Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly hi...Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly higher risk of sudden cardiac death compared to those with an anomalous right coronary artery. The anomalous coronary artery traversing between the ascending aorta and the pulmonary artery markedly heightens the risk of myocardial ischemia, arrhythmia, and sudden death. Symptomatic patients often exhibit a longer intramural course of the coronary artery, which may necessitate earlier intervention or influence the choice of surgical repair method. Surgical intervention is advocated for patients with this anomaly, even in the absence of symptoms. For anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an intramural course, coronary unroofing is the preferred revascularization procedure. This report presents a case of AOLCA originating from the right sinus of Valsalva, treated surgically using the unroofing technique for the aortic intramural segment of the anomalous coronary artery traversing between the great vessels. The unroofing technique is recommended for treating AOLCA with an extensive intramural course that does not involve the commissure.展开更多
BACKGROUND Isolated single coronary artery is a rare congenital anomaly.R-I subtype single coronary artery is even rarer.In this subtype,a very large right coronary artery extends in the coronary sulcus to the anterio...BACKGROUND Isolated single coronary artery is a rare congenital anomaly.R-I subtype single coronary artery is even rarer.In this subtype,a very large right coronary artery extends in the coronary sulcus to the anterior base of the heart where it produces the left anterior descending coronary artery.Currently,only a few case reports are available in the literature for this anomaly.CASE SUMMARY Here,we report the case of a 62-year-old woman who presented to the cardiology clinic with decreased exercise tolerance and poor blood pressure control.The patient underwent coronary angiography(CAG)and emission computed tomography(ECT).CAG images revealed a single gigantic right coronary artery(R-I type)arising from the right coronary sinus with branches supplying the left coronary territory.The ECT results confirmed myocardial ischemia at the location of the absent left coronary artery.The ECT findings confirmed that ischemia was consistent with the vascular loss location in CAG images.In such anomalies,there is a compensatory widening of the coronary artery lumen.Medical treatment was administered,and the patient was discharged.CONCLUSION Isolated single coronary arteries are associated with ischemia and potentially fatal acute coronary events.Hence,controlling risk factors is critical.展开更多
AIM To compare the behavior of pulmonary hypertension(PHT) associated with coronary artery fistulas(CAFs) between the Asian and Caucasian subjects.METHODS CAFs may be complicated with PHT secondary to leftto-right shu...AIM To compare the behavior of pulmonary hypertension(PHT) associated with coronary artery fistulas(CAFs) between the Asian and Caucasian subjects.METHODS CAFs may be complicated with PHT secondary to leftto-right shunt. Literature review limited to the English language. A total of 211 reviewed patients were collected. Of those, 111 were of Asian and 100 were of Caucasian ethnic origin. The mean age of the Asian and the Caucasian groups of patients were 48.9(range 19-83) and 49.9 years(range 16-85), respectively. In both groups, right heart catheterization was the most commonly(95%) used method for determining pulmonary artery pressure. RESULTS From all of the reviewed subjects, PHT was found in 49 patients(23%), of which 15 were Asian and 34 were Caucasian. In 75% of PHT subjects, mild to moderate PHT was reported and 76% of the fistulas had a vascular mode of termination. Treatment was surgical in 61%, followed by percutaneous therapeutic embolization(27%) and finally conservative medical management in 12% of PHT subjects. PHT was associated with a slight female gender predominance. The majority demonstrated mild to moderate PHT. PHT was reported more frequent in the Caucasian compared with the Asian ethnicity group. The majority of fistulas in patients with PHT had a vascular mode of termination. The results of this review are intended to be indicative and require cautious interpretation.CONCLUSION The likelihood for a CAF patient to develop PHT is presented when possessing the following features, with a Caucasian female having a fistula with a vascular mode of termination.展开更多
