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Sample records for arterial coronary revascularization

  1. Hybrid coronary artery revascularization: logistics and program development.

    Science.gov (United States)

    Friedrich, Guy J; Jonetzko, Patricja; Bonaros, Nikos; Schachner, Thomas; Danzmayr, Michael; Kofler, Ruth; Laufer, G; Pachinger, O; Bonatti, Johannes

    2005-01-01

    Planning hybrid coronary artery revascularization--a combination of cardiac surgery with percutaneous procedures--requires, at first sight, a very complex logistical setup. Technical and equipment related details should be defined as early as possible in order to have time for training of all OR personnel involved. The most challenging aspect in OR-located hybrid coronary revascularization remains a very close cooperation of cardiac surgeons and interventional cardiologists. This teamwork does include indication findings and subsequent referral of multivessel coronary artery disease patients to hybrid procedures, as well as high individual flexibility of interventionalists and surgeons. The major prerequisite for this cooperation is a mutual acceptance of different revascularization approaches and the intent to combine their most striking advantages. Intraoperative graft angiography during coronary artery bypass grafting (CABG) procedures is one important step toward simultaneous hybrid coronary revascularization procedures. We describe our experience with on table angiography using a mobile C-arm for intraoperative imaging. This fluoroscopy system can in selected cases be used for simultaneous hybrid procedures. PMID:16112939

  2. Revascularization options in stable coronary artery disease: it is not how to revascularize, it is whether and when to revascularize.

    Science.gov (United States)

    Torosoff, Mikhail T; Sidhu, Mandeep S; Desai, Karan P; Fein, Steven A; Boden, William E

    2015-09-01

    Patients with acute coronary syndromes and severe multivessel or left main coronary artery disease have better outcomes when prompt revascularization is performed in addition to optimal medical therapy (OMT). However, in patients with stable ischemic heart disease, randomized strategy trials have revealed equipoise between initial strategies of OMT alone and OMT plus revascularization. Conducted in diverse stable ischemic heart disease patient populations and throughout the spectrum of atherosclerotic and ischemic burden, the RITA-2, MASS II, COURAGE, BARI 2D and FAME 2 trials demonstrate that OMT alone and OMT plus revascularization yield similar outcomes with respect to mortality and myocardial infarction. What remains unclear is whether there may be one or more subsets of patients with stable ischemic heart disease in whom revascularization may be associated with a reduction in mortality or myocardial infarction, which is to be addressed in the ongoing ISCHEMIA trial.

  3. Total Arterial Revascularization: Bypassing Antiquated Notions to Better Alternatives for Coronary Artery Disease

    Science.gov (United States)

    Samak, Mostafa; Fatullayev, Javid; Sabashnikov, Anton; Zeriouh, Mohamed; Schmack, Bastian; Ruhparwar, Arjang; Karck, Matthias; Popov, Aron-Frederik; Dohmen, Pascal M.; Weymann, Alexander

    2016-01-01

    Total arterial revascularization is the leading trend in coronary artery bypass grafting (CABG) for the treatment of coronary artery disease (CAD). Adding to its superiority to vein conduits, arteries allow for a high degree of versatility and long-term patency, while minimizing the need for reintervention. This is especially important for patients with multi-vessel coronary artery disease, as well as young patients. However, arterial revascularization has come a long way before being widely appreciated, with some yet unresolved debates, and advances that never cease to impress. In this review, we discuss the evolution of this surgical technique and its clinical success, as well as its most conspicuous limitations in light of accumulated published date from decades of experience. PMID:27698339

  4. Diabetes does not influence treatment decisions regarding revascularization in patients with stable coronary artery disease

    OpenAIRE

    Breeman, A.; de Boer, M.J.; Bertrand, M. E.; Wijns, W.; Ottervanger, J.P.; Boersma, E.; Hoeks, S; Lenzen, M. (Prof. Dr.); Sechtem, U; Legrand, Victor

    2006-01-01

    OBJECTIVE - To evaluate whether in stable angina preference for coronary revascularization by either percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) is influenced by diabetes status and whether this has prognostic implications. RESEARCH DESIGN AND METHODS - A total of 2,928 consecutive patients with stable angina who were enrolled in the prospective Euro Heart Survey on Coronary Revascularization were studied. Multivariable analyses were applied to evaluate t...

  5. Comparably improved health-related quality of life after total arterial revascularization versus conventional coronary surgery--Copenhagen arterial revascularization randomized patency and outcome trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Lund, Jens T; Lilleør, Nikolaj B;

    2011-01-01

    OBJECTIVE: We compared health-related quality of life up to 11 months after coronary artery bypass grafting using total arterial revascularization versus conventional coronary surgery. METHODS: In this randomized single-center trial, 161 patients underwent total arterial revascularization using.......01). For total arterial revascularization, there were also not statistically significant improvements for 'physical component summary' (P=0.09), 'bodily pain' (P=0.07) and 'vitality' (P=0.08). CONCLUSION: Health-related quality of life up to 1 year after total arterial revascularization is equal or slightly...... of the general Danish population. On all scales of the SF-36, there was statistically significant improvement at 3 and 11 months in both groups. For 'social functioning', the improvement following total arterial revascularization was significantly higher than following conventional revascularization (P=0...

  6. Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

    Directory of Open Access Journals (Sweden)

    Burgess SN

    2015-06-01

    Full Text Available Sonya N Burgess,1 John J Edmond,2 Craig P Juergens,1 John K French11Department of Cardiology, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia; 2Department of Cardiology, Dunedin Public Hospital, Dunedin, New Zealand Background: Coronary artery bypass graft surgery is arguably the most intensively studied surgical procedure, and percutaneous coronary intervention (PCI has been subjected to more randomized clinical trials than any other interventional procedure. Changes seen in revascularization techniques have been numerous. The rapid evolution of evidence-based revascularization procedures has occurred as a result of many pivotal large randomized clinical trials. Objective: This review compares and contrasts outcomes from two coronary revascularization techniques, coronary artery bypass grafting (CABG and PCI, with particular reference to the landmark trials that inform practice guidelines. Methods: We undertook a comprehensive review of published literature addressing trials in this field performed to address current knowledge both in the predrug-eluting stent and postdrug-eluting stent era. Results and discussion: Surgical and percutaneous revascularization strategies have different strengths and weaknesses, and neither strategy is superior in all patients, clinical presentations, or anatomical subgroups. Current data support the use of percutaneous intervention in ST elevation myocardial infarction and in single-vessel disease. In noncomplex multivessel disease and isolated left main stem PCI, the data support non-inferiority of PCI compared to CABG as reflected in the 2014 European Society of Cardiology guidelines. Landmark revascularization trials of multivessel disease comparing CABG to PCI found no survival benefit to CABG over PCI, except in patients with complex disease. In these trials, revascularization drove differences in primary endpoints and in all but the

  7. Coronary bypass revascularization with radial artery and internal mammary artery grafts

    Institute of Scientific and Technical Information of China (English)

    甄文俊; 佟宏峰; 王永忠; 孙耀光; 黄文; 马玉健; 田家政; 吴良洪

    2002-01-01

    Objective To evaluate radial artery (RA) and internal mammary artery (IMA) grafts in coronary artery bypass and the use of color Doppler ultrasound in the peri-operative evaluation of IMA and radial-ulnar collateral circulation.Methods From June 1998 to June 2000, sixty cases of coronary bypass revascularization with RA and IMA were performed. Preoperatively, the radial-ulnar collateral circulation was evaluated with the modified Allen's test, color Doppler ultrasound and noninvasive oxygen saturation measurement. The IMA lumen and blood flow were measured at the first intercostal space with color Doppler ultrasound preoperatively and postoperatively.Results One patient (1.7%) died of serious cardiac arrhythmia on the fourth postoperative day. There were no arterial graft harvest related complications. Before harvesting, the ulnar artery blood flow was 30.78±9.71?ml/min, and it increased to 43.36±13.98?ml/min (40.87% increase, P0.05), but the systolic/diastolic flow ratio markedly decreased from 8.57±3.98?ml/min to 3.41±4.87?ml/min (P<0.01).Conclusions Arterial grafts can be safely used for coronary bypass revascularization with good results. The ulnar artery blood flow can increase compensatively after RA harvesting. The diastolic blood flow of grafted IMA markedly increased postoperatively. Color Doppler ultrasound was very helpful both in evaluating the radial-ulnar collateral circulation before RA harvesting and in assessing the patency of the grafted IMA after coronary artery bypass grafting (CABG).

  8. Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting for Diabetics with Multivessel Coronary Artery Disease: The Korean Multicenter Revascularization Registry (KORR)

    OpenAIRE

    Gwon, Hyeon-Cheol; Choi, Seung Hee; Choi, Byung-Il William; Cho, Seung Yun; Ro, Young Moo; Lee, Won Ro; ,

    2005-01-01

    This study was designed to assess the relative merits of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in multivessel coronary artery disease (MVCAD), particularly for Korean diabetics. Among 3,279 patients with MVCAD who were recommended for revascularization were enrolled from nine centers in Korea, 2,154 were selected after statistical adjustments for the disparities between two groups. Survival rates were not significantly different for three years be...

  9. Off - Pump Coronary Artery Bypass Graft Surgery: A Safe Method For Complete Revascularization

    Directory of Open Access Journals (Sweden)

    Mirkhani S. H

    2002-07-01

    Full Text Available In recent years off-pump coronary artery bypass surgery (OPCAB has emerged as preferred method for revascularization of coronary arteries in relatively selected group of patients. Considering patients receiving incomplete revascularization need significantly higher postoperative catheterization and re-intervention (PTCA or CABG, we performed this study to identify safety and feasibility of this technique for total revascularization in nearly all patients requiring coronary artery graft surgery."nMaterials and Methods: In this study, 150 consecutive patients underwent OPCAB by one surgeon. Octopus device used for regional wall stabilization. Vascular control achieved by ethibond loops, occluder, and shunts. Situations such as cardiomegaly, poor ventricular function, advanced age, hemodynamic instability, and small coronary arteries were not considered contraindications to OPCAB."nResults: Of 150 OPCAB cases, 146 (97.3 percent were completely off-pump. The mean number of grafts per patient was 4.1 (range, 2 to 6. Total 595 distal grafts anastomosed to LAD (140 diagonals (140, right coronary artery (145, left circumflex (164. Thirty-day mortality and myocardial infarction were 0.6 percent and 3.3 percent respectively OPCAB patient experienced lesser postoperative bleeding had shorter stay at surgical intensive care unit and extubated earlier. Conduits used were left internal mammary artery, radial artery and greater saphenous vein."nConclusion: OPCAB is a safe method for complete revascularization in nearly all patients. The OPCAB patients experience less complications, have shorter hospital stay, absolute contraindication for OPCAB other than severe, diffuse coronary artery disease with poor run-off which is better treated by cardiopulmonary bypass.

  10. Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis after coronary revascularization

    OpenAIRE

    Grube, Eberhard; Bootsveld, Andreas; Buellesfeld, Lutz; Yuecel, Seyrani; Shen, Joseph T; Imhoff, Michael

    2008-01-01

    Background: Resting electrocardiogram (ECG) shows limited sensitivity and specificity for the detection of coronary artery disease (CAD), where patients with a history of coronary revascularization may pose special challenges. Several methods exist to enhance sensitivity and specificity of resting ECG for diagnosis of CAD, but such methods are not better than a specialist's judgement. We compared a new computer-enhanced, resting ECG analysis device, 3DMP, to coronary angiography to evaluate t...

  11. Impact of myocardial perfusion imaging on in-hospital coronary angiography and revascularization of patients with suspected coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    HAN Ping-ping; HE Zuo-xiang; TIAN Yue-qin; FANG Wei; YANG Min-fu; ZHANG Xiao-li; SHEN Rui; SUN Xiao-xin; QIAO Shu-bin; YANG Yue-jin

    2011-01-01

    Background Noninvasive cardiac imaging is now central to the diagnosis and management of patients with moderate probability for coronary artery disease. The aim of this study was to assess the impact of stress myocardial perfusion single photon emission computerized tomography (SPECT) on in-hospital coronary angiography and revascularization for such patients.Methods Between January 2005 and June 2007, 1053 consecutive in-hospital patients (423 women, the average age of (57.2±11.2) years) with suspected coronary artery disease but without any prior interventional treatment were retrospectively analyzed. All patients underwent a 2-day stress/rest 99m Tc-methoxyisobutylisonitrile (MIBI) myocardial perfusion SPECT, including 984 exercise test and 69 adenosine test.Results Overall, stress/rest myocardial perfusion SPECT was normal in 973 patients (92.4%) and abnormal in 80 patients (7.6%). A total of 190 patients underwent coronary angiography, 46 underwent percutaneous coronary intervention and 10 coronary artery bypass grafting during hospitalization. From the whole perspective, only 14.7% of patients with normal SPECT underwent coronary angiography, so did 58.8% of patients with abnormal SPECT (x2=97.0,P<0.001); furthermore, the rates of revascularization in patients with normal and abnormal SPECT were 2.8% and 36.3%,respectively (27 out of 973 vs. 29 out of 80, x2=157.9, P<0.001). The extent and severity of ischemia did not add more predictive value for subsequent coronary angiography, but did have impact on revascularization. Multivariate analysis showed that reversible perfusion defect was the most predictive variable for referral rate to coronary angiography (odds ratio=7.5, P<0.001).Conclusions Abnormal myocardial perfusion SPECT is a powerful referral for in-hospital coronary angiography and revascularization during the same hospitalization. Thus, stress/rest SPECT is an effective gatekeeper for early coronary angiography and invasive treatment for

  12. Serum YKL-40 for monitoring myocardial ischemia after revascularization in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Harutyunyan, Marina Jurjevna; Johansen, Julia S; Mygind, Naja D;

    2014-01-01

    AIM: The aim was to investigate the inflammatory biomarker YKL-40 as a monitor of myocardial ischemia in patients with coronary artery disease (CAD). METHODS: A total of 311 patients with stable CAD were included. Blood samples were taken at baseline, the day after coronary angiography and/or after...... percutaneous coronary intervention and after 6 months. RESULTS: A total of 148 (48%) patients were revascularized and 163 patients underwent only coronary angiography. In the entire population, serum YKL-40 increased significantly from baseline to 6 months (p = 0.05). This tendency was seen...... of disease progression but not of myocardial ischemia in patients with stable CAD....

  13. Perspectives of anatomical and clinical criteria use in revascularization of patients with stable coronary artery disease

    Directory of Open Access Journals (Sweden)

    Genkal E.N.

    2015-09-01

    Full Text Available The aim of the study is to describe the development of the algorithm for the data analysis of Russian coronary artery disease (CAD Registry. The algorithm allows determining the need in percutaneous coronary intervention (PCI and evaluation the validity of PCI in patients with stable CAD on the basis of appropriate use criteria for coronary revascularization by the American College of Cardiology. Two measures propose for clinical decision support and automated assessment of PCI appropriateness «The need in PCI in patients with stable CAD» and «PCI validity in patients with stable CAD».

  14. Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis after coronary revascularization

    Directory of Open Access Journals (Sweden)

    Eberhard Grube, Andreas Bootsveld, Lutz Buellesfeld, Seyrani Yuecel, Joseph T Shen, Michael Imhoff

    2008-01-01

    Full Text Available Background: Resting electrocardiogram (ECG shows limited sensitivity and specificity for the detection of coronary artery disease (CAD, where patients with a history of coronary revascularization may pose special challenges. Several methods exist to enhance sensitivity and specificity of resting ECG for diagnosis of CAD, but such methods are not better than a specialist's judgement. We compared a new computer-enhanced, resting ECG analysis device, 3DMP, to coronary angiography to evaluate the device's accuracy in detecting hemodynamically relevant CAD. Methods: A convenience sample of 172 patients with a history of coronary revascularization scheduled for coronary angiography was evaluated with 3DMP before coronary angiography. 3DMP's sensitivity and specificity in detecting hemodynamically relevant coronary stenosis as diagnosed with coronary angiography were calculated as well as odds ratios for the 3DMP severity score and coronary artery disease risk factors. Results: The 3DMP system accurately identified 50 of 55 patients as having hemodynamically relevant stenosis (sensitivity 90.9%, specificity 88.0%. Positive and negative predictive values for the identification of coronary stenosis as diagnosed in coronary angiograms were 62.7% and 97.8% respectively. Risk and demographic factors in a logistic regression model had a markedly lower predictive power for the presence of coronary stenosis in these patients than did 3DMP severity score (odds ratio 2.04 [0.74-5.62] vs. 73.57 [25.10-215.68]. A logistic regression combining severity score with risk and demographic factors did not add significantly to the prediction quality (odds ratio 80.00 [27.03-236.79]. Conclusions: 3DMP's computer-based, mathematically derived analysis of resting two-lead ECG data provides detection of hemodynamically relevant CAD in patients with a history of coronary revascularization with high sensitivity and specificity that appears to be at least as good as those

  15. [Ischemic burden vs. coronary artery morphology : What is crucial for the indication of revascularization?].

    Science.gov (United States)

    Heber, D; Hacker, M

    2016-08-01

    Ischemic heart disease still represents the leading cause of death in the western world despite a decrease of mortality in the last decade. For the diagnostics of coronary artery morphology, invasive coronary angiography represents the gold standard. Nevertheless, in recent years the importance of functional diagnostics of the coronary arteries has increased and various imaging procedures for the measurement of fractional flow reserve (FFR) during coronary angiography were established and recommended for ischemia testing in the actual guidelines on myocardial revascularization.Imaging modalities for diagnostics of the functional relevance of coronary artery disease include stress echocardiography, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). These procedures enable advanced risk stratification and therapy guiding in patients with suspected or known coronary artery disease. In future algorithms, hybrid imaging may facilitate the determination of anatomical and functional aspects after only one investigation.In the present article, the role of ischemia testing is compared with morphological methods for the diagnosis of coronary artery disease, individual risk stratification, and therapy guiding.

  16. [Ischemic burden vs. coronary artery morphology : What is crucial for the indication of revascularization?].

    Science.gov (United States)

    Heber, D; Hacker, M

    2016-08-01

    Ischemic heart disease still represents the leading cause of death in the western world despite a decrease of mortality in the last decade. For the diagnostics of coronary artery morphology, invasive coronary angiography represents the gold standard. Nevertheless, in recent years the importance of functional diagnostics of the coronary arteries has increased and various imaging procedures for the measurement of fractional flow reserve (FFR) during coronary angiography were established and recommended for ischemia testing in the actual guidelines on myocardial revascularization.Imaging modalities for diagnostics of the functional relevance of coronary artery disease include stress echocardiography, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and positron emission tomography (PET). These procedures enable advanced risk stratification and therapy guiding in patients with suspected or known coronary artery disease. In future algorithms, hybrid imaging may facilitate the determination of anatomical and functional aspects after only one investigation.In the present article, the role of ischemia testing is compared with morphological methods for the diagnosis of coronary artery disease, individual risk stratification, and therapy guiding. PMID:27333984

  17. Short-term clinical outcomes after hybrid coronary revascularization versus off-pump coronary artery bypass for the treatment of multivessel or left main coronary artery disease: a meta-analysis

    OpenAIRE

    Hu, Fang-Bin; Cui, Lian-Qun

    2015-01-01

    Background Hybrid coronary revascularization (HCR) and off-pump coronary artery bypass grafting (OPCABG) are both feasible, less invasive techniques for coronary revascularization. Although both techniques utilize the left internal mammary artery to left anterior descending artery graft, HCR uses drug-eluting stents instead of saphenous vein bypass. It remains unclear whether HCR is equal to, better or worse than OPCABG. Methods and results A meta-analysis was carried out using a random-effec...

  18. Role of radial artery in total arterial myocardial revascularization in coronary bypass surgery

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background Total arterial revascularization (TAR) was widely utilized in coronary artery bypass grafting (CABG) as a result of its better long-term effect compared with vein grafts.Of the arterial conduits,radial artery (RA) gained popularity for its easy availability and reported long-term patency.Thus,the objective of this study was to investigate the effect of RA in TAR in CABG.Methods From January 2000 to December 2006,85 patients (56 male and 29 female) at a mean age of 57.0±5.2 years,underwent TAR in CABG RA and left internal mammary artery (LIMA) with composite Y or T and seauential grafting techniques were used.Post-operative complications were recorded and follow-up was performed.Results Eighty-five LIMA and 149 RA grafts including 21 single and 64 bilateral RA were collected.A total of 87 distal anastomoses were done with the LIMA and another 152 were done with the RA,with the mean number of diStal anastOmosis per patient of 2.81±0.47.The proximal RA ends were anastomsed directly to the aorta in 140 grafts with Y or T graft off in situ LIMA in 9,Yor T graft off Rain 9.The distal end was anastomsed to right coronary artery system in 92,to Obtuse margma in 46,to diagonal in 19 and to ramous intermedius in 5.Nine sequential anastomoses were Derformed with RA.Nine composite Y or T grafts were constructed with RA and LIMA while another 9 were constructed with RA and RA.One (1.2%) patient died,3 patients (3.5%) experienced acute renal failure and 2 (2.4%) developed stroke.All patienfs were still alive and no patient had evidences of newly occurred myocardial infarction or angina after a mean tollow-up of 36.5±4.1 months (6-67 months).Postoperatively at 6 month,mean left ventricular ejective fraction was increased to 0.49±0.09,compared with that of 0.43±0.11 preoperatively (P=0.027).Postoperative mean New York Heart Association class was 2.5±0.5,compared with that of 3.0±0.4 preoperatively (P=0.003).Conclusions TAR with arterial conduits of which RA was

  19. Correlation between coronary artery calcification and the need for revascularization in patients with no previous diagnosis of arterial coronary disease

    International Nuclear Information System (INIS)

    Introduction: about half of deaths from coronary heart disease (CHD) are not preceded by cardiac symptoms or previous diagnosis. Quantification of coronary artery calcification (CAC) by computed tomography is a strong predictor of events and improves the stratification the Framingham Risk Score. Objective: to evaluate the ability of the calcium score to predict the necessity invasive treatment (bypass (CABG) or intervention coronary percutaneous (ICP)) with no previous CAD. Method: retrospective study in pts without prior CAD and with quantification of CAC during 2009. The CAC was obtained in 64 multislice CT without contrast, with synchronized ECG acquisition, 120kV, 80-100mA, radiation <1mSv, and measured by the Agatston calcium score (CS) (threshold of 130 HU). Mean, median, and diagnostic tests were used. Results: We evaluated 263 pts (171 men), 59±13 years, BMI = 27.7 kg/m2, and mean follow up of 18±3 months. The total CS was 199.5±24.39. In patients with diabetes (DM), the CS was 320.5±67.56 and 166±24.47 in non-DM. The 23 patients who underwent invasive treatment had an average CS of 692 ± 72.3 versus 134.7 ± 21.35 in patients not treated (p <0.001). Of the 47 pts with CS ≥ 400, 17 were treated (CABG or ICP). Of the 216 pts with CS <400, 6 underwent treatment. Of the treated pts, 15 without diabetes had average CS 672.7 ± 92.04 versus 728.3 ± 11 of DM (8pts). In pts without DM who not underwent invasive treatment (191 pts), only 18 pts had SC ≥ 400. Conclusion: CS ≥ 400 was a strong predictor of revascularization (CABG or ICP) with good diagnostic performance in patients without prior diagnosis of CAD in the following 18 months. (author)

  20. Correlation between coronary artery calcification and the need for revascularization in patients with no previous diagnosis of arterial coronary disease

    Energy Technology Data Exchange (ETDEWEB)

    Prazeres, Carlos Eduardo Elias dos; Cury, Roberto Caldeira; Bello, Juliana Hiromi Silva Matsumoto [Instituto do Coracao (InCor/FM/USP), Sao paulo, SP (Brazil); Magalhaes, Tiago Augusto [Hospital Pro-Cardiaco, Rio de Janeiro, RJ (Brazil); Moreira, Valeria de Melo; Carlos Eduardo Rochitte, E-mail: rochitte@gmail.com, E-mail: crochitte@hcor.com.br [Hospital do Coracao (HCOR), Sao Paulo, SP (Brazil)

    2012-10-15

    Introduction: about half of deaths from coronary heart disease (CHD) are not preceded by cardiac symptoms or previous diagnosis. Quantification of coronary artery calcification (CAC) by computed tomography is a strong predictor of events and improves the stratification the Framingham Risk Score. Objective: to evaluate the ability of the calcium score to predict the necessity invasive treatment (bypass (CABG) or intervention coronary percutaneous (ICP)) with no previous CAD. Method: retrospective study in pts without prior CAD and with quantification of CAC during 2009. The CAC was obtained in 64 multislice CT without contrast, with synchronized ECG acquisition, 120kV, 80-100mA, radiation <1mSv, and measured by the Agatston calcium score (CS) (threshold of 130 HU). Mean, median, and diagnostic tests were used. Results: We evaluated 263 pts (171 men), 59±13 years, BMI = 27.7 kg/m2, and mean follow up of 18±3 months. The total CS was 199.5±24.39. In patients with diabetes (DM), the CS was 320.5±67.56 and 166±24.47 in non-DM. The 23 patients who underwent invasive treatment had an average CS of 692 ± 72.3 versus 134.7 ± 21.35 in patients not treated (p <0.001). Of the 47 pts with CS ≥ 400, 17 were treated (CABG or ICP). Of the 216 pts with CS <400, 6 underwent treatment. Of the treated pts, 15 without diabetes had average CS 672.7 ± 92.04 versus 728.3 ± 11 of DM (8pts). In pts without DM who not underwent invasive treatment (191 pts), only 18 pts had SC ≥ 400. Conclusion: CS ≥ 400 was a strong predictor of revascularization (CABG or ICP) with good diagnostic performance in patients without prior diagnosis of CAD in the following 18 months. (author)

  1. First reported revascularization of complex occlusion of the right coronary artery using the IVUS-guided reverse CART technique via a gastroepiploic artery graft.

    Science.gov (United States)

    Dai, Jian; Katoh, Osamu; Zhou, Hua; Kyo, Eisho

    2016-02-01

    When patients who have previously undergone coronary artery bypass graft surgery develop ischemia symptoms that cannot be controlled by optimal medical therapy, repeat revascularization is indicated. The revascularization strategy should be based on individual clinical and anatomical characteristics. We report here a challenging patient who presented with recurrent stable angina due to worsening of a proximal right coronary artery (RCA) stenosis to chronic total occlusion (CTO) after anastomosis of the right gastroepiploic artery (GEA) to the posterior descending artery. A soft guidewire was advanced through the right GEA collateral channel to the distal end of the CTO, but the dedicated CTO guidewires could not be advanced across the severely calcified CTO using the retrograde wire crossing or kissing wire techniques. The RCA was eventually revascularized by implantation of drug-eluting stents using the intravascular ultrasound-guided reverse controlled antegrade and retrograde subintimal tracking technique.

  2. Utilizing risk scores in determining the optimal revascularization strategy for complex coronary artery disease

    NARCIS (Netherlands)

    V. Farooq (Vasim); S. Brugaletta (Salvatore); P.W.J.C. Serruys (Patrick)

    2011-01-01

    textabstractPercutaneous coronary intervention (PCI) of multivessel and/or left main stem disease have been shown to be potentially legitimate revascularization alternatives in appropriately selected patients. Risk stratification is an important component in guiding patients to identify the most app

  3. Pharmacological treatment and perceived health status during 1-year follow up in patients diagnosed with coronary artery disease, but ineligible for revascularization. Results from the Euro Heart Survey on Coronary Revascularization

    NARCIS (Netherlands)

    Lenzen, M.; Scholte op Reimer, W.; Norekval, T.M.; De Geest, S.; Fridlund, B.; Heikkila, J.; Jaarsma, Trijntje (Tiny); Martensson, J.; Moons, P.; Smith, K; Stewart, S.; Stromberg, A; Thompson, D.R.; Wijns, W.

    2006-01-01

    BACKGROUND: It has been recognized that a clinically significant portion of patients with coronary artery disease (CAD) continue to experience anginal and other related symptoms that are refractory to the combination of medical therapy and revascularization. The Euro Heart Survey on Revascularizatio

  4. Interventional Revascularization of Coronary Artery Lesions in Diabetic Patients; In-hospital and One Year Follow up

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Zibaeenezhad

    2012-12-01

    Full Text Available Background: Diabetes mellitus is a life threatening disease accompanied by several micro- and macro vascular complications. Several modalities are available for interventional revascularization of coronary artery lesions, but their efficacy in diabetic patients is studied only in few patients. Materials and Method: This study evaluated major in- hospital complications and clinical outcome after one year in 200 consecutive patients who underwent percutaneous Coronary Intervention from 2007 to 2009. Results: Our findings showed comparable single and 2 vessel stenting, regarding major adverse cardiovascular event in diabetic and nondiabetic patients. In connection with long term and in hospital outcome, no statistically significant difference was found between one and two vessel stenting when drug eluting stent was used in diabetic patients. Conclusion: The use of drug eluting stent in single or two vessel disease of diabetic patients is technically satisfactory and clinically safe and can substitute for coronary artery bypass grafting.

  5. Comparable three months' outcome of total arterial revascularization versus conventional coronary surgery: Copenhagen Arterial Revascularization Randomized Patency and Outcome trial

    DEFF Research Database (Denmark)

    Damgaard, S.; Lund, J.T.; Lilleor, N.B.;

    2008-01-01

    .9 in the conventional group (P = .004). Three months' follow-up for the arterial versus conventional groups showed the following: deaths: 1 (0.6%) versus 0; stroke: 3 (1.9%) versus 3 (1.8%); myocardial infarction: 6 (3.7%) versus 4 (2.4%); sternal wound reoperation: 4 (2.5%) versus 0 (P = .054); arm and leg wound...

  6. Coronary revascularization in ischemic heart disease: lessons from observational studies and randomized clinical trials

    NARCIS (Netherlands)

    N.F. Mercado (Nestor)

    2003-01-01

    textabstractThis thesis presents an overview of clinical trials and observational studies on coronary revascularization and evaluates the results obtained with revascularization in different subsets of patients treated with percutaneous coronary intervention or coronary artery bypass graft surgery.

  7. Reviewing hybrid coronary revascularization: challenges, controversies and opportunities.

    Science.gov (United States)

    Kayatta, Michael O; Halkos, Michael E

    2016-07-01

    Two main approaches to myocardial revascularization currently exist, coronary artery bypass and percutaneous coronary intervention. In patients with advanced coronary artery disease, coronary artery bypass surgery is associated with improved long term outcomes while percutaneous coronary intervention is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach. This new approach, hybrid coronary revascularization, has shown encouraging early results. Minimally invasive techniques for bypass surgery have played a large part of bringing this approach into contemporary practice. PMID:27042753

  8. Usefulness of preoperative coronary angiography and brain computed tomography in cases of coronary artery disease and cerebrovascular disease undergoing revascularization for arteriosclerosis obliterans

    Energy Technology Data Exchange (ETDEWEB)

    Sakurada, Tall; Shibata, Yoshiki [Southern Tohoku Fukushima Hospital (Japan)

    2003-05-01

    Coronary angiography and brain computed tomography were preoperatively performed to evaluate the clinical condition of coronary artery disease and cerebrovascular disease in 101 patients (mean age, 68.4 years) with revascularization for arteriosclerosis obliterans. Eighty patients had hypertension, 12 had diabetes, and 26 had hyperlipidemia. Seventy-one patients (70.3%) had coronary stenosis. Significant stenoses in major coronary artery branches were confirmed in 35 patients, including 13 patients with old myocardial infarction. Coronary artery bypass grafting and percutaneous coronary angioplasty were performed in 2 and 7 patients with critical stenosis, respectively. Of 57 patients, who underwent brain computed tomography, abnormalities were found in 52 patients (91.2%), including cortical infarction in 9, lacunar infarction in 35, and leukoaraiosis in 27 patients. During the follow-up period 13 patients died (including 3 cases of myocardial infarction and 3 cases of stroke). Actuarial survival rate at 5 years was 80.4%. The influence of ischemic heart disease and cerebrovascular disease on early and late mortality after surgical reconstruction for peripheral occlusive vascular disease is significant. Using visual diagnostic techniques, such as coronary angiography and brain computed tomography, long term survivor should be closely observed for multiple arteriosclerotic vascular diseases. (author)

  9. Usefulness of preoperative coronary angiography and brain computed tomography in cases of coronary artery disease and cerebrovascular disease undergoing revascularization for arteriosclerosis obliterans

    International Nuclear Information System (INIS)

    Coronary angiography and brain computed tomography were preoperatively performed to evaluate the clinical condition of coronary artery disease and cerebrovascular disease in 101 patients (mean age, 68.4 years) with revascularization for arteriosclerosis obliterans. Eighty patients had hypertension, 12 had diabetes, and 26 had hyperlipidemia. Seventy-one patients (70.3%) had coronary stenosis. Significant stenoses in major coronary artery branches were confirmed in 35 patients, including 13 patients with old myocardial infarction. Coronary artery bypass grafting and percutaneous coronary angioplasty were performed in 2 and 7 patients with critical stenosis, respectively. Of 57 patients, who underwent brain computed tomography, abnormalities were found in 52 patients (91.2%), including cortical infarction in 9, lacunar infarction in 35, and leukoaraiosis in 27 patients. During the follow-up period 13 patients died (including 3 cases of myocardial infarction and 3 cases of stroke). Actuarial survival rate at 5 years was 80.4%. The influence of ischemic heart disease and cerebrovascular disease on early and late mortality after surgical reconstruction for peripheral occlusive vascular disease is significant. Using visual diagnostic techniques, such as coronary angiography and brain computed tomography, long term survivor should be closely observed for multiple arteriosclerotic vascular diseases. (author)

  10. Less invasive coronary artery revascularization with a minimized extracorporeal circulation system: preliminary results of a comparative study with off-pump-procedures

    OpenAIRE

    Wittwer, Thorsten; Sabashnikov, Anton; Rahmanian, Parwis B; Choi, Yeong-Hoon; Zeriouh, Mohamed; Mehler, Thorsten O; Wahlers, Thorsten

    2013-01-01

    Background Coronary-artery-bypass-grafting (CABG) with conventional extracorporeal circulation (CECC) is associated with adverse effects such as systemic inflammatory response leading to a decrease in systemic vascular resistance and hemodynamic instability. Modern "less invasive" procedures have been established recently which potentially avoid negative side effects of CECC. The aim of this study was to compare perioperative outcome following coronary revascularization using either a minimiz...

  11. Efficacy of post-operative clopidogrel treatment in patients revascularized with coronary artery bypass grafting after myocardial infarction

    DEFF Research Database (Denmark)

    Sørensen, Rikke; Abildstrøm, Steen Z; Hansen, Peter R;

    2011-01-01

    OBJECTIVES: The objective of this study was to examine the clinical efficacy of clopidogrel treatment on death and recurrent myocardial infarction (MI) among MI patients revascularized by coronary artery bypass graft surgery (CABG). BACKGROUND: The benefit from post-operative clopidogrel in CABG......-treated MI patients is largely unknown. METHODS: All patients admitted with first-time MI between 2002 and 2006, treated with CABG within 180 days after admission, were identified by nationwide administrative registers. Clopidogrel treatment was determined by claimed prescriptions after discharge from...... surgery. Risk of death or recurrent MI, and of a combined end point of the 2, were assessed by cumulative incidence and Cox proportional hazards model. A propensity score-matched subgroup analysis was done. RESULTS: We included 3,545 patients, and of these, 957 (27.0%) were treated with clopidogrel after...

  12. One-year results of total arterial revascularization vs. conventional coronary surgery: CARRPO trial

    DEFF Research Database (Denmark)

    Damgaard, Sune; Wetterslev, Jørn; Lund, Jens T;

    2009-01-01

    revascularization (CR) using left ITA and vein grafts. The primary angiographic outcome was the patency index: number of patent grafts (Mean patency index (+/-SD) was 87 +/- 22% in the TAR group and 88...

  13. [Indices of intraoperative flowmetry, determining patency of grafts in the remote period after revascularization of the right coronary artery].

    Science.gov (United States)

    Bazylev, V V; Nemchenko, E V; Pavlov, A A; Karnakhin, V A

    2016-01-01

    The authors studied the threshold values of ultrasound flowmetry concerning composite T-grafts, combined I-grafts, and autovenous shunts during revascularization of the right coronary artery (RCA), determining high risk for the development of shunt occlusion in the remote postoperative period. The retrospective study included a total of 223 patients subjected to revascularization of the RCA's basin with the help of composite T-grafts, combined I-grafts, and autovenous shunts. Depending on the method of bypass grafting of the RCA and its branches, all patients were subdivided into 3 groups: Group 1 was composed of 65 patients in whom the RCA basin was revascularized by a branch of the composite T-graft, Group 2 comprised 112 patients who endured autovenous aortocoronary bypass grafting, and Group 3 consisted of 46 patients in whom the RCA basin was shunted by a combined mammarovenous I-graft. The groups had no statistically significant differences on the main clinical and demographic parameters. Intraoperative assessment of the blood flow through the coronary shunts was carried out by means of ultrasound flowmetry. The remote results were evaluated based on the findings of the control coronaroshuntography which was carried out in all patients within the terms varying from 16 to 43 months. In the remote period in Group 1 patients (T-graft), 59 (90%) mammary shunts were patent, in Group 2 - 99 (88.4%) autovenous shunts, and in Group 3 (I-graft) 42 (95.5%) shunt were patent. Cumulative probability of freedom from shunt occlusion within the terms up to 3 years after surgery in Group 1 amounted to 82±0.5%, in Group 2 to 58±2.1%, and in Group 3 to 86±1.9%, with the differences between Group 2 and other groups being statistically significant (p=0.01). The Poisson regression analysis showed that the risk for graft occlusion increased by 10% with the resistance index in the branch of the T-graft from 4.0; by 8% with the resistance index in the autovein from 2.9; and by 3

  14. Structural-functional State and feature remodeling of left ventricle in patients with coronary artery disease after revascularization

    OpenAIRE

    ALYAVI ANIS LUTFULLAEVICH; KAMILOVA UMIDA KABIROVNA; TULAGANOVA DILDORA KARIMOVNA; RADJABOVA DIYORA ISKANDAROVNA; SHODIEV JASUR DAVLATOVICH

    2016-01-01

    The article estimated the dynamics of systolic and diastolic function in patients with acute myocardial infarction after myocardial revascularization. The study involved 42 patients with acute myocardial infarction with ST segment elevation up to 6 hours of onset. Primary stenting of the infarct-related artery in patients with acute myocardial infarction with ST segment elevation allows most early as possible to prevent the development of pathological remodeling of the left ventricle compared...

  15. Off-pump coronary artery bypass grafting versus optimal medical therapy alone:effectiveness of incomplete revascularization in high risk patients

    Institute of Scientific and Technical Information of China (English)

    Filippo Prestipino; Cristiano Spadaccio; Antonio Nenna; Fraser WH Sutherland; Gwyn W Beattie; Mario Lusini; Francesco Nappi; Massimo Chello

    2016-01-01

    BackgroundGeriatric patients with multivessel coronary artery disease (CAD) are a challenging group to treat; these cases elicit dis-cussion within heart teams regarding the actual benefit of undertaking major surgery on these patients and often lead to abandon the surgical option. Percutaneous procedures represent an important option, but coronary anatomy may be unfavorable. Off-pump coronary artery bypass (OPCAB) provides good quality graft on left anterior descending (LAD) without exposing the patient to cardiopulmonary bypass, and might be the ideal choice in patients with multiple comorbidities, not eligible to percutaneous or on-pump procedures. The objective of this study was to compare survival during a mid-term follow-up in high-risk patients with no percutaneous alternative, either treated with OPCAB or discharged in medical therapy.MethodsWe retrospectively evaluated from June 2008 to June 2013, 83 high-risk patients with multivessel CAD were included: 42 were treated with incomplete off-pump revascularization using left internal mammary artery (LIMA) on LAD; 41 were discharged in optimal medical therapy (OMT), having refused surgery. Follow-up ended in March 2015, with a telephonic interview. Primary endpoint was survival from all-cause mortality; secondary endpoints were survival from cardiac-related mortality and freedom from non-fatal major adverse cardiac events (MACEs).ResultsDuring follow up, 11 deaths in OPCAB group and 27 deaths in OMT group occurred. Death was due to cardiac factors in 6 and 15 patients, respectively. MACEs were observed in 6 patients in OPCAB group and in 4 patients in OMT group. With regards to survival from all-cause mortality, patients who underwent OPCAB survived more than those dis-charged in OMT (Log Rank < 0.001), and OMT group carries a propensity score-adjusted hazard ratio of 3.862 (P < 0.001). With regards to survival from cardiac-related events, patients who underwent OPCAB survived more than those discharged in

  16. Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

    OpenAIRE

    Li-Qun Chi; Jian-Qun Zhang; Qing-Yu Kong; Wei Xiao; Lin Liang; Xin-Liang Chen

    2015-01-01

    Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD). Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeo...

  17. Impact of previous percutaneous transluminal coronary angioplasty and/or stenting revascularization on outcomes after surgical revascularization : insights from the imagine study

    NARCIS (Netherlands)

    Chocron, Sidney; Baillot, Richard; Rouleau, Jean Lucien; Warnica, Wayne J.; Block, Pierre; Johnstone, David; Myers, Martin G.; Calciu, Cristina Dana; Nozza, Anna; Martineau, Pierre; van Gilst, Wiek H.

    2008-01-01

    Aim To determine the impact of previous coronary artery revascularization by percutaneous transluminal coronary angioplasty and/or stenting (PCI) on outcome after subsequent coronary artery bypass grafting (CABG). Methods and results The ischaemia management with Accupril post-bypass Graft via Inhib

  18. Emergency off-pump coronary artery surgery

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja; Zulfiqar Haider; Haider Zaman

    2004-01-01

    Background Off-pump coronary artery bypass grafting is fast-becoming a procedure of choice for elective revascularization in high-risk patients with multi-vessel coronary artery disease. However, the role of off-pump coronary artery bypass grafting for patients with acute coronary syndromes requiring emergency revascularization still requires validation. We present our experience to show the feasibility of off-pump coronary artery surgery as an emergency revascularization technique. Methods From April 2001 to September 2003, emergency (operation within 24 hours after hospitalization) coronary artery bypass grafting without cardiopulmonary bypass (CPB) was performed in 66 patients with a mean age of (66.9±5.4) years (range 49-72 years). They presented acute coronary syndromes with 38 patients on platelet glycoprotein Ⅱb/Ⅲa receptor antagonists. All patients underwent off-pump coronary artery bypass surgery via sternotomy with the intention of complete coronary revascularization.Results An average of 2.9 grafts per patient were performed and the posterior descending artery and marginal branches of the circumflex artery were grafted in 83.3% of the patients. There were 4 events of intraoperative cardiac instability, precipitated by occlusion of right coronary artery or positioning of a cardiomegaly heart, leading to immediate conversion to CPB. The mortality rate was 3% (2/66). Two patients suffered postoperative stroke while three needed hemofiltration for acute renal failure. Post surgery elective coronary angiography (n=46) showed no significant stenosis.Conclusion Emergency off-pump coronary artery surgery with complete revascularization is feasible in patients with acute coronary syndrome with low morbidity and mortality and excellent early results.

  19. Effect of metabolic syndrome on prognosis and clinical characteristics of revascularization in patients with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    HU Rong; JIA Chang-qi; LIU Xin-min; DONG Jian-zeng; LIU Xiao-hui; CHEN Fang; ZHOU Yu-jie; L(U) Shu-zheng; WU Xue-si; MA Chang-sheng; NIE Shao-ping; L(U) Qiang; KANG Jun-ping; DU Xin; ZHANG Yin; GAO Ying-chun; HE Li-qun

    2006-01-01

    Background People with metabolic syndrome are at higher risk for developing coronary artery disease (CAD).The effect of the metabolic syndrome on outcomes in patients with preexisting CAD has not been well studied.This study was conducted to assess the prevalence, characteristics, in hospital and long term prognosis of CAD with metabolic syndrome and to determine the factors influencing the prognosis of the disease.Methods The DESIRE registry contains data of 3696 patients with CAD between 2001 and 2004. Mean long term followup was (829±373) days. Diagnosis of metabolic syndrome was based on modified International Diabetes Federation (IDF) Worldwide Definition of the Metabolic Syndrome, using body mass index (BMI)instead of waist circumference.Results Of 2596 patients with complete records of height, weight, and so on, 1280 (49.3%) were identified with metabolic syndrome. The patients with metabolic syndrome had higher level of body mass index, systolic blood pressure, diastolic blood pressure, fasting glucose and disordered blood lipid (all P<0.0001), with higher creatinine [(10.5±4.3) mg/L vs (9.9±2.9) mg/L, P<0.0001] and the number of white blood cells [(7.49±2.86)× 109/L vs (7.19 ± 2.62) × 109/L, P=0.008) compared with those without metabolic syndrome. The patients with metabolic syndrome showed severer coronary angiographic alterations (left main artery and/or ≥2-vessel)(73.6% vs 69.6%, P=0.031). There were no significant differences of major adverse cardiac and cerebral events(MACCE) or mortality in hospital between the two groups. During followup, the ratio of MACCE in CAD with metabolic syndrome patients increased significantly (11.8% vs 10.0%, P=0.044). Fasting blood glucose (≥ 1000mg/L) and triglyceride (TG, ≥ 1500 mg/L) were responsible for most of the increased risk associated with the metabolic syndrome (adjusted OR 1.465, 95% CI 1.037-1.874, P=0.032; OR 1.378, 95% CI 1.014-1.768,P=0.044).Conclusions The prevalence of metabolic

  20. Intimal Detachment of the Left Main Coronary Artery in a Marfan Patient with Acute Aortic Dissection: An Alternative Technique for Coronary Revascularization.

    Science.gov (United States)

    Song, Joon Young; Kim, Tae Youn; Choi, Jong Bum; Kuh, Ja Hong

    2016-05-01

    In patients with acute type A aortic dissection, intimal detachment associated with circumferential dissection of the left main coronary artery (LMCA) is a rare but lethal complication. We report a Marfan patient with dissection and intimal detachment of the LMCA that was caused by acute aortic dissection involving the left aortic sinus and that was reconstructed using a short reversed saphenous vein graft. doi: 10.1111/jocs.12746 (J Card Surg 2016;31:348-350). PMID:27073038

  1. Validation of the SYNTAX revascularization index to quantify reasonable level of incomplete revascularization after percutaneous coronary intervention.

    Science.gov (United States)

    Généreux, Philippe; Campos, Carlos M; Farooq, Vasim; Bourantas, Christos V; Mohr, Friedrich W; Colombo, Antonio; Morel, Marie-Angèle; Feldman, Ted E; Holmes, David R; Mack, Michael J; Morice, Marie-Claude; Kappetein, A Pieter; Palmerini, Tullio; Stone, Gregg W; Serruys, Patrick W

    2015-07-15

    Incomplete revascularization is common after percutaneous coronary intervention (PCI). Whether a "reasonable" degree of incomplete revascularization is associated with a similar favorable long-term prognosis compared with complete revascularization remains unknown. We sought to quantify the proportion of coronary artery disease burden treated by PCI and evaluate its impact on outcomes using a new prognostic instrument-the Synergy Between PCI with Taxus and Cardiac Surgery (SYNTAX) Revascularization Index (SRI). The baseline SYNTAX score (bSS), the residual SYNTAX score, and the delta SYNTAX score (ΔSS) were determined from 888 angiograms of patients enrolled in the prospective SYNTAX trial. The SRI was then calculated for each patient using the following formula: SRI = (ΔSS/bSS]) × 100. Outcomes were examined according to the proportion of revascularized myocardium (SRI = 100% [complete revascularization], 50% to SYNTAX score was 4.5 ± 6.9. The mean SRI was 85.3 ± 21.2% and was 100% in 385 patients (43.5%), <100% to 50% in 454 patients (51.1%), and <50% in 48 patients (5.4%). Five-year adverse outcomes, including death, were inversely proportional to the SRI. An SRI cutoff of <70% (present in 142 patients [16.0%] after PCI) had the best prognostic accuracy for prediction of death and, by multivariable analysis, was an independent predictor of 5-year mortality (hazard ratio [HR] 4.13, 95% confidence interval [CI] 2.79 to 6.11, p <0.0001). In conclusion, the SRI is a newly described method for quantifying the proportion of coronary artery disease burden treated by PCI. The SRI is a useful tool in assessing the degree of revascularization after PCI, with SRI ≥70% representing a "reasonable" goal for patients with complex coronary artery disease.

  2. COMPARATIVE EVALUATION OF THE ANTIHYPERTENSIVE EFFECT OF PERINDOPRIL AND LOSARTAN POTASSIUM IN PATIENTS WITH ARTERIAL HYPERTENSION AND STENOTIC CORONARY ATHEROSCLEROSIS BEFORE REVASCULARIZATION: AN OPEN RANDOMIZED COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    O. A. Osipova

    2011-01-01

    Full Text Available Aim. To compare effects of perindopril and losartan potassium on the parameters of the ambulatory blood pressure (BP monitoring (ABPM and circadian BP profile in patients with arterial hypertension (HT and stenotic coronary atherosclerosis before myocardium revascularization. Material and methods. 59 patients with HT degree 2-3 at the age of 35-69 were examined. ABPM was performed in all patients. Daily profile was assessed by the degree of nocturnal BP reduction. Patients were randomized to receive perindopril or losartan potassium. Perindopril was administered at dose of 4 mg/day with subsequent rising up to 8 mg/day in next 7 days. The initial dose of losartan potassium was 25 mg with subsequent rising up to 50 mg 2 times a day. Duration of observation was 8 weeks. Results. Perindopril reduced 24-hour and daytime systolic BP (SBP by 17.2% (p<0.0001, nighttime SBP - by 22.5% (p<0.0001, 24-hour and daytime diastolic BP (DBP - by 18.3% and 17.6% (p<0.0001, respectively , nighttime DBP - by 27.2% (p<0.0001. Losartan potassium reduced 24-hour SBP by 25.7% (p<0.0001, daytime SBP - by 23.6% (p<0.0001, night-time SBP – by 25.5% (p<0.0001, 24-hour DBP - by 27.4%, daytime DBP - by 26.3%, nighttime DBP - by 18.5% (p=0.003. Perindopril decreased in number of non-dippers by 24,3% and night-peakers by 5.4% as well as increased in number of dippers by 27% and over-dippers by 2.7%. A number of patients with SAD profile corresponding to non-dipper type was 45.5% more in losartan taking than this when perindopril receiving (p=0.027. Conclusion. In patients with HT and stenotic coronary atherosclerosis perindopril therapy increases a number of patients with normal BP profile before myocardium revascularization.

  3. Ectopic Origin of Coronary Arteries Diagnozed by Coronary Angiography

    Science.gov (United States)

    Krasniqi, Xhevdet; Gorani, Daut; Sejdiu, Basri; Citaku, Hajdin

    2016-01-01

    Introduction: Anomalous origin of coronary arteries from opposite sinus of Valsalva is rare finding. The incidence of anomalous origination of the left coronary artery from right sinus is 0.15% and the right coronary artery from the left sinus is 0.92%. The ectopic origin of left coronary artery or right coronary artery from opposite sinus depending on pathways and considering atherosclerotic changes are manifested with different clinical significance. Case report: We report two cases, the first case the coronary angiography showed the left coronary artery arising from the right coronary sinus, presenting with proximally and distally stenosed left anterior descending artery (LAD), associated with medial and distal stenosed right coronary artery (RCA). The second case the coronary angiography revealed the right coronary artery arising from the left coronary sinus, associated with tortuous medial and distal segments of left anterior descending artery (LAD), without atherosclerotic changes. The first case successfully underwent treatment procedures based on guidelines for revascularization. Conclusion: The coronary angiography of patients with coronary ischemia determines atherosclerotic disease with possibility of the presence of coronary artery anomalies that in cases with ectopic origin from opposite sinus continues to exist as a challenge during treatment in interventional cardiology. PMID:27482140

  4. Total Arterial Revascularization with Internal Mammary Artery or Radial Artery Graft Configuration

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    To investigate the clinical use of π graft in total arterial revascularization and its outcomes, a retrospective analysis of 23 patients out of 1000 patients undergoing total arterial coronary bypass surgery with a π graft between September 1994 and December 2004 was performed. In the selected patients for the management of triple vessel disease with middle diagonal/intermediate ramus disease such that a skip with the left internal mammary artery (LIMA) or radial artery (RA),the main stem of π graft, to the left anterior descending coronary artery (LAD) will not work and the right internal mammary artery (RIMA) or right gastroepiploic artery (RGEA) cannot pick up the diagonal/intermediate ramus, hence the LAD and diagonal/intermediate ramus were grafted with a mini Y graft using the distal segment of LIMA, RIMA, RA or RGEA, together with the bilateral internal mammary artery (BIMA) or LIMA-RA T graft to compose π graft. Twenty-three patients (18 males, 5 females) underwent the π graft procedure. There were no deaths or episodes of myocardial infarction, stroke, and deep sternal wound infection. One patient required reopening for controlling bleeding. Until the end of 2004, during a mean follow-up of 81.0 ±28.4 months, no angina needing re-intervention or operative therapy or coronary related death occurred. In conclusion, in patients with specific coronary artery anatomy/stenosis, the BIMA (sometimes LIMA with RA or RGEA) π graft can be successfully performed for total arterial revascularization with good midterm outcomes.

  5. Benefit of cardiac rehabilitation programme in revascularized coronary patient

    OpenAIRE

    Laura Crăciun; Claudiu Avram; Adina Avram; Stela Iurciuc; Dan Gaiţă

    2009-01-01

    Objective: Evaluating the cardiovascular risk profile in revascularized coronary patients at 16 months after revascularization(PCI+CABG). Material and method: We evaluated the cardiovascular risk profile, compliance to the secondary preventionmeasures and reaching guideline targets in revascularized coronary patients included in EuroASpire III Romania. The patientswere divided in two groups: the selection criteria was the adherence to cardiac rehabilitation programme (CRP+/CRP-). Result:The p...

  6. Revascularization Strategies in Patients with Diabetes Mellitus and Acute Coronary Syndrome.

    Science.gov (United States)

    Buntaine, Adam J; Shah, Binita; Lorin, Jeffrey D; Sedlis, Steven P

    2016-08-01

    Patients with diabetes mellitus (DM) have more severe CAD and higher mortality in acute coronary syndrome (ACS) than patients without DM. The optimal mode of revascularization-coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI)-remains controversial in this setting. For patients with DM and ST-segment elevation myocardial infarction, prompt revascularization of the culprit artery via PCI is generally preferable. In non-ST-elevation ACS, the decision on mode of revascularization is more challenging. Trials comparing CABG with percutaneous transluminal coronary angioplasty, bare metal stents, and first-generation drug-eluting stents in DM patients with multivessel have demonstrated decreased mortality in those receiving CABG. On the other hand, trials and retrospective analyses comparing CABG to PCI with second-generation drug-eluting stents have not shown a statistically significant mortality benefit favoring CABG. This potentially narrowed that gap between CABG and PCI requires further investigation. PMID:27339854

  7. Anomalous Coronary Artery: Run of a Lifetime.

    Science.gov (United States)

    Green, Michael Stuart; Sehgal, Sankalp; Smukler, Naomi; Suber, LaDouglas Jarod; Saththasivam, Pooven

    2016-09-01

    The anatomy of the coronary circulation is well described with incidence of congenital anomalies of approximately 0.3% to 1.0%. Although often incidental, 20% are life-threatening. A 25-year-old woman with syncopal episodes collapsed following a 10-km run. Coronary anatomy evaluation showed an anomalous left main coronary artery originating from the right sinus of valsalva and following a course between the aorta and the pulmonary outflow tract. Percutaneous coronary intervention was followed by eventual surgical revascularization. Abnormal course of coronary arteries plays a role in the pathogenesis of sudden death on exertion. Origin of the left main coronary from the right sinus of valsalva is a rare congenital anomaly. The expansion of the roots of the aorta and pulmonary trunk with exertion lead to compression of the coronary artery and syncope. Our patient raises awareness of a potentially fatal coronary artery path. Intraoperative identification of anomalous coronaries by utilizing intraoperative transesophageal echocardiography was critical.

  8. Triple-Vessel Percutaneous Coronary Revascularization In Situs Inversus Dextrocardia

    Directory of Open Access Journals (Sweden)

    Nikolaos Kakouros

    2010-01-01

    Full Text Available Dextrocardia with situs inversus occurs in approximately one in 10,000 individuals of whom 20% have primary ciliary dyskinesia inherited as an autosomal recessive trait. These patients have a high incidence of congenital cardiac disease but their risk of coronary artery disease is similar to that of the general population. We report what is, to our knowledge, the first case of total triple-vessel coronary revascularization by percutaneous stent implantation in a 79-year-old woman with situs inversus dextrocardia. We describe the successful use of standard diagnostic and interventional guide catheters with counter rotation and transversely inversed image acquisition techniques. The case also highlights that the right precordial pain may represent cardiac ischemia in this population.

  9. 冠心病血运重建术后患者二级预防现状调查%Compliance of secondary prevention in patients with coronary artery disease post coronary revascularization

    Institute of Scientific and Technical Information of China (English)

    任文林; 皮林; 张明明; 胡大一; 许玉韵; 周立辉; 吴旸; 张凤英; 范宗静; 赵扣荣; 王彦辉; 李莉; 李贵华

    2012-01-01

    Objective To investigate the compliance status of secondary prevention in patients with coronary artery disease (CAD) following revascularization.Methods A total of 512 patients with CAD who received procedures for coronary revascularization were enrolled in the study from January 2009 to October 2010,including 472 cases of percutaneous coronary intervention stenting,25 cases of coronary artery bypass grafting and 15 cases of stenting plus bypass.The demographic information,prophylactic drug therapies, lifestyle changes and modifiable risk factors were surveyed with questionnaires,anthroposomatological measurements and laboratory tests in patients 3 months after coronary revascularization.Results The proportion of patients on statins,aspirin,β-blockers,angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) and influenza vaccination were 81.4% (417/512),93.9% ( 481/512 ),82.0% ( 420/512 ),76.2% ( 390/512 ) and 3.7% ( 19/512 ) respectively.Based on the criteria recommended by the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines for Secondary Prevention for Patients with Coronary and Other Atherosclerotic Vascular Disease: 2006 Update, the percentages of achieving therapeutic targets of modifiable risk factor management were as follows:glycosylated hemoglobin (90.2%,462/512 ),total cholesterol ( 68.6%,351/512 ),triglycerides ( 58.8%,301/512 ),high-density lipoprotein cholesterol ( 91.6%,469/512 ),low-density lipoprotein cholesterol ( 44.5 %,228/512 ),systolic pressure ( 75.2 %,385/512 ) and diastolic pressure (90.4%,463/512 ) respectively.And the proportions of improved lifestyle were as follows:smoking cessation/non-smoking 81.4% (417/512),diet control 78.5% ( 402/512 ),achieving weight targets 61.7% (316/512)and regular exercise 58.2% (298/512).Conclusions There is a relatively high percentage of standardized antiplatelet therapy and continuous statins medication in patients

  10. Coronary anomaly: the single coronary artery

    Institute of Scientific and Technical Information of China (English)

    QIN Xu-guang; XIONG Wei-guo; LU Chun-peng; GONG Cheng-jie; SHANG Li-hua

    2010-01-01

    @@ Single coronary artery (SCA), defined as an artery that arises from the arterial trunk and nourishes the entire myocardium, is rare. We report two cases of SCA, one is the right coronary artery (RCA) originating from the middle of left descending artery (LAD), and the other is the left main coronary artery (LMCA) arising from the proximal right coronary artery.

  11. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

    Science.gov (United States)

    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; PURL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  12. Intraoperative angiography after coronary bypass grafting in a patient presenting with a single coronary artery: a case report.

    Science.gov (United States)

    Bigdeli, Amir K; Kilian, Eckehard; Beiras-Fernandez, Andres; Vogt, Ferdinand; Reichart, Bruno; Kur, Felix

    2010-06-01

    Among coronary artery anomalies, single coronary artery is one of the rarest anomalies. Pulmonary origins of the coronary arteries, coronary artery fistulae, and anomalous aortic origins of the coronary arteries are the most common anomalies requiring surgical intervention. In this case, we describe the performance of bypass grafting after unsuccessful attempts at percutaneous coronary intervention in a 72-year old male patient with single coronary artery arising from the right sinus of Valsalva and with associated diffuse coronary atherosclerosis. Intraoperative angiography was performed to evaluate the revascularization of this anomalous coronary system. The patient remains symptom free 6 months after the operation.

  13. Carotid artery revascularization : Surgical and endovascular developments

    OpenAIRE

    de Borst, G. J.

    2007-01-01

    Carotid artery revascularization. Surgical and endovascular developments. Stroke is among the most disabling chronic diseases and the third major cause of death in the Western world. In the Netherlands around 12 per 1000 inhabitants suffers a stroke, and in 2005 over 10.000 people died as a result of stroke representing 7.6% of all deaths. In 10-20% of patients stroke is heralded by transient cerebral deficit. These harbingers of stroke allow a certain amount of time to search for the cause o...

  14. Arterial hypertension and associated factors in patients submitted to myocardial revascularization

    Directory of Open Access Journals (Sweden)

    Flávia Cortez Colósimo

    2015-04-01

    Full Text Available OBJECTIVE To identify the prevalence of arterial hypertension and associated factors in patients submitted to myocardial revascularization. METHOD Cross-sectional study using the database of a hospital in São Paulo (SP, Brazil containing 3010 patients with coronary artery disease submitted to myocardial revascularization. A multiple logistic regression was performed to identify variables independently associated with hypertension (statistical significance: p1.3: (OR=1.37;CI:1.09-1.72. CONCLUSION A high prevalence of arterial hypertension and association with both non-modifiable and modifiable factors was observed.

  15. Screening asymptomatic patients with diabetes for unknown coronary artery disease: Does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?

    Directory of Open Access Journals (Sweden)

    Romano Stefania

    2009-12-01

    Full Text Available Abstract Background Coronary artery disease is the leading cause of morbidity and mortality in patients with type 2 diabetes. Screening for asymptomatic coronary artery disease with treatment by means of revascularization seems to be an appealing option for prevention. The utility of such a strategy has never been challenged in a randomized trial. Methods/Design In the present study a cohort of diabetic patients without any symptoms and without known coronary artery disease will be screened at two diabetes outpatients services. Those with intermediate or high risk (equal or greater than 10% according to the Italian risk chart will be asked to participate and enrolled. They will be seen and followed in order to provide the best adherence to medical therapy. Half of the patients will be randomized to undergo an exercise tolerance testing while the other group will continue to be regularly seen at diabetes outpatients services. Best medical/behavioral therapy will be offered to both groups. Those patients with a positive exercise tolerance testing will be studied by coronary angiography and treated according to the severity of coronary lesions by percutaneous stenting or surgery. The objective of the study is to evaluate the efficacy of the screening strategy aimed at revascularization. A cost-effectiveness analysis will be performed at the end of the follow up. Discussion The study will provide useful information about prevention and treatment of diabetic patients at high risk of coronary events. It will be made clearer if detection of silent coronary artery disease has to be recommended and followed by treatment. Given the simplicity of the study protocol, it will be easily transferable to the real world. Trial registration (ClinicalTrials.gov: NCT00547872

  16. Optimal treatment of multivessel complex coronary artery disease

    OpenAIRE

    SUN, HAIHUI; CUI, LIANQUN

    2014-01-01

    The aim of the present study was to investigate major cardiac events and the similarities and differences of medical costs among patients with multivessel complex coronary artery disease (MCCAD) during the three-year follow-up. The MCCAD patients had undergone single complete revascularization (CR), fractionated revascularization (FR) or partial revascularization (PR) and the present study aimed to screen the optimal treatment program. A total of 2,309 MCCAD patients who had been treated at a...

  17. Progression from stenosis to occlusion in the proximal native coronary artery after coronary artery bypass grafting.

    Science.gov (United States)

    Tanaka, Akihito; Ishii, Hideki; Oshima, Hideki; Shibata, Yohei; Tatami, Yosuke; Osugi, Naohiro; Ota, Tomoyuki; Kawamura, Yoshihiro; Suzuki, Susumu; Usui, Akihiko; Murohara, Toyoaki

    2016-07-01

    Coronary artery bypass grafting (CABG) is an established treatment for multivessel coronary artery disease. However, problematic situations are occasionally encountered after CABG, such as disease progression in the native coronary artery with graft occlusion, which causes difficulty in revascularization. The purpose of this study was to evaluate changes in the native coronary artery after CABG. Between 2009 and 2012 in our institution, 351 patients underwent CABG, and 768 bypass grafts were anastomosed to non-occluded coronary arteries. Of these, 489 bypass grafts had available early postoperative angiographic results (≤6 months) suitable for assessment in this study. We defined malignant graft failure after CABG to be bypass graft occlusion and de novo complete occlusion of the target native coronary artery proximal to the graft anastomosis site. In the early angiographic results, 17 grafts were occluded (17/489; 3.5 %). Two of the grafts displayed malignant graft failure (a saphenous vein graft to the right coronary artery and a saphenous vein graft to the diagonal branch) (2 of 17 occluded grafts, and 2 of 489 studied grafts). Of the patent bypass grafts, 24 involved progression to occlusion in the proximal native coronary artery (19 saphenous vein grafts, 4 left internal thoracic artery grafts, and 1 right internal thoracic artery graft). Malignant graft failure was uncommon during short-term follow-up after CABG. At the same time, disease progression in the proximal native coronary artery from stenosis to occlusion following patent bypass grafting was relatively common, especially for vein grafts.

