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Left main coronary artery

Felix G Meinel, U Joseph Schoepf, Jacob C Townsend, Brian A Flowers, Lucas L Geyer, Ullrich Ebersberger, Aleksander W Krazinski, Wolfgang G Kunz, Kolja M Thierfelder, Deborah W Baker, Ashan M Khan, Valerian L Fernandes, Terrence X O'Brien
We aimed to determine the diagnostic yield and accuracy of coronary CT angiography (CCTA) in patients referred for invasive coronary angiography (ICA) based on clinical concern for coronary artery disease (CAD) and an abnormal nuclear stress myocardial perfusion imaging (MPI) study. We enrolled 100 patients (84 male, mean age 59.6 ± 8.9 years) with an abnormal MPI study and subsequent referral for ICA. Each patient underwent CCTA prior to ICA. We analyzed the prevalence of potentially obstructive CAD (≥50% stenosis) on CCTA and calculated the diagnostic accuracy of ≥50% stenosis on CCTA for the detection of clinically significant CAD on ICA (defined as any ≥70% stenosis or ≥50% left main stenosis)...
June 15, 2018: Scientific Reports
Hassan Tahir, Timothy Kennedy, M Umer Awan, Bassam Omar, Christopher Malozzi, G Mustafa Awan
Coronary artery disease is a major cause of morbidity and mortality, and while most commonly is atherosclerotic, it can present with variable manifestations, both congenital and acquired. One such manifestation is coronary aneurysm, which is a localized dilatation of a coronary artery wall segment to greater than 1.5 times the adjacent normal segments. While a dilated outpouching of a coronary artery has been commonly classified as a coronary aneurysm, a non-dilated outpouching is rare and is referred to as a diverticulum, with only one previous case report in the literature...
June 2018: Cardiology Research
Yue Wang, Gary S Mintz, Zhichun Gu, Yue Qi, Yue Wang, Mengru Liu, Xiaofan Wu
BACKGROUND: Although several meta-analyses have demonstrated the utility of intravascular ultrasound (IVUS) in guiding drug-eluting stent (DES) implantation compared to angiography-guidance, there has been a dearth of evidence in the left main coronary artery (LMCA) lesion subset. METHODS: We performed a meta-analysis to compare clinical outcomes of IVUS versus conventional angiography guidance during implantation of DES for patients with LMCA disease. Pubmed, Cochrane Library, Embase were searched...
June 14, 2018: BMC Cardiovascular Disorders
Jay Ramchand, Sheila K Patel, Piyush M Srivastava, Omar Farouque, Louise M Burrell
BACKGROUND: Angiotensin converting enzyme 2 (ACE2) is an endogenous regulator of the renin angiotensin system. Increased circulating ACE2 predicts adverse outcomes in patients with heart failure (HF), but it is unknown if elevated plasma ACE2 activity predicts major adverse cardiovascular events (MACE) in patients with obstructive coronary artery disease (CAD). METHODS: We prospectively recruited patients with obstructive CAD (defined as ≥50% stenosis of the left main coronary artery and/or ≥70% stenosis in ≥ 1 other major epicardial vessel on invasive coronary angiography) and measured plasma ACE2 activity...
2018: PloS One
Takao Konishi, Naohiro Funayama, Tadashi Yamamoto, Daisuke Hotta, Shinya Tanaka
BACKGROUND: A high coronary artery calcium score (CACS) predicts a poor prognosis in patients with coronary artery disease. We examined the relationship between the bifurcation angle and the CACS of the left main (LM) and left anterior descending (LAD) arteries in patients suffering from chronic kidney disease (CKD). METHODS: We analyzed the data of 121 patients who underwent coronary computed tomography between October 2014 and June 2015 and whose estimated glomerular filtration rate (eGFR) was <60 ml/min/1...
2018: PloS One
Hai-Wei Liu, Ya-Ling Han, Quan-Min Jin, Xiao-Zeng Wang, Ying-Yan Ma, Geng Wang, Bin Wang, Kai Xu, Yi Li, Shao-Liang Chen
Background: Very few data have been reported for ST-segment elevation myocardial infarction (STEMI) caused by unprotected left main coronary artery (ULMCA) occlusion, and very little is known about the results of this subgroup of patients who underwent primary percutaneous coronary intervention (PCI). The aim of this study was to determine the clinical features and outcomes of patients with STEMI who underwent primary PCI for acute ULMCA occlusion. Methods: From January 2000 to February 2014, 372 patients with STEMI caused by ULMCA acute occlusion (ULMCA-STEMI) who underwent primary PCI at one of two centers were enrolled...
