Single coronary artery arising from the right sinus of Valsalva (case report)

A single coronary artery is a rare congenital anomaly of the coronary arteries where only one coronary artery arises from the aortic trunk by a single coronary ostium, supplying the entire heart. We report a case of a 70 years-old man with mitral valvular insufficiency and atherosclerotic right and left circumflex coronary arteries, in whom coronary angiography showed a single coronary artery arising from a single ostium in the right sinus of Valsalva (R-II-B subtype) and transverse trunk coursed between aorta and pulmonary artery. The clinical significance and subtype of the single coronary artery are discussed.     

The problem of complications of percutaneous coronary interventions. Part III. Optimal hemostasis

Successes in interventional cardioangiology allowed to widen area of application of percutaneous interventions. After broadened anticoagulant and antiplatelet therapy introducers are often withdrawn several hours after procedure. As a consequence exended compression of puncture site is required. This results in increase of procedure time, rate of development of complications, as well as patient s discomfort. Devices elaborated for puncture site closure allow shortening of introducer presence in an artery, hemostasis duration, and length of hospitalization. However the use of these devices is associated with higher cost and possibility of complications related to their placement. Aim of the present review is comparison of various types of closure devices with each other and with manual compression as well as assessment of their effect on rate of development of peripheral complications.     

Pulmonary arterial hypertension: changing approaches to management

The review is devoted to different aspects of pulmonary arterial hypertension (PAH); new classification of PAH is published in 2010. There are idiopathic PAH and PAH associated with other diseases. Current guidelines recommend to treat PAH only after the verification of diagnosis with right heart catheterization and acute tests with vasodilators. Patients-reactors should be treated with calcium antagonists. The following drugs related to one of three categories should be used in PAH: (1) prostanoids (epoprostenol, iloprost et al.); (2) blockers of endothelin receptors (bosentan, ambrisentan, sitaxsentan); (3) phosphodiesterase 5 type inhibitors (sildenafil, tadalafil et al.) In majority of cases the combined treatment is used, usually the combination of bosentan and sildenafil is used.     

Possibilities of recanalization of chronic coronary occlusions with penetration catheter <Tornus>

Percutaneous coronary interventions (PCI) for chronic total occlusions (CTO) remain one of most difficult parts of interventional cardiology. Introduction of novel devices and methods of recanalization of CTO have facilitated fulfillment of these interventions and increased number of successful procedures. Howere a number of cases it is impossible to position a balloon in the site of occlusion even after its successful crossing with a guidewere. Penetration catheter Tornus was specifically created for such cases. It allows to form a channel in CTO for subsequent dilation and stent implantation. We present a review of available clinical studies assessing efficacy of the use of Tornus catheter during PCI for CTO, as well as results of its comparison with efficacy of rotational atherectomy. Authors of these studies concluded that Tornus catheter was highly effective in cases when it was not possible to pass a catheter for changing usual "RotaWire" guide with the aim of conducting rotational atherectomy, or in cases of impossibility to pass a balloon along a guidewere for predilation of the occlusion site. At the same time the use of penetration catheter had no advantages over rotational atherectomy.     

Functional state of the left and right heart ventricles in chronic alcoholic damage to the heart (findings of two-dimensional echocardiography)

Twenty eight patients aged 31 to 56 years with Stages II-III chronic alcoholism were examined. All the patients underwent a thorough clinical, X-ray, and instrumental studies which provided the possibility to exclude coronary artery and valve diseases. Two-dimensional echocardiography revealed that chronic alcoholics had profound ventricular dysfunctions. The abnormalities in the right ventricle (its dilation and reduced ejection fraction) occur earlier than in the left one and they become deteriorated with lower left ventricular contractility.     

Achievements of invasive cardiology 2003. Part I.

The authors present a review of research works completed or conducted in 2003 which according to their opinion contributed most to the rapidly progressing field of invasive/interventional cardiology. The year passed was characterized by wide introduction into clinical practice of stents coated with antirestenotic agents, substantial advances in pharmacological support and improvements of safety of coronary interventions, active studies of contrast induced nephropathy and assessment of novel devices for myocardial protection against distal embolism during interventions both on coronary arteries and vein grafts. Recent results of comparisons of mechanical and pharmacological myocardial reperfusion in acute ST-elevation myocardial infarction can be considered revolutionary for clinical cardiology. Part I of the review deals with invasive treatment of acute coronary syndrome and pharmacological support of coronary interventions.     

