Rare coronary anastomoses between the aorta,pulmonary trunk,left coronary artery,and subclavian artery

We report a rare case of coronary anastomoses in an 83‐year‐old male cadaveric heart. Anomalous vessels arose from the right sinus of the aorta, left main coronary artery, left anterior descending artery, left anterior medial atrial artery, and left subclavian artery. These vessels bifurcated and anastomosed, and finally connected to the pulmonary trunk. The present case is categorized as a multilateral coronary artery fistula in cardiology. Clin. Anat. 25:969–972, 2012. © 2012 Wiley Periodicals, Inc.     

Subclavian artery stenosis as a cause of acute coronary syndrome in a patient after coronary artery bypass grafting

We described a case of a 74-year-old man who suffered from acute coronary syndrome 7 years after coronary artery bypass grafting. The patient underwent angioplasty of the obtuse marginal branch of the left coronary artery from venous graft access, which did not result in relief of ailments. Only angioplasty of the narrowed subclavian artery caused an improvement in the patient''s condition. The clinical significance of narrowing within the subclavian artery in patients after the procedure of implanting the left subclavian artery into the coronary artery system was discussed.     

Giant coronary sinus aneurysm secondary to right coronary arteriovenous fistula leading to pseudo-mitral stenosis

We herein report a case in which a right coronary to coronary sinus arteriovenous fistula determined progressive aneurysmatic dilatation of the coronary sinus. Severe compression of the left atrium ensued. This led to a clinical and instrumental picture similar to that observed in severe mitral stenosis.     

Coronary artery aneurysms in patients with hyper IgE recurrent infection syndrome

Hyper IgE recurrent infection syndrome (HIES, or Job's syndrome) is a primary immunodeficiency characterized by recurrent skin and lung infections, eczema, elevated serum immunoglobulin E (IgE) levels, and various connective tissue and skeletal system abnormalities including characteristic facies, scoliosis, joint hyperextensibility, retained primary dentition, craniosynostosis, osteopenia, and pathologic fractures. We have identified two patients with aneurysmal coronary artery disease. One was a forty-three-year-old man with HIES and coronary artery aneurysms and ectasia identified on cardiac catheterization following myocardial infarction. The other was a 48-year-old man with coronary artery ectasia-aneurysm identified after cardiac catheterization for evaluation of chest pain. Although connective tissue abnormalities are common in HIES, this is the first report of coronary artery aneurysms in HIES. Further studies are necessary to determine the incidence, pathogenesis, and optimal therapy of these arterial abnormalities in HIES.     

先天性冠状动脉瘘21例的临床分析

目的 探讨先天性冠状动脉瘘的治疗经验。方法 回顾性分析2005年12月—2014年4月山东大学齐鲁医院收治的21例先天性冠状动脉瘘患者的临床资料,其中男12例、女9例,年龄2个月~74岁、平均27.8岁。21例患者均经心脏彩超或冠状动脉造影明确诊断。 13例在体外循环下行经心腔或肺动脉冠状动脉瘘修补术,3例行介入封堵术,5例无症状、瘘口较小(1.5~3.5 mm)且不合并其他心脏畸形及并发症患者给予药物保守治疗。结果 16例患者手术顺利,无围手术期死亡或心、脑并发症发生;术后1例合并卵圆孔未闭患者出现肺动脉高压危象,1例术后发现1.5 mm残余瘘,予相应处理后均痊愈出院。15例手术患者和5例保守治疗患者获0.7～9年(平均3.9年)随访。15例手术患者术后心脏彩超检查示冠状动脉瘘异常分流均消失,其中1例残余瘘患者瘘口闭合,1例患者冠状动脉近端出现迂曲瘤样改变;5例药物保守治疗患者中2例患者瘘口自然闭合,1例患者瘘口较前减小,2例患者瘘口无明显变化,均无相关并发症发生。结论 手术治疗先天性冠状动脉瘘疗效确实可靠;对无症状、不合并其他需手术处理的心脏畸形、瘘口＜4 mm者,可采取保守治疗,部分患者可自然愈合。     

