Coronary angiography of cardiac myxoma

BACKGROUND: Myxoma usually presents with nonspecific symptoms. Preoperative coronary angiography is presently only considered if patients are at increased risk of coronary artery disease (CAD). The angiographic patterns of cardiac myxoma have not been fully described. HYPOTHESIS: The aim of our study was to investigate coronary angiograms as well as patterns of tumor vascularity in patients with cardiac myxoma. METHODS: From January 1990 to December 2003, 33 patients with cardiac myxoma, who had received surgical resection at our hospital, were enrolled; of these, 9 patients underwent preoperative coronary angiography. The severity and extent of coronary artery stenosis, as well as tumor angiographic patterns, were analyzed. Coronary artery disease is defined as a > 50% stenosis in diameter at any segment of the coronary artery viewed by two orthogonal views on cineangiogram. RESULTS: Four (44.4%) patients showed concomitant CAD. The presence of coronary risk factors was not different between patients with and without CAD. Contrast media-enhanced tumor vasculature was found in five (55.6%) patients. Four (80%) patients had multiple feeding arteries. There was the characteristic "sea anemone" appearance of the tumor vasculature composed of (1) basal vascular network, (2) vessel stem, (3) backbone branches, and (4) dye brushes. These findings were characteristic of cardiac myxoma. CONCLUSION: Coronary angiography can detect the concomitant coronary disease and the unique vascular appearances of cardiac myxoma. Familiarity with the "sea-anemone" angiographic findings may help in the diagnosis of cardiac myxoma.     

Coronary artery-left ventricular communications: A report of two cases and review of the literature

Two patients with chest pain had angiographically-demonstrated communications between the three coronary arteries and the left ventricular chamber. Communications between coronary arteries and the left ventricle are unusual and communications between all three coronary arteries and the left ventricle are rare. These anomalies are, however, commonly associated with symptoms of chest pain. The presence of left ventricular hypertrophy and a widened pulse pressure may suggest a greater hemo-dynamic effect of the shunt flow than often suspected angiographically.     

老年高血压患者冠状动脉造影2330例结果分析

目的探讨老年高血压患者冠状动脉造影(CAG)的特点及其影响因素.方法对2330例老年高血压患者的相关临床资料与CAG的结果进行回顾性分析.结果①老年高血压CAG阳性率高占82.0%(1910/2330),多支病变、慢性完全闭塞病变及左主干病变多;②老年高血压合并冠心病的易患因素:糖尿病、吸烟、高脂血症、典型心绞痛症状强烈提示冠心病;③血压水平的高低与冠状动脉病变的程度和范围呈正相关,3级高血压患者多支、严重病变多见.结论老年高血压患者并发冠心病比例高,且与糖尿病、吸烟、高脂血症密切相关,应重视患者的心绞痛症状、冠状动脉病变程度与血压水平有关.     

Coronary artery dissection secondary to coronary arteriography: Presentation of three cases and review of the literature

Three cases of coronary artery dissection secondary to coronary arteriography are presented. Two of these include autopsy material demonstrating medial degeneration in the coronary arteries, which may have predisposed these arteries to dissect The literature on catheter-induced coronary artery dissection is reviewed and an analysis is presented.     

Coronary artery spasm during cardiac angiography

Unexpected occurrence of coronary artery spasm is sometimes observed during cardiac catheterization. We report here two cases of coronary artery spasm with hypotension and urticaria subsequent to administration of contrast material. The etiology of coronary artery spasm is discussed.     

Correct positioning for cardiac angiography: Insights from mri

The recommended angiographic projections for optimally demonstrating various cardiac structures vary, and do not always achieve their aim. To determine the most appropriate radiographic projections to optimally demonstrate cardiac structures, we reviewed the orientations of major cardiac structures and the associated great vessels, as demonstrated by axial MRI. Measurements were made from 187 MRI examinations of the heart. These measurements confirmed that the optimum angiographic projections for various cardiac structures are at variance with a number of the recommended views. Recommendations for the angiographic projections most likely to provide optimum display of various cardiac structures and associated great vessels in different patient populations are presented. © 1993 Wiiey-Liss, Inc.     

Coronary anomalies by cardiac computed tomographic angiography

BACKGROUND: Early identification of an anomalous coronary anatomy is quite relevant because of the increased incidence of sudden cardiac death or related symptoms of myocardial ischemia in the patients. Invasive coronary angiography (ICA) is not only invasive, but expensive, and cannot always adequately provide the required information about the abnormal coronary anatomy. Cardiac computed tomographic angiography (CTA) is a robust noninvasive imaging modality that has several clinical applications and is now being used increasingly in practices across the nation. It not only provides high-resolution anatomical information of the coronary artery tree but also helps define other aspects of the cardiovascular anatomy, be it normal or abnormal. HYPOTHESIS: This study sought to determine the clinical role played by CTA in the evaluation of different types of coronary arterial anomalies by reviewing CTA studies since 1997. METHODS: We reviewed 6,089 case studies of contrast CTA conducted at our institution. There were 53 coronary anomalies in 39 patients (0.64%). RESULTS: Computed tomographic angiography correctly identified the course of coronary arteries in all cases. CONCLUSION: The results of this study support the use of CTA as a safe and effective noninvasive imaging modality for defining coronary arterial anomalies in an appropriate clinical setting, providing detailed three-dimensional anatomic information that may be difficult to obtain with invasive angiography.     

