Cases reported "Coronary Disease"

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11/30. Left internal mammary--left ventricular fistula after Vineberg operation.

    This communication presents an unusual complication in a patient who underwent the Vineberg procedure with the formation of an internal mammary to left-ventricular fistula, which caused a new apical diastolic murmur. This represents a previously unreported etiology for the appearance of an apical blowing diastolic murmur.
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12/30. Coronary artery fistula: an abnormality affecting all age groups.

    A coronary artery fistula is an abnormal communication between a coronary artery and a cardiac chamber, great vessel, or other vascular structure. It is an infrequent but potentially important abnormality that can affect any age group. Most are congenital in origin, although other etiologies, in particular trauma, have been identified. Many are small and found incidentally during coronary arteriography, while others are identified as the cause of a continuous murmur, myocardial ischemia, congestive heart failure, or, rarely, bacterial endocarditis. The diagnosis should be considered in any patient presenting with a continuous murmur or in the setting of congestive heart failure, myocardial ischemia, or bacterial endocarditis without an obvious etiology. The pathophysiologic mechanisms resulting in symptoms include cardiac volume overload due to the shunting of blood and reduction of the myocardial blood supply due to "coronary steal." The diagnosis of coronary artery fistula may be suggested by the finding of a continuous murmur in a precordial location, which is atypical for patent ductus arteriosus. Two-dimensional echocardiography may demonstrate dilated coronary arteries, and pulse-wave and color-flow Doppler examinations can display turbulent flow in the suspected fistula and its receiving chamber or vessel. Angiography is generally needed to confirm the diagnosis and elucidate anatomic detail. The natural history of coronary artery fistula is variable, with long periods of stability in some patients and gradual progression of symptoms in others. Small fistulas detected incidentally at the time of angiography do not require immediate surgical correction, but careful follow-up is indicated because the potential for enlargement with physiologically important shunting exists and cannot readily be predicted. Spontaneous closure is uncommon. Surgical repair of the fistula is recommended for symptomatic patients and for some without symptoms because a quantitatively small shunt does not predict freedom from future symptoms or complications. Those selected for medical management must be followed closely.
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13/30. Doppler echocardiographic findings in coronary-pulmonary fistula.

    We describe a patient with a coronary-pulmonary fistula who had a syncopal attack. He had also pectus excavatum. Doppler echocardiography revealed late diastolic flow in the left high parasternal region which was not caused by pulmonary insufficiency, but by the jet through the fistulous communication. Selective coronary angiography demonstrated the fistula between the left anterior descending artery and the pulmonary trunk.
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14/30. Diffuse coronary artery to left ventricular communications: an unusual cause of demonstrable ischemia.

    Diffuse communications between both the left and right coronary arteries and the left ventricle were found in a 46-year-old man presenting with typical angina pectoris. Symptoms were reproducible on treadmill exercise and ST segment depression, and redistribution septal defects were documented on stress thallium scintigraphy. Antianginal drugs were effective in treating the patient's symptoms. Only 13 patients with similar anatomy have been previously described. This report is the first to document reproducible objective evidence of ischemia in such patients. The literature is reviewed and possible mechanisms of ischemia and its treatment discussed.
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15/30. myocardial reperfusion by thrombolysis after acute total left main artery occlusion--a case report.

    Coronary recanalization with thrombolytic agents is a new therapeutic approach to the treatment of acute myocardial infarction that can be beneficial even to patients in cardiogenic shock. Although few cases have been reported in the literature, treatment of acute occlusion of the left main coronary artery (LMCA) has been made possible by myocardial reperfusion. This communication concerns a patient with acute LMCA occlusion who was successfully treated by thrombolytic therapy with streptokinase followed by revascularization of the myocardium seventy-two hours after reperfusion was achieved.
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16/30. Systemic aspergillosis as cause of myocardial infarction.

    Systemic aspergillosis is encountered with increasing prevalence in immunocompromised patients undergoing chemotherapy. The current communication describes the clinical and postmortem findings in three leukemic patients who developed myocardial infarction secondary to aspergillus embolization of the coronary arteries. They were all immunosuppressed owing to previous chemotherapy and had been treated for suspected fungal infection with amphotericin b (0.6 mg/kg) for at least 1 week prior to this episode. It is postulated that the infection was spread through the blood since in all three cases the descending branch of the left coronary artery was occluded. Heart involvement resulting from fungal infection should be suspected when chest symptoms of unknown origin occur in this patient population.
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17/30. angioplasty catheter communication mimicking coronary arterial dissection.

    We report a case in which a sudden communication between the pressure and balloon inflation lumens of a percutaneous transluminal angioplasty (PTCA) catheter angiographically mimicked dissection of the coronary artery. This case illustrates a previously undescribed catheter artifact that must be differentiated from other complications of PTCA.
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18/30. Anomalous left coronary artery from pulmonary artery. Unusual case complicated by coronary arterial disease and fistula from coronary artery to left ventricle.

    A 42-year-old woman with an anomalous left coronary artery originating from the pulmonary artery and a fistula from the left coronary artery to the left ventricle was treated by aortocoronary bypass grafting of an autologous saphenous vein. The presence of an abundant collateral circulation and of fistulous communications between the left coronary artery and the left ventricle, in our opinion, was the reason that this patient remained asymptomatic until the age of 40 years. We believe that this is the first report of the findings in an adult patient who had these two rare congenital anomalies complicated occlusive coronary arterial disease.
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19/30. Redistribution on the thallium scan in myocardial sarcoidosis: concise communication.

    Resting and redistribution thallium studies were performed in four young patients with sarcoidosis to evaluate the possibility of myocardial involvement. In each case the resting scan showed marked defects that resolved on the redistribution studies. In a different patient population, these results would have implied significant coronary artery disease.
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20/30. Acquired coronary-to-bronchial artery communication: a possible cause of coronary steal.

    An unusual case of an acquired coronary-to-bronchial artery communication is presented. Collateral flow to the lung was provided by the right coronary circulation following obstruction of pulmonary blood flow by chronic pulmonary emboli. A coronary steal phenomenon may have caused an exacerbation of cardiac symptoms by further reducing already compromised coronary blood flow in a patient with atherosclerotic coronary artery disease.
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