  18. A Multidisciplinary Approach to Unplanned Conversion from Off-Pump to On-Pump Beating Heart Coronary Artery Revascularization in Patients with Compromised Left Ventricular Function

    Directory of Open Access Journals (Sweden)

    Georgia Tsaousi

    2014-01-01

    Full Text Available Aim. To comparably assess the perioperative risk factors that differentiate off-pump coronary artery bypass (OPCAB grafting cases from those sustaining unplanned conversion to on-pump beating heart (ONCAB/BH approach, in patients with left ventricular ejection fraction (LVEF 2 days (P=0.007. Conclusions. Patients with LVEF < 40% undergoing ONCAB/BH are subjected to more preoperative comorbidities and implicated ICU stay than their OPCAB counterparts, which influences adversely short-term morbidity, while operative mortality remains unaffected.

  19. Brachytherapy in coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Song, Ho Chun [Chonnam National University Medicine School, Gwangju (Korea, Republic of)

    2006-04-15

    Coronary artery disease is a leading cause of morbidity and mortality across the world. Percutaneous coronary intervention has become the major technique of revascularization. However, restenosis remains a major limitation of this procedure. Recently the need for repeat intervention due to restenosis, the most vexing long-term failure of percutaneous coronary intervention, has been significantly reduced owing to the introduction to two major advances, intracoronary brachytherapy and the drug-eluting stents, intracoronary brachytherapy has been employed in recent years to prevent restenosis lesions with effective results, principally in in-stent restenosis. Restenosis is generally considered as an excessive form of normal wound healing divided up in processes: elastic recoil, neointimal hyperplasia, and negative vascular remodeling. Restenosis has previously been regarded as a proliferative process in which neointimal thickening, mediated by a cascade of inflammatory mediators and other factors, is the key factor. Ionizing radiation has been shown to decrease the proliferative response to injury in animal models of restenosis. Subsequently, several randomized, double-blind trials have demonstrated that intracoronary brachytherapy can reduce the rates to both angiographic restenosis and clinical event rates in patients undergoing percutaneous coronary intervention for in-stent restenosis. Some problems, such as late thrombosis and edge restenosis, have been identified as limiting factors of this technique. Brachytherapy is a promising method of preventing and treating coronary artery restenosis.

  20. The Right Gastroepiploic Artery Graft for Coronary Artery Bypass Grafting: A 30-Year Experience

    Science.gov (United States)

    Suma, Hisayoshi

    2016-01-01

    Throughout its 30-year history, the right gastroepiploic artery (GEA) has been useful for in situ grafts in coronary artery bypass grafting (CABG). The early graft patency rate is high, and the late patency rate has improved by using the skeletonized GEA graft and proper target selection, which involves having a target coronary artery with a tight >90% stenosis. Total arterial revascularization with the internal thoracic artery and GEA grafts is an option for achieving better outcomes from CABG procedures. PMID:27525230

  1. Benefit of cardiac rehabilitation programme in revascularized coronary patient

    Directory of Open Access Journals (Sweden)

    Laura Crăciun

    2009-06-01

    Full Text Available Objective: Evaluating the cardiovascular risk profile in revascularized coronary patients at 16 months after revascularization(PCI+CABG. Material and method: We evaluated the cardiovascular risk profile, compliance to the secondary preventionmeasures and reaching guideline targets in revascularized coronary patients included in EuroASpire III Romania. The patientswere divided in two groups: the selection criteria was the adherence to cardiac rehabilitation programme (CRP+/CRP-. Result:The prevelence of cardiovascular risk factors was about 76%, with an increased significance in CRP- group (p0.05, OR>1. Conclusion: At 16 months after revascularisation, the patientsstill present a high risk. The level of cardio-metabolic and hemodynamic risk are maintained the same by unreaching thetargeted values recomended by ESC prevention guideline. The patients in CPR+ group had a significant improvement ofcardiovascular risk factors. Indication but also compliance to structured cardiac rehabilitation programme after myocardialrevascularisation remains at a suboptimal level.

  2. Revascularização da artéria coronária direita intra-atrial Revascularization of intracavitary right coronary artery

    Directory of Open Access Journals (Sweden)

    Artur Lourenção Júnior

    1990-12-01

    Full Text Available A artéria coronária direita, em seu trajeto no sulco atrioventricular direito, pode, em raras ocasiões, penetrar na cavidade atrial direita. Esta variação anatômica poderá modificar a tática cirúrgica em operações de revascularização miocárdica. No presente trabalho, relatamos o caso em que a ponte de veia safena para a artéria coronária direita foi realizada em posição intra-atrial direita.The right coronary artery, during your course in the right atrioventricular sulcus, can sometimes penetrate the right atrial cavity. This anatomical variety can modify the surgical tactics in aortocoronary by-pass surgery. In this paper we present a patient in whom the by-pass with saphenous vein graft to the right coronary artery was made in right intracavitary position.

  3. Coronary Artery Disease - Coronary Heart Disease

    Science.gov (United States)

    ... Tools & Resources Stroke More Coronary Artery Disease - Coronary Heart Disease Updated:May 20,2016 View an animation of ... call 9-1-1. Risk Factors and Coronary Heart Disease Major risk factors that can't be changed ...

  4. Coronary Artery Bypass

    Directory of Open Access Journals (Sweden)

    Kadri Ceberut

    2011-01-01

    Full Text Available Ancient schwannoma is a rare variant of neural tumors though rarely seen in the thorax. The combination with coronary artery diseases is also rare. Here we describe a 66 year-old male who had undergone one-stage combined surgery for thoracic ancient schwannomas removal and coronary artery disease. The masses were, respectively, 13 cm in the middle mediastinum and 5 cm in diameter originating from the intercostal nerve. The tumors were successfully removed using sternotomy, and then a coronary artery bypass grafting was performed. Here we discuss this rare tumor in relation to the relevant literature.

  5. Drug therapy or coronary angioplasty for the treatment of coronary artery disease : New insights

    NARCIS (Netherlands)

    Amoroso, G; Van Boven, AJ; Crijns, HJGM

    2001-01-01

    Background In the last decade percutaneous transluminal coronary angioplasty has become a very popular strategy For the treatment of coronary artery disease, although its efficacy in reducing ischemic events and the subsequent need for revascularization has yet to be proved. Methods We reviewed the

  6. Early results of coronary artery bypass grafting with coronary endarterectomy for severe coronary artery disease

    Directory of Open Access Journals (Sweden)

    Toischer Karl

    2009-09-01

    failure: 3; stroke: 1; cancer: 1; unknown reasons: 3. NYHA-classification significantly improved after CABG with CE from 2.2 ± 0.9 preoperative to 1.7 ± 0.9 postoperative. CCS also changed from 2.4 ± 1.0 to 1.5 ± 0.8 Conclusion Early results of coronary endarterectomy are acceptable with respect to mortality, NYHA & CCS. This technique offers a valuable surgical option for patients with endstage coronary artery disease in whom complete revascularization otherwise can not be obtained. Careful patient selection will be necessary to assure the long-term benefit of this procedure.

  7. [Revascularization of the carotid and vertebral arteries in the elderly].

    Science.gov (United States)

    Illuminati, G; Bezzi, M; D'Urso, A; Giacobbi, D; Ceccanei, G; Vietri, F

    2004-01-01

    From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population. PMID:15803810

  8. Coronary artery spasm

    Science.gov (United States)

    ... blocker or a long-acting nitrate long-term. Beta-blockers are another type of medicine that is used with other coronary artery problems. However, beta-blockers may make this problem worse. They should be ...

  9. Coronary Artery Bypass Surgery

    Science.gov (United States)

    ... don't help, you may need coronary artery bypass surgery. The surgery creates a new path for ... narrowed area or blockage. This allows blood to bypass (get around) the blockage. Sometimes people need more ...

  10. Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients with Coronary Artery Disease and Diabetic Nephropathy: A Single Center Experience

    OpenAIRE

    Bae, Ki Sun; Park, Hyeong Cheon; Kang, Byung Seung; Park, Jong Won; Chon, Nu Ri; Oh, Kyung Jin; Yoon, Young Won; Hong, You Sun; Ha, Sung Kyu

    2007-01-01

    Background Patients with diabetic nephropathy (DN) and coronary artery disease (CAD) represent a subset of patients with high cardiovascular morbidity and mortality. The optimal revascularization strategy using either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The purpose of this study was to compare the clinical outcomes of PCI to CABG in DN patients with CAD. Methods The clinical and angiographic records of DN patients with CAD ...

  11. The role of 99mTc-SestaMIBI in predicting post-revascularization recovery in patients with chronic coronary artery disease and LV dysfunction: a meta-analysis

    International Nuclear Information System (INIS)

    The utility of 99mTc-Sesta (MIBI) as a marker of myocardial viability is still a controversial topic. A perusal of the different published studies was therefore done to address this issue by looking at the ability of this tracer to predict recovery or non-recovery of a dysfunctional myocardium after revascularization based on MIBI uptake. Literature search was done using the Index Medicus, MEDLINE and cross-reference on the use of 99mTc-SestaMIBI in thrombolytic therapy, revascularization and viability assessment. Only studies in human were included. A qualitative and quantitative (visual) uptake was studied. These segments are supposedly expected to have no recovery even after revascularization. Eventual revascularization was done however on their corresponding coronary vessels. 57% (78/136) showed recovery in function while only 43% (58/136) were identified correctly (p>0.05=ns). Quantitative analysis of uptake were done on these segments with poor visual uptake. One study (Marzullo et.al.) divided these segments into those with MIBI uptake above and below 55%. His findings revealed that 35/45 segments with uptake >55% had improved function after revascularization (PPV=78%) while 14/21 segments with uptake 50% showed functional improvement while 61% (NPV) of segments with uptake 99mTc-SestaMIBI is primarily a perfusion agent. Attempts therefore to use this tracer to asses myocardial viability should be made with caution and if ever, must be done quantitatively. (author)

  12. Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Li-Qun Chi

    2015-01-01

    Full Text Available Background: It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD. Coronary endarterectomy (CE offers an alternative choice of coronary artery reconstruction and revascularization. In this study, short-term result of CE combined with coronary artery bypass graft (CABG was discussed in the treatment for the diffused CAD. Methods: From January 2012 to April 2014, 221 cases of CABG were performed by the same surgeon in our unit. Among these cases, 38 cases of CE + CABG were performed, which was about 17.2% (38/221 of the cohort. All these patients were divided into two groups: CE + CABG group (Group A and CABG alone group (Group B. All clinical data were compared between the two groups, and postoperative complications and in-hospital mortality were analyzed. The categorical and continuous variables were analyzed by Chi-square test and Student′s t-test respectively. Results: Diabetes mellitus, hypertension, hyperlipidemia, and peripheral vascular disease were more common in group A. In this cohort, a total of 50 vessels were endarterectomized. Among them, CE was performed on left anterior descending artery in 11 cases, on right coronary artery in 29 cases, on diagonal artery in 3 cases, on intermediate artery in 2 cases, on obtuse marginal artery in 5 cases. There was no hospital mortality in both groups. The intro-aortic balloon pump was required in 3 cases in Group A (3/38, which was more often than that in Group B (3/183. At the time of follow-up, coronary computed tomography angiogram showed all the grafts with CE were patent (50/50. There is no cardio-related mortality in both groups. All these patients were free from coronary re-intervention. Conclusions: Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

  13. Sequential saphenous vein grafting combined with selective arterialization of middle cardiac vein during off-pump coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    YU Yang; QI Dan-ni; GU Cheng-xiong

    2010-01-01

    @@ Currently coronary artery bypass grafting (CABG) is the most commonly used procedure for revascularization of coronary heart disease. However it may not be suitable for the patients with diffuse coronary artery diseases. Under this circumstance, retrograde perfusion via cardiac venous system, namely retrograde coronary venous bypass graft (CVBG), may be the proper therapeutic selection.1 The idea of myocardial revascularization by means of grafting the coronary venous system is more than a century old. However, few clinical trials and long-term outcome data have been presented. The use of venous arterialization has not been widely used. We report the use of a sequential saphenous vein graft from the aorta to middle cardiac vein in a patient with diffuse lesions in right coronary artery during off-pump coronary artery bypass surgery (OPCAB).

  14. [The single coronary artery].

    Science.gov (United States)

    Godart, F; Berzin, B; Rihani, R; Pecheux, M; Dutoit, A

    1992-04-01

    Single coronary artery is a fairly rare entity which may nevertheless be found in 0.4 per cent of coronary arteriograms. The authors report 3 cases seen in 2 departments of cardiology. In each patient, despite the existence of definite cardiovascular risk factors, this distribution was a factor worsening coronary ischemia, leading to complete thrombosis in one case. Although most often a chance discovery, a review of the literature justifies the attribution to this anomaly of the onset of angina, infarction or even sudden death. PMID:1642437

  15. Bilateral Internal Thoracic Artery Configuration for Coronary Artery Bypass Surgery

    Science.gov (United States)

    Boodhwani, Munir; Hanet, Claude; de Kerchove, Laurent; Navarra, Emiliano; Astarci, Parla; Noirhomme, Philippe; El Khoury, Gebrine

    2016-01-01

    Background— Bilateral internal thoracic arteries (BITA) have demonstrated superior patency and improved survival in patients undergoing coronary artery bypass grafting. However, the optimal configuration for BITA utilization and its effect on long-term outcome remains uncertain. Methods and Results— We randomly assigned 304 patients undergoing coronary artery bypass grafting using BITA to either in situ or Y grafting configurations. The primary end point was 3-year angiographic patency. Secondary end points included major adverse cardiac and cerebrovascular events (ie, death from any cause, stroke, myocardial infarction, or repeat revascularization) at 7 years. More coronary targets were able to be revascularized using internal thoracic arteries in patients randomized to Y grafting versus in situ group (3.2±0.8 versus 2.4±0.5 arteries/patient; P<0.01). The primary end point did not show significant differences in graft patency between groups. Secondary end points occurred more frequently in the in situ group (P=0.03), with 7-year rates of 34±10% in the in situ and 25±12% in the Y grafting groups, driven largely by a higher incidence of repeat revascularization in the in situ group (14±4.5% versus 7.4±3.2% at 7 years; P=0.009). There were no significant differences in hospital mortality or morbidity or in late survival, myocardial infarction, or stroke between groups. Conclusions— Three-year systematic angiographic follow-up revealed no significant difference in graft patency between the 2 BITA configurations. However, compared with in situ configuration, the use of BITA in a Y grafting configuration results in lower rates of major adverse cardiovascular and cerebrovascular events at 7 years. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01666366. PMID:27406988

  16. Prevalence and 1-year prognosis of transient heart failure following coronary revascularization.

    Science.gov (United States)

    Ambrosetti, Marco; Griffo, Raffaele; Tramarin, Roberto; Fattirolli, Francesco; Temporelli, Pier Luigi; Faggiano, Pompilio; De Feo, Stefania; Vestri, Anna Rita; Giallauria, Francesco; Greco, Cesare

    2014-09-01

    The occurrence of heart failure during the whole pre-discharge course of coronary revascularization, as far as its influence on subsequent prognosis, is poorly understood. The present study examined the effect of transient heart failure (THF) developing in the acute and rehabilitative phase on survival after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI). Patients in the Italian survey on cardiac rehabilitation and secondary prevention after cardiac revascularization (ICAROS) were analyzed for THF, the latter being defined either as signs and symptoms consistent with decompensation or cardiogenic shock. ICAROS was a prospective, multicenter registry of 1,262 consecutive patients discharged from 62 cardiac rehabilitation (CR) facilities, providing data on risk factors, lifestyle habits, drug treatments, and major cardiovascular events (MACE) during a 1-year follow-up. Records were linked to the official website of the Italian Association of Cardiovascular Prevention and Rehabilitation (GICR-IACPR). The overall prevalence of pre-discharge THF was 7.6%, with 69.8% of cases in acute wards, 22.9% during CR, and 7.3% in both settings. THF affected more frequently patients with chronic cardiac condition (42.7 vs. 30.6%; p After discharge, THF patients showed good maintenance rates of RAAS modulators (90.6%) and beta-blockers (83.3%), while statin therapy significantly decreased from 81.3 to 64.6% (p after coronary revascularization had increased post-discharge mortality and cardiovascular events. Hemodynamic instability, rather than recurrent myocardial ischemia, seems to be linked with worse prognosis. PMID:24146110

  17. Case Report: Coronary arterial spasm in single right coronary artery

    Institute of Scientific and Technical Information of China (English)

    En-zhi JIA; Qi-jun SHAN; Zhi-jian YANG; Tie-bing ZHU; Lian-sheng WANG; Ke-jiang CAO; Wen-zhu MA

    2009-01-01

    We presented a case of anomalous single-coronary artery detected incidentally during routine coronary angiography. A 32-year-old male Chinese patient presented with recurrent pre-syncope and six episodes of syncope. Coronary angiography and coronary-computed tomography (CT)-angiography performed by a dual-source computed tomography (DSCT) revealed that the patient had a single large right coronary artery. A moderately large branch originated from the proximal part of the single right coronary artery and extended to the left, passing the anterior to the pulmonary artery, and divided into the anterior descending artery branch and circumflex branch at the base of the left auricular appendage. The episodes of the syncope were suspected to be caused by coronary arterial spasm, so this patient was on a regimen of 30 mg of diltiazem every 6 h and had no recurrence of syncope during follow-up.

  18. Dual anterior descending coronary artery associated with coronary artery disease

    Directory of Open Access Journals (Sweden)

    Siqueira Luciane da L. V.

    2003-01-01

    Full Text Available The patient is a male with risk factors for coronary artery disease, who was referred for cardiac catheterization after acute myocardial infarction in the inferior wall. The patient underwent transluminal coronary angioplasty in the right coronary artery with successful stent implantation.

  19. Coronary revascularization in a patient with dextrocardia and situs inversus.

    Science.gov (United States)

    Siddiqi, Mohammad Salman; Al Harrasi, Khoula; Ziadinov, Edem; Al-Sabti, Hilal; Sharma, Ashok Kumar

    2014-10-01

    A few cases of coronary artery bypass surgery in patients with dextrocardia and situs inversus have been reported so far worldwide. This is the first reported case from the Gulf region. The operation was performed with the surgeon standing on the left side. Grafts included right internal mammary artery to the left anterior descending artery, and saphenous vein to the diagonal and obtuse marginal arteries. The patient was discharged home after 12 days, with no complication. He was doing well after 3 months of follow-up.

  20. Coronary angiographies of patients with recurrent acute coronary syndrome following coronary artery bypass grafting

    Institute of Scientific and Technical Information of China (English)

    JIA Yu-he; YANG Yue-jin; WEI Yi-zhen; YAO Min; HU Sheng-shou

    2005-01-01

    @@ Coronary artery bypass grafting (CABG) is considered as a more complete means of revascularization than percutaneous coronary intervention (PCI). However, acute coronary syndrome (ACS) can still occur after CABG. The culprit vessel can be the graft vessel or the native vessel. Many questions remain unanswered in the Chinese literature regarding this topic: what are the short- and long-term pathological changes that induce ACS? Is there any difference between arterial and venous grafts with respect to the frequency of restenosis? Are there any patterns of ACS-related vessels in different periods after CABG? We aim to answer these fundamental questions by analyzing coronary angiographies of patients with recurrent ACS following CABG and provide evidence for reducing post-CABG restenosis.

  1. Current status of coronary artery bypass surgery

    Institute of Scientific and Technical Information of China (English)

    CHEN Xin

    2009-01-01

    @@ Surgical revascularization for atherosclerotic heart disease, also called coronary artery bypass grafting (CABG), was first performed in 1962, and is one of the great achievements in medicine. Relief of angina, improvement of exercise tolerance, and the realization of survival benefit have been documented.1 CABG has been used in multi-vessel disease and left main stenosis for over 40 years.2 In the last two decades the mortality of CABG has decreased to less than 2% despite an aging population with increased risk factors. However, percutaneous coronary intervention (PCI), especially with drug-eluting stents, has been challenging CABG, While PCI has improved, CABG has also progressed with better peri-operative management, a higher use of arterial grafting, off-pump surgery, and improved techniques with minimally invasive surgical options.3,4

  2. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    Science.gov (United States)

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease. PMID:23804483

  3. Comparison of Long-Term Outcome After Percutaneous Coronary Intervention Versus Coronary Artery Bypass Grafting in Patients With Unprotected Left Main Coronary Artery Disease (from the CREDO-Kyoto PCI/CABG Registry Cohort-2).

    OpenAIRE

    Shiomi, Hiroki; MORIMOTO, TAKESHI; Hayano, Mamoru; Furukawa, Yutaka; Nakagawa, Yoshihisa; Tazaki, Junichi; Imai, Masao; Yamaji, Kyohei; Tada, Tomohisa; Natsuaki, Masahiro; Saijo, Sayaka; Funakoshi, Shunsuke; Nagao, Kazuya; Hanazawa, Koji; Ehara, Natsuhiko

    2012-01-01

    The long-term outcome of percutaneous coronary intervention (PCI) compared to coronary artery bypass grafting (CABG) for unprotected left main coronary artery disease (ULMCAD) remains to be investigated. We identified 1,005 patients with ULMCAD of 15,939 patients with first coronary revascularization enrolled in the CREDO-Kyoto PCI/CABG Registry Cohort-2. Cumulative 3-year incidence of a composite of death/myocardial infarction (MI)/stroke was significantly higher in the PCI group than in the...

  4. Off-Pump Complete Coronary Revascularization with 860 Cases and Two Year Experience

    Institute of Scientific and Technical Information of China (English)

    谢斌; 张镜芳; Pravin Kuma; Devi Prasad Shetty

    2002-01-01

    Background Cardiopulmonary bypass (CPB) produces a well-documented diffuse inflammatory response that affects multiple organ systems. To avoid the deleterious effects of cardiopulmonary bypass, off-pump coronary artery bypass grafting is becoming increasingly popular world- wide.We reviewed our experience of complete coronary artery revascularization on the beating heart without CPB.Methods From Aug 1998 to Aug 2000, 860off-pump revascularizations (99 % since January 1999) were performed at Manipal Hospital Heart Foundation. The patients consist of males 757(88%), females 103(12%) . Averaged age 64. 2±15years. All surgeries were performed through a median sternotomy. Exposure techniques are tailored to individual vessels and cardiac regions. Local immobilization is performed with octopus. Vascular control is achieved with occluders and shunts. Results Among 860 off-pump CABG patients. Single graft 72(8.3 % ), two grafts 208 (24. 2 % ), three grafts 469(54.5 % ), four grafts 101 (11.8 % ), five graft 10(1.2 % ) . The average number of grafts per patient was 2.72 ±0. 32. Operative mortality was 0.69 % (6patients). Anesthetic time 3.9 + 1.2hours, extubation time 6 ± 2. 5 hours, Blood requirement 360 ±90 ml,Preoperative LVEF 60.2 + 8.5 %, Post LVEF 64. 1 +14 % Low cardiac output 48 patients (5.6 % ), IABP requirement: 25 patients(2.9 %), 25 patients converted to CPB during OP-CAB (2.9 % ) and 20 of them were done with on pump beating heart. 25 patientsshowed myocardial ischemic and 16 patients showed perioperative myocardial infarction. ICU stay 1. 1 ± 0.8days, hospital stay 6.2±1.1 days. Conclusion Off-pump coronary artery bypass in complete revas cularization is a safe, effective technique and suitable.

  5. Right Coronary Artery Arising from Circumflex Artery: A Case of Single Coronary Artery Anomaly

    Directory of Open Access Journals (Sweden)

    Hekim Karapınar

    2013-08-01

    Full Text Available Coronary artery anomalies could be cause of conflicts for catheterization, especially, in the setting of acute coronary syndrome. We described a case of rare single coronary anomaly which the right coronary artery arisen from terminal part of left circumflex artery. Patient was presented with non-ST segment elevation myocardial infarction. Coronary angiography revealed subtotal stenosis of left anterior descending artery at the mid portion. Left circumflex artery lying in usual route and branch out the posterior descending artery. The right coronary artery arisen from terminal circumflex artery. Left anterior descending artery lesion was stented without any complication.

  6. Application of SYNTAX score in choosing the optimal revascularization strategies in patients with complex coronary artery disease%SYNTAX积分用于复杂冠心病患者血运重建策略价值研究

    Institute of Scientific and Technical Information of China (English)

    何继强; 玉献鹏; 李全; 高阅春; 孙广龙; 于洋; 吴强; 陈方

    2013-01-01

    Objective The aim of this study was to evaluate SYNTAX score,role in guiding the choice of optimal revascularization strategies in patients with complex coronary artery disease.Methods 361 consecutive patients with de novo left main or three-vessel coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI) with drug-eluting stent (n =191) or coronary artery bypass grafting (CABG) (n =170) between Jan.2008 and Dec.2008 were prospectively studied.Their angiograms were scored according to the SYNTAX score.The patients were divided into three groups according to the SYNTAX score;the lowest SYNTAX score (SYNTAX score ≤ 22),intermediate SYNTAX score (SYNTAX score of 23 to 32),and the highest SYNTAX score (SYNTAX score ≥ 33).The primary end point of this study were defined as the rate of major adverse cardiac and cerebrovascular events (MACCE) at 2 years.The MACCE-free survival curves were estimated by the Kaplan-Meier method.Propensity score analysis was performed using a stratified Cox regression with treatment strategy (PCI vs CABG) as a fixed dummy covariate.Results The overall SYNTAX score ranged from 5 to 65 with mean ± standard deviation of 29.8 ± 11.7.The rate of MACCE at 2 years in the PCI group was significantly higher than that in CABG group (15.7% vs 10.0%,P =0.038).Patients with the lowest or intermediate scores in two groups had similar rate of 2-year MACCE,whereas among patients with the highest scores,the event rate was significantly increased in the PCI group (28.1% vs 11.1%,P =0.011).Conclusion The overall rate of 2-year MACCE in the PCI group was significantly higher compared with CABG.The rate of 2-year MACCE was similar between the two treatment groups for patients with the lowest or intermediate SYNTAX scores.Among patients with highest SYNTAX scores,those in the PCI group had a significantly higher 2-year MACCE rate than those in the CABG group.%目的 评价SYNTAX积分在指导复杂冠心病患者血运

  7. Who Needs Coronary Artery Bypass Grafting?

    Science.gov (United States)

    ... Rehabilitation Coronary Heart Disease Heart Attack Heart Surgery Percutaneous Coronary Intervention Send a link to NHLBI to someone by ... coronary arteries that can't be treated with percutaneous coronary intervention (PCI), also known as coronary angioplasty. Your doctor ...

  8. Coronary revascularization in adults with dextrocardia: surgical implications of the anatomic variants.

    Science.gov (United States)

    Murtuza, Bari; Gupta, Prity; Goli, Giri; Lall, Kulvinder S

    2010-01-01

    Most reports of coronary artery bypass grafting in adult patients with dextrocardia have focused on the surgeon's position with respect to the operating table. Herein, we describe the cases of 2 patients with dextrocardia who underwent surgery at our own institution, then discuss preoperative evaluation, surgical approaches, and patient outcomes that have been reported in the medical literature. Whereas most patients, including ours, have presented with classic situs inversus totalis and dextrocardia, a few patients have had other associated anomalies or atypical morphologic conditions. Careful imaging, and perhaps cardiac catheterization, is required. Particular attention should be paid to cannulation technique and conduits that can best be used within the altered orientation of the heart. Morbidity rates in these revascularized patients seem comparable with those in coronary artery bypass patients whose coronary anatomy is normal. Anatomic variants in dextrocardia are important from the surgical viewpoint due to the increasing population of patients with repaired congenital heart disease who reach adulthood, and in whom other cardiac defects and abnormalities of cardiac position are common.

  9. Correlations Between the Gradient of Contrast Density, Evaluated by Cardio CT, and Functional Significance of Coronary Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Orzan Marius

    2016-06-01

    Full Text Available Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.

  10. Spontaneous Coronary Artery Dissection.

    Science.gov (United States)

    Tweet, Marysia S; Gulati, Rajiv; Hayes, Sharonne N

    2016-07-01

    Spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with SCAD. Formerly considered "rare," these technological advances and heightened awareness suggest that SCAD is more prevalent than prior estimates. SCAD is associated with female sex, young age, extreme emotional stress, or extreme exertion, pregnancy, and fibromuscular dysplasia. The clinical characteristics and management strategies of SCAD patients are different than for atherosclerotic heart disease and deserve specific consideration. This review will highlight recent discoveries about SCAD as well as describe current efforts to elucidate remaining gaps in knowledge.

  11. Spontaneous Coronary Artery Dissection.

    Science.gov (United States)

    Tweet, Marysia S; Gulati, Rajiv; Hayes, Sharonne N

    2016-07-01

    Spontaneous coronary artery dissection is an important etiology of nonatherosclerotic acute coronary syndrome, myocardial infarction, and sudden death. Innovations in the catheterization laboratory including optical coherence tomography and intravascular ultrasound have enhanced the ability to visualize intimal disruption and intramural hematoma associated with SCAD. Formerly considered "rare," these technological advances and heightened awareness suggest that SCAD is more prevalent than prior estimates. SCAD is associated with female sex, young age, extreme emotional stress, or extreme exertion, pregnancy, and fibromuscular dysplasia. The clinical characteristics and management strategies of SCAD patients are different than for atherosclerotic heart disease and deserve specific consideration. This review will highlight recent discoveries about SCAD as well as describe current efforts to elucidate remaining gaps in knowledge. PMID:27216840

  12. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    OpenAIRE

    Serruys, Patrick; Morice, Marie-Claude; Kappetein, Arie Pieter; Colombo, Antonio; Holmes, David; Mack, Michael; Stahle, E.; Feldman, Ted; Brand, Marcel, van den; Bass, Eric; Dyck, Nic; Leadly, Katrin; Dawkins, Keith; Mohr, Friedrich

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating patients with previously untreated three-vessel or left main coronary artery disease (or both). METHODS We randomly assigned 1800 patients with three-vessel or left main coronary artery disease to und...

  13. Coronary Flow Reserve Predicts Cardiopulmonary Fitness in Patients with Coronary Artery Disease Independently of Systolic and Diastolic Function

    DEFF Research Database (Denmark)

    Snoer, Martin; Olsen, Rasmus Huan; Monk-Hansen, Tea;

    2014-01-01

    Aims Despite revascularization and optimal medical treatment, patients with coronary artery disease (CAD) have reduced exercise capacity. In the absence of coronary artery stenosis, coronary flow reserve (CFR) is a measure of coronary microvascular function, and a marker of future poor outcome...... early (E) and late (A) inflow velocities, and tissue Doppler diastolic (e′) and systolic (s′) velocities. Peak coronary flow velocity (CFV) was measured in the LAD using pulse-wave Doppler. CFR was calculated as the ratio between peak CFV at rest and during vasodilator stress. Median CFR was 2.22 (1...

  14. Early Results of Coronary Endarterectomy Combined with Coronary Artery Bypass Grafting in Patients with Diffused Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    Li-Qun Chi; Jian-Qun Zhang; Qing-Yu Kong; Wei Xiao; Lin Liang; Xin-Liang Chen

    2015-01-01

    Background:It is still a challenge for the cardiac surgeons to achieve adequate revascularization for diffused coronary artery disease (CAD).Coronary endarterectomy (CE) offers an alternative choice of coronary artery reconstruction and revascularization.In this study,short-term result of CE combined with coronary artery bypass graft (CABG) was discussed in the treatment for the diffused CAD.Methods:From January 2012 to April 2014,221 cases of CABG were performed by the same surgeon in our unit.Among these cases,38 cases of CE + CABG were performed,which was about 17.2% (38/221) of the cohort.All these patients were divided into two groups:CE + CABG group (Group A) and CABG alone group (Group B).All clinical data were compared between the two groups,and postoperative complications and in-hospital mortality were analyzed.The categorical and continuous variables were analyzed by Chi-square test and Student's t-test respectively.Results:Diabetes mellitus,hypertension,hyperlipidemia,and peripheral vascular disease were more common in group A.In this cohort,a total of 50 vessels were endarterectomized.Among them,CE was performed on left anterior descending artery in 11 cases,on right coronary artery in 29 cases,on diagonal artery in 3 cases,on intermediate artery in 2 cases,on obtuse marginal artery in 5 cases.There was no hospital mortality in both groups.The intro-aortic balloon pump was required in 3 cases in Group A (3/38),which was more often than that in Group B (3/183).At the time of follow-up,coronary computed tomography angiogram showed all the grafts with CE were patent (50/50).There is no cardio-related mortality in both groups.All these patients were free from coronary re-intervention.Conclusions:Coronary endarterectomy + CABG can offer satisfactory result for patients with diffused CAD in a short-term after the operation.

  15. Coronary Artery Bypass Grafting

    Science.gov (United States)

    ... Rehabilitation Coronary Heart Disease Heart Attack Heart Surgery Percutaneous Coronary Intervention Send a link to NHLBI to someone by ... include lifestyle changes, medicines, and a procedure called percutaneous coronary intervention (PCI), also known as coronary angioplasty. PCI is ...

  16. Off-pump Coronary Endarterectomy and Bypass Grafting in Patients With Diffuse Coronary Artery Disease

    Institute of Scientific and Technical Information of China (English)

    Chen Xin; Xu Ming; Jiang Yinshuo; Sui Kaihu; Qiu Zhibing; Wang Liming; Liu Peisheng

    2006-01-01

    Objectives To summarize our preliminary experience on off-pump coronary endarterectomy and bypass grafting in patients with diffuse coronary artery disease. Methods Over a 3-year period, 53 patients (41 male) with diffuse coronary artery disease underwent off-pump coronary endarterectomy and bypass grafting at our institution.Patients' age ranged from 55 to 79 years. Prior to surgery, 70% of patients were in CCS angina class 2 (n=5) or 3 (n=32), and nearly half of them (26/53) had history of myocardial infarction. Most patients (n=50) had triple vessel lesions, with left main stem involvement in 9. Their left ventricular ejection fraction ranged from 26% to 65% (mean 52%). At the end of operation, a flow-meter was routinely applied to measure the perfusion flow of each postendarterectomy graft. Results In total, 70 endarterectomies were performed in 53 patients, including 38 in left anterior descending artery (LAD), 8 in circumflex artery and 24 in right coronary artery. Four operations were emergency or urgent in nature. Five patients received on-lay venous patch after endarterectomy in LAD, followed by left internal mammary artery (LIMA) grafting on the patch. The graft conduits included 53 LIMAs and 2 radial arteries,and saphenous veins in others. Mean number of grafts per patient was 3.75. The overall index of completeness of revascularization reached 1.03±0.07. There was no death in this group of patients during their post-operative hospital stay (mean duration = 9 days).Intra-operatively, 63 (90%) out of the 70 grafts after coronary endarterectomy showed satisfactory flow. Two patients had perioperative myocardial infarctions but neither experienced significant hemodynamic deteriations. Conclusions Off-pump coronary endarterectomy with bypass grafting is technically feasible and can be performed safely in patients with diffuse coronary artery disease. This strategy may help to improve the completeness of myocardial revascularization.

  17. Optimal treatment of multivessel complex coronary artery disease

    Science.gov (United States)

    SUN, HAIHUI; CUI, LIANQUN

    2014-01-01

    The aim of the present study was to investigate major cardiac events and the similarities and differences of medical costs among patients with multivessel complex coronary artery disease (MCCAD) during the three-year follow-up. The MCCAD patients had undergone single complete revascularization (CR), fractionated revascularization (FR) or partial revascularization (PR) and the present study aimed to screen the optimal treatment program. A total of 2,309 MCCAD patients who had been treated at a single center in the last decade, among which 1,020 cases underwent single CR, 856 cases successively underwent FR and 433 cases only underwent PR, were followed-up for three years. Major cardiac events, including all-cause mortality, myocardial infarction, severe heart failure, rehospitalization and revascularization (coronary artery bypass grafting and coronary stent reimplantation), were set as the end points. In addition, the three-year medical costs associated with heart disease were analyzed. The three-year cardiac event rate in the CR group (17%) was significantly lower compared with the other two groups and the average three-year medical costs in the CR group (62,100 RMB) were significantly lower than those in the other two groups. Therefore, under permissive conditions, single CR is the optimal and most economical treatment strategy for patients with MCCAD. PMID:24926344

  18. Quality of life after PCI with drug-eluting stents or coronary-artery bypass surgery

    NARCIS (Netherlands)

    D.J. Cohen (David J.); B.A. van Hout (Ben); P.W.J.C. Serruys (Patrick); F.W. Mohr (Friedrich); C.M. Miguel (Carlos); P. den Heijer (Peter); M.M. Vrakking (M. M.); K.K. Wang (Kenneth); E.M. Mahoney (Elizabeth M.); S. Audi (Salma); K. Leadly (Katrin); K.D. Dawkins (Keith); A.P. Kappetein (Arie Pieter)

    2011-01-01

    textabstractBACKGROUND: Previous studies have shown that among patients undergoing multivessel revascularization, coronary-artery bypass grafting (CABG), as compared with percutaneous coronary intervention (PCI) either by means of balloon angioplasty or with the use of bare-metal stents, results in

  19. 机器人非体外循环冠状动脉旁路移植与支架置入杂交手术%Myocardial "hybrid" revascularization-totally endoscopic coronary bypass grsfting on beating heart and stent placement-in-termediate results of an alternative approach to multivessel coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    高长青; 刘宏斌; 卢才义; 杨明; 王刚; 王加利; 李丽霞; 赵悦; 肖苍松; 吴扬; 周琪

    2008-01-01

    branch in all patients before surgery. And 4 cases had history of myocardial infraction. Lung functions of all the patients were normal and no patient had history of pleurisy. Without sternotomy, through 3 ports about 1 cm in the left thorax, the left internal mammary artety was harvested by da Vinci S robotic system, and simultaneously single vessel coronary artery bypass grafting via small thoracotomy(SVST)or totally endoscopic coronary bypass (TECAB) was performed off-pump. Then percutaneous coronary intervention was performed shout 1 week after the operation and the IMA graft patency was assessed at the same time. Results All patients had gone through off-pump robotic bypass surgery and stent placement in distinct hybrid session without complications. Conclusion Hybrid coronary artery revascularization enables total revascularization in patients with multivessel coronary artery disease without sternotomy.

  20. [Noninvasive diagnostic of coronary artery disease].

    Science.gov (United States)

    Zuber, Michel; Zellweger, Michael; Bremerich, Jens; Auf der Mauer, Christoph; Buser, Peter T

    2009-04-01

    Noninvasive imaging of coronary artery disease has extensively evolved during the last decade. Today, at least four imaging techniques with excellent image quality such as echocardiography, myocardial perfusion scintigraphy and PET, cardiac magnetic resonance and cardiac CT are widely available in order to estimate the risk for future ischemic events, to corroborate the suspected diagnosis of coronary artery disease, to demonstrate the extent and localisation of myocardial ischemia, to diagnose myocardial infarction and measure it's size, to identify the myocardium at risk during acute ischemia, to differentiate between viable and nonviable myocardium and thereby provide the basis for indications of revascularisations, to follow revascularized patients over long time, to assess the risk for sudden cardiac death and the development of heart failure after myocardial infarction and to depict atheromatosis and atherosclerosis of the coronary artery tree. Echocardiography is the most widely used imaging method in cardiology. It provides excellent information on morphology and function of nearly all cardiac structures. Stress echocardiography has been proven to be a reliable tool for the demonstration of myocardial ischemia and for the acquisition of prognostic data. Newer ultrasound techniques may further improve investigator dependence and thereby reproducibility. The completeness of echocardiography will always depend on acoustic windows, which are given in a specific patient. Myocardial perfusion scintigraphy provides the largest database especially on prognosis in coronary artery disease. It has been the for the depictions of ischemic and infarcted myocardium. Radiation exposure will always be an issue. Newer hybrid techniques combining nuclear methods with cardiac CT may add arguments, which will be needed for clinical decision-making. Cardiac magnetic resonance has evolved as an important tool in the diagnosis of cardiovascular diseases. It is investigator

  1. 52. Early revascularization on veno-arterial ECMO for patients with cardiogenic shock post stemi

    Directory of Open Access Journals (Sweden)

    K. Alkhamees

    2016-07-01

    Full Text Available Refractory Cardiogenic shock (CS complicates 5–7% of cases of ST-elevation myocardial infarction (STEMI, and is a leading cause of hospital death after myocardial infarction. CS complicating acute myocardial infarction continues to have a high mortality of 60–80% despite early revascularization and adjunctive therapies. We studied the effectiveness of veno-arterial (VA – Extracorporeal Membrane Oxygenator (ECMO for the patients with CS post STEMI during coronary angiography at our institute. Between January 2014 to April 2015, 8 male patients who suffered from progressive severe refractory CS post STEMI underwent emergent peripheral VA-ECMO implantation while performing cardiopulmonary resuscitation during coronary angiography. 7 patients of underwent PCI, while 1 patient was not amenable to PCI or CABG. The mean duration of support was 8.5 ± 5.8 days. 6 patients were successfully weaned from ECMO. While on ECMO support, 2 patients died. Mean EF after ECMO explantation was 32.5% ± 10.5%. The 30-day survival was 50%. Early revascularization on ECMO allows supporting hemodynamic efficiently in cardiogenic shock patients.

  2. Coronary CT angiography in coronary artery disease: Opportunities and challenges

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2016-06-01

    Full Text Available Coronary CT angiography is widely recognised as a reliable imaging modality for the diagnosis of coronary artery disease. Coronary CT angiography not only provides excellent visualisation of anatomical changes in the coronary artery with high diagnostic value in the detection of lumen stenosis or occlusion, but also offers quantitative characterisation of coronary plaque components. Furthermore, coronary CT angiography allows myocardial perfusion imaging with diagnostic value comparable to the reference standard method. Coronary CT angiography-derived haemodynamic analysis has the potential to evaluate functional significance of coronary lesions. This review article aims to provide an overview of clinical applications of coronary CT angiography in coronary artery disease.

  3. Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure.

    Science.gov (United States)

    Kosuga, Tsuneharu; Komukai, Kimiaki; Miyanaga, Satoru; Kubota, Takeyuki; Nakata, Kotaro; Suzuki, Kenichiro; Yamada, Takayuki; Yoshida, Jun; Kimura, Haruka; Yoshimura, Michihiro

    2016-05-01

    In patients with heart failure, coronary artery disease is the most common underlying heart disease, and is associated with increased mortality. However, estimating the presence or absence of coronary artery disease in patients with heart failure is sometimes difficult without coronary imaging. We reviewed 155 consecutive patients hospitalized with heart failure who underwent coronary angiography. The patients were divided into two groups: patients with (N = 59) and without (N = 96) coronary artery stenosis. The clinical characteristics and blood sampling data were compared between the two groups. The patients with coronary artery stenosis were older than those without. The prevalence of diabetes mellitus (DM), dyslipidemia and a history of revascularization was higher in the patients with coronary artery stenosis. Patients with coronary artery stenosis tended to have wall motion asynergy more frequently than those without. On the other hand, the prevalence of atrial fibrillation (AF) was lower in patients with coronary artery stenosis. The serum hemoglobin level and estimated glomerular filtration rate were lower in patients with coronary artery stenosis than in those without. In the multivariate analysis, DM (odds ratio 3.517, 95 % CI 1.601-7.727) was found to be the only the predictor of the presence of coronary artery stenosis in patients with heart failure. In conclusion, coronary imaging is strongly recommended for heart failure patients with DM to confirm the presence of coronary artery stenosis. PMID:25822806

  4. Diabetes is a predictor of coronary artery stenosis in patients hospitalized with heart failure.

    Science.gov (United States)

    Kosuga, Tsuneharu; Komukai, Kimiaki; Miyanaga, Satoru; Kubota, Takeyuki; Nakata, Kotaro; Suzuki, Kenichiro; Yamada, Takayuki; Yoshida, Jun; Kimura, Haruka; Yoshimura, Michihiro

    2016-05-01

    In patients with heart failure, coronary artery disease is the most common underlying heart disease, and is associated with increased mortality. However, estimating the presence or absence of coronary artery disease in patients with heart failure is sometimes difficult without coronary imaging. We reviewed 155 consecutive patients hospitalized with heart failure who underwent coronary angiography. The patients were divided into two groups: patients with (N = 59) and without (N = 96) coronary artery stenosis. The clinical characteristics and blood sampling data were compared between the two groups. The patients with coronary artery stenosis were older than those without. The prevalence of diabetes mellitus (DM), dyslipidemia and a history of revascularization was higher in the patients with coronary artery stenosis. Patients with coronary artery stenosis tended to have wall motion asynergy more frequently than those without. On the other hand, the prevalence of atrial fibrillation (AF) was lower in patients with coronary artery stenosis. The serum hemoglobin level and estimated glomerular filtration rate were lower in patients with coronary artery stenosis than in those without. In the multivariate analysis, DM (odds ratio 3.517, 95 % CI 1.601-7.727) was found to be the only the predictor of the presence of coronary artery stenosis in patients with heart failure. In conclusion, coronary imaging is strongly recommended for heart failure patients with DM to confirm the presence of coronary artery stenosis.

  5. Comparison of different multivessel revascularization methods in type 2 diabetes mellitus patients accom-panying with coronary artery disease%2型糖尿病合并冠心病多支血管病变血运重建方式选择

    Institute of Scientific and Technical Information of China (English)

    张宏; 侯凯; 丛洪良; 李曦铭; 李作成

    2014-01-01

    Objective To compare two different revascularization methods in type 2 diabetes mellitus (T2DM) patients with multivessel coronary artery disease treated by percutaneous coronary intervention (PCI) and coronary artery bypass graft ( CABG) .Methods T2DM patients with multivessel disease undergoing success-ful PCI or CABG were enrolled in the study .They were diagnosed by coronary angiography ( CAG) in Tianjin Chest Hospital from May 2009 to May 2010 whose.The patients were followed up for 3 years.The information of patients including physical performance , clinical features , and laboratory examination results were collected .The major ad-verse cardio cerebral events(MACCE)including death, myocardial infarction(MI), revascularization, angina pecto-ris, heart failure, and stroke were collected.Results During the 3 years of follow-up, MACCE(31.58% vs 17.68%, P<0.01), death(4.82%vs 1.10%, P<0.05), MI(4.39%vs 1.10%, P<0.05), angina pectoris (17.27%vs 10.50%, P<0.05)occurred more frequently in PCI group than in CABG group .Conclusion Evi-dences now tend to support CABG for revascularization in T 2DM patients with multivessel disease .%目的:比较2型糖尿病(type 2 diabetes mellitus,T2DM)合并冠心病多支血管病变患者接受经皮冠状动脉介入治疗( percutaneous coronary intervention ,PCI)或冠状动脉旁路移植术( coronary artery by-pass graft,CABG)3年后的预后情况,探讨该类患者如何选择再血管化治疗方式。方法选择2009年5月1日至2010年5月31日于天津市胸科医院连续进行的冠状动脉造影( coronary angiography ,CAG)确诊T2DM伴多支血管病变并成功行PCI或CABG治疗且病例及随访资料完整者,进行为期3年的随访,收集患者一般情况、临床指标、实验室检查指标等信息,分析死亡、心肌梗死、再次血运重建、再发心绞痛、心力衰竭、卒中等主要不良心脑血管事件( major adverse cardio cerebral events

  6. Use of arterial conduit for arterial revascularization during liver and multivisceral transplantation

    Institute of Scientific and Technical Information of China (English)

    MA Yi; LI Qiang; YE Zhi-ming; ZHU Xiao-feng; HE Xiao-shun

    2011-01-01

    Background At present, revascularization is still one of the most critical technologies in orthotopic liver transplantation (OLT). Hepatic artery (HA) variations occur frequently in both donors and recipients. Moreover, there are always some pathological changes in the recipient hepatic artery. If handled improperly, it may cause complications after anastomosis.Therefore, arterial conduit could be used in primary OLT, re-OLT and multiple-OLT. This study aimed to investigate the indications, methods and techniques with usage of arterial conduit for HA revascularization during adult OLT.Methods We reviewed 1200 patients of consecutive OLTs performed during 2000-2009 in the First Affiliated Hospital of Sun Yat-sen University. Of these patients, 48 recipients with artery variations received HA revascularization with usage of arterial conduit and special postoperative managements. The indications, methods, techniques, and the managements of postoperative complications in adult OLT with usage of arterial conduit for HA revascularization were analyzed.Results In 48 cases with artery bypass, the arterial conduit were anastomosed between donor hepatic artery and recipient infrarenal aorta (n=32), between donor hepatic artery and recipient suprarenal aorta (n=10), and between donor upper abdominal organ cluster artery and recipient suprarenal aorta (n=6). The technique was applied in 4% (48/1200 cases) of the whole OLTs performed in the same period, and the patency rate of the conduits was 100%. Forty patients (83.3%) survived, and the average survival time was 3.9 years. Eight patients (16.7%) died (all due to tumor recurrence),while the average survival time was 1.2 years. All these patients have not experienced artery-related complications in their survival time.Conclusions When recipient HA has variations or pathological changes in OLT, the donor artery should be anastomosed to recipient abdominal aorta with an arterial conduit to achieve satisfactory outcomes

  7. Passive Leg Raising Correlates with Future Exercise Capacity after Coronary Revascularization

    OpenAIRE

    Huang, Shu-Chun; Wong, May-Kuen; Lin, Pyng-Jing; Tsai, Feng-Chun; Wen, Ming-Shien; Kuo, Chi-Tai; Hsu, Chih-Chin; Wang, Jong-Shyan

    2015-01-01

    Hemodynamic properties affected by the passive leg raise test (PLRT) reflect cardiac pumping efficiency. In the present study, we aimed to further explore whether PLRT predicts exercise intolerance/capacity following coronary revascularization. Following coronary bypass/percutaneous coronary intervention, 120 inpatients underwent a PLRT and a cardiopulmonary exercise test (CPET) 2–12 days during post-surgery hospitalization and 3–5 weeks after hospital discharge. The PLRT included head-up, le...

  8. Subclinical Coronary Plaque Burden in Asymptomatic Relatives of Patients With Documented Premature Coronary Artery Disease

    DEFF Research Database (Denmark)

    Christiansen, Morten Krogh; Jensen, Jesper Møller; Bøtker, Hans Erik;

    Introduction: A family history of premature coronary artery disease (CAD) is a well-known risk factor for adverse coronary events with age of onset being inversely related to the degree of heritability. Hypothesis: We hypothesized that asymptomatic first degree relatives, of patients with premature...... CAD, suffer a high burden of subclinical coronary atherosclerosis. Methods: First degree relatives, aged 30-65 years, of patients with a documented coronary revascularization procedure before the age of 40 years, were invited to participate in the study. Participants were matched by age, sex...... and absence of a family history, with patients referred for coronary CT angiography (CTA) because of atypical angina or non-anginal chest pain. A pooled blinded analysis was performed. The main outcome measure was the number of plaque-affected coronary segments. Results: 88 relatives and 88 symptomatic...

  9. Gene therapy and angiogenesis in patients with coronary artery disease

    DEFF Research Database (Denmark)

    Kastrup, Jens

    2010-01-01

    Not all patients with severe coronary artery disease can be treated satisfactorily with current recommended medications and revascularization techniques. Various vascular growth factors have the potential to induce angiogenesis in ischemic tissue. Clinical trials have only evaluated the effect...... of VEGF and FGF in patients with coronary artery disease. The initial small and unblinded studies with either recombinant growth factor proteins or genes encoding growth factors were encouraging, demonstrating both clinical improvement and evidence of angiogenesis. However, subsequent larger double...... an improvement in clinical results can be obtained with a cocktail of growth factors or by a combination of gene and stem cell therapy in patients with severe coronary artery disease, which cannot be treated effectively with current treatment strategies....

  10. Coronary Artery Bypass Graft Surgery (Beyond the Basics)

    Science.gov (United States)

    ... for people with coronary heart disease is called "percutaneous coronary intervention" (PCI), or "stenting." This involves using a flexible ... artery disease: Coronary artery bypass graft surgery versus percutaneous coronary intervention Coronary artery bypass grafting in patients with cerebrovascular ...

  11. Minimally invasive cardiac surgery-coronary artery bypass graft.

    Science.gov (United States)

    Lemma, Massimo; Atanasiou, Thanos; Contino, Monica

    2013-01-01

    Coronary artery bypass graft (CABG) is among the most common operations performed in the world. Different surgical strategies can be used with different invasiveness. This paper describes a recent development of the technique that merges the advantages resulting from both the adoption of an 'off-pump no-touch aorta operation' and a 'complete arterial revascularization through a left minithoracotomy' in a single procedure. This operation is currently known with the acronym MICS (minimally invasive cardiac surgery)-CABG (minimally invasive cardiac surgery). It is an off-pump operation performed through a minithoracotomy in the fourth or fifth left intercostal space across the midclavicular line. The left internal thoracic artery (LITA) is harvested under direct vision using a special rib-retractor with multiple interchangeable thoracotomy blades, including blades to use with lift systems for proximal artery harvesting, while the right radial artery (RA) is harvested endoscopically. A Y-connection is made between the two arteries. The LITA is used to bypass the left anterior descending coronary artery, while the right RA is used on the obtuse marginal branches and/or the posterior descending coronary artery. A special coronary stabilizer and a heart positioner with a shaft for remote thoracic insertion are needed.

  12. The role of coronary artery disease in heart failure.

    Science.gov (United States)

    Lala, Anuradha; Desai, Akshay S

    2014-04-01

    Enhanced survival following acute myocardial infarction and the declining prevalence of hypertension and valvular heart disease as contributors to incident heart failure (HF) have fueled the emergence of coronary artery disease (CAD) as the primary risk factor for HF development. Despite the acknowledged role of CAD in the development of HF, the role of coronary revascularization in reducing HF-associated morbidity and mortality remains controversial. The authors review key features of the epidemiology and pathophysiology of CAD in patients with HF as well as the emerging data from recent clinical trials that inform the modern approach to management.

  13. Coronary CT angiography in clinical triage of patients at high risk of coronary artery disease

    DEFF Research Database (Denmark)

    Kühl, J Tobias; Hove, Jens D; Kristensen, Thomas S;

    2016-01-01

    OBJECTIVES: To test if cardiac computed tomography angiography (CCTA) can be used in the triage of patients at high risk of coronary artery disease. DESIGN: The diagnostic value of 64-detector CCTA was evaluated in 400 patients presenting with non-ST segment elevation myocardial infarction using...... in patients with high likelihood of coronary artery disease and could, in theory, be used to triage high risk patients. As many obstacles remain, including logistical and safety issues, our study does not support the use of CCTA as an additional diagnostic test before ICA in an all-comer NSTEMI population....... invasive coronary angiography (ICA) as the reference method. The relation between the severity of disease by CCTA and a combined endpoint of death, re-hospitalization due to new myocardial infarction, or symptom-driven coronary revascularization was assessed. RESULTS: CCTA detects significant (>50...

  14. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease

    NARCIS (Netherlands)

    P.W.J.C. Serruys (Patrick); M-C. Morice (Marie-Claude); A.P. Kappetein (Arie Pieter); A. Colombo (Antonio); D.R. Holmes Jr (David); M.J. Mack (Michael); E. Stahle; T.E. Feldman (Ted); M.J.B.M. van den Brand (Marcel); E.J. Bass (Eric); N. van Dyck (Nic); K. Leadly (Katrin); K.D. Dawkins (Keith); F.W. Mohr (Friedrich)

    2009-01-01

    textabstractBACKGROUND Percutaneous coronary intervention (PCI) involving drug-eluting stents is increasingly used to treat complex coronary artery disease, although coronary-artery bypass grafting (CABG) has been the treatment of choice historically. Our trial compared PCI and CABG for treating pat

  15. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography

    Directory of Open Access Journals (Sweden)

    Weintraub Nealw F

    2009-04-01

    Full Text Available Abstract We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

  16. Physiologic assessment of coronary artery fistula

    Energy Technology Data Exchange (ETDEWEB)

    Gupta, N.C.; Beauvais, J. (Creighton Univ., Omaha, NE (USA))

    1991-01-01

    Coronary artery fistula is an uncommon clinical entity. The most common coronary artery fistula is from the right coronary artery to the right side of the heart, and it is less frequent to the pulmonary artery. The effect of a coronary artery fistula may be physiologically significant because of the steal phenomenon resulting in coronary ischemia. Based on published reports, it is recommended that patients with congenital coronary artery fistulas be considered candidates for elective surgical correction to prevent complications including development of congestive heart failure, angina, subacute bacterial endocarditis, myocardial infarction, and coronary aneurysm formation with rupture or embolization. A patient is presented in whom treadmill-exercise thallium imaging was effective in determining the degree of coronary steal from a coronary artery fistula, leading to successful corrective surgery.

  17. Anomalous Origin of Right Coronary Artery from Distal Left Circumflex Artery: A Very Rare Variant of Single Coronary Artery Anomaly

    OpenAIRE

    Arash Gholoobi

    2016-01-01

    Among coronary anomalies, Single Coronary Artery (SCA) is a rare anomaly in which one coronary artery stems from a single coronary ostium from the aortic sinuses, nourishing the entire heart. A very rare subtype of this anomaly is the anomalous origin of the Right Coronary Artery (RCA) from the distal Left Circumflex (LCx) artery.

  18. Serum protein profiles predict coronary artery disease in symptomatic patients referred for coronary angiography

    Directory of Open Access Journals (Sweden)

    LaFramboise William A

    2012-12-01

    Full Text Available Abstract Background More than a million diagnostic cardiac catheterizations are performed annually in the US for evaluation of coronary artery anatomy and the presence of atherosclerosis. Nearly half of these patients have no significant coronary lesions or do not require mechanical or surgical revascularization. Consequently, the ability to rule out clinically significant coronary artery disease (CAD using low cost, low risk tests of serum biomarkers in even a small percentage of patients with normal coronary arteries could be highly beneficial. Methods Serum from 359 symptomatic subjects referred for catheterization was interrogated for proteins involved in atherogenesis, atherosclerosis, and plaque vulnerability. Coronary angiography classified 150 patients without flow-limiting CAD who did not require percutaneous intervention (PCI while 209 required coronary revascularization (stents, angioplasty, or coronary artery bypass graft surgery. Continuous variables were compared across the two patient groups for each analyte including calculation of false discovery rate (FDR ≤ 1% and Q value (P value for statistical significance adjusted to ≤ 0.01. Results Significant differences were detected in circulating proteins from patients requiring revascularization including increased apolipoprotein B100 (APO-B100, C-reactive protein (CRP, fibrinogen, vascular cell adhesion molecule 1 (VCAM-1, myeloperoxidase (MPO, resistin, osteopontin, interleukin (IL-1β, IL-6, IL-10 and N-terminal fragment protein precursor brain natriuretic peptide (NT-pBNP and decreased apolipoprotein A1 (APO-A1. Biomarker classification signatures comprising up to 5 analytes were identified using a tunable scoring function trained against 239 samples and validated with 120 additional samples. A total of 14 overlapping signatures classified patients without significant coronary disease (38% to 59% specificity while maintaining 95% sensitivity for patients requiring

  19. Coronary Artery Manifestations of Fibromuscular Dysplasia

    OpenAIRE

    Michelis, Katherine C.; Olin, Jeffrey W.; Kadian-Dodov, Daniella; D’Escamard, Valentina; Kovacic, Jason C.

    2014-01-01

    Fibromuscular dysplasia (FMD) involving the coronary arteries is an uncommon but important condition that can present as acute coronary syndrome, left ventricular dysfunction, or potentially sudden cardiac death. Although the classic angiographic “string of beads” that may be observed in renal artery FMD does not occur in coronary arteries, potential manifestations include spontaneous coronary artery dissection, distal tapering or long, smooth narrowing that may represent dissection, intramur...

  20. MORPHOMETRIC STUDY OF THE RIGHT CORONARY ARTERY

    Directory of Open Access Journals (Sweden)

    El Sayed S. Atta-Alla

    2015-09-01

    Full Text Available Introduction: The anatomy of the coronary arteries is fascinating and most varied. The aim of the present work was to study the gross anatomy of the right coronary artery (RCA regarding its importance for interventional cardiologists and cardiac surgeons. Materials and Methods: The material of the present study included 30 preserved hearts obtained from the dissecting rooms of anatomy departments, Faculty of Medicine, Beirut Arab University and Alexandria University. Results: Present study revealed that the length of the first segment of RCA ranged from 5.7 to 8.0 cm with a mean of 6.3 ± 0.6 cm; Its external diameter ranged from 4.0 mm to 7.0 mm with a mean of 5.1 ± 0.7 mm. The length of the second segment of RCA ranged from 3.4 to 6.0 cm with a mean of 4.9 ± 0.7 cm; Its external diameter ranged from 3.1 mm to 5.6 mm with a mean of 4.3 ± 0.8 mm. The right conus artery was found to arise at a distance 0.5 to 2.4 cm with a mean of 1.5 ± 0.6 cm from the beginning of RCA. At a distance 0.6 cm to 2.6 cm with a mean of 1.6 ± 0.6 cm from its beginning, the RCA was found to give its SAN branch. At a distance 2.7 cm to 5.6 cm with a mean of 4.2 ± 0.8 cm from its beginning, the RCA was found to give its acute marginal branch. Whether it terminated at or beyond the cardiac crux, RCA was found to give origin to the posterior interventricular branch in all specimens. In all specimensthe AVN artery was found to arise from RCA at the region of cardiac crux. Myocardial bridging was recorded in 2 specimens. Conclusion: This study directs the attention towards the importance of the right coronary artery in the supply of the myocardium and the patterns obtained here may be clinically relevant during percutaneous coronary interventions or surgical revascularization.

  1. Target vessel revascularization following percutaneous coronary intervention. A 10-year report from the Danish Percutaneous Transluminal Coronary Angioplasty Registry

    DEFF Research Database (Denmark)

    Jensen, Lisette Okkels; Thayssen, Per; Kassis, Eli;

    2005-01-01

    OBJECTIVE: To present the rate of target vessel revascularization (TVR) in a consecutive and unselected national population over 10 years. DESIGN: From 1989 to 1998 all percutaneous coronary interventions (PCIs) performed in Denmark were recorded in the Danish PTCA Registry. RESULTS: From 1989 to...

  2. Surgical Treatment of 13-year-old Patient with Coronary Artery Disease and Supravalvular Aortic Stenosis with Familial Hypercholesterolemia

    Directory of Open Access Journals (Sweden)

    Yüksel Atay

    2011-12-01

    Full Text Available Familial hypercholesterolemia is a genetic disorder caused by a mutation in low density lipoprotein (LDL gene. The homozygous type of the disease is rare and causes tendon xanthomas and coronary artery disease during the early years of life. Because of that, some of these patients needs early coronary revascularization. We presented 13-year-old patient who underwent coronary artery bypass graft due to familial hypercholesterolemia and repair of supravalvular aortic stenosis at the same time.

  3. Surgical Treatment of 13-year-old Patient with Coronary Artery Disease and Supravalvular Aortic Stenosis with Familial Hypercholesterolemia

    OpenAIRE

    Yüksel Atay; Mirali Mecidov; Fatih Ayık; Emrah Oğuz

    2011-01-01

    Familial hypercholesterolemia is a genetic disorder caused by a mutation in low density lipoprotein (LDL) gene. The homozygous type of the disease is rare and causes tendon xanthomas and coronary artery disease during the early years of life. Because of that, some of these patients needs early coronary revascularization. We presented 13-year-old patient who underwent coronary artery bypass graft due to familial hypercholesterolemia and repair of supravalvular aortic stenosis at the same time.

  4. Hypothesis of Long-Term Outcome after Coronary Revascularization in Japanese Patients Compared to Multiethnic Groups in the US.

    Directory of Open Access Journals (Sweden)

    Taku Inohara

    Full Text Available Ethnicity has a significant impact on coronary artery disease (CAD. This study investigated the long-term outcomes of Japanese patients undergoing revascularization compared with US patients belonging to multiple ethnic groups.We evaluated clinical outcomes, based on ethnicity, of patients included in the Coronary Revascularization Demonstrating Outcome (CREDO-Kyoto and the Texas (US Heart Institute Research Database (THIRDBase registries. For the analysis, we included 8871 patients from the CREDO-Kyoto registry (median follow-up period [FU], 3.5 years; interquartile range [IQR], 2.6-4.3 and 6717 patients from the THIRDBase registry (FU, 5.2 years; IQR, 3.8-6.5 who underwent percutaneous coronary intervention or bypass surgery. Cox proportional hazard models were constructed to compare the adjusted long-term outcomes for each ethnic group. A total of 8871 Japanese, 5170 Caucasians, 648 African-Americans, 817 Hispanics, and 82 Asian-Americans were identified. When adjusted, Japanese patients had significantly better outcomes than US patients, classified by ethnicity (Caucasians: hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.35-1.79; Hispanics: HR, 1.53; 95% CI, 1.22-1.93; African-Americans: HR, 2.03; 95% CI, 1.62-2.56, except for Asian-Americans (HR, 0.84; 95% CI. 0.38-1.89 who had outcomes similar to Japanese patients.Our findings indicate better survival outcomes in re-vascularized Japanese CAD patients compared to major ethnic groups in the US, including Caucasian, Hispanic, and African-American CAD patients. The characteristics and outcomes of Japanese CAD patients were similar to those of Asian-Americans, despite the sample size limitations in the US dataset.

  5. "Obesity paradox" in coronary artery disease.

    Science.gov (United States)

    Akin, Ibrahim; Nienaber, Christoph A

    2015-10-26

    Obesity used to be among the more neglected public health problems, but has unfolded as a growing medical and socioeconomic burden of epidemic proportions. Morbid obesity is linked to traditional cardiovascular risk factors like, hypertension, hyperlipidemia and diabetes, and suspected to incur increased morbidity and mortality in the Western and even third world populations. This patient cohort is also at greater risk to develop coronary artery disease. Recent population-based registries revealed that 43% and 24% of all cases of coronary revascularization were carried out in overweight and obese patients, respectively. However, despite evidence of a positive correlation between obesity and increased cardiovascular morbidity, some authors have described a better clinical outcome in overweight and obese patients, a phenomenon they coined "obesity paradoxon". Thus, there is an ongoing debate in light of conflicting data and the possibility of confounding bias causing misconception and challenging the "obesity paradox". In this review article we present the current evidence and throughly discuss the validity of the "obesity paradoxon" in a variety of clinical settings.

