Left main coronary compression syndrome(LMCS)may complicate pulmonary artery aneurysms(PAA),usually developed in the context of pulmonary arterial hypertension(PAH).We report the case of a 51-year-old female patient w...Left main coronary compression syndrome(LMCS)may complicate pulmonary artery aneurysms(PAA),usually developed in the context of pulmonary arterial hypertension(PAH).We report the case of a 51-year-old female patient with an atrial septal defect(unsuitable for device closure)complicated by a PAA generating a 90%left main stenosis.The significant PAH held us back from immediate surgery.After specific dual PAH-targeted therapy(sildenafil and bosentan),the atrial septal defect could be closed with a unidirectional valved patch;the PAAinduced LMCS was treated by reductive arterioplasty.The postoperative course was uneventful.Follow-up showed clinical improvement,but PAH treatment was still needed.After three months,coronary angiography showed only an insignificant residual left main stenosis,proving that reductive pulmonary arterioplasty was effective in treating LMCS.Any PAA requires further evaluation for LMCS,a dangerous but treatable complication.The“treat-repair-treat”strategy and shunt-closure with a unidirectional valved patch can both improve surgical prospects of LMCS with shunt-related PAH.展开更多
Objective:To obtain early results of off-pump coronarE~ artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar ...Objective:To obtain early results of off-pump coronarE~ artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB). Methods:Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76 ± 0.98, CCAB group:3.81 ± 1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P 〉 0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis, re-operation for bleeding (or tamponade) were similar in the two groups (P 〉 0.05). Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group(P 〈 0.05).Conclusion: Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.展开更多
We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(E...We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(ECG)suggested acute coronary syndrome(ACS)affecting the left main coronary artery.Therefore,he was referred to our hospital for urgent coronary angiography.展开更多
Left main (LM) stenting is considered by many to be one of the last frontiers of interventional cardiology. Beginning with the VA cooperative study published in 1976 demonstrating a mortality benefit for patients ... Left main (LM) stenting is considered by many to be one of the last frontiers of interventional cardiology. Beginning with the VA cooperative study published in 1976 demonstrating a mortality benefit for patients undergoing coronary artery bypass grafting (CABG), i the standard of care for treatment of left main coronary artery disease has been surgical.The most recent 2005 update of the ACC/AHA/SCAI Practice Guidelines on PCI 2 again notes that "CABG using IMA grafting is the 'gold standard' for treatment of unprotected left main disease and has proven benefit on long-term outcomes."……展开更多
Objective To evaluate a very long-term clinical outcomes of patients treated with coronary artery bypass grafting(CABG) and percutaneous coronary intervention(PCI) with drug-eluting stents(DES) for ostial/shaft lesion...Objective To evaluate a very long-term clinical outcomes of patients treated with coronary artery bypass grafting(CABG) and percutaneous coronary intervention(PCI) with drug-eluting stents(DES) for ostial/shaft lesions in unprotected left main coronary artery(ULMCA). Methods & Results A total of 472 patients with isolated ostial/shaft lesions in ULMCA were enrolled, who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital. The major endpoints of this study were death, repeat revascularization, non-procedural myocardial infarction(MI) and stroke. The median follow-up was twelve years(interquartile range: 9.4–14.0 years) in the overall patients. There were no significant differences of incidence of death(23.3% vs. 25.6%, P = 0.227), repeat revascularization(27.3% vs. 28.4%, P = 0.423), non-procedural MI(20.0% vs. 14.5%, P = 0.561), and stroke(6.1% vs. 9.3%, P = 0.255) between PCI and CABG groups before multivariate adjusting. After adjusting covariates with multivariate Cox hazard regression model, there were still no significant differences between PCI and CABG groups. Conclusions During the median follow-up of twelve years, we found that PCI with DES was as effective and safe as CABG in patients with left main ostial/shaft lesion in this observational study.展开更多
