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Vanezis A. Iatrogenic Dissection of the Left Internal Mammary Artery During Percutaneous Coronary Intervention of Jump Radial Artery Graft Bifurcation Disease: A Case Report. Interv Cardiol 2023; 18:e27. [PMID: 38213744 PMCID: PMC10782429 DOI: 10.15420/icr.2023.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/28/2023] [Indexed: 01/13/2024] Open
Abstract
Guide-catheter-induced ostial coronary artery dissection is a feared complication of percutaneous coronary intervention, but thankfully the incidence is low. We describe a case of catheter-induced ostial dissection of the left internal mammary artery (LIMA) with multiple radial jump grafts during percutaneous coronary intervention of radial graft bifurcation disease via the LIMA. The dissection led to loss of flow and profound haemodynamic compromise and cardiac arrest as the LIMA supplied the majority of the myocardium in this patient. Intravascular ultrasound was not immediately available, so an Export AP thrombus aspiration catheter (Medtronic) was used over the coronary wire in place to allow the injection of contrast while simultaneously pulling back on the catheter to delineate the extent of the dissection and guide accurate drug-eluting stent placement. The report is a cautionary tale to the reader to treat the LIMA with respect and think long and hard before considering any interventional procedure that uses the LIMA as a conduit.
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Affiliation(s)
- Andrew Vanezis
- Trent Cardiac Centre, Nottingham City Hospital Nottingham, UK
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2
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Viegas JM, Ferreira V, Pereira-da-Silva T, Ferreira RC. Threading the needle: a case report of double-wiring technique and double intracoronary imaging guidance for a multifenestrated iatrogenic coronary artery dissection. Eur Heart J Case Rep 2023; 7:ytad212. [PMID: 37168363 PMCID: PMC10166514 DOI: 10.1093/ehjcr/ytad212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 01/20/2023] [Accepted: 04/21/2023] [Indexed: 05/13/2023]
Abstract
Background Iatrogenic coronary artery dissection (ICAD) may represent a serious complication of percutaneous coronary intervention. Stenting the dissected segment is recommended in large dissections with compromised distal blood flow, although wiring the true lumen is often difficult. Case summary A 64-year-old woman with effort angina was submitted to invasive coronary angiography that revealed a severe stenosis in the distal right coronary artery. A large spiral ICAD occurred after pre-dilatation and guidewire position is lost. We report the treatment of this multifenestrated dissection using combined intracoronary imaging guidance with angiographic co-registered optical coherence tomography and real-time intravascular ultrasound, which were crucial to achieve a successful outcome. Discussion A double-wiring technique with double intracoronary imaging guidance enables a comprehensive depiction of the compromised artery and should be considered in selected cases to guide true lumen wiring and stent implantation.
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Affiliation(s)
| | - Vera Ferreira
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Rua de Santa Marta 50, 1169-024 Lisbon, Portugal
| | - Tiago Pereira-da-Silva
- Department of Cardiology, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central, Rua de Santa Marta 50, 1169-024 Lisbon, Portugal
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3
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Mori R, Macaya F, Giacobbe F, Moreno V, Quadri G, Chipayo D, Bianco M, Salinas P, Rolfo C, Mejía-Rentería H, Boi A, Tirado-Conte G, Cavallino C, Nombela-Franco L, Cinconze S, Jiménez-Quevedo P, Pavani M, Fernández-Ortiz A, Chinaglia A, Fuentes-Ferrer ME, Núñez-Gil IJ, Gonzalo N, Cerrato E, Varbella F, Escaned J. Association between hormone therapy and short-term cardiovascular events in women with spontaneous coronary artery dissection. Rev Esp Cardiol (Engl Ed) 2023; 76:165-172. [PMID: 35850485 DOI: 10.1016/j.rec.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND OBJECTIVES Changes in sex hormone levels are a known triggering factor for spontaneous coronary artery dissection (SCAD) in women. However, it is unknown whether exposure to exogenous hormone therapy (HT) at the time of SCAD presentation modifies the clinical course of this condition. We investigated the association between HT in female patients presenting with SCAD and short-term clinical outcomes. METHODS We enrolled consecutive patients presenting with SCAD from the DISCO-IT/SPA (dissezioni spontanee coronariche Italian-Spanish) registry. Women on HT (estrogens, progestagens, or gonadotropins) at the time of presentation were identified, and their clinical characteristics and short-term outcomes were compared with those not receiving active HT. The outcome measure was nonfatal myocardial infarction and/or unplanned percutaneous coronary intervention during the first 28 days after the index catheterization. RESULTS Of 224 women presenting with SCAD (mean age 52.0±10.0 years), 39 (17.4%) were currently using HT while 185 (82.6%) were not. No significant differences were noted in the baseline demographics, clinical presentation, angiographic features, or initial treatment received between the 2 groups. All patients on systemic HT (n=36, 92%) discontinued it at the time of diagnosis. The composite outcome occurred in 7 (17.9%) patients with prior HT compared with 14 (7.6%) without (P=.039). After multivariable adjustment, HT remained associated with the composite outcome recorded in the first 28 days of follow-up (HR, 3.53; 95%CI, 1.30-9.61; P=.013). CONCLUSIONS In women with SCAD, exposure to HT at the time of clinical presentation was associated with short-term recurrent cardiovascular events such as nonfatal myocardial infarction and/or unplanned percutaneous revascularization.
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Affiliation(s)
- Ricardo Mori
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Fernando Macaya
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain.
| | - Federico Giacobbe
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Víctor Moreno
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Giorgio Quadri
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi Hospital, Rivoli, Turin, Italy
| | - David Chipayo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Matteo Bianco
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Pablo Salinas
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Cristina Rolfo
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Hernán Mejía-Rentería
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alberto Boi
- Dipartimento di Cardiologia, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Gabriela Tirado-Conte
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Chiara Cavallino
- Dipartimento di Cardiologia, Sant'Andrea Hospital, Vercelli, Italy
| | - Luis Nombela-Franco
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Sebastian Cinconze
- Dipartimento di Cardiologia, Azienda Ospedaliera S Croce e Carle, Cuneo, Italy
| | - Pilar Jiménez-Quevedo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Marco Pavani
- Dipartimento di Cardiologia, Azienda Ospedaliera Brotzu, Cagliari, Italy
| | - Antonio Fernández-Ortiz
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Alessandra Chinaglia
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Manuel Enrique Fuentes-Ferrer
- Departamento de Medicina Preventiva, Unidad de soporte metodológico a la investigación, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - Iván J Núñez-Gil
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Nieves Gonzalo
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
| | - Enrico Cerrato
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Ferdinando Varbella
- Dipartimento di Cardiologia, San Luigi Gonzaga University Hospital, Orbassano, Turin, Italy
| | - Javier Escaned
- Departamento de Cardiología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense de Madrid, Madrid, Spain
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Son SA, Lee SC, Lee E, Lee JH. Traumatic coronary artery dissection misdiagnosed as stress-induced cardiomyopathy in a patient with multiple trauma. Trauma Case Rep 2022; 42:100698. [PMID: 36247881 PMCID: PMC9554819 DOI: 10.1016/j.tcr.2022.100698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/05/2022] Open
Abstract
Traumatic coronary artery dissection resulting from blunt trauma, is a relatively rare and life-threatening event. We present a case report of a 42-year-old male who presented with electrocardiogram abnormality and cardiac enzyme elevation following a fall from a height of 3 m. The patient was misdiagnosed with stress-induced cardiomyopathy because of the absence of clinical signs of acute coronary syndrome. The patient was subsequently diagnosed with traumatic coronary artery dissection using coronary angiography, and the relevance of the trauma was confirmed using intravascular ultrasonography (IVUS). Herein, we highlight that trauma team should maintain a high suspicion of traumatic coronary artery dissection, although the early recognition of traumatic coronary artery dissection can be difficult. Additionally, the importance of coronary angiography with IVUS modalities for the evaluation of traumatic coronary artery dissection is highlighted.