  6. Inflammation in coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun

    2011-01-01

    The concept that atherosclerosis is an inflammation has been increasingly recognized,and subsequently resulted in great interest in revealing the inflammatory nature of the atherosclerotic process.More recently,a large body of evidence has supported the idea that inflammatory mechanisms play a pivotal role throughout all phases of atherogenesis,from endothelial dysfunction and the formation of fatty streaks to plaque destabilization and the acute coronary events due to vulnerable plaque rupture.Indeed,although triggers and pathways of inflammation are probably multiple and vary in different clinical entities of atherosclerotic disorders,an imbalance between anti-inflammatory mechanisms and pro-inflammatory factors will result in an atherosclerotic progression.Vascular endothelial dysfunction and lipoprotein retention into the arterial intima have been reported as the earliest events in atherogenesis with which inflammation is linked.Inflammatory has also been extended to the disorders of coronary microvasculature,and associated with special subsets of coronary artery disease such as silent myocardial ischemia,myocardial ischemia-reperfusion,cardiac syndrome X,variant angina,coronary artery ectasia,coronary calcification and in-stent restenosis.Inflammatory biomarkers,originally studied to better understand the pathophysiology of atherosclerosis,have generated increasing interest among researches and clinicians.The identification of inflammatory biomarkers and cellular/molecular pathways in atherosclerotic disease represent important goals in cardiovascular disease research,in particular with respect of the development of therapeutic strategies to prevent or reverse atherosclerotic diseases.

  7. The Prognosis of Patients With Nonobstructive Coronary Artery Disease Versus Normal Arteries Determined by Invasive Coronary Angiography or Computed Tomography Coronary Angiography: A Systematic Review.

    Science.gov (United States)

    Huang, Fang-Yang; Huang, Bao-Tao; Lv, Wen-Yu; Liu, Wei; Peng, Yong; Xia, Tian-Li; Wang, Peng-Ju; Zuo, Zhi-Liang; Liu, Rui-Shuang; Zhang, Chen; Gui, Yi-Yue; Liao, Yan-Biao; Chen, Mao; Zhu, Ye

    2016-03-01

    Limited data exist regarding the outcomes of patients with nonobstructive coronary artery disease (CAD) detected by computed tomography coronary angiography (CTCA) or invasive coronary angiography (ICA). Our aim was to compare the prognosis of patients with nonobstructive coronary artery plaques with that of patients with entirely normal arteries. The MEDLINE, Cochrane Library, and Embase databases were searched. Studies comparing the prognosis of individuals with nonobstructive CAD versus normal coronary arteries detected by CTCA or ICA were included. The primary outcome was major adverse cardiac events (MACE) including cardiac death, nonfatal myocardial infarction, hospitalization due to unstable angina or revascularization. A fixed effects model was chosen to pool the estimates of odds ratios (ORs). Forty-eight studies with 64,905 individuals met the inclusion criteria. Patients in the nonobstructive CAD arm had a significantly higher risk of MACE compared to their counterparts in the normal artery arm (pooled OR, 3.17, 95% confidence interval, 2.77-3.63). When excluding revascularization as an endpoint, hard cardiac composite outcomes were also more frequent among patients with nonobstructive CAD (pooled OR, 2.10; 95%CI, 1.79-2.45). All subgroups (age, sex, follow-up duration, different outcomes, diagnostic modality, and CAD risk factor) consistently showed a poorer prognosis with nonobstructive CAD than with normal arteries. When dividing the studies into a CTCA and ICA group for further analysis based on the indications for diagnostic tests, we also found nonobstructive CAD to be associated with a higher risk of MACE in both stable and acute chest pain. Patients with nonobstructive CAD had a poorer prognosis compared with their counterparts with normal arteries.

  8. Anomalous right coronary artery arising from left anterior descending artery

    Directory of Open Access Journals (Sweden)

    M.L. Sreenivas Kumar

    2012-07-01

    Full Text Available A 54-year-old male patient presented with acute myocardial infarction involving left anterior descending and right coronary artery territories. Coronary angiogram showed a single coronary artery with right coronary artery arising from left anterior descending artery (LAD, which coursed anterior to right ventricular outflow tract and thrombotic lesion in mid left anterior descending artery before origin of right coronary artery. The patient was treated with thrombolytic therapy and glycoprotein IIb/IIIa inhibitors. Anomalous origin of right coronary artery as a branch of LAD is a very rare type of congenital coronary artery anomalies. It is important to recognize this anomaly as it can be associated with extensive myocardial ischemia and sudden cardiac death in young persons even without atherosclerosis.

  9. The use of a Perma-Flow graft for coronary artery bypass surgery.

    Science.gov (United States)

    Schmid, C; Weyand, M; Kerber, S; Breithardt, G; Scheld, H H

    1996-01-01

    We report on our first clinical use of a Perma-Flow graft for coronary artery bypass surgery (CABG). It may well be that repeated successful use of this graft will offer a chance for revascularization to patients who might otherwise have been denied for lack of appropriate vessels.

  10. First-in-Man Computed Tomography-Guided Percutaneous Revascularization of Coronary Chronic Total Occlusion Using a Wearable Computer: Proof of Concept.

    Science.gov (United States)

    Opolski, Maksymilian P; Debski, Artur; Borucki, Bartosz A; Szpak, Marcin; Staruch, Adam D; Kepka, Cezary; Witkowski, Adam

    2016-06-01

    We report a case of successful computed tomography-guided percutaneous revascularization of a chronically occluded right coronary artery using a wearable, hands-free computer with a head-mounted display worn by interventional cardiologists in the catheterization laboratory. The projection of 3-dimensional computed tomographic reconstructions onto the screen of virtual reality glass allowed the operators to clearly visualize the distal coronary vessel, and verify the direction of the guide wire advancement relative to the course of the occluded vessel segment. This case provides proof of concept that wearable computers can improve operator comfort and procedure efficiency in interventional cardiology. PMID:26608117

  11. Emergency endovascular revascularization of tandem occlusions: Internal carotid artery dissection and intracranial large artery embolism.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Eichel, Roni; Gomori, Moshe; Itshayek, Eyal

    2016-06-01

    Internal carotid artery dissection (ICAD) with concomitant occlusive intracranial large artery emboli is an infrequent cause of acute stroke, with poor response to intravenous thrombolysis. Reports on the management of this entity are limited. We present our recent experience in the endovascular management of occlusive ICAD and major intracranial occlusion. Consecutive anterior circulation acute stroke patients meeting Medical Center criteria for endovascular management of ICAD from June 2011 to June 2015 were included. Clinical, imaging, and procedure data were collected retrospectively under Institutional Review Board approval. The endovascular procedure for carotid artery revascularization and intracranial stent thrombectomy is described. Six patients met inclusion criteria (National Institutes of Health Stroke Scale score 12-24, time from symptom onset 2-8hours). Revascularization of the extracranial carotid dissection and stent thrombectomy were achieved in 5/6 patients, resulting in complete recanalization (Thrombolysis in Myocardial Infarction flow grade 3 in a mean 2.7hours), and modified Rankin Scale score 0-2 at 90 day follow-up. In one patient, attempts to microcatheterize the true arterial lumen failed and thrombectomy was therefore not feasible. No arterial dissection, arterial rupture or accidental stent detachment occurred, and there was no intracerebral hemorrhage or hemorrhagic transformation. Our preliminary data on this selected subgroup of patients suggest the presented approach is safe, feasible in a significant proportion of patients, and efficacious in achieving arterial recanalization and improving patient outcome. Crossing the dissected segment remains the most important limiting factor in achieving successful ICA recanalization. Further evaluation in larger series is warranted. PMID:26924182

  12. Randomized Trial of Complete Versus Lesion-Only Revascularization in Patients Undergoing Primary Percutaneous Coronary Intervention for STEMI and Multivessel Disease

    Science.gov (United States)

    Gershlick, Anthony H.; Khan, Jamal Nasir; Kelly, Damian J.; Greenwood, John P.; Sasikaran, Thiagarajah; Curzen, Nick; Blackman, Daniel J.; Dalby, Miles; Fairbrother, Kathryn L.; Banya, Winston; Wang, Duolao; Flather, Marcus; Hetherington, Simon L.; Kelion, Andrew D.; Talwar, Suneel; Gunning, Mark; Hall, Roger; Swanton, Howard; McCann, Gerry P.

    2015-01-01

    Background The optimal management of patients found to have multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction is uncertain. Objectives CvLPRIT (Complete versus Lesion-only Primary PCI trial) is a U.K. open-label randomized study comparing complete revascularization at index admission with treatment of the infarct-related artery (IRA) only. Methods After they provided verbal assent and underwent coronary angiography, 296 patients in 7 U.K. centers were randomized through an interactive voice-response program to either in-hospital complete revascularization (n = 150) or IRA-only revascularization (n = 146). Complete revascularization was performed either at the time of P-PCI or before hospital discharge. Randomization was stratified by infarct location (anterior/nonanterior) and symptom onset (≤3 h or >3 h). The primary endpoint was a composite of all-cause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 12 months. Results Patient groups were well matched for baseline clinical characteristics. The primary endpoint occurred in 10.0% of the complete revascularization group versus 21.2% in the IRA-only revascularization group (hazard ratio: 0.45; 95% confidence interval: 0.24 to 0.84; p = 0.009). A trend toward benefit was seen early after complete revascularization (p = 0.055 at 30 days). Although there was no significant reduction in death or MI, a nonsignificant reduction in all primary endpoint components was seen. There was no reduction in ischemic burden on myocardial perfusion scintigraphy or in the safety endpoints of major bleeding, contrast-induced nephropathy, or stroke between the groups. Conclusions In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the composite primary endpoint at 12 months compared with treating only the

  13. Short, Intermediate and long term outcomes of CABG vs. PCI with DES in Patients With Multivessel Coronary Artery Disease. Meta-Analysis of Six Randomized Controlled Trials.

    OpenAIRE

    Zaher Fanari; Weiss, Sandra A; Wei Zhang; Sonnad, Seema S.; Weintraub, William S.

    2014-01-01

    Objective: Comparing outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomised controlled trials (RCT). Background: PCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCT have compared outcomes of the two modalities in patients with multivessel CAD. Methods: We did...

  14. Obesity and coronary artery disease: evaluation and treatment.

    Science.gov (United States)

    Garcia-Labbé, David; Ruka, Emmeline; Bertrand, Olivier F; Voisine, Pierre; Costerousse, Olivier; Poirier, Paul

    2015-02-01

    With the increasing prevalence of obesity, clinicians are now facing a growing population of patients with specific features of clinical presentation, diagnostic challenges, and interventional, medical, and surgical management. After briefly discussing the effect of obesity on atherosclerotic burden in this review, we will focus on strategies clinicians might use to ensure better outcomes when performing revascularization in obese and severely obese patients. These patients tend to present comorbidities at a younger age, and their anthropometric features might limit the use of traditional cardiovascular risk stratification approaches for ischemic disease. Alternative techniques have emerged, especially in nuclear medicine. Positron emission tomography-computed tomography might be the diagnostic imaging technique of choice. When revascularization is considered, features associated with obesity must be considered to guide therapeutic strategies. In percutaneous coronary intervention, a radial approach should be favoured, and adequate antiplatelet therapy with new and more potent agents should be initiated. Weight-based anticoagulation should be contemplated if needed, with the use of drug-eluting stents. An "off-pump" approach for coronary artery bypass grafting might be preferable to the use of cardiopulmonary bypass. For patients who undergo bilateral internal thoracic artery grafting, harvesting using skeletonization might prevent deep sternal wound infections. In contrast to percutaneous coronary intervention, lower surgical bleeding has been observed when lean body mass is used for perioperative heparin dose determination.

  15. On-pump versus off-pump coronary artery bypass surgery

    DEFF Research Database (Denmark)

    Houlind, Kim Christian

    2013-01-01

    Off pump coronary artery bypass surgery has been purported to be safer than conventional coronary artery bypass surgery performed using cardiopulmonary bypass. This theory was supported by a number of early series, but failed to be confirmed by a number of small, randomized controlled trials...... . Conversely, it has been suggested that revascularization after off pump surgery is associated with fewer grafts and lower graft patency, potentially leading to a higher risk of cardiovascular morbidity and need for repeated, coronary interventions. Since 2009, three major randomized controlled trials have...

  16. Effects of different therapies on coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    吕树铮; 刘文娴; 宋现涛; 陈韵岱; 柳弘; 陈立颖; 卢艳玲; 陈欣; 田锐; 张金荣

    2003-01-01

    Objective To analyse the effects of different therapies on coronary artery disease (CAD).Methods A total of 1055 patients who suffered from CAD diagnoised by coronary angiograpy were divided into three groups, namely pure drug therapy, percutanious coronary intervention (PCI) and coronary artery bypass graft (CABG) groups. Follow up was carried out from March to May in 2001, and the major adverse cardiac events (MACEs) including death, no-lethal myocardial infarction (MI) and revascularization were observed. In long-term observation, angina reoccured, and their improvement was evaluated. The short-term period was defined as the duration of 30 days after discharge, and the long term period was defined as the duration from 30 days after discharge.Results In the long-term period, the recurrences of angina both in PCI group and CABG group were lower than pure drug group (P 0.018, 0.002 respectively). No differences about long-term endpoint events were observed among these three groups (P>0.05). Forty-two patients suffering from left main coronary disease were intervened by the three therapies, and there was no death or MI both in PCI and CABG groups, three patients died and suffered from AMI in pure drug therapy group (P=0.015). In the short-term period, mortality in CABG group (5.77%) was higher than those in the other two groups (1.91% for PCI, and 1.40% for medical therapy, P=0.002), and no obvious difference observed in the latter two groups. No significance was concluded about the recent MI among this three groups (P=0.357). There were no differences on revascularization in these three groups.Conclusions Percutanious coronary interventions can not only reduce the attack of angina but also improve the life quality of patients, however it can not improve the long-term existance but left main CAD.

  17. The Effect of Elective Percutaneous Coronary Intervention of the Right Coronary Artery on Right Ventricular Function

    Directory of Open Access Journals (Sweden)

    Farahnaz Nikdoust

    2014-12-01

    Full Text Available Background: Right Ventricular (RV dysfunction has been introduced as a predictor of mortality in acute myocardial infarction. Objectives: This study aimed to investigate the effect of right coronary revascularization on systolic and diastolic RV dysfunction. Patients and Methods: This study was conducted on unstable angina patients who were candidate for elective Percutaneous Revascularization Intervention (PCI on the right coronary artery. The participants were initially evaluated by transthoracic echocardiography and tissue Doppler imaging prior to PCI and the RV function parameters were assessed. Echocardiography was repeated two months after PCI and the results were compared with baseline. Paired t-test was used to compare the pre- and post-procedural measurements. Besides, Pearson’s correlation was used to find out the linear association between the RV function parameters and Left Ventricular Ejection Fraction (LVEF. P value < 0.05 was considered as statistically significant. Results: This study was conducted on 30 patients (mean age = 60.00 ± 8.44 years; 24 [80%] males. In the pre-procedural echocardiography, 15 patients (50% had normal RV function, 14 patients (46.7% had grade-1 RV dysfunction, and only 1 patient (3.3% had grade-2 RV dysfunction. Following PCI, however, all the patients had normal systolic and diastolic RV functions. Comparison of echocardiographic RV function parameters showed an improvement in both systolic and diastolic functional parameters of the RV. Nonetheless, no significant correlation was observed between these parameters and Left Ventricular (LV function. Conclusions:: A significant improvement was found in RV function, but not LV function, after right coronary PCI. Revascularization of the right coronary artery may be beneficial for the patients who suffer from RV failure due to ischemia

  18. The Evolution of Coronary Revascularization Appropriateness Use Criteria: From Mandatory to Forgotten.

    Science.gov (United States)

    Sattur, Sudhakar; Brener, Sorin J

    2015-01-01

    The appropriateness use criteria (AUC) for coronary revascularization have been formulated through the joint efforts of several professional societies. The goals of AUC were to aid in physician decision making and to objectively define the need and context for revascularization. These criteria, developed using a standardized approach, were widely promoted and adopted in many practices. Rigorous use in daily practice and public reporting of adherence to these criteria has exposed some of their deficiencies. Revisions to the original version were made to accommodate public and physician sentiments. Not surprisingly, the recent percutaneous coronary intervention performance measures developed by the same professional societies that have proposed AUC, have suggested that AUC should be used for internal quality improvement only at this time. Therefore, the present role and future application of AUC to cardiology practice is uncertain. The goals of this review are to describe methodology and development of the coronary revascularization AUC, to focus on the strengths and limitations of AUC, and to identify challenges related to application of these criteria in daily practice. PMID:26827745

  19. Late intervention in an asymptomatic pediatric patient with anomalous left coronary artery

    Institute of Scientific and Technical Information of China (English)

    John; C; Lam; Michael; Giuffre; Kimberley; A; Myers

    2014-01-01

    Anomalous left coronary artery from the pulmonary artery(ALCAPA) is most commonly diagnosed within the first year of life with congestive heart failure symptomatology reflecting left ventricle(LV) dysfunction. The late diagnosis of ALCAPA is presented in a 5-yearold without significant LV dysfunction, mild LV dilatation and only mild mitral regurgitation that did not change significantly after surgery. The timing of surgical intervention in the late diagnosis of ALCAPA remains unclear despite risks of significant ongoing myocardial injury secondary to coronary artery hypoperfusion and progressive mitral valve dysfunction. Intervention in this case allows for revascularization which may reverse ventricular and valvular dysfunction.

  20. [Direct revascularization of the myocardium using the internal mammary artery].

    Science.gov (United States)

    Péterffy, A; Homolay, P; Szécsi, J; Vaszily, M; Horváth, S

    1989-07-01

    The best graft in coronary bypass operations is the internal mammary artery (IMA) as its rate of staying open for long term is better than that of the vena saphena magna. The authors present the operative and postoperative results of their first 161 patients who were subjected to IMA grafting. 126 were men and 35 women of the patients and the average age was 50.2 years. Before the operation the majority of the patients belonged to NYHA III state (69.6%). 86 patients (53.4%) had myocardial infarction before the operation, 50.3% were operated on because of 3 blood vessel diseases and the stricture of the main trunk was confirmed in 12.4%. 128 patients underwent only coronary bypass operation, in the others thrombendarterectomy (17 patients), valvular operation (11 patients) and resection of the left ventricular aneurysma (5) were carried out simultaneously. The IMA graft was placed in the majority of the cases on the LAD (70.8%) or as a sequential anastomosis on the LAD-diagonal system (21.1%). The average number of peripheral anastomoses was 2.8 anastomoses patient. 2.5% was the rate of early mortality (4 patients), reoperation was performed in 10 cases because of bleeding or tamponade and perioperative infarction occurred in 8 cases. 3.1% was the rate of late mortality (5 patients). The average follow-up examination time was 12.7 months (3-39 months). At the postoperative examinations 88.8% of the patients were free of angina and 108 patients got into NYHA I state after the operation. Of the 43 control bicycle ergometric examinations 35 were negative and 8 positive.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2748162

  1. Concomitant coronary and renal revascularization improves left ventricular hypertrophy more than coronary stenting alone in patients with ischemic heart and renal disease.

    Science.gov (United States)

    Dong, Hao-jian; Huang, Cheng; Luo, De-mou; Ye, Jing-guang; Yang, Jun-qing; Li, Guang; Luo, Jian-fang; Zhou, Ying-ling

    2016-01-01

    Percutaneous transluminal renal artery stenting (PTRAS) has been proved to have no more benefit than medication alone in treating atherosclerotic renal artery stenosis (ARAS). Whether PTRAS could improve left ventricular hypertrophy (LVH) and reduce adverse events when based on percutaneous coronary intervention (PCI) for patients with coronary artery disease (CAD) and ARAS is still unclear. A retrospective study was conducted, which explored the effect of concomitant PCI and PTRAS versus PCI alone for patients with CAD and ARAS complicated by heart failure with preserved ejection fraction (HFpEF). A total of 228 patients meeting inclusion criteria were divided into two groups: (1) the HFpEF-I group, with PCI and PTRAS; (2) the HFpEF-II group, with PCI alone. Both groups had a two-year follow-up. The left ventricular mass index (LVMI) and other clinical characteristics were compared between groups. During the follow-up period, a substantial decrease in systolic blood pressure (SBP) was observed in the HFpEF-I group, but not in the HFpEF-II group. There was marked decrease in LVMI in both groups, but the HFpEF-I group showed a greater decrease than the HFpEF-II group. Regression analysis demonstrated that PTRAS was significantly associated with LVMI reduction and fewer adverse events after adjusting for other factors. In HFpEF patients with both CAD and ARAS, concomitant PCI and PTRAS can improve LVH and decrease the incidence of adverse events more than PCI alone. This study highlights the beneficial effect of ARAS revascularization, as a new and more aggressive revascularization strategy for such high-risk patients.

  2. Epicardial ultrasound in coronary artery bypass surgery

    OpenAIRE

    Budde, R.P.J.

    2005-01-01

    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeon may face several intraoperative difficulties: 1. Localization of the target coronary artery for bypass grafting. 2. Selection of the optimal anastomotic site on the target coronary artery. 3. Asses...

  3. Coronary artery dissection by an oversized balloon.

    Science.gov (United States)

    Yafi, Wael; Jacquemin, Laurent

    2014-01-01

    Percutaneous coronary intervention (PCI) as a treatment of coronary artery disease can be a simple, rapid procedure with a clear benefit for the patient, but it could also become a complex procedure with fatal consequences. These complications depend on the lesion itself, material used and also on operating staff. In this case we report a coronary artery dissection of the circumflex (CX) artery caused by inflation of an oversized balloon. We discuss here the management and evolution of this complication. PMID:25479753

  4. Coronary artery steal: demonstration by digital coronary radiography

    International Nuclear Information System (INIS)

    The authors, using a new digital coronary radiographic technique, report the demonstration of contrast-material-induced coronary artery steal. Attempts to measure myocardial blood flow using arteriographic techniques in the setting of complex coronary anatomy can be complicated by heterogeneous flow patterns

  5. Iatrogenic dissection of the left main coronary artery during elective diagnostic procedures: A report on three cases

    Directory of Open Access Journals (Sweden)

    Đenić Nemanja

    2016-01-01

    Full Text Available Introduction. Left main coronary artery dissection is a rare and potentially life-threatening complication of coronary angiography and angioplasty which requests urgent revascularization. Case report. During the period between 2010 and November 2014 at single healthcare center we did totally 8,884 coronary procedures, out of which 2,333 were percutaneous coronary interventions (PCI. In this period we had a total of 3 (0,03% left main coronary artery dissections, and all of them were successfully treated by PCI. We presented three cases with iatrogenic dissection of the left main coronary artery, occurred during elective diagnostic procedures, successfully treated with PCI with different techniques. Conclusion. PCI could be fast and life-saving approach in iatrogenic dissections of the left main coronary artery.

  6. The value of hybrid SPECT/CT imaging in assessment of 'functionally relevant coronary artery lesion'

    International Nuclear Information System (INIS)

    Objective: There is great interest in the assessment of functionally relevant coronary artery lesions and its value in coronary artery disease (CAD) management by hybrid SPECT/CT. The objective of this study was to evaluate the clinical value and the feasibility of imaging of hybrid SPECT/CT in detecting the 'functionally relevant coronary artery lesions (FRCAL)'. Methods: Forty patients with suspected or known CAD performed computed tomography coronary angiography (CTCA) and stress/rest myocardial perfusion imaging (MPI) with 99Tcm-methoxyisobutyhsomtrile (MIBI) by hybrid SPECT/CT. Stress/rest MPI was performed with standard two-day protocol, and CTCA was performed the second day. Adenosine was infused intravenously at a constand rate of 0.14 mg·kg-1·min-1 for 6 min. CTCA was performed with standard contrast medium autotrack sequence. Images of MPI and CTCA were fused by special fusion software (AutoQUNANT'7.0) in order to evaluate the functional relationship between myocardial ischemia and CAD, videlicet 'FRCAL'. Results: Twenty of the 40 patients had coronary atherosclerosis, malformation or coronary stenosis, with a total of 33 diseased coronary vessels (15 left anterior descending coronay artery, 9 left circumflex coronary artery and 9 right coronary artery). The remaining 20 patients had normal results. MPI were normal in 22 and 18 showed myocardial ischemia and (or) infarct. The ratio of normal MPI in normal CTCA was 92.47% (86/93) by SPECT/CT imaging. The positive rates of detecting ischemia were 42.86% (6/14, 75% diameter stenosis or blockage). About 20. 83% (25/120) of all the narrowed coronary arteries were determined to be 'FRCAL' and 25.93% (7/27) of the patients without coronary, stenosis had myocardial ischemia. And then 15.38% (2/13) of the patients with CAD avoided invasive procedures (that was coronary angiography). About 42.86% (6/ 14) needed drug treatment or coronary revascularization (75% diameter stenosis but no coronary revascularization

  7. Electrocardiographic localization of infarct related coronary artery in acute ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    C.S. Thejanandan Reddy

    2013-07-01

    Full Text Available The electrocardiogram (ECG remains a crucial tool in the identification and management of acute myocardial infarction (MI. A detailed analysis of patterns of ST-segment elevation may influence decisions regarding the use of reperfusion therapy. The early and accurate identification of the infarct-related artery on the ECG can help predict the amount of myocardium at risk and guide decisions regarding the urgency of revascularization. The specificity of the ECG in acute MI is limited by individual variations in coronary anatomy as well as by the presence of preexisting coronary artery disease, particularly in patients with a previous MI, collateral circulation, or previous coronary-artery bypass surgery. The ECG is also limited by its inadequate representation of the posterior, lateral, and apical walls of the left ventricle. Despite these limitations, the electrocardiogram can help in identifying proximal occlusion of the coronary arteries, which results in the most extensive and most severe myocardial infarctions.

  8. Off-pump and on-pump coronary artery bypass surgery:time to move on

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

    @@ To the editor: Chen and colleagues,1 and the editorial staff of the Chinese Medical Journal, deserve much credit for carrying out and publishing a prospective comparative study of on-pump and off-pump coronary artery bypass (OPCAB) surgery in 300 patients with triple-vessel coronary artery disease. Although this study is limited by non-randomization and selection bias yet contrary to the previously published prospective, randomized studies by Van Dijk et al,2 and Ascione et al,3 the patient population of this study is more representative of current coronary artery surgery practices. Even more important is the conclusion that OPCAB can be applied to patients with triple-vessel coronary artery disease and "in experienced hands" can achieve similar completeness of revascularization and similar early surgical results.

  9. Phrenic Nerve Injury during Coronary Artery Bypass

    OpenAIRE

    Guinn, Gene A.; Beall, Arthur C.; Lamki, Neela; Heibig, Jacques; Thornby, John

    1990-01-01

    After coronary artery bypass, some patients have diaphragmatic elevation, usually on the left side. To test our hypothesis that this phenomenon is due to phrenic nerve injury resulting from either 1) dissection of the proximal portion of the left internal mammary artery or 2) topical cooling of the heart with icy slush, we performed the following 2-part study. First, we reviewed our hospital records of 99 coronary artery bypass patients, 55 of whom had received left internal mammary artery gr...

  10. Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

    OpenAIRE

    Claudiu Avram; Adina Avram; L.aura Crăciun; Stela Iurciuc; Lucian Hoble; Alexandra Rusu; Bogdan Almăjan-Guţă; Silvia Mancaş

    2010-01-01

    The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Grou...

  11. Reusing the patent internal mammary artery as a conduit in redo coronary artery bypass surgery.

    Science.gov (United States)

    Nwaejike, Nnamdi; Tennyson, Charlene; Mosca, Roberto; Venkateswaran, Rajamiyer

    2016-03-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was, in patients with previous internal mammary artery/internal thoracic artery (ITA) grafts, can the internal mammary artery/ITA be reused/recycled in redo coronary artery bypass surgery? Fourteen papers were found using the reported search of which 10 represented the best evidence to answer the clinical question. There was variation in patient selection, the number of patients reported, outcome measures recorded, and methods and duration of follow-up. The results were mostly in favour of using a recycled ITA when it could be safely harvested. Most studies were retrospective. One large series of 60 patients who underwent redo coronary artery bypass grafting (CABG) using previously implanted ITAs had a mean time to reoperation of 117 ± 68 months. They reported no operative deaths; no patients required further or subsequent target vessel revascularization; 30-day mortality was 8.3% and myocardial infarction rate was 3%. Another two series of 16 and 12 patients underwent recycling of arterial grafts during coronary artery revascularization with no perioperative deaths in either. Postoperative angiography was performed in 10 patients in one of these studies, which showed excellent flow in all redone left internal thoracic artery (LITA) grafts. One study reported results from a prospective cohort of 9 patients who underwent redo coronary artery bypass grafting. Interval between operations was between 1 and 132 months. There was no perioperative mortality, but 1 patient required reintervention (to an interposition vein graft). A further study of 4 patients who underwent redo CABG using ITAs that were patent but with severe stenosis at the distal anastomosis had no mortality. Postoperative angiography showed patency of all grafts. There have also been 4 case reports on reusing the ITA/ITA in redo CABG with no damage to the reused LITA, no perioperative

  12. Lower-extremity arterial revascularization: Is there any evidence for diabetic foot ulcer-healing?

    Science.gov (United States)

    Vouillarmet, J; Bourron, O; Gaudric, J; Lermusiaux, P; Millon, A; Hartemann, A

    2016-02-01

    The presence of peripheral arterial disease (PAD) is an important consideration in the management of diabetic foot ulcers. Indeed, arteriopathy is a major factor in delayed healing and the increased risk of amputation. Revascularization is commonly performed in patients with critical limb ischaemia (CLI) and diabetic foot ulcer (DFU), but also in patients with less severe arteriopathy. The ulcer-healing rate obtained after revascularization ranges from 46% to 91% at 1 year and appears to be improved compared to patients without revascularization. However, in those studies, healing was often a secondary criterion, and there was no description of the initial wound or its management. Furthermore, specific alterations associated with diabetes, such as microcirculation disorders, abnormal angiogenesis and glycation of proteins, can alter healing and the benefits of revascularization. In this review, critical assessment of data from the literature was performed on the relationship between PAD, revascularization and healing of DFUs. Also, the impact of diabetes on the effectiveness of revascularization was analyzed and potential new therapeutic targets described. PMID:26072053

  13. The effects of fenoldopam on coronary conduit blood flow after coronary artery bypass graft surgery.

    LENUS (Irish Health Repository)

    Halpenny, M

    2012-02-03

    OBJECTIVE: To quantify the effects of fenoldopam, 0.1 microg\\/kg\\/min, on left internal mammary artery (LIMA) and saphenous vein blood flow after coronary anastomosis. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: University teaching hospital, single institution. PARTICIPANTS: Thirty-one American Society of Anesthesiologists III patients undergoing elective coronary revascularization. INTERVENTIONS: A perivascular ultrasonic flow probe (Linton Instrumentation, Norfolk, UK) was placed around the LIMA and saphenous vein graft after coronary anastomosis. MEASUREMENTS AND MAIN RESULTS: Immediately before and at 5-minute intervals for 15 minutes after starting the infusion, blood flow was measured in the LIMA and one saphenous vein graft using a transit time ultrasonic flow probe. Heart rate, blood pressure, and central venous pressure were documented at these time points. Administration of fenoldopam, 0.1 microg\\/kg\\/min, did not alter heart rate or blood pressure. A small, nonsignificant increase in LIMA blood flow occurred during the 15-minute study period (30 +\\/- 12 to 35 +\\/- 10 mL\\/min) in patients who received fenoldopam. No significant changes occurred in the placebo group. CONCLUSIONS: The findings indicate that fenoldopam, 0.1 microg\\/kg\\/min, did not influence coronary conduit blood flow to a clinically significant extent. The small increase in LIMA blood flow may be of greater importance in high-risk patients or in the prevention of coronary arterial spasm.

  14. Minimal Invasive Coronary Artery Fistula Ligation

    OpenAIRE

    Mitropoulos, Fotios A.; Kanakis, Meletios A.; Chatzis, Andrew; Contrafouris, Constantinos; Sofianidou, Ioanna A.; Lioulias, Achilleas G.

    2014-01-01

    A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay.

  15. Multimodality imaging of coronary artery bypass grafts

    NARCIS (Netherlands)

    Salm, Liesbeth Pauline

    2006-01-01

    This thesis describes multiple imaging modalities to examine coronary artery bypass grafts, and the research which was performed to further develop noninvasive imaging techniques to detect stenoses in native coronary arteries and bypass grafts in patients who experienced recurrent chest pain after c

  16. Coronary artery anomalies in Turner Syndrome

    DEFF Research Database (Denmark)

    Viuff, Mette H; Trolle, Christian; Wen, Jan;

    2016-01-01

    BACKGROUND: Congenital heart disease, primarily involving the left-sided structures, is often seen in patients with Turner Syndrome. Moreover, a few case reports have indicated that coronary anomalies may be more prevalent in Turner Syndrome than in the normal population. We therefore set out...... to systematically investigate coronary arterial anatomy by computed tomographic coronary angiography (coronary CTA) in Turner Syndrome patients. METHODS: Fifty consecutive women with Turner Syndrome (mean age 47 years [17-71]) underwent coronary CTA. Patients were compared with 25 gender-matched controls. RESULTS......: Coronary anomaly was more frequent in patients with Turner Syndrome than in healthy controls [20% vs. 4% (p = 0.043)]. Nine out of ten abnormal cases had an anomalous left coronary artery anatomy (absent left main trunk, n = 7; circumflex artery originating from the right aortic sinus, n = 2). One case had...

  17. Potential role of Chinese medicinal herbs in the prevention of coronary artery restenosis

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Percutaneous coronary intervention (PCI) especially stent implantation has now become a mainstay of therapeutic armamentarium in the treatment of patients with coronary artery disease even at clinically or angiographically high risk. However, restenosis requiring reintervention remains a major limitation and a challenging problem of percutaneous revascularization. 1 Despite the use of coronary stents, the rate of restenosis is still relatively high, affecting a quarter or more of overall patients treated by bare- metal stents and around 10% of those treated by drug- eluting stents, which may be even higher for complex PCI (long lesion, bifurcation, small vessel disease) or at unfavorable clinical conditions (diabetes, chronic renal failure). 2,3

  18. Coronary artery disease in type 2 diabetes mellitus:Recent treatment strategies and future perspectives

    Institute of Scientific and Technical Information of China (English)

    Ryo; Naito; Takatoshi; Kasai

    2015-01-01

    Patients with type 2 diabetes mellitus(T2DM) are at a higher risk of developing coronary artery disease(CAD) than are non-T2 DM patients. Moreover, the clinical outcomes in CAD with T2 DM are poor despite improvements in medications and other interventions. Coronary artery bypass grafting is superior to percutaneous coronary intervention in treating multivessel coronary artery disease in diabetic patients. However, selecting a revascularization strategy depends not only on the lesion complexity but also on the patient’s medical history and comorbidities. Additionally, comprehensive risk management with medical and non-pharmacological therapies is important, as is confirmation regarding whether the risk-management strategies are being appropriately achieved. Furthermore, non-pharmacological interventions using exercise and diet during the earlier stages of glucose metabolism abnormalities, such as impaired glucose tolerance, might be beneficial in preventing the development or progression of T2 DM and in reducing the occurrence of cardiovascular events.

  19. CORONARY ARTERY DOMINANCE PATTERN IN EAST-GODAVARI DISTRICT: A CADAVERIC STUDY

    Directory of Open Access Journals (Sweden)

    Arindom

    2016-01-01

    Full Text Available With the advent of coronary angiography, coronary artery diseases can be well combated; but with time sedentary life style and stress as our constant partner have kept coronary artery disease as one of the major causes of death. Revascularization procedures demand a sound knowledge of the course of coronary arteries and their branches, both normal and their quite common variations. In this regard, posterior inter-ventricular artery (PIVA deserves a special importance; PIVA determines the coronary dominance depending on its parent artery. Dominance can be right, left or of balanced type. Balanced type means that PIVA is derived from both right & left coronary arteries. Circulation can occur when both the coronary arteries emit a branch in that area. These and other variations form a very important repertoire of information based on which coronary bypass surgery and angioplasty can be safely and effectively performed. The aim of this study therefore is to document the coronary dominance pattern in this East Godavari district of Andhra-Pradesh. 60 adult human hearts were collected from museum of Anatomy department during the tenure of 5 years (2009 to 2014 and were preserved in 10% formalin. The hearts were dissected carefully to observe the posterior inter-ventricular artery in the posterior inter-ventricular sulcus of each heart and dominance pattern was recorded. In our present study right dominance type was the commonest (46 out of 60 followed by left dominance (10 out of 60. Only 4 out of 60 were of the balanced type. Present study, though not of the only member of its kind will definitely add up to the already existing vast knowledge, based on which various diagnostic and therapeutic intervention of coronary artery diseases can be done effectively and safely

  20. Downstream Procedures and Outcomes After Stress Testing For Suspected Coronary Artery Disease in the United States

    Science.gov (United States)

    Mudrick, Daniel W; Cowper, Patricia A; Shah, Bimal R; Patel, Manesh R; Jensen, Neil C; Drawz, Matthew J; Peterson, Eric D; Douglas, Pamela S

    2013-01-01

    Background Millions of Americans with suspected coronary artery disease undergo non-invasive cardiac stress testing annually. Downstream procedures and subsequent outcomes among symptomatic patients without known coronary disease referred for stress testing are not well characterized in contemporary community practice. Methods We examined administrative insurance billing data from a national insurance provider from November 2004 through June 2007. After excluding patients with prior cardiac disease or chest pain evaluation, we identified 80,676 people age 40–64 years with outpatient cardiac stress testing within 30 days after an office visit for chest pain. We evaluated rates of invasive coronary angiography, coronary revascularization, and cardiovascular events after stress testing. Results Within 60 days, only 8.8% of stress test patients underwent cardiac catheterization and only 2.7% underwent revascularization; within one year only 0.5% suffered death, myocardial infarction, or stroke. There were marked geographic variations in one-year rates of catheterization (3.8–14.8%) and revascularization (1.2–3.0%) across 20 hospital referral regions. Conclusions In this large national cohort of middle-aged patients without previously coded cardiac diagnosis who were referred for stress testing after outpatient chest pain evaluation, few proceeded to invasive angiography or revascularization, and subsequent cardiovascular events were infrequent. PMID:22424017

  1. Exertion and acute coronary artery injury.

    Science.gov (United States)

    Black, A; Black, M M; Gensini, G

    1975-12-01

    Twelve cases of myocardial infarction as related to strenuous exertion are presented with the pathological findings in several of these cases. Three cases with coronary arteriography are also presented. The pathology of coronary arteriosclerotic plaques and the vulnerability to acute injury is reviewed and discussed. It is concluded that strenuous exertion can cause acute injury to coronary artery plaques due to the unusual stressful whip-like action to which coronary arteries are subject. These injuries may initiate as cracks in the plaques or subintimal hemorrhages and proceed to coronary occlusion and ultimate myocardial infarction. With this concept in mind we use the term of "crack in the plaque" (Black's Crack in the Plaque) to account for the sudden appearance of clinical coronary artery disease appearing during or shortly after exertion, or other stressful situations in patients without previous existing evidence of clinical coronary artery disease. This could also account for exacerbation of symptoms or death occurring after exertion in previously quiescent asymptomatic known coronary artery disease subjects. This concept may explain some of the puzzling features of coronary disease.

  2. Emergency revascularization of acute internal carotid artery occlusion: Follow the spike, it guides you.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Leker, Ronen R; Eichel, Roni; Itshayek, Eyal

    2016-07-01

    The present study sought to examine the incidence of the angiographic "spike sign" and to assess its predictive significance for achieving carotid revascularization in 54 patients with acute internal carotid artery (ICA) occlusions that required urgent endovascular revascularization. Clinical and imaging files of consecutive patients with ICA occlusion who were treated in a tertiary care academic medical center from 2011-2015 were retrospectively examined under Institutional Review Board approval with a waiver of the requirement for informed consent. All proximal ICA occlusions were treated by stent-assisted carotid angioplasty, and all distal embolic occlusions were managed with stent-assisted mechanical thrombectomy. The study included 24 patients with acute ICA occlusion (group 1) and 30 patients with tandem ICA-intracranial occlusions (group 2). The spike sign was seen in 16/24 patients in group 1 (67%), and successful ICA revascularization was achieved in 14/16 (88%). The sign was seen in 26/30 patients in group 2 (87%), and ICA revascularization was successful in all 26 (100%). The remaining 12 patients had no spike sign, and ICA revascularization was successful in only 7/12 (58%). The spike sign is a transient finding that represents the proximal patent remnant of the stenotic corridor in fresh clot. Acute ICA occlusion frequently leaves the spike sign as a marker of the recent thrombotic event. The spike vertex points to the "path of least resistance" for the guidewire to cross the occlusion and engage the true arterial lumen, a critical step during ICA endovascular revascularization. PMID:26935747

  3. THE ROLE OF LIPOTROPIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE BEFORE AND AFTER CORONARY REVASCULARIZATION

    Directory of Open Access Journals (Sweden)

    R. N. Adzhiev

    2013-01-01

    Full Text Available Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011. The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

  4. THE ROLE OF LIPOTROPIC THERAPY IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE BEFORE AND AFTER CORONARY REVASCULARIZATION

    Directory of Open Access Journals (Sweden)

    R. N. Adzhiev

    2015-09-01

    Full Text Available Review of large of trials that prove the positive impact of high-dose lipid-lowering therapy on the prognosis in patients with ischemic heart disease (IHD are presented. The data on the efficacy of the lipid profile correction by lipid apheresis in patients with hypercholesterolemia that is refractory to optimal medical therapy are showed. The results of the large trials (LIPS, ARMYDA, NAPLES II, ARMYDA-RECAPTURE, Post-CABG, TNT and meta-analyzes on the role of statins, prescribed before and after coronary artery bypass surgery and stenting, in reducing the risk of early and late cardiac events and the need for repeat myocardial revascularization are analyzed. The issue of therapeutic apheresis should be considered in cases of refractory hypercholesterolemia according to ESC/EAS Guidelines for the management of dyslipidaemias (2011. The tendency to reduction in the risk of stent restenosis and vein graft lesions after lipid apheresis is found in very high risk patients with IHD and refractory hypercholesterolemia that underwent coronary stenting or bypass surgery.

  5. Acoustic detection of coronary artery disease.

    Science.gov (United States)

    Semmlow, John; Rahalkar, Ketaki

    2007-01-01

    Coronary artery disease (CAD) occurs when the arteries to the heart (the coronary arteries) become blocked by deposition of plaque, depriving the heart of oxygen-bearing blood. This disease is arguably the most important fatal disease in industrialized countries, causing one-third to one-half of all deaths in persons between the ages of 35 and 64 in the United States. Despite the fact that early detection of CAD allows for successful and cost-effective treatment of the disease, only 20% of CAD cases are diagnosed prior to a heart attack. The development of a definitive, noninvasive test for detection of coronary blockages is one of the holy grails of diagnostic cardiology. One promising approach to detecting coronary blockages noninvasively is based on identifying acoustic signatures generated by turbulent blood flow through partially occluded coronary arteries. In fact, no other approach to the detection of CAD promises to be as inexpensive, simple to perform, and risk free as the acoustic-based approach. Although sounds associated with partially blocked arteries are easy to identify in more superficial vessels such as the carotids, sounds from coronary arteries are very faint and surrounded by noise such as the very loud valve sounds. To detect these very weak signals requires sophisticated signal processing techniques. This review describes the work that has been done in this area since the 1980s and discusses future directions that may fulfill the promise of the acoustic approach to detecting coronary artery disease.

  6. [Pediatric case of congenital coronary artery fistula; surgical result and late changes in coronary artery aneurysm].

    Science.gov (United States)

    Sugawara, Masaaki; Oguma, Fumiaki; Hirahara, Hiroyuki

    2014-07-01

    Congenital coronary artery fistula is an uncommon heart anomaly involving the coronary arteries. We report here a case of a 4-year-old boy who had a coronary fistula from the right coronary artery to the right ventricle, with a coronary aneurysm. He was asymptomatic, but the calculated ratio of pulmonary blood flow to systemic blood flow was shown to be high [pulmonary flow (Qp)/systemic flow(Qs)=1.78]. The coronary angiography showed that the right coronary artery was dilated beginning at the ostium and had an aneurysm at the acute marginal portion. A large spherical aneurysm approximately 20 mm in diameter was found to have been connected with coronary fistula opening into the right ventricle. Surgical repair by closure of the fistula under direct vision, partial resection and suture closure of the aneurysm was performed. Plication of the proximal portion of the right coronary artery was not performed, and the diffusely dilated artery was left untouched. After this operation, he recovered well under anticoagulant treatment with warfarin and aspirin. Postoperative angiography was performed 17 months after the surgery to evaluate morphological changes in the coronary artery. The angiography confirmed the closure of the fistula and the regression of coronary artery dilatation.

  7. Combining PCI and CABG: the Role of Hybrid Revascularization

    OpenAIRE

    Green, Kelly D.; Lynch, Donald R.; Chen, Tyffany P.; Zhao, David

    2013-01-01

    Hybrid coronary revascularization combines the benefits of both percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in the treatment of multivessel coronary artery disease (CAD) by combining the benefits of the LIMA-to-LAD graft and drug eluting stent (DES) to non-LAD regions. Through this approach, a patient receives the long-term benefit of the LIMA graft and avoids the morbidity of a full sternotomy and saphenous vein grafts. Available data related to outcom...

  8. Surgical myocardial revascularization without extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Salomón Soriano Ordinola Rojas

    2003-05-01

    Full Text Available OBJECTIVE: To assess the immediate postoperative period of patients undergoing myocardial revascularization without extracorporeal circulation with different types of grafts. METHODS: One hundred and twelve patients, 89 (79.5% of whom were males, were revascularized without extracorporeal circulation. Their ages ranged from 39 to 85 years. The criteria for indicating myocardial revascularization without extracorporeal circulation were as follows: revascularized coronary artery caliber > 1.5 mm, lack of intramyocardial trajectory on coronary angiography, noncalcified coronary arteries, and tolerance of the heart to the different rotation maneuvers. RESULTS: Myocardial revascularization without extracorporeal circulation was performed in 112 patients. Three were converted to extracorporeal circulation, which required a longer hospital stay but did not impact mortality. During the procedure, the following events were observed: atrial fibrillation in 10 patients, ventricular fibrillation in 4, total transient atrioventricular block in 2, ventricular extrasystoles in 58, use of a device to retrieve red blood cells in 53, blood transfusion in 8, and arterial hypotension in 89 patients. Coronary angiography was performed in 20 patients on the seventh postoperative day when the grafts were patent. CONCLUSION: Myocardial revascularization without extracorporeal circulation is a reproducible technique that is an alternative for treating ischemic heart disease.

  9. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease

    Directory of Open Access Journals (Sweden)

    Hyung Gon Je

    2015-05-01

    Full Text Available Improvement in quality of life (QoL is a primary treatment goal for patients with peripheral arterial disease (PAD. The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ and ankle-brachial index (ABI, and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p < 0.001. PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p’s < 0.001. As expected the ABI of treated limbs showed significant improvement post-revascularization (p < 0.001. ABI after revascularization correlated with patient-reported changes in the physical function and QoL domains of the PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI < 0.15. Interestingly, poor responders reported improvement in symptoms on the PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization.

  10. Drug-eluting stents:is it the beginning of the end for coronary artery bypass surgery?

    Institute of Scientific and Technical Information of China (English)

    Shahzad G Raja

    2004-01-01

    @@ Myocardial revascularization therapy of coronary artery disease is one of the most important medical advances of the past 50 years.1 Coronary revascularization by either bypass surgery or coronary angioplasty relieves angina and may improve the prognosis in patients with coronary artery disease.2,3 Randomized comparisons reveal no difference in survival free from myocardial infarction (MI) between surgery and balloon angioplasty.4,5 Stenting significantly improved the long-term outcome, while surgery is still associated with fewer reinterventions during follow-up.6-10 However, subsequent improvements in both percutaneous and surgical techniques may now limit the validity of any conclusions that have been drawn from the earlier studies. In fact, the lines of demarcation for patients suited for bypass or angioplasty are becoming blurry with each passing day.

  11. Off-pump sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system

    Institute of Scientific and Technical Information of China (English)

    YU Yang; YAN Xiao-lei; WEI Hua; YANG Jun-feng; GU Cheng-xiong

    2011-01-01

    Background Off-pump coronary artery bypass surgery (OPCAB) has been widely applied in recent years as a less invasive method of myocardial revascularization. This study evaluated the sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system during OPCAB.Methods From April 2004 to August 2010, patients with diffuse right coronary lesions were studied retrospectively and divided into two groups. Group 1 included seventeen patients who underwent this surgery while group 2 included twenty-one patients without right coronary artery surgical therapy. All patients presented with symptoms of angina. Blood flow of bridged vessels was measured. The perioperative ventricular parameters including left ventricular ejection fraction and end diastolic diameter were compared. During follow-up, myocardial nuclide imaging and coronary angiography were carried out.Results Off-pump coronary artery bypass was performed with an average of 3.6 grafts per patient. Hospital mortality was zero. At the time of follow-up, the patients in group 1 recovered better than in group 2 (P<0.05). In both groups, the mean New York Heart Association (NYHA) class and ejection fraction increased significantly (P<0.001) and the mean left ventricular end-diastolic diameter decreased significantly (P <0.05). Myocardial blood supply of inferior wall in group 1 was obviously improved by myocardial nuclide imaging. Coronary angiography for eight patients in group 1 verified that there was blood flow to myocardium in the arterialized vein.Conclusions Sequential bilateral internal mammary artery grafting combined with selective arterialization of the coronary venous system can be performed during OPCAB. A postoperative improvement in the cardiac functions and the quality of life was documented, increasing our expectation for extensive application.

  12. 二维应变超声心动图评价冠心病血运重建前后左心室局部功能%Evaluation on regional function of left ventricle pre- and post-revascularization in coronary artery disease patients by two dimensional strain echocardiography

    Institute of Scientific and Technical Information of China (English)

    王健; 康春松; 董建红; 薛继平

    2009-01-01

    目的 探讨冠心病心肌缺血改善前后不同时间点的应变、应变率特点,评价二维应变成像在冠心病患者疗效评价中的价值.方法 24例血运重建治疗的冠心病患者,应用二维应变检测病变节段血运重建前,重建后1周、1月、3月的应变和应变率参数的变化.结果 病变节段治疗前应变-时间曲线、应变率-时间曲线整个心动周期轮廓杂乱,峰值应变(S)、收缩期峰值应变率(SRS)与舒张早期峰值应变率(SRE)波峰低平,部分节段S波峰倒置.治疗后1周,病变节段S、SRS、SRE及舒张晚期峰值应变率(SRA)各峰值指标有所上升,与治疗前比较差异无统计学意义(P>0.05).治疗后1月,病变节段S、SRE与治疗前比较明显上升(P<0.01).治疗后3月应变-时间曲线、应变率-时间曲线轮廓趋于整齐,S、SRS、SRE及SRA峰值明显上升,与治疗前比较差异有统计学意义(P<0.01),S、SRS、SRA与治疗后1周、1月比较差异有统计学意义(P<0.01).结论 二维应变可无创定量评价冠心病血运重建后不同时间的应变及应变率,评价局部心肌收缩、舒张功能.%Objective To probe into the characteristics of strain and strain rate in different time points of coronary artery disease (CAD) patients before and after the improvement of myocardial ischemia, to evaluate the value of two-dimensional strain (2DS) imaging in assessing curative effect of CAD patients. Methods The changes of strain and strain rate in local lesion segments before revascularization,and one week,one month and three months after revascularization of 24 CAD patients accepting revascularization therapy were detected by 2DS. Results Before revascularization treatment,the outlines of strain-time curves and strain-rate-time curves of lesion segments of CAD patients in whole cardiac circle were cluttered. The peak strain (S),the peak systolic strain rate (SRS) and the peak early diastolic strain rate (SRE) were low and calm. The

  13. Left main coronary artery compression in pulmonary arterial hypertension

    DEFF Research Database (Denmark)

    Al-Badri, Kadhem Helo Abbas; Jensen, Jesper Møller; Christiansen, Evald H;

    2015-01-01

    In patients with pulmonary arterial hypertension (PAH), chest pain is most likely due to right ventricular demand ischemia. We report a patient with idiopathic PAH who developed severe angina due to extrinsic compression of the left main coronary artery (LMCA) from a dilated pulmonary artery trunk....... The diagnosis was verified by electrocardiogram after exercise, coronary angiography including intravascular ultrasound, and cardiac multidetector computed tomography (MDCT). The origin of the LMCA was high in the left coronary sinus, facilitating extrinsic compression. The patient was successfully treated...

  14. Percutaneous transluminal coronary angioplasty for culprit lesions in patients with post myocardial infarction angina based on dextrocardia and anomalous coronary arteries. Case reports and methods.

    Science.gov (United States)

    Yabe, Y; Tsukahara, R

    1995-05-01

    Four cases of successful coronary angioplasty for anomalous coronary arteries, including dextrocardia associated with three-vessel disease, single left coronary artery with proximal left anterior descending lesion, anomalous right coronary artery (RCA) from adjacent left coronary sinus of Valsalva associated with proximal RCA lesion, and anomalous left circumflex angulated lesion bifurcated from the RCA, were encountered. Four cases with 8 target lesions who had a mean age of 63.5 +/- 11.5 years old are presented. All the targets lesions were completely dilated through balloon angioplasty, including use of a newly developed support device for cases with large jeopardized myocardium. The factors for complete revascularization were appropriate selection of catheters and originality and ingenuity of procedural technique based on the anatomic characteristics.

  15. Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization.

    Science.gov (United States)

    Moreno, Nuno; da Silva Castro, Alexandra; Pereira, Adriana; Silva, João Carlos; Almeida, Pedro Bernardo; Andrade, Aurora; Maciel, Maria Júlia; Pinto, Paula

    2013-06-01

    Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting. The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing. Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients. PMID:23809629

  16. Ischemia induced by coronary steal through a patent mammary artery side branch: a role for embolization.

    Science.gov (United States)

    Moreno, Nuno; da Silva Castro, Alexandra; Pereira, Adriana; Silva, João Carlos; Almeida, Pedro Bernardo; Andrade, Aurora; Maciel, Maria Júlia; Pinto, Paula

    2013-06-01

    Non-occlusion of the internal mammary artery side branches may cause ischemia due to flow diversion after coronary artery bypass grafting. The authors present the case of a 67-year-old man with recurrent angina after undergoing myocardial revascularization with a left internal mammary artery to left anterior descending bypass. He presented with impaired anterior wall myocardial perfusion in the setting of a patent left internal mammary artery side branch. Effective percutaneous treatment was carried out through coil embolization, with improved flow and clinical symptoms, confirmed through ischemia testing. Coronary steal through a patent mammary artery side branch is a controversial phenomenon and this type of intervention should be considered only in carefully selected patients.

  17. Peripheral arterial disease and revascularization of the diabetic foot.

    Science.gov (United States)

    Forsythe, R O; Brownrigg, J; Hinchliffe, R J

    2015-05-01

    Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration. In addition to peripheral arterial disease, functional changes in the microcirculation also contribute to the development of a diabetic foot ulcer, along with other factors such as infection, oedema and abnormal biomechanical loading. Peripheral arterial disease typically affects the distal vessels, resulting in multi-level occlusions and diffuse disease, which often necessitates challenging distal revascularisation surgery or angioplasty in order to improve blood flow. However, technically successful revascularisation does not always result in wound healing. The confounding effects of microvascular dysfunction must be recognised--treatment of a patient with a diabetic foot ulcer and peripheral arterial disease should address this complex interplay of pathophysiological changes. In the case of non-revascularisable peripheral arterial disease or poor response to conventional treatment, alternative approaches such as cell-based treatment, hyperbaric oxygen therapy and the use of vasodilators may appear attractive, however more robust evidence is required to justify these novel approaches.

  18. Peripheral artery disease in patients with coronary artery disease.

    Science.gov (United States)

    Atmer, B; Jogestrand, T; Laska, J; Lund, F

    1995-03-01

    The prevalence of peripheral vascular disease in patients with coronary artery disease has been investigated in many different ways and depends on the diagnostic methods and the definition of the atherosclerotic manifestations in the different vascular beds. In this study we used the non-invasive methods digital volume pulse plethysmography and ankle and toe blood pressure measurements to identify arterial abnormalities in the lower limbs in 58 patients (49 males and 9 females; age 37-72 years) examined with coronary angiography. The prevalence of peripheral artery disease was 22%, in agreement with the results of most previous investigations. There was a tendency towards increasing prevalence of peripheral artery disease with more advanced coronary artery disease: 14% of the patients with no or minimal coronary atheromotous lesions, 18% of the patients with moderate coronary atheromotous lesions and 32% of the patients with marked coronary atheromotous disease. For this reason a non-invasive investigation of the peripheral arterial circulation should be included early in the clinical consideration of patients with chest pain or similar symptoms suggesting coronary heart disease. Toe pressure measurement appears to be the most appropriate technique being rather simple in management and also in evaluation of results. PMID:7658111

  19. Risks of Death and Graft Failure After Surgical Versus Percutaneous Coronary Revascularization in Renal Transplant Patients

    OpenAIRE

    Charytan, David M.; Li, Shuling; Liu, Jiannong; Qiu, Yang; Herzog, Charles A.

    2013-01-01

    Background Reliable data regarding absolute and relative risks of death and graft failure after coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) in renal transplant patients are unavailable. Methods and Results Renal transplant patients undergoing inpatient CABG (n=1400) or PCI (n=4097) were identified from United States Renal Data System data. Cumulative incidence of nonfatal graft failure and death was reported for observed events. A Cox model with th...

  20. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... 10 minutes. Okay. Good. We’re in the safety zone. Okay. One important things is that the ... on the coronary artery, and I just, for safety reasons, would like to keep this part. We’ ...

  1. Anesthetic management for 1-stop hybrid revascularization of coronary artery disease%冠心病患者"一站式"杂交手术的麻醉处理

    Institute of Scientific and Technical Information of China (English)

    王剑辉; 韩志岩; 林霖; 李立环

    2010-01-01

    目的 分析冠心病患者"一站式"杂交手术的麻醉管理经验和相关问题.方法 2007年7月至2009年6月北京阜外医院63例冠心病"一站式"杂交手术患者,先行小切口不停跳的乳内动脉到前降支的搭桥手术,术后即刻造影确认乳内动脉搭桥是否通畅,随后行冠状动脉介入治疗.术中连续监测有创血压、五导联心电图、中心静脉压(CVP)、脉搏血氧饱和度、体温等.诱导和维持宜采用小剂量阿片类药物为主的静吸复合麻醉方案,并且根据手术需要采取特定的抗凝方案.结果 术中血流动力学稳定,出血少,术后机械通气时间短;利用快通道技术实施术毕即刻拔管6例;围术期无一例患者死亡.结论 该类手术具有的微创特性对循环的影响小,单纯麻醉管理的难度不大,注意术中需要采取特殊的抗凝方案.快通道技术的实施可以进一步体现该类手术的优势.%Objective To summarize the anesthesia managements on 63 CAD patients undergoing 1-stop hybrid revascularization from July 2007 to June 2009 in Fuwai Hospital Methods ECG, direct BP, SpO2, PET CO2, CVP and body temperature were monitored during anesthesia. The management of intraoperative anesthesia should preferably use a small dosage of opioids with inhalation or intravenous anesthesia. At the same time , specific anticoagulation management was administered. Results The hemodynamics were stabilized. the time of tracheal intubation were shorter. 6 patients were immediate extubated in the operating room with application of fast-track technology. No patient died. Conclusions Such minimally invasive surgery has little effect on the circulation. The difficulty of anesthetic management is smaller. Specific anticoagulation management is administered. Implementation of the Fast-track technology can demonstrate the further advantages in such surgery.

  2. Coronary Computed Tomography Angiography Derived Fractional Flow Reserve and Plaque Stress

    DEFF Research Database (Denmark)

    Nørgaard, Bjarne Linde; Leipsic, Jonathon; Koo, Bon-Kwon;

    2016-01-01

    Fractional flow reserve (FFR) measured during invasive coronary angiography is an independent prognosticator in patients with coronary artery disease and the gold standard for decision making in coronary revascularization. The integration of computational fluid dynamics and quantitative anatomic...

  3. Coronary artery bypass grafts and MDCT imaging: what to know and what to look for

    Energy Technology Data Exchange (ETDEWEB)

    Marano, Riccardo; Storto, Maria L. [G. d' Annunzio University, SS. Annunziata Hospital, Department of Clinical Sciences and Bioimaging-Section of Radiology, Chieti (Italy); Liguori, Carlo; Rinaldi, Pierluigi; Savino, Giancarlo; Bonomo, Lorenzo [Catholic University, A. Gemelli Hospital, Department of Bioimaging and Radiological Sciences, Rome (Italy); Politi, Marco A. [Casa Sollievo della Sofferenza-Interventional Radiology, San Giovanni Rotondo (Italy)

    2007-12-15

    Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings. (orig.)

  4. Coronary artery bypass grafts and MDCT imaging: what to know and what to look for.

    Science.gov (United States)

    Marano, Riccardo; Liguori, Carlo; Rinaldi, Pierluigi; Storto, Maria Luigia; Politi, Marco Angelo; Savino, Giancarlo; Bonomo, Lorenzo

    2007-12-01

    Multi-detector row CT (MDCT) scanners with high spatial and temporal resolutions are now available and are increasingly used for non-invasive assessment of vascular disease, including coronary arteries and coronary artery bypass grafts (CABG). Follow-up of patients who have previously undergone surgical revascularization for coronary artery disease is nowadays one of the main applications of MDCT. Thanks to the continuous technical evolution of the CT scanners, it is now possible to scan the heart and the full anatomic extent of grafts with sub-millimeter slice-thickness within a single breath-hold. In the evaluation of these patients, it is important for the radiologist to be familiar with the different types of grafts and surgical techniques to know the main characteristics of each graft type and what to look for in the assessment of a patient who has undergone coronary artery surgical revascularization. This review summarizes some surgical aspects, the biological characteristics of conduits, and the main technical MDCT features, and describes the CABG anatomy together with some typical CT findings. PMID:17874112

  5. Off-Pump Versus On-Pump Coronary Artery Bypass Grafting

    DEFF Research Database (Denmark)

    Møller, Christian H; Steinbrüchel, Daniel A

    2014-01-01

    Coronary artery bypass grafting (CABG) remains the preferred treatment in patients with complex coronary artery disease. However, whether the procedure should be performed with or without the use of cardiopulmonary bypass, referred to as off-pump and on-pump CABG, is still up for debate....... Intuitively, avoidance of cardiopulmonary bypass seems beneficial as the systemic inflammatory response from extracorporeal circulation is omitted, but no single randomized trial has been able to prove off-pump CABG superior to on-pump CABG as regards the hard outcomes death, stroke or myocardial infarction....... In contrast, off-pump CABG is technically more challenging and may be associated with increased risk of incomplete revascularization. The purpose of the review is to summarize the current literature comparing outcomes of off-pump versus on-pump coronary artery bypass surgery....

  6. Single coronary artery anomaly: the left main coronary artery originating from the proximal segment of right coronary artery

    Institute of Scientific and Technical Information of China (English)

    ZHU Jun; QIN Xu-guang; WU Qing-yu; XIONG Wei-guo; LU Chun-peng; WANG Rong-feng

    2011-01-01

    This case report we presented is that the anomalous left main coronary artery (LMCA) originates from the proximal segment of right coronary artery. In order to confirm the origin and course of the anomalous LMCA, a multi-slice computed tomography (MSCT) of the heart was performed on a 64-slice machine (Philips 64 Slice, Philips, USA) after 6 months of coronary angiography operation. The results showed that the anomalous LMCA originates from the proximal segment of right coronary artery, lies posteriorly to the aorta before taking acute sharply to go between the aorta and left atrium. It was classified as R-Ⅱ P subtype according to Lipton's classification. It is a rare case in the clinical practice.

  7. 杂交冠状动脉血运重建术治疗冠心病的新进展%New Progress of Hybrid Coronary Revascularization in Treating Coronary Heart Disease

    Institute of Scientific and Technical Information of China (English)

    侯婷婷; 刘广忠; 孙丽; 赵冠棋(综述); 李悦; 李为民(审校)

    2015-01-01

    目前,冠心病治疗手段主要是药物治疗、经皮冠状动脉介入术、冠状动脉旁路移植术等。临床上冠状动脉多支狭窄患者多选择微创介入治疗,但尤其多支血管病变合并其他疾病患者根据SYNTAX积分或指南,多推荐冠状动脉旁路移植术。然而,心脏外科手术创伤及并发症等缺点,经皮冠状动脉介入术也存在血管再狭窄、血栓等事件风险,随着医学技术不断进步,杂交冠状动脉血运重建术孕育而生,现就杂交冠状动脉血运重建术的定义、手术策略及患者选择、新研究进展做一综述。%Currently,treatment strategy of coronary heart disease mainly includes drug therapy, percutaneous coronary intervention ( PCI) , and coronary artery bypass grafting ( CABG).In the practice,patients with serious coronary artery stenosis prefer to choose PCI, es-pecially SYNTAX score or guidelines of treatment patients with multivessel disease are more recommended to choose CABG.However, disad-vantages of CABG are severe surgical trauma and complications, similarly,PCI also has complications with stent restenosis and thrombosis e-vent.With the development of medical technology, hybrid coronary revascularization is coming out.This article is reviewing the definition, patient selection strategies,and new research progress of hybrid coronary revascularization.