Atherosclerotic diseases is a diffuse process that involves the coronaries, carotids, renals and all other peripheral arteries owing to the systemic nature of atherosclerotic pathophysiology. This systemic precipitant...Atherosclerotic diseases is a diffuse process that involves the coronaries, carotids, renals and all other peripheral arteries owing to the systemic nature of atherosclerotic pathophysiology. This systemic precipitants that promote aggressive atherogenesis have been confirmed in multiple studies showing a relationship between atherosclerotic disease in one vascular bed with disease in another. However, the strength of this relationship varies from patient to patient. Thus, the practical utility of the diffuse nature of atheresclerosis is questionable. Ge and colleagues have proposed the use of left main (LM)coronary artery disease as a potential marker for left anterior descending (lAD) atherosclerotic disease. At first thought, this seems useless since the evaluation of the LM (by angiography or IVUS) can just as easily be performed in the LAD so why bother searching for such a surrogate? However, newer (non-invasive) imaging modalifies are making great gains and will be able to reliably image the LM sooner than the LAD (especially the distal LAD) so such a surrogate could have practical applications.展开更多
Objective:To evaluate the clinical efficacy of a drug-eluting stent(DES)combined with a drug-coated balloon(DCB)in the treatment of left main coronary artery bifurcation lesions.Methods:A retrospective analysis was co...Objective:To evaluate the clinical efficacy of a drug-eluting stent(DES)combined with a drug-coated balloon(DCB)in the treatment of left main coronary artery bifurcation lesions.Methods:A retrospective analysis was conducted on the clinical data of eight patients with left main coronary artery bifurcation lesions treated with a DES combined with a DCB who were admitted to our hospital from July 2016 to July 2017.These eight patients all underwent DES treatment for their left main coronary artery and left anterior descending coronary artery lesions,and DCB treatment at the ostium of the left circumflex artery;six of the patients underwent surgical procedures under the guidance of intravascular ultrasonography.Immediate postoperative angiography was used to evaluate the patency of the diseased vessels,and the restenosis rate at the 6-month follow-up after the operation and the incidence of serious clinical events within 6 months were assessed as well.Results:The use of a DES combined with a DCB in the treatment of left main coronary artery bifurcation lesions had a low restenosis rate(left main coronary artery(8.4±5.3)%,left anterior descending coronary artery(18.2±5.0)%,left circumflex artery(30.5±16.5)%).No serious clinical events occurred in any patients.Conclusion:A DES combined with a DCB is a safe and effective interventional treatment for left main artery coro-nary bifurcation lesions.展开更多
BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatmen...BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult.Ostial compromise of the side branch decreases patient prognosis,and its management is still an issue despite the different strategies and devices available.CASE SUMMARY A 42-year-old male patient was admitted to hospital due to chest pain and syncope.Coronary angiography showed acute LM occlusion.Following thrombus aspiration,a LM bifurcation lesion remained.Coronary angiography was repeated one week later,and at the same time,3D optical coherence tomography(OCT)was carried out to better show the geometry of the bifurcation,which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina.After assessment of the plaque characteristics and the minimum lumen area,the cross-over strategy,kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion.A“moving”carina was found twice during the intervention.Good stent apposition and expansion were confirmed by OCT after proximal optimization technique.The three-month follow-up showed good recovery and normal cardiac function.CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.展开更多
BACKGROUND Left main coronary artery(LMCA)supplies more than 80%of the left ventricle,and significant disease of this artery carries a high mortality unless intervened surgically.However,the influence of coronary arte...BACKGROUND Left main coronary artery(LMCA)supplies more than 80%of the left ventricle,and significant disease of this artery carries a high mortality unless intervened surgically.However,the influence of coronary artery bypass grafting(CABG)surgery on patients with LMCA disease on morbidity intensive care unit(ICU)outcomes needs to be explored.However,the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.AIM To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.METHODS Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG.Patients were divided into 2 groups;those with LMCA disease as group 1(75 patients)and those without LMCA disease as group 2(324 patients).We correlated ICU outcome parameters including ICU length of stay,post-operative atrial fibrillation,acute kidney injury,re-exploration,perioperative myocardial infarction,post-operative bleeding in both groups.RESULTS Patients with LMCA disease had a significantly higher prevalence of diabetes(43.3%vs 29%,P=0.001).However,we did not find a statistically significant difference with regards to ICU stay,or other morbidity and mortality outcome measures.CONCLUSION Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement.Diabetes was more prevalent in patients with LMCA disease.These findings may help in guiding decision making for future practice and stratifying the patients’care.展开更多
