Ultrasonic Diagnostic Strategy for the Causes of Coronary Artery Dilatation in Infants

2021 ◽  
Author(s):  
Jinling Hu ◽  
Weidong Ren
Keyword(s):  
Coronary Artery ◽  
Pulmonary Stenosis ◽  
Coronary Artery Fistula ◽  
Lesion Detection ◽  
Diagnostic Strategy ◽  
Systematic Analysis ◽  
Coronary Artery Dilatation ◽  
Significant Difference ◽  
Segmental Dilatation ◽  
Tubular Dilatation

Abstract Objective:To explore a differential diagnosis strategy for the causes of coronary artery dilatation (CAD) in infants．Methods: Clinical and echocardiography data for 243 infants with CAD from the Shengjing Hospital of China Medical University were analyzed retrospectively. The patients were divided into congenital and acquired groups according to the CAD causes.Results: The lesion detection rate for CAD in 22,925 infants who underwent echocardiography was 1.06% (243/22,925). The acquired group accounted for 84.77% (206/243) of participants, all of which had Kawasaki disease. The congenital group accounted for 15.23% (37/243) of patients, including coronary artery fistula [12.35% (30/243)], anomalous origin of the coronary artery [2.06% (5/243)], severe pulmonary stenosis [0.41% (1/243)], and moderate aortic stenosis [0.41% (1/243)]. There was no significant difference in the Z-score for CAD between the two groups of children (P>0.05). There were differences in the scope and shape of CAD between the two groups (all P<0. 05). Acquired causes mainly manifested as segmental dilatation, while congenital causes manifested as tubular dilatation. The sensitivity and specificity of segmental dilatation in predicting acquired causes were 97.57% and 100%, respectively, and that of tubular dilatation in predicting congenital causes were 97.30% and 98.06%, respectively. Conclusion: It is particularly important to diagnose the cause of CAD because its treatment depends on its etiology. When an echocardiography examination identifies CAD in infants, comprehensive and systematic analysis can quickly and accurately determine the cause of CAD according to the diagnostic strategy process and evaluation of dilatation and cardiac structure characteristics.

Abstract O.53: Occult Coronary Artery Dilatation: An Unrecognized Category Of Coronary Involvement

Circulation ◽  
2015 ◽  
Vol 131 (suppl_2) ◽  
Author(s):  
Soha Rached-d'Astous ◽  
Nour Rached-d'Astous ◽  
Frederic Dallaire ◽  
Nagib Dahdah
Keyword(s):  
Coronary Artery ◽  
Linear Equations ◽  
Young Patients ◽  
Treatment Resistance ◽  
Trend Test ◽  
Ivig Treatment ◽  
Z Score ◽  
Inflammatory Parameters ◽  
Coronary Artery Dilatation ◽  
Significant Difference

Background: The current definition of Coronary artery dilatation (CAD), Z-score >2.5, in KD may omit patients at higher risk of later complications. We propose a category of occult CAD with a Z-score variation ≥ 2 for the same CA on 2 different echocardiograms, but absolute Z-score < 2.5. We compared this new category with cases of CAD and normal CA. >Method: A retrospective review included 337 patients diagnosed with KD in our institution. Echographic data were retrieved for the fist year following diagnosis. Patients were classified in three categories: definite CA dilatation (dCAD) with Z-score ≥ 2.5, occult CA dilatation (oCAD) and normal CA (nCA). We compared inflammatory profile, IVIG treatment resistance, and timing of CA involvement. Results: There were 26.3% patients with nCA, 32.2% with oCAD and 41.1% with dCAD.Patients with KD incomplete diagnostic criteria represented 35%, 14% and 17% for NCAD, OCAD and DCAD groups respectively (p=0.008). Median time for CAD was 7 and 9.5 days for dCAD and oCAD respectively (p=0.2). A Jonckheere trend test identified a progression of inflammatory parameters through the three groups for Platelet count (p< 0.001), Albumin (p = 0.007), ESR (p = 0.04), but not for CRP (p = 0.76) and WBC (p = 0.16). There was a significant difference in treatment resistance, with 5%, 19% and 31% for NCAD, OCAD and DCAD respectively (p=0,002). Conclusion: OCAD group appears like a distinctive subgroup of KD patients showing intermediate inflammatory profiles and treatment respond in the NCAD to DCAD spectrum. Recent Z-score equations, more accurate for young patients’ CA size than former linear equations, may explain the high incidence of dCAD in this report. Further studies are needed to define the profile and propensity to complications of this subpopulation.

scholarly journals Clinical Analysis of Chronic Active EBV Infection with Coronary Artery Dilatation and Matched Case-control Study

