A Rare Case of Transcatheter Closure of Both Inlet and Outlet of a Left Coronary Artery-to-Left Ventricular Fistula with Giant Coronary Artery Aneurysm

A congenital coronary artery fistula (CCAF) combined with giant coronary aneurysm (CAA) is a rare congenital cardiac abnormality. We reported an 8-year-old patient who underwent transcatheter closure of both inlet and outlet of a proximal left coronary artery (LCA)-to-left ventricular (LV) fistula with CAA of 41 mm × 28 mm in diameter, during which acute occlusion of left anterior descending coronary artery (LAD) occurred immediately after device implantation at the inlet of fistula. We managed to prevent the patient from major adverse cardiac events by conservative therapy with dual antiplatelet agents instead of surgical removal of the device. The patient recovered well and had been follow-up for 2 years with no late complications reported.     

冠状动脉畸形及其临床意义

目的 :探讨冠状动脉造影的人群中冠状动脉畸形的检出率、临床特点和预后。　　方法 :回顾性总结 3 188例行冠状动脉造影术的人群。　　结果 :3 188例行冠状动脉造影术的人群中 ,共检出冠状动脉畸形 42例 ,检出率为 1 3 2 % ,其中 81%为冠状动脉起源和分布异常 ,19%为冠状动脉静脉瘘 ;76 2 %为对心肌灌注没有影响、相对良性的畸形 ,2 3 8%为对心肌灌注有潜在影响、有一定的危险性的畸形。　　结论 :右冠状动脉起源于左冠状动脉窦、左主干起源于右冠状动脉窦并穿行于主动脉和肺动脉之间、左主干起自肺动脉等是非常严重的冠状动脉畸形 ,患者常发生心绞痛、急性心肌梗死和心力衰竭 ,这些畸形一旦发现 ,应进行预防性的手术矫正。小冠状动脉瘘多数无临床症状 ,但多发和大冠状动脉瘘可发生充血性心力衰竭、心肌缺血。冠状动脉畸形并非罕见 ,某些类型的冠状动脉畸形可致严重的临床后果 ,应尽早进行预防性地手术矫正     

Multiple coronary artery aneurysm formation one year and four years after sirolimus-eluting coronary stent implantation

A 61 years old male patient having the complaint of angina pectoris underwent coronary angiography that revealed critical luminal stenosis at left anterior descending artery (LAD) and diagonal branch. Percutaneous transluminal coronary angioplasty was performed and sirolimus eluting stents (CYPHER; Johnson & Johnson – Cordis) 2.75 ×10 mm and 2.75×10 mm were deployed respectively. One year after the procedure coronary angiography revealed coronary artery aneurysm (CAA) formation in diagonal branch and mild ectasia in LAD stent area. Last coronary angiography four years and three months after initial intervention showed multiple CAA at diagonal branch and LAD. This case report is an example of late formation of CAA by sirolimus-coated coronary stent.     

平板运动试验阳性对冠状动脉造影正常患者的评价

为评价平板运动试验阳性而冠状动脉造影正常的胸痛患者的临床意义，对３６例平板运动试验阳性而造影阴性的患才与３６例运动试验和造影阳性的患者进行临床资料及平板运动试验参数的对照分析。     

Multiple coronary artery aneurysms combined with abdominal aortic aneurysm

Coronary artery aneurysm (CAA) is defined as coronary dilatation which exceeds the diameter of a normal adjacent segment or the diameter of the patients's largest coronary vessel by as much as 1.5 times. It is an uncommon pathology with a frequency of 1-4% in routine autopsies or coronary angiographies. Atherosclerosis plays an important role in the development of CAA, and it may be a predominant cause in the majority of patients. However, the timing of surgical intervention and the treatment options for CAA are still controversial. In this report, we present a patient who had multiple CAAs of all main coronary arteries and abdominal aortic aneurysm. Different treatment modalities and indications are also discussed.     

冠状动脉瘤及其临床分析

目的利用较大样本冠状动脉造影资料分析国人冠状动脉造影的人群中冠状动脉瘤的检出率、病因、临床特点和预后。方法回顾性研究分析1993年12月至2006年12月8628例成年人冠状动脉造影资料,将检出的冠状动脉瘤进行总结和分类,并与国内外文献进行比较。结果8628例行冠状动脉造影术的人群中,共检出冠状动脉瘤80例,检出率为0.927%,其中男性61例,女性19例。冠状动脉瘤检出率在男女性别之间无显著性差异(P>0.01)。好发部位依次为右冠状动脉、左前降支和左回旋支;有心绞痛病史者72例,42例合并心肌梗死;同时存有冠状动脉狭窄≥50%的病人72例;瘤体内发现血栓61例;瘤体发生于单支冠状动脉者63例,2支者6例,3支并左主干者6例;无一例瘤体破裂。本病可引起心肌梗死等严重临床后果,抗血小板、抗凝及血运重建可明显改善预后。结论国人成年人冠状动脉瘤是冠状动脉粥样硬化的一个少见的亚类或变异型,非一个独立临床疾病,动脉瘤和狭窄通常是共有的。动脉瘤内常有血栓,易引起心肌梗死,如不积极干预,则愈后较差。     

