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Akira Funada Sumio Mizuno Kazuo Ohsato Tatsuaki Murakami Ikuo Moriuchi Katsushi Misawa Hiromasa Kokado Yoshifumi Shimada Kentarou Ishida Hirokazu Ohashi 《Circulation journal》2006,70(10):1312-1317
BACKGROUND: Iatrogenic coronary ostial stenosis (ICOS) is a rare but potentially life-threatening complication of aortic valve replacement (AVR). This complication is usually diagnosed by angiography and treated with aortocoronary bypass surgery. CASE REPORTS: In the present 3 cases pre-operative coronary angiography confirmed normal coronary arteries and they underwent uncomplicated AVR. Coronary lesions were clinically manifest within 4 months after surgery, and repeat coronary angiography demonstrated bilateral ostial stenosis in 1 patient and left main trunk stenosis in the other 2. Two cases were detected by multidetector computed tomography (MDCT) before angiography. MDCT and Virtual Histology suggested fibrous tissue formation in the lesions. All 3 patients were successfully underwent percutaneous coronary intervention (PCI) and stenting. The post-procedure clinical course has been uneventful, except for elective stenting of a recurrent lesion in 1 asymptomatic patient. CONCLUSIONS: The incidence of ICOS after AVR is low. Noninvasive MDCT is useful for early diagnosis and PCI is a possible alternative treatment. ICOS may be caused by fibrous tissue formation, and therefore be distinct from conventional atherosclerosis. 相似文献
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Coronary ostial stenosis after aortic valve replacement without coronary cannulation 总被引:1,自引:0,他引:1
S Rath D A Goor Y Har-Zahav A Buttler Z Ziskind 《The American journal of cardiology》1988,61(13):1156-1157
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Alexeyi Sorokin Hellmuth Weich Anton Doubell Johannes A. Moolman 《Acute cardiac care》2013,15(2):113-115
A 49‐year‐old patient presented with angina pectoris and clinical findings of aortic valve stenosis and regurgitation. Rheumatic aortic valve stenosis and regurgitation was diagnosed on echocardiography. Coronary angiography findings showed severe calcification in the aorta root with right coronary ostial occlusion, and were suggestive of left main ostial stenosis and proximal main stem stenosis, which was confirmed on CT angiography. Curvilinear calcification of the aorta was present on CT angiography. The findings suggested syphilitic aortitis. Syphilis serology was positive (RPR titre 1/16). The angina was caused by severe coronary ostial disease likely due to syphilitic aortitis and exacerbated by the rheumatic aortic valve stenosis and regurgitation. 相似文献
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A 49-year-old patient presented with angina pectoris and clinical findings of aortic valve stenosis and regurgitation. Rheumatic aortic valve stenosis and regurgitation was diagnosed on echocardiography. Coronary angiography findings showed severe calcification in the aorta root with right coronary ostial occlusion, and were suggestive of left main ostial stenosis and proximal main stem stenosis, which was confirmed on CT angiography. Curvilinear calcification of the aorta was present on CT angiography. The findings suggested syphilitic aortitis. Syphilis serology was positive (RPR titre 1/16). The angina was caused by severe coronary ostial disease likely due to syphilitic aortitis and exacerbated by the rheumatic aortic valve stenosis and regurgitation. 相似文献
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L. Hornbech Larsen K. Fuglsang Kofoed M. Dalsgaard T. Kristensen H. Elming D.A. Steinbrüchel L. Køber H. Kelbæk C. Hassager 《International journal of cardiology》2013
Background
In patients referred for aortic valve replacement (AVR) a pre-surgical assessment of coronary artery disease is mandatory to determine the possible need for additional coronary artery bypass grafting. The diagnostic accuracy of coronary computed tomography angiography (coronary CTA) was evaluated in patients with aortic valve stenosis referred for surgical AVR.Methods
Between March 2008 and March 2010 a total of 181 consecutive patients were included. All patients underwent pre-surgical coronary CTA (64- or 320-detector CT scanner) and invasive coronary angiography (ICA). The analyses were performed blinded to each other.Results
The mean ± SD age of the included patients was 71 ± 9 years and 59% were male. The prevalence of significant coronary artery stenosis > 70% by ICA was 36%. Average heart rate during coronary CTA was 65 ± 16 bpm. In a patient based analysis 94% of the patients (171/181) were considered fully evaluable. Coronary CTA had a sensitivity of 68%, a specificity of 91%, a positive predictive value of 81%, and a negative predictive value of 83%. Advanced age, obstructive lung disease, NYHA function class III/IV, and high Agatston score were found to be significantly associated with disagreement between ICA and coronary CTA in univariate analysis.Conclusion
In patients with aortic valve stenosis referred for surgical AVR the diagnostic accuracy of coronary CTA to identify significant coronary artery disease is moderate. Coronary CTA may be used successfully in a subset of patients with low age, no chronic obstructive lung disease, NYHA function class < III and low coronary Agatston score. 相似文献6.
