Fate of Right Coronary Artery Occlusion after a Surgically Repaired Aorto- Ventricular Tunnel in a Neonate

The aorto-ventricular tunnel is a rare congenital cardiac anomaly.We present a case of aorto-ventricular tunnel diagnosed via fetal echocardiography.Emergency surgery was performed on the 2nd day of life to close the tun-nel,located just in front of the right coronary ostium,due to the patient’s unstable health condition.The post-operative period revealed complete occlusion of the right coronary artery.Due to the patient’s stability,we opted not to reintervene on the right coronary artery.The patient fully recovered without the need for further coronary intervention.In cases of patients with an aorto-ventricular tunnel(AVT)and associated coronary lesions,it is crucial to exercise caution when intervening in the coronary arteries.

Intra-atrial course of right coronary artery:A case report

BACKGROUND Intra-atrial right coronary artery(RCA)is a rare and generally asymptomatic anomaly of development of the coronary arteries.This malformation could potentially expose the patient to a catastrophic outcome in the case of injury during interventional or surgical procedures.Currently,only a few case reports and no systematic reviews are available in the literature.CASE SUMMARY We report the case of a 54-year-old man with atypical chest pain who underwent multi-detector computed tomography angiography(MDCTA).The exam revealed no significant coronary artery stenoses;however,an intra-atrial course of mid RCA was evident.Medical therapy was administered,and the patient was discharged to home without undergoing a conventional angiography.Previously reported autoptic and clinical cases were retrieved from the PubMed literature database to compare the clinicopathological features of this case.CONCLUSION MDCTA depicted the abnormal course of the coronary artery in this patient as an intra-atrial course of the mid RCA.Finding this abnormality was crucial to avoid an inadvertent injury during interventional or surgical procedures.

Causes of epigastric pain and vomiting after laparoscopic-assisted radical right hemicolectomy-superior mesenteric artery syndrome

BACKGROUND Superior mesenteric artery syndrome(SMAS)is a rare condition causing functional obstruction of the third portion of the duodenum.Postoperative SMAS following laparoscopic-assisted radical right hemicolectomy is even less prevalent and can often be unrecognized by radiologists and clinicians.AIM To analyze the clinical features,risk factors,and prevention of SMAS after laparoscopic-assisted radical right hemicolectomy.METHODS We retrospectively analyzed clinical data of 256 patients undergoing laparoscopicassisted radical right hemicolectomy in the Affiliated Hospital of Southwest Medical University from January 2019 to May 2022.The occurrence of SMAS and its countermeasures were evaluated.Among the 256 patients,SMAS was confirmed in six patients(2.3%)by postoperative clinical presentation and imaging features.All six patients were examined by enhanced computed tomography(CT)before and after surgery.Patients who developed SMAS after surgery were used as the experimental group.A simple random sampling method was used to select 20 patients who underwent surgery at the same time but did not develop SMAS and received preoperative abdominal enhanced CT as the control group.The angle and distance between the superior mesenteric artery and abdominal aorta were measured before and after surgery in the experimental group and before surgery in the control group.The preoperative body mass index(BMI)of the experimental group and the control group was calculated.The type of lymphadenectomy and surgical approach in the experimental and control groups were recorded.The differences in angle and distance were compared preoperatively and postoperatively in the experimental group compared.The differences in angle,distance,BMI,type of lymphadenectomy and surgical approach between the experimental and control groups were compared,and the diagnostic efficacy of the significant parameters was assessed using receiver operating characteristic curves.RESULTS In the experimental group,the aortomesenteric angle and distance after surgery were significantly decreased than those before surgery(P<0.05).The aortomesenteric angle,distance and BMI were significantly higher in the control group than in the experimental(P<0.05).There was no significant difference in the type of lymphadenectomy and surgical approach between the two groups(P>0.05).CONCLUSION The small preoperative aortomesenteric angle and distance and low BMI may be important factors for the complication.Over-cleaning of lymph fatty tissues may also be associated with this complication.

Venopulmonary ECMO Improved Hypoxemia and Supported the Right Ventricle in a Patient with Decompensated Eisenmenger Syndrome

Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.