川崎病并发巨大冠状动脉瘤急性期临床特征与危险因素分析

目的 以川崎病（KD）并发巨大冠状动脉瘤（GCAA）的病例对照研究,分析KD急性期的临床特征,并探讨并发GCAA的危险因素。方法选取2001年5月至2009年5月在广州市妇女儿童医疗中心儿童医院住院的KD并发GCAA患儿为GCAA组;选取同期KD并发中小冠状动脉瘤（CAA）患儿为对照组。对两组患儿的临床特征进行比较,对可能影响GCAA发生的因素进行单因素分析,并进行多因素Logistic逐步回归分析。结果GCAA组纳入22例,其中男19例,女3例,发病年龄3个月至10岁,平均（2．9±2．8）岁。中小CAA组纳入65例,其中男51例,女14例。Pearson χ2检验结果提示,年龄≤6个月或≥5岁、发热时间〉14d、延误诊断、确诊前单独使用糖皮质激素、Hb降低、ESR升高和ALB降低与GCAA发生相关（P均〈0．05）。多因素Logistic逐步回归分析提示,延误诊断（OR=2．998,95％CI：1．004～8．950,P=0．047）,确诊前单独使用糖皮质激素（OR=6．556,95％CI：1．561～28．542,P=0．010）,ESR≥100mm·h^-1（OR=3．591,95％CI：1．164～11．079,P=0．026）为发生GCAA的独立危险因素。结论延误诊断、确诊前单独使用糖皮质激素和ESR≥100mm·h^-1为KD并发GCAA的独立危险因素。     

小儿左冠状动脉异常的矫治术麻醉管理方法探讨

目的分析小儿起源于肺动脉的左冠状动脉异常矫治手术的麻醉特点,为今后开展类似手术提供可行的麻醉管理方法。方法回顾性分析2006年3月至2010年7月本院20例小儿起源于肺动脉的左冠状动脉异常矫治术的麻醉管理方法。结果采用静吸复合全麻,术中均未出现急性心衰或心梗,CPB时间为58～204（80.6±44.4）min,主动脉阻断时间为25～125（53.4±32.2）min,开放主动脉后均自动复跳,适时应用血管活性药物,以保证麻醉平稳,停CPB时SBP为（78.6±8.0）mmHg,DBP为（45.4±3.5）mmHg,HR为（130.8±10.5）次/min,术中无死亡及麻醉并发症。1例术后第2天死于严重低心排综合征,死亡率为5%,其余痊愈出院。结论小儿左冠状动脉异常矫治术以静吸复合全麻的方法 ,辅以严密监测,尽力维持血流动力学稳定,积极采取各种措施避免加重心肌缺血的麻醉管理方法是正确可行的,可以推广应用于术前有心功能损害的手术。     

Significance of small dense low-density lipoprotein as a risk factor for coronary artery disease and acute coronary syndrome

Small dense LDL (sd-LDL) has recently emerged as an important coronary artery disease (CAD) risk factor. This study was performed to investigate how LDL particle size is related to CAD and acute coronary syndrome (ACS). Blood samples were collected from 504 patients that underwent coronary angiography to evaluate chest pain. The LDL particle size of these samples was measured. The mean LDL particle size was smaller in patients with angiographically proven CAD than in the controls (26.41 +/- 0.95 vs 26.73 +/- 0.64 nm, p < 0.001), and was negatively correlated with the Framingham risk score (r=-0.121, p=0.007). Patients with more extensive CAD had smaller LDL particles. LDL particle size was also smaller in patients with acute coronary syndrome as compared to non-ACS patients (26.09 +/- 1.42 vs 26.54 +/- 0.63 nm, p=0.011). These results suggest that sd-LDL is independently associated with the incidence and extent of CAD, and can be a risk factor for the development of ACS in the Korean population.     

右冠状动脉起源于左主干5例临床分析

目的：分析右冠状动脉起源于左主干的临床特征，探讨其与心肌缺血的关系。方法：回顾分析5例右冠状动脉起源于左主干的临床资料及相关文献。结果：（1）本组5例患者中，女性1例，男性4例，年龄27～70岁。（2）临床表现主要为胸痛、胸闷等心绞痛症状，除1例老年患者外，其余4例病人都有典型的心绞痛症状和缺血心电图变化。（3）冠状动脉造影示3例合并严重冠状动脉粥样硬化，给予冠状动脉搭桥术，术后随访2月～6年无明显不适；另2例冠状动脉无明显病变，药物治疗后仍有劳累性心绞痛发作，其中1例半年后猝死。结论：右冠状动脉起源于左主干是一种罕见的冠脉畸形，对存在严重心肌缺血的患者应进行预防性冠状动脉搭桥术或介入治疗，预防不良事件的发生。     

Comparing mortality and myocardial infarction between coronary artery bypass grafting and drug-eluting stenting in patients with diabetes mellitus and multivessel coronary artery disease: a meta-analysis

Introduction

We aim to compare the midterm outcomes between coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in diabetic patients who had multivessel coronary artery diseases (CAD).

