共查询到20条相似文献,搜索用时 31 毫秒
1.
Salah E. Altarabsheh MD Salil V. Deo MD Abeer Rababa'h PhD Sakher Mayaah MD Mohammad Alkhasawneh MD Dalia A. Alhabahbeh MD Yagthan M. Obeidat MD 《Journal of cardiac surgery》2020,35(9):2379-2381
Giant right coronary artery (RCA) aneurysm is a rare coronary artery pathology. We describe a 45-year-old gentleman who presented with unstable angina of recent onset. Diagnostic workup including chest computed tomography angiography and left heart catheterization demonstrated three-vessel coronary artery disease with giant proximal RCA aneurysm. In the view of the severity of the coronary artery disease and the risk of rupture associated with the giant RCA aneurysm and the clinical presentation, the patient was successfully treated by coronary artery bypass surgery. During this procedure, the RCA aneurysm was ligated at both inflow and outflow. The patient recovered well and was discharged home. 相似文献
2.
Yamazaki S Yokoyama S Shingaki M Miyake T Koh E 《Kyobu geka. The Japanese journal of thoracic surgery》2008,61(2):157-160
The successful surgical treatment for a coronary artery aneurysm was reported. A 38-year-old female presented with angina pectoris due to right coronary artery stenosis. Angiography revealed a right coronary artery aneurysm and 90% stenosis at a site just proximal to the aneurysm, accompanied by the relatively large right ventricular (RV) branch originating from a mid portion of the aneurysm. Off-pump coronary artery bypass grafting (CABG) to the right coronary artery (RCA) #3, translocation of RV branch to RCA #3, and ligation of RCA proximal and distal to the aneurysm were successfully performed. Post-operative course had been uneventful with satisfactory angiographic results. Coronary translocation with CABG could be a treatment option for coronary artery aneurysms. 相似文献
3.
Satsuki Komoda Takeshi Komoda Ekaterina Ivanitskaia-Kuehn Stephan Dreysse Miralem Pasic Roland Hetzer 《General thoracic and cardiovascular surgery》2010,58(2):78-81
We describe the case of a 67-year-old man with a rare combination of a giant coronary artery aneurysm with a fistula draining
into the coronary sinus. The patient presented with a sensation of retrosternal pressure. He was examined by coronary angiography,
which revealed a large aneurysm of the right coronary artery (RCA) with a fistula. This fistula originated from the distal
RCA shortly beyond the crux and drained into the coronary sinus. The aneurysm was in the proximal portion of the RCA, measuring
4 cm in diameter and 7 cm in length. Surgical repair by closure of the fistula under direct vision, suture closure and plication
of the aneurysm, and coronary artery bypass was performed. Postoperative echocardiography and computed tomography confirmed
closure of the fistula. The patient remains symptom-free at 4 months after surgery. 相似文献
4.
Minami H Asada T Gan K Abe K Izumi S 《General thoracic and cardiovascular surgery》2007,55(6):248-251
We report a 33-year-old woman who had a 60-mm thoracic aneurysm of the ascending aorta with Marfan syndrome and effort angina
due to compression of the right coronary artery (RCA) by the aneurysm. Surgery was performed using the Bentall procedure and
a coronary artery bypass graft to the RCA. Postoperatively, coronary angiography showed that the coronary flow of the RCA
was restored by removing the aneurysmal compression. The patient was discharged without angina on postoperative day 21. 相似文献
5.
M Nakano S Horikoshi H Emoto H Okuyama T Arai H Kurosawa 《[Zasshi] [Journal]. Nihon Kyōbu Geka Gakkai》1992,40(9):1738-1743
A case of 50-year-old man who developed coronary aneurysm at the initial PTCA site following dilatation was reported. The patient was suffered severe effort angina pectoris and admitted to our hospital. Coronary angiography revealed 99% stenosis in the right coronary artery (RCA), and the underwent balloon dilatation of the RCA lesion with 3.0 mm balloon catheter at 3 atm of pressure. PTCA provided sufficient coronary dilatation, however a small dissection remained. He was discharged from the hospital without any symptom. Two months after PTCA he was suffered from recurrent angina, and electrocardiographic exercise stress test was positive for ST segment depression in inferior wall. The repeat coronary angiography showed severe stenosis of the original lesion and aneurysm formation at the area of dissection which occurred during initial angioplasty. Coronary artery bypass surgery with a saphenous vein graft performed successfully. 相似文献
6.
