1/126. Treatment of a large congenital coronary fistula with coil embolization.A 77-year-old woman suffering from progressive dyspnea and chest pain for 2 1/2 years was admitted to hospital. There were no ECG changes at exercise test and a dobutamine stress echocardiography was normal. At catheterization, right-sided pressures were within normal limits. coronary angiography revealed a congenital coronary fistula, 3-4 mm in diameter, from the left anterior descending artery to the proximal pulmonary artery. There was no significant rise in blood oxygen saturation in the pulmonary artery. Transcatheter coil embolization was performed in the distal part of the tortuous fistula. Flow ceased within minutes, demonstrating the feasibility and efficacy of this technique for treating large fistulas.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/126. A case of vasospastic angina presenting Brugada-type ECG abnormalities.An electrophysiological study and a provocative test of coronary artery spasm was attempted in a 68-year-old man who was having syncopal attacks and chest pain. His electrocardiogram had the characteristics of brugada syndrome and ventricular fibrillation (VF) was induced by programmed electrical stimulation. ST-segment elevation became exaggerated by procainamide, which could not prevent the induction of VF. coronary angiography revealed no stenotic lesions, and spasm in the left coronary artery was induced by intracoronary administration of acetylcholine with similar chest pain to that experienced before. Under treatment with diltiazem and flecainide, which suppressed the induction of VF, the patient experienced no recurrence of symptoms despite persistent ST-segment elevation. No previous reports have described coronary spasm associated with Brugada-type ECG abnormalities, and patients with syncope should be evaluated carefully.- - - - - - - - - - ranking = 0.66666666666667keywords = artery (Clic here for more details about this article) |
3/126. plasma endothelin-1 elevation associated with alcohol-induced variant angina.Vasospastic angina as a result of alcohol ingestion has been reported, but the mechanism of alcohol-induced coronary artery spasm is presently unknown. This report presents 2 cases of alcohol-induced variant angina (VA) with elevated levels of plasma endothelin-1 after alcohol ingestion. In case 1, the plasma endothelin-1 concentration was 3.15 pg/ml before drinking (normal <2.30 pg/ml) and increased to 4.09 pg/ml when measured 5 h after alcohol ingestion. After 2 months of abstinence, the plasma endothelin-1 concentration was 2.88 pg/ml and 6 months after abstinence, it decreased to 2.03 pg/ml (normal range). In case 2, the plasma endothelin-1 concentration was 2.44 pg/ml before drinking and increased to 4.36 pg/ml when measured 5 h after alcohol ingestion. After 2 months of abstinence, the plasma endothelin-1 concentration was 3.04 pg/ml and 6 months after abstinence, it decreased to 2.09 pg/ml (normal range). These 2 cases suggest that a relationship may exist between alcohol-induced VA and elevation in the plasma endothelin-1 concentration after alcohol ingestion.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
4/126. myocardial infarction with moyamoya disease and pituitary gigantism in a young female patient.myocardial infarction is very rare in young female patients with systemic vascular disorders. moyamoya disease is a cerebrovascular disease associated with an abnormal vascular network. This report presents a 19-year-old female patient who suffered from chest pain and exertional dyspnea for 2 months prior to admission. She had a history of moyamoya disease and pituitary gigantism since childhood. Her ejection fraction on echocardiogram was 20% and a perfusion defect with partial reversibility in the anterior wall was demonstrated on stress single photon emission computed tomography (SPECT). Diagnostic coronary angiogram revealed critical stenosis in the middle left anterior descending artery, which was treated by coronary stenting. Her subjective symptoms were relieved and the perfusion defect seen on SPECT decreased after coronary intervention.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
5/126. Surgical treatment of a coronary artery fistula with concomitant saccular coronary artery aneurysm: a case report.An extremely rare case of a coronary artery fistula with a concomitant saccular aneurysm is presented. A 65-year-old woman, who had a history of chest bruising 5 years earlier, suffered from chest pain, which was diagnosed as being due to left coronary artery-pulmonary artery fistulae concomitant with a giant saccular coronary artery aneurysm. Suture closure of the afferent coronary artery to the aneurysm, aneurysmorrhaphy, and transpulmonary closure of coronary artery-pulmonary artery fistulae were performed. The postoperative course was uneventful and the patient was well at 3 months after the operation. Because the risk of surgery appears to be less than the potential development of fatal complications, it is recommended for the treatment of coronary artery fistula with a concomitant saccular aneurysm.- - - - - - - - - - ranking = 5.3333333333333keywords = artery (Clic here for more details about this article) |
