False positive retroaortic left circumflex coronary artery in a patient with atrial septal defect

Retroaortic course of coronary artery is a relative contraindication for device closure of an atrial septal defect. In this brief report, we demonstrate, for the first time, inferior aortic recess mimicking retroaortic left circumflex coronary artery in a patient with atrial septal defect. This distinction is important to avoid spurious diagnosis of anomalous coronary artery denying patient a chance of nonsurgical closure of atrial septal defect.     

Left circumflex coronary artery to left atrial fistula in a patient with mitral stenosis: Invasive and noninvasive findings with pathophysiologic correlation

We report a case of an angiographically documented fistula between the circumflex coronary artery and a left atrial appendage thrombus in a patient with mitral stenosis, flow from which can be demonstrated solely by a color doppler transesophageal echocardiogram. Evaluation of catheter derived hemodynamics and angiographic flow patterns reveals a heretofore undescribed physiologic property of coronary to atrial shunts in patients with mitral stenosis. © 1996 Wiley-Liss, Inc.     

Delay in diagnosis of right atrial myxoma

Clinical, echocardiographic, and nuclear angiographic findings in a 51-year-old woman who presented with a history of dyspnea are discussed. Initial echocardiography revealed no abnormality. However, a subsequent radionuclide angiogram revealed a filling defect on the right side of the heart. This represented a right atrial myxoma. Radionuclide angiography can provide a useful noninvasive tool in the diagnosis of intracardiac tumors when echocardiography has not been helpful.     

Fluctuating symptomatic cryofibrinogenaemia in a patient with left atrial myxoma

Summary. We report a case of left atrial myxoma associated with a fluctuating level of cryofibrinogen. Her initial symptoms and signs were consistent with primary cryofibrinogenaemia, but a repeat episode occurred without the cryofibrinogen being detectable. A more typically embolic cerebro-vascular accident (CVA) occurred, with the subsequent discovery of the patient's myxoma. The cryofibrinogen was again present but it disappeared with resection of the myxoma. We propose that the degree of activation of the coagulation system around the myxoma fluctuated, causing variable conversion of fibrinogen to fibrin, so that at times partially cross-linked fibrin(ogen) resulted in cryofibrinogen, but at other times frank emboli from more complete clotting occurred.     

Relationship between slow coronary flow and left atrial appendage blood flow velocities

AIMS: This study was undertaken to assess whether slow coronary flow (SCF)is related to low left atrial appendage (LAA) blood flow velocities. METHODS: Study subjects consist of 44 patients with SCF and 11 volunteer subjects with normal coronary angiogram. The diagnosis of SCF was made using the TIMI frame count method. The blood flow velocities were obtained by placing a pulsed-wave Doppler sample volume inside the proximal third of the LAA. RESULTS: The mean LAA emptying velocities (MEV)were significantly lower in patients than control subjects (34.5 +/- 9.9 cm/sec vs 84.0 +/- 12.1 cm/sec; P < 0.001). In bivariate analysis, significant correlation was found between MEV, and systolic pulmonary venous flow, mean TIMI frame count, deceleration time, and isovolumetric relaxation time (P < 0.05). By multiple linear regression analysis, mean TIMI frame count (beta=-0.865, P < 0.001) was identified as independent predictors of MEV. CONCLUSION: This study indicates that SCF phenomenon may be related to low LAA blood flows.     

Giant left atrial appendage aneurysm compressing the left anterior descending coronary artery

Left atrial appendage aneurysm (LAAA) is a rare congenital structural heart disease. It is often diagnosed by echocardiography; however, other imaging modalities can add to its diagnosis and its potential effects on the surrounding structures. A 16‐year‐old boy presented with dyspnea and palpitation. Transthoracic echocardiography showed a large LAAA communicating with the LA through a narrow neck with impaired left ventricular (LV) systolic function. Multidetector cardiac tomography showed that the LAAA is compressing the left anterior descending artery. The LAAA was surgically resected followed by improvement of the LV systolic function.     

Diagnosis of left atrial tumors by coronary angiography and left ventriculography

The left ventriculograms and pulmonary and coronary angiograms of eight patients with left atrial (LA) tumors were reviewed. The patients' ages ranged from 52 to 65 years. In each case the tumor was outlined during left ventriculography. Coronary arteriography allowed visualization of tumor vessels in six cases (six of seven myxomas). Two of the patients had significant coronary obstructions. It is concluded that a left ventriculogram is a sensitive diagnostic test for the presence of LA tumors. Coronary arteriography is indicated in patients with LA tumors in this age group and is likely to provide independent evidence of the presence of an LA tumor.     

Assessment of left atrial appendage function by transesophageal echocardiography in patients two weeks after acute coronary syndromes

Background For many years in ischemic heart disease, ventricles rather than atria received attention so not much is known about left atrial function in left ventricular ischemia. Objective Our study aimed to evaluate left atrial appendage (LAA) function by means of biplane transesophageal echocardiography in patients ten days after acute coronary syndromes (ACS). Methods The study was performed on 16 adult patients (65.9±9.9 years old) in whom transesophageal echocardiography was done 10 days after ACS. The following left atrial appendage (LAA) planimetric parameters were analyzed: LAA transversal dimension, LAA longitudinal dimension,LAA maximal area, and LAA minimal area. LAA ejection fraction was calculated and analyzed. The following LAA Doppler parameters were analyzed: the peak LAA emptying and the peak LAA filling velocities. The control group consisted of 14 patients (43±14.6 years old) without cardiovascular diseases. Results Both LAA longitudinal dimension and LAA transversal dimension were significantly higher in patients with ACS than in control patients. The same was observed for LAA maximal area. Also LAA ejection fraction was higher in patients with ACS . LAA minimal area did not differ in the patients in either group. LAA peak emptying flow (LAAE) and LAA peak filling flow (LAAF) were significantly higher in patients of the study group than of the control group. Conclusion Our study shows that two weeks after acute coronary syndrome LAA as a reservoir as well as a pump works at a higher level than it does in the control group. (J Geriatr Cardiol 2005; 2(4):198-201)     

