ABSTRACT
Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic coronary artery disease, which typically affects women with a low cardiovascular risk profile, and its prevalence as a cause of acute coronary syndrome and sudden death is probably under-recognized. The pathophysiology of SCAD consists essentially in the formation of an intramural hematoma, with or without intimal tear, which causes luminal compression and obstruction. The most used technique for the diagnosis of SCAD is coronary angiography. Intravascular imaging tools, such as intravascular ultrasound and optical coherence tomography, provide a more accurate characterization of the coronary wall, allowing diagnosis when angiography is unclear. We present the case of a young woman admitted with typical chest pain associated with electrocardiographic changes and elevated cardiac troponin I.
Subject(s)
Aortic Dissection/surgery , Coronary Aneurysm/surgery , Percutaneous Coronary Intervention/methods , Ultrasonography, Interventional , Adult , Algorithms , Aortic Dissection/blood , Aortic Dissection/diagnostic imaging , Aortic Dissection/epidemiology , Aortic Dissection/physiopathology , Biomarkers , Chest Pain/diagnosis , Chest Pain/etiology , Coronary Aneurysm/blood , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/epidemiology , Coronary Aneurysm/physiopathology , Coronary Angiography , Coronary Artery Disease/diagnosis , Diagnosis, Differential , Drug-Eluting Stents , Electrocardiography , Female , Humans , Prognosis , Troponin I/bloodABSTRACT
Rupture of the interventricular septum is a rare and life-threatening complication of acute myocardial infarction. Postmyocardial infarction, ventricular septal defect is associated with very high morbidity and mortality. The therapy of this complication is the surgical closure. The Amplatzer occluder is currently used to close percutaneously atrial septal defect, patent foramen ovale, and selected congenital ventricular septal defect. Few cases are described regarding transcatheter closure of a postinfarction ventricular septal defect. Here we report a case of a large postinfarction ventricular septal defect successfully closed with Amplatzer multifenestrated atrial septal defect occluder device because of its peculiar anatomical characteristics.
Subject(s)
Cardiac Catheterization , Myocardial Infarction/complications , Prostheses and Implants , Ventricular Septal Rupture/therapy , Aged, 80 and over , Echocardiography , Female , Humans , Ventricular Septal Rupture/diagnostic imaging , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/pathologyABSTRACT
Patients with severe depression of left ventricular ejection fraction and high-risk coronary lesions are at risk of developing complications during percutaneous coronary interventions (PCI). Intra-aortic balloon pump (IABP) is a support that helps the interventionalist in such hemodynamic complications during high-risk PCI, but it does not offer complete circulatory support. Instead, TandemHeart (Cardiac Assist, Pittsburg, PA, USA) is a percutaneous left ventricular assist device (pLVAD) that gives total left circulatory support and can be used for patients in cardiogenic shock or for elective PCI at high-risk. TandemHeart is a percutaneous transseptal ventricular assist device that allows a rapid percutaneous left ventricular support without the need for surgical implantation. Between November 2003 and April 2005, 6 patients admitted to our coronary care unit (CCU) underwent either emergency (n = 3) or elective (n = 3) placement of the TandemHeart device before a high-risk procedure. From our initial experience we conclude that the percutaneous transseptal ventricular assist device, TandemHeart, can be easily and rapidly deployed either in emergency or in elective high-risk PCI to achieve complete cardiac assistance.
Subject(s)
Heart Failure/therapy , Heart-Assist Devices , Myocardial Ischemia/surgery , Myocardial Revascularization/methods , Aged , Equipment Design , Female , Follow-Up Studies , Heart Failure/complications , Humans , Male , Middle Aged , Myocardial Ischemia/complications , Risk FactorsSubject(s)
Aorta , Aortic Dissection/therapy , Coronary Aneurysm/therapy , Coronary Artery Disease/therapy , Sinus of Valsalva , Stents , Angioplasty, Balloon, Coronary , Aorta/pathology , Blood Vessel Prosthesis Implantation , Coronary Angiography , Device Removal , Electrocardiography , Humans , Male , Middle Aged , Severity of Illness Index , Sinus of Valsalva/pathology , Tomography, X-Ray ComputedABSTRACT
Mediastinal irradiation can induce coronary artery disease characterized by fibrous lesions developing in the absence of lipid/foam cell accumulation. We document several consecutive cases of acute coronary artery occlusion developing over radiation-induced lesions in patients who were relatively young, without evidence of classical risk factors for atherosclerosis, and in whom the coronary vasculature was otherwise apparently free of disease. The finding of acute coronary artery occlusion at the site of a fibrous lesion lends further support to the hypothesis that acute coronary syndromes may not necessarily be identifiable with ulceration/disruption of the atherosclerotic plaque as the underlying mechanism of acute thrombus formation.
