Right atrial myxoma associated with vascular malformation and atypical chest pain.

A 58-yr-old woman with a right atrial myxoma associated with a vascular malformation supplied by the right coronary artery is described. She presented with atypical chest pain that was reproduced during angiography of the malformation. Findings were confirmed during surgery.     

Dual origin of the left circumflex coronary artery: A case report

We describe a patient with two separate vessels having different origins supplying the circumflex coronary artery distribution. This represents a previously undescribed coronary artery anomaly.     

Coronary angiography of cardiac myxoma

BACKGROUND: Myxoma usually presents with nonspecific symptoms. Preoperative coronary angiography is presently only considered if patients are at increased risk of coronary artery disease (CAD). The angiographic patterns of cardiac myxoma have not been fully described. HYPOTHESIS: The aim of our study was to investigate coronary angiograms as well as patterns of tumor vascularity in patients with cardiac myxoma. METHODS: From January 1990 to December 2003, 33 patients with cardiac myxoma, who had received surgical resection at our hospital, were enrolled; of these, 9 patients underwent preoperative coronary angiography. The severity and extent of coronary artery stenosis, as well as tumor angiographic patterns, were analyzed. Coronary artery disease is defined as a > 50% stenosis in diameter at any segment of the coronary artery viewed by two orthogonal views on cineangiogram. RESULTS: Four (44.4%) patients showed concomitant CAD. The presence of coronary risk factors was not different between patients with and without CAD. Contrast media-enhanced tumor vasculature was found in five (55.6%) patients. Four (80%) patients had multiple feeding arteries. There was the characteristic "sea anemone" appearance of the tumor vasculature composed of (1) basal vascular network, (2) vessel stem, (3) backbone branches, and (4) dye brushes. These findings were characteristic of cardiac myxoma. CONCLUSION: Coronary angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma. Familiarity with the "sea-anemone" angiographic findings may help in the diagnosis of cardiac myxoma.     

Predictors of early mortality in patients with angiographically documented left main coronary artery disease

To determine predictors of early death after coronary angiography In patients with significant left main coronary artery disease (≥ 60% diameter narrowing, LMCAD), we reviewed the clinical records of patients with LMCAD who died after angiography. Of 1,288 patients with LMCAD studied between January 1978 and October 1989, 21 died within 2 days after angiography (group 1). As a control group, 85 patients were randomly sampled from 1,196 patients who survived at least 30 days after angiography (group 2). The predictors of early death after angiography in patients with LMCAD were older age (P < 0.05), New York Heart Association Class III or IV (P < 0.005), shorter duration of unstable angina (P < 0.005), higher left ventricular end-diastolic pressure (P < 0.006), lower ejection fraction (P < 0.005), and significant left circumflex artery disease (P < 0.006). The use of heparin infusion after angiography did not appear to be a significant factor. It is suggested that earlier operation or more aggressive management be undertaken in patients who, at cardiac catheterization, have significant LMCAD associated with the above-listed variables.     

Primary Cardiac Angiosarcoma with Spontaneous Ruptures of the Right Atrium and Right Coronary Artery

Primary tumors of the heart are rarely seen. Cardiac angiosarcomas are malignant tumors that almost always have a poor prognosis. Atrium rupture and coronary artery fistula are very rare complications of primary cardiac angiosarcoma. We describe a 57‐year‐old man suffering from primary cardiac angiosarcoma with spontaneous ruptures of the right atrium and right coronary artery (RCA). Theoretically, either of these ruptures invariably results in pericardial effusion and tamponade that is rare but potentially life threatening. In this instance, however, the patient might have developed fibrous adhesions resulted from previous bloody pericardial effusion. A massive pericardial effusion was localized, which consequently prevented cardiac tamponade and hemodynamic collapse. Echocardiography revealed the tumor progression leading to detectable infiltration of solid mass into the right atrial (RA) wall, which is close to RCA. And color Doppler displayed the flow into the pericardial cavity through a disrupted RA wall and perforated RCA. Echocardiography remains the primary method of choice for evaluation of cardiac masses.     

