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Karacali K, Celik IE, Yesilmese Kocak D, Yarlioglues M. Woven coronary artery with acute myocardial infarction. Coron Artery Dis 2024; 35:348-349. [PMID: 38436054 DOI: 10.1097/mca.0000000000001350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Kadir Karacali
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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2
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Erkan M, Severgün K. A high-risk coronary anomaly combination: left main coronary artery atresia accompanied by interarterial course of right coronary artery. Coron Artery Dis 2024; 35:350-351. [PMID: 38451505 DOI: 10.1097/mca.0000000000001351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Affiliation(s)
| | - Kübra Severgün
- Department of Cardiology, University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
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3
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Kwon HW, Song MK, Lee SY, Kim GB, Kwak JG, Cho S, Kim WH, Bae EJ. Risk Factors for Coronary Artery Complications After Prosthetic Pulmonary Valve Implantation in Patients With Congenital Heart Disease. Circ J 2024; 88:652-662. [PMID: 38325847 DOI: 10.1253/circj.cj-23-0752] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND Coronary artery complications (CACs) in patients who undergoing prosthetic pulmonary valve implantation for congenital heart disease can lead to fetal outcomes. However, the incidence of and risk factors for CACs in these patients remain unknown.Methods and Results: A retrospective cohort study was conducted on patients who underwent cardiac computed tomography or invasive coronary angiography after prosthetic pulmonary valve implantation at Seoul National University Hospital from June 1986 to May 2021. Among 341 patients, 25 (7.3%) were identified with CACs, and 2 of them died. Among the patients with CACs, congenital coronary anomalies and an interarterial course of the coronary artery were identified in 11 (44%) and 18 (72%) patients, respectively. Interarterial and intramural courses of the coronary artery were associated with a 4.4- and 10.6-fold increased risk of CACs, respectively. Among patients with tetralogy of Fallot and pulmonary atresia, the aortic root was rotated further clockwise in patients with coronary artery compression compared to those without it (mean [±SD] 128.0±19.9° vs. 113.5±23.7°; P=0.024). The cut-off rotation angle of the aorta for predicting the occurrence of coronary artery compression was 133°. CONCLUSIONS Perioperative coronary artery evaluation and prevention of CACs are required in patients undergoing prosthetic pulmonary valve implantation, particularly in those with coronary artery anomalies or severe clockwise rotation of the aortic root.
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Affiliation(s)
- Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
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4
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Lanckneus M, Truyens M, Pauwels R. Spontaneous coronary artery dissection of two coronary arteries in a young female patient: a case report. Acta Cardiol 2024; 79:254-257. [PMID: 38441059 DOI: 10.1080/00015385.2024.2323873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/06/2024] [Indexed: 03/06/2024]
Affiliation(s)
- Marie Lanckneus
- Faculty of Medicine and Health Sciences, University Hospital of Ghent, Ghent, Belgium
| | - Marie Truyens
- Department of Gastroenterology, University Hospital of Ghent, Ghent, Belgium
| | - Ruben Pauwels
- Department of Cardiology, AZ Sint-Lucas Ghent, Ghent, Belgium
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5
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Giovannico L, Santeramo V, Moschou M, Di Bari N, Bottio T. Coronary artery-to-pulmonary artery fistula: a rare congenital heart disease from cardiovascular imaging to the intraoperative findings. J Cardiovasc Med (Hagerstown) 2024; 25:342-343. [PMID: 38407850 DOI: 10.2459/jcm.0000000000001605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Affiliation(s)
| | | | - Maria Moschou
- School of Medicine, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Medical School, Bari, Italy
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6
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Ait Mokhtar O, Hamidouche K, Amini N, Boudjemline Y, Azzouz A, Benkhedda S. [Anomalous origin of right coronary artery from pulmonary artery associated to left main coronary stenosis]. Ann Cardiol Angeiol (Paris) 2024; 73:101737. [PMID: 38341990 DOI: 10.1016/j.ancard.2024.101737] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 12/16/2023] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
We describe herein a case of a 16 years-old female patient referred to our department for further exploration of a chest pain. Color Doppler echocardiography revealed an abnormal flow at the level of the pulmonary artery. Exercise testing was abnormal leading to further imaging including computed cardiac tomography followed by coronary angiography which showed anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) associated with mid shaft left main stenosis. We discuss this uncommon association and therapeutic options.
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Affiliation(s)
- Omar Ait Mokhtar
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria.
| | | | | | | | - Abdelmalek Azzouz
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria
| | - Salim Benkhedda
- Mustapha University hospital, Algiers, Algeria; Cardiology oncology collaborative group, Algiers, Algeria
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7
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Pham V, Picard F, Jegou A. Coronary cameral fistula secondary to pacemaker implantation. Coron Artery Dis 2024; 35:169-170. [PMID: 38165028 DOI: 10.1097/mca.0000000000001312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Affiliation(s)
- Vincent Pham
- Department of Cardiology, Hôpital privé de Parly 2 Le Chesnay, Chesnay
| | - Fabien Picard
- Department of Cardiology, Cochin Hospital, Hôpitaux Universitaire Paris Centre, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Arnaud Jegou
- Department of Cardiology, Hôpital privé de Parly 2 Le Chesnay, Chesnay
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8
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Brunton N, Best PJM, Skelding KA, Cendrowski EE. Spontaneous Coronary Artery Dissection (SCAD) from an Interventionalist Perspective. Curr Cardiol Rep 2024; 26:91-96. [PMID: 38236518 PMCID: PMC10991027 DOI: 10.1007/s11886-023-02019-w] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome (ACS), particularly among women < 50 years of age. Here, we aim to review the pathogenesis of SCAD, discuss SCAD as an initial manifestation of systemic arterial disease, and highlight invasive strategies as well as unique challenges in the care of women with SCAD. RECENT FINDINGS A paradigm shift has occurred in the care of SCAD patients in the past decade as recommendations for conservative management have become widespread. Invasive interventions are reserved for patients with hemodynamic compromise or active ischemia due to increased periprocedural complications and failure rates. Certain patient populations have been identified for larger territory infarcts and proximal disease including patients with known connective tissue disease, premenopausal women, and patients with pregnancy-associated SCAD (P-SCAD). Current recommended management of SCAD is conservative. Despite a growing awareness of SCAD and its known association with systemic arteriopathies in women, evidence-based data remains scarce. Future studies focused on identifying genetic factors, optimal medical therapy after SCAD, and techniques to minimize interventional complications are needed.
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Affiliation(s)
- Nichole Brunton
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
| | - Patricia J M Best
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA.
| | | | - Emily E Cendrowski
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 1st St SW, Rochester, MN, 55905, USA
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Yoshida K, Miura Y, Fukunaga Y, Mitsuishi A. A Y-incision to enlarge the aortic root for aortic valve stenosis with anomalous aortic origin of the right coronary artery. J Cardiothorac Surg 2024; 19:54. [PMID: 38311727 PMCID: PMC10840288 DOI: 10.1186/s13019-024-02518-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 01/28/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Anomalous aortic origin of the coronary artery (AAOCA) is a rare congenital heart disease. Therefore, optimal indications for surgery in patients with severe aortic valve stenosis (AS) complicated by AAOCA remain uncertain. CASE PRESENTATION We report the case of a 57-year-old male patient who underwent aortic valve replacement (AVR) and aortic root enlargement using a Y-incision procedure for severe AS with an anomalous aortic origin of the right coronary artery (AAORCA). Since preoperative single-photon emission computed tomography revealed no ischaemic lesions, an aortic root enlargement with a Y-incision was performed to prevent the potential compression of the prosthetic valve on the AAOCA and prosthesis-patient mismatch. CONCLUSIONS Preoperative evaluation of the coronary anatomy and myocardial ischaemia using advanced imaging modalities and aortic root enlargement with the Y-incision procedure is an effective strategy for preventing ischaemic complications in cases of severe AS with AAORCA.
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Affiliation(s)
- Keisuke Yoshida
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1 Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan.