Coronary angiography utilization in the evaluation of a potential heart donor by age: a narrative review

Heart transplant is the gold standard treatment for patients with heart failure. The limitation to providing heart transplantation to patients suffering from end stage heart disease is the stable organ supply within the United States despite increasing demand. Transplant centers across the United States have begun to expand traditional cardiac donor selection metrics previously utilized. As a result, the use of extended criteria donors, such as older donors, those with longer ischemic times, and donors considered high risk has increased. Current guidelines suggest that coronary angiography be performed when evaluating a donor above the age of 45. Angiographic guidelines for evaluation of the donor heart are based specifically on age, with little evidence based guidance surrounding the use of angiography in a younger donor with comorbidities or increased risk behavior which may lead to premature coronary artery disease. Recently, we have seen an increase in younger heart donors, many of whom have succumbed due to drug overdose with ensuing high risk behaviors. Given the increased risk nature of these donors, consideration of performing coronary angiography is determined by clinical “gestalt” of the transplant center evaluating the heart for use, which may lead to underutilization of donor organs without evidence to support the practice. Here, we review the guidelines, literature, and controversy surrounding the use of coronary angiography in evaluating donor hearts for transplantation.     

Lessons learned from the review of cardiac catheterization laboratories: A report from the laboratory survey committee of the society for cardiac angiography and interventions

The Laboratory Survey Committee of the Society for Cardiac Angiography and Interventions was created as a resource for physicians and administrators to provide comprehensive independent outside review services for cardiac catheterization laboratories. Since 1989, when the committee began its work, surveys of 23 catheterization laboratories have been completed. Our review of this experience identified several recurring problems among the laboratories. The purpose of this paper is to summarize our experience and highlight the lessons we learned in the hope that this information will benefit many other laboratories. Cathet. Cardiovasc. Intervent. 46:24–31, 1999. © 1999 Wiley-Liss, Inc.     

我院冠心病患者的临床特点及冠状动脉造影分析

目的探讨我院冠状动脉粥样硬化性心脏病（CHD）患者的临床特征及冠状动脉（CA）病变特点。方法回顾性分析我院76例疑诊CHD患者的临床特征及冠状动脉造影（CAG）资料。结果合并原发性高血压、高脂血症及糖尿病者分别为75．0％、52．6％和30．2％。有吸烟史者占31．2％。其中心肌梗死组、典型心绞痛组、不典型胸痛组的CAG阳性率分别为100％、81．08％、22．22％。心电图ST—T改变与冠状动脉造影总的符合率为60．4％。CAG显示：冠脉供血呈右优势型者57例（75％），均衡型者11例（14％），左优势型者8例（11％）。病变累及CA136支，单支病变占31．6％，2支病变占21．0％，多支病变占45．6％；A型病变38支（27．9％），B型病变52支（38．2％），C型病变46支（33．8％），重度以上狭窄占65．2％，23例（40．4％）有不同程度的侧支循环，其中5例（21．7％）为3级。结论我院CHD患者普遍高龄，且合并多种危险因素，临床表现可不典型，CA分布以右优势型居多，CA病变以2支及多支病变为主，B型及C型病变占多数、CA狭窄程度较严重，部分病例已有不同程度的侧支循环。     

冠状动脉造影时心肌桥的检出率及其临床意义

目的探讨冠状动脉造影时心肌桥的检出率及其临床意义。方法2655例接受冠状动脉造影的患者,根据造影显示冠状动脉管腔收缩期狭窄程度判定心肌桥,并根据收缩期狭窄程度分为3级。结果共检出69例心肌桥,检出率2.6%,部位均位于左前降支。其中1级狭窄59例(85.5%),2级狭窄9例(13.0%),3级狭窄1例(1.4%)。21例(30.4%)在心肌桥近端有粥样硬化病变,28例(40.6%)有不同程度的心绞痛。1例95%收缩期狭窄病例置入冠脉内支架,其他病例经药物治疗,临床症状消失。结论冠状动脉造影时收缩期狭窄是临床判定心肌桥的唯一依据。心肌桥可导致缺血性心脏事件,对于有缺血症状者应予适当治疗。     

女性冠心病患者动态心电图与冠脉造影对比研究

目的：探讨动态心电图与冠脉造影对女性冠心病的诊断价值。方法将150例女性患者动态心电图与冠脉造影结果进行对比分析。结果动态心电图ST T改变诊断女性冠心病的灵敏度为74.2%,特异度为75.5%,Kappa检验结果显示K值=0.4727,提示动态心电图和冠脉造影结果具有一致性。动态心电图对冠心病单支、双支和三支血管病变的灵敏度为60%,75%,91%。结论动态心电图对于女性冠心病的心肌缺血诊断有重要参考价值。     

Suture closure of the femoral arteriotomy following invasive cardiac procedures: a detailed analysis of efficacy, complications, and the impact of early ambulation in 1,200 consecutive, unselected cases.