Material and methods

A comprehensive literature search was conducted to identify the related clinical studies with a follow-up for 1 year at least. The endpoints were death, myocardial infarction, and major adverse cardiac and cerebrovascular events (MACCE).

Results

Finally, the analysis of ten studies involving 5,264 patients showed that patients with CABG had worse baseline characteristics, a higher rate of stable angina pectoris, a higher percentage of triple-vessel disease, higher incidence of chronic total occlusion and a higher SYNTAX score. However, there was no significant difference in mortality between the two groups. Additionally, the rates of myocardial infarction and MACCE were markedly decreased in the CABG group.

Conclusions

The strategy of CABG is better than PCI for diabetic patients with multivessel CAD. The CABG can significantly reduce the rates of myocardial infarction and MACCE and is comparable in mortality despite the worse baseline characteristics.     

Giant right coronary artery aneurysm secondary to Kawasaki disease in child: a case report

Coronary artery aneurysm or ectasia was reported in approximately 15% to 25% of the affected children, particularly in the proximal end of the main blood vessel and the left anterior descending part. Rare patients have been reported with aneurysm in the distal end of the right coronary artery. In this case report, we present a rare case with aneurysm in the distal end of the right coronary artery. Multi-slice computed tomography was performed for the coronary angiography. Aspirin (10 mg/kg body weight per day) and gamma globulin (2 kg/kg body weight) was administrated via intravenous injection. The patient is currently in a healthy status with a 12-month follow up.     

冠状动脉畸形及其临床意义

目的：研究冠状动脉畸形及其临床意义。方法：在460例冠状动脉的解剖中，发现7例冠状动脉异常，并对此动脉开口移位和冠状动静脉瘘进行解剖与观察。结果：在7例中，5例冠状动脉开口移位，经动脉圆锥前、主动脉后或主动脉与肺动脉干之间横过心底，到达其分布区。单一（右）冠状动脉Ⅱ型或一冠状动脉发自对侧主动脉窦提供解释：此冠状动脉畸形的青年，可在运动时或运动后猝死。2例冠状动静脉瘘，显示冠状动脉和肺动脉干与左室之间，存在毛细血管前吻合。结论：冠状动脉畸形在临床实践中有其意义，其发生有它的胚胎学基础。     

Transgenic expression of matrix metalloproteinase-2 induces coronary artery ectasia

Coronary artery ectasia (CAE) is generally diagnosed in patients undergoing arteriography for presumptive atherosclerotic coronary artery disease. CAE is commonly considered as a variant of atherosclerotic disease; however, recent studies suggest that CAE is the result of a systemic vascular disorder. There is increasing evidence that aneurysmal vascular disease is a systemic disorder characterized by enhanced expression of pro-inflammatory cytokines and increased synthesis of enzymes capable of degrading elastin and other components of the vascular wall. Matrix metalloproteinase-2 degrades a number of extracellular substrates, including elastin and has been shown to play a critical role in the development of abdominal aortic aneurysms. This study characterizes the development of CAE in a unique murine transgenic model with cardiac-specific expression of active MMP-2. Transgenic mice were engineered to express an active form of MMP-2 under control of the α-myosin heavy chain promoter. Coronary artery diameters were quantified, along with studies of arterial structure, elastin integrity and vascular expression of the MMP-2 transgene. Latex casts quantified total coronary artery volumes and arterial branching. Mid-ventricular coronary luminal areas were increased in the MMP-2 transgenics, coupled with foci of aneurysmal dilation, ectasia and perivascular fibrosis. There was no evidence for atherogenesis. Coronary vascular elastin integrity was compromised and coupled with inflammatory cell infiltration. Latex casts of the coronary arteries displayed ectasia with fusiform dilatation. The MMP-2 transgenic closely replicates human CAE and supports a critical and initiating role for this enzyme in the pathogenesis of this disorder.     

