cardiovascular-agents and Coronary-Vessel-Anomalies

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. The majority of cases reported in the literature involve a single vessel; multivessel and left main (LM) coronary artery involvement is rare. We present a case of triple vessel and LM SCAD in a postpartum patient and review the literature regarding percutaneous coronary intervention in the setting of SCAD.

Topics: Acute Coronary Syndrome; Adult; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Drug-Eluting Stents; Female; Humans; Percutaneous Coronary Intervention; Postpartum Period; Pregnancy; Treatment Outcome; Ultrasonography, Interventional; Vascular Diseases

Patients with systemic lupus erythematosus (SLE) present an increased prevalence of coronary heart disease. The majority of cases of acute coronary syndrome (ACS) in patients with SLE are due to atherosclerosis. Less common causes include thrombosis of an angiographically normal coronary artery and coronary vasculitis. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS in these patients. We report the case of a 53-year-old female diagnosed of SLE presenting with an ACS caused by SCAD. She was treated medically and her clinical course was favorable. A literature search identified seven additional cases of SCAD associated with SLE. The main clinical features found in these reports are revised. ACS caused by SCAD in SLE patients is a condition likely under-reported in literature. SCAD should be suspected in patients with SLE and ACS, especially in younger women without evident cardiovascular risk factors. An early accurate diagnosis of SCAD is key to provide specific treatment, which differs from that of usual atherosclerotic ACS.

Topics: Acute Coronary Syndrome; Cardiovascular Agents; Coronary Vessel Anomalies; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Middle Aged; Risk Factors; Treatment Outcome; Vascular Diseases

Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented.

Topics: American Heart Association; Cardiac Imaging Techniques; Cardiovascular Agents; Consensus; Conservative Treatment; Coronary Artery Bypass; Coronary Vessel Anomalies; Female; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Predictive Value of Tests; Pregnancy; Prevalence; Risk Assessment; Risk Factors; Treatment Outcome; United States; Vascular Diseases

Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndromes and sudden cardiac death. The epidemiology, pathogenesis, and optimal approaches to diagnosis and management are poorly understood. Additionally, SCAD as a syndrome is commonly under-recognized and its prognosis is not well studied. Guidelines on management of SCAD have not yet been established. We present three cases of SCAD that varied in their clinical presentation and describe the different management strategies utilized. This is followed by a review of the clinical features, epidemiology, prognosis, and potential treatment strategies for patients presenting with SCAD.

Topics: Adult; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies; Drug-Eluting Stents; Electrocardiography; Female; Humans; Male; Percutaneous Coronary Intervention; Risk Factors; Treatment Outcome; Ultrasonography, Interventional; Vascular Diseases; Young Adult

Topics: Cardiac Surgical Procedures; Cardiology; Cardiovascular Agents; Clinical Decision-Making; Consensus; Coronary Vessel Anomalies; Death, Sudden, Cardiac; Evidence-Based Medicine; Genetic Predisposition to Disease; Humans; Percutaneous Coronary Intervention; Prevalence; Risk Assessment; Risk Factors; Treatment Outcome

Spontaneous coronary artery dissection (SCAD) remains an infrequent, elusive, and challenging clinical entity of unknown etiology eight decades after its initial description. Our understanding of the pathophysiology of SCAD, initially limited to information from early pathological studies, case reports, and very short series, has been enriched recently by relatively large contemporary series of patients studied prospectively. The typical presentation involves a young woman without coronary risk factors suffering an acute coronary syndrome but, actually, most patients are middle-aged and have coronary risk factors. A high number of conditions have been related to SCAD, but fibromuscular dysplasia has shown a major intriguing association with potential pathophysiological implications. SCAD may present (a) with an intimal tear and the classic angiographic 'flap' leading to the appearance of two lumens (true and false), or (b) without an intimal rupture, as an intramural hematoma. An increased clinical awareness together with new diagnostic tools have led to a major surge in the diagnosis of SCAD. High-resolution intracoronary techniques provide unique diagnostic insights into the underlying pathophysiology and facilitate identification of the disease in patients misdiagnosed previously. After the initial acute ischemic insult, most patients stabilize and have a benign clinical course and eventually experience spontaneous healing of the vessel wall during follow-up. However, recurrences may still occur in up to 10-20% of cases. Accordingly, a conservative medical management (watchful waiting strategy) has been recommended as the initial approach. Revascularization remains particularly challenging and may be associated with suboptimal results, acute complications, and poor long-term outcome. Nevertheless, in patients with ongoing or refractory ischemia and adequate anatomy, revascularization should be attempted. Some novel and attractive coronary interventions have been proposed in this uniquely challenging anatomic scenario. This review aims to present a comprehensive and contemporary update on this elusive and intriguing clinical entity.

