Spontaneous coronary artery dissection by intravascular ultrasound in a patient with myocardial infarction

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome and sudden cardiac death. The incidence, causes, pathogenesis, and treatment have not been defined clearly, but spontaneous coronary artery dissection should be considered in young patients without major cardiovascular risk factors or in patients in the peripartum period who present with acute coronary syndrome. The treatment is often challenging. Medical treatment is usually considered, and percutaneous coronary intervention or coronary artery bypass surgery may be possible in some patients. We herein report two cases of middle-aged males with myocardial infarction who were treated with percutaneous coronary angioplasty.

Utility of Global Strain by Two-Dimensional and Three-Dimensional Speckle Tracking for Assessing Left Ventricular Diastolic Function: Comparison with Pressure Wire Analysis

BACKGROUND AND OBJECTIVES: We evaluated the utility of two-dimensional (2D) and three-dimensional (3D) left ventricular (LV) global myocardial deformity parameters for assessing LV diastolic function by comparing invasive measures of LV performance. SUBJECTS AND METHODS: Echocardiography and LV pressure were assessed in 39 patients. Myocardial LV longitudinal, circumferential, and radial deformations, as well as area strain, were evaluated utilizing 2D and 3D speckle tracking software. The 2D early diastolic strain rate (2D-SRe) was measured from the 3 apical and 3 short axis views. The 3D diastolic index (3D-DI) was calculated by the % change of global strain during the first one-third of the diastolic period. LV end diastolic pressure (LVEDP) and the rate of LV pressure change (dP/dt) were collected using a pressure-conducted catheter and tau was calculated. RESULTS: dP/dt(min) were related to early mitral annular velocity (e'), 2D-SRe(long), 2D-SRe(radial), as well as 3D-DI(long), and 3D-DI(as). Additionally, LVEDP was associated with the ratio of mitral early diastolic velocity (E) to 2D-SRe(long), 2D-SRe(circ), 2D-SRe(radial), 3D-DI(long), 3D-DI(circ), and 3D-DI(as). E/2D-SRe(long), E/2D-SRe(radial), E/3D-DI(long), and E/3D-DI(as) were comparable with E/e' in predicting patients with elevated LVEDP. Among those patients with E/e' of 8 to 15, E/3D-DI(long) provided incremental value in identifying those with LVEDP > or =15 mm Hg. CONCLUSION: 2D-SRe(long), 2D-SRe(radial), 3D-DI(long), and 3D-DI(as) were related to LV relaxation, and the ratios of E to those parameters were associated with LVEDP. In addition, among patients with indeterminate E/e', E/3D-DI(long) offered incremental value in predicting elevated LVEDP, suggesting it may provide supplementary information in the evaluation of LV diastolic function.

A Case of Retrograde Dissection at the Right Sinus of Valsalva Resulted from Dissection of Right Coronary Artery during Ergonovine Test

Retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention. That may occur due to trauma to the ostium from catheter manipulation and may sometimes require surgical repair. A 50-year old male patient was admitted because of chest pain. During catheterization of the right coronary artery (RCA) after ergonovine test, we encountered coronary artery dissection with retrograde dissection of right sinus of Valsalva leading to RCA occlusion. Then we placed coronary artery stent (4.0x24 mm Driver stent) at right coronary artery ostium and his coronary blood flow of RCA was recovered and no further extension of dissection was observed. Here, we present a case of acute myocardial infarction which resulted from the acute dissection of the sinus of Valsalva with obstruction of the right coronary ostia by intimal flap during angiography.