Percutaneous cervical carotid artery access with stenting of the left internal carotid artery in an elderly patient

To describe the successful endovascular treatment in a nonagenarian with symptomatic internal carotid artery stenosis using direct carotid artery access. An independent 98 year-old man was admitted to our hospital for symptoms of progressive weakness with disorientation and dysphasia. Carotid Duplex ultrasonography was performed which revealed a totally occluded right internal carotid artery and high grade stenosis of the left internal carotid artery by velocities of 608/240 cm/sec. The patient refused surgical endarterectomy and thus he was referred for carotid artery stenting. Using the femoral artery approach and multiple catheter techniques, access to the common carotid artery could not be accomplished safely. The procedure was aborted and he was therefore brought back to the catheterization laboratory the following day for direct carotid access. Carotid artery stenting was accomplished by using of a 6F sheath percutaneously in the left common carotid, cerebral protection device (CPD) and a Nitinol stent. The patient was discharged the following day without complications. At 14 months follow-up the patient is functional and independent without recurrence of symptoms. Carotid artery stenting via direct access can be accomplished in patients when the femoral artery approach is anatomically prohibitive. In this case of advanced age and the patient’s refusal for surgery, direct carotid access was his only option.

Surgical treatment of abnormal systemic artery to the left lower lobe: A case report

BACKGROUND Abnormal systemic artery to the left lower lobe is a rare congenital abnormality characterized by anomalous communication between the systemic and pulmonary circulation.Owing to its rarity,there is limited clinical experience with respect to the diagnosis and treatment of this disease.CASE SUMMARY We report a 60-year-old man who presented with a history of hemoptysis for 20 d.Contrast-enhanced computed tomography of the chest confirmed the diagnosis of abnormal systemic artery to the left lower lobe,and surgical treatment was performed.The aberrant artery arising from the descending thoracic aorta was ligated,followed by removal of the left lower lobe.The patient showed good recovery and was discharged 6 d after the surgery.At the 1-year follow-up,the patient had recovered completely,and lung CT showed no abnormal findings.CONCLUSION We present a case of abnormal systemic artery to the left lower lobe that was successfully managed by surgical resection of the aberrant artery and the left lower lobe.This case report adds to the clinical experience of diagnosing and treating this rare entity.

How much can be inferred from the left main coronary artery?

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.

Rise of the Right and Regression of the Left in Latin America

Though the turn to the right in Latin America will continue over the short term, the left has not diminished and its resurgence remains possible. The political situation in Latin America has undergone dramatic changes since 2015, when an ebbing of the"pink tide"and rise of the right in several countries occurred, coupled with US support to the right.Flexible political strategies and rightists' political pragmatism are occurring as the continent's middle class expands, coupled with US support to the right. Some conditions that promote the right's revival remain operative, but for the new right regimes, addressing economic vitality, the wellbeing of the poor, corruption, and divisions from within are imminent challenges against which a left resurgence has competitive ground.

Misdiagnosis of hemangioma of left triangular ligament of the liver as gastric submucosal stromal tumor:Two case reports

BACKGROUND Extragastric lesions are typically not misdiagnosed as gastric submucosal tumor(SMT).However,we encountered two rare cases where extrinsic lesions were misdiagnosed as gastric SMTs.CASE SUMMARY We describe two cases of gastric SMT-like protrusions initially misdiagnosed as gastric SMTs by the abdominal contrast-enhanced computed tomography(CT)and endoscopic ultrasound(EUS).Based on the CT and EUS findings,the patients underwent gastroscopy;however,no tumor was identified after incising the gastric wall.Subsequent surgical exploration revealed no gastric lesions in both patients,but a mass was found in the left triangular ligament of the liver.The patients underwent laparoscopic tumor resection,and the postoperative diagnosis was hepatic hemangiomas.CONCLUSION During EUS procedures,scanning across different layers and at varying degrees of gastric cavity distension,coupled with meticulous image analysis,has the potential to mitigate the likelihood of such misdiagnoses.

Surgical Outcomes of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Children： An Echocardiography Follow？up

Background：Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare but potentially life-threatening congenital heart defect. A retrospective analysis was carried out to elucidate the surgical outcomes of ALCAPA in infants and children using follow-up echocardiography. Methods： From September 2008 to March 2017, 26 children diagnosed with ALCAPA underwent left coronary re-implantation. All surviving patients received echocardiography during follow-up. Results： The mortality rate after the operation was 11.5%. Before repair, twenty patients （76.9%） presented with left ventricular （LV） dysfunction. The mean Z-score of the preoperative LV end-diastolic diameter was 4.42 ± 2.09. Mitral regurgitation （MR） was present in all patients. Two patients （7.7%）, both with mitral valve prolapse, underwent mitral valve repair at the time of ALCAPA repair. Two children required postoperative extracorporeal membrane oxygenation. LV function normalized at a median time of 5.3 months （range：0.5–36.0 months）. The Z-score of the LV end-diastolic diameter decreased simultaneously. The degree of MR gradually decreased in all surviving patients.All patients had patency of the proximal left coronary artery confirmed by echocardiography at the most recent follow-up. Six patients （26.1%） showed supravalvar pulmonary stenosis and seven patients （30.4%） showed right pulmonary stenosis during follow-up. Conclusions： Coronary re-implantation was effective for rebuilding a dual coronary system in patients with ALCAPA and resulted in progressive improved LV function and reduced functional MR. Echocardiography was valuable for evaluating the outcomes. LV function, the degree of MR, and possible complications could be detected with follow-up echocardiography.

