Effect of primary percutaneous coronary intervention on myocardial repolarization.

OBJECTIVE: We aimed to investigate the effect of coronary perfusion on QT interval dispersion in patients with acute myocardial infarction (MI). METHODS: Seventy-seven consecutive patients who had undergone primary percutaneous coronary intervention (PCI) for a first ST segment elevation MI during the first 12 h of symptom onset were included in the study. After achievement of thrombolysis in MI (TIMI) 3 flow of the infarct-related artery, corrected TIMI frame count (cTFC) and TIMI myocardial perfusion grade (TMPG) were measured. ECGs were performed in the following manner: at baseline, within 1 h after completion of the procedure, 24 h after the procedure and 48 h after the procedure. The corrected QT dispersion (QTd) and ST segment resolution (STR) were calculated. RESULTS: There was a difference between the durations of corrected QTd (cQTd) before PCI and cQTd just after PCI. On the first day, cQTd before PCI was significantly more prolonged (52.3 ± 80 vs. 41.5 ± 49, P = 0.05) than cQTd on second day (52.3 ± 80 vs. 37 ± 50, P = 0.001). In the correlation analysis conducted among the durations of cQTd, cTFC and TMPG, no significant association was established. STR was, however, inversely correlated with duration of cQTd. CONCLUSION: Our study results demonstrated that primary percutaneous coronary intervention leads to progressive shortening of QT dispersion in successful reperfusion, even in reduced cTFC.

Assessment of coronary veins in patients with isolated coronary artery ectasia by antegrade coronary venous angiography.

BACKGROUND: Coronary artery ectasia (CAE) is characterized by an abnormal dilatation of the coronary arteries. The most common cause of CAE is atherosclerosis but other possible etiologies include congenital abnormalities and inflammatory and connective tissue disease. Earlier studies have documented the association of CAE with the presence of aneurysms in other vascular beds. However, cardiac venous system in patients with isolated CAE has not been studied earlier. In this study, we aimed to assess coronary venous vessels by antegrade coronary venous angiography in patients with isolated CAE. METHODS: Twenty-four patients with isolated CAE without significant stenosis and 21 age-matched and sex-matched controls without CAE were included in this study. The anatomy of the coronary venous system was imaged in a left anterior oblique view at an angle of 45° by antegrade coronary angiography. RESULTS: Patients with isolated CAE had significantly larger coronary veins compared with control individuals with angiographically normal coronary arteries (coronary sinus ostium: 10.1 ± 1.0 vs. 8.5 ± 2.2 mm, respectively, P=0.003; coronary sinus mid level: 7.9 ± 1.4 vs. 6.5 ± 1.6, respectively, P=0.003; great cardiac vein: 5.6 ± 1.0 vs. 4.3 ± 0.8, respectively, P=0.001; middle cardiac vein: 3.9 ± 1.3 vs. 3.7 ± 1.4, respectively, P=0.52; posterior or lateral vein: 3.2 ± 1.1 vs. 2.4 ± 0.7, respectively, P=0.016). CONCLUSION: We have shown for the first time a significant dilatation in the coronary veins in patients with isolated CAE, suggesting the presence of a more extensive vascular destruction in the coronary circulation.

Isolated pulmonic valve endocarditis in an adult patient with ventricular septal defect and infundibular pulmonary stenosis.

Ventricular septal defect associated with infundibular pulmonary stenosis is a relatively uncommon congenital cardiac defect. We report the first case of a patient with perimembranous small ventricular septal defect and infundibular stenosis suffered from pulmonary valve endocarditis and septic pulmonary embolism.