  8. Internal mammary artery dilatation in a patient with aortic coarctation, aortic stenosis, and coronary disease. Case report

    Directory of Open Access Journals (Sweden)

    Martinez Cereijo Jose M

    2011-04-01

    Full Text Available Abstract The ideal surgical approach is unclear in adult patients with coarctation of the aorta that is associated with other cardiovascular pathologies that require intervention. Standard median sternotomy allows simultaneous, coronary revascularization surgery, valve replacement and repair of aortic coarctation. However the collateral circulation and the anatomy of the mammary arteries must be determined, to avoid possible complications. We report a case of a 69 year-old man with aortic coarctation, aortic stenosis, coronary artery disease and internal mammary artery dilatation who underwent concomitant surgical procedures through a median sternotomy.

  9. Updates in management of coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Heon; Chae, Shung Chull [Kyungpook National University Medical School, Daegu (Korea, Republic of)

    2005-02-15

    Coronary artery disease (CAD) has been increasing during the last decade and is the one of major causes of death. The management of patients with coronary artery disease has evolved considerably. There are two main strategies in the management of CAD, complementary, not competitive, each other; the pharmacologic therapy to prevent and treat CAD and the percutaneous coronary intervention (PCI) to restore coronary flow. Antiplatelet drugs and cholesterol lowering drugs have central roles in pharmacotherapy. Drug eluting stent (DES) bring about revolutional changes in PCL in the management of patients with ST segment elevation acute myocardial infarction (AMI), there has been a debate on the better strategy for the restoration of coronary flow. Thrombolytic therapy is widely available and easy to administer, whereas primary PCI is less available and more complex, but more complete. Recently published evidences in the pharmacologic therapy including antiplatelet and statin, and PCI including DES and reperfusion therapy in patients with ST segment elevation AMI were reviewed.

  10. Doppler findings in a rare Coronary Artery Fistula

    OpenAIRE

    Jorns Carl; Jung Christian; Huhta James

    2007-01-01

    Abstract One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF). It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD) artery to the left ventricular (LV) apex. Associated cardiac abnormalities were found: a ventricula...

  11. Coronary artery disease: the other half of the heaven

    Energy Technology Data Exchange (ETDEWEB)

    Milan, E. [PET Center, Nuclear Medicine Unit, S. Giacomo Apostolo Hospital, Castelfranco Veneto, Treviso (Italy)

    2005-03-01

    Coronary artery disease (CAD) is the leading cause of death in both men and women in the United States as well as in the most of the industrialized world. Emerging data have displayed important sex-based differences in CAD: its pathophysiology, clinical presentation, diagnostic strategies, response to therapies, and adverse outcomes. Although the incidence of CAD has doubled among women in the past decade, and the rate of women referred to diagnostic testing and revascularization has increased, this disease in female population is still identified less often, at a later stage and treated less aggressively than in men. Significant advances have been made in scintigraphic myocardial perfusion imaging for detection of ischemia, determination of prognosis, assessment of variability and evaluation on the efficacy of revascularization. With the introduction of technetium-99m perfusion agents, gated single emission computed tomography and attenuation correction, myocardial perfusion imaging in women has achieved as high sensitivity and specificity for the detection of CAD as that observed in men and can be considered an adequate noninvasive test to follow-up women with heart disease.

  12. Ischemia monitoring in off-pump coronary artery bypass surgery using intravascular near-infrared spectroscopy

    Directory of Open Access Journals (Sweden)

    Zerkowski Hans-Reinhard

    2006-05-01

    Full Text Available Abstract Background In off-pump coronary artery bypass surgery, manipulations on the beating heart can lead to transient interruptions of myocardial oxygen supply, which can generate an accumulation of oxygen-dependent metabolites in coronary venous blood. The objective of this study was to evaluate the reliability of intravascular near-infrared spectroscopy as a monitoring method to detect possible ischemic events in off-pump coronary artery bypass procedures. Methods In 15 elective patients undergoing off-pump myocardial revascularization, intravascular near-infrared spectroscopic analysis of coronary venous blood was performed. NIR signals were transferred through a fiberoptic catheter for signal emission and collection. For data analysis and processing, a miniature spectrophotometer with multivariate statistical package was used. Signal acquisition and analysis were performed before and after revascularization. Spectroscopic data were compared with hemodynamic parameters, electrocardiogram, transesophageal echocardiography and laboratory findings. Results A conversion to extracorporeal circulation was not necessary. The mean number of grafts per patient was 3.1 ± 0.6. An intraoperative myocardial ischemia was not evident, as indicated by electrocardiogram and transesophageal echocardiography. Continuous spectroscopic analysis showed reproducible absorption spectra of coronary sinus blood. Due to uneventful intraoperative courses, clear ischemia-related changes could be detected in none of the patients. Conclusion Our initial results show that intravascular near-infrared spectroscopy can reliably be used for an online intraoperative ischemia monitoring in off-pump coronary artery bypass surgery. However, the method has to be further evaluated and standardized to determine the role of spectroscopy in off-pump coronary artery bypass surgery.

  13. Contributions of nuclear cardiology to prognosis and risk stratification in coronary artery disease

    International Nuclear Information System (INIS)

    Myocardial perfusion imaging in patients with suspected or known coronary artery disease and stable symptoms enables not only accurate diagnosis of disease but also entails prognostic value. Myocardial perfusion SPECT contributes to assessment of future cardiac events independently of other clinical parameters. A normal stress myocardial perfusion scan is associated with a favorable prognosis in all pre-test risk subsets similar to that of the general population independent of history, symptoms, and exercise electrocardiography test variables. Cardiac risk and benefit from invasive therapeutic strategies increase in relation to the severity of the abnormality of perfusion and function assessed by gated myocardial perfusion SPECT. Thus, stress myocardial perfusion imaging may serve as a gatekeeper for referral to coronary angiography enabling effective risk stratification in patients with suspected or documented coronary artery disease. In severe coronary artery disease accompanied by left ventricular dysfunction preoperative prediction of reversibility of functional impairment and improvement in survival after revascularization can be achieved by viability testing using nuclear cardiology. Absence of viability is associated with no significant difference in functional and survival outcomes, irrespective of treatment strategy. Therefore, unnecessary revascularization can be avoided in cases with absent evidence of viability. (orig.)

  14. Passive Leg Raising Correlates with Future Exercise Capacity after Coronary Revascularization.

    Directory of Open Access Journals (Sweden)

    Shu-Chun Huang

    Full Text Available Hemodynamic properties affected by the passive leg raise test (PLRT reflect cardiac pumping efficiency. In the present study, we aimed to further explore whether PLRT predicts exercise intolerance/capacity following coronary revascularization. Following coronary bypass/percutaneous coronary intervention, 120 inpatients underwent a PLRT and a cardiopulmonary exercise test (CPET 2-12 days during post-surgery hospitalization and 3-5 weeks after hospital discharge. The PLRT included head-up, leg raise, and supine rest postures. The end point of the first CPET during admission was the supra-ventilatory anaerobic threshold, whereas that during the second CPET in the outpatient stage was maximal performance. Bio-reactance-based non-invasive cardiac output monitoring was employed during PLRT to measure real-time stroke volume and cardiac output. A correlation matrix showed that stroke volume during leg raise (SVLR during the first PLRT was positively correlated (R = 0.653 with the anaerobic threshold during the first CPET. When exercise intolerance was defined as an anaerobic threshold < 3 metabolic equivalents, SVLR / body weight had an area under curve value of 0.822, with sensitivity of 0.954, specificity of 0.593, and cut-off value of 1504·10-3mL/kg (positive predictive value 0.72; negative predictive value 0.92. Additionally, cardiac output during leg raise (COLR during the first PLRT was related to peak oxygen consumption during the second CPET (R = 0.678. When poor aerobic fitness was defined as peak oxygen consumption < 5 metabolic equivalents, COLR / body weight had an area under curve value of 0.814, with sensitivity of 0.781, specificity of 0.773, and a cut-off value of 68.3 mL/min/kg (positive predictive value 0.83; negative predictive value 0.71. Therefore, we conclude that PLRT during hospitalization has a good screening and predictive power for exercise intolerance/capacity in inpatients and early outpatients following coronary

  15. Passive Leg Raising Correlates with Future Exercise Capacity after Coronary Revascularization.

    Science.gov (United States)

    Huang, Shu-Chun; Wong, May-Kuen; Lin, Pyng-Jing; Tsai, Feng-Chun; Wen, Ming-Shien; Kuo, Chi-Tai; Hsu, Chih-Chin; Wang, Jong-Shyan

    2015-01-01

    Hemodynamic properties affected by the passive leg raise test (PLRT) reflect cardiac pumping efficiency. In the present study, we aimed to further explore whether PLRT predicts exercise intolerance/capacity following coronary revascularization. Following coronary bypass/percutaneous coronary intervention, 120 inpatients underwent a PLRT and a cardiopulmonary exercise test (CPET) 2-12 days during post-surgery hospitalization and 3-5 weeks after hospital discharge. The PLRT included head-up, leg raise, and supine rest postures. The end point of the first CPET during admission was the supra-ventilatory anaerobic threshold, whereas that during the second CPET in the outpatient stage was maximal performance. Bio-reactance-based non-invasive cardiac output monitoring was employed during PLRT to measure real-time stroke volume and cardiac output. A correlation matrix showed that stroke volume during leg raise (SVLR) during the first PLRT was positively correlated (R = 0.653) with the anaerobic threshold during the first CPET. When exercise intolerance was defined as an anaerobic threshold < 3 metabolic equivalents, SVLR / body weight had an area under curve value of 0.822, with sensitivity of 0.954, specificity of 0.593, and cut-off value of 1504·10-3mL/kg (positive predictive value 0.72; negative predictive value 0.92). Additionally, cardiac output during leg raise (COLR) during the first PLRT was related to peak oxygen consumption during the second CPET (R = 0.678). When poor aerobic fitness was defined as peak oxygen consumption < 5 metabolic equivalents, COLR / body weight had an area under curve value of 0.814, with sensitivity of 0.781, specificity of 0.773, and a cut-off value of 68.3 mL/min/kg (positive predictive value 0.83; negative predictive value 0.71). Therefore, we conclude that PLRT during hospitalization has a good screening and predictive power for exercise intolerance/capacity in inpatients and early outpatients following coronary revascularization

  16. Peripheral arterial stenosis and coronary artery disease coincidence

    Directory of Open Access Journals (Sweden)

    Reza Ghasemi

    2014-12-01

    Full Text Available Atherosclerosis is a chronic slow-developing condition affecting medium-size and large blood vessels. It is the principal underlying pathology of coronary heart disease and stroke. In some countries, coronary artery disease (CAD is the cause of nearly half (48% of the deaths and, loss of productivity life. Peripheral arterial disease (PAD is defined as atherosclerosis in peripheral arteries instead of coronary arteries. CAD and PAD have same risk factors and underlying pathophysiological processes. Therefore, patient with CAD should be considered for PAD. Ankle brachial index (ABI, duplex sonography, and some other non-invasive techniques are recommended for PAD diagnosis in patients with the history of CAD. Pharmacotherapy, endovascular interventions, and surgical management could be chosen according to the patient’s situation. Cardiologists and general practitioners should consider PAD in a patient with CAD or DM as a strong correlated disease.      

  17. Correlation between Patient-Reported Symptoms and Ankle-Brachial Index after Revascularization for Peripheral Arterial Disease.

    Science.gov (United States)

    Je, Hyung Gon; Kim, Bo Hyun; Cho, Kyoung Im; Jang, Jae Sik; Park, Yong Hyun; Spertus, John

    2015-01-01

    Improvement in quality of life (QoL) is a primary treatment goal for patients with peripheral arterial disease (PAD). The current study aimed to quantify improvement in the health status of PAD patients following peripheral revascularization using the peripheral artery questionnaire (PAQ) and ankle-brachial index (ABI), and to evaluate possible correlation between the two methods. The PAQ and ABI were assessed in 149 symptomatic PAD patients before, and three months after peripheral revascularization. Mean PAQ summary scores improved significantly three months after revascularization (+49.3 ± 15 points, p PAQ scores relating to patient symptoms showed the largest improvement following revascularization. The smallest increases were seen in reported treatment satisfaction (all p's PAQ. Twenty-two percent of PAD patients were identified as having a poor response to revascularization (increase in ABI PAQ, although this was less marked than in patients with an increase in ABI > 0.15 following revascularization. In conclusion, data from the current study suggest a significant correlation between improvement in patient-reported outcomes assessed by PAQ and ABI in symptomatic PAD patients undergoing peripheral revascularization.

  18. A single coronary artery with the right coronary artery originating from the left anterior descending artery detected by cardiac CT: A case report

    International Nuclear Information System (INIS)

    The right coronary artery arising from the left anterior descending artery is a rare coronary artery anomaly. In a 56 year old female, an anomaly with the right coronary artery, originating from the left anterior descending artery, coursing anteriorly to the pulmonary artery was detected by cardiac CT. Therefore, we hereby report a case of the single left coronary artery diagnosed by a 64 slice multidetector cardiac CT

  19. Hemodynamics of left internal mammary artery bypass graft: Effect of anastomotic geometry, coronary artery stenosis, and postoperative time.

    Science.gov (United States)

    Fan, Tingting; Lu, Yuan; Gao, Yan; Meng, Jie; Tan, Wenchang; Huo, Yunlong; Kassab, Ghassan S

    2016-03-21

    Although the left internal mammary artery (LIMA) bypass graft is the best choice for surgical revascularization, its hemodynamics are still complex and can result in long-term graft failure. Here, we performed a hemodynamic analysis of the LIMA-coronary artery with end-to-side/side-to-side anastomoses based on 15 patient-specific CTA images at various postoperative periods. We hypothesize that hemodynamic patterns are determined by the interplay of LIMA geometry, anastomotic configuration, and severity of native coronary artery stenosis, which are strongly affected by the postoperative time. A 3D finite volume method with the inlet pressure wave and outlet resistance boundary conditions was used to compute the distribution of pressure and flow, from which the time-averaged wall shear stress (TAWSS), oscillation shear index (OSI), time-averaged WSS gradient (TAWSSG), and transverse WSS (transWSS) were determined. To characterize the hemodynamic environment, we defined surface area ratios of low TAWSS (≤4dynes/cm(2)), high OSI (≥0.15), TAWSSG (≥500dynes/cm(3)), and transWSS (≥6dynes/cm(2)) in the LIMA graft and at the anastomosis between LIMA graft and coronary artery. These ratios were determined by the interplay of multiple morphometric parameters in the LIMA-coronary artery, but increased with postoperative time. These findings have significant implications for understanding LIMA graft patency. PMID:26900034

  20. Prognostic value of computed tomography coronary angiography in patients with suspected coronary artery disease: a 24-month follow-up study

    Energy Technology Data Exchange (ETDEWEB)

    Aldrovandi, Annachiara; Maffei, Erica; Seitun, Sara; Martini, Chiara; Ruffini, Livia; Crisi, Girolamo; Ardissino, Diego [Azienda Ospedaliero-Universitaria, Department of Radiology and Cardiology, Parma (Italy); Palumbo, Alessandro [Azienda Ospedaliero-Universitaria, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Brambilla, Valerio [University of Parma, Cardiovascular Prevention and Rehabilitation Unit, Don Gnocchi ONLUS, Parma (Italy); Zuccarelli, Alessandra [Ospedale di Carrara, Department of Cardiology, Carrara (Italy); Tarantini, Giuseppe [University of Padua, Department of Cardiology, Padua (Italy); Weustink, Annick C.; Mollet, Nico R.; Feyter, Pim J. de; Krestin, Gabriel P. [Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Cademartiri, Filippo [Azienda Ospedaliero-Universitaria, Department of Radiology and Cardiology, Parma (Italy); Erasmus Medical Center, Department of Radiology and Cardiology, Rotterdam (Netherlands); Azienda Ospedaliero-Universitaria di Parma, Department of Radiology, c/o Piastra Tecnica - Piano 0 - CT Section, Parma (Italy)

    2009-07-15

    The aim of this study was to determine the predictive value of 64-slice computed tomography coronary angiography (CTCA) for major cardiac events in patients with suspected coronary artery disease (CAD). A total of 187 consecutive patients (119 men, age 62.5 {+-} 10.5 years) without known heart disease underwent single-source 64-slice CTCA (Somatom Sensation 64, Siemens) for clinical suspicion of CAD. Patients underwent follow-up for the occurrence of cardiac death, nonfatal myocardial infarction, unstable angina and cardiac revascularization. In total, 2,822 coronary segments were assessed. Forty-two segments (1.5%) were not assessable because of insufficient image quality. Overall, CTCA revealed absence of CAD in 65 (34.7%) patients, nonobstructive CAD (coronary plaque {<=}50%) in 87 (46.5%) patients and obstructive CAD (>50%) in 35 (18.8%) patients. A total of 20 major cardiac events (3 myocardial infarctions, 16 cardiac revascularizations, 1 unstable angina) occurred during a mean follow-up of 24 months. One noncardiac death occurred. Seventeen events occurred in the group of patients with obstructive CAD and three events occurred in the group of nonobstructive CAD. The event rate was 0% among patients with normal coronary arteries at CTCA. CTCA has a 100% negative predictive value for major cardiac events at 24-month follow-up in patients with normal coronary arteries. (orig.)

  1. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Science.gov (United States)

    ROBOT-ASSISTED MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERY OPERATION PINNACLEHEALTH HARRISBURG HOSPITAL HARRISBURG, PA 00:00:08 ... Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery operation. ...

  2. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ROBOT-ASSISTED MINIMALLY INVASIVE CORONARY ARTERY BYPASS SURGERY OPERATION PINNACLEHEALTH HARRISBURG HOSPITAL HARRISBURG, PA 00:00:08 ... Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery operation. ...

  3. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Yeonyee Elizabeth [Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam 463-707 (Korea, Republic of); Lim, Tae-Hwan [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul 138-736 (Korea, Republic of)

    2014-07-01

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future.

  4. Current Roles and Future Applications of Cardiac CT: Risk Stratification of Coronary Artery Disease

    International Nuclear Information System (INIS)

    Cardiac computed tomography (CT) has emerged as a noninvasive modality for the assessment of coronary artery disease (CAD), and has been rapidly integrated into clinical cares. CT has changed the traditional risk stratification based on clinical risk to image-based identification of patient risk. Cardiac CT, including coronary artery calcium score and coronary CT angiography, can provide prognostic information and is expected to improve risk stratification of CAD. Currently used conventional cardiac CT, provides accurate anatomic information but not functional significance of CAD, and it may not be sufficient to guide treatments such as revascularization. Recently, myocardial CT perfusion imaging, intracoronary luminal attenuation gradient, and CT-derived computed fractional flow reserve were developed to combine anatomical and functional data. Although at present, the diagnostic and prognostic value of these novel technologies needs to be evaluated further, it is expected that all-in-one cardiac CT can guide treatment and improve patient outcomes in the near future

  5. Successful percutaneous coronary intervention for chronic total occlusion of right coronary artery in patient with dextrocardia.

    Science.gov (United States)

    Munawar, Muhammad; Hartono, Beny; Iskandarsyah, Kurniawan; Nguyen, Thach N

    2013-07-01

    Situs inversus with dextrocardia is rare congenital anomaly. Coronary artery disease in such patients is quite rare. We reported a 52-year-old man with dextrocardia and chronic total occlusion at the proximal right coronary artery just after conus branch and severe stenosis at the proximal left anterior descending artery. He underwent successful percutaneous coronary intervention with stenting of total occluded right coronary artery and simultaneously stenting of the proximal left anterior descending artery.

  6. Comparison of Coronary Artery Bypass Grafting with Percutaneous Coronary Intervention for Unprotected Left Main Coronary Artery Disease

    OpenAIRE

    Kawecki, Damian; Morawiec, Beata; Fudal, Marcin; Milejski, Wojciech; Jacheć, Wojciech; Nowalany-Kozielska, Ewa

    2011-01-01

    Purpose Coronary artery bypass grafting (CABG) is the optimal treatment option for left main coronary artery disease (LMCAD). However, LMCAD remains a constant topic of discussion between cardiac surgeons and interventional cardiologists. The aim of this study was to assess the efficacy of LMCAD treatments by comparing the mid-term outcomes of CABG and percutaneous coronary intervention (PCI) using bare metal stents or drug-eluting stents (DESs). Materials and Methods The study population was...

  7. Awake off-pump coronary artery bypass surgery in 25 patients

    Institute of Scientific and Technical Information of China (English)

    GUO Huiming(郭惠明); Murali Chakravarthy; Vivek Jawali; K Jayaprakash; NV Shivananda

    2003-01-01

    Objectives To test the fea-sibility of the use of high thoracic epidural anesthesia as a sole anesthetic in patients undergoing off pump coronary artery bypass surgery, avoiding general anesthesia. Methods Between October 2002 to April 2003, twenty five cases underwent beating heart coronary artery revascularization without endotracheal general anesthesia, using high thoracic epidural anesthesia and analgesia. All the patients underwent epidural catheterization on the evening before the surgery. Results The patients in all received 71 grafts (single n = 11, double n = 5, triple n = 6, quadruple n = 3). Six patients underwent repeat coronary artery bypass. Except one was converted to general anesthesia and cardiopulmonary bypass, the other patients underwent off-pump coronary artery bypass graft surgery, 2 patients underwent grafting via left thoracotomy (MIDCAB) and the rest through mid sternotony. There was no mortality. Mean length of stay in the intensive care tnit was 16.2 ( 4.2 hours and hospital was 3.0(1.2 days. Conclusions Our experience confirms the feasibility of performing multiple coronary artery bypassesin conscious patients without endotracheal general an esthesia.

  8. Trends in Coronary Angiography, Revascularization, and Outcomes of Cardiogenic Shock Complicating Non-ST-Elevation Myocardial Infarction.

    Science.gov (United States)

    Kolte, Dhaval; Khera, Sahil; Dabhadkar, Kaustubh C; Agarwal, Shikhar; Aronow, Wilbert S; Timmermans, Robert; Jain, Diwakar; Cooper, Howard A; Frishman, William H; Menon, Venu; Bhatt, Deepak L; Abbott, J Dawn; Fonarow, Gregg C; Panza, Julio A

    2016-01-01

    Early revascularization is the mainstay of treatment for cardiogenic shock (CS) complicating acute myocardial infarction. However, data on the contemporary trends in management and outcomes of CS complicating non-ST-elevation myocardial infarction (NSTEMI) are limited. We used the 2006 to 2012 Nationwide Inpatient Sample databases to identify patients aged ≥ 18 years with NSTEMI with or without CS. Temporal trends and differences in coronary angiography, revascularization, and outcomes were analyzed. Of 2,191,772 patients with NSTEMI, 53,800 (2.5%) had a diagnosis of CS. From 2006 to 2012, coronary angiography rates increased from 53.6% to 60.4% in patients with NSTEMI with CS (ptrend <0.001). Among patients who underwent coronary angiography, revascularization rates were significantly higher in patients with CS versus without CS (72.5% vs 62.6%, p <0.001). Patients with NSTEMI with CS had significantly higher risk-adjusted in-hospital mortality (odds ratio 10.09, 95% confidence interval 9.88 to 10.32) as compared to those without CS. In patients with CS, an invasive strategy was associated with lower risk-adjusted in-hospital mortality (odds ratio 0.43, 95% confidence interval 0.42 to 0.45). Risk-adjusted in-hospital mortality, length of stay, and total hospital costs decreased over the study period in patients with and without CS (ptrend <0.001). In conclusion, we observed an increasing trend in coronary angiography and decreasing trend in in-hospital mortality, length of stay, and total hospital costs in patients with NSTEMI with and without CS. Despite these positive trends, overall coronary angiography and revascularization rates remain less than optimal and in-hospital mortality unacceptably high in patients with NSTEMI and CS.

  9. Coronary Artery Revascularization in Patients with Diabetes Mellitus

    Science.gov (United States)

    ... LIBRARY Hello, Guest! My alerts Sign In Join Facebook Twitter Home About this Journal Editorial Board General Statistics Circulation Cover Doodle → Blip the Doodle Go Red For Women's Issue Information for Advertisers Author Reprints Commercial Reprints Customer Service and Ordering ...

  10. Pseudotumour formation in atheromatous coronary arteries.

    Science.gov (United States)

    Treacy, Ann D; Norita, Katsuya; Ingram, Peter J; Sheppard, Mary N

    2015-05-01

    Three cases with mass like lesions (pseudotumours) surrounding atheromatous coronary arteries were referred to the Royal Brompton Hospital for expert pathology review. All were males with mean age 74 years (range 55-91). In all cases, coronial autopsies were carried out for sudden deaths in the community. Past medical histories of note were hypertension (N = 2) and ischaemic heart disease (N = 1), with one patient having a past history of aortic aneurysm repair. At autopsy, firm, white and whorled masses surrounded both right and left coronary arteries ranging in size from 9 to 25 mm in diameter. Each coronary artery had intimal atheroma with associated stenosis ranging from moderate to severe. A thrombus was identified in one case. Histological sections showed a mixed inflammatory infiltrate extending from the media into the adventitia of each coronary artery, composed predominantly of plasma cells and lymphocytes with rare neutrophils and eosinophils. There was accompanying dense fibrosis accounting for approximately 50% of the mass size on microscopic examination of slides. The presence of intimal circumferential atheroma was confirmed in all cases. Immunohistochemical studies showed staining with IgG4 in two of three cases. Atheroma may be associated with mild chronic inflammation present in the intima or associated with plaques and adventitia. The differential diagnosis for coronary artery inflammatory masses would include vasculitis, syphilis, inflammatory pseudotumor and IgG4 associated disease. This is the first report of isolated coronary artery IgG4 related disease in association with atheroma. PMID:25882155

  11. Inpatient and outpatient cardiac rehabilitation programmes improve cardiometabolic risk in revascularized coronary patients with type 2 diabetes

    Directory of Open Access Journals (Sweden)

    Claudiu Avram

    2010-12-01

    Full Text Available The purpose of this paper is to evaluate cardiometabolic risk reduction of diabetic patients following coronary revascularizationprocedures after participation in outpatients or inpatients cardiac rehabilitation programmes. Materials and methods: weperformed a retrospective analytical study which included a group of 103 revascularized coronary patients with diabetesmellitus. Depending on participation in a cardiac rehabilitation program we have defined the following subgroups of patients:Group O (N=37 - attended the outpatient cardiac rehabilitation program; Group H (N=37 - attended the inpatient cardiacrehabilitation program; Group C (N=34 - did not participate in any cardiac rehabilitation program. Between those two momentsof assessment: T0 - revascularization / early post-revascularization and T1 - time of the interview (16±2.3 months afterrevascularization, patients in groups A and S participated in outpatient cardiac rehabilitation program (12 weeks, 3sessions/week of exercise training, with clinical and paraclinical evaluation scheduled at 1, 6, 12 months afterrevascularization, or inpatient cardiac rehabilitation program (3 weeks, intensive sessions, scheduled at 1, 3, 6 and 12months after revascularization. Results: at the end of the study, we found significant differences among the three groups forthe following parameters: body mass index (p=0.01, systolic blood pressure (p=0.002, total cholesterol (p<0.001, LDLcholesterol(p<0.001 and non-HDL cholesterol (p=0.004 in favor of groups A and S, that have participated in comprehensivecardiac rehabilitation programs. Conclusions: comprehensive cardiac rehabilitation programmes, performed outpatient orinpatient, are effective methods of reducing the high cardiometabolic risk, specific in revascularized coronary patients withdiabetes.

  12. A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease

    NARCIS (Netherlands)

    E.J. Topol (Eric); F. Leya; C.A. Pinkerton; P.L. Whitlow (Patrick); B. Hofling; C.A. Simonton; R.R. Masden; P.W.J.C. Serruys (Patrick); M.B. Leon (Martin); D.O. Williams (David); S.B. King 3rd (Spencer); B. Daniel; D.B. Mark (Daniel); J.M. Isner; D.R. Holmes Jr (David); S.G. Ellis (Stephen); K.L. Lee (Kerry); G.P. Keeler; L.G. Berdan (Lisa); T. Hinohara; R.M. Califf (Robert)

    1993-01-01

    textabstractBACKGROUND. Directional coronary atherectomy is a new technique of coronary revascularization by which atherosclerotic plaque is excised and retrieved from target lesions. With respect to the rate of restenosis and clinical outcomes, it is not known how this procedure compares with ballo

  13. [Anatomy and physiology of the heart and coronary arteries].

    Science.gov (United States)

    Leclercq, Florence

    2015-03-01

    The myocardium assures the supply of oxygen to the body. The provision of oxygen to the myocardium by the coronary arteries is dependent on two key parameters: the coronary blood flow and the ability to extract oxygen from the arterial blood. Coronary artery disease is almost always the consequence of atherosclerosis and can lead to myocardial infarction.

  14. Impact of previous coronary artery bypass surgery on clinical outcome after percutaneous interventions with second generation drug-eluting stents in TWENTE trial and Non-Enrolled TWENTE registry

    NARCIS (Netherlands)

    Sen, Hanim; Lam, Ming Kai; Tandjung, K.; Löwik, Marije M.; Houwelingen, van K. Gert; Stoel, Martin G.; Louwerenburg, Hans W.; Man, de Frits H.A.F.; Linssen, Gerard C.M.; Grandjean, Jan G.; Doggen, Carine J.M.; Birgelen, von Clemens

    2014-01-01

    Background Patients with previous coronary artery bypass grafting (CABG) who underwent percutaneous coronary intervention (PCI) have an increased repeat revascularization rate, but data on contemporary second-generation drug-eluting stents (DES) are scarce. Methods We evaluated 1-year clinical outc

  15. Comparison of health-related quality of life after percutaneous coronary intervention and coronary artery bypass surgery

    Science.gov (United States)

    Yazdani-Bakhsh, Razieh; Javanbakht, Mehdi; Sadeghi, Masoumeh; Mashayekhi, Atefeh; Ghaderi, Hossein; Rabiei, Katayoun

    2016-01-01

    BACKGROUND Health-related quality of life (HRQOL) evaluation is an important measure of the impact of the disease. As more people with coronary heart disease (CHD) live longer, doctors and researchers want to know how they manage in day to day life. It looked like adults with CHD had a decrease QOL. The aim of this study was to comparison of HRQOL of patients who underwent percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) and to assess its main determinants in the whole sample of coronary artery disease (CAD) patients. METHODS The study was carried out to estimate HRQOL of 109 patients who underwent invasive coronary revascularization [PCI (n = 75) and CABG (n = 34)]. We applied HRQOL after 6 months and 2 years in both groups and scores were compared. The HRQOL data were obtained using MacNew Heart Disease questionnaire with dimensions emotional, physical and social that estimated. Data entry and analysis were performed by SPSS. RESULTS A total MacNew scale in CABG and PCI group in 6 months after treatment were 45.32 ± 13.75 and 53.52 ± 15.63, respectively (P = 0.010). After 2 years HRQOL mean changed to 51.176 ± 14.80 and 49.55 ± 16.22, respectively, in CABG and PCI group (P = 0.428). Our results in within-group analysis showed total MacNew scale and its subscales were changed significantly after 2 years in CABG and PCI group’s scores were detected. We found in the whole sample of CAD patients those who had a higher level of income and education and were not either overweight or obese experienced better HRQOL. CONCLUSION Our results showed that patients who underwent PCI experienced significantly higher HRQOL in 6 months after revascularization but over 24 months follow-up no difference was observed between the two groups.

  16. “Obesity paradox” in coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Ibrahim; Akin; Christoph; A; Nienaber

    2015-01-01

    Obesity used to be among the more neglected public health problems, but has unfolded as a growing medical and socioeconomic burden of epidemic proportions. Morbid obesity is linked to traditional cardiovascular risk factors like, hypertension, hyperlipidemia and diabetes, and suspected to incur increased morbidity and mortality in the Western and even third world populations. This patient cohort is also at greater risk to develop coronary artery disease. Recent population-based registries revealed that 43% and 24% of all cases of coronary revascularization were carried out in overweight and obese patients, respectively. However, despite evidence of a positive correlation between obesity and increased cardiovascular morbidity, some authors have described a better clinical outcome in overweight and obese patients, a phenomenon they coined "obesity paradoxon". Thus, there is an ongoing debate in light of conflicting data and the possibility of confounding bias causing misconception and challenging the "obesity paradox". In this review article we present the current evidence and throughly discuss the validity of the "obesity paradoxon" in a variety of clinical settings.

  17. Coronary Artery Diagnosis Aided by Neural Network

    Science.gov (United States)

    Stefko, Kamil

    2007-01-01

    Coronary artery disease is due to atheromatous narrowing and subsequent occlusion of the coronary vessel. Application of optimised feed forward multi-layer back propagation neural network (MLBP) for detection of narrowing in coronary artery vessels is presented in this paper. The research was performed using 580 data records from traditional ECG exercise test confirmed by coronary arteriography results. Each record of training database included description of the state of a patient providing input data for the neural network. Level and slope of ST segment of a 12 lead ECG signal recorded at rest and after effort (48 floating point values) was the main component of input data for neural network was. Coronary arteriography results (verified the existence or absence of more than 50% stenosis of the particular coronary vessels) were used as a correct neural network training output pattern. More than 96% of cases were correctly recognised by especially optimised and a thoroughly verified neural network. Leave one out method was used for neural network verification so 580 data records could be used for training as well as for verification of neural network.

  18. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... completely endoscopic coronary artery bypass grafting procedure using robotics. We call this operation a “TECAB,” “Totally Endoscopic ... scrub nurse, also a lot of experience with robotics now. And Dr. Atiq Rahman, fellow here for ...

  19. Epicardial ultrasound in coronary artery bypass surgery

    NARCIS (Netherlands)

    Budde, R.P.J.

    2005-01-01

    Chapter 1 Coronary artery bypass surgery (CABG) is traditionally performed via a median sternotomy approach on cardiopulmonary bypass (arrested heart). Since the mid 1990ties, beating heart, minimally invasive and even totally endoscopic CABG are (re)explored. In all approaches to CABG, the surgeo

  20. Patient's Perception About Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Kelminda Maria Bulhões Mendonça

    2015-10-01

    Full Text Available ABSTRACT OBJECTIVE: The diagnosis of coronary artery disease referred for heart surgery has an important psychological component. The purpose of this study was to access the difficulties experienced by individuals awaiting coronary artery bypass grafting and to determine strategies that facilitate adaptation to a new lifestyle, modified by the disease. METHODS: A qualitative, exploratory study involving patients admitted to a university teaching hospital in the city of Salvador, Bahia, Brazil, awaiting coronary artery bypass grafting. Semi-structured interviews were performed in accordance with a previously defined script based on the study objective. Each transcription was read in its entirety to verify the representativeness, homogeneity and pertinence of the data obtained (pre-analysis, followed by separation of categories of analysis. RESULTS: The descriptions of this study show that patients admitted to the completion of coronary artery bypass grafting experience a wide range of psychological difficulties, considering that surgery acquires interpretations that vary according to individuals' subjectivity. The patients recognized the benefit of being able to discuss their feelings as a means of diminishing their fear and anxiety. CONCLUSION: Helping patients find resources to confront more positively the daily hospitalization is an important aspect for the health care professionals who assist them. This goal can be achieved through modification of the biomedical model of care for a biopsychosocial view. The investment of time and attention is of fundamental importance and aims to overcome existing deficiencies that interfere with the outcome of patients after cardiac surgery.

  1. [Robot-assisted Coronary Artery Bypass Grafting].

    Science.gov (United States)

    Ishikawa, Norihiko; Watanabe, Go

    2016-07-01

    The application for robot-assisted coronary surgery ranges from internal thoracic artery (ITA) harvesting with hand-sewn anastomoses to totally endoscopic coronary artery bypass grafting (TECAB), either on- or off-pump. The bilateral IMA can be harvested with the aid of a surgical robot and then multivessel bypass grafting can follow. Such robot-assisted minimally invasive direct coronary artery bypass grafting is called "ThoraCAB". Surgical robots cannot only endoscopically harvest the ITA but they can also anastomose the coronary artery in TECAB. But TECAB still has the difficulties, such as narrow surgical field in Japanese patients. Both procedures have the significant advantages of minimizing surgical trauma, such as reduced comlications, faster return back to normal activities and being improved cosmesis, and which have resulted in the development of minimally invasive surgery. Robot-assisted cardiac surgery for structural heart disease has been approved by the Ministry of Health, Labour and Welfare (MHLW) since December 2015, however, robot-assisted cardiac surgery for TECAB has not been approved yet in Japan.

  2. Treatment of a coronary artery to superior vena cava fistula resulting from early closure of a Possis Perma-Flow graft.

    Science.gov (United States)

    Graham, M M; Kells, C M; Sullivan, J; O'Neill, B J

    1999-06-01

    The Perma-Flow graft used in bypass surgery achieves more complete revascularization when paucity of native conduits exists. We report a coronary artery to superior vena cava fistula as a complication of this graft, leading to severe right heart failure. The fistula was successfully occluded percutaneously, improving the patient's clinical situation.

  3. Garroteamento da artéria coronária na revascularização do miocárdio: Relação entre o grau de aterosclerose e a lesão vascular: estudo experimental Occlusion of coronary artery in myocardial revascularization: Relationship between the degree of atherosclerosis and vascular injury: an experimental study

    Directory of Open Access Journals (Sweden)

    Luís Roberto Gerola

    1987-04-01

    Full Text Available As anastomoses safena ou mamária-coronária, sendo suturas realizadas em vasos de fino calibre, necessitam de condições ideais para sua realização. Mesmo em circulação extracorpórea e pinçamento aórtico, pode persistir sangramento pela arteriotomia coronária, obrigando o cirurgião a realizar algumas manobras, entre elas os garroteamentos proximal e distai, para conseguir um campo exangue. Mais recentemente, face à possibilidade de se executar a revascularização miocárdica sem circulação extracorpórea, tornou-se fundamental dispor-se de um método que possibilite a oclusão temporária da artéria coronária para a realização das anastomoses. Com esta preocupação, foi realizado um estudo experimental, procurando avaliar seis métodos de hemostasia temporária, aplicados em artérias com graus variáveis de aterosclerose. O modelo experimental utilizado foi a artéria coronária direita, em cadáver. O estudo histológico, aplicando as colorações de hematoxilina-ecosina, Weigert e hematoxilina fosfotúngstica, permitiu a determinação objetiva da intensidade da aterosclerose na artéria coronária e os padrões e graus de lesões causados à parede arterial pelos métodos utilizados para sua oclusão temporária. Nessa amostra, os resultados sugerem uma tendência de relacionamento direto entre a gravidade da lesão arterial induzida pelo garroteamento e a severidade da aterosclerose coronária, independente do tipo de dispositivo utilizado para a interrupção do fluxo coronário.Coronary artery surgery, specially when performed without cardiopulmonary bypass, needs an "atraumatic" method that allows temporary coronary occlusion with minimal injury to the vessel wall. An experimental study was performed using the right coronary artery of cadaver hearts in order to evaluate the methods of "atraumatic" clamping of arteries with variable degrees of atherosclerosis. The vessels were evaluated histologically both for

  4. Congenital coronary-pulmonary artery fistula originating from right and left coronary artery

    Directory of Open Access Journals (Sweden)

    Ali Kemal Gür

    2013-12-01

    Full Text Available Coronary artery fistula (CAF is a rare congenital anomalywith an incidence of 1 in 50 000 live births. The fistula wasobserved at the right coronary artery in 53%, the left coronaryartery in 42% and both coronary artery in 5% of thecases. Echocardiography examination in a 46 year-oldwoman with the symptoms of chest pain, palpitation anddyspnea revealed a severe mitral valve insufficiency anda moderate to severe tricuspid valve insufficiency. A CAForiginating from the proximal part of the left anterior descendingartery (LAD and another fistula originating fromosteal part of the right coronary artery (RCA were detectedby coronary angiography. Both fistulas were draininginto the main pulmonary artery. The coronary artery fistulaclosed under cardiopulmonary by-pass. Mitral insufficiencyoriginated from the posterior leaflet was diagnosedintra-operative exploration, and thereafter it was repairedwith mitral annuloplasty including a quadrangular resectionand use of a 32 No St Jude mitral ring. Tricuspid valvewas repaired with Calangos Ring annuloplasty. Followingsix day hospital stay, the woman was discharged free ofany symptom.Key words: Dyspnea, double arteriovenous fistula, mitral and tricuspid insufficiency

  5. Cardiac power index, mean arterial pressure, and Simplified Acute Physiology Score II are strong predictors of survival and response to revascularization in cardiogenic shock.

    Science.gov (United States)

    Popovic, Batric; Fay, Renaud; Cravoisy-Popovic, Aurelie; Levy, Bruno

    2014-07-01

    Short-term prognostic factors in patients with cardiogenic shock (CS) have previously been established using only hemodynamic parameters without taking into account classic intensive care unit (ICU) severity score or organ failure/support. The aim of this study was to assess early predictors of in-hospital mortality of a monocentric cohort of patients with ST-elevation myocardial infarction complicated by early CS. We retrospectively studied 85 consecutive patients with CS complicating acute myocardial infarction and Thrombolysis in Myocardial Infarction flow grade 3 after percutaneous coronary revascularization. All patients were managed according to the following algorithm: initial resuscitation by a mobile medical unit or in-hospital critical care physician unit followed by percutaneous coronary revascularization and CS management in the ICU. Prehospital CS was diagnosed in 69% of cases, initially complicated by an out-of-hospital cardiac arrest in 64% of cases. All patients were treated with vasopressors, 82% were ventilated, and 22% underwent extrarenal epuration. The 28-day mortality rate was 39%. Under multivariate analysis, initial cardiac power index, mean arterial pressure of less than 75 mmHg at hour 6 of ICU management, and Simplified Acute Physiology Score II were independent predictive factors of in-hospital mortality. In conclusion, parameters directly related to cardiac performance and vascular response to vasopressors and admission Simplified Acute Physiology Score II are strong predictors of in-hospital mortality.

  6. Dextrocardia with situs inversus totalis: coronary artery bypass grafting.

    Science.gov (United States)

    Hashmi, Salila; Anis, Mariam; Darr, Umer

    2012-01-01

    Dextrocardia with situs inversus is a rare congenital abnormality involving a left-handed mal rotation of the visceral organs. The incidence of coronary artery disease is the same as that in the general population. Performing coronary artery bypass surgery on patients with dextrocardia poses a more challenging task. It is recommended that the right internal mammary artery be the first choice of graft for the anterior descending artery for a "situs inversus" situation. We report 2 cases of patients with Dextrocardia who developed coronary artery disease and underwent coronary artery bypass grafting. Also mentioned is the slight difference in our technique.

  7. Revascularization options in patients with chronic kidney disease.

    Science.gov (United States)

    Ashrith, Guha; Elayda, MacArthur A; Wilson, James M

    2010-01-01

    Cardiovascular disease is the leading cause of death in patients who have chronic kidney disease or end-stage renal disease and are undergoing hemodialysis. Chronic kidney disease is a recognized risk factor for premature atherosclerosis. Unfortunately, most major randomized clinical trials that form the basis for evidence-based use of revascularization procedures exclude patients who have renal insufficiency. Retrospective, observational studies suggest that patients with end-stage renal disease and severe coronary occlusive disease have a lower risk of death if they undergo coronary revascularization rather than medical therapy alone. Due to a lack of prospective studies, however, the relative merits of percutaneous versus surgical revascularization are merely a matter of opinion. Several small, retrospective studies have shown that coronary artery bypass grafting is associated with higher procedural death but better long-term survival than is percutaneous coronary intervention. This difference appears to result from poor long-term results of percutaneous coronary intervention in patients who have chronic kidney disease or end-stage renal disease.Because randomized trials comparing percutaneous coronary intervention and coronary artery bypass grafting have included patients undergoing balloon angioplasty and placement of bare-metal stents, their conclusions are suspect in the era of drug-eluting stents. In this review, we discuss different revascularization options for patients with chronic kidney disease, the outcomes of revascularization procedures, and the risk factors for adverse outcomes.

  8. ANGIOGRAPHIC PROFILE OF LEFT MAIN CORONARY ARTERY (LMCA STENOSIS

    Directory of Open Access Journals (Sweden)

    Malladi Srinivasa

    2015-02-01

    Full Text Available Among patients with coronary artery disease, left coronary artery (LMCA stenosis is the dangerous form of coronary arterial involvement, associated with increased mortality and morbidity unless immediate intervention is done. The gold standard treatment for left main coronary artery (LMCA stenosis is the emergency coronary artery bypass grafting to its branches, left anterior descending artery (LAD, and left circumflex artery (LCX. Of percutaneous intervention in the form of angioplasty and stenting of left main coronary artery are increasingly done. The anatomy and the site of stenosi s in the left main coronary artery determine the management option. In this context, the involvement of left main coronary artery and its anatomical pattern are important in deciding management options. AIM: To study the angiographic profile of significant Left main coronary artery (LMCA stenosis among the patients who underwent coronary angiography. METHODS: A total of 1911 cases of significant coronary arterial disease, who underwent coronary angiography a t King George Hospital, Visakhapatnam were studied in the present study and their coronary angiograms were analysed with respect to the pattern of involvement. RESULTS: of the 1911 cases of coronary artery disease, 118 patients have left main coronary arte ry disease. M/F ratio is 93/25. Of them 68.4% are hypertensive, 41.5 % are diabetics, 34.7% are smokers. Mean age of presentation was 59 yrs. Isolated LMCA involvement is seen in 5, associated with single vessel disease in 9, double vessel disease in 12 an d triple vessel diseases in 93. Ostio - proximal involvement is seen in 21, mid segment involvement in 13, distal – bifurcation involvement in 93 and total occlusion of LMCA in 1 case. CONCLUSION: Significant LMCA involvement is seen in 6.1%. In majority of c ases, it is associated with triple vessel disease and distal bifurcation is the commonest site involved.

  9. MR Imaging of Coronary Arteries and Plaques.

    Science.gov (United States)

    Dweck, Marc R; Puntman, Valentina; Vesey, Alex T; Fayad, Zahi A; Nagel, Eike

    2016-03-01

    Cardiac magnetic resonance offers the promise of radiation-free imaging of the coronary arteries, providing information with respect to luminal stenosis, plaque burden, high-risk plaque characteristics, and disease activity. In combination, this would provide a comprehensive, individualized assessment of coronary atherosclerosis that could be used to improve patient risk stratification and to guide treatment. However, the technical challenges involved with delivering upon this promise are considerable, requiring sophisticated approaches to both data acquisition and post-processing. In this review, we describe the current status of this technology, its capabilities, its limitations, and what will be required in the future to translate this technology into routine clinical practice. PMID:26965732

  10. The innovation of composite core dual coil coronary guide-wire technology: A didactic coronary chronic total occlusion revascularization case report.

    Science.gov (United States)

    Tomasello, Salvatore Davide; Giudice, Pietro; Attisano, Tiziana; Boukhris, Marouane; Galassi, Alfredo R

    2014-10-01

    The treatment of coronary chronic total occlusions (CTO) continues to solicit technical innovations. As success primarily depends on crossing the lesion with a wire, all aspects regarding tip shape retention, torque precision, and penetration ability of the guide-wire have greatly influenced new techniques and strategies. The world of interventional cardiology has to look carefully at these developments, and to use them accordingly to improve the success rate in ordinary percutaneous coronary interventions. We present a didactical case report of a CTO revascularization treated with a new 'dual core' technology guide-wire. PMID:25278725

  11. Reconstruction of Heel With Propeller Flap in Postfasciotomy and Popliteal Artery Revascularization State.

    Science.gov (United States)

    Kang, Jin Seok; Choi, Hwan Jun; Tak, Min Sung

    2016-06-01

    Free flaps are still the gold standard for large defects of the lower limb, but propeller perforator flaps have become a simpler and faster alternative to free flaps because of some advantages such as reliable vascular pedicle, wide mobilization and rotation, great freedom in design, low donor site morbidity, and easy harvest with no requirement for anastomosis. But when the vessels show insufficient findings in preoperative evaluation using a Doppler probe or the vessel is injured, the surgeon should avoid performing free flap surgery to prevent flap failure and should select a propeller perforator flap as an alternative method on the condition that more than one perforator is intact. In this study, we report reconstruction of soft tissue defects of the heel with a pedicled propeller flap in postfasciotomy and popliteal artery revascularization state by making an incision on the central portion above the Achilles tendon, which can be covered by the posterior tibial artery perforator or the peroneal artery perforator based flaps. In conclusion, we showed that although the popliteal artery was injured, the soft tissue defect can be reconstructed using a perforator propeller flap if intact distal flow in the anastomosis site was confirmed. PMID:25673623

  12. Left Main Coronary Artery Disease: Secular Trends in Patient Characteristics, Treatments, and Outcomes.

    Science.gov (United States)

    Lee, Pil Hyung; Ahn, Jung-Min; Chang, Mineok; Baek, Seunghee; Yoon, Sung-Han; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Lee, Cheol Whan; Park, Seong-Wook; Park, Duk-Woo; Park, Seung-Jung

    2016-09-13

    Left main coronary artery (LMCA) disease is the highest-risk lesion subset of ischemic heart disease, and has traditionally been an indication for coronary artery bypass grafting (CABG). Recent evidence suggests comparable clinical outcomes between percutaneous coronary intervention (PCI) and CABG for LMCA disease, with similar rates of mortality and serious composite outcomes, a higher rate of stroke with CABG, and a higher rate of repeat revascularization with PCI. These results have been translated to the current guideline recommendation that PCI is a reasonable alternative to CABG in patients with low to intermediate anatomic complexity. However, how the characteristics, treatment, and clinical outcomes of patients with unprotected LMCA disease have evolved over time has not yet been fully evaluated. We therefore described secular trends in the characteristics and long-term outcomes of unprotected LMCA disease using "real-world" clinical experience from the IRIS-MAIN (Interventional Research Incorporation Society-Left MAIN Revascularization) registry together with a broad review of this topic. PMID:27609687

  13. Coronary artery bypass grafting for Kawasaki disease

    Institute of Scientific and Technical Information of China (English)

    GUO Hong-wei; CHANG Qian; XU Jian-ping; SONG Yun-hu; SUN Han-song; HU Sheng-shou

    2010-01-01

    Background Kawasaki disease (KD) is the leading cause of pediatric ischemic heart disease. The incidence of serious coronary sequelae is low and about 2%-3% of patients with KD, but once myocardial infarction occurs in children, the mortality is quite high and 22% at the first infarction.This study aimed to evaluate the efficacy of coronary artery bypass grafting (CABG) in patients with KD.Methods Eight patients with a history of KD underwent CABG between October 1997 and July 2005. The number of bypass grafts placed was 2 to 4 per patient (mean 2.5±0.8). Various bypass grafts were used in patients, i.e. the left internal mammary artery (LIMA) in 3 patients, bilateral internal mammary artery (IMA) in 2 patients, LIMA plus gastroepiploic artery (GEA) in 1 patient and total saphenous vein grafts (SVGs) in 2 patients. The combined procedures included ventricular aneurysmectomy in 1 patient, mitral valve plasty in 1 and right coronary aneurysmectomy in 1. One patient was not able to wean from cardiopulmonary bypass (CPB), after being supported with intra-aortic balloon pump (IABP), the patient was weaned from CPB successfully.Results One patient died of low cardiac output syndrome and acute renal failure 19 days after operation. Other patients recovered and were discharged uneventfully. During the follow-up that ranged from 3 to 57 months (mean 27 months),clincal angina disappeared or improved. Cardiac function was in Class Ⅰ-Ⅱ (NYHA).Conclusion CABG is a safe and effective procedure for Kawasaki coronary artery disease. However long-term results need to be followed up.

  14. Safety and Efficacy of a Novel Technique in the Use of Fractional Flow Reserve in Complex Coronary Artery Lesions

    Directory of Open Access Journals (Sweden)

    Wen-Ming He

    2015-01-01

    Full Text Available Background: Fractional flow reserve (FFR has become an increasingly important index when making decisions with respect to revascularization of coronary artery stenosis. However, the pressure guidewire used in obtaining FFR measurements is difficult to control and manipulate in certain complex coronary artery lesions, resulting in increased fluoroscopy time and contrast dye usage. This study examined a novel (NOV technique for obtaining FFR measurements in hope of easing the difficulties associated with evaluating and treating complex coronary artery lesions. Methods: Fifty-six patients with complex coronary artery lesions were assigned to a conventional (CON FFR technique group or a NOV FFR technique group. The NOV technique involved the use of a balloon and wire exchange within the coronary artery. The fluoroscopy time, contrast dye usage, and FFR-related complications were assessed after completing the FFR measurement procedure for each patient. Results: The median time required for fluoroscopy in the NOV technique group was significantly less than that in the CON technique group; additionally, lesser amounts of contrast dye were used in the NOV technique group (both P 0.05. Conclusions: Compared to the CON technique used for measuring FFR, the new technique reduced the fluoroscopy time and amount of contrast dye used when evaluating complex coronary artery lesions. The new technique did not increase the risk of operation or decrease the success rate.

  15. Successful Primary Percutaneous Coronary Intervention in a Patient With Acute Myocardial Infarction and Single Coronary Artery Ostium

    OpenAIRE

    Kim, Donghan; Jeong, Myung Ho; Lee, Ki Hong; Lee, Min Goo; Park, Keun-Ho; Sim, Doo Sun; Yoon, Nam Sik; Yoon, Hyun Ju; Kim, Kye Hun; Hong, Young Joon; Kim, Ju Han; Ahn, Youngkeun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

    2012-01-01

    One of the single anomalous origins of coronary artery that has rarely been reported is a congenital anomaly of coronary circulation that occurs in the left coronary artery originating from the right coronary sinus of valsalva. We report a 49-year-old male patient with non-ST segment elevated myocardial infarction that was identified to have an anomalous origin of the left coronary artery from the right coronary artery (RCA) with thrombotic total occlusion of RCA by coronary angiography and c...

  16. Myocardial revascularization in patient with situs inversus totalis: case report

    Directory of Open Access Journals (Sweden)

    Soncini da Rosa George Ronald

    2002-01-01

    Full Text Available This is a report of an unusual case of a patient, with dextrocardia and a "situs inversus totalis". She presented angina pectoris during an ECG stress test. The coronary arteriography revealed severe obstruction in the main left coronary artery. The patient underwent coronary artery bypass grafting surgery. We did not find a similar case in the national medical literature. The myocardial revascularization performed utilizing the right mammary artery for anterior descending artery and saphenous vein grafts for first diagonal branch and first marginal branch.

  17. Arterial stiffness as a risk factor for coronary artery disease.

    Science.gov (United States)

    Liao, Josh; Farmer, John

    2014-02-01

    Hypertension is a major modifiable risk factor, and clinical trials have demonstrated that successful reduction of elevated blood pressure to target levels translates into decreased risk for the development of coronary artery disease, stroke, heart failure, and renal failure. The arterial system had previously been regarded as a passive conduit for the transportation of arterial blood to peripheral tissues. The physiologic role the arterial system was greatly expanded by the recognition of the central role of the endothelial function in a variety of physiologic processes. The role of arterial function and structure in cardiovascular physiology was expanded with the development of a variety of parameters that evaluate arterial stiffness. Markers of arterial stiffness have been correlated with cardiovascular outcomes, and have been classified as an emerging risk factor that provides prognostic information beyond standard stratification strategies involving hypertension, diabetes, obesity, dyslipidemia and smoking. Multiple epidemiologic studies have correlated markers of arterial stiffness such as pulse-wave velocity, augmentation index and pulse pressure with risk for the development of fatal and nonfatal cardiovascular events. Additionally, measurements of arterial stiffness had clarified the results of clinical trials that demonstrated differing impacts on clinical outcomes, despite similar reductions in blood pressure, as measured by brachial and sphygmomanometry.

  18. Computerized two-lead resting ECG analysis for the detection of coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Eberhard Grube, Andreas Bootsveld, Seyrani Yuecel, Joseph T. Shen, Michael Imhoff

    2007-01-01

    Full Text Available Background: Resting electrocardiogram (ECG shows limited sensitivity and specificity for the detection of coronary artery disease (CAD. Several methods exist to enhance sensitivity and specificity of resting ECG for diagnosis of CAD, but such methods are not better than a specialist's judgement. We compared a new computer-enhanced, resting ECG analysis device, 3DMP, to coronary angiography to evaluate the device's accuracy in detecting hemodynamically relevant CAD. Methods: A convenience sample of 423 patients without prior coronary revascularization was evaluated with 3DMP before coronary angiography. 3DMP's sensitivity and specificity in detecting hemodynamically relevant coronary stenosis as diagnosed with coronary angiography were calculated as well as odds ratios for the 3DMP severity score and coronary artery disease risk factors. Results: 3DMP identified 179 of 201 patients with hemodynamically relevant stenosis (sensitivity 89.1%, specificity 81.1%. The positive and negative predictive values for identification of coronary stenosis as diagnosed in coronary angiograms were 79% and 90% respectively. CAD risk factors in a logistic regression model had markedly lower predictive power for the presence of coronary stenosis in patients than did 3DMP severity score (odds ratio 3.35 [2.24-5.01] vs. 34.87 [20.00-60.79]. Logistic regression combining severity score with risk factors did not add significantly to the prediction quality (odds ratio 36.73 [20.92-64.51]. Conclusions: 3DMP's computer-based, mathematically derived analysis of resting two-lead ECG data provides detection of hemodynamically relevant CAD with high sensitivity and specificity that appears to be at least as good as those reported for other resting and/or stress ECG methods currently used in clinical practice.

  19. Augmentation index is associated with coronary revascularization in patients with high Framingham risk scores: a hospital-based observational study

    OpenAIRE

    Choi, JoonHyouk; Kim, Song-Yi; Joo, Seung-Jae; Kim, Ki-Seok

    2015-01-01

    Background This study analyzed PWAs in patients with high Framingham risk scores to determine whether PWA is predictive of coronary artery disease (CAD) severity and percutaneous coronary intervention (PCI) treatment. Methods In total, 310 patients were screened due to suspected CAD; 78 were excluded due to PCI history (32), atrial fibrillation (11), or acute myocardial infarction (35). The augmentation index (AIx) was analyzed immediately before coronary angiography. PCI was performed in 73 ...

  20. Minimally invasive direct coronary artery bypass plus coronary stent for acute coronary syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    Caiyi Lu; Gang Wang; Qi Zhou; Jinwen Tian; Lei Gao; Shenhua Zhou; Jinyue Zhai; Rui Chen; Zhongren Zhao; Cangqing Gao; Shiwen Wang; Yuxiao Zhang; Ming Yang; Qiao Xue; Cangsong Xiao; Wei Gao; Yang Wu

    2008-01-01

    A 69-year old female patient was admitted because of 3 days of worsened chest pain.Coronary angiography showed60% stenosis of distal left main stem,chronic total occlusion of left anterior descending (LAD),70% stenosis at the ostium of a smallleft circumflex,70-90%stenosis at the paroxysmal and middle part of a dominant fight coronary artery (RCA),and a normal left internalmammary artery (LIMA) with normal origination and orientation.Percutaneous intervention was attempted but failed on the occludedlesion of LAD.The patient received minimally invasive direct coronary artery bypass (MIDCAB) with left LIMA isolation by Davincirobot.Eleven days later,the RCA lesion was treated by Sirolimus Rapamicin eluting stents implantation percutaneously.Then thepatient was discharged uneventfully after 3 days hospitalization.Our experience suggests that two stop shops of hybrid technique befeasible and safe in the treatment of elderly patient with multiple coronary diseases.

  1. Aggressive lipid-lowering therapy compared with angioplasty in stable coronary artery disease

    NARCIS (Netherlands)

    Pitt, B; Waters, D; Brown, WV; van Boven, AJ; Schwartz, L; Title, LM; Eisenberg, D; Shurzinske, L; McCormick, LS

    1999-01-01

    Background Percutaneous coronary revascularization is widely used in improving symptoms and exercise performance in patients with ischemic heart disease and stable angina pectoris. In this study, we compared percutaneous coronary revascularization with lipid-lowerin Methods We studied 341 patients w

  2. Echocardiographic evaluation of coronary arteries in congenital heart disease.

    Science.gov (United States)

    Freire, Grace; Miller, Michelle S

    2015-12-01

    Among populations of patients with the congenital heart disease, there is considerable diversity in the anatomy of the coronary arteries. Understanding these anatomical differences is vitally important in directing interventions and surgical repair. In this report, the authors describe the echocardiographic evaluation of the variants of coronary artery anatomy in the following lesions: transposition of the great arteries, congenitally corrected transposition of the great arteries, double-inlet left ventricle, common arterial trunk, tetralogy of Fallot, and double-outlet right ventricle.

  3. Psychosocial Complications of Coronary Artery Disease

    OpenAIRE

    Karimi-Moonaghi, Hossein; Mojalli, Mohammad; Khosravan, Shahla

    2014-01-01

    Background: Cardiovascular diseases are the leading causes of death around the world. The coronary artery disease (CAD) is one of the most common diseases in this category, which can be the trigger to various psychosocial complications. We believe that inadequate attention has been paid to this issue. Objectives: The purpose of the present study was to explore the psychosocial complications of CAD from the Iranian patients’ perspective. Patients and Methods: A qualitative design based on the ...

  4. Audiometric changes after coronary artery bypass graft

    Directory of Open Access Journals (Sweden)

    Khorsandi M T

    2007-09-01

    Full Text Available Background: Hearing is one of the most significant senses; There fore, any defect can be frightening. The incidence of sever hearing loss following coronary artery bypass surgery has been estimated as one per thousand. This Prospective study carried out to determine hearing effects of coronary artery bypass surgery."nMethods: age, audiometric changes before and after surgery (hearing levels at multiple frequencies, speech reception threshold and speech discrimination score, minimum blood pressure during the operation, and the time on bypass, measured on One hundred consecutive patients who candidate for coronary artery bypass surgery and the results analysed."nResults: One hundred patients completed the tests. Based on hearing changes found on pre- and post-operative tests, the patients were divided into 3 groups: Those with no change (47 patients according to their audiometric results; those with slight changes ≤10 db (43 patients; and those having average deficits of more than 10 db (10 patients. All the patients were male. None of the patients had complete or severe sensorineural hearing loss. The third group had more prolonged pumping duration when compared with the others groups (p=0.002. Furthermore, 90 percent of patients with a sensorineural hearing loss more than 10 db had diabetes mellitus and hyperlipidemia as risk factors."nConclusion: Sudden sensorineural hearing loss is a sequela in patients who undergoing coronary artery bypass surgery; however, it was usually mild and asymptomatic. Pumping time during the operation is a significant factor in occurring of this complication. With proper treatment of underlying diseases and eliminating the risk factors with improvement of our cardiopulmonary pumps we probably can get better hearing results.

  5. CT perfusion assessment of Moyamoya syndrome before and after direct revascularization (superficial temporal artery to middle cerebral artery bypass)

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Yueqin [Hospital of Qingdao University, Department of Radiology, Qingdao (China); Hospital of Jining Medical College, CT Department, Jining (China); Xu, Wenjian [Hospital of Qingdao University, Department of Radiology, Qingdao (China); Guo, Xiang; Shi, Zhitao; Sun, Zhanguo; Wang, Jiehuan [Hospital of Jining Medical College, CT Department, Jining (China); Gao, Lingyun [Hospital of Jining Medical College, MR Department, Jining (China); Jin, Feng [Hospital of Jining Medical College, Department of Neurosurgery, Jining (China); Chen, Weijian; Yang, Yunjun [Hospital of Wenzhou Medical University, Department of Radiology, Wenzhou (China)

    2016-01-15

    To evaluate the utility of CT perfusion (CTP) for the assessment of superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis in patients with Moyamoya syndrome (MMS). Twenty-four consecutive MMS patients, who underwent unilateral STA-MCA bypass surgery, received CTP before and after surgery. The relative perfusion parameter values of surgical hemispheres before treatment were compared with post-treatment values. All patients underwent CT angiography (CTA) before and after surgery in order to confirm the patency of bypass. The follow-up CTA after surgery clearly demonstrated 20 (20/24, 83.3 %) bypass arteries, whereas four (16.7 %) bypass arteries were occluded or very small. Postoperative rMTT and rTTP values (P < 0.05) of the surgical side were significantly lower than pre-operation. In patients (n = 20) with bypass patency, postoperative rCBF, rMTT and rTTP values (P < 0.05) of the surgical side were significantly improved. However, the differences of all parameters were not significant (P > 0.05) in the patients (n = 4) without bypass patency after revascularization. This study demonstrates that CTP can provide a crucial quantitative assessment of cerebral haemodynamic changes in MMS before and after STA-MCA anastomosis. (orig.)

  6. Nuclear cardiology and coronary surgery

    DEFF Research Database (Denmark)

    Eckardt, R.; Andersen, L.I.; Hesse, B.

    2008-01-01

    Rising age, repeated percutaneous coronary revascularizations, and co-morbidity such as overweight, diabetes, and hypertension, characterize a change over the last 20-30 years in coronary patients referred to coronary artery bypass grafting (CABG). This patient group represents a great part of to...

  7. Depression in Coronary Artery Disease

    Directory of Open Access Journals (Sweden)

    Nasser Safaie

    2012-09-01

    Full Text Available Introduction: Depression is one of the Common psychological disorders. From the cognitive point of view, the unhealthy attitudes increase the severity of the depression. The aim of this study was to investigate depression and unhealthy attitudes in coronary patients hospitalized at Tabriz Shahid Madani Heart Center. Methods: One hundred twenty eight hospitalized patients having myocardial Infarctions were studied regarding unhealthy attitudes, severity of depression and demographic data. Results: The study showed a significant relation between unhealthy attitudes, BDI (Beck Depression Inventory and severe depression. Moreover, a significant relation existed between gender and depression (P=0.0001. In addition, the level of education increased the intensity of unhealthy attitudes (P=0.0001. Several researches in both outside and inside Iran support the idea. Conclusion: Based on present study and more other investigations, it can be suggested to provide the necessary elements and parameters such as antidepressant medication, psychologists, complementary treatment for coping with negative mood and its unwanted consequences.