June 20, 2018: Chinese Medical Journal
Sana Chams, Skye El Sayegh, Mulham Hamdon, Sarwan Kumar, Zain Kulairi
BACKGROUND: Takotsubo cardiomyopathy or stress cardiomyopathy is characterized by transient left ventricular apical ballooning in the absence of coronary occlusion. The underlying pathophysiological mechanism is still unclear but possible causes have been proposed mainly catecholamine cardiotoxicity, followed by metabolic disturbance, coronary microvascular impairment, and multivessel epicardial coronary artery vasospasm. Takotsubo cardiomyopathy accounts for 1-2% of patients presenting with acute coronary syndrome with the majority of patients diagnosed with Takotsubo cardiomyopathy being women > 55 years of age...
June 10, 2018: Journal of Medical Case Reports
Soichiro Kitamura
BACKGROUND: Pediatric coronary artery bypass surgery (PCABS) for congenital heart disease has become increasingly important in infants and children undergoing modern cardiac surgery, because of its life-saving potential in unsuccessful coronary transfer surgery. This review summarizes the current surgical role of PCABS for treating congenital heart diseases. METHODS: Databases, mainly PUBMED, were searched for relevant publications regarding coronary bypass surgery in the pediatric population, from 1970 (commencement) to March 2018...
June 5, 2018: Annals of Thoracic Surgery
Roopinder K Sandhu, Kenneth K Quadros, Yan Yun Liu, Michael Glikson, Valentina Kutyifa, Phillipe Mabo, Stefan Hohnloser, Gilles O'Hara, Liselot VanErven, Jorg Neuzner, Josef Kautzner, Frederik Gadler, Xavier Vinolas, Ursula Appl, Stuart J Connolly, Jeff S Healey
Aims: No standard practice exists with respect to anaesthesiologist-directed sedation (ADS) vs. sedation by proceduralist (PDS) for defibrillation threshold (DT) testing. We aimed to evaluate adverse events and safety outcomes with ADS vs. PDS for DT testing. Methods and results: A post hoc analysis of the Shockless Implant Evaluation (SIMPLE) study was performed among the 1242 patients who had DT testing (624 ADS and 618 PDS). We evaluated both intraoperative and in-hospital adverse composite events and two safety composite outcomes at 30-days of the main trial...
June 6, 2018: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Zhiyong Du, Zeliu Shu, Wei Lei, Chun Li, Kewu Zeng, Xiaoyu Guo, Mingbo Zhao, Pengfei Tu, Yong Jiang
Myocardial ischemia (MI) is an escalating public health care burden worldwide. Baoyuan decoction (BYD) is a traditional Chinese medicine formula with cardioprotective activity; however, its pharmacological characteristics and mechanisms are obscured. Herein, a multi-omics strategy via incorporating the metabonomics, transcriptomics, and pharmacodynamics was adopted to investigate the effects and molecular mechanisms of BYD for treating MI in a rat model of left anterior descending coronary artery (LADCA) ligation...
2018: Frontiers in Pharmacology
Payal K Gurnani, Allison Bohlmann, Robert J March
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been used as a bridge to cardiac recovery in patients following a major cardiac event. There is a lack of literature surrounding prolonged use of eptifibatide and optimal dosing during ECMO. This case report describes our experience with extended durations and standard dosing of eptifibatide in the setting of ECMO. CASE: A 40-year-old male with a history of Marfan's syndrome, aortic root and ascending aortic aneurysm status post a modified Bentall with a St...
June 1, 2018: Perfusion
Luis Arboine, Juan M Palacios
New England Journal of Medicine, Volume 378, Issue 23, June 2018.
June 7, 2018: New England Journal of Medicine
Naoki Misumida, Ahmed Elsharawy Ahmed, Mariah Barlow, Rachel Goodwin, Elliot Goodwin, Ameer Musa, Mohammad Mathbout, Gbolahan Ogunbayo, Sun Moon Kim, Ahmed Abdel-Latif, Khaled M Ziada
Anatomical SYNTAX score (SS1) and SYNTAX score II (SS2) are often utilized to determine the optimal revascularization strategy. Although US veterans have unique characteristics that may affect outcomes after revascularization, the prognostic values of SS1 and SS2 in veterans have not yet been validated. We performed a retrospective analysis of consecutive veteran patients who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) for left main and/or 3-vessel disease from 2009 to 2014...
