scholarly journals 478 A rare case of right ventricular ischaemia and ventricular tachycardia in neonate caused by intermittent occlusion of origin of the right coronary artery by an echogenic mass

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Padmanabhan
Keyword(s):  
Ventricular Tachycardia ◽  
Coronary Artery ◽  
Early Diagnosis ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Right Coronary Artery ◽  
Perinatal Asphyxia ◽  
Poor Condition ◽  
Post Surgery ◽  
The Right

Abstract OnBehalf Cornwall A term neonate with poor condition at birth was noted to be markedly bradycardic when crying. ECG showed first degree heart block. Echocardiogram demonstrated poor bi-ventricular function. He was treated for Hypoxic ischemic encephalopathy (HIE). In the next few hours he developed short episodes of ventricular tachycardia with left bundle branch block and non-conducted P waves suggesting an origin of tachycardia from the right ventricle. His repeat ECHO suggested that he had right ventricular infarction due to a very rare finding of intermittent occlusion of the origin of the right coronary artery by an echogenic mass. He was transferred for emergency cardiac surgery to remove a clot of 1.6cm, occluding the right coronary artery. Histology findings were in keeping with a thrombus. Thrombophilia screen for both parents and infant were negative. MRI Brain did not show evidence of HIE suggesting his poor condition at birth was secondary to intermittent coronary ischemia. Discussion: Myocardial infarction (MI) in neonates is a rarely encountered and potentially life-threatening condition, with mortality rate as high as 90%. We present one of the first reported cases of successful surgical management of an acute right coronary artery thrombosis after an early diagnosis. The cause of thrombosis remains unclear in our patient. They were born in poor condition with initial pH 6.9 and lactate of 10, but with a structurally normal heart and negative thrombophilia screen. Perinatal asphyxia is a potential cause; however there is doubt that this may be a symptom rather than cause of the right coronary artery occlusion. Early diagnosis was key in management after a high level of clinical suspicion. He made significant recovery with near normal RV function, and is currently on captopril and carvedilol post-surgery. This is one of the first cases to document near full return of cardiac function following ischaemia to the right ventricle Abstract 478 Figure. 5

Congenital bifid origin of right coronary artery co-existing with congenital right coronary to right ventricular fistula

1997 ◽  
Vol 7 (3) ◽  
pp. 325-327
Author(s):  
Samuel Ramirez-Marroquin ◽  
Alfredo Santibañez-Salgado ◽  
Juan Calderon-Colmenero
Keyword(s):  
Coronary Artery ◽  
Right Ventricle ◽  
Right Ventricular ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
World Literature ◽  
Anomalous Origin ◽  
One Year ◽  
The Right

AbstractAnomalous origin of the coronary arteries is a well-known phenomenon, but is less well reported in world literature. We present our findings in a one year old boy in whom there was bifid, or “y”, origin of the right coronary artery, co-existing with a fistula from the right coronary artery which opened into the right ventricle.

Defective regional myocardial development and vascularization in one variant of tricuspid atresia—clinical and necropsy findings in three cases

1992 ◽  
Vol 2 (1) ◽  
pp. 42-52 ◽  
Author(s):  
William N. O'Connor ◽  
Carol M. Cottrill ◽  
Michael T. Marion ◽  
Jacqueline A. Noonan
Keyword(s):  
Coronary Artery ◽  
Right Ventricle ◽  
Tricuspid Valve ◽  
Right Coronary Artery ◽  
Interventricular Septum ◽  
Ventricular Myocardium ◽  
Tricuspid Atresia ◽  
Subaortic Stenosis ◽  
Myocardial Development ◽  
The Right

SummaryFive previously reported cases have established the combination of a small right ventricle (sometimes with Uhl's anomaly), imperforate tricuspid valve with fibrotic tensor apparatus, congenital absence of the pulmonary valve, and an intact interventricular septum with muscular subaortic stenosis as a rare variant of tricuspid atresia. In this study of three new autopsy cases, we additionally identified Ebstein's malformation of the imperforate tricuspid valve, partial Uhl's anomaly, regional dysplasia of right ventricular myocardium and thinning of the interventricular septum by intramyocardial sinusoids from the right ventricle. All three new cases had epicardial anomalies of the right coronary artery—a fistula to right ventricle, ostial stenosis and proximal arterial hypoplasia. Sinusoidal connections from the right ventricle to the right coronary artery and to the sclerotic left anterior descending artery were identified in serial sections of the right ventricle and septum. Myofiber disarray, with thick walled intramyocardial arteries and sinusoids from left ventricle, involved the bulging subaortic interventricular septum. These studies are consistent with the hypothesis that defective development of the the right ventricle, along with its blood supply and associated atrioventricular and arterial valves, may underlie this unusual form of congenital heart disease.