Partial portal vein arterialization using right gastroepiploic artery:A novel solution for portal hypoperfusion

To the Editor:Establishing dual arterial and portal inflow is essential for liver transplantation[1].Inadequate portal inflow compromises graft function and graft survival[2].Portal hypoperfusion is usually a consequence of spontaneous portosystemic shunt,ligation of which

Congenital absence of the right coronary artery:A case report

BACKGROUND As a rare anomaly,congenital absence of the right coronary artery(RCA)occurs during the development of coronary artery.Patients with congenital absence of the RCA often show no clinical symptoms,and this disease is considered benign.The left coronary artery gives blood supply to the whole myocardium.The prevalence of congenital absence of the RCA is approximately 0.024%-0.066%.There are few cases reported as for this disease.In this work,a patient,with congenital absence of the RCA diagnosed by coronary angiography(CAG),was described.CASE SUMMARY A 41-year-old man arrived at our hospital for treatment,due to the repeated palpitations for a duration of one year.Considering the possibility of coronary heart disease,the patient underwent CAG that indicated the congenital absence of the RCA.Unfortunately,the patient refused to accept computed tomography coronary angiography(CTCA),to further confirm the congenital absence of the RCA.CONCLUSION Single coronary artery is a rare type of coronary artery abnormality,which usually has no obvious clinical manifestations and is considered as a benign disease.CAG is the main means by which congenital absence of the RCA can be diagnosed,and the disease can also be further confirmed by CTCA.

Chest pain showing precordial ST-segment elevation in a 96-year-old woman with right coronary artery occlusion:A case report

BACKGROUND Typically,right coronary artery(RCA)occlusion causes ST-segment elevation in inferior leads.However,it is rarely observed that RCA occlusion causes STsegment elevation only in precordial leads.In general,an electrocardiogram is considered to be the most important method for determining the infarct-related artery,and recognizing this is helpful for timely discrimination of the culprit artery for reperfusion therapy.In this case,an elderly woman presented with chest pain showing dynamic changes in precordial ST-segment elevation with RCA occlusion.CASE SUMMARY A 96-year-old woman presented with acute chest pain showing precordial STsegment elevation with dynamic changes.Myocardial injury markers became positive.Coronary angiography indicated acute total occlusion of the proximal nondominant RCA,mild atherosclerosis of left anterior descending artery and 75%stenosis in the left circumflex coronary artery.Percutaneous coronary intervention was conducted for the RCA.Repeated manual thrombus aspiration was performed,and fresh thrombus was aspirated.A 2 mm×15 mm balloon was used to dilate the RCA with an acceptable angiographic result.The patient’s chest pain was relieved immediately.A postprocedural electrocardiogram showed alleviation of precordial ST-segment elevation.The diagnosis of acute isolated right ventricular infarction caused by proximal nondominant RCA occlusion was confirmed.Echocardiography indicated normal motion of the left ventricular anterior wall and interventricular septum(ejection fraction of 54%),and the right ventricle was slightly dilated.The patient was asymptomatic during the 9-mo follow-up period.CONCLUSION Cardiologists should be conscious that precordial ST-segment elevation may be caused by occlusion of the nondominant RCA.

Sirolimus-eluting stent fractures associated with aneurysm and very late stent thrombosis in the right coronary artery

Although the occurrence of coronary stent fracture is rare,recent reports showed that stent fracture after sirolimus-eluting stent(SES)implantation may be associated with neointimal hyperplasia and restenosis.We report two cases of stent fracture that occurred late after elective SES implantation into the right coronary artery(RCA)that were related to the aneurysm,restenosis,thrombosis,and vessel occlusion.……

Atypical double right coronary artery:a case report and literature review

Coronary artery anomalies are a kind of rare congenital coronary disease most of which are nonmalignant and asymptomatic,while some could lead to severe clinical manifestations and even sudden cardiac death.Here,we reported an atypical anomaly of a double right coronary artery with no obvious atherosclerosis on angiograms,in a 51-year-old woman who showed mild symptoms and had ischemic signs on electrocardiogram.This anomaly is neither similar to the typical appearances of a split right coronary artery nor a large right ventricle branch,is probably account for the potential risk of myocardial ischemia and highly likely to be missed during coronary angiography.

