Abstract 17085: An Anomalous Outcome Of Renal Transplant

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Pooja Prasad ◽  
Kristian Enestvedt ◽  
Rehman Shehzad ◽  
Harsh Golwala
Keyword(s):  
Renal Transplant ◽  
Renal Disease ◽  
Beta Blocker ◽  
Graft Function ◽  
Left Ventricular ◽  
Inferior Wall ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Metabolic Equivalents ◽  
Anti Platelet Therapy

Case Presentation: A 65 year old man with diabetic renal disease developed acute dyspnea at rest on the first post-operative day after an uncomplicated deceased donor renal transplant. He was hypertensive, tachycardic, and hypoxemic. His electrocardiogram showed anterior ST elevations with reciprocal inferior ST depressions and his chest x-ray revealed pulmonary edema. He was given anti-platelet therapy, nitroglycerin, beta blocker and taken emergently for angiography. He had a thrombotic occlusion of a co-dominant anomalous left circumflex artery arising from the ostium of a moderate caliber right coronary artery. He underwent successful percutaneous coronary intervention. His post-revascularization echocardiogram showed a hypokinetic to akinetic inferior wall with preserved global left ventricular systolic function. Coronary CT for further assessment of the course of the anomalous artery was not pursued given minimal benefit and the risk of worsening graft function. He was discharged on dual anti-platelet therapy, beta blocker and a statin. Discussion: There is no consensus about risk stratification before renal transplant. Our patient’s pre-operative exercise treadmill test (ETT) showed reduced functional capacity at 5.6 metabolic equivalents, failure to reach target heart rate, with 1.0 mm down sloping ST depression in infero-lateral leads with no ischemic symptoms. While our patient had an equivocal ETT, his lack of angina argued against further work-up. Post-operatively, a pro-inflammatory state, increased shear stress, acquired thrombophilia and immunosuppressive medications can all contribute to plaque rupture with thrombus formation. Atherosclerosis due to diabetes and renal disease coupled with mechanical factors such as passive compression at the intraarterial course, acute angle take-off or valve-like closure of the slit orifice may have subjected our patient with an anomalous left circumflex artery to an acute ST-elevation MI.

Prevalence and Localization of Hibernating Myocardium Among Patients with Left Ventricular Dysfunction

2019 ◽  
Vol 15 (9) ◽  
pp. 884-889
Author(s):  
Emine Acar ◽  
Ayşegül Aksu ◽  
Gökmen Akkaya ◽  
Gamze Çapa Kaya
Keyword(s):  
Scar Tissue ◽  
Left Ventricular ◽  
Hibernating Myocardium ◽  
Circumflex Artery ◽  
Irrigation Area ◽  
Left Circumflex Artery ◽  
Pet Ct ◽  
Perfusion Defects ◽  
The Right ◽  
Fdg Pet Ct

Objective: This study evaluated how much of the myocardium was hibernating in patients with left ventricle dysfunction and/or comorbidities who planned to undergo either surgical or interventional revascularization. Furthermore, this study also identified which irrigation areas of the coronary arteries presented more scar and hibernating tissue. Methods: At rest, Tc-99m MIBI SPECT and cardiac F-18 FDG PET/CT images collected between March 2009 and September 2016 from 65 patients (55 men, 10 women, mean age 64±12) were retrospectively analyzed in order to evaluate myocardial viability. The areas with perfusion defects that were considered metabolic were accepted as hibernating myocardium, whereas areas with perfusion defects that were considered non-metabolic were accepted as scar tissue. Results: Perfusion defects were observed in 26% of myocardium, on average 48% were associated with hibernation whereas other 52% were scar tissue. In the remaining Tc-99m MIBI images, perfusion defects were observed in the following areas in the left anterior descending artery (LAD; 31%), in the right coronary artery (RCA; 23%) and in the Left Circumflex Artery (LCx; 19%) irrigation areas. Hibernation areas were localized within the LAD (46%), LCx (54%), and RCA (64%) irrigation areas. Scar tissue was also localized within the LAD (54%), LCx (46%), and RCA (36%) irrigation areas. Conclusion: Perfusion defects are thought to be the result of half hibernating tissue and half scar tissue. The majority of perfusion defects was observed in the LAD irrigation area, whereas hibernation was most often observed in the RCA irrigation area. The scar tissue development was more common in the LAD irrigation zone.