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1 Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Yukiko Fukunaga
- Department of Surgery, Kochi Medical School Hospital, Kochi, Japan
| | - Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School Hospital, 185-1 Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
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Salamanca J, García-Guimaraes M, Sabaté M, Sanz-Ruiz R, Macaya F, Roura G, Jimenez-Kockar M, Nogales JM, Tizón-Marcos H, Velazquez M, Veiga G, Gamarra A, Aguilar R, Jiménez-Borreguero LJ, Díez-Villanueva P, Bastante T, Núñez-Gil I, Alfonso F. Non-atherosclerotic acute cardiac syndromes: spontaneous coronary artery dissection and Takotsubo syndrome. Comparison of long-term clinical outcomes. Coron Artery Dis 2024; 35:50-58. [PMID: 37990625 DOI: 10.1097/mca.0000000000001304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) and Takotsubo syndrome (TTS) constitute two common causes of nonatherosclerotic acute cardiac syndrome particularly frequent in women. Currently, there is no information comparing long-term clinical outcomes in unselected patients with these conditions. METHODS We compared the baseline characteristics, in-hospital outcomes, and the 12-month and long-term clinical outcomes of two large prospective registries on SCAD and TTS. RESULTS A total of 289 SCAD and 150 TTS patients were included; 89% were women. TTS patients were older with a higher prevalence of cardiovascular risk factors. Precipitating triggers were more frequent in TTS patients, while emotional triggers and depressive disorders were more common in the SCAD group. Left ventricular ejection fraction was lower in TTS patients, but SCAD patients showed higher cardiac biomarkers. In-hospital events (43.3% vs. 5.2%, P <0.01) occurred more frequently in TTS patients. TTS patients also presented more frequent major adverse events at 12-month (14.7% vs. 7.1%, HR 5.3, 95% CI: 2.4-11.7, P <0.01) and long-term (median 36 vs. 31 months, P =0.41) follow-up (25.8% vs. 9.6%, HR 4.5, 95% CI: 2.5-8.2, P <0.01). Atrial fibrillation was also more frequent in TTS patients. Moreover, TTS patients presented a higher 12-month and long-term mortality (5.6% vs. 0.7%, P =0.01; and 12.6% vs. 0.7%, P <0.01) mainly driven by noncardiovascular deaths. CONCLUSION Compared to SCAD, TTS patients are older and present more cardiovascular risk factors but less frequent depressive disorder or emotional triggers. TTS patients have a worse in-hospital, mid-term, and long-term prognosis with higher noncardiac mortality than SCAD patients.
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Affiliation(s)
- Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Marcos García-Guimaraes
- Department of Cardiology, Hospital Universitario Arnau de Vilanova & Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida
| | - Manel Sabaté
- Department of Cardiology, IDIBAPS, Hospital Clinic de Barcelona, Barcelona
| | - Ricardo Sanz-Ruiz
- Department of Cardiology, Hospital General Universitario Gregorio Marañón
| | - Fernando Macaya
- Department of Cardiology, Hospital Clínico San Carlos, Madrid
| | - Gerard Roura
- Department of Cardiology, Hospital Universitari de Bellvitge
| | | | | | | | - Maite Velazquez
- Department of Cardiology, Hospital Universitario 12 de Octubre. Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), CIBER-CV, Madrid
| | - Gabriela Veiga
- Department of Cardiology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Sanitaria IDIVAL, Santander, Spain
| | - Alvaro Gamarra
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Rio Aguilar
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Luis Jesús Jiménez-Borreguero
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Pablo Díez-Villanueva
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Teresa Bastante
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
| | - Iván Núñez-Gil
- Department of Cardiology, Hospital Clínico San Carlos, Madrid
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa. Instituto de Investigación Sanitaria Princesa (IIS-IP). CIBER-CV. Universidad Autónoma de Madrid, Madrid
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11
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Karila-Cohen J, Laux D, Houyel L, Bonnet D. Aorta Without Coronary Arteries: Anatomic Variants of a Rare Malformation. Pediatr Cardiol 2024; 45:200-207. [PMID: 37934240 DOI: 10.1007/s00246-023-03330-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/16/2023] [Indexed: 11/08/2023]
Abstract
Absence of connection of both coronary arteries to the aorta is an extremely rare congenital malformation. Most cases reported are anatomic variants of anomalous left coronary artery to pulmonary artery, found in isolation or in association with other congenital heart defects. We describe here four cases of patients born without any coronary artery connected to the aorta, including two with an almost complete absence of epicardial coronary arteries, one with single coronary artery to the right pulmonary artery, and one with left ventricular connection of a single coronary artery. Those exceptional coronary malformations have a poor prognosis and are often diagnosed at autopsy. Total absence of epicardial coronary arteries, present in two of our patients and described only once in the literature, leads us to reconsider current knowledge of human coronary artery development.
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Affiliation(s)
- Julie Karila-Cohen
- Medical and Surgical Unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects - M3C, University Hospital Necker-Enfants Malades, Paris, France.
| | - Daniela Laux
- Medical and Surgical Unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects - M3C, University Hospital Necker-Enfants Malades, Paris, France
| | - Lucile Houyel
- Medical and Surgical Unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects - M3C, University Hospital Necker-Enfants Malades, Paris, France
- University Paris Cité, Paris, France
| | - Damien Bonnet
- Medical and Surgical Unit of Congenital and Paediatric Cardiology, Reference Centre for Complex Congenital Heart Defects - M3C, University Hospital Necker-Enfants Malades, Paris, France
- University Paris Cité, Paris, France
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12
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Al Abbad KA, AlSaflan A, Makhdom F, El Ghoneimy YF, Al Mubarak L, Nashy MR, Almansori M, Johnston KJ, El Tahan MR. Severe Myxomatous Mitral Regurgitation With Normal Left Ventricular Function in a Woman With an Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery. J Cardiothorac Vasc Anesth 2024; 38:346-348. [PMID: 37891143 DOI: 10.1053/j.jvca.2023.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Komail A Al Abbad
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Abdulhadi AlSaflan
- Anesthesiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fahad Makhdom
- Cardiac Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Yasser F El Ghoneimy
- Cardiac Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Lujain Al Mubarak
- Anesthesiology Department, Royal Commission Hospital Jubail, Jubail, Saudi Arabia
| | - Medhat R Nashy
- Cardiac Surgery Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Menoufiya University, Menoufiya, Egypt
| | - Mohammed Almansori
- Cardiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Keith J Johnston
- Anesthesiology Department, King Hamad University Hospital, Bahrain
| | - Mohamed R El Tahan
- Cardiothoracic Anesthesia, Anesthesiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia; Cardiothoracic Anaesthesia Unit, Department of Anaesthesia, Surgical Intensive Care and Pain Medicine, College of Medicine, Mansoura University, Mansour, Egypt
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13
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Khalil G, Elbadri A, Abbasi SH, Das I, Ladwiniec A. An unusual cause of acute coronary syndrome: thrombosis of right coronary artery to right atrium fistula. BMJ Case Rep 2023; 16:e257368. [PMID: 38160024 PMCID: PMC10759029 DOI: 10.1136/bcr-2023-257368] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Abstract
Coronary arterial fistulae are rare, but it is one of the most common coronary artery anomalies. Most of the cases are asymptomatic in younger patients unless it is large and of haemodynamic significance. The incidence of thromboembolic complications usually increases with age. We report a case of a young male in his early 20s presenting with central chest pain. Coronary computed tomographic angiography revealed acute coronary syndrome due to a fistula between right coronary artery and right atrium occluded by thrombus. After discussion with coronary and congenital heart multidisciplinary team, a consensus was agreed that we should manage him conservatively with anticoagulant and antiplatelet therapy and a 3-month follow-up strategy that included repeating cardiac imaging. After a year, his anticoagulation and antiplatelet medication was discontinued.
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Affiliation(s)
- Ghayyur Khalil
- Kettering General Hospital, Kettering, Northamptonshire, UK
| | - Azza Elbadri
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, UK
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14
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Lalani K, Rao MS, Padmakumar R, Parikh P. Rare Coronary Anomaly of Posterior Descending Artery Arising from Superdominant Left Anterior Descending Artery. Methodist Debakey Cardiovasc J 2023; 19:88-91. [PMID: 38161507 PMCID: PMC10756155 DOI: 10.14797/mdcvj.1310] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 11/08/2023] [Indexed: 01/03/2024] Open
Abstract
Coronary artery anomalies are uncommon anatomical variations that are usually detected incidentally during a coronary angiogram or computed tomography angiography. We report a case of a diabetic and hypertensive middle-aged male who presented with chest discomfort. Coronary angiography revealed no signs of coronary artery disease but showed a left anterior descending artery (LAD) looping around the left ventricular apex and running through the posterior interventricular groove as a posterior descending artery (PDA) beyond the crux. The nondominant right coronary artery (RCA) and left circumflex artery (LCX) had no connection with the PDA. The patient's diabetic and hypertensive medications were adjusted, and he remained asymptomatic after 3 months. Interventionalists should be aware of the types of coronary anomalies that may complicate diagnosis and management during percutaneous coronary intervention.
