Acute myocardial ischemia secondary to interruption of coronary blood flow (original) (raw)
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Journal of the American College of Cardiology, 2011
Dextrocardia associated with atrial situs solitus is commonly referred to as dextroversion. Dextroversion is a result of early interruption of normal embryological development and, therefore, rarely occurs without other associated cardiac and noncardiac anomalies. While percutaneous coronary intervention has been described in many cases of dextrocardia with situs inversus, it has not been previously described in dextroversion. We report the case of an 88-year-old woman with dextroversion who presented with an acute anterior myocardial infarction that was successfully treated with coronary stent implantation. D extrocardia in its various forms is a relatively rare congenital anomaly, with an estimated incidence of 1 in 10,000 (1). While variations in terminology and classification systems exist, the condition of dextrocardia with situs solitus is commonly referred to as dextroversion (2, 3). We report the case of a patient with known dextroversion but no other known cardiac or noncardiac anomalies who presented with an anterior myocardial infarction that was successfully treated with primary percutaneous stent implantation.
Acute coronary events associated with percutaneous transluminal coronary angioplasty
The American Journal of Cardiology, 1984
Acute coronary events reported in patients enrolled in the NHLBI PTCA Registry were analyzed. Data were collected on 3,079 patients from 105 contributlng centers. Coronary vascular events (dissection, occlusion, spasm, embolism, perforation or rupture) or ischemic events (Ml or prolonged angina) occurred in 418 patients (13.8%). Major complications (Ml), emergency surgery or death) occurred in 280 patients (67%) with acute coronary events. The most frequent events were prolonged angina, which occurred in 211 (6.8%), and MI, in 170 (5.5%). Coronary dissection, occlusion and spasm each occurred in approximately 5 % of patients. Coronary embolism, perforation and rupture were rare (<0.2% for each), Dissection and occlusion each had a hinh frequency (>80 %) of associated major PTCA carries an inherent risk of significant complications.1-3 A detailed review of complications encountered with PTCA in the first 1,500 patients enrolled in the NHLBI PTCA Registry has been reported. The most important of these complications can be characterized as acute coronary events. The Registry has subsequently increased enrollment to 3,079 patients, and this data base provides an excellent measure of the type, frequency and outcome of acute coronary events occurring with PTCA and also allows identification of predictors of these events. The occurrence of acute coronary vascular and ischemic events associated with or following PTCA and the clinical and angiographic predictors of these events are reviewed. Methods Dam were analyzed in 3,079 patients enrolled in the NHLBI PTCA Registry through September 1982. The results include only first PTCA procedures and do not include additional patients enrolled under special protocols (those with PTCA
PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS POST SURGICAL REVASCULARISATION
Journal of the American College of Cardiology, 2010
Dextrocardia associated with atrial situs solitus is commonly referred to as dextroversion. Dextroversion is a result of early interruption of normal embryological development and, therefore, rarely occurs without other associated cardiac and noncardiac anomalies. While percutaneous coronary intervention has been described in many cases of dextrocardia with situs inversus, it has not been previously described in dextroversion. We report the case of an 88-year-old woman with dextroversion who presented with an acute anterior myocardial infarction that was successfully treated with coronary stent implantation. D extrocardia in its various forms is a relatively rare congenital anomaly, with an estimated incidence of 1 in 10,000 (1). While variations in terminology and classification systems exist, the condition of dextrocardia with situs solitus is commonly referred to as dextroversion (2, 3). We report the case of a patient with known dextroversion but no other known cardiac or noncardiac anomalies who presented with an anterior myocardial infarction that was successfully treated with primary percutaneous stent implantation.