The prognosis of left main coronary artery disease is largely affected by the appropriate selection of the treatment strategy. A 45-year-old male presented with severe chest pain and two episodes of ventricular tachyc...The prognosis of left main coronary artery disease is largely affected by the appropriate selection of the treatment strategy. A 45-year-old male presented with severe chest pain and two episodes of ventricular tachycardia, which was reverted after DC shock. Coronary angiography revealed critical stenotic lesion in the left main coronary artery. The patient successfully underwent urgent angioplasty with stent deployment in the left main coronary artery.展开更多
This aortic valve replacement (AVR) remains the gold standard for symptomatic aortic stenosis. Peri-operative complications like dissection, stenosis involving coronary artery are well described in many series. We pre...This aortic valve replacement (AVR) remains the gold standard for symptomatic aortic stenosis. Peri-operative complications like dissection, stenosis involving coronary artery are well described in many series. We present a rare iatrogenic complication of disrupted left main coronary artery during the delivery of cardioplegia while performing AVR in a 54 year male patient for severe calcific aortic stenosis. The inadvertent injury to the artery was timely noticed and managed successfully with long saphenous vein graft.展开更多
Hemodynamically significant left main coronary artery stenosis(LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left cir-cumflex a...Hemodynamically significant left main coronary artery stenosis(LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left cir-cumflex artery has no previous patent grafts.Previous randomized studies have demonstrated a significant re-duction in mortality when revascularization by coronary artery bypass graft(CABG) surgery was undertaken compared with medical treatment.Therefore,current practice guidelines do not recommend percutaneous coronary intervention(PCI) for such a lesion because of the proven benefit of surgery and high rates of reste-nosis with the use of bare metal stents.However,with the advent of drug-eluting stents(DES),the long term outcomes of PCI with DES to treat unprotected LMCA stenoses have been acceptable.Therefore,apart from the current guidelines,PCI for treatment of unprotected LMCA stenosis is often undertaken in individuals who are at a very high risk of CABG or refuse to undergo a sternotomy.Future randomized studies comparing CABG vs PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in clinical knowledge for the adoption of appropriate treatment.展开更多
Acute total or subtotal occlusion of left main coronary artery (LMCA) is a catastrophic and mostly fatal event. Patients may present with cardiogenic shock and die whenever this event occurs. Survival is strongly depe...Acute total or subtotal occlusion of left main coronary artery (LMCA) is a catastrophic and mostly fatal event. Patients may present with cardiogenic shock and die whenever this event occurs. Survival is strongly dependent on the presence of collateral blood flow to the left coronary artery or a dominant right coronary artery, and emergency intervention for preserving the left ventricular function. Here, we present a case of a 14-year-old boy with subtotal occlusion of the LMCA accompanying acute myocardial infarction probably caused by congenital syphilis according to his positive serum syphilis antibody. His survival was closely associated with a dominant right coronary artery and timely thrombolytic therapy. Finally, he was treated with angioplasty and paclitaxel-eluting stent implantation. He was followed up after stenting and was doing quite well at the time when we wrote this paper.展开更多
BACKGROUND Single coronary artery(SCA)originating from a solitary ostium in the aorta and perfusing the entire myocardium is a very rare congenital anomaly of the coronary artery.Furthermore,a right coronary artery(RC...BACKGROUND Single coronary artery(SCA)originating from a solitary ostium in the aorta and perfusing the entire myocardium is a very rare congenital anomaly of the coronary artery.Furthermore,a right coronary artery(RCA)arising from the mid segment of the left anterior descending artery(LAD)is an extremely uncommon variation of SCA.CASE SUMMARY A 76-year-old woman presented a 5-mo history of exertional angina.Selective coronary angiography revealed an SCA,with severe ostial stenosis that originated from the left sinus of Valsalva and bifurcated normally into the LAD and circumflex coronary artery.In addition,an anomalous RCA originated from the mid segment of the LAD as a separate branch.Successful balloon angioplasty and stenting for the SCA ostial stenosis were performed on the patient.CONCLUSION Percutaneous coronary intervention(PCI)of the main trunk for SCA is very similar to PCI of an unprotected left main coronary artery.Although technical difficulties and risks do exist,PCI for severe ostial stenosis of the main trunk is safe and efficacious in selected SCA patients.展开更多
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 ...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.展开更多
