ABSTRACT
Calcium levels in the Coronary Artery are an indicative marker of the presence and extent of atherosclerosis. This serves as an additional prognostic indicator in addition to traditional risk factors. Moreover, the coronary calcium test is associated with a descriptor known as the calcium score or calcium score (Cs), which is primarily useful for stratifying the risk of asymptomatic patients, while for patients with acute or chronic chest pain, coronary axial computed tomography is generally required. A retrospective analysis of data was conducted in the radiology department of King Salman Specialist Hospital in Hail City, the kingdom of Saudi Arabia, between January and May 2022. A total of 40 patients were randomly selected, 25 males and 15 females. The study included all patients with or suspected of having a calcium deposit who underwent a CT scan using the Siemens SOMATOM definition MDC scan. Patients underwent a scan with the preparations and laboratory tests required for their coronary artery calcium scores. In this study, males were more likely to be affected by calcium deposits (64%), whereas females were 36%. Approximately 50 percent of the study populations were found to be normal (no identifiable calcium deposits) and 37.5% to have moderate calcium deposits. There is a significant association between CACS and moderate CVD risks based on age and gender in this study. Better control of cardiovascular system (CVS) risks is recommended in all primary care centers in the Kingdom of Saudi Arabia (KSA).Copyright © 2022 International Journal of Pharmaceutical Research and Allied Sciences. All rights reserved.
ABSTRACT
Clinical Information Patient Initials or Identifier Number: 56 years old woman Relevant Clinical History and Physical Exam: A 56-years-old woman with underlying history of hyperlipidemia without medical treatment. She experienced effort precordial tightness and shortness of breath for 8 months after COVID-19 vaccination. She received exercise TI 201 myocardial perfusion scan showed myocardial ischemia. EKG found old anterior wall myocardial infarction. Echocardiogram showed left ventricle anterior wall hypokinesia, LVEF 38%. [Formula presented] Relevant Test Results Prior to Catheterization: Coronary angiogram found left anterior descending artery from proximal to middle 70~80% long diffuse stenosis with spontaneous recanalized coronary thrombus. Also left anterior descending artery diagonal 2 branch bifurcation was 70% stenosis with spontaneous recanalized coronary thrombus (Medina 1.1.1) [Formula presented] [Formula presented] Relevant Catheterization Findings: Coronary angiogram found left coronary artery middle and diagonal branch braided apperance. OCT found recanalized thrombi, high backscattered septa that divided the lumen into multiple small cavities, created "lotus root" appearance. [Formula presented] [Formula presented] Interventional Management Procedural Step: Left main coronary artery was engaged with EBU3.5/7F guiding catheter. We advanced Runthrough to LAD-D and second wire Sion to LAD-DB2 but can't advance. Then we used with Sasuke double lumen catheter and successful advance Pilot 50 to LAD-DB2 distal. OCT found multiple channels with LAD-D and DB2 branch wires are at different channels, so we used cutting balloon 2.5 x 10mm as unconventional method. OCT was rechecked again and successfully destroyed to multiple channel of SRCT between LAD and Diagonal 2 branch. Long diffuse dissection found after POBA so we deployed to LAD-DB2 branch with DES Synergy 2.5 x 16mm and advanced LAD-M bifurcation to Pantera LEO 3.0 x 20mm and done Mini-Crush technique. Deployed for main vessel LAD-P to M long diffuse lesion with DES Xience 2.75 x 48mm at 14atm. Then we rewire Fielder XTR to DB2 branch with the support of Sasuke but difficult to deliver to Diagonal 2 branch. POT with Pantera LEO 3.0 x 20mm to LAD stent proximal site. Then successfully advance Fielder XTR to DB2 branch. Final kissing balloon technique with Pantera 2.75 x 12mm to LAD main vessel and MINI TREK 1.5 x15mm to LAD-DB2. [Formula presented] [Formula presented] [Formula presented] Conclusion(s): This is a case of SRCT (Spontaneous Recannalized Coronary Thrombus) that was confirmed with OCT. For secure side branch patency, main trunk & side branch wire must be in same channel. Due to relatively unstable hemodynamic, we chose to use unconventional method with 2.5 x 10mm Wolverine cutting balloon. Relatively large side-branch diagonal branch, possible dissection at ostial diagonal branch, we chose upfront 2 stents, bifurcation stenting technique we used Mini-crush stenting. Some difficult when rewire to side branch and initial POT to main branch stent proximal and then successfully delivered. If without guidewire recross, unrescuable side-branch occlusion can be occurred.Copyright © 2023