Topics: Acute Coronary Syndrome; Adult; Age Factors; Aged; Cardiovascular Agents; Conservative Treatment; Coronary Angiography; Coronary Vessel Anomalies; Female; Humans; Male; Middle Aged; Multimodal Imaging; Myocardial Reperfusion; Predictive Value of Tests; Risk Factors; Sex Factors; Tomography, Optical Coherence; Treatment Outcome; Ultrasonography, Interventional; Vascular Diseases; Watchful Waiting

Anomalous origin of a coronary artery from the aorta is a potentially serious anomaly that occurs in about 0.1-0.2% of the population. This percentage is small; however, it translates into about 4000 annual births with these anomalies. The clinical presentation of these anomalies is rare, and hence most are and will remain asymptomatic. The various anatomic anomalies are described, with anomalous origin of the left coronary artery that then passes between the aorta and pulmonary artery being the most serious of these anomalies. The pathophysiology resulting from these anomalies is described, as are methods for identifying those who require treatment; however, we still do not know the best methods of determining which patients need treatment.

Topics: Aorta, Thoracic; Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Global Health; Humans; Incidence; Prevalence; Vascular Surgical Procedures

Woven coronary artery is an extremely rare and is still not a clearly defined coronary anomaly in which epicardial coronary artery is divided into multiple thin channels at any segment of the coronary artery, and subsequently, these multiple channels merge again in a normal conduit. A few cases have been reported till now. In this case report, we present a 58-year-old male with a woven right coronary artery.

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Circulation; Coronary Vessel Anomalies; Humans; Male; Middle Aged; Treatment Outcome

Concealed undiagnosed congenital anomalies of coronary arteries (CACA) can cause sudden death of young men. Isolated CACA are detected at 0.6-1.8% of coronary angiographies. Classification of CACA (2002) includes anomalous origin of coronary artery from pulmonary artery, anomalous origin of coronary artery from the aorta, congenital atresia of the left main coronary artery, coronary arteriovenous fistula, coronary artery with myocardial bridge, coronary artery aneurism, coronary artery stenosis. In most cases coronary artery anomalies for long time remain asymptomatic. Clinical picture of anomalous origin of coronary artery from pulmonary artery is often erroneously related to cardiomyopathy or myocarditis because of signs of heart failure. Modern methods of visualization are used for diagnosis of CACA: echocardiography (transthoracic and transesophageal), computer angiotomography (electron beam tomography, multispiral computer tomography), magnetic resonance angiography, thallium stress scintigraphy, single photon positron emission tomography, dobutamine stress echocardiography, endovascular ultrasound study. Coronary angiography is the gold standard for diagnosis of congenital anomalies of coronary arteries. Drug therapy, transluminal balloon angioplasty with stenting or surgical revascularization are indicated to patients with overt clinical picture.