Phasic characteristics of arterial inflow and venous outflow of right ventricular myocardium in dogs

1992 ◽  
Vol 262 (5) ◽  
pp. H1422-H1427 ◽  
Author(s):  
O. Hiramatsu ◽  
A. Kimura ◽  
T. Yada ◽  
T. Yamamoto ◽  
Y. Ogasawara ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Ventricular ◽  
Right Coronary Artery ◽  
Pulmonary Stenosis ◽  
Systolic Pressure ◽  
Laser Doppler Velocimeter ◽  
Venous Outflow ◽  
Coronary Veins ◽  
Arterial Inflow ◽  
The Right

To clarify the characteristics and causes of phasic blood flow in coronary circulation of the right ventricle we measured blood velocities in peripheral portions of the right coronary artery and vein in dogs under three conditions: control, transient pulmonary stenosis, and isoproterenol administration. An optical fiber sensor of a laser Doppler velocimeter was fixed onto the vessels (150-500 microns OD) with cyanoacrylate. The phasic pattern of distal arterial velocity was compared with the proximal velocity in the right coronary artery measured with an ultrasound pulsed Doppler velocimeter. Systolic-to-total velocity area ratio in the small epicardial artery [0.38 +/- 0.03 (SE)] was found to be smaller than in the large epicardial artery (0.51 +/- 0.02, P less than 0.01), indicating a capacitive filling of the epicardial artery during systole. The velocity waveform in small right coronary veins was predominantly systolic; i.e., it increased with a rise of right ventricular pressure and decreased with right ventricular relaxation. Comparison of the waveforms during isoproterenol infusion and pulmonary stenosis indicates that contraction of the ventricle is more important than right ventricular systolic pressure in retarding arterial inflow and accelerating venous outflow.

The Influence of Collateral Flow on the Antegrade and Retrograde Distribution of Cardioplegia in Patients with an Occluded Right Coronary Artery 

1998 ◽  
Vol 89 (5) ◽  
pp. 1099-1107 ◽  
Author(s):  
Solomon Aronson ◽  
Eric Jacobsohn ◽  
Robert Savage ◽  
Mario Albertucci
Keyword(s):  
Coronary Artery ◽  
Right Ventricle ◽  
Right Coronary Artery ◽  
Contrast Echocardiography ◽  
Coronary Artery Occlusion ◽  
Artery Occlusion ◽  
Collateral Flow ◽  
Predictive Values ◽  
Antegrade Cardioplegia ◽  
The Right

Background The predictive value of electrocardiography (ECG) and coronary angiography for cardioplegia distribution in patients with an occluded right coronary artery was evaluated. Methods Coronary angiograms and ECGs were evaluated in 15 patients with right coronary artery occlusion. Prediction of antegrade cardioplegia distribution was based on ECG evidence of infarction and coronary collateral flow determined from the angiogram. Antegrade and retrograde delivery of cardioplegia was directly assessed in all patients by myocardial contrast echocardiography. Intraoperative transesophageal echocardiographic images of the right ventricular free wall, the apex, and the intraventricular septum were recorded while 4 ml of Albunex (Mallinckrodt Medical, St. Louis, MO) was injected into antegrade and retrograde cardioplegic catheters during cardioplegia delivery. The observed (myocardial contrast echocardiography) cardioplegia distribution was compared to the predicted cardioplegia distribution. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated. Results Eighty seven of 90 (97%) segments were analyzed. Angiography and ECG poorly predicted incomplete cardioplegia distribution. Electrocardiography was a better predictor of inadequate cardioplegia distribution to the right ventricle than was angiography. The negative predicted values of cardioplegia distribution ranged from 20 to 50% for the septum and right ventricle, respectively, with ECG criteria and from 0 to 33% for the septum and apex, respectively, with angiographic criteria. Antegrade cardioplegia delivery was distributed to the right ventricle in 31% of patients, despite 100% occlusion of the right coronary artery; whereas retrograde cardioplegia delivery to the right ventricle occurred 20% of the time. Conclusions In the presence of 100% right coronary artery occlusion, retrograde cardioplegia delivery is not often observed and antegrade delivery of cardioplegia to the right ventricle is not easily predicted. The preoperative angiography and ECG are not predictive of coronary collateral circulation and therefore not predictive of cardioplegia distribution to the right ventricle.

scholarly journals A case of right ventricular infarction due to acute Type A aortic dissection with anomalous aortic origin of the right coronary artery from the left sinus of Valsalva

2021 ◽  
Author(s):  
Yojiro Machii ◽  
Naohiro Shimada ◽  
Takashi Okamoto ◽  
Masashi Tanaka
Keyword(s):  
Coronary Artery ◽  
Aortic Dissection ◽  
Right Ventricular ◽  
Right Coronary Artery ◽  
Acute Type ◽  
Sinus Of Valsalva ◽  
Right Ventricular Infarction ◽  
Ventricular Infarction ◽  
The Right ◽  
Left Sinus Of Valsalva

Anomalous aortic origin of a coronary artery from the opposite sinus is a rare congenital condition that can cause sudden death in young people. When it is associated with acute aortic dissection, acute myocardial infarction can occur due to enlargement of the sinus of Valsalva. We report the case of a 71-year-old man with anomalous origin of the right coronary artery from the left sinus of Valsalva, who developed right ventricular infarction due to the compression of the right coronary artery between the aorta and pulmonary artery trunk.

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