Last centuries have witnessed tremendous sophistication and progress in the detection,diagnosis and treatment of coronary artery fistulas(CAFs).In many countries,CAFs were reported to be visualized and treated using s...Last centuries have witnessed tremendous sophistication and progress in the detection,diagnosis and treatment of coronary artery fistulas(CAFs).In many countries,CAFs were reported to be visualized and treated using several imaging techniques and different management strategies.Reports from nearly all continents of the globe have contributed to the description of CAFs,not only in Asia and Europe but also throughout North and Latin America.However,these reports have to be cautiously analyzed as many of them were published as a case report and careful interpretation is warranted due to possible publication bias.A literature search was performed using PubMed search interface to select papers dealing with congenital CAFs in adult population between 2000-2009.A total of 233 subjects were collected,and analysed according to their drainage site and treatment modality.They were divided into two subgroups:percutaneous transluminal embolization group(PTE group,n=122)and surgical ligation group(SL group,n=111).In the SL group,atherosclerotic coronary artery disease(19%)and associated congenital lesions(23%)were more prevalent compared with the PTE group(9%and 8%),respectively.Infective endocarditis was more frequently seen in the SL group besides syncope,congestive heart failure and hemopericardium.In both groups multimodality diagnostic workup composed of several non-invasive and invasive imaging techniques for fistula visualization were performed and drainage sites into the different cardiac chambers and intrathoracic great vessels were similarly distributed in the two groups.展开更多
AIM:To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery(SCA) in adults.METHODS:We identified 15 patients with a SCA detected from four Dutch a...AIM:To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery(SCA) in adults.METHODS:We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and 2013.Symptomatic patients who underwent routine diagnostic coronary angiography(CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were analyzed.RESULTS:Fifteen(7 females) with a mean age of 58.5 ± 13.78 years(range 43-86) had a SCA.ConventionalCAG demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 patients.Minimal to moderate coronary atherosclerotic changes were found in 4,and severe stenotic lesions in another 4 patients.Seven patients were free of coronary atherosclerosis.Runs of non-sustained ventricular tachycardia were documented in 2 patients,one of whom demonstrated transmural ischemic changes on presentation.Myocardial perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary artery.Multi-slice computed tomography(MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary artery.Percutaneous coronary intervention was successfully performed in 3 patients.Eight patients were managed medically.Arterial bypass graft was performed in 4 patients with the squeezed SCA.CONCLUSION:SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis.The availability and sophistication of MSCT facilitates the delineation of the course of a SCA.We present a Dutch case series and review of the literature.展开更多
Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial is...Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, fimctional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional sig- nificance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.展开更多
Coronary artery anomalies (CAAs) occur in 0.64 % to 5.6% of patients undergoing coronary angiography, Most pathophysiology and clinical histories involving CCAs have been fully clarified in the past 30 years. Isolat...Coronary artery anomalies (CAAs) occur in 0.64 % to 5.6% of patients undergoing coronary angiography, Most pathophysiology and clinical histories involving CCAs have been fully clarified in the past 30 years. Isolated congenital coronary artery-left ventricle direct microfismlas (CVmF) have been recently described, but the clinical significance and anatomical characteristics associated with this rare type of CAA in a western population are still unclear.展开更多
Although congenital heart diseases are uncommon in the elderly,coronary artery anomalies may be incidentally discovered in old age.We sought to determine the incidence and clinical features of coronary artery anomalie...Although congenital heart diseases are uncommon in the elderly,coronary artery anomalies may be incidentally discovered in old age.We sought to determine the incidence and clinical features of coronary artery anomalies (CAAs) in patients over 65 years of age.Patients and methods Medical records of patients undergoing coronary artery angiography in the years 1997-2002 at the Legnago General Hospital were retrospectively reviewed.The clinical profiles of all patients with CAAs and CAA subtypes were noted.Comparison between patients under and over 65 was performed.Data are given as mean standard deviation and as percentages.Results Sixty- six