scholarly journals Difficult questions of Kawasaki syndrome treatment

2015 ◽  
Vol 96 (4) ◽  
pp. 615-619
Author(s):  
E A Degtyareva ◽  
M G Kantemirova ◽  
O I Zhdanova ◽  
S A Tyul’kina ◽  
D M Kul’kova
Keyword(s):  
Coronary Artery ◽  
Acetylsalicylic Acid ◽  
Coronary Arteries ◽  
Right Coronary Artery ◽  
Giant Aneurysm ◽  
Kawasaki Syndrome ◽  
Dalteparin Sodium ◽  
The Right

Aim. To summarize the existing literature data and to optimize protocols of anticoagulant therapy for Kawasaki syndrome. Methods. A review of treatment results in 10 patients with Kawasaki syndrome, where an individual approach to anticoagulation led to a positive result, and surgical treatment was not required, is presented. Results. In 5 of 6 patients with timely diagnosis and treatment according to the protocol, transient ectasia of coronary arteries with further normalization of their size within 4-7 months of follow up was detected. In one child on the 12th day of the disease small aneurysms of the right and left coronary arteries were identified. They disappeared after 7 months from the debut of the disease. In 3 patients, diagnosis and treatment have been delayed. In this group, a giant aneurysm of the proximal left anterior descending branch of the left coronary artery with the signs of thrombosis was discovered in a child aged 9 months on the 45th day of the disease. Anticoagulation with heparin with further switching to dalteparin sodium (Fragmin) was accompanied by adequate anticoagulation to the 3rd day of treatment. Aneurysms decreased to 2-4 mm without signs of thrombosis after 24 months of treatment with warfarin in combination with acetylsalicylic acid (Aspirin). In a girl of 1 year and 4 months of age, on the 20th day of the disease, it was complicated by exudative pericarditis with high risk for tamponade, which required a pericardial puncture and catheterization, and a giant aneurysm of the right coronary artery with the signs of thrombosis was found on the 45th day of the disease. Adequate anticoagulation was reached on the 3rd day of treatment with dalteparin sodium (Fragmin). Long-term use of warfarin in combination with acetylsalicylic acid (Aspirin) was continued. At follow-up at 4 months aneurysm of the right coronary artery has not decreased, but the size and the density of the blood clot reduced significantly. A year later, the aneurysm decreased to 5-6 mm without signs of thrombosis. At the next case of a 3 year old child, who was treated according to the treatment standards, ectasia of the right and left coronary arteries was revealed on the 14th day of treatment, disappearing after of long-term use of acetylsalicylic acid (Aspirin). Conclusion. At further development of standards and following up antithrombotic treatment in patients with the complicated forms of Kawasaki disease, the possibility of individual treatment adjustment based on the detection of thrombophilia genetic markers, which increase the risk for thrombotic complications, should be considered.

Occlusive disease confined to the right coronary artery: Clinical features, surgical treatment and long-term follow-up in 124 patients

1979 ◽  
Vol 43 (6) ◽  
pp. 1103-1108 ◽  
Author(s):  
Michele A. Codini ◽  
Philip W. Hassan ◽  
Robert G. Hauser ◽  
Marshall D. Goldin ◽  
Joseph V. Messer
Keyword(s):  
Coronary Artery ◽  
Surgical Treatment ◽  
Clinical Features ◽  
Right Coronary Artery ◽  
Occlusive Disease ◽  
Long Term Follow Up ◽  
The Right

Long-term follow-up of PTCA of the right coronary artery with shepherd's crook morphology

1989 ◽  
Vol 56 (6) ◽  
pp. 577-579 ◽  
Author(s):  
E. M. Tuzcu ◽  
C. Simpfendorfer ◽  
D. Gossman ◽  
K. Badwhar
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Long Term Follow Up ◽  
The Right

scholarly journals Anomalous origin of the right coronary artery with interarterial course: red flag or innocent bystander?