Meta-analysis of the efficacy and safety of extended right liver transplantation versus whole liver transplantation

Objective:To compare the differences in postoperative survival and complications between extended right liver transplantation(ERLT)and whole liver transplantation(WLT).Methods:The Chinese and English databases were searched for clinical studies on comparing ERLT with WLT for end-stage liver disease from the date of database construction to April 15,2022.The searched literature was de-duplicated and selected according to the order of title,abstract and content,after which NOS quality evaluation was performed for literature that matched the study.Postoperative complications and survival data were extracted from the eligible literature and subjected to Meta-analysis with Review Manager 5.3,and finally data sensitivity analysis and publication bias tests were performed.Results:The complication of ERLT such as biliary complications[OR=1.77,95%CI=(1.39,2.25),P<0.00001],biliary leakage[OR=2.16,95%CI=(1.64,2.84),P<0.0001],total vascular complications[OR=2.00,95%CI=(1.48,2.70),P<0.0001],hepatic arterial thrombosis[OR=2.06,95%CI=(1.50,2.83),P<0.00001],re-Transplantation[OR=1.93,95%CI=(1.53,2.45),P<0.00001]have a higher occurrence rate compared with WLT.While the biliary stenosis[OR=0.74,95%CI=(0.48,1.15),P=0.18],hepatic portal vein thrombosis[OR=1.72,95%CI=(0.84,3.49),P=0.14],primary non-function[OR=1.27,95%CI=(0.80,2.02),P=0.32]had no statistically difference in the incidence of complications after liver transplantation.In terms of survival,ERLT had lower 1-year graft survival rate[OR=0.64,95%CI=(0.54,0.76),P<0.00001]and patient survival rate[OR=0.75,95%CI=(0.62,0.91),P=0.003]than WLT.Fortunately,there was no statistically difference in 5-year graft survival rate[OR=0.97,95%CI=(0.76,1.23),P=0.78]and 5-year patient survival rate[OR=0.94,95%CI=(0.78,1.14),P=0.54].Conclusion:ERLT is a safe and effective treatment for adult end-stage liver disease.As a surgical method with postoperative complications and survival similar to that of WLT,ERLT can increase the source of donor liver.

Systemic right ventricle complications in levo-transposition of the great arteries: A case report and review of literature

BACKGROUND Congenitally corrected levo-transposition of the great arteries(L-TGA)is a congenital heart disease in which the ventricles and great arteries are transposed from their typical anatomy.In L-TGA,the double discordance,atrioventricular and ventriculoarterial,create an acyanotic milieu which allows patients to survive their early decades,however,progressive systemic right ventricle(sRV)dys-function creates complications later in life.sRV dysfunction and remodeling predisposes patients to intracardiac thrombus(ICT)formation.CASE SUMMARY A 40-year-old male with L-TGA presented with symptoms of acute decom-pensated heart failure.In childhood,he had surgical repair of a ventricular septal defect.In adulthood,he developed sRV dysfunction,systemic tricuspid valve(sTV)regurgitation,and left-bundle branch block for which he underwent cardiac resynchronization therapy.Transthoracic echocardiogram showed a sRV ejection fraction of 40%,severe sTV regurgitation,and a newly identified sRV ICT.ICT was confirmed by ultrasound-enhancing agents and transesophageal echocardio-graphy.Our patient was optimized with guideline-directed medical therapy and diuresis.Anticoagulation was achieved with a vitamin K antagonist(VKA)and he was later referred for evaluation by advanced heart failure and heart transplant services.CONCLUSION Anticoagulation with VKA is the mainstay of treatment in the absence of conclusive data supporting direct oral anticoagulant use in ICT in patients with congenital heart disease.This case illustrates the natural history of L-TGA and highlights the importance of surveillance and monitoring with dedicated cardiac imaging to identify complications.

Pulmonary arterial hypertension confirmed by right heart catheterization following COVID-19 pneumonia: A case report and review of literature

BACKGROUND Pulmonary arterial hypertension(PAH)is a disease of the arterioles resulting in an increased resistance in pulmonary circulation with associated high pressures in the pulmonary arteries,causing irreversible remodeling of the pulmonary arterial walls.Coronavirus disease 2019(COVID-19)has been associated with development of new onset PAH in the literature leading to symptoms of dyspnea,cough and fatigue that persist in spite of resolution of acute COVID-19 infection.However,the majority of these cases of COVID related PAH were diagnosed using echocardiographic data or via right heart catheterization in mechanically ventilated patients.CASE SUMMARY Our case is the first reported case of COVID related PAH diagnosed by right heart catheterization in a non-mechanically ventilated patient.Right heart catheterization has been the gold standard for diagnosis of pulmonary hypertension.Our patient had right heart catheterization four months after her initial COVID-19 infection due to persistent dyspnea.CONCLUSION This revealed new onset PAH that developed following her infection with COVID-19,an emerging sequela of the infection.