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Affiliation(s)
- Kanhai Lalani
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - M. Sudhakar Rao
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - R. Padmakumar
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Pankti Parikh
- St. John’s Medical College, St. John’s National Academy of Health Sciences, Bangalore, Karnataka, India
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15
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Civieri G, Vadori M, Masiero G, Iop L, Tansella D, Pergola V, Cozzi E, Iliceto S, Tona F. Spontaneous coronary artery dissection in women with acute myocardial infarction: is there a new role for autoimmunity? Eur Heart J Acute Cardiovasc Care 2023; 12:856-861. [PMID: 37389577 DOI: 10.1093/ehjacc/zuad070] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/01/2023]
Abstract
AIMS Spontaneous coronary artery dissection (SCAD) is an uncommon cause of acute myocardial infarction in women and has an unclear pathophysiology. Autoantibodies (AAs) targeting angiotensin-II receptor type 1 (AT1R) and endothelin-1 receptor type A (ETAR) have known detrimental effects on endothelial function. We investigated the prevalence of these AAs in SCAD-affected female patients. METHODS AND RESULTS Female patients diagnosed at coronary angiography with myocardial infarction and SCAD were consecutively enrolled. Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA titres and seropositivity prevalence were compared between SCAD patients, ST-elevation myocardial infarction (STEMI) patients, and healthy women. Ten women with SCAD and 20 age-matched controls (10 women with STEMI and 10 healthy women) were included. Six out of 10 (60%) women with myocardial infarction and SCAD were seropositive for AT1R-AAs and ETAR-AAs. In contrast, only one (10%) healthy woman and one (10%) STEMI patient were seropositive for AT1R-AAs (P = 0.03 and P = 0.03, respectively). One STEMI patient was seropositive for ETAR-AAs, while none of the healthy women was found to be seropositive (P = 0.03 and P = 0.01, respectively). The median AA titre was significantly higher in SCAD patients than in healthy women (P = 0.01 for AT1R-AAs; P = 0.02 for ETAR-AAs) and STEMI patients (P < 0.001 for AT1R-AAs; P = 0.002 for ETAR-AAs). CONCLUSION Autoantibodies targeting angiotensin-II receptor type 1 and ETAR-AA seropositivity is significantly higher in SCAD women with myocardial infarction than in healthy women or female patients with STEMI. Our findings, corroborated by previous data in the literature and biological plausibility, suggest a possible role for AT1R-AAs and ETAR-AAs in the pathophysiology of SCAD in women with acute myocardial infarction and should warrant further studies with larger sample sizes.
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Affiliation(s)
- Giovanni Civieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Marta Vadori
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Giulia Masiero
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Laura Iop
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Donatella Tansella
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Valeria Pergola
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Emanuele Cozzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Via N. Giustiniani 2, 35128 Padova (PD), Italy
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16
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Chua F, Vongbunyong K, Urgun DA, Ghashghaei R. Anomalous origin of left main coronary artery from the right sinus of Valsalva. BMC Cardiovasc Disord 2023; 23:618. [PMID: 38097961 PMCID: PMC10722684 DOI: 10.1186/s12872-023-03616-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Anomalous coronary arteries are rare congenital variations with cases ranging from asymptomatic to life-threatening. Given the wide variability of coronary anomalies, it is challenging to predict their clinical consequences. Here, we present the 'malignant' variant - interarterial course of the left coronary artery between the aorta and pulmonary trunk - given the highest risk of sudden cardiac death among the various coronary anomalies. CASE PRESENTATION Our case presents a 22-year-old male presenting to the emergency department after a syncopal episode that occurred while the patient was driving a motor vehicle. Initial Computed Tomography (CT) of the chest performed as part of the trauma work-up revealed a rare case of an anomalous origin of the left main coronary artery (LMCA) originating from a common ostium with the right coronary artery (RCA). The LMCA was found to have a malignant course, as it was positioned between the aorta and pulmonary artery. Given the high risk of sudden cardiac arrest with this congenital variant, the patient underwent coronary artery bypass grafting. CONCLUSION Anomalous coronary arteries remain the second leading cause of sudden cardiac death in young adult patients. The risk of sudden cardiac death depends on the congenital variant of the anomalous coronary artery as well as the course these vessels take. This case highlights a rare congenital variant featuring both the LMCA and RCA originating from a common ostium, with the LMCA having a malignant course, a variant with the highest risk of sudden cardiac death.
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Affiliation(s)
- Frederick Chua
- Department of Medicine, University of California, Irvine, USA.
- , Orange, CA, USA.
| | | | | | - Roxana Ghashghaei
- Department of Medicine, Division of Cardiology, University of California, Irvine, USA
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17
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Combaret N, Motreff P. [French National registry of spontaneous coronary artery dissections : ''DISCO registry'']. Ann Cardiol Angeiol (Paris) 2023; 72:101684. [PMID: 37890323 DOI: 10.1016/j.ancard.2023.101684] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
AIM Spontaneous coronary artery dissection (SCAD) is a form of acute coronary syndrome (ACS). The aim of this registry is to assess the clinical and angiographic features of SCAD, to describe the therapeutic management and prognosis, and to identify links with other vascular diseases. METHOD From 2016 to 2018, 424 patients with a diagnosis of SCAD were included prospectively and retrospectively in 51 French cardiology centres. RESULTS 373 patients with confirmed SCAD were included. The mean age was 51.5±10.3 years with 90.6% women. 54.7% of patients had <2 cardiovascular risk factors. ACS occurred in 96.2% of patients. 84.2% of patients were managed conservatively, 15.5% interventionally and 0.3% surgically. At 1-year follow-up, recurrence of SCAD occurred in 3.3%. No deaths occurred. The association with fibro-muscular dysplasia was found in 45% of cases and genetic analysis confirmed a strong relationship between the occurrence of SCAD and gene variations at the PHACTR1 locus. CONCLUSION The DISCO registry is the largest European cohort of SCAD. It confirms that this disease mainly affects young women with few cardiovascular risk factors, and that there is a strong association with the presence of fibromuscular dysplasia (45%). Conservative management should be preferred, with a favourable prognosis (no deaths at 1 year; recurrence rate of 3.3%).
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Affiliation(s)
- N Combaret
- Service de cardiologie, Centre Hospitalier Universitaire Gabriel-Montpied, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France.
| | - P Motreff
- Service de cardiologie, Centre Hospitalier Universitaire Gabriel-Montpied, CNRS, Université Clermont Auvergne, Clermont-Ferrand, France
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18
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Akita K, Malik A, Briasoulis A, Kuno T. The relationship between spontaneous coronary artery dissection and COVID-19. J Cardiovasc Med (Hagerstown) 2023; 24:933-935. [PMID: 37642654 DOI: 10.2459/jcm.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Affiliation(s)
- Keitaro Akita
- Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center
| | - Aaqib Malik
- Department of Cardiology, Westchester Medical Center, New York, New York
| | - Alexandros Briasoulis
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Toshiki Kuno
- Division of Cardiology, Montefiore Medical Center
- Division of Cardiology, Jacobi Medical Center, Albert Einstein College of Medicine, New York, NY, USA
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19
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Bai W, Tang H. Coronary occlusion after TAVI in a patient with an anomalous left coronary artery. Rev Esp Cardiol (Engl Ed) 2023; 76:1071. [PMID: 37506968 DOI: 10.1016/j.rec.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023]
Affiliation(s)
- Wenjuan Bai
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Hong Tang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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20
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Turner EA, Ivynian SE, Hickman L, DiGiacomo M. The Patient Experience After Spontaneous Coronary Artery Dissection. Heart Lung Circ 2023; 32:1426-1433. [PMID: 38030470 DOI: 10.1016/j.hlc.2023.09.023] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE There is considerable burden of anxiety, depression, and post-traumatic stress disorder in patients with spontaneous coronary artery dissection (SCAD), yet research is limited on the experience and impact of SCAD from the patient perspective. This literature review sought to describe the current state of the literature on the patient experience of SCAD and consequences for patients following a SCAD event from the patient perspective. To better understand how people's experiences of SCAD affect their wellbeing, quality of life, lifestyles, and identity, and what would be useful from the patient perspective, an integrative review was performed. METHODS An integrative literature review was conducted to understand the experience of SCAD and the post-event implications. Five databases were searched. Search terms included 'spontaneous coronary artery dissection', 'SCAD', 'patient', 'experience', 'perspective', and 'opinion'. English-language, peer-reviewed primary research in people with a diagnosis of SCAD that reflected the patient experience was included. Data indicating the SCAD experience including distress prevalence were extracted into an Excel spreadsheet, and narrative synthesis of included studies followed. FINDINGS From 325 identified studies, five were included for review, yielding a combined sample of 447 participants. Patients with SCAD reported a lack of information about SCAD and the recovery process, and use of the internet for obtaining information. Patients with SCAD reported challenges in recovery including anxiety associated with fear of recurrence and uncertainty, and a need for greater support. A wide range of negative emotions was reported during and after the SCAD event. Participants reported participating in support groups, with mixed reviews of their appropriateness and effectiveness.