Topics: Adult; Angioplasty, Balloon, Coronary; Asymptomatic Diseases; Cardiomyopathies; Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Death, Sudden, Cardiac; Diagnosis, Differential; Echocardiography; Heart Failure; Humans; Magnetic Resonance Angiography; Male; Myocarditis; Tomography, Spiral Computed; Young Adult

Topics: Aged; Cardiovascular Agents; Chest Pain; Clinical Decision-Making; Computed Tomography Angiography; Conservative Treatment; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Electrocardiography; Exercise Test; Humans; Image Processing, Computer-Assisted; Male; Multimodal Imaging; Sinus of Valsalva

Topics: Adult; Aged; California; Cardiovascular Agents; Clinical Decision-Making; Coronary Vessel Anomalies; Defibrillators, Implantable; Electric Countershock; Female; Humans; Incidence; Male; Middle Aged; Percutaneous Coronary Intervention; Recurrence; Retrospective Studies; Risk Factors; ST Elevation Myocardial Infarction; Tachycardia, Ventricular; Time Factors; Treatment Outcome; Vascular Diseases; Ventricular Fibrillation

Coronary artery anomalies can provoke intermittent vasospasm and endothelial dysfunction, which can cause takotsubo cardiomyopathy. However, in takotsubo cardiomyopathy, apical myocardial regions are typically affected, and these do not correlate with a specific epicardial coronary distribution territory. We report the case of a 74-year-old woman who presented with acute respiratory failure and suspected myocardial infarction. She had a left coronary artery anomaly, dominant right coronary artery supply, takotsubo cardiomyopathy, depressed left ventricular ejection fraction, and no atherosclerotic disease. In the absence of exercise ischemia, we considered the anomalous artery to be an incidental finding. After 6 weeks of medical therapy, the patient's ejection fraction was normal; one year later, she remained asymptomatic. The anomalous left coronary artery in the presence of dominant right coronary supply did not explain the diffuse apical regional wall-motion abnormalities in our patient. To our knowledge, this is the first report of coexisting takotsubo cardiomyopathy and anomalous coronary artery in a patient presenting with acute dyspnea.

Topics: Aged; Cardiovascular Agents; Coronary Vessel Anomalies; Dyspnea; Female; Humans; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Function, Left

Coronary artery anomalies are rare congenital variants of coronary artery anatomy accounting second most common cause of sudden cardiac death in young competitive athletes. A single ostium coronary artery anomalous is an extremely rare variant with an incidence of less than 0.004%. They may present as chest pain, arrhythmia, or sudden death. Recently, advanced imaging techniques such as computed tomography and magnetic resonance imaging coronary angiography are becoming the alternatives investigation for diagnosis. We reported a rare case of 50 years old lady who presented with acute chest pain with normal electrocardiography, echocardiography, and cardiac markers. Coronary Computed tomography angiography revealed anomalous coronary artery anatomy with both right and left coronary artery arising from the large common trunk of the right coronary cusp, left main coronary artery having trans-septal course, there was no flow-limiting coronary artery disease. She was medically managed with a single antiplatelet, beta-blocker, and statin therapy.

Topics: Administration, Oral; Adrenergic beta-Antagonists; Angina Pectoris; Biomarkers; Cardiovascular Agents; Computed Tomography Angiography; Coronary Angiography; Coronary Vessel Anomalies; Echocardiography; Electrocardiography; Female; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Middle Aged; Platelet Aggregation Inhibitors

Topics: Aged; Bronchopulmonary Sequestration; Cardiovascular Agents; Conservative Treatment; Coronary Vessel Anomalies; Female; Humans; Multimodal Imaging; Myocardial Ischemia; Pulmonary Artery; Treatment Outcome

Topics: Aortic Valve; Atherectomy, Coronary; Bicuspid Aortic Valve Disease; Cardiovascular Agents; Coronary Artery Disease; Coronary Vessel Anomalies; Heart Defects, Congenital; Heart Failure; Heart Valve Diseases; Humans; Stroke Volume; Treatment Outcome; Vascular Calcification; Ventricular Function, Left

Topics: Absorbable Implants; Angioplasty, Balloon, Coronary; Cardiac Catheters; Cardiovascular Agents; Coated Materials, Biocompatible; Coronary Vessel Anomalies; Health Care Surveys; Humans; Practice Patterns, Physicians'; Prosthesis Design; Stents; Treatment Outcome; Vascular Diseases

