scholarly journals Multiple Coronary Chamber Microfistulas or Persistent Thebesian Vessels?

2017 ◽  
Vol 2 (3) ◽  
pp. 262-265
Author(s):  
Daniel Cernica ◽  
Lehel Bordi ◽  
Elena Beganu ◽  
Ioana Rodean ◽  
Imre Benedek
Keyword(s):  
Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Left Ventricular ◽  
Vascular Network ◽  
Bundle Branch Block ◽  
Cardiac Chamber ◽  
Atherosclerotic Lesions ◽  
Left Ventricular Chamber ◽  
History Of ◽  
Gender Specific

Abstract Coronary fistulas are rare, not gender-specific congenital conditions, consisting of communications between the coronary arteries and either another coronary vessel or a cardiac chamber. In contrast to large fistulas, small fistulas, named “minimae cordis veneae” or the Thebesius venous system, are draining into heart chambers and form a vascular network in the cardiac lumen. In this article, we present the case of a 72-year-old female with a significant history of cardiovascular disease, admitted to our clinic because of rest dyspnea, fatigue, and minimal chest pain. The 12-lead electrocardiogram showed a trifascicular block (a second-degree atrioventricular block Mobitz II, associated with a right bundle branch block and left anterior fascicle block) and negative T waves in DII, DIII, aVF, V4–V6 leads. An invasive coronary angiography was performed, which revealed no significant atherosclerotic lesions. However, a persistent capillary blush was present at the apex site of the left ventricular chamber, draining from the distal segments of both the anterior descending coronary artery and the posterior interventricular coronary artery. The intramural vascular network generating a left ventricle angiogram image of this kind was suggestive for persistent Thebesian vessels connecting the two coronaries with the left ventricular chamber.

scholarly journals Gender-specific risk of complications in catheter ablation for atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Plasek ◽  
J Plasek ◽  
P Peichl ◽  
D Wichterle ◽  
R Cihak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Body Height ◽  
Left Ventricular ◽  
Navigation Systems ◽  
3D Navigation ◽  
Bundle Branch Block ◽  
Specific Risk ◽  
Gender Specific

Abstract Background Catheter ablation is an established treatment modality for atrial fibrillation (AF). The risk of procedural complications is not negligible. Some studies suggested that female patients have a higher risk of complications. Purpose To identify gender-specific predictors of major complications (MCs) in patients undergoing catheter ablation for AF in a tertiary ablation centre. Methods A total of 4733 catheter ablations for AF (65% paroxysmal, 26% repeated procedures) were performed at our centre between January 2006 and August 2018. Patients (71% males) aged 60±10 years and had body mass index of 29±4 kg/m2 at the time of the procedure. Radiofrequency point-by-point ablation was employed in 96.3% procedures with the use of 3D navigation systems and facilitated by intracardiac echocardiography. Pulmonary vein isolation was mandatory; cavotricuspid isthmus and left atrial substrate ablation were performed in 22% and 38% procedures, respectively. MCs were defined as those that resulted in permanent injury, required intervention or prolonged hospitalization. Variables were assessed by uni- and multivariate analysis, two-sided α<0.05 was considered significant. Results A total of 160 (3.4%) MCs were detected - 60 (4.4%) in females and 100 (2.9%) in males (P=0.012). Both lower body height and the presence of bundle branch block (BBB) were associated with MCs only in females; for left bundle branch block (LBBB), the effect size was higher. On the contrary, higher left ventricular end-diastolic diameter (LVEDd) and persistent AF were associated with MCs in males (Table). Conclusion Females have a higher risk of MCs during catheter ablation for AF. Body height, AF type, BBB, and LVEDd may belong among gender-specific risk factors for MCs in AF ablation procedures. Whether BBB and LVEDd represent true risk factors warrants a validation in further studies. Funding Acknowledgement Type of funding source: None

scholarly journals Coronary Flow in Patients with Three-Vessel Disease: Simulated Hemodynamic Variables in relation to Angiographically Assessed Collaterality and History of Myocardial Infarction

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Issam Abouliatim ◽  
Majid Harmouche ◽  
Agnès Drochon ◽  
Mahmoud Maasrani ◽  
Hervé Corbineau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Collateral Flow ◽  
Anterior Myocardial Infarction ◽  
Ventricular Ejection Fraction ◽  
Flow Rates ◽  
Chronic Occlusion ◽  
History Of