血管内支架在冠状动脉复杂病变中的临床应用

因冠状动脉复杂病变或经皮冠状动脉腔内成形术（PTCA）并发内膜夹层12例，成功植入冠状动脉支架（CS）17支，取得显著临床效果，且并发症少。初步结果提示，冠心病介入治疗中选择性应用CS，有益于PTCA后急性并发症的防治，亦可减少冠状动脉再狭窄的形成。     

Case Report: Incidental Finding of a Giant Cardiac Mass

Coronary artery fistula (CAF) is a rare anomalous connection between a coronary artery and another coronary artery, major vessel, or cardiac chamber. Prevalence of CAF is reportedly 1% to 2% in patients who undergo coronary angiography.1 One of the most common complications of CAF is formation of a coronary artery aneurysm (CAA). A study conducted by Said and colleagues in 1995 found that CAA formation was present in 26% of patients who had proven CAF by way of angiography.2 Although a precise definition of the term “giant” CAA is still lacking, it generally refers to a dilatation that exceeds the reference vessel diameter by four times.3 We report an interesting case of a 38-year-old patient who was incidentally found to have a presumed large right ventricular aneurysm, which after an open-heart surgery was identified as a CAF with formation of an unruptured giant CAA.     

川崎病的心血管病变观察

目的　观察川崎病 ( KD)的心血管病变。方法　对 2 6例 KD的住院患儿 ,于急性期或亚急性期行心电图、超声心动图、血清肌钙蛋白 I( c Tn I)及肌酸磷酸激酶 ( CK)及其同工酶 ( CK-MB)检查 ,并于病程不同时期 ( 6个月～ 2年 )进行复查。结果　冠状动脉病变 10例 ,占 3 8.5 % ,其中冠状动脉扩大 7例 ,冠状动脉瘤 3例 ,发生于急性期或亚急性期 9例 ,发生于病程第 9个月 1例。心肌炎 2例 ,主动脉瓣、二尖瓣反流各 1例。心电图异常 8例 ,占 3 0 .8%。血清 c Tn I阳性 12例 ,占 46.2 % ,CK-MB升高 7例 ,占 2 6.9%。结论　KD的心血管并发症表现形式多样 ,主要为冠状动脉扩大和冠状动脉瘤 ,其次是心电图异常 ,c Tn I阳性 ,CK-MB升高 ,主动脉瓣及二尖瓣反流。     

Coronary Artery Anomalies in D-Transposition of the Great Artery Following Arterial Switch Operation

Background: The survival rate of patients following arterial switch operation (ASO) exceeds 95%, but coronary artery anomalies (CAA) contribute to a 2% incidence of sudden cardiac arrest later in life. Therefore, we aimed to assess abnormal findings of coronary arteries in post-ASO patients. Methods: Coronary computed tomography angiography (CCTA) is performed on post-ASO patients who meet institutional criteria. Intraoperative findings of coronary artery patterns were retrospectively reviewed and categorized using the Leiden classification system. Coronary artery anomalies were detected by CCTA and associations with coronary artery compromise were explored. Results: Forty-three patients who had CCTA with a median age of 15.6 years (12–21.3 years) were included in the study. Unusual coronary patterns were identified in 20 (46%) patients before ASO. CCTA identified 25 CAA in 22 patients (eleven with prepulmonic course, nine with interarterial course, three with acute take-off angle, and two with significant stenosis). Postoperative CAA was more common in patients with unusual coronary patterns (90% vs. 17.4%; p < 0.001). Nine patients experienced chest pain and two patients required coronary artery bypass graft. A common ostium of RCA and LAD or LMCA were associated with significant chest pain (OR 14.3%, 95% CI 2.5 to 82.3). Conclusions: Coronary artery anomalies in post-ASO are common. All post-ASO patients should have coronary artery imaging before participating in competitive sport and when they reach adolescence. Patients with unusual preoperative coronary artery patterns should undergo coronary artery imaging when feasible. Follow-up imaging studies are indicated in patients with post-operative coronary artery abnormalities.     