scholarly journals Left ventricular summit -- concept, anatomical description and clinical significance

2021 ◽  
Author(s):  
Marcin Kuniewicz ◽  
Artur Baszko ◽  
Mateusz Holda ◽  
Dyjhana Ali ◽  
Grzegorz Karkowski ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Cardiac Computed Tomography ◽  
Nerve Fibers ◽  
Left Ventricular ◽  
Autonomic Nerve ◽  
Radiofrequency Energy ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Electrophysiological Procedures ◽  
Septal Perforator

The left ventricular summit (LVS) is a triangular area located at the most superior portion of the left epicardial ventricular region, surrounded by the two branches of the left coronary artery: the left anterior interventricular artery and the left circumflex artery. The triangle is bounded by the apex, septal and mitral margins and base. This review aims to provide a systematic and comprehensive anatomical description and proper terminology in the LVS region that may facilitate exchanging information among anatomists and electrophysiologists, increasing knowledge of this cardiac region. We postulate that the most dominant septal perforator (not the first septal perforator) should characterize the LVS definition. Abundant epicardial adipose tissue overlying the LVS myocardium may affect arrhythmogenic processes and electrophysiological procedures within the LVS region. The LVS is divided into two clinically significant regions: accessible and inaccessible areas. Rich arterial and venous coronary vasculature and a relatively dense network of cardiac autonomic nerve fibers are present within the LVS boundaries. Although the approach to the LVS may be challenging, it can be executed indirectly using the surrounding structures. Delivery of the proper radiofrequency energy to the arrhythmia source, avoiding coronary artery damage at the same time, may be a challenge. Therefore, coronary angiography or cardiac computed tomography imaging is strongly recommended before any procedure within the LVS region. Further research on LVS morphology and physiology should increase the safety and effectiveness of invasive electrophysiological procedures performed within this region of the human heart. Published in Diagnostics: https://doi.org/10.3390/diagnostics11081423

Function of mature coronary collateral vessels and cardiac performance in the exercising dog

1985 ◽  
Vol 59 (2) ◽  
pp. 392-400 ◽  
Author(s):  
J. C. Longhurst ◽  
S. Motohara ◽  
J. M. Atkins ◽  
G. A. Ordway
Keyword(s):  
Blood Flow ◽  
Stroke Volume ◽  
Myocardial Blood Flow ◽  
Left Ventricular ◽  
Functional Responses ◽  
Circumflex Artery ◽  
Ventricular Performance ◽  
Left Circumflex Artery ◽  
Severe Exercise ◽  
Collateral Vessels

Formation of extensive collateral vessels after chronic constriction of a coronary artery in dogs can provide for similar increases in blood flow to native and collateralized regions of myocardium during exertion. Previous investigations have not compared myocardial blood flow and cardiac functional responses during exercise in constricted and nonconstricted (sham) animals. Thus we evaluated left ventricular performance and myocardial blood flow at rest and during mild, moderate, and severe exertion in sham-operated dogs and in dogs 2–3 mo after placement of an Ameroid occluder around the proximal left circumflex artery. Changes in double product, maximal left ventricular dP/dt, and pressure-work index were similar in both groups for each level of exertion. Despite similar increases in estimated myocardial O2 demand and similar diastolic perfusion pressures, average transmural myocardial blood flow increased less in the constrictor animals, particularly during severe exercise (2.74 +/- 0.22 vs. 1.45 +/- 0.29 ml X min-1 X g-1). The smaller increases in blood flow occurred equally in native and collateralized regions as well as in the papillary muscles and boundary areas between the native and collateralized regions. The differences in flow in the native and collateralized regions were uniform across the wall of the myocardium. We also observed smaller increases in stroke volume and cardiac output in the constrictor group, disparities which increased with increasing exertion (stroke volume, severe exercise = 0.92 +/- 0.13 vs. 0.53 +/- 0.09 ml/kg). We postulate that myocardial active hyperemia is limited either because the coronary vessels remaining after chronic circumflex occlusion cannot dilate sufficiently or that there is inappropriate active vasoconstriction during severe exertion.