H Okamoto K Yasuura A Matsuura T Akita M Sawazaki T Abe A Seki Y Ogawa M Hoshino 《Kyobu geka. The Japanese journal of thoracic surgery》1991,44(4):331-333
A 43-year-old female patient suffering from effort angina underwent coronary artery bypass grafting. Coronary arteriogram demonstrated complete occlusion of the left main, proximal circumflex (Cx), and proximal left anterior descending coronary arteries (LAD) and a nonocclusive fusiform calcified aneurysm of the proximal right coronary artery (RCA). The left coronary artery system opacified via collateral vessels from the RCA. No other abnormalities were found in the entire aorta and its major branches. Myocardial revascularization was performed using the right IMA to bypass to the Cx and the left IMA to bypass to the LAD successfully. Prior to the operation, she had neither coronary risk factors nor inflammatory signs, though she had experienced fever of unknown origin lasting about a week when she was 11 years old. Accordingly we supposed that such coronary arterial lesions might have arisen from Kawasaki's disease in her childhood. 相似文献
7.
A 26-year-old male presented with radiographical evidence of enlargement of the right side of the heart. Echocardiography and computed tomography-scan revealed a diffuse, hugely enlarged right coronary artery (RCA) aneurysm, with the distal portion flowing directly into the left ventricle (LV). A radical correction operation was performed successfully. The RCA was reconstructed with an autograft of a greater saphenous vein after the aneurysm was removed and the RCA-to-LV fistula was closed. The postoperative course was uneventful and the patient was discharged on 12th day after operation. 相似文献
8.
Aoki I Horikoshi S Mizuno A Miyamoto M Suzuki H 《Kyobu geka. The Japanese journal of thoracic surgery》2000,53(13):1115-1118
A 62-year-old female, cardiac echography and catheterization revealed against aneurysming right coronary arteriovenous fistula. To avoid rupture of the aneurysm, the right coronary orifice was closed. Subsequently, the arteriovenous fistula orifice adjacent to the coronary venous sinus was closed. In addition, to avoid transfer of a thrombus in the aneurysm to the RCA, suture ligature of the right coronary aneurysm was performed, and surgery was completed. The postoperative course was uneventful. Postoperative heart catheterization showed good collateral blood circulation from the LAD to the RCA. 相似文献
9.
T Shimoyama K Hirooka M Ohnuki H Nagaoka 《Kyobu geka. The Japanese journal of thoracic surgery》2001,54(12):1045-1048
A 67-year-old female was admitted to our hospital with heart failure. Echocardiography, chest CT and MRA revealed an unruptured aneurysm of sinus of Valsalva. Cardiac catheterization and angiography detected obstruction of the ostium of the right coronary artery and moderate aortic regurgitation. Operative findings showed an extracardiac unruptured aneurysm arising from the right sinus of Valsalva. The orifice of the aneurysm was closed with Gore-Tex patch, then aortic valve replacement combined with single CABG to RCA was simultaneously performed. The pathological findings strongly suggested its acquired origin. 相似文献
10.
Abstract We report a case of a 75-year-old man suffering from a covered perforated aneurysm of a saphenous bypass graft to the right coronary artery (RCA) constructed 22 years ago. Additional complete revascularization had been performed in 2001. A thoracic computed tomography scan for evaluation of fever of unknown origin had revealed a huge hematoma in front of the right heart. Coronary angiography showed open bypasses but an irregular-shaped aneurysm of the venous graft to the RCA right before the distal anastomosis. Occurrence of a new right-sided pleural effusion led to the emergent operation since rupture of the aneurysm and drainage into the pleura was likely. A massive precordial hematoma was found and the existence of the perforated aneurysm could be confirmed. After institution of cardiopulmonary bypass the graft was resected. Since the patient had a functioning bypass to the RIVP, there was no need for additional revascularization. The patient underwent an uneventful postoperative course. 相似文献
11.
Tsutomu Sugimoto Kazuo Yamamoto Shinpei Yoshii Koji Shimada Masatake Katsu Yasunori Iida Shigetaka Kasuya 《Annals of thoracic and cardiovascular surgery》2006,12(6):435-437
We report on a case of a 65-year-old man who was admitted for anterior chest pain on effort. He had received coronary artery bypass grafting (CABG) surgery 20 years ago with saphenous vein grafts (SVGs) to the left anterior descending artery (LAD) and right coronary artery (RCA). An angiography demonstrated large aneurysmal dilatation of both grafts and a fistulous communication between the middle portion of the right SVG and the right atrium (RA). The aneurysm was excised surgically, and the fistula was closed with the right atrial wall with additional bypass grafts of the left internal thoracic artery (LITA) and gastroepiploic artery (GEA). 相似文献
12.