Coronary artery aneurysms

There is no consensus on the best management of coronary artery aneurysms (CAA) in adults. We describe two patients with CAA and review transcatheter approaches to exclude them from the circulation. © 2013 Wiley Periodicals, Inc.     

Normal to normal: a method of treatment of coronary aneurysms with deployment of bare-metal stents

Coronary artery aneurysm (CAA) is defined as a coronary dilatation that exceeds the diameter of normal adjacent segments or the diameter of the patient's largest coronary vessel by 1.5 times. The presence of a CAA is not always without complications. Thrombosis with myocardial infarction, formation of arteriovenous fistulae, vasospasm, and even rupture, may occur especially with very large aneurysms. These complications dictate the need for medical, surgical or percutaneous therapy. The latter consists mainly of the use of polytetrafluoroethylene (PTFE)-covered stents. Compared to PTFE-covered stents, bare-metal stents (BMS) have better flexibility, making implantation in tortuous vessels easier, and permitting access to sidebranches when a bifurcation lesion is involved. Their use in treatment of CAA has rarely been reported. We present three cases with CAA that have been treated with BMS with excellent post-procedure angiographic results and complete exclusion of the aneurysm at mid-term angiographic follow-up.     

多层螺旋CT血管成像诊断“恶性”冠状动脉畸形

目的:探讨"恶性"冠状动脉畸形(coronary artery anomalies,CAA)的MDCTA影像特点及诊断价值。方法:2005年至2009年,我院完成冠状动脉多层螺旋CT血管成像(MDCTA)检查38 573例,检出"恶性"CAA 54例[1.40‰,女性29例,平均年龄(51±15)岁]。结果:左冠状动脉起源于肺动脉4例(0.10‰);冠状动脉起自对侧冠状窦或单支冠状动脉畸形,且近段走行于主、肺动脉间38例(0.99‰);多发或较大冠状动脉瘘12例(0.31‰)。结论:MDCTA可无创而可靠的显示"恶性"CAA开口部位、走行路径、毗邻关系、有无瘘口及并存异常。     

川崎病合并冠状动脉损害的临床超声随访简

目的 探讨川崎病（Kawasaki disease,KD）合并冠状动脉损害患儿的临床预后.方法 回顾分析2002年1月至2011年12月收治的KD合并冠状动脉损害254例患儿的临床诊治与随访资料.结果 本组冠状动脉损害占KD患者总数的28％,其中冠状动脉扩张（CAD）216例,占KD的28.16％,冠状动脉瘤（CAA）38例,占4.2％.随访结果：随访冠状动脉扩张210例,其中有单侧（左或右冠状动脉）冠状动脉扩张99例（47.14％）随访3个月内恢复正常;21例（17.5％）6～12个月内恢复正常.双侧（左、右冠状动脉）冠状动脉扩张26例（11.26％）随访12～18个月恢复正常,59例（25.54％）随访18～36个月恢复正常,5例（近期）仍在随访中.随访冠状动脉瘤35例,冠状动脉瘤内径＜6 mm 28例12～36个月恢复正常,冠状动脉内径＞8 mm的巨大动脉瘤7例,2例随访12～24个月尚未恢复,3例随访24～36个月双侧均有回缩或单侧恢复后留有不同程度的冠状动脉扩张;2例分别随访6年、8年仍存单侧冠状动脉瘤,另侧冠状动脉扩张.结论 轻、中度冠状动脉扩张预后较好,冠状动脉瘤的恢复相对冠状动脉扩张时间长;巨大动脉瘤特别伴有心肌病变,以及多脏器损害预后较差.     

冠状动脉介入术后外周血管并发症发生的原因与处理

目的 :探讨经皮冠状动脉 (冠脉 )介入术后外周血管并发症的发生率、原因和处理方法。方法 :分析经皮冠脉介入术后有外周血管并发症的患者的临床资料。结果 :2 348例患者中 5 7例 (2 .4 % )发生外周血管并发症 ,其中穿刺部位单纯血肿 4 4例 (1.9% ) ,严重出血 5例 (0 .2 % ) ,假性动脉瘤 5例 (0 .2 % ) ,股动脉夹层 1例(0 .0 4 % ) ,下肢静脉血栓形成 2例 (0 .0 8% )。 2例患者需要外科处理 ,无一例死亡。冠脉介入治疗术后外周血管并发症的发生率显著高于冠脉造影术 (6 .2 %∶1.0 % ,P <0 .0 1)。经验不足的术者外周血管并发症的发生率显著增高。结论 :冠脉介入术后外周血管并发症并不少见 ,主要与穿刺方法不当和抗凝治疗有关。但只要及时处理 ,绝大多数预后良好     

