Anomalous origin of left main cononary artery from anterior sinus of Valsalva with myocardial infarction

The origin of the left main coronary artery, or its branches, from the right or anterior sinus of Valsalva is a recognized congenital anomaly. The origin of the entire left main coronary artery from a separate ostium in the right sinus of Valsalva and its course to the right and behind the ascending aorta, in a living patient without associated congenital heart disease, has not been described. This anomaly was recognized as the cause of an anterior myocardial infarction in a 12-year-old girl, and it is the subject of this case report.     

肺动脉右心室直接吻合纠治复杂先天性心脏病

目的 探讨肺动脉右心室直接吻合纠治复杂先天性心脏病的效果。方法 2001年3月至2004年6月，对17例复杂先天性心脏病病儿采用肺动脉右心室直接吻合方法予以纠治，其中3周岁以下者11例。肺动脉闭锁合并室间隔缺损6例，完全性大动脉错位合并室间隔缺损和肺动脉狭窄4例，永存动脉干4例，法洛四联症合并冠状动脉横跨右心室流出道3例。12例一期根治，5例分期纠治。结果 手术死亡1例。5例分期手术中的3例已成功二期根治。随访1～40个月，所有病儿生长发育良好，心功能0～Ⅰ级。结论 肺动脉右心室直接吻合应用于纠治某些复杂先天性心脏病可取得满意效果。对无同种带瓣管道可选用的婴幼儿病例，此术式尤为适用。     

Persistent primitive trigeminal artery aneurysm

The trigeminal artery is the most common persistent carotid-basilar anastomotic channel observed in adult life, and its occurrence probably represents a defect in cerebrovascular development. It can be associated with other congenital abnormalities such as cerebral aneurysms, but only rarely do aneurysms of the primitive trigeminal artery itself arise. The authors present a new case of an aneurysm arising directly from the primitive trigeminal artery and discuss its significance and treatment.     

Sequestration of the posterobasal segment of the right lower pulmonary lobe

Pulmonary sequestration is a rare congenital malformation that receives its blood supply from a systemic artery. We report a case of pulmonary sequestration treated by ligature of the anomalous artery without pulmonary resection. Pulmonary sequestration must be treated surgically before the occurrence of severe complications.     

Anomalies encountered during varicose vein surgery

During 5,050 stripping operations for varicose veins, three noticeable deviations from the normal anatomy were encountered. In two patients (0.04%) the long saphenous vein entered the femoral vein completely separate from its branches, which joined to form a common trunk before emptying into the femoral vein. In one patient (0.02%), the femoral vein and artery were transposed in the region of the fossa ovalis. In one patient (0.02%), a long saphenous artery was encountered. It arose from the femoral artery just proximal to the origin of the deep femoral artery and accompanied the long saphenous vein along the medial aspect of the upper thigh. In some patients, a large venous cluster overlying the fossa ovalis was encountered, usually the result of a congenital venous anomaly. Surgical problems can be minimized if the possibility of these congenital anomalies is always considered.     

A case of congenital hypoplasia of the right external iliac artery.

A 18 years male had congenital hypoplasia of the right external iliac artery and thrombosis of its narrowest part. Congenital megacolon, anal atresia and hyposomical nanism were also present. Surgical intervention was indicated because he was developing arterial insufficiency and muscular hypotrophy of the right leg. A bypass was performed with a reversed autogenous vein between the common iliac artery and the common femoral artery.     

A case report of coronary artery fistula into the left ventricle

Communication of the right coronary artery with the left ventricle is considerably rare. We report a case of congenital fistula of the left ventricle. Closure of the fistula was successfully done by Symbas' modification. Thirty cases with coronary artery fistula to the left ventricle reported in Japanese literatures, including our case were reviewed in regard to its surgical treatment.     

Cervical congenital spondylolytic spondylolisthesis associated with duplication of the vertebral artery: case report

