ABSTRACT
BACKGROUND Ventricular rupture is a complication of acute myocardial infarction (AMI) that results in hemopericardium and cardiac tamponade and has a high mortality rate. Most cases involve the left ventricular free wall, and there have been few previous reports of solitary right ventricular free wall rupture. This report is of a case of fatal right ventricular free wall rupture during percutaneous coronary intervention (PCI) for inferior acute myocardial infarction (AMI). CASE REPORT A 76-year-old woman underwent emergency coronary angiography following inferior AMI. During angiography and attempted percutaneous coronary intervention (PCI), sudden onset of cardiac arrest occurred due to cardiac tamponade. Blood was drained from the pericardium by pericardiocentesis. Despite of advanced cardiac support, the patient died. The post mortem findings showed a solitary right ventricular free wall rupture due to inferior myocardial infarction. CONCLUSIONS A rare case is presented of right ventricular free wall rupture following AMI that occurred during PCI. This case demonstrates that early diagnosis and management are required to prevent patient mortality.
Subject(s)
Cardiac Tamponade/etiology , Heart Rupture, Post-Infarction/etiology , Heart Ventricles/injuries , Inferior Wall Myocardial Infarction/surgery , Percutaneous Coronary Intervention/adverse effects , Aged , Fatal Outcome , Female , HumansSubject(s)
Aortic Aneurysm/diagnostic imaging , Aortic Dissection/diagnostic imaging , Coronary Vessels/diagnostic imaging , Inferior Wall Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/diagnostic imaging , Tomography, Optical Coherence , Acute Disease , Adult , Aortic Dissection/surgery , Aortic Aneurysm/surgery , Computed Tomography Angiography , Diagnosis, Differential , Humans , Inferior Wall Myocardial Infarction/surgery , Multidetector Computed Tomography , Predictive Value of Tests , ST Elevation Myocardial Infarction/surgerySubject(s)
Aortic Dissection/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Coronary Artery Disease/therapy , Inferior Wall Myocardial Infarction/therapy , Stents/adverse effects , Stroke/etiology , Aged , Aortic Dissection/etiology , Coronary Angiography , Coronary Artery Bypass , Coronary Artery Disease/complications , Coronary Artery Disease/surgery , Coronary Vessels/injuries , Coronary Vessels/surgery , Device Removal , Echocardiography , Humans , Iatrogenic Disease , Inferior Wall Myocardial Infarction/diagnosis , Inferior Wall Myocardial Infarction/etiology , Inferior Wall Myocardial Infarction/surgery , Prosthesis Failure/adverse effects , Recovery of Function , Reoperation , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/surgery , ST Elevation Myocardial Infarction/therapySubject(s)
Coronary Aneurysm/surgery , Drug-Eluting Stents , Inferior Wall Myocardial Infarction/surgery , Percutaneous Coronary Intervention/instrumentation , ST Elevation Myocardial Infarction/surgery , Coronary Aneurysm/complications , Coronary Aneurysm/diagnostic imaging , Coronary Angiography , Humans , Inferior Wall Myocardial Infarction/diagnostic imaging , Inferior Wall Myocardial Infarction/etiology , Male , Middle Aged , Recurrence , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/etiology , Treatment OutcomeSubject(s)
Cardiac Catheterization/methods , Heart Valve Prosthesis Implantation/methods , Inferior Wall Myocardial Infarction/complications , Mitral Valve Insufficiency/surgery , Mitral Valve/surgery , Ventricular Septal Rupture/surgery , Aged, 80 and over , Cardiac Catheterization/instrumentation , Coronary Angiography , Drug-Eluting Stents , Echocardiography, Doppler, Color , Echocardiography, Three-Dimensional , Echocardiography, Transesophageal , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Humans , Inferior Wall Myocardial Infarction/diagnosis , Inferior Wall Myocardial Infarction/physiopathology , Inferior Wall Myocardial Infarction/surgery , Male , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/etiology , Mitral Valve Insufficiency/physiopathology , Percutaneous Coronary Intervention/instrumentation , Prosthesis Design , Septal Occluder Device , Treatment Outcome , Ventricular Septal Rupture/diagnostic imaging , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/physiopathologySubject(s)
Coronary Thrombosis/diagnosis , Coronary Vessels , Inferior Wall Myocardial Infarction/complications , Coronary Angiography , Coronary Thrombosis/complications , Coronary Thrombosis/diagnostic imaging , Coronary Thrombosis/surgery , Diagnosis, Differential , Female , Humans , Inferior Wall Myocardial Infarction/surgery , Middle Aged , Percutaneous Coronary InterventionSubject(s)
Coronary Aneurysm/complications , Inferior Wall Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/etiology , Aged , Computed Tomography Angiography , Coronary Aneurysm/diagnostic imaging , Coronary Aneurysm/surgery , Coronary Angiography/methods , Coronary Artery Bypass , Female , Humans , Inferior Wall Myocardial Infarction/diagnostic imaging , Inferior Wall Myocardial Infarction/surgery , Ligation , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery , Treatment OutcomeABSTRACT
In a woman with chest pain, <0.1 mV ST-segment elevation in lead III, and virtually no ST elevation in leads II and aVF, striking ST-segment depression in lead aVL, the reciprocal lead to lead III, confirmed the diagnosis of acute inferior myocardial infarction.