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Affiliation(s)
- Elizabeth A Turner
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia.
| | - Serra E Ivynian
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia
| | - Louise Hickman
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia; Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia
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21
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Gaudino M, Di Franco A, Arbustini E, Bacha E, Bates ER, Cameron DE, Cao D, David TE, De Paulis R, El-Hamamsy I, Farooqi KM, Girardi LN, Gräni C, Kochav JD, Molossi S, Puskas JD, Rao SV, Sandner S, Tatoulis J, Truong QA, Weinsaft JW, Zimpfer D, Mery CM. Management of Adults With Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review. Ann Thorac Surg 2023; 116:1124-1141. [PMID: 37855783 DOI: 10.1016/j.athoracsur.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/20/2023]
Abstract
As a result of increasing adoption of imaging screening, the number of adult patients with a diagnosis of anomalous aortic origin of the coronary arteries (AAOCA) has grown in recent years. Existing guidelines provide a framework for management and treatment, but patients with AAOCA present with a wide range of anomalies and symptoms that make general recommendations of limited applicability. In particular, a large spectrum of interventions can be used for treatment, and there is no consensus on the optimal approach to be used. In this paper, a multidisciplinary group of clinical and interventional cardiologists and cardiac surgeons performed a systematic review and critical evaluation of the available evidence on the interventional treatment of AAOCA in adult patients. Using a structured Delphi process, the group agreed on expert recommendations that are intended to complement existing clinical practice guidelines.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Eloisa Arbustini
- Transplant Research Area and Centre for Inherited Cardiovascular Diseases, Scientific Department, IRCCS and Polyclinic San Matteo Foundation, Pavia, Italy
| | - Emile Bacha
- Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York
| | - Eric R Bates
- Cardiovascular Center, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Duke E Cameron
- Division of Cardiac Surgery, Corrigan Minehan Heart Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Tirone E David
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ruggero De Paulis
- Department of Cardiac Surgery, European Hospital, Rome, Italy; UniCamillus University, Rome, Italy
| | - Ismail El-Hamamsy
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, New York-Presbyterian, Columbia University Irving Medical Center, New York, New York
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonathan D Kochav
- Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Silvana Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - John D Puskas
- Department of Cardiovascular Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sunil V Rao
- Division of Interventional Cardiology, NYU Langone Health, New York, New York
| | - Sigrid Sandner
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - James Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Quynh A Truong
- Department of Radiology, New York Presbyterian, Weill Cornell Medicine, New York, New York
| | - Jonathan W Weinsaft
- Greenberg Cardiology Division, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Daniel Zimpfer
- Division of Cardiac Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, Dell Medical School at The University of Texas at Austin/Dell Children's Medical Center, Austin, Texas
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22
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Visina JM, Haque N, Huang S, Aday AW, Kim ES. Prevalence of extracoronary vascular abnormalities does not vary by age of presentation in patients with spontaneous coronary artery dissection (SCAD). Vasc Med 2023; 28:589-591. [PMID: 37622755 PMCID: PMC10872828 DOI: 10.1177/1358863x231191901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Jacqueline M Visina
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nowrin Haque
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shi Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Aaron W Aday
- Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Esther Sh Kim
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC, USA
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23
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Ratti A, Belmonte M, Paolisso P, Shumkova M, Botti G, Viscusi MM, Bertolone DT, Gallinoro E, Barbato E, Andreini D, Vanderheyden M. Dual left anterior descending coronary artery and anomalous origin of left circumflex artery: a novel coronary anomaly revealed by CCTA. Int J Cardiovasc Imaging 2023; 39:2527-2529. [PMID: 37759093 DOI: 10.1007/s10554-023-02958-z] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
In the rare coronary anomaly of Dual LAD, two segments of the vessel reside within the anterior interventricular sulcus. In our case, the short LAD originated from the Left Coronary Sinus (LCS), while the long LAD emerged from the Right Coronary Sinus (RCS). The LCx arose from the RCS, and the RCA displayed typical features. This anomaly was deemed incidental, prompting routine follow-up. It underscores the significance of integrating CCTA for a thorough assessment, offering crucial insights for patient management.
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Affiliation(s)
- Angelo Ratti
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
- University of Milan, Milan, Italy
| | - Marta Belmonte
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
- University Federico II, Naples, Italy
| | - Pasquale Paolisso
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
- University Federico II, Naples, Italy
| | - Monika Shumkova
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Giulia Botti
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Michele Mattia Viscusi
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | - Dario Tino Bertolone
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium
| | | | | | - Daniele Andreini
- University of Milan, Milan, Italy
- Galeazzi-Sant'Ambrogio Hospital, Milan, Italy
| | - Marc Vanderheyden
- OLV-Clinic, Cardiovascular Center Aalst, OLV Hospital, Moorselbaan 164, Aalst, 9300, Belgium.
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24
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Denegri A, Szarpak L, Pruc M, Jaguszewski MJ. Spontaneous coronary artery dissection and Takotsubo syndrome. Eur J Intern Med 2023; 117:137-139. [PMID: 37586984 DOI: 10.1016/j.ejim.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Andrea Denegri
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Lukasz Szarpak
- Henry JN Taub Department of Emergency Medicine, Baylor College of Medicine, One Baylor Plaza - BCM285, Houston, TX 77030, USA.
| | - Michal Pruc
- Department of Public Health, International Academy of Ecology and Medicine, Kyiv, Ukraine
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25
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Arslan P, Atik Ugan S, Guzeltas A. A rare disease detected in a school-age child aortopulmonary window with anomalous right coronary artery from the pulmonary artery. Cardiol Young 2023; 33:2427-2429. [PMID: 37431743 DOI: 10.1017/s1047951123001713] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Aortopulmonary window is a condition characterized by a communication between the pulmonary artery and the ascending aorta. The coexistence of aortopulmonary window and an anomalous right coronary artery originating from the pulmonary artery is rarely observed together, as mentioned in previous studies. In this report, we aim to describe our diagnostic and treatment experiences with a 6-year-old patient diagnosed with aortopulmonary window associated with an abnormal origin of the right coronary artery from the pulmonary artery.
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Affiliation(s)
- Perver Arslan
- Pediatric Cardiology, İstanbul Mehmet Akif Ersoy Göğüs Kalp Ve Damar Cerrahisi Eğitim Ve Araştırma Hastanesi, Istanbul, Turkey
| | - Sezen Atik Ugan
- Pediatric Cardiology, Cerrahpaşa Medical Faculity, Istanbul, Turkey
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26
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Kalustian AB, Doan TT, Masand P, Gowda ST, Eilers LF, Reaves-O'Neal DL, Sachdeva S, Qureshi AM, Heinle J, Molossi SM, Binsalamah ZM. Evolution of surgical repair of intraseptal anomalous left coronary artery with myocardial ischaemia. Cardiol Young 2023; 33:2342-2349. [PMID: 36861393 DOI: 10.1017/s1047951123000197] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
BACKGROUND Anomalous aortic origin of the left coronary artery with intraseptal course is a rare coronary anomaly associated with an increased risk of myocardial ischaemia. The role and techniques for surgical intervention are evolving, with numerous novel surgical techniques for this challenging anatomy reported in the last 5 years. We report our single-centre experience with surgical repair of intraseptal anomalous left coronary artery in the paediatric population, including clinical presentation, evaluation, and short- to mid-term outcomes. METHODS All patients with coronary anomalies presenting to our institution undergo standardised clinical evaluation. Five patients aged 4 to 17 years underwent surgical intervention for intraseptal anomalous aortic origin of the left coronary artery between 2012 and 2022. Surgical techniques included coronary artery bypass grafting (n = 1), direct reimplantation with limited supra-arterial myotomy via right ventriculotomy (n = 1), and transconal supra-arterial myotomy with right ventricular outflow tract patch reconstruction (n = 3). RESULTS All patients had evidence of haemodynamically significant coronary compression, and three had evidence of inducible myocardial ischaemia pre-operatively. There were no deaths or major complications. Median follow-up was 6.1 months (range 3.1-33.4 months). Patients who underwent supra-arterial myotomy (with or without reimplantation) had improved coronary flow and perfusion based on stress imaging and catheterisation data. CONCLUSIONS Surgical approaches to intraseptal anomalous left coronary artery with evidence of myocardial ischaemia continue to evolve, with new techniques demonstrating promising improvement in coronary perfusion. Further studies are warranted to determine long-term outcomes and refine indications for repair.