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
F Albuquerque ◽  
P De Araujo Goncalves ◽  
H Marques ◽  
A Ferreira ◽  
P Freitas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Right Coronary Artery ◽  
Anomalous Origin ◽  
Long Term Outcomes ◽  
Cardiac Symptoms ◽  
Increased Risk ◽  
The Right

Abstract Funding Acknowledgements Type of funding sources: None. Background Anomalous origin of the right coronary artery (right ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomographic angiography (CCTA) has led to increasing recognition of this condition, even among healthy individuals. This study sought to examine the prevalence, anatomical characteristics and outcomes of right ACAOS with IAC in patients undergoing CCTA for all-indications. Methods We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital between January 2012 and December 2020. Right ACAOS patients with IAC were analyzed for cardiac symptoms (anginal chest pain, syncope, aborted SCD) and long-term outcomes were evaluated for myocardial infarction, ischemic test results, revascularization procedures and all-cause or cardiovascular (CV) mortality. CCTAs were reviewed for proposed high-risk features (ie., take-off angle, length and severity of proximal narrowing, intramural course, interarterial length) and concomitant coronary artery disease (CAD). Association between high-risk features was analyzed. Long-term outcomes were evaluated. Results Among 10,928 patients referred for CCTA during the study period, we identified 28 patients (0.3% prevalence) with right ACAOS and IAC. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented cardiac symptoms. During a median follow-up of 44.1 ± 31.8 months, there were no CV deaths and only 1 patient (3.65%) underwent surgical revascularization. Baseline characteristics and CCTA findings are presented in figure 1. Conclusion Right ACAOS and IAC is an uncommon finding, with an observed prevalence of 0.3%. CCTA provides excellent anatomical characterization of anomalous vessels, including suggested high-risk features. In a population of asymptomatic patients who survived this condition well into adulthood, the risk of events was very low and medical follow up might be a reasonable option.

Giant right coronary artery aneurysm

2020 ◽  
Vol 28 ◽  
pp. 1-3
Author(s):  
Alexandre Bonfim ◽  
Ronald Souza ◽  
Sérgio Beraldo ◽  
Frederico Nunes ◽  
Daniel Beraldo
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Coronary Artery Aneurysm ◽  
Clinical Course ◽  
Artery Aneurysm ◽  
Giant Aneurysm ◽  
Coronary Artery Aneurysms ◽  
History Of ◽  
Artery Disease ◽  
The Right

Right coronary artery aneurysms are rare and may result from severe coronary disease, with few cases described in the literature. Mortality is high, and therapy is still controversial. We report the case of a 72-year-old woman with arterial hypertension, and a family history of coronary artery disease, who evolved for 2 months with episodes of palpitations and dyspnea on moderate exertion. During the evaluation, a giant aneurysm was found in the proximal third of the right coronary artery. The patient underwent surgical treatment with grafting of the radial artery to the right coronary artery and ligation of the aneurysmal sac, with good clinical course.

scholarly journals Anomalous origin of the right coronary artery with interarterial course: a mid-term follow-up of 28 cases

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Francisco Albuquerque ◽  
Pedro de Araújo Gonçalves ◽  
Hugo Marques ◽  
António Ferreira ◽  
Pedro Freitas ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Risk ◽  
Right Coronary Artery ◽  
Cardiac Death ◽  
Anomalous Origin ◽  
Cardiac Symptoms ◽  
Asymptomatic Patients ◽  
Increased Risk ◽  
The Right

