Congenital anomalies of the coronary arteries: Report of an unusual case associated with cardiac hypertrophy

An instance is recorded, in a male infant dying at the age of three months, of an abnormal origin of the left coronary artery from the pulmonary artery, associated with marked enlargement of the heart (due to hypertrophy and dilatation of the left ventricle), together with extensive degenerative changes in the ventricular wall supplied by the malposed vessel. In view of these findings, it is probable that the paroxysmal attacks of acute discomfort precipitated by exertion and associated with profound vasomotor collapse occurring in this infant were those of angina pectoris. The electrocardiographic picture in our case was similar to that seen in adults with important coronary disease. In the few recorded cases (8 in number in addition to our own) of this rare anomaly a characteristic pathological picture has resulted. Death within the first year has been the rule. Two of the cases have been exceptional.A review of congenital variations in the coronary vessels and a discussion of their embryological background are included. A bibliography is appended.     

Congenital tracheal stenosis with associated cardiopulmonary anomalies: report of two cases with a review of the literature

We present two infants with congenital tracheal stenosis with complete tracheal rings. Both had associated congenital anomalies. The first case showed cardiac malformations, and the second case had agenesis of the right lung. We review the literature, in particular with reference to tracheal stenosis and pulmonary agenesis. We also propose that the constellation of anomalies may result from defects in the cervical mesenchyme and, as such, may represent one end of a spectrum of cervical mesenchymal field defects.     

Localization of coronary artery disease with exercise induced ST segment depression: coronary angiographic correlation

Abnormalities of the 12 lead electrocardiogram (ECG) are often used to localize the anatomic site of myocardial ischemia and vessel involvement in patients (pts) with coronary artery disease. This study is to determine if ischemia of specific vascular segments can be identified by exercise induced ST segment depression (STD) on 12-lead ECG. One hundred and forty three pts with a positive treadmill stress testing (TST) who had coronary arteriography within one month of TST were reviewed. There were 114 men and 29 women, aged 34-74 years (mean 55 years). The Bruce protocol was used for TST. Significant coronary stenosis was defined as obstruction of 70% or greater of the luminal diameter. The pattern of STD on 12 lead ECG during exercise was similar in pts with single vessel disease involving the left anterior descending artery (LAD), right coronary artery (RCA) or circumflex artery (Cx). This pattern of STD in single vessel disease was also comparable to 2-vessel, 3-vessel or left main stem disease. Twenty-two percent of pts with LAD disease had isolated STD in inferior leads. Twenty-five and 29% of pts with RCA and Cx disease respectively had STD in the anterior leads alone during exercise testing. It is concluded that exercise induced STD in 12 lead ECG can not predict ischemia of specific vascular segments or specific vessel involvement.     

Interventricular septal defects with associated major vascular anomalies; report of three cases

Three cases of ventricular septal defect are reported in which associated anomalies were simultaneously and successfully corrected by open-heart surgery. These included patent ductus arteriosus, anomaly of the aortic arch, anomalous left upper lobe pulmonary vein draining into the left innominate vein, and coarctation of the aorta.     

Successful percutaneous coronary intervention of anomalous origin right coronary arteries with 3-D RCA guide catheters: a report of three cases

Right coronary arteries with anomalous origin (ARCA) may be associated with myocardial ischemia and sudden death. Selective catheterization and percutaneous coronary intervention (PCI) of ARCA can be technically challenging due to their slit-like orifice and aortic intramural course with abrupt angulation. The 3DRCA guide catheter is a unique catheter with a helical configuration that provides optimal guide support during PCI. We describe three cases of successful PCI to right coronary arteries with anomalous origin (two from the left sinus of Valsalva, one with ectopic origin from the right sinus of Valsalva) using 3DRCA guide catheters after a variety of other catheters were tried unsuccessfully.     

先天性肝纤维化伴Caroli病3例

先天性肝纤维与先天性肝内胆管护张症(又称Caroli病)是一组临床少见的常染色体隐性遗传性疾病,以儿童、青少年多发,临床常易漏诊、误诊,其病变常累及整个肝脏,且多与先天性肾囊肿等伴发.     