6/126. nitric oxide successfully used to treat acute chest syndrome of sickle cell disease in a young adolescent.OBJECTIVES: To report a case of acute chest syndrome (ACS) of sickle cell disease treated successfully with nitric oxide and to review the physiologic effects of nitric oxide and its potential ability to improve outcome in ACS. DESIGN: Descriptive case report. SETTING: Eighteen-bed pediatric intensive care unit in a university children's hospital. PATIENT: A 15-yr-old black male with sickle cell disease, bilateral pulmonary infiltrates, refractory hypoxemia, and unstable hemodynamics. INTERVENTION: In addition to exchange transfusion, invasive hemodynamic monitoring, and aggressive ventilatory support, inhaled nitric oxide was administered in the gas mixture in a concentration of 20 ppm for 72 hrs. MEASUREMENTS AND MAIN RESULTS: cardiac output, pulmonary arterial pressure, pulmonary artery occlusion pressure, systemic vascular resistance, pulmonary vascular resistance, shunt fraction, and alveolar-arterial oxygen gradient were compared with and without inhaled nitric oxide. Marked reductions in pulmonary arterial pressure and pulmonary vascular resistance were noted. cardiac output improved, and shunt fraction and alveolar-arterial oxygen gradient were markedly reduced. The patient required decreased ventilator and hemodynamic support and rapidly made a complete recovery. CONCLUSIONS: nitric oxide may be beneficial for patients with ACS because of its ability to ameliorate pulmonary hypertension and ventilation/perfusion mismatch. nitric oxide may confer some protection against polymerization of sickle hemoglobin and exert a reversible antiplatelet effect that may be beneficial in ACS. Further study is necessary to determine the safety and efficacy of inhaled nitric oxide as a treatment for ACS.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
7/126. Odynophagia in a woman with known coronary artery disease and ischemia on electrocardiogram.Esophageal intramural hematoma can mimic other causes of chest pain. When the patient is known to have coronary artery disease, the diagnosis may be difficult. Moreover, the course may be complicated and may harm the patient if antiplatelet drugs, thrombolytics, and anticoagulants are used. The presence of odynophagia should alert the clinician to the possibility of an esophageal origin, even in a patient with known coronary artery disease. We present a case in which early recognition of the clinical presentation prevented potential iatrogenic complications.- - - - - - - - - - ranking = 15.173013852054keywords = artery disease, artery (Clic here for more details about this article) |
8/126. Normal electrocardiogram with total occlusion of the left anterior descending coronary artery.Total occlusion of the left anterior descending coronary artery is usually characterized by ST-segment elevation in the anterior leads of the surface electrocardiogram. We report a case of a patient who had a persistently normal electrocardiogram throughout his hospitalization despite the angiographic findings of total occlusion of the left anterior descending coronary artery and no collateral vessels. Percutaneous transluminal coronary angioplasty with stent placement was performed successfully.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
9/126. Alteration of coronary flow velocity during spontaneous angina in a patient with microvascular angina.Phasic coronary flow velocity in the left and right coronary artery was recorded in a patient with microvascular angina. Coronary flow velocity during anginal attack was characterized by diminished systolic forward velocity, the appearance of systolic flow reversal, increase in diastolic flow velocity and its rapid deceleration. It was also accompanied with abnormal coronary flow reserve. These findings completely recovered at follow-up examination. A subgroup of patients with microvascular angina may show unique and reversible coronary flow abnormalities during chest pain.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
10/126. Coexistence of giant aneurysm of sinus of valsalva and coronary artery aneurysm associated with idiopathic hypereosinophilic syndrome.Aneurysms of the coronary sinuses of Valsalva and coronary artery aneurysms are uncommon cardiac anomalies, and cases in which these two uncommon lesions occur at the same time are extremely rare. A case of a woman with unstable angina who had a giant aneurysm of the left coronary sinus and multiple coronary artery aneurysms associated with an idiopathic hypereosinophilic syndrome is presented. Her sustained eosinophilia, elevated eosinophilic cationic protein concentration, and pathological findings of eosinophil infiltration of the aortic wall suggested the association of eosinophilia induced vascular injury as the cause of these aneurysms. This is the first such case to survive following surgical treatment.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
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