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Affiliation(s)
- Shin-Ah Son
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Sang Cjeol Lee
- Department of Thoracic and Cardiovascular Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea
| | - Eunkyu Lee
- Department of Internal Medicine, CHA University, CHA Gumi Medical Center, Gumi, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, Republic of Korea,Corresponding author at: Department of Internal Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu 41944, Republic of Korea.
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5
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Blevins AJ, Repas SJ, Alexander BM, Siebenburgen C. Blunt traumatic coronary artery dissection: A case study. Trauma Case Rep 2022; 37:100594. [PMID: 35028357 PMCID: PMC8739455 DOI: 10.1016/j.tcr.2021.100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/28/2022] Open
Abstract
Background Coronary artery dissection is an extremely rare but lethal complication of blunt chest trauma. Dissection may cause thrombus formation or vasospasm, leading to the clinical presentation of acute myocardial infarction. Diagnosis can be difficult as traumatic chest pain has several etiologies; therefore, an electrocardiogram (ECG) is necessary in all cases of thoracic trauma [1-3]. Case report Thirty-eight-year old female, with no significant past medical history, presented to a freestanding emergency department with complaints of severe chest pain and right shoulder pain after a blunt trauma water sport accident. Upon selective angiography of left and right coronary artery and left heart catheterization, the patient was found to have an occluded distal left anterior descending artery (LAD). The patient underwent aspiration thrombectomy of the proximal LAD artery and percutaneous transluminal coronary angioplasty (PTCA) of distal LAD artery, which decreased the stenosis from 100% to less than 10%. The patient was discharged home on hospital day three with follow up in one month.Coronary artery dissection should be considered in blunt thoracic trauma particularly in cases of unexplained chest pain, regardless of the mechanism of injury, age of patient or comorbidities. Patients should be evaluated with an ECG, troponin, and possibly an echocardiogram to rule out this type of injury.
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Affiliation(s)
- Aaron J Blevins
- Wright State University Boonshoft School of Medicine, 3640 Colonel Glenn Hwy, Fairborn, OH 45324, USA
| | - Steven J Repas
- Wright State University Boonshoft School of Medicine, 3640 Colonel Glenn Hwy, Fairborn, OH 45324, USA
| | - Brittney M Alexander
- Acute Care, Trauma, and General Surgery, Kettering Medical Center, 3535 Southern Blvd, Dayton, OH 45429, USA
| | - Christa Siebenburgen
- Acute Care, Trauma, and General Surgery, Kettering Medical Center, 3535 Southern Blvd, Dayton, OH 45429, USA
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Lee TJ, Wan Rahimi WFB, Low MY, Nurruddin AA. Type E coronary artery dissection caused by intravascular lithotripsy balloon rupture; vessel anatomy and characteristics in a lithoplasty complication case as detailed by optical coherence tomography: a case report. Eur Heart J Case Rep 2021; 5:ytab432. [PMID: 34993399 PMCID: PMC8728719 DOI: 10.1093/ehjcr/ytab432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/11/2021] [Accepted: 10/20/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Intravascular lithotripsy is a new method used to treat calcified coronary lesions (CCLs). Percutaneous coronary intervention of CCLs has conventionally been classified as a complex procedure. In the majority of calcified cases, atherectomy is required for sufficient plaque modification prior to stent implantation. Intravascular lithotripsy has been shown to be safe and effective in clinical trials, but as worldwide usage increases, cases of complications are beginning to emerge. CASE SUMMARY We describe a 71-year-old woman, who after an episode of non-ST-elevation acute coronary syndrome underwent coronary angiography. The culprit vessel was identified to be a severely stenosed left anterior descending artery which was also heavily calcified and tortuous. Intravascular lithotripsy (IVL) was employed for calcium modification prior to stent implantation, but the IVL balloon ruptured during shockwave lithotripsy, resulting in coronary artery dissection. Subsequent management steps and stent deployment resulted in favourable angiographic results. Our findings are further detailed on optical coherence tomography, demonstrating certain features which might predispose to IVL balloon rupture. DISCUSSION We discuss the mechanism of action during intravascular lithotripsy, and how the shockwaves from the lithotripter modify calcified lesions, whilst keeping soft tissue unharmed. Results from clinical trials and multiple real-world studies have shown that complication rates are low. This case report aims to illustrate how the rupture of an intravascular lithotripsy balloon can result in coronary artery dissection. Optical coherence tomography can help in identifying potential anatomical features which may precede such complications.
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Affiliation(s)
- Tjen Jhung Lee
- Department of Cardiology, Institute Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Wan Faizal Bin Wan Rahimi
- Department of Cardiology, Institute Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Ming Yoong Low
- Department of Cardiology, Institute Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Amin Ariff Nurruddin
- Department of Cardiology, Institute Jantung Negara (National Heart Institute), 145, Jalan Tun Razak, 50400 Wilayah Persekutuan Kuala Lumpur, Malaysia
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Fogelson B, Tahir H, Livesay J, Baljepally R. Iatrogenic Arteriovenous Fistula Secondary to Coronary Artery Dissection Caused by Contrast Injection Into a Chronically Occluded Right Coronary Artery. J Med Cases 2021; 12:411-414. [PMID: 34691338 PMCID: PMC8510666 DOI: 10.14740/jmc3754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 11/21/2022] Open
Abstract
Coronary arteriovenous fistulas and coronary cameral fistulas are rare anomalies that involve the abnormal communication between a coronary artery and a venous structure, such as a coronary vein or a right-sided cardiac chamber. Iatrogenic coronary arteriovenous fistulas and coronary cameral fistulas can be uncommon complications of coronary artery angiography and intervention. Acquired coronary arteriovenous fistulas that develop during percutaneous coronary intervention of chronic total occlusions have been previously reported in the literature. However, a coronary arteriovenous fistula resulting from contrast injection into a chronically and totally occluded right coronary artery during diagnostic coronary angiography is very rare. We present a unique case of a contrast-induced iatrogenic right coronary dissection leading to a coronary arteriovenous fistula communicating to the right atrium through the middle cardiac vein.
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Affiliation(s)
- Benjamin Fogelson
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Hassan Tahir
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - James Livesay
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
| | - Raj Baljepally
- Department of Medicine, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA
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8
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Rahman N, Ullah I, Adnan G, Khan MA, Farhad A, Shah I, Abidi J. Clinical Outcomes and Prevalence of Intravascular Ultrasound Use at a Tertiary Care Hospital in a South Asian Country. J Clin Imaging Sci 2021; 11:42. [PMID: 34513206 PMCID: PMC8422435 DOI: 10.25259/jcis_93_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/16/2021] [Indexed: 11/04/2022] Open
Abstract
Objectives: Intravascular ultrasound (IVUS) plays a pivotal role in the current era of coronary interventions. We aimed to determine the prevalence of IVUS use and clinical outcomes of IVUS-guided percutaneous treatment of coronary arteries lesions in a South Asian country. Material and Methods: It is a retrospective observational study, a total of 134 consecutive patients having done IVUS, was enrolled from January 2013 to March 2020 at a single center. Results: Out of 134 patients, 97 (72.4%) were male with a mean age of 63.1 ± 12.9 years. The prevalence of IVUS in our center was 3.0%. The most frequent comorbidity observed was dyslipidemia, n = 111 (82.8%). Non-ST-elevation myocardial infarction, n = 50 (37.3%), was the common mode of presentation. On coronary angiogram, the left main (LM) disease was found in n = 46 (34.3%), however, single-vessel disease, n = 51 (38.1%), was most commonly noted. IVUS utilization was higher in the left anterior descending, n = 94 (70.1%), followed by LM, n = 46 (34.3%). The LM mean minimal luminal area was 6.0 ± 2.6 mm2 and minimal luminal diameter was 4.53 mm ± 0.6 (mean). The coronary artery dissection was noted in n = 15 (11.2%). The mean duration of follow-up in our study was 40.3 ± 30.1 months. Major adverse cardiac events (MACEs) were recorded in n = 13 (9.7%), which included heart failure, n = 4 (3%). Cardiovascular death and target vessel revascularization occurred in n = 3 (2.2%). Conclusion: IVUS results in a significant decrease in MACE. Our data might support the broader use of IVUS in both developed and in our part of the world.