  8. New stent design for use in small coronary arteries during percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Juan F Granada

    2010-10-01

    Full Text Available Juan F Granada1, Barbara A Huibregtse2, Keith D Dawkins21The Jack H Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Columbia University Medical Center, New York, NY, USA; 2Boston Scientific Corporation, Natick, MA, USAAbstract: Patients with diabetes mellitus, of female gender, increased age, and/or with peripheral vascular disease often develop coronary stenoses in small caliber vessels. This review describes treatment of these lesions with the paclitaxel-eluting 2.25 mm TAXUS® Liberté® Atom™ stent. Given the same stent composition, polymer, antirestenotic drug (paclitaxel, and release kinetics as the first-generation 2.25 mm TAXUS® Express® Atom™ stent, the second-generation TAXUS Liberté Atom stent incorporates improved stent design characteristics, including thinner struts (0.0038 versus 0.0052 inches, intended to increase conformability and deliverability. In a porcine noninjured coronary artery model, TAXUS Liberté Atom stent implantation in small vessels demonstrated complete strut tissue coverage compared with the bare metal stent control, suggesting a similar degree of tissue healing between the groups at 30, 90, and 180 days. The prospective, single-armed TAXUS ATLAS Small Vessel trial demonstrated improved instent late loss (0.28 ± 0.45 versus 0.84 ± 0.57 mm, P < 0.001, instent binary restenosis (13.0% versus 38.1%, P < 0.001, and target lesion revascularization (5.8% versus 17.6%, P < 0.001 at nine months with the TAXUS Liberté Atom stent as compared with the bare metal Express stent control, with similar safety measures between the two groups. The TAXUS Liberté Atom also significantly reduced nine-month angiographic rates of both instent late loss (0.28 ± 0.45 versus 0.44 ± 0.61 mm, P = 0.03 and instent binary restenosis (13.0% versus 25.9%, P = 0.02 when compared with the 2.25 mm TAXUS Express Atom control. The observed reduction in target lesion revascularization with the TAXUS

  9. Multiple coronary-cameral fistulas to the left ventricle arising from both coronary arteries

    OpenAIRE

    Pathak, Ranjan; Giri, Smith; Hwang, Inyong; Alsafwah, Shadwan

    2016-01-01

    Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and a cardiac chamber or major vessel, seen in about 0.8% of the cases undergoing coronary angiography. Most patients are asymptomatic and diagnosis is made incidentally during coronary angiography. We present an image case of CCF which was found incidentally during pre-liver transplantation work up.Keywords: coronary cameral fistula; coronary angiography; Management(Published: 6 July 2016)Citation: Journal of...

  10. Coronary computed tomography angiography: emerging technique for coronary artery imaging - pictorial essay

    International Nuclear Information System (INIS)

    Assessment of potential coronary artery disease is the single most common indication for cardiovascular imaging. Currently, definite anatomic diagnosis requires invasive cardiac catheterization. Recent developments in computed tomography (CT) technology have resulted in substantially improved noninvasive coronary artery imaging. We review an imaging protocol for coronary CT angiography (CTA), study interpretation, and current and future potential applications of this technology. (author)

  11. Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.

    Science.gov (United States)

    Nagai, T; Mukai, T; Takahashi, S; Takada, A; Saito, K; Harada, K; Mori, S; Abe, N

    2014-03-01

    Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death.

  12. Paradoxical coronary artery embolism - A rare cause of myocardial infarction

    OpenAIRE

    Hakim, Fayaz A.; Kransdorf, Evan P.; Abudiab, Muaz M.; Sweeney, John P.

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirec...

  13. Multidetector computed tomography of the coronary arteries - pictorial essay

    International Nuclear Information System (INIS)

    Multidetector computed tomography (MDCT) is being used more frequently for the detection of atherosclerotic coronary artery disease (CAD). MDCT allows for very rapid image acquisition with little motion artifact, resulting in the ability to quantitate calcified atherosclerotic plaque. Congenital coronary artery anomalies are readily identified using this technique. A key advantage is the noninvasiveness of the study, with no intravascular contrast media needed. Knowledge of coronary artery anatomy as well as of the potential pitfalls is required. (author)

  14. A Case Report on Spontaneous Coronary Artery Dissection

    Directory of Open Access Journals (Sweden)

    Tunaggina Afrin Khan

    2015-01-01

    Full Text Available Spontaneous coronary artery dissection is an extremely rare cause of acute coronary syndrome. Although it predominantly affects young women in the peripartum period, it can also occur in men. The left coronary artery is most frequently involved. The usual presentation is ST segment elevation myocardial infarction. Although several treatment modalities have been proposed, the optimal treatment options still remain to be established. This current case report focuses on a 40- year-old male presented with acute coronary syndrome and subsequently was found to have coronary artery dissection.

  15. Comparison of drug eluting stent implantation with coronary artery bypass surgery in the treatment of patients with chronic total occlusion and multiple vessel disease

    Institute of Scientific and Technical Information of China (English)

    LIU Wei; ZHU Xiao-Ling; MA Chang-sheng; KANG Jun-ping; DU Xin; CHEN Fang; ZHOU Yu-jie; L(U) Shu-zheng; HUANG Fang-jiong; GU Cheng-xiong

    2011-01-01

    Background In patients with chronic total occlusion (CTO) and multivessel coronary artery disease, the comparison of surgical and the percutaneous revascularization strategies has rarely been conducted. The aim of this study was to compare long term clinical outcomes of drug eluting stent (DES) implantation with coronary artery bypass surgery (CABG)in the patients with CTO and multivessel disease.Methods From a prospective registry of 6000 patients in our institution, we included patients with CTO and multivessel coronary artery disease who underwent either CABG (n=679) or DES (n=267) treatment. Their propensity risk score was used for adjusting baseline differences.Results At a median follow-up of three years, propensity score adjusted Cox regression analysis showed that the rate of major adverse cardiac cerebrovascular events (MACCE) was lower in CABG group (12.7% vs. 24.3%, hazard ratio (HR) 1.969, 95% Cl 1.219-3.179, P=0.006) mainly due to lower rate of target vessel revascularization in CABG group than in DES group (3.1% vs. 17.2%, HR 16.14, 95% CI 5.739-45.391, P <0.001). The incidence of cardiac death or myocardial infarction (composite end point) was not significantly different between these two groups. On multivariate analysis, the significant predictors of MACCE were only the type of revascularization. Age, left ventricular ejection fraction (LVEF), and complete revascularization were identified as significant predictors of composite end points.Conclusions Our study shows that in patients with CTO and multivessel coronary disease, DES can offer comparable long term outcomes in cardiac death and myocardial infraction free survival in comparison with CABG. However, there is an increased rate of MACCE which results from more repeat revascularizations. Obtaining a complete revascularization is crucial for decreasing adverse cardiac events.

  16. Correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium scan

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sang Hoon; Hong, Yong Kook; Park, Sung Il; Lee, Hyang Mee; Choe, Kyu Ok [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1998-08-01

    To determine the correlation between obstructive coronary artery disease and electron beam tomography coronary artery calcium(EBT CAC) scan and to measure the difference in calcium score according to symptoms. Materials and Methods : Fifty-six patients underwent EBT CAC scanning and either coronary angiography or stress thallium 201 scanning or the treadmill test. When the results were positive, coronary artery obstructive disease(CAOD) was assumed to be present. The patients were divided into three groups : symptomatic CAOD,asymptomatic CAOD, and asymptomatic non- CAOD; those with a previous history of myocardial ischemia or who showed positive results in any of the three tests relating to typical symptoms of angina were assigned to the symptomatic group. Results : The number of cases assigned to group to group 1,2 and 3 was 19, 16 and 21, respectively; total CAC scores were 571 {+-} 751, 600 {+-} 726 293{+-} 401, respectively. The difference in CAC score between asymptomatic CAOD and asymptomatic non- CAOD was not statistically significant(p=0.079) but in asymptomatic CAOD, the score tended to be higher. The CAC score was not different between symptomatic and asymptomatic CAOD(p>0.1). When the CAC threshold was 1, sensitivity was 89% and specificity was 14%;when the threshold was 200, sensitivity was 60% and specificity was 67%. Conclusion : When the EBT CAC score is high, further evaluation provides early evidence of coronary artery obstructive disease.

  17. Early outcome after off-pump coronary artery bypass grafting: effect on mortality and stroke Resultado inicial após revascularização miocárdica: efeito na mortalidade e no acidente cerebrovascular

    OpenAIRE

    Delawer Reber; Marcus Fritz; Alfred Germing; Peter Marks; Axel Laczkovics

    2008-01-01

    OBJECTIVE: One of the major and devastating complications of the coronary artery bypass grafting (CABG) is the stroke. Avoiding cardiopulmonary bypass (CPB) may reduce this neurological complication. In the past years there was an increased interest in the off-pump coronary artery grafting (OPCAB). The benefit of this method of revascularization in term of stroke and mortality is controversially discussed. METHODS: A retrospective analysis of collected data from 252 patients were operated wit...

  18. Presence of anomalous coronary seen on angiogram is not associated with increased risk of significant coronary artery disease.

    Science.gov (United States)

    Suryanarayana, Prakash; Kollampare, Shubha; Riaz, Irbaz Bin; Lee, Justin; Husnain, Muhammad; Luni, Faraz Khan; Movahed, Mohammad Reza

    2014-12-01

    It is unclear if anomalous coronary arteries are at higher risk for atherosclerosis. The link between anomalous coronary artery and early coronary artery disease has been suggested. The aim of this study is to determine whether the coronary artery anomaly predisposes to development of significant coronary disease. Using retrospective chart review, patients with documented anomalous coronary arteries recognized during coronary angiography between years 2000 to 2007 were analyzed. Prevalence of significant atherosclerotic coronary artery disease (defined as more than 50% luminal narrowing) was compared between normal and anomalous coronaries. A total of 147 patients with anomalous coronary arteries were found. Right coronary artery was the most common anomalous artery 128 of 148 (86.5%) in our dataset. There was no difference in the occurrence of atherosclerosis between anomalous and nonanomalous coronaries. Significant atherosclerosis was present in 59 of the 148 anomalous coronary arteries (37.8%), and 112 of the 293 nonanomalous coronary arteries (38.2%, p = 0.9). On the basis of our study, there is no evidence that anomalous coronary arteries predispose to significant coronary artery disease in comparison to normal coronary arteries.

  19. Multiple coronary-cameral fistulas to the left ventricle arising from both coronary arteries

    OpenAIRE

    Ranjan Pathak; Smith Giri; Inyong Hwang; Shadwan Alsafwah

    2016-01-01

    Coronary-cameral fistula (CCF) is an anomalous connection between a coronary artery and a cardiac chamber or major vessel, seen in about 0.8% of the cases undergoing coronary angiography. Most patients are asymptomatic and diagnosis is made incidentally during coronary angiography. We present an image case of CCF which was found incidentally during pre-liver transplantation work up.

  20. A Case of Double Right Coronary Artery with Separate Ostium

    Directory of Open Access Journals (Sweden)

    Jalal Kheirkhah

    2015-10-01

    Full Text Available Coronary artery anomalies are rare, with their incidence varying from 1 to 5%. Angiography is a commonly used modality for the assessment of coronary artery anomalies. Based on previous reports, a majority of coronary artery anomalies are of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery. Coronary artery anomalies may cause myocardial ischemia secondary to atherosclerosis in the same artery. We present a rare case of duplicated right coronary artery with a separate ostium, which caused myocardial ischemia. Our patient was a 51-year-old diabetic woman with typical chest pain and dyspnea on exertion. Electrocardiography showed left axis deviation, poor R progression, and biphasic T wave in the precordial leads. Echocardiography revealed left ventricular ejection fraction of 30-35% and global hypokinesia. Coronary angiography demonstrated three-vessel disease and a double ostial right coronary artery. We recommended coronary artery bypass graft surgery, but the patient refused it and we continued her treatment with anti-ischemic drugs.

  1. Syncope with spontaneous coronary artery dissection in an elderly woman

    Institute of Scientific and Technical Information of China (English)

    CHEN Yu-feng; CHANG Mu-hsin; CHANG Ting-chuan; LAI Chao-hung; JONG Gwo-ping

    2011-01-01

    Diagnosis of spontaneous coronary artery dissection (SCAD) is challenging because of its rarity and uncertain etiology.It frequently occurs in young women during pregnancy and in the postpartum period,and rarely found in elder women with no history of cardiovascular disease or coronary risk factors.In this article we report a case of SCAD in a 75-year-old woman without traditional cardiovascular risk factors who presented with syncope and mild chest discomfort.There were no abnormal electrocardiographic changes and no elevated cardiac enzymes were detected.Computed tomography of brain revealed nothing abnormal.Coronary artery disease was suspected.Coronary angiogram revealed dissection in the middle left circumflex artery.The patient underwent percutaneous transluminal coronary angioplasty and was free of symptoms at 6-month follow-up.Our report suggests that emergency coronary angiography is indicated if syncope caused by coronary artery disease is suspected.

  2. Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?

    International Nuclear Information System (INIS)

    Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds. - Highlights: • Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. • In recent years, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in

  3. Coronary artery bypass surgery or coronary stenting in diabetic patients: too soon to make a statement?

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, Alfredo E., E-mail: arodriguez@centroceci.com.ar

    2014-11-15

    Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. However, almost simultaneously with this data, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in adverse cardiac events compared to 1st generation DES in patients with diabetes. In this editorial we review the old and new randomized data in diabetic patients and conclude that there are many unresolved issues to make a definitive statement regarding which is the best revascularization preference in diabetic patients and the measured final efficacy of PCI and CABG will not be reached until the arrival of RCT using next generation DES, including complete absorbable scaffolds. - Highlights: • Diabetic patients have been associated with poor procedural and long term outcome if they were treated either with percutaneous coronary interventions or coronary artery bypass surgery. Recently several randomized clinical trials (RCT) in this subset of patients have been published showing a greater incidence of major adverse cardiovascular events, death/myocardial infarction/stroke, if they were treated with first generation drug eluting stents (DES) which was not observed previously in the bare metal stent era. • In recent years, several RCT demonstrated better safety profile with new generation DES including biocompatible polymers, biodegradable polymers and lately complete absorbable DES, all of them showed reduction in

  4. Genetics and Genomics of Coronary Artery Disease.

    Science.gov (United States)

    Pjanic, Milos; Miller, Clint L; Wirka, Robert; Kim, Juyong B; DiRenzo, Daniel M; Quertermous, Thomas

    2016-10-01

    Coronary artery disease (or coronary heart disease), is the leading cause of mortality in many of the developing as well as the developed countries of the world. Cholesterol-enriched plaques in the heart's blood vessels combined with inflammation lead to the lesion expansion, narrowing of blood vessels, reduced blood flow, and may subsequently cause lesion rupture and a heart attack. Even though several environmental risk factors have been established, such as high LDL-cholesterol, diabetes, and high blood pressure, the underlying genetic composition may substantially modify the disease risk; hence, genome composition and gene-environment interactions may be critical for disease progression. Ongoing scientific efforts have seen substantial advancements related to the fields of genetics and genomics, with the major breakthroughs yet to come. As genomics is the most rapidly advancing field in the life sciences, it is important to present a comprehensive overview of current efforts. Here, we present a summary of various genetic and genomics assays and approaches applied to coronary artery disease research. PMID:27586139

  5. Blood serum atherogenicity and coronary artery calcification.

    Science.gov (United States)

    Sobenin, Igor A; Myasoedova, Veronica A; Anisimova, Elena V; Pavlova, Xenia N; Möhlenkamp, Stefan; Schmermund, Axel; Seibel, Rainer; Berenbein, Sina; Lehmann, Nils; Moebus, Susanne; Jöckel, KarlHeinz; Orekhov, Alexander N; Erbel, Raimund

    2014-01-01

    The phenomenon of blood serum atherogenicity was described as the ability of human serum to induce lipid accumulation in cultured cells. The results of recent two-year prospective study in asymptomatic men provided the evidence for association between the changes in serum atherogenicity and dynamics of carotid intima-media thickness progression. The present study was undertaken to test the hypothesis that blood serum atherogenicity and its changes in dynamics may be associated with accumulation of coronary calcium in subclinical atherosclerosis. It was performed in 782 CHD-free participants of The Heinz Nixdorf RECALL (Risk Factors, Evaluation of Coronary Calcium and Lifestyle) Study, in whom blood samples have been taken at the baseline and at the end of 5-year follow-up. Opposite to the previous findings, the changes in serum atherogenicity did not correlate neither with the extent of coronary artery calcification, nor with the changes in Agatston CAC score. There was a moderate but significant rise in serum atherogenicity after 5-year followup period, and the same dynamics was observed for Agatston CAC score, but not for convenient lipid-related risk factors. The absence of association of the changes in serum atherogenicity with the changes in Agatston CAC score, along with previous findings, provides a point of view that serum-induced intracellular cholesterol accumulation is not related to the processes of calcium deposition in arterial wall, since the last one reflects the progression of already existing subclinical atherosclerotic lesions. PMID:24533940

  6. Single coronary artery; extremely rare coronary anomaly successfully treated surgically in young adult male.

    LENUS (Irish Health Repository)

    Shah, A R

    2010-05-01

    Single coronary artery arising from aortic root, is a rare congenital anomaly. A 30-year-old male presented with acute myocardial infarction (MI) complaining of chest pain and raised troponin levels. Emergency angiography showed no coronary lesions but both left and right coronary arteries arising from single ostium. Patient was operated electively and perioperative findings confirmed the diagnosis of single coronary artery, as left coronary artery after taking origin from right sinus of valsalva runs through the septum, before dividing into left anterior descending and circumflex branches. The single coronary ostium opened with a slit like incision over the course of left main coronary, making the size of ostium three to four times bigger than the native one. In addition left internal mammary artery was harvested and grafted to the left anterior descending branch distally. Patient made successful recovery. Four months follow up dobutamine stress echo showed no inducible ischemia.

  7. Succesful treatment of spontaneous dissection of the coronary artery by primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Yüksel Çavuşoğlu

    2011-09-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction. The disease is usually seen in young-middle aged women and leads to sudden death in the majority of cases. In survived patients, diagnosis of SCAD has been made with coronary anjiography. Involvement of left main coronary artery (LMCA is very unusual. We describe on a case of SCAD involving the LMCA in a young woman presenting with an acute myocardial infarction and cardiogenic shock status. There were no risk factors for coronary artery disease and no evidence of atherosclerosis on angiography. Coronary angiography revealed dissection of the LMCA that extended into the anterior descending and circumflex coronary arteries. The dissection was successfully treated with primary coronary artery stenting. The patient was discharged without complication. There was no problem in the first evaluation at the end of the first of the month. J Clin Exp Invest 2011; 2 (3: 299-303.

  8. The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update: focus on rehabilitation and exercise and surgical coronary revascularization.

    Science.gov (United States)

    Moe, Gordon W; Ezekowitz, Justin A; O'Meara, Eileen; Howlett, Jonathan G; Fremes, Steve E; Al-Hesayen, Abdul; Heckman, George A; Ducharme, Anique; Estrella-Holder, Estrellita; Grzeslo, Adam; Harkness, Karen; Lepage, Serge; McDonald, Michael; McKelvie, Robert S; Nigam, Anil; Rajda, Miroslaw; Rao, Vivek; Swiggum, Elizabeth; Virani, Sean; Van Le, Vy; Zieroth, Shelley; Arnold, J Malcolm O; Ashton, Tom; D'Astous, Michel; Dorian, Paul; Giannetti, Nadia; Haddad, Haissam; Isaac, Debra L; Kouz, Simon; Leblanc, Marie-Hélène; Liu, Peter; Ross, Heather J; Sussex, Bruce; White, Michel

    2014-03-01

    The 2013 Canadian Cardiovascular Society Heart Failure Management Guidelines Update provides focused discussions on the management recommendations on 2 topics: (1) exercise and rehabilitation; and (2) surgical coronary revascularization in patients with heart failure. First, all patients with stable New York Heart Association class I-III symptoms should be considered for enrollment in a tailored exercise training program, to improve exercise tolerance and quality of life. Second, selected patients with suitable coronary anatomy should be considered for bypass graft surgery. As in previous updates, the topics were chosen in response to stakeholder feedback. The 2013 Update also includes recommendations, values and preferences, and practical tips to assist the clinicians and health care workers manage their patients with heart failure.

  9. Isolated single coronary artery presenting as acute coronary syndrome: case report and review.

    Science.gov (United States)

    Mahapatro, Anil K; Patro, A Sarat K; Sujatha, Vipperala; Sinha, Sudhir C

    2014-06-01

    Congenital single coronary artery is commonly associated with complex congenital heart diseases and manifests in infancy or childhood. But isolated single coronary artery is a rare congenital anomaly which can present as acute coronary syndrome in adults. The aim of the work is to discuss on isolated single coronary artery in two adults presenting as acute coronary syndrome. The first case underwent coronary angiography (CAG) through right radial route, but switched over to femoral for confirmation of diagnosis and due to radial spasm. An aortic root angiogram was done to rule out presence of any other coronary ostia. It revealed a single coronary artery originating from right sinus of valsalva. After giving rise to posterior descending artery branch at crux, it continued in the atrioventricular groove to the anterior basal surface of the heart and traversed as anterior descending artery. There was no atheromatous occlusive stenosis. This is R-I type single coronary artery as per Lipton classification. In the second case, angiography was completed through right radial route. It revealed a single coronary artery arising from right aortic sinus. Anterior descending and circumflex branch were originating from proximal common trunk of the single coronary artery and supplying the left side of the heart. The right coronary artery has diffuse atheromatous disease without significant stenosis in any major branch. This is R-III C type as per Lipton classification. A coronary anomaly of both origin and course is very rare. It may be encountered in adults evaluated for atherosclerotic coronary heart disease. Knowledge and understanding of anatomical types of this congenital anomaly will reduce time, anxiety, complications during CAG and cardiac surgery. PMID:25075168

  10. Contemporary Review on Spontaneous Coronary Artery Dissection.

    Science.gov (United States)

    Saw, Jacqueline; Mancini, G B John; Humphries, Karin H

    2016-07-19

    Spontaneous coronary artery dissection (SCAD) is gaining recognition as an important cause of myocardial infarction, especially in young women. There has been a surge in the diagnosis of SCAD in recent years, presumably due to an increased use of coronary angiography, and the clinical availability and application of high-resolution intracoronary imaging. The improved recognition and diagnosis, together with increased publications and attention through social media, have considerably raised awareness of this condition, which was once believed to be very rare. Recent publications of moderate to large contemporary case series have helped elucidate the early natural history, presenting characteristics (clinical and angiographic), underlying etiology, management, and cardiovascular outcomes with this condition, thus providing observations and important clinical insights of value to clinicians managing this challenging and perplexing patient cohort. The aim of our review is to provide a comprehensive contemporary update of SCAD to aid health care professionals in managing these patients in both the acute and chronic settings. PMID:27417009

  11. DECT evaluation of noncalcified coronary artery plaque

    Energy Technology Data Exchange (ETDEWEB)

    Ravanfar Haghighi, Rezvan [Medical Imaging Research Center and Colorectal Research Center, Shiraz University of Medical Science, Shiraz 719 363 5899 (Iran, Islamic Republic of); Chatterjee, S. [BGVS Chemical Engineering Building (Old), Indian Institute of Science, Bangalore 560012 (India); Tabin, Milo; Singh, Rishi P.; Sharma, Munish; Krishna, Karthik [Department of Forensic Medicine, All India Institute of Medical Sciences, New Delhi 110029 (India); Sharma, Sanjiv; Jagia, Priya [Department of Cardiac-Radiology, All India Institute of Medical Sciences, New Delhi 110029 (India); Ray, Ruma; Arava, Sudhir [Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029 (India); Yadav, Rakesh [Department of Cardiology, All India Institute of Medical Sciences, New Delhi 110029 (India); Vani, V. C. [Department of Instrumentation and Applied Physics, Indian Institute of Science, Bangalore 560012 (India); Lakshmi, R.; Kumar, Pratik, E-mail: drpratikkumar@gmail.com [Department of Cardiac-Biochemistry, All India Institute of Medical Sciences, New Delhi 110029 (India); Mandal, Susama R. [Department of Medical Physics Unit IRCH, All India Institute of Medical Sciences, New Delhi 110029 (India)

    2015-10-15

    Purpose: Composition of the coronary artery plaque is known to have critical role in heart attack. While calcified plaque can easily be diagnosed by conventional CT, it fails to distinguish between fibrous and lipid rich plaques. In the present paper, the authors discuss the experimental techniques and obtain a numerical algorithm by which the electron density (ρ{sub e}) and the effective atomic number (Z{sub eff}) can be obtained from the dual energy computed tomography (DECT) data. The idea is to use this inversion method to characterize and distinguish between the lipid and fibrous coronary artery plaques. Methods: For the purpose of calibration of the CT machine, the authors prepare aqueous samples whose calculated values of (ρ{sub e}, Z{sub eff}) lie in the range of (2.65 × 10{sup 23} ≤ ρ{sub e} ≤ 3.64 × 10{sup 23}/cm{sup 3}) and (6.80 ≤ Z{sub eff} ≤ 8.90). The authors fill the phantom with these known samples and experimentally determine HU(V{sub 1}) and HU(V{sub 2}), with V{sub 1},V{sub 2} = 100 and 140 kVp, for the same pixels and thus determine the coefficients of inversion that allow us to determine (ρ{sub e}, Z{sub eff}) from the DECT data. The HU(100) and HU(140) for the coronary artery plaque are obtained by filling the channel of the coronary artery with a viscous solution of methyl cellulose in water, containing 2% contrast. These (ρ{sub e}, Z{sub eff}) values of the coronary artery plaque are used for their characterization on the basis of theoretical models of atomic compositions of the plaque materials. These results are compared with histopathological report. Results: The authors find that the calibration gives ρ{sub e} with an accuracy of ±3.5% while Z{sub eff} is found within ±1% of the actual value, the confidence being 95%. The HU(100) and HU(140) are found to be considerably different for the same plaque at the same position and there is a linear trend between these two HU values. It is noted that pure lipid type plaques

  12. Are cost-benefit analyses needed for the management of coronary artery disease?

    International Nuclear Information System (INIS)

    Health economics has classified several levels of cost-effectiveness: Technical capacity, diagnostic impact, therapeutic impact, patient outcome, societal benefit. When clinical utility is defined in terms of percent correct diagnosis of coronary artery disease (CAD), nuclear cardiology is the most cost-effective initial modality in patients with an intermediate pretest likelihood of CAD. For the resources used the strategy of therapy determine the long-term costs. Myocardial perfusion SPECT yields incremental prognostic information for prediction of both cardiac death and hard events. Patient with normal or mildly abnormal scans after exercise stress may not require invasive interventions. Therefore nuclear cardiac testing is a cost-effective initial modality even on the level of therapeutic impact. The results of myocardial SPECT are used to help reduce unnecessary coronary angiography and revascularization procedures. (orig.)

  13. Acute multivessel coronary artery occlusion: a case report

    Directory of Open Access Journals (Sweden)

    Gan Feng

    2012-09-01

    Full Text Available Abstract Background In terms of clinical and angiographic findings, multiple simultaneous coronary occlusions in acute myocardial infarction are infrequent, and the mechanism of the occlusions is unclear. Case presentation We herein report a rare case of two simultaneously occluded coronary arteries, one of which subsequently underwent spontaneous lysis. An 88-year-old man had a 3-hour attack of acute crushing retrosternal chest pain. His first electrocardiogram showed ST-segment elevation in the inferior (II, III, and aVF and anterior (V3–V6 leads. His second electrocardiogram in the cardiac care unit showed ST-segment elevation in the inferior leads but ST-segment depression in the anterior leads. Emergency coronary angiography revealed that the right coronary artery was acutely and totally occluded at the midportion and that the proximal and midportion of the left anterior descending coronary artery had an acute thrombus. According to his electrocardiogram and coronary angiography findings, we inferred that the right coronary artery and left anterior descending coronary artery first totally occluded simultaneously, and then the thrombus in the left anterior descending coronary artery spontaneously underwent partial lysis. Therefore, intervention of the right coronary artery was performed followed by injection of glycoprotein IIB-IIIA inhibitor into the left anterior descending coronary artery. He had an uneventful hospital course and was discharged home 10 days later. Conclusion Because patients with multivessel coronary artery occlusion are often in serious condition, abnormal electrocardiographic results must be identified and affected vessel should be opened timely and efficiently to save the myocardium and reduce complications such as congestive heart failure.

  14. Coronary artery anomalies: prevalence and clinical profile in elderly patients

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Giorgio Rigatelli; Mario Trivellato

    2004-01-01

    Objective Although congenital heart diseases are uncommon in the elderly, coronary artery anomalies may be incidentally discovered in old age. We sought to determine the incidence and clinical features of coronary artery anomalies (CAAs) in patients over 65 years of age. Patients and methods Medical records of patients undergoing coronary artery angiography in the years 1997-2002 at the Legnago General Hospital were retrospectively reviewed, The clinical profiles of all patients with CAAs and CAA subtypes were noted. Comparison between patients under and over 65 was performed. Data are given as mean standard deviation and as percentages. Results Sixtysix patients (1.21%, Female/Male 22/44, mean age 65.3 ± 10.6 years) out of the 5450 who underwent coronary angiography in the years 1997-2002 had CAAs. In mast cases (63%, 41/66 patients), the patients were over 65.CAAs were discovered incidentally in these elderly patients while undergoing coronary artery angiography for dilated cardiomyopathy, ischemic heart disease, and valvular heart disease in 75% of the cases (30/41 patients). Patients over 65 had more cardiac comorbidities and .a higher incidence of coronary atherosclerosis. Conclusions The angiographic incidence of CAAs in elderly patients is increasing as the population ages and this occurrence calls for a wider knowledge of the anatomy and pathophysiology of CAAs among geriatric cardiologists. Elderly patients seem to present with lower risk coronary anomalies (separated origin of left anterior descending coronary artery and circanfflex artery, origin of circumflex artery from the right sinus or the right coronary artery, double coronary artery)but have a higher risk profile compared to younger patients due to the frequency of cardiac comorbidities and superimposed coronary artery atherosclerosis.

  15. Coronary artery disease in patients with dementia.

    Science.gov (United States)

    Fowkes, Ross; Byrne, Matthew; Sinclair, Hannah; Tang, Eugene; Kunadian, Vijay

    2016-09-01

    Our population is ageing. The prevalence of dementia is increasing as the population ages. Dementia is known to share many common risk factors with coronary artery disease including age, genetics, smoking, the components of the metabolic syndrome and inflammation. Despite the growing ageing population with dementia, there is underutilization of optimal care (pharmacotherapy and interventional procedures) in this cohort. Given common risk factors and potential benefit, patients with cognitive impairment and dementia should be offered contemporary care. However, further research evaluating optimal care in this patient cohort is warranted. PMID:27159265

  16. Giant aneurysm in a left coronary artery fistula

    DEFF Research Database (Denmark)

    Frestad, Daria; Helqvist, Steffen; Helvind, Morten;

    2013-01-01

    Congenital coronary artery fistula complicated with giant coronary artery aneurysm is a very rare condition. In this case report, we present a 65-year-old woman, referred to us with a continuous heart murmur, occasional atypical chest pain and few episodes of fainting. A giant aneurysm and a coro...

  17. Paradoxical coronary artery embolism - a rare cause of myocardial infarction.

    Science.gov (United States)

    Hakim, Fayaz A; Kransdorf, Evan P; Abudiab, Muaz M; Sweeney, John P

    2014-01-01

    Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO) with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence. PMID:25774255

  18. Paradoxical coronary artery embolism - A rare cause of myocardial infarction

    Directory of Open Access Journals (Sweden)

    Fayaz A Hakim

    2014-01-01

    Full Text Available Paradoxical coronary artery embolism is a rare, but often an underdiagnosed cause of acute myocardial infarction. It should be considered in patient who presents with chest pain and otherwise having a low risk profile for atherosclerosis coronary artery disease. We describe a case of paradoxical coronary artery embolism causing ST segment elevation myocardial infarction in a patient with upper extremity venous thrombosis. Echocardiography demonstrated a patent foramen ovale (PFO with bidirectional shunt. In addition to treatment of acute coronary event closure of the PFO should be considered to prevent a recurrence.

  19. Role of 320-slice multislice computed tomography coronary angiography in the assessment of coronary artery stenosis

    Directory of Open Access Journals (Sweden)

    Mohamed Ahmed Youssef

    2014-06-01

    Conclusion: In conclusion, MSCT coronary angiography is a very helpful and rapid non-invasive coronary imaging modality that was able to detect and grade coronary artery stenosis better than other noninvasive examinations used to detect CAD, such as exercise stress testing. Due to its very high negative predictive value, it may eliminate the need for invasive coronary procedures in the presence of normal coronary imaging.

  20. Successful treatment of cardiogenic shock by stenting of the left main coronary artery in acute myocardial infarction

    Directory of Open Access Journals (Sweden)

    Knežević Božidarka

    2008-01-01

    Full Text Available Introduction. Patients with non-ST elevation acute coronary syndromes (NSTE-ACS are sometimes severely hemodynamicly compromised. Urgent coronary angiography should be performed in these patients in percutaneous coronary intervention (PCI centers according to the ESC NSTE-ACS guidelines to determine suitabilty for percutaneous or surgical revascularization. Case report. We reported a 62-year-old male with chest pain admitted to the Coronary Care Unit. ST segment depression of 2 mm in leads I, L and V4-6 was revealed at electrocardiogram. After following 6 hours the patient had chest pain and signs of cardiogenic shock despite of the therapy. Chest x-ray showed pulmonary edema. Echocardiographic examination showed dyskinetic medium and apical segments of septum. The patient underwent coronary angiography immediately which revealed 75% stenosis of the left main coronary artery with thrombus. The use of a GPIIb/III inhibitor-tirofiban and stent implantation resulted in TIMI III flow. After that the patient had no chest pain and acute heart failure subsided in the following days Echocardiography done at the fourth day from PCI showed only hypokinesis medium and apical segment of septum. The patient was discharged at day 11 from admission in a stable condition. Conclusion. Stenting of left main coronary artery stenosis in patients with cardiogenic shock and non- ST segment elevation acute coronary syndromes may be a life saving procedure.

  1. Comparative study of on-pump and off-pump coronary bypass surgery in patients with triple-vessel coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    陈鑫; 徐明; 史宏伟; 穆心伟; 陈振强; 邱志兵

    2004-01-01

    Background Studies on selected patients undergoing off-pump versus on-pump coronary artery bypass surgery have produced inconsistent results, especially in patients with multiple coronary artery disease. This study compared the clinical results of on-pump and off-pump coronary bypass surgery in patients with triple-vessel disease.Methods A total of 300 consecutive isolated, multiple coronary artery bypass grafting (CABG) patients were assigned to the off-pump coronary artery bypass (OPCAB, n=150) or CABG with cardiopulmonary bypass (CCABG, n=150) groups. There were no significant differences regarding degree of angina, history of myocardial infarction or diabetes, and presence of left main coronary artery disease between the two groups. Ejection fraction in the OPCAB group before surgery was lower than in the CCABG group (P<0.01). In addition, more patients had a history of stroke and abnormal renal function preoperatively in the OPCAB group(P< 0.01). In OPCAB patients, single deep pericardial stay suture with a sling snared down was used to expose the target vessels, along with a stabilizer and a coronary shunt. A Medi-Stim Butterfly Flowmeter was used to measure blood flow through grafts in both groups.Results No OPCAB patient was converted to the CCABG group. The average numbers of distal anastomoses and the indexes of completeness of revascularization (ICR) were similar in both groups. Postoperative respiratory support time and the volumes of chest tube drainage and of blood transfusions were less in the OPCAB group than in the CCABG group (both P<0.01). The postoperative incidences of pulmonary dysfunction and renal insufficiency were lower in the OPCAB group than in the CCABG group (both P<0.05). There were no significant differences between the two groups in mortality and other causes of morbidity (periopetative myocardial infarction, stroke, atrial fibrillation). Conclusions OPCAB can be applied to patients with triple-vessel coronary artery disease and can

  2. Study on the screening program and risk factors of carotid artery stenosis with coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    李庆祥

    2013-01-01

    Objective The purpose of this research project was to evaluate the relationship and risk factors between coronary artery disease and carotid artery stenosis (CAS) ,screened by duplex ultra-sonography.Methods 1339 patients with coronary artery disease were enrolled into this

  3. Prospective coronary angioscopy assessment of allograft coronary artery disease in human cardiac transplant recipients

    Science.gov (United States)

    Jain, Ashit; Ventura, Hector O.; Collins, Tyrone J.; Ramee, Stephen R.; White, Christopher J.

    1993-09-01

    Annual angiographic assessment to determine the presence or progression of allograft coronary artery disease (CAD) has been unable to modify the natural history of this disease. Coronary angioscopy is a sensitive method to detect the early presence of coronary artery disease and in a retrospective analysis severity of CAD by angioscopy correlated with the time since transplantation. The purpose of this study was to prospectively evaluate progression of coronary artery disease over a one year period in 40 cardiac transplant recipients. The progression of coronary artery disease as assessed by angioscopy is directly related to time after transplantation and therefore angioscopy may be the method of choice for detection and evaluation of therapeutic regimens to control allograft coronary artery disease.

  4. Correlation between plasma renalase level and coronary artery disease

    OpenAIRE

    He, Benhong; Hao, Jianjun; Sheng, Weiwei; XIANG, YUANCAI; Zhang, Jiemei; Zhu, Hao; TIAN, JINGCHENG; Zhu, Xu; Feng, Yunxia

    2014-01-01

    Objective: To explore the correlation between the plasma renalase level of coronary artery disease (CAD) patients and the degree of coronary artery stenosis. Methods: A total of 180 patients who received coronary angiography in our hospitals from August 2013 to October 2013 were selected as the CAD group, of which 164 were finally diagnosed as CAD. Another 140 healthy subjects were selected as the control group. The plasma renalase levels of the two groups were detected by ELISA to analyze CA...

  5. Early Coronary Artery Bypass Grafting Following Life-Saving Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Kerem Yay

    2013-10-01

    Full Text Available Aim: Percutaneous coronary intervention is usually the initial treatment option for treatment of emergent and severe coronary atherosclerosis with suitable coronary arteries. We aimed to investigate the clinical features, morbidity and mortality rates of coronary artery bypass grafting performed following life-saving stent procedures and patency rates of these stents. Material and Method: Between January 2005 and December 2008, we performed coronary artery bypass grafting on 23 patients who had previous percutaneous coronary intervention to the culprit artery for acute myocardial infarction. Early postoperative coronary angiography was obtained for evaluation of stent patency. Results: In-hospital mortality occurred in five patients (21.7%. Coronary angiographic examination of the remaining patients revealed severe stenosis or occlusion at 16 out 20 stents (80%. The mean time interval between percutaneous coronary intervention and coronary artery bypass grafting was found to be statistically significant regarding stent patency (p=0.007. Discussion: Bypass grafting to a previously stented coronary artery may be the relevant approach even if the angiographic findings are normal, because intraoperative manipulation and systemic effects of cardiopulmonary bypass if used will result in deformity or occlusion of the stent.

  6. The Development of Coronary Artery Stents: From Bare-Metal to Bio-Resorbable Types

    Directory of Open Access Journals (Sweden)

    Ming-Yun Ho

    2016-07-01

    Full Text Available Coronary artery disease is the leading cause of death worldwide. Conventional balloon angioplasty is associated with high rates of complications such as coronary dissection and vessel recoil. The deployment of bare-metal stents (BMSs can overcome these problems and achieve a better patency rate than simple balloon angioplasty. It has been shown that the stent design including structure platform, size, length, and strut thickness has a major influence on the clinical results. Even though angioplasty with BMS implantation is widely used in coronary interventions, the restenosis rate due to neointimal hyperplasia remains high. Therefore, drug-eluting stents (DESs coated with anti-proliferative agents and polymers have been developed to reduce the restenosis rate and improve the clinical outcomes. Although the repeat revascularization rate of DESs is lower than that of BMSs, the long-term stent thrombosis rate is higher than for BMSs. Therefore, new and emerging generations of stents, in which, for example, thinner struts and bioresorbable polymers are used, are available for clinical use. However, there are only a limited number of clinical trials, in which these newer stents have been compared with BMSs and first- and second-generation DESs. The purpose of this review was to provide up-to-date information on the evolution of coronary artery stents from BMSs to DESs to bioresorbable stents (BRSs.

  7. Coronary artery disease incidence between type II diabetic and non-diabetic patients with Leriche syndrome.

    Directory of Open Access Journals (Sweden)

    Ozeren M

    2003-10-01

    Full Text Available BACKGROUND: Coronary artery disease (CAD is the major determinant of preoperative morbidity and mortality for patients requiring major vascular surgery. The management of CAD in these patients is controversial. AIMS: The incidence and severity of CAD in diabetic and non-diabetic patients with Leriche syndrome was explored. SETTINGS AND DESIGN: 107 patients with Leriche syndrome were selected as major vascular occlusion and grouped according to their diabetic Status. Sex, age, dyslipidemia, obesity, hypertension, clinic cardiac status, coronary angiographic lesions and coronary revascularisation procedures were noted. MATERIAL & METHODS: Patients′ demographics, intra-operative and per-operative data were recorded and compared. In every patient with Leriche syndrome scheduled for elective vascular reconstruction coronary angiography was performed. Lesions were evaluated for the percentages of stenosis. Preliminary coronary bypass or percutaneous coronary intervention was recommended for those found to have advanced or severe CAD. Results of revascularisation procedures were compared. STATISTICAL ANALYSIS USED: Chi-square or Fisher exact chi-square test is used for conditional variables. Independent samples was analysed by using t-test. Kruskal-Wallis variance test was used if the variances are not homogeneous according to the Levene test. RESULTS: No difference was found in both groups except family history and obesity. Coronary angiographic investigation indicates that 59% of DIAB group and 38% of NONDIAB group patients have advanced or severe CAD which has a high probability for myocardial revascularization. Overall revascularisation rate is 37.8% in DIAB group and 45.7% in NONDIAB group (p=0,641. Preoperative mortality was found 2.7% in diabetics and 4.2% in non-diabetics (p=0.342. CONCLUSIONS: Leriche syndrome with diabetes mellitus is more likely to have advanced coronary disease than those without diabetes mellitus. Coronary angiography

  8. Safety and Efficacy of a Novel Technique in the Use of Fractional Flow Reserve in Complex Coronary Artery Lesions

    Institute of Scientific and Technical Information of China (English)

    Wen-Ming He; Chang-Ling Li; Yong Sun; Zhong Zhou; Yi-Feng Mai

    2015-01-01

    Background:Fractional flow reserve (FFR) has become an increasingly important index when making decisions with respect to revascularization of coronary artery stenosis.However,the pressure guidewire used in obtaining FFR measurements is difficult to control and manipulate in certain complex coronary artery lesions,resulting in increased fluoroscopy time and contrast dye usage.This study examined a novel (NOV) technique for obtaining FFR measurements in hope of easing the difficulties associated with evaluating and treating complex coronary artery lesions.Methods:Fifty-six patients with complex coronary artery lesions were assigned to a conventional (CON) FFR technique group or a NOV FFR technique group.The NOV technique involved the use of a balloon and wire exchange within the coronary artery.The fluoroscopy time,contrast dye usage,and FFR-related complications were assessed after completing the FFR measurement procedure for each patient.Results:The median time required for fluoroscopy in the NOV technique group was significantly less than that in the CON technique group; additionally,lesser amounts of contrast dye were used in the NOV technique group (both P < 0.05).The NOV technique was successfully performed in thirty patients,without any FFR-related complications.However,the CON technique failed in three patients,including two who experienced coronary artery spasms (P > 0.05).Conclusions:Compared to the CON technique used for measuring FFR,the new technique reduced the fluoroscopy time and amount of contrast dye used when evaluating complex coronary artery lesions.The new technique did not increase the risk of operation or decrease the success rate.

  9. Percutaneous Revascularization in a Case of Vasospastic Angina Associated with Polymorphic Ventricular Tachycardia

    Directory of Open Access Journals (Sweden)

    Roxana Rudzik

    2015-12-01

    Full Text Available Introduction: Coronary vasospasm is a possible cause of ventricular tachyarrhythmias and is frequently associated with atherosclerotic lesions. The revascularization of mild to moderate coronary artery stenosis which causes symptoms only due to associated vasospasm is still a matter of debate, as the standard treatment of Prinzmetal angina is represented by the long term administration of calcium-channel blockers.

  10. Harmonic skeleton guided evaluation of stenoses in human coronary arteries.

    Science.gov (United States)

    Yang, Yan; Zhu, Lei; Haker, Steven; Tannenbaum, Allen R; Giddens, Don P

    2005-01-01

    This paper presents a novel approach that three-dimensionally visualizes and evaluates stenoses in human coronary arteries by using harmonic skeletons. A harmonic skeleton is the center line of a multi-branched tubular surface extracted based on a harmonic function, which is the solution of the Laplace equation. This skeletonization method guarantees smoothness and connectivity and provides a fast and straightforward way to calculate local cross-sectional areas of the arteries, and thus provides the possibility to localize and evaluate coronary artery stenosis, which is a commonly seen pathology in coronary artery disease. PMID:16685882

  11. Premature coronary artery disease in systemic lupus erythematosus with extensive reocclusion following coronary artery bypass surgery.

    Science.gov (United States)

    D Agate, David J; Kokolis, Spyros; Belilos, Elise; Carsons, Steven; Andrieni, Julia; Argyros, Thomas; Glasser, Lynne A; Dangas, George

    2003-03-01

    A 21-year-old woman with a history of systemic lupus erythematosus (SLE) presented to the emergency room with a chief complaint of substernal chest pain and palpitations. She had undergone a four-vessel coronary artery bypass graft operation with separate saphenous vein grafts to the left anterior descending (LAD), obtuse marginal (OM) 1 and 2, and distal right coronary arteries (RCA) 8 months prior to admission. The patient underwent angiography of the coronary vessels, which showed severe diffuse disease with a long, 90% narrowing of the vein graft to the LAD and closed vein grafts to OM1 and OM2. The RCA graft showed mild diffuse disease. An intervention was done in which the LAD was stented twice with subsequent TIMI 3 flow. Advances in medical therapy and a better understanding of the disease have contributed to a dramatic improvement in the long-term survival of patients with SLE. However, despite the overall long-term improvement, coronary artery disease remains a major cause of morbidity and mortality with an incidence of approximately nine-fold greater than would be expected for this population. PMID:12612393

  12. The Effect of Endovascular Revascularization of Common Iliac Artery Occlusions on Erectile Function

    Energy Technology Data Exchange (ETDEWEB)

    Gur, Serkan, E-mail: mserkangur@yahoo.com [Sifa Hospital, Department of Radiology (Turkey); Ozkan, Ugur [Baskent University, Department of Radiology, Faculty of Medicine (Turkey); Onder, Hakan; Tekbas, Gueven [Dicle University, Department of Radiology, Faculty of Medicine (Turkey); Oguzkurt, Levent [Baskent University, Department of Radiology, Faculty of Medicine (Turkey)

    2013-02-15

    To determine the incidence of erectile dysfunction in patients with common iliac artery (CIA) occlusive disease and the effect of revascularization on erectile function using the sexual health inventory for males (SHIM) questionnaire. All patients (35 men; mean age 57 {+-} 5 years; range 42-67 years) were asked to recall their sexual function before and 1 month after iliac recanalization. Univariate and multivariate analyses were performed to determine variables effecting improvement of impotence. The incidence of impotence in patients with CIA occlusion was 74% (26 of 35) preoperatively. Overall 16 (46%) of 35 patients reported improved erectile function after iliac recanalization. The rate of improvement of impotence was 61.5% (16 of 26 impotent patients). Sixteen patients (46%), including seven with normal erectile function before the procedure, had no change. Three patients (8%) reported deterioration of their sexual function, two of whom (6%) had normal erectile function before the procedure. The median SHIM score increased from 14 (range 4-25) before the procedure to 20 (range 1-25) after the procedure (P = 0.005). The type of recanalization, the age of the patients, and the length of occlusion were related to erectile function improvement in univariate analysis. However, these factors were not independent factors for improvement of erectile dysfunction in multivariate analysis (P > 0.05). Endovascular recanalization of CIA occlusions clearly improves sexual function. More than half of the patients with erectile dysfunction who underwent endovascular recanalization of the CIA experienced improvement.

  13. Prospective randomized clinical study of arterial pumps used for routine on pump coronary bypass grafting.

    Science.gov (United States)

    Keyser, Andreas; Hilker, Michael K; Diez, Claudius; Philipp, Alois; Foltan, Maik; Schmid, Christof

    2011-05-01

    In a number of studies, centrifugal blood pumps--in comparison with roller pumps--have been shown to attenuate trauma to blood components. Nevertheless, the impact of these results on the postoperative course needs to be discussed controversially. In a prospective randomized study, 240 consecutive adult patients underwent elective myocardial revascularization with cardiopulmonary bypass employing five different pumps (Roller, Avecor, Sarns, Rotaflow, Bio-Medicus). We analyzed clinical course, blood loss, damage of blood components, and impairment of the hemostatic system. The study population was homogenous with respect to age, gender, myocardial function, and operative data. No differences were found with respect to time of ventilation, duration of intensive care stay, hospitalization, and laboratory data. The choice of arterial pump during standard extracorporeal bypass for elective coronary artery bypass grafting is no matter of concern.

  14. [Approaches potentiating cardioprotective effect of ambulatory physical training in patients with ischemic heart disease and multivessel coronary artery involvement after coronary stenting].

    Science.gov (United States)

    Liamina, N P; Kotel'nikova, E V; Biziaeva, E A; Karpova, É S

    2014-01-01

    Cardiorehabilitation of patients with multivessel coronary lesions is an obligatory component of ambulatory stage of care. With the aim of potentiating cardioprotective and antiischemic impact of rehabilitative preventive measures in 36 patients with ischemic heart disease (IHD) and multivessel coronary artery involvement who had undergone percutaneous coronary intervention we studied cardioprotective and antiischemic effect of long-term (24 weeks) administration of 70 mg/day trimetazidine in combination with moderate intensity physical training with the use of distance surveillance by a physician. The chosen therapeutic approach in patients with residual ischemia after incomplete anatomical revascularization provided early persistent formation of cardioprotective and antiischemic effect proven by increase of tolerance to physical exercise, improvement of diastolic function, and positive dynamics of both ECG parameters and biochemical markers of myocardial ischemia.

  15. Dual left anterior descending artery with anomalous origin of long LAD from pulmonary artery - rare coronary anomaly detected on computed tomography coronary angiography

    Science.gov (United States)

    Vohra, Aditi; Narula, Harneet

    2016-01-01

    Dual left anterior descending artery is a rare coronary artery anomaly showing two left anterior descending arteries. Short anterior descending artery usually arises from the left coronary artery, while long anterior descending artery has anomalous origin and course. Dual left anterior descending artery with origin of long anterior descending artery from the pulmonary artery (ALCAPA) is a very rare coronary artery anomaly which has not been reported previously in the literature. We present the computed tomography coronary angiographic findings of this rare case in a young female patient who presented with atypical chest pain.

  16. Coronary artery calcification in chronic kidney disease: An update

    OpenAIRE

    Stompór, Tomasz

    2014-01-01

    Arterial calcification is a well-recognized complication of advanced atherosclerosis. Chronic kidney disease (CKD) is characterized by significantly more pronounced, disseminated and fast-progressing calcification of the vascular system, including the coronary arteries. New computed tomography-based imaging techniques allow for the noninvasive assessment and monitoring of calcification in different vascular sites. Coronary artery calcification (CAC) develops early in the course of CKD and is ...

  17. Above-knee vein harvest for coronary revascularization increases ASEPSIS score.

    Science.gov (United States)

    Akowuah, Enoch; Shrivastava, Vivek; Ponniah, Alan; Jamnadas, Binal; Chilton, Gary; Cooper, Graham

    2006-02-01

    The long saphenous vein may be harvested from the thigh or the lower leg, depending on the operating surgeon's preference. This prospective study compared the incidence of altered wound healing between these two sites in 175 patients undergoing routine coronary artery bypass grafting over a 3-month period. The patients were divided into 3 groups. In group A, the vein harvest site was restricted to above the upper border of the patella. Group B included harvest sites that started at the ankle but extended above the level of the upper border of the patella. In group C, the vein harvest site was restricted to below the upper border of the patella. The wounds were assessed daily using the ASEPSIS scoring system. In group A, significantly more patients (24%) had an ASEPSIS score > 10, compared to group B (3%) and group C (2%). The mean ASEPSIS score was significantly lower in group C than groups A or B, 1.5 +/- 2.4 vs. 6.5 +/- 3.2 or 3.7 +/- 1.7, respectively. The ASEPSIS score is reduced when vein harvest is restricted to below the level of the knee.

  18. Woven Coronary Artery Disease Successfully Managed with Percutaneous Coronary Intervention: A New Case Report

    Directory of Open Access Journals (Sweden)

    Yakup Alsancak

    2015-01-01

    Full Text Available Woven coronary artery is relatively rare and can be complicated in both acute and chronic phases. A few case reports have been published until now. Herein we report a case with right woven coronary artery managed with drug-eluted stent implantation without complication.

  19. Secretory phospholipase A2 in patients with coronary artery disease.

    Science.gov (United States)

    Lima, Luciana Moreira; Carvalho, Maria das Graças; da Fonseca Neto, Cirilo Pereira; Garcia, José Carlos Faria; Sousa, Marinez Oliveira

    2010-04-01

    This study investigated the correlation of sPLA2 (secretory phospholipase A2) activity with the atheromatosis extent in subjects with coronary artery disease (CAD) undergoing coronary angiography. We analyzed 123 patients, including 35 subjects with angiographically normal coronary arteries (controls), 31 with mild/moderate atheromatosis (stenosis of 30-70% of the luminal diameter in one or more coronary arteries) and 57 with severe atheromatosis (>70% stenosis). Plasma sPLA2 activity was significantly higher in subjects with severe [127.7 U/ml (102.3-162.7); p tabagism, hypertension, sedentarism, family history for coronary artery disease, diabetes mellitus, total cholesterol, HDLc, LDLc, triglycerides, high sensitivity C-reactive protein and phospholipase A2, only sPLA2 was observed to be independently associated with severe CAD (>70% of stenosis) (p < 0.0001). PMID:19449149

  20. A Numerical Multiscale Framework for Modeling Patient-Specific Coronary Artery Bypass Surgeries

    Science.gov (United States)

    Ramachandra, Abhay B.; Kahn, Andrew; Marsden, Alison

    2014-11-01

    Coronary artery bypass graft (CABG) surgery is performed to revascularize diseased coronary arteries, using arterial, venous or synthetic grafts. Vein grafts, used in more than 70% of procedures, have failure rates as high as 50% in less than 10 years. Hemodynamics is known to play a key role in the mechano-biological response of vein grafts, but current non-invasive imaging techniques cannot fully characterize the hemodynamic and biomechanical environment. We numerically compute hemodynamics and wall mechanics in patient-specific 3D CABG geometries using stabilized finite element methods. The 3D patient-specific domain is coupled to a 0D lumped parameter circulatory model and parameters are tuned to match patient-specific blood pressures, stroke volumes, heart rates and heuristic flow-split values. We quantify differences in hemodynamics between arterial and venous grafts and discuss possible correlations to graft failure. Extension to a deformable wall approximation will also be discussed. The quantification of wall mechanics and hemodynamics is a necessary step towards coupling continuum models in solid and fluid mechanics with the cellular and sub-cellular responses of grafts, which in turn, should lead to a more accurate prediction of the long term outcome of CABG surgeries, including predictions of growth and remodeling.

  1. CLINICAL PROGRESS IN CORONARY ARTERY BYPASS GRAFT%冠状动脉搭桥术的临床应用进展

    Institute of Scientific and Technical Information of China (English)

    姚建民; 成杞润

    2001-01-01

    Conventional coronary artery bypass graft performed through median sternotomy with hypothermic extracorporeal circulation and saphenous vein grafts is both saft and effective.To reduce perioperative morbidity further,and promote earlier hospital discharge and long-term graft patency rate,great efforts have ben recently made in coronary surgery.we reviewed the literature relevent to clinical progress in minimally invasive coronary bypass graft,total arterial revascularization and coronary operation in advanced age,and discussed their surgical indications,operative techniques and clinical results.Studies about off pump,thoracoscope or axial flow pump-assisted myocardial revacularization have demonstrated favourable results such as reduced systemic inflammatory respones,avoiding ischemia-prefusion injury,lower cost and shorter hospital stay.Clinical practice also showed that patients who received two arterial graft or total arterial revascularization had decreased risk of death,reoperation and angioplasty,and that advanced age in and of itself should not be a contraindication to an coronary bypass operation,although morbidity,mortality and cost may be higher.

  2. [Aftermaths of lesions of coronary arteries in Kawasaki disease].

    Science.gov (United States)

    Vostokova, A A; Grunina, E A; Klemenov, A V

    2016-01-01

    Kawasaki disease, also known as cutaneous-mucous-glandular mucocutaneous glandular syndrome, is acute systemic vasculitis of small-to-medium calibre arteries, frequently involving coronary arteries, affect almost exceptionally children, with reports concerning cases of Kawasaki syndrome in 20-to-30-year-old adults being extremely rare. The most serious manifestation of Kawasaki disease is coronaritis and formation of coronary artery aneurysms. The dynamics of the formed coronary aneurysms and, consequently, the fate of patients may be different. Thrombosis of an aneurysm in the early period of the disease and stenosing of the affected coronary artery later on present possible complications of Kawasaki disease and potential causes of myocardial infection in young adults. Increased risk of coronary artery thromboses in Kawasaki disease is conditioned by a decrease in velocity of blood flow and its turbulent pattern in the aneurysms, endothelial dysfunction due to currently existing or endured coronaritis and thrombocytosis typical of this pathology. Predisposing factors of coronary artery stenosing are unfavourable haemodynamic conditions appearing at the sites of the "entry" and "exit" of the aneurysm. Described herein are two case reports of myocardial infarction, one of which being a complication of an acute case of Kawasaki disease in a 29-year-old patient, with the second one being a consequence of coronary artery stenosing in a 25-year-old patient who had endured Kawasaki disease in his childhood.

  3. Spontaneous Coronary Artery Dissection following Topical Hormone Replacement Therapy

    Directory of Open Access Journals (Sweden)

    Alexander L. Pan

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection is a rare condition, usually presenting as an acute coronary syndrome, and is often seen in states associated with high systemic estrogen levels such as pregnancy or oral contraceptive use. While topical hormonal replacement therapy may result in increased estrogen levels similar to those documented with oral contraceptive use, there are no reported cases of spontaneous coronary dissection with topical hormonal replacement therapy. We describe a 53-year-old female who developed two spontaneous coronary dissections while on topical hormonal replacement therapy. The patient had no other risk factors for coronary dissection. After withdrawal from topical hormonal therapy, our patient has done well and has not had recurrent coronary artery dissections over a one-year follow-up period. The potential contributory role of topical hormonal therapy as a cause of spontaneous coronary dissection should be recognized.

  4. Carotid artery stenting in patients with coexistent carotid and coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    LUO Jian-fang; HUANG Wen-hui; WANG Shuo; DAI Cheng-bo; LI Guang; CHEN Ji-yan; ZHOU Ying-ling; WANG Li-juan

    2007-01-01

    @@ Atherosclerotic disease, as a systemic process, affects all arteries to varying degrees. In particular,coexistent carotid and coronary artery diseases are common; Management of such patients has been a point of continuing controversy.

  5. Outcome and Graft Patency in Coronary Artery Bypass Grafting with Coronary Endarterectomy

    OpenAIRE

    Nemati, Mohammad Hassan; Astaneh, Behrooz; Khosropanah, Shahdad

    2015-01-01

    Background Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. Methods This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After fo...

  6. Succesful treatment of spontaneous dissection of the coronary artery by primary percutaneous coronary intervention

    OpenAIRE

    Yüksel Çavuşoğlu; Ömer Göktekin; Kadir Uğur Mert; Muharrem Nasifov; Hüseyin Uğur Yazıcı

    2011-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction. The disease is usually seen in young-middle aged women and leads to sudden death in the majority of cases. In survived patients, diagnosis of SCAD has been made with coronary anjiography. Involvement of left main coronary artery (LMCA) is very unusual. We describe on a case of SCAD involving the LMCA in a young woman presenting with an acute myocardial infarction and cardiogenic shock status. There w...

  7. Mesenchymal stem cells improve medullary inflammation and fibrosis after revascularization of swine atherosclerotic renal artery stenosis.

    Directory of Open Access Journals (Sweden)

    Behzad Ebrahimi

    Full Text Available Atherosclerotic renal artery stenosis (ARAS raises blood pressure and can reduce kidney function. Revascularization of the stenotic renal artery alone does not restore renal medullary structure and function. This study tested the hypothesis that addition of mesenchymal stem cells (MSC to percutaneous transluminal renal angioplasty (PTRA can restore stenotic-kidney medullary tubular transport function and attenuate its remodeling. Twenty-seven swine were divided into three ARAS (high-cholesterol diet and renal artery stenosis and a normal control group. Six weeks after ARAS induction, two groups were treated with PTRA alone or PTRA supplemented with adipose-tissue-derived MSC (10 × 10(6 cells intra-renal. Multi-detector computed tomography and blood-oxygenation-level-dependent (BOLD MRI studies were performed 4 weeks later to assess kidney hemodynamics and function, and tissue collected a few days later for histology and micro-CT imaging. PTRA effectively decreased blood pressure, yet medullary vascular density remained low. Addition of MSC improved medullary vascularization in ARAS+PTRA+MSC and increased angiogenic signaling, including protein expression of vascular endothelial growth-factor, its receptor (FLK-1, and hypoxia-inducible factor-1α. ARAS+PTRA+MSC also showed attenuated inflammation, although oxidative-stress remained elevated. BOLD-MRI indicated that MSC normalized oxygen-dependent tubular response to furosemide (-4.3 ± 0.9, -0.1 ± 0.4, -1.6 ± 0.9 and -3.6 ± 1.0 s(-1 in Normal, ARAS, ARAS+PTRA and ARAS+PTRA+MSC, respectively, p<0.05, which correlated with a decrease in medullary tubular injury score (R(2 = 0.33, p = 0.02. Therefore, adjunctive MSC delivery in addition to PTRA reduces inflammation, fibrogenesis and vascular remodeling, and restores oxygen-dependent tubular function in the stenotic-kidney medulla, although additional interventions might be required to reduce oxidative-stress. This study supports development of

  8. Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Yuoness, Salem A.; Goha, Ahmed M.; Romsa, Jonathan G.; Akincioglu, Cigdem; Warrington, James C.; Datta, Sudip; Gambhir, Sanjay; Urbain, Jean-Luc C.; Vezina, William C. [London Health Sciences Centre, Department of Nuclear Medicine, London, ON (Canada); Massel, David R. [London Health Sciences Centre, Division of Cardiology, London, ON (Canada); Martell, Rafael [Private Practice, London, ON (Canada)

    2015-09-15

    Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPI and 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 - 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 - 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports

  9. Very high coronary artery calcium score with normal myocardial perfusion SPECT imaging is associated with a moderate incidence of severe coronary artery disease

    International Nuclear Information System (INIS)

    Myocardial perfusion imaging (MPI) has limitations in the presence of balanced multivessel disease (MVD) and left main (LM) coronary artery disease, occasionally resulting in false-normal results despite the high cardiovascular risk associated with this condition. The purpose of this study was to assess the incidence of severe coronary artery disease (CAD) in the presence of a very high Agatston coronary artery calcium (CAC) score (>1,000) in stable symptomatic patients without known CAD but with normal MPI results. A total of 2,659 prospectively acquired consecutive patients were referred for MPI and evaluation of CAC score by CT. Of this patient population, 8 % (222/2,659) had ischemia without myocardial infarction (MI) on MPI and 11 % (298/2,659) had abnormal MPI (MI and/or ischemia). On presentation 1 % of the patients (26/2,659) were symptomatic, had a CAC score >1,000 and normal MPI results. The definition of normal MPI was strict and included a normal hemodynamic response without ischemic ECG changes and normal imaging, particularly absence of transient ischemic dilation. All of these 26 patients with a CAC score >1,000 and normal MPI findings underwent cardiac catheterization. Of these 26 patients, 58 % (15/26) had severe disease (≥70 % stenosis) leading to revascularization. Of this group, 47 % (7/15) underwent percutaneous intervention, and 53 % (8/15) underwent coronary artery bypass grafting. All of these 15 patients had either MVD (14/15) or LM coronary artery disease (1/15), and represented 0.6 % (15/2,659) of all referred patients (95 % CI 0.3 - 0.9 %). The majority, 90 % (8/9), had severe CAD with typical chest pain. A very high CAC score (>1,000) with normal MPI in a small subset of symptomatically stable patients was associated with a moderate incidence of severe CAD (95 % CI 37 - 77 %). Larger studies and/or a meta-analysis of small studies are needed to more precisely estimate the incidence of CAD in this population. This study also supports

  10. Doppler findings in a rare Coronary Artery Fistula

    Directory of Open Access Journals (Sweden)

    Jorns Carl

    2007-03-01

    Full Text Available Abstract One of the primary forms of congenital anomalies of the coronary arteries is coronary artery fistula (CAF. It is defined as a direct communication between the coronary artery and any surrounding cardiac chamber or vascular structure, which bypasses the myocardial capillary bed. We present a newborn baby with a large coronary artery fistula connecting the left anterior descending (LAD artery to the left ventricular (LV apex. Associated cardiac abnormalities were found: a ventricular septal defect (diameter 4 mm, a patent foramen ovale as well as trivial tricuspid and mitral regurgitation. Here we demonstrate the echocardiograms of an extremely rare form of CAF diagnosed within the first days of postnatal life.