Subject(s)
Inferior Wall Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/diagnosis , Aged , Chest Pain/etiology , Coronary Angiography , Electrocardiography , Female , Humans , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/surgery , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/surgery , StentsABSTRACT
Guidewire recrossing into the abruptly occluded side branch (SB) after main vessel (MV) stenting in the coronary bifurcation is difficult, particularly if the SB has a dissection because the true lumen of SB is collapsed by a hematoma and the second guidewire easily goes into the false lumen. This paper reports a bailout technique to rescue the occluded SB that was complicated by a hematoma because of an unsuccessful guidewire recrossing after MV stenting using a small balloon dilation in the collapsed SB true lumen behind the stent strut and wire penetration.
Subject(s)
Coronary Vessels/surgery , Drug-Eluting Stents , Inferior Wall Myocardial Infarction/surgery , Percutaneous Coronary Intervention/methods , Coronary Angiography , Coronary Vessels/diagnostic imaging , Humans , Inferior Wall Myocardial Infarction/diagnosis , Male , Middle Aged , Ultrasonography, InterventionalABSTRACT
BACKGROUND: The purpose of this study was to examine the relationship between left ventricular (LV) function, cytokine levels and site of myocardial infarction (MI) in patients undergoing coronary artery bypass grafting (CABG). METHODS: Sixty patients undergoing CABG were divided into three groups (n = 20) according to their history of site of myocardial infarction (MI): no previous MI, anterior MI and posterior/inferior MI. In the pre-operative period, detailed analysis of LV function was done by transthoracic echocardiography. The levels of adrenomedullin, interleukin-1-beta, interleukin-6, tumour necrosis factor-alpha (TNF-α) and angiotensin-II in both peripheral blood samples and pericardial fluid were also measured. RESULTS: Echocardiographic analyses showed that the anterior MI group had significantly worse LV function than both the group with no previous MI and the posterior/inferior MI group (p < 0.05 for LV end-systolic diameter, fractional shortening, LV end-systolic volume, LV end-systolic volume index and ejection fraction). In the anterior MI group, both plasma and pericardial fluid levels of adrenomedullin and and pericardial fluid levels of interleukin-6 and interleukin- 1-beta were significantly higher than those in the group with no previous MI (p < 0.05), and pericardial fluid levels of adrenomedullin, interleukin-6 and interleukin-1-beta were significantly higher than those in the posterior/inferior MI group (p < 0.05). CONCLUSIONS: The results of this study indicate that (1) patients with an anterior MI had worse LV function than patients with no previous MI and those with a posterior/inferior MI, and (2) cytokine levels in the plasma and pericardial fluid in patients with anterior MI were increased compared to patients with no previous MI.
Subject(s)
Anterior Wall Myocardial Infarction/surgery , Coronary Artery Bypass , Cytokines/metabolism , Inferior Wall Myocardial Infarction/surgery , Myocardium/metabolism , Pericardial Fluid/metabolism , Ventricular Function, Left , Adrenomedullin/metabolism , Aged , Angiotensin II/metabolism , Anterior Wall Myocardial Infarction/diagnostic imaging , Anterior Wall Myocardial Infarction/metabolism , Anterior Wall Myocardial Infarction/physiopathology , Biomarkers/metabolism , Echocardiography , Female , Humans , Inferior Wall Myocardial Infarction/diagnostic imaging , Inferior Wall Myocardial Infarction/metabolism , Inferior Wall Myocardial Infarction/physiopathology , Male , Middle Aged , Myocardium/pathology , Treatment OutcomeABSTRACT
A patient presented with an inferior non-ST segment elevation myocardial infarction and a tight lesion on the distal right coronary artery. After stent implantation, a large scaffold malapposition was observed by optical coherence tomography. This case emphasizes the importance of not expanding a bioresorbable vascular scaffold more than 0.5 mm over its nominal size.