Atrial myxoma's and coronary angiography

Coronary angiography is not an only important component of preoperative evaluation of the patient with underlying coronary artery disease but also diagnostic tool for delineating cardiac myxomas. This also serve as an important surgical anatomical marker. We present two cases which presented with repeated episode of chest pain, were found to have atrial blushing on coronary angiography subsequent confirmation of diagnosis of atrial myxoma on echocardiography. © 2010 Wiley‐Liss, Inc.     

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis

We report the case of a 56-year-old woman with a history of rheumatic heart disease. The clinical, electrocardiographic, and radiologic findings suggested mitral stenosis. Left atrial obstructive myxoma simulating a thrombus was found by transthoracic echocardiography (TTE). The diagnosis was established by use of transesophageal echocardiography (TEE), confirmed after surgery and by anatomical investigation. Cardiac myxoma associated with mitral stenosis may be difficult to diagnose accurately using TTE. The advantage of TEE in this case and in patients with mitral stenosis is emphasized.     

Concomitant occurrence of a left atrial myxoma and an adenocarcinoma of the lung

A 72-year-old previously healthy woman was found to have both a left atrial myxoma and a left lung mass during the evaluation for two cerebrovascular events. Resection of the atrial myxoma and a biopsy of the left lung mass were performed. Six weeks later she underwent a left upper lobectomy for adenocarcinoma of the lung. This case illustrates the concomitant occurrence of a left atrial myxoma and a primary lung cancer in a patient who underwent a successful staged treatment for both diseases.     

Recurrent myxoma implanted in the left atrial appendage

We present the case of a young woman who developed myxomas in multiple cardiac chambers for the third time. One of the tumors was found in the left atrial appendage with the use of transesophageal echocardiography, indicating that this technique is the method of choice for the follow-up of multiple myxomas.     

The transesophageal echocardiographic diagnosis of left atrial myxoma simulating a left atrial thrombus in the setting of mitral stenosis.

We report a case of left atrial myxoma simulating a thrombus on transthoracic echocardiography, but correctly diagnosed using transesophageal echocardiography. As this tumor is usually fatal unless surgically resected, a correct diagnosis is essential. Myxomas which do not prolapse between the mitral valve leaflets and coexist with mitral stenosis may be difficult to diagnose accurately using transthoracic echocardiography. The advantages of transesophageal compared with transthoracic echocardiography in the diagnosis of nonclassical left atrial myxoma are discussed.     

Left atrial myxoma associated with rheumatic mitral stenosis

The rare occurrence of mitral stenosis and coexistent left atrial myxoma is reported. The patient had a 25-year history of rheumatic heart disease and was referred for evaluation of progressive mitral stenosis without clinical suspicion of left atrial myxoma. The tumor was discovered by routine echocardiography in the course of evaluation of mitral stenosis. However, prior to surgery the patient experienced an episode of embolization of the tumor without major clinical sequelae. The utility of echocardiography in this case and in patients with mitral stenosis is discussed as well as the patient's spontaneous "cure."     

Noninvasive evaluation of a cutting balloon entrapped in a left main coronary artery using transesophageal echocardiography

There are reports in the literature describing the utility of transesophageal echocardiography (TEE) in the evaluation of the coronary arteries. Studies have also shown the value of TEE in patients undergoing coronary intervention such as assessing coronary anatomy and flow following angioplasty. We report an interesting case where TEE helped to establish the location of a fractured cutting balloon device lodged in the left main coronary artery and obviated the need for cardiac surgery to remove the fractured balloon catheter. To our knowledge, this is the first case report of this type of complication utilizing a cutting balloon device.     

Non-invasive diagnosis of a congenital coronary artery fistula

This report describes a large congenital coronary artery fistula of the left circumflex artery draining into the coronary sinus in a 46 year old woman. The fistula was initially diagnosed by cross-sectional and transesopha-geal echocardiography using multiplane probe. Additionally, the entire course of the fistula was visualised in electron beam tomography. Angiography confirmed echocardiographic and tomographic findings.     

Incremental value of live/real time three-dimensional over two-dimensional transesophageal echocardiography in the evaluation of right coronary artery fistula

We report an adult with a right coronary artery to right atrial fistula in whom live/real time three-dimensional transesophageal echocardiography with its ability to trace the entire course and obtain en face views of the fistula connections, was able to provide significant incremental information over two-dimensional transesophageal echocardiography.     

Large left circumflex coronary artery with a fistula to superior vena cava: Diagnosis by echocardiography

The left circumflex coronary artery associated with a fistula to superior vena cava is a rare entity. We describe a 7‐year‐old girl who presented with a cardiac murmur and was diagnosed with a coronary artery fistula between the left circumflex artery and superior vena cava by echocardiography. The surgical occlusion of the fistula was successful.