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Affiliation(s)
- Alyssa B Kalustian
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Tam T Doan
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Prakash Masand
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Srinath T Gowda
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay F Eilers
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dana L Reaves-O'Neal
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Shagun Sachdeva
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Athar M Qureshi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Heinle
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Silvana M Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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27
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Baytugan NZ, Celik AI, Bezgin T, Cagdas M, Alicik G. An unusual complication after the mitral valve replacement: Ischemic ventricular tachycardia due to the anomalous origin of circumflex artery injury. Coron Artery Dis 2023; 34:529-530. [PMID: 37799053 DOI: 10.1097/mca.0000000000001262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
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28
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Li Y, Wei P, Xu Z, Xu L, Wan J, Zhang F, Fang F, Pan X, Zhang G. Outcomes following transcatheter closure or surgical repair of coronary-left ventricular fistula: A single-center study with 10-year experience. Hellenic J Cardiol 2023; 74:39-47. [PMID: 37321292 DOI: 10.1016/j.hjc.2023.06.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/06/2023] [Accepted: 06/11/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Coronary arteries drain into the left ventricle, known as coronary-left ventricular fistula (CLVF), an extremely rare anomalous coronary artery disease. Little is known about the outcomes following transcatheter closure (TC) or surgical closure (SC) of CLVF. METHOD This was a single-center retrospective study including 42 consecutive patients who underwent either the TC or SC procedure from January 2011 to December 2021. The baseline and anatomic characteristics of the fistulas, procedural outcomes, and late outcomes were summarized and analyzed. RESULTS The mean age was 31.6 ± 16.2 years, with 28 male patients (66.7%). Fifteen patients underwent SC group and the remaining received TC group. There were no differences in age, comorbidities, clinical presentations, and anatomic characteristics between the 2 groups. The procedural success rate was similar (93.3% vs. 85.2%, P = 0.639) without operative and in-hospital mortality in both groups. Notably, patients who underwent TC had a significantly shorter postoperative in-hospital length of stay (2.11 ± 1.49 vs. 7.73 ± 2.37 days, P<0.001). The median follow-up time was 4.6 years (2.5-5.7 years, TC group) and 3.98 years (0.42-7.15 years, SC group), respectively. No difference was observed in the incidence of recanalization of the fistula (7.4% vs. 6.7%, P = 1) and myocardial infarction (0% vs. 0%). Cerebral infarction due to discontinuation of anticoagulants happened to two patients in the TC group. Importantly, thrombotic occlusion of the fistulous tract with patent parent coronary artery was found in 7 patients of the TC group. CONCLUSION Both transcatheter and SC are safe and effective for patients with CLVF. Thrombotic occlusion is a noteworthy late complication, and its presence indicates the use of anticoagulants lifelong.
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Affiliation(s)
- Yihang Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Peijian Wei
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhongying Xu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Liang Xu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Junyi Wan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fengwen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Fang Fang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiangbin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
| | - Gejun Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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Dalby ST, Angtuaco MJ. Percutaneous device closure of hemodynamically significant coronary fistula following endomyocardial biopsy in a pediatric heart transplant patient. Cardiol Young 2023; 33:2461-2462. [PMID: 37529932 DOI: 10.1017/s1047951123002597] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
Coronary artery fistula is a rare but well-documented complication of right ventricular endomyocardial biopsy, particularly in the adult population. Typically, these fistulae never reach clinical or hemodynamic significance, but some may cause coronary steal and ventricular dysfunction. We report a case of a significant coronary artery fistula requiring device closure in the cardiac catheterization laboratory with subsequent improvement of clinical symptoms and cardiac function.
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Affiliation(s)
- Stephen T Dalby
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, USA
- Department of Pediatrics, University of California San Diego, Rady Children's Hospital, San Diego, CA, USA
| | - Michael J Angtuaco
- Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, Little Rock, AR, USA
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30
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Andreou AY. Anomalous left circumflex coronary artery entailing a risk of compression following valve surgery: a caveat regarding preoperative diagnosis. Coron Artery Dis 2023; 34:517-519. [PMID: 37799048 DOI: 10.1097/mca.0000000000001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Affiliation(s)
- Andreas Y Andreou
- Department of Cardiology, Limassol General Hospital, Limassol
- University of Nicosia Medical School, Nicosia, Cyprus
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31
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Van Damme A, McDermott S, McMurtry S, Kung JY, Gyenes G, Norris C. Secondary Prevention and Rehabilitation for Spontaneous Coronary Artery Dissection: A Systematic Review. Can J Cardiol 2023; 39:S395-S411. [PMID: 37604409 DOI: 10.1016/j.cjca.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a serious, noniatrogenic and nontraumatic cardiac event that predominantly affects women, with a high risk of recurrence. Secondary prevention strategies are not well understood in this population. Therefore, the aim of this systematic review is to determine the current evidence on secondary prevention strategies and their effect on recurrent cardiac events and quality of life (QOL). METHODS A literature search was conducted on August 21, 2021, of Ovid MEDLINE, Ovid Embase, CINAHL, Cochrane Library (via Wiley), Google Scholar, and ProQuest Dissertations & Theses Global. Literature on adult SCAD survivors who underwent secondary prevention measures with reported outcomes on major adverse cardiovascular events or QOL were included. Articles solely on pregnancy-associated SCAD or fibromuscular dysplasia were excluded. RESULTS Thirty studies were included in this review. A variety of research methodologies were explored. There were no randomized controlled trials. Overall, the quality of the evidence was moderate. Although evidence on secondary prevention was limited, tailored medical management was shown to have the most effect on decreasing recurrent events. Cardiac rehabilitation (CR) was supported as a safe and effective program for SCAD patients, with no reported associations with recurrent SCAD events or major adverse cardiovascular events. CR along with psychosocial interventions showed promise in improving QOL in SCAD survivors. CONCLUSIONS Medical management has the most effect in reducing recurrent events. CR, as a secondary prevention program, can provide interventions that might improve QOL. Randomized trial evidence on therapies for patients with SCAD are needed.
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Affiliation(s)
- Andrea Van Damme
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada.
| | - Susanna McDermott
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
| | - Sean McMurtry
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Janice Y Kung
- University of Alberta, John W. Scott Health Sciences Library, Walter C. Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Gabor Gyenes
- Faculty of Medicine and Dentistry, University of Alberta, Walter C. MacKenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton Clinic Health Academy, Edmonton, Alberta, Canada
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Kawasaki K, Kondo T, Wakatabe M, Abe T, Orii K. [Anomalous Origin of Right Coronary Artery with Intramural Course, Aortic Valve Stenosis and Coronary Artery Stenosis:Report of a Case]. Kyobu Geka 2023; 76:945-948. [PMID: 38056953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Anomalous origin of the coronary artery is a rare congenital malformation that can cause myocardial ischemia and arrhythmia in patients with or without atherosclerotic lesions. We present a case of aortic stenosis (AS) and coronary artery stenosis complicated by anomalous origin of the right coronary artery (RCA) from the aortic valve sinus and its intramural course. The patient was a 66-year-old woman who was diagnosed with AS 4 years prior, and scheduled for surgery owing to gradual progression of stenosis. Preoperative coronary angiography revealed an abnormal origin of the RCA, and during the surgery, the RCA was found located within the aortic wall close to the aortotomy. Thus, bypass surgery was performed using a great saphenous vein, to prevent ischemia of the RCA territory. The patient had good intraoperative and postoperative course, and a coronary computed tomography scan clearly showed the reconstructed RCA.
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Affiliation(s)
- Kyohei Kawasaki
- Department of Cardiac Surgery, Saitama Prefecture Cardiovascular and Respiratory Center, Kumagaya, Japan
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33
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Ech-Chenbouli A, El Gallazzi N, Raissuni Z. [Anomalous connections of coronary arteries : About 4 cases and litterature review]. Ann Cardiol Angeiol (Paris) 2023; 72:101611. [PMID: 37329822 DOI: 10.1016/j.ancard.2023.101611] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/24/2023] [Indexed: 06/19/2023]
Abstract
Coronary connection anomalies are a rare congenital anatomical aberration with an angiographic incidence of around 1%. In the majority of cases, these anomalies are incidentally discovered during coronary angiography or coro CT and remain silent without clinical translation, while in a certain number of cases, they can be responsible for serious clinical manifestations of up to sudden death. Coronary CT is crucial in the management of its patients since it makes it possible to objectify the presence of a pre-aortic course or the existence of an intramural aortic trajectory, two characteristics associated with the occurrence of sudden death. Through four clinical cases we illustrate the different situations in which we had to manage these anomalies.
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Affiliation(s)
| | | | - Zaineb Raissuni
- service de cardiologie du centre hospitalier Mohammed VI -Tanger, Morocco..