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Affiliation(s)
- Nasir Rahman
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Ihsan Ullah
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Ghufran Adnan
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Maria Ali Khan
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Awais Farhad
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Izat Shah
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Jabir Abidi
- Department of Medicine, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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Abstract
Pregnancy-related acute myocardial infarction is a rare and potentially life-threatening cardiovascular event, the incidence of which is growing due to the heightened prevalence of several risk factors, including increased maternal age. Its main aetiology is spontaneous coronary artery dissection, which particularly occurs in pregnancy and may engender severe clinical scenarios. Therefore, despite frequently atypical and deceptive presentations, early recognition of such a dangerous complication of gestation is paramount. Notwithstanding diagnostic and therapeutic improvements, pregnancy-related acute myocardial infarction often carries unfavourable outcomes, as emergent management is difficult owing to significant limitations in the use of ionising radiation-e.g. during coronary angiography, potentially harmful to the foetus even at low doses. Notably, however, maternal mortality has steadily decreased in recent decades, indicating enhanced awareness and major medical advances in this field. In our paper, we review the recent literature on pregnancy-related acute myocardial infarction and highlight the key points in its management.
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Affiliation(s)
- Andrea Carlo Merlo
- Department of Internal Medicine and Medical Specialties (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Gian Marco Rosa
- Department of Internal Medicine and Medical Specialties (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy
- Cardiology Unit, DICATOV-Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine and Medical Specialties (DIMI), Chair of Cardiovascular Diseases, University of Genoa, Genoa, Italy.
- Cardiology Unit, DICATOV-Cardiothoracic and Vascular Department, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
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10
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Ogah OS, Osibowale BT, Adebayo O, Adeyanju AT, Okorie CE, Adeoye AM, Aje A, Adebiyi AA. Pregnancy-associated Acute Myocardial Infarction (PAMI): Case Report. West Afr J Med 2021; 38:596-598. [PMID: 34180213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cardiovascular diseases are recognised complications of pregnancy, however, pregnancy-associated acute myocardial infarction (PAMI) is uncommon. Pregnancy is known to increase risk of myocardial infarction even in the absence of traditional risk factors for atherosclerotic vascular disease. Our patient presented with acute chest pain two weeks after delivery and her electrocardiogram was in keeping with STelevation myocardial infarction (STEMI). Coronary angiography revealed coronary artery dissection and she was managed conservatively. Various pathophysiological mechanisms of PAMI have been described in literature including spontaneous coronary artery dissection (SCAD) found in our case. The diagnosis is often missed and earlier reported cases were diagnosed at autopsy. Therefore, we report this case as a learning tool. Also, there is a need for a high index of suspicion in pregnant patients presenting with features suggestive of aortic dissection, and its diagnosis should be thought of in peripartum women presenting with acute chest pain.
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Affiliation(s)
- O S Ogah
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - B T Osibowale
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - O Adebayo
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A T Adeyanju
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - C E Okorie
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A M Adeoye
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
| | - A Aje
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A A Adebiyi
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Oyo State, Nigeria
- Cardiology Unit, Department of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
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11
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Takago S, Iino K, Saito N, Ueda H, Yamamoto Y, Kimura K, Takemura H. Partial aortic root remodeling for chronic aortic dissection with coronary intimal tear. Gen Thorac Cardiovasc Surg 2020; 69:744-747. [PMID: 33125594 DOI: 10.1007/s11748-020-01532-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022]
Abstract
While there are many reports on partial aortic root remodeling, it is rarely performed for chronic aortic dissection of the coronary artery. This report presents a case of a 69-year-old man incidentally diagnosed with aortic dissection during routine checkup. He had a history of percutaneous coronary intervention from the left main trunk to the left anterior descending artery and left circumflex artery. Computed tomography revealed a chronic type A aortic dissection with an aneurysmal aortic root. The false lumen of the Valsalva sinus originated from the left anterior descending artery and expanded largely to the non-coronary Valsalva sinus. We performed partial aortic root remodeling, resecting the dissected non-coronary Valsalva sinus. The postoperative course was uneventful. Partial aortic root remodeling was effective, but its use might be controversial for chronic aortic dissection without resection of the primary entry of the left anterior descending artery. Moreover, close follow-up is required.
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Affiliation(s)
- Shintaro Takago
- Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Kenji Iino
- Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Naoki Saito
- Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hideyasu Ueda
- Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Yoshitaka Yamamoto
- Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Keiichi Kimura
- Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hirofumi Takemura
- Department of Cardiovascular Surgery, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa, 920-8641, Japan
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12
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Fitzpatrick JJ, Noman A, Ryan N, Dawson DK. Recurrent spontaneous coronary artery dissection in a middle-aged male athlete patient: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974485 PMCID: PMC7501942 DOI: 10.1093/ehjcr/ytaa231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/20/2019] [Accepted: 06/30/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is a rare condition, mainly affecting young women. Cases in male patients are rare, especially with recurrence. CASE SUMMARY A 59-year-old male non-elite athlete presented as an ST-elevation myocardial infarction following a 5-km run. Urgent coronary angiogram was normal, but cardiac magnetic resonance showed a myocardial infarction. Four years later, he experienced similar chest pain with no ST-elevation on electrocardiogram and a mild troponin rise. Urgent coronary angiogram was initially thought normal but subsequent close inspection confirmed a Type 2b SCAD. Cardiac magnetic resonance showed a small additional myocardial infarction contained within an area of acute myocardial oedema. DISCUSSION Spontaneous coronary artery dissection is more common in young women compared to men and recurrent dissection has been rarely reported in the literature. Cohort studies have shown the rate of recurrent dissection to be 13-16%, but most of the patients in these cohorts are female. Poor data exists on the best treatment of SCAD in men, but given the presence of intramural thrombus, dual antiplatelet therapy was discontinued on the presumption that it may exacerbate an intramural bleeding process.
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Affiliation(s)
- John J Fitzpatrick
- Department of Radiology, NHS Grampian, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - Awsan Noman
- Department of Cardiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - Nicola Ryan
- Department of Cardiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - Dana K Dawson
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZN, UK
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13
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Albiero R, Seresini G. Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms. Eur Heart J Case Rep 2020; 4:1-6. [PMID: 33089040 PMCID: PMC7239234 DOI: 10.1093/ehjcr/ytaa133] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/22/2020] [Accepted: 04/28/2020] [Indexed: 11/16/2022]
Abstract
Background Spontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term ‘SCAD’ is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient. Case summary In this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2. Discussion A higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with ‘thrombolysis first’ for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD.
