Cases reported "Coronary Disease"

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1/30. A large coronary artery saphenous vein bypass graft aneurysm with a fistula: case report and review of the literature.

    We describe a patient who developed a large aneurysm of saphenous vein graft to the right coronary artery with a fistulous communication to the right atrium. The presence of a fistulous communication of a saphenous vein graft aneurysm after coronary bypass surgery to one of the heart chambers is extremely rare. The diagnosis was made by coronary angiography and confirmed by CT and MRI. At surgery the aneurysm was ligated and excised. The fistula to the right atrium was closed. Repeat coronary artery bypass surgery with aortic valve replacement was performed at the same time without complications. Cathet. Cardiovasc. Intervent. 48:214-216, 1999.
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2/30. Telemedical experiences at an Antarctic station.

    Wintering-over in Antarctica represents a physician's most remote and inaccessible scenario, apart from a space station. Because of the harsh and unpredictable winter weather, Antarctic stations are typically inaccessible for over six months of the year. telephone and fax communication, and recently other forms of telemedicine, have provided vital links to specialists. The author was the sole physician for more than 250 people wintering-over during the 1995 austral winter at McMurdo Station. There were several instances of serious or life-threatening illness where the author relied on teleconsultation. These cases included new-onset coronary artery disease, posterior hip dislocation, complicated colles' fracture and acute appendicitis. There were also numerous consultations for non-emergency clinical presentations normally managed by specialists. telemedicine was a crucial link to specialists from the remote and inaccessible environment of Antarctica.
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3/30. 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.
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4/30. Local pulmonary malformation caused by bilateral coronary artery and bronchial artery fistulae to the left pulmonary artery in a patient with coronary artery disease.

    At 10 years of age and again at 25, our patient had been treated for pulmonary tuberculosis due to the presence of a localized pulmonary shadow. coronary angiography at age 59 revealed 3 fistulous communications: from the right and circumflex coronary arteries and from the left bronchial artery. All 3 emptied into the same recipient artery, the distal part of a left pulmonary artery branch, which produced substantial left-to-right shunt. On computed tomography, cystic formations could be seen in the pulmonic area. The pulmonary tuberculosis for which this patient had been treated in his youth was in the same part of the lung where the shunt was discovered. Our conclusion is that the initial diagnosis was in error.
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5/30. fistula between a saphenous vein graft aneurysm and the pulmonary artery trunk.

    We report the case of a 52-year-old man who was admitted for atypical thoracic pain 18 years after a saphenous vein bypass graft of the left anterior descending coronary artery. Investigations demonstrated an aneurysm of the middle portion of the vein graft with a fistulous communication to the pulmonary artery trunk. The aneurysm was excised surgically, and the fistula was closed with an autogenous pericardial patch.
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6/30. "Wireless" laser recanalization of chronic total coronary occlusions.

    Chronic total occlusions in particular, completely obstructed aorto-ostial lesions are among the most challenging targets in interventional cardiology. Excimer laser is a debulking technology for revascularization of complex lesions. Treatment of total occlusions with laser angioplasty can be applied providing that a guidewire traverses the entire length of the occlusion prior to device activation. In many patients with total occlusions, a guidewire is unable to penetrate the target stenosis. This communication presents a new technique termed "wireless" laser recanalization. This approach entails recanalization of a total occlusion with a laser catheter without a leading guidewire.
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7/30. Transesophageal three-dimensional echocardiographic assessment of left main coronary artery fistula.

    We describe a patient with a left main coronary artery fistula with an opening at the superior vena cava-right atrial junction in whom three-dimensional transesophageal echocardiography permitted more accurate assessment of the shape and size of the communication site than two-dimensional transesophageal echocardiography.
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8/30. communication between left main stem trunk and proximal segment of left anterior descending coronary artery rescues left ventricular ejection fraction of a patient with three-vessel disease.

    The well-known congenital anomalies of the left main stem refer mainly to its anomalous origin from the pulmonary artery or the right aortic sinus. We present a patient with a large communication between the left main stem trunk and the proximal segment of the left anterior descending coronary artery which preserves the left ventricular systolic performance in the setting of significant three-vessel disease.
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9/30. Localization of a coronary artery fistula using contrast transesophageal echocardiography.

    With the increasing use of transesophageal and other cardiac imaging, coronary fistulas are being discovered more often. The clinical significance of these communications is unclear. Microbubble echo-contrast has been used to enhance endocardial definition, myocardial perfusion, and augment Doppler signals. This case describes the use of microbubbles to enhance the color Doppler signals to better define location and extent of a coronary artery fistula communicating with the left ventricle.
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10/30. Valvular heart disease in the older adult: a case study presentation.

    Mr. C's case was interesting from both a medical and nursing point of view. He presented both medical and nursing challenges. For medicine, the major challenge was the decision of whether or not to do open heart surgery on a patient with an ejection fraction of 20-30%. For nursing, the major challenge was increasing Mr. C's motivation to participate in his care and to learn essential new behaviors to practice at home. Mr. C was able to be discharged to his home in stable condition with information he needed to achieve his new self-care behaviors. Mr. C's case offers many possibilities for future research. To be more specific, the study could focus on the open heart surgery patient. A study could also be done in this same area looking at how patient education impacts motivation and increasing readiness to learn. This case demonstrates how important collaboration and consistency are in following a plan of care to positively effect the patient's progress. Often times there is more than one health care professional involved in the teaching of the patient. To be most effective, the teaching plan must be consistent with all involved. This is achieved through good communication among health team members regarding what the patient has been taught, what he understands, and additional teaching needs of the patient (13). Keeping these points in mind will help guide the nurse in her quest to provide the patient with the best possible care.
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