We study patients with stenoses of the left main coronary artery (LMCA), left anterior descending artery (LAD), and left circumflex branch (LCx) and with chronic occlusion of the right coronary artery (RCA), undergoing off-pump coronary surgery. An analog electrical model is used to provide quantitative estimations of the distribution of flows and pressures across the coronary network (in the stenosed native arteries, the collateral branches, the capillary areas, and so forth). The present paper demonstrates that the clinical information collected for the 10 patients included in the study (Rentrop score, history of myocardial infarction, left ventricular ejection fraction (LVEF)) are well correlated with the predicted hydrodynamic data. Patients with a good collaterality (Rentrop score = 3) or patients without anterior myocardial infarction have (i) less severe stenoses on the LMCA, (ii) lower microvascular resistances, (iii) higher grafts flow rates when the revascularization is performed, (iv) higher collateral flow rates towards the territory of the occluded artery, (v) better perfusion of this area, and (vi) better total perfusion of the heart.

scholarly journals Sintilimab-Induced Myocarditis Overlapping Myositis in a Patient With Metastatic Thymoma: A Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Zi-xuan Yang ◽  
Xuan Chen ◽  
Si-qi Tang ◽  
Qing Zhang
Keyword(s):  
Immune Checkpoint Inhibitor ◽  
Clinical Course ◽  
Checkpoint Inhibitor ◽  
Troponin T ◽  
Left Ventricular ◽  
Moderate Increase ◽  
Bundle Branch Block ◽  
History Of ◽  
Grade 3 ◽  
Left Ventricular Enlargement

Although immune checkpoint inhibitor (ICI)-related myocarditis has been widely discussed, a lot of gaps and challenges in its clinical course and rational intervention remain elusive. We present the case of a 33-year-old man with a history of metastatic thymoma who developed dyspnea and muscle weakness 1 month after the first dose of sintilimab. He was asymptomatic but found to have a mild elevation of troponin-T and a moderate increase of creatine kinase 20 days after the infusion. Although the scheduled second dose was deferred, he developed dyspnea, left bundle branch block, and left ventricular enlargement that is suggestive of Grade 3 ICI-related myocarditis, complicated with myositis/myasthenia gravis 10 days later. Fortunately, his response to intensive immunosuppressive therapy was good.

Abstract 17234: Cisplatin Induced Coronary Artery Atherosclerosis Leading To St-elevation Myocardial Infarction: A Case Report

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Sheikh Bilal B Khalid ◽  
Javaria Mahmood
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Chest Pain ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Premature Coronary Artery Disease ◽  
Chemotherapeutic Regimen ◽  
History Of ◽  
St Elevation ◽  
Artery Disease

Introduction: Cisplatin-based chemotherapeutic regimen (CBCR) is known for increasing risk of venous thromboembolic (TE) disease. We report a unique case of STEMI associated with CBCR which we believe was caused by coronary artery thrombosis. Case description: A 31-yo man with a past history of germ cell tumor presented with chest pain radiating to back and left arm. It started this morning and intensity did not worsen with exertion. He denied any dyspnea, diaphoresis or palpitations. He was non-smoker and non-obese. He denied any family history of premature coronary artery disease. He had undergone unilateral orchiectomy a year ago, and was currently receiving chemotherapy with bleomycin, etoposide and cisplatin; the last dose of his 3 rd cycle was given the day before. EKG showed ST elevation in leads I, aVL, V4 and V5. Troponin I was high to 6.9 ng/ml (ULN 0.045 ng/ml). He received intravenous infusion of thrombolytic. An angiogram done the next day showed moderate mid-LAD disease with residual clot. A CT scan and an echocardiogram later showed left ventricular thrombus (LVT). He was kept on therapeutic enoxaparin along with aspirin. Follow up echocardiogram showed resolution of the thrombus. His chemotherapy was stopped, and he has been kept on active surveillance since then. Discussion: Most cases of CBCR-associated myocardial infarction that have been reported have been seen in the older population with other risk factors for coronary artery disease. Cases where angiographic data was available, coronary artery vasospasm appeared to be the culprit rather than a true plaque rupture. While the presence of LVT raises possibility of thromboembolism to coronaries causing MI, the angiographic findings support accelerated plaque formation to be the cause of infarction. In earlier reports, elevated pre-treatment level of von Willebrand factor has been postulated to have some role in the disease pathogenesis. Other possible mechanisms for pathogenesis include endothelial cell damage, platelet activation, and imbalance between thromboxane-prostacyclin levels. This case emphasizes the need to keep cardiac etiologies of chest pain in the differential when evaluating patients on CBCR as timely intervention is life saving and prevent morbidity.

