Significant Stenosis of the Brachiocephalic Trunk and Moderate Stenosis of the Left Circumflex Artery in Computed Tomography Angiography Images

Atherosclerosis, as a civilization disease, is a serious epidemiological problem. Significant carotid disease and significant coronary artery disease result in acute consequences, such as ischemic stroke and myocardial infarction, which are the major causes of cardiovascular mortality. Typically, atherosclerosis of the aortic arch branches involves the bulbs of the common carotid arteries and the proximal segments of the internal carotid arteries, and can be effectively assessed by ultrasonography. Computed tomography angiography enables the identification of patients with less typical clinical manifestations of atherosclerosis, e.g., brachiocephalic trunk stenosis with symptoms of the steal syndrome and moderate stenosis in the coronary arteries. We present examples of computed tomography angiography images of this type of changes.

A Rare Case of Left Ventricular Non-Compaction with Coronary Artery Anomaly Complicated by ST-Elevation Myocardial Infarction and Subcutaneous Defibrillator Implantation

Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy caused by arrest of normal endomyocardial embryogenesis and characterized by the persistence of ventricular hypertrabeculation, isolated or associated to other congenital defects. A 33-year-old male, with family history of sudden cardiac death (SCD), presented to our ER with typical chest pain and was diagnosed with anterior STEMI. Coronary angiography showed an anomalous origin of the circumflex artery from the right coronary artery and a critical stenosis on the proximal left anterior descending artery, treated with primary percutaneous coronary intervention. The echocardiogram documented left ventricular severe dysfunction with lateral wall hypertrabeculation, strongly suggestive for non-compaction, confirmed by cardiac MRI. At 3 months follow up, for the persistence of the severely depressed EF (30%) and the family history for SCD, the patient underwent subcutaneous ICD (sICD) implantation for primary prevention. To the best of our knowledge, this is the first case of LVNC associated with anomalous coronary artery origin and STEMI reported in the literature. Arrhythmias are common in LVNC due to endocardial hypoperfusion and fibrosis. sICD overcomes the risks of transvenous ICD, and it is a valuable option when there is no need for pacing therapy for bradycardia, cardiac resynchronization therapy and anti-tachycardia pacing.

Superdominant Right Coronary Artery with Absent Left Coronary Artery and Left Circumflex Artery with Anomalous Left Anterior Descending Artery

The occurrence of super-dominant “single coronary artery” is an extremely rare and seldom reported phenomenon. The heart is dependent on a single vessel which makes its occlusion, if present, catastrophic. Here, the authors present an extremely rare combination of superdominant right coronary artery coexisting with absent left coronary artery and left circumflex artery with abnormal origin of left anterior descending artery from right coronary sinus. Precise morphological and physiological knowledge and evaluation of these anomalies is a must for opting the best available therapeutic modality and better prognosis.

Coronary artery aneurism: a clinical case

INTRODUCTION: Coronary artery aneurysm is a local dilatation of vessel 1.5–2-fold the initial diameter. In more than 40%, an aneurism is located in the right coronary artery, the next most common locations are the anterior interventricular artery and circumflex artery. An aneurism of the left coronary artery is a very rare finding seen in approximately 0.1% of patients. It is believed that in more than 50% of cases, coronary artery aneurisms develop with the underlying atherosclerosis, in 20–30% of cases they are hereditary, and in 10–20% of cases they are described in association with inflammatory diseases. Although thrombosis inside the cavity of aneurism may lead to distal embolization and development of myocardial infarction even in the absence of atherosclerosis of coronary arteries, its existence is not in all cases the indication for surgical treatment and in most cases decision on surgical approach is dictated by the severity of the coronary artery disease. In the given work, a clinical case of a patient with an aneurism of the left coronary artery is presented that developed after stenting with a bare metal stent. In our opinion, factors that influenced formation of aneurism in this clinical case were a dynamic impact of the blood flow on the damaged wall of the left main coronary artery through the holes in the stent, absence of endothelization of the implant surface in result of interaction of different biochemical and molecular-genetic mechanisms. CONCLUSION: Coronary artery aneurisms are not sufficiently studied and require investigations in the following directions: etiology and pathogenesis; optimal surgical treatment methods; place of conservative therapy in asymptomatic patients.

