Cases reported "Coronary Vessel Anomalies"

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1/160. Anomalous origin of the left main coronary artery: anatomical correction and concomitant LIMA-to-LAD grafting.

    A 55-year-old woman with angina pectoris and exertional dyspnea underwent surgical correction of an anomalous left main coronary artery (LMCA) originating from the right sinus of valsalva. During the operation, the roof of the intramurally coursing LMCA was opened into the aortic lumen, and a neo-coronary ostium was created by suturing the circumference of the LMCA intima to the aortic intima. In addition, a left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery anastomosis was performed. Post-operative coronary angiography demonstrated two independent, patent orifices of both the LMCA and the right coronary artery. The technique presented herein, of combined anatomical correction and LIMA-to-LAD grafting, is feasible and leads to distinct angiographic and clinical improvement.
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keywords = operative
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2/160. cesarean section in a mother with uncorrected congenital coronary to pulmonary artery fistula.

    PURPOSE: We report a case of a 33 yr old woman with pulmonary hypertension secondary to uncorrected right coronary artery to pulmonary artery fistula who underwent two successful operative deliveries under general anesthesia. CLINICAL FEATURES: This woman underwent an emergency Caesarean section at 32 wk gestation because she presented in NYHA Class IV, heart failure and premature labour. She did not have antenatal follow-up. For her second pregnancy, she was managed from the first trimester of pregnancy by the cardiologist, obstetrician and anesthesiologist. She received oral furosemide and digoxin from eight weeks gestation. pregnancy was managed to term before she progressed to NYHA Class IV and cardiac failure at 37 wk gestation. She had a Caesarean section under general anesthesia. She received rapid sequence induction of anesthesia and tracheal intubation with 0.1 mg x kg(-1) etomidate, 2 mg x kg(-1) succinylcholine and maintenance with nitrous oxide 50% in oxygen, isoflurane 1% and 0.1 mg x kg(-1) vecuronium. fentanyl, 2 microg x kg(-1) helped to obtund the hypertensive response to intubation. analgesia was provided with 1 mg x kg(-1) morphine. Glyceryl trinitrate infusion, 10-30 microg x min(-1) was used in addition to the anti-heart failure therapy. End-tidal capnography, electrocardiogram, pulse oximetry, continuous arterial blood pressure and pulmonary arterial catheter provided hemodynamic monitoring. The lungs were mechanically ventilated for 24 hr postoperatively. She received anti-heart failure therapy which she continued after discharge. She was NYHA class II upon discharge. She defaulted from further follow-up. CONCLUSION: Although the literature advocates, in this situation, controlled vaginal delivery utilising epidural analgesia, we describe the successful outcome for operative delivery under general anesthesia in a patient with secondary pulmonary hypertension and heart failure.
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keywords = operative
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3/160. Intralobar lung sequestration with systemic coronary arterial supply.

    Pulmonary sequestration is a rare anomaly. An accurate pre-operative evaluation of its vascular supply is essential for the surgeon's operative approach. We describe here an intrapulmonary sequestration with vascular arterial supply via the left circumflex and the right coronary artery. This case demonstrates that if aortography is unrevealing, then a coronary source should be considered in the preoperative search for the arterial supply to a pulmonary sequestration. Moreover, pulmonary sequestration should be listed in the differential diagnosis of aberrant coronary arteries.
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ranking = 3
keywords = operative
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4/160. Sudden death and cerebral anoxia in a young woman with congenital ostial stenosis of the left main coronary artery.

    We report a 36-year-old woman with ventricular fibrillation, subsequent sudden clinical cardiac death, and a prolonged brain anoxia. After a successful resuscitation coronary angiography revealed congenital ostial left main coronary artery (LMCA) stenosis. Surgical anastomosis of the left internal mammary artery (LIMA) to LAD led to a complete recovery. Postoperative electrophysiological examination, mainly programmed ventricular stimulation, failed to excite any rhythm disturbances. Cathet. Cardiovasc. Intervent. 48:67-70, 1999.
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ranking = 1
keywords = operative
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5/160. Right ventricular thrombosis early after bidirectional Glenn shunt.

    thrombosis in the right ventricle occurred early after bidirectional superior cavopulmonary shunt in 2 patients with pulmonary atresia with intact ventricular septum and major right ventricular coronary artery communication, and perioperative brain infarction occurred in 1 patient. Clinicians should be aware of the hazards of this potentially lethal complication, and transfusion of platelets and fresh plasma should be minimized. Although the hemodynamic state is good, echocardiography should be performed frequently and strict anticoagulation should be started as early as possible.
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keywords = operative
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6/160. Divided left atrium associated with supravalvar mitral ring.

    Reported is a case with a rare association of divided left atrium, supramitral stenosing ring of the left atrium, connection of the left superior caval vein to the roof of the left atrium, unroofed coronary sinus with an interatrial communication at the mouth of the unroofed sinus and ventricular septal defect. The need for a complete echocardiographic examination in the presence of pulmonary venous obstruction is emphasized. Surgery was successful in spite of significant preoperative pulmonary hypertension.
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ranking = 1
keywords = operative
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7/160. Acute myocardial infarction in a patient with anomalous left coronary artery origin and primary antiphospholipid syndrome.

    Anomalous left main coronary artery (LMCA) originating from the right coronary sinus and running between the aorta and pulmonary trunk is a rare congenital condition. Although this disease is known to be associated with myocardial infarction and sudden death, the precise mechanism is uncertain. A 14-year-old male with this anomaly developed myocardial infarction during exercise complicated by primary antiphospholipid syndrome. He was admitted to hospital with persistent chest pain and sudden cardiac collapse that occurred while he was running. cardiac catheterization demonstrated a narrowed segment in the LMCA and impaired blood flow, prompting a diagnosis of extensive anterior myocardial infarction. Emergency bypass surgery was performed using a single saphenous vein graft to the left anterior descending artery. Postoperative angiography showed the presence of an anomalous LMCA arising from the right sinus of valsalva and running between the great vessels. The aortic samples were pathologically normal. He was discovered to also have primary antiphospholipid syndrome and was discharged without symptoms after warfarin therapy. Complicated primary antiphospholipid syndrome may trigger myocardial infarction in asymptomatic patients with this type of coronary anomaly.
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ranking = 1
keywords = operative
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8/160. Occlusion of left coronary artery ostium by an aortic valve cusp.

    Congenital anomalies of the aortic valve can be associated with other cardiac anomalies. In this report, we present a patient with an aortic valve anomaly associated with occlusion of left coronary ostia. In addition, we reviewed the literature and found 10 similar cases. Although compatible with life, this anomaly can lead to significant symptoms. Preoperative diagnosis as well as proper therapeutic planning should be tailored to correct valvular competence and restore coronary blood flow.
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ranking = 1
keywords = operative
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9/160. Surgical treatment of the congenital fistulae of coronary arteries.

    Six cases of coronary artery fistulae surgically treated are presented. All patient but one was male; the ages varied from 4 to 44 years. The fistulae originated from the left coronary artery in three cases from the right in two cases and from both arteries in one case. The draining heart chambers were the right atrium in three, the right ventricle in two and the pulmonary artery in one case. Associated lesions were present in three cases. One patient died on the early postoperative period and the evolution was satisfactory in five cases.
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keywords = operative
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10/160. Early presentation of a congenital coronary artery fistula in a neonate.

    A neonate developed severe congestive heart failure secondary to a congenital coronary artery fistula requiring emergent surgery. Intraoperative transesophageal echocardiography helped guide successful emergent closure of the fistula without complications.
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ranking = 1
keywords = operative
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