Aortic valve endocarditis causing fatal myocardial infarction caused by ostial coronary artery obliteration

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Stress only (SO) instead of stress/rest single photon emission computed tomography myocardial perfusion imaging (MPI) is encouraged if perfusion and left ventricular ejection fraction (LVEF) are normal on SO images. Concurrent coronary artery calcium (CAC) scoring has also been recommended to assess atherosclerotic burden in ‘normal’ MPIs. However, the safety of SO MPI in high CAC cases is unclear as additional rest imaging may show transient ischaemic dilation (TID) and/or impaired LVEF reserve (iLVEFr) which are markers of severe coronary artery disease (CAD) and indicate ‘balanced ischaemia’. Purpose We aim to assess the incidence and outcomes of TID and iLVEFr in stress/rest MPIs with normal SO images and elevated CAC. Methods Retrospective analysis of all normal stress/rest MPIs performed between 1 March 2016 to 31 January 2017 with concurrently measured CAC >300. A SO protocol was not in place then. Prone post stress images were routinely done. Known CAD cases were excluded. A reader reviewed only the post stress supine/prone images and excluded cases ineligible for SO MPI (non-homogenous perfusion, LVEF ≤50%, abnormal wall motion). The remaining cases were assessed for TID (software derived TID ratio >1.20) and iLVEFr (stress LVEF – rest LVEF ≤-5%). Coronary angiography (CAG) and major adverse cardiac events (MACE, defined as cardiac death, non fatal myocardial infarction, revascularisation) within 24 months post MPI were traced using electronic medical records. Results There were 230 cases included (mean age 71, 56.5% male) of which 43 (18.7%) had TID and/or iLVEFr (9 TID, 22 iLVEFr, 12 both). There were no significant differences in baseline characteristics, CAC and aspirin/statin use between cases with or without TID and/or iLVEFr (Table 1). More patients in the TID and/or iLVEFr group underwent elective CAG [10 (23.3%) vs 10 (5.3%), p = 0.001] although CAG diagnosis of severe CAD (left main, 3-vessel or 2-vessel disease with proximal left anterior descending involvement) was not different [4/6 (40.0%) vs 5/10 (50.0%), p = 1.000). MACE was significantly higher in the TID and/or iLVEFr group [10 (23.3%) vs 16 (8.6%), p = 0.013], driven by higher elective revascularisation [8 (18.6%) vs 8 (4.3%), p = 0.003] with no significant differences in cardiac death or non fatal myocardial infarction (Table 2). Conclusion TID and/or iLVEFr is seen in <20% of cases eligible for SO MPI with high CAC, suggesting that routine rest scan in these cases exposes the majority to unnecessary radiation. Identification of TID and/or iLVEFr is associated with higher 24 month MACE, driven by higher elective revascularisation from more CAG referral. Approximately half of cases in each group had revascularisation for non severe CAD not typically associated with TID and/or impaired LVEFr. Overall cardiac death and non fatal myocardial infarction rates were low and not significantly different between groups with or without TID and/or iLVEFr.

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Detection of Antigens of Cardiotropic Viruses in Atherosclerotic Plaques in Patients with Fatal Myocardial Infarction

Kardiologiia ◽

10.18087/cardio.2019.7.2577 ◽

2019 ◽

Vol 59 (7) ◽

pp. 38-43 ◽

Cited By ~ 1

Author(s):

Ya. V. Alekseeva ◽

M. S. Rebenkova ◽

A. E. Gombozhapova ◽

Yu. V. Rogovskaya ◽

V. V. Ryabov

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Epstein Barr Virus ◽

Parvovirus B19 ◽

Atherosclerotic Plaques ◽

Barr Virus ◽

Virus Antigens ◽

Epstein Barr ◽

Simplex Virus ◽

Fatal Myocardial Infarction

Aim. To assess the frequency of detection of cardiotropic virus antigens in coronary artery atherosclerotic plaques in patients with fatal myocardial infarction (MI).Materials and methods. We examined fragments of coronary plaques of 12 patients with fatal type 1 MI. Immunohistochemistry (IHC) of plaques was performed with the paraffin blocks using antibodies to Herpes simplex virus (HSV)-1, HSV-2, HSV-6, cytomegalovirus (CMV), parvovirus B19, adenovirus, Epstein-Barr virus and enteroviruses.Results. According to the IHC all patients had virus antigens. The most common virus agents in fragments of coronary plaques were HSV-6 (10 patients) and enteroviruses (5 patients). Antigens of CMV, parvovirus B19, adenovirus, Epstein-Barr virus were not detected in any case.Conclusions. In this study viral antigens in coronary artery atherosclerotic plaques were found in all victims of fatal MI. There was no difference in the frequency of detection and type of viral agents between plaques in culprit arteries and uncomplicated atherosclerotic plaques.

