RESUMO
A 62-year-old woman was admitted to a regional hospital for acute myocardial infarction. Emergency coronary angiography revealed occlusion of the first diagonal branch, and transesophageal echocardiography showed severe mitral regurgitation due to anterior papillary muscle rupture. She was transferred to our hospital in a state of cardiogenic shock despite the use of high-dose catecholamine and intra-aortic balloon pumping. We immediately performed mitral valve replacement. The patient's postoperative course was uneventful and she was ambulatory when transferred to another hospital on foot on postoperative day 19. Physicians should be aware that fatal anterior papillary muscle rupture may be caused by isolated occlusion of the diagonal branch.
RESUMO
Las arterias que irrigan la cara pulmonar del corazón y la superficie posterior del ventrículo derecho presentan una expresión variable. Se evaluaron 154 corazones frescos de material de autopsia. Las arterias coronarias fueron sometidas a proceso de inyección con resinas sintéticas. Se observó la rama posterolateral derecha (sólo en dominancia derecha) en 24 corazones (15,6 por ciento), de los cuales 20 (83,3 por ciento) se originaron directamente de la arteria coronaria derecha y 4 de la marginal derecha. Ésta estuvo presente en el 40 por ciento de los casos que tenían una rama interventricular posterior corta y en el 5,6 por ciento con presencia de rama larga (p= 0,001). Se observó además, ramas diagonales en 74 corazones (48 por ciento), ramas anterosuperiores en 126 (81,8 por ciento) y ramas laterales en 123 (79,9 por ciento). Las ramas de longitud media fueron las más frecuentes: diagonales (52,3 por ciento); anterosuperiores (62,7 por ciento) y laterales (47,1 por ciento). El calibre de las ramas diagonales fue de 2,01 mm (DE 0,59). De las ramas diagonales, las que presentaron menor calibre correspondieron a los especímenes con dominancia izquierda 1,88 mm DS 0,52), sin ser significativo (P 0,608), mientras que las ramas laterales de mayor calibre correspondieron a corazones con dominancia izquierda (p=0,022). De las ramas diagonales se observaron puentes miocárdicos en 11 muestras (14,9 por ciento); 6 (4,8 por ciento) en las ramas anterosuperiores y 2 (8,3 por ciento) en los corazones que presentaban ramas posterolaterales derechas. Las ramas laterales no presentaron puentes miocárdicos. Se observó presencia de la rama posterolateral derecha en un sexto de los individuos con dominancia derecha y las ramas diagonales presentaron, en su mayoría, un curso epicárdico que finalizó en el tercio medio de la cara obtusa del corazón.
The arteries that irrigate the lung face of the heart and the posterior surface of the right ventricle present a variable expression. 154 fresh hearts were evaluated obtained as autopsy material. The coronary arteries were subjected to injection process with synthetic resins. Right posterolateral branch (right dominance) was observed in 24 hearts (15.6 percent), of which 20 (83.3 percent) originated of the right coronary artery and 4 of the marginal right artery. Within these in 40 percent of the cases were observed in short posterior interventricular branch and 5.6 percent with long branch (p = 0.001). It was observed diagonal branches in 74 hearts (48 percent), anterosuperior branches in 126 (81.8 percent) and lateral branches in 123 (79.9 percent). The branches of middle longitude were the most frequent: diagonals (52.3 percent); anterosuperiors (62.7 percent) and laterals (47.1 percent). The calliper of the diagonal branches was of 2.01 mm (SD 0.59). Of the diagonal branches, those that presented smaller calliper corresponded to the specimens with left dominance (1.88 mm SD 0.52), without significance (P 0.608), while the lateral branches of more calliper corresponded to hearts with left dominance (p=0.022). It was also observed myocardial bridges in 11 diagonal branches (14.9 percent); in 6 anterosuperior branches (4.8 percent) and in 2 right posterolateral branches (8.3 percent). The lateral branches do not presented myocardial bridges. Prevalence of the right posterolateral branch was observed in a sixth of the individuals with right dominance, and the majority of diagonal branches presented an epicardic course that concluded in the middle third of the obtuse face of the heart.
Assuntos
Humanos , Masculino , Adolescente , Adulto , Feminino , Pessoa de Meia-Idade , Circulação Coronária , Vasos Coronários/anatomia & histologia , Cadáver , Colômbia , Ventrículos do Coração/anatomia & histologiaRESUMO
BACKGROUND: Twelve lead electrocardiagram is often used to localize the site of myocardial infarction and coronary artery stenosis. There are many studies to correlate the electrocardiographic abnormalities and the site of coronary artery stenosis in patients with ischemic heart disease. In patients with acute myocardial infarction, however, a few studies that correlate the site of coronary artery stenosis and abnormal Q wave in leads I or aVL have been reported. METHOD: In 60 patients with acute myocardial infarction(Male : Female=48 : 12), the author investigated the development of abnormal Q wave in leads I or aVL and the presence, severity and location of stenosis in left anterior descending coronary artery and its first diagonal branch, and correlated abnormal Q wave and the presence of first diagonal branch stenosis with the progression of myocardial infarction. RESULTS: The presence of first diagonal branch stenosis can be predicted in patients with acute myocardial infarction who had abnormal Q wave in leads I of aVL with sensitivity and specificity of 70% and 85% during the early stage respectively and 88% and 96% after stabilization of infarction respectively. CONCLUSION: With the presence of abnormal Q wave in leads I or aVL in patients with acute myocardial infarction, it can be predicted that there is stenosis in the first diagonal branch. Howeve, there should be more experineces and further and metriculous studies.