Trauma induced by nontraumatic coronary devices and its impact on vascular reactivity and morphology

2002 ◽  
Vol 283 (6) ◽  
pp. H2356-H2362 ◽  
Author(s):  
Jörg M. Strotmann ◽  
Johann Bauersachs ◽  
Daniela Fraccarollo ◽  
Michael Kirchengast ◽  
Philipp A. Schnabel ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Vascular Reactivity ◽  
Low Pressure ◽  
Coronary Perfusion ◽  
Neointima Formation ◽  
Clinical Consequences ◽  
The Right ◽  
And Function ◽  
Endothelial Nitric Oxide ◽  
The Impact

This study evaluated the impact of low-pressure balloon devices on coronary morphology and function. An active coronary perfusion catheter (2.5-mm balloon diameter, inflation with 1 bar for 30 min) was placed in the left anterior descending coronary artery of 12 German landrace pigs under general anesthesia. After 3 mo, coronary segments with balloon contact were compared with control segments taken from the right coronary artery as to histology, vascular reactivity, and expression of endothelial nitric oxide synthase. Thirty-three balloon treated segments were analyzed. Twenty of these segments (61%) showed neointima formation. In these segments endothelium-independent relaxation induced by sodium nitroprusside was preserved. However, endothelium-dependent bradykinin-induced relaxation was significantly attenuated compared with both the control segments and the balloon-treated segments without neointima formation. In >60% of the ballooned arterial segments examined, low-pressure balloon devices induced neointima formation accompanied by reduced endothelium-dependent relaxation. Thus interventions with so-called nontraumatic coronary devices can induce relevant vascular injury, with potential adverse clinical consequences.

Biology of bone marrow-derived endothelial cell precursors

2007 ◽  
Vol 292 (1) ◽  
pp. H1-H18 ◽  
Author(s):  
Gina C. Schatteman ◽  
Martine Dunnwald ◽  
Chunhua Jiao
Keyword(s):  
Bone Marrow ◽  
Endothelial Cell ◽  
Marrow Cell ◽  
Tumor Type ◽  
Physiological Relevance ◽  
Bone Marrow Derived Cells ◽  
And Function ◽  
Endothelial Nitric Oxide ◽  
The Impact ◽  
Endothelial Precursors

Over the past decade, the old idea that the bone marrow contains endothelial cell precursors has become an area of renewed interest. While some still believe that there are no endothelial precursors in the blood, even among those who do, there is no consensus as to what they are or what they do. In this review, we describe the problems in identifying endothelial cells and conclude that expression of endothelial nitric oxide synthase may be the most reliable antigenic indicator of the phenotype. The evidence for two different classes of endothelial precursors is also presented. We suggest that, though there is no single endothelial cell precursor, we may be able to use these phenotypic variations to our advantage in better understanding their biology. We also discuss how a variety of genetic, epigenetic, and methodological differences can account for the seemingly contradictory findings on the physiological relevance of bone marrow-derived precursors in normal vascular maintenance and in response to injury. Data on the impact of tumor type and location on the contribution of bone marrow-derived cells to the tumor vasculature are also presented. These data provide hope that we may ultimately be able to predict those tumors in which bone marrow-derived cells will have a significant contribution and design therapies accordingly. Finally, factors that regulate bone marrow cell recruitment to and function in the endothelium are beginning to be identified, and several of these, including stromal derived factor 1, monocyte chemoattractant factor-1, and vascular endothelial growth factor are discussed.

scholarly journals Anomalous Origin of Coronary Arteries

2020 ◽  
Author(s):  
Xhevdet Krasniqi ◽  
Hajdin Çitaku
Keyword(s):  
Coronary Artery ◽  
Coronary Arteries ◽  
Interventional Cardiology ◽  
Anomalous Origin ◽  
Coronary Artery Anomalies ◽  
Circumflex Artery ◽  
Artery Disease ◽  
Recent Classification ◽  
The Right ◽  
And Function