Yasuura K Takagi Y Ohara Y Takami Y Matsuura A Okamoto H 《The Annals of thoracic surgery》2000,69(3):728-731
BACKGROUND: The right gastroepiploic artery (GEA) has been used as the second reliable arterial graft for coronary artery bypass grafting (CABG). However, concern regarding the flow competition with the recipient coronary artery has remained. METHODS: An application of in situ GEA grafting to the right coronary artery (RCA) was studied by using a theoretical model. The theoretical model of CABG was given variables; ie, the diameters and the lengths of both in situ GEA and proximal segment of the RCA, and the degree of proximal stenosis in the RCA. According to the range of these variables obtained from clinical data, the ratio of the GEA flow to the flow of the RCA distal to the anastomosis was calculated. RESULTS: Main factors to determine the flows in the two parallel paths were the inner diameters of both vessels, and the degree of the proximal stenosis. When the inner diameters of the GEA were 0.5 mm larger than that of the RCA, the GEA carried more than 50% of the total flow of the RCA distal to the anastomosis despite a moderate stenosis in the RCA. When the inner diameter of the GEA was equal to, or 0.5 mm smaller than, that of the RCA, the GEA flow was dominated by the native RCA flow unless the proximal stenosis was critical. CONCLUSIONS: If the inner diameter of the GEA is 0.5 mm larger than that of the RCA, CABG with the GEA can be applied more widely. If not, the application would basically be limited. 相似文献
13.
Tsutomu Takagi 《Journal of Echocardiography》2012,10(1):24-26
A 69-year-old male patient, who had a history of coronary stent implantation to the proximal right coronary artery (RCA),
presented with exertional chest pain. Transthoracic Doppler echocardiography revealed retrograde coronary flow in the distal
RCA, and treadmill stress echocardiography revealed inducible myocardial ischemia in the inferior and posterior segments.
Coronary angiography demonstrated a severe stenotic lesion with flow delay in the mid RCA and collateral circulation to the
distal RCA from the left coronary artery. Detection of retrograde coronary flow in the distal RCA using transthoracic Doppler
echocardiography is a useful method to diagnose subtotal occlusion of the RCA. 相似文献
14.
Hirofumi Nakagawa Akihiro Nabuchi Hirohito Terada Susumu Hiranuma Takuya Miyazaki Hiroshi Okuyama Masahiro Endo 《Annals of thoracic and cardiovascular surgery》2015,21(4):378-381
Coronary artery bypass grafting (CABG) has been widely performed for coronary artery disease. Therefore, cases requiring reoperative CABG are increasing. We performed a minimally invasive direct coronary artery bypass (MIDCAB) procedure on four patients, as reoperative CABG surgery for the right coronary artery (RCA), employing the right gastroepiploic artery (RGEA). The target sites were the distal RCA in two patients and the posterior descending (PD) branch in the other two. Complete revascularization was accomplished in all patients without sternotomy, cardiopulmonary bypass (CPB), or blood transfusion. The mean operative time was 3.0 h (range: 2.4–3.7 h). Postoperative coronary angiography showed all grafts to be patent. All patients were discharged without postoperative complications and remained free from cardiac events during a mean follow-up period of 1.5 years (range: 0.5–3.0 years). MIDCAB for the RCA, employing the RGEA via a subxiphoid incision showed, excellent revascularization in redo CABG cases. This technique is a safe and effective method for redo cases. 相似文献
15.
Closed endarterectomy for diffuse right coronary artery disease: early results with angiographic controls 总被引:1,自引:0,他引:1
Erdil N Cetin L Kucuker S Demirkilic U Sener E Tatar H 《Journal of cardiac surgery》2002,17(4):261-266
BACKGROUND: Due to reported high morbidity and mortality, surgeons tend not to endarterectomize the diffusely diseased right coronary artery. Most prefer not to bypass this artery in such situation. We compared the endarterectomized right coronary patients with patients having total occlusion of right coronary artery not needing endarterectomy who received right coronary artery (RCA) bypass. MATERIAL AND METHODS: Between August 1998 and May 2000, 1226 patients had coronary artery bypass grafting (CABG) at Alkan Hospital, of whom 59 had right coronary artery endarterectomy (REC) along with RCA bypass with saphenous vein graft. We compared the results of 59 RCE patients with 50 patients who underwent RCA bypass without RCE. RESULTS: Compared with the control group, the RCE group had a higher incidence of diabetes. There were no statistically significant differences between groups for mortality and morbidity. Among postoperative variables only the cross-clamp time was longer for the RCE group (33.5 +/- 10 min vs. 27.3 +/- 8 min, p < 0.05). Surviving patients were followed for a mean period of 7 +/- 5 months. No recurrence of angina occurred during the follow-up. Control angiography at the sixth month was performed on 42 RCE patients accepting the procedure, and all grafts were found patent. CONCLUSION: Endarterectomy for diffusely atherosclerotic right coronary artery for selected patients did not bring additional mortality and morbidity to the CABG procedure, and short term clinical and angiographic results were excellent. 相似文献
16.
