Coronary artery ostioplasty without a patch for congenital left main coronary artery ostial atresia.
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ABSTRACT:
SUBMITTER: Peng Y
PROVIDER: S-EPMC9735359 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Coronary artery ostioplasty without a patch for congenital left main coronary artery ostial atresia.
Peng Yongxuan Y Bai Kai K Huang Jihong J Wu Yurong Y Liu Wei W Chen Sun S Lu Yanan Y
JTCVS techniques 20220906
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Project description:Atresia of the right coronary artery ostium is a rare anatomic variant of the coronary circulation. It is often difficult to differentiate from single coronary artery. Its presence unassociated with any other anomaly has never been described in an adult individual. We report this unusual anomaly and discuss its anatomical and pathophysiological significance and possible ways to differentiate from single coronary artery.
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Project description:Calcified nodules in human coronary arteries are usually focally distributed. Non-invasive imaging of coronary arteries by bedside emergency transthoracic echocardiography in adults is possible and may become a useful adjunct to other methods of coronary artery examination. Coronary artery stenosis can be identified as localized color aliasing and accelerated flow velocities. Complete visualization of individual ostial coronary segments might ease the demonstration of coronary stenosis by bedside transthoracic echocardiography. The left main coronary artery stenosis requires prompt emergency evaluation and treatment because emergency conditions have higher mortality rates. The authors wish to emphasize the usefulness of emergency bedside echo-Doppler for a prompt diagnosis and treatment of this life-threatening condition.
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Project description:Although a rare form of congenital heart disease, anomalies of the coronary arteries can present as heart failure in infants. The most common lesion is an anomalous left coronary artery arising from the pulmonary artery, but other abnormalities can present similarly. This case is an infant who is found to have left coronary ostial stenosis causing dilated cardiomyopathy.
| S-EPMC8048097 | biostudies-literature
Project description:Coronary ostial atresia is a developmental abnormality that typically causes asymptomatic anomalies in the coronary blood supply. This case report, which presents 2 symptomatic patients with right coronary artery abnormalities, explores difficulties in diagnosing coronary ostial atresia and distinguishing it from single coronary artery and coronary artery disease-related acquired occlusion. Factors underlying management decisions are also discussed.
| S-EPMC10378718 | biostudies-literature
Project description:This study was designed to evaluate ostial left main coronary artery (LMCA) stenosis and investigate concomitant stenotic lesions of LMCA and right coronary arteries (RCA) and their demographic and angiographic features. We evaluated 11,283 patients who underwent coronary angiography. Patients were placed into four groups according to having ostial or nonostial LMCA or RCA stenosis. Significant LMCA stenosis was observed in 242 (8.3%) of the patients, and only 68 (28.1%) of them had significant ostial LMCA stenosis. There was a significant correlation between ostial stenosis of LMCA and RCA (p = 0.03). The frequency of female gender was greater in ostial LMCA and ostial RCA stenosis groups compared with the other groups (p = 0.01). Ostial LMCA and RCA stenosis were related significantly. Both female predominance and coexistence of ostial LMCA and RCA stenosis might have suggest a different pathological ground for this disease.
| S-EPMC3331624 | biostudies-other
Project description:We report the case of a 13-year-old boy who, while running in a school gymnasium, experienced sudden syncope and seizure. CPR was started immediately, and an automated external defibrillator (AED) was attached, but shock was not induced. He was referred to our hospital for loss of consciousness and intermittent general tonic-clonic seizure. A 12-lead electrocardiogram showed normal sinus rhythm and no ST-T wave abnormalities. Echocardiography showed normal structural heart and normal cardiac function. On the second day of hospitalization, AED electrocardiogram showed complete atrioventricular (AV) block at syncope and seizure. After the patient recovered from this neurological state, we performed the treadmill exercise test, and it did not show ST-T wave abnormalities or AV block, and he did not complain of chest pain. Coronary angiography showed atresia of the left main trunk and the collateral vessel from the right coronary artery connected to the left coronary artery. He was diagnosed with congenital left main coronary artery atresia. We began administration of calcium antagonist and aspirin to prevent a coronary artery spasm and then performed a coronary artery bypass graft (CABG) to prevent sudden cardiac death. After CABG, he has had no syncope episodes at rest or during light exercise. <Learning objective: In pediatric patients, syncope during strenuous exercise should mandate exclusion of cardiac events, especially coronary artery anomalies. Coronary artery anomalies that could cause sudden cardiac death sometimes show no abnormalities at rest or even during exercise stress on 12-lead electrocardiogram. It is very important to suspect cardiogenic syncope during strenuous exercise.>.