Primary congenital anomalies of the coronary arteries: a coronary: arteriographic study

Geographic variations in the incidence of different congenital coronary anomalies are well known, but infrequently studied in the Indian population. Among 4,100 adult patients who underwent diagnostic coronary arteriography, 39 (0.95%) patients (34 males, 5 females) had one or more anomalous coronary arteries. Their mean age was 46.4 +/- 8.2 years (range, 26-68 years). Thirty-five (89.74%) had anomalies of origin and distribution, while the remaining four (10.25%) had coronary artery fistulae. Right coronary artery was the commonest anomalous vessel, involved in 19 (48.74%) patients. It was originating from the left sinus of Valsalva in 15 and from the non-facing aortic sinus in four patients. Anomalous left circumflex artery was the second commonest anomaly, seen in 14 (35.89%) patients. Anomalous left anterior descending artery and anomalous left coronary artery from pulmonary artery were seen in one patient each. Among patients with coronary fistulae, two had fistulae between the left anterior descending artery and the main pulmonary artery, one between the conal artery and the right atrium, while the fourth patient had fistulae from the right coronary as well as from the left anterior descending artery to the left atrium. Atherosclerotic plaques in the anomalous arteries were seen in only 13 (33.33%) patients, much less than the overall incidence of coronary artery disease in patients with congenital coronary anomalies in this series (66.66%). In four (10.25%) patients, only the anomalous vessels were involved in coronary artery disease. Thus, in a small subgroup there does not appear to be an increased risk for development of atherosclerotic coronary artery disease in anomalous coronary arteries. Recognition of coronary anomalies is important in patients undergoing coronary arteriography, coronary interventions and cardiac surgery. Variations in the frequency of primary congenital coronary anomalies may possibly have a genetic background.     

Novel technique for stent delivery in tortuous coronary arteries: report of three cases.

We present a novel technique for stent delivery across tortuous lesions. Gentle forward pressure was applied on the stent balloon while the balloon was inflated to 2-3 atm. This resulted in the balloon and stent crossing the impeding segment and settling in the target site where it was deployed with excellent angiographic outcome.     

Double-trouble: three cases with simultaneous stent thrombosis in different coronary arteries

We report about three cases with a unique simultaneous double- trouble stent thrombosis in different coronary arteries. Although the triggering mechanism remains purely speculative, it is possible that suboptimal stent size and perhaps underexpansion caused the stent thrombosis in one stent resulting in a heightened platelet activation and impaired hemodynamics causing the second stent thrombosis.     

Congenital aneurysm of the coronary arteries. Apropos of 2 cases

Two cases of aneurysm of the coronary arteries were diagnosed by coronary angiography in the course of a myocardial infarction. The first aneurysm was located at the level of the left coronary trunk in a 32 year-old woman; it was complicated with a massive anterior infarction which led to a heart transplant in the following months. The second aneurysm was located on the right coronary artery in an 18 year-old man; the inferior infarction was rudimentary and the subsequent course was quite favorable. Congenital aneurysm of the coronary arteries is a rare anomaly, often localized on the left coronary trunk and almost always diagnosed in young patients following myocardial infarction.     

Erythema nodosum associated with antiphospholipid antibodies: a report of three cases

Erythema nodosum is a dermatologic condition characterized by painful, erythematous nodules on the anterior surfaces of the lower extremities. Its association with a variety of conditions has been previously described. We present three cases of erythema nodosum in patients with elevated anticardiolipin antibodies. In one patient, a temporal relationship was seen in the simultaneous detection of antibodies and skin lesions. We propose an association between erythema nodosum and the antiphospholipid antibody syndrome (APS).     

The use of intrastent peripheral stent in large coronary arteries: report of three cases.

We report three cases of coronary angioplasty using the IntraTherapeutics Intrastent biliary stent. We describe a technique utilizing routine coronary angioplasty equipment including 8 Fr guiding catheters and 0.014" guidewires. This technique can be easily performed in large-diameter coronary arteries.