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34
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Warner ED, Gulati A, Halpern E, Fischman DL, Ruggiero NJ, Keith SW, Layser RB, McCarey M, Savage MP. Clinical Outcomes in Adult Patients With an Anomalous Right Coronary Artery from the Left Sinus of Valsalva. Am J Cardiol 2023; 204:122-129. [PMID: 37541148 DOI: 10.1016/j.amjcard.2023.07.066] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/07/2023] [Accepted: 07/13/2023] [Indexed: 08/06/2023]
Abstract
An anomalous origin of the right coronary artery from the opposite sinus of Valsalva with an intramural course (R-ACAOS-IM) may cause sudden cardiac death in children and adolescents. However, the natural history and management of patients in whom this anomaly is detected later during adulthood remains uncertain. The goals of this study were to assess the impact of an R-ACAOS-IM on the clinical outcomes in an adult population and to determine if adult patients with this anomaly who do not have significant coronary artery disease (CAD) can be managed safely without surgical intervention. A database review identified patients aged >35 years with anomalous coronary arteries diagnosed by cardiac catheterization or coronary computed tomography angiography. The outcomes of patients with R-ACAOS-IM were compared with patients with anomalous left circumflex coronary arteries with retroaortic course (LCx-RA) (an anomaly not associated with ischemic events). The primary outcome was all-cause mortality. The study population consisted of 185 patients aged 59 ± 12 years. Clinical characteristics were similar in the R-ACAOS-IM (n = 88) and LCx-RA (n = 97) groups. At a follow-up of 6.6 ± 4.5 years, there was no difference in mortality (hazard ratio 0.64, 95% confidence interval 0.32 to 1.28, p = 0.20) when adjusted for gender, age, and CAD. A subgroup analysis of 88 patients with no obstructive CAD managed nonoperatively found no difference between the LCx and R-ACAOS-IM groups in mortality (hazard ratio 2.45, 95% confidence interval 0.45 to 13.40, p = 0.30). There was no significant difference between the 2 groups in the composite outcome of death, nonfatal myocardial infarction, or survived cardiac arrest. The outcome of adult patients who have anomalous R-ACAOS-IM are similar to patients who have anomalous LCx-RA with a known benign course. In conclusion, these results suggest that most patients who survive this anomaly into adulthood may be managed conservatively without intervention.
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Affiliation(s)
- Eric D Warner
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Aishwarya Gulati
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Ethan Halpern
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - David L Fischman
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Nicholas J Ruggiero
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Scott W Keith
- Division of Biostatistics, Department of Pharmacology Physiology and Cancer Biology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Robert B Layser
- Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania; Department of Radiology, Chesapeake Regional Medical Center, Chesapeake, Virginia
| | - Melissa McCarey
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Michael P Savage
- Division of Cardiology, Thomas Jefferson University, Philadelphia, Pennsylvania.
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Bonelli JM, Schroh AM, Peirone A, Romero G, Schroh ML. [Abnormal aortic origin of coronary arteries]. Arch Cardiol Mex 2023; 93:482-489. [PMID: 37669688 DOI: 10.24875/acm.22000136] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 01/31/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction The anomalous aortic origin of the coronary arteries has an estimated prevalence of 0.02-5.7%. It can be associated with sudden death when it has an interarterial or intramural pathway or be damaged during interventions on the mitral, pulmonary and/or aortic annulus or percutaneous closure of an interatrial septal defect. Objective To identify these patients by imaging techniques such as transthoracic color Doppler echocardiography (TTE), computed tomography (CT) multislice angiography or coronary angiography. Methods The imaging techniques used for the detection of coronary anomalies were TTE, multislice coronary angiography or coronary angiography according to what is generally accepted. Results Fifteen patients were identified; in 12 of them the suspicion was due to TTE and in the remaining 3, CT multislice angiography was diagnostic. The circumflex artery was the coronary artery most involved, associated or not with another coronary anomaly (12/15 patients) and in the other three cases, the anomalous coronary artery had an interarterial course, with the right coronary arteries and the anterior descending coronary arteries being involved. Conclusions The under diagnosis by TTE of coronary artery abnormalities may be due to the difficulty of visualization that is accentuated with age. Their detection is crucial because they can both, lead to sudden death associated with an intramural and/or interarterial pathway and complicate an interventional procedure on the interatrial septum or within the mitral, pulmonary and/or aortic rings.
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Affiliation(s)
- Juan M Bonelli
- Servicio de Tomografía Axial Computarizada, Fundación Escuela de Medicina Nuclear (FUESMEN), Mendoza, Argentina
| | - Ana M Schroh
- Sección de Ecocardiografía Pediátrica, Instituto de Cardiología Infantil, Mendoza, Argentina
| | - Alejandro Peirone
- Servicio de Hemodinamia, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - Gabriel Romero
- Sección de Ecocardiografía Pediátrica, Instituto de Cardiología Infantil, Mendoza, Argentina
| | - María L Schroh
- Servicio de Tomografía Axial Computarizada, Fundación Escuela de Medicina Nuclear (FUESMEN), Mendoza, Argentina
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Kalustian AB, Eilers LF, Doan TT, Reaves-O'Neal D, Molossi S, Binsalamah ZM. Transection and reimplantation of anomalous right coronary artery from single left coronary artery in a collegiate athlete. Cardiol Young 2023; 33:1746-1749. [PMID: 36951042 DOI: 10.1017/s1047951123000574] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Coronary artery anomalies may induce myocardial ischaemia and sudden cardiac death when associated with areas of compression or stenosis. We present a case of transection and reimplantation of an anomalous interarterial right coronary artery arising from a single left main coronary artery. The 18-year-old collegiate athlete had exertional chest pain and haemodynamically significant compromise to coronary blood flow.
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Affiliation(s)
- Alyssa B Kalustian
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Lindsay F Eilers
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Tam T Doan
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dana Reaves-O'Neal
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Silvana Molossi
- Division of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Ziyad M Binsalamah
- Division of Congenital Heart Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Alfonso F, Sanz-Ruiz R, Sabate M, Roura G, Velazquez M, Macaya F, Veiga G, Camacho-Freire S, Bastante T, García-Guimaraes M. Clinical Implications of TIMI Flow Grade 0/1 in Patients With Spontaneous Coronary Artery Dissection. JACC Cardiovasc Interv 2023; 16:2061-2063. [PMID: 37480894 DOI: 10.1016/j.jcin.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 07/24/2023]
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Papakonstantinou NA, Leontiadis E, Katsaridis SD, Milonakis M, Avgerinos D, Papadopoulos K, Malakos I, Stavridis GT. Anomalous circumflex artery: a benign variant generating a malignant potential after valve surgery. Coron Artery Dis 2023; 34:364-371. [PMID: 37139563 DOI: 10.1097/mca.0000000000001247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Coronary artery anomalies are a diverse group of congenital disorders presenting with highly variable clinical manifestations. The anomalous origin of left circumflex artery from the right coronary sinus following a retro-aortic trajectory is a well-recognized anatomic variation. Despite its benign course, it can prove lethal in association with valvular surgery. When single aortic valve replacement or combined with mitral valve replacement is performed, the aberrant coronary vessel may be compressed by or between the prosthetic rings triggering postoperative lateral myocardial ischemia. If left untreated, the patient is at risk of sudden death or myocardial infarction with its detrimental complications. Skeletonization and mobilization of the aberrant coronary artery is the most widely accepted intervention, but valve downsizing or concomitant surgical or transcatheter revascularization have also been described. However, large series are lacking from the literature. Therefore, no guidelines exist. This study is a thorough review of the literature concerning the aforementioned anomaly in association with valvular surgery.
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Affiliation(s)
- Nikolaos A Papakonstantinou
- 3 Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
- Division of Cardiovascular Surgery, Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | | | | | - Michael Milonakis
- 3 Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Dimitrios Avgerinos
- 3 Cardiac Surgery Department, Onassis Cardiac Surgery Center, Athens, Greece
| | - Kyrillos Papadopoulos
- Department of Cardiac Surgery Intensive Care Unit, Onassis Cardiac Surgery Center, Athens, Greece
| | - Ioannis Malakos
- lnterventional Cardiology Department, Onassis Cardiac Surgery Center
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Formato GM, Agnifili ML, Arzuffi L, Rosato A, Ceserani V, Zuniga Olaya KG, Secchi F, Deamici M, Conti M, Auricchio F, Bedogni F, Frigiola A, Lo Rito M. Morphological Changes of Anomalous Coronary Arteries From the Aorta During the Cardiac Cycle Assessed by IVUS in Resting Conditions. Circ Cardiovasc Interv 2023; 16:e012636. [PMID: 37417226 PMCID: PMC10348625 DOI: 10.1161/circinterventions.122.012636] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Anomalous aortic origin of coronary artery (AAOCA) with intramural segment is associated with risk of sudden cardiac death, probably related to a compressive mechanism exerted by the aorta. However, the intramural compression occurrence and magnitude during the cardiac cycle remain unknown. We hypothesized that (1) in end diastole, the intramural segment is narrower, more elliptic, and has greater resistance than extramural segment; (2) the intramural segment experiences a further compression in systole; and (3) morphometry and its systolic changes vary within different lumen cross-sections of the intramural segment. METHODS Phasic changes of lumen cross-sectional coronary area, roundness (minimum/maximum lumen diameter), and hemodynamic resistance (Poiseuille law for noncircular sections) were derived from intravascular ultrasound pullbacks at rest for the ostial, distal intramural, and extramural segments. Data were obtained for 35 AAOCA (n=23 with intramural tract) after retrospective image-based gating and manual lumen segmentation. Differences between systolic and end-diastolic phases in each section, between sections of the same coronary, and between AAOCA with and without intramural tract were assessed by nonparametric statistical tests. RESULTS In end diastole, both the ostial and distal intramural sections were more elliptical (P<0.001) than the reference extramural section and the correspondent sections in AAOCA without intramural segment. In systole, AAOCA with intramural segment showed a flattening at the ostium (-6.76% [10.82%]; P=0.024) and a flattening (-5.36% [16.56%]; P=0.011), a narrowing (-4.62% [11.38%]; P=0.020), and a resistance increase (15.61% [30.07%]; P=0.012) at the distal intramural section. No-intramural sections did not show morphological changes during the entire cardiac cycle. CONCLUSIONS AAOCA with intramural segment has pathological segment-specific dynamic compression mainly in the systole under resting conditions. Studying AAOCA behavior with intravascular ultrasound during the cardiac cycle may help to evaluate and quantify the severity of the narrowing.