ABSTRACT
Background Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is an extremely rare disorder. Case A 20-year-old, 36-week pregnant female (G1P0) presented with acute shortness of breath, sharp chest pain and fever. She was COVID-19 positive and required BiPAP. Echocardiogram showed 40% EF, dilated LV with global hypokinesis and moderate mitral regurgitation (MR). She was hypotensive and on oxygen despite diuresis, emergent cesarean and COVID-19 treatment. Left heart catheterization showed anomalous takeoff of the left main coronary artery (LCA) from the dilated pulmonary artery (PA) with coronary steal (Figure 1). She had ALCAPA repair with LIMA to LAD bypass grafting. Decision-making Differential diagnoses included peripartum cardiomyopathy, Covid-myocarditis, pulmonary embolism, and spontaneous coronary artery dissection. LHC was performed only when symptoms failed to improve and troponin kept rising. ALCAPA has two major clinical subtypes - Infantile type and adult type. Adult type presents as dyspnea, chest pain, reduced exercise ability, and sudden cardiac death. Despite having good RCA to LCA collaterals, adult patients can still have ongoing ischemia of the LV myocardium, causing ischemic MR, malignant ventricular dysrhythmias. Diagnosis was delayed due to pregnancy and COVID-19 infection. Conclusion ALCAPA is a lethal coronary disorder. Elevated troponin and dilated cardiomyopathy with acute MR should raise suspicion of ALCAPA in young adults. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
Congenital coronary anomalies are among the rare disorders of the otherwise normal heart. A 2-year-old toddler was evaluated for de novo heart failure after a flu-like event 2 months before being suspicious of post-Covid-19 dilated cardiomyopathy. The cardiac magnetic resonance (CMR) technique displayed the basal to mid subendocardial to transmural scar, suggestive of an ischemic etiology. Further assessment with CT and invasive angiography confirmed the very uncommon left main coronary artery atresia (LMCAA) as the main cause of the patient's heart failure. This is not only the first reported LMCAA case that had undergone a CMR study but was also initially suspected with characteristic CMR findings.
ABSTRACT
Background and Aim: Cardiovascular manifestations are common (35-100%) in multisystem inflammatory syndrome in children (MIS-C), including ventricular dysfunction, shock, coronary artery dilation, pericardial effusion and conduction abnormalities. Our study aimed to analyse cardiovascular involvement in our patients with MIS-C treated in our hospital. Method(s): The retrospective cohort study included all patients with MIS-C treated from April 2020 to December 2021 in the Mother and Child Health Institute of Serbia. In every case, cardiovascular manifestations were analysed: ventricular dysfunction, coronary artery dilatation, pericardial effusion, shock and ECG changes. Result(s): The study included 77 patients, 45 boys and 32 girls, aver-age years of age 9.3 +/- 4.8. Elevated cardiac troponin I and pro-BNP were observed in 35.9% and 87.8% of patients, respectively. Myocardial dysfunction was observed in half of our patients (50.6%), with an average ejection fraction of 50.5 +/- 8.9%. Children older than 10 years had 4 times higher chances for myo-cardial dysfunction (OR 4.3, 95%CI 1.6-10.8;p = 0.003). Shock syndrome had 21.1% of children on admission, while 5.3% devel-oped shock during the in-hospital stay. Transient coronary artery (CA) dilatation was observed in 6.5% of patients;left CA in 3 pts (Z score +2,95 +/- 0.3), right CA in one patient (Z score +2), and in one LCA and RCA (RCA Z score 2.6). Transient CA dilatations were observed only in patients with KD-like clinical presentation (5/54 pts). Mild pericardial effusion with spontaneous resolution was detected in 28.6% of children, while one female adolescent had severe pericardial effusion with threatening cardiac tamponade. On the standard ECG, 53% of children had negative T wave in inferior or/and precordial leads averagely on day 2 (IQR 1-3 day);transient QTc prolongation was registered in 46% of patients, averagely on day 7 (IQR 5-9). Sinus bradycardia and coronary rhythm were registered in 42.1% of patients, while premature ven-tricular beats were observed in 2.7% of pts. left ventricle thrombus was detected in one patient with normal echocardiography find-ing. In this patient, increased activity of Factor VIII and XII was proven. Conclusion(s): Cardiac manifestations are common and potentially life-threatening in MIS-C and should be assessed for at presenta-tion and during the clinical course as indicated.