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BASILICA Trial: One-Year Outcomes of Transcatheter Electrosurgical Leaflet Laceration to Prevent TAVR Coronary Obstruction

Circulation Cardiovascular Interventions ◽

10.1161/circinterventions.120.010238 ◽

2021 ◽

Vol 14 (5) ◽

Author(s):

Jaffar M. Khan ◽

Adam B. Greenbaum ◽

Vasilis C. Babaliaros ◽

Danny Dvir ◽

Mark Reisman ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

End Points ◽

Transcatheter Aortic Valve ◽

Artery Obstruction ◽

Coronary Obstruction

Background: Coronary artery obstruction is a rare, devastating complication of transcatheter aortic valve replacement. Transcatheter electrosurgical aortic leaflet laceration (Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction [BASILICA]) is a novel technique to prevent coronary artery obstruction. We report the 1-year outcomes of the BASILICA trial. Primary end points of 30-day success and safety have been reported previously. Methods: The BASILICA trial was a prospective, multicenter, single-arm safety and feasibility study. Subjects with severe native or bioprosthetic aortic valve disease at high or extreme risk for surgery, and high risk of coronary artery obstruction, were included. End points at 1 year included death, stroke, and myocardial infarction. Source data was independently verified and end points independently adjudicated. Results: Thirty subjects were enrolled between February 2018 and July 2018. At 30 days, BASILICA was successful in 28 subjects (93.3%), there were 3 strokes (10%), including 1 disabling stroke (3.3%), 1 death (3.3%), and 1 periprocedural myocardial infarction (3.3%). Between 30 days and 1 year, there were no additional strokes, no myocardial infarction, and 2 deaths (10% 1-year mortality). No subject needed repeat intervention for aortic valve or coronary disease. Two subjects had infective endocarditis (6.7%), but neither was isolated to the aortic valve. There were no hospital admissions for heart failure. Fourteen (46.7%) subjects required repeat hospital admission for other causes. Aortic valve gradients on echocardiography, New York Heart Association functional class, and Kansas City Cardiomyopathy Questionnaire scores improved from baseline to 30 days and were maintained at 1 year. Conclusions: In these subjects with multiple comorbidities and restrictive anatomy that underwent transcatheter aortic valve replacement, there was no late stroke, myocardial infarction, or death related to BASILICA. Mitigation of coronary obstruction remained intact at 1 year and was not related to recurrent readmission. These results are reassuring for patients and physicians who wish to avoid the long-term complications related to snorkel stenting. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03381989.

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Acute Myocardial Infarction due to Coronary Artery Embolism in a Patient with a Tissue Aortic Valve Replacement

The Permanente Journal ◽

10.7812/tpp/11-082 ◽

2011 ◽

Author(s):

Joel Levis

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Artery Embolism ◽

Coronary Artery Embolism

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Investigation ofKIF6Trp719Arg gene polymorphism in a case-control study of coronary artery disease and non-fatal myocardial infarction in the Eastern Province of Saudi Arabia

Annals of Saudi Medicine ◽

10.5144/0256-4947.2016.21.3.1140 ◽

2016 ◽

Vol 36 (2) ◽

pp. 105-111 ◽

Cited By ~ 2

Author(s):

Chittibabu Vatte ◽

Cyril Cyrus ◽

Abdullah Mohammed Al Shehri ◽

Shahanas Chathoth ◽

Mohammed Almansori ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Saudi Arabia ◽

Coronary Artery ◽

Case Control Study ◽

Case Control ◽

Eastern Province ◽

Artery Disease ◽

Fatal Myocardial Infarction ◽

Control Study

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Myocardial ischaemia and valve insufficiency caused by a dysplastic aortic valve cusp: a previously unreported unique morphologic anomaly

Cardiology in the Young ◽

10.1017/s1047951120001377 ◽

2020 ◽

Vol 30 (7) ◽

pp. 1046-1049 ◽

Cited By ~ 1

Author(s):

Sharmeen Samuel ◽

Preeta Dhanantwari ◽

Nilanjana Misra ◽

David B. Meyer

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Aortic Valve ◽

Left Coronary Artery ◽

Surgical Repair ◽

Accurate Diagnosis ◽

Valve Morphology ◽

Non Invasive ◽

Valve Insufficiency ◽

Neonatal Population

AbstractIsolated aortic regurgitation and myocardial infarction are a rare congenital defect among neonatal patients. We present a case of a neonate with an unusual aortic valve morphology causing both regurgitation and obstruction of the left coronary artery ostium. Despite both non-invasive and invasive imaging modalities, accurate diagnosis of the valve morphology was only determined by direct visualisation at the time of surgical repair. To the knowledge of authors, this particular aortic valve morphology in neonatal population has not been previously reported in the literature.

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