patients (1.21%,Female/Male 22/44,mean age 65.3±10.6 years) out of the 5450 who underwent coronary angingraphy in the years 1997-2002 had CAAs.In most cases (63%,41/66 patients),the patients were over 65. CAAs were discovered incidentally in these elderly patients while undergoing coronary artery angiography for dilated cardiomyopathy, ischemic heart disease,and valvular heart disease in 75% of the cases (30/41 patients).Patients over 65 had more cardiac comorbidities and a higher incidence of coronary atherosclerosis.Conclusions The angingraphic incidence of CAAs in elderly patients is increasing as the population ages and this occurrence calls for a wider knowledge of the anatomy and pathophysiology of CAAs among geriatric cardiologists.Elderly patients seem to present with lower risk coronary anomalies (separated origin of left anterior descending coronary artery and circumflex artery,origin of circumflex artery from the right sinus or the right coronary artery,double coronary artery) but have a higher risk profile compared to younger patients due to the frequency of cardiac coraorbidities and superimposed coronary artery atherosclerosis.(J Geriatr Cardiol 2004;1:40-43.)展开更多
Intercoronary connection is a rare variant of coronary anomalies with a direct continuity between two main coronary arteries. It may function as an alternative pathway to blood flow in compromised coronary circulation...Intercoronary connection is a rare variant of coronary anomalies with a direct continuity between two main coronary arteries. It may function as an alternative pathway to blood flow in compromised coronary circulation. 64 years old male presented with 4 weeks history of retro-sternal chest pain and shortness of breath;his risk factors were diabetes mellitus, hypertension and smoking. Physical examination was normal and he had no audible murmur;he had elevated cardiac enzymes;in echocardiography there was inferior wall hypokinesia, cardiac catheterization revealed complete occlusion of med right coronary artery and complete occlusion of the left main (LM) trunk. Blood flow to the entire myocardium came from large abnormal coronary connection between the right coronary artery ostium and the proximal left anterior descending artery. A smaller arterial communication maintained blood flow to the distal right coronary artery. Cardiac computed tomographic angiography confirmed the presence of a patent left main ostium followed by complete occlusion. This unusual anatomical variation has saved the life of the patient and allowed time for surgical revascularization. The patient underwent successful triple coronary artery bypass grafts with no postoperative difficulties or complications. On one-year follow-up, the patient is asymptomatic, fully active with no new ECG or echocardiography changes.展开更多
Background:The incidence of congenital coronary artery anomalies (CCAAs) is different between ethnic groups,but there is no report about Uyghur CCAAs because of the limitation of inspection methods.This study deter...Background:The incidence of congenital coronary artery anomalies (CCAAs) is different between ethnic groups,but there is no report about Uyghur CCAAs because of the limitation of inspection methods.This study determined the prevalence of Uyghur CCAAs and analysis the difference of CCAAs between Uyghur and Han ethnic groups by the method of multi-slice computed tomography coronary angiography (MSCTCA).Methods:Seven thousand four hundred and sixty-nine MSCTCA were analyzed for the CCAAs retroactively,1934 were Uyghur patients while 4746 were Han patients.All the coronary artery images dates obtained by MSCTCA were evaluated for the CCAAs by two doctors.Results:Nineteen kinds of CCAAs were found:(1) The overall incidence of CCAAs was 2.72% (203/7469) among all patients,2.34% (111/4746) among Han patients whereas a significant higher 3.93% (76/1934) among Uyghur patients (χ^2 =12.780,P 〈 0.05); (2) the incidence of CCAAs among male patients was 2.48% (76/3069) in Han while 4.33% (56/1293) in Uyghur (χ^2 =10.663,P 〈 0.05); (3) the incidence of CCAAs on the left side was 1.07% (51/4746) among Han patients while 2.17% (42/934) among Uyghur patients (χ^2 =12.047,P 〈 0.05); (4) among these 19 kinds of CCAAs,there were significant differences of the incidence of the following kinds of CCAAs between Uyghur and Han:Left coronary artery (LCA) high location (χ^2 =8.320,P =0.004),right coronary artery (RCA) originate from left coronary sinus (χ^2 =5.450,P =0.020),and RCA originate from left Coronary sinus + LCA high location (P =0.024).Conclusions:There exists some difference in CCAAs between Uyghur and Han ethnic groups.The CCAAs incidence of Uyghur is higher than that of Han,especially in male patients and on the left side; among all kinds of CCAAs,the incidence of LCA high location,RCA originate from left coronary sinus,RCA originate from left coronary sinus + LCA high locations of Uyghur is higher than Han.展开更多
Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery (ALCAPA). However, controv...Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery (ALCAPA). However, controversy still exists over the initial management of mitral regurgitation (MR) at the time of ALCAPA repair. Methods Between March 2005 and March 2015, 52 consecutive patients (20 males and 32 females) underwent direct aortic implantation of ALCAPA. Median age at surgery was 10 months (range, 2 to 193). Mean weight was 9.7_+7.8 kg. In order to facilitate the analysis, description of MR was given a numeric grade: 0 = none, 1 = trivial, 2 = mild, 2.5 = mild-moderate, 3 = moderate, 3.5 = moderate-severe, and 4 = severe. Results The LV shortening fraction (LVFS) demonstrated significant improvement between presentation and discharge (32.1±10.1% vs. 28.6±9.6%, P = 0.023), and there was also significant improvement in the mean MR grade between presentation and discharge (2.40+1.16 vs. 2.91+ 1.19, P = 0.001). There were 4 hospital deaths (7.7%). The median follow-up was 21 months (range 1.5 to 111), 3 patients (5.8%) were lost to follow-up, 1 patient required reoperation for mitral valve replacement. Significant improvement was seen in LVFS between discharge and late follow-up (38.0±6.0% vs. 32.1±10.1%, P = 0.001), however, the degree of MR did not dem- onstrate further change (2.29_+1.20 vs. 2.40+1.16, P = 0.541). Conclusion Creation of a dual coronary system with direct aortic implantation of the left coronary artery results in complete recovery of left ventricular function. Concomitant mitral valve (MV) repair for ALCAPA patients with moderate-severe and severe MR is helpful to early MV function recovery.展开更多
目的研究右冠状动脉异常起源于肺动脉(anomalous origin of right coronary artery from the pulmonary artery,ARCAPA)的临床特点,了解不同手术方式的预后情况。方法回顾性分析9例确诊为ARCAPA患儿(患者)的临床资料,包括临床表现、辅...目的研究右冠状动脉异常起源于肺动脉(anomalous origin of right coronary artery from the pulmonary artery,ARCAPA)的临床特点,了解不同手术方式的预后情况。方法回顾性分析9例确诊为ARCAPA患儿(患者)的临床资料,包括临床表现、辅助检查、手术方式及随访情况。结果共计8例患儿(儿童),1例患者(成人);男7例,女2例;患儿中位月龄67.5个月,成人患者年龄69岁。患儿中4例因活动后胸闷气促就诊,3例因体检发现心脏杂音就诊,1例因脑梗死就诊完善心脏检查诊断,成人患者因气促胸闷行冠状动脉造影检查后诊断。心电图(ECG)检查示3例患儿无明显心肌缺血表现,1例部分下壁导联深Q波,4例(均>6岁)有不同程度右胸导联ST段抬高表现,成人患者提示完全性右束支传导阻滞(CRBBB)、右胸导联T波双向;经胸超声心动图(TTE)检查显示成人患者术前左心室舒张末期内径(LVEDD)增大明显伴左心室射血分数(LVEF)下降,房室瓣重度反流;有2例患儿术前左心室舒张末期内径增大,左心室射血分数均正常。所有患儿(患者)均完成手术治疗,成人患者行右冠状动脉(RCA)异位开口修补+冠状动脉旁路移植术,5例患儿行右冠状动脉直接移植至主动脉(AO)根部手术,1例患儿右冠状动脉延长后移植至主动脉根部,2例患儿行右冠状动脉结扎术。成人患者术后使用多巴胺5 d,米力农3 d强心治疗,3 d后转出重症监护室,术后复查经胸超声心动图示房室瓣反流好转,目前随访3年,左心室射血分数正常。患儿术后撤机时间为0.5~1 d,使用强心药多巴胺1~2 d,1~2 d后转出重症监护室。目前中位随访时间为36个月,所有术后患者均心功能正常,无需要再次手术患者,无死亡患者。结论ARCAPA患者早期无明显心功能不全症状,临床表现不典型,超声心动图可能漏诊或误诊,及时手术治疗预后效果好。展开更多
52-year-old man presented with a history of angina .pectoris over 3 months. He had a history ofhypertension and hyperlipidemia. His physical examination, blood chemistry, ECG, chest X-ray were normal. A treadmill exer...52-year-old man presented with a history of angina .pectoris over 3 months. He had a history ofhypertension and hyperlipidemia. His physical examination, blood chemistry, ECG, chest X-ray were normal. A treadmill exercise ECG test was performed using the Bruce protocol. Owing to 1 mm ST segment depressions at derivations DⅡ, DⅢ, aVE V4-V6, and typical chest pain at third stage the test was evaluated as ischemia-positive test. Therefore, he was scheduled fox diagnostic coronary angiography.展开更多
文摘Anomalous origin of the left coronary artery (AOLCA) from the right sinus of Valsalva constitutes a rare congenital coronary artery anomaly. Patients with an anomalous left main coronary artery face a significantly higher risk of sudden cardiac death compared to those with an anomalous right coronary artery. The anomalous coronary artery traversing between the ascending aorta and the pulmonary artery markedly heightens the risk of myocardial ischemia, arrhythmia, and sudden death. Symptomatic patients often exhibit a longer intramural course of the coronary artery, which may necessitate earlier intervention or influence the choice of surgical repair method. Surgical intervention is advocated for patients with this anomaly, even in the absence of symptoms. For anomalous aortic origin of a coronary artery from the opposite sinus of Valsalva with an intramural course, coronary unroofing is the preferred revascularization procedure. This report presents a case of AOLCA originating from the right sinus of Valsalva, treated surgically using the unroofing technique for the aortic intramural segment of the anomalous coronary artery traversing between the great vessels. The unroofing technique is recommended for treating AOLCA with an extensive intramural course that does not involve the commissure.