Background contextCervical bilateral congenital spondylolysis with spondylolisthesis is an abnormality both of congenital and mechanical origin, characterized by its primary feature, cervical bilateral spondylolysis. We are unaware of any reports describing cervical congenital spondylolytic spondylolisthesis associated with duplication of the vertebral artery.PurposeTo report the case of a patient affected with cervical bilateral congenital spondylolysis with spondylolisthesis associated with duplication of the vertebral artery.Study designA unique case report from a university hospital and a literature review.Patient sampleAn 18-year-old man who arrived at the emergency department complaining of neck pain starting from a car accident 5 days ago.MethodsNeurologic examination and images taken by ordinary radiographs, magnetic resonance imaging (MRI) scans, ordinary computed tomography (CT) scans, and CT angiograms with three-dimensional (3D) reconstruction.ResultsNeurologic examination did not find evidence of strength deficit in upper extremities. Ordinary radiographs of the cervical spine showed spondylolisthesis of C6 and C7 and a cortical cleft between the superior and inferior articular facets of the C6 vertebra and spina bifida of the C6 and C2 vertebrae and an abnormal appearance of the remnant spinous processes of the cervical vertebrae. Magnetic resonance imaging confirmed the abnormalities that had been noted on the radiographs. Computed tomography scans of the cervical spine showed congenital spondylolytic spondylolisthesis and spina bifida of the C6 vertebra and duplication of the vertebral artery. They also showed double origins of the vertebral artery depicted by 3D angiographic reconstruction. Conservative treatment of wearing a cervical collar and receiving muscle relaxants and anti-inflammatory drugs was effective. With the pain completely subsided, the patient was discharged 5 days after arriving at the emergency department.ConclusionsVascular abnormalities should be suspected and investigated in cases of congenital spondylolysis or spondylolytic spondylolisthesis. We strongly suggest performing angio-CT or angio-MRI and 3D reconstruction in these cases. Awareness of the presence of a duplicated vertebral artery and the course of its limbs could significantly help planning in cases proceeding to surgery.     

Subclavian artery aneurysm in association with congenital absence of ipsilateral internal carotid artery

Aneurysms of the subclavian artery are rare. Similarly, congenital absence of the internal carotid artery is an extremely rare vascular anomaly. In this report, we discuss the case of a 54 year-old woman with an unusual aneurysm of the right subclavian artery in association with congenital absence of the right internal carotid artery. The aneurysm was successfully surgically repaired. On the basis of the appearance of the aneurysm and the absence of known atherosclerotic risk factors in this patient, it is hypothesized that the aneurysm is, in fact, congenital and related to anomalous development of the embryonic aortic arch branches.     

Coil embolization of symptomatic persistent sciatic artery aneurysm: a case report

Persistent sciatic artery is a rare congenital vascular anomaly of the lower extremity. This artery is predisposed to atherosclerosis or aneurysm formation. Persistent sciatic artery aneurysm often causes limb-threatening ischemia owing to its thrombosis or its mural thrombus. We report a case of successful transcatheter coil embolization for persistent sciatic artery aneurysm. An 89-year-old woman presented to our hospital, suffering from severe ischemia of the right leg and a pulsatile mass in the right buttock. Angiography and enhanced computed tomography revealed right persistent sciatic artery aneurysm with mural thrombus and complete occlusion of the distal end. After she underwent major amputation because of the advanced ischemia following unsuccessful thrombectomy, we performed coil embolization for the aneurysm successfully. Endovascular treatment including transcatheter embolization for persistent sciatic artery aneurysm is safe, effective, and less invasive than surgery. Its application gives various therapeutic options for the treatment of persistent sciatic artery aneurysm.     

A new surgical approach to the management of symptomatic aberrant right subclavian artery

Aberrant right subclavian artery is a rare congenital anomaly that usually does not produce symptoms. Symptomatic patients require surgical intervention. Ligation of the aberrant artery through a left thoracotomy has been advocated as the operation of choice. If development of vertebrobasilar insufficiency is anticipated, division and ligation of the aberrant artery and its anastomosis to the right common carotid artery or aortic arch are performed at a second operation. In the procedure advocated here, both ligation and anastomosis of the aberrant artery are performed simultaneously through midsternotomy. Normal blood flow is thereby established to the right upper extremity, which obviates any early or late complications.     

Diagnosing common carotid artery agenesis using duplex ultrasound

The complete absence of a common carotid artery, also known as common carotid artery (CCA) agenesis, is a well-described yet extremely rare congenital anomaly. Most carotid system anomalies are related to origins of the external or internal carotid arteries. All such anomalies are typically asymptomatic unless associated with a concomitant arterial lesion that results in a workup for symptomatic intracerebral pathology or a focal neurological deficit. The literature is scant on the topic, being limited to singular case reports. We report 3 cases of CCA agenesis and provide the readers with insightful data on the available literature.     

Computed tomography angiography is an excellent tool for the diagnosis of congenital coronary artery anomalies: a report of 2 cases

Congenital coronary artery anomalies are sporadically discovered in patients undergoing coronary angiography and in autopsy series. Although most anomalies are clinically insignificant, some may become causes of cardiovascular morbidities and mortality. Diagnosis is commonly made with conventional coronary artery angiography. The current development of modern cardiac computed tomography allows less invasive imaging of the coronary arteries and might provide additional anatomical and morphological information. Herein, we report our experience with computed tomography coronary angiography, describing 2 clinical cases of patients with symptomatic congenital coronary artery anomalies requiring cardiac surgery.     