AbstractAnomalous origin of the right coronary artery from the opposite sinus (right-ACAOS) with interarterial course (IAC) has been associated with increased risk of sudden cardiac death (SCD). Widespread use of coronary computed tomography angiography (CCTA) has led to increased recognition of this condition, even among healthy individuals. Our study sought to examine the prevalence, anatomical characteristics, and outcomes of right-ACAOS with IAC in patients undergoing CCTA for suspected coronary artery disease (CAD). We conducted a retrospective analysis of consecutive patients referred for CCTA at one tertiary hospital from January 2012 to December 2020. Patients exhibiting right-ACAOS with IAC were analyzed for cardiac symptoms and mid-term occurrence of first MACE (cardiac death, SCD, non-fatal myocardial infarction (MI) or revascularization of the anomalous vessel). CCTAs were reviewed for anatomical high-risk features and concomitant CAD. Among 10,928 patients referred for CCTA, 28 patients with right-ACAOS with IAC were identified. Mean age was 55 ± 17 years, 64% were male and 11 (39.3%) presented stable cardiac symptoms. Most patients had at least one high risk anatomical feature. During follow-up, there were no cardiac deaths or aborted SCD episodes and only 1 patient underwent surgical revascularization of the anomalous vessel. Right-ACAOS with IAC is an uncommon finding (prevalence of 0.26%). In a contemporary population of predominantly asymptomatic patients who survived this condition well into adulthood, most patients were managed conservatively with a low event rate. Additional studies are needed to support medical follow-up as the preferred option in this setting.

Direct Reimplantation Procedure in Anomalous Aortic Origin of the Right Coronary Artery: Long-Term Single Center Outcomes

2021 ◽  
Vol 12 (6) ◽  
pp. 693-699
Author(s):  
Daouda Amadou ◽  
Julia Mitchell ◽  
Christian Bulescu ◽  
Olivier Metton ◽  
Roland Henaine ◽  
...  
Keyword(s):  
Physical Activity ◽  
Coronary Artery ◽  
Right Coronary Artery ◽  
Early Death ◽  
Time Lapse ◽  
Single Center ◽  
Complete Restoration ◽  
Single Center Study ◽  
The Right

Background: Anomalous aortic origin of the right coronary artery is known to be a cause of sudden cardiac death in athletes. There are no specific guidelines concerning treatment strategy in the literature. The aim of this study is to describe and report our experience of direct reimplantation technique in the treatment of this anomaly. Methods: This was a retrospective single center study of 30 patients who underwent surgery in the congenital heart disease unit of Louis Pradel Heart and Lung Hospital between January 2003 and December 2016. The mean follow-up was seven years (3 months-17 years). Results: Thirty patients underwent surgery. The median age was 17 years (0.2-52 years). There were 24 males. The median weight was 58 kg (3.6-118 kg). Fourteen patients were actively engaged in sports. Twenty-six patients had exertional chest pain or syncope. The median time lapse between diagnosis and intervention was 4.5 months (0.5-179 months). Twenty-seven (90%) patients underwent reimplantation of the anomalous coronary artery without transverse aortotomy, while in 3 (10%) patients transverse aortotomy was used to facilitate reimplantation to avoid tension at the anastomosis. There was no early death; one late death occurred in the third postoperative month. At the last follow-up, all patients had returned to normal physical activity without evidence of ischemia. Conclusions: Direct reimplantation allows for a complete restoration of the coronary anatomy and enables patients to return to normal physical activity. Our study shows encouraging results using a direct reimplantation technique without aortotomy.

scholarly journals A right coronary artery aneurysm 16 years after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery

2019 ◽  
Vol 29 (1) ◽  
pp. 157-158
Author(s):  
Akira Furutachi ◽  
Kojiro Furukawa ◽  
Aiko Komatsu ◽  
Eijiro Nogami
Keyword(s):  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Coronary Artery ◽  
Surgical Repair ◽  
Artery Aneurysm ◽  
Anomalous Origin ◽  
Artery Graft ◽  
Long Term Follow Up ◽  
The Right

Abstract Anomalous origin of the right coronary artery (RCA) from the pulmonary artery is a very rare congenital heart disease, and several reports have described long-term events after surgery. We report the case of a 46-year-old woman who underwent reimplantation of the RCA for anomalous origin of the right coronary artery from the pulmonary artery 16 years ago. An RCA aneurysm gradually developed and dilated over time, and we resected the aneurysm and also grafted the right gastroepiploic artery graft to the distal RCA. Careful long-term follow-up is required to avoid overlooking such a rare but life-threatening complication after surgical repair of anomalous origin of the right coronary artery from the pulmonary artery.

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