case of incessant, refractory PVT in a patient with an unknown etiology requiring percutaneous coronary intervention (PCI) post CABG. The patient was a 73-year-old female with multiple comorbidities who presented to the hospital with anginal chest pain for one day. Initial electrocardiogram (EKG) showed sinus tachycardia with ST-segment depressions in the inferior-lateral leads. Initial cardiac troponin I was elevated at 28.280 ng/mL. Dual antiplatelet therapy and heparin were started. Urgent coronary angiography revealed significant triple-vessel disease, and she subsequently underwent three-vessel CABG. Her postoperative course was complicated by PVT refractory to all antiarrhythmic therapy and ventricular fibrillatory (VF) arrest with the recovery of spontaneous circulation after defibrillation and amiodarone bolus. Despite normal electrolytes and discontinuation of all QT-prolonging agents, PVT persisted. Urgent coronary angiography revealed a patent venous graft to a previously underappreciated severely stenotic distal segment of the left anterior descending artery (LAD). She underwent PCI of the culprit lesion with the termination of PVT. Although acute graft failure is regularly the culprit for acute myocardial infarction perioperatively, emergent coronary angiography post coronary bypass surgery revealed patent grafts and a previously underestimated severe coronary lesion contributing to ongoing ischemia. Post CABG percutaneous coronary intervention (PCI) yielded a complete resolution of her arrhythmia.
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Affiliation(s)
- Michele M Iguina
- Internal Medicine, Aventura Hospital and Medical Center, Aventura, USA
| | - Shaun Smithson
- Cardiology, Aventura Hospital and Medical Center, Aventura, USA
| | - Mauricio Danckers
- Critical Care Medicine, Aventura Hospital and Medical Center, Aventura, USA
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Godil SA, Saqi B, Godil K, Sabzwari SRA, Rajeswaran Y. Catastrophic Cardiac Complications of Takayasu's Arteritis. Cureus 2020; 12:e9142. [PMID: 32789080 PMCID: PMC7417183 DOI: 10.7759/cureus.9142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 07/11/2020] [Indexed: 11/17/2022] Open
Abstract
Takayasu's arteritis (TA) causes inflammation and necrosis of vessel walls, leading to aneurysm formation, extensive coronary damage and valvular abnormalities. We review a case of recurrent coronary, aortic and mitral valve involvement in a patient with TA and discuss the various treatment options available for such patients.
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Affiliation(s)
- Sara A Godil
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
| | - Bilal Saqi
- Cardiology, Lehigh Valley Health Network, Allentown, USA
| | - Kareem Godil
- Internal Medicine, Lehigh Valley Health Network, Allentown, USA
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Abstract
Coronary artery disease is one of the leading causes of death in the United States. The utility of revascularization in patients presenting with acute coronary syndrome is well elucidated, both in reducing death and re-infarction. However, in patients with chronic stable angina, the optimal management strategy is less clear. While medical management with aggressive control of risk factors and lifestyle changes are the cornerstones of treatment, the utility of revascularization in this subset of patients has always been a topic of debate.
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Affiliation(s)
- Talha Ahmed
- Internal Medicine, University of Maryland Medical Center, Baltimore, USA
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Pala AA, Taner T, Tatli AB, Ozsin KK, Yavuz S. The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery. Cureus 2020; 12:e7811. [PMID: 32467787 PMCID: PMC7249771 DOI: 10.7759/cureus.7811] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Low hematocrit level is a hematological problem that is frequently encountered in the preoperative evaluation of patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to investigate the effect of preoperative hematocrit level on the first 30-day outcomes in patients undergoing CABG surgery. METHODS Ninety-four patients undergoing isolated CABG were included in the study. The patients were divided into two groups as patients with preoperative low hematocrit levels (<36%) in Group 1 and patients with preoperative normal hematocrit levels (≥36%) in Group 2. RESULTS Forty-six patients in Group 1 (mean age: 63.6 ± 7.9 years) and 48 patients in Group 2 (mean age: 56.5 ± 8.8 years) were enrolled. European System for Cardiac Operative Risk Evaluation (EuroSCORE) scoring was statistically significantly higher in Group 1 (p = 0.011). In the postoperative period, the amount of drainage, transfusion of blood, and blood products were significantly higher in Group 1 (p < 0.001). The mortality rate of Group 1 was statistically higher in the first 30 days postoperatively (p = 0.020). CONCLUSION Low preoperative hematocrit levels are associated with increased mortality after CABG surgery. We suggest that patients' preoperative hematocrit levels must be added to the risk scoring systems as an assessment parameter.
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Affiliation(s)
- Arda Aybars Pala
- Cardiovascular Surgery, Adıyaman Training and Research Hospital, Adıyaman, TUR
| | - Temmuz Taner
- Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, TUR
| | - Ahmet Burak Tatli
- Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, TUR
| | - Kadir Kaan Ozsin
- Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, TUR
| | - Senol Yavuz
- Cardiovascular Surgery, University of Health Sciences, Bursa Yüksek İhtisas Training and Research Hospital, Bursa, TUR
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