Subject(s)
Absorbable Implants/adverse effects , Angioplasty, Balloon, Coronary/instrumentation , Coronary Restenosis , Non-ST Elevated Myocardial Infarction , Prosthesis Implantation/adverse effects , Reoperation , Tissue Scaffolds/adverse effects , Angioplasty, Balloon, Coronary/methods , Coronary Angiography/methods , Coronary Restenosis/diagnosis , Coronary Restenosis/etiology , Coronary Restenosis/surgery , Coronary Vessels/diagnostic imaging , Drug-Eluting Stents , Humans , Inferior Wall Myocardial Infarction/diagnosis , Inferior Wall Myocardial Infarction/surgery , Male , Middle Aged , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/surgery , Prosthesis Failure/etiology , Prosthesis Implantation/methods , Reoperation/instrumentation , Reoperation/methods , Tomography, Optical Coherence/methods , Treatment OutcomeABSTRACT
OBJECTIVES: In acute inferior ST-segment elevation myocardial infarction (STEMI), multiple criteria have been proposed to predict the culprit artery based on the 12-lead electrocardiogram (ECG). We assessed the utilities of 11 traditional and 2 new criteria to devise a new ECG algorithm to localize the culprit artery in acute inferior STEMI. METHODS: We analyzed electrocardiographic and angiographic findings of 194 consecutive patients with acute inferior STEMI to devise a new ECG algorithm, further validated in another cohort of 80 patients with acute inferior STEMI. RESULTS: In derivation cohort, the 2 new criteria including (1) ST-segment depression in lead I equal to half of that in lead aVL and (2) equal ST-segment elevation in leads II, III, and aVF did not prove useful. The most powerful electrocardiographic criteria were (1) the ratio of ST elevation in lead III to that in lead II, (2) the ratio of ST depression in lead I to that in lead aVL, and (3) ST changes in lead I; these formed a 3-step algorithm. Application of this algorithm suggested the location of the culprit artery in 192 of 194 patients (nearly 99%) in the derivation cohort. In validation cohort, the algorithm possessed a sensitivity and specificity of 100% and 89%, respectively, for predicting the right coronary artery and 89% and 100%, respectively, for predicting the left circumflex artery. CONCLUSIONS: A new 3-step algorithm based on 12-lead ECG is proposed to localize the culprit artery at the bedside of acute inferior STEMI patients before primary percutaneous coronary intervention, allowing immediate decisions about therapy.
Subject(s)
Algorithms , Anterior Wall Myocardial Infarction/diagnosis , Coronary Artery Disease/diagnosis , Electrocardiography , Inferior Wall Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/diagnosis , Aged , Anterior Wall Myocardial Infarction/diagnostic imaging , Anterior Wall Myocardial Infarction/surgery , Coronary Angiography , Coronary Artery Disease/diagnostic imaging , Coronary Artery Disease/surgery , Female , Humans , Inferior Wall Myocardial Infarction/diagnostic imaging , Inferior Wall Myocardial Infarction/surgery , Male , Middle Aged , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/surgery , Sensitivity and SpecificityABSTRACT
INTRODUCTION: Dual left anterior descending (LAD) artery is a very rare inherited anomaly. It can be incidentally revealed during primary percutaneous coronary intervention (pPCI) and may produce difficulties in detecting and treating the culprit lesion. CASE REPORT: We presented a 52-year-old male patient with ST-segment elevation myocardial infarction (STEM1) of inferior wall, in whom dual LAD anomaly was revealed during pPCI: a short LAD artery originated from the left main coronary artery and a long LAD artery originated from the proximal part of the right coronary artery (RCA). A bare metal stent was successfully implanted in the place of the culprit lesion in RCA and ST-segment resolution was achieved in ECG. After two hours, the patient was referred again to the catheter lab due to new STEMI of anteroseptal wall. Another bare metal stent was implanted in new infarction related artery, this time it was proximal part of the short LAD. CONCLUSION: Careful and correct interpretation of ECG is very helpful in detection and treatment of the culprit lesion in cases with dual LAD.