Coronary arteries supply the heart muscle with blood maintaining myocardial hemostasis and function. Coronary artery anomalies may persist after birth affecting cardiovascular system through haemodynamic impairment caused from shunting, ischaemia, especially in young children or adolescents and young adults. In patients undergoing coronary angiography the incidence of anomalous origination of the left coronary artery from right sinus is 0.15% and the right coronary artery from the left sinus is 0.92%. A recent classification of the coronary anomalies is based on anatomical considerations, recognizing three categories: anomalies of the origin and course, anomalies of the intrinsic coronary artery anatomy, and anomalies of the termination. In the setting of anomalous coronary artery from the opposite sinus, the proximal anomalous CA may run anterior to the pulmonary trunk (prepulmonic), posterior to the aorta (retroaortic), septal (subpulmonic), or between the pulmonary artery and the aorta itself (interarterial). Among them, only those with an interarterial aorta-pulmonary course are regarded as hidden conditions at risk of ischaemia and even sudden death. We presented two cases with anomalous origin of coronary arteries from opposite sinus, and two other cases with anomalous origin of left circumflex artery. The atherosclerotic coronary artery disease leads to the need of coronarography which can find out the presence of coronary artery anomalies. Anomalous origin of coronary artery that is present with atherosclerotic changes continues to exist as a challenge during treatment in interventional cardiology.

scholarly journals P1488 Anomalous origin of left coronary artery from right pulmonary artery in association with scimitar syndrome

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Aly ◽  
R Lizano Santamaria ◽  
S J Yoo
Keyword(s):  
Pulmonary Hypertension ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Scimitar Syndrome ◽  
Right Atrial ◽  
Anomalous Origin ◽  
Coronary Perfusion ◽  
Antegrade Flow ◽  
The Right

Abstract Clinical Presentation A full-term neonate was referred to our institution because of respiratory distress. CXR was significant for right lung hypoplasia and mild cardiomegaly. ECG showed normal sinus rhythm, right atrial enlargement, and right ventricular hypertrophy with no signs of ischemia. Imaging Findings The initial echocardiogram demonstrated PAPVD with the right upper pulmonary vein draining into IVC/RA junction with flow acceleration (mean gradient= 7 mmHg), moderate ASD, small muscular VSD with left-right shunting, moderate PDA with bidirectional shunting. Forward flow was seen in the proximal part of left main coronary artery (LMCA). RV systolic pressure was supra-systemic with a qualitatively moderately reduced RV systolic function. The patient was taken to the catheterization lab where MPA angiography revealed an antegrade flow from the RPA into LMCA supplying both the anterior descending and the circumflex arteries. A selective injection within the scimitar vein showed drainage of the right lung into a vertical vein connecting with stenosis to IVC. A follow up echocardiogram to re-examine the coronary origin revealed an anomalous origin of LMCA from proximal RPA; 3 mm distal to branch pulmonary artery bifurcation with mainly antegrade low velocity flow into LMCA and LAD. (Image 1) Role of Imaging in Patient Care - Imaging of the coronary origin in patients with ALCAPA can be challenging especially if the LMCA originates from RPA. Also, the presence of pulmonary hypertension might contribute to maintain coronary perfusion and lead to misinterpretation of the antegrade flow in LMCA and its branches. - In certain situations, cardiac catheterization is essential to make the diagnosis of ALCAPA which prevented a potentially catastrophic outcome. Catheter intervention with a series of balloon dilations of the stenotic scimitar vein was successful in relieving the stenosis. Summary/Discussion Points: - Extensive review of the available literature revealed only three cases of Scimitar syndrome associated with ALCAPA. In all of these cases, the LMCA originated from the posterior sinus of MPA. Our case is the first to report ALCAPA from RPA in association with Scimitar syndrome. This presentation might have led to the initial misinterpretation of the echocardiography images. - The presence of pulmonary hypertension in our patient maintained an adequate antegrade flow across the LMCA preventing significant coronary steal and signs of myocardial ischemia. - The report highlights the challenges in making the diagnosis of ALCAPA with echocardiograms. Moreover, we discuss the role of cross-sectional and invasive imaging to rule out potential coronary arteries anomalies in patients with Scimitar syndrome, as this a rare although a very significant association that may have important implications in their outcomes. Abstract P1488 Figure. ALCAPA origin from RPA

