[The role of ultrasonography of the peripheral arteries in diagnosing coronary artery disease]. / Czy ocena zmian miazdzycowych w tetnicach obwodowych moze odegrac role w rozpoznawaniu choroby wiencowej?

Atherosclerosis develops simultaneously in multiple arterial beds, that creates opportunity to diagnose of coronary artery disease. Aim of the study was the evaluation of association between atherosclerotic involvement of peripheral arteries assessed by ultrasound and significant coronary artery disease revealed by angiography. Study included 410 patients, (73% males), mean age 56.0 +/- 9.5 year scheduled for coronary angiography. During ultrasound examination of common carotid and common femoral arteries arterial wall intima-media (IMT) thickness and atherosclerotic plaques presence were assessed. Significant coronary artery disease (CAD) was diagnosed with coronary angiography as diameter stenosis > 50%. Intimo-media thickness (IMT) of common carotid arteries did not differ between groups with and without significant coronary artery disease (right 6.6 vs 6.4 mm, p = ns, left 6.9 vs 6.6 mm, p = ns) but in common femoral arterial was greater in patients with coronary artery disease (right 8.2 vs 7.1 mm, p < 0.005, left 7.9 vs 7.1 mm, p = 0.03). Atherosclerotic plaques in carotid and femoral arteries was detected more often in CAD patients (90.1% vs 34.6%, p < 0.0001). Positive predictive value for CAD diagnosis with detection of plaque in carotid or femoral artery was 93% and negative prognostic value for exclusion CAD after plaque exclusion in all arteries was 61%. Search for atherosclerotic plaques in ultrasound examination of peripheral arteries may facilitate CAD diagnosis in selected patients groups.

[Myocardial infarction in a patient with hemophilia A--a case report]. / Zawal serca u chorego z hemofilia typu A.

A 43-year-old men with hemophilia A was admitted to CCU due to anginal pain lasting for sixteen hours. ECG revealed anterior wall myocardial infarction and elevated CK and MB-CK levels confirmed the diagnosis. Exercise test performed later was positive and the patient underwent elective coronary angiography which showed 90% stenosis of left anterior descending (LAD) and closed circumflex coronary artery. Next, angioplasty of LAD, preceded by antihemophilic globulin (factor VIII) administration, was successfully performed.

[Angioplasty of unprotected two coronary artery ostia using cardiopulmonary bypass as a single emergency procedure - case report]. / Jednoczasowa angioplastyka niezabezpieczonych ujsc aortalnych obu tetnic wiencowych w krazeniu pozaustrojowym.

Mortality in patients with a significant left main and right coronary artery ostia stenosis is high, reaching 50% during a five-year follow-up period. To date, this type of lesion has been rarely treated with percutaneous coronary interventions (PCI). We present a case of a 50-year-old man who had had coronary artery bypass surgery because of left main stenosis in the past and was currently admitted to the hospital because of unstable angina. Coronary angiography showed tight left main and right coronary ostia stenosis and total occlusion of the left anterior descending artery. Vein grafts were occluded. The PCI procedure combined with the cardiopulmonary bypass was performed. The lesions were dilated and stents were successfully implanted. The patient tolerated the procedure well. He was discharged five days after PCI and the course of a 12-month follow-up was uneventful.