We sought to assess the angiographic and long-term clinical outcomes in a predominantly medically treated population with spontaneous coronary artery dissection (SCAD).. There are little data on the angiographic and long-term outcome in patients with SCAD.. We studied 64 patients with SCAD (mean age 53 years, 94% females, three peripartum) with acute coronary syndrome who were treated using coronary bypass grafting (n = 1), percutaneous coronary intervention (n = 7), or medical therapy (n = 56). A repeat angiogram was performed in 40/64 (63%) patients. The median clinical follow-up was 4.5 years.. Five (8%) patients had a major cardiac event. One patient with peripartum left main SCAD and cardiogenic shock died during PCI. One patient with conservatively treated SCAD of the posterior descending artery suffered out-of-hospital cardiac arrest 16 days after the initial angiogram but survived. Three patients experienced a second SCAD in another vessel 3.7, 4.7, and 7.9 years after the index event while the initial dissection had healed. Thirty medically treated patients underwent a scheduled repeat angiogram showing healing of the dissection in all but one patient. After a median follow-up of 4.5 (1.8-8.4) years, all 63 patients surviving the index event were alive and free of symptoms suggestive of myocardial ischemia.. In general, the long-term outcome of patients with SCAD is excellent, and medical therapy can be safely applied in the majority of patients. However, SCAD can be a life-threatening and sometimes catastrophic event, and some patients experience early or late complications including SCAD of another vessel. © 2015 Wiley Periodicals, Inc.

Topics: Acute Coronary Syndrome; Adult; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Percutaneous Coronary Intervention; Predictive Value of Tests; Pregnancy; Recurrence; Registries; Risk Assessment; Risk Factors; Shock, Cardiogenic; Switzerland; Time Factors; Treatment Outcome; Vascular Diseases

: Spontaneous coronary artery dissection (SCAD) is a rare and poorly understood cause of acute coronary syndrome in relatively young patients. Nowadays, the optimal treatment of SCAD is uncertain. A conservative approach seems to be preferable, but in particular conditions, an invasive strategy is necessary. The poor rate of procedural success, the high risk of procedural complications and the uncertain long and mid-term results make the interventional treatment of SCAD a challenge. We report a case of a young male patient presenting with SCAD successfully treated with a sirolimus-eluting self-expanding coronary stent. To our knowledge, the use of self-expanding coronary stent for SCAD has never been described yet and we discuss about the rationale of a possible larger use in clinical practice.

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Drug-Eluting Stents; Humans; Male; Middle Aged; Percutaneous Coronary Intervention; Prosthesis Design; Sirolimus; ST Elevation Myocardial Infarction; Tomography, Optical Coherence; Treatment Outcome; Vascular Diseases

Topics: Adult; Cardiovascular Agents; Collateral Circulation; Coronary Angiography; Coronary Circulation; Coronary Vessel Anomalies; Coronary Vessels; Drug-Eluting Stents; Humans; Male; Percutaneous Coronary Intervention; Sirolimus; Treatment Outcome

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Cough; Cystic Fibrosis; Disease Management; Electrocardiography; Female; Humans; Middle Aged; Respiratory Function Tests; Risk Factors; Treatment Outcome; Vascular Diseases

Topics: Cardiac Catheterization; Cardiovascular Agents; Collateral Circulation; Coronary Angiography; Coronary Stenosis; Coronary Vessel Anomalies; Fractional Flow Reserve, Myocardial; Humans; Male; Middle Aged; Severity of Illness Index; Tomography, X-Ray Computed

Topics: Adult; Cardiovascular Agents; Coronary Vessel Anomalies; Electrocardiography; Humans; Male; Radiography; Severity of Illness Index; Treatment Outcome; Vascular Diseases

We present analysis of a case history of a patient with rare congenital heart disorder - Bland-White-Garland syndrome. The 25 years old women was first diagnosed with this disorder during an examination in the cardiological department of the Moscow clinical hospital No83. The paper contains discussion of difficulties of diagnosis and peculiarities of management of adults with this pathology as well as of a problem of the choice of further therapeutic approaches.