The Impact of the Right Coronary Artery Geometric Parameters on Hemodynamic Performance

2019 ◽  
Vol 10 (2) ◽  
pp. 257-270 ◽  
Author(s):  
N. Pinho ◽  
L. C. Sousa ◽  
C. F. Castro ◽  
C. C. António ◽  
M. Carvalho ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Geometric Parameters ◽  
Hemodynamic Performance ◽  
The Right ◽  
The Impact

scholarly journals Superoxide dismutase restores eNOS expression and function in resistance pulmonary arteries from neonatal lambs with persistent pulmonary hypertension

2008 ◽  
Vol 295 (6) ◽  
pp. L979-L987 ◽  
Author(s):  
Kathryn N. Farrow ◽  
Satyan Lakshminrusimha ◽  
William J. Reda ◽  
Stephen Wedgwood ◽  
Lyubov Czech ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Pulmonary Arteries ◽  
Newborn Infants ◽  
Persistent Pulmonary Hypertension ◽  
Ros Production ◽  
Enos Expression ◽  
Neonatal Lambs ◽  
And Function ◽  
Endothelial Nitric Oxide ◽  
The Impact

Endothelial nitric oxide (NO) synthase (eNOS) expression and activity are decreased in fetal lambs with persistent pulmonary hypertension (PPHN). We sought to determine the impact of mechanical ventilation with O2 with or without inhaled NO (iNO) or recombinant human SOD (rhSOD) on eNOS in the ductal ligation model of PPHN. PPHN lambs and age-matched controls were ventilated with 100% O2 for 24 h alone or combined with 20 ppm iNO continuously or a single dose of rhSOD (5 mg/kg) given intratracheally at delivery. In 1-day spontaneously breathing lambs, eNOS expression in resistance pulmonary arteries increased relative to fetal levels. eNOS expression increased in control lambs ventilated with 100% O2, but not in PPHN lambs. Addition of iNO or rhSOD increased eNOS expression and decreased generation of reactive oxygen species (ROS) in PPHN lambs relative to those ventilated with 100% O2 alone. However, only rhSOD restored eNOS function, increased tetrahydrobiopterin (BH4), a critical cofactor for eNOS function, and restored GTP cyclohydrolase I expression in isolated vessels and lungs from PPHN lambs. These data suggest that ventilation of PPHN lambs with 100% O2 increases ROS production, blunts postnatal increases in eNOS expression, and decreases available BH4 in PPHN lambs. Although the addition of iNO or rhSOD diminished ROS production and increased eNOS expression, only rhSOD improved eNOS function and levels of available BH4. Thus therapies designed to decrease oxidative stress and restore eNOS coupling, such as rhSOD, may prove useful in the treatment of PPHN in newborn infants.

Analysis of blood flow in the entire coronary arterial tree

2005 ◽  
Vol 289 (1) ◽  
pp. H439-H446 ◽  
Author(s):  
N. Mittal ◽  
Y. Zhou ◽  
C. Linares ◽  
S. Ung ◽  
B. Kaimovitz ◽  
...  
Keyword(s):  
Blood Flow ◽  
Coronary Artery ◽  
Coronary Blood Flow ◽  
Flow Distribution ◽  
Model Parameters ◽  
Coronary Perfusion ◽  
Arterial Tree ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
The Right