ABSTRACT
Background and Aim: The Coronavirus disease 2019/COVID-19/exerts an unprecedented global impact on public health and health care delivery. The aim of this study was to evaluate the knowledge on SARS-CoV-2, epidemiology, clinical presentation including cardiovascular and immunological status in postCovid children. Method(s): A group of 70 children/previously healthy or with no pre-existing heart disease/from Sarajevo with positive postcovid history, formed this study. Patients were evaluated at the Polyclinic Eurofarm in Sarajevo, from October 2020 till April 2021. Following history and epidemiological data, a detailed cardio-vascular examination has been performed including oxygen satu-ration, pulse, blood pressure, electrocardiogram/ECG/, values of polymerase chain reaction (PCR), serological tests for corona, lab-oratory blood tests and echocardiography. Result(s): The group consisted of 70 children/40 boys/: infants: 10, 1-5 years: 20;6-10:12;11-15:21;16-18 years: 7;forming five groups. Symptoms differ depending on age group, younger chil-dren had no or mild symptoms in comparison to the older group of children. The values of immunoglobulin G were significantly higher in the older group of children with (p lt;0.05;p = 0.043) indicating that the immune system with age is more responsive to the virus. PCR test was negative in 9/70 children. The majority of children/64.3 %/were asymptomatic. Two boys aged 14 years, had palpitation on exertion, shortness of breath, ECG changes, lower oxygen saturation/91% and 94%/, elevated creatinine phosphokinase miofibrilae/CPKMB/: 38 and 45, in one patient the diameter of left coronary artery/LCA/was enlarged up do 3.8mm, no aneurysm, no skin changes, with normal ejection frac-tion of left ventricle. They were on short period/10-15days/of treatment with nonsteroids including low doses of Aspirin, vita-mins/C and D/, rest and no sport activities. After treatment and a regime of no activities, they were fully recovered, free of symptoms, with normal oxygen saturation, normal values of CPKMB, diameter of LCA was within a normal range according to age and body weight of the patient. Conclusion(s): Practitioners should consider the possibility of COVID-19 in children with atypical symptomatology and posi-tive or suspicious epidemiological survey, paying special attention to coronary and immunological status.
ABSTRACT
Background: COVID-19 infection and Multisystem Inflammatory Syndrome in Children (MIS-C) in hospitalized pediatric patients have been associated with cardiac manifestations . Generally, children have asymptomatic or mild COVID-19 infection and MISC is rare. We examined the cardiac implications of asymptomatic or mild COVID-19 infection in non-hospitalized children to better define this outcome. Methods: We queried the electronic medical record for patients ≤18 years-old referred for outpatient pediatric cardiology evaluation following COVID-19 infection from 5/1/2020 - 4/30/2021. We excluded patients without a confirmatory COVID test (PCR or serology), who had been hospitalized for any condition related to COVID-19 (including MIS-C), or with history of cardiac disease that could affect coronary artery dimension. We recorded electrocardiogram (EKG) and echocardiogram (ECHO) findings, and laboratory studies performed during a preceding emergency department or most recent cardiology clinic visit. Results: Of 277 records reviewed, 134 met inclusion criteria (Figure 1);mean age 9.6 +/- 5.4 years, 53% male. 131 patients had a normal or minor variant on EKG and ECHO (Table 1). Three patients had coronary artery (CA) abnormalities on ECHO: 1) 7-year-old male with history of mild COVID-19 infection;borderline left main CA dilation (Z-score +2.1 on largest measurement). Plan for close follow-up and repeat ECHO. 2) 16-year-old male with positive COVID serology;dilated right CA (Z-score +2.3);started on aspirin. Plan for close follow-up, repeat ECHO, and possible CT angiography. 3) 8-yearold male with history of mild COVID-19 infection;dilated left main CA (Z-score +2.6);started on aspirin;CT angiography confirmed enlarged left main CA. Plan for close follow-up and repeat ECHO. Prior to COVID-19 this patient had an ECHO with normal CA dimensions (Z-score -0.4). Conclusion: While cardiac disease in children with COVID-19 infection is uncommon, we report three pediatric patients who may have developed CA dilation following confirmed mild or asymptomatic COVID-19 infection. Current return to play guidelines recommend cardiology evaluation after moderate to severe COVID-19 infection, as studies have reported myocarditis in young healthy athletes. Our study adds to the body of literature on COVIDrelated cardiac disease and may have important implications for post-COVID surveillance in young healthy children following minimal illness. Data collection is ongoing.