Subject(s)
Coronary Vessel Anomalies , Heart Conduction System/physiopathology , Myocardial Infarction/diagnosis , Myocardial Infarction/surgery , Percutaneous Coronary Intervention , Stents , Anterior Wall Myocardial Infarction/diagnosis , Anterior Wall Myocardial Infarction/surgery , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/surgery , Electrocardiography , Humans , Incidental Findings , Inferior Wall Myocardial Infarction/diagnosis , Inferior Wall Myocardial Infarction/surgery , Male , Middle Aged , Myocardial Infarction/physiopathology , Percutaneous Coronary Intervention/methods , Reoperation , Treatment OutcomeSubject(s)
Coronary Vessels/pathology , Drug-Eluting Stents/adverse effects , Inferior Wall Myocardial Infarction/surgery , Percutaneous Coronary Intervention/adverse effects , Sinus Arrest, Cardiac/diagnosis , Sinus Arrest, Cardiac/etiology , Aged , Coronary Angiography/methods , Diabetes Mellitus, Type 2/complications , Female , Humans , Hyperlipidemias/complications , Risk Factors , Time FactorsABSTRACT
Hydatid disease is a parasitic infection caused by the larvae of Echinococcus granulosus, which is still endemic in many developing countries. Cardiac involvement is rare but potentially very serious on account of various clinical presentations and nonspecific symptoms that occasionally mimic acute coronary syndrome. We describe a case of ruptured left ventricular hydatid cyst presenting as acute inferolateral myocardial infarction with electrocardiographic changes. Because coronary angiography revealed normal coronary arteries, the final diagnosis was made on the basis of echocardiography and magnetic resonance imaging. On-pump surgical resection followed by albendazole therapy yielded an excellent outcome.
Subject(s)
Acute Coronary Syndrome/etiology , Echinococcosis/complications , Heart Diseases/complications , Inferior Wall Myocardial Infarction/etiology , Acute Coronary Syndrome/diagnosis , Acute Coronary Syndrome/surgery , Albendazole/therapeutic use , Anticestodal Agents/therapeutic use , Cardiopulmonary Bypass , Coronary Angiography , Coronary Artery Bypass , Echinococcosis/diagnosis , Echinococcosis/drug therapy , Echinococcosis/parasitology , Electrocardiography , Heart Diseases/diagnosis , Heart Diseases/drug therapy , Heart Diseases/parasitology , Humans , Inferior Wall Myocardial Infarction/diagnosis , Inferior Wall Myocardial Infarction/surgery , Magnetic Resonance Imaging , Male , Middle Aged , Predictive Value of Tests , Rupture, Spontaneous , Treatment OutcomeABSTRACT
We report a case of ruptured head of posteromedial papillary muscle and prolapse of anterior mitral valve leaflet that caused severe mitral regurgitation (MR) and cardiogenic shock as a complication of inferior wall myocardial infarction in an 80-year-old man. Emergency coronary angiogram revealed thrombotic occlusion at proximal right coronary artery. Transesophageal echocardiogram revealed ruptured head of posteromedial papillary muscle and prolapse of anterior mitral valve leaflet causing severe MR. After percutaneous coronary intervention with bare metal stent, the patient underwent mitral valve repair with saphenous vein graft to the posterolateral branch of the right coronary artery. The patient was discharged from hospital on day 14 of admission.
Subject(s)
Coronary Angiography/methods , Echocardiography, Transesophageal/methods , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/diagnostic imaging , Shock, Cardiogenic/diagnostic imaging , Shock, Cardiogenic/etiology , Aged, 80 and over , Humans , Inferior Wall Myocardial Infarction/surgery , Male , Mitral Valve/diagnostic imaging , Mitral Valve/injuries , Mitral Valve/surgery , Papillary Muscles/diagnostic imaging , Papillary Muscles/injuries , Papillary Muscles/surgery , Percutaneous Coronary Intervention/methods , Rupture , Stents , Treatment OutcomeSubject(s)
Brugada Syndrome/physiopathology , Heart Ventricles/pathology , Inferior Wall Myocardial Infarction/surgery , Ischemia/complications , Ischemia/etiology , Adult , Angiography , Angioplasty/methods , Brugada Syndrome/etiology , Diagnosis, Differential , Elective Surgical Procedures/methods , Electrocardiography , Humans , MaleABSTRACT
Rupture of the interventricular septum after myocardial infarction (MI) is an uncommon but serious complication, usually leading to congestive heart failure and cardiogenic shock. Surgical repair is usually the only definitive treatment for these patients because medical management is associated with a 30-day mortality approaching 100%. However with conventional surgical repair, operative mortality rates range from 33% to 53%. Furthermore, outcomes in patients with posterior ventricular septal defect (VSD) have been reported to have mortality rates up to 86%. Therefore, alternative treatment should be considered to improve management of this mechanical complication. We report the case of a 63-year-old man in whom VSD developed after an inferior MI. The patient presented with shortness of breath and a recent ST-elevation inferior MI. Transthoracic echocardiography revealed a 50% left ventricular ejection fraction with mild-moderate right ventricular dysfunction. A posterior VSD (diameter ≥ 12 mm), moderate ischemic mitral regurgitation (MR), and a posterior pseudoaneurysm were also seen. The operative risk was considered to be too high for VSD repair because the surgery would have to include bypass grafting, mitral valve replacement, and pseudoaneurysm correction. Consequently, an urgent heart transplantation was considered the best option. The patient underwent heart transplantation 9 days after initial symptoms, and the recovery was unremarkable. To achieve a definitive optimal treatment, we propose that patients with posterior VSD with significant MR or pseudoaneurysm, or both, should be considered as heart transplant candidates.