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Affiliation(s)
- Remo Albiero
- Interventional Cardiology Unit, Cardiovascular Department, Sondrio Hospital, Sondrio (SO), Italy
| | - Giuseppe Seresini
- Interventional Cardiology Unit, Cardiovascular Department, Sondrio Hospital, Sondrio (SO), Italy
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14
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Cattaneo MM, Moccetti M, Cattaneo M, Sürder D, Suter T, Martinelli M, Roost E, Schmidli J, Banz Y, Schneiders C, Pedrazzini G, Corti R, Räber L, Crea F, Mohacsi P, Gallino A. Intractable coronary fibromuscular dysplasia leading to end-stage heart failure and fatal heart transplantation. ESC Heart Fail 2020; 7:714-720. [PMID: 31994838 PMCID: PMC7160508 DOI: 10.1002/ehf2.12626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/22/2019] [Accepted: 01/03/2020] [Indexed: 11/26/2022] Open
Abstract
Coronary fibromuscular dysplasia is uncommon, and even rarer its unstable and recurrent course. We present the unique case of a 52‐year‐old woman who underwent in total 12 coronary angiographies and three percutaneous coronary intervention within 24 months because of repetitive acute coronary syndromes due to refractory spasm, dissection, restenosis all leading to end‐stage heart failure, and heart transplantation. The patient died 12 days after the heart transplantation complicated by intraoperative acute thrombotic occlusion of left anterior descending artery of the graft despite normal pretransplant coronary angiography. Autopsy of the recipient heart confirmed coronary fibromuscular dysplasia with massive intimal hyperplasia and restenosis.
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Affiliation(s)
- Magdalena Maria Cattaneo
- Cardiovascular Research, Hospital of San Giovanni, Bellinzona, 6500, Switzerland.,Internal Medicine, Hospital of San Giovanni, Bellinzona, 6500, Switzerland
| | | | - Mattia Cattaneo
- Cardiovascular Research, Hospital of San Giovanni, Bellinzona, 6500, Switzerland.,Cardiocentro Ticino, Lugano, 6900, Switzerland
| | | | - Thomas Suter
- Cardiology, University Hospital Inselspital, Bern, 3010, Switzerland
| | | | - Eva Roost
- Cardiovascular Surgery, University Hospital Inselspital, Bern, 3010, Switzerland
| | - Jürg Schmidli
- Cardiovascular Surgery, University Hospital Inselspital, Bern, 3010, Switzerland
| | - Yara Banz
- Pathology, University of Bern, Bern, 3008, Switzerland
| | | | | | | | - Lorenz Räber
- Cardiology, University Hospital Inselspital, Bern, 3010, Switzerland
| | - Filippo Crea
- Cardiology, Catholic University, Rome, 00168, Italy
| | - Paul Mohacsi
- Cardiology, University Hospital Inselspital, Bern, 3010, Switzerland
| | - Augusto Gallino
- Cardiovascular Research, Hospital of San Giovanni, Bellinzona, 6500, Switzerland.,University of Zurich, Zurich, 8006, Switzerland
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15
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Doberentz E, Wegner A, Geile J, Madea B. Natural cardiac death after stent implantation with iatrogenic injury of a coronary artery. Forensic Sci Med Pathol 2019; 16:366-369. [PMID: 31713779 DOI: 10.1007/s12024-019-00195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 11/27/2022]
Abstract
In forensic practice, autopsies are regularly carried out in cases of suspected medical malpractice to determine whether a treatment resulted in death. Intraoperative deaths, as well as deaths shortly after an operation, can be particularly suspicious as iatrogenic. We report a case of a 75-year-old woman with a complaint of intermittent angina pectoris who underwent cardiac catheterization. Intra-interventionally, coronary artery dissection occurred and was stabilized by the placement of two stents. After this procedure, the patient suffered from chest pain. At 5.5 h after the procedure ended, the woman suddenly and unexpectedly died. At forensic autopsy, a hemopericardium with cardiac tamponade was found to have been caused by the rupture of a myocardial infarction that was several days old and had remained clinically unrecognized. This case report illustrates the importance of forensic autopsies in terms of external quality assurance in medicine.
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Affiliation(s)
- Elke Doberentz
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
| | - Anja Wegner
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany
| | - Julian Geile
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany
| | - Burkhard Madea
- Institute of Legal Medicine, University of Bonn, Stiftsplatz 12, 53111, Bonn, Germany
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16
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Buja LM, Zehr B, Lelenwa L, Ogechukwu E, Zhao B, Dasgupta A, Barth RF. Clinicopathological complexity in the application of the universal definition of myocardial infarction. Cardiovasc Pathol 2019; 44:107153. [PMID: 31760238 DOI: 10.1016/j.carpath.2019.107153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 08/28/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
A universal definition of myocardial infarction (UDMI) has been established, periodically updated, and refined over the past twenty years. The primary purpose of the UDMI is to bring uniformity and accuracy to clinical diagnosis. Herein, a review and analysis of the UDMI is presented with emphasis on clinicopathological correlation. Determination of the presence of myocardial injury is based on the detection of abnormal serum cardiac biomarkers, particularly cardiac troponin (cTn), and in the current fourth iteration of the UDMI, high sensitivity (hs)-cTn. Differentiation of myocardial infarction from other causes of myocardial injury requires the documentation of clinical evidence of myocardial ischemia. In this review, difficulties in applying the UDMI in actual practice are discussed, based on the experience and perspective of those of us who face these problems as part of our own practice of pathology. The complexity in application of the UDMI is highlighted by the presentation of five illustrative cases involving the differential diagnosis of myocardial injury and myocardial infarction due to atherothrombotic and nonatherothrombotic coronary artery disease. The cases include myocardial infarction due to severe coronary atherosclerosis, supply-demand mismatch, coronary artery dissection associated with an eosinophilic coronary periarteritis, and coronary thromboembolism, and a case with a differential diagnosis of myocarditis and myocardial infarction. These cases illustrate how pathological findings can contribute to more accurate application of the UDMI and how, when critically applied, the UDMI can be used to better characterize myocardial infarcts in clinical practice.
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Affiliation(s)
- Louis Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States.
| | - Bradley Zehr
- Department of Pathology, The Ohio State University (OSU), United States
| | - Laura Lelenwa
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States
| | - Eze Ogechukwu
- Department of Pathology, The Ohio State University (OSU), United States
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UT Health), United States
| | - Rolf F Barth
- Department of Pathology, The Ohio State University (OSU), United States
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17
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Zhang D, Shi J, Hou J, Guo Y. Successful recognition and percutaneous coronary intervention of delayed severe multiple coronary artery dissection caused by cardiac surgery: a case report. BMC Surg 2019; 19:118. [PMID: 31443701 PMCID: PMC6708194 DOI: 10.1186/s12893-019-0579-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 08/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multiple coronary artery dissection is rare after cardiac surgery. It is difficult to recognize and is easily misdiagnosed as low output syndrome as a result of cardiopulmonary bypass (CPB). CASE PRESENTATION A 43-year-old woman who had undergone cardiac surgery presented with unstable hemodynamics, and progressively increasing lactate, B-type natriuretic peptide, and cardiac enzyme levels, along with electrocardiogram (ECG) changes. Angiography indicated the presence of severe multiple coronary artery dissection, and 3 stents were implanted, which improved the patient's hemodynamic status and cardiac function. CONCLUSIONS In the present report, we describe our experience with identifying and treating delayed severe multiple coronary artery dissection caused by cardiac surgery. Timely angiography is vital in patients suspected with coronary artery dissection, and percutaneous coronary intervention (PCI) should be considered as a treatment strategy for cases with severe multiple coronary artery dissection and unstable hemodynamics after cardiac surgery.
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Affiliation(s)
- Dengshen Zhang
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jun Shi
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, Sichuan, 610041, People's Republic of China
| | - Jianglong Hou
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, Sichuan, 610041, People's Republic of China.