scholarly journals Electrocardiographic localization of infarct related coronary artery in acute inferior wall ST elevation myocardial infraction and in hospital outcome in tertiary cardiac care center

2018 ◽  
Vol 15 (1) ◽  
pp. 23-27
Author(s):  
Rajaram Khanal ◽  
Arun Sayami ◽  
Ratnamani Gajurel ◽  
Hemanta Shrestha ◽  
Sanjeev Thapa ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Hospital Mortality ◽  
Care Center ◽  
Inferior Wall ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
St Segment ◽  
Myocardial Infraction ◽  
Infarct Related Artery ◽  
St Elevation

Background: In addition to diagnosing the acute ST Elevation MI stratifying (STEMI) high-risk patients and proper treatment strategies are important issues in managing patients. The goal of this study was to determine the relation of ST segment changes in Electrocardigram with the site of occlusion in vessel , to evaluate the prognostic value of ST segment deviation in aVR and its role in identification of Infarct Related Artery (IRA) in patients with acute inferior myocardial infarction.Methods: The study included 56 patients with acute inferior wall STEMI. All patients underwent Coronary Angiogram. Patients were divided into two groups based on the IRA and were followed up during their hospital stay for complications.Result: The culprit artery was Right Coronary Artery (RCA) in 40 patients (71.4%) and Left Circumflex Artery (LCX) in 13 patients (23.2%). Study showed 92% sensitivity, 80% specificity for predicting RCA related infarction with ST elevation lead III > lead II and 83% sensitivity ,90% specificity for (LCX) with ST elevation lead II > lead III . The overall in-hospital mortality was 3.5%.ST depression in aVR was associated with 87.5% specificity and 83% sensitivity in diagnosing LCX as the Infarct Related Artery (IRA). The in-hospital mortality rates for patients with ST segment deviation in aVR (20 patients) and no ST segment changes (36 patients) were 5% and 2.7% respectively.Conclusion: In addition to the conventional ECG criteria for identifying culprit vessel, lead aVR may be useful in clinical practice when assessing patients with inferior STEMI and with poor in-hospital outcome.Nepalese Heart Journal 2018; 15(1): 23-27

Double-patch and glue repair of a postinfarction left ventricular pseudoaneurysm

2020 ◽  
pp. 021849232095716
Author(s):  
Atsushi Miyagawa ◽  
Homare Okamura ◽  
Yuichiro Kitada ◽  
Mamoru Arakawa ◽  
Hideo Adachi
Keyword(s):  
Artery Bypass ◽  
Left Ventricular ◽  
Patch Repair ◽  
Appetite Loss ◽  
Circumflex Artery ◽  
Total Occlusion ◽  
Left Ventricular Pseudoaneurysm ◽  
Left Circumflex Artery ◽  
Maximal Diameter ◽  
Leg Edema

An 85-year-old man with appetite loss, lightheadedness, and leg edema was referred to our institution. Computed tomography and transthoracic echocardiography revealed a left ventricular pseudoaneurysm with a maximal diameter of 80 mm and severe mitral regurgitation. Coronary angiography showed 90% stenosis and total occlusion of the left circumflex artery at segments 11 and 12, respectively. He was diagnosed with postinfarction left ventricular pseudoaneurysm and underwent patch repair using two bovine pericardium patches and biological glue, mitral valve replacement, and coronary artery bypass grafting. His postoperative course was uneventful.