The purpose of this study was to assess the efficacy and safety of using a percutaneous suture device to close femoral arteriotomies following invasive cardiac procedures. All patients presenting for invasive cardiac procedures performed from the femoral artery were considered for suture closure. Patients were carefully assessed for access site complications, oozing, and the impact of suture closure on the safety of early ambulation. Clinical follow-up at 3-6 months was performed to assess for late complications. Femoral artery suture closures were performed in 1,200 consecutive cases in 1,097 patients. In 12.8% of cases, the patients ambulated within 1 hr. The success rate was 91.2% and the complication rate was 3.4%. Complications included the development of a hematoma (2.1%), the need for vascular surgery (0.6%), retroperitoneal hemorrhage (0.3%), blood transfusion (0.7%), local infection (0.5%), and pseudoaneurysm formation (0.1%). Factors found to be independently predictive of procedural failure were an age > 70 years, an ACT > 300 sec, left femoral artery access, and the performance of primary angioplasty. Follow-up at 3-6 months revealed no major hemorrhagic complications. We conclude that percutaneous suture closure effectively achieves femoral artery hemostasis in patients undergoing invasive cardiac procedures. The technique permits early ambulation and is associated with a relatively low incidence of complication.     

Five year trends in cardiac catheterization: A report from the registry of the society for cardiac angiography and interventions

The Society for Cardiac Angiography and Interventions has maintained a registry of cardiac catheterizations since 1979 and of percutaneous cardiac interventions since 1990. Data from 392,923 procedures (317,592 diagnostic catheterizations, 74,963 coronary interventions, and 368 valvuloplasties) for the years 199G1994 inclusive are presented. Over the 5 year period there was a trend toward same day and 23 hr discharges (19% in 1990 to 29% in 1994), and a decrease in combined right and left heart procedures from 38% to 26%. For cardiac catheterizations ionic contrast use declined from 26% of procedures to 13% in 1994. The use of ionic contrast was even lower in interventional procedures, with laboratories reporting use in 21% of procedures in 1990 dropping to 9% in 1994. Balloons were the first choice device in 92.5% of native arteries and 82.7% of grafts in 1994. For the first time in 1994 more mitral than aortic valvuloplasties were reported.     

Coronary artery anomalies:prevalence and clinical profile in elderly patients

Although congenital heart diseases are uncommon in the elderly,coronary artery anomalies may beincidentally discovered in old age.We sought to determine the incidence and clinical features of coronary arteryanomalies (CAAs) in patients over 65 years of age.Patients and methods Medical records of patientsundergoing coronary artery angiography in the years 1997-2002 at the Legnago General Hospital were retrospectivelyreviewed.The clinical profiles of all patients with CAAs and CAA subtypes were noted.Comparison between patientsunder and over 65 was performed.Data are given as mean standard deviation and as percentages.Results Sixty-six patients (1.21%,Female/Male 22/44,mean age 65.3±10.6 years) out of the 5450 who underwent coronaryangingraphy in the years 1997-2002 had CAAs.In most cases (63%,41/66 patients),the patients were over 65.CAAs were discovered incidentally in these elderly patients while undergoing coronary artery angiography for dilatedcardiomyopathy, ischemic heart disease,and valvular heart disease in 75% of the cases (30/41 patients).Patientsover 65 had more cardiac comorbidities and a higher incidence of coronary atherosclerosis.Conclusions Theangingraphic incidence of CAAs in elderly patients is increasing as the population ages and this occurrence calls fora wider knowledge of the anatomy and pathophysiology of CAAs among geriatric cardiologists.Elderly patients seemto present with lower risk coronary anomalies (separated origin of left anterior descending coronary artery andcircumflex artery,origin of circumflex artery from the right sinus or the right coronary artery,double coronary artery)but have a higher risk profile compared to younger patients due to the frequency of cardiac coraorbidities andsuperimposed coronary artery atherosclerosis.(J Geriatr Cardiol 2004;1:40-43.)     

冠状动脉造影检查在冠心病诊断中作用的再探讨

目的探讨冠状动脉造影（CAG）检查在诊断冠心病中作用,就其对多年来被认为是金标准作用进行再探讨。方法对138例怀疑有冠心病的患者,均经普通ECG,动态ECG,活动平板和CAG。结果只有71例患者的冠状动脉造影检查符合目前冠心病标准,其余67例患者冠状动脉未达标（轻度-中度狭窄,或完全正常或仅见散在斑块形成）。结论冠心病的诊断是一个较为复杂的问题,CAG检查是诊断冠心病的一个重要依据,有相当比例的冠心病患者（CAG）无明显异常。