Background:Limited data are available regarding intermediate and long-term outcomes of transcatheter closure(TCC)of coronary cameral fistulas(CCFs)in the pediatric patients.Methods:All pediatric patients diagnosed wit...Background:Limited data are available regarding intermediate and long-term outcomes of transcatheter closure(TCC)of coronary cameral fistulas(CCFs)in the pediatric patients.Methods:All pediatric patients diagnosed with CCFs who were scheduled to undergo TCC between 2005 and 2019 were retrospectively enrolled in the study.Results:A total of 66 patients(median age:3.93 years,median weight:15 kg)underwent attempted TCC of CCFs.Immediate successful device implantation was achieved in 62 patients,and immediate complete occlusion was achieved in 44 patients(44/62%,71.0%).The closure procedure was waived in 2 patients due to anatomical factors.A total of 6 periprocedural complications occurred in 5 patients,including acute myocardial infarction(n=3),procedure-related death(n=1),device embolization(n=1),and rupture of tricuspid chordae tendineae(n=1).The acute procedural success rate was 89.4%(59/66),while the acute complication rate was 9.1%(6/66).Follow-up data were collected for 58(93.5%)out of 62 patients at a median of 9.3 years(range:3.0–15.7 years).10 adverse events occurred in 9 patients,including 5 follow-up complications(1 aortic valve perforation,1 coronary thrombosis,1 progressive aneurysmal dilation after reintervention,and 2 cases of new-onset tricuspid valve prolapse with significant regurgitation),and 5 closure failure with large residual shunts.The intermediate and long-term adverse event rate was 17.2%(10/58).The anatomical features associated with both acute and follow-up adverse events were large CCFs(p=0.005),and giant coronary artery aneurysms(CAAs)(p=0.029).Conclusions:TCC of CCFs in infants and children appears to be effective and is associated with a relatively low complication rate.Large CCFs and giant CAAs represent a higher risk of both acute and intermediate and long-term adverse events after closure.展开更多
Coronary cameral fistula (CCF) is a very rare coronary anomaly in which a communication exists between one of the coronaries and a cardiac chamber. Most of the times it is an incidental finding detected at the time of...Coronary cameral fistula (CCF) is a very rare coronary anomaly in which a communication exists between one of the coronaries and a cardiac chamber. Most of the times it is an incidental finding detected at the time of a coronary angiography. However, sometimes it can have serious presentation like unstable angina, coronary steal or ventricular arrhythmia. We present a rare case of coronary cameral fistula arising from left circumflex artery (LCx) draining in to left ventricular (LV) apex and presenting as unstable angina.展开更多
The inverted retina is a basic characteristic of the vertebrate eye.This implies that vertebrates must have a common ancestor with an inverted retina.Of the two groups of chordates,cephalochordates have an inverted re...The inverted retina is a basic characteristic of the vertebrate eye.This implies that vertebrates must have a common ancestor with an inverted retina.Of the two groups of chordates,cephalochordates have an inverted retina and urochordates a direct retina.Surprisingly,recent genetics studies favor urochordates as the closest ancestor to vertebrates.The evolution of increasingly complex organs such as the eye implies not only tissular but also structural modifications at the organ level.How these configurational modifications give rise to a functional eye at any step is still subject to debate and speculation.Here we propose an orderly sequence of phylogenetic events that closely follows the sequence of developmental eye formation in extant vertebrates.The progressive structural complexity has been clearly recorded during vertebrate development at the period of organogenesis.Matching the chain of increasing eye complexity in Mollusca that leads to the bicameral eye of the octopus and the developmental sequence in vertebrates,we delineate the parallel evolution of the two-chambered eye of vertebrates starting with an early ectodermal eye.This sequence allows for some interesting predictions regarding the eyes of not preserved intermediary species.The clue to understanding the inverted retina of vertebrates and the similarity between the sequence followed by Mollusca and chordates is the notion that the eye in both cases is an ectodermal structure,in contrast to an exclusively(de novo)neuroectodermal origin in the eye of vertebrates.This analysis places cephalochordates as the closest branch to vertebrates contrary to urochordates,claimed as a closer branch by some researchers that base their proposals in a genetic analysis.展开更多