Femoral pseudoaneurysm due to diagnostic or interventional angiographic procedures

The authors investigated the incidence of, diagnostic methods for, and treatment strategies for iatrogenic femoral pseudoaneurysms in their hospital and compared the results with those in the literature. The hospital records of 25,273 patients who had coronary or peripheral angiography and angioplasty in Sani Konukoglu Medical Center from September 1997 to December 2002 were collected retrospectively. All the complications were detected and femoral pseudoaneurysm cases were selected. Diagnostic criteria and treatment strategy were documented. All results were compared with the literature. Femoral pseudoaneurysm was the second in number of complications and bleeding the first. Twenty-eight patients with pseudoaneurysm were diagnosed with color Doppler ultrasound (US) imaging (0.11%). Eleven of these closed spontaneously within 3-7 days. Image-guided compression therapy was applied to the remaining 17 and was effective in 10. The remaining 7 patients were operated on successfully. In this series the incidence of iatrogenic femoral pseudoaneurysm was comparable with the literature (0.02%-2%). Color Doppler US is the best diagnostic tool for this complication, and no other method was necessary. Eleven cases of spontaneous closure may show a rather benign prognosis, but close follow-up is advised. Image-guided compression is also an effective and noninvasive method of therapy for this complication. In late cases with a thick neck, surgery should be done immediately. It is easy to prevent rather than treat this complication. The similar incidence in the literature and in this series shows that a number of complications are to be expected, and so prompt and early diagnosis and effective treatment are very important. Application of good external compression after catheterization, selecting the thinnest introducer, use of B-mode and color Doppler US imaging for suspected cases, and image-guided compression therapy are also effective in early cases with a thin neck of the aneurysm.     

Effectiveness of excimer laser coronary angioplasty in treatment of patients with in-stent restenosis

In-stent restenosis (ISR), when treated with balloon angioplasty (PTCA) alone, has an angiographic recurrence rate of 30-85%. Ablating the hypertrophic neointimal tissue prior to PTCA is an attractive alternative, however late outcomes of such treatment have not been fully determined. This multicenter case control study assessed angiographic and clinical outcomes of 137 consecutive procedures in 125 patients treated for ISR with either PTCA alone (n = 58) or excimer laser assisted coronary angioplasty (ELCA, n = 67). Demographics were similar. Lesions selected for ELCA compared with those selected for \PTCA were longer (17.1+/-9.9 mm vs. 13.6+/-9.1 mm; p=0,034), more complex (ACC/AHA type C: 36,5% vs. 14,3%; p=0,006), and with reduced antegrade flow (TIMI flow < 3: 18,9% vs. 4,8%; p = 0,025). ELCA- and PTCA treated patients had similar rates of procedural success (98,5 and 98,3%, respectively, p=1,0), major clinical complications (3,0% and 8,6%; respectively, NS), major cardiac events at 1 year (37,3 and 46,6%. respectively, NS), and target lesion revascularization (32,8 and. 34,5%; respectively, NS). These data suggest that ELCA in patients with complex in-stent restenosis is as safe and effective as PTCA. Despite higher lesion complexity in ELCA-treated patients, no increase in event rates was observed.     

Effects of the hypoxic test on left and right ventricular contractility in progressive systemic sclerosis with pulmonary arterial hypertension

The purpose of this investigation was to assess hypoxic test effects on left and right ventricular contractility in patients with progressive systemic sclerosis (PSS) and pulmonary arterial hypertension (PAH). Ten patients (mean age 48.8±13.2 years) who were diagnosed with PSS and PAH were included in the study. All the patients underwent left and right heart catheterization. Right ventricular (RV) contractility was measured according to the method of Ferlinz [1] and left ventricular (LV) contractility according to the method of Kennedy et al. [2] using indirect digital substraction angiography. The mean pulmonary artery pressures ( _PA) and oxygen saturation of the pulmonary artery (S_aO₂) were registered at each stage of graded hypoxic exposure 14%, 12%, and 10% of O₂. Right atrial pressures (P_RA,syst, P_RA,diast, _RA), right ventricular pressures (P_RV,syst, P_RV,diast, _RV, P_RV,end-diast), right and left ventricular end-diastolic volume index (EDVI), end-systolic volume index (ESVI), stroke volume index (SVI), cardiac index (CI), ejection fraction (EF), and heart rate (HR) were calculated before and after breathing a hypoxic mixture of 10% of O₂ for 30 minutes. The hypoxic test induced significant elevation (p<0.05) of _PA, P_RA,syst, P_RA,diast, _RA, P_RV,syst, P_RV,end-diast, RV EDVI, LV, EDVI, CI, and HR, whereas, S_aO₂ decreased significantly after the hypoxic test. These findings suggest that patients with PSS and PAH are characterized by hyperreactivity of pulmonary artery to hypoxia and the preservation of compensatory mechanism of RV and LV contractility.