Anomalous origin of the left main coronary artery from the right sinus of Valsalva: disabling angina and syncope with noninterarterial courses case report of two patients.

Anomalous origin of the left main coronary artery from the right sinus of Valsalva or the right coronary artery is a rare coronary anomaly. This anomaly has been associated with sudden cardiac death in younger patients, depending on its course relative to the pulmonary artery. The authors report this rare anomaly in two patients. It presented as unstable angina in the first patient with a septal course. In the second patient, it presented as syncope with an anterior free wall course and absent left circumflex artery. A septal course causing unstable angina has not been reported previously.

Paravalvular regurgitation: a rare complication following valve replacement surgery.

Paravalvular regurgitation is an uncommon but important complication, usually following valve replacement surgery. Early recognition and management are important for reoperations are associated with high morbidity and mortality rates. Presently, little data are available on this topic. The authors review the subject.

Coronary artery aneurysms, aortic dissection, and hypertension secondary to primary aldosteronism: a rare triad. A case report.

Primary aldosteronism is a relatively uncommon etiology of hypertension. Plasma renin activity is suppressed in the majority of the cases but not always. Plasma renin activity has been associated with increased vascular injury. The occurrence of vascular complications has rarely been reported with low plasma renin activity. The authors report a case of long-standing secondary hypertension due to primary aldosteronism with coronary artery aneurysms and aortic dissection. Diagnosing is important, for therapeutic intervention can be curative.

Takayasu's arteritis: an unusual manifestation--a case report.

Takayasu's arteritis is a rare entity. The authors describe a case of a middle-aged woman with an atypical form of Takayasu's arteritis. This manifestation has not been described previously.

Rescue PTCA complicated by pulmonary artery rupture after tPA and abciximab.

Since the introduction of pulmonary artery catheterization for hemodynamic monitoring, several complications associated with its use have been described. Pulmonary artery rupture is an infrequent complication of flow-directed pulmonary artery catheters. We report a case of pulmonary artery rupture complicating rescue PTCA in the presence of systemic platelet inhibition with abciximab (Reopro), anticoagulation, and thrombolytic therapy. With the increasing use of these medications in patients undergoing acute coronary interventions, particularly those patients requiring hemodynamic monitoring, this uncommon but potentially fatal complication may be seen more frequently.

ST-T alternans and myocardial ischemia.

Previous studies using intracoronary electrocardiography have demonstrated that ST-T alternans can develop during standard balloon coronary angioplasty. Total occlusion with a large amount of myocardium in jeopardy is the postulated prerequisite. In this study, the authors used perfusion balloons instead of standard balloons, so coronary perfusion was maintained and ischemia was minimized. Fourteen patients with standard balloon technique and 11 patients with perfusion balloon technique were studied. The ST segment was less elevated during perfusion angioplasty (0.15 +/- 0.05 mV vs 1.04 +/- 0.19 mV, p<0.001). There were six (43%) patients with ST-T alternans with standard balloon technique compared with none in the perfusion balloon group (p<0.001). In this study, the authors found that there was less ischemia, less ST segment elevation, and lack of ST-T alternans on the intracoronary electrocardiogram during perfusion balloon angioplasty. These findings support the postulate that a large amount of ischemic myocardium is a prerequisite for ST-T alternans.