文摘BACKGROUND Isolated single coronary artery is a rare congenital anomaly.R-I subtype single coronary artery is even rarer.In this subtype,a very large right coronary artery extends in the coronary sulcus to the anterior base of the heart where it produces the left anterior descending coronary artery.Currently,only a few case reports are available in the literature for this anomaly.CASE SUMMARY Here,we report the case of a 62-year-old woman who presented to the cardiology clinic with decreased exercise tolerance and poor blood pressure control.The patient underwent coronary angiography(CAG)and emission computed tomography(ECT).CAG images revealed a single gigantic right coronary artery(R-I type)arising from the right coronary sinus with branches supplying the left coronary territory.The ECT results confirmed myocardial ischemia at the location of the absent left coronary artery.The ECT findings confirmed that ischemia was consistent with the vascular loss location in CAG images.In such anomalies,there is a compensatory widening of the coronary artery lumen.Medical treatment was administered,and the patient was discharged.CONCLUSION Isolated single coronary arteries are associated with ischemia and potentially fatal acute coronary events.Hence,controlling risk factors is critical.
文摘AIM To compare the behavior of pulmonary hypertension(PHT) associated with coronary artery fistulas(CAFs) between the Asian and Caucasian subjects.METHODS CAFs may be complicated with PHT secondary to leftto-right shunt. Literature review limited to the English language. A total of 211 reviewed patients were collected. Of those, 111 were of Asian and 100 were of Caucasian ethnic origin. The mean age of the Asian and the Caucasian groups of patients were 48.9(range 19-83) and 49.9 years(range 16-85), respectively. In both groups, right heart catheterization was the most commonly(95%) used method for determining pulmonary artery pressure. RESULTS From all of the reviewed subjects, PHT was found in 49 patients(23%), of which 15 were Asian and 34 were Caucasian. In 75% of PHT subjects, mild to moderate PHT was reported and 76% of the fistulas had a vascular mode of termination. Treatment was surgical in 61%, followed by percutaneous therapeutic embolization(27%) and finally conservative medical management in 12% of PHT subjects. PHT was associated with a slight female gender predominance. The majority demonstrated mild to moderate PHT. PHT was reported more frequent in the Caucasian compared with the Asian ethnicity group. The majority of fistulas in patients with PHT had a vascular mode of termination. The results of this review are intended to be indicative and require cautious interpretation.CONCLUSION The likelihood for a CAF patient to develop PHT is presented when possessing the following features, with a Caucasian female having a fistula with a vascular mode of termination.
文摘Last centuries have witnessed tremendous sophistication and progress in the detection,diagnosis and treatment of coronary artery fistulas(CAFs).In many countries,CAFs were reported to be visualized and treated using several imaging techniques and different management strategies.Reports from nearly all continents of the globe have contributed to the description of CAFs,not only in Asia and Europe but also throughout North and Latin America.However,these reports have to be cautiously analyzed as many of them were published as a case report and careful interpretation is warranted due to possible publication bias.A literature search was performed using PubMed search interface to select papers dealing with congenital CAFs in adult population between 2000-2009.A total of 233 subjects were collected,and analysed according to their drainage site and treatment modality.They were divided into two subgroups:percutaneous transluminal embolization group(PTE group,n=122)and surgical ligation group(SL group,n=111).In the SL group,atherosclerotic coronary artery disease(19%)and associated congenital lesions(23%)were more prevalent compared with the PTE group(9%and 8%),respectively.Infective endocarditis was more frequently seen in the SL group besides syncope,congestive heart failure and hemopericardium.In both groups multimodality diagnostic workup composed of several non-invasive and invasive imaging techniques for fistula visualization were performed and drainage sites into the different cardiac chambers and intrathoracic great vessels were similarly distributed in the two groups.