Background: Pulmonary artery aneurysm (PAA) is an unusual finding and its association with left main coronary (LMCA) compression is even more infrequent. Cardiac CT evaluates of presence and size of PAA and the degree...Background: Pulmonary artery aneurysm (PAA) is an unusual finding and its association with left main coronary (LMCA) compression is even more infrequent. Cardiac CT evaluates of presence and size of PAA and the degree of LMCA compression. The aim of this study is to describe two cases of adults with compression of LMCA with PAA associated with PDA and pulmonary hypertension. Case presentation: The first case is a 27-year-old man with PAA (78 mm diameter) and LMCA compression of 70% between the aortic sinus and the PAA. He presented angina as a manifestation of the LMCA compression. During follow-up the patient died. The second case is a 28-year-old man with PAA (110 mm diameter) that compresses LMCA in 55%, he rejected surgical treatment, but he is in close follow-up with medical treatment. Conclusion: Cardiac computed tomography played an important role both in the diagnosis and identification of high-risk PAA patients.展开更多
Background The 5-year cardiac mortality rate has been reported to be more than 50% in patients with left main coronary artery (LMCA) stenosis. The purpose of this study was to visualize the LMCA using intravascular ul...Background The 5-year cardiac mortality rate has been reported to be more than 50% in patients with left main coronary artery (LMCA) stenosis. The purpose of this study was to visualize the LMCA using intravascular ultrasound in patients who undergo interventions of the left anterior descending coronary artery (LAD). This was done in order to see the incidence and severity of plaque formation in the LMCA in patients with severe lAD stenosis, and to address if scanning LMCA is able to rule out lAD significant stenosis or vice versa. Methods A total of 293 patients with intervention of the LAD stenosis were examined with intravascular ultrasound(IVUS). The images of 278 patients were suitable for analysis. Results Fifty-three (19%) were found to have angiographic lumen reduction in the LMCA ranging from 11% to 35% (19 ± 8%). Sixty-one patients were found to have native calcification in the LMCA. Atherosclerotic plaques in LMCA were detected in 211/278 (76%) patients, of which 164/211 (78%) were eccentric, and 51/211 (24%) had calcium deposit. The cross-sectional plaque area ranged from 1.5 mm2 to 21 mm2 (8.4 ± 4.7 mm2 ). Area of stenosis was 34 ± 14 % (8-66 % ) and diameter of stenosis was 21 ± 8% ( 7-42% ). A weak relationship concerning severity of stenosis between LAD stenosis and LMCA stenosis was found in the 59 patients with pre-interventional IVUS examinations ( r = 0.47, P < 0.05 ). Condusions LMCA is frequently involved with atherosclerotic lesions in patients with severe LAD stenosis. A weak relationship does exist concerning the severity of stenosis between lAD and LMCA. However, IVUS for LMCA lesion is not able to rule out LAD stenosis.展开更多
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
文摘Left main coronary compression syndrome(LMCS)may complicate pulmonary artery aneurysms(PAA),usually developed in the context of pulmonary arterial hypertension(PAH).We report the case of a 51-year-old female patient with an atrial septal defect(unsuitable for device closure)complicated by a PAA generating a 90%left main stenosis.The significant PAH held us back from immediate surgery.After specific dual PAH-targeted therapy(sildenafil and bosentan),the atrial septal defect could be closed with a unidirectional valved patch;the PAAinduced LMCS was treated by reductive arterioplasty.The postoperative course was uneventful.Follow-up showed clinical improvement,but PAH treatment was still needed.After three months,coronary angiography showed only an insignificant residual left main stenosis,proving that reductive pulmonary arterioplasty was effective in treating LMCS.Any PAA requires further evaluation for LMCS,a dangerous but treatable complication.The“treat-repair-treat”strategy and shunt-closure with a unidirectional valved patch can both improve surgical prospects of LMCS with shunt-related PAH.
基金This work was supported by the Fund of Social Development in Jiangsu province(NO:BS2006013)
文摘Objective:To obtain early results of off-pump coronarE~ artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB). Methods:Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January 1999 and May 2006. Non-randomized, retrospective data analysis included demo- graphic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: The number of distal anastomo- sis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76 ± 0.98, CCAB group:3.81 ± 1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P 〉 0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis, re-operation for bleeding (or tamponade) were similar in the two groups (P 〉 0.05). Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in the OPCAB group compared with CCAB group(P 〈 0.05).Conclusion: Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.
文摘We present the case of a 74-year-old man with diabetes and hypertension who had to be rescued owing to a near-drowning syndrome at sea.When he was rescued,he complained of dyspnea and chest pain.An electrocardiogram(ECG)suggested acute coronary syndrome(ACS)affecting the left main coronary artery.Therefore,he was referred to our hospital for urgent coronary angiography.
