1/144. Transesophageal echocardiography and concurrent coronary angiography for the rapid assessment of papillary muscle rupture.Echocardiography with color flow imaging is valuable for identifying mechanical complications of myocardial infarction. Transesophageal echocardiography is useful for critically ill patients in whom transthoracic imaging is often insufficient. A case of papillary muscle rupture is presented in which transesophageal echocardiography was performed concurrently with coronary angiography. The detailed information obtained from two-dimensional and color flow imaging eliminated the need for diagnostic right heart catheterization and left ventriculography. Transesophageal echocardiography used in this manner can facilitate expeditious surgical management.- - - - - - - - - - ranking = 1keywords = coronary (Clic here for more details about this article) |
2/144. diagnosis of ruptured sinus of valsalva aneurysms: potential value of transesophageal echocardiography.Two patient cases are reported in which an aneurysm of the right coronary sinus of valsalva ruptured into the right ventricular outflow tract, near the crux of the heart. Transthoracic two-dimensional echocardiography and transesophageal echocardiography using Doppler color flow mapping allowed accurate preoperative assessment of the left-to-right shunt, which was subsequently confirmed by contrast aortography and surgery.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
3/144. Spontaneous rupture of a saphenous vein graft.We present a case of spontaneous rupture of a right coronary bypass vein graft in a 57-year-old woman 10 years after coronary by-pass surgery. Although rare, this diagnosis should be considered in such patients presenting with appropriate symptoms.- - - - - - - - - - ranking = 0.4keywords = coronary (Clic here for more details about this article) |
4/144. Pseudoaneurysm of the left ventricle progressing from a subepicardial aneurysm.A 56-year-old man presented with an inferior myocardial infarction and a huge pseudoaneurysm below the inferior surface of the left ventricle, which had progressed from a small subepicardial aneurysm over a 6-month period. Transthoracic echocardiography, doppler color flow images, radionuclide angiocardiography, magnetic resonance imaging and contrast ventriculography all revealed an abrupt disruption of the myocardium at the neck of the pseudoaneurysm, where the diameter of the orifice was smaller than the aneurysm itself, and abnormal blood flows from the left ventricle to the cavity through the orifice with an expansion of the cavity in systole and from the cavity to the left ventricle with the deflation of the cavity in diastole. coronary angiography revealed 99% stenosis at the atrioventricular nodal branch of the right coronary artery. At surgery the pericardium was adherent to the aneurysmal wall and a 1.5-cm orifice between the aneurysm and the left ventricle was seen. Pathological examination revealed no myocardial elements in the aneurysmal wall. The orifice was closed and the postoperative course was uneventful. Over-intense physical activity as a construction worker was considered to be the cause of the large pseudoaneurysm developing from the subepicardial aneurysm. These findings indicate that a subepicardial aneurysm may progress to a larger pseudoaneurysm, which has a propensity to rupture, however, it can be surgically repaired.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
5/144. Colonic perforation following prolonged hypovolaemia in a major burns injury.Perforation of the lower gastrointestinal tract is rare in burns patients. A 41-year-old male, who sustained 40% total body surface area burns and subsequently developed an acute abdomen on day 15 postburn, is presented. Emergency management included a subtotal colectomy and ileostomy formation performed to repair a perforated transverse colon found at laparotomy. The burns were debrided and grafted and the patient required cardiac, renal and respiratory support initially in the ITU setting before making a complete recovery. It is suggested that ischaemia caused the perforated transverse colon due to a prolonged low flow state. This was not detected until invasive cardiovascular catheterisation was performed and revealed a hypovolaemic state, which was corrected by fluids and noradrenaline. Both the previous cardiac history of the patient (Fallot's Tetralogy repair) and the noradrenaline may have exacerbated the low flow state within the mesenteric circulation leading to ultimate perforation. This case highlights the difficulties that may arise in resuscitating a patient who has previously had a cardiac defect repaired. Despite repair, abnormal physiology may persist resulting in misleading observations that produce undetected hypovolaemia with subsequent adverse events, as in this case. In such patients, early invasive cardiovascular monitoring should be considered.- - - - - - - - - - ranking = 0.014945466023314keywords = circulation (Clic here for more details about this article) |
6/144. Spontaneous dissections of all three coronary arteries in a 33-week-pregnant woman.The clinical course and angiographic follow-up of a woman with spontaneous coronary dissections in all three coronary arteries during the third trimester of pregnancy is described. Mother and child survived and subsequent clinical course was uneventful. At 6-month follow-up, dissections in the right and circumflex coronary artery had healed completely. At the site of the dissection in the LAD, an aneurysm had formed. This is to our knowledge the first report of antepartum and antemortem diagnosis of pregnancy related coronary dissections in all three coronary arteries. Cathet. Cardiovasc. Intervent. 48:207-210, 1999.- - - - - - - - - - ranking = 1.8keywords = coronary (Clic here for more details about this article) |
7/144. Spontaneous dissection of three major coronary arteries subsequent to cystic medial necrosis.This case report describes the devastating consequences of spontaneous coronary dissection in a 36-year-old female patient. Surgical revascularization was attempted, but diffuse myocardial infarction developed. The patient was bridged to heart transplantation but died secondary to multiple organ failure. To our knowledge, this is the only reported case of spontaneous dissection of the three main coronary arteries due to severe cystic medial necrosis.- - - - - - - - - - ranking = 1.2keywords = coronary (Clic here for more details about this article) |
8/144. radiation-related arterial disease.Arterial occlusive disease has been recognized in association with radiation arteriopathy and, rarely, with spontaneous arterial disruption. This association results from the greater role of radiation therapy in the current management of malignant diseases coupled with longer patient survival and the lengthy latency period between radiation and clinical manifestations of radiation arteriopathy. Experience with six patients having radiation-associated arterial disease was retrospectively reviewed. There were four men and two women, with a mean age of 51 years (range, 36-74). arteries exposed to radiation include two carotids, three subclavians, one coronary, and one femoral. The time from radiation therapy until clinical arterial disease was a mean of 14.3 years (range, 4-30). Operative repairs with polytetrafluoroethylene and saphenous vein bypass grafts were performed in four patients, stent placement in one patient, and one patient had spontaneous carotid disruption that ultimately was treated with ligation. In conclusion, elective bypass can be performed safely and successfully for arterial occlusive disease in a previously irradiated artery. In contrast, life-threatening arterial disruption secondary to radiation arteriopathy usually requires concomitant exposure to a source of bacterial contamination, and ligation may be the best choice to prevent recurrent hemorrhage.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
9/144. Cardiac rupture with false aneurysm after myocardial infarction.A case of cardiac rupture is reported after myocardial infarction. Leaking blood was contained within the pericardium and a false aneurysm developed. Ten months later this was successfully repaired. The neck of the aneurysm was transected, the defect in the left ventricle closed and saphenous vein bypass grafts were applied to the anterior descending and right coronary arteries. The literature on this subject is briefly reviewed.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
10/144. Acute heart failure due to local dehiscence of aortic wall at aortic valvular commissure.Spontaneous dehiscence of the aortic wall at the aortic commissure is not recognized as one of the usual pathological causes of aortic regurgitation. We describe the case of a 56-year-old man with hypertension, who experienced acutely progressive congestive heart failure due to massive aortic regurgitation. Local layer dehiscence around the commissure was noted with partial detachment of the commissure resulting in the loss of commissural support with secondary rupture of a non-coronary cusp, which led to massive aortic regurgitation.- - - - - - - - - - ranking = 0.2keywords = coronary (Clic here for more details about this article) |
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