scholarly journals What is the cause of hypotension? A rare complication of percutaneous coronary intervention of a chronic total occlusion: a case report

2019 ◽  
Author(s):  
Vincenzo Vetrugno ◽  
Harish Sharma ◽  
Jonathan N Townend ◽  
Sohail Q Khan
Keyword(s):  
Coronary Arteries ◽  
Rare Complication ◽  
Coronary Intervention ◽  
Percutaneous Treatment ◽  
Total Occlusion ◽  
Severe Hypotension ◽  
Atrioventricular Groove ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
High Index Of Suspicion

Abstract Background In the last few years, complex techniques and advanced equipment became available to treat chronically occluded coronary arteries. Such procedures portend a series of possible complications that operators should be ready to quickly recognize and deal with. Case summary A 75-year-old lady with uncontrolled stable angina underwent percutaneous treatment of a chronically occluded right coronary artery. After balloon angioplasty and stenting, she developed a severe hypotension, refractory to fluid resuscitation and vasopressors. Computerized tomography scan demonstrated an intramural haematoma (IMH) of the right atrioventricular groove resulting in life-threatening pseudotamponade (or dry tamponade), as further confirmed by cardiac magnetic resonance imaging (MRI). The decision was for conservative management and haemodynamic support by intra-aortic balloon pump. Clinically, the patient improved and was discharged a few days later. Follow-up MRI confirmed resolution of the IMH. Discussion Severe hypotension during percutaneous treatment of chronically occluded coronary arteries may be related to various causes. Differential diagnosis is thus important in this setting and should include IMH, a rare but potentially fatal complication as it may cause compression of cardiac chambers and lead to pseudotamponade. A high index of suspicion is required to diagnose IMH but there are no clear guidelines for management of such cases.

scholarly journals Case report: Recovery after large intramyocardial dissecting haematoma of the ventricular septum—a rare complication of myocardial infarction

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
David Lovasz ◽  
Daniele Camboni ◽  
Judith Zeller ◽  
Christof Schmid
Keyword(s):  
Myocardial Infarction ◽  
Plaque Rupture ◽  
Rare Complication ◽  
Coronary Intervention ◽  
Ventricular Septum ◽  
Feasible Option ◽  
Life Threatening ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Abstract Background Intramyocardial dissecting haematoma is a rare and potentially life-threatening complication of myocardial infarction (MI). Only a few isolated cases have been reported so far. Case summary We report the case of a patient with a large, obstructing intramyocardial haematoma of the ventricular septum following MI due to plaque rupture of the right coronary artery (RCA) and following successful coronary intervention. The clinically inapparent haematoma was discovered during routine echocardiography and confirmed by both computed tomography (CT) and magnetic resonance imaging (MRI). With non-surgical treatment, the patient remained clinically stable. Repeated echocardiography showed gradual regression of the haematoma. Follow-up echocardiography 3 months after the initial diagnosis demonstrated no evidence of septal haematoma. Discussion This report suggests that even large intramyocardial haematoma may recede without operative intervention. Echocardiography, CT, and MRI are all helpful in quantifying the size of the haematoma. The appropriate management should be patient-oriented, depending on clinical stability and progression of the haematoma. Conservative treatment in clinically stable patients suffering from septal haematoma following MI and coronary intervention can be a feasible option.

scholarly journals Unnecessary PCI Attempt for Presumed CTO Which Was Revealed To Be Anomalous Coronary Arteries – Role of Coronary CT Angiography

2020 ◽  
Vol 23 (5) ◽  
pp. E665-E667
Author(s):  
Hyungdon Kook ◽  
Jin-Ho Choi ◽  
Hyun Jong Lee ◽  
Cheol Woong Yu
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
The Right ◽  
Anomalous Coronary ◽  
Anomalous Coronary Arteries

Herein, we present a brief case of anomalous coronary arteries mistaken to be chronic total occlusion. Since we first presumed the anomalous coronary arteries to be chronic total occlusion of the distal right coronary artery, percutaneous coronary intervention was attempted for the presumed lesion, but it failed. Before the second attempt of percutaneous coronary intervention, coronary computed tomography angiography revealed the coronary artery from the left anterior descending artery corresponding with the distal part of the right coronary artery without connection to the right coronary artery. Therefore, we recognized the patient had anomalous coronary arteries with no connection of the vascular wall between the main and distal segments of the right coronary artery. This case may give insights to the importance of meticulous examination of coronary computed tomography angiography imaging before chronic total occlusion percutaneous coronary intervention to avoid the unnecessary procedure.

scholarly journals Debate of Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in a Multimorbidity Patient with Complex Coronary Lesions

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Sotirios Mitsiadis ◽  
Nikolaos Miaris ◽  
Antonios Dimopoulos ◽  
Anastasios Theodosis-Georgilas ◽  
Spyridon Tsiamis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Syntax Score ◽  
Complete Revascularization ◽  
Total Occlusion ◽  
Diagonal Branch ◽  
Coronary Lesions ◽  
Artery Disease ◽  
The Right

Background. While complete revascularization in coronary artery disease is of high priority, the method of implementation in patients with complex coronary lesions and multiple comorbidities is not directed by published guidelines. Case Presentation. A 53-year-old female with a chronic total occlusion of the right coronary artery and a bifurcation lesion of the left anterior descending artery and the first diagonal branch, presented with non-ST elevation myocardial infarction. Her past medical history concerned thymectomy and prior chest radiation for thymoma, myasthenia gravis, peripheral artery disease, and cervical cancer treated with surgery and radiation. Although SYNTAX score II favored surgical revascularization, the interventional pathway was finally successfully followed. However, it was complicated with vessel perforation and tamponade managed with pericardiocentesis. Conclusion. Comorbidities are not all involved in common risk models and require individualization until more evidence comes to light.