UNRUPTURED ANEURYSM OF THE LEFT CORONARY SINUS OF VALSALVA ASSOCIATED WITH ANEURYSM OF THE INTERVENTRICULAR SEPTUM

Aneurysms of the coronary sinus of Valsalva are commonly seen in the oriental people.Their clinical courses and prognosis depend on the location,size and propensity to rupture.They often occur in the right coronary sinus and tend to rupture to the

Angiographic differentiation of systolic narrowing of the left anterior descending coronary artery in hypertrophic cardiomyopathy from myocardial bridges

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.

Left Atrium Emboligenic Myxoma: Case Report and Review of the Literature

Introduction: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. Observation: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. Conclusion: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.

Postoperative management of patients with repair of anomalous origin of the left coronary artery from the pulmonary arterya report of 30 cases

Anomalous origin of the left coronary artery from the pulmonary artery （ALCAPA） is a rare congenital anomaly It demonstrated the combined effects of the absence of a normal coronary flow with a coronary steal and the profound ischemia that can produce left ventricular dysfunction and mitral regurgitation. We here introduce the postoperative management of patients with repair of anomalous ori artery from the pulmonary artery, with an emphasis on its outcome. Methods Reco gin rds of the left coronary of 31 patients with anomalous origin of the left coronary artery from the pulmonary artery receiving surgery from 1998 to 2010 were reviewed retrospectively, 10 of which were treated with the mitral valve surgically at the same time. The age of patients was 4 months to 16 years （m kilograms）, all of which were diagno edian, sed of anomalous origin of the left coronary artery from the pulmonary by echocardiography and cardiac catheterization. After surgery, electrocardiogram, echocardiography, arterial blood pressure, transcutaneous oxygen saturation and central venous pressure were monitored. Common postoperative complications in our group were analysed. And preoperative and postoperative data including area of mitral regurgitation, left ventricular systolic diameter and left ventricular distolic diameter were obtained. Cardiopulmonary bypass time and mechanical ventilation time of postoperative patients with no pneumonia were compared with those with pneumonia. Binary logistic regression was applied for the analysis of the risk factors of postoperative pneumonia. Results Of 31 patients, 30 survived after surgery with early mortality of 3.23%. One patient died of severe low cardiac output syndrome. Mechanical ventilation time was 4 hours to 168 hours hours （mean, 39.68 ± 50.52 hours; median, 18 hours）. ICU stay was 16 hours to 425 hours （mean, 111.65 ± 127.03 hours; median, 44 hours）. In our group, common postoperative complications were myocardial ischemia（n = 12, 36.4%）, infection（n = 11, 33.3%） including pneumonia （n = 10, 30.3%）, postoperative tachyarrhythmia（n = 5, 15.2%）, low postoperative cardiac output（n = 2, 6.1%）, endocarditis（n = 1, 3.0%）. Compared with preop-erative data, postoperative data including area of mitral regurgitation, left ventricular systolic diameter and left ventricular distolic diameter decreased remarkably（P 〈 0.01）, with left ventricular ejection fraction significantly improved （P 〈 0.05）. Compared with mechanical ventilation time of patients with no postoperative pneumonia, time of those with pneumonia apparently prolonged（P 〈 0.01 ） while cardiopulmonary bypass time extended （P 〈 0.05）. Mechanical ventilation time was a risk factor of postoperative pneumonia （OR = 1.041, OR 95%CI = （1.010, 1.073）. Conclusions Proper therapy strategies according to the knowledge of the ALCAPA disease and the change of postoperative pathology and physiology play an important role in avoiding the postoperative complications and improving postoperative outcomes.

Percutaneous placement of an IABP in the left axillary/subclavian position provides safe,ambulatory long-term support as bridge to heart transplantation

Objectives We evaluated the feasibility, tolerability, and efficacy of a strategy for percutaneous pump （IABP） placement through the left axillary-subelavian artery to provide mechanical in patients with end-stage heart failure as a bridge to heart transplantation. intra-aortic balloon circulatory support

Sweet Nothings Are Better Heard in the Left Ear

首先我们应该弄明白标题中的主语Sweet Nothings为何物?其含义是:情话。如:whisper sweet nothings in somebody's ear对某人悄悄地说情话。本文对告诉年轻人:说情话,请对准对方的左耳。为什么?请细读本文!】

Lu Xun, Shin Eon-jun, and Karashima Takeshi

Shin Eon-jun and Karashima interacted with Lu Xun during a similar period but their relationships with him proceeded in different directions. Shin Eon-jun participated in the independence movements in Korea, introduced Lu Xun from the progressive position, and actively reported the political situation and philosophical trends in China. On the other hand, Karashima put his major focus on Lu Xun and left wing literature, when introducing the new literature of China, but gradually revealed an opportunistic attitude and actively participated in promoting Japan＇s ＂National Policy.＂

FOREIGN ABSTRACT COLLECTION

Contrast-induced acute kidney injury after primary percutaneous coronary intervention： Results from theHORIZONS-AMI substudy