Risk factors and coronary angiographic profile in young STEMI patients: results from a tertiary care centre in south-central India

Background: Compared to older counterparts, a significant distinction has been found related to risk factors, clinical presentation, and prognosis of ST-segment elevation myocardial infarction (STEMI) in younger patients. To date, a lack of studies has been looked, specifically at-risk factors and angiographic profile of STEMI among younger patients; with this in mind, we conducted the present study.Methods: This hospital-based, cross-sectional, open-label study was carried out at Deccan College of Medical Sciences between April 2018 and December 2019. Patients under 40 years with the presentation of STEMI were included. All patients were subjected to electrocardiography, 2D echocardiography, and coronary angiogram. Baseline demographics, risk factors, and procedural characteristics were recorded.Results: Of 51 young STEMI patients, 41 (80.4%) were male and 10 (19.6%) were female. The most common risk factors associated with the development of STEMI in young patients were smoking (58.8%), followed by diabetes (45.1%), and dyslipidaemia (45.1%). Anterior wall MI was the most frequent presentation (84.3%). The left anterior descending artery was the most frequently (62.8%) involved vessel, followed by left circumflex artery (9.8%), and right coronary artery (5.9%).Conclusions: Insights gained from the study can aid in identifying clinical characteristics of STEMI in young patients, which may be beneficial to achieve appropriate and timely management. Further, the young population should be educated as to control modifiable risk factors and smoking cessation to prevent coronary artery disease since they belong to the highly productive group in the community.

Epicardial and Endocardial Ablation Based on Channel Mapping in Patients With Ventricular Tachycardia and Chronic Chagasic Cardiomyopathy: Importance of Late Potential Mapping During Sinus Rhythm to Recognize the Critical Substrate

Background Ventricular tachycardia (VT) in patients with chronic chagasic cardiomyopathy (CCC) is associated with considerable morbidity and mortality. Catheter ablation of VT in patients with CCC is very complex and challenging. The main goal of this work was to assess the efficacy of VT catheter ablation guided by late potentials (LPs) in patients with CCC. Methods and Results Seventeen consecutive patients with refractory VT and CCC were prospectively included in the study. Combined endo‐epicardial voltage and late activation mapping were obtained during baseline rhythm to define scarred and LP areas, respectively. The end point of the ablation procedure was the elimination of all identified LPs. Epicardial and endocardial dense scars (<0.5 mV) were detected in 17/17 and 15/17 patients, respectively. LPs were detected in the epicardial scars of 16/17 patients and in the endocardial scars of 14/15 patients. A total of 63 VTs were induced in 17 patients; 22/63 (33%) were stable and entrained, presenting LPs recorded in the isthmus sites. The end point of ablation was achieved in 15 of 17 patients. Ablation was not completed in 2 patients because of cardiac tamponade or vicinity of the phrenic nerve and circumflex artery. Three patients (2 with unsuccessful ablation) had VT recurrence during follow‐up (39 months). Conclusions Endo‐epicardial LP mapping allows us to identify the putative isthmuses of different VTs and effectively perform catheter ablation in patients with CCC and drug‐refractory VTs.

Is the Prevalence of Coronary Artery Anomalies Different in Countries with Small Populations? – A Retrospective Study in Northern Cyprus

Background: Although the prevalence of coronary artery anomalies (CAA) is due to accidental and rare discoveries, it varies between different countries or geographies. CAA are rare congenital disorders having various clinical definitions. Its prevalence varies in angiographic and autopsy series in adult populations and is approximately 1% in average. While the incidence ranges from 0.2% to 5.64% in coronary angiographic (CAG) studies, it is around 0.3% in autopsy series. We aimed to estimate the frequency of CAA in our patient population. Methods: The coronary angiographic data of 4099 consecutive adult patients, who underwent CAG between January 2019 and December 2020, were analyzed and retrospectively studied. Results: The mean age of the total patients who underwent CAG was 61.59 ± 13.67 years (range, 18-98 years). CAA were found in 76 patients (1.85% incidence), origin and course anomaly in 62 patients (81.6%), and coronary artery termination anomaly in 14 patients (18.4%). Separate exits of the left anterior descending (LAD) and left circumflex (LCX) coronary artery from the left sinus of Valsalva (LSV) were the most common anomalies (36.84%). Coronary artery fistulas were seen in 14 (18.42%) patients. Abnormal origin of left circumflex artery (LCX) from the right coronary artery (RCA) or right sinus valsalva (RSV) was seen in 13 (17.11%) patients. Outflow anomalies from the contralateral coronary sinus were detected in 10 (13.16%) patients. Conclusion: The incidence and pattern of CAA in our patient population showed similarity with previous studies. Physicians should be aware of CAA that may be associated with potentially serious cardiac incidents, because recognition of these CAA is important for the decision of treatment procedures.