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Affiliation(s)
| | - Mauro Luca Agnifili
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Luca Arzuffi
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Antonio Rosato
- 3D and Computer Simulation Laboratory (G.M.F., A.R.), University of Pavia, Italy
| | - Valentina Ceserani
- IRCCS Policlinico San Donato, Milan, Italy. Department of Civil Engineering and Architecture, University of Pavia, Italy (V.C., M.C., F.A.)
| | | | - Francesco Secchi
- Department of Radiology (F.S.), University of Pavia, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy (F.S.)
| | - Miriam Deamici
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Michele Conti
- IRCCS Policlinico San Donato, Milan, Italy. Department of Civil Engineering and Architecture, University of Pavia, Italy (V.C., M.C., F.A.)
| | - Ferdinando Auricchio
- IRCCS Policlinico San Donato, Milan, Italy. Department of Civil Engineering and Architecture, University of Pavia, Italy (V.C., M.C., F.A.)
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology (M.L.A., L.A., M.D., F.B.), University of Pavia, Italy
| | - Alessandro Frigiola
- Department of Congenital Cardiac Surgery (K.G.Z.O., A.F., M.L.R.), University of Pavia, Italy
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery (K.G.Z.O., A.F., M.L.R.), University of Pavia, Italy
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Selcuk A, Korun O, Sasmazel A. Persistent left superior vena cava draining into the unroofed coronary sinus in a patient with tetralogy of Fallot and coronary sinus orifice atresia. Cardiol Young 2023; 33:1199-1200. [PMID: 36408642 DOI: 10.1017/s1047951122003638] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION In this study, we present a case of directing persistent left superior vena cava drainage into the unroofed coronary sinus to the right atrium in a patient with tetralogy of Fallot and coronary sinus orifice atresia without innominate vein. CASE REPORT A 16-month-old boy diagnosed with tetralogy of Fallot was admitted. Following intracardiac repair, the left superior vena cava was divided from the left atrial junction, passed through under the ascending aorta and anastomosed to the right superior vena cava. CONCLUSION To our knowledge, this is the first patient reported with persistent left superior vena cava, unroofed coronary sinus, coronary sinus orifice atresia, and tetralogy of Fallot. The extracardiac direct anastomosis technique was used successfully to direct persistent left superior vena cava to the right atrium without any post-procedure complications.
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Affiliation(s)
- Arif Selcuk
- Department of Pediatric Cardiac Surgery, Cengiz Gokcek Gynecology, Obstetrics and Children's Hospital, Gaziantep, Turkey
| | - Oktay Korun
- Department of Pediatric Cardiac Surgery, Cerrahpasa Medical Faculty Hospital, Istanbul, Turkey
| | - Ahmet Sasmazel
- Department of Pediatric Cardiac Surgery, Medipol Mega Univesity Hospital, Istanbul, Turkey
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Vongbunyong K, Chua F, Ghashghaei R. Pregnancy-related spontaneous coronary artery dissection: a rare cause of acute coronary syndrome in the third trimester. BMC Cardiovasc Disord 2023; 23:292. [PMID: 37291481 PMCID: PMC10251557 DOI: 10.1186/s12872-023-03323-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 05/26/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Spontaneous Coronary Artery Dissection (SCAD) is a rare cause of myocardial infarction and sudden cardiac death that is mostly seen in younger patients without significant cardiac risk factors. The mechanism by which SCAD causes an acute coronary event is related to the compromise of the coronary artery lumen as a result of hematoma within the vessel wall. In comparison to their non-pregnant counterparts, when SCAD is associated with pregnancy, it has been associated with an increased risk of life-threatening arrhythmias, cardiogenic shock, and death. The underlying mechanism behind SCAD is not yet fully understood, and despite the condition's high mortality rate, it remains underdiagnosed. CASE PRESENTATION Our case features a 38-year-old woman at 29 weeks of gestation presenting with chest pain that persisted despite initial management. Coronary angiography revealed a Type 2a spontaneous dissection of the left anterior descending artery. Given the risks of percutaneous coronary intervention in SCAD management and overall clinical stability, the patient was treated with conservative management. CONCLUSION SCADs are a rare cause of acute coronary syndrome that can be found in patients without any prior cardiac risk factors. It is important to have a high index of suspicion when diagnosing SCADs given, they can cause life-threatening arrhythmias, cardiogenic shock, and death. This case highlights considerations that must be taken into account when treating P-SCAD, as opposed to SCAD in the postpartum period.
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Affiliation(s)
- Kenny Vongbunyong
- Department of Medicine, University of California, 333 The City Blvd. West, Suite 400, Orange, Irvine, CA, 92868, USA.
| | - Frederick Chua
- Department of Medicine, University of California, 333 The City Blvd. West, Suite 400, Orange, Irvine, CA, 92868, USA
| | - Roxana Ghashghaei
- Department of Medicine, Division of Cardiology, University of California, Irvine, CA, USA
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42
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Sharma A, Jaswal V, Singhal M. Separate right sinus origin of right coronary artery, conus artery and anomalous left main with retroaortic course. Coron Artery Dis 2023; 34:220. [PMID: 36951752 DOI: 10.1097/mca.0000000000001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Affiliation(s)
| | - Vivek Jaswal
- Cardiovascular and thoracic surgery PGIMER, Chandigarh, India
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García-Arias MR, Alvarado-Alvarado JA, Duarte-Argüello JE, Argüello-Portillo CR, Patrón-Chi SA, Meléndez-Ramírez G. An unusual association: Chronic coronary syndrome and Bland-White-Garland syndrome. Arch Cardiol Mex 2023; 93:252-255. [PMID: 35298116 PMCID: PMC10161804 DOI: 10.24875/acm.21000158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 02/28/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Mario R. García-Arias
- Departament of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | | | - José E. Duarte-Argüello
- Departament of Cardiology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Carlos R. Argüello-Portillo
- Departament of Medicine, School of Medicine, The University of Alabama, Birminghan, Alabama, United States of America
| | - Sergio A. Patrón-Chi
- Departament of Cardiovascular Image, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Gabriela Meléndez-Ramírez
- Departament of Cardiovascular Image, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
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44
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Muñoz-Rodríguez R, Baute-Darias J, Hernández-Baldomero IF. [Cardiac rehabilitation after spontaneous coronary artery dissection: From doubt to fact]. Rehabilitacion (Madr) 2023; 57:100759. [PMID: 36192206 DOI: 10.1016/j.rh.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/30/2022] [Indexed: 04/12/2023]
Affiliation(s)
- R Muñoz-Rodríguez
- Servicio de Cardiología. Hospital Universitario de Canarias. La Laguna, Tenerife, España.
| | - J Baute-Darias
- Servicio de Rehabilitación y Medicina Física. Hospital Universitario de Canarias. La Laguna, Tenerife, España
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45
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Pujara J, Panda S, Singh G, Harbola G, Sachan P, Chhauda T, Vachaparampil R. Left main coronary artery aneurysm with fistula to superior vena cava: A challenging case. Ann Card Anaesth 2023; 26:215-218. [PMID: 37706391 PMCID: PMC10284485 DOI: 10.4103/aca.aca_326_20] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/20/2021] [Accepted: 06/05/2021] [Indexed: 09/15/2023] Open
Abstract
Coronary artery fistulas (CAFs) are rare congenital coronary artery abnormalities, with direct communication between a coronary artery and a cardiac chamber, great vessel or other structure. We report here, a rare case of a 25-year-old male with CAF from the aneurysmal left main coronary artery to the superior vena cava detected on echocardiography and computerized tomography (CT) coronary angiography.