经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难的处理

目的探讨经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难的处理方法。方法经右桡动脉行冠状动脉造影时,由于右锁骨下动脉和(或)头臂干迂曲,致共用导管选择左冠状动脉口困难,此时将共用导管前端即第一、二弯之间及第二弯近段徒手塑形,使其弯曲度增大,观察用此方法行选择性左冠状动脉造影的结果及安全性。结果 35例选择左冠状动脉口困难的患者均造影成功,成功率100%,无相关并发症发生。28例患者经造影确诊冠心病。结论经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难时,行导管前端塑形是一种有效、简便、安全且经济的方法。     

Coronary artery revascularization prior to abdominal nonvascular surgery

BackgroundDoes preoperative revascularization of the myocardium reduce cardiac risk in noncardiac surgery? The aim of this study was to evaluate the clinical effectiveness of preoperative cardioprotection by coronary artery revascularization in abdominal nonvascular surgery under general anesthesia.Materials and methodsThe observational clinical study included 111 consecutive patients with angiographically verified coronary artery disease. Two stratification groups of patients were compared, those with coronary artery revascularization (34 patients, 30.6%) and those without coronary artery revascularization (77 patients, 64.9%), in relation to frequency of perioperative cardiac complications. The patients were followed up until the 30th postoperative day. During operation and in the following 72 postoperative hours, the patients were monitored by continuous ST-T segment recording. Twelve-lead electrocardiography was performed immediately after surgery and on postoperative days 1, 2, and 7 as well as 1 day before discharge. Serum troponin T levels were controlled at 6, 24, and 96 h postoperatively.ResultsThe number of patients with major cardiac complications was 0 (0.0%, n=34) in the revascularized myocardium group and 10 (12.9%, n=77) in the nonrevascularized myocardium group (P<.05). Three patients in the nonrevascularized myocardium group died of acute myocardial infarction, congestive heart failure, and malignant arrhythmias, respectively, with severe coronary artery stenosis verified angiographically.ConclusionsPreoperative cardioprotection by coronary artery revascularization significantly reduces morbidity and mortality in patients who have undergone abdominal nonvascular surgery. Patients with severe coronary artery stenosis and indication for coronary artery revascularization independently of noncardiac surgery should first undergo cardiosurgical intervention prior to elective abdominal nonvascular surgery.     

The Evaluation of the Safety and Efficacy of Transradial Coronary Procedures

Objectives To evaluate the safety and efficacy of transradial coronary procedures (TRCP). Methods The data of 83 cases who accepted transradial coronary angiography (CAG) and transradial percutaneous coronary intervention (PCI) in our department were summarized. The success rates, proximal coronary complications, peripheral vascular complications, severe vagal reflex, mean operation time (MOT), mean recumbent time (MRT), mean hospital-staying time (MHT) were analyzed. The data were compared with that of 420 cases of transfemoral coronary procedures (TFCP) in the same period. Results Success rates and proximal coronary complications were similar in both groups. Severe vagal reflexes were less in TRCP group than in TFCP group. MOT was longer in TRCP group. MRT and MHT were shorter in TRCP group. 12( 14.5%) radial artery spasm, 3(3.6%) radial artery obstruction, 1 sudden respiratory arrest caused by jugular hematoma were observed in TRCP group. Conclusions The efficacy and safety of TRCP are definite. TRCP is more economical. For the purpose of properly evaluate the peripheral vascular complications of TRCP, it is necessary to pay special attention to radial artery occlusion, radial artery stenosis, and jugular hematoma.     

Treatment of a coronary artery aneurysm by use of a covered stent graft - a case report

Coronary artery aneurysm is a rare finding at coronary angiography. Most coronary aneurysms remain asymptomatic. There is no consensus on its management; some advocate aggressive approach while others advocate conservative management. A case of coronary artery aneurysm successfully treated by implantation of a polytetrafluoroethylene-covered coronary stent is presented.     

冠状动脉瘘的临床分析

目的探讨11例先天性冠状动脉瘘(CAF)的临床特点及治疗方法。方法2003年至2005年,应用超声心动图、升主动脉及选择性冠状动脉造影检查确诊CAF 11例,其中单支瘘管起源于左冠状动脉5例,右冠状动脉2例,双侧起源4例。6例行外科手术治疗,2例患者行导管弹簧栓堵闭术,另3例未进行有创治疗,以药物保守治疗。结果8例手术及介入治疗均成功,无死亡及并发症发生。所有患者随访6～36个月,均无残余瘘发生。结论超声心动图及选择性冠状动脉造影是CAF的主要确诊手段。外科手术和经导管栓堵术闭合CAF均安全有效,应在临床症状出现之前进行根治性治疗。