文摘AIM:To assess the current diagnostic and therapeutic management and the clinical implications of congenital single coronary artery(SCA) in adults.METHODS:We identified 15 patients with a SCA detected from four Dutch angiography centers in the period between 2010 and 2013.Symptomatic patients who underwent routine diagnostic coronary angiography(CAG) for suspected coronary artery disease and who incidentally were found to have isolated SCA were analyzed.RESULTS:Fifteen(7 females) with a mean age of 58.5 ± 13.78 years(range 43-86) had a SCA.ConventionalCAG demonstrated congenital isolated SCA originating as a single ostium from the right sinus of Valsalva in 6 patients and originating from the left in 9 patients.Minimal to moderate coronary atherosclerotic changes were found in 4,and severe stenotic lesions in another 4 patients.Seven patients were free of coronary atherosclerosis.Runs of non-sustained ventricular tachycardia were documented in 2 patients,one of whom demonstrated transmural ischemic changes on presentation.Myocardial perfusion scintigraphic evidence of transmural myocardial ischemia was found in 1 patient due to kinking and squeezing of the SCA with an interarterial course between the aorta and pulmonary artery.Multi-slice computed tomography(MSCT) was helpful to delineate the course of the anomalous artery relative to the aorta and pulmonary artery.Percutaneous coronary intervention was successfully performed in 3 patients.Eight patients were managed medically.Arterial bypass graft was performed in 4 patients with the squeezed SCA.CONCLUSION:SCA may be associated with transient transmural myocardial ischemia and aborted sudden death in the absence of coronary atherosclerosis.The availability and sophistication of MSCT facilitates the delineation of the course of a SCA.We present a Dutch case series and review of the literature.
文摘Coronary artery anomalies (CAAs) may be discovered more often as incidental findings during the normal diagnostic process for other cardiac diseases or less frequently on the basis of manifestations of myocardial ischemia. The cardiovascular professional may be involved in their angiographic diagnosis, fimctional assessment and eventual endovascular treatment. A complete angiographic definition is mandatory in order to understand the functional effects and plan any intervention in CAAs: computed tomography and magnetic resonance imaging are useful non-invasive tools to detect three-dimensional morphology of the anomalies and its relationships with contiguous cardiac structures, whereas coronary arteriography remains the gold standard for a definitive anatomic picture. A practical idea of the possible functional sig- nificance is mandatory for deciding how to manage CAAs: non-invasive stress tests and in particular the invasive pharmacological stress tests with or without intravascular ultrasound monitoring can assess correctly the functional significance of the most CAAs. Finally, the knowledge of the particular endovascular techniques and material is of paramount importance for achieving technical and clinical success. CAAs represent a complex issue, which rarely involve the cardiovascular professional at different levels. A timely practical knowledge of the main issues regarding CAAs is important in the management of such entities.
文摘Coronary artery anomalies (CAAs) occur in 0.64 % to 5.6% of patients undergoing coronary angiography, Most pathophysiology and clinical histories involving CCAs have been fully clarified in the past 30 years. Isolated congenital coronary artery-left ventricle direct microfismlas (CVmF) have been recently described, but the clinical significance and anatomical characteristics associated with this rare type of CAA in a western population are still unclear.