Large left circumflex artery aneurysm and left ventricular-coronary sinus fistula

2017 ◽  
Vol 72 (3) ◽  
pp. 353-354
Author(s):  
Zaher Hakim ◽  
Alexandros Briasoulis ◽  
Anil Attili ◽  
Rabih Touma
Keyword(s):  
Coronary Sinus ◽  
Artery Aneurysm ◽  
Left Ventricular ◽  
Circumflex Artery ◽  
Left Circumflex Artery

Exercise training normalizes β-adrenoceptor expression in dogs susceptible to ventricular fibrillation

2007 ◽  
Vol 293 (5) ◽  
pp. H2702-H2709 ◽  
Author(s):  
Bethany J. Holycross ◽  
Monica Kukielka ◽  
Yoshinori Nishijima ◽  
Ruth A. Altschuld ◽  
Cynthia A. Carnes ◽  
...  
Keyword(s):  
Gene Expression ◽  
Ventricular Fibrillation ◽  
Exercise Training ◽  
Left Ventricular ◽  
Treadmill Running ◽  
Rt Pcr ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Protein Levels ◽  
Ventricular Tissue

Previous studies demonstrated an enhanced β2-adrenoceptor (AR) responsiveness in animals susceptible to ventricular fibrillation (VF) that was eliminated by exercise training. The present study investigated the effects of endurance exercise training on β1-AR and β2-AR expression in dogs susceptible to VF. Myocardial ischemia was induced by a 2-min occlusion of the left circumflex artery during the last minute of exercise in dogs with healed infarctions: 20 had VF [susceptible (S)] and 13 did not [resistant (R)]. These dogs were randomly assigned to either 10-wk exercise training [treadmill running; n = 9 (S) or 8 (R)] or an equivalent sedentary period [ n = 11 (S) or 5 (R)]. Left ventricular tissue β-AR protein and mRNA were quantified by Western blot analysis and RT-PCR, respectively. Because β2-ARs are located in caveolae, caveolin-3 was also quantified. β1-AR gene expression decreased (∼5-fold), β2-AR gene expression was not changed, and the ratio of β2-AR to β1-AR gene expression was significantly increased in susceptible compared with resistant dogs. β1-AR protein decreased (∼50%) and β2-AR protein increased (400%) in noncaveolar fractions of the cell membrane in susceptible dogs. Exercise training returned β1-AR gene expression to levels seen in resistant animals but did not alter β2-AR protein levels in susceptible dogs. These data suggest that β1-AR gene expression was decreased in susceptible dogs compared with resistant dogs and, further, that exercise training improves β1-AR gene expression, thereby restoring a more normal β-AR balance.

Abstract 16801: Papillary Muscle Tip Approximation in Repair of Ischemic Mitral Regurgitation in a Chronic Swine Model

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kanika Kalra ◽  
Samantha Zhan Moodie ◽  
Dongyang Xu ◽  
Muralidhar Padala
Keyword(s):  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Left Ventricular ◽  
Ischemic Mitral Regurgitation ◽  
Diastolic Filling ◽  
Swine Model ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Post Surgery ◽  
Better Than