2020 ◽  
Author(s):  
Ang Wei ◽  
Honghao Ma ◽  
Liping Zhang ◽  
Zhigang Li ◽  
Yitong Guan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Serum Ferritin ◽  
Clinical Manifestations ◽  
Control Group ◽  
Hematopoietic Stem ◽  
Ebv Infection ◽  
Coronary Artery Dilatation ◽  
Tnf Α ◽  
Significant Difference

Abstract Objective To investigate the clinical characteristics, treatment, prognosis, and risk factors of chronic active EBV infection (CAEBV) associated with coronary artery dilatation (CAD) in children.Methods Children with CAEBV associated with CAD hospitalized in Beijing Children’s Hospital, Capital Medical University, from March 2016 to December 2019 were analyzed. At the same time, children with CAEBV without CAD were selected as the control group, matched by sex, age, treatment and admission time. The clinical manifestations, laboratory and ultrasonic examinations, treatment and prognosis of the children were collected in both groups.Results There were 10 children with CAEBV combined with CAD, accounting for 8.9% (10/112) of CAEBV patients at the same period, which including 6 males and 4 females, with onset age of 6.05 (2.8-14.3) years. The median follow-up time was 20 (6-48) months. All the patients had high copies of EBV-DNA in whole blood 1.18x107（1.90x105-3.96x107）copies/mL and plasma 1.81x104（1.54x103-1.76x106）copies/mL, and the Epstein-Barr virus encoded small RNA in biopsy was all positive. Among the 10 children, 8 had bilateral CAD, with 2 patients unilateral. After diagnosis, 7 children were treated with L-DEP chemotherapy in our hospital. After chemotherapy, four patients accepted allo-genetic Hematopoietic Stem Cell Transplantation (HSCT). The others were waiting for HSCT. By the end of the follow-up, CAD had returned to normal in 3 patients, and the time from diagnosis of CAD to recovery was 21 (18-68) d. The level of LDH, serum ferritin, TNF-α and IL-10 had statistically significant difference between the two groups (P=0.009, 0.008, 0.026 and 0.030). There were no significant differences in survival rate between the two groups (P=0.416).Conclusion The incidence of CAEBV with CAD was low. CAEBV with CAD did not influence the prognosis. Patients with CAEBV had high LDH, serum ferritin, TNF-α and IL-10 in the early onset were prone to have CAD.

Markers of Hemostatic Activation in Affected Coronary Arteries during Angioplasty

1994 ◽  
Vol 72 (05) ◽  
pp. 672-675 ◽  
Author(s):  
Nicolas W Shammas ◽  
Michael J Cunningham ◽  
Richard M Pomearntz ◽  
Charles W Francis
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Venous Blood ◽  
Balloon Inflation ◽  
Blood Samples ◽  
Hemostatic System ◽  
Significant Difference ◽  
Hemostatic Markers ◽  
Artery Disease ◽  
High Doses

SummaryTo characterize the extent of early activation of the hemostatic system following angioplasty, we obtained blood samples from the involved coronary artery of 11 stable angina patients during the procedure and measured sensitive markers of thrombin formation (fibrino-peptide A, prothrombin fragment 1.2, and soluble fibrin) and of platelet activation ((3-thromboglobulin). Levels of hemostatic markers in venous blood obtained from 14 young individuals with low pretest probability for coronary artery disease were not significantly different from levels in venous blood or intracoronary samples obtained prior to angioplasty. Also, there was no translesional (proximal and distal to the lesion) gradient in any of the hemostatic markers before or after angioplasty in samples obtained between 18 and 21 min from the onset of the first balloon inflation. Furthermore, no significant difference was noted between angioplasty and postangioplasty intracoronary concentrations. We conclude that intracoronary hemostatic activation does not occur in the majority of patients during and immediately following coronary angioplasty when high doses of heparin and aspirin are administered.

The Effect of Antiplatelet Drugs on Plasma Betathromboglobulin in Coronary Artery Disease

1979 ◽  
Author(s):  
P Han ◽  
A Turpie ◽  
E Genton ◽  
M Gent
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Crossover Trial ◽  
Specific Protein ◽  
Antiplatelet Drugs ◽  
Significant Difference ◽  
Pre Treatment ◽  
Artery Disease ◽  
Therapeutic Doses ◽  
Granule Release

