1/33. 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 = 1keywords = giant (Clic here for more details about this article) |
2/33. Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography.Coronary artery fistula is a rare congenital malformation that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, coronary aneurysm and sudden death. Clinical symptomatology depends upon the underlying anatomy and the size of the fistulous connection between the left or right side of the heart. We report the successful management of a giant right coronary artery with fistulization into the right atrium. Intraoperative transesophageal echocardiography with colour flow Doppler was used for precise location of the fistulous communication, selective demonstration of vessels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Furthermore the effect of shunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
3/33. coronary artery bypass grafting in adult coronary artery disease due to suspected Kawasaki disease in childhood.Development of coronary artery aneurysms is one typical complication of Kawasaki disease and can cause coronary artery disease even in early childhood. Information about course and outcome in adults is rare. Here, we present a 49-year-old man with serious three-vessel coronary artery disease and giant coronary artery aneurysms following suspected Kawasaki disease.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
4/33. Unusual ECG responses to exercise stress testing.We describe the case of a patient with coronary artery disease who developed transient ST-segment depression, right bundle branch block (RBBB), left anterior hemiblock, ST-segment elevation ST), and "giant" T-waves in her electrocardiogram (ECG), an assortment of ECG patterns heretofore unreported in conjunction with exercise stress testing (EST). The amplitude of the ST was modulated by the superimposed RBBB, as was shown by its augmentation after the abrupt disappearance of RBBB. Following recession of the latter "giant" T-waves, which usually are encountered in the hyperacute phase of myocardial infarction, developed and persisted late in the recovery period. Cardiac enzymes after EST were negative, and arteriography revealed a stenotic left anterior descending coronary artery. The present case indicates that a variety of ECG expressions of severe transmural ischemia or myocardial infarction can also be manifest in the course of EST; this also suggests a common pathophysiological mechanism in severe EST-triggered ischemia and the early phase of myocardial infarction.- - - - - - - - - - ranking = 2keywords = giant (Clic here for more details about this article) |
5/33. Prominent systolic coronary flow in a coronary artery fistula with a giant aneurysma.A 68-year-old Japanese woman was admitted to hospital because of chest oppression during exertion. coronary angiography showed a coronary artery fistula with a giant aneurysm, which originated from both the left anterior descending (LAD) and right coronary arteries. We investigated coronary blood flow velocity using the Doppler guide wire technique. The coronary flow pattern showed a very prominent systolic component, whereas the diastolic flow components were nearly normal before the operation at the LAD site proximal to the coronary artery fistula. This pattern returned to normal after the operation. This report describes the relationship between the coronary steal phenomenon and coronary flow dynamics investigated directly using the Doppler guidewire technique.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
6/33. Late-term myocardial infarction after surgical ligation of a giant coronary artery fistula.A case is presented of a patient with recurrent myocardial infarctions after surgical treatment of a giant coronary artery fistula. The etiology was due to thrombus development in a large blind pouch, with propagation into more proximal vessels. Stenting of the proximal vessel provided temporary benefit, but recurrence eventually required surgical closure of the blind pouch.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
7/33. coronary artery disease obscuring giant cell myocarditis--a case report.A case in which the diagnosis of idiopathic giant cell myocarditis was obscured by the presence of severe coronary artery disease is described. A 47-year-old man presented with recurrent inferior myocardial infarction and complete heart block. cardiac catheterization confirmed severe 2-vessel disease and left ventricular dysfunction. Incessant ventricular arrhythmia rapidly ensued, which did not respond to anti-arrhythmic therapy and overdrive pacing despite complete surgical revascularization. He eventually died. autopsy revealed giant cell myocarditis superimposed on coronary artery disease. Acute myocarditis masquerading as myocardial infarction has been well known, but virtually all reported cases had normal coronary arteries. This case illustrated the fact that even in the presence of obvious coronary artery disease the remote possibility of myocarditis should not be entirely disregarded. Although giant cell myocarditis is a rare and frequently fatal disorder, recent studies suggest that combined immunosuppressive therapy may improve the prognosis.- - - - - - - - - - ranking = 7keywords = giant (Clic here for more details about this article) |
8/33. A giant aneurysm of the circumflex coronary artery with fistulous connection to the coronary sinus: a case report.Non-atherosclerotic coronary artery aneurysms are rare and most of them remain asymptomatic. We report a case who has a giant circumflex coronary artery aneurysm with fistulisation into the coronary sinus. The patient presents with dyspnea and palpitation due to atrial fibrillation with rapid ventricular response. The diagnostic contributions of echocardiography, coronary angiography are discussed. The hemodynamic effects of this anomaly are reviewed.- - - - - - - - - - ranking = 5keywords = giant (Clic here for more details about this article) |
9/33. Delayed development of a giant coronary pseudoaneurysm after stent placement for chronic total occlusion.A 42-year-old man developed a giant pseudoaneurysm in a stented coronary segment despite excellent results after stent placement for chronic total occlusion. The aneurysm was treated successfully with the deployment of a covered stent. Delayed development of a giant pseudoaneurysm after stent implantation for chronic total occlusion is an uncommon complication.- - - - - - - - - - ranking = 6keywords = giant (Clic here for more details about this article) |
10/33. myocardial infarction caused by rheumatoid vasculitis: histological evidence of the involvement of T lymphocytes.Rheumatoid arthritis (RA) is a chronic joint disease that can be complicated with extra-articular manifestations due to vasculitis. We describe a patient with RA who developed systemic vasculitis and died of myocardial infarction. autopsy demonstrated vasculitis of the left anterior descendent and circumflex coronary arteries, which were narrowed or occluded with organizing thrombosis. Formation of granuloma with multinucleated giant cells was also observed in media of the circumflex artery. There was no microscopic evidence of atheroma formation in the coronary arteries. Of note, there was a follicle-like infiltration of CD45RO-positive T lymphocytes in interna of the left coronary arteries and the right renal artery. Although not frequently reported, coronary vasculitis as a cause of myocardial infarction should be considered in patients with RA. Moreover, our results suggest that infiltration of T lymphocytes might be involved in the development of rheumatoid vasculitis.- - - - - - - - - - ranking = 1keywords = giant (Clic here for more details about this article) |
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