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital of Sichuan University, No.37 Guo Xue Alley, Chengdu, Sichuan, 610041, People's Republic of China
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18
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Meng PN, Wu Q, Xia Y, Yin DL, You W, Wu ZM, Xu C, Chen KL, Gu J, Xie DJ, Ye F. [Characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection in young female patients]. Zhonghua Xin Xue Guan Bing Za Zhi 2019; 46:536-542. [PMID: 30032544 DOI: 10.3760/cma.j.issn.0253-3758.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the characteristics of acute myocardial infarction caused by spontaneous coronary artery dissection(SCAD) in young female patients. Methods: In this casecontrolstudy,127 young(≤55 years) female patients with acute myocardial infarction onset within 1 week in Nanjing first hospital, Xuzhou central hospital, affiliated hospital of Xuzhou medical university, and Lianyungang first people's hospital were enrolled between January 2013 and February 2017,and the clinical data were retrospectively analyzed. According to their clinical manifestations and coronary angiography(CAG) results,the patients were divided into coronary atherosclerosis disease(CAD) group(CAG evidenced atherosclerosis, n=83) and SCAD group(CAG detected coronary artery dissection,n=44).The SCAD patients were subdivided into definite group (the results affirmed from intravenous ultrasound or optical coherence tomography, n=21) and probable group (the CAG results highly confirmed to characteristics of SCAD,but no intravenous ultrasound or optical coherence tomography image affirmation,n=23). Then, according to the different treatment strategies, the SCAD patients were subdivided into conservative treatment group(treated with drugs,n=19) and interventional therapy group(treated with percutaneous coronary intervention,n=25). Results: (1)Compared to CAD group, patients in the SCAD group had less risk factors, such as hypertension history (25.0% (11/44) vs. 45.8% (38/83) , P=0.022) and diabetes history (6.8% (3/44) vs. 21.7% (18/83) , P=0.043),and had lower levels of fasting blood glucose (5.34(4.59,5.87) mmol/L vs. 7.12(5.18,8.60)mmol/L, P=0.001),total cholesterol((3.94±1.14) mmol/L vs. (4.91±1.50) mmol/L, P=0.001),triglyceride(1.42 (0.91,1.64) mmol/L vs. 1.89 (1.23,2.45) mmol/L, P=0.005),and low density lipoprotein cholesterol ((2.24±0.91) mmol/L vs. (2.94±1.16) mmol/L, P=0.001),CAG results showed that patients in the SCAD group had more single vessel lesion (88.6% (39/44) vs. 39.8% (33/83) , P=0.001), and their target lesion stenosis was less severe ( (79.2±22.4) % vs. (91.5±12.1) %, P=0.001). (2) The clinical risk factors such as hypertension history, diabetes history, smoking history, family history of cardiology disease, fasting blood glucose,total cholesterol,triglyceride and low density lipoprotein cholesterol were similar between definite group and probable group (all P>0.05). CAG results showed that prevalence of single vessel lesion (100% (21/21) vs. 78.3% (18/23) , P=0.050) and percent of target lesion stenosis ( (76.9±20.6) % vs. (81.2±24.1) %, P=0.529) were similar between definite group and probable group.(3)There were no significant difference in single vessel(84.0% (21/25) vs. 94.7% (18/19) , P=0.370), target lesion stenosis(85.0(70.0,100.0)% vs. 75.0(50.0,90.0)%, P=0.186),and survival rates in hospital(96.0% (24/25) vs. 100% (19/19) , P=1.000) between interventional therapy group and conservative treatment group. Conclusions: Prevalence of SCAD is highin young female patients with acute myocardial infarction. Acute myocardial infarction patients with less risk factors of CAD and with CAG showing smooth lesion of narrowing segment and normal finding in the other vessels, are more likely to be diagnosed with SCAD.Acute myocardial infarction patients caused by SCAD have high survival rate either receiving percutaneous coronary intervention or drug treatment.
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Affiliation(s)
- P N Meng
- Department of Cardiology, Nanjing Hospital, Nanjing First Medical University, Nanjing 210006, China
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19
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Ezad S, Williams TD, Condon J, Boyle AJ, Collins NJ. Common themes in patients requiring urgent cardiothoracic surgery after percutaneous coronary interventions: Case series and review of the literature. Cardiovasc Revasc Med 2018; 19:976-979. [PMID: 29691185 DOI: 10.1016/j.carrev.2018.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
Urgent cardiothoracic surgical intervention for the management of complications of percutaneous coronary intervention is uncommon in the stent era. Nonetheless, given increasing procedural complexity, in part reflecting an aging population, an ongoing hazard for urgent surgery remains. We sought to review the incidence and outcome of urgent cardiothoracic surgery in patients undergoing PCI in a contemporary cohort at a tertiary referral centre. The incidence of cardiothoracic intervention for PCI related complications was low at 0.1% over a ten-year period, with iatrogenic coronary artery and aortic root dissection unable to successfully managed percutaneously recurrent precipitants for surgical involvement. Procedural features associated with the need for urgent surgery are noted and methods to overcome such complications discussed.
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Affiliation(s)
- Saad Ezad
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Trent D Williams
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Jeremy Condon
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
| | - Andrew J Boyle
- Cardiovascular Department, John Hunter Hospital, Newcastle, Australia
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20
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Ishtiaq R, Saddique A, Akram A, Arif M, Muhammad F, Chaudhry UH. Spontaneous Right Coronary Artery Dissection In A Normotensive Post-Partum Female. J Ayub Med Coll Abbottabad 2018; 30:280-283. [PMID: 29938435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Acute myocardial infarction following coronary artery dissection during the post-partum period is a rare entity. Greater hemodynamic stress and hormonal changes increase the risk of developing a coronary artery dissection post-partum. Herein, we report the first case of a normotensive patient from Pakistan that presented with inferior wall myocardial infarction following 10-days postpartum due to right coronary artery dissection. This article highlights the importance of prompt diagnosis and subsequent life-saving treatment.
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Affiliation(s)
| | | | - Ali Akram
- District Teaching Hospital, Sargodha, Pakistan
| | - Mariam Arif
- District Teaching Hospital, Sargodha, Pakistan
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21
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Ihdayhid AR, Brown AJ, McGaw D, Ko B. Threading the Eye of the Needle: A Challenging Case of Iatrogenic Spiral Coronary Artery Dissection. Heart Lung Circ 2018; 27:e73-e77. [PMID: 29475592 DOI: 10.1016/j.hlc.2018.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/13/2018] [Indexed: 11/25/2022]
Abstract
Catheter induced coronary dissection is an uncommon but potentially catastrophic complication of coronary angiography. We report a case of a 48-year-old female with normal coronary arteries on angiography complicated by extensive catheter induced spiral dissection. Wiring into the true lumen was a formidable challenge as a consequence of the large false lumen obliterating the true lumen. We present management strategies and in particular, highlight the important role of intravascular ultrasound (IVUS) imaging.
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Affiliation(s)
- Abdul Rahman Ihdayhid
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Vic, Australia
| | - Adam J Brown
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Vic, Australia
| | - David McGaw
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Vic, Australia
| | - Brian Ko
- Monash Cardiovascular Research Centre, Monash University and MonashHeart, Monash Health, Clayton, Vic, Australia.
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22
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Haraguchi Y, Sakakura K, Yamamoto K, Taniguchi Y, Nakashima I, Wada H, Sanui M, Momomura SI, Fujita H. Spontaneous Recanalization of the Obstructed Right Coronary Artery Caused by Blunt Chest Trauma. Int Heart J 2018; 59:407-412. [PMID: 29479014 DOI: 10.1536/ihj.17-173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Blunt chest trauma can cause a wide variety of injuries including acute myocardial infarction (AMI). Although AMI due to coronary artery dissection caused by blunt chest trauma is very rare, it is associated with high morbidity and mortality. In the vast majority of patients with AMI, primary percutaneous coronary interventions (PCI) are performed to recanalize obstructed arteries, but PCI carries a substantial risk of hemorrhagic complications in the acute phase of trauma. We report a case of AMI due to right coronary artery (RCA) dissection caused by blunt chest trauma. The totally obstructed RCA was spontaneously recanalized with medical therapy. We could avoid primary PCI in the acute phase of blunt chest trauma because electrocardiogram showed early reperfusion signs. We performed an elective PCI in the subacute phase when the risk of bleeding subsided. Since the risk of severe hemorrhagic complications is greater in the acute phase of blunt chest trauma as compared with the late phase, deferring emergency PCI is reasonable if signs of recanalization are observed.