Topics: Adult; Benzazepines; Cardiovascular Agents; Cardiovascular Surgical Procedures; Coronary Angiography; Coronary Vessel Anomalies; Coronary Vessels; Female; Heart Failure; Humans; Ivabradine; Metoprolol; Mitral Valve Insufficiency; Multidetector Computed Tomography; Prognosis; Pulmonary Artery; Syndrome; Treatment Outcome

Topics: Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Echocardiography, Transesophageal; Electrocardiography; Exercise Test; Humans; Male; Middle Aged; Myocardial Perfusion Imaging; Predictive Value of Tests; Tomography, Emission-Computed, Single-Photon

Few cases of anomalous origin of the left coronary artery from the pulmonary artery remain asymptomatic until adolescence, and it is very rare to find a patient with this disease reaching the age of 70 without having undergone any surgery. Up to now, there have been only three other cases of patients, more than 70 years of age, with this congenital heart effect described in medical literature. We report the clinical history and the cardiac morphofunctional findings of 12 years of follow-up after a very late diagnosis of anomalous origin of the left coronary artery from the pulmonary artery.

Topics: Aged; Cardiac Surgical Procedures; Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Electrocardiography; Female; Humans; Pulmonary Artery; Tachycardia; Tomography, X-Ray Computed; Treatment Outcome; Treatment Refusal

In percutaneous coronary intervention for chronic total occlusion (CTO), the retrograde approach is an advanced technique. To improve the long-term patency rate, stent implantation is necessary for CTO, however, antegrade stent delivery to the lesion is contraindicated in cases where there is an anomalous origin or deviation of the coronary artery, or the edge of a previously implanted stent extends into the aorta. We report a successful case of retrograde stent implantation via a septal perforator in a patient with marked deviation of the RCA origin. In this case, antegrade stent implantation was difficult because antegrade catheter insertion carried a risk of crush deformation of an ostial stent.

Topics: Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Occlusion; Coronary Restenosis; Coronary Stenosis; Coronary Vessel Anomalies; Drug-Eluting Stents; Equipment Design; Humans; Male; Metals; Middle Aged; Prosthesis Design; Prosthesis Failure; Radiography, Interventional; Sirolimus; Stents; Treatment Outcome

There is a lack of Tunisian data on the frequency and clinical significance of different coronary artery anomalies.. All patients who underwent coronary angiography from March 1996 to December 2006 were considered. Only patients with congenital anomalous aortic origin of the coronary artery were included.. Among 7330adult patients who underwent diagnostic coronary angiography, 20 (0.27%) patients (13men; mean age 53.3years) had anomalies of the coronary artery origin. The right coronary artery was the vessel involved most frequently (n=10); it originated separately from the left sinus of Valsalva (SV) in three patients and from the posterior sinus of Valsalva in one patient. In the other patients, it arose from the left main coronary artery or its branches in a single coronary artery originating from the left sinus of Valsalva. Isolated anomalous left circumflex artery was the second most frequent anomaly (n=6). Isolated anomalous left anterior descending artery was seen in one patient. A single coronary artery arising from the right SV was seen in three patients. Atheroslerotic lesions were seen in eight cases. Four patients underwent coronary revascularization; the remainder received medical management. All 20 patients are alive and had an uneventful follow-up (mean 34.2months).. In Tunisia, the incidence of congenital anomalous aortic origin of the coronary artery in adults is 0.27%. The right coronary artery is involved most frequently. Medical management seems promising.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Artery Disease; Coronary Vessel Anomalies; Female; Humans; Incidence; Male; Middle Aged; Myocardial Infarction; Sinus of Valsalva; Stents; Treatment Outcome; Tunisia; Young Adult