Introduction: Mitral valve (MV) repair with undersized annuloplasty (UMA) for ischemic mitral regurgitation (IMR) is being abandoned in favor of valve replacement (MVR) following CTSN trial results. However, in patients with durable repair, survival and left ventricular function (LVF) were significantly better than MVR. Achieving a durable repair with UMA is challenging as it draws leaflets away from papillary muscle (PM) insertions, causing unphysiological tethering and unicuspid configuration that fails (FigA-B). Hypothesis: Drawing PM tips together with an approximating stitch (PMT-A) can relieve leaflet tethering and enable better repair (FigC). A chronic swine model of IMR was used to compare effects of isolated PMT-A, UMA and PMT-A+UMA on MV and LV at 3 months post surgery. Methods: Twenty-five farm swine underwent catheterization and occlusion of left circumflex artery, resulting in postero-lateral myocardial infarction (MI). Two months after MI, IMR severity of >2+ was confirmed on echo, and animals underwent one of the 3 repairs: PMT-A (n=6), UMA (n=8), PMT-A+UMA (n=11). Echo was performed postoperatively and repeated with MRI at 3 months (FigD). MV kinematics, coaptation geometry, and LVF were assessed. Results: IMR was eliminated after all repairs and did not recur through the study. Annulus continued to grow after PMT-A, but not in UMA or PMT-A+UMA group (FigE1) without increasing severity of IMR. Compared to prerepair, tenting depth was significantly reduced only in PMT-A and PMT-A+UMA groups (FigE2). Both leaflet excursion angles (diastolic minus systolic angles) increased after PMT-A, but not in other groups (FigE3-4). LV size and LVF was similar between groups, confirming that PMT-A did not perturb diastolic filling. Conclusions: In this model of IMR, PMT-A improved leaflet mobility, compared to isolated UMA or PMT-A+UMA. PMT-A is a simple technique that can potentially improve durability of MV repair by restoring valvular kinematics.

Abstract 2607: Impact Of Acute Myocardial Infarction On Perfusion In Non-infarct Related Territories. Study With Sestamibi G-spect Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jerzy Pregowski ◽  
Michal Ciszewski ◽  
Anna Teresinska ◽  
Lukasz Kalinczuk ◽  
Mariusz Kruk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Angioplasty ◽  
Left Ventricle Ejection Fraction ◽  
Inferior Wall ◽  
Culprit Lesion ◽  
Infarct Zone ◽  
Circumflex Artery ◽  
Left Circumflex Artery ◽  
Defect Score ◽  
Total Lack

In the setting of acute STEM blood flow may be slower also in non infarct related arteries. This may impact perfusion beyond infarct zone. The aim of our study was to assess viability and perfusion in non-infarcted myocardium using sestamibi G-SPECT. 36 pts with anterior STEMI within 12 hours from pain onset were enrolled. All pts were hemodynamically stable (Kilip≤3) on admission, without prior myocardial infarction and underwent primary angioplasty (pPCI). Two G-SPECTs at rest were performed: SPECT 1 - sestamibi injected immediately before pPCI (scintigrams registered within 6 hrs from pPCI) and SPECT 2, performed 5– 8 days later. Perfusion of the myocardium was visually assessed and standard grading (0 – 4) for 17 segments was used, where 0 indicates no, 1 - mild, 2 and 3 moderate perfusion abnormalities and 4 - total lack of perfusion. Sum of perfusion segmental defects grades for each territory and for the whole myocardium produces respective Summary Defect Score (SDS) indices. Higher SDS indicates more severe and wider perfusion defect. Left anterior descending artery (LAD) territory consists of 7, right coronary (RCA) and left circumflex artery (LCX) territories consist of 5 segments. Separate SDS for LAD (SDS LAD), for RCA (SDS RCA) and for LCX (SDS LCX) territories were calculated for SPECT 1 and SPECT 2. Also SDS for basal RCA segments (SDS RCA basal) and for basal LCX segments (SDS LCX basal) were calculated to avoid bias related to overlapping of blood supply. Results are presented in Table . Both total SDS and SDS indices for separate vessel territories decreased while left ventricle ejection fraction increased between G-SPECT 1 and G-SPECT 2 procedures. Conclusions In pts with anterior STEMI and culprit lesion in LAD perfusion of inferior wall is significantly reduced in acute phase. This suggests that anterior STEMI may cause global myocardial ischemia even in patients without cardiogenic shock. Table

Sign in / Sign up

Export Citation Format

Share Document