Implications of the presence of an aberrant right hepatic artery in patients undergoing pancreaticoduodenectomy

AIM:To analyze the differences in outcomes and the clinical impact following pancreatoduodenectomy(PD)in patients with and without aberrant right hepatic artery(aRHA).METHODS:All patients undergoing PD between January 2008 and December 2012 were divided into two groups,one with aRHA and the other without.These groups were compared to identify differences in the intraoperative variables,the oncological clearance and the postoperative morbidity,mortality and hospital stay.RESULTS:A total of 225 patients underwent PD,of which 43(19.1%)patients were found to have eitheraccessory or replaced right hepatic arteries(aRHA group).The aRHA was preserved in 79%of the patients.There was no significant difference in the intraoperative blood loss but operative time was prolonged,reflecting the complexity of the procedure[420±44(240-540)min vs 480±45(300-600)min,P<0.05)].There were no differences in the incidence of postoperative complications(pancreatic leak,pancreatic fistula,delayed gastric emptying and mortality)and hospital stay.Oncological clearance in the form of positive resection margins[13(7.1%)vs 3(6.9%)]and lymph node yield were also similar in the two groups.CONCLUSION:An aRHA is found in approximately one fifth of patients undergoing PD.Preservation is technically possible in most patients and can increase the operative complexity but does not negatively affect the safety or oncological outcomes of the procedure.

Aorta-pulmonary septal defect and aortic origin of the right pulmonary artery with interruption of the aortic arch:a clinical analysis of 5 cases

Objective Reviewing the experience in diagnosis and treatment of cases with aorta-pulmonary septal defect and aortic origin of right pulmonary artery complicated with interruption of aortic arch. Methods Clinical data from medical records for 5 patients (4 boys and 1 girl,age from 1 to 18 years on admission) who had been treated in Wuhan Asia Heart Hospital between 2005 and 2009

First jejunal artery, an alternative graft for right hepatic artery reconstruction

Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision andsafe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely. However the right hepatic artery reconstruction has also been carried out with several other vessels like gastroduodenal artery, right gastroepiploic artery or the splenic artery. We report a case of 63-year-old man presenting with history of progressive jaundice, pruritus and impaired appetite. Following various imaging modalities including computed tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, intraductal ultrasound extrahepatic bile duct cancer was diagnosed; however, none of those detected vessel invasion. Intraoperatively, right hepatic artery invasion was revealed. Right hepatic artery was resected and reconstructed with a graft harvested from the first jejunal artery(JA). Postoperative outcome was satisfactory with a long-term graft patency. First JA can be a reliable graft option for right hepatic artery reconstruction.

Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome: A case report

BACKGROUND We report a rare case of numbness in the right hand,finally diagnosed as bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome and explain the cause of these diseases.CASE SUMMARY The patient was a 65-year-old woman.She complained of dizziness,numbness and weakness of the right hand for 6 mo.She was diagnosed with bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome by ultrasound,enhanced computed tomography,computed tomography angiography and other examinations.Considering the surgical risks,the patient refused the aberrant right subclavian artery stent implantation and was discharged.We hypothesize that these two kinds of deformity and right subclavian steal syndrome may not occur by accident and result from multiple malformations.CONCLUSION Bilateral common carotid artery common trunk with aberrant right subclavian artery combined with right subclavian steal syndrome is rare.This case reminds interventional radiologists of the possibility of these abnormalities before surgery.

Retrograde embolization technique of the right gastric artery during the implantation of port-catheter system for hepatic arterial infusion chemotherapy

Objective:This study aimed to introduce and evaluate a new embolization technique for the right gastric artery(RGA) during percutaneous implantation of a port-catheter system for hepatic arterial infusion chemotherapy(HAIC).Methods:From January 2013 to January 2017,159 patients with unresectable advanced liver cancer underwent percutaneous implantation of a port-catheter system.In 86 of these patients(56 men;aged 28-88 years;mean:60.6±12.0 years),in whom the RGA was obvious on arteriography,embolization of RGA was attempted using microcoils to protect the gastric mucosa during HAIC.In the first phase(first three years),antegrade embolization of the RGA using a 2.7 Fr microcatheter was performed in 55 patients.In the second phase(next two years),embolization of the RGA was attempted by combining antegrade embolization and retrograde embolization through the left gastric artery(LGA) in 31 patients.The success rates and the incidence of acute gastroduodenal mucosal toxicity(AGMT) in these two groups were compared.Results:The total success rate of the RGA embolization was 70.9%.The success rate was 83.9% in 31 patients who underwent combined antegrade and retrograde embolization,which was significantly higher than that of antegrade embolization alone(63.6%) performed in 55 patients(p=0.047).No complications related to embolization of RGA were documented.The incidence of AGMT was 29.1%(16/55) in patients in the first phase,which was significantly higher than that in the patients in the second phase(9.7%,3/31)(p=0.037).Conclusion: A combination of retrograde embolization via LGA could increase the success rates of RGA embolization and reduce the incidence of AGMT after HAIC.

