Four Coronary Arteries Separately Originating from the Right Sinus of Valsalva.

An 82-year-old woman was admitted to our hospital with heart failure. Coronary angiography revealed one anatomically normal right coronary artery and three left coronary arteries (LCA-1, LSA-2, and LSA-3) separately originating from the right sinus of Valsalva, comprising multiple atherosclerotic lesions. LCA-1 became the obtuse marginal branch after branching off into the septal branches. LCA-2 was the main circumflex artery with an obstructive lesion. LCA-3 corresponded to the distal part of the anterior descending branch. The patient died 14 days after hospitalization. We describe the rarity of quadriostial origin, the unusual course, and the unusual branching of the coronary arteries.

A case of acute coronary artery occlusion associated with very rapid onset heparin-induced thrombosis without thrombocytopenia.

An 81-year-old woman was admitted to our hospital with acute heart failure. A coronary stent was implanted in the left circumflex artery (LCX) on day 3, and elective percutaneous coronary intervention for stenosis in the left anterior descending artery (LAD) was planned for day 10. However, 15 minutes after heparin administration, sudden thrombotic occlusion occurred first in the LAD and then in the LCX. Although anti-platelet factor 4/heparin antibody positivity was detected, there was no significant decrease in platelet counts. This suggests that in the event of unexplained thrombosis, heparin-induced thrombosis should be suspected irrespective of platelet counts and early onset.

Platelet function measured using a whole blood aggregometer can predict bleeding events.

AIM: We hypothesized that excessive suppression of platelet function due to antiplatelet therapy can increase the incidence of bleeding complications. The aim of the present study was to find whether we could predict bleeding events by measuring platelet function. METHODS: We enrolled 743 subjects whose platelet function was measured using a whole blood aggregometer based on a screen filtration pressure method. Of these subjects, 551 (74.2%) were treated with some type of antiplatelet agent. The endpoints were bleeding or ischemic events requiring hospitalization or extension of hospital stay. We prospectively compared the platelet function of subjects with and without bleeding or ischemic events. RESULTS: During 556 ± 207 days of follow-up, 52 (7.0%) bleeding events and 20 (2.7%) ischemic events were observed. Kaplan-Meier analysis using the log-rank test revealed that an aggregation rate of < 20% induced by 8 µ M adenosine diphosphate (ADP) was significantly associated with a greater number of bleeding events (11.9% vs. 5.2%; p = 0.0007). Cox proportional hazards model showed that age > 75 years (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.03-3.10; p = 0.039), estimated glomerular filtration rate < 60 ml/min/1.73 m(2) (HR, 1.82; 95% CI, 1.06-3.18; p = 0.031) and aggregation rate < 20% induced by 8 µ M ADP (HR, 2.18; 95% CI, 1.24-3.80; p = 0.0071) were independent predictors of bleeding events. CONCLUSIONS: Low platelet function demonstrated using a whole blood aggregometer was an independent predictor of bleeding complications.

Head-to-head comparison of the cardio-ankle vascular index between patients with acute coronary syndrome and stable angina pectoris.

We aimed to evaluate whether there was a difference in the arterial stiffness assessed by the cardio-ankle vascular index (CAVI) between patients with acute coronary syndrome (ACS) and those with stable angina pectoris (SAP). A total of 199 consecutive patients, 79 with ACS and 120 with SAP, who underwent emergency or elective coronary revascularization were enrolled. The CAVI was measured within 2 days after the procedures, and was compared between the ACS and SAP patients. As parameters related to arteriosclerosis, carotid intima-media thickness (IMT) and number of stenotic coronary vessels were also evaluated. Although IMT was significantly greater in SAP patients (2.1±1.1 vs. 2.4±0.9; P=0.022), CAVI was significantly higher in ACS patients (10.0±1.7 vs. 9.3±1.3; P=0.0012). After an adjustment for the clinical parameters with a significant difference between the two patient groups, CAVI remained significantly higher in ACS patients than in SAP patients (odds ratio 1.92, 95% confidence interval 1.30-3.02; P=0.0023). A multiple linear regression analysis revealed that age (ß=0.44; P<0.0001) and ACS (ß=0.3; P<0.0001) were the independent determinants of CAVI. A significant decrease in CAVI was observed at 6 months of follow-up as compared with the acute phase in 18 patients with ACS (10.9±1.6 vs. 10.0±1.5; P=0.019). In conclusion, CAVI was significantly and independently higher in patients with ACS than in those with SAP, which might result from a transient increase in the CAVI caused by acute myocardial ischemia.

Very late stent thrombosis after drug-eluting stent implantation in a patient with antiphospholipid syndrome.

A 74-year-old woman was admitted to our hospital with chest pain and shortness of breath. Coronary arteriograms revealed occlusion of a drug-eluting stent, which had been implanted 33 months earlier, in the middle right coronary artery. During percutaneous coronary intervention, distal embolization developed and a thrombus was detected with an aspiration catheter. Serological examinations performed 1 year before and during the present hospitalization revealed positive lupus anticoagulant activity. Thrombophilic tendencies, such as antiphospholipid syndrome, are noteworthy as one of the causative factors in very late stent thrombosis.

Successful retrieval of a dislodged paclitaxel-eluting coronary stent in the abdominal aorta using a Günther Tulip Vena Cava MReye Filter Retrieval Set.

Although the incidence of stent dislodgement has gradually decreased, dislodgement is still a potential cause of serious complications if it happens. We report a case of complicated dislodgement of a paclitaxel-eluting coronary stent during percutaneous coronary intervention and the successful retrieval in the abdominal aorta using a Günther Tulip Vena Cava MReye Filter Retrieval Set, which was inserted from the right femoral artery. This retrieval set has a unique curve loop that was useful to retrieve the dislodged stent in the abdominal aorta.

[Pheochromocytoma with reversal of tako-tsubo-like transient left ventricular dysfunction: a case report].

A 59-year-old male was admitted to the emergency department because of sustained chest oppression. Electrocardiography revealed J type ST depression and peaked T wave in leads II, III, aVF, and V4-V6. No stenosis was found in the coronary arteries by urgent coronary angiography. Left ventricular abnormal wall movement with akinesis in the base and hyperkinesis in the apical area was observed and improved on the 12th day. Myocardial scintigraphy with iodine-123-metaiodobenzylguanidine showed completely defective images and decreased accumulation in the base with combined thallium-201 and iodine-123-beta-methyl-p-iodophenyl-pentadecanoic acid. Myocardial biopsy on the 12th day disclosed contraction band necrosis. The diagnosis was catecholamine-induced cardiomyopathy caused by pheochromocytoma.