A fifty-year-old female with recent history of LAD stent placement for instent restenosis, presented with chest pain and ventricular fibrillatory arrest. Angiography revealed total occlusion of her LAD stent. She unde...A fifty-year-old female with recent history of LAD stent placement for instent restenosis, presented with chest pain and ventricular fibrillatory arrest. Angiography revealed total occlusion of her LAD stent. She underwent IVUS study, balloon angioplasty and stent placements. Post balloon dilatation of the under-deployed distal stent resulted in dual coronary artery perforations with extravasation of contrast into the LV cavity, a Type 4 Ellis coronary artery perforation (CAP). No extravasation was noted into the pericardium. Immediately a covered stent was deployed which completely sealed both perforation sites with resultant TIMI grade 3 flow. Under-deployment of stents is a common occurrence and is underappreciated. It can happen due to various reasons. Not many options exist at that time but to use a high pressure balloon and post dilate the stent. One rare complication is CAP due to post stent dilatation, with incidence reported as 0.1% to 3.0% of PCI procedures. Among the various type of CAP, Ellis Type 4 is of the least frequent however no studies have looked at its exact incidence rate. Prompt recognition and quick intervention are essential to good patient outcome. We chose to deploy a covered stent over the perforation with interim balloon tamponading. Deployment of the stent successfully sealed both the CAPs. Remarkably the patient remained stable and did not complain of chest pain throughout the procedure. The patient did well;she was discharged on dual antiplatelet therapy and is continuing to do well. We report a rare case of 2 distal LAD perforations that drained into the LV (an Ellis Type 4 CAP) caused by post stent dilatation that were successfully treated with a single covered stent. We report successful management of this case along with review of literature about management and dilemmas encountered is such instances.展开更多
A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individ...A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individual anatomical structures. In particular, a CCF forming a “fistula lake” with multiple inflow vessels is so unique that few studies have focused on the technique to close it. We report the successful management of a CCF originating from multiple coronary arteries and draining into the left ventricle via a “fistula lake” by ligation and clipping of associated communication tracts. On the postoperative coronary computed tomography angiography, the fistula lake and the small vessels entering it had all disappeared.展开更多
基金Guangdong Provincial Clinical Research Center for Cardiovascular Disease[Grant No.2020B1111170011]Guangzhou Science and Technology Project[Grant No.2023A04J0485]National Key R&D Program of China[Grant No.2016YFC1100305].
文摘Background:Limited data are available regarding intermediate and long-term outcomes of transcatheter closure(TCC)of coronary cameral fistulas(CCFs)in the pediatric patients.Methods:All pediatric patients diagnosed with CCFs who were scheduled to undergo TCC between 2005 and 2019 were retrospectively enrolled in the study.Results:A total of 66 patients(median age:3.93 years,median weight:15 kg)underwent attempted TCC of CCFs.Immediate successful device implantation was achieved in 62 patients,and immediate complete occlusion was achieved in 44 patients(44/62%,71.0%).The closure procedure was waived in 2 patients due to anatomical factors.A total of 6 periprocedural complications occurred in 5 patients,including acute myocardial infarction(n=3),procedure-related death(n=1),device embolization(n=1),and rupture of tricuspid chordae tendineae(n=1).The acute procedural success rate was 89.4%(59/66),while the acute complication rate was 9.1%(6/66).Follow-up data were collected for 58(93.5%)out of 62 patients at a median of 9.3 years(range:3.0–15.7 years).10 adverse events occurred in 9 patients,including 5 follow-up complications(1 aortic valve perforation,1 coronary thrombosis,1 progressive aneurysmal dilation after reintervention,and 2 cases of new-onset tricuspid valve prolapse with significant regurgitation),and 5 closure failure with large residual shunts.The intermediate and long-term adverse event rate was 17.2%(10/58).The anatomical features associated with both acute and follow-up adverse events were large CCFs(p=0.005),and giant coronary artery aneurysms(CAAs)(p=0.029).Conclusions:TCC of CCFs in infants and children appears to be effective and is associated with a relatively low complication rate.Large CCFs and giant CAAs represent a higher risk of both acute and intermediate and long-term adverse events after closure.
