1/125. Left ventricular ischemia due to coronary stenosis as an unexpected treatable cause of paroxysmal atrial fibrillation.We present a patient with exercise-induced paroxysmal atrial fibrillation who was eventually scheduled for a Cox-maze operation due to persistence of his complaints of fatigue, impaired exercise tolerance, and predominantly exercise-related irregular palpitations despite treatment with several antiarrhythmic drugs. A preoperative exercise stress test without antiarrhythmic or negative chronotropic drugs, however, showed clear evidence of myocardial ischemia. After coronary angioplasty of a significant stenosis in the left anterior descending artery, there was no recurrence of atrial fibrillation during a follow-up of 7 months.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/125. Right ventricular myocardial bridge in a patient with pulmonary hypertension--a case report.Myocardial bridge is a not uncommon finding in routine diagnostic coronary angiography or pathological examination of the heart. It is almost always confined to the left ventricle and the left anterior descending coronary artery. This report describes a patient with chronic lung disease, severe left ventricular dysfunction, and pulmonary hypertension in whom coronary angiography revealed bridging of the right ventricular branch of the right coronary artery.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
3/125. Transient left ventricular failure following bilateral lung transplantation for pulmonary hypertension.BACKGROUND: Bilateral lung transplantation is an established therapy for end-stage pulmonary hypertension. Its early postoperative outcome may be biased by various complications resulting in unexpected deterioration of the patient in terms of hemodynamics and blood gases. methods: We have reviewed the early postoperative course of patients who underwent bilateral lung transplantation for pulmonary hypertension at our institution and analyzed all available data, especially hemodynamic measurements, echocardiographic documentation and therapeutical strategies, in those cases where cardiac dysfunction was found to be responsible for clinical deterioration. RESULTS: Three out of 20 lung transplant recipients operated for pulmonary hypertension experienced severe respiratory insufficiency accompanied by hemodynamic decompensation during the first days after surgery. Clinical and laboratory findings together with results of echocardiography and pulmonary artery catheterism helped establish the diagnosis of left ventricular failure. This proved to be transitory, but the response to therapy (inotropic drugs, afterload reduction and eventually prostaglandins) was very variable. Adequately treated, this complication did not preclude the outcome of transplantation by itself. CONCLUSION: Left ventricular failure is a possible complication after lung transplantation for pulmonary hypertension. Echocardiography and pulmonary artery catheterism may be useful adjuvant diagnostic tools, beside routine physical examination, chest X-ray, and laboratory analysis. Therapy of this complication must be adapted individually and may be complex.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
4/125. Thrombotic occlusion of the main stem of the left coronary artery in a neonate.Thrombotic coronary arterial occlusion, and myocardial infarction, are rare in the newborn. We report such a happening presenting shortly after birth with cardiogenic shock, no left ventricular output and a systemic circulation dependent on flow from a patent arterial duct.- - - - - - - - - - ranking = 4keywords = artery (Clic here for more details about this article) |
5/125. Right-sided pulsus alternans in diastolic left ventricular dysfunction.Pulsus alternans is usually found in patients with reduced systolic ventricular function. We describe a patient with shortness of breath, hypertension, and left ventricular hypertrophy, but with normal left and right systolic function. Pulsus alternans was demonstrated in the pulmonary wedge position, pulmonary artery, and right ventricle, but not in the aorta or left ventricle. Cathet. Cardiovasc. Intervent. 47:336-339, 1999.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
6/125. 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 = 1keywords = artery (Clic here for more details about this article) |
7/125. Anesthetic management of high-risk cardiac patients undergoing noncardiac surgery under the support of intraaortic balloon pump.patients with severely impaired left ventricular function, an uncorrectable coronary artery disease, and a recent myocardial infarction are at high risk of cardiac complications after major noncardiac surgery. We present two patients with extensive three-vessel coronary artery disease who underwent intraperitoneal surgery under the support of intraaortic balloon pump (IABP). In one patient, the IABP was inserted urgently because of the development of chest pain with significant ST depression on arrival in the operating room, and the other patient was managed with prophylactic IABP. There were no intraoperative or postoperative cardiac events in either patient. Thus, IABP should be considered in the perioperative management of patients with severe cardiac diseases.- - - - - - - - - - ranking = 34.907836371722keywords = artery disease, artery (Clic here for more details about this article) |
8/125. myocardial stunning in hyperthyroidism.The cases of two patients with hyperthyroidism and acute left ventricular (LV) dysfunction with segmental wall motion abnormalities resulting in heart failure are reported. Both had electrocardiographic changes mimicking ischemic coronary artery disease. Treatment with antithyroid medications, beta blockers, and angiotensin-converting enzyme inhibitors rapidly restored LV function. The rapid reversibility suggests a role for myocardial stunning, an important entity to recognize in hyperthyroidism since this form of LV dysfunction can be reversed with appropriate treatment.- - - - - - - - - - ranking = 17.453918185861keywords = artery disease, artery (Clic here for more details about this article) |
9/125. Segmental degradation of left ventricular wall motion after persistent coronary fistula in a posttransplantation patient: a case report and short review of literature.A 50-year-old man received an orthotopic heart transplant because of severe coronary heart disease and congestive heart failure. Two years after the transplantation, a continuous murmur occurred at the left sternal edge after repeated endomyocardial biopsies. Echocardiography and coronary angiography revealed a dilated left anterior descending artery with a fistula to the right ventricle. The circumflex was large with an equally postero-lateral branch, and the right coronary artery was rather small with collaterals to the distal part of the left anterior descending branch. The patient had refused any intervention to close the fistula. The left ventricular levogram was normal. Two years later, in a follow-up angiogram, the left ventricular ejection fraction had decreased as a result of hypo- and akinesis of the apex and posterior wall. We suggest that this local wall motion disturbance derives from a steal phenomenon rather than being a sequela of rejection. The decrease in left ventricular ejection fraction was associated with shortness of breath upon moderate exercise. Standard heart failure medication relieved the patient's symptoms. The observation of local wall motion disturbances in this case, as well as conflicting views in the literature, raises the question whether postbiopsy coronary fistulas in transplant patients should be closed.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
10/125. Concomitant aortic root remodeling and coronary bypass in a patient with poor left ventricular function.A 58-year-old man who had previously undergone rectal cancer surgery and who had poor left ventricular function underwent concomitant aortic root remodeling and coronary bypass for aortic root aneurysm with aortic regurgitation and severe coronary artery disease. Intermittent retrograde cold blood cardioplegia and leukocyte-depleted terminal blood cardioplegia were used for myocardial protection. Angiographic studies 1 month after surgery showed improved left ventricular function at an ejection fraction from 24 to 46%. During a 1-year follow-up, he has remained free of any cardiac event. Even though this report is limited to a case and follow-up, this technique is expected to be beneficial even in patients with severely depressed left ventricular function when the postoperative quality of life is considered.- - - - - - - - - - ranking = 17.453918185861keywords = artery disease, artery (Clic here for more details about this article) |
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