The left main coronary artery (LMCA) is responsible for supplying about 75% to 100% of the left ventricular cardiac mass. Left main stem coronary artery (LMCA) disease reduces flow to a large portion of the myocardium...The left main coronary artery (LMCA) is responsible for supplying about 75% to 100% of the left ventricular cardiac mass. Left main stem coronary artery (LMCA) disease reduces flow to a large portion of the myocardium, placing the patient at high risk for life-threatening events such as left ventricular dysfunction and arrhythmias with a high mortality approaching 50% in those treated medically. For several decades, coronary artery bypass grafting (CABG) has been considered as a gold standard treatment of unprotected left main coronary artery (ULMCA). However, successful percutaneous coronary interventions (PCI) have been increasingly reported recently due to improved stent technology and better operator expertise. In spite of these factors, management can be challenging especially in LMCA bifurcational & trifurcational lesions, and therefore an integrated approach combining special techniques, physiological evaluation and adjunctive pharmacological agents should be combined for better clinical outcome. Herein, we describe a new promising technique named (Kurdistan technique) for the treatment of trifurcation unprotected left main stem lesion. In the last 18 months, 21 patients with significant trifurcational LMS had underwent PCI using this technique in our hospital (Sulaimany Heart Hospital/Kurdistan). The procedural success rate was 100%, follow up coronary angiography done between 6 - 12 months after the procedure for all the patients with no significant in-stent restenosis in any patient. One case is presented here demonstrating the technique.展开更多
BACKGROUND In the classic descriptions of the human liver,the common hepatic duct forms at the confluence of left and right hepatic ducts.Many authors have documented variations in the intra-hepatic ductal system,but ...BACKGROUND In the classic descriptions of the human liver,the common hepatic duct forms at the confluence of left and right hepatic ducts.Many authors have documented variations in the intra-hepatic ductal system,but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations.AIM To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography(MRC)in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean.Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders.METHODS This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean.We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1,2017 to March 31,2019.Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang’s classification.A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant.The variants in our population were compared to the global population.RESULTS There were 152 MRCs evaluated in this study in 86 males and 66 females.There were 109(71.7%)persons with“classic”biliary anatomy(type A1)and variants were present in 43(28.3%)persons.There was no statistical relationship between the presence of anatomic variants and gender or ethnicity.We encountered the following variants:29(19.1%)type A2,7(4.6%)type A3,6(3.95%)type A4,0 type A5 and a single variant(quadrification)that did not fit the classification system.Compared to the global prevalence,our population had a significantly greater occurrence of A1 anatomy(71.7%vs 62.6%;P=0.0227)and A2 trifurcations(19.1%vs 11.5%;P=0.0069),but a significantly lower incidence of A3 variants(4.61%vs 11.5%;P=0.0047).CONCLUSION There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics.Specifically,persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.展开更多
文摘The left main coronary artery (LMCA) is responsible for supplying about 75% to 100% of the left ventricular cardiac mass. Left main stem coronary artery (LMCA) disease reduces flow to a large portion of the myocardium, placing the patient at high risk for life-threatening events such as left ventricular dysfunction and arrhythmias with a high mortality approaching 50% in those treated medically. For several decades, coronary artery bypass grafting (CABG) has been considered as a gold standard treatment of unprotected left main coronary artery (ULMCA). However, successful percutaneous coronary interventions (PCI) have been increasingly reported recently due to improved stent technology and better operator expertise. In spite of these factors, management can be challenging especially in LMCA bifurcational & trifurcational lesions, and therefore an integrated approach combining special techniques, physiological evaluation and adjunctive pharmacological agents should be combined for better clinical outcome. Herein, we describe a new promising technique named (Kurdistan technique) for the treatment of trifurcation unprotected left main stem lesion. In the last 18 months, 21 patients with significant trifurcational LMS had underwent PCI using this technique in our hospital (Sulaimany Heart Hospital/Kurdistan). The procedural success rate was 100%, follow up coronary angiography done between 6 - 12 months after the procedure for all the patients with no significant in-stent restenosis in any patient. One case is presented here demonstrating the technique.
文摘BACKGROUND In the classic descriptions of the human liver,the common hepatic duct forms at the confluence of left and right hepatic ducts.Many authors have documented variations in the intra-hepatic ductal system,but to the best of our knowledge there has been no report on bile duct variations in Caribbean populations.AIM To evaluate the variations in bile duct anatomy using magnetic resonance cholangiography(MRC)in unselected patients at a major hepatobiliary referral centre in the Eastern Caribbean.Knowledge of the intra-hepatic biliary anatomy is important to optimize service delivery for any physician treating liver and biliary disorders.METHODS This study was carried out at a tertiary referral hospital for hepatobiliary diseases in the Eastern Caribbean.We retrospectively evaluated magnetic resonance cholangiograms in 152 consecutive patients at this facility over a two-year period from April 1,2017 to March 31,2019.Two consultant radiologists experienced in MRC interpretation reviewed all scans and described biliary anatomy according to the Huang’s classification.A systematic review of published studies was performed and relevant data were extracted in order to calculate the global prevalence of each biliary variant.The variants in our population were compared to the global population.RESULTS There were 152 MRCs evaluated in this study in 86 males and 66 females.There were 109(71.7%)persons with“classic”biliary anatomy(type A1)and variants were present in 43(28.3%)persons.There was no statistical relationship between the presence of anatomic variants and gender or ethnicity.We encountered the following variants:29(19.1%)type A2,7(4.6%)type A3,6(3.95%)type A4,0 type A5 and a single variant(quadrification)that did not fit the classification system.Compared to the global prevalence,our population had a significantly greater occurrence of A1 anatomy(71.7%vs 62.6%;P=0.0227)and A2 trifurcations(19.1%vs 11.5%;P=0.0069),but a significantly lower incidence of A3 variants(4.61%vs 11.5%;P=0.0047).CONCLUSION There are significant differences in intra-hepatic biliary anatomy in this unselected Eastern Caribbean population compared to global statistics.Specifically,persons of Caribbean descent have a greater incidence of Huang A2 trifurcations and a lower incidence of Huang A3 variants.