  11. Identifying, characterizing, and classifying congenital anomalies of the coronary arteries.

    Science.gov (United States)

    Shriki, Jabi E; Shinbane, Jerold S; Rashid, Mollie A; Hindoyan, Antereas; Withey, James G; DeFrance, Anthony; Cunningham, Mark; Oliveira, George R; Warren, Bill H; Wilcox, Alison

    2012-01-01

    The clinical manifestations of coronary artery anomalies vary in severity, with some anomalies causing severe symptoms and cardiovascular sequelae and others being benign. Cardiovascular computed tomography (CT) has emerged as the standard of reference for identification and characterization of coronary artery anomalies. Therefore, it is important for the reader of cardiovascular CT images to be thoroughly familiar with the spectrum of coronary artery anomalies. Hemodynamically significant anomalies include atresia, origin from the pulmonary artery, interarterial course, and congenital fistula. Non-hemodynamically significant anomalies include duplication; high origin; a prepulmonic, transseptal, or retroaortic course; shepherd's crook right coronary artery; and systemic termination. In general, coronary arteries with an interarterial course are associated with an increased risk of sudden cardiac death. Coronary artery anomalies that result in shunting, including congenital fistula and origin from the pulmonary artery, are also commonly symptomatic and may cause steal of blood from the myocardium. Radiologists should be familiar with each specific variant and its specific constellation of potential implications. PMID:22411942

  12. The Importance of Patency in Patients with Critical Limb Ischemia undergoing Endovascular Revascularization for Infrapopliteal Arterial Disease

    Directory of Open Access Journals (Sweden)

    Frederic eBaumann

    2015-01-01

    Full Text Available Critical limb ischemia (CLI represents the most severe form of peripheral arterial disease (PAD and frequently occurs in medically frail patients. CLI patients frequently exhibit multi-segmental PAD commonly including the tibial arterial segment. Endovascular therapy has been established as first-line revascularization strategy for most CLI patients. Restenosis was reported to occur in up to more than two thirds of CLI patients undergoing angioplasty of complex tibial arterial obstructions. Nevertheless, favourable clinical outcomes were observed for infrapopopliteal angioplasty when compared with bypass surgery despite higher patency rates for the latter. Based on these observations, infrapopliteal patency was considered to be only of secondary importance upon clinical outcomes in CLI patients. In contrast to these earlier observations, however, recent findings from two randomized clinical trials indicate that infrapopliteal patency does impact on clinical outcomes in CLI patients. Purpose of the present manuscript is to provide a critical reappraisal of the present literature on the clinical importance of tibial arterial patency in CLI patients undergoing endovascular revascularization and to discuss utility and limitations of currently available anti-restenosis technologies.

  13. An Unusual Appearance of Double Right Coronary Artery

    Directory of Open Access Journals (Sweden)

    Ahmet Akcay

    2010-01-01

    Full Text Available Double right coronary artery (RCA is an extremely rare coronary artery anomaly. We aimed to report an atherosclerotic double RCA which appeared after primary percutaneous intervention performed to treat acute inferior myocardial infarction. This is the first case in the literature, which the coronary arteries that can be accepted as double RCA have been hidden by total atherosclerotic occlusion of the proximal part of the RCA. In this paper, also the definition, correct diagnosis, and appropriate diagnostic methods for double RCA were discussed.

  14. Validation of a Novel Clinical Prediction Score for Severe Coronary Artery Diseases before Elective Coronary Angiography

    OpenAIRE

    Zhang-Wei Chen; Ying-Hua Chen; Ju-Ying Qian; Jian-Ying Ma; Jun-Bo Ge

    2014-01-01

    OBJECTIVES: Coronary artery disease (CAD) severity is associated with patient prognosis. However, few efficient scoring systems have been developed to screen severe CAD in patients with stable angina and suspected CAD before coronary angiography. Here, we present a novel scoring system for CAD severity before elective coronary angiography. METHODS: Five hundred fifty-one patients with stable angina who were admitted for coronary angiography were enrolled in this study. Patients were divided i...

  15. Coronary artery calcium scoring in myocardial infarction

    International Nuclear Information System (INIS)

    Background. The aim of this study was to evaluate coronary artery calcium scoring and the assessment of the risk factors in patients with myocardial infarction (MI). Methods. During the period of three years, 27 patients with MI were analyzed. The average age of patients was 66.1 years (46 to 81). Coronary arteries calcium was evaluated by multi row detector computed tomography (MTDC) Somatom Volume Zoom Siemens, and, retrospectively by ECG gating data acquisition. Semi automated calcium quantification to calculate Agatston calcium score (CS) was performed with 4 x 2.5 mm collimation, using 130 ml of contrast medium, injected with an automatic injector, with the flow rate of 4 ml/sec. The delay time was determined empirically. At the same time several risk factors were evaluated. Results. Out of 27 patients with MI, 3 (11.1%) patients had low CS (10- 100), 5 (18.5%) moderate CS (101- 499), and 19 (70.4%) patients high CS (>500). Of risk factors, smoking was confirmed in 17 (63.0%), high blood pressure (HTA) in 10 (57.0%), diabetes mellitus in 7 (25.9%), positive family history in 5 (18.5%), pathological lipids in 5 (18.5%), alcohol abuse in 4 (1.8%) patients. Six (22.2%) patients had symptoms of angina pectoris. Conclusions. The research showed high correlation of MI and high CS (>500). Smoking, HTA, diabetes mellitus, positive family history and hypercholesterolemia are significant risk factors. Symptoms are relatively poor in large number of patients. (author)

  16. Off-pump versus on-pump coronary artery bypass surgery for the treatment of left main with triple coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Zhibing Qiu; Xin Chen; Ming Xu; Kaihu Shi; Yinshuo Jiang; Liqiong Xiao

    2008-01-01

    Objective:To obtain early results of off-pump coronary artery bypass grafting(OPCAB) in patients with significant left main coronary artery(LMCA) and triple vessels stenosis by comparing with those of a similar group undergoing conventional coronary artery bypass surgery(CCAB). Methods:Data for patients with significant LMCA and triple vessels stenosis who underwent CCAB or OPCAB were collected retrospectively between January I999 and May 2006. Non-randomized, retrospective data analysis included demographic and preoperative risk factors, operative details, clinical outcome and early follow-up. Results: The number of distal anastomosis and grafts varied from 3 to 6. The average number per patient was similar in the two groups (OPCAB group:3.76±0.98, CCAB group:3.81±1.02). Thirty-day mortality occurred to one patient in the OPCAB group whereas two early deaths were observed in the CCAB group but did not reach statistical significance (P>0.05). The frequency of atrial fibrillation (AF), IABP usage, mediastinitis,re-operation for bleeding (or tamponade) were similar in the two groups (P>0.05). Postoperative inotropic requirements, peak CKMB, ventilation time, blood loss, FFP, RBC transfusion need and the length of ICU-stay were all significantly lower in thc OPCAB group compared with CCAB group(P<0.05).Conclusion: Significant LMCA and triple-vessel stenosis can safely and effectively undergo myocardial revascularization using OPCAB surgery. LMCA should no longer be seen as a contraindication to perform OPCAB grafting.

  17. Pre-discharge exercise test for evaluation of patients with complete or incomplete revascularization following primary percutaneous coronary intervention: a DANAMI-2 sub-study

    DEFF Research Database (Denmark)

    Valeur, N.; Clemmensen, P.; Grande, P.;

    2008-01-01

    OBJECTIVES: It is unclear whether the completeness of revascularization impacts on the prognostic value of an exercise test after primary percutaneous coronary intervention (PCI). METHODS: The DANAMI-2 trial included patients with ST elevation acute myocardial infarction randomized to primary PCI...... or fibrinolysis. Of the 790 patients randomized to primary PCI, 572 performed an exercise test. Prospectively, 310 patients were classified as having complete and 216 as having incomplete revascularization. Primary endpoint was a composite of reinfarction and/or death. RESULTS: Patients with incomplete...

  18. Acute Ischemic Stroke Involving Both Anterior and Posterior Circulation Treated by Endovascular Revascularization for Acute Basilar Artery Occlusion via Persistent Primitive Trigeminal Artery

    Science.gov (United States)

    Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji

    2016-01-01

    We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke. PMID:27446523

  19. Acute Ischemic Stroke Involving Both Anterior and Posterior Circulation Treated by Endovascular Revascularization for Acute Basilar Artery Occlusion via Persistent Primitive Trigeminal Artery.

    Science.gov (United States)

    Imahori, Taichiro; Fujita, Atsushi; Hosoda, Kohkichi; Kohmura, Eiji

    2016-07-01

    We report a case of acute ischemic stroke involving both the anterior and posterior circulation associated with a persistent primitive trigeminal artery (PPTA), treated by endovascular revascularization for acute basilar artery (BA) occlusion via the PPTA. An otherwise healthy 67-year-old man experienced sudden loss of consciousness and quadriplegia. Magnetic resonance imaging showed an extensive acute infarction in the right cerebral hemisphere, and magnetic resonance angiography showed occlusion of the right middle cerebral artery (MCA) and BA. Because the volume of infarction in the territory of the right MCA was extensive, we judged the use of intravenous tissue plasminogen activator to be contraindicated. Cerebral angiography revealed hypoplasia of both vertebral arteries and the presence of a PPTA from the right internal carotid artery. A microcatheter was introduced into the BA via the PPTA and revascularization was successfully performed using a Merci Retriever with adjuvant low-dose intraarterial urokinase. After treatment, his consciousness level and right motor weakness improved. Although persistent carotid-vertebrobasilar anastomoses such as a PPTA are relatively rare vascular anomalies, if the persistent primitive artery is present, it can be an access route for mechanical thrombectomy for acute ischemic stroke. PMID:27446523

  20. Direct communication between the left circumflex and the right coronary arteries: a very rare coronary anomaly circulation.

    Science.gov (United States)

    Oliveira, Marcos Danillo Peixoto; Cavalcanti, Rafael R César; Kajita, Alexandre H; Miranda, Thais; Kajita, Luiz J; Horta, Pedro E; Ribeiro, Expedito E; Lemos, Pedro Alves

    2016-02-01

    Coronary artery anomalies (CAA) are congenital changes in their origin, course, and/or structure. Intercoronary communication (ICC) is a very rare subset with uni- or bidirectional blood flow between two or more coronary arteries. We present the case of a 58-year-old man with an acute coronary syndrome whose coronary angiography incidentally showed a surprising and very rare communication between the right coronary and left circumflex arteries.

  1. Effects of Intermittent Pneumatic Compression on Reduction of Postoperative Lower Extremity Edema and Normalization of Foot Microcirculation Flow in Patients Undergoing Arterial Revascularization

    OpenAIRE

    Pawlaczyk, Katarzyna; Gabriel, Marcin; Urbanek, Tomasz; Dzieciuchowicz, Łukasz; Krasiński, Zbigniew; Gabriel, Zofia; Olejniczak-Nowakowska, Małgorzata; Stanisić, Michał

    2015-01-01

    Background In patients with chronic leg ischemia, the beneficial effect of arterial revascularization can be significantly decreased due to postoperative leg swelling. The aim of this study was to assess the effects of intermittent pneumatic compression (IPC) on skin flow normalization in patients undergoing revascularization procedures due to chronic leg ischemia. Material/Methods We evaluated 116 patients with chronic leg ischemia. The patients were divided into groups according to the perf...

  2. Correlation of invasive central arterial pressure with peripheral arterial pressure and coronary sclerosis

    Institute of Scientific and Technical Information of China (English)

    吴琪

    2013-01-01

    Objective To study the consistency among non-invasive and invasive brachial artery pressure,radial artery pressure and invasive central arterial pressure,and to explore the correlation between the severe degree of coronary artery disease and invasive central aortic pressure.

  3. Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy.

    Science.gov (United States)

    Saini, Ashish P; Cyran, Stephen E; Ettinger, Steven M; Pauliks, Linda B

    2016-08-16

    A 15-year-old boy with transposition of the great arteries (TGA) and neonatal arterial switch operation (ASO) presented with complete occlusion of the left main coronary artery (LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram (CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies. PMID:27574609

  4. Coronary artery occlusion after arterial switch operation in an asymptomatic 15-year-old boy

    Science.gov (United States)

    Saini, Ashish P; Cyran, Stephen E; Ettinger, Steven M; Pauliks, Linda B

    2016-01-01

    A 15-year-old boy with transposition of the great arteries (TGA) and neonatal arterial switch operation (ASO) presented with complete occlusion of the left main coronary artery (LMCA). Intra-operatively, an intramural left coronary artery was identified. Therefore, since age 7 years he had a series of screening exercise stress tests. At 13 years old, he had 3 to 4 mm ST segment depression in the infero-lateral leads without symptoms. This progressed to 4.2 mm inferior ST segment depression at 15 years old with normal stress echocardiogram. Sestamibi myocardial perfusion scan and cardiac magnetic resonance imaging was inconclusive. Therefore, a coronary angiogram was obtained which showed complete occlusion of the LMCA with ample collateralization from the right coronary artery system. This was later confirmed on a computed tomogram (CT) angiogram, obtained in preparation of coronary artery bypass grafting. The case illustrates the difficulty of detecting coronary artery stenosis and occlusion in young patients with rich collateralization. Coronary CT angiogram and conventional angiography were the best imaging modalities to detect coronary anomalies in this adolescent with surgically corrected TGA. Screening CT angiography may be warranted for TGA patients, particularly for those with known coronary anomalies. PMID:27574609

  5. Comparison of hybrid procedure and open surgical revascularization for multilevel infrainguinal arterial occlusive disease

    Directory of Open Access Journals (Sweden)

    Zhou M

    2014-09-01

    of decreased primary patency for HYBRID (P=0.017 and P=0.019, respectively.Conclusion: Multilevel infrainguinal artery occlusive diseases could be treated by hybrid procedure, with shorter hospitalization, less perioperative morbidity, and similar early- and long-term efficacy compared with open revascularization. A hybrid procedure should be considered for patients with high surgical risk, but critical limb ischemia, diabetes, and renal insufficiency could compromise its long-term patency. Keywords: hybrid procedure, atherosclerotic occlusive disease, endovascular treatment 

  6. Multiple giant coronary aneurysms arising from coronary istula to the pulmonary artery revealed in aorta CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Ju; Lee, Ki Nam [Dept. of Radiology, Dong A University Hospital, Dong-A University College of Medicine, Busan (Korea, Republic of); Lee, Jong Min [Dept. of Radiology, Kyungpook National University Hospital, Kyungpook National University College of Medicine, Daegu (Korea, Republic of)

    2015-12-15

    Coronary fistula is a rare coronary abnormality through which blood drains into the cardiac chamber, great vessel or other vessels. In addition, giant aneurysm arising from coronary fistula is rare pathologic manifestation. Herein, we presented a rare case of multiple giant coronary artery aneurysms arising from coronary to pulmonary artery fistula in a 79-year-old woman presenting with sudden loss of consciousness. The aneurysms were detected using thoracic computed tomography angiography and consequently confirmed by invasive coronary angiography.

  7. Novel treatment of coronary artery fistulae concealing severe coronary artery lesion: using thrombus aspiration catheter as a delivery guide.

    Science.gov (United States)

    Korkmaz, Levent; Acar, Zeydin; Dursun, Ihsan; Akyüz, Ali Rıza; Korkmaz, Ayca Ata

    2014-03-01

    In this case report, we present the occlusion of multiple coronary artery fistulae originating from proximal left anterior descending (LAD) and right sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspiration catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulae with the help of thrombus aspiration catheter. Our experience may suggest that thrombus aspiration catheters can be used in treating coronary artery fistulae with difficult anotomy. PMID:24748888

  8. Value of Acceleration Flow in the Left Anterior Descending Coronary Artery for the Detection of Coronary Artery Stenosis by Transthoracic Coronary Color Doppler Echocardiography

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    Whether the localized flow acceleration occurs in the resting stenotic left anterior descending coronary artery was explored and its value for detection of coronary stenosis estimated.Blood flow in the left anterior descending coronary arteries in 45 patients was detected by transthoracic color Doppler echocardiograph and multipoint pulse Doppler spectrums were recorded in the same segment. The ratio of the maximal peak diastolic velocity to the minimal peak diastolic velocity was calculated. The ratio ≥1.5 was the cutoff value for the presence of localized acceleration flow.There were 23 patients with localized acceleration flow examined by echocardiography. Twenty of them were found to have luminal diameter stenosis (60 %- 98 %) in the left anterior descending coronary arteries by coronary angiography and 3 patients were normal. There were 22 patients without localized acceleration flow examined by echocardiography. Eighteen of them had no or <60% stenosis. Four patients had serious stenosis (≥95 %) or occluded segments in the left anterior descending coronary arteries on coronary angiography. The ratio of the maximal peak diastolic velocity to the minimal peak diastolic velocity was significantly higher in patients with left anterior descending coronary artery stenosis than that in those without stenosis (1.9±0.3 vs 1.3±0.2, P<0.01) and it correlated significantly with left anterior descending coronary artery stenosis (r=0.77, P<0.01). The specificity by using the ratio≥1.5 for stenosis detection was 85.7 % (18/21), and the sensitivity was 83.3 % (20/24). This study demonstrated that local blood flow velocity was increased in the resting stenotic left anterior descending coronary artery. Transthoracic color Doppler echocardiography is a reliable noninvasive method to detect localized acceleration flow in the left anterior descending coronary artery stenosis and it is useful in the noninvasive diagnosis of stenosis in the left anterior descending

  9. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Report of an Adult Case

    Directory of Open Access Journals (Sweden)

    Celso K. Takimura

    2002-03-01

    Full Text Available We report the clinical findings, pathophysiology, diagnostic characteristics, and surgical repair of anomalous origin of the left coronary artery from the pulmonary artery in a 26-year-old female patient with a clinical diagnosis of coronary heart disease.

  10. Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Marcelo A. Nakazone

    2010-01-01

    Full Text Available Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

  11. Computed tomography of coronary artery anomaly - case report

    International Nuclear Information System (INIS)

    Background: Anomalies of coronary vessels can be described as varies group of congenital heart disease, which can have different level of clinical manifestation and changeable pathophysiological mechanisms. Diagnosis and imaging of vessel course is essential before percutaneous angioplasty intervention and coronary artery bypass grafting as well as before implantation of artificial valve. Case Report: Patient with cardiologic history, previously percutaneous intervention were performed and left circumflex coronary artery were assessed as occluded. Computed tomography revealed anomalous origin of patent circumflex branch arising from right Valsava sinus. Conclusions: Selective percutaneus coronary angiography is challenging in case of coronary anomalies, there are only few indirect symptoms of anomalies. The advantage of computed tomography over classic coronarography is visibility of all patent coronary vessels after single administration of contrast medium. It is possible to describe its anatomic relations, evaluation of walls and its changes

  12. Coronary artery surgery: cardiotomy suction or cell salvage?

    Directory of Open Access Journals (Sweden)

    Kelleher Andrea

    2007-10-01

    Full Text Available Abstract Coronary artery bypass grafting (CABG today results in what may be regarded as acceptable levels of blood loss with many institutions avoiding allogeneic red cell transfusion in over 60% of their patients. The majority of cardiac surgeons employ cardiotomy suction to preserve autologous blood during on-pump coronary artery bypass surgery; however the use of cardiotomy suction is associated with a more pronounced systemic inflammatory response and a resulting coagulopathy as well as exacerbating the microembolic load. This leads to a tendency to increased blood loss, transfusion requirement and organ dysfunction. Conversely, the avoidance of cardiotomy suction in coronary artery bypass surgery is not associated with an increased transfusion requirement. There is therefore no indication for the routine use of cardiotomy suction in on-pump coronary artery surgery.

  13. Robot-Assisted Minimally Invasive Coronary Artery Bypass Surgery Operation

    Medline Plus

    Full Text Available ... Harrisburg Hospital campus. We are going to witness a robot-assisted minimally invasive coronary artery bypass surgery ... you're starting to do and maybe give a little background on the patient's condition? 00:00: ...

  14. Antiplatelet therapy at the time of coronary artery bypass grafting

    DEFF Research Database (Denmark)

    Kremke, Michael; Tang, Mariann; Bak, Mikkel;

    2013-01-01

    OBJECTIVES: The purpose of this multicentre cohort study was to examine the relationship between antiplatelet therapy (APT) at the time of coronary artery bypass grafting (CABG) and postoperative bleeding complications, transfusion requirements and adverse cardiovascular events. METHODS: A matched...

  15. Off-pump coronary artery bypass grafting or percutaneous transluminal coronary angioplasty with stenting for proximal left anterior descending coronary artery disease?

    NARCIS (Netherlands)

    Drenth, Derk Jan

    2005-01-01

    This thesis describes and discusses the results of a prospective randomized controlled clinical trial comparing percutaneous coronary angioplasty with stenting (stenting) and off-pump coronary artery bypass grafting with a left internal mammary artery (surgery) in patients with a high-grade stenosis

  16. Spontaneous coronary artery dissection as a cause of myocardial infarction

    Institute of Scientific and Technical Information of China (English)

    Aytekin; Aksakal; U?ur; Arslan; Mehmet; Yaman; Mehmet; Urumda?; Ahmet; Hakan; Ate?

    2014-01-01

    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.

  17. Cost-effectiveness of new cardiac and vascular rehabilitation strategies for patients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Sandra Spronk

    Full Text Available OBJECTIVE: Peripheral arterial disease (PAD often hinders the cardiac rehabilitation program. The aim of this study was evaluating the relative cost-effectiveness of new rehabilitation strategies which include the diagnosis and treatment of PAD in patients with coronary artery disease (CAD undergoing cardiac rehabilitation. DATA SOURCES: Best-available evidence was retrieved from literature and combined with primary data from 231 patients. METHODS: We developed a markov decision model to compare the following treatment strategies: 1. cardiac rehabilitation only; 2. ankle-brachial index (ABI if cardiac rehabilitation fails followed by diagnostic work-up and revascularization for PAD if needed; 3. ABI prior to cardiac rehabilitation followed by diagnostic work-up and revascularization for PAD if needed. Quality-adjusted-life years (QALYs, life-time costs (US $, incremental cost-effectiveness ratios (ICER, and gain in net health benefits (NHB in QALY equivalents were calculated. A threshold willingness-to-pay of $75,000 was used. RESULTS: ABI if cardiac rehabilitation fails was the most favorable strategy with an ICER of $44,251 per QALY gained and an incremental NHB compared to cardiac rehabilitation only of 0.03 QALYs (95% CI: -0.17, 0.29 at a threshold willingness-to-pay of $75,000/QALY. After sensitivity analysis, a combined cardiac and vascular rehabilitation program increased the success rate and would dominate the other two strategies with total lifetime costs of $30,246 a quality-adjusted life expectancy of 3.84 years, and an incremental NHB of 0.06 QALYs (95%CI:-0.24, 0.46 compared to current practice. The results were robust for other different input parameters. CONCLUSION: ABI measurement if cardiac rehabilitation fails followed by a diagnostic work-up and revascularization for PAD if needed are potentially cost-effective compared to cardiac rehabilitation only.

  18. Coronary spasm as the cause of myocardial ischaemia in a patient with anomalous origin of the left anterior descending artery from the proximal right coronary artery

    OpenAIRE

    Nakazato, Jun; Hirata, Kazuhito; Wake, Minoru

    2014-01-01

    A 49-year-old woman developed angina at rest. A CT of the coronary artery revealed that the left anterior descending artery arose from the right coronary artery, and traversed between the aorta and pulmonary trunk. An exercise stress myocardial scintigraphy did not reproduce myocardial ischaemia or anginal symptoms. A coronary angiography did not show any atherosclerotic changes. Finally, an ergotamine provocation test for vasospasm revealed diffuse severe spasm in the right coronary artery a...

  19. MR-based coronary artery blood velocity measurements in patients without coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Schiemann, M.; Esmaeili, A.; Vogl, T.J. [Johann Wolfgang Goethe-University, Institute of Diagnostic and Interventional Radiology University Hospital, Frankfurt am Main (Germany); Bakhtiary, F.; Moritz, A. [University HospitalJohann Wolfgang Goethe-University, Department of Thoracic and Cardiovascular Surgery, Frankfurt am Main (Germany); Hietschold, V. [University Hospital Carl Gustav Carus Technical University Dresden, Institute of Diagnostic Radiology, Dresden (Germany); Koch, A.; Abolmaali, N.D. [Johann Wolfgang Goethe-University, Institute of Diagnostic and Interventional Radiology University Hospital, Frankfurt am Main (Germany); University Hospital Carl Gustav Carus Techinical University Dresden, ZIK OncoRay - Molecular Imaging, Dresden (Germany); Ackermann, H. [Johann Wolfgang Goethe University, Department for Biomathematics, Frankfurt am Main (Germany)

    2006-05-15

    To evaluate the feasibility of MR-based coronary blood velocity measurements (MRvenc) in patients without coronary artery disease (CAD). Eighty-three patients with angiographically excluded CAD received MRvenc of the proximal segments of both coronary arteries (CAs). Using a retrospectively ECG-gated breath-hold phase-contrast FLASH sequence with high temporal resolution, flow data were technically acquirable in 137/166 (83%) CAs. Quantification and analysis of blood velocities in systole and diastole of both CAs were performed. Biphasic velocity profiles were found in 83/100 CAs. Median systolic and diastolic velocities differed significantly in LCA (19 cm/s, 24 cm/s; P<0.0001) and RCAs (14 cm/s, 16 cm/s; P<0.01). The diastolic/systolic velocity ratio was calculated in LCAs and RCAs with a median of 1.3 and 1.1, respectively. The velocity profiles of the remaining CAs were monophasic (17 CAs) or revealed severe alterations of the physiologic velocity profile with reduced flow undulations and steady velocities (37 CAs). Optimized clinical MRvenc is feasible to quantify blood velocities in the CAs. Potential indications are (1) non-invasive monitoring of patients after aortic valve reconstruction as well as (2) detection of asymptomatic CAD patients. (orig.)

  20. The clinical application of clopidogrel in current coronary artery surgery

    Institute of Scientific and Technical Information of China (English)

    Yangyang Zhang; Kejiang Cao

    2008-01-01

    The article presents an overview of the current clinical application of clopidogrel in coronary artery surgery. The viewpoint is that clopidogrel can reduce preoperative and postoperative ischemic events of coronary artery bypass grafting(CABG). With the development of standardized medication and the corresponding preventive technique, it will be of great value to reduce hemorrhage complications and obtain the maximum benefit from clopidogrel' s anti-platelet properties.

  1. Giant atrial septal aneurysm originating from the right coronary artery.

    Science.gov (United States)

    Osada, Hiroaki; Kanemitsu, Naoki; Meshii, Katsuaki; Ohnaka, Motoaki

    2016-08-01

    Giant coronary artery aneurysm is a rare clinical entity and its involvement in the interatrial space is extremely rare. We here report the rare surgical case of a 67-year old man with giant right coronary artery aneurysm located in the atrial septum with fistula formation to the right atrium, complicated with congestive heart failure, rapid atrial fibrillation and left atrial appendage thrombus. The patient eventually recovered fully without sequelae. PMID:27118290

  2. Coronary Artery Dissection: Not Just a Heart Attack

    Science.gov (United States)

    ... Stroke More Coronary Artery Dissection: Not Just a Heart Attack Updated:May 24,2016 Sometimes a heart attack ... Disease Go Red For Women Types of aneurysms Heart Attack • Home • About Heart Attacks Acute Coronary Syndrome (ACS) • ...

  3. Risk stratification of patients suspected of coronary artery disease

    DEFF Research Database (Denmark)

    Jensen, Jesper Møller; Voss, Mette; Hansen, Vibeke B;

    2012-01-01

    To compare the performance of five risk models (Diamond-Forrester, the updated Diamond-Forrester, Morise, Duke, and a new model designated COronary Risk SCORE (CORSCORE) in predicting significant coronary artery disease (CAD) in patients with chest pain suggestive of stable angina pectoris....

  4. Recurrent Syncope Attributed to Left Main Coronary Artery Severe Stenosis

    Directory of Open Access Journals (Sweden)

    Min Li

    2015-01-01

    Full Text Available Patients with acute coronary syndrome (ACS rarely manifest as recurrent syncope due to malignant ventricular arrhythmia. We report a case of a 56-year-old Chinese male with complaints of paroxysmal chest burning sensation and distress for 2 weeks as well as loss of consciousness for 3 days. The electrocardiogram (ECG revealed paroxysmal multimorphologic ventricular tachycardia during attack and normal heart rhythm during intervals. Coronary angiograph showed 90% stenosis in left main coronary artery and 80% stenosis in anterior descending artery. Two stents sized 4.0*18 mm and 2.75*18 mm were placed at left main coronary artery and anterior descending artery, respectively, during percutaneous coronary intervention (PCI. The patient was discharged and never had ventricular arrhythmia again during a 3-month follow-up since the PCI. This indicated that ventricular tachycardia was correlated with persistent severe myocardial ischemia. Coronary vasospasm was highly suspected to be the reason of the sudden attack and acute exacerbation. PCI is recommended in patients with both severe coronary artery stenosis and ventricular arrhythmia. Removing myocardial ischemia may stop or relieve ventricular arrhythmia and prevent cardiac arrest.

  5. Detection of malignant right coronary artery anomaly by multi-slice CT coronary angiography

    International Nuclear Information System (INIS)

    Coronary artery anomalies occur in 0.3-0.8% of the population and infer a high risk for sudden cardiac death in young adults. Diagnosis is usually established during coronary angiography, which is hampered by poor spatial visualization. Magnetic resonance imaging is an alternative, but it is not feasible in the presence of metal objects or claustrophobia. In this report, a 15-year-old boy experienced ventricular fibrillation and was successfully resuscitated. Cardiac catheterization was inconclusive, and pacemaker implantation prohibited the use of MR imaging. Multi-slice CT coronary angiography revealed a malignant anomalous right coronary artery. (orig.)

  6. Impact of SYNTAX score on 1-year clinical outcomes in patients undergoing percutaneous coronary intervention for unprotected left main coronary artery.

    Science.gov (United States)

    Nozue, Tsuyoshi; Kamijima, Ryo; Iwaki, Taku; Michishita, Ichiro

    2012-01-01

    SYNTAX score is an angiographic scoring system that was developed to quantify the number, complexity, and location of lesions in patients undergoing coronary revascularization. Up to now, the impact of SYNTAX score on clinical outcomes in patients undergoing percutaneous coronary intervention (PCI) for unprotected left main coronary artery (LMCA) lesions has not been fully examined. Therefore, we evaluate the usefulness of the SYNTAX score and identify the cutoff value of this score to predict 1-year clinical outcomes in patients undergoing PCI for unprotected LMCA lesions. This was a single-center retrospective study that included 49 consecutive patients undergoing elective PCI for unprotected LMCA lesions. We calculated the SYNTAX score and examined the correlations between this score and 1-year clinical outcomes. Major adverse cardiac events (MACE) occurred in 12 patients (24%): target lesion revascularization in 9 patients (18%), myocardial infarction in 2 (4%), and cardiac death in 1 (2%). The frequency of MACE was significantly higher in the intermediate (47%) or high score group (50%) than in the low score group (4%). Furthermore, the SYNTAX score was significantly higher in the MACE group than in the non-MACE group (31 vs. 22, p = 0.008). Receiver-operating characteristic curve showed that the SYNTAX score exhibited 83% sensitivity and 76% specificity for predicting the development of MACE at a cutoff value 26. These results demonstrate that the SYNTAX score could be a useful tool to predict 1-year clinical outcomes in patients undergoing elective PCI for unprotected LMCA lesions.

  7. Homocysteine as risk factor for coronary artery disease in pakistan

    International Nuclear Information System (INIS)

    Pakistani people belong to an ethnic group which has the highest rate of coronary artery disease. There are a number of risk factors for developing the coronary artery disease (CAD). Homocysteine, a sulphur containing amino acid, has been reported to be an independent risk factor for CAD. The present study was done to find out the role of hyperhomocysteinemia in the development of coronary artery disease in Pakistan. Materials and Methods: A cross sectional study was carried out. There were 40 angiographically diagnosed male patients of coronary artery disease between 30 - 40 years of age taken as cases and 40 age, sex and socioeconomically matched healthy subjects with normal carotid doppler study taken as controls. Fasting venous blood from cases and controls was taken in E.D.T.A vacationers. Plasma was analyzed for homo-cysteine level by enzyme immunoassay method. Results: Mean plasma concentration of homocysteine in coronary artery disease patients i.e. cases was 13.5 +- 6.8 mu mol/L and was higher than the mean for controls (10.76 +- 2.27 mu mol/L) to a significant extent. Conclusion: Hyperhomocysteinemia through inter-play with the classical cardiovascular risk factors may be aggravating the risk of coronary artery disease in Pakistani people. (author)

  8. Low prevalence of significant carotid artery disease in Iranian patients undergoing elective coronary artery bypass

    Directory of Open Access Journals (Sweden)

    Karimi Fatemeh

    2007-01-01

    Full Text Available Abstract Background Coronary artery bypass grafting ranks as one of the most frequent operations worldwide. The presence of carotid artery stenosis may increase the stroke rate in the perioperative period. Routine preoperative noninvasive assessment of the carotid arteries are recommended in many institutions to reduce the stroke rate. Methods 271 consecutive patients undergoing coronary artery bypass grafting at Shaheed Madani hospital of Tabriz, Iran (age, 58.5 Y; 73.1% male underwent preoperative ultrasonography for assessment of carotid artery wall thickness. Results Plaque in right common, left common, right internal and left internal carotid arteries was detected in 4.8%, 7.4%, 43.2% and 42.1% of patients respectively. 5 patients (1.8% had significant ( Conclusion Consecutive Iranian patients undergoing elective coronary artery bypass surgery show a very low prevalence of significant carotid artery disease.

  9. RELATIONS OF ENDOTHELIAL FUNCTION AND BLOOD FLOW IN BRACHIAL ARTERY AND CORONARY ARTERY

    Institute of Scientific and Technical Information of China (English)

    孙寅光; 沈卫峰; 施仲伟; 张大东

    2003-01-01

    Objective To determine the relations between endothelium dependent vasodilator function and blood flow in the brachial and coronary arteries in patients with suspected coronary artery disease.MethodsTwenty eight patients with suspected coronary artery disease underwent brachial artery endothelial function test by using high resolution B mode ultrasound before coronary angiography (CAG) and coronary flow reserve (CFR) test by using intracoronary Doppler technique. The correlation of coronary artery dilatation induced by an increase in blood flow after intracoronary adenosine infusion and brachial artery flow mediated dilatation (FMD) following reactive hyperemia was evaluated. The relation between the change of brachial artery blood flow and CFR was also studied.ResultsThere was a positive correlation between brachial FMD and percent change of coronary diameter after adenosine infusion (12.50%±9.35% vs 11.38%±7.55%, r=0.425,P=0.02). There was also a weak negative relation between brachial flow change following reactive hyperemia and CFR (r=0.397, P=0.04).ConclusionThere is a correlation between the coronary endothelial function and the CFR by ultrasonic determination of brachial flow changes following reactive hyperemia.

  10. Non-invasive prediction of hemodynamically significant coronary artery stenoses by contrast density difference in coronary CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Hell, Michaela M., E-mail: michaela.hell@uk-erlangen.de [Department of Cardiology, University of Erlangen (Germany); Dey, Damini [Department of Biomedical Sciences, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Taper Building, Room A238, 8700 Beverly Boulevard, Los Angeles, CA 90048 (United States); Marwan, Mohamed; Achenbach, Stephan; Schmid, Jasmin; Schuhbaeck, Annika [Department of Cardiology, University of Erlangen (Germany)

    2015-08-15

    Highlights: • Overestimation of coronary lesions by coronary computed tomography angiography and subsequent unnecessary invasive coronary angiography and revascularization is a concern. • Differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve, were assessed. • At a threshold of ≥24%, contrast density difference predicted hemodynamically significant lesions with a specificity of 75%, sensitivity of 33%, PPV of 35% and NPV of 73%. • The determination of contrast density difference required less time than transluminal attenuation gradient measurement. - Abstract: Objectives: Coronary computed tomography angiography (CTA) allows the detection of obstructive coronary artery disease. However, its ability to predict the hemodynamic significance of stenoses is limited. We assessed differences in plaque characteristics and contrast density difference between hemodynamically significant and non-significant stenoses, as defined by invasive fractional flow reserve (FFR). Methods: Lesion characteristics of 59 consecutive patients (72 lesions) in whom invasive FFR was performed in at least one coronary artery with moderate to high-grade stenoses in coronary CTA were evaluated by two experienced readers. Coronary CTA data sets were acquired on a second-generation dual-source CT scanner using retrospectively ECG-gated spiral acquisition or prospectively ECG-triggered axial acquisition mode. Plaque volume and composition (non-calcified, calcified), remodeling index as well as contrast density difference (defined as the percentage decline in luminal CT attenuation/cross-sectional area over the lesion) were assessed using a semi-automatic software tool (Autoplaq). Additionally, the transluminal attenuation gradient (defined as the linear regression coefficient between intraluminal CT attenuation and length from the ostium) was determined

  11. Global metabolic optimality in the structure of the coronary arteries

    CERN Document Server

    Keelan, Jonathan; Hague, James P

    2014-01-01

    The structure of the large coronary arteries is both heritable and reasonably consistent between individuals, but the extent to which this results from evolutionary pressure towards an energy-efficient, globally-optimal, structure is unknown. We present an algorithm for the determination of an energetically globally optimal arterial tree in arbitrary tissue geometries. We demonstrate through application of the algorithm that it is possible to generate in-silico vasculatures that closely match porcine anatomical data on all length scales. We therefore conclude that evolutionary pressure has resulted in a near globally optimal structure of the larger coronary arteries. We also examine the effect of changing length scales, predicting that the structures of the coronary arteries can change from a meandering form for small animals to very straight vessels for large animals. The method presented here is not limited to hearts, and represents a major advance in modeling the arterial vasculature, that could have impor...

  12. Two-vessel coronary artery dissection in the peripartum period. Case report and literature review.

    Science.gov (United States)

    Madu, E C; Kosinski, D J; Wilson, W R; Burket, M W; Fraker, T D; Ansel, G M

    1994-09-01

    The authors report a case of early peripartum myocardial infarction resulting from spontaneous dissection of the left anterior descending coronary artery and right coronary artery in a twenty-four-year-old woman. This is the first report of double-vessel coronary dissection involving both the left and right coronary arteries diagnosed antemortem and successfully treated.

  13. Time trends in coronary revascularization procedures among people with COPD: analysis of the Spanish national hospital discharge data (2001–2011

    Directory of Open Access Journals (Sweden)

    de Miguel-Díez J

    2015-10-01

    Full Text Available Javier de Miguel-Díez,1 Rodrigo Jiménez-García,2 Valentín Hernández-Barrera,2 Pilar Carrasco-Garrido,2 Héctor Bueno,3 Luis Puente-Maestu,1 Isabel Jimenez-Trujillo,2 Alejandro Alvaro-Meca,2 Jesús Esteban-Hernandez,2 Ana López de Andrés21Pneumology Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Madrid, Spain; 2Preventive Medicine and Public Health Teaching and Research Unit, Department of Health Sciences, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain; 3Centro Nacional de Investigaciones Cardiovasculares, Instituto de investigación i+12, Cardiology Department, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, SpainBackground: People with COPD suffering from coronary artery disease are frequently treated with revascularization procedures. We aim to compare trends in the use and outcomes of these procedures in COPD and non-COPD patients in Spain between 2001 and 2011.Methods: We identified all patients who had undergone percutaneous coronary interventions (PCIs and coronary artery bypass graft (CABG surgeries, using national hospital discharge data. Discharges were grouped into: COPD and no COPD.Results: From 2001 to 2011, 428,516 PCIs and 79,619 CABGs were performed. The sex and age-adjusted use of PCI increased by 21.27% per year from 2001 to 2004 and by 5.47% per year from 2004 to 2011 in patients with COPD. In-hospital mortality (IHM among patients with COPD who underwent a PCI increased significantly from 2001 to 2011 (odds ratio 1.11; 95% confidence interval 1.03–1.20. Among patients with COPD who underwent a CABG, the sex and age-adjusted CABG incidence rate increased by 9.77% per year from 2001 to 2003, and then decreased by 3.15% through 2011. The probability of dying during hospitalization in patients who underwent a CABG did not change significantly in patients with and without COPD (odds ratio, 1.06; 95

  14. Computerized analysis of coronary artery disease: Performance evaluation of segmentation and tracking of coronary arteries in CT angiograms

    Energy Technology Data Exchange (ETDEWEB)

    Zhou, Chuan, E-mail: chuan@umich.edu; Chan, Heang-Ping; Chughtai, Aamer; Kuriakose, Jean; Agarwal, Prachi; Kazerooni, Ella A.; Hadjiiski, Lubomir M.; Patel, Smita; Wei, Jun [Department of Radiology, University of Michigan, Ann Arbor, Michigan 48109 (United States)

    2014-08-15

    Purpose: The authors are developing a computer-aided detection system to assist radiologists in analysis of coronary artery disease in coronary CT angiograms (cCTA). This study evaluated the accuracy of the authors’ coronary artery segmentation and tracking method which are the essential steps to define the search space for the detection of atherosclerotic plaques. Methods: The heart region in cCTA is segmented and the vascular structures are enhanced using the authors’ multiscale coronary artery response (MSCAR) method that performed 3D multiscale filtering and analysis of the eigenvalues of Hessian matrices. Starting from seed points at the origins of the left and right coronary arteries, a 3D rolling balloon region growing (RBG) method that adapts to the local vessel size segmented and tracked each of the coronary arteries and identifies the branches along the tracked vessels. The branches are queued and subsequently tracked until the queue is exhausted. With Institutional Review Board approval, 62 cCTA were collected retrospectively from the authors’ patient files. Three experienced cardiothoracic radiologists manually tracked and marked center points of the coronary arteries as reference standard following the 17-segment model that includes clinically significant coronary arteries. Two radiologists visually examined the computer-segmented vessels and marked the mistakenly tracked veins and noisy structures as false positives (FPs). For the 62 cases, the radiologists marked a total of 10191 center points on 865 visible coronary artery segments. Results: The computer-segmented vessels overlapped with 83.6% (8520/10191) of the center points. Relative to the 865 radiologist-marked segments, the sensitivity reached 91.9% (795/865) if a true positive is defined as a computer-segmented vessel that overlapped with at least 10% of the reference center points marked on the segment. When the overlap threshold is increased to 50% and 100%, the sensitivities were 86

  15. Novel treatment of coronary artery fistulae concealing severe coronary artery lesion: using thrombus aspiration catheter as a delivery guide

    OpenAIRE

    Korkmaz, Levent; Acar, Zeydin; Dursun, İhsan; Akyüz, Ali Rıza; Korkmaz, Ayca Ata

    2014-01-01

    In this case report, we present the occlusion of multiple coronary artery fistulae originating from proximal left anterior descending (LAD) and right sinus valsavla and empting to the pulmonary artery at the same place. We occluded LAD fistulae by using thrombus aspiration catheter as a delivery guide. To the best of our knowlege, this is the first case of occlusion of coronary fistulae with the help of thrombus aspiration catheter. Our experience may suggest that thrombus aspiration catheter...

  16. Integrated SPECT/CT for assessment of haemodynamically significant coronary artery lesions in patients with acute coronary syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Rispler, Shmuel [Technion - Israel Institute of Technology, Department of Cardiology, Rambam Health Care Campus and the B. Rappaport Faculty of Medicine, Haifa (Israel); Technion - Israel Institute of Technology, Department of Nuclear Medicine, Rambam Health Care Campus and the B. Rappaport Faculty of Medicine, Haifa (Israel); Aronson, Doron; Roguin, Ariel; Beyar, Rafael [Technion - Israel Institute of Technology, Department of Cardiology, Rambam Health Care Campus and the B. Rappaport Faculty of Medicine, Haifa (Israel); Abadi, Sobhi; Engel, Ahuva [Technion - Israel Institute of Technology, Department of Medical Imaging, Rambam Health Care Campus and the B. Rappaport Faculty of Medicine, Haifa (Israel); Israel, Ora; Keidar, Zohar [Technion - Israel Institute of Technology, Department of Nuclear Medicine, Rambam Health Care Campus and the B. Rappaport Faculty of Medicine, Haifa (Israel)

    2011-10-15

    Early risk stratification in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) is important since the benefit from more aggressive and costly treatment strategies is proportional to the risk of adverse clinical events. In the present study we assessed whether hybrid single photon emission computed tomography (SPECT)/coronary computed tomography angiography (CCTA) technology could be an appropriate tool in stratifying patients with NSTE-ACS. SPECT/CCTA was performed in 90 consecutive patients with NSTE-ACS. The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) was used to classify patients as low- or high-risk. Imaging was performed using SPECT/CCTA to identify haemodynamically significant lesions defined as >50% stenosis on CCTA with a reversible perfusion defect on SPECT in the corresponding territory. CCTA demonstrated at least one lesion with >50% stenosis in 35 of 40 high-risk patients (87%) as compared to 14 of 50 low-risk patients (35%; TIMI-RS <3; p <0.0001). Of the 40 high-risk and 50 (16%) low-risk TIMI-RS patients, 16 (40%) and 8 (16%), respectively, had haemodynamically significant lesions (p = 0.01). Patients defined as high-risk by a high TIMI-RS, a positive CCTA scan or both (n = 45) resulted in a sensitivity of 95%, specificity of 49%, PPV of 35% and NPV of 97% for having haemodynamically significant coronary lesions. Those with normal perfusion were spared revascularization procedures, regardless of their TIMI-RS. Noninvasive assessment of coronary artery disease by SPECT/CCTA may play an important role in risk stratification of patients with NSTE-ACS by better identifying the subgroup requiring intervention. (orig.)

  17. Integrated SPECT/CT for assessment of haemodynamically significant coronary artery lesions in patients with acute coronary syndrome

    International Nuclear Information System (INIS)

    Early risk stratification in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) is important since the benefit from more aggressive and costly treatment strategies is proportional to the risk of adverse clinical events. In the present study we assessed whether hybrid single photon emission computed tomography (SPECT)/coronary computed tomography angiography (CCTA) technology could be an appropriate tool in stratifying patients with NSTE-ACS. SPECT/CCTA was performed in 90 consecutive patients with NSTE-ACS. The Thrombolysis in Myocardial Infarction risk score (TIMI-RS) was used to classify patients as low- or high-risk. Imaging was performed using SPECT/CCTA to identify haemodynamically significant lesions defined as >50% stenosis on CCTA with a reversible perfusion defect on SPECT in the corresponding territory. CCTA demonstrated at least one lesion with >50% stenosis in 35 of 40 high-risk patients (87%) as compared to 14 of 50 low-risk patients (35%; TIMI-RS <3; p <0.0001). Of the 40 high-risk and 50 (16%) low-risk TIMI-RS patients, 16 (40%) and 8 (16%), respectively, had haemodynamically significant lesions (p = 0.01). Patients defined as high-risk by a high TIMI-RS, a positive CCTA scan or both (n = 45) resulted in a sensitivity of 95%, specificity of 49%, PPV of 35% and NPV of 97% for having haemodynamically significant coronary lesions. Those with normal perfusion were spared revascularization procedures, regardless of their TIMI-RS. Noninvasive assessment of coronary artery disease by SPECT/CCTA may play an important role in risk stratification of patients with NSTE-ACS by better identifying the subgroup requiring intervention. (orig.)

  18. Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

    Institute of Scientific and Technical Information of China (English)

    Xiang HU; Qiang ZHAO

    2011-01-01

    Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left antetior descending coronary arteries is unclear.This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library.Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years,there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right intemal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery

  19. Transmyocardial laser revascularization. Early clinical experience

    Directory of Open Access Journals (Sweden)

    Oliveira Sérgio Almeida de

    1999-01-01

    Full Text Available OBJECTIVE: To analyze the initial clinical experience of transmyocardial laser revascularization (TMLR in patients with severe diffuse coronary artery disease. METHODS: Between February, 1998 and February, 1999, 20 patients were submitted to TMLR at the Heart Institute (InCor, University of São Paulo Medical School, Brazil, isolated or in association with conventional coronary artery bypass graft (CABG. All patients had severe diffuse coronary artery disease, with angina functional class III/IV (Canadian Cardiovascular Society score unresponsive to medical therapy. Fourteen patients were submitted to TMLR as the sole therapy, whereas 6 underwent concomitant CABG. Fifty per cent of the patients had either been previously submitted to a CABG or to a percutaneous transluminal coronary angioplasty (PTCA. Mean age was 60 years, ranging from 45 to 74 years. RESULTS: All patients had three-vessel disease, with normal or mildly impaired left ventricular global function. Follow-up ranged from 1 to 13 months (mean 6.6 months, with no postoperative short or long term mortality. There was significant symptom improvement after the procedure, with 85% of the patients free of angina, and the remaining 15 % of the patients showing improvement in functional class, as well as in exercise tolerance. CONCLUSION: This novel technique can be considered a low risk alternative for a highly selected group of patients not suitable for conventional revascularization procedures.

  20. Coronary CT Angiography in Coronary Artery Disease: Correlation between Virtual Intravascular Endoscopic Appearances and Left Bifurcation Angulation and Coronary Plaques

    Directory of Open Access Journals (Sweden)

    Zhonghua Sun

    2013-01-01

    Full Text Available The aim of this study is to investigate the relationship between intraluminal appearances of coronary plaques and left coronary bifurcation angle and plaque components using coronary CT virtual intravascular endoscopy (VIE. Fifty patients suspected of coronary artery disease undergoing coronary CT angiography were included in the study. The left bifurcation angle in patients with diseased left coronary artery which was measured as 94.3° ± 16.5 is significantly larger than that in patients with normal left coronary artery, which was measured as 76.5° ± 15.9 (P<0.001. Irregular VIE appearances were found in 10 out of 11 patients with mixed plaques in the left anterior descending (LAD and left circumflex (LCx, while, in 29 patients with calcified plaques in the LAD and LCx, irregular VIE appearances were only noticed in 5 patients. Using 80° as a cut-off value to determine coronary artery disease, smooth VIE appearances were found in 95% of patients (18/19 with left bifurcation angle of less than 80°, while irregular VIE appearances were observed in nearly 50% of patients (15/31 with left bifurcation angle of more than 80°. This preliminary study shows that VIE appearances of the coronary lumen are directly related to the types of plaques.

  1. Advances in nanotechnology for the management of coronary artery disease.

    Science.gov (United States)

    Rhee, June-Wha; Wu, Joseph C

    2013-02-01

    Nanotechnology holds tremendous potential to advance the current treatment of coronary artery disease. Nanotechnology may assist medical therapies by providing a safe and efficacious delivery platform for a variety of drugs aimed at modulating lipid disorders, decreasing inflammation and angiogenesis within atherosclerotic plaques, and preventing plaque thrombosis. Nanotechnology may improve coronary stent applications by promoting endothelial recovery on a stent surface utilizing bio-mimetic nanofibrous scaffolds, and also by preventing in-stent restenosis using nanoparticle-based delivery of drugs that are decoupled from stents. Additionally, nanotechnology may enhance tissue-engineered graft materials for application in coronary artery bypass grafting by facilitating cellular infiltration and remodeling of a graft matrix.

  2. Impact of Critical Limb Ischemia on Long-Term Cardiac Mortality in Diabetic Patients Undergoing Percutaneous Coronary Revascularization

    OpenAIRE

    Liistro, Francesco; Angioli, Paolo; Grotti, Simone; Brandini, Rossella; Porto, Italo; Ricci, Lucia; Tacconi, Danilo; Ducci, Kenneth; Falsini, Giovanni; Bellandi, Guido; Bolognese, Leonardo

    2013-01-01

    OBJECTIVE Development of critical limb ischemia (CLI) has been reported as an independent predictor of cardiac mortality in diabetic patients. We aimed to determine whether CLI, managed in a structured setting of close collaboration between different vascular specialists and treated with early endovascular intervention, has any impact on long-term cardiac mortality of diabetic patients initially presenting with symptomatic coronary artery disease (CAD). RESEARCH DESIGN AND METHODS We designed...

  3. Effect of Cardiac Rehabilitation Program on Heart Rate Recovery after Percutaneous Coronary Intervention and Coronary Artery Bypass Grafting

    Directory of Open Access Journals (Sweden)

    Ali Abbasi

    2008-07-01

    Full Text Available Background: The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery (HRR in patients who received percutaneous coronary intervention (PCI or coronary artery bypass grafting (CABG. Methods: Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program (phase 2 after PCI (n=62 or CABG (n=178 at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR.Results: All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors (except for diabetes mellitus was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively (p=0.019. Conclusion: The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality (i.e. PCI or CABG after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients.

  4. Osteopontin in relation to Prognosis following Coronary Artery Bypass Graft Surgery

    Directory of Open Access Journals (Sweden)

    Eftihia Sbarouni

    2016-01-01

    Full Text Available Cardiovascular events may occur even after complete revascularization in patients with coronary artery disease. We measured preoperative osteopontin (OPN levels in 131 consecutive patients (66.5±10 years old, 117 men and 14 women with left ventricular ejection fraction of 50.7±9.2% and low logistic EuroScore (3.5±3.2% undergoing elective Coronary Artery Bypass Grafting (CABG surgery. Patients were prospectively followed up for a median of 12 months (range 11–24. The primary study endpoint was the composite of cardiovascular death, nonfatal myocardial infarction, need for repeat revascularization, and hospitalization for cardiovascular events. Pre-op OPN plasma levels were 77.9 (49.5, 150.9. Patients with prior acute myocardial infarction (AMI had significantly higher OPN levels compared to those without [131.5 (52.2, 219 versus 73.3 (45.1, 125, p=0.007]. OPN levels were positively related to EuroScore (r=0.2, p=0.031. Pre-op OPN levels did not differ between patients who had a major adverse event during follow-up compared to those with no event (p=0.209 and had no effect on the hazard of future adverse cardiac events [HR (95% CI: 1.48 (0.43–4.99, p=0.527]. The history of AMI was associated with increased risk of subsequent cardiovascular events at follow-up (p=0.02. OPN is associated with preoperative risk assessment prior to low-risk CABG but did not independently predict outcome.

  5. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    Directory of Open Access Journals (Sweden)

    Parag Chevli

    2014-09-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50 and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset of chest pain and was admitted for the treatment of acute coronary syndrome. The coronary angiography showed dissection of the left anterior descending artery. The patient underwent successful percutaneous transluminal coronary angioplasty and stent placement.

  6. High-resolution coronary MR angiography for evaluation of patients with anomalous coronary arteries: visualization of the intramural segment

    Energy Technology Data Exchange (ETDEWEB)

    Biko, David M. [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); The Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States); Chung, Claudia; Chung, Taylor [UCSF Benioff Children' s Hospital Oakland, Department of Diagnostic Imaging, Oakland, CA (United States); Hitt, David M. [Philips Healthcare, Cleveland, OH (United States); Kurio, Gregory [UCSF Benioff Children' s Hospital Oakland, Department of Cardiology, Oakland, CA (United States); Reinhartz, Olaf [UCSF Benioff Children' s Hospital Oakland, Department of Cardiac Surgery, Oakland, CA (United States)

    2015-08-15

    Anomalous origin of the coronary artery from the contralateral coronary sinus is a rare coronary anomaly associated with sudden death. The inter-arterial course is most closely associated with sudden death, but it has been suggested that the presence of an intramural segment of a right anomalous coronary is associated with more symptoms and therefore may be an important criterion for intervention in these patients. To demonstrate that MR angiography can accurately determine the presence or absence of an intramural segment in an anomalous coronary artery. All studies of children who underwent MR angiography for the evaluation of an anomalous coronary artery were retrospectively reviewed by two pediatric radiologists in consensus. Criteria for an intramural anomalous coronary artery were the presence of a small or slit-like ostium and the relative smaller size of the proximal intramural portion of the coronary artery in relation to the more distal epicardial coronary artery. The anomalous coronary artery was classified as not intramural if these two findings were absent. These findings were correlated with operative reports confirming the presence or absence of an intramural segment. Twelve patients (86%) met MR angiography criteria for the presence of an intramural course. Only 2 patients (14%) met MR angiography criteria for a non-intramural course. When correlating with intraoperative findings, MR angiography was successful in distinguishing between intramural and non-intramural anomalous coronary arteries in all cases (P = 0.01). MR angiography may be able to reliably identify the intramural segment of an anomalous coronary artery in older children using the imaging criteria of a small or slit-like ostium and relative decrease in size of the proximal portion of the anomalous coronary artery compared to the distal portion of the anomalous coronary artery. Determining the presence of the intramural segment may help with surgical planning and may be an important

  7. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet's disease.

    Science.gov (United States)

    Cook, Amanda L; Rouster-Stevens, Kelly; Williams, Derek A; Hines, Michael H

    2010-07-01

    Behcet's disease is a rare autoimmune vasculitis characterized by oral aphthosis, genital ulcers, and ocular and cutaneous lesions. Vascular involvement usually affects the veins more commonly than the arteries, and coronary arterial involvement is extremely rare. We report an adolescent with Behcet's disease who developed a large pseudoaneurysm of the left anterior descending coronary artery requiring a coronary arterial bypass graft.

  8. Non-obstructive coronary artery disease assessed by coronary computed tomography angiography

    DEFF Research Database (Denmark)

    Nielsen, L.; Bøtker, H. E.; Sorensen, H.;

    2015-01-01

    Introduction: Coronary CT angiography (CTA) detects non-obstructive coronary artery disease (CAD) that may not be recognized by functional testing, but the prognostic impact is not well understood. This study aimed to compare the risk of myocardial infarction (MI) and all-cause mortality...... in patients without or with non-obstructive and obstructive CAD assessed by coronary CTA. Methods: Consecutive patients without known coronary artery disease (CAD) and with chest pain who underwent coronary CTA (>64-detector row) between January 2007 and December 2012 in the 10 centers participating...... in the Western Denmark Cardiac Computed Tomography Registry were included. The endpoints were 3-year MI or all-cause mortality. The coronary CTA result was defined as normal (0% luminal stenosis), non-obstructive CAD (1%-49% luminal stenosis) or obstructive CAD (>50% luminal stenosis; 1-vessel, 2-vessel, or 3...

  9. Smoking and hyperlipidemia are important risk factors for coronary artery spasm

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Objective To investigate the role of coronary artery spasm in the etiology of chest pain lacking significant coronary stenosis and to identify the clinical risk factors related to coronary artery spasm. Methods Two hundred and seventy five patients with chest pain, but without significant coronary artery stenosis underwent the intracoronary acetylcholine test. Coronary artery spasm was diagnosed while coronary artery stenosis increased to 90% and was accompanied by the usual chest pain with or without ischemic changes on electrocardiogram. Logistic regression was employed to investigate the relationships between coronary artery spasm and sex, age, hypertension, diabetes mellitus, smoking, hyperlipidemia and results of electrocardiographic treadmill stress test. Left ventricular ejection fraction and end diastolic pressure were compared between spasm group and non-spasm group. Results Coronary artery spasm was detected in 103 out of 271 patients, a rate of 38%. Logistic regression analysis showed that smoking and hyperlipidemia increased the relative risk of coronary artery spasm 4.2 times and 2.3 times, respectively. There was a significantly negative relationship between diabetes mellitus and coronary artery spasm. Furthermore, there was no coronary artery spasm detected in left ventricular ejection fraction and end diastolic pressure. Conclusions Coronary artery spasm was one of the important etiological factors for patients with chest pain but no coronary artery stenosis. Smoking and hyperlipidemia were the main clinical risk factors for coronary artery spasm.

  10. Major risk-stratification models fail to predict outcomes in patients with multivessel coronary artery disease undergoing simultaneous hybrid procedure

    Institute of Scientific and Technical Information of China (English)

    WANG Hao-ran; ZHENG Zhe; XIONG Hui; XU Bo; LI Li-huan; GAO Run-lin; HU Sheng-shou

    2013-01-01

    Background The hybrid procedure for coronary heart disease combines minimally invasive coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) and is an alternative to revascularization treatment.We sought to assess the predictive value of four risk-stratification models for risk assessment of major adverse cardiac and cerebrovascular events (MACCE) in patients with multivessel disease undergoing hybrid coronary revascularization.Methods The data of 120 patients were retrospectively collected and the SYNTAX score,EuroSCORE,SinoSCORE and the Global Risk Classification (GRC) calculated for each patient.The outcomes of interest were 2.7-year incidences of MACCE,including death,myocardial infarction,stroke,and any-vessel revascularization.Results During a mean of 2.7-year follow-up,actuarial survival was 99.17%,and no myocardial infarctions occurred.The discriminatory power (area under curve (AUC)) of the SYNTAX score,EuroSCORE,SinoSCORE and GRC for 2.7-year MACCE was 0.60 (95% confidence interval 0.42-0.77),0.65 (0.47-0.82),0.57 (0.39-0.75) and 0.65 (0.46-0.83),respectively.The calibration characteristics of the SYNTAX score,EuroSCORE,SinoSCORE and GRC were 3.92 (P=0.86),5.39 (P=0.37),13.81 (P=0.32) and 0.02 (P=0.89),respectively.Conclusions In patients with multivessel disease undergoing a hybrid procedure,the SYNTAX score,EuroSCORE,SinoSCORE and GRC were inaccurate in predicting MACCE.Modifying risk-stratification models to improve the predictive value for a hybrid procedure is needed.

  11. The effects of dexmedetomidine on attenuation of stress response to endotracheal intubation in patients undergoing elective off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Sajith Sulaiman

    2012-01-01

    Full Text Available This study was designed to study the efficacy of intravenous dexmedetomidine for attenuation of cardiovascular responses to laryngoscopy and endotracheal intubation in patients with coronary artery disease. Sixty adult patients scheduled for elective off-pump coronary artery bypass surgery were randomly allocated to receive dexmedetomidine (0.5 mcg/kg or normal saline 15 min before intubation. Patients were compared for hemodynamic changes (heart rate, arterial blood pressure and pulmonary artery pressure at baseline, 5 min after drug infusion, before intubation and 1, 3 and 5 min after intubation. The dexmedetomidine group had a better control of hemodynamics during laryngoscopy and endotracheal intubation. Dexmedetomidine at a dose of 0.5 mcg/kg as 10-min infusion was administered prior to induction of general anesthesia attenuates the sympathetic response to laryngoscopy and intubation in patients undergoing myocardial revascularization. The authors suggest its administration even in patients receiving beta blockers.

  12. Spontaneous coronary artery dissection causing acute coronary syndrome in a young patient without risk factors

    OpenAIRE

    Chevli, Parag; Kelash, Fnu; Gadhvi, Pragnesh; Grandhi, Sreeram; Syed, Amer

    2014-01-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction that is more common in younger patients (under age 50) and in women. Although the etiology is not known, some predisposing conditions to SCAD are well known and include Marfan syndrome, pregnancy and peripartum state, drug abuse, and some anatomical abnormalities of the coronary arteries such as aneurysms and severe kinking. We describe a case of SCAD in a young woman who presented with sudden onset o...

  13. Association of ischemic stroke to coronary artery disease using computed tomography coronary angiography

    DEFF Research Database (Denmark)

    Jensen, Jesper Møller; Medina, Hector; Nørgaard, Bjarne Linde;

    2012-01-01

    BACKGROUND: While patients with coronary artery disease (CAD) and cerebrovascular disease share similar risk factor profiles, data on whether IS can be considered a "CAD equivalent" are limited. We aimed to determine whether ischemic stroke is an independent predictor of CAD by using cardiac...... increase odds of having coronary artery plaque (odds ratio [OR] 4.9, P4 segments of plaque than 0-4 segments as compared to patients without stroke (OR 18.3, P...

  14. Circulating endothelial cells in coronary artery disease and acute coronary syndrome

    NARCIS (Netherlands)

    Schmidt, David E; Manca, Marco; Höfer, Imo E

    2015-01-01

    Circulating endothelial cells (CECs) have been put forward as a promising biomarker for diagnosis and prognosis of coronary artery disease and acute coronary syndromes. This review entails current insights into the physiology and pathobiology of CECs, including their relationship with circulating en

  15. Pregnancy risks in women with pre-existing coronary artery disease, or following acute coronary syndrome

    NARCIS (Netherlands)

    Burchill, Luke J.; Lameijer, Heleen; Roos-Hesselink, Jolien W.; Grewal, Jasmine; Ruys, Titia P. E.; Kulikowski, Julia D.; Burchill, Laura A.; Oudijk, M. A.; Wald, Rachel M.; Colman, Jack M.; Siu, Samuel C.; Pieper, Petronella G.; Silversides, Candice K.

    2015-01-01

    Objective The objective of this study was to determine outcomes in pregnant women with pre-existing coronary artery disease (CAD) or following an acute coronary syndrome (ACS) including myocardial infarction (MI). Background The physiological changes of pregnancy can contribute to myocardial ischaem

  16. Hostility, Anger and Risk of Coronary Artery Atherosclerosis

    Directory of Open Access Journals (Sweden)

    E Masoudnia

    2011-02-01

    Full Text Available Introduction: The previous researches about the etiology of coronary artery atherosclerosis have accentuated on clinical and medical risk factors, such as cigarette smoking, hypertension, diabetes mellitus, hyperlipidemia, positive family background, myocardial ischemia history in family, atherogenic diet, increase of A lipoprotein, inflammatory factors such as increase of cross-reactive protein and so on. Although factors in behavioral medicine are recognized as an independent risk factor in coronary artery atherosclerosis, few researches have been done on hostility and anger. The aim of this study was to determine the difference between normal people(Control group and people with coronary artery atherosclerosis(Case group with regards to hostility and anger. Methods: This study was performed as a case-control design. Data was collected from seventy-seven patients with coronary artery atherosclerosis who had referred to Afshar Hospital Professional Heart Clinic in Yazd city and seventy-eight normal people were used as control. Two groups completed the Buss and Perry Aggression Questionnaire(BPAQ to measure their hostility and anger. Results: The results of the analysis showed that there was a statistically significant difference regarding hostility(p<.05 and anger(p<.001 between the two groups. Hierarchical multiple logistic regression analysis showed that the sociodemographic and clinical variables(step 1 explained 35.5 % to 47.4%, while hostility and anger(step 2 explained 6.7% to 9% of the variance in incidence of coronary artery atherosclerosis. Conclusion: Hostility and anger are strong risk factors for coronary artery atherosclerosis or CAD in Iran. Therefore, in order to decrease the incidence rate of coronary artery atherosclerosis in Iran, alongside medical interventions, attention should also be paid towards behavioral interventions in order to modify hostile and angrily behavior.

