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1.
Case Rep Cardiol ; 2023: 9335392, 2023.
Article in English | MEDLINE | ID: mdl-36923544

ABSTRACT

Coronary artery bypass graft (CABG) pseudoaneurysms are a rare but often unrecognized clinical entity. They are prone to rupture and hemodynamic compromise and should therefore be on the differential in the appropriate patient. We present a case of a gentleman with a recent CABG surgery who presented with acute onset dyspnea and a large pleural effusion. Imaging revealed a saphenous vein graft pseudoaneurysm embedded in a mediastinal hematoma. Four weeks later, prior to planned stenting, the pseudoaneurysm had spontaneously closed. This case highlights an unusual acute presentation of a CABG pseudoaneurysm and a multidisciplinary approach to its management.

2.
Eur Heart J Case Rep ; 6(6): ytac204, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35668844

ABSTRACT

Background: Loeys-Dietz syndrome (LDS) is a connective tissue disorder that commonly presents with vascular abnormalities. Owing to the rarity and severity of the condition, consensus guidelines for aortic surgery thresholds vary. In addition, evaluation of coronary arteries in patients with LDS (either routinely or before aortic root surgery) remain undefined. In this case report, we discuss a patient with LDS who found to have an ectatic aortic root and a coronary artery aneurysm and discuss guidelines for evaluation and management in this patient population. Case summary: A 48-year-old woman was incidentally found to have a 45 mm ectatic aortic root during evaluation for a neck mass. As part of pre-operative evaluation for aortic root replacement, left heart catheterization revealed a left main coronary artery aneurysm. Family history revealed aortic aneurysms, sudden cardiac death, and tall height. Physical examination was notable for pectus excavatum and elongated limbs. Workup for inflammatory aetiologies of aortic root dilation was negative. Genetic testing revealed a heterozygous pathogenic TGBF3 variant, consistent with LDS Type 5. She subsequently underwent two-vessel coronary artery bypass, excision of her left main coronary artery aneurysm, and ascending aortic replacement. Discussion: In this case, we describe a patient with LDS who was noted to have a coronary artery aneurysm, a rare finding in the initial presentation of disease. In addition, we examine guidelines regarding evaluation of management of aortic root disease and coronary aneurysms.

3.
JACC Case Rep ; 3(14): 1622-1624, 2021 Oct 20.
Article in English | MEDLINE | ID: mdl-34729515

ABSTRACT

This paper describes the case of a 68-year-old man who presented in cardiac tamponade due to a right ventricular free wall rupture after a recent ST-segment elevation myocardial infarction. After a pericardiocentesis, the ventricular defect resolved spontaneously. The patient was managed medically and avoided surgical intervention. (Level of Difficulty: Intermediate.).

6.
J Invasive Cardiol ; 18(12): 584-92, 2006 Dec.
Article in English | MEDLINE | ID: mdl-17197707

ABSTRACT

OBJECTIVES: Three cases of severe, diffuse coronary artery spasm after drug-eluting stent placement at our institution prompted this review. BACKGROUND: Drug-eluting stents have gained widespread use due to extraordinarily low rates of restenosis. Despite these generally superior clinical outcomes, the specter of rare idiosyncratic reactions remains a concern. METHODS: We performed searches of Medline and the U.S. FDA Manufacturer And User facility Device Experience database (MAUDE) to identify and describe spasm after coronary stent placement. Searches included drug-eluting and bare-metal stents. Institutional cases are reviewed. Location, time course and outcome of cases are described. RESULTS: Thirteen cases of spasm were identified after stent placement. Seven cases occurred after Cypher drug-eluting stent placement, 2 after Taxus drug-eluting stent placement, 1 after BiodivYsio and 3 after bare-metal stents. Five patients experienced diffuse, multivessel spasm--2 after Cypher, 2 after Taxus, and 1 after a Velocity stent. Of these 5 patients, 2 died. An additional 2 required intra-aortic balloon pump placement for cardiogenic shock. Another had persistent symptomatic, diffuse coronary spasm documented by angiography at 1 year. CONCLUSIONS: We describe coronary spasm after stent placement, particularly after drug-eluting stents. Outcomes associated with diffuse severe spasm after stenting are poor, and the pathophysiology remains poorly understood.