目的:初步评价MSCT在冠状动脉成像中的临床应用价值。方法:18例疑诊冠状动脉狭窄患者行MSCT扫描,利用影像曲面重建,3D重建,了解冠状动脉病变情况,并与冠状动脉造影对比。结果:18例76支血管同时经MSCT和CAG成像。冠状动脉造影发现狭窄27支,其中左前降支(LAD)病变11支,回旋支(LCA)病变3支,左主干(LMA)2支,右冠(RCA)病变9支,桥支病变2支。MSCT发现狭窄23支,其中左前降支病变11支,回旋支病变3支,左主干病变1支,右冠病变9支,桥支病变2支。MSCT成像的敏感性为81.5%(22/27),特异性100%,阳性推测值91.7%,阴性推测值94.2%。结论:在控制心率的情况下,MSCT可作为冠状动脉狭窄的一种无创筛选检查方法。 相似文献
17.
A 75-year-old lady with hypertension and paroxysmal atrial fibrillation underwent echocardiography to evaluate cardiac function. Transthoracic Doppler echocardiography revealed retrograde coronary flow in the right coronary artery (RCA) and left circumflex artery (LCX). Computed tomographic coronary angiography demonstrated normal but tortuous coronary arteries. This tortuosity of the coronary arteries was thought be a cause of pseudo-retrograde coronary flow in the RCA and LCX. The present case demonstrates a pitfall of retrograde coronary flow for the detection of coronary artery occlusion in daily practice. 相似文献
18.
Abstract Despite its rarity, anomalous origin of the right coronary artery (RCA) from the left coronary sinus can pose risk of sudden death. Because of this risk, many patients elect surgical correction of this anomaly. Surgical strategies for correction of this include ostioplasty, coronary artery reimplantation, and, more commonly, coronary artery bypass grafting. After coronary artery bypass grafting, some advocate ligation of the proximal RCA, speculating that competitive flow will cause graft failure. As no objective criteria for this have been established, we propose a method using of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. We present three cases in which an RCA with an anomalous origin from the left sinus was corrected with coronary artery bypass grafting with the assistance of intraoperative Doppler flow measurements to guide the decision to preserve the proximal anomalous native vessel. In each case, the RCA was bypassed using a saphenous vein graft (SVG) that was used to bypass origin of the RCA. Flow through the graft was compared with and without ligation of the proximal RCA, before creation of the proximal anastomosis. In each case, flow through the SVG was not significantly reduced with the proximal RCA patent and ligation was not performed. 相似文献
19.
The abnormal origin of the left circumflex artery from the proximal right coronary artery (RCA) is considered a coronary artery anomaly. Most of the coronary artery anomalies are diagnosed incidentally by coronary artery angiography, and several considerations are needed to avoid fatal complications in patients undergoing aortic valve replacement (AVR). We report a case of AVR with anomalous origin of the left circumflex artery from a common ostium of the RCA, and discuss the use of a smaller prosthesis to avoid compression of the anomalous left circumflex artery. 相似文献
20.
Surgical treatment of giant coronary artery aneurysm 总被引:3,自引:0,他引:3
Li D Wu Q Sun L Song Y Wang W Pan S Luo G Liu Y Qi Z Tao T Sun JZ Hu S 《The Journal of thoracic and cardiovascular surgery》2005,130(3):817-821
OBJECTIVE: Giant coronary artery aneurysm is an extremely uncommon disease. Most previous reports have involved only single cases. This report describes 6 patients with giant coronary artery aneurysm, examines its causes, and aims to establish the optimal surgical strategies for this exceptional and rare pathology. METHODS: From July 1996 to October 2004, a total of 30,268 patients underwent heart surgery at Fuwai Hospital in Beijing. Among these, 6 patients had giant coronary artery aneurysm diagnosed and underwent operation. Various surgical strategies were used for the operations of these 6 patients, such as coronary artery aneurysm resection, coronary artery reconstruction, and concomitant coronary bypass. Additional procedures, such as fistula closure, aortic valve replacement, aortoplasty, and embolectomy, were done at same time for the patients with complications of coronary fistula, aortic valve insufficiency, or thrombus. Patients were followed up from 8 to 87 months, with a mean of 48 months. Doppler echocardiography, ultrafast computed tomography, and 3-dimensional aerial image studies were performed during follow-up. RESULTS: Five of these six cases were found combined with coronary artery fistula, and the cause for these giant coronary artery aneurysms was congenital. The remaining case was caused by atherosclerosis. After surgery, all patients recovered uneventfully, without in-hospital mortality. None died during the follow-up, nor did any have recurrence of the symptoms or giant coronary artery aneurysm. CONCLUSION: Giant coronary artery aneurysm is a rare entity that is commonly caused by congenital malformation and combined with other cardiac anomalies. An optimal surgical operation should be based on the specific cardiac anomaly of the individual patient. 相似文献