Chest trauma causing acute myocardial infarction.

We report a case in which blunt chest injury during football match caused an intimal tear in the left anterior descending coronary artery resulting into acute anterior wall myocardial infarction.

Endomyocardial biopsy causing coronary artery-right ventricular fistula after cardiac transplantation.

We present 3 cases of coronary artery-right ventricular fistulae diagnosed on yearly check-ups on 160 cardiac transplant patients between September 1982 and January 1995. The fistula was communicating with the ventricular branch of the right coronary artery, the septal branch of the left anterior descending artery and the distal right coronary artery in the three cases being reported. Histological examination of the endomyocardial biopsy specimen showed the presence of small calibre arteries which were not seen in other cases. Although endomyocardial biopsy carries a risk of less than 0.5 percent, the possibility of causing coronary artery-ventricular fistula should be added to the list of the complications of this procedure. The shunt caused by these fistulae is small and has no hemodynamic significance and usually does not warrant any treatment.

Percutaneous transluminal coronary angioplasty of left main coronary artery.

The present study is a retrospective analysis of 15 percutaneous angioplasty procedures of the left main coronary artery performed in 12 patients (8 males (66%) with a mean age of 64 +/- 12 (range 45-79) years. Twelve dilatations were elective: 8 for unstable angina, 3 for stable angina, and 1 after a recent myocardial infarction. All elective patients were protected with at least 1 patent graft to the distal left coronary artery. Emergency dilatation for evolving myocardial infarction with cardiogenic shock was done in 3 patients. The right coronary artery was dominant in 11 cases. The mean ejection fraction was 49 +/- 18% (range 21-7%). All dilatations were done through the femoral approach. Two dilatations were performed with the "kissing balloon" technique and 2 with the "kissing wire" technique. An intra-aortic balloon counterpulsation was used in 3 cases (21%). In 8 cases (53%), 1 additional coronary artery was dilated in the same session. The technical success rate was 100% and the clinical success rate 73%. For the elective dilatations, the technical success rate was 100% and the clinical success rate 92% (11/12). Four patients died during hospitalisation (27%). The mortality rate was 100% (3/3) for emergency dilatations and 8% (1/12) for elective dilatations (patient with dilatation of 3 vessels and 1 graft in the same session). After a mean follow-up of 25 +/- 28 (rang 1-88) months, the 8 patients discharged from hospital were alive.(ABSTRACT TRUNCATED AT 250 WORDS)

Early experience with coronary stenting.

From April 1988 to December 1991, we implanted 75 coronary stents (29 self-expanding and 46 balloon expandable) in 62 patients. All had New York Heart Association class II to IV angina, and 11 (18%) had prior coronary artery bypass grafting (CABG). Thirty nine patients (63%) had 1 vessel disease, and 23 (37%) had multivessel disease. The mean left ventricular ejection fraction was 63 +/- 11%. The indications for coronary stenting were acute post percutaneous transluminal coronary angioplasty (PTCA) occlusion in 45 (73%) (bail out stenting) and restenosis in 17 (24%) (elective stenting). There were 52 single stent (84%), 7 double stent (11%), and 3 triple stent procedures (5%). The mean stent diameter was 3.8 +/- 0.5 mm, and the mean stent length 21 +/- 7 mm. The attempted vessels were the left main coronary artery in 2(3%), left anterior descending coronary artery in 27 (44%), left circumflex coronary artery in 8 (13%), right coronary artery in 17 (27%), and a saphenous vein graft in 8 (13%). Technical success was achieved in 74 stent implantations (98%). Technical failure occurred in 1 case with a self expanding stent because of inability to reach the lesion. In hospital complications (mean hospital stay 10 +/- 10, range 2-60 days) included temporary stent occlusion in 2 patients (3%) treated by balloon dilatation and thrombolysis with intravenous urokinase, permanent stent occlusion in 5 patients (8%), Q-wave infarction in 5 patients (8%), CABG in 4 patients (11%), and death in 3 patients (5%). At least 1 major complication (Q wave infarction, CABG, or death) occurred in 8 patients (13%).(ABSTRACT TRUNCATED AT 250 WORDS)

Unusual presentation of aneurysm of aorta.

An unusual case of a saccular aneurysm of arch of aorta, masquerading as pulmonary artery branch stenosis, proved by cardiac catheterisation and angio cardiography is presented.