A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography ex...A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment.展开更多
A 63-year-old male with old myocardial infarction was referred to cardiology department with cardiac arrest.Electrocardiogram revealed Q wave in the precordial leads demonstrating ischemia of anterior left ventricular...A 63-year-old male with old myocardial infarction was referred to cardiology department with cardiac arrest.Electrocardiogram revealed Q wave in the precordial leads demonstrating ischemia of anterior left ventricular wall.Mild pulmonary edema was documented on chest X-ray.Transthoracic echocardiography showed severely reduced left ventricular function (EF: 28%) with enlarged left atrium and ventricle.Coronary angiography was performed showing a total occlusion of the proximal portion of the left anterior descending artery (LAD)(Figure 1) with chronic total occlusion in the proximal portion of right coronary artery.Xience stent 2.75 × 23 mm (Abbott) was implanted in the proximal LAD lesion.Coronary angiography after percutaneous coronary intervention (PCI) revealed no definite coronary fistula (Figure 2).Two weeks later,follow-up coronary angiography demonstrated multiple coronary-left ventricular fistulas (Figure 3) which were absent in the previous angiography.展开更多
Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1...Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1.3% based published series.1＇2 The most common coronary anomaly is separate origin of the left anterior descending coronary artery （LAD） and left circumflex coronary artery （LCX） from the left sinus of the Valsalva. The second most common anomaly is the origin of the LCX artery from the right coronary artery （RCA） or right sinus of the Valsalva. We present two cases of coronary artery anomalies： one is the left main coronary artery （LMCA） arising from the proximal RCA, the other is the LAD originating from the proximal RCA.展开更多
In this case report, we present the occlusion of multiple coronary artery fistulaes originating from proximal left anterior descending （LAD） and fight sinus valsavla and empting to the pulmonary artery at the same p...In this case report, we present the occlusion of multiple coronary artery fistulaes originating from proximal left anterior descending （LAD） and fight sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspira- tion catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulaes with the help of throm- bus aspiration catheter. Our experience may suggest that thrombus aspiration catheters can be used in treating coronary artery fistulaes with difficult anotomv.展开更多
To the Editor： I read with great interest the case report of multiple myocardial bridges affecting both coronary arteries in a patient with hypertrophic cardiomyopathy. However, I differ with the authors in their int...To the Editor： I read with great interest the case report of multiple myocardial bridges affecting both coronary arteries in a patient with hypertrophic cardiomyopathy. However, I differ with the authors in their interpretation of the coronary arteriograms.展开更多
BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnor...BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnormal ECG pattern is classified into type A(biphasic T waves)and type B(deeply inverted T waves),based on the T wave pattern seen in the pericodial chest leads.CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus(T1DM),gastroparesis,mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea,vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin.Noted to have fasting blood sugar 392 mg/dL.Admitted for diabetic gastroparesis.During the hospital course,the patient was asymptomatic and denied any chest pain.On admission,No ECG and troponin draws were performed.On day 2,the patient became hypoxic with oxygen saturation 80%on room air,intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis.Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin.Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome,wherein the right coronary artery and circumflex artery display a remarkable 100%constriction,alongside a proximal LAD stenosis of 90%-95%.Notably,this occurrence transpired in a patient grappling with extensive complications arising from T1DM.Moreover,it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.展开更多
文摘A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment.
文摘A 63-year-old male with old myocardial infarction was referred to cardiology department with cardiac arrest.Electrocardiogram revealed Q wave in the precordial leads demonstrating ischemia of anterior left ventricular wall.Mild pulmonary edema was documented on chest X-ray.Transthoracic echocardiography showed severely reduced left ventricular function (EF: 28%) with enlarged left atrium and ventricle.Coronary angiography was performed showing a total occlusion of the proximal portion of the left anterior descending artery (LAD)(Figure 1) with chronic total occlusion in the proximal portion of right coronary artery.Xience stent 2.75 × 23 mm (Abbott) was implanted in the proximal LAD lesion.Coronary angiography after percutaneous coronary intervention (PCI) revealed no definite coronary fistula (Figure 2).Two weeks later,follow-up coronary angiography demonstrated multiple coronary-left ventricular fistulas (Figure 3) which were absent in the previous angiography.
文摘Coronary artery anomalies （CAAs） are present at birth, but are usually asymptomatic and are found during coronary angiography or multi-slice computed tomography （MSCT） examinations. Their prevalence is less than 1.3% based published series.1＇2 The most common coronary anomaly is separate origin of the left anterior descending coronary artery （LAD） and left circumflex coronary artery （LCX） from the left sinus of the Valsalva. The second most common anomaly is the origin of the LCX artery from the right coronary artery （RCA） or right sinus of the Valsalva. We present two cases of coronary artery anomalies： one is the left main coronary artery （LMCA） arising from the proximal RCA, the other is the LAD originating from the proximal RCA.
文摘In this case report, we present the occlusion of multiple coronary artery fistulaes originating from proximal left anterior descending （LAD） and fight sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspira- tion catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulaes with the help of throm- bus aspiration catheter. Our experience may suggest that thrombus aspiration catheters can be used in treating coronary artery fistulaes with difficult anotomv.
文摘To the Editor： I read with great interest the case report of multiple myocardial bridges affecting both coronary arteries in a patient with hypertrophic cardiomyopathy. However, I differ with the authors in their interpretation of the coronary arteriograms.
文摘BACKGROUND Wellen’s syndrome is a form of acute coronary syndrome associated with proximal left anterior descending artery(LAD)stenosis and characteristic electro-cardiograph(ECG)patterns in pain free state.The abnormal ECG pattern is classified into type A(biphasic T waves)and type B(deeply inverted T waves),based on the T wave pattern seen in the pericodial chest leads.CASE SUMMARY We present the case of a 37-year-old male with history of type 1 diabetes mellitus(T1DM),gastroparesis,mild peripheral artery disease and right toe cellulitis on IV antibiotics who presented to the emergency department with nausea,vomiting and abdominal pain for 3 d and as a result couldn’t take his insulin.Noted to have fasting blood sugar 392 mg/dL.Admitted for diabetic gastroparesis.During the hospital course,the patient was asymptomatic and denied any chest pain.On admission,No ECG and troponin draws were performed.On day 2,the patient became hypoxic with oxygen saturation 80%on room air,intermittent mild right-sided chest pain which he attributed to vomiting from his gastroparesis.Initial ECG done was significant for Biphasic T wave changes in leads V2 and V3 and elevated high sensitivity troponin.Patient was transitioned to cardiac intensive care unit and cardiac catheterization performed with result significant for extensive coronary artery disease.CONCLUSION This case highlights an exceptional manifestation of Wellen's syndrome,wherein the right coronary artery and circumflex artery display a remarkable 100%constriction,alongside a proximal LAD stenosis of 90%-95%.Notably,this occurrence transpired in a patient grappling with extensive complications arising from T1DM.Moreover,it underscores the utmost significance of promptly recognizing the presence of Wellen's syndrome and swiftly initiating appropriate medical intervention.
