Background: Anomalies of the coronary arteries are uncommon, usually discovered incidentally during diagnostic cardiac catheterization or cardiac computed tomography (CCT). Coronary artery fistula (CAF) is one of the ...Background: Anomalies of the coronary arteries are uncommon, usually discovered incidentally during diagnostic cardiac catheterization or cardiac computed tomography (CCT). Coronary artery fistula (CAF) is one of the varieties of coronary termination anomalies. Some of CAF patients have symptoms of myocardial ischemia. Methods: In King Abdulaziz university hospital (KAUH) over six years period, five patients presented with acute coronary syndrome (ACS) and were diagnosed to have CAF by cardiac catheterization during the diagnostic workup of ischemic heart disease (IHD), four males and one female, mean age 57.4 ± 6.6 years;four patients had CAF with associated coronary atherosclerotic disease (CAD);one patient had large complex CAF with no significant CAD;all patients with CAD underwent closure/excision of the CAF with surgical revascularization;the patient with no CAD preferred surgical excision over endovascular intervention. Results: All patients had surgery with uneventful postoperative course and they were doing well with 3 to 7 years outpatient follow up. Conclusion: Surgical management is safe in patients with coronary artery anomalies presenting with ACS.展开更多
<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot incr...<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot increase to the expected value for dialysis. From a mechanical perspective, the vascular resistance at the artificially designed anastomosis causes an energy loss that affects blood flow rate growth and leads to early failure. This research studied how to maximize the RCAVF maturity and primary patency by controlling the energy loss rate. We theoretically analyzed and derived a model that evaluates the energy loss rate <em>E</em><sub><em>avf</em></sub> in RCAVF as a function of its blood vessel geometric parameters (GPs) for given flow rates. There was an aggregate of five controllable GPs in RCAVF: radial artery diameter (<em>D</em><sub><em>ra</em></sub>), cephalic vein diameter (<em>D</em><sub><em>cv</em></sub>), blood vessel distance between artery and vein (<em>h</em>), anastomotic diameter (<em>D</em><sub><em>a</em></sub>), and anastomotic angle (<em>θ</em>). Through this analysis, it was found that <em>E</em><sub><em>avf</em></sub> was inversely proportional to <em>D</em><sub><em>ra</em></sub>, <em>D</em><sub><em>cv</em></sub>, <em>D</em><sub><em>a</em></sub>, and <em>θ</em>, whereas proportional to <em>h</em>. Therefore, we recommended surgeons choose the vessels with large diameters, close distance, and increase the diameter and angle of the anastomosis to decrease the early failure of RCAVF. Simultaneously, we could explain the results of many clinical empiricisms with our formula. We found that increasing <em>D</em><sub><em>cv</em></sub> and <em>θ</em> was more significant in reducing <em>E</em><sub><em>avf</em></sub> than increasing <em>D</em><sub><em>ra</em></sub> and <em>D</em><sub><em>a</em></sub>. Based on our model, we could define two critical energy loss rates (<em>CEL</em><sub><em>a</em></sub>, <em>CEL</em><sub><em>b</em></sub>) to help surgeons evaluate the blood vessels and choose the ideal range of <em>θ</em>, and help them design the preoperative RCAVF plan for each patient to increase the maturity and the primary patency of RCAVF.</span>展开更多
患者女,60岁,间断劳累后胸闷伴心悸、出汗、恶心1周,休息20~30 min后可缓解;7年前无明显诱因晕厥1次,未接受系统诊治;高血压病史2年,规律用药。查体:血压150/105 mm Hg,心肺查体未见明显异常。实验室检查及心电图未见明显异常。超声心动...患者女,60岁,间断劳累后胸闷伴心悸、出汗、恶心1周,休息20~30 min后可缓解;7年前无明显诱因晕厥1次,未接受系统诊治;高血压病史2年,规律用药。查体:血压150/105 mm Hg,心肺查体未见明显异常。实验室检查及心电图未见明显异常。超声心动图:左心室舒张末期容积118 ml,左心室舒张功能减低。展开更多
文摘Background: Anomalies of the coronary arteries are uncommon, usually discovered incidentally during diagnostic cardiac catheterization or cardiac computed tomography (CCT). Coronary artery fistula (CAF) is one of the varieties of coronary termination anomalies. Some of CAF patients have symptoms of myocardial ischemia. Methods: In King Abdulaziz university hospital (KAUH) over six years period, five patients presented with acute coronary syndrome (ACS) and were diagnosed to have CAF by cardiac catheterization during the diagnostic workup of ischemic heart disease (IHD), four males and one female, mean age 57.4 ± 6.6 years;four patients had CAF with associated coronary atherosclerotic disease (CAD);one patient had large complex CAF with no significant CAD;all patients with CAD underwent closure/excision of the CAF with surgical revascularization;the patient with no CAD preferred surgical excision over endovascular intervention. Results: All patients had surgery with uneventful postoperative course and they were doing well with 3 to 7 years outpatient follow up. Conclusion: Surgical management is safe in patients with coronary artery anomalies presenting with ACS.
文摘<span style="font-family:Verdana;">The main reason for the early failure of radio-cephalic arteriovenous fistula (RCAVF) is non-maturity, which means that the blood flow rate in the fistula cannot increase to the expected value for dialysis. From a mechanical perspective, the vascular resistance at the artificially designed anastomosis causes an energy loss that affects blood flow rate growth and leads to early failure. This research studied how to maximize the RCAVF maturity and primary patency by controlling the energy loss rate. We theoretically analyzed and derived a model that evaluates the energy loss rate <em>E</em><sub><em>avf</em></sub> in RCAVF as a function of its blood vessel geometric parameters (GPs) for given flow rates. There was an aggregate of five controllable GPs in RCAVF: radial artery diameter (<em>D</em><sub><em>ra</em></sub>), cephalic vein diameter (<em>D</em><sub><em>cv</em></sub>), blood vessel distance between artery and vein (<em>h</em>), anastomotic diameter (<em>D</em><sub><em>a</em></sub>), and anastomotic angle (<em>θ</em>). Through this analysis, it was found that <em>E</em><sub><em>avf</em></sub> was inversely proportional to <em>D</em><sub><em>ra</em></sub>, <em>D</em><sub><em>cv</em></sub>, <em>D</em><sub><em>a</em></sub>, and <em>θ</em>, whereas proportional to <em>h</em>. Therefore, we recommended surgeons choose the vessels with large diameters, close distance, and increase the diameter and angle of the anastomosis to decrease the early failure of RCAVF. Simultaneously, we could explain the results of many clinical empiricisms with our formula. We found that increasing <em>D</em><sub><em>cv</em></sub> and <em>θ</em> was more significant in reducing <em>E</em><sub><em>avf</em></sub> than increasing <em>D</em><sub><em>ra</em></sub> and <em>D</em><sub><em>a</em></sub>. Based on our model, we could define two critical energy loss rates (<em>CEL</em><sub><em>a</em></sub>, <em>CEL</em><sub><em>b</em></sub>) to help surgeons evaluate the blood vessels and choose the ideal range of <em>θ</em>, and help them design the preoperative RCAVF plan for each patient to increase the maturity and the primary patency of RCAVF.</span>
文摘患者女,60岁,间断劳累后胸闷伴心悸、出汗、恶心1周,休息20~30 min后可缓解;7年前无明显诱因晕厥1次,未接受系统诊治;高血压病史2年,规律用药。查体:血压150/105 mm Hg,心肺查体未见明显异常。实验室检查及心电图未见明显异常。超声心动图:左心室舒张末期容积118 ml,左心室舒张功能减低。