| S-EPMC6149280 | biostudies-literature
Project description:BackgroundCurrent recommendations for the best views for the left main coronary artery (LMCA) ostium intervention are empirical.ObjectivesTo determine the optimal projection to visualize the LMCA ostium using only fluoroscopy.MethodsThe optimal projection to visualize the LMCA ostium was determined using fluoroscopic images of superimposing the lowest points of the distal ends of two J tipped wires in the noncoronary cusp (NCC) and right coronary cusp (RCC). This was validated independently using 3-dimensional computed tomography (3D-CT) reconstruction.ResultsSatisfactory images of the overlapping wires in NCC and RCC could be obtained in 90% (45/50). Between the fluoroscopic and the 3D-CT reconstruction approaches, the mean difference for NCC and RCC overlapping at horizontal axes is -1.8 with a 95% limit of agreement between -3.94 and 0.34 (p=0.10) and at vertical axes -1.6 with a 95% limit of agreement between -3.46 and 0.26 (p=0.09); and the mean difference for the optimal projection to visualize the LMCA ostium at horizontal axes is -3.22 with a 95% limit of agreement between -7.26 and 0.81 (p=0.11) and at vertical axes -2.31 with a 95% limit of agreement between -5.83 and 1.21 (p=0.09). The 3D angulation deviation for the optimal projection to visualize the LMCA ostium was 8.5° ± 4.7° when the LMCA ostium faced the NCC-RCC commissure (n = 32) and 22.3° ± 16.0° (p=0.009) when it did not (n = 13).ConclusionsThe optimal projection for LMCA ostial intervention can be determined using fluoroscopic images of superimposing wires in the NCC and RCC when the LMCA ostium faces the NCC-RCC commissure, as was the case in 71% of the patients studied.
| S-EPMC8930230 | biostudies-literature
Project description: Not available
| S-EPMC7724382 | biostudies-literature
Project description:In ostial or proximal left main coronary artery (LMCA) obstruction, re-establishment of normal antegrade flow via the main trunk may be preferable to distal bypass grafting. The objective of this study was to assess the effectiveness of patch plasty of the left main (LM) trunk of the coronary artery for more than 10 years. Direct widening of the LMCA was recommended to patients with ostial, proximal, or midpoint stenosis of the main trunk. Group I of 16 patients had isolated LM obstruction with no distal disease, and Group II of 15 patients had, in addition, right coronary obstruction. The mean age was 60.9 years (age group, 47 to 83 years). Nineteen patients underwent this operation through an anterior transverse aortotomy. No endarterectomies were performed. In Group II, in addition, a single saphenous vein bypass graft was placed in the right coronary artery. There were no operative deaths. Follow-up period extends from 10 to 18 years (mean 11.2). Eight patients had angiography from 3 to 9 years after surgery and all show adequate LM trunk caliber. Noncardiac deaths occured in five patients (26.3%) at 2 months, and 1, 4, 6, and 7 years after surgery. Two women with isolated ostial stenosis diagnosed as a spasm have not shown progression of coronary disease 7 to 9 years after the operation. Widening of the LMCA should be considered in selective cases, only when ostial, proximal, or midportion stenosis of the main vessel exist, even if a right coronary bypass graft is required.
| S-EPMC3331652 | biostudies-other
Project description:The usual sources of pulmonary blood flow in pulmonary atresia (PA) with(VSD) are patent ductus arteriosus and aortopulmonary collaterals. However, rarely fistulous collaterals may also arise from the coronary arteries which usually open into the main pulmonary trunk or branch pulmonary arteries. In such cases, selective coronary angiogram may be required for the demonstration of pulmonary arterial anatomy. A case of PA with VSD with failure to demonstrate pulmonary arteries on routine catheterization study (ventricular, aortic root, and descending aortic angiograms) is being presented here. A coronary artery-to-pulmonary artery fistula was suspected in view of dilated left main coronary artery, and pulmonary arteries were well demonstrated with selective coronary angiogram.
| S-EPMC6521668 | biostudies-literature