Subject(s)
Angioplasty, Balloon, Coronary/methods , Coronary Artery Disease/therapy , Coronary Restenosis/etiology , Coronary Vasospasm/complications , Stents , Coronary Artery Disease/complications , Coronary Artery Disease/diagnostic imaging , Coronary Restenosis/diagnostic imaging , Coronary Restenosis/physiopathology , Coronary Vasospasm/physiopathology , Coronary Vasospasm/therapy , Drug Delivery Systems , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Radiography , Severity of Illness Index
7.
Catheter Cardiovasc Interv ; 61(2): 217-21, 2004 Feb.
Article in English | MEDLINE | ID: mdl-14755816

ABSTRACT

The experience of brachytherapy in the treatment of in-stent restenosis of allograft arteries is limited. We present two cases of in-stent restenosis treated with brachytherapy with favorable angiographic follow-up at 10 months in one patient and at 17 months in the other.


Subject(s)
Brachytherapy , Coronary Restenosis/radiotherapy , Stents/adverse effects , Coronary Angiography , Heart Transplantation , Humans , Male , Middle Aged , Transplantation, Homologous
8.
J Invasive Cardiol ; 15(11): 677-80, 2003 Nov.
Article in English | MEDLINE | ID: mdl-14608145

ABSTRACT

The pedicled right gastroepiploic artery is used as an arterial conduit in a select group of patients undergoing coronary artery bypass grafting with favorable patency and survival rates. Myocardial ischemia can occur, especially secondary to distal anastomotic stenosis. Percutaneous coronary interventions have been successful in treating these stenoses, precluding further challenging and higher risk operations. The restenosis rate of such interventions is unknown. We describe a case of distal right gastroepiploic graft anastomotic stenosis that was initially treated with percutaneous angioplasty, but later required stenting for restenosis. Subsequent in-stent restenosis was successfully treated with angioplasty and brachytherapy via the left axillary approach.


Subject(s)
Brachytherapy/methods , Coronary Artery Bypass/adverse effects , Coronary Restenosis/radiotherapy , Prosthesis Implantation/adverse effects , Stents/adverse effects , Angioplasty, Balloon, Coronary/adverse effects , Coronary Artery Bypass/methods , Coronary Restenosis/etiology , Gastroepiploic Artery/surgery , Humans , Male , Middle Aged
10.
Am Heart J ; 144(3): 501-7, 2002 Sep.
Article in English | MEDLINE | ID: mdl-12228788

ABSTRACT

BACKGROUND: Approximately 50% of percutaneous coronary interventions in the United States are performed with unfractionated heparin and no IIb/IIIa agent. The operator must weigh the risks and benefits of more intensive anticoagulation during these percutaneous interventions. This study helps clarify the relationship between patient and procedural factors, such as the intensity of heparin anticoagulation as measured by activated clotting time (ACT), and the risk of blood loss and bleeding complications. METHODS: Four hundred twenty-nine patients undergoing elective or urgent percutaneous coronary intervention were followed up prospectively for 72 hours after intervention for clinical bleeding complications. Blood loss, defined as the difference between preprocedural and nadir postprocedural hematocrit adjusted for interval transfusions, was also tracked. In-laboratory ACTs, as well as other potential clinical and procedural predictors of blood loss and bleeding risk, were collected and analyzed. RESULTS: Maximum in-laboratory ACT was significantly related to blood loss as measured by the change in hematocrit (P =.017) and to the risk of major bleeding complications (P =.002). In multivariate analysis, patient age (P =.004), sex (P =.014), procedure length (P <.001), and additional interventions (P <.001) were significant, independent predictors of blood loss. Major bleeding complications were significantly, independently predicted by patient age (P <.001), additional interventions (P =.015), and maximum in-laboratory ACT (P <.001). CONCLUSIONS: Compared with the other clinical and procedural predictors of bleeding complications, maximum in-laboratory ACT was second only to patient age in significance as a multivariate predictor of postprocedural bleeding complications. Maximum in-laboratory ACT was found to be the most significant modifiable univariate and multivariate predictor of clinical bleeding complications after percutaneous coronary intervention. Particularly in patients with nonmodifiable risk factors for blood loss and bleeding complications such as advanced age, female sex, and multiple and prolonged procedures, avoiding high intensity anticoagulation with unfractionated heparin is associated with lower bleeding risk.


Subject(s)
Angioplasty, Balloon/methods , Anticoagulants/administration & dosage , Blood Coagulation/drug effects , Coronary Disease/blood , Coronary Disease/therapy , Hemorrhage/chemically induced , Heparin/administration & dosage , Age Factors , Anticoagulants/adverse effects , Anticoagulants/pharmacology , Female , Follow-Up Studies , Hematocrit/statistics & numerical data , Hemorrhage/blood , Heparin/adverse effects , Heparin/pharmacology , Humans , Male , Middle Aged , Multivariate Analysis , Prospective Studies , Risk Factors , Sex Factors , Whole Blood Coagulation Time
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