文摘Although congenital heart diseases are uncommon in the elderly,coronary artery anomalies may be incidentally discovered in old age.We sought to determine the incidence and clinical features of coronary artery anomalies (CAAs) in patients over 65 years of age.Patients and methods Medical records of patients undergoing coronary artery angiography in the years 1997-2002 at the Legnago General Hospital were retrospectively reviewed.The clinical profiles of all patients with CAAs and CAA subtypes were noted.Comparison between patients under and over 65 was performed.Data are given as mean standard deviation and as percentages.Results Sixty- six patients (1.21%,Female/Male 22/44,mean age 65.3±10.6 years) out of the 5450 who underwent coronary angingraphy in the years 1997-2002 had CAAs.In most cases (63%,41/66 patients),the patients were over 65. CAAs were discovered incidentally in these elderly patients while undergoing coronary artery angiography for dilated cardiomyopathy, ischemic heart disease,and valvular heart disease in 75% of the cases (30/41 patients).Patients over 65 had more cardiac comorbidities and a higher incidence of coronary atherosclerosis.Conclusions The angingraphic incidence of CAAs in elderly patients is increasing as the population ages and this occurrence calls for a wider knowledge of the anatomy and pathophysiology of CAAs among geriatric cardiologists.Elderly patients seem to present with lower risk coronary anomalies (separated origin of left anterior descending coronary artery and circumflex artery,origin of circumflex artery from the right sinus or the right coronary artery,double coronary artery) but have a higher risk profile compared to younger patients due to the frequency of cardiac coraorbidities and superimposed coronary artery atherosclerosis.(J Geriatr Cardiol 2004;1:40-43.)
文摘Intercoronary connection is a rare variant of coronary anomalies with a direct continuity between two main coronary arteries. It may function as an alternative pathway to blood flow in compromised coronary circulation. 64 years old male presented with 4 weeks history of retro-sternal chest pain and shortness of breath;his risk factors were diabetes mellitus, hypertension and smoking. Physical examination was normal and he had no audible murmur;he had elevated cardiac enzymes;in echocardiography there was inferior wall hypokinesia, cardiac catheterization revealed complete occlusion of med right coronary artery and complete occlusion of the left main (LM) trunk. Blood flow to the entire myocardium came from large abnormal coronary connection between the right coronary artery ostium and the proximal left anterior descending artery. A smaller arterial communication maintained blood flow to the distal right coronary artery. Cardiac computed tomographic angiography confirmed the presence of a patent left main ostium followed by complete occlusion. This unusual anatomical variation has saved the life of the patient and allowed time for surgical revascularization. The patient underwent successful triple coronary artery bypass grafts with no postoperative difficulties or complications. On one-year follow-up, the patient is asymptomatic, fully active with no new ECG or echocardiography changes.
文摘Background:The incidence of congenital coronary artery anomalies (CCAAs) is different between ethnic groups,but there is no report about Uyghur CCAAs because of the limitation of inspection methods.This study determined the prevalence of Uyghur CCAAs and analysis the difference of CCAAs between Uyghur and Han ethnic groups by the method of multi-slice computed tomography coronary angiography (MSCTCA).Methods:Seven thousand four hundred and sixty-nine MSCTCA were analyzed for the CCAAs retroactively,1934 were Uyghur patients while 4746 were Han patients.All the coronary artery images dates obtained by MSCTCA were evaluated for the CCAAs by two doctors.Results:Nineteen kinds of CCAAs were found:(1) The overall incidence of CCAAs was 2.72% (203/7469) among all patients,2.34% (111/4746) among Han patients whereas a significant higher 3.93% (76/1934) among Uyghur patients (χ^2 =12.780,P 〈 0.05); (2) the incidence of CCAAs among male patients was 2.48% (76/3069) in Han while 4.33% (56/1293) in Uyghur (χ^2 =10.663,P 〈 0.05); (3) the incidence of CCAAs on the left side was 1.07% (51/4746) among Han patients while 2.17% (42/934) among Uyghur patients (χ^2 =12.047,P 〈 0.05); (4) among these 19 kinds of CCAAs,there were significant differences of the incidence of the following kinds of CCAAs between Uyghur and Han:Left coronary artery (LCA) high location (χ^2 =8.320,P =0.004),right coronary artery (RCA) originate from left coronary sinus (χ^2 =5.450,P =0.020),and RCA originate from left Coronary sinus + LCA high location (P =0.024).Conclusions:There exists some difference in CCAAs between Uyghur and Han ethnic groups.The CCAAs incidence of Uyghur is higher than that of Han,especially in male patients and on the left side; among all kinds of CCAAs,the incidence of LCA high location,RCA originate from left coronary sinus,RCA originate from left coronary sinus + LCA high locations of Uyghur is higher than Han.
