Anomalous origin of the left anterior descending artery from the main pulmonary artery with multi-detector row computed tomography coronary angiography.

Anomalous origin of the left anterior descending artery from the main pulmonary artery is a rare congenital anomaly of the coronary artery. We present a case report of a 31-year-old male patient with anomalous origin of the left anterior descending artery from the main pulmonary artery that was diagnosed by multi-detector row computed tomography coronary angiography and correlated with conventional angiography. The results indicate that multi-detector row computed tomography plays an important role in the diagnosis of some rare coronary anomalies that conventional angiography cannot clarify.

Real-time dobutamine stress myocardial contrast echocardiography for detecting coronary artery disease: correlating abnormal wall motion and disturbed perfusion.

BACKGROUND: Real-time myocardial contrast echocardiography (MCE) makes possible the simultaneous visualization of changes in perfusion imaging and wall motion. OBJECTIVES: To assess the accuracy of real-time MCE for detecting the presence and extent of coronary artery disease (CAD), and to evaluate the correlation between wall motion and myocardial perfusion by visual examination. METHODS: A total of 140 consecutive patients without resting wall motion abnormalities were screened to undergo dobutamine stress MCE with power modulation and coronary angiography. Significant coronary disease was defined by the quantification of over 50% stenosis in a major epicardial vessel. The visual identification of wall motion and myocardial perfusion abnormalities was determined by blind review. RESULTS: Eight patients were excluded due to suboptimal images (feasibility 94.3%). Myocardial contrast enhancement analysis and wall motion analysis were similar in terms of sensitivity (81.2% versus 83.5%, respectively) and specificity (76.5% versus 80.9%, respectively) in detecting the presence of CAD. Myocardial contrast enhancement analysis tended to have a greater sensitivity than wall motion analysis in detecting the ischemic extent over multiple vascular territories among patients with multiple-vessel disease (sensitivity 83.8% versus 71.4% [P=0.09], and abnormal segment length 54.7+/-21.1% versus 48.9+/-24.7% [P=0.03] for myocardial contrast enhancement and wall motion analysis, respectively). There was good concordance between the presence of myocardial ischemia and wall motion abnormality for the segment-by-segment analysis (89.7% agreement, kappa = 0.745). The correlation of the wall motion score and perfusion score at peak stress was also good (r=0.793, P=0.015). CONCLUSIONS: Dobutamine stress MCE with power modulation is similar in sensitivity and specificity to wall motion analysis for detecting the presence of CAD. However, it provides greater sensitivity in evaluating the extent of ischemia in patients with multiple-vessel disease.

Echocardiographic features of primary cardiac sarcoma.

Primary cardiac sarcoma is extremely rare and seldom causes symptoms until late in its course. Discomfort may occur only when the mass causes obstruction to the intracardiac flow. Early diagnosis is vital because it allows prompt and relevant management. We describe the history and echocardiographic features in four patients with primary cardiac sarcoma and review the current literature.

Long-term clinical follow-up after successful direct coronary stenting without predilatation.

BACKGROUND: Direct stent implantation without predilatation is considered a promising new technique that may reduce procedural time, radiation exposure, ischemic time and cost, but little information is available concerning the long-term outcome. The aim of this study was to investigate the long-term clinical outcome of successful direct stenting without predilatation. METHODS: We prospectively undertook a clinical follow-up program (minimum 8 months) in a consecutive series of 101 patients (113 lesions) who were successfully treated with direct stenting without predilatation. RESULTS: Clinical follow-up was obtained in all 101 patients at a mean period of 12.8 months (range 8 to 18.9). Stress test results were available in 94 patients (94%). During the follow-up period, 23 patients (23%) had one or more events, which included death in 2 patients (2%), target vessel revascularization in 14 (14%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society I to II) treated medically in 6 (6%). Cumulative event-free survival at 8 and 18 months were 80% and 72%, respectively. Long-term clinical event rate was not significantly different among the clinical presentations, lesion types, or stent types. Angiographic follow-up was performed in 43 (43%) patients with 45 lesions. Restenosis (defined as 50% diameter stenosis) was observed in 14 of the lesions (31%). CONCLUSIONS: Direct stenting without predilatation is an effective method of coronary intervention in terms of low long-term clinical event rate.

Initial experience of using color kinesis in the diagnosis of coronary artery disease.

BACKGROUND: Color kinesis (CK) is a recently developed echocardiographic technique. This report describes our initial effort in the validation of the use of CK for the diagnosis of coronary artery disease (CAD). METHODS: Two-dimensional (2-D) echocardiography and CK were studied in 30 normal subjects and 24 CAD patients. Coronary angiography was performed in the 24 patients. Significant (> 70% luminal diameter stenosis) CAD was present in 18 patients (79%), all of whom had history of myocardial infarction. Regional fractional area change in each segment was displayed as a stacked color histogram. The histograms derived from these 30 normal subjects were averaged to obtain the normal pattern of left ventricular contraction; the mean value +/- 1 SD was considered the reference histogram. When the regional fractional area change deviated from this normal reference, this segment was considered as having regional wall motion abnormality. The detection of wall motion abnormalities by visual interpretation of 2-D echocardiography, reviewing the CK loop recording, and CK stacked histograms were compared. To assess the relationship of measurement of endocardial excursion of CK images, the width of the color band was measured at the midpoint of each segment along a line perpendicular to the cardiac border. The endocardial excursion measured by 2 independent observers was compared using linear regression analysis and calculation of intraclass correlation coefficient. RESULTS: The sensitivity and specificity for detection of CAD were 77.8% and 66.6%, respectively, for CK loop reviewing, 83.3% and 66.7% for CK stacked histogram analysis, and 77.8% and 83.3% for 2-D echocardiography. The overall accuracies for CAD detection were 75% for CK loop reviewing, 79.2% for CK stacked histogram analysis, and 79.2% for the 2-D echocardiography (not significant in all comparisons). The correlation of measurement of endocardial excursion from the CK images by 2-observers was good (r = 0.85, p < 0.01), and intraclass correlation coefficient was 0.99 (p < 0.0001). CONCLUSIONS: Our data demonstrate that both the CK loop reviewing and stacked histogram analysis were comparable to 2-D echocardiography for detecting CAD.