Subject(s)
Heart Failure/surgery , Heart Rupture, Post-Infarction/surgery , Heart Transplantation/methods , Inferior Wall Myocardial Infarction/surgery , Disease Progression , Follow-Up Studies , Heart Failure/etiology , Heart Rupture, Post-Infarction/complications , Heart Rupture, Post-Infarction/diagnosis , Humans , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/diagnosis , Male , Middle Aged , Risk Assessment , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVES: The aim of this study was to assess the long-term prognostic value of the global longitudinal strain of the right ventricle (GLSRV) in patients with inferior ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). BACKGROUND: RV systolic dysfunction is an important prognostic factor in patients with inferior STEMI. METHODS: All consecutive inferior STEMI patients were included from January 2005 to December 2013. RV systolic function was analyzed with GLSRV using velocity vector imaging (Siemens, Mountain View, California), as well as conventional echocardiographic indices, including right ventricular fractional area change (RVFAC) and tricuspid annular plane systolic excursion (TAPSE). RESULTS: We analyzed a total of 282 consecutive inferior STEMI patients (212 men, age 63 ± 13 years) treated with primary PCI. During the follow-up period (54 ± 35 months), 59 patients (21%) had 1 or more major adverse cardiovascular event (MACE) (43 deaths, 7 nonfatal MI, 4 target vessel revascularization, and 6 heart failure admission). The best cutoff value of GLSRV for the prediction of MACE was ≥-15.5% (area under the curve = 0.742, p < 0.001) with a sensitivity of 73% and a specificity of 65%. GLSRV showed better sensitivity and specificity than RVFAC and TAPSE. After multivariate analysis, GLSRV showed a higher c-statistic value (0.770) than RVFAC (0.749) and TAPSE (0.751) in addition to age, Killip class, troponin-I, left ventricular (LV) ejection fraction and RV infarction. Patients with GLSRV≥-15.5% showed significantly lower 5-year survival rate (74 ± 5% vs. 89 ± 3%, p < 0.001) and lower MACE-free survival rate (64 ± 5% vs. 87 ± 3%, p < 0.001) than the control group. CONCLUSIONS: Because GLSRV showed additive predictive value to age and LV function, it can be the strongest parameter of RV systolic function evaluating the prognosis after PCI for acute inferior STEMI particularly in patients with preserved LV function.
Subject(s)
Echocardiography/methods , Heart Ventricles/physiopathology , Inferior Wall Myocardial Infarction/diagnostic imaging , Stroke Volume/physiology , Ventricular Dysfunction, Right/etiology , Ventricular Function, Right , Disease Progression , Female , Follow-Up Studies , Heart Ventricles/diagnostic imaging , Humans , Inferior Wall Myocardial Infarction/complications , Inferior Wall Myocardial Infarction/surgery , Male , Middle Aged , Percutaneous Coronary Intervention , Prognosis , Retrospective Studies , Ventricular Dysfunction, Right/diagnostic imaging , Ventricular Dysfunction, Right/physiopathologyABSTRACT
Isolated single coronary artery without other congenital cardiac anomalies is very rare among the different variations of anomalous coronary patterns. The prognosis in patients with single coronary varies according to the anatomic distribution and associated coronary atherosclerosis. If the left main coronary artery travels between the aorta and pulmonary arteries, it may be a cause of sudden cardiac death. We present multimodality images of a single coronary artery, in which the whole coronary system originated by a single trunk from the right sinus of Valsalva with inter-arterial course of left main coronary artery. This rare type of single coronary artery was classified as RII-B type according to Lipton's scheme of classification. A significant flow-limiting lesions were found in the right coronary artery that was successfully treated with percutaneous coronary intervention.