Aberrant penetrating posterior descending artery from proximal right coronary artery

We report a rare variant of the posterior descending artery (PDA) in a 51-year-old African-American male discovered in coronary CT angiography. Arising from the proximal right coronary artery near its ostium, the anomalous PDA penetrated posteriorly toward the atrioventricular junction septum, exited through the inferior pyramidal space into the posterior interventricular groove and continued in the groove as a short PDA. Along its course it gave rise to small branches to the medial wall of the right atrium, the atrioventricular node region, and the inferoseptal wall of the right ventricle.     

胃网膜动脉与冠状动脉搭桥术的应用解剖

为胃网膜动脉与冠状动脉搭桥术提供解剖学资料。本文在30具成年尸体上对胃网膜动脉、网膜动脉和冠状动脉进行了观测。测量结果:胃网膜动脉弓长度为29.3cm;而胃网膜右动脉的起始部至主动脉根部为28.9cm;胃网膜左动脉起始部至主动脉根部为29.2cm。测量数据表明,应用胃网膜动脉移位术足以吻接任何冠状动脉。     

Systemic artery to pulmonary artery aneurysm malformations associated with variants at MCF2L

Arteriovenous malformations (AVM) are characterized by abnormal vessels connecting arteries and veins resulting in a disruption of normal blood flow. Hereditary hemorrhagic telangiectasia (HHT) is the most common cause of pulmonary AVM characterized by a right to left shunt. Here we describe a distinct malformation where the flow of blood was from a systemic artery to the pulmonary artery (PA) resulting in a left to right shunt instead of the right to left shunt seen in individuals with HHT. This distinct malformation was identified in seven probands, one from a multiplex family containing 10 affected individuals from five generations. To identify the molecular basis of this distinct malformation, we performed exome sequencing (ES) on the seven probands and the affected paternal female cousin from the multiplex family. PhenoDB was used to prioritize candidate causative variants along with burden analysis. We describe the clinical and radiological details of the new systemic artery to PA malformation with or without pulmonary artery aneurysm (SA-PA(A)) and recommend distinct treatment techniques. Moreover, ES analysis revealed possible causative variants identified in three families with variants in a novel candidate disease gene, MCF2L. Further functional studies will be necessary to better understand the molecular mechanisms involved on SA-PA(A) malformation, however our findings suggest that MCF2L is a novel disease gene associated with SA-PA(A).     

先天性左冠状动脉主干闭锁3例超声心动图特征及文献复习

目的 通过研究先天性左冠状动脉主干闭锁（LMCAA）的超声心动图表现,提高对LMCAA诊断的准确性.方法 回顾性分析经冠状动脉造影证实的3例LMCAA患儿的超声心动图检查结果,并复习相关文献,总结LMCAA超声心动图特征.结果 LMCAA特异性超声心动图特征：①主动脉左冠状动脉窦内无左冠状动脉主干开口,左冠状动脉主干近心端闭锁呈盲端,远心端内径细窄,发育不良;②右冠状动脉内径增宽;③多切面未显示左冠状动脉与肺动脉确切连接的证据.LMCAA非特异性超声心动图特征：①左心室明显扩大,左室收缩功能可正常或减低;②二尖瓣腱索、乳头肌回声显著增强,可伴有二尖瓣脱垂.彩色多普勒超声特征：①收缩期二尖瓣口可见中至大量反流信号;②左、右冠状动脉之间形成细小侧支循环; ③左冠状动脉前降支和回旋支血流为逆向灌注（向心性）;④发育不良的左冠状动脉虽然在肺动脉周围分布,但彩色多普勒超声不能显示其与肺动脉连接的确切逆灌血流信号.结论 LMCAA有特异性的超声心动图特征,提高对LMCAA的全面认识是诊断本病的关键.     

Dissecting aneurysms involving both anterior cerebral artery and aorta

Non-traumatic intracranial dissecting aneurysm (IDA) has been recently reported with increasing frequency and is recognized as a possible cause of subarachnoid hemorrhage. However, the pathogenesis of this disease is still unclear. Cystic medial necrosis (CMN) is known to be a cause of aortic dissection, especially in Marfan's syndrome. Presented herein is the case of a 49-year-old man who had IDA of the right anterior cerebral artery and abdominal aortic dissection without Marfan's syndrome. Histological examination showed medial degenerative changes with the accumulation of acid mucopolysaccharides in various intra- and extracranial arteries. Coexistence of dissecting aneurysms in the anterior cerebral artery and aorta suggests the presence of underlying pathogenesis that is common to these two dissection processes.