ABSTRACT
Anomalous origin of the left main coronary artery from the right sinus of Valsalva or the right coronary artery is a rare coronary anomaly. This anomaly has been associated with sudden cardiac death in younger patients, depending on its course relative to the pulmonary artery. The authors report this rare anomaly in two patients. It presented as unstable angina in the first patient with a septal course. In the second patient, it presented as syncope with an anterior free wall course and absent left circumflex artery. A septal course causing unstable angina has not been reported previously.
Subject(s)
Coronary Vessel Anomalies/diagnosis , Sinus of Valsalva/abnormalities , Aged , Angina, Unstable/diagnosis , Arteries/abnormalities , Diagnosis, Differential , Female , Humans , Middle Aged , Syncope/diagnosisABSTRACT
Paravalvular regurgitation is an uncommon but important complication, usually following valve replacement surgery. Early recognition and management are important for reoperations are associated with high morbidity and mortality rates. Presently, little data are available on this topic. The authors review the subject.
Subject(s)
Aortic Valve Insufficiency/etiology , Heart Valve Prosthesis Implantation/adverse effects , Mitral Valve Insufficiency/etiology , Pulmonary Valve Insufficiency/etiology , Tricuspid Valve Insufficiency/etiology , Aortic Valve Insufficiency/complications , Aortic Valve Insufficiency/diagnosis , Aortic Valve Insufficiency/epidemiology , Aortic Valve Insufficiency/therapy , Humans , Incidence , Mitral Valve Insufficiency/complications , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/epidemiology , Mitral Valve Insufficiency/therapy , Pulmonary Valve Insufficiency/complications , Pulmonary Valve Insufficiency/diagnosis , Pulmonary Valve Insufficiency/epidemiology , Pulmonary Valve Insufficiency/therapy , Tricuspid Valve Insufficiency/complications , Tricuspid Valve Insufficiency/diagnosis , Tricuspid Valve Insufficiency/epidemiology , Tricuspid Valve Insufficiency/therapyABSTRACT
Primary aldosteronism is a relatively uncommon etiology of hypertension. Plasma renin activity is suppressed in the majority of the cases but not always. Plasma renin activity has been associated with increased vascular injury. The occurrence of vascular complications has rarely been reported with low plasma renin activity. The authors report a case of long-standing secondary hypertension due to primary aldosteronism with coronary artery aneurysms and aortic dissection. Diagnosing is important, for therapeutic intervention can be curative.
Subject(s)
Aortic Aneurysm, Thoracic/etiology , Aortic Dissection/etiology , Coronary Aneurysm/etiology , Hyperaldosteronism/complications , Hypertension/etiology , Adrenal Cortex Neoplasms/complications , Adrenocortical Adenoma/complications , Adult , Female , Humans , Hyperaldosteronism/blood , Hypertrophy, Left Ventricular/etiology , Renin/bloodABSTRACT
Takayasu's arteritis is a rare entity. The authors describe a case of a middle-aged woman with an atypical form of Takayasu's arteritis. This manifestation has not been described previously.
Subject(s)
Takayasu Arteritis/diagnostic imaging , Aorta, Abdominal/diagnostic imaging , Aortography , Brachiocephalic Trunk/diagnostic imaging , Coronary Angiography , Exercise Test , Female , Humans , Iliac Artery/diagnostic imaging , Middle Aged , Takayasu Arteritis/classificationABSTRACT
Since the introduction of pulmonary artery catheterization for hemodynamic monitoring, several complications associated with its use have been described. Pulmonary artery rupture is an infrequent complication of flow-directed pulmonary artery catheters. We report a case of pulmonary artery rupture complicating rescue PTCA in the presence of systemic platelet inhibition with abciximab (Reopro), anticoagulation, and thrombolytic therapy. With the increasing use of these medications in patients undergoing acute coronary interventions, particularly those patients requiring hemodynamic monitoring, this uncommon but potentially fatal complication may be seen more frequently.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Antibodies, Monoclonal/therapeutic use , Anticoagulants/therapeutic use , Fibrinolytic Agents/therapeutic use , Immunoglobulin Fab Fragments/therapeutic use , Pulmonary Artery/injuries , Tissue Plasminogen Activator/therapeutic use , Abciximab , Aged , Aged, 80 and over , Angiography , Cardiac Catheterization , Extravasation of Diagnostic and Therapeutic Materials/etiology , Fatal Outcome , Female , Humans , RuptureABSTRACT
Previous studies using intracoronary electrocardiography have demonstrated that ST-T alternans can develop during standard balloon coronary angioplasty. Total occlusion with a large amount of myocardium in jeopardy is the postulated prerequisite. In this study, the authors used perfusion balloons instead of standard balloons, so coronary perfusion was maintained and ischemia was minimized. Fourteen patients with standard balloon technique and 11 patients with perfusion balloon technique were studied. The ST segment was less elevated during perfusion angioplasty (0.15 +/- 0.05 mV vs 1.04 +/- 0.19 mV, p<0.001). There were six (43%) patients with ST-T alternans with standard balloon technique compared with none in the perfusion balloon group (p<0.001). In this study, the authors found that there was less ischemia, less ST segment elevation, and lack of ST-T alternans on the intracoronary electrocardiogram during perfusion balloon angioplasty. These findings support the postulate that a large amount of ischemic myocardium is a prerequisite for ST-T alternans.