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Affiliation(s)
- Yumiko Haraguchi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Ikue Nakashima
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masamitsu Sanui
- Department of Anesthesiology and Critical Care Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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23
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Abstract
CASE PRESENTATION A 68-year-old female presented with non-ST-segment elevation myocardial infarction, and urgency coronary angiography was performed. The procedure was complicated with right coronary artery dissection leading to type-1 Brugada ECG pattern. DISCUSSION Brugada phenocopies (BrP) are clinical entities that present with electrocardiograms identical to those found in Brugada Syndrome (BrS) but are the result of different medical conditions. This report provides evidence that atypical causes of myocardial ischemia may induce BrP. Appropriate electrocardiogram and clinical differentiation of Brugada phenocopy from true Brugada syndrome may prevent unnecessary treatments. Although patients with true high-risk BrS are candidates for ICD therapy, the natural history of BrP remains unknown and seems to be more benign, depending on the severity of the underlying condition.
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Affiliation(s)
- Aldo G Carrizo
- Cardiology Division, McMaster University, Hamilton, Ontario, Canada.
| | - Anahi Goransky
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Adrian Baranchuk
- Cardiology Division, Queen's University, Kingston, Ontario, Canada
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24
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Wilczynska-Golonka M, Rostoff P, Siniarski A, Skrzypek A, Gackowski A, Konduracka E, Nessler J. Trauma-induced acute myocardial infarction due to delayed dissection of the left anterior descending coronary artery. Am J Emerg Med 2017; 35:939.e1-939.e2. [PMID: 28041756 DOI: 10.1016/j.ajem.2016.12.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 11/17/2022] Open
Abstract
Acute myocardial infarction is a very rare, life-threatening complication of blunt chest trauma. A 27-year-old man with no previous medical history was admitted to the emergency department due to multiple trauma following a car accident. After 48h following the accident, the patient's condition rapidly deteriorated, with severe dyspnea at rest, tachycardia, and increasing chest pain. A 12-lead ECG showed a sinus tachycardia at 120bpm with significant ST-segment elevation in leads V1 to V5, pathologic Q wave in I, aVL, and QS complex in leads V1 to V4. Bedside echocardiography disclosed akinesis of the anterior and lateral walls, apex, and anterior septum with severely decreased left ventricular ejection fraction of 30%. Urgent coronary angiography revealed an occlusive dissection of the proximal left anterior descending coronary artery. Primary percutaneous coronary intervention with a Biolimus A9™-eluting stent implantation were successfully performed. The further course was uneventful. At 12-month follow-up, the patient has remained asymptomatic with no recurrence of cardiovascular symptoms.
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Affiliation(s)
- Magdalena Wilczynska-Golonka
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Pawel Rostoff
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland.
| | - Aleksander Siniarski
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Agnieszka Skrzypek
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Andrzej Gackowski
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Ewa Konduracka
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
| | - Jadwiga Nessler
- Department of Coronary Disease and Heart Failure, Faculty of Medicine, Jagiellonian University Medical College, The John Paul II Hospital, Krakow, Poland
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Roukas KI, Lampropoulos K, Salachas A. Coronary artery dissection after the use of the thrombus aspiration catheter in anterior ST-elevation myocardial infarction. Indian Heart J 2016; 68 Suppl 2:S77-S78. [PMID: 27751335 PMCID: PMC5067764 DOI: 10.1016/j.ihj.2016.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 01/19/2016] [Accepted: 01/27/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kriton-Ioannis Roukas
- Department of Cardiology, Catheterization Laboratory, Evaggelismos General Hospital of Athens, Greece
| | - Konstantinos Lampropoulos
- Department of Cardiology, Catheterization Laboratory, Evaggelismos General Hospital of Athens, Greece.
| | - Anastasios Salachas
- Department of Cardiology, Catheterization Laboratory, Evaggelismos General Hospital of Athens, Greece
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26
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Jorge-Pérez P, García-González MJ, Ávalos-Pinto RM, G-Cosio-Carmena MD, Renes-Carreño E, Delgado JF, Yanes-Bowden G, Ferrer-Hita JJ. Spontaneous coronary dissection and cardiogenic shock requiring mechanical circulatory support in a non-transplant center. Int J Cardiol 2016; 221:629-30. [PMID: 27420590 DOI: 10.1016/j.ijcard.2016.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/04/2016] [Indexed: 11/22/2022]
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Spence S, Sud M, Bajaj R, Zavodni A, Sandhu S, Madan M. Postpartum spontaneous coronary, vertebral, and mesenteric artery dissections: a case report. J Med Case Rep 2016; 10:153. [PMID: 27268217 PMCID: PMC4897916 DOI: 10.1186/s13256-016-0937-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spontaneous coronary artery dissection is a rare cause of myocardial infarction that must always be considered on a clinician's differential diagnosis, particularly in patients <50-years old with a paucity of typical vascular risk factors. CASE PRESENTATION We describe a case of a 33-year-old white woman, 3 weeks postpartum, presenting with retrosternal chest and back pain, neck pain and stiffness, and intermittent headaches. Subsequent workup revealed concurrent spontaneous dissections in three separate medium-sized arterial beds. CONCLUSIONS She was successfully managed in a conservative fashion, highlighting that percutaneous or surgical revascularization can often be foregone in favor of conservative medical therapy.
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Affiliation(s)
- Sean Spence
- Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room D3 80, Toronto, Ontario, M4N 3M5, Canada
| | - Maneesh Sud
- Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room D3 80, Toronto, Ontario, M4N 3M5, Canada
| | - Ravi Bajaj
- Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room D3 80, Toronto, Ontario, M4N 3M5, Canada
| | - Anna Zavodni
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room D3 80, Toronto, Ontario, M4N 3M5, Canada
| | - Sharron Sandhu
- Division of Rheumatology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room D3 80, Toronto, Ontario, M4N 3M5, Canada
| | - Mina Madan
- Division of Cardiology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada. .,Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room D3 80, Toronto, Ontario, M4N 3M5, Canada.
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28
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Magarkar V, Lathi P. A case of spontaneous coronary artery dissection in early pregnancy managed by PCI. Indian Heart J 2016; 68 Suppl 2:S25-S27. [PMID: 27751306 PMCID: PMC5067731 DOI: 10.1016/j.ihj.2016.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 11/05/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome in pregnant and peripartum women. This report presents a rare case of spontaneous coronary artery dissection in early pregnancy managed by coronary angioplasty and, combined obstetric and cardiac care, resulting in the delivery of a normal infant through cesarean section.