Vascular aneurysm producing divided right atrium in a patient with pulmonary atresia and intact ventricular septum

2000 ◽  
Vol 10 (3) ◽  
pp. 281-285 ◽  
Author(s):  
John C. Wood ◽  
Miguel Reyes-Mugica ◽  
Gary Kopf
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Right Atrium ◽  
Pulmonary Atresia ◽  
Pulmonary Trunk ◽  
Ventricular Septum ◽  
Intact Ventricular Septum ◽  
Atrioventricular Groove ◽  
The Right

AbstractWe describe a patient with pulmonary atresia and intact ventricular septum in whom the right atrium was divided by a vascular aneurysm located in the right atrioventricular groove. We postulate that the structure represents an aneursymally dilated right coronary artery taking anomalous origin from the pulmonary trunk, with fistulous communication to the right atrium. We discuss the findings relative to concepts of development of the coronary arteries in normal hearts and in pulmonary atresia with an intact ventricular septum.

Aspergillus meningitis and discitis from low-back procedures in an immunocompetent patient

2007 ◽  
Vol 48 (6) ◽  
pp. 687-689 ◽  
Author(s):  
A. B. Larson Kolbe ◽  
A. M. McKinney ◽  
A. Tuba Karagulle Kendi ◽  
D. Misselt
Keyword(s):  
Steroid Injection ◽  
Rare Complication ◽  
Immunocompetent Patient ◽  
Epidural Steroid Injection ◽  
Low Back ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
The Right ◽  
Epidural Steroid ◽  
The Brain

We present a case of an immunocompetent patient who developed Aspergillus meningitis, subsequent to discitis, presumed to be from an epidural steroid injection. Magnetic resonance imaging (MRI) of the lumbar spine confirmed the diagnosis of discitis. Fluoroscopic-guided aspiration of the disc showed growth of Aspergillus fumigatus. MRI of the brain revealed involvement of the right third cranial nerve. Repeat MRIs demonstrated multiple leptomeningeal masses consistent with granulomatous meningitis. Meningitis is a rare complication of discitis, discogram, or epidural steroid injection. Aspergillus usually only infects immunocompromised patients, but rarely can affect immunocompetent patients.

scholarly journals Percutaneous treatment of anomalous right coronary artery with malignant course. Report of three cases

2021 ◽  
pp. 1-7
Author(s):  
Maurício Prudente ◽  
Henrique Guimarães ◽  
Débora Rocha ◽  
Flavio Barbosa ◽  
Frederico Nacruth ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Surgical Intervention ◽  
Coronary Intervention ◽  
Percutaneous Treatment ◽  
Coronary Anomalies ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
The Right ◽  
Ischemic Events

Coronary anomalies are rare congenital malformations that are associated with an increased risk of arrhythmias, ischemic events and sudden death. Many remain asymptomatic throughout the patient’s life, and are diagnosed incidentally by imaging tests. The treatment is necessary when ischemia is confirmed or in the presence of symptoms, and surgical intervention is the method of choice. However, some studies allow percutaneous treatment to be used as an alternative, especially in anomalies of the right coronary artery. In view of this, the objective of this study was to report three cases of congenital malformation of the right coronary artery treated by percutaneous coronary intervention.

Multivessel primary PCI in patient with peripheral arterial disease

2017 ◽  
Vol 14 (1) ◽  
pp. 35-38
Author(s):  
Bishal K.C. ◽  
Chandra Mani Adhikari ◽  
Binay Kumar Rauniyar ◽  
Deepak Limbu ◽  
Rabi Malla
Keyword(s):  
New York ◽  
Coronary Arteries ◽  
Heart Association ◽  
Coronary Intervention ◽  
Arterial Disease ◽  
Sudden Onset ◽  
Functional Class ◽  
Total Occlusion ◽  
St Segment Elevation ◽  
Temporary Pacing

Thrombosis of multiple coronary arteries is extremely rare finding in the setting of acute myocardial infarction. This often leads to cardiogenic shock and sudden cardiac death. We report a case of 61 years old gentleman who presented with complaints of sudden onset of chest pain of 4hours duration and dizziness with near syncope 2 hours prior to presentation and ST segment elevation in anterior and inferior leads with complete heart block. Coronary angiogram revealed total occlusion of left anterior descending (LAD) and right coronary arteries (RCA). After the PCI to RCA follwed by LAD, patient went into Pulse less electrical activity. Cardiopulmonary resuscitation, immediate percutaneous coronary intervention of the LAD and RCA, temporary pacing, immediate intubation and mechanical ventilation was carried out. The patient was eventually discharged with a New York Heart Association functional class II heart failure.Nepalese Heart Journal 2017; 14(1): 35-38

Tunnelling a calcified total occlusion

2021 ◽  
pp. 021849232110410
Author(s):  
Jogendra Singh ◽  
Dibyasundar Mahanta ◽  
Rudra P Mahapatra ◽  
Ramachandra Barik
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Right Coronary Artery ◽  
Chronic Total Occlusion ◽  
Coronary Intervention ◽  
Alternative Technique ◽  
Total Occlusion ◽  
Alternative Approach ◽  
Calcific Plaque ◽  
The Right

Among the complex and high-risk coronary intervention cases, a calcified total occlusion of coronary artery poses a great challenge. We came across a 48 years old male who had calcified total occlusion of the right coronary artery. The chronic total occlusion was crossed using Nic-Nano balloon and the calcific plaque was modified using intravascular lithotripsy as an alternative technique to rotational atherectomy which we felt as an evolving alternative approach to treat the calcified total occlusion.

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