  17. Lung cancer resection with concurrent off-pump coronary artery bypasses: safety and efficiency

    Science.gov (United States)

    Ma, Xuchen; Huang, Fangjiong; Zhang, Zhitai; Song, Feiqiang

    2016-01-01

    Background To assess the safety and efficacy of combined surgery for patients with concurrent lung cancer and severe coronary heart disease (CHD). Methods Between 2003 and 2014, 34 patients with stage I or II lung cancer and simultaneous severe CHD underwent combined off-pump coronary artery bypass (OPCAB) grafting and lung resection. Surgically, myocardial revascularization was performed first and followed by lobectomies through the same or a second incision. Video-assisted thoracoscopes were used in some cases. Five patients also received chemotherapy before or after combined surgery in an effort to improve the long-term survival. Results All patients survived the operation and no new myocardial infarctions (MIs) occurred in the perioperative period. The most frequent complications were cardiac arrhythmias (5 cases), atelectasis (4 cases), and pulmonary infections (2 cases). All patients were followed up for 5–60 months. Within this period, 6 patients (17.6%) died due to cancer recurrence. The 3- and 5-year survivals were 75% and 67% for these lung cancer patients, respectively. Conclusions Combined OPCAB and pulmonary resection for early stage lung cancer patients with concurrent severe CHD is a relatively safe and effective treatment with satisfactory long-term survival rates, especially for those patients with three-vessel disease who are not usually candidates for percutaneous coronary intervention (PCI) before open surgery.

  18. [Screening for coronary artery disease (CAD) in asymptomatic diabetics. How to and in whom to screen?].

    Science.gov (United States)

    Matos, Pedro

    2013-04-01

    Screening for coronary artery disease (CAD) in the asymptomatic diabetic patient is controversial with respect to both patient selection and rational choice of screening methods. Epidemiological studies in the real world and improved knowledge on risk markers have changed the criteria that help refine global risk stratification in a patient population that is per se high risk. Over the past years, it is likely that we have been overestimating the risk when using the classical risk factors. This review highlights the role of novel risk markers in the global assessment of diabetic patients, and identifies the best diagnostic approaches to select those patients who might benefit most from revascularization procedures or more aggressive treatment goals, despite the absence of symptoms. Factors such as the presence of kidney disease, cardiovascular autonomic neuropathy or atherosclerotic disease in other arterial territories, may exponentially increase the risk of poor outcomes in diabetic patients. With the aim of rationalizing the use of diagnostic procedures, we propose a sequential approach that combines anatomic and functional data with the coronary calcium score. This approach may serve as a filter to select patients for further assessment with more expensive and less available tests so as to optimize the cost-benefit ratio of screening. PMID:23721974

  19. Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting.

    Science.gov (United States)

    Kabas, J S; Kisslo, J; Flick, C L; Johnson, S H; Craig, D M; Stanley, T E; Smith, P K

    1990-03-01

    Intraoperative evaluation of the effectiveness of myocardial revascularization has been limited by an inability to assess regional myocardial perfusion. Microbubbles of sonicated diatrizoate sodium and diatrizoate meglumine (Renografin) have been an effective echocardiographic contrast agent and have been employed clinically during cardiac catheterization. This recent development in contrast-enhanced two-dimensional echocardiography permits real-time imaging of transmural myocardial blood flow but has not been evaluated in the operating room. This study represents the initial surgical application of this directed technique and was designed to evaluate the safety and efficacy of intraoperative perfusion contrast echocardiography in assessing the results of coronary artery bypass grafting. Twenty men with significant coronary artery disease ranging in age from 49 to 73 years were studied. Direct contrast agent injection into completed saphenous vein bypass grafts caused the myocardium supplied by each graft to be well delineated and provided a tomographic view of contrast distribution. The enhanced region was well correlated with the size and distribution of the native vessel. Rapid contrast washout (less than 20 seconds) indicated satisfactory regional perfusion. Contrast echocardiography prolonged the operation less than 10 minutes and did not result in any perioperative complications.

  20. Lipoprotein lipase gene polymorphisms and the risk of target vessel revascularization after percutaneous coronary intervention

    NARCIS (Netherlands)

    Monraats, Pascalle S; Rana, Jamal S; Nierman, Melchior C; Pires, Nuno M M; Zwinderman, Aeilko H; Kastelein, John J P; Kuivenhoven, Jan Albert; de Maat, Moniek P M; Rittersma, Saskia Z H; Schepers, Abbey; Doevendans, Pieter A F; de Winter, Robbert J; Tio, René A; Frants, Rune R; Quax, Paul H A; van der Laarse, Arnoud; van der Wall, Ernst E; Jukema, J Wouter

    2005-01-01

    OBJECTIVES: We sought to identify polymorphisms in genes that predispose to restenosis. BACKGROUND: Variations in the lipoprotein lipase (LPL) gene have been implicated in a number of pathophysiologic conditions associated with coronary heart disease. The present study examines the impact of polymor

  1. Prognosis of unprotected left main coronary artery stenting and the factors affecting the outcomes in Chinese

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    Background The long term prognosis of unprotected left main coronary artery (LMCA) stenting is controversial This study was conducted to evaluate the immediate and long term outcomes of LMCA stenting in Chinese patients and to determine which factors affect the outcomes. Methods From May 1997 to March 2003,224 patients in 23 hospitals underwent elective unprotected LMCA stenting with bare metal stents. Their clinical records were analysed to ascertain immediate and long term outcomes of LMCA stenting as well as factors influencing the prognosis .Results Stents were implanted into LMCA successfully in 223 cases (99.6 %). One death (0.5%) and one case of non-Q wave nonfatal myocardial infarction (MI) occurred in hospital. The mean follow-up time was (15.6±12.3) months. Cardiac death developed in 10 cases (4.5%), noncardiac death in 2 cases (0.9%), nonfatal MI in 4 cases (1.8%), target lesion revascularization (TLR) of LMCA in 26 cases (11.7%) and TLR of nonLMCA in 37 cases (16.5%). Univariate analysis showed that cardiac death correlated with left ventricular ejection fraction (LVEF < 40%), female gender and LMCA combined with multivessel disease; that major adverse cardiac events (MACE) correlated with LVEF < 40%, bifurcation lesion and incomplete revascularization. Logistic regression analysis revealed that LVEF < 40% and female gender were independent predictors of cardiac death and MACE. Follow-up angiography was performed in 102 cases (45.7%). The restenosis rate was 31.4%. Conclusions Long-term outcomes of stenting for selected patients with unprotected LMCA stenosis is acceptable. It should be performed in inoperable or low risk patients with LVEF ≥ 40% and isolated LMCA disease or LMCA combined with multivessel diseases in whom complete revascularization can be obtained.

  2. Graft patency in off-pump and conventional coronary artery bypass grafting for treatment of triple vessel coronary disease

    Institute of Scientific and Technical Information of China (English)

    胡盛寿; 王小启; 宋云虎; 吕锋

    2003-01-01

    Objective To compare graft patency in off-pump and conventional coronary artery bypass grafting by using the transit time flow meter in the treatment of triple vessel coronary artery disease. Methods Between June 2000 and April 2001, 60 patients with triple vessel coronary artery disease underwent coronary artery bypass grafting. They were divided into two groups: off-pump and conventional coronary artery bypass. All completed grafts were tested intraoperatively using Transit Time Flow Measurement (TTFM). Preoperative and postoperative variables of the two groups were also compared. Results There were no significant differences in sex, age, weight, acute or remote myocardial infarction, hypertension, diabetes and type of bypass grafts between the two groups. The number of bypass grafts and the assisted respiratory time of the off-pump coronary artery bypass grafting (OPCAB) group were significantly less than those of the conventional coronary artery bypass grafting (CCABG) group. The flow and pulsatile index (PI) of the left anterior descending artery bypass grafts and the right coronary artery bypass grafts were not significantly different between the OPCAB and CCABG groups. The flow of OM in the CCABG group with the multiple anastomosis site of sequential grafts was higher than that in the OPCAB group. Diffused narrow coronary artery bypass grafts in both groups had less flow.Conclusion No signficant differences in graft patency were observed in patients with triple vessel coronary artery disease who had undergone OPCAB or CCABG.

  3. Intracoronary transluminal attenuation gradient in coronary CT angiography for determining coronary artery stenosis.

    Science.gov (United States)

    Choi, Jin-Ho; Min, James K; Labounty, Troy M; Lin, Fay Y; Mendoza, Dorinna D; Shin, Dae Hee; Ariaratnam, Nikki S; Koduru, Sunaina; Granada, Juan F; Gerber, Thomas C; Oh, Jae K; Gwon, Hyeon-Cheol; Choe, Yeon Hyeon

    2011-11-01

    Coronary computed tomography angiography (CTA) assessment of calcified or complex coronary lesions is frequently challenging. Transluminal attenuation gradient (TAG), defined as the linear regression coefficient between luminal attenuation and axial distance, has a potential to evaluate the degree of coronary stenosis. We examined the value of TAG in determining the stenosis severity on 64-slice coronary CTA. The value of TAG of 370 major coronary arteries was measured from 7,263 intervals of 5-mm length. Compared with coronary CTA and invasive coronary angiography, TAG decreased consistently and significantly with maximum stenosis severity on a per-vessel basis, from -1.91 ± 4.25 Hounsfield units/10 mm for diameter stenosis of 0% to 49% to -13.37 ± 9.81 Hounsfield units/10 mm for diameter stenosis of 100% (p TAG to the interpretation of coronary CTA improved diagnostic accuracy (p = 0.001), especially in vessels with calcified lesions (N = 127; net reclassification improvement 0.095; p = 0.046). TAG appears to be able to contribute to improved classification of coronary artery stenosis severity in coronary CTA, especially in severely calcified lesions. PMID:22093264

  4. Automatic centerline extraction of coronary arteries in coronary computed tomographic angiography.

    Science.gov (United States)

    Yang, Guanyu; Kitslaar, Pieter; Frenay, Michel; Broersen, Alexander; Boogers, Mark J; Bax, Jeroen J; Reiber, Johan H C; Dijkstra, Jouke

    2012-04-01

    Coronary computed tomographic angiography (CCTA) is a non-invasive imaging modality for the visualization of the heart and coronary arteries. To fully exploit the potential of the CCTA datasets and apply it in clinical practice, an automated coronary artery extraction approach is needed. The purpose of this paper is to present and validate a fully automatic centerline extraction algorithm for coronary arteries in CCTA images. The algorithm is based on an improved version of Frangi's vesselness filter which removes unwanted step-edge responses at the boundaries of the cardiac chambers. Building upon this new vesselness filter, the coronary artery extraction pipeline extracts the centerlines of main branches as well as side-branches automatically. This algorithm was first evaluated with a standardized evaluation framework named Rotterdam Coronary Artery Algorithm Evaluation Framework used in the MICCAI Coronary Artery Tracking challenge 2008 (CAT08). It includes 128 reference centerlines which were manually delineated. The average overlap and accuracy measures of our method were 93.7% and 0.30 mm, respectively, which ranked at the 1st and 3rd place compared to five other automatic methods presented in the CAT08. Secondly, in 50 clinical datasets, a total of 100 reference centerlines were generated from lumen contours in the transversal planes which were manually corrected by an expert from the cardiology department. In this evaluation, the average overlap and accuracy were 96.1% and 0.33 mm, respectively. The entire processing time for one dataset is less than 2 min on a standard desktop computer. In conclusion, our newly developed automatic approach can extract coronary arteries in CCTA images with excellent performances in extraction ability and accuracy. PMID:21637981

  5. The feasibility of left radial artery approach for coronary angiography

    Institute of Scientific and Technical Information of China (English)

    Liangbo Chen; Can Chen; Shian Huang

    2008-01-01

    Objective:To study the feasibility of the left radial approach for coronary angiography. Methods:195 patients diagnosed with coronary atherosclerotic heart disease were randomly divided for coronary angiography(CAG) into a left radial artery approach group(98 cases) and a fight radial artery approach group(97 cases) from Jan 2006 to Dec 2006. Selective coronary angiographies were performed with 5F TIG catheters. The time of puncturing, duration under X-ray fluoroscopy and of the operation, successful rates of puncturing and coronary angiography were recorded. Results:There was no difference in the time of puncturing(2.25 -F 1.58 min vs 2.19±1.62 min), duration under X-ray fluoroscopy(3.12±1.53 min vs 3.21±1.49 min) and the duration of the operation(12.87±2.52 rain vs 12.98±2.85 min), nor in the success rates of puncturing(95.91% vs 95.87%) and coronary angiography(94.90% vs 94.85%). Conclusion: Coronary angiography can be accomplished via the left radial artery approach, indicating that this is a worthwhile clinical approach.

  6. Two congenital coronary abnormalities affecting heart function: anomalous origin of the left coronary artery from the pulmonary artery and congenital left main coronary artery atresia

    Institute of Scientific and Technical Information of China (English)

    Xiao Yanyan; Jin Mei; Han Ling; Ding Wenhong; Zheng Jianyong; Sun Chufan; Lyu Zhenyu

    2014-01-01

    Background The anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) and congenital left main coronary artery atresia (CLMCA-A) are two kinds of very rare coronary heart diseases which affect heart function profoundly.This study aimed to retrospectively illustrate the clinical features and therapy experience of ALCAPA and CLMCA-A patients.Methods From April 1984 to July 2012,in Beijing Anzhen Hospital,23 patients were diagnosed with ALCAPA and 4 patients with CLMCA-A.We summarized the clinical data of the 27 cases and retrospectively analyzed the clinical manifestation,diagnosis,and treatments of these two kinds of congenital coronary abnormalities.Results The 23 patients (13 males and 10 females,aged ranging from 2.5 months to 65 years) identified with ALCAPA were classified into infantile type (age of onset younger than 12 months,16 cases) and adult type (age of onset older than 12 months,7 cases).Four patients were diagnosed with CLMCA-A (three males and one female,aged ranging from 3 months to 2 years).The main clinical manifestations of infantile-type ALCAPA and CLMCA-A include repeated respiratory tract infection,heart failure,dyspnea,feeding intolerance,diaphoresis,and failure to thrive.And these two congenital coronary abnormalities might be misdiagnosed as endocardial fibroelastosis,dilated cardiomyopathy,and acute myocardial infarction.As for the adult-type ALCAPA,cardiac murmurs and discomfort of the precordial area are the most common presentations and might be misdiagnosed as coronary heart disease,myocarditis,or patent ductus arteriosus.In ECG examination:Infantile-type ALCAPA and CLMCA-A showed abnormal Q waves with T wave inversion in leads I,avL,and V4-V6,especially in lead avL.However,ECG of adult-type ALCAPA lacked distinct features.In chest radiography:pulmonary congestion and cardiomegaly were the most common findings in infantile-type ALCAPA and CLMCA-A,while pulmonary artery segment dilation was more common in

  7. Perspectives on the 2014 ESC/EACTS Guidelines on Myocardial Revascularization: Fifty Years of Revascularization: Where Are We and Where Are We Heading?

    NARCIS (Netherlands)

    F. Costa (Francesco); S. Ariotti (Sara); M. Valgimigli (Marco); P.H. Kolh (Philippe); S. Windecker (Stephan)

    2015-01-01

    textabstractThe joint European Society of Cardiology and European Association of Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization collect and summarize the evidence regarding decision-making, diagnostics, and therapeutics in various clinical scenarios of coronary artery

  8. Hydroxychloroquine, a promising choice for coronary artery disease?

    Science.gov (United States)

    Sun, Lizhe; Liu, Mengping; Li, Ruifeng; Zhao, Qiang; Liu, Junhui; Yang, Yanjie; Zhang, Lisha; Bai, Xiaofang; Wei, Yuanyuan; Ma, Qiangqiang; Zhou, Juan; Yuan, Zuyi; Wu, Yue

    2016-08-01

    Coronary artery disease is a common disease that seriously threaten the health of more than 150 million people per year. Atherosclerosis is considered to be the main cause of coronary artery disease which begins with damage or injury to the inner layer of a coronary artery, sometimes as early as childhood. The damage may be caused by various factors, including: smoking, high blood pressure, hypercholesterolemia, sedentary lifestyle, diabetes and insulin resistance. Once a coronary artery disease has developed, all patients need to be treated with long term standard treatment, including heart-healthy lifestyle changes, medicines, and medical procedures or surgery. Hydroxychloroquine, an original antimalarial drug, prevents inflammation caused by lupus erythematosus and rheumatoid arthritis. It is relatively safe and well-tolerated during the treatment. Since atherosclerosis and rheumatoid arthritis have resemble mechanism and increasing clinical researches confirm that hydroxychloroquine has an important role in both anti-rheumatoid arthritis and cardiovascular protection (such as anti-platelet, anti-thrombotic, lipid-regulating, anti-hypertension, hypoglycemia, and so on), we hypothesize that hydroxychloroquine might be a promising choice to coronary artery disease patients for its multiple benefits. PMID:27372847

  9. Prospective assessment of regional myocardial perfusion before and after coronary revascularization surgery by quantitative thallium-201 scintigraphy

    International Nuclear Information System (INIS)

    Because thallium-201 uptake relates directly to the amount of viable myocardium and nutrient blood flow, the potential for exercise scintigraphy to predict response to coronary revascularization surgery was investigated in 47 consecutive patients. All patients underwent thallium-201 scintigraphy and coronary angiography at a mean (+/- standard deviation) of 4.3 +/- 3.1 weeks before and 7.5 +/- 1.6 weeks after surgery. Thallium uptake and washout were computer-quantified and each of six segments was defined as normal, showing total or partial redistribution or a persistent defect. Persistent defects were further classified according to the percent reduction in regional thallium activity; PD25-50 denoted a 25 to 50% constant reduction in relative thallium activity and PD greater than 50 denoted a greater than 50% reduction. Of 82 segments with total redistribution before surgery, 76 (93%) showed normal thallium uptake and washout postoperatively, versus only 16 (73%) of 22 with partial redistribution (probability [p] . 0.01). Preoperative ventriculography revealed that 95% of the segments with total redistribution had preserved wall motion, versus only 74% of those with partial redistribution (p . 0.01). Of 42 persistent defects thought to represent myocardial scar before surgery, 19 (45%) demonstrated normal perfusion postoperatively. Of the persistent defects that showed improved thallium perfusion postoperatively, 75% had normal or hypokinetic wall motion before surgery, versus only 14% of those without improvement (p less than 0.001). Whereas 57% of the persistent defects that showed a 25 to 50% decrease in myocardial activity demonstrated normal thallium uptake and washout postoperatively, only 21% of the persistent defects with a decrease in myocardial activity greater than 50% demonstrated improved perfusion after surgery (p . 0.02)

  10. Viable Myocardium Impact on Left Ventricular Function after Late Revascularization of Infarct-related Artery in Acute Myocardial Infarction

    Institute of Scientific and Technical Information of China (English)

    Ma Likun; Yu Hua; Huang Xiangyang; Feng Kefu; Han Xiaoping; Ye Qi

    2006-01-01

    Objectives The long-term benefit of late reperfusion of infarct-related artery (IRA) after acute myocardial infarction (AMI) is controversial, and the benefit mechanisms remain uncertain. Low dose dobutamine stress echocardiography (LDSE) can identify viable myocardium and predict improvement of wall motion after revascularization. Methods Sixtynine patients with first AMI who did not received early reperfusion therapy were studied by LDSE at 5 to 10 days after AMI. Wall motion abnormality and left ventricular size were measured at the same time.Successful PCI were done in all patients at 10 to 21 days after AMI onset. Patients were divided in two groups based on the presence or absence of viable myocardium. Echocardiography was repeated six months later. Results There were 157 motion abnormality segments. 89 segments (57%) were viable during LDSE. 26 patients (38%) with viability and 43(62%) without. In viable group, left ventricular ejection fraction (LVEF) was increased (P<0.05),and left ventricular end systolic volume index (LVESVI) and wall motion score (WMS) were decreased (P<0.05 and P<0.01) significantly at 6 months compared with baseline. But in patients without viability, LVEF was decreased (P<0.01), and LVESVI and left ventricular end diastolic volume index (LVEDVI) were increased (P<0.05) significantly after 6 months, and the WMS did not changed (P>0.05). LVEF increased (P<0.05) and WMS decreased (P<0.05) on LDSE during acute phase in patients with viability, but they were not changed in the nonviable group. Conclusions Late revascularization of IRA in patients with presence of viable myocardium after AMI is associated with long-term preservation left ventricular function and less ventricular remodeling.Improvement of left ventricular systolic function on LDSE indicates late phase recovery of left ventricular function after late revascularization.

  11. Comparison of Percutaneous Coronary Intervention with Drug Eluting Stents Versus Coronary Artery Bypass Grafting in Patients With Multivessel Coronary Artery Disease: Meta-Analysis of Six Randomized Controlled Trials

    Science.gov (United States)

    Fanari, Zaher; Weiss, Sandra A.; Zhang, Wei; Sonnad, Seema S.; Weintraub, William S.

    2015-01-01

    Objective Comparing outcomes of percutaneous coronary intervention (PCI) with drug eluting stent (DES) and Coronary Artery Bypass Grafting (CABG) in patients with multivessel Coronary Artery Disease (CAD) using data from randomized controlled trials (RCT). Background PCI and CABG are established strategies for coronary revascularization in the setting of ischemic heart disease. Multiple RCT have compared outcomes of the two modalities in patients with multivessel CAD. Methods We did a meta-analysis from six RCT in the contemporary era comparing the effectiveness of PCI with DES to at 1 year, 2 years and 5 years respectively. Results Compared to CABG, at one year PCI was associated with a significantly higher incidence of TVR (RR= 2.31; 95% CI: [1.80–2.96]; P=<0.0001), lower incidence of stroke (RR= 0.35; 95% CI: [0.19–0.62]; P=0.0003), and no difference in death (RR= 1.02; 95% CI: [0.77–1.36]; P= 0.88) or MI (RR= 1.16; 95% CI: [0.72–1.88]; P= 0.53). At 5 years, PCI was associated with a higher incidence of death (RR= 1.3; 95% CI: [1.10 – 1.54]; P= 0.0026) and MI (RR= 2.21; 95% CI: [1.75–2.79]; P=<0.00 01).While the higher incidence of MI with PCI was noticed in both diabetic and non-diabetics, death was increased mainly in diabetic patients. Conclusion In patients with multi-vessel CAD, PCI with DES is associated with no significant difference in death or MI at 1 or 2 years. However at 5 years, PCI is associated with higher incidence of death and MI. PMID:25662779

  12. Percutaneous coronary Intervention for ostial occlusion lesion of an anomalous right coronary artery

    Institute of Scientific and Technical Information of China (English)

    Shi-Wei Yang; Yu-Jie Zhou

    2009-01-01

    Ostial lesions present many challenges for percutaneous coronary intervention (PCI). Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including "buddy wire" technique and "focused-force" angioplasty.

  13. Prognostic value of changes in arterial stiffness in men with coronary artery disease

    OpenAIRE

    Iana A Orlova; Eradzh Yu Nuraliev; Yarovaya, Elena B; et al

    2010-01-01

    Iana A Orlova, Eradzh Yu Nuraliev, Elena B Yarovaya, Fail T AgeevOutpatient department, Russian Cardiology Research Center, Moscow, Russian Federation Background: Men with coronary artery disease (CAD) have been shown to have enhanced arterial stiffness. Arterial function may change over time according to treatment, but the prognostic value of these changes has not been investigated.Objectives: The aim of the present study was to assess whether an improvement in large artery rigidity in respo...

  14. Congenital coronary artery fistulas: dual-source CT findings from consecutive 6624 patients with suspected or confirmed coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    YUN Hong; ZENG Meng-su; YANG Shan; JIN Hang; YANG Xue

    2011-01-01

    Background Coronary artery fistulas (CAFs) are rare congenital abnormality often unintentionally found in patients with coronary artery disease.Clinical diagnosis of CAFs is difficult due to symptomless or lack of specific symptoms.Dual-source computed tomography (DSCT) might be a useful diagnostic tool for CAFs.The study aimed to retrospectively summarize the imaging features of CAFs delineated at DSCT in 48 CAF patients detected from consecutive 6624 patients with suspected or confirmed coronary artery disease in our institution.Methods Forty-eight patients underwent DSCT angiography by using retrospective electrocardiographic (ECG) gating after infusion of 70 ml of intravenous contrast material during breath hold.Maximum intensity projection (MIP),curved planar reconstruction (CPR),and volume rendering technique (VR) were obtained.Anomalous termination of coronary artery in each subject was evaluated by two radiologists (with more than 10 years experience with cardiovascular imaging),and disagreement between diagnosis readers was settled by a consensus reading.Ten of 48 patients also underwent traditional coronary angiography (CAG) simultaneously.Results In each CAF case,DSCT angiography clearly demonstrated the origin,the termination,the size of abnormal vessel and its course in relation to surrounding great vessels.CAF arising from right coronary artery was the most common type,left circumflex was the least one involved among three coronaries,and pulmonary artery was the most common drainage site.Aneurismal fistulous tract,coronary atherosclerosis,myocardial bridging and anomalous origin of coronary artery were also detected in this group.The demonstration of drainage sites in CAG was consistent with DSCT angiography in 9 patients,and judgment on one anomalous connection in CAG was inconsistent with that in DSCT angiography.Conclusions DSCT angiography could provide accurate delineation of anomalous communications,size and numbers of fistulas in patients with

  15. Comparative study of graft flow between on-pump and off-pump coronary bypass surgery for patients with multivessel coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    Xin Chen; Ming Xu; Zhibing Qiu; Yinshuo Jiang; Liming Wang; Liqiong Xiao

    2006-01-01

    Objective: To Comparatively study grafts flow between on-pump and off-pump coronary bypass surgery for patients with triple coronary artery disease. Methods: The grafts flow was studied in 100 patients of OPCAB and compared with100 cases of CCABG by means of Medi-Stim Butterfly Flowmeter measurement intraoperatively. Results: The mean number of the distal anastomosis was 3.78+ 1.11 in CCABG group, and 3.83 + 0.93 in OPCAB group. The index of completeness of revascularization in CCABG group was 1.01 + 0.08, and 1.10+ 0.09 in OPCAB group. The flow of grafts was satisfied in all patients. The PI values were all under 5. There was no significant difference in the mean graft flow and PI value between two groups.Conclusion: OPCAB can provide the same grafts flow and similar completeness of revascularization when compared with CCABG which indicates the similar anastomosis quality of grafts in OPCAB and CCABG groups.

  16. Tibolone and its metabolites acutely relax rabbit coronary arteries in vitro

    DEFF Research Database (Denmark)

    Lund, Claus Otto; Nilas, Lisbeth; Pedersen, Susan Helene;

    2004-01-01

    OBJECTIVES: To compare the acute effects of estradiol, tibolone and its metabolites on coronary arteries in vitro and to investigate possible vascular mechanisms. METHODS: Coronary artery ring segments from female rabbits were mounted in myographs for isometric tension recordings. Concentration...

  17. Lack of Correlation Between Depression and Coronary Artery Calcification in a Non-Selected Danish Population

    DEFF Research Database (Denmark)

    Devantier, Torben Albert; Nørgaard, Bjarne Linde; Sand, Niels Peter;

    2013-01-01

    BACKGROUND: Depression is associated with coronary artery disease, and atherosclerosis seems to play a central role in this relation. In several studies, multislice computed tomography (CT) has been applied for detection and quantification of coronary artery calcification (CAC) in relation...

  18. Vascular function and mild renal impairment in stable coronary artery disease

    NARCIS (Netherlands)

    van der Harst, P; Smilde, TDJ; Buikema, H; Voors, AA; Navis, G; van Veldhuisen, DJ; van Gilst, WH

    2006-01-01

    Objective - In patients with coronary artery disease, the concomitant presence of renal function impairment is associated with decreased survival. We aimed to assess whether in coronary artery diseased patients renal function impairment is associated with systemic vascular function, functional param

  19. Off-pump coronary artery bypass grafting in patients with mirror-imaging dextrocardia.

    Science.gov (United States)

    Yuan, Xin; Sun, Hansong; Wang, Xianqiang

    2015-08-01

    Dextrocardia requires alterations in techniques during coronary artery bypass graft (CABG) surgery. We report two cases undergoing off-pump coronary artery bypass graft (OPCAB) surgery and discuss techniques for the operative management of these patients.

  20. Myocardial perfusion imaging with higenamine hydrochloride stress studies in diagnosis of coronary artery disease

    Institute of Scientific and Technical Information of China (English)

    周维

    2013-01-01

    Objective To evaluate the stress test efficacy and safety of higenamine hydrochloride,MPI studies were performed in patients with coronary artery disease. Methods Sixty-eight patients with suspected coronary artery

  1. Diabetes mellitus: a prothrombotic state. Implications for outcomes after coronary revascularization

    Directory of Open Access Journals (Sweden)

    Clarissa Cola

    2009-01-01

    Full Text Available Clarissa Cola1, Salvatore Brugaletta1, Victoria Martín Yuste1, Bieito Campos1, Dominick J Angiolillo2, Manel Sabaté11Interventional Cardiology Unit, Department of Cardiology, Sant Pau University Hospital, Barcelona, Spain; 2Interventional Cardiology Unit, Shands Jacksonville, University of Florida, Florida, USAAbstract: Coronary stent thrombosis is a serious problem in the drug-eluting stent era. Despite aggressive antiplatelet therapy during and after percutaneous coronary intervention (PCI, the incidence of sub-acute stent thrombosis remains approximately 0.5%–2%, which may represent a catastrophic clinical situation. Both procedural factors and discontinuation of antiplatelet therapy are normally associated with this event. We report on simultaneous stent thromboses of two drug-eluting stents implanted in two different vessels, which resulted in a life-threatening clinical condition. Possible contributing factors that led to synergistic thrombotic effects are discussed.Keywords: diabetes mellitus, platelet function, antiplatelet therapy, drug-eluting stent, stent thrombosis

  2. Coronary artery ectasia and systolic flow cessation in a patient with hypertrophic cardiomyopathy: a case report.

    Science.gov (United States)

    Zografos, Theodoros; Kokladi, Maria; Katritsis, Demosthenes

    2010-12-01

    Coronary artery ectasia (CAE) is characterized by diffuse or localized inappropriate dilation of coronary arteries and is often associated with slow coronary blood flow. Although CAE has been described to coexist with several clinical entities there are only three reports of CAE in the presence of hypertrophic cardiomyopathy (HCM). We report a case of CAE and slow coronary flow with systolic flow cessation in a 61-year old male with coronary artery disease and HCM.

  3. Assessment of coronary artery disease using coronary computed tomography angiography and biochemical markers

    Institute of Scientific and Technical Information of China (English)

    Gitsios; Gitsioudis; Hugo; A; Katus; Grigorios; Korosoglou

    2014-01-01

    Chronic inflammatory mechanisms in the arterial wall lead to atherosclerosis,and include endothelial cell damage,inflammation,apoptosis,lipoprotein deposition,calcification and fibrosis.Cardiac computed tomography angiography(CCTA)has been shown to be a promising tool for non-invasive assessment of theses specific compositional and structural changes in coronary arteries.This review focuses on the technical background of CCTA-based quantitative plaque characterization.Furthermore,we discuss the available evidence for CCTA-based plaque characterization and the potential role of CCTA for risk stratification of patients with coronary artery disease.

  4. Coronary artery fistula draining into pulmonary artery and optimal management: a review

    OpenAIRE

    Rippel, Radoslaw Adam; Kolvekar, Shyam

    2013-01-01

    Coronary artery fistula is a rare congenital malformation of high variability. The disease is illustrated with a description of a case example. The management of patients with coronary artery fistulas remains controversial. Both spontaneous regression and life threatening complications have been described. The fistula can be ligated or embolised; however, there are no long term outcome data regarding management. Intraoperative risk of myocardial infarction is less than 5% and death rate varie...

  5. Cigarette smoke upregulates rat coronary artery endothelin receptors in vivo

    DEFF Research Database (Denmark)

    Cao, Lei; Zhang, Yaping; Cao, Yong-Xiao;

    2012-01-01

    BACKGROUND: Cigarette smoking is a strong cardiovascular risk factor and endothelin (ET) receptors are related to coronary artery diseases. The present study established an in vivo secondhand smoke (SHS) exposure model and investigated the hypothesis that cigarette smoke induces ET receptor......(B) receptors of smoke exposed rats were higher than that of animals exposed to fresh air, suggesting that SHS upregulates ET(A) and ET(B) receptors in coronary arteries in vivo. Immunofluorescence staining showed that the enhanced receptor expression was localized to the smooth muscle cells of coronary...... arteries. The protein levels of phosphorylated (p)-Raf-1 and p-ERK1/2 in smoke exposed rats were significantly higher than in control rats, demonstrating that SHS induces the activation of the Raf/ERK/MAPK pathway. Treatment with Raf-1 inhibitor GW5074 suppressed SHS-induced enhanced contraction mediated...

  6. Surgical treatment of anomalous origin of coronary artery from the pulmonary artery

    Institute of Scientific and Technical Information of China (English)

    WU Qing-yu; XU Zhong-hua

    2008-01-01

    Background Anomalous origin of coronary artery from the pulmonary artery is a rare congenial cardiac malformation with a mortality rate of up to 90% within the first year of life without surgical intervention. Direct implantation of the anomalous coronary artery (ACA)into the aorta is successful in early life, but it may have increased surgical difficulty and risk with age. This retrospective study summarized our operative experience in direct implantation for treatment of this coronary anomaly in pediatric and adult patients. Methods From August 2000 to January 2003. 4 consecutive patients aged from 9 months to 41 years underwent dual coronary repair. Among them, two children and one infant with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA)and one adult was anomalous origin of right coronary artery from the pulmonary artery(ARCAPA). Coronary arteries were directly implanted into the ascending aorta in 4 patients. In a boy with ALCAPA associated with moderate mitral insufficiency(MI), whose ACA arose remotely from the ascending aorta, we created a tube-shaped graft using part of the pulmonary arterial wall in continuity with the origin of the left coronary artery (LCA). Concomitant moderate MI was repaired in 2 patients, including this boy, after a dual-coronary repair. Results All patients survived. There were no hospital or late deaths and no major complications as well. Echocardiography revealed that the left ventricular (LV)function including LV end-diastolic dimension(EDD)and ejection fraction(EF)was markedly improved at hospital discharge. At 3-6 years follow-up after surgery all patients were asymptomatic and currently in NYHA class I. Conclusions The best results are achieved with direct implantation of the ACA into the ascending aorta and simultaneous mitral valve repair if needed. Direct implantation is feasible in pediatric and adult patients with ALCAPA or ARCAPA including the coronary artery in a location remote from

  7. Developments in the percutaneous treatment of obstructive coronary artery disease

    OpenAIRE

    Agostoni, P.

    2009-01-01

    Percutaneous coronary interventions are recognized techniques to treat coronary artery disease. However, despite the progress in the development of materials and techniques, several limitations affect the acute and long-term performance of these procedures. In particular, there are three mayor drawbacks: restenosis, thrombosis and technical feasibility of the procedure. The recent introduction of drug-eluting stents has been a major step forward in reducing restenosis. The pivotal randomized ...

  8. Advances in Nanotechnology for the Management of Coronary Artery Disease

    OpenAIRE

    Rhee, June-Wha; Wu, Joseph C.

    2012-01-01

    Nanotechnology holds tremendous potential to advance the current treatment of coronary artery disease. Nanotechnology may assist medical therapies by providing a safe and efficacious delivery platform for a variety of drugs aimed at modulating lipid disorders, decreasing inflammation and angiogenesis within atherosclerotic plaques, and preventing plaque thrombosis. Nanotechnology may improve coronary stent applications by promoting endothelial recovery on a stent surface utilizing bio-mimetic...

  9. Friedreich's Ataxia as a Cause of Premature Coronary Artery Disease

    OpenAIRE

    Giugliano, Gregory R.; Sethi, Prabhdeep S.

    2007-01-01

    Friedreich's ataxia is the most common hereditary neurodegenerative disorder, and more than half of all patients show echocardiographic evidence of cardiomyopathy. Although angina has been reported in these patients, the role of coronary artery disease has previously been dismissed and is therefore underestimated. Premature obstructive coronary disease has rarely been angiographically demonstrated in patients with Friedreich's ataxia. We present an unusual case of a 35-year-old woman with Fri...

  10. Rapid functional upregulation of vasocontractile endothelin ETB receptors in rat coronary arteries

    DEFF Research Database (Denmark)

    Skovsted, Gry Freja; Pedersen, Anne Fog; Larsen, Rikke;

    2012-01-01

    Endothelin ET(B) receptors mediate under normal physiological conditions vasorelaxation in coronary arteries. However, vasocontractile ET(B) receptors appear in coronary arteries of ischemic heart disease patients. Interestingly, organ culture of isolated coronary arteries also induces upregulation...... of vasocontractile ET(B) receptors. This study examines the early time course and mechanism behind upregulation of contractile ET(B) receptors in isolated rat coronary arteries during short-term organ culture....

  11. MYOCARDIAL REVASCULARIZATION IN PATIENTS WITH LEFT VENTRICULAR SYSTOLIC DYSFUNCTION: PROBLEM STATEMENT

    Directory of Open Access Journals (Sweden)

    A. B. Mironkov

    2013-01-01

    Full Text Available Outcomes of myocardium revascularization in patients with chronic left ventricular systolic dysfunction due to coronary artery disease are still unclear. The identification of dysfunctional myocardial with residual viability that can improve after revascularization are very important for further patient treatment. Hibernating myocardium can be identified by different methods and its presence and extent can predict functional and structural recovery after revascularization. New medical treatments and devices, have improved the prognosis of this patients and their use is supported by a number of clinical trials. The prognostic benefits of coronary revascularization for patients with chronic left ventricular dysfunction on optimal medical therapy and novel devices a randomized trial is still needed. 

  12. Coronary spasm as the cause of myocardial ischaemia in a patient with anomalous origin of the left anterior descending artery from the proximal right coronary artery.

    Science.gov (United States)

    Nakazato, Jun; Hirata, Kazuhito; Wake, Minoru

    2014-01-01

    A 49-year-old woman developed angina at rest. A CT of the coronary artery revealed that the left anterior descending artery arose from the right coronary artery, and traversed between the aorta and pulmonary trunk. An exercise stress myocardial scintigraphy did not reproduce myocardial ischaemia or anginal symptoms. A coronary angiography did not show any atherosclerotic changes. Finally, an ergotamine provocation test for vasospasm revealed diffuse severe spasm in the right coronary artery and the left anterior descending artery. Surgical correction of the anomaly was deferred and the patient was managed with medications to control spasm with good clinical outcome. PMID:24920513

  13. Prevalence of Congenital Coronary Artery Anomalies and Variants in 2697 Consecutive Patients Using 64-Detector Row Coronary CTAngiography

    Directory of Open Access Journals (Sweden)

    Farzaneh Fattahi Masrour

    2012-01-01

    Full Text Available Background: Coronary artery anomalies are not common, but could be very serious.Objectives: This study determines the frequency of coronary anomalies and normal variants by multi-detector-row computed tomography (MDCT.Patients and Methods: The results of cardiac MDCT study in 2697 consecutive patients were analyzed retrospectively. Acquisition was performed by a 64-detector row CT machine. Imaging results were assessed by experienced radiologists.Results: Myocardial bridging was by far the most frequent coronary variant (n = 576, 21.3%. Eighty-three subjects (3.1% showed other coronary anomalies and variants. Anomalies of origination and course of the left main coronary artery (LMCA were detected in 1.09% of the subjects. The frequency of these anomalies in the right coronary artery (RCA, left circumflex artery (LCx, left anterior descending artery (LAD, posterior descending artery (PDA and obtuse marginal (OM artery were 1.24%, 0.33%, 0.1%, 0.07% and 0.03%, respectively. The single coronary pattern was seen in 0.18% and coronary fistulas in 0.07%.Conclusion: Based on the fact that coronary CT-angiography using MDCT can display different coronary anomalies, this study shows similar results to other reports on the subject. Future advances in the performance of CT machines will further improve the quality of CT-based cardiac imaging.Keywords: Coronary Artery Disease,Tomography,X-Ray Computed,Patients

  14. Spontaneous coronary artery dissection: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Monodeep Biswas

    2012-01-01

    Full Text Available Spontaneous coronary artery dissection (SCAD is an unusual cause of acute coronary syndrome or sudden cardiac death. SCAD has most frequently been described as presenting as an acute coronary syndrome in females during the peripartum period. It may also be associated with autoimmune and collagen vascular diseases, Marfan′s syndrome, chest trauma, and intense physical exercise. The most common presentation of SCAD is the acute onset of severe chest pain associated with autonomic symptoms. This condition has a high mortality rate if not identified and treated promptly. Here, we present a case of SCAD presenting with stroke, followed by a brief review.

  15. Haemodynamic response to endotracheal intubation in coronary artery disease: Direct versus video laryngoscopy

    OpenAIRE

    Muralidhar Kanchi; Nair, Hema C; Sanjay Banakal; Keshava Murthy; C Murugesan

    2011-01-01

    Endotracheal intubation involving conventional laryngoscopy elicits a haemodynamic response associated with increased heart and blood pressure. The study was aimed to see if video laryngoscopy and endotracheal intubation has any advantages over conventional laryngoscopy and endotracheal intubation in patients with coronary artery disease. Thirty patients suffering from coronary artery disease scheduled for elective coronary artery bypass grafting (CABG) were studied. The patients were randoml...

  16. Split Right Coronary Artery Its Definition and Its Territory

    OpenAIRE

    Sawaya, Fadi J.; Sawaya, Jaber I.; Angelini, Paolo

    2008-01-01

    We report here, for perhaps the 1st time in the English-language literature, the extent of the territory fed by the anterior bifurcation of the (anomalous) split right coronary artery (RCA). A 64-year-old man presented with an occlusion of the anterior bifurcation of a split RCA—which resulted in an infarct that involved both the inferoseptal left ventricular wall and the anterior right ventricular free wall. Split RCA is the same anomaly as the improperly named “double right coronary artery....

  17. Functional Relevance of Coronary Artery Disease by Cardiac Magnetic Resonance and Cardiac Computed Tomography: Myocardial Perfusion and Fractional Flow Reserve

    Directory of Open Access Journals (Sweden)

    Gianluca Pontone

    2015-01-01

    Full Text Available Coronary artery disease (CAD is one of the leading causes of morbidity and mortality and it is responsible for an increasing resource burden. The identification of patients at high risk for adverse events is crucial to select those who will receive the greatest benefit from revascularization. To this aim, several non-invasive functional imaging modalities are usually used as gatekeeper to invasive coronary angiography, but the diagnostic yield of elective invasive coronary angiography remains unfortunately low. Stress myocardial perfusion imaging by cardiac magnetic resonance (stress-CMR has emerged as an accurate technique for diagnosis and prognostic stratification of the patients with known or suspected CAD thanks to high spatial and temporal resolution, absence of ionizing radiation, and the multiparametric value including the assessment of cardiac anatomy, function, and viability. On the other side, cardiac computed tomography (CCT has emerged as unique technique providing coronary arteries anatomy and more recently, due to the introduction of stress-CCT and noninvasive fractional flow reserve (FFR-CT, functional relevance of CAD in a single shot scan. The current review evaluates the technical aspects and clinical experience of stress-CMR and CCT in the evaluation of functional relevance of CAD discussing the strength and weakness of each approach.

  18. "The challenge facing renal artery revascularization: what have we not proven and why we must"?

    LENUS (Irish Health Repository)

    Hynes, B G

    2012-01-04

    Endovascular renal artery stent therapy for atherosclerotic renal artery stenosis (RAS) is associated with excellent acute technical success, low complication rates and acceptable long-term patency. However, the clinical benefits to patients of renal artery stenting remain uncertain. To facilitate debate regarding the treatment of RAS, we need to understand the epidemiology, basic physiology and clinical consequences of renal artery stenosis. We must attempt to determine which patients are likely to benefit from renal artery stenting, assess the nuances of the percutaneous procedure and review the current literature pertaining to renal artery stenting.

  19. Coronary leukocyte activation in relation to progression of coronary artery disease.

    Science.gov (United States)

    de Vries, Marijke A; Alipour, Arash; Birnie, Erwin; Westzaan, Andrew; van Santen, Selvetta; van der Zwan, Ellen; Liem, Anho H; van der Meulen, Noëlle; Cabezas, Manuel Castro

    2016-03-01

    Leukocyte activation has been linked to atherogenesis, but there is little in vivo evidence for its role in the progression of atherosclerosis. We evaluated the predictive value for progression of coronary artery disease (CAD) of leukocyte activation markers in the coronary circulation. Monocyte and neutrophil CD11b, neutrophil CD66b expression and intracellular neutrophil myeloperoxidase (MPO) in the coronary arteries were determined by flow cytometry in patients undergoing coronary angiography. The primary outcome included fatal and nonfatal myocardial infarction or arterial vascular intervention due to unstable angina pectoris. In total 99 subjects who were included, 70 had CAD at inclusion (26 patients had single-vessel disease, 18 patients had twovessel disease and 26 patients had three-vessel disease). The median follow-up duration was 2242 days (interquartile range: 2142-2358). During follow-up, 13 patients (13%) developed progression of CAD. Monocyte CD11b, neutrophil CD11b and CD66b expression and intracellular MPO measured in blood obtained from the coronary arteries were not associated with the progression of CAD. These data indicate that coronary monocyte CD11b, neutrophil CD11b and CD66b expression and intracellular MPO do not predict the risk of progression of CAD. PMID:26831871

  20. Endovascular management of patients with coronary artery disease and diabetic foot syndrome:A long-term follow-up

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Paolo Cardaioli; Fabio dell'Avvocata; Massimo Giordan; Giovanna Lisato; Francesco Mollo

    2011-01-01

    Background To investigate the long-term results of global coronary and peripheral interventional treatment of diabetic foot patients.Methods We retrospectively included 220 diabetic patients (78.5±15.8 years,107 females,all with Fontaine III or IV class) who were referred to our centre for diabetic foot syndrome and severe limb ischemia from January 2006 to December 2010.Patients were evaluated by a team of interventional cardiologists and diabetologists in order to assess presence of concomitant coronary artery disease (CAD) and eventual need for coronary revascularization. Stress-echo was performed in all patients before diagnostic peripheral angiography. Patients with indications for coronary angiography were submitted to combined diagnostic angiography and then to eventual staged peripheral and coronary interventions.Doppler ultrasonography and foot transcutaneous oximetry of transcutaneous oxygen pressure (TcPO2) before and after the procedure were performed as well as stressechocardiography and combined cardiologic and diabetic examination at 1 and 6 month and yearly.Results Stress-echocardiography was performed in 94/220 patients and resulted positive in 56 patients who underwent combined coronary and peripheral angiography.In the rest of 126 patients,combined coronary and peripheral angiography was performed directly for concomitant signs and symptoms of coronary heart disease in 35 patients.Coronary revascularization was judged necessary in 85/129 patients and was performed percutaneously after peripheral interventions in 72 patients and surgically in 13 patients.For Diabetic foot interventions the preferred approach was ipsilateral femoral antegrade in 170/220 patients (77.7%) and contralateral cross-over in 40/220 patients (18.8%) and popliteal retrograde+femoral antegrade in 10/220 patients (4.5%).Balloon angioplasty was performed in 252 legs (32 patients had bilateral disease):the procedure was successful in 239/252 legs with an immediate success rate

  1. Mendelian randomization studies in coronary artery disease.

    Science.gov (United States)

    Jansen, Henning; Samani, Nilesh J; Schunkert, Heribert

    2014-08-01

    Epidemiological research over the last 50 years has discovered a plethora of biomarkers (including molecules, traits or other diseases) that associate with coronary artery disease (CAD) risk. Even the strongest association detected in such observational research precludes drawing conclusions about the causality underlying the relationship between biomarker and disease. Mendelian randomization (MR) studies can shed light on the causality of associations, i.e whether, on the one hand, the biomarker contributes to the development of disease or, on the other hand, the observed association is confounded by unrecognized exogenous factors or due to reverse causation, i.e. due to the fact that prevalent disease affects the level of the biomarker. However, conclusions from a MR study are based on a number of important assumptions. A prerequisite for such studies is that the genetic variant employed affects significantly the biomarker under investigation but has no effect on other phenotypes that might confound the association between the biomarker and disease. If this biomarker is a true causal risk factor for CAD, genotypes of the variant should associate with CAD risk in the direction predicted by the association of the biomarker with CAD. Given a random distribution of exogenous factors in individuals carrying respective genotypes, groups represented by the genotypes are highly similar except for the biomarker of interest. Thus, the genetic variant converts into an unconfounded surrogate of the respective biomarker. This scenario is nicely exemplified for LDL cholesterol. Almost every genotype found to increase LDL cholesterol level by a sufficient amount has also been found to increase CAD risk. Pending a number of conditions that needed to be fulfilled by the genetic variant under investigation (e.g. no pleiotropic effects) and the experimental set-up of the study, LDL cholesterol can be assumed to act as the functional component that links genotypes and CAD risk and

  2. Spontaneous coronary artery dissection: case report and literature review.

    Science.gov (United States)

    D'Ovidio, Cristian; Sablone, Sara; Carnevale, Aldo

    2015-05-01

    Spontaneous coronary artery dissection (SCAD) is a rare cause of acute myocardial infarction and sudden cardiac death. It occurs most commonly in otherwise healthy women during pregnancy or the postpartum period. The true incidence of SCAD is underestimated, as most cases are diagnosed at autopsy. The pathophysiology of SCAD is still not fully understood, and its management can be challenging. This report describes a 35-year-old pregnant female who presented with an acute antero-lateral ST elevation secondary to spontaneous dissection of the left anterior descending artery and the circumflex artery. The diagnosis was established by coronary artery angiography. However, the patient died following cardiac tamponade. The examination of this case represented a starting point for the reviewing of the diagnosis, clinical course, and management of SCAD, and for the placing of this in context with the existing literature. This study highlights the importance of prompt diagnosis and subsequent lifesaving treatment.

  3. FACTORES DE RIESGO CARDIOVASCULAR Y CALIDAD DE VIDA EN MUJERES REVASCULARIZADAS CON STENT CORONARIOS / Cardiovascular risk factors and quality of life in women who under-went revascularization with coronary stenting

    Directory of Open Access Journals (Sweden)

    José C. Castillo Núñez

    2013-10-01

    descriptive, longitudinal prospective study was conducted in women (n=62 who underwent revascularization with PTCA and stent implantation from January to June 2011. Clinical follow-up was performed for 180 days through medical consultations. Results: The mean age was 52.8 years and the most frequent cardiovascular risk factor was hypertension (66.1 %; diabetes (24.2 % was the least prevalent. One-vessel atherosclerotic coronary artery disease was the most common (87.1%, and three-vessel disease (1.6% was the least frequent one. Only one stent was implanted in 75.8 % of patients, and only one patient required the implantation of three stents; 83.9% of patients expressed that their quality of life was good, 14.5 % considered it was acceptable and one patient estimated it was poor. During clinical follow-up, no cardiovascular events was reported in 93.5 % of patients. Diabetes and poor quality of life showed a statistically significant association with the extent of atherosclerotic coronary artery disease, the number of stents used and cardiovascular events. Conclusions: Women with atherosclerotic coronary artery disease who underwent revascularization with coronary stents show a high frequency of risk factors, and have a favorable clinical course with a prevalence of positive perceptions concerning their quality of life.

  4. Outcomes of patients with spontaneous coronary artery dissection

    Science.gov (United States)

    McGrath-Cadell, Lucy; McKenzie, Pamela; Emmanuel, Sam; Muller, David W M; Graham, Robert M; Holloway, Cameron J

    2016-01-01

    Background Spontaneous coronary artery dissection (SCAD) is an uncommon but serious condition presenting as an acute coronary syndrome (ACS) or cardiac arrest. The pathophysiology and outcomes are poorly understood. We investigated the characteristics and outcomes of patients presenting with SCAD. Methods In a retrospective study of a large cohort of patients with SCAD, data were collected regarding clinical presentation, patient characteristics, vascular screening, coronary artery involvement and clinical outcomes. Results 40 patients with SCAD (95% women, mean age 45±10 years) were included. At least 1 traditional cardiovascular risk factor was present in 40% of patients. Migraine was reported in 43% of patients. Events preceding SCAD included parturition (8%), physical stress (13%), emotional stress (10%) and vasoconstrictor substance-use (8%). 65% of patients had a non-ST elevation ACS (NSTEACS) at presentation, 30% had an ST elevation myocardial infarction (STEMI) and 13% had a cardiac arrest. The left anterior descending artery was most frequently involved (68% of patients), and 13% had involvement of multiple coronary territories. Fibromuscular dysplasia (FMD) was identified in 7 (37%) of 19 patients screened. 68% of patients were managed medically, 30% had percutaneous coronary intervention and 5% had coronary artery bypass grafting. Over a median 16-month follow-up period, 8% of patients had at least 1 recurrent SCAD event. There were no deaths. Conclusions Patients with SCAD in this study often had multiple coronary territories involved (13%) and extracardiac vascular abnormalities, suggesting a systemic vascular process, which may explain the high incidence of migraine. All patients with SCAD should be screened for FMD and followed closely due to the possibility of recurrence.

  5. Diabetes patients show different time-course of myocardial perfusion improvement after coronary artery bypass grafting

    Energy Technology Data Exchange (ETDEWEB)

    Lee, J. J.; Seok, J. W.; Eo, J. S. [Seoul National University Hospital, Seoul (Korea, Republic of)] (and others)

    2005-07-01

    Diabetes mellitus is an independent risk factor of cardiovascular disease. Diabetes is known to cause microangiopathy. The microangiopathy is hardly detectable on the coronary angiography. Myocardial perfusion imaging shows the resultant perfusion status which reflects the microangiopathy. For patients who underwent revascularization, the microangiopathy could affect the myocardial perfusion improvement. Diabetes patients probably experience the different myocardial perfusion improvement as compared to the non-diabetes patients although they have similar angiographic findings. The aim of this study is to find out whether there is a time-course difference of perfusion improvement between the diabetes and non diabetes patients who showed patent angiographic findings after coronary artery grafting surgery (CABG). A total of 129 patients who underwent coronary artery bypass grafting surgery were enrolled in this study. Myocardial SPECTs performed at previous, short-term (3 month), and mid-term (1 year) to CABG. One-year follow up angiography was done 411{+-}121 days after surgery. Graft patency was determined according to the FitzGibbon et al. Segments were assigned to vascular territories using a 20 segment model. The segments of excellent patency were included in this study. Time course differences of concerned segments were analyzed using RMANOVA. The number of segments enrolled was 764 of diabetes and 1083 of non-diabetes. At short-term follow up, reversibility score was 2.8{+-}8.1% in diabetes and 0.3{+-}7.5% in non-diabetes. At long-term follow up, reversibility score was 1.8{+-}8.0% in diabetes and 0.1{+-}7.3% in non-diabetes. The time-course of reversibility score was significantly different between the diabetes and non diabetes (p<0.001) Diabetic segments showed high residual reversibility score than non-diabetic segments after CABG although the angiographic finding was patent in both groups. This result is maybe attributable to microangiopathy induced by

  6. The value of semi-quantitative myocardial metabolic-perfusion scores in coronary artery bypasses grafting

    International Nuclear Information System (INIS)

    Objective: Coronary artery bypass grafting (CABG) is the preferred method of coronary revascularization in the coronary artery disease (CAD) patients with multi-vessel involvement. The study was aimed to evaluate the role of semi-quantitative assessment of myocardial viability scores using PET in CABG. Methods: Twenty-one consecutive patients with multi-vessel CAD were recruited from the department of cardiac/thoracic surgery. All patients underwent gated myocardial perfusion imaging (G-MPI) and 18F-fluorodeoxyglucose (FDG) myocardial PET imaging to assess the extent and severity of ischemia as well as the myocardial viability. The images were interpreted according to the semi-quantitative method issued by American Society of Nuclear Cardiology (ASNC) imaging guidelines using a 20-segment nomenclature. Summed rest score (SRS) and summed difference score (SDS) were calculated accordingly. All patients were scheduled for CABG within 2 weeks after the radionuclide myocardial imaging. The follow-up G-MPI was performed in all patients in the 3rd month after the surgery. Results: Out of the total 420 segments, 164 segments had abnormal myocardial perfusion by preoperative G-MPI. Among them, 93 segments were identified as non-viable (with difference score≥0) and the remaining 71 viable (with difference score <0). Based on their SDS, the patients were divided into 3 groups: group A (SDS≥0, n=5), group B (-5≤SDS<0, n8) and group C (SDS < -5, n=8). The mean change of global left ventricular ejection fraction (LVEF) after CABG in the three groups were -3.6%, 3.38% and 6.88% respectively. Conclusion: Assessment of myocardial viability by PET imaging is valuable in predicting whether the CAD patients may benefit from CABG. (authors)

  7. Simulation of stent deployment in a realistic human coronary artery

    OpenAIRE

    van der Steen Anton FW; Wentzel Jolanda J; Thury Attila; Petrini Lorenza; Socci Laura; Schievano Silvia; Migliavacca Francesco; Gijsen Frank JH; Serruys Patrick WS; Dubini Gabriele

    2008-01-01

    Abstract Background The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might give insights in the understanding of the process of restenosis. Methods 3D recon...

  8. Successful retrieval of an unexpanded coronary stent from the left main coronary artery during primary percutaneous coronary intervention

    Directory of Open Access Journals (Sweden)

    Šalinger-Martinović Sonja

    2011-01-01

    Full Text Available Introduction. Dislodgement and embolization of the new generation of coronary stents before their deployment are rare but could constitute a very serious complication. Case Outline. We report a case of a stent dislodgement into the left main coronary artery during the primary coronary intervention of infarct related left circumflex artery in a patient with acute myocardial infarction. The dislodged and unexpanded bare-metal stent FlexMaster 3.0x19 mm (Abbot Vascular was stranded and bended in the left main coronary artery (LMCA, probably by the tip of the guiding catheter, but stayed over the guidewire. It was successfully retrieved using a low-profile Ryujin 1.25x15 balloon catheter (Terumo that was passed through the stent, inflated and then pulled back into the guiding catheter. After that, the whole system was withdrawn through the 6 F arterial sheath via the transfemoral approach. After repeated cannulation via the 6F arterial sheath, additional BMW and ATW guidewires were introduced into the posterolateral and obtuse marginal branches and a bare-metal stent Driver (Medtronic Cardiovascular Inc 3.0x18 mm was implanted in the target lesion. Conclusion. Stent dislodgement is a rare but potentially life-threatening complication of the percutaneous coronary intervention. This incident occurring in the LMCA in particular during an acute myocardial infarction requires to be urgently resolved. The avoidance of rough manipulation with the guiding catheter and delivery system may help in preventing this kind of complications.

  9. Simulation of stent deployment in a realistic human coronary artery

    Directory of Open Access Journals (Sweden)

    van der Steen Anton FW

    2008-08-01

    Full Text Available Abstract Background The process of restenosis after a stenting procedure is related to local biomechanical environment. Arterial wall stresses caused by the interaction of the stent with the vascular wall and possibly stress induced stent strut fracture are two important parameters. The knowledge of these parameters after stent deployment in a patient derived 3D reconstruction of a diseased coronary artery might give insights in the understanding of the process of restenosis. Methods 3D reconstruction of a mildly stenosed coronary artery was carried out based on a combination of biplane angiography and intravascular ultrasound. Finite element method computations were performed to simulate the deployment of a stent inside the reconstructed coronary artery model at inflation pressure of 1.0 MPa. Strut thickness of the stent was varied to investigate stresses in the stent and the vessel wall. Results Deformed configurations, pressure-lumen area relationship and stress distribution in the arterial wall and stent struts were studied. The simulations show how the stent pushes the arterial wall towards the outside allowing the expansion of the occluded artery. Higher stresses in the arterial wall are present behind the stent struts and in regions where the arterial wall was thin. Values of 200 MPa for the peak stresses in the stent strut were detected near the connecting parts between the stent struts, and they were only just below the fatigue stress. Decreasing strut thickness might reduce arterial damage without increasing stresses in the struts significantly. Conclusion The method presented in this paper can be used to predict stresses in the stent struts and the vessel wall, and thus evaluate whether a specific stent design is optimal for a specific patient.

  10. High-Risk Acute Coronary Syndrome in a Patient with Coronary Subclavian Steal Syndrome Secondary to Critical Subclavian Artery Stenosis

    Directory of Open Access Journals (Sweden)

    Zaher Fanari

    2014-01-01

    Full Text Available Patients with multivessel coronary artery disease are more likely to have extensive atherosclerosis that involves other major arteries. Critical subclavian artery (SCA stenosis can result in coronary subclavian steal syndrome that may present as recurrent ischemia and even myocardial infarction in patients with coronary artery bypass graft (CABG. In patients with concomitant severe native coronary disease, occluded saphenous venous grafts (SVG to other arteries, percutaneous intervention on critical subclavian artery (SCA stenosis that will compromise the blood flow to left internal mammary graft (LIMA and left anterior descending (LAD artery will be a high-risk procedure and may be associated with cardiogenic shock, especially in patients with preexisting ischemic cardiomyopathy. The use of percutaneous left ventricular (LV assist device like Impella will offer better hemodynamic support and coronary perfusion and therefore results in decreased myocardial damage, maximized residual cardiac function, and lower incidence of cardiogenic shock.

  11. Wall Shear Stress Distribution in Patient Specific Coronary Artery Bifurcation

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    Vahab Dehlaghi

    2010-01-01

    Full Text Available Problem statement: Atherogenesis is affected by hemodynamic parameters, such as wall shear stress and wall shear stress spatial gradient. These parameters are largely dependent on the geometry of arterial tree. Arterial bifurcations contain significant flow disturbances. Approach: The effects of branch angle and vessel diameter ratio at the bifurcations on the wall shear stress distribution in the coronary arterial tree based on CT images were studied. CT images were digitally processed to extract geometrical contours representing the coronary vessel walls. The lumen of the coronary arteries of the patients was segmented using the open source software package (VMTK. The resulting lumens of coronary arteries were fed into a commercial mesh generator (GAMBIT, Fluent Inc. to generate a volume that was filled with tetrahedral elements. The FIDAP software (Fluent Corp. was used to carry out the simulation by solving Navier-Stokes equations. The FIELDVIEW software (Version 10.0, Intelligent Light, Lyndhurst, NJ was used for the visualization of flow patterns and the quantification of wall shear stress. Post processing was done with VMTK and MATLAB. A parabolic velocity profile was prescribed at the inlets and outlets, except for 1. Stress free outlet was assigned to the remaining outlet. Results: The results show that for angle lower than 90°, low shear stress regions are observed at the non-flow divider and the apex. For angle larger than 90°, low shear stress regions only at the non-flow divider. By increasing of diameter of side branch ratio, low shear stress regions in the side branch appear at the non-flow divider. Conclusion: It is concluded that not only angle and diameter are important, but also the overall 3D shape of the artery. More research is required to further quantify the effects angle and diameter on shear stress patterns in coronaries.

  12. A 7-year, single-center research and long term follow-up of graft patency of robotic total arterial off-pump coronary artery bypass grafting

    Directory of Open Access Journals (Sweden)

    Guo-peng LIU

    2016-06-01

    Full Text Available Objective  The aim of the study was to explore the long-term benefits of coronary artery bypass grafting (CABG. Methods  From January 2007 to November 2014, 240 patients (187 males and 53 females, average age 59 years received robotic off-pump CABG assisted with da Vinci Surgical System (Intuitive Surgical, USA in our center. Totally endoscopic coronary artery bypass (totally robot-assisted TECAB, n=100 or mini-thoracotomy direct coronary artery bypass (free of internal mammary artery, IMA, by robot, MIDCAB, n=140 grafting was performed. Patients were followed-up regularly, and their graft patency was assessed every 6 months by coronary angiography or 64-multi-slide CT angiography. Results  All the procedures were completed successfully without conversion to median sternotomy or cardiopulmonary bypass , there was no operative mortality. 237 unilateral IMA grafts (98.7% and 3 bilateral IMA grafts (1.3% were used. Hybrid revascularization of non-left anterior descending vessels was performed in 24 patients (10%. In the follow-up of 41.1±12.9 months, no death, stroke or myocardial infarction occurred. All grafts were patent before discharge. The IMA graft patency was 97.1% in TECAB and 96.4 % in MIDCAB over 3 years (up to 91 months after surgery. Conclusions  Robotic off-pump CABG using IMA grafts is a safe and effective surgery method in selected patients. The long-term outcome and patency of IMA grafts are excellent. DOI: 10.11855/j.issn.0577-7402.2016.06.15

  13. Percutaneous Coronary Intervention in Single Coronary Artery from Right Sinus: Radial Route is Right

    Directory of Open Access Journals (Sweden)

    Rakesh Mahla

    2015-01-01

    Full Text Available We present percutaneous coronary intervention (PCI using radial approach in a rare case of single coronary artery originating from the right sinus. Although these anomalies and stenosis of anomalous vessels have been described previously, treatment of atherosclerotic lesions by PCI has rarely been reported. There is a definite procedural risk during PCI in patients with a single ostium because dissection with the guiding catheter would result in a catastrophic event. Additionally, technical difficulties may occur due to the ostial configuration and course of the branch to be stented. The patient suffered an acute coronary syndrome-inferior wall STEMI, and was thrombolysed elsewhere within a window period of 4 h. He had post myocardial infarction (MI angina and was referred to our center after 3 days of thrombolysis. We present this technically challenging and rare case in which PCI of right coronary artery was performed through the radial route.

