Relationship between Different Degrees of Compression and Clinical Symptoms in Patients with Myocardial Bridge and the Risk Factors of Proximal Atherosclerosis

Objective. To explore the relationship between different degrees of compression and clinical symptoms in patients with the myocardial bridge and the risk factors of proximal atherosclerosis. Methods. The clinical data of 156 patients with the myocardial bridge who underwent selective coronary angiography in our hospital from December 2010 to December 2015 were collected. The patients were divided into Noble grade I group (102 cases) and Noble grades II-III group (54 cases) according to the degree of mural coronary artery systolic stenosis. According to the results of coronary angiography, 156 patients with the myocardial bridge were divided into an atherosclerosis group (the myocardial bridge combined with atherosclerosis at the proximal end of the myocardial bridge of simple wall coronary artery), 91 cases, and a control group (isolated myocardial bridge), 65 cases. The relationship between different degrees of compression and clinical symptoms in patients with the myocardial bridge was observed, and the logistic regression model was used to analyze the risk factors of proximal atherosclerosis in patients with the myocardial bridge. Results. The incidence of atherosclerotic stenosis, angina pectoris, and myocardial infarction in the proximal part of the myocardial bridge in the Noble grades II-III group was higher than that in the Noble grade I group ( P < 0.05 ). The differences in age, hypertension, and Noble classification between the two groups were statistically significant ( P < 0.05 ). The differences of total cholesterol (TC) and C-reactive protein (CRP) between the two groups were statistically significant ( P < 0.05 ). Multivariate analysis showed that age, hypertension, Noble grade, and CRP were all risk factors for proximal atherosclerosis in patients with the myocardial bridge ( P < 0.05 ). Conclusion. The more severe the compression of the myocardial bridge, the greater the risk of cardiovascular events for patients and the higher the incidence of atherosclerotic stenosis in the proximal part of the myocardial bridge. In addition, the occurrence of atherosclerosis in the proximal coronary artery of the myocardial bridge may be affected by age, hypertension, Noble grade, and CRP level.

Ruptured sinus of valsalva aneurysm presenting as syncope and hypotension: a case report

Background Unruptured sinus of valsalva aneurysm (SOVA) are typically asymptomatic, and hence can be easily ignored. Ruptured sinus of valsalva aneurysm (RSOVA) usually protrude into the right atrium or ventricular. However, in this case, the RSOVA protruded into the space between the right atrium and the visceral pericardium leading to compression of the right proximal coronary artery. Very few such cases have been reported till date. Case presentation We describe a case of ruptured right SOVA in a 61-year-old man with syncope and persistent hypotension. At the beginning, considered the markedly elevated troponin, acute myocardial infarction was considered. However, emergency coronary angiography unexpectedly revealed a large external mass compressed right coronary artery (RCA) resulting in severe proximal stenosis. Then, aorta computed tomography angiography (CTA) and urgent surgery confirmed that the ruptured right SOVA led to external compression of the right proximal coronary artery. Finally, ruptured right SOVA repair and RCA reconstruction were successfully performed, and the patient was discharged with no residual symptoms. Conclusions It is very important to be vigilant about the existence of SOVA. RSOVA should be suspected in a patient presenting with acute hemodynamic compromise, and echocardiography should be immediately performed. Moreover, it is very important to achieve dynamic monitoring by using cardiac color ultrasound. Definitive diagnosis often requires cardiac catheterization, and an aortogram should be performed unless endocarditis is suspected.

Isolated Congenital Coronary Ostial Stenosis in a Young Infant: A Case Report

Coronary ostial stenosis is a rare congenital cardiac anomaly, frequently associated with hypoplasia of the proximal coronary artery. This condition is potentially life-threatening, as it may present with myocardial ischemia and sudden death. We present a case of left coronary ostial stenosis in a 48-day-old infant symptomatic for sudden cardiac arrest, who successfully underwent surgical angioplasty. Any cardiac arrest in a neonate or young infant should raise suspicion of coronary ostial stenosis/atresia, considering the difficulty in diagnosing this congenital heart defect.

Abstract O.72: The Spectrum Of Cardiovascular Lesions Requiring Intervention In Young Adults After Kawasaki Disease

Background: Coronary artery aneurysms resulting from vascular inflammation associated with Kawasaki disease (KD) in childhood may remain clinically silent until adulthood. Young adults presenting with large aneurysms, unstable angina, or myocardial infarction (MI) following KD in childhood present unique challenges to the interventional cardiologist and cardiothoracic surgeon. We present a range of management issues raised by this patient population. Methods: Participants who underwent cardiovascular interventions were identified from an observational cohort of 154 individuals with a history of KD enrolled in the San Diego Adult KD Collaborative. Of these 154 participants, 63 (40.9%) were originally diagnosed with KD and followed by one of the co-authors (JCB) and were designated as Cohort 1. The remaining 91 participants (Cohort 2) were referred by their physician or self-referred for participation in the study. Results: Of the 154 participants, 20 (12.9%; 2 from Cohort 1 and 18 from Cohort 2) underwent cardiovascular interventions: 9 had percutaneous interventions and 11 had surgery. Twelve participants had been diagnosed with KD in childhood, 7 had a history of a KD-compatible illness in childhood, and 1 had proximal coronary artery aneurysms compatible with KD. Fourteen participants were asymptomatic until experiencing a major cardiovascular event: 8 presented with an acute MI, 3 presented with angina, 1 presented with end-stage congestive heart failure requiring cardiac transplantation, and 2 presented with extremity claudication. Conclusions: Cardiovascular complications in individuals with a history of KD illustrate the following points: 1) Even small to moderate-sized aneurysms that “normalize” by echocardiography in childhood can lead to stenosis and thrombosis decades after the acute illness; 2) Coronary interventions without intravascular ultrasound may result in underestimation of vessel lumen diameter; 3) Failure to assess the extent of calcification may lead to suboptimal procedural outcomes, and 4) Patients with symptomatic peripheral aneurysms may benefit from endarterectomy or resection. Interventional cardiologists should be aware of the complications encountered in this growing population of young adults.

Dihydroergotamine and sumatriptan in isolated human coronary artery, middle meningeal artery and saphenous vein

Background Dihydroergotamine (DHE) and sumatriptan are contraindicated in patients with cardiovascular disease because of their vasoconstricting properties, which have originally been explored in proximal coronary arteries. Our aim was to investigate DHE and sumatriptan in the proximal and distal coronary artery, middle meningeal artery and saphenous vein. Methods Blood vessel segments were mounted in organ baths and concentration response curves for DHE and sumatriptan were constructed. Results In the proximal coronary artery, meningeal artery and saphenous vein, maximal contractions to DHE (proximal: 8 ± 4%; meningeal: 32 ± 7%; saphenous: 52 ± 11%) and sumatriptan (proximal: 17 ± 7%; meningeal: 61 ± 18%, saphenous: 37 ± 8%) were not significantly different. In the distal coronary artery, contractions to DHE (5 ± 2%) were significantly smaller than those to sumatriptan (17 ± 9%). At clinically relevant concentrations, mean contractions to DHE and sumatriptan were below 3% in proximal coronary arteries and below 6% in distal coronary arteries. Contractions in the meningeal artery and saphenous vein were higher (7%–38%). Conclusions Contractions to DHE in distal coronary arteries are smaller than those to sumatriptan, while at clinical concentrations they both induce only slight contractions. In meningeal arteries contractions to DHE and sumatriptan are significantly larger, showing their cranioselectivity. Contractions to DHE in the saphenous vein are higher than those in the arteries, confirming its venous contractile properties.