ABSTRACT
At the time of the ongoing coronavirus pandemic, we are encountering patients who are Covid-19 positive and have severe coronary artery disease. Patients requiring cardiac surgery are particularly challenging. A multidisciplinary discussion aimed at assessing surgery tolerability and considering the most appropriate approach is important given the higher risk of surgical mortality. We report a case of a high-risk Covid-19 positive symptomatic female patient with an acute coronary syndrome and a critical calcified stenosis of the main stem of the left coronary artery. This patient was not suitable for cardiac surgery and she underwent a percutaneous coronary intervention using a left ventricular mechanical support system and intravascular lithotripsy.
ABSTRACT
Purpose of Study Objective: To evaluate the short and midterm cardiac outcomes in children hospitalized with MIS-C in two pediatric intensive care units (PICU) in New Jersey. Methods Used Design/Methods: We conducted a retrospective review of children admitted to the PICU with a diagnosis of MIS-C between April 2020 through March 2021. Cardiac biomarkers and echocardiograms performed during hospitalization were analyzed. Follow-up echocardiograms were performed two to eight weeks post-discharge, with interval follow-up of up to one year. Shortening fraction (SF) was used to assess left ventricular systolic function using standard M-mode (SF < 28% considered abnormal). Summary of Results Results: Twenty-seven patients (18 male;median age 11 years) were included. The mean peak Troponin I in 25 patients was 2.10 +/- 5.0 ng/dL, and mean peak NTProBNP level in 26 patients was 1,606 +/- 1293 pg/dL. Most patients had normalization of cardiac biomarkers by time of discharge (table 1). Seven of the 23 patients who had an echocardiogram on admission had a SF less than 28%. Lowest SF and SF at the time of discharge were compared in 21 patients with a median improvement of 6% (p <0.001) (table 2). Nineteen patients had a follow-up echocardiogram two to ten weeks post discharge and 18 of those had normal left ventricular systolic function (p < 0.001). No patient had evidence of diastolic dysfunction at follow-up. Eight patients had midterm follow-up five to seven months post-discharge;one patient was followed for one-year post-discharge. Abnormalities that persist in these patients include low normal left ventricular systolic function. Three subjects had evidence of left coronary artery dilation (z score >2) during hospitalization and continued to have diffuse dilation at follow up, with one developing right coronary artery dilation. Conclusions Conclusion: In this cohort of patients, most children admitted to the PICU with MIS-C had abnormal cardiac biomarkers with normal to mildly decreased left ventricular systolic function that improved by time of discharge and continued to improve with midterm (5-7 months) follow-up. A very small subset of patients, however, continue to have cardiac complications including diffuse coronary artery dilation. (Table Presented).