Abstract 10961: QRS Duration and Left Bundle Branch Block Do Not Deter Assessment of Low Voltage in Cardiac Amyloidosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Brett W Sperry ◽  
Michael N Vranian ◽  
Hariom Joshi ◽  
Rory Hachamovitch ◽  
Mazen Hanna
Keyword(s):  
Left Bundle Branch Block ◽  
Cardiac Amyloidosis ◽  
Low Voltage ◽  
Left Ventricular ◽  
S Wave ◽  
Bundle Branch Block ◽  
Propensity Matching ◽  
History Of ◽  
Ventricular Wall Thickness ◽  
Qrs Duration

Introduction: Left bundle branch block (LBBB) with QRS duration > 120 msec is typically associated with increased ECG voltage without a necessary increase in left ventricular wall thickness. Studies assessing voltage criteria in amyloidosis and other cardiomyopathies have excluded patients with LBBB. We sought to assess the effects of QRS duration and LBBB on voltage criteria in cardiac amyloidosis. Methods: We performed a retrospective analysis of patients with newly diagnosed cardiac amyloidosis at our institution from 2001-2014. Low voltage in the precordial leads was defined by the Sokolow criteria (S wave in V1 plus R wave in V5 or V6 ≤ 15mm). Limb lead voltage was calculated by the sum of the entire QRS complex voltage of leads I, II and III with low voltage being defined as each lead ≤ 5 mm. Patients with left bundle branch block were propensity matched to assess voltage criteria based upon age, sex, history of HTN, amyloid type (AL vs TTR), anteroseptal thickness and BSA to those with QRS < 120msec. Results: In 299 subjects (age 69.6 +/- 11.7 years, male 69%, HTN 53%, AL 53%, IVS 18.1 +/- 4.1 mm, BSA 1.95 +/- 0.26, EF 48 +/- 14%), mean QRS duration was 107 +/- 25 msec with 71 patients (24%) having a QRS duration greater than 120 msec (17 LBBB). The average limb voltage was 15.1 +/- 7.3 mm with low limb lead voltage seen in 62% of patients. Low precordial lead voltage was found in 73% of patients with a mean Sokolow voltage of 12.9 +/- 7.5 mm. After propensity matching the 17 patients with LBBB on a 1:3 basis with patients with a narrow complex QRS, there was no difference in any measure of voltage criteria. Conclusion: LBBB is not associated with higher voltage and does not hinder the ability to detect low voltage in patients with cardiac amyloidosis.

Abstract O.18: Histopathological Analysis Of Sudden Death Adults With Coronary Artery Aneurysms

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Kei Takahashi ◽  
Toshiaki Oharaseki ◽  
Yuki Yokouchi ◽  
Yasunori Enomoto ◽  
Kino Hayashi ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Atherosclerotic Lesion ◽  
Histopathological Study ◽  
Histopathological Analysis ◽  
Type I ◽  
Coronary Artery Aneurysms ◽  
Thrombotic Occlusion ◽  
Atherosclerotic Lesions ◽  
Arterial Lesions ◽  
History Of