中老年心房颤动伴非典型胸痛患者冠状动脉造影结果分析

目的探讨中老年患者不明原因心房颤动与冠心病的关系。方法48例心房颤动的中老年患者分别分为伴典型胸痛(A组)23例和伴非典型胸痛(B组)25例,均接受冠状动脉造影检查,分析两组冠状动脉病变阳性率和危险因素之间的关系。结果A组中有2l例(91.3%)有冠心病,而B组中仅有5例(20%)有冠心病,差异有显著性(P<0.01),A组血脂水平、血糖水平、高血压发病率均高于B组(P<0.05)。结论非典型胸痛或非典型胸痛伴冠心病危险因素的中老年心房颤动患者,诊断冠心病要慎重,必要时应作冠状动脉造影检查以减少误诊。     

Diagnostic value of atrial pacing and thallium-201 scintigraphy for the assessment of patients with chest pain

Atrial pacing was performed either alone (n = 23) or in combination with thallium-201 scintigraphy (n = 113) in 136 patients referred for evaluation of chest pain. The presence of coronary artery disease (CAD) was excluded by cardiac catheterization in 12 patients and confirmed in 124. Both pacing-induced ST depression and angina had sensitivities of 48% for CAD; specificities were 75% and 83%, respectively. An abnormal thallium-201 scan (one or more reversible and/or fixed perfusion defects) was seen in 72% of patients with CAD (specificity 83%). Reversible perfusion defects were present in 47% of patients with CAD (specificity 83%), and fixed defects in 36% (specificity 100%). Pacing was associated with either ST depression or an abnormal perfusion scan in 81% of patients (specificity 67%). There were no significant differences in the results of atria pacing or thallium-201 scintigraphy in patients with or without a history of myocardial infarction, or in those with or without previous coronary artery bypass surgery. Pacing-induced ST depression, or both ST depression and a reversible perfusion defect occurred significantly less frequently in patients with peripheral vascular disease than in those without this diagnosis (p less than .05). With only one exception, there were no significant differences in the sensitivities of any indicators of ischemia (ST depression, angina, or perfusion scans), either individually or in combination, as the peak pacing rate or double product achieved increased.(ABSTRACT TRUNCATED AT 250 WORDS)     

Left atrial myxoma with left ventricular myxoma diagnosed by ultrasound examination: A case report

Rationale:Left ventricular (LV) myxoma is a rare type of benign cardiac tumor, which may result in unfavorable consequences due to embolism, arrhythmia, obstruction to the outflow tract, and other constitutional symptoms. LV myxoma can be easily misdiagnosed as LV thrombosis. Although some literatures have reported LV myxoma, the echocardiographic features of Left atrial (LA) myxoma with LV myxoma have rarely been reported till date. Here, we report case of LA myxoma with LV myxoma diagnosed by echocardiographic examination.Patient concerns:A 56-year-old male patient suffering from chest tightness and asthma for 6 months and progressive aggravation for 1 month was admitted to our hospital.Diagnosis:Echocardiographic imaging gave the suspicion of LA myxoma with LV myxoma, which was confirmed by pathology.Interventions:This patient was treated surgically.Outcomes:The patient had no postoperative complications and is currently under regular follow-up.Lessons:Echocardiography can be an effective imaging method for the evaluation of LV myxoma. The combination of echocardiography and clinical symptoms may help to make an accurate diagnosis.     

Coronary angioplasty–unstable lesions and prolonged balloon inflation time

One of the most important complications after percutaneous transluminal coronary angioplasty is the abrupt closure of the dilated vessel (unstable lesion). The treatment of choice for this complication is a new dilation, but unfortunately many of these cases require immediate surgery to avoid an acute myocardial infarction. Prolonged balloon inflations have been suggested to control this kind of complication. In order to discover the effect of prolonged inflations on the incidence of unstable lesions we studied 439 patients enrolled in two groups: Group I (195 patients and 207 arteries) treated with balloon inflation time less than 40 sec per session and Group II (244 patients and 265 arteries) treated with inflation time over 60 sec since the first series of inflations. As a result there was a significantly lower incidence of unstable lesions and immediate surgery in Group II without an increase in the incidence of diffuse ischemia.     