ABSTRACT
Clinical Information Patient Initials or Identifier Number: R Relevant Clinical History and Physical Exam: A 64-year-old lady with underlying dyslipidemia presented to our emergency department with typical chest pain. Immediate electrocardiogram was performed which showed sinus rhythm, ST elevation at lead 1, aVL and V1, hyperacute T wave at V2 till V3 with ST depression at leads II, III and aVF. Hence a diagnosis of acute anterolateral myocardial infarction, Killip 1 was given and urgent referral to cardiologist was made. Subsequently, she was subjected for primary angioplasty. Relevant Test Results Prior to Catheterization: Blood results showed sodium of 134 mmol/L, potassium of 3.5 mmol/L, urea of 3.2 mmol/L and creatinine of 67 mmol/L. Liver enzymes were within normal limits with aspartate transaminase of 38 U/L and alkaline phosphatase of 91 U/L. Creatinine kinase was 330 U/L but increased to 2861 U/L during subsequent day. In addition, COVID-19 RTK antigen was negative. Relevant Catheterization Findings: Coronary angiogram revealed mild disease at proximal right coronary artery and proximal left circumflex. Minimal disease was noted at distal left main stem, but severe disease was observed from proximal left anterior descending till mid left anterior descending. Heterogenous plague suggesting thrombus was seen at ostial first diagonal as well. [Formula presented] [Formula presented] Interventional Management Procedural Step: Right femoral assess was obtained with 7Fr sheath, and SL 3.5 7Fr guiding catheter was engaged to left coronary artery. Intracoronary heparin and tirofiban were given prior to wiring. First diagonal was wired with Sion Blue while left anterior descending was wired with Runthrough Floppy. Post-wiring both vessels, coronary flow remained TIMI 3 and hence we decided to proceed with IVUS. From IVUS, noted fibrous elastic plague with heavy thrombus burden. Intracoronary streptokinase was given and noted improvement of thrombus from IVUS. BMW wired to left circumflex. Lesion predilated with scoring balloon and associated with no reflow events, resolved post vasodilators. Left main stem was stented with Onyx 3.5 x 26 mm and deployed at 16 atm. Both side branches wires were rewired into same branches via Crusade microcatheter. LMS stent was post dilated with NC Euphora 4.5 mm at nominal pressure. Noted impingement of both ostium diagonal and circumflex branches. Balloon kissing inflation was performed for both LAD/Diagonal bifurcation and LMS/LAD/circumflex bifurcation. POT was performed post balloon kissing inflation with NC Euphora 3.5 mm and 4.5 mm for both LAD and LMS respectively. Next, IVUS was repeated for mid LAD stent length and Onyx 3.0 mm X 15 mm was deployed at nominal pressure. IVUS repeated and noted under-expansion of overlapped segments and post dilated with NC Euphora 3.0 mm at high pressure. [Formula presented] [Formula presented] [Formula presented] [Formula presented] Conclusions: Our clinical vignette demonstrated few learning points including utilization of IVUS during primary angioplasty. Understanding of plague characteristic ensures adequate stents expansion especially with fibro elastic plague. In addition, we also demonstrated several precautions in dealing with bifurcation lesions including usage of double lumen microcatheter for wiring the side branches. Even though we opted for provisional stenting, balloon kissing inflation played pivotal role in preserving flow into side branches.
ABSTRACT
Introduction: COVID-19-related thrombotic events are associated with an increase in the risk of mortality and morbidity. Considering the research on the pathophysiology of the disease, the significance of cardiac thrombosis is being more recognized. Case Presentation: This study aimed to present the first case report of a Left Main Coronary Artery (LMCA) thrombosis due to COVID-19 infection in a middle-aged male with a mechanical valve on anticoagulant therapy and with an International Normalized Ratio (INR) within the therapeutic range. Conclusions: The results suggested that the therapeutic INR range may need to be higher (about 3.5) during the acute phase of COVID-19 infection to prevent thrombotic events amongst patients with COVID-19 who are on anticoagulant therapy. However, further evidence is required to determine the target range for INR in patients with COVID-19 who are on anticoagulants prior to infection.
ABSTRACT
Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a serious congenital malformation. Reports about asymptomatic, incidentally discovered ALCAPA in adults are scarce. We describe a patient with no known pre-existing cardiac condition admitted to our hospital with coronavirus disease 2019 (COVID-19) and was incidentally found to have ALCAPA. To the best of our knowledge, this is the first reported case of incidentally discovered ALCAPA in a COVID-19 patient and highlights the importance of appropriate investigation of the coronary status by Multidetector Cardiac Computed Tomographic Angiography (MDCCTA) in individuals with asymptomatic left ventricular dysfunction. The presentation of this case, discussion and literature review serves to iterate the necessity of appropriately investigating patients with asymptomatic LV dysfunction.