Non-ST elevation myocardial infarction (NSTEMI) and complex coronary artery fistula in a fit 57-year-old man and its management

2021 ◽  
Vol 14 (2) ◽  
pp. e237321
Author(s):  
Muhamamd Isfandyar Khan Malik
Keyword(s):  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Main Pulmonary Artery ◽  
Coronary Artery Fistula ◽  
Stent Insertion ◽  
Wave Inversion ◽  
Gated Acquisition ◽  
St Elevation ◽  
Obtuse Marginal

A fit 57-year-old man presented with exertional chest pain to the emergency department and was found to have anterolateral T wave inversion on ECG and blood troponin of 1290. Coronary angiography showed a severe proximal to mid-course lesion in mid left anterior descending (LAD) artery, severe ostial disease in obtuse marginal 1 (OM1) and large coronary artery fistula between proximal LAD and main pulmonary artery (PA). Subsequent cardiac CT multiple gated acquisition scan showed a coronary artery to main PA fistula, fed by small branches of the LAD and right coronary artery (RCA). Cardiac magnetic resonance (CMR) showed preserved left ventricle systolic function, ejection fraction 62% and small left to right shunt. Following multidisciplinary team (MDT) discussion, the patient was offered coronary artery bypass grafting (CABG) and fistula ligation as first option, but percutaneous intervention (PCI) to the LAD would also be feasible. After lengthy discussions the patient declined CABG and opted for PCI and stent insertion.

scholarly journals 996 Non ST Elevation Myocardial Infarction (NSTEMI) And Complex Coronary Artery Fistula In A Fit 57 Year Old Man And Its Management

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
M I K Malik
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Main Pulmonary Artery ◽  
Coronary Artery Fistula ◽  
Stent Insertion ◽  
Rare Finding ◽  
Wave Inversion ◽  
Obtuse Marginal

Abstract A fit 57-year-old man presented with exertional chest pain to the emergency department and was found to have anterolateral T wave inversion on ECG and blood troponin of 1290. Coronary angiography showed a severe proximal to mid-course lesion in the mid left anterior descending artery (LAD), severe ostial disease in obtuse marginal 1 (OM1) and large a coronary artery fistula (CAF) between the proximal LAD and main pulmonary artery (PA). Subsequent cardiac computer tomography multiple gated acquisition (CT MUGA) scan showed a coronary artery to main PA fistula, fed by small branches of the LAD and right coronary artery (RCA). Cardiac magnetic resonance (CMR) showed preserved left ventricle systolic function, ejection fraction 62%, and small left to right shunt. Following multidisciplinary discussion, the consensus was to offer coronary artery bypass grafting (CABG) and fistula ligation as the first option, but percutaneous intervention (PCI) to the LAD would also be feasible. After lengthy discussions, the patient declined CABG and opted for PCI and stent insertion. CAF on angiogram is a rare finding, CAF is an abnormal connection between a coronary artery and either a cardiac chamber or a great vessel including the pulmonary artery. This case highlights a rare finding and its subsequent investigative workup and management considerations.

A Giant Right Coronary Artery of Diffuse Ectasia Induced by a Right Ventricular Fistula

2015 ◽  
Vol 18 (6) ◽  
pp. 253
Author(s):  
Renyuan Li ◽  
Yiming Ni ◽  
Peng Teng ◽  
Weidong Li
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Artery Bypass ◽  
Coronary Artery Fistula ◽  
Rare Entity ◽  
Fistula Closure ◽  
Unique Case ◽  
Coronary Ectasia ◽  
The Right ◽  
Giant Size

<p>Coronary artery fistula (CAF) is a rare entity. Sometimes it may associate with mild diffuse or segmental coronary ectasia. CAF with giant coronary artery is exceptionally rare. We present a unique case of a 49-year-old female patient with a giant right coronary artery of diffuse ectasia coexisting with a fistula draining into the right ventricle. To our best knowledge, CAF with diffuse coronary ectasia of such giant size has never been reported. The patient was treated successfully by resection of the dilated right coronary artery, fistula closure, and coronary artery bypass grafting.</p>

An Atypical Presentation of Acute Coronary Syndrome

2012 ◽  
Vol 8 (1) ◽  
pp. 67
Author(s):  
Syed Khurram Mushtaq Gardezi ◽  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular Systolic Function ◽  
Regional Wall Motion ◽  
Dobutamine Stress ◽  
Left Ventricular ◽  
Ventricular Systolic Function ◽  
Coronary Syndrome

A 61-year-old man was admitted to hospital with severe occipital headache and weakness and numbness of the left arm. His electrocardiograms showed changes hinting at acute coronary syndrome (ACS). However, in view of his clinical presentation, he underwent tests for likely subarachnoid haemorrhage, but this was ruled out. The next day, he was referred to cardiology. A transthoracic echocardiogram showed reduced left ventricular systolic function along with regional wall motion abnormalities involving inferoposterior walls. The patient was treated as per the protocol for ACS. A dobutamine stress echocardiogram confirmed inferior myocardial infarction with evidence of myocardial viability in the affected left ventricular segments. Subsequent investigations confirmed three-vessel coronary artery disease and reduced left ventricular systolic function. The patient underwent successful coronary artery bypass grafting.

scholarly journals Treatment of Iatrogenic Aortocoronary Arteriovenous Fistula with Coronary Covered Stent

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Ender Ornek ◽  
Harun Kundi ◽  
Emrullah Kiziltunc ◽  
Mustafa Cetin
Keyword(s):  
Coronary Artery ◽  
Arteriovenous Fistula ◽  
Saphenous Vein ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Covered Stent ◽  
Circumflex Artery ◽  
Coronary Vein ◽  
Coronary Artery Stent ◽  
Obtuse Marginal

An 83-year-old man, who underwent coronary artery bypass operation of left internal mammary artery (LIMA) to left anterior descending (LAD) artery, with sequential saphenous vein to the first and second obtuse marginal (OM) branches of circumflex artery 5 years ago and coronary artery stent implantation to right coronary artery 2 months ago, was admitted to the hospital with syncope and chest pain. Aortosaphenous graft selective angiography revealed that first sequential side to side ligation was inadvertently anastomosed to left posterolateral coronary vein with resultant flow into the coronary sinus and distal end to side sequential anastomosis to OM 2 coronary artery which was filling very weakly. In order to close this iatrogenic coronary arteriovenous fistula and to supply saphenous vein flow to OM artery, we decided to implant a graft covered stent into the saphenous vein at the same session.