Coronary artery dissection—A complication of cardiac catheterization without sequelae: Case report and review of the literature

This report describes an acute right coronary artery dissection occurring during diagnostic cardiac catheterization. Following catheter manipulation in the vicinity of the aortic valve, the patient complained of mild chest discomfort and had transient electrocardiographic evidence of acute inferior wall myocardial infarction with runs of 2:1 atrioventricular block. Within 5 min, the EKG reverted to precatheterization appearance, and the patient was asymptomatic. Coronary angiography revealed a dissection of the proximal vessel without obstruction. The patient had no clinical sequelae while monitored in the intensive care unit. The patient underwent elective aortic and mitral valve replacement. The area of the dissection was directly visualized, and no abnormality was noted. We review the literature of spontaneous and iatrogenic coronary artery dissections with regard to pathology, diagnosis, and prognosis, and make recommendations for therapy.     

Cardiac hemangioma presenting as atypical chest pain.

A 44-year-old man presented with atypical chest pain and dyspnea. Investigation revealed the presence of a 15-mm rounded, well-vascularized left-ventricular mass. The mass was removed surgically and histopathologic evaluation identified a cardiac hemangioma.     

Right atrial myxoma: unusual clinical presentation and atypical glandular histology.

A 57-year-old black female presented with a 1-month of right-sided congestive heart failure and clinical evidence of pulmonic and tricuspid valvular stenosis and insufficiency. The echocardiographic examination and ventriculography demonstrated a large right atrial tumor interfering with the function of both right-sided valves. The patient underwent successful surgical resection of the tumor. Histologically, the tumor had cellular areas typical of myxoma, as well as glandular areas, a feature which has been described very rarely in this lesion. Electron microscopy of the glandular zones, which has never been reported previously, shown cells having essential homology with the usual myxoma elements. The atypical histopathology of this lesion supports the theory that atrial myxomas are true neoplasms, and are not derived from unusually organized mural thrombi.     

Hemorrhage and associated fistula formation in a left atrial myxoma causing coronary artery steal syndrome

A 59‐year‐old woman with episodes of chest pain was diagnosed with cardiac myxoma. Transesophageal echocardiography (TEE) showed a massive vascularized tumor and there was a blood stream spurting from the internal cavity of tumor into left atrium through an interconnected sinus tract. Coronary artery angiography (CAG) indicated that the mass was enhanced upon the administration of contrast media, which spouted into the cardiac chamber. This is the first case to report the development of the coronary artery steal syndrome due to hemorrhage and associated fistula formation in a left atrial myxoma, which was detected by TEE and confirmed by CAG.     

中老年不典型胸痛患者经食管心房调搏负荷试验的临床价值

目的探讨中老年不典型胸痛患者经食管心房调搏负荷试验的临床诊断价值。方法将96例中老年患者分为不典型胸痛50例（A组）和典型胸痛46例（B组），均接受经食管心房调搏负荷试验及冠状动脉造影检查，分析冠状动脉病变阳性率与经食管心房渊搏负荷试验阳性并伴冠心病危险因素的关系。结果A组冠心病（18．0％）明显低于B组（91．3％）（P〈0．01）。A组中高血脂、高血糖、高血压发病率均低于B组（P〈0．05）．以经食管心房调搏负荷试验阳性伴有冠心病危险因素诊断冠心病，A组敏感性（63．6％）低于B组（92．0％），差异有显著性意义（P〈0．05），A组特异性及准确性（97．5％和90％）与B组（100％和91．3％）比较差异无显著性意义（P〉0．05）。A组以单支血管病变为主（89．0％），显著高于B组（43．0％）（P〈0．05）。两组累及血管顺序均为左前降支（40．0％和43．1％）、右冠状动脉（40．0％和36．5％）、左回旋支（20．0％和17．6％）（P〉0．05）。两组病变分型均以A型多见（70．0％和67．6％，P〉0．05），其次为B型（20．0％和25．6％，P〉0．05），C型少见。结论对中老年不典型胸痛根据经食管心房调搏负荷试验阳性伴冠心病危险因素者，应行冠状动脉造影检查，为明确诊断尽早提供客观依据。     

A prospective randomized study of 4.1 French catheters utilizing the percutaneous right brachial approach for the diagnosis of coronary artery disease