文摘 Left main (LM) stenting is considered by many to be one of the last frontiers of interventional cardiology. Beginning with the VA cooperative study published in 1976 demonstrating a mortality benefit for patients undergoing coronary artery bypass grafting (CABG), i the standard of care for treatment of left main coronary artery disease has been surgical.The most recent 2005 update of the ACC/AHA/SCAI Practice Guidelines on PCI 2 again notes that "CABG using IMA grafting is the 'gold standard' for treatment of unprotected left main disease and has proven benefit on long-term outcomes."……
文摘Objective To evaluate a very long-term clinical outcomes of patients treated with coronary artery bypass grafting(CABG) and percutaneous coronary intervention(PCI) with drug-eluting stents(DES) for ostial/shaft lesions in unprotected left main coronary artery(ULMCA). Methods & Results A total of 472 patients with isolated ostial/shaft lesions in ULMCA were enrolled, who received DES implantation or underwent CABG between January 2003 and July 2009 in Beijing Anzhen Hospital. The major endpoints of this study were death, repeat revascularization, non-procedural myocardial infarction(MI) and stroke. The median follow-up was twelve years(interquartile range: 9.4–14.0 years) in the overall patients. There were no significant differences of incidence of death(23.3% vs. 25.6%, P = 0.227), repeat revascularization(27.3% vs. 28.4%, P = 0.423), non-procedural MI(20.0% vs. 14.5%, P = 0.561), and stroke(6.1% vs. 9.3%, P = 0.255) between PCI and CABG groups before multivariate adjusting. After adjusting covariates with multivariate Cox hazard regression model, there were still no significant differences between PCI and CABG groups. Conclusions During the median follow-up of twelve years, we found that PCI with DES was as effective and safe as CABG in patients with left main ostial/shaft lesion in this observational study.
文摘Atherosclerotic diseases is a diffuse process that involves the coronaries, carotids, renals and all other peripheral arteries owing to the systemic nature of atherosclerotic pathophysiology. This systemic precipitants that promote aggressive atherogenesis have been confirmed in multiple studies showing a relationship between atherosclerotic disease in one vascular bed with disease in another. However, the strength of this relationship varies from patient to patient. Thus, the practical utility of the diffuse nature of atheresclerosis is questionable. Ge and colleagues have proposed the use of left main (LM)coronary artery disease as a potential marker for left anterior descending (lAD) atherosclerotic disease. At first thought, this seems useless since the evaluation of the LM (by angiography or IVUS) can just as easily be performed in the LAD so why bother searching for such a surrogate? However, newer (non-invasive) imaging modalifies are making great gains and will be able to reliably image the LM sooner than the LAD (especially the distal LAD) so such a surrogate could have practical applications.
基金Support for this study was provided by the Funding Project of the National Natural Science Foundation of China(81774076)the Clinical Special Project of Shanghai Health and Family Planning Commission(201840247)+2 种基金the Shanghai Key Medical Specialties Construction Project(ZK2019A11)the Young Elite Scientists Sponsorship Program of CAST(QNRC2-B03)the Clinical Advantage Discipline of Health System of Putuo District in Shanghai(2019ysxk01).
文摘Objective:To evaluate the clinical efficacy of a drug-eluting stent(DES)combined with a drug-coated balloon(DCB)in the treatment of left main coronary artery bifurcation lesions.Methods:A retrospective analysis was conducted on the clinical data of eight patients with left main coronary artery bifurcation lesions treated with a DES combined with a DCB who were admitted to our hospital from July 2016 to July 2017.These eight patients all underwent DES treatment for their left main coronary artery and left anterior descending coronary artery lesions,and DCB treatment at the ostium of the left circumflex artery;six of the patients underwent surgical procedures under the guidance of intravascular ultrasonography.Immediate postoperative angiography was used to evaluate the patency of the diseased vessels,and the restenosis rate at the 6-month follow-up after the operation and the incidence of serious clinical events within 6 months were assessed as well.Results:The use of a DES combined with a DCB in the treatment of left main coronary artery bifurcation lesions had a low restenosis rate(left main coronary artery(8.4±5.3)%,left anterior descending coronary artery(18.2±5.0)%,left circumflex artery(30.5±16.5)%).No serious clinical events occurred in any patients.Conclusion:A DES combined with a DCB is a safe and effective interventional treatment for left main artery coro-nary bifurcation lesions.