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Affiliation(s)
- Vilas Magarkar
- Department of Cardiology, Seth Nandalal Dhoot Hospital, Aurangabad, India.
| | - Pravir Lathi
- Department of Cardiology, Seth Nandalal Dhoot Hospital, Aurangabad, India
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29
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Piraino D, Cortese B, Buccheri D, Dendramis G, Andolina G. Healing after coronary artery dissection: The effect of a drug coated balloon angioplasty in a bifurcation lesion. A lesson from intravascular ultrasound analysis. Int J Cardiol 2016; 203:298-300. [PMID: 26520278 DOI: 10.1016/j.ijcard.2015.10.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 11/21/2022]
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30
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Sharma S, Raut N, Potdar A. Spontaneous coronary artery dissection: Case series and review of literature. Indian Heart J 2016; 68:480-5. [PMID: 27543469 PMCID: PMC4990736 DOI: 10.1016/j.ihj.2015.11.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022] Open
Abstract
AIM Spontaneous coronary artery dissection (SCAD) is a less recognized cause of ST elevation myocardial infarction (STEMI) in clinical practice. The aim of this communication is to describe a case series in South Asian population and highlight on the long-term clinical outcomes on conservative management. METHODS A retrospective analysis of data of five patients (6 instances) of SCAD managed in a tertiary care center during January 1994 to June 2015 was done. Clinical, angiographic, therapeutic, and follow-up data till end of June 2015 are analyzed. RESULTS All patients were young (mean - 33 years) and predominantly male. Etiology of SCAD was diverse and included peripartum state, vigorous activity and atherosclerosis. Left anterior descending (LAD) coronary artery was predominantly involved and the majority had angiographic type 1 SCAD. Medical treatment provides excellent long-term benefits. Coronary stenting provided symptomatic benefit in a patient with favorable anatomy. CONCLUSIONS Clinical recognition of SCAD is difficult. It should be suspected in peripartum state, young females and in presence of other precipitating factors. Coronary angiography is essential for establishing the diagnosis. Medical treatment provides favorable long-term survival. IMPLICATIONS AND PRACTICE The awareness of SCAD is important for all clinicians involved in STEMI care. A prompt suspicion can avoid administration of thrombolytic therapy. Early coronary angiography will provide an accurate diagnosis and help in deciding appropriate therapy. Percutaneous intervention can be challenging.
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Affiliation(s)
- Satyavan Sharma
- Professor and Head of Cardiology and Interventional Cardiologist, Department of Cardiology, Bombay Hospital and Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Nikhil Raut
- Senior Registrar, Department of Cardiology, Bombay Hospital and Bombay Hospital Institute of Medical Sciences, Mumbai, India.
| | - Anil Potdar
- Honorary Cardiologist, Department of Cardiology, Bombay Hospital and Bombay Hospital Institute of Medical Sciences, Mumbai, India
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31
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Tatekoshi Y, Yuda S, Ogasawara M, Muranaka A, Kokubu N, Hase M, Tachibana K, Tsuchihashi K, Higami T, Miura T. Successful diagnosis of pericardial rupture caused by blunt chest trauma using contrast ultrasonography. J Med Ultrason (2001) 2015; 43:95-8. [PMID: 26703173 DOI: 10.1007/s10396-015-0663-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 07/09/2015] [Indexed: 10/23/2022]
Abstract
A 65-year-old male developed acute myocardial infarction due to coronary artery dissection and tricuspid valve injury after blunt chest trauma. Acute myocardial infarction was treated by coronary artery intervention; however, refractory heart failure with pleural effusion remained. The first transthoracic echocardiography (TTE) on admission failed to clearly visualize the tricuspid valve and right ventricle due to poor image quality. A follow-up TTE with contrast ultrasonography revealed pericardial rupture in addition to tricuspid regurgitation. Ruptures of the tricuspid papillary muscle and pericardium were confirmed during surgery and were repaired successfully. Blunt chest trauma results in various cardiac injuries including cardiac rupture, intramural hematoma, valvular injury, coronary artery injury, and electrical disturbances, leading to critical conditions and high mortality. Of such blunt trauma-induced injuries, coronary artery dissection, tricuspid valve injury, and pericardial rupture caused by blunt chest trauma are rare, and simultaneous occurrence of the three types of injuries that were successfully repaired has not been reported. In addition, this case indicates the utility of contrast ultrasonography for diagnosis of pericardial rupture caused by blunt chest trauma.
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Affiliation(s)
- Yuki Tatekoshi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan.
| | - Satoshi Yuda
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan.,Department of Infection Control and Clinical Laboratory Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Makoto Ogasawara
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan
| | - Mamoru Hase
- Department of Emergency Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazutoshi Tachibana
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kazufumi Tsuchihashi
- Division of Health Care Administration and Management, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Higami
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-0061, Japan
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Inokuchi G, Makino Y, Motomura A, Chiba F, Torimitsu S, Hoshioka Y, Iwase H. Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography. Int J Legal Med 2016; 130:759-63. [PMID: 26126482 DOI: 10.1007/s00414-015-1215-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 06/11/2015] [Indexed: 10/23/2022]
Abstract
Coronary artery injury is a rare complication following blunt chest trauma (BCT), and can be fatal. Here we report findings on postmortem selective coronary angiography of right coronary artery rupture after an assault involving blunt trauma to the chest. A woman in her 60s died after her son stomped on her chest. There were no appreciable signs of injury on external examination, and cause of death could not be determined by postmortem computed tomography (PMCT). Internal findings indicated that an external force had been applied to the anterior chest, as evidenced by subcutaneous hemorrhage and pericardial and cardiac contusions. Postmortem coronary angiography revealed irregularity of the intima and of the fat tissue surrounding the proximal part of the right coronary artery associated with a local filling defect. Histopathological examination suggested coronary rupture with dissection of the tunica media and compression of the lumen cavity. The key points in the present case are that no fatal injuries could be determined on external examination, and the heart and coronary artery injuries were not evident on PMCT. Criminality might be overlooked in such cases, as external investigation at the crime scene would be inadequate and could result in a facile diagnosis of cause of death. This is the first report of coronary artery rupture with dissection that was detected by CT coronary angiography, and provides helpful findings for reaching an appropriate decision both forensically and clinically.
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33
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Makino Y, Inokuchi G, Yokota H, Hayakawa M, Yajima D, Motomura A, Chiba F, Torimitsu S, Nakatani Y, Iwase H. Sudden death due to coronary artery dissection associated with fibromuscular dysplasia revealed by postmortem selective computed tomography coronary angiography: A case report. Forensic Sci Int 2015; 253:e10-5. [PMID: 26048864 DOI: 10.1016/j.forsciint.2015.05.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 05/13/2015] [Accepted: 05/14/2015] [Indexed: 11/29/2022]
Abstract
We present an autopsy case of sudden death due to coronary artery dissection associated with fibromuscular dysplasia (FMD) in a young female patient. Postmortem selective coronary artery computed tomography (CT) angiography revealed dissections of the left anterior descending and left circumflex arteries. These findings were confirmed by subsequent autopsy. Histopathological examination revealed coronary artery FMD, which is considered a risk factor for dissection. To the best of our knowledge, this is the first postmortem radiology-pathology correlation of coronary artery dissection associated with FMD.
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Affiliation(s)
- Yohsuke Makino
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Hajime Yokota
- Department of Radiology, Chiba University Hospital, Inohana 1-8-1, Chuo-ku 260-8677, Chiba, Japan.
| | - Mutsumi Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Fumiko Chiba
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Yukio Nakatani
- Department of Diagnostic Pathology, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
| | - Hirotaro Iwase
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku 113-0033, Tokyo, Japan; Department of Legal Medicine, Graduate School of Medicine, Chiba University, Inohana 1-8-1, Chuo-ku 260-8670, Chiba, Japan.
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Noel A, Castellant P, Gilard M, Mansourati J. Acute myocardial infarction due to left anterior descending coronary artery dissection after rubber bullet shooting. Int J Cardiol 2015; 184:653-654. [PMID: 25771231 DOI: 10.1016/j.ijcard.2015.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Antoine Noel
- Department of Cardiology, CHU Brest, Hôpital La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France.
| | - Philippe Castellant
- Department of Cardiology, CHU Brest, Hôpital La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France.
| | - Martine Gilard
- Department of Cardiology, CHU Brest, Hôpital La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France.
| | - Jacques Mansourati
- Department of Cardiology, CHU Brest, Hôpital La Cavale Blanche, Boulevard Tanguy Prigent, 29609 Brest Cedex, France.