基金supported by Guangdong Province Medical Scientific Research Foundation(No.A2016116)
文摘Background At present, creation of a dual coronary system with direct aortic implantation is the preferred management for anomalous origin of left coronary artery from the pulmonary artery (ALCAPA). However, controversy still exists over the initial management of mitral regurgitation (MR) at the time of ALCAPA repair. Methods Between March 2005 and March 2015, 52 consecutive patients (20 males and 32 females) underwent direct aortic implantation of ALCAPA. Median age at surgery was 10 months (range, 2 to 193). Mean weight was 9.7_+7.8 kg. In order to facilitate the analysis, description of MR was given a numeric grade: 0 = none, 1 = trivial, 2 = mild, 2.5 = mild-moderate, 3 = moderate, 3.5 = moderate-severe, and 4 = severe. Results The LV shortening fraction (LVFS) demonstrated significant improvement between presentation and discharge (32.1±10.1% vs. 28.6±9.6%, P = 0.023), and there was also significant improvement in the mean MR grade between presentation and discharge (2.40+1.16 vs. 2.91+ 1.19, P = 0.001). There were 4 hospital deaths (7.7%). The median follow-up was 21 months (range 1.5 to 111), 3 patients (5.8%) were lost to follow-up, 1 patient required reoperation for mitral valve replacement. Significant improvement was seen in LVFS between discharge and late follow-up (38.0±6.0% vs. 32.1±10.1%, P = 0.001), however, the degree of MR did not dem- onstrate further change (2.29_+1.20 vs. 2.40+1.16, P = 0.541). Conclusion Creation of a dual coronary system with direct aortic implantation of the left coronary artery results in complete recovery of left ventricular function. Concomitant mitral valve (MV) repair for ALCAPA patients with moderate-severe and severe MR is helpful to early MV function recovery.
文摘目的研究右冠状动脉异常起源于肺动脉(anomalous origin of right coronary artery from the pulmonary artery,ARCAPA)的临床特点,了解不同手术方式的预后情况。方法回顾性分析9例确诊为ARCAPA患儿(患者)的临床资料,包括临床表现、辅助检查、手术方式及随访情况。结果共计8例患儿(儿童),1例患者(成人);男7例,女2例;患儿中位月龄67.5个月,成人患者年龄69岁。患儿中4例因活动后胸闷气促就诊,3例因体检发现心脏杂音就诊,1例因脑梗死就诊完善心脏检查诊断,成人患者因气促胸闷行冠状动脉造影检查后诊断。心电图(ECG)检查示3例患儿无明显心肌缺血表现,1例部分下壁导联深Q波,4例(均>6岁)有不同程度右胸导联ST段抬高表现,成人患者提示完全性右束支传导阻滞(CRBBB)、右胸导联T波双向;经胸超声心动图(TTE)检查显示成人患者术前左心室舒张末期内径(LVEDD)增大明显伴左心室射血分数(LVEF)下降,房室瓣重度反流;有2例患儿术前左心室舒张末期内径增大,左心室射血分数均正常。所有患儿(患者)均完成手术治疗,成人患者行右冠状动脉(RCA)异位开口修补+冠状动脉旁路移植术,5例患儿行右冠状动脉直接移植至主动脉(AO)根部手术,1例患儿右冠状动脉延长后移植至主动脉根部,2例患儿行右冠状动脉结扎术。成人患者术后使用多巴胺5 d,米力农3 d强心治疗,3 d后转出重症监护室,术后复查经胸超声心动图示房室瓣反流好转,目前随访3年,左心室射血分数正常。患儿术后撤机时间为0.5~1 d,使用强心药多巴胺1~2 d,1~2 d后转出重症监护室。目前中位随访时间为36个月,所有术后患者均心功能正常,无需要再次手术患者,无死亡患者。结论ARCAPA患者早期无明显心功能不全症状,临床表现不典型,超声心动图可能漏诊或误诊,及时手术治疗预后效果好。
文摘52-year-old man presented with a history of angina .pectoris over 3 months. He had a history ofhypertension and hyperlipidemia. His physical examination, blood chemistry, ECG, chest X-ray were normal. A treadmill exercise ECG test was performed using the Bruce protocol. Owing to 1 mm ST segment depressions at derivations DⅡ, DⅢ, aVE V4-V6, and typical chest pain at third stage the test was evaluated as ischemia-positive test. Therefore, he was scheduled fox diagnostic coronary angiography.