Effect of CABG on coronary flow reserve in atresia of the left coronary ostium.

We evaluated the change of coronary flow reserve using a Doppler guidewire before and after coronary artery bypass grafting to assess the coronary hemodynamic effect of surgical revascularization in a 13-year-old boy with congenital atresia of the left coronary ostium, which is one of the rarest of the congenital coronary anomalies. Coronary flow reserve in the right coronary artery and left anterior descending artery increased significantly after coronary revascularization, and a microvascular bed developed in the left anterior descending artery.     

儿童先天性支气管动脉-肺动脉瘘的影像学评价:MSCTA与DSA对比

目的评价MSCT与DSA对儿童先天性支气管动脉-肺动脉瘘显示的一致性。方法先天性支气管动脉-肺动脉瘘患儿16例,其中6例因不明原因每日反复咯血200～400ml而接受多层螺旋CTA及DSA检查以及选择性支气管动脉栓塞治疗;其余10例因先天性心脏病就诊,均诊断为动脉导管未闭（PDA）,接受多层螺旋CTA及DSA检查。结果 DSA显示16例患儿共20支支气管动脉,均存在支气管动脉-肺动脉瘘。CTA显示20支支气管动脉,与DSA的显示率（20/20,100%）一致;其中13支呈增生性改变,管腔内径2～4mm,11支可见支气管动脉-肺动脉瘘。6例大咯血患儿经选择性支气管动脉栓塞治疗后效果良好,咯血症状消失。所有患儿随访平均时间为165天（1～12个月）,均未发现复发咯血。结论多层螺旋CTA能够显示部分支气管动脉-肺动脉瘘的直接及间接征象,但对于观察肺内支气管动脉-肺动脉瘘以及隐匿的支气管动脉-肺动脉瘘有一定局限性,诊断仍需借助DSA检查。     

Intracranial carotid artery occlusion with telangiectasia (moyamoya disease) associated with persistent primitive trigeminal artery--case report.

A 35-year-old female presented with moyamoya disease coincidentally associated with a persistent primitive trigeminal artery (PPTA). Bilateral encephalo-duro-arterio-synangiosis was performed and the postoperative course was uneventful. Moyamoya disease and PPTA might have a congenital origin, but moyamoya disease may be promoted by a PPTA. The hemodynamics of PPTA during progressive occlusive change in the internal carotid artery in moyamoya disease should be re-evaluated to determine its function in the development of moyamoya vessels.     

Ruptured berry aneurysm of the anterior ethmoidal artery associated with bilateral spontaneous internal carotid artery occlusion in the neck. Case report

A unique case is described of subarachnoid hemorrhage from a ruptured berry aneurysm of the right anterior ethmoidal artery, and its pathogenesis is discussed. The literature suggests an increased incidence of posterior circulation aneurysms in moyamoya disease, of contralateral anterior circulation aneurysms in agenesis of the carotid artery, and of aneurysms at various sites in spontaneous and iatrogenically acquired obstructions of the internal carotid artery. In addition to congenital anomalies of the vessel wall and systemic hypertension, increased regional blood flow should be regarded as an important factor in the generation of berry aneurysms.     

Vascular insufficiency in Okihiro's syndrome secondary to hypothenar hammer syndrome

The presence of Okihiro's syndrome (congenital thenar hypoplasia and Duane's anomaly) in a patient became clinically significant when a hypothenar hammer syndrome developed. The ulnar artery occlusion resulted in a compromise of the hand's vascular supply because of a congenital hypoplastic radial artery. Resection of the thrombosed ulnar artery and insertion of an interposition vein graft restored circulation to the hand. Anatomic features in this case include a hypoplastic radial artery and double motor branch of the median nerve. Clinicians should consider Okihiro's syndrome in the differential diagnosis of thenar muscle atrophy since there are genetic, diagnostic, and clinical implications.     

Internal thoracic artery grafting for congenital coronary malformations.

We report 2 patients with congenital coronary anomalies (atresia of left main coronary artery and anomalous origin of the left coronary artery from the pulmonary artery) successfully treated with single or double internal thoracic artery grafting. Because the internal thoracic artery has a potential for circumferential as well as longitudinal development, and because of the uncertainty of ultimate vein graft function, we believe that the internal thoracic artery is the best graft material for the treatment of congenital coronary malformations requiring bypass operation in children, adolescents, or even in adults.     

Coronary angioplasty for congenital obstruction of the left main coronary artery

We present three children who underwent coronary angioplasty for the surgical treatment of a congenital obstruction of the left main coronary artery. An azygos vein patch or graft was a feasible and useful material for reconstructing congenital ostial stenosis and atresia of the left main coronary artery.