基金Supported by National Natural Science Foundation of China,No.81570360Beijing Lisheng Cardiovascular Grant,No.LHJJ201612425
文摘BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult.Ostial compromise of the side branch decreases patient prognosis,and its management is still an issue despite the different strategies and devices available.CASE SUMMARY A 42-year-old male patient was admitted to hospital due to chest pain and syncope.Coronary angiography showed acute LM occlusion.Following thrombus aspiration,a LM bifurcation lesion remained.Coronary angiography was repeated one week later,and at the same time,3D optical coherence tomography(OCT)was carried out to better show the geometry of the bifurcation,which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina.After assessment of the plaque characteristics and the minimum lumen area,the cross-over strategy,kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion.A“moving”carina was found twice during the intervention.Good stent apposition and expansion were confirmed by OCT after proximal optimization technique.The three-month follow-up showed good recovery and normal cardiac function.CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.
文摘BACKGROUND Left main coronary artery(LMCA)supplies more than 80%of the left ventricle,and significant disease of this artery carries a high mortality unless intervened surgically.However,the influence of coronary artery bypass grafting(CABG)surgery on patients with LMCA disease on morbidity intensive care unit(ICU)outcomes needs to be explored.However,the impact of CABG surgery on the morbidity of the ICU population with LMCA disease is worth exploring.AIM To determine whether LMCA disease is a definitive risk factor of prolonged ICU stay as a primary outcome and early morbidity within the ICU stay as secondary outcome.METHODS Retrospective descriptive study with purposive sampling analyzing 399 patients who underwent isolated urgent or elective CABG.Patients were divided into 2 groups;those with LMCA disease as group 1(75 patients)and those without LMCA disease as group 2(324 patients).We correlated ICU outcome parameters including ICU length of stay,post-operative atrial fibrillation,acute kidney injury,re-exploration,perioperative myocardial infarction,post-operative bleeding in both groups.RESULTS Patients with LMCA disease had a significantly higher prevalence of diabetes(43.3%vs 29%,P=0.001).However,we did not find a statistically significant difference with regards to ICU stay,or other morbidity and mortality outcome measures.CONCLUSION Post-operative performance of Patients with LMCA disease who underwent CABG were comparable to those without LMCA involvement.Diabetes was more prevalent in patients with LMCA disease.These findings may help in guiding decision making for future practice and stratifying the patients’care.
文摘The prognosis of left main coronary artery disease is largely affected by the appropriate selection of the treatment strategy. A 45-year-old male presented with severe chest pain and two episodes of ventricular tachycardia, which was reverted after DC shock. Coronary angiography revealed critical stenotic lesion in the left main coronary artery. The patient successfully underwent urgent angioplasty with stent deployment in the left main coronary artery.
文摘This aortic valve replacement (AVR) remains the gold standard for symptomatic aortic stenosis. Peri-operative complications like dissection, stenosis involving coronary artery are well described in many series. We present a rare iatrogenic complication of disrupted left main coronary artery during the delivery of cardioplegia while performing AVR in a 54 year male patient for severe calcific aortic stenosis. The inadvertent injury to the artery was timely noticed and managed successfully with long saphenous vein graft.
文摘Hemodynamically significant left main coronary artery stenosis(LMCA) is found in around 4% of diagnostic coronary angiograms and is known as unprotected LMCA stenosis if the left coronary artery and left cir-cumflex artery has no previous patent grafts.Previous randomized studies have demonstrated a significant re-duction in mortality when revascularization by coronary artery bypass graft(CABG) surgery was undertaken compared with medical treatment.Therefore,current practice guidelines do not recommend percutaneous coronary intervention(PCI) for such a lesion because of the proven benefit of surgery and high rates of reste-nosis with the use of bare metal stents.However,with the advent of drug-eluting stents(DES),the long term outcomes of PCI with DES to treat unprotected LMCA stenoses have been acceptable.Therefore,apart from the current guidelines,PCI for treatment of unprotected LMCA stenosis is often undertaken in individuals who are at a very high risk of CABG or refuse to undergo a sternotomy.Future randomized studies comparing CABG vs PCI using DES for treatment of unprotected LMCA stenosis would be a great advance in clinical knowledge for the adoption of appropriate treatment.
