Bifurcation stenting of unprotected common trunk: a case report and review of the literature]

Left main disease is the most severe form of atherosclerotic heart disease, with severe prognostic implications in the short-medium term. The traditional therapeutic approach has been surgical, with placement of bypass grafts both on the LAD and the circumflex artery. Published experience with the percutaneous approach to left main disease has been disappointing because of acute procedural problems and poor long-term outcome. On the other hand, a review of the literature shows a strong negative selection of patients offered PTCA of left main-stem lesions: most published series are composed of extremely high-risk patients, often in cardiogenic shock or with severe extracardiac multisystem disease, with a prohibitive surgical risk and an inherently poor acute and mid-term prognosis. We describe such a patient, a 77-year-old woman with end-stage renal disease on hemodialysis, who developed unstable angina due to distal critical left main disease, with involvement of the origin of both the LAD and the circumflex branch. Angina did not stabilize with medical therapy; the patient was denied surgery because of a prohibitively high surgical risk. A bifurcation stenting procedure was performed with no acute complications, a satisfactory one-month angiographic follow-up and no recurrence of angina until the death of the patient 4 months after the procedure for extracardiac reasons. As indicated by a recent paper by M. Leon, we likewise suggest that left main disease (especially in its simpler proximal variants) may actually be a good target for state-of-the-art transcatheter interventions, including primary stenting, under close angiographic follow-up and careful positive (instead of negative) selection of patients.     

Recurrent spontaneous coronary artery dissection: A case report and review of the literature

Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome. Recurrent spontaneous dissection is even more rare. A case of recurrent coronary artery dissection is reported and the literature is reviewed.     

Pregnancy associated spontaneous coronary artery dissection: A case report and review of literature

BACKGROUNDPregnancy-associated spontaneous coronary artery dissection (PSCAD) is an important cause of chest pain and acute myocardial infarction in pregnant and postpartum women. Pregnancy is considered an isolated risk factor for spontaneous coronary artery dissection. The etiology, pathogenesis, and incidence of PSCAD are not known.CASE SUMMARYWe present a case of a 33-year-old postpartum female who presented with sudden onset chest pain and was diagnosed with spontaneous coronary artery dissection and needed urgent catheterization revealing left anterior descending coronary artery dissection. She underwent emergent coronary artery bypass graft surgery with good post-operative recovery.CONCLUSIONMost patients with PSCAD can be managed conservatively with medical management and have good outcomes. Patients with high-risk presentations benefit from the invasive approach. Coronary artery bypass graft may be required in select few patients based on angiography findings. Due to the risk of recurrent spontaneous coronary artery dissection, subsequent pregnancies are discouraged.     

Intravascular ultrasound in the management of acute coronary artery dissection: A case report

Crossing total occlusions is frequently difficult. The guidewire may enter a false lumen, thereby preventing successful balloon dilatations. We present a case of an acute arterial dissection following attempted angioplasty of a totally occluded right coronary artery. With an intravascular ultrasound probe in the false lumen, we were able to visualize a second guidewire and direct its passage into the true arterial lumen. This allowed for successful balloon dilatation and stent deployment restoring vessel patency.     

Stent treatment of an aortocoronary dissection during percutaneous coronary intervention. A case report and brief literature review

Aortocoronary dissection as a complication of diagnostic angiography or percutaneous coronary intervention is a rare occurrence. We describe a patient, in whom retrograde aortic dissection appeared during percutaneous coronary intervention to the right coronary artery, which was successfully treated by a 4-stent implantation.     

Coronary artery stenting for spontaneous coronary artery dissection: A case report and review of the literature

Spontaneous coronary artery dissection is an uncommon cause of acute coronary syndromes. It occurs in three major groups: in young women in the peripartum period, in patients with atherosclerotic disease, and in an idiopathic group. There are a number of associated conditions, but the pathogenesis remains unclear. Diagnosis can only be made at angiography. Treatments include medical therapy, coronary artery bypass grafts, and newer interventional procedures. We report on a case of spontaneous coronary artery dissection involving the left circumflex artery in a young adult male presenting with a myocardial infarction after exercise. There were no risk factors for coronary artery disease and no evidence of atherosclerosis on angiography. The dissection was treated with primary coronary artery stenting without predilation, achieving an excellent result. To our knowledge, this is the third known case of successful coronary artery stenting for this condition and the first case of primary stenting without prior angioplasty. Cathet. Cardiovasc. Diagn. 45:280–286, 1998. © 1998 Wiley-Liss, Inc.     

Acute type A aortic dissection involving the left main trunk of the coronary artery--a report of two successful cases.

This report describes 2 cases of a type A acute aortic dissection combined with myocardial infarction caused by a retrograde dissection into the left main trunk of the coronary artery. Successful surgical treatments, including the replacement of the ascending aorta, aortic valve resuspension and coronary artery bypass grafting, were performed in both patients, and they recovered well from cardiogenic shock. However, left ventricular function of both patients remained depressed postoperatively, which limited their quality of life. Because no definite method for salvaging infarcted myocardium has yet been established, either more timely surgery or the preoperative placement of a perfusion catheter in the left main coronary artery is mandatory.     

