ABSTRACT
We present a rare case of a coronary pseudoaneurysm after a Bentall-Bono procedure. During a routine follow-up computed tomography scan, a pseudoaneurysm located between the aorta and the proximal portion of the right coronary artery was diagnosed. Contrast extravasation was observed with partial thrombosis of the pseudoaneurysm. Coronary angiography and intravascular ultrasound were performed showing the point of contrast extravasation dependent of the right coronary artery in its proximal portion. An angioplasty procedure was performed sealing the pseudoaneurysm with the implantation of a covered stent. After an uneventful postoperative follow-up, the patient was discharged home. Learning objective: The development of a coronary artery pseudoaneurysm (CAP) after complex cardiac surgeries, like Bentall-Bono procedure, could be a life-threatening condition. The possible derived complications of CAP are rupture, compression of surrounding structures, or coronary ischemia.Although surgical approach to a CAP may have an extremely high surgical risk, most of the cases require a complex surgical repair. We describe a novel possible treatment option by angioplasty and sealing of the CAP with the implantation of a covered stent.
ABSTRACT
BACKGROUND: Coronary arterial disease is the main cause of morbidity in western countries and coronary angiography is the most important diagnosis test. Lately, coronary angiotomography has been introduced for studying coronary arteries in a non-invasive way. Our goal was to assess the diagnostic accuracy of coronary angiotomography in the diagnosis of coronary arterial disease. MATERIAL AND METHODS: Cross-sectional study for assessing diagnostic test comparing coronary angiotomography to invasive angiography in patients without previous coronary disease. All the patients underwent both tests consecutively in a blind way. Coronary arteries were studied according to the modified reference model of coronary segmentary analysis of the American Heart Association. Tomography validity indexes (sensitivity, specificity, positive--PPV--and negative--NPV--predictive values and global value) by patient, artery, and segment were calculated. RESULTS: We studied 121 patients (47 females--38.8%--and 74 males--61.2%-). Prevalence of coronary arterial disease was 38%. The most frequent risk factor detected was hypertension. We obtained a 100% sensitivity and NPV studying patients as a whole by patient, a specificity of 92% (95% CI: 86.0-99.0) and a global value of 94% (95% CI: 89.0-99.0). The higher validity by artery was for anterior descending artery with a specificity of 98% (CI95%: 90.0-96.0) and NPV of 97% (IC95%: 96.0-100). The segment with higher validity was distal right coronary artery with 100% specificity and PPV. CONCLUSION: A high diagnostic validity of coronary angiotomography was obtained and it could be considered as another diagnostic test for studying coronary arterial disease.
Subject(s)
Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Tomography, X-Ray Computed , Cross-Sectional Studies , Female , Humans , Male , Middle AgedABSTRACT
Coronary collateral circulation usually develops as a consequence of recurrent ischemia associated with severe stenosis. In exceptional cases, it can develop with moderate coronary lesions if there is severe recurrent vasospasm. In this situation, the presenting clinical features of vasospastic angina (i.e., effort angina with ST-segment depression) can be identical to those of a severe permanent lesion. We present a patient who exhibited effort angina and ST-segment depression on treadmill testing. Angiography showed severe right coronary artery stenosis and the development of coronary collateral circulation from the other main artery. After repeated intracoronary bolus injection of nitroglycerin, only a moderate stenosis was still apparent and the collateral circulation had disappeared.
Subject(s)
Angina Pectoris/complications , Collateral Circulation , Coronary Circulation , Coronary Stenosis/complications , Coronary Vasospasm/etiology , Angina Pectoris/diagnosis , Angina Pectoris/diagnostic imaging , Angina Pectoris/physiopathology , Coronary Angiography , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/drug therapy , Coronary Stenosis/physiopathology , Coronary Vasospasm/diagnosis , Coronary Vasospasm/diagnostic imaging , Electrocardiography , Exercise Test , Humans , Male , Middle Aged , Nitroglycerin/administration & dosage , Vasodilator Agents/administration & dosageABSTRACT
La circulación colateral coronaria aparece como consecuencia de la isquemia miocárdica recurrente, generalmente debida a lesiones coronarias severas y fijas, y de manera excepcional puede desarrollarse en lesiones no significativas provocadas por un vasospasmo coronariosevero. En esta situación, la angina vasospástica puede manifestarse como una angina de esfuerzo con descenso del segmento ST. Presentamos el caso de un paciente con angina de esfuerzo, ergometría clínicamente positiva y descenso horizontal del segmento ST. En la angiografía se observó una estenosis crítica en la arteria coronaria derecha y el desarrollo de circulación colateral heterocoronaria. Tras la administración de nitroglicerina intracoronaria, la lesión finalmente fue moderada con desaparición de la circulación colateral
Coronary collateral circulation usually develops as a consequence of recurrent ischemia associated with severe stenosis. In exceptional cases, it can develop with moderate coronary lesions if there is severe recurrent vasospasm. In this situation, the presenting clinical features of vasospastic angina (i.e., effort angina with ST-segment depression) can be identical to those of a severe permanent lesion. We present a patient who exhibited effort angina and ST-segment depression on treadmill testing. Angiography showed severe right coronary artery stenosis and the development of coronary collateral circulation from the othermain artery. After repeated intracoronary bolus injectionof nitroglycerin, only a moderate stenosis was still apparent and the collateral circulation had disappeared