文摘Acute total or subtotal occlusion of left main coronary artery (LMCA) is a catastrophic and mostly fatal event. Patients may present with cardiogenic shock and die whenever this event occurs. Survival is strongly dependent on the presence of collateral blood flow to the left coronary artery or a dominant right coronary artery, and emergency intervention for preserving the left ventricular function. Here, we present a case of a 14-year-old boy with subtotal occlusion of the LMCA accompanying acute myocardial infarction probably caused by congenital syphilis according to his positive serum syphilis antibody. His survival was closely associated with a dominant right coronary artery and timely thrombolytic therapy. Finally, he was treated with angioplasty and paclitaxel-eluting stent implantation. He was followed up after stenting and was doing quite well at the time when we wrote this paper.
基金Supported by "100" Level Talent Plan of Guizhou High-level Innovative Talent Training Program,No.2016-4023Guizhou Province Clinical Research Centre for Cardiovascular Diseases,No.2017-5405
文摘BACKGROUND Single coronary artery(SCA)originating from a solitary ostium in the aorta and perfusing the entire myocardium is a very rare congenital anomaly of the coronary artery.Furthermore,a right coronary artery(RCA)arising from the mid segment of the left anterior descending artery(LAD)is an extremely uncommon variation of SCA.CASE SUMMARY A 76-year-old woman presented a 5-mo history of exertional angina.Selective coronary angiography revealed an SCA,with severe ostial stenosis that originated from the left sinus of Valsalva and bifurcated normally into the LAD and circumflex coronary artery.In addition,an anomalous RCA originated from the mid segment of the LAD as a separate branch.Successful balloon angioplasty and stenting for the SCA ostial stenosis were performed on the patient.CONCLUSION Percutaneous coronary intervention(PCI)of the main trunk for SCA is very similar to PCI of an unprotected left main coronary artery.Although technical difficulties and risks do exist,PCI for severe ostial stenosis of the main trunk is safe and efficacious in selected SCA patients.
文摘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.
文摘Background: Pulmonary artery aneurysm (PAA) is an unusual finding and its association with left main coronary (LMCA) compression is even more infrequent. Cardiac CT evaluates of presence and size of PAA and the degree of LMCA compression. The aim of this study is to describe two cases of adults with compression of LMCA with PAA associated with PDA and pulmonary hypertension. Case presentation: The first case is a 27-year-old man with PAA (78 mm diameter) and LMCA compression of 70% between the aortic sinus and the PAA. He presented angina as a manifestation of the LMCA compression. During follow-up the patient died. The second case is a 28-year-old man with PAA (110 mm diameter) that compresses LMCA in 55%, he rejected surgical treatment, but he is in close follow-up with medical treatment. Conclusion: Cardiac computed tomography played an important role both in the diagnosis and identification of high-risk PAA patients.
文摘Background The 5-year cardiac mortality rate has been reported to be more than 50% in patients with left main coronary artery (LMCA) stenosis. The purpose of this study was to visualize the LMCA using intravascular ultrasound in patients who undergo interventions of the left anterior descending coronary artery (LAD). This was done in order to see the incidence and severity of plaque formation in the LMCA in patients with severe lAD stenosis, and to address if scanning LMCA is able to rule out lAD significant stenosis or vice versa. Methods A total of 293 patients with intervention of the LAD stenosis were examined with intravascular ultrasound(IVUS). The images of 278 patients were suitable for analysis. Results Fifty-three (19%) were found to have angiographic lumen reduction in the LMCA ranging from 11% to 35% (19 ± 8%). Sixty-one patients were found to have native calcification in the LMCA. Atherosclerotic plaques in LMCA were detected in 211/278 (76%) patients, of which 164/211 (78%) were eccentric, and 51/211 (24%) had calcium deposit. The cross-sectional plaque area ranged from 1.5 mm2 to 21 mm2 (8.4 ± 4.7 mm2 ). Area of stenosis was 34 ± 14 % (8-66 % ) and diameter of stenosis was 21 ± 8% ( 7-42% ). A weak relationship concerning severity of stenosis between LAD stenosis and LMCA stenosis was found in the 59 patients with pre-interventional IVUS examinations ( r = 0.47, P < 0.05 ). Condusions LMCA is frequently involved with atherosclerotic lesions in patients with severe LAD stenosis. A weak relationship does exist concerning the severity of stenosis between lAD and LMCA. However, IVUS for LMCA lesion is not able to rule out LAD stenosis.
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.