Platelets play a role in the development and complications of coronary artery disease (CAD) and a number of abnormalities of platelet function which can be corrected by antiplatelet drugs have been described. Betathromboglobulin (BTG), a platelet-specific protein which is released from α-granules during platelet activation is significantly elevated in patients with angiographically demonstrated CAD (51.0 ± 31.0 ng/ml., n = 50) compared to normal (28.0 ± 8.0 ng/ml., n = 70) p < 0.001. The effect of sulphinpyrazone (800 mg.) or aspirin (1200 mg.)/dipyridamole (200 mg.) on plasma BTG in CAD was studied in a blind prospective crossover trial in 25 patients. Mean BTG concentration pre-treatment was 52.3 ng/ml. and after 1 month’s treatment with placebo, sulphinpyrazone or aspirin/dipyridamole mean plasma BTG concentrations were 53.5, 49.6 and 56.7 ng/ml. respectively. Analysis of variance showed no significant difference between the means (p > 0.1) . This study confirms increased plasma BTG concentrations in patients with CAD and indicates that therapeutic doses of these antiplatelet drugs do not significantly effect the BTG level and thus appear not to prevent α-granule release in CAD.

Coronary artery fistula to the left ventricle

1987 ◽  
Vol 23 (3) ◽  
pp. 420
Author(s):  
B H Lee ◽  
S J Yu ◽  
E S Moon ◽  
S H Kim ◽  
Y H Choi
Keyword(s):  
Coronary Artery ◽  
Left Ventricle ◽  
Coronary Artery Fistula

Right Coronary Artery Fistula Draining into the Right Atrium and Associated with Mitral Valve Stenosis: A Case Report

2007 ◽  
Vol 10 (4) ◽  
pp. E325-E328 ◽  
Author(s):  
Ali Gürbüz ◽  
Ufuk Yetkin ◽  
Ömer Tetik ◽  
Mert Kestelli ◽  
Murat Yesil
Keyword(s):  
Case Report ◽  
Coronary Artery ◽  
Mitral Valve ◽  
Right Coronary Artery ◽  
Right Atrium ◽  
Coronary Artery Fistula ◽  
Mitral Valve Stenosis ◽  
The Right

A Giant Right Coronary Artery of Diffuse Ectasia Induced by a Right Ventricular Fistula

2015 ◽  
Vol 18 (6) ◽  
pp. 253
Author(s):  
Renyuan Li ◽  
Yiming Ni ◽  
Peng Teng ◽  
Weidong Li
Keyword(s):  
Coronary Artery ◽  
Right Coronary Artery ◽  
Artery Bypass ◽  
Coronary Artery Fistula ◽  
Rare Entity ◽  
Fistula Closure ◽  
Unique Case ◽  
Coronary Ectasia ◽  
The Right ◽  
Giant Size

<p>Coronary artery fistula (CAF) is a rare entity. Sometimes it may associate with mild diffuse or segmental coronary ectasia. CAF with giant coronary artery is exceptionally rare. We present a unique case of a 49-year-old female patient with a giant right coronary artery of diffuse ectasia coexisting with a fistula draining into the right ventricle. To our best knowledge, CAF with diffuse coronary ectasia of such giant size has never been reported. The patient was treated successfully by resection of the dilated right coronary artery, fistula closure, and coronary artery bypass grafting.</p>

Ligation of a Fistula between the Left Main Coronary Artery and Both the Pulmonary Artery and the Right Ventricle

2012 ◽  
Vol 15 (2) ◽  
pp. 119 ◽  
Author(s):  
I. Halil Algin ◽  
Aytekin Yesilay ◽  
N. Murat Akcar
Keyword(s):  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Pulmonary Artery ◽  
Right Ventricle ◽  
Left Main Coronary Artery ◽  
Coronary Artery Fistula ◽  
Left Main ◽  
Symptomatic Disease ◽  
Coronary Artery Fistulas ◽  
The Right

The frequency of coronary artery fistula among all coronary angiography patients is 0.1% to 0.2%; however, involvement of both the pulmonary artery and the right ventricle is a rare clinical entity. A 53-year-old man patient was admitted to our clinic with rarely occurring chest pain, palpitations, and dyspnea. A coronary angiogram showed a fistula between the left main coronary artery and both the pulmonary artery and the right ventricle. We performed a ligation of this fistula without cardiopulmonary bypass. Aorta and right ventricle sutures were made, and the proximal and distal portions of the fistula were obliterated with 5-0 Prolene sutures and previously prepared Teflon felt. The patient recovered and was discharged without any complications. The surgical indications for coronary artery fistulas are symptomatic disease, an aneurysmic coronary artery, signs of heart failure, and ischemia. The surgical options in such cases�depending on whether the fistula is complicated or not�are simple ligation or transarterial ligation under cardiopulmonary bypass.

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