Giant coronary arteriovenous fistula. A case report and review of the literature

Coronary artery fistulas are rare congenital anomalies. Although they constitute the most common form of hemodynamically significant coronary malformation, the incidence is around 0.002% in the general population. We report the successful surgical closure of a very large coronary artery fistula, originating from the left coronary artery and draining into the right atrium with left-to-right shunt of more than 50% and a review of the literature.     

Spontaneous dissection of the left main coronary artery: case report and review of the literature

Abstract Primary coronary artery dissection is a rare cause of myocardial infarction. It should be suspected in young, healthy females. It is a condition which is treated by myocardial revascularisation. (Aust NZ J Med 1991; 21: 891–892.)     

Intravascular leiomyomatosis: report of a case and review of the literature

So far, only 13 cases with extension of an intravascular leiomyoma into the heart have been reported. We present the second known case of leiomyomatosis with extension of the tumor through the tricuspid valve into the right ventricle, which was first removed successfully. Ten years after an abdominal hysterectomy for a myomatous uterus, a 53-year old woman presented with a intracavitary mass in the right-sided heart chambers which could be followed retrogradely into the inferior vena cava and right pelvic veins, representing an intravasal extension from the pelvic leiomyoma. The clinical picture, the two-stage operative management, and the postoperative course are reviewed and the literature on the subject is presented.     

Spontaneous renal artery dissection. Case report and review of the literature]

Focal idiopathic renal arterial dissection (RAD) is a rare event. Nevertheless, a RAD should always be considered in the differential diagnosis in patients with flank pain or acute abdomen, since only an immediate diagnosis and correction can guarantee the maintenance of kidney function. Early operation is also necessary because other clinical pictures with a similarly dramatic clinical course and similar symptoms can likewise only be treated surgically. These include a renal arterial aneurysm with endo-aneurysmatic thrombus and poststenotic dilatation in fibromuscular dysplasia. We describe the case of an isolated idiopathic RAD which could only be diagnosed in the context of abdominal pain symptoms. Clinical, pathophysiological and therapeutic aspects of RAD are discussed with reference to the case report and the international specialist literature.     

Spontaneous coronary artery dissection: A single-center case series and literature review

Background

Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndrome (ACS). Better recognition and diagnosis has raised awareness of this condition. However, the pathophysiology of SCAD and its prognosis are still little understood. We aimed to investigate the characteristics and prognosis of patients with SCAD, and subsequently performed a review of literature.

Acute myocardial infarction from spontaneous coronary artery dissection a case report and review of the literature

Spontaneous coronary artery dissection is a rare event as a cause of acute myocardial infarction. Optimal treatment remains unclear. In this report, we describe a case of spontaneous acute coronary artery dissection presenting as recurrent acute myocardial infarction in a postmenopausal woman, successfully treated with systemic thrombolysis. The case is discussed with review of the pertinent literature.     

Acute type A aortic dissection involving the left main coronary artery and the aortic valve--a case report.

The authors report a case study of a 60 year-old-male admitted to the Coronary Care Unit with severe chest pain, hypertension and ST depression on the anterior and lateral leads of the electrocardiogram. A diastolic murmur was heard in the aortic area. The chest X-ray showed an enlarged superior mediastinum. The transthoracic echocardiogram revealed an image that indicated an intimal flap above the aortic plane with severe aortic regurgitation. An aortography was performed and confirmed the diagnosis of acute type A aortic dissection with partial obstruction of the left main coronary artery, probably due to compression by the hematoma. The patient underwent emergency surgical repair with replacement of the aortic valve and ascending aorta. The patient survived without complications post surgery and was discharged ten days after onset of symptoms. Twenty months later, the patient was asymptomatic and the transesophageal echocardiogram showed a dissection of the descending thoracic aorta, mild aortic regurgitation and good left ventricular systolic function.     

Acute type A aortic dissection involving the left main coronary artery and the aortic valve--a case report.

The authors report a case study of a 60 year-old-male admitted to the Coronary Care Unit with severe chest pain, hypertension and ST depression on the anterior and lateral leads of the electrocardiogram. A diastolic murmur was heard in the aortic area. The chest X-ray showed an enlarged superior mediastinum. The transthoracic echocardiogram revealed an image that indicated an intimal flap above the aortic plane with severe aortic regurgitation. An aortography was performed and confirmed the diagnosis of acute type A aortic dissection with partial obstruction of the left main coronary artery, probably due to compression by the haematoma. The patient underwent emergency surgical repair with replacement of the aortic valve and ascending aorta. The patient survived without complications post surgery and was discharged ten days after onset of symptoms. Twenty months later, the patient was asymptomatic and the transesophageal echocardiogram showed a dissection of the descending thoracic aorta, mild aortic regurgitation and good left ventricular systolic function.     

Moraxella (Branhamella) catarrhalis bacteremia. A case report and literature review

Moraxella catarrhalis is increasingly recognized as a cause of pulmonary and upper airway disease, but bacteremia remains unusual. We treated a 71-year-old man who died of rapidly progressive bacteremic M catarrhalis bronchopneumonia. This case, and a review of the 27 previously reported M catarrhalis bacteremias in the literature, demonstrated that M catarrhalis can be a virulent organism capable of causing serious infection and death in both immunocompetent and compromised hosts.