Cardiology Clinics, 1985
During the last 15 years, coronary artery bypass graft surgery has become an effective therapeutic modality in the treatment of patients with coronary artery disease. The initial surgical concepts of constructing one and, occasionally, two grafts were modified by improved surgical techniques, methods of myocardial preservation, preoperative cardiologic evaluation, perioperative care, and cardiac rehabilitation and the availability of short-and long-term patient follow-up data. Thus, more extensive and effective myocardial revascularization surgery was able to be performed with concomitant lowering of the surgical morbidity and mortality. P e r c u t a n e o u s t r a n s l u m i n a l c o r o n a r y angioplastyll has become a possible alternative to myocardial revascularization surgery in select groups of patients with obstructive coronary disease. The demonstration that coronary angioplasty proved to be a safe and efficacious therapeutic modality in patients (usually without prior bypass surgery) with isolated proximal coronary stenosis(es),15 created the potential for its use in patients with more extensive coronary artery disease. This article will describe our experience and approach to situations in which complex coronary angioplasty is attempted: coronary and/or saphenous vein graft angioplasty in patients with prior coronary bypass graft surgery, multiple coronary angioplasties, and chronic coronary occlusions. METHODS All patients who underwent transluminal coronary angioplasty had coronary atherosclerosis that was the cause of severe angina pectoris or had a severe stenosis(es) that produced significant myocardial ischemia that was documented by objective noninvasive studies (exercise stress testing and myocardial scintigraphy [when not clinically contraindicated]) and by coronary cinearteriography. The patient's anatomy, that is, the site of the stenosis(es), was the primary determinant of whether or not transluminal coronary angioplasty would be attempted. In pat i e n t s u n d e r g o i n g m u l t i p l e c o r o n a r y angioplasties, the anatomic requirement was such that more than one lesion was present that was considered accessible to the angioplasty catheter (distal as well as proximal stenoses). In addition, certain individuals underwent multiple dilatations with significant disease in other vessels that would not be dilated or were not accessible to the dilatation catheter. These par
Journal of the American College of …, 1988
Because the effects ?F :hanging technology in ,?ercutaneous transluminal coronary q$oplasty, increased operator experience and use of the procedure in patierts with extensive disease are unknown in regard to compliration patterns, the mitial 1977-1981 cohort ;rnd the recent 198 §-1986 cohort of the National Hear!, Lung, and 81o~J Institute Percutaneous Transluminul Coronary bgioplasty Registry wereanalyzed with respect to complications. Compared with the initial Lohort of 1.855 patients. the 1,801 new cohort patients were older and had an increased prevalence of muitivessel coronary artery disease, depressed left ventricular function and prior infarction. Overall complication rates in the recent cohort were either unchanged or decreased from the rates in the i&da! c&ort despite a higher risk patient population. The most significant decreases were in the incidence of coronary spasm (p < 0.001 I and the need for emergency coronary bypass surgery (p = _-0.01). Qrerzd! in-hospital mortalitp was low but ~2s Deandent on the extent of ~4 di..~as~-O.2% for sing:e se4 071F.lW17 S#h 'I) I IS0 HOLhICS FIT Al, JACC Vol. 12. No. 5 COMPLICATIONS (IIT I?IIATII)N November 19RH: I I-W-55 HOLMES ET AL. JACC Vnl. II. No. 5 COMPLICATIONS Or I~ILATION November 198fJ! 1149-55
Circulation, 1989
In 1,801 patients in the 1985-1986 Percutaneous Transluminal Coronary Angioplasty Registry, overall 1-year mortality was 3.2%, the 1-year myocardial infarction rate was 7.2%, and the 1-year coronary artery bypass surgery rate was 13.2%. In the 78% of the cohort with all lesions successfully dilated and without major procedural complications (successful patients), the corresponding rates were 1.9%, 2.6%, and 6.4%. Nearly 20% of all deaths, 40% of all infarctions, and 25% of all bypass operations occurred in the small subset of patients (6.8%) who sustained periprocedural occlusion. Event rates were higher in patients with multivessel disease than in those with one-vessel disease. At 1 year, angina-free status was reported by approximately three fourths of all surviving patients, regardless of initial success. However, compared with successful patients, unsuccessful patients underwent intervening bypass surgery (42% vs. 6%) to achieve asymptomatic status more frequently. Comparison of...
The American Journal of Cardiology, 1999
BackgrouTld. Predilection sire for the acute myocardial ill/arclion of the right ventricle, (AMI-RV) is the upper third of the rig/II corollary artery and for this reason sitch an infarction is followed by numerous complications, primarily by conduction disorders and very often by suddell and rapid cardiogenic shock developme1lf. Methods. Primary percwafleolls trans/uminal coronary oll8ioplasry (PPTCA) was performed 011 three patiellts, ill whom the acllfe infarction of the right \'ell(ricular \Vas diagnosed and who had been hospitalized six hours after the beginning 0/ chest pain. /n all three patiellls ill(racoronary stell(was implanted. 0" the admission potiell(s had been in the threatening cardiogenic shock, with the prominent chest pain and with the elevation oj ST-segmelll in V 4 R>2 m V. /n the course of i"ten1entioll patients were administered low-molecular intracoronary heparin, witli direct platelet glycoprotein lib/II/a illhibitors (abciximab), according to the established procedure applied ill such cases. Results. The complete dilatation of the inJarcted artery lVas established with tile signs 0/ reperfusion alld the further clinical course was completely nonnal. there was no heart Jail//re and patients had 110 sI/bjectil'e difficulties. Conclusion. Invasive approach in the trealmem of AMI-RV is justifiable. alld possibly the therapy oj choice a/these patients, providing well trained and equipped team is available.
Coronary angioplasty in patients with severe left ventricular dysfunction
Journal of The American College of Cardiology, 1990
The applications for coronary angioplasty have greatly expanded and the procedure is now increasingly used in complex and potentially high risk conditions. This report describes the short· and long·term effects of coronary angioplasty in 61 patients with severely depressed left ventricular function (ejection fraction~35 %) with unstable or refractory anginal symptoms, or both, in whom revascularization was necessary despite increased risk.