  14. Coronary artery calcium and exercise electrocardiogram as predictors of coronary events in asymptomatic adults.

    Science.gov (United States)

    Grossman, Chagai; Ehrlich, Shay; Shemesh, Joseph; Koren-Morag, Nira; Grossman, Ehud

    2015-03-15

    Early identification of patients at risk for coronary heart disease is crucial to formulate effective preventive strategies. The elevated risk of coronary artery calcium (CAC) for coronary heart disease is well established. Our aim was to estimate the relative risk of abnormal exercise electrocardiography (Ex ECG) in the presence of CAC. During the year 2001, 566 asymptomatic subjects performed a treadmill exercise test and consented to perform an unenhanced computed tomography to assess CAC. Patients were followed until December 2012. The relative risk for coronary events (acute myocardial infarction, hospitalization for unstable angina or coronary catheterization that resulted in angioplasty or coronary artery bypass surgery), of abnormal Ex ECG and presence of CAC were analyzed. An abnormal Ex ECG was found in 71 subjects (12.5%), and CAC was found in 286 subjects (50.5%). During a mean follow-up of 6.5 ± 3.3 years, 35 subjects experienced a first coronary event. In those without CAC, the rate of coronary events was low (4 of 280; 1.4%) regardless of the Ex ECG results. Subjects with both CAC and abnormal Ex ECG had the highest rate of coronary events (13 of 39; 33%). The adjusted hazard ratio for coronary events, in subjects with CAC, was 5.16 (95% confidence interval 2.52 to 10.60) in those with abnormal Ex ECG compared with those with normal Ex ECG. In conclusion, in subjects with CAC, further risk stratification can be achieved by an Ex ECG, whereas in those without CAC, an Ex ECG has less additional value in predicting coronary events. PMID:25616536

  15. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA in an Adult

    Directory of Open Access Journals (Sweden)

    Yunus Nazli

    2013-08-01

    Full Text Available Anomalous origin of the left main coronary artery from the pulmonary artery (ALCAPA, also known as Garland-Bland-White syndrome, is an extremely rare but potentially fatal congenital cardiovascular anomaly and it often exists as an isolated condition. We report an unusual case of a 32 years-old patient with ALCAPA presenting with chest pain and dyspnea who underwent surgical correction of this rare anomaly. This anomaly was simply repaired by the combination of LMCA ligation and coronary artery bypass grafting.

  16. Effects of statin treatment in patients with coronary artery disease and chronic kidney disease.

    Science.gov (United States)

    Kaneko, Hidehiro; Yajima, Junji; Oikawa, Yuji; Tanaka, Shingo; Fukamachi, Daisuke; Suzuki, Shinya; Sagara, Koichi; Otsuka, Takayuki; Matsuno, Shunsuke; Funada, Ryuichi; Kano, Hiroto; Uejima, Tokuhisa; Koike, Akira; Nagashima, Kazuyuki; Kirigaya, Hajime; Sawada, Hitoshi; Aizawa, Tadanori; Yamashita, Takeshi

    2014-01-01

    Statins reduce cardiovascular morbidity and mortality from coronary artery disease (CAD). However, the effects of statin therapy in patients with CAD and chronic kidney disease (CKD) remain unclear. Within a single hospital-based cohort in the Shinken Database 2004-2010 comprising all patients (n = 15,227) who visited the Cardiovascular Institute, we followed patients with CKD and CAD after percutaneous coronary intervention (PCI). A major adverse cardiovascular and cerebrovascular event (MACCE) was defined by composite end points, including death, myocardial infarction, cerebral infarction, cerebral hemorrhage, and target lesion revascularization. A total of 391 patients were included in this study (median follow-up time 905 ± 679 days). Of these, 209 patients used statins. Patients with statin therapy were younger than those without. Obesity and dyslipidemia were more common, and the glomerular filtration rate (GFR) was significantly higher, in patients undergoing statin treatment. MACCE and cardiac death tended to be less common, and all-cause death was significantly less common, in patients taking statins. Multivariate analysis showed that low estimated GFR, poor left ventricular ejection fraction, and the absence of statin therapy were independent predictors for all-cause death of CKD patients after PCI. Statin therapy was associated with reduced all-cause mortality in patients with CKD and CAD after PCI.

  17. CCR2 and coronary artery disease: a woscops substudy

    Directory of Open Access Journals (Sweden)

    Gray Ian C

    2010-02-01

    Full Text Available Abstract Background Several lines of evidence support a role for CCL2 (monocyte chemotactic protein-1 and its receptor CCR2 in the development of atherosclerosis. The aim of the present study was to determine the association of the CCR2 Val64Ile polymorphism with the development of coronary artery disease in the WOSCOPS study sample set. Findings A total of 443 cases and 1003 controls from the West of Scotland Coronary Prevention Study (WOSCOPS were genotyped for the Val64Ile polymorphism in the CCR2 gene. Genotype frequencies were compared between cases and controls. The CCR2 Val64Ile polymorphism was found not to be associated with coronary events in this study population (odds ratio 1.15, 95% CI 0.82-1.61, p = 0.41. Conclusions This case-control study does not support an association of the CCR2 Val64Ile polymorphism with coronary artery disease in the WOSCOPS sample set and does not confirm a possible protective role for CCR2 Val64Ile in the development of coronary artery disease.

  18. Patients With Suspected Coronary Artery Disease Referred for Examinations in the Era of Coronary Computed Tomography Angiography

    DEFF Research Database (Denmark)

    Zorlak, Adja; Zorlak, Amet; Thomassen, Anders;

    2015-01-01

    -photon emission computed tomography (SPECT), or ICA qualified for inclusion. The patients were followed for 1 year, and additional downstream diagnostic tests and need of coronary revascularization were registered. A total of 1,069 patients were included. A noninvasive test was the first examination in 797...... 797 patients) in the noninvasive group (p <0.0001). In the comparison between CCTA and SPECT, there were no significant differences in downstream testing (16% [72 of 444 patients] vs 17% [53 of 310], p = 0.55), and revascularization rate (20% [14 of 69 patients with positive findings] vs 9% [6 of 67...

  19. Simulation of Blood Flow Coronary Artery with Consecutive Stenosis and Coronary-Coronary Bypass

    Directory of Open Access Journals (Sweden)

    Omid Arjmandi-Tash

    2011-08-01

    Full Text Available Introduction: In this research the behavior of coronary arteries has been studied with symmetric and asymmetric consecutive stenosis, and grafted vessels. Methods: The incompressible Navier-Stokes and energy equations were discretized with second-order upwind method. Assumptions such as Newtonian fluid, wall rigidity and steady-flow were used. Results: All the calculations showed the same results with Newtonians and non-Newtonian fluids. It was found that the possibility of stenosis be reduced by increasing the graft angle. However, there exists further stenosis possibility. Among the three graft angles 20, 30 ̊ and 40, the 30 ̊ was found to be the reliable ones. Conclusion: Based on these findings, it can be deduced that there would be a high risk of further atherosclerosis when the first stenose has the maximum percentage.

  20. Factors Associated with Early Adverse Events after Coronary Artery Bypass Grafting Subsequent to Percutaneous Coronary Intervention

    OpenAIRE

    Kamal, Yasser Ali; Mubarak, Yasser Shaban; Alshorbagy, Ashraf Ali

    2016-01-01

    Background A previous percutaneous coronary intervention (PCI) may affect the outcomes of patients who undergo coronary artery bypass grafting (CABG). The objective of this study was to compare the early in-hospital postoperative outcomes between patients who underwent CABG with or without previous PCI. Methods The present study included 160 patients who underwent isolated elective on-pump CABG at the department of cardiothoracic surgery, Minia University Hospital from January 2010 to Decembe...

  1. Severity of coronary artery disease in obese patients undergoing coronary angiography

    International Nuclear Information System (INIS)

    Objective: To assess the relationship of severity of coronary artery disease with obesity in patients undergoing coronary angiography. Design: Cross sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology - National Institute of Heart Diseases (AFIC-NIHD), 1st February 2010 to 31st August 2010 Patients and Methods: The study population included 468 patients undergoing coronary angiography. Obesity was classified according to the BMI using the National Institutes of Health (NIH) criteria as normal (BMI 21-24 kg/m2), overweight (BMI 25-29 kg/m2), obesity class I (BMI 30-34 kg/m2), obesity class II (BMI 35 to 39 kg/m2 and obesity class III (BMI 40 or above kg/m2). Coronary angiography data were obtained from the Siemens Queries software system, which maintains the database including detailed angiographic findings of all patients at this institution. Significant lesions were defined as those with >70% diameter narrowing of coronary arteries (>50% for the left main coronary artery). We attempted to quantify the 'severity of CAD' by ascertaining the prevalence of High-Risk Coronary Anatomy (HRCA). Results: Insignificant difference was observed in traditional risk factors i.e. age, diabetes mellitus and smoking except hypertension and gender. Statistically significantly low prevalence of HRCA was encountered in the obese group (57.7%) as compared to normal/overweight group (75.8%) (p < 0.05). Conclusion: We conclude that obesity is associated with less severe coronary artery disease. (author)

  2. Percutaneous Coronary Intervention in Single Coronary Artery from Right Sinus: Radial Route is Right

    OpenAIRE

    Rakesh Mahla; Himanshu Mahla; Dinesh Choudhary; Pintu Nahata

    2015-01-01

    We present percutaneous coronary intervention (PCI) using radial approach in a rare case of single coronary artery originating from the right sinus. Although these anomalies and stenosis of anomalous vessels have been described previously, treatment of atherosclerotic lesions by PCI has rarely been reported. There is a definite procedural risk during PCI in patients with a single ostium because dissection with the guiding catheter would result in a catastrophic event. Additionally, technical ...

  3. Effect of Percutaneous Coronary Intervention on Left Ventricular Diastolic Function in Patients With Coronary Artery Disease

    OpenAIRE

    Salehi, Nahid; Saidi, Mohammadreza; Rai, Alireza; Najafi, Farid; Javeedannejad, Seedmokhtar; Babanejad, Mehran; Tadbiri, Hooman

    2015-01-01

    Background: There is considerable disagreement over the effects of percutaneous coronary intervention (PCI) on left ventricular diastolic function that has necessitated the investigation of diastolic indices. The present study was conducted to evaluate left ventricular diastolic function and its indices, three months after performing the PCI procedure in patients with coronary artery disease (CAD). Methods: In a quasi-experimental clinical trial study (before and after), 51 patients with CAD ...

  4. Matrix Gla Protein polymorphisms are associated with coronary artery calcification

    Science.gov (United States)

    Matrix Gla Protein (MGP) is a key regulator of vascular calcification. Genetic variation at the MGP locus could modulate the development of coronary artery calcification (CAC). We examined the cross-sectional association between MGP SNPs [rs1800802 (T-138C), rs1800801 (G-7A),and rs4236 (Ala102Thr)...

  5. Diagnosis of coronary artery disease with dobutamine-stress MRI

    NARCIS (Netherlands)

    Kuijpers, D

    2005-01-01

    Dobutamine-stress cardiovascular magnetic resonance (CMR) is a new diagnostic tool for the non-invasive detection of coronary artery disease. Technological advances in CMR have evolved this technique to an adequate alternative to the standard cardiac stress tests. Its high reproducibility and excell

  6. Hepatitis C virus infection and risk of coronary artery disease

    DEFF Research Database (Denmark)

    Roed, Torsten; Lebech, Anne-Mette; Kjaer, Andreas;

    2012-01-01

    Several chronic infections have been associated with cardiovascular diseases, including Chlamydia pneumoniae, human immunodeficiency virus and viral hepatitis. This review evaluates the literature on the association between chronic hepatitis C virus (HCV) infection and the risk of coronary artery...... disease (CAD)....

  7. Biocompatibility of phosphorylcholine coated stents in normal porcine coronary arteries

    NARCIS (Netherlands)

    D.M. Whelan (Deirdre); S.C. Krabbendam; P.D. Verdouw (Pieter); P.W.J.C. Serruys (Patrick); E.A. van Vliet (Erwin); W.J. van der Giessen (Wim); H.M.M. van Beusekom (Heleen)

    2000-01-01

    textabstractOBJECTIVE: To improve the biocompatibility of stents using a phosphorylcholine coated stent as a form of biomimicry. INTERVENTIONS: Implantation of phosphorylcholine coated (n = 20) and non-coated (n = 21) stents was performed in the coronary arteries of 25 pigs. The an

  8. Coronary Artery Disease: from Atherosclerosis to Cardiogenic Shock

    NARCIS (Netherlands)

    J.M. Cheng (Jin Ming)

    2015-01-01

    markdownabstract__Abstract__ The aim of this thesis is twofold: 1. to investigate the prognostic value of intracoronary imaging and blood biomarkers in patients with coronary artery disease; 2. to improve risk prediction and management of patients with cardiogenic shock from acute myocardial infarc

  9. Fabric heart retractor for coronary artery bypass operations.

    Science.gov (United States)

    Kazama, S; Ishihara, A

    1993-06-01

    A new device for heart retraction during coronary artery bypass operations has been developed. It provides safe and steady support and an unobstructed view of the lateral, posterior, and inferior surfaces of the heart; in addition, it is easy to handle.

  10. Challenges in predicting the need for coronary artery bypass grafting at presentation in patients with non-ST-segment elevation acute coronary syndromes.

    Science.gov (United States)

    Mehta, Rajendra H; Chen, Anita Y; Pollack, Charles V; Roe, Matthew T; Zalenski, Robert J; Clements, Elizabeth A; Gibler, W Brian; Ohman, E Magnus; Harrington, Robert A; Peterson, Eric D

    2006-09-01

    In the case of non-ST-segment elevation acute coronary syndromes (NSTE-ACSs), the acute use of certain antiplatelet agents is complicated by concerns about perioperative bleeding risks in patients requiring coronary artery bypass grafting (CABG) during the index hospitalization. As a result, clinicians often withhold potentially useful agents, such as clopidogrel, before determining patients' coronary anatomy. An accurate predictive model could allow for a better balance of this safety concern with the demonstrated benefits of agents such as clopidogrel. To create an accurate decision-making tool that would assess, at hospital presentation, the need for CABG in patients with NSTE-ACSs, we studied 61,974 high-risk patients with NSTE-ACS admitted to 311 CABG-capable hospitals participating in Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) from 2001 to 2003. A total of 8,395 patients (14%) underwent CABG during their initial hospital stay. A multivariate model was developed and identified 13 presenting clinical characteristics significantly associated with the likelihood of CABG (previous CABG, male gender, previous heart failure, diabetes, hyperlipidemia, renal insufficiency, ST depression and transient ST elevation, age > or = 75 years, previous percutaneous coronary intervention, family history of coronary artery disease, hypertension, trends in CABG rates, and previous stroke). This model had only modest predictive accuracy and calibration (c-index = 0.67). In conclusion, although certain presenting clinical features are associated with an increased likelihood of CABG in patients with NSTE-ACSs during the index hospitalization, it remains difficult to reliably identify, before diagnostic angiography, those who will subsequently undergo surgical revascularization. PMID:16923449

  11. Spontaneous coronary artery dissection in a young man - Case report

    Directory of Open Access Journals (Sweden)

    Auer Johann

    2011-03-01

    Full Text Available Abstract A 31 year old man with a 17-year-history of drug abuse (heroine and cannabis was admitted with recurrent chest pain over a period of about three weeks. Chest discomfort severely worsened during the 5 hours before hospital admission. Electrocardiography revealed poor R-wave progression and non specific repolarization abnormalities. Echocardiography showed extensive left ventricular anterior and apical wall motion abnormalities and a ventricular thrombus located at the apex of the left ventricle was present. Subsequently, a diagnosis of acute coronary syndrome was made. Coronary angiography revealed spontaneous coronary artery dissection of the left anterior descending (LAD artery with Thrombolysis In Myocardial Infarction (TIMI flow 2 to 3. We managed the patient conservatively. The clinical course was uneventful and repeated angiography on day 4 demonstrated spontaneous healing of large parts of the dissection with TIMI 3 flow in the LAD.

  12. Giant saccular aneurysm of the left main coronary artery

    Institute of Scientific and Technical Information of China (English)

    Esref Tuncer; Ugur Onsel Turk; Emin Alioglu

    2013-01-01

    uniform definition of this pathology. Aneurysms of the left main coronary artery (LMCA) are extremely uncommon, with an incidence of 0.1%. It has been demonstrated that atherosclerosis is the main cause of these anomalies in adults, and Kawasaki disease in children and adolescents. Other causes include connective tissue disorders, trauma, vasculitis, congenital, mycotic, and idiopathic. These dilated sections of the coronary artery are not benign pathology because they are subject to spasm, thrombosis, and subsequent distal embolism, spontaneous dissection and rupture. Treatment options include anticoagulation, custom-made covered stents, reconstruction, resection, and exclusion with bypass. Our report on an old case illustrates the giant saccular LMCA aneurysm leading to myocardial ischemia due to coronary steal phenomenon.

  13. Pathophysiology of coronary artery disease leading to acute coronary syndromes

    OpenAIRE

    Ambrose, John A; Singh, Manmeet

    2015-01-01

    Acute myocardial infarction (AMI) and sudden cardiac death (SCD) are among the most serious and catastrophic of acute cardiac disorders, accounting for hundreds of thousands of deaths each year worldwide. Although the incidence of AMI has been decreasing in the US according to the American Heart Association, heart disease is still the leading cause of mortality in adults. In most cases of AMI and in a majority of cases of SCD, the underlying pathology is acute intraluminal coronary thrombus f...

  14. An unusual combination of myocardial bridging and coronary artery aneurysm identified on 64-detector coronary angiography.

    Science.gov (United States)

    Meraj, Perwaiz M; Makaryus, Amgad N; Boxt, Lawrence M

    2007-10-01

    Coronary artery aneurysm is an uncommon finding. It is defined as a dilated coronary artery which exceeds the diameter of the normal adjacent vessel by 1.5-2 times. Although theorized mechanisms include atherosclerotic coronary artery disease (CAD) and iatrogenic causes such as the use of percutaneous coronary interventions (PCI), the natural history and prognosis of this disease remain obscure. We describe a case of a 75 year old man who was found to have a long segmental myocardial bridge immediately followed by a 5 mm inner diameter aneurysm in the left anterior descending artery (LAD) detected on 64-detector cardiac computed tomography (64-CT). The post myocardial bridge aneurysmal dilatation in this case is unique, and has not been previously described. With the advent of 64-CT, more incidental cardiac anomalies and irregularities are likely to be found. In the end, the question as to the clinical significance of these findings and their treatment remains controversial. We report this novel case and review the literature for recommendations on treatment and management of patients with coronary aneurysms. PMID:17043905

  15. Coronary angiography and pathogenesis of coronary artery disease in young male survivors of myocardial infarction

    Energy Technology Data Exchange (ETDEWEB)

    Szamosi, A.; Hamsten, A.; Walldius, G.; Faire, U. de

    Coronary angiography was performed 3 to 6 months after myocardial infarction in 107 males below the age of 45 (mean age 39.7+-3.9, range 23-44 years). The coronary angiograms were allocated to various groups according to the presence or absence of obvious atheromatous changes. Metabolic evaluation included determination of cholesterol and triglyceride concentrations in the major serum lipoproteins. Marked elevation of low density lipoprotein (LDL) cholesterol concentration was found in patients with angiographic evidence of atheromatosis, in contrast to patients with normal coronary angiograms or with single occlusion and no other abnormalities. Thus, there was a correlation between angiographic appearance of the coronary arteries and disturbances of LDL metabolism. It is proposed that coronary angiography may distinguish between atheromatous and nonatheromatous pathogenesis of myocardial infarction at young age.

  16. Acute Coronary Syndrome Due to Spontaneous Coronary Artery Dissection in a Middle-Aged Man

    Directory of Open Access Journals (Sweden)

    Davran Cicek

    2014-08-01

    Full Text Available True spontaneous coronary artery dissection (SCAD is an extremely rare but important cause of acute coronary syndrome, with only about 200 cases reported in the literature. Diagnosis is often made at autopsy. Risk factors include oral contraceptive use, atherosclerotic disease and the peripartum period. SCAD should be considered when a healthy young patient presents with the onset of acute myocardial ischemic syndrome. A timely diagnosis and intervention are mandatory as SCAD can cause sudden death. We present a case of SCAD with an uncommon clinical presentation of acute coronary syndrome and without identifiable risk factors, and successfully treated with non-invasive (medical therapy.

  17. Rate of Urgent Coronary Artery Bypass Grafting in Elective Percutaneous Coronary Intervention (PCI)

    OpenAIRE

    Yonos Nozari; Seyed Amir Kassaei

    2008-01-01

    Background: Latest research shows that about 0.5% of percutaneous coronary intervention (PCI) patients will need urgent coronary artery bypass grafting (CABG) because of coronary accidents. The ACC/AHA guidelines regard on-site cardiac surgery back-up obligatory for PCI centers. It seems the need for urgent CABG in some Iranian PCI centers is less than 0.5%, which may affect decision-making for performing PCI without on-site surgical back-up in the same condition in Iran.Methods: This retrosp...

  18. YKL-40 a new biomarker in patients with acute coronary syndrome or stable coronary artery disease

    DEFF Research Database (Denmark)

    Wang, Y.Z.; Ripa, R.S.; Johansen, J.S.;

    2008-01-01

    Background. YKL-40 is involved in remodelling and angiogenesis in non-cardiac inflammatory diseases. Aim was to quantitate plasma YKL-40 in patients with ST-elevation myocardial infarction (STEMI) or stable chronic coronary artery disease (CAD), and YKL-40 gene activation in human myocardium....... Methods and results. We included 73 patients: I) 20 patients with STEMI; II) 28 patients with stable CAD; III) 15 CAD patients referred for coronary by-pass surgery. YKL-40 mRNA expression was measured in myocardium subtended by stenotic or occluded arteries and areas with no apparent disease; and IV) 10...

  19. Prevalence of Congenital Coronary Artery Anomalies and Variants in 2697 Consecutive Patients Using 64-Detector Row Coronary CTAngiography

    International Nuclear Information System (INIS)

    Coronary artery anomalies are not common, but could be very serious. This study determines the frequency of coronary anomalies and normal variants by multi-detector-row computed tomography (MDCT). The results of cardiac MDCT study in 2697 consecutive patients were analyzed retrospectively. Acquisition was performed by a 64-detector row CT machine. Imaging results were assessed by experienced radiologists. Myocardial bridging was by far the most frequent coronary variant (n = 576, 21.3%). Eighty-three subjects (3.1%) showed other coronary anomalies and variants. Anomalies of origination and course of the left main coronary artery (LMCA) were detected in 1.09% of the subjects. The frequency of these anomalies in the right coronary artery (RCA), left circumflex artery (LCx), left anterior descending artery (LAD), posterior descending artery (PDA) and obtuse marginal (OM) artery were 1.24%, 0.33%, 0.1%, 0.07% and 0.03%, respectively. The single coronary pattern was seen in 0.18% and coronary fistulas in 0.07%. Based on the fact that coronary CT-angiography using MDCT can display different coronary anomalies, this study shows similar results to other reports on the subject. Future advances in the performance of CT machines will further improve the quality of CT-based cardiac imaging

  20. Minimally invasive coronary artery bypass grafting: initial Connecticut experience.

    Science.gov (United States)

    Tellides, G; Maragh, M R; Smith, J M; Kopf, G S; Ezekowitz, M; Remetz, M; Elefteriades, J A

    1997-03-01

    We report the initial Connecticut experience with minimally invasive coronary artery bypass grafting. This procedure allows bypass grafting to the left anterior descending coronary artery utilizing the internal mammary artery as the conduit. The procedure is minimally invasive because it is performed through a mini-thoracotomy incision in the fourth anterior intercostal space and it is conducted without the use of cardiopulmonary bypass. The procedure has been applied to 13 patients operated between February and October 1996. All but one patient selected were poor candidates for conventional coronary artery bypass surgery because of advanced age (6), chronic renal failure/dialysis/kidney transplant (4), redo status with vulnerable grafts (1), severe peripheral vascular disease (6), severe chronic obstructive pulmonary disease (4). All patients survived operation and were discharged in good condition. Mean postoperative intubation time was seven hours and mean hospital stay was 4.5 days despite the very high pre-existing comorbidity of these patients. All patients are alive at the current follow-up time. Two patients required a conventional bypass procedure for occlusion of the minimally invasive graft, the first because of diffuse disease in the target artery and the second attributable to the technical limitations of minimally invasive coronary artery bypass grafting; both tolerated the subsequent procedure well. All patients are now angina-free. All four grafts studied by routine postoperative angiography were widely patent. Routine post-operative exercise nuclear imaging was normal in an additional patient. This procedure of minimally invasive coronary artery bypass grafting offers significant advantages compared to the conventional bypass procedure (short hospital stay, quick recovery, and, especially, avoidance of cerebrovascular accidents caused by the heart-lung machine). This minimally invasive procedure is expected to apply to a growing percentage of

  1. Rationale and design of the Leipzig (LIFE Heart Study: phenotyping and cardiovascular characteristics of patients with coronary artery disease.

    Directory of Open Access Journals (Sweden)

    Frank Beutner

    Full Text Available OBJECTIVE: We established the Leipzig (LIFE Heart Study, a biobank and database of patients with different stages of coronary artery disease (CAD for studies of clinical, metabolic, cellular and genetic factors of cardiovascular diseases. DESIGN: The Leipzig (LIFE Heart Study (NCT00497887 is an ongoing observational angiographic study including subjects with different entities of CAD. Cohort 1, patients undergoing first-time diagnostic coronary angiography due to suspected stable CAD with previously untreated coronary arteries. Cohort 2, patients with acute myocardial infarction (MI requiring percutaneous revascularization. Cohort 3, patients with known left main coronary artery disease (LMCAD. RESULTS: We present preliminary results of demographics and phenotyping based on a 4-years analysis of a total of 3,165 subjects. Cohort 1 (n=2,274 shows the typical distribution of elective coronary angiography cohorts with 43% cases with obstructive CAD and 37% normal angiograms. Cohorts 2 and 3 consist of 590 and 301 subjects, respectively, adding patients with severe forms of CAD. The suitability of the database and biobank to perform association studies was confirmed by replication of the CAD susceptibility locus on chromosome 9p21 (OR per allele: 1.55 (any CAD, 1.54 (MI, 1.74 (LMCAD, p<10(-6, respectively. A novel finding was that patients with LMCAD had a stronger association with 9p21 than patients with obstructive CAD without LMCAD (OR 1.22, p=0.042. In contrast, 9p21 did not associate with myocardial infarction in excess of stable CAD. CONCLUSION: The Leipzig (LIFE Heart Study provides a basis to identify molecular targets related to atherogenesis and associated metabolic disorders. The study may contribute to an improvement of individual prediction, prevention, and treatment of CAD.

  2. Detection of coronary artery disease by thallium scintigraphy in patients with valvar heart disease.

    OpenAIRE

    Huikuri, H V; Korhonen, U R; Heikkilä, J; Takkunen, J T

    1986-01-01

    In patients with valvar heart disease detection of coronary artery disease by conventional non-invasive methods may be difficult. The usefulness of thallium-201 exercise scintigraphy for detecting coronary artery disease was evaluated in 16 patients with aortic stenosis, 17 with aortic regurgitation, nine with mitral stenosis, and six with mitral regurgitation who were investigated by coronary angiography. Only two of 21 patients with greater than or equal to 50% coronary artery obstruction h...

  3. Role of coronary physiology in the contemporary management of coronary artery disease.

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-02-16

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications. PMID:25685761

  4. Role of coronary physiology in the contemporary management of coronary artery disease.

    Science.gov (United States)

    Ruparelia, Neil; Kharbanda, Rajesh K

    2015-02-16

    Coronary artery disease (CAD) remains the leading cause of death worldwide with approximately 1 in 30 patients with stable CAD experiencing death or acute myocardial infarction each year. The presence and extent of resultant myocardial ischaemia has been shown to confer an increased risk of adverse outcomes. Whilst, optimal medical therapy (OMT) forms the cornerstone of the management of patients with stable CAD, a significant number of patients present with ischaemia refractory to OMT. Historically coronary angiography alone has been used to determine coronary lesion severity in both stable and acute settings. It is increasingly clear that this approach fails to accurately identify the haemodynamic significance of lesions; especially those that are visually "intermediate" in severity. Revascularisation based upon angiographic appearances alone may not reduce coronary events above OMT. Technological advances have enabled the measurement of physiological indices including the fractional flow reserve, the index of microcirculatory resistance and the coronary flow reserve. The integration of these parameters into the routine management of patients presenting to the cardiac catheterization laboratory with CAD represents a critical adjunctive tool in the optimal management of these patients by identifying patients that would most benefit from revascularisation and importantly also highlighting patients that would not gain benefit and therefore reducing the likelihood of adverse outcomes associated with coronary revascularisation. Furthermore, these techniques are applicable to a broad range of patients including those with left main stem disease, proximal coronary disease, diabetes mellitus, previous percutaneous coronary intervention and with previous coronary artery bypass grafting. This review will discuss current concepts relevant to coronary physiology assessment, its role in the management of both stable and acute patients and future applications.

  5. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... and we also like that aspect of this new type of surgery. The internal mammary artery is ... when it’s needed. Internal mammary artery. That’s a new word. That’s a new word, huh? Naked or ...

  6. Acute Stroke and Obstruction of the Extracranial Carotid Artery Combined with Intracranial Tandem Occlusion: Results of Interventional Revascularization

    Energy Technology Data Exchange (ETDEWEB)

    Lescher, Stephanie, E-mail: stephanie.lescher@kgu.de; Czeppan, Katja; Porto, Luciana [Hospital of Goethe University, Institute of Neuroradiology (Germany); Singer, Oliver C. [Hospital of Goethe University, Department of Neurology (Germany); Berkefeld, Joachim [Hospital of Goethe University, Institute of Neuroradiology (Germany)

    2015-04-15

    PurposeDue to high thrombus load, acute stroke patients with tandem obstructions of the extra- and intracranial carotid arteries or the middle cerebral artery show a very limited response to systemic thrombolysis. Interventional treatment with mechanical thrombectomy—often in combination with acute stenting of underlying atherosclerotic stenosis or dissection—is increasingly used. It has been shown that such complex interventions are technically feasible. The lack of optimal management strategies and clinical data encouraged us to review our acute stroke interventions in patient with anterior circulation tandem lesions to determine lesion patterns, interventional approaches, and angiographic or clinical outcomes.Patients and MethodsWe retrospectively analyzed a series of 39 consecutive patients with intracranial vessel occlusion of the anterior circulation simultaneously presenting with high-grade cervical internal carotid artery (ICA) stenosis or occlusion.ResultsEmergency ICA stent implantation was technically feasible in all patients, and intracranial recanalization with TICI ≥ 2b was reached in a large number of patients (64 %). Good clinical outcomes (mRS ≤ 2 at 3 months) were achieved in one third of the patients (36 %). Symptomatic hemorrhages occurred in four patients (10 %). Mortality was 10 %.ConclusionEndovascular recanalization of acute cervical carotid artery occlusion was technically feasible in all patients, and resulted in high extra- and intracranial revascularization rates. A trend for favorable clinical outcome was seen in a higher TICI score, younger age, good collateral status, and combined IV rTPA and endovascular therapy.

  7. Spontaneous coronary artery dissection in men presenting with acute coronary syndrome, successfully managed by intravascular ultrasound-guided percutaneous coronary intervention

    OpenAIRE

    Thomas, Bethan Nia; Aslam, Sajid; Cullen, James; Anantharaman, Rajaram

    2014-01-01

    Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. It is most commonly seen in young women, without atherosclerosis, in the peripartum period. Management options include conservative medical treatment, percutaneous coronary intervention or a surgical approach depending on the presentation, extent of dissection and luminal stenosis. We describe three unusual cases of spontaneous coronary artery dissection occurring in young/middle-aged men—the first in associati...

  8. Non-invasive imaging for subclinical coronary atherosclerosis in patients with peripheral artery disease

    DEFF Research Database (Denmark)

    Ripa, Rasmus Sejersten; Kjaer, Andreas; Hesse, Birger

    2014-01-01

    Patients with peripheral artery disease are at high risk of coronary artery disease. An increasing number of studies show that a large proportion of patients with peripheral artery disease have significant coronary atherosclerosis, even in the absence of symptoms. Although the reported prevalence...... of subclinical coronary artery disease varies widely in patients with peripheral artery disease, it could include more than half of patients. No consensus exists to date on either the rationale for screening patients with peripheral artery disease for coronary atherosclerosis or the optimal algorithm and method...

  9. What Is the Best Proximal Anastomosis for the Free Right Internal Thoracic Artery during Bilateral Internal Thoracic Artery Revascularization? A Prospective, Randomized Study

    Directory of Open Access Journals (Sweden)

    S. Neragi-Miandoab

    2014-01-01

    Full Text Available Objective. Bilateral internal thoracic artery (BITA grafting provides improved graft patency and potential survival advantage in selected patients as compared to single left internal thoracic artery (LITA revascularization. The ideal functional BITA configuration remains controversial. Methods. Patients undergoing planned BITA revascularization with greater than 75% stenosis in both the left anterior descending artery (LAD and in a circumflex branch were prospectively randomized to one of two proximal free right internal thoracic artery (RITA connections directly off the aorta (Ao (n=12 or as a “t” graft off the LITA (t (n=12. The LITA was placed to the LAD in all cases, and the RITA was placed to a single lateral wall vessel. Intraoperative transit time flow measurements of all arterial grafts were performed, and RITA fractional flow parameters were compared between the 2 groups. Results. There were no differences in preoperative patient variables between the two groups. Cross-clamp times (91.5+15.3 versus 68.0+12.5 minutes, P<0.01 and total cardiopulmonary bypass times (109.0+16.2 versus 85.0+15.1 minutes, P<0.01 were shorter in the t group. The Ao group demonstrated significantly higher mean RITA flow (38.3±13.5 versus 22.1±9.5, P<0.01, mean RITA conductance (flow/mean arterial pressure (0.45±0.16 versus 0.28±0.11, P<0.01, RITA fractional flow (0.52 ± 0.15 versus 0.36 ± 0.11, P<0.01, and RITA fractional conductance (0.51 ± 0.15 versus 0.36 ± 0.11, P<0.01 than the “t” grafted patients. Thirty-day mortality and wound infection were 0% for each group. Over an average of 42.8+6.6 months of followup there were no mortalities in either group. Repeat angiography were performed in 4 patients (33% in the Ao group and 2 patients in the t group (16%. One occluded RITA graft and one ostial RITA stenosis were detected in the Ao group. Conclusions. Acute flow measurements indicate that the free RITA anastomosed to the aorta

  10. Intracranial cerebral artery stenosis with associated coronary artery and extracranial carotid artery stenosis in Turkish patients

    Energy Technology Data Exchange (ETDEWEB)

    Alkan, Ozlem [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey)], E-mail: yalinozlem@hotmail.com; Kizilkilic, Osman; Yildirim, Tulin [Department of Radiology, Baskent University, Faculty of Medicine, Ankara (Turkey); Atalay, Hakan [Department of Cardiovascular Surgery, Baskent University, Faculty of Medicine, Ankara (Turkey)

    2009-09-15

    Purpose: Although it has been demonstrated that there is a high prevalence of extracranial carotid artery stenosis (ECAS) in patients with severe coronary artery disease, intracranial cerebral artery stenosis (ICAS) is rarely mentioned. We evaluated the prevalence of ICAS in patients with ECAS having elective coronary artery bypass grafting (CABG) surgery to determine the relations between ICAS, ECAS and atherosclerotic risk factors. Methods: We retrospectively reviewed the digital subtraction angiography findings of 183 patients with ECAS {>=} 50% preparing for CABG surgery. The analyses focused on the intracranial or extracranial location and degree of the stenosis. The degree of extracranial stenoses were categorized as normal, <50%, 50-69%, 70-89%, and 90-99% stenosis and occluded. The degree of intracranial stenosis was classified as normal or {<=}25%, 25-49%, and {>=}50% stenosis and occluded. Traditional atherosclerotic risk factors were recorded. Results: ECAS < 70% in 42 patients and ECAS {>=} 70% in 141 patients. ICAS was found in 51 patients and ICAS {>=} 50% in 30 patients. Regarding risk factors, we found hypertension in 135 patients, diabetes mellitus in 91 patients, hyperlipidemia in 84 patients, and smoking in 81 patients. No risk factor was significant predictors of intracranial atherosclerosis. The severity of ICAS was not significantly associated with that of the ECAS. Conclusions: We found ICAS in 27.8% of the patients with ECAS > 50% on digital subtraction angiography preparing for CABG. Therefore a complete evaluation of the neck vessels with magnetic resonance or catheter angiography seems to be indicated as well as intracranial circulation for the risk assessment of CABG.

  11. Ivabradine in stable coronary artery disease without clinical heart failure

    DEFF Research Database (Denmark)

    Fox, Kim; Ford, Ian; Steg, Philippe Gabriel;

    2014-01-01

    BACKGROUND: An elevated heart rate is an established marker of cardiovascular risk. Previous analyses have suggested that ivabradine, a heart-rate-reducing agent, may improve outcomes in patients with stable coronary artery disease, left ventricular dysfunction, and a heart rate of 70 beats per...... minute or more. METHODS: We conducted a randomized, double-blind, placebo-controlled trial of ivabradine, added to standard background therapy, in 19,102 patients who had both stable coronary artery disease without clinical heart failure and a heart rate of 70 beats per minute or more (including 12...... without activity-limiting angina (P=0.02 for interaction). The incidence of bradycardia was higher with ivabradine than with placebo (18.0% vs. 2.3%, Pcoronary artery disease without clinical heart failure, the addition of ivabradine to standard...

  12. Gender Differences in In-Hospital Outcomes After Coronary Artery Bypass Grafting.

    Science.gov (United States)

    Swaminathan, Rajesh V; Feldman, Dmitriy N; Pashun, Raymond A; Patil, Rupa K; Shah, Tara; Geleris, Joshua D; Wong, Shing-Chiu; Girardi, Leonard N; Gaudino, Mario; Minutello, Robert M; Singh, Harsimran S; Bergman, Geoffrey; Kim, Luke K

    2016-08-01

    Women historically have a greater risk of operative mortality than men after coronary artery bypass grafting (CABG). There is paucity of contemporary data in gender outcomes of surgical revascularization and understanding modifiable factors that contribute to gender differences are critical for quality improvement and practice change. We, therefore, sought to examine whether the gender gap in CABG outcomes is closing in the contemporary era by conducting a retrospective analysis from the Nationwide Inpatient Sample database from 2003 to 2012. We included all patients who underwent isolated CABG surgery (n = 2,272,998; female n = 623,423 [27.4%]; male n = 1,649,575 [72.6%]). The annual rate of CABG surgeries decreased by 53.7% in men and 57.8% in women over the 10-year study period. Although internal mammary artery use in women was less frequent than in men in 2003 (77.4% vs 81.9%, p gap by 2012 (86.2% vs 87.0%, ptrend 0.003). Overall, unadjusted in-hospital mortality was greater in women (3.2% vs 1.8%, p gap is slowly closing. PMID:27269585

  13. Primary stenting of an anomalous left main coronary artery originating from the right sinus of Valsalva during acute myocardial infarction

    OpenAIRE

    Gökhan Çiçek; Servet Altay; Seçkin Satılmış; Zekeriya Nurkalem

    2015-01-01

    Anomalous origin of left and right coronary arteries from a single coronary ostium in the right sinus of Valsalva is rare. Previously, few reports have described percutaneous coronary interventions (PCI) in this anomaly. We report a case of a 78-year-old female who had acute inferior myocardial infarction with a severe lesion in the anomalous left main coronary artery (LMCA) arising from a single ostium in the right sinus of Valsalva.Key words: Coronary artery anomaly, single coronary artery,...

  14. Peripheral artery disease in korean patients undergoing percutaneous coronary intervention: prevalence and association with coronary artery disease severity.

    Science.gov (United States)

    Kim, Eun Kyoung; Song, Pil Sang; Yang, Jeong Hoon; Song, Young Bin; Hahn, Joo-Yong; Choi, Jin-Ho; Gwon, Hyeon-Cheol; Lee, Sang Hoon; Hong, Kyung Pyo; Park, Jeong Euy; Kim, Duk-kyung; Choi, Seung-Hyuk

    2013-01-01

    Peripheral artery disease (PAD) is an important marker for the risk stratification of patients with coronary artery disease (CAD). We investigated the prevalence of PAD in patients undergoing percutaneous coronary intervention (PCI) with CAD and the relationship between ankle-brachial pressure index (ABPI) and CAD severity. A total of 711 patients undergoing PCI for CAD from August 2009 to August 2011 were enrolled. PAD diagnosis was made using the ABPI. The prevalence of PAD was 12.8%. In PAD patients, mean values of right and left ABPI were 0.71 ± 0.15 and 0.73 ± 0.15. Patients with PAD had a higher prevalence of left main coronary disease (14.3% vs 5.8%, P = 0.003), more frequently had multivessel lesions (74.9% vs 52.1%, P ABPI-based PAD screening should be implemented in all patients undergoing PCI with CAD, especially in severe cases. PMID:23341717

  15. Study of Percutaneous Coronary Intervention in Patient with Coronary Artery Disease at Tertiary Care Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Virendra C. Patil

    2015-10-01

    Full Text Available Background: The interventional treatment option for the coronary artery disease has recently gained popularity. This study was intended to elaborate Percutaneous Coronary Intervention (PCI and coronary angiographic profile in patients with coronary artery disease. Material & Methods: This was a retrospective study conducted over one year period. The patients with significant Coronary Artery Disease (CAD by angiogram were included in this study. The p value < 0.05 was considered as statistically significant. Results: Total 135 patients with CAD were enrolled with mean age of 59.65±10.32. Total 59.24% of males and 40.74% of females underwent Percutaneous Transluminal Coronary Angioplasty (PTCA (p=0.00234. Total 67.40% of patients had hypertension, 48.75% of male patients had history of tobacco consumption, 27.5% of males and 21.81% of females had Type 2 Diabetes Mellitus (T2DM, 58.75% of males and 43.63% of females had dyslipidemia, 33.75% of males and 23.63% of females had obesity, 33.75% of males and 30.90% of females had metabolic syndrome. Total 41.25% of males and 45.45% of females had affection of Left Anterior Descending (LAD (p=0.0207, 18.75% of males and 20% of females had Left Circumflex (LCx lesion or Right Coronary Artery (RCA. Total 10% of males and 9.09% of females had LAD and LCX lesion. Total 7.5% of males and 9% of females had affection of LAD+ RCA. Among 22.5% of males and 16.36% of females received bare metal stents and 77.5% of males and 83.62% of females received drug eluting stents. The case fatality rate was 1.41%. Conclusions: Study highlights the burden of modifiable coronary artery disease risk factors like, hypertension, obesity and metabolic syndrome undergoing PTCA. Male patients outnumbered with most common coronary artery lesion being LAD. Our findings suggest that favorable outcomes, matching the international data can be achieved in a rural hospital setting.

  16. Diagnostic Accuracy of Coronary Calcium Score Less than 100 in Excluding Coronary Artery Disease

    Science.gov (United States)

    Hanifehpour, Reza; Motevalli, Marzieh; Ghanaati, Hossein; Shahriari, Mona; Aliyari Ghasabeh, Mounes

    2016-01-01

    Background Coronary artery calcium score (CACS) is a quantitative assessment of calcifications and an established predictor of cardiovascular events. Objectives In this study, we evaluated the diagnostic accuracy, negative predictive value (NPV), positive predictive value (PPV), specificity and sensitivity of CACS less than 100 in predicting significant coronary artery stenosis in patients with risk of coronary artery disease (CAD) in a vessel-based analysis. Patients and Methods A cross sectional study was carried out on a study population of 2527 consecutive stable patients with symptoms suggestive of CAD who were referred for coronary computed tomographic angiography (CCTA). We performed 1343 studies with 256 slice machine in Shahid Rajaee hospital and the other studies were carried out with 64 slice machine in Imam Khomeini hospital and the calcium score was quantified according to the Agatston method. Results At the cutoff point of 100 for coronary calcium scoring, there was high specificity (87%), high sensitivity (79%), high efficiency (84%), high PPV (79%), and high NPV (87%) in the diagnosis of significant stenosis in the whole heart. The frequency of zero calcium scoring was 59% in normal or nonsignificant stenosis and 7.6% in significant stenosis in the whole heart. Calcium scoring increased with greater severity of the arterial stenosis (P values management of patients. In CACS less than 100, it has a NPV of 87% in excluding significant stenosis in patients with the risk of CAD but it does not have enough diagnostic accuracy for surely excluding coronary stenosis, so we should perform a combination of CACS and coronary CT angiography for patients.

  17. ANALYSIS OF 312 CASES OF REPEAT CORONARY ARTERY BYPASS GRAFTING

    Institute of Scientific and Technical Information of China (English)

    陈长志; 陆佩中

    2003-01-01

    Objective To evaluate repeat coronary artery bypass grafting (CABG) in 312 patients.Methods The data of 312 patients (average age 65±9 years) who had CABG operation in Hartford hospital were collected and analyzed. The mean duration follow up after the first CABG was 11.8±4.5 years. A total of 1069 bypass grafts were performed. Among them, 386 were arterial grafts such as internal mammary artery, radial artery and gastroepiploic artery; 682 were venous grafts and 1 Gore-Tex graft. Results The operative mortality was 4. 5%. Fifteen patients (4. 8%) had peri-operative myocardial infarction and 46 patients (15%) had low cardiac output syndrome. Intra-aortic balloon pump (IABP) was used in 131 patients before, during and after operation. One hundred and nineteen patients weaned off IABP and recovered. ConclusionAlthough the difficulties and risk factors were increased, the results of redo CABG were still good.

  18. Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease.

    Science.gov (United States)

    Aykan, Ahmet Çağrı; Hatem, Engin; Karabay, Can Yücel; Gül, İlker; Gökdeniz, Tayyar; Kalaycıoğlu, Ezgi; Turan, Turhan; Kara, Faruk; Arslan, Ahmet Oğuz; Dursun, İhsan; Çetin, Mustafa; Güler, Ahmet

    2015-08-01

    We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r = 0.495, p low-density lipoprotein (B = 0.114, p = 0.003, CI95% = 0.001-0.006) and high-density lipoprotein (B = -0.360, p artery disease had complex coronary artery disease.

  19. Role of TGF beta signaling in Remodeling of Non-Coronary Artery Aneurysms in Kawasaki disease /

    OpenAIRE

    Lee, Aaron Ming

    2014-01-01

    Coronary artery aneurysms remain a life-threatening complication of Kawasaki disease (KD), the most common form of pediatric acquired heart disease in developed countries (1). Potentially life-threatening coronary artery aneurysms (CAA) develop in 25% of untreated children and 5% of children treated with high dose intravenous immunoglobulin during the acute phase of the self-limited vasculitis (2). Non-coronary artery aneurysms (NCAA) in extra-parenchymal, muscular arteries occur in a minorit...

  20. Stationary digital chest tomosynthesis for coronary artery calcium scoring

    Science.gov (United States)

    Wu, Gongting; Wang, Jiong; Potuzko, Marci; Harman, Allison; Pearce, Caleb; Shan, Jing; Lee, Yueh Z.; Zhou, Otto; Lu, Jianping

    2016-03-01

    The coronary artery calcium score (CACS) measures the buildup of calcium on the coronary artery wall and has been shown to be an important predictor of the risk of coronary artery diseases (CAD). Currently CACS is measured using CT, though the relatively high cost and high radiation dose has limited its adoption as a routine screening procedure. Digital Chest Tomosynthesis (DCT), a low dose and low cost alternative to CT, and has been shown to achieve 90% of sensitivity of CT in lung disease screening. However commercial DCT requires long scanning time and cannot be adapted for high resolution gated cardiac imaging, necessary for CACS. The stationary DCT system (s- DCT), developed in our lab, has the potential to significantly shorten the scanning time and enables high resolution cardiac gated imaging. Here we report the preliminary results of using s-DCT to estimate the CACS. A phantom heart model was developed and scanned by the s-DCT system and a clinical CT in a phantom model with realistic coronary calcifications. The adapted fan-beam volume reconstruction (AFVR) method, developed specifically for stationary tomosynthesis systems, is used to obtain high resolution tomosynthesis images. A trained cardiologist segmented out the calcifications and the CACS was obtained. We observed a strong correlation between the tomosynthesis derived CACS and CT CACS (r2 = 0.88). Our results shows s-DCT imaging has the potential to estimate CACS, thus providing a possible low cost and low dose imaging protocol for screening and monitoring CAD.

  1. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... artery. Yes. Okay. And we see some fat calcium plaque here on the vessel. This part is ... ancient Greek, to make an opening between two channels. So I think we are almost ready to ...

  2. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... Artery Bypass” grafting. Let me first introduce our team here. My name is Johannes Bonatti. I’m ... the anesthesia side, Patrick Odonker, leading the anesthesia team, working with Teresa Nemitz. It is a special ...

  3. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... This usually leads us to the fifth intercostal space here on the anterior axillary node. This is ... for the peripheral arteries. Okay. Again, fifth intercostal space, anterior axillary line is where we are with ...

  4. TECAB - Totally Endoscopic Coronary Artery Bypass

    Medline Plus

    Full Text Available ... the sternum and cannulate the aorta and the right atrium. In this operation, since we are not ... exactly perpendicular to the camera port here. All right. The femoral artery will be used to give ...

  5. TECAB - Totally Endoscopic Coronary Artery Bypass

    Science.gov (United States)

    ... of the patient’s artery is, could be near occlusive, and we want to continue profusing the leg ... It’s very helpful. It’s like a pilot is training in a simulator. The postage is also very ...

  6. Oral azithromycin in extended dosage schedule for chronic, subclinical Chlamydia pneumoniae infection causing coronary artery disease: a probable cure in sight? Results of a controlled preliminary trial

    Directory of Open Access Journals (Sweden)

    Dogra J

    2012-06-01

    Full Text Available Jaideep DograPoly Clinic, Central Government Health Scheme, Jaipur, Rajasthan, IndiaPurpose: Two mega trials have raised the question as to whether the hypothesis that infection plays a role in atherosclerosis is still relevant. This controlled preliminary trial investigated an extended dose of azithromycin in the treatment of Chlamydia pneumoniae infection causing coronary artery disease (CAD.Patients and methods: Forty patients with documentary evidence of CAD were screened for immunoglobulin G titers against C. pneumoniae and grouped into either the study group (patients with positive titer, n = 32 or control group (patients with negative titer, n = 8. Cases who met inclusion criteria could not have had coronary artery bypass graft surgery or percutaneous coronary intervention in the preceding 6 months. Informed consent was obtained from every patient. Baseline blood samples were analyzed for red blood cell indices, serum creatinine, and liver function tests, and repeated every 2 months. A primary event was defined as the first occurrence of death by any cause, recurrent myocardial infarction, coronary revascularization procedure, or hospitalization for angina. Patients in the study group received 500 mg of oral azithromycin once daily for 5 days, which was then repeated after a gap of 10 days (total of 24 courses in the 1-year trial period. The control group did not have azithromycin added to their standard CAD treatment.Results: In the study group, 30 patients completed the trial. Two patients had to undergo percutaneous coronary intervention in the initial first quarter of the 1-year trial period. In the control group, one patient died during the trial, one had to undergo coronary artery bypass graft surgery, and one had percutaneous coronary intervention.Conclusion: The patients tolerated the therapy well and there was a positive correlation between azithromycin and secondary prevention of CAD.Keywords: azithromycin, Chlamydia pneumoniae

  7. Pathology of Coronary Chronic Total Occlusion

    Directory of Open Access Journals (Sweden)

    Kenichi Sakakura

    2016-06-01

    Full Text Available There is an increasing need for percutaneous revascularization procedures of coronary Chronic Total Occlusion (CTO, because many patients with severe coronary artery disease have limited options for revascularization. Although the success rate of percutaneous revascularization of CTOs was unsatisfactory from the 1990s to the 2000s, recent technological advances in interventional strategies have improved the success rate to 85%. Detailed histological assessment of human autopsy studies of CTO has contributed significantly to the refinement in Percutaneous Coronary Intervention (PCI techniques and device development. We have recently reported the pathological findings and characteristics of CTOs that occur in different clinical scenarios. In this review, we discuss the pathology of CTOs to facilitate greater understanding of revascularization strategies for CTOs.

  8. Coronary CT Angiography versus Conventional Cardiac Angiography for Therapeutic Decision Making in Patients with High Likelihood of Coronary Artery Disease

    NARCIS (Netherlands)

    Moscariello, Antonio; Vliegenthart, Rozemarijn; Schoepf, U. Joseph; Nance, John W.; Zwerner, Peter L.; Meyer, Mathias; Townsend, Jacob C.; Fernandes, Valerian; Steinberg, Daniel H.; Fink, Christian; Oudkerk, Matthijs; Bonomo, Lorenzo; O'Brien, Terrence X.; Henzler, Thomas

    2012-01-01

    Purpose: To assess the efficacy of coronary computed tomographic (CT) angiography for therapeutic decision making in patients with high likelihood of coronary artery disease (CAD)-specifically the ability of coronary CT angiography to help differentiate patients without and patients with a need for

  9. Revascularisation versus medical treatment in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Windecker, Stephan; Stortecky, Stefan; Stefanini, Giulio G;

    2014-01-01

    OBJECTIVE: To investigate whether revascularisation improves prognosis compared with medical treatment among patients with stable coronary artery disease. DESIGN: Bayesian network meta-analyses to combine direct within trial comparisons between treatments with indirect evidence from other trials...... stent, early generation paclitaxel eluting stent, sirolimus eluting stent, and zotarolimus eluting (Endeavor) stent, and new generation everolimus eluting stent, and zotarolimus eluting (Resolute) stent among patients with stable coronary artery disease. DATA SOURCES: Medline and Embase from 1980......: Among patients with stable coronary artery disease, coronary artery bypass grafting reduces the risk of death, myocardial infarction, and subsequent revascularisation compared with medical treatment. All stent based coronary revascularisation technologies reduce the need for revascularisation...

  10. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    Energy Technology Data Exchange (ETDEWEB)

    Barros, Marcio Vinicius Lins; Siqueira, Bruna Pinto; Guimaraes, Carolina Camargos Braichi; Cruz, David Filipe Silva; Guimaraes, Leiziane Assuncao Alves; Lima, Maicom Marcio Perigolo, E-mail: marciovlbarros@gmail.com [Faculdade de Saude e Ecologia Humana, Vespasiano, MG (Brazil); Nunes, Maria do Carmo Pereira [Universidade de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Siqueira, Maria Helena Albernaz [Hospital Materdei, Belo Horizonte, MG (Brazil)

    2015-07-15

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  11. Prognosis of non-significant coronary atherosclerotic disease detected by coronary artery tomography

    International Nuclear Information System (INIS)

    Introduction: Although studies have shown high diagnostic accuracy of coronary tomography (CT) in detecting coronary artery disease (CAD), data on the prognostic value of this method in patients with no significant coronary obstruction are limited. Objective: To evaluate the value of CT in predicting adverse events in patients with suspected CAD and no significant coronary obstruction. Methods: We prospectively evaluated 440 patients between January 2008 and July 2013 by MDCT, diagnosed with no significant obstruction or no atherosclerotic coronary obstruction with an average follow-up of 33 months. The outcomes evaluated were: cardiac death, myocardial infarction, unstable angina associated with hospitalization or coronary artery bypass grafting. Results: Of the 440 patients studied, 295 (67%) were men with mean age 55.9 ± 12.0 years. Non-significant obstruction was found in 152 (35%) of the patients and there were 49 (11%) outcomes. In the multivariate analysis using the Cox regression model, the predictors of clinical outcomes were non-significant obstruction on CT (hazard ratio 3.51; 95% CI 1.73 - 7.8; p <0.01), age and hypertension. Non-significant obstruction on CT was associated with adverse clinical outcomes and survival analysis showed a significant difference (log-rank 24.6; p <0.01) in predicting these outcomes. Conclusion: The detection of non-significant atherosclerotic obstruction by CT was associated with the presence of adverse events in patients with suspected CAD, which may prove useful in the risk stratification of these patients. (author)

  12. Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study.

    Science.gov (United States)

    Gökgöl, Can; Diehm, Nicolas; Nezami, Farhad Rikhtegar; Büchler, Philippe

    2015-12-01

    Nitinol stent oversizing is frequently performed in peripheral arteries to ensure a desirable lumen gain. However, the clinical effect of mis-sizing remains controversial. The goal of this study was to provide a better understanding of the structural and hemodynamic effects of Nitinol stent oversizing. Five patient-specific numerical models of non-calcified popliteal arteries were developed to simulate the deployment of Nitinol stents with oversizing ratios ranging from 1.1 to 1.8. In addition to arterial biomechanics, computational fluid dynamics methods were adopted to simulate the physiological blood flow inside the stented arteries. Results showed that stent oversizing led to a limited increase in the acute lumen gain, albeit at the cost of a significant increase in arterial wall stresses. Furthermore, localized areas affected by low Wall Shear Stress increased with higher oversizing ratios. Stents were also negatively impacted by the procedure as their fatigue safety factors gradually decreased with oversizing. These adverse effects to both the artery walls and stents may create circumstances for restenosis. Although the ideal oversizing ratio is stent-specific, this study showed that Nitinol stent oversizing has a very small impact on the immediate lumen gain, which contradicts the clinical motivations of the procedure.

  13. Coronary artery bypass surgery in the diabetic patient.

    LENUS (Irish Health Repository)

    Maher, M

    2012-02-03

    Coronary artery and peripheral occlusive arterial disease frequently complicate diabetes mellitus, with death due to atherosclerotic coronary artery disease being three times more likely in diabetic compared to non-diabetic patients. The profile of 32 diabetic patients and 32 matched controls who underwent coronary artery bypass (CABG) is studied and their early and late postoperative outcomes are described. The mean age was 61 +\\/- 1 year in both groups. The diabetic group comprised 26 non-insulin dependent and 6 insulin dependent diabetics, who had a mean duration of diabetes of 8.5 years (range 2 months--35 years). The median number of grafts per patient performed in the diabetic group and the control group was 3.5 and 3 respectively. There was no mortality in the series, however considerably greater wound morbidity rates were encountered in the diabetic group when compared to matched controls. One renal transplant patient in the diabetic group suffered irreversible acute tubular necrosis and became dialysis dependent post-operatively. Longterm follow-up showed no longterm mortality in either group, with full relief of angina achieved in 75% of diabetic patients compared with 87.5% of matched controls. In addition diabetic patients suffered greater longterm cardiac morbidity than the control group (21.8% versus 12.5%). The results of this study suggest that CABG is a safe operation for the diabetic patient. Diabetic patients receive satisfactory symptomatic relief of angina, but suffer increased perioperative wound complications and greater incidence of longterm cardiac morbidity.

  14. Modern antiplatelet agents in coronary artery disease.

    LENUS (Irish Health Repository)

    Power, Rachel F

    2012-10-01

    Dual antiplatelet therapy is well recognized in the prevention of thrombotic complications of acute coronary syndrome and percutaneous coronary interventions. Despite clinical benefits of aspirin and clopidogrel therapy, a number of limitations curtail their efficacy: slow onset of action, variability in platelet inhibitory response and potential drug-drug interactions. Furthermore, the single platelet-activation pathway targeted by these agents allows continued platelet activation via other pathways, ensuring incomplete protection against ischemic events, thus, underscoring the need for alternate antiplatelet treatment strategies. A number of novel antiplatelet agents are currently in advance development and many have established superior effects on platelet inhibition, clinical outcomes and safety profile than clopidogrel in high-risk patients. The aim of this review is to provide an overview of the current status of P2Y12 receptor inhibition and PAR-1 antagonists in determining a future strategy for individualized antiplatelet therapy.

  15. Contemporary Management of Coronary Artery Disease and Acute Coronary Syndrome in Patients with Chronic Kidney Disease and End-Stage Renal Disease

    Science.gov (United States)

    Huang, Chin-Chou; Chen, Jaw-Wen

    2013-01-01

    Chronic kidney disease (CKD) and end-stage renal disease (ESRD) have emerged as a worldwide public health problem. Due to the remarkably higher incidence and prevalence of this chronic disease in Taiwan than in other countries, CKD/ESRD has contributed to a significant health burden in Taiwan. Patients with CKD/ESRD have an increased risk of coronary artery disease (CAD) and acute coronary syndrome (ACS) compared to the normal population. Patients with ACS alone can present differently than patients with ACS and CKD/ESRD. Also, due to the lower prevalence of chest pain and ST-segment elevation, CKD/ESRD patients were more difficult to diagnose than other patients. Furthermore, whether advances in ACS management with medical therapy and an early invasive approach could improve patient outcomes with CKD/ESRD is not known. The use of antiplatelets such as aspirin and other antithrombotic agents might reduce the incidence of ACS or stroke in CKD patients. However, such use could also increase bleeding risk and even increase the likelihood of mortality, especially in dialysis patients. While recent clinical data suggest the potential benefit of aggressive management with coronary intervention for CAD and ACS in this category of patients, further clinical studies are still indicated for the proper medical strategy and revascularization therapy to improve the outcomes of CAD and ACS in CKD/ESRD patients, both in Taiwan and worldwide. PMID:27122697

  16. Re-implant of the right coronary artery: a surgical technique for the treatment of ostial lesions

    Directory of Open Access Journals (Sweden)

    Bongiovani Hércules Lisboa

    2002-01-01

    Full Text Available Previously described surgical treatment for ostial coronary artery stenosis relied on either venous or arterial bypasses or ostial patch angioplasty. These surgical procedures are performed with bovine pericardium, saphenous vein or internal thoracic artery. We describe a technique of right coronary artery re-implantation into the aorta. The procedure was performed in four patients with right coronary artery ostial stenosis along with other left coronary artery lesions.

  17. Safety and efficacy of dalteparin in percutaneous coronary intervention in Chinese patients with non-ST-elevation acute coronary artery syndromes: comparison with unfractionated heparin

    Institute of Scientific and Technical Information of China (English)

    Xing Ke; Haichu Yu; Qixin Wang

    2009-01-01

    Objective To prospectively evaluate the safety and therapeutic efficacy ofdalteparin in patients with high risk non-ST-elevation acute coronary syndromes (ACS) during percutaneous coronary intervention (PCI). Methods Atotal of 175 patients with high risk non-ST-elevation ACS were randomly assigned to 2 groups [dalteparin group and unfractionated heparin (UFH) group]. The patients in dalteparin group were given dalteparin at a dose of 5,000U subcutaneously soon after diagnosis and then an additional 60U/ kg intravenous bolus ofdalteparin before emergent PCI. Vascular access sheaths were removed immediately after PCI or coronary artery angiography; the patients in UFH group were given UFH intravenously at a dose of 25mgjust before PCI and an additional 65mg bolus was administered if angiographic findings showed that the patients were suitable for percutaneous transluminai coronary angioplasty (PTCA). Sheaths were removed at 4-6 hours after PCI; Results Eighty-three patients in dalteparin group underwent PCI while 82 patients in UFH group underwent PCI; anti-Xa activities of 52 patients in dalteparin group were measured. The average anti-Xa activity was (0.83±0.26) U/ml at 15 minutes after intravenous injection of dalteparin and anti-Xa>0.5U/ml was obtained in 96.1% of the patients; hematomas at puncture sites were significantly fewer in dalteparin group as compared with UFH group (2.3% vs 9. 2%, P < 0.05); none of the patients in 2 groups suffered major bleeding events. No death, acute arterial reocclusion or emergent revascularization events occurred at 30 days after PCI. Conclusions Our study demonstrated that early subcutaneous injection of dalteparin at a dose 5,000U after diagnosis and an additional 60U/kg intravenous bolus ofdalteparin before PCI is safe and efficacious for patients with high risk non-ST-elevation ACS undergoing emergent PCI

  18. Dutch survey of congenital coronary artery fistulas in adults: coronary artery-left ventricular multiple micro-fistulas multi-center observational survey in the Netherlands.

    NARCIS (Netherlands)

    Said, S.A.M.; Werf, T. van der

    2006-01-01

    BACKGROUND: Congenital coronary artery-left ventricular multiple micro-fistulas (CA-LVMMFs) in adults are rare anomalies. They may cause angina pectoris and myocardial infarction in association with normal coronary arteries. METHODS AND RESULTS: From the medical databases of a Dutch Survey of corona

  19. Usefulness of multidetector-row CT (MD-CT) for assessment of coronary artery stenosis

    International Nuclear Information System (INIS)

    Coronary arteries stenosis were evaluated in 49 cases by volume rendering (VR) and partial maximum intensity projection (partial MIP) using multidetector-row CT (MD-CT). Left main trunk (LMT) and left anterior descending artery (LAD) were less affected by cardiac pulsation artifact and presented good images. Right coronary artery (RCA) was affected by cardiac pulsation artifact and image quality was inferior as compared to left coronary artery (LCA). It is suggested that MD-CT is useful for assessment of coronary artery stenosis, especially LCA. (author)

  20. Adjunctive intra-coronary imaging for the assessment of coronary artery disease

    Science.gov (United States)

    Shah, Nikunj; Ussen, Bassey

    2016-01-01

    Atherosclerotic coronary artery disease remains a leading cause of worldwide morbidity and mortality. Invasive angiography currently remains the gold standard method of diagnosing and treating coronary disease; however, more sophisticated adjunctive interventional technologies have been developed to combat the inter and intra-observer variability frequently encountered in the assessment of lesion severity. Intravascular imaging now plays a key role in optimising percutaneous coronary interventions and provides invaluable information as part of the interventional cardiologist’s diagnostic arsenal. The principles, technical aspects and uses of two modalities of intracoronary imaging, intravascular ultrasound and optical coherence tomography, are discussed. We additionally provide examples of cases where the adjunctive intracoronary imaging was superior to angiography alone in successfully identifying and treating acute coronary syndromes.