April 12, 2018: American Journal of Cardiology
Zachary Oman, Nauman Khalid, Subbarao Boppana, Tarek Helmy, Elsayed Abo-Salem
The management of coronary thrombus is not well defined. Current therapies include medical management with anticoagulation, antiplatelet, and thrombolytic therapies or revascularization with percutaneous coronary interventions including mechanical thrombectomy, and coronary artery bypass grafting surgery. In this report, we present a patient with significant left main coronary artery thrombus burden with advanced cirrhosis and recent esophageal variceal bleeding who was successfully treated with conservative medical management...
May 17, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Qian Li, Ying Tong, Yong Yin, Pinjing Cheng, Guanzhong Gong
PURPOSE: The aim was to measure the cardiac motion-induced displacements of major coronary artery bifurcations utilizing electrocardiography (ECG)-gated four-dimensional computed tomography (4D-CT) and to determine the margin of coronary artery bifurcations. METHODS: Thirty-seven female patients who underwent retrospective ECG-gated 4D-CT in inspiratory breath hold (IBH) were enrolled. The left main coronary artery bifurcation (LM), the obtuse marginal branch bifurcation (OM), the first diagonal branch bifurcation (D1 ), the second diagonal branch bifurcation (D2 ), the caudal portion of the left anterior descending branch (APX), the first right ventricular artery bifurcation (V) and the acute marginal branch bifurcation (AM) were contoured...
May 2018: Physica Medica: PM
Ruben Jansen, Brigitte Bathgate, Alexander Bufe, Jan-Erik Guelker
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) still remains a major challenge in interventional cardiology. This case describes a complex PCI of the left main coronary artery and of a CTO of the right coronary artery using a minimal extracorporeal circulation system (MECC) in a patient with an aortic valve bioprothesis in extraanatomic position. It illustrates that complex recanalization strategies can be solved combining it with mechanical circulatory support technologies.
2018: Case Reports in Cardiology
Tetiana Glushko, Richard Seifert, Fraser Brown, Deon Vigilance, Blanca Iriarte, Oleg M Teytelboym
Transseptal course of coronary artery has often been described as a benign entity; however, this report and literature analysis provides growing evidence of high risk of serious cardiovascular events in this anomaly. We present a case of unstable angina in a patient with anomalous common origin of left and right coronary arteries from a single coronary ostium at the right sinus of Valsalva, with subsequent transseptal course of the left main artery, review of relevant literature, and discussion of possible management options...
June 2018: Radiology Case Reports
Metin Çoksevim, Murat Akçay, Korhan Soylu, Ömer Göktekin
No abstract text is available yet for this article.
June 2018: Anatolian Journal of Cardiology
Francesco Nudi, Orazio Schilllaci, Giuseppe Biondi-Zoccai, Annamaria Pinto, Giandomenico Neri, Enrica Procaccini, Francesco Versaci, Alessandro Nudi, Fabrizio Tomai, Giacomo Frati, Ami E Iskandrian
AIMS: Prior studies using stress myocardial perfusion imaging (MPI), which examined the association between obstructive epicardial coronary disease and presence of myocardial ischemia did not provide a detailed assessment on a regional level. We examined this relationship in a large population of patients in whom the coronary anatomy was defined by invasive coronary angiography. METHODS: We retrospectively extracted details on individuals undergoing MPI with single photon emission computed tomography (SPECT) who had coronary angiography within 12 months...
May 24, 2018: Journal of Cardiovascular Medicine
Nicholas P Villano, Murray Kwon, Reza Ardehali
Coronary artery aneurysms are abnormal dilations of arterial segments, in some cases associated with underlying atherosclerosis. Although affected patients can be asymptomatic, some are at risk of plaque rupture, dissection, and other complications. Investigations into the optimal management of these vascular malformations are ongoing, because no consensus exists regarding when and how best to intervene. We present the case of a 58-year-old man whose large left main coronary artery aneurysm we ligated and removed during 5-vessel coronary artery bypass grafting...
April 2018: Texas Heart Institute Journal
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