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35
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Aksakal A, Arslan U, Yaman M, Urumdaş M, Ateş AH. Spontaneous coronary artery dissection as a cause of myocardial infarction. World J Cardiol 2014; 6:1290-1292. [PMID: 25548620 PMCID: PMC4278165 DOI: 10.4330/wjc.v6.i12.1290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/15/2014] [Accepted: 11/10/2014] [Indexed: 02/06/2023] Open
Abstract
Spontaneous coronary artery dissection (SCAD) is a rare disease that is usually seen in young women in left descending coronary artery and result in events like sudden cardiac death and acute myocardial infarction. A 70-year-old man was admitted to the emergency department with chest pain which started 1 h ago during a relative’s funeral. The initial electrocardiography demonstrated 2 mm ST-segment depression in leads V1-V3 and the patient underwent emergent coronary angiography. SCAD simultaneously in two different coronary arteries [left anterior descending (LAD) artery and left circumflex (LCx)] artery was detected and SCAD in LCx artery was causing total occlusion which resulted in acute myocardial infarction. Successful stenting was performed thereafter for both lesions. In addition to the existence of SCAD simultaneously in two different coronary arteries, the presence of muscular bridge and SCAD together at the same site of the LAD artery was another interesting point which made us report this case.
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36
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Nizamuddin SL, Broderick DK, Minehart RD, Kamdar BB. Spontaneous coronary artery dissection in a parturient with Nail-Patella syndrome. Int J Obstet Anesth 2015; 24:69-73. [PMID: 25433575 DOI: 10.1016/j.ijoa.2014.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/21/2014] [Accepted: 07/22/2014] [Indexed: 01/25/2023]
Abstract
Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndrome, occurring predominantly in women during and immediately after pregnancy; it carries a mortality rate of greater than 50%. While the exact etiology is unknown, possible contributing factors include pregnancy-related hormonal, connective tissue and hemodynamic changes. We present a case of a 35-year-old multigravid woman with Nail-Patella syndrome who developed an acute myocardial infarction secondary to spontaneous coronary artery dissection during labor which was not diagnosed until after delivery. We hypothesize that abnormal collagen fiber formation found in Nail-Patella syndrome may have put her at an increased risk of coronary dissection and myocardial infarction. Regardless of etiology, a delay in diagnosis of myocardial ischemia can lead to significant morbidity and mortality. In light of the increasing burden of cardiac disease in the obstetric population, clinicians should remain vigilant for signs of myocardial infarction and prepare for definitive diagnosis and treatment.
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Fu ZL, Yao HC. Percutaneous coronary intervention for acute myocardial infarction following blunt chest trauma. Int J Cardiol 2013; 168:2983-4. [PMID: 23642814 DOI: 10.1016/j.ijcard.2013.04.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/04/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Zuo-Lin Fu
- Department of Cardiology, Liao Cheng Hospital, Liao Cheng, Shan Dong Province, China.
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Arora S, Atreya AR, Penumetsa SC, Hiser WL. Cardio-embolic stroke following remote blunt chest trauma. J Cardiovasc Dis Res 2013; 4:61-4. [PMID: 24023477 DOI: 10.1016/j.jcdr.2013.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2012] [Accepted: 10/07/2012] [Indexed: 10/26/2022] Open
Abstract
A cardio-embolic stroke as a sequela of remote blunt chest trauma is a rare clinical presentation. Blunt chest trauma can cause various acute cardiac complications like arrhythmias, cardiac contusion etc. However, delayed consequences such as left ventricular thrombus resulting in thromboembolic phenomena are reported infrequently. A 30-year-old healthy man presented to an outside facility with transient neurological deficits. An MRI brain showed lesions suggestive of embolic etiology. A trans-thoracic echocardiogram (TTE) showed a 1.5 × 1.5 cm mass present in the left ventricular (LV) apex. Patient was transferred to our institution for cardiac surgery evaluation. On detailed questioning, he reported an incident of blunt chest trauma during a martial arts exhibition fight that took place 2 years back. Given this history, a cardiac catheterization was done, which showed 30% stenosis in mid-left anterior descending artery (LAD) without any other significant obstructive lesion. A trans-esophageal echocardiogram (TEE) showed akinesis of the LV apex and confirmed TTE finding of a mass, consistent with an apical thrombus. Surgery was deferred and patient was started on anticoagulation. A cardiac MRI done 2 weeks later showed evidence of apical infarction in the LAD territory. LAD is the most commonly affected coronary vessel by blunt traumatic injuries, likely due to its vulnerable anatomical position on the anterior aspect of the heart. A variety of mechanisms including intimal tear, rupture and spasm have been implicated in the pathogenesis of myocardial infarction after blunt chest trauma.
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Affiliation(s)
- Sonali Arora
- Department of Internal Medicine, Baystate Medical Center/Tufts University School of Medicine, Springfield, MA, USA
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40
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Imoto K, Uchida K, Karube N, Yasutsune T, Cho T, Kimura K, Masuda M, Morita S. Risk analysis and improvement of strategies in patients who have acute type A aortic dissection with coronary artery dissection. Eur J Cardiothorac Surg 2013; 44:419-24; discussion 424-5. [PMID: 23504116 DOI: 10.1093/ejcts/ezt060] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To identify the risk factors for mortality and establish improved treatment strategies in patients who have acute type A aortic dissection with coronary artery dissection. METHODS From January 1994 through December 2011, we performed surgery in 516 patients with acute type A aortic dissection. We studied 75 (15%) of these patients who had coronary artery dissection. Myocardial ischaemia was present in 48 (64%) of the 75 patients. The culprit coronary artery was the right coronary artery (RCA) in 26 patients, the left coronary artery (LCA) in 19 and the RCA + LCA in 3. For coronary artery reconstruction, preoperative coronary stent placement was done in 7 patients (RCA, 4 and LCA, 3), aortic root replacement in 14, coronary artery bypass grafting in 23 and biological glue application in 28. The relationships of preoperative risk factors and coronary artery reconstruction procedure with in-hospital death and postoperative low cardiac output syndrome (LOS) were analysed using Fisher's exact test. RESULTS Hospital death was 18/75 patients (24%), 16/48 (33%) among patients with ischaemia and 2/27 (7.4%) without ischaemia. The culprit lesion involved the RCA in 4/26 patients (15%), the LCA in 9/19 (47%) and the RCA + LCA in 3/3 (100%). Factors related to operative mortality were ischaemia (P = 0.019), LCA territory ischaemia (P = 0.003) and preoperative cardiopulmonary arrest (CPA) (P = 0.013). Postoperative LOS was less common in patients with coronary stent placement (P = 0.042). CONCLUSIONS In patients who undergo surgery for acute type A dissection with coronary artery dissection, preoperative CPA and myocardial ischaemia (particularly LCA territory ischaemia) negatively affect survival outcomes. Early revascularization by coronary stent placement is effective in preventing postoperative LOS.
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Affiliation(s)
- Kiyotaka Imoto
- Department of Cardiovascular Surgery, Yokohama City University, Medical Center, Yokohama, Japan.
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Paraskevaidis S, Theofilogiannakos EK, Chatzizisis YS, Mantziari L, Economou F, Ziakas A, Hadjimiltiades S, Styliadis IH. Spontaneous dissection of right coronary artery manifested with acute myocardial infarction. Open Cardiovasc Med J 2010; 4:178-80. [PMID: 21127744 PMCID: PMC2995159 DOI: 10.2174/1874192401004010178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2010] [Revised: 07/21/2010] [Accepted: 07/23/2010] [Indexed: 11/22/2022] Open
Abstract
Spontaneous coronary artery dissection is a rare cause of acute ischemic coronary events and sudden cardiac death. It usually occurs in young women without traditional risk factors for coronary artery disease during pregnancy or postpartum period. However, it has also been reported in patients with atherosclerotic coronary disease. We present a case of spontaneous right coronary artery dissection in a 48-year male with recent myocardial infarction and previous percutaneous coronary intervention.
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Affiliation(s)
- Stelios Paraskevaidis
- 1 Cardiology Department, AHEPA Hospital, Aristotle University Medical School, Thessaloniki, Greece
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