Project description:Background:Quadfurcation of single coronary artery (SCA) from the right is an extremely rare anomaly and acute coronary syndrome in such patients is catastrophic. Case summary:We report a 56-year-old Bangladeshi male who presented with an acute inferior wall ST-elevation myocardial infarction. He was taken to the Cath lab for primary percutaneous coronary intervention which showed the presence of SCA arising from the right aortic sinus with multiple lesions including a bifurcation lesion. Percutaneous coronary intervention was done successfully in two sessions. Discussion:Tackling multiple lesions in a case of SCA with quadfurcation was challenging especially in the setting of SCA and bifurcation lesions. This is first reported case of this kind.
Project description:Nondominant right coronary artery (NDRCA) occlusion is rare and generally affects a small volume of myocardium. Despite this, NDRCA occlusion can result in dramatic clinical sequelae. These cases demonstrate the characteristic electrocardiographic findings and consequences of NDRCA occlusion, highlighting the importance of recognition of this pathologic condition to institute appropriate management. (Level of Difficulty: Intermediate.).
Project description:This report describes the case of a symptomatic patient with a right coronary artery fistula draining into the coronary sinus who underwent transcatheter closure, which was deployed in the drainage site to seal off the exit of the fistula. (Level of Difficulty: Advanced.).
Project description:ObjectivesPatients with right ventricular (RV) infarctions associated with inferior infarctions have higher rates of adverse events than isolated inferior infarctions. Right atrial volume index (RAVI) has recently been described as a predictor of clinical outcome in patients with chronic systolic heart failure and pulmonary hypertension. The aim of this study is to assess the ability of RAVI to predict the persistent RV dysfunction after acute inferior STEMI due to occlusion of proximal RCA. To the best of our knowledge, this is the first study to investigate the relation between RAVI and persistent RV dysfunction in such group of patients.Patients and methodsSixty-five consecutive patients with recent first acute inferior STEMI who underwent primary percutaneous coronary intervention (PPCI) were prospectively included in the study. Echocardiographic evaluation was performed at the time of discharge and at 3 months. All the patients underwent standard echocardiographic assessment using conventional 2D and tissue Doppler imaging (TDI).ResultsPatients were divided into two groups according to right ventricular function (RVF) 3 months after acute myocardial infarction (AMI). The normal RVF group included 41 (63%) patients and the impaired RVF group included 24 (37%) patients. RAVI was significantly higher in patients with impaired RVF (p=<0.001). RAVI was a predictor of persistently impaired RV function (odds ratio = 1.786, 95% confidence interval, 1.367-2.335, p value= <0.001) and (odds ratio = 1.829, 95% confidence interval, 1.358-2.462, p value= <0.001) in univariate and multivariable logistic regression analyses respectively. In receiving operator characteristics (ROC) curve analysis, RAVI with a cutoff value ≥ 30 ml/m2 had a 87.5% sensitivity, a 92.24% specificity area under Receiving operator characteristics (ROC) curve = 0.964 for predicting persistently impaired RVF.ConclusionIn patients with inferior STEMI with proximal RCA occlusion, RAVI is an independent predictor of persistently impaired RVF with a cut-off value ≥ 30 ml/m2.
Project description:We present the case of a 55-year-old man who had a diagnosis of an acute anterior ST-segment elevation myocardial infarction. Emergency angiography demonstrated that both coronary systems originated from the right coronary sinus with a culprit proximal left anterior descending artery lesion, which was stented. This is a rare presentation, with only 1 similar case found in published reports. (Level of Difficulty: Intermediate.).
Project description:Graphical abstract Highlights • Mycotic aneurysm of the aortic sinus is a rare complication of aortic valve endocarditis.• Mycotic aneurysm of left sinus causing LM compression and circumflex occlusion is shown.• We present TTE and TEE approaches to making the diagnosis of this complex lesion.• Sketches of complications of aortic valve endocarditis are presented.
Project description:BackgroundDelayed coronary artery occlusion (CAO) is a rare but fatal complication after transcatheter aortic valve replacement, chimney stenting is the standard technique for established CAO or impending CAO.Case presentationWe describe a female patient who developed non-ST elevation myocardial infarction after receiving transcatheter aortic valve replacement and chimney stenting 4 months prior. An angiogram revealed delayed coronary artery occlusion with a deformed stent, which was never reported. This patient was subsequently treated with a new chimney stent.ConclusionsFor self-expanding valves, the coronary ostium is protected by chimney stenting, delayed coronary artery occlusion can occur and cause catastrophic complications.