文摘Coronary cameral fistula (CCF) is a very rare coronary anomaly in which a communication exists between one of the coronaries and a cardiac chamber. Most of the times it is an incidental finding detected at the time of a coronary angiography. However, sometimes it can have serious presentation like unstable angina, coronary steal or ventricular arrhythmia. We present a rare case of coronary cameral fistula arising from left circumflex artery (LCx) draining in to left ventricular (LV) apex and presenting as unstable angina.
文摘The inverted retina is a basic characteristic of the vertebrate eye.This implies that vertebrates must have a common ancestor with an inverted retina.Of the two groups of chordates,cephalochordates have an inverted retina and urochordates a direct retina.Surprisingly,recent genetics studies favor urochordates as the closest ancestor to vertebrates.The evolution of increasingly complex organs such as the eye implies not only tissular but also structural modifications at the organ level.How these configurational modifications give rise to a functional eye at any step is still subject to debate and speculation.Here we propose an orderly sequence of phylogenetic events that closely follows the sequence of developmental eye formation in extant vertebrates.The progressive structural complexity has been clearly recorded during vertebrate development at the period of organogenesis.Matching the chain of increasing eye complexity in Mollusca that leads to the bicameral eye of the octopus and the developmental sequence in vertebrates,we delineate the parallel evolution of the two-chambered eye of vertebrates starting with an early ectodermal eye.This sequence allows for some interesting predictions regarding the eyes of not preserved intermediary species.The clue to understanding the inverted retina of vertebrates and the similarity between the sequence followed by Mollusca and chordates is the notion that the eye in both cases is an ectodermal structure,in contrast to an exclusively(de novo)neuroectodermal origin in the eye of vertebrates.This analysis places cephalochordates as the closest branch to vertebrates contrary to urochordates,claimed as a closer branch by some researchers that base their proposals in a genetic analysis.
文摘A fifty-year-old female with recent history of LAD stent placement for instent restenosis, presented with chest pain and ventricular fibrillatory arrest. Angiography revealed total occlusion of her LAD stent. She underwent IVUS study, balloon angioplasty and stent placements. Post balloon dilatation of the under-deployed distal stent resulted in dual coronary artery perforations with extravasation of contrast into the LV cavity, a Type 4 Ellis coronary artery perforation (CAP). No extravasation was noted into the pericardium. Immediately a covered stent was deployed which completely sealed both perforation sites with resultant TIMI grade 3 flow. Under-deployment of stents is a common occurrence and is underappreciated. It can happen due to various reasons. Not many options exist at that time but to use a high pressure balloon and post dilate the stent. One rare complication is CAP due to post stent dilatation, with incidence reported as 0.1% to 3.0% of PCI procedures. Among the various type of CAP, Ellis Type 4 is of the least frequent however no studies have looked at its exact incidence rate. Prompt recognition and quick intervention are essential to good patient outcome. We chose to deploy a covered stent over the perforation with interim balloon tamponading. Deployment of the stent successfully sealed both the CAPs. Remarkably the patient remained stable and did not complain of chest pain throughout the procedure. The patient did well;she was discharged on dual antiplatelet therapy and is continuing to do well. We report a rare case of 2 distal LAD perforations that drained into the LV (an Ellis Type 4 CAP) caused by post stent dilatation that were successfully treated with a single covered stent. We report successful management of this case along with review of literature about management and dilemmas encountered is such instances.
文摘A left-sided lesion of a coronary cameral fistula (CCF) is extremely rare. Surgical closure of the fistula is indicated when symptoms emerge or as a preventive strategy, while surgical approaches depend on the individual anatomical structures. In particular, a CCF forming a “fistula lake” with multiple inflow vessels is so unique that few studies have focused on the technique to close it. We report the successful management of a CCF originating from multiple coronary arteries and draining into the left ventricle via a “fistula lake” by ligation and clipping of associated communication tracts. On the postoperative coronary computed tomography angiography, the fistula lake and the small vessels entering it had all disappeared.