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Affiliation(s)
- Jigisha Pujara
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Suvendu Panda
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Guriqbal Singh
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Garima Harbola
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Pragya Sachan
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Tanya Chhauda
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
| | - Ryan Vachaparampil
- Department of Cardiac Anesthesiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, Gujarat, India
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46
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Kobayashi M, Muneuchi J, Sugitani Y, Yamada A, Ezaki H, Watanabe M. Coronary anomalies associated with ventricular septal defect. Heart Vessels 2023; 38:255-264. [PMID: 35882655 DOI: 10.1007/s00380-022-02144-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/15/2022] [Indexed: 01/10/2023]
Abstract
Coronary anomalies encompass different conditions in terms of anomalous origin, coursing, and branching, which are occasionally associated with congenital heart disease. This study aimed to explore coronary anomalies associated with ventricular septal defect that was a stereotypical congenital heart disease. We retrospectively reviewed angiographic findings in patients with ventricular septal defect who required corrective surgery, and identified coronary abnormalities, including anomalous origin, coursing, and branching of coronary arteries based on angiography. We studied the prevalence and types of coronary anomalies among them. A total of 998 patients with ventricular septal defect was studied. Age and weight were 2.0 (2.1-15.2) months and 5.7 (4.1-8.7) kg, respectively. There were 115 patients (12%) with syndrome or genetic disorder, and 34 patients (3%) with extracardiac major organ anomalies. The overall prevalence of coronary anomalies was 6.2%. All coronary anomalies were anomalous origin and coursing, among 3 patients accompanied anomalous intrinsic coronary anatomy. Originating within aortic root above the Valsalva sinus was the most common coronary anomaly. Coronary anomalies were independently correlated with bicuspid aortic valve (odds ratio [OR]: 8.02, 95% confidence interval [CI]: 2.34-23.4) and persistent left superior caval vein (OR: 5.02, 95% CI: 1.93-11.7). We showed the possibility that minor cardiac variants, such as bicuspid aortic valve and persistent left superior caval vein, contribute to higher prevalence of coronary anomalies in patients with ventricular septal defect.
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Affiliation(s)
- Masaru Kobayashi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-2, Kishionura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8507, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-2, Kishionura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8507, Japan.
| | - Yuichiro Sugitani
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-2, Kishionura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8507, Japan
| | - Ayumu Yamada
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-2, Kishionura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8507, Japan
| | - Hiroki Ezaki
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-2, Kishionura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8507, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Kyushu Hospital, Japan Community Healthcare Organization, 1-8-2, Kishionura, Yahatanishi-ku, Kitakyushu, Fukuoka, 806-8507, Japan
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47
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Yalta K, Yalta T, Yetkın E. Co-existing cardiomyopathy in the setting of congenital coronary artery anomalies: Further insights into pathogenetic and clinical aspects. Kardiol Pol 2023; 81:816-817. [PMID: 36640019 DOI: 10.33963/kp.a2023.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 01/14/2023] [Indexed: 09/05/2023]
Affiliation(s)
- Kenan Yalta
- Department of Cardiology, Trakya University, Edirne, Turkey.
| | - Tulin Yalta
- Department of Pathology, Trakya University, Edirne, Turkey
| | - Ertan Yetkın
- Department of Cardiology, Türkiye Hastanesi, Istanbul, Turkey
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48
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Trang PTT, Cuong TC, Tha TTT, Dil MH, Cuong NM, Tin DN, Tran NT, Thang LM, Chinh ND, Hoa T, Dung BT, Hieu TB, Duc NM. A Complicated Case Report of Coronary Artery Fistula. Med Arch 2023; 77:489-492. [PMID: 38313104 PMCID: PMC10834043 DOI: 10.5455/medarh.2023.77.489-492] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/25/2023] [Indexed: 02/06/2024] Open
Abstract
Background Coronary artery fistulas (CAFs), also, known as coronary arteriovenous malformation, are aberrant connections between coronary arteries and other structures, such as other artery branches or heart chambers. CAFs are infrequent and asymptomatic in young patients, but symptoms and complications become more frequent with age. CAFs can affect hemodynamic parameters and lead to complications, such as myocardial ischemia, heart failure, arrhythmia, and infective endocarditis. Objective The aim of this article was to present a typical CAF case with severe symptoms who underwent successful embolization to resolve their symptoms. Case presentation A 50-year-old Vietnamese male visited our cardiac outpatient clinic (S.I.S General Hospital, Can Tho, Vietnam) because of exertional dyspnea and chest pain. Signs of congestive heart failure and abnormal murmur were not presented on chest auscultation. Diagnostic digital subtraction angiography was performed to determine the detailed angioarchitecture of the CAF, revealing a fistulous connection between the left anterior descending artery (LAD) and the LV chamber through an aneurysm. In addition, the RCA measured 7 mm in diameter with a fistula (16 × 9 mm) draining into an aneurysm and then terminating into the LV chamber. The patient had an RCA aneurysm with a fistula into the LV. It was treated successfully by closing the fistula with a vascular plug. Access to the fistula was complex and difficult because of complications due to the CAF. After the procedure, the patient had no chest pain or shortness of breath and was discharged after three days. After six months, he was taking dual antiplatelet therapy and antihypertensive medications and felt better. We performed contrast computed tomography (CT) to examine the fistula after a year, which showed the successful closure of the fistula without any relevant alteration in the coronary artery. Conclusion CAF closure is indicated if patients have symptoms or secondary complications, and percutaneous closure is a safe and effective method to manage CAF. A CAF is rare and does not have specific symptoms, making it difficult to diagnose. Most patients are asymptomatic and have serious recent complications. Currently, the percutaneous transcatheter method is popular because it is noninvasive and successful in most patients.
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Affiliation(s)
- Pham-Thi Thao Trang
- Department of Internal medicine, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran Chi Cuong
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran-Thi Thanh Tha
- Department of Internal medicine, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Mai Hoang Dil
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen Manh Cuong
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Do Nguyen Tin
- Department of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh city, Vietnam
| | - Nguyen Tran Tran
- Department of Internal medicine, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Le Minh Thang
- Digital Subtraction Angiography Unit, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Nguyen Duc Chinh
- Department of Cardiology, Can Tho S.I.S General Hospital, Can Tho, Vietnam
| | - Tran Hoa
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Bui The Dung
- Department of Cardiology, University Medical Center HCMC, Ho Chi Minh City, Vietnam
| | - Tran Ba Hieu
- Coronary Care Unit, Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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49
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Rahimov U, Karimli E, Mustafaeva S, Kocamaz O. An Abnormal Left Main Coronary Artery Origin, Which is Rare in A Young Athlete with A Bicuspid Aorta. Turk Kardiyol Dern Ars 2023; 51:69-71. [PMID: 36689286 DOI: 10.5543/tkda.2022.83445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
A bicuspid aortic valve (BAV) is one of the most congenital anomalies of the heart in adults. It is also associated with a higher-than-expected incidence of coronary artery anomalies. We present a rare case of congenital BAV associated with anomalous origin of the left main coronary artery (LMCA) from the posterior left coronary sinus of Valsalva in young symptomatic athlete.
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Affiliation(s)
- Uzeyir Rahimov
- Department of Cardiology, Baku Medical Plaza, Baku, Azerbaijan
| | - Emin Karimli
- Department of Cardiology, Baku Medical Plaza, Baku, Azerbaijan
| | | | - Ozgur Kocamaz
- Department of Cardiovascular Surgery, Baku Medical Plaza, Baku, Azerbaijan
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50
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Kanagala SG, Gupta V, Dunn GV, Kaur H, Zieneddine F, Jain R, Garg N. Narrative Review of Anomalous Origin of Coronary Arteries: Pathophysiology, Management, and Treatment. Curr Cardiol Rev 2023; 19:50-55. [PMID: 37259216 PMCID: PMC10636800 DOI: 10.2174/1573403x19666230530095341] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 04/19/2023] [Accepted: 05/01/2023] [Indexed: 06/02/2023] Open
Abstract
Coronary artery anomalies (CAA) are a diverse group of congenital anomalies and are the second most common cause of sudden cardiac death in the young population after Hypertrophic Cardiomyopathy (HCM). Symptoms range from chest pain, syncope, or sudden cardiac arrest to completely asymptomatic. The prevalence of congenital coronary artery anomalies in the general population is estimated to be between 1% and 2%. CAA often gets underdiagnosed due to the lack of knowledge of the disease process. Approximately 5% of patients with acute myocardial infarction do not have atherosclerotic coronary artery disease or luminal narrowing due to other causes. Congenital coronary artery anomalies account for 50-60% of this 5% of patients. Most patients are asymptomatic for most of their lives, and chest pain is the most common symptom in symptomatic patients when referred for coronary angiography, typically when the diagnosis is typically made. The malignant coronary artery is a rare presentation of a coronary anomaly when associated with atherosclerotic coronary artery disease or valvular heart disease. Patients with symptoms of an abnormal coronary artery origin will receive medical treatment/observation, exercise restriction, coronary angioplasty with stent deployment, or surgical repair.
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Affiliation(s)
| | - Vasu Gupta
- Dayanand Medical College and Hospital, Ludhiana, India
| | - Garrett V Dunn
- Pennsylvania State College of Medicine, Hershey, Pennsylvania-17033, United States
| | | | - Farid Zieneddine
- Department of Internal Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA-17033, United States
| | - Rohit Jain
- Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Nikita Garg
- Department of Pediatrics, SIU School of Medicine, Springfield, Illinois, USA
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