To determine the utility of 4.1 French (F) catheters in diagnosing coronary artery disease, 50 patients were randomized to 4.1F Multipurpose or Judkins catheters utilizing the percutaneous right brachial approach. The randomized 4.1F tip shape catheter completed the procedure in 40% of the patients, and overall the 4.1F catheters completed the catheterization in 72% of the cases. With excessive or prolonged manipulation, the catheters were noted to kink and soften and required replacement for a catheter of similar or larger size. In 28% of the cases, larger F sizes (5F and 6F) were used to complete the procedure. There was 1 (2%) procedural complication. The total procedural success (accounting for all F sizes) without clinical complication was 98%. There was no difference between the 4.1F Judkins or Multipurpose catheter shapes for coronary arteriography by either qualitative or quantitative angiographic analysis. Left ventricular opacification was improved with the 4.1F Pigtail vs. the 4.1 Multipurpose by qualitative angiographic analysis. When the 4.1F angiograms were compared by quantitative angiography in blinded, but not randomized fashion to angiograms performed with 6F Judkins catheters, there was improved opacification of the LAD and diastolic frame of the left ventriculogram with the larger catheter. This difference was not noted with qualitative angiography. This study indicates that 4.1F catheters can be utilized from the right brachial approach for the diagnosis of coronary artery disease, thus avoiding the need for supine bedrest associated with routine femoral artery catheterization while maintaining diagnostic accuracy. © 1992 Wiley-Liss, Inc.     

Report of a new anomaly of the left anterior descending artery: type VI dual LAD

A 48-year-old man with past medical history of coronary artery disease, previous angioplasty, hyperlipidemia, and generalized anxiety disorder presented with atypical chest pain. Coronary angiography and CT angiography revealed a variant dual left anterior descending (LAD) coronary artery not previously described. Spindola-Franco et al. have categorized dual LAD into four angiographic subtypes based on the origin and course of both a short- and a long branch of the LAD. Additionally, Manchanda et al. have described a novel variant of dual LAD with the short- and long LAD originating directly from the left and right coronary sinuses, respectively (Type V, see Table I). In the case presented, the long LAD arises from the right coronary artery and follows a unique route underneath the right ventricular outflow tract in the interventricular septal area to the anterior interventricular groove. We propose that this anatomy represents a new variant of dual LAD (Type VI).     

64层螺旋CT冠状动脉成像对不典型胸痛冠心病患者的诊断价值

目的评价64层螺旋CT冠脉成像对不典型胸痛患者进行鉴别诊断的价值。方法对72例不典型胸痛患者进行64层螺旋CT冠脉成像,再进行选择性冠脉造影（SCA）,以SCA为标准对64层螺旋CT结果的准确性进行评价。结果64层螺旋CT冠脉成像的敏感度、特异度和准确度分别为96%、79%和90%;64层螺旋CT对中度以上狭窄和轻度狭窄的诊断正确率分别为89%、58%（P<0.01）;64层螺旋CT对左回旋支和右冠状动脉病变的判断能力相对较差。结论64层螺旋CT能够胜任不典型胸痛冠心病患者的筛查。     

Right atrial myxoma in an asymptomatic child. Echocardiographic diagnosis

Tumours of the heart in children are rare, particularly myxomas.A case of right atrial myxoma is described in an asymptomaticyoung boy aged seven years. The diagnosis was made by M-Modeechocardiography which was recorded because of a cardiac murmur.Two-dimensional echocardiography confirmed the diagnosis andgave further information (size, morphology of tumour and stalk)which was confirmed by pathological examination. Today, two-dimensionalechocardiography is of great value for visualizing tumours ofthe right side of the heart, and offers the possibility of referringpatients for surgical excision without cardiac catheterization.     

Use of sideholes for diagnostic coronary arteriography by judkins technique in patients with ostial coronary stenosis

Patients with ostial left main coronary artery stenosis are at increased risk from diagnostic cardiac catheterization. In order to reduce this risk a modified Judkins coronary catheter with a sidehole 1.5–2 cm from the tip has been used in 6 patients in whom pressure damping was observed after initial use of a standard end-hole Judkins left coronary catheter. This eliminates damping and allows forceful hand injection with good proximal and distal vessel opacification. It also allows the acquisition of multiple views without the need for catheter removal after each injection, thereby reducing the risk involved in multiple cannulations of a vessel with a potentially unstable lesion at its origin. The technique has also been used for ostial lesions in a right coronary artery and a vein graft.