Abstract 16231: Long-term Outcomes of Coronary Artery Bypass Grafting versus Percutaneous Coronary Intervention in Patients With Non-st Elevation Acute Coronary Syndrome

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kiro Barssoum ◽  
Ashish Kumar ◽  
Devesh Rai ◽  
Adnan Kharsa ◽  
Medhat Chowdhury ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Meta Analysis ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Long term outcomes of culprit multi-vessel and left main patients who presented with Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and underwent either coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) are not well defined. Randomized trials comparing the two modalities constituted mainly of patients with stable coronary artery disease (SCAD). We performed a meta-analysis of studies that compared the long term outcomes of CABG vs. PCI in NSTE-ACS. Methods: Medline, EmCare, CINAHL, Cochrane databases were queried for relevant articles. Studies that included patients with SCAD and ST-elevation myocardial infarction were excluded. Our primary outcome was major adverse cardiac events (MACE) at 3-5 years, defined as a composite of all-cause mortality, stroke, re-infarction and repeat revascularization. The secondary outcome was re-infarction at 3 to 5 years. We used the Paule-Mandel method with Hartung-Knapp-Sidik-Jonkman adjustment to estimate risk ratio (RR) with 95% confidence interval (CI). Heterogeneity was assessed using Higgin’s I 2 statistics. All statistical analysis was carried out using R version 3.6.2 Results: Four observational studies met our inclusion criteria with a total number of 6695 patients. At 3 to 5 years, the PCI group was associated with a higher risk of MACE as compared to CABG, (RR): 1.52, 95% CI: 1.28 to 1.81, I 2 =0% (PANEL A). The PCI group also had a higher risk of re-infarctions during the period of follow up, RR: 1.88, 95% CI 1.49 to 2.38, I 2 =0% (PANEL B). Conclusion: In this meta-analysis, CABG was associated with a lower risk of MACE and re-infarctions as compared to PCI during 3 to 5 years follow up period.

scholarly journals Echocardiographic parameters of left ventricular non-systolic function predict length of stay following coronary artery bypass graft -- a prospective observational study

2021 ◽  
Author(s):  
samhati Mondal ◽  
Nauder Faraday ◽  
Weidong Gao ◽  
Sarabdeep Singh ◽  
Sachidanand Hebbar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Hospital Stay ◽  
Coronary Artery Bypass ◽  
Prospective Observational Study ◽  
Systolic Function ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Echocardiographic Parameters ◽  
Systolic Phase

Background: Abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase, with or without a diagnosis of heart failure, is a common finding that can be easily diagnosed by intra-operative transesophageal echocardiography (TEE). However, its association with duration of hospital stay after coronary artery bypass (CAB) is unknown. Objective: To determine if Abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase is associated with length of hospital stay after coronary artery bypass surgery (CAB). Method: Prospective observational study at a single tertiary academic medical center Result: Median time to hospital discharge was significantly longer for subjects with abnormal left ventricular (LV) echocardiographic parameters during non-systolic phase (9.1/IQR 6.6-13.5 days) than those with normal LV non-systolic function (6.5/IAR 5.3-9.7days) (P< 0.001). The probability of hospital discharge was 34% lower (HR 0.66/95% CI 0.47-0.93) for subjects with abnormal LV function even during non-systole despite a normal LV systolic function, independent of potential confounders, including a baseline diagnosis of heart failure Conclusions and Relevance: In patients with normal systolic function undergoing CAB, non-systolic LV dysfunction is associated with prolonged duration of postoperative hospital stay. This association cannot be explained by baseline comorbidities or common post-operative complications.

scholarly journals Familial Hypercholesterolaemia With Premature Coronary Artery Disease: A Case Report

2020 ◽  
Vol 1 (3-4) ◽  
pp. 150-153
Author(s):  
Chandramukhi Sunehra ◽  
Krishnaswamy Raghu
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Systolic Function ◽  
Color Doppler ◽  
Artery Bypass ◽  
Density Lipoprotein ◽  
Left Ventricular ◽  
Lipid Lowering ◽  
Premature Coronary Artery Disease ◽  
Artery Disease

A young, 18-year-old lady presented with history of chest pain on exertion typical of angina. General examination revealed multiple tendon xanthomas. Systemic examination was unremarkable. Electrocardiogram showed segment (ST) depression in inferior and lateral leads. Echocardiogram revealed normal left ventricular systolic function and no left ventricular regional wall motion abnormalities. Diastolic flow turbulence was noted in the left main coronary artery and proximal left anterior descending artery on color Doppler interrogation across the coronary arteries. Lipid profile showed unusually high total cholesterol and low-density lipoprotein cholesterol. Subsequent evaluation with coronary angiogram revealed triple vessel coronary artery disease. The patient underwent coronary artery bypass surgery and is on antiplatelet and lipid-lowering drug therapy.

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