Histopathological study on coronary arterial lesions of adult autopsy cases who had a history of Kawasaki disease (KD) in childhood or who had coronary artery aneurysms (CAANs) was performed to analyze the relationship between post-inflammatory arterial lesions and atherosclerosis. Materials and Methods: Five autopsy cases who contracted KD at childhood and 11 autopsy cases who had giant CAANs at autopsy although a history of KD was not confirmed were included in this study. The age at death ranged from 18 to 57 years old. Forty-eight coronary artery (CA) branches from 16 autopsies were histologically examined focusing on the atherosclerosis which developed on the post-inflammatory lesions. Results: CAANs occurred in 30 arteries among 48 CA branches. CAANs were classified into 2 types; dilated CAANs (22 branches) and recanalized CAANs (8 branches). Dilated CAANs: The early atherosclerotic lesions, which corresponded to Type III or less of AHA classification, were seen in 16 CAs, and among them 6 branches had thrombotic luminal occlusion caused by the intimal erosion. On the other hand, the advanced atherosclerotic lesions corresponding to Type IV or more were observed in 6 of 22 branches and thrombotic occlusion of the lumen was observed in 5 of 6 CA branches. The cause of those thrombotic occlusion was estimated the rupture of atheroma. Recanalized CAANs: All atherosclerotic lesions developed in the recanalized CAANs were classified to the early lesions. Thrombotic occlusion was seen in 1 of 8 branches. Non-CAANs: There were 18 CAs with no aneurysm formation. The majority of Non-CAANs (16 of 18 branches) showed early atherosclerotic lesions (Type I or II), but 2 branches of 1 patient showed the advanced atherosclerotic lesion and the lumen was occluded by the fresh thrombus caused by intimal erosion. Conclusion: This histological study targeted at the post-inflammatory CA lesions in adult suggests two things: 1) Though advanced atherosclerotic lesions were often observed in the dilated CAANs, the atherosclerosis in the recanalized CAANs and Non-CAANs was still in early stage. 2) The erosion of the intima plays an important role in a formation of the thrombotic occlusion in the post-inflammatory arterial lesions even in adulthood.

Two-year course of cognitive function and mood in adults with congestive heart failure and coronary artery disease: the Heart-Mind Study

2011 ◽  
Vol 24 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Osvaldo P. Almeida ◽  
Christopher Beer ◽  
Nicola T. Lautenschlager ◽  
Leonard Arnolda ◽  
Helman Alfonso ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Congestive Heart Failure ◽  
Coronary Artery ◽  
Cognitive Function ◽  
Short Form ◽  
Verbal Learning ◽  
Left Ventricular ◽  
History Of ◽  
Artery Disease

ABSTRACTBackground: Congestive heart failure (CHF) has been associated with impaired cognitive function, but it is unclear if these changes are specific to CHF and if they get worse with time. We designed this study to determine if adults with CHF show evidence of cognitive decline compared with adults with and without coronary artery disease (CAD).Methods: A longitudinal study was carried out of 77 adults with CHF (ejection fraction, EF < 0.4), 73 adults with a clinical history of CAD and EF > 0.6, and 81 controls with no history of CAD. The Cambridge Cognitive Examination of the Elderly (CAMCOG) was the primary outcome measure. Secondary measures included the California Verbal Learning Test (CVLT), digit coding and copying, Hospital Anxiety and Depression Scale (HADS), and the short form health survey (SF36). Endpoints were collected at baseline and after 12 and 24 months.Results: The adjusted CAMCOG scores of CHF participants declined 0.9 points over two years (p = 0.022) compared with controls without CAD. There were no differences between the groups on other cognitive measures. Participants with CHF and with CAD experienced similar changes in cognitive function over two years. Left ventricular EF and six-minute walk test results could not explain the observed associations.Conclusions: The changes in cognitive function and mood associated with CHF over two years are subtle and not specific to CHF.

scholarly journals First Diagonal Coronary Artery: Left Ventricular Fistula Presenting as Unstable Angina

2013 ◽  
Vol 2013 ◽  
pp. 1-2
Author(s):  
Murat Sener ◽  
Mehmet Akkaya ◽  
Muammer Bilici
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Unstable Angina ◽  
Left Ventricular ◽  
Vascular Structure ◽  
Rare Form ◽  
Cardiac Chamber

Coronary artery fistulae are characterized by communications between a coronary artery and a cardiac chamber or another vascular structure. They are usually congenital, but acquired forms may occur. Most patients are usually asymptomatic. However, some studies have emphasized that the incidence of symptoms and complications increases with age, particularly after the age of 20 (Liberthson et al. 1979, Hong et al. 2004). We aimed to present a very rare form of fistula originating from the first diagonal artery and connecting into the left ventricle.

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