Total endovascular repair of aberrant right subclavian artery using caster branched stent-graft

A 57-year-old man has 20-year history of hypertension presented with intermittent chronic pain in the chest area and shoulder blades over the last three months.Computed tomographic angiography(CTA)on admission revealed a chronic type B aortic dissection(TBAD)with an aberrant right subclavian artery(ARSA)crossed behind the trachea and bovine aortic arch(Figure IB).

Does Right Coronary Artery Stenosis Increase Morbi-Mortality in Patients Undergoing Coronary Artery Bypass Graft for Left Main Coronary Artery Disease?

Background: The association of right coronary artery (RCA) stenosis in patients undergoing myocardial revascularization for left main coronary artery (LMCA) stenosis affects the prognosis. This study aimed to compare immediate results of patients with isolated LMCA stenosis and those with combined RCA stenosis. Patients and methods: We retrospectively evaluated 107 consecutive patients with LMCA disease who underwent coronary artery bypass grafts. The patients were divided into two groups: isolated LMCA stenosis (n = 36) and LMCA stenosis + RCA stenosis (n = 71). Different variables (preoperative, intra operative and post operative) were compared. Results: Patients with LMCA stenosis + RCA stenosis experienced higher prevalence of diabetes mellitus (p = 0.024) and smoker (p = 0.032). Also left ventricular EF was reduced (p = 0.004). Myocardial revascularization was more complete in patients with LMCA stenosis + RCA stenosis (p = 0.033), but in-hospital mortality rate was higher (12.6% vs 5.5%) in isolated LLMCA stenosis, but it did not reach statistical significance (p = 0.32). Except low output syndrome (LOS) that was frequent in presence of RCA stenosis (p = 0.026), no significant difference was found between groups for other complications. Conclusion: The presence of RCA stenosis in patients undergoing CABG for LMCA disease increases 30 day mortality but without significant impact on overall morbidities.

Correlation between ductus venosus spectrum and right ventricular diastolic function in isolated single-umbilical-artery foetus and normal foetus in third trimester

BACKGROUND Single umbilical artery(SUA)is the most common umbilical cord malformation in prenatal diagnosis.The presence of an SUA can cause blood circulation disorder in the foetus and functional changes of the foetal heart,affecting foetal circulation.The right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester were evaluated using the spectral Doppler of blood flow in the foetal ductus venosus(DV).AIM To evaluate the right ventricular diastolic functions in foetuses with isolated SUA and in normal foetuses in the third trimester.METHODS Colour Doppler was used to measure the spectrum of foetal DV and tricuspid orifice in 34 foetuses with isolated SUA aged 28-39 wk and in age-matched healthy controls.The DV flow velocities and velocity ratios were measured.The early passive/late active(E/A)ratio at the tricuspid orifice and tissue Doppler Tei index of the foetal right ventricular in the two groups were also measured.RESULTS During the third trimester,the isolated SUA group showed a lower‘a’-wave peak velocity in the DV than the control group(P<0.05).The correlations between the velocity ratios and E/A ratio at the tricuspid orifice in the two groups were analysed,and the correlation between the ventricular late diastolic velocity/ventricular diastolic peak flow velocity and E/A ratios was the best(R^2of the isolated SUA group:0.520;R2 of the control group:0.358).The correlations between the velocity ratios and tissue Doppler Tei index of foetal right ventricular in the two groups were analysed,and the correlation between the pulsatility index for veins(PIV)and tissue Doppler Tei index ratios was the best(R2 of the isolated SUA group:0.865;R2 of the control group:0.627).CONCLUSION In the isolated SUA group,the atrial systolic peak velocity‘a’decreased,and this finding might be related to the changes in foetal cardiac functions.The ratio of ventricular late diastolic velocity to ventricular diastolic peak flow velocity was closely related to the E/A ratio at the tricuspid valve and can be used to identify changes in the right ventricular diastolic functions of isolated SUA and healthy foetuses.PIV was closely related to the tissue Doppler Tei index of the foetal right ventricular and can be used to identify the right ventricular overall functions of isolated SUA and healthy foetuses.