A hemodynamic analysis of coronary blood flow must be based on the measured branching pattern and vascular geometry of the coronary vasculature. We recently developed a computer reconstruction of the entire coronary arterial tree of the porcine heart based on previously measured morphometric data. In the present study, we carried out an analysis of blood flow distribution through a network of millions of vessels that includes the entire coronary arterial tree down to the first capillary branch. The pressure and flow are computed throughout the coronary arterial tree based on conservation of mass and momentum and appropriate pressure boundary conditions. We found a power law relationship between the diameter and flow of each vessel branch. The exponent is ∼2.2, which deviates from Murray’s prediction of 3.0. Furthermore, we found the total arterial equivalent resistance to be 0.93, 0.77, and 1.28 mmHg·ml−1·s−1·g−1 for the right coronary artery, left anterior descending coronary artery, and left circumflex artery, respectively. The significance of the present study is that it yields a predictive model that incorporates some of the factors controlling coronary blood flow. The model of normal hearts will serve as a physiological reference state. Pathological states can then be studied in relation to changes in model parameters that alter coronary perfusion.

276 Management of Giant Coronary Artery Aneurysms as a Coronary Sequelae of Kawasaki Disease – Surgical or Conservative Management?

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
F F Quek ◽  
R Tulloh
Keyword(s):  
Coronary Artery ◽  
Kawasaki Disease ◽  
Cardiac Mri ◽  
Previous History ◽  
Developed Countries ◽  
Strenuous Exercise ◽  
Coronary Perfusion ◽  
Best Interest ◽  
Coronary Aneurysms ◽  
The Right

Abstract Introduction Kawasaki Disease (KD) is the commonest childhood acquired heart disease in developed countries, predominantly affecting children younger than 5 years of age. These patients are at high risks of developing coronary arterial aneurysms (CAA) and CAA with absolute internal luminal diameters measuring ≥8mm or Z-score ≥10 is classified as giant coronary aneurysms (GCA). Case Report A 19-year-old girl with previous history of Kawasaki disease was diagnosed with giant coronary aneurysms on echocardiograms. Her subsequent CT coronary angiography showed large aneurysms in the right coronary artery (29mm x 25mm) and left anterior descending artery (10mm x 10mm) with signs of calcification. However, surprisingly, despite the evidence of large coronary aneurysms, she was completely asymptomatic and was physically active. Her cardiac MRI scan showed right coronary perfusion deficit in the distal right coronary territory but with no evidence of myocardial infarction. After having a detailed discussion in the MDT and with colleagues from San Diego, USA, a conservative approach was decided to be in the patient’s best interest. She has been advised to avoid competitive or strenuous exercise due to the associated risks. She is fit-and-well and is currently on Warfarin variable dose and Aspirin 75mg OD, with annual cardiac MRI surveillance.

scholarly journals Pitfalls in Diagnosis: Suspected Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery

2014 ◽  
Vol 41 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Jeffrey A. Robinson ◽  
Susan G. MacLellan-Tobert ◽  
Justin M. Horner ◽  
Frank Cetta
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Coronary Artery ◽  
Ductus Arteriosus ◽  
Main Pulmonary Artery ◽  
Doppler Imaging ◽  
Anomalous Origin ◽  
Color Flow ◽  
The Right ◽  
And Function

Anomalous coronary arteries are rare in the general population. We report the case of a term neonate who underwent an echocardiogram to evaluate a possible patent ductus arteriosus. Unexpectedly, an apparent anomalous origin of the right coronary artery from the main pulmonary artery was detected by surface 2-dimensional transthoracic echocardiography and color-flow Doppler imaging. Because ventricular size and function were normal, the patient ultimately underwent cardiac catheterization to verify the anatomy before proposed surgery. Angiograms showed that the right coronary artery arose from the left anterolateral portion of the mid-ascending aorta. The patient did not require surgery. This case report illustrates pitfalls that can occur in the diagnosis of coronary artery anomalies.

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