Tsukiji M Akasaka T Wada N Okahashi N Kume T Yoshitani H Neishi Y Watanabe N Yoshida K 《Journal of cardiology》2004,44(5):207-213
An 80-year-old woman underwent aortic valve replacement with Freestyle stentless prosthetic valve for the stenosis. Four months later, she was admitted with myocardial ischemia. Coronary angiography revealed severe stenosis in the ostium of both right and left coronary arteries. Coronary artery bypass grafting was performed. One year later, percutaneous coronary intervention was carried out for the bilateral coronary arteries because of unstable angina. Intravascular ultrasonography demonstrated localized, membranous, homogeneous, and severe stenoses in the ostium of the right and left coronary arteries. Histological examination of a specimen taken by directional coronary atherectomy showed intimal hypertrophy, mucinous degeneration, and hyaline degeneration without reactive change. There were no findings of atherosclerosis. These clinical, angiographical histological and intravascular ultrasonography findings suggest that the immunological reaction to the heterograft was the mechanism of the bilateral ostial coronary arteries stenoses in the present case. The possibility of immunological reaction after aortic valve replacement with heterograft should be considered. There have been no report on intravascular echocardiographic and histological findings. 相似文献
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Muhammad A. Khan Francesco Prati Magdi El-Omar 《Cardiovascular Revascularization Medicine》2013,14(5):299-301
Iatrogenic coronary ostial stenosis following aortic valve replacement (AVR) occurs in up to 3.4% of cases and usually presents within the first 6 months following surgery. We present the case of an 85 year old man who developed an acute coronary syndrome 2 months following AVR. Coronary angiography revealed a severe de novo lesion in the left main stem, which, on optical coherence tomography, was shown to be due to severe intimal hyperplasia. The most likely underlying mechanism is vessel wall trauma caused by the rigid tip cannula used for administration of cardioplegia solution. Surgeons should be aware of this possibility when administering this solution via the antegrade approach. 相似文献
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Zakrzewski D Orłowska-Baranowska E Rawczyńska-Englert I 《Polskie Archiwum Medycyny Wewn?trznej》1998,100(1):63-65
A case of 48-year old patient, who developed anginal symptoms 3 months after aortic and mitral valves replacement was presented. The patient underwent coronary angiography, which revealed severe left main coronary stenosis. Successful surgery was done with grafting of left anterior descending and circumflex arteries. Opinions on etiology, diagnosis and management of this rare complication are discussed. 相似文献
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P B Kurnik M Innerfield J D Wachspress W J Eldredge H L Waxman 《American heart journal》1990,120(4):919-927
Left ventricular mass and function were measured using ultrafast computed tomography, and were correlated with clinical status in 17 patients with aortic stenosis and/or insufficiency undergoing aortic valve replacement or balloon valvuloplasty. Wall mass was 159 +/- 38 gm/m2 initially, decreased 25% to 116 +/- 29 gm/m2 at 4 month (p less than 0.001), and decreased a total of 34% to 105 +/- 33 gm/m2 at 8 months after valve repair. By 8 months not only was the mean wall mass within the normal range, but only three patients retained abnormal hypertrophy. Ejection fraction increased 8% (p = 0.06). Clinical function improved in all patients, with only three patients remaining outside of New York Heart Association functional class 1 at 8 months. Regression of ventricular mass into the normal range correlated with attainment of class 1 functional status (p less than 0.02), despite a lack of increase of ejection fraction. The single patient followed for 8 months after valvuloplasty had minor wall mass regression and minor clinical improvement. 相似文献
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A 44-year-old woman with a history of chest radiotherapy developedostial coronary artery disease associated with aortic valvulardisease and a lesion of the right internal mammary artery. 相似文献
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Subasit Acharji MD Arvind Agnihotri MD Joseph Carrozza MD 《Catheterization and cardiovascular interventions》2017,90(1):169-172
Unicuspid aortic valve (UAV) offers unique challenges to transcatheter aortic valve replacement (TAVR), due to asymmetric expansion and apposition of the prosthesis during implantation. Although TAVR in bicuspid is now a well described experience, TAVR in unicuspid valve has not yet been described. A challenging case is described with TAVR in UAV using a Edwards Sapiens prosthesis via transapical approach. © 2016 Wiley Periodicals, Inc. 相似文献
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Superior mediastinal obstruction with aortic dissection after aortic valve replacement. Diagnosis by computed tomography. 下载免费PDF全文
In two patients aortic dissection occurred as a late complication of aortic valve replacement and caused superior vena caval obstruction. The dissection and superior vena caval obstruction were diagnosed by computed tomography. 相似文献
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