Herein, we describe the case of a 50-year-old man who had a fistula, located between the left anterior descending coronary artery and the left ventricle, that caused myocardial infarction. Electrocardiography revealed a loss of R-wave progression in leads V(1) through V(4), and transthoracic echocardiography showed an apical aneurysm. Selective coronary angiography was performed. Dimensions of the left anterior descending coronary artery, and digital caliper measurements of stenosis within, were normal. After the injection of angiographic contrast material from the distal part of the left anterior descending coronary artery, a smoky, opaque accumulation colored the left ventricle. The digital caliper measurement of the left anterior descending coronary artery was again found to be normal. In the apex of the left ventricle, ventriculography in the left anterior oblique position revealed a small aneurysm, and a myocardial perfusion scan showed a fixed perfusion defect.Cases of coronary fistulae that result in myocardial infarction are rare. Because the patient had no ongoing symptoms after his myocardial infarction, medical therapy was prescribed.

Topics: Cardiovascular Agents; Coronary Angiography; Coronary Vessel Anomalies; Echocardiography; Electrocardiography; Heart Diseases; Heart Ventricles; Humans; Male; Middle Aged; Myocardial Infarction; Vascular Fistula

Topics: Angioplasty, Balloon, Coronary; Aortography; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vessel Anomalies; Humans; Male; Middle Aged; Myocardial Infarction; Stents; Treatment Outcome

Isolated single coronary artery (SCA) is an extremely rare congenital coronary anomaly. Some subgroups of SCA can lead to angina pectoris, acute myocardial infarction or even sudden death in the absence of atherosclerosis. Young patients, especially, have the risk of serious clinical events, but middle-aged-to elderly patients have a variable clinical course.. The aim of this study was to present the clinical and angiographic properties, relatively long-term follow-up (54+/-14 months) and management of adult patients (mean age 57+/-12 years) with SCA. The records of 70,850 patients undergoing coronary angiography between 1999 and 2005 were reviewed. Ten patients (0.024%) were found to have SCA, originating from the left sinus of Valsalva in 3 (30%) patients and from the right sinus of Valsalva in 7 patients (70%). No atherosclerotic involvement was seen in 7 (70%) patients. One patient was also treated by stent implantation to the SCA. Other patients were followed medically. All patients have been followed uneventfully.. Medical treatment is usually adequate for middle-aged to elderly patients with SCA in the absence of ischemia and/or acute coronary syndrome.

Topics: Adult; Aged; Angina Pectoris; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Artery Disease; Coronary Vessel Anomalies; Coronary Vessels; Female; Humans; Male; Middle Aged; Retrospective Studies; Sinus of Valsalva; Stents; Time Factors; Treatment Outcome; Turkey

To describe a single-center experience of using retrospectively gated multislice computed tomographic (MSCT) coronary angiography for imaging congenital coronary anomalies.. We retrospectively reviewed the clinical information and imaging studies for 9 patients diagnosed as having congenital coronary anomalies on invasive, selective coronary angiography between February 2001 and October 2003 at the Mayo Clinic in Jacksonville, Fla. Two experienced observers classified by consensus the origin and proximal course of the abnormal coronary arteries as seen on MSCT.. In 1 patient, MSCT showed a normal but extremely anterior origin of the right coronary artery from the right aortic sinus of Valsalva. In the other 8 patients, the origin and course of 4 anomalous right coronary arteries, 2 anomalous left circumflex coronary arteries, and 2 single coronary arteries were recognized easily on MSCT.. Similar to electron beam computed tomography and magnetic resonance imaging, widely available MSCT can characterize the proximal course of congenitally abnormal coronary arteries and thus aid in clinical decision making for patients with such anomalies.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies; Dyspnea; Female; Florida; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Patient Selection; Predictive Value of Tests; Retrospective Studies; Tomography, Spiral Computed

The relationship between alterations in the immunohistochemical expression of three vasoactive agents [endothelial nitric oxide synthase (eNOS), endothelin-1 (ET-1), and angiotensin-converting enzyme (ACE)] and the occurrence human atherosclerosis was investigated in relation to the myocardial bridge (MB) of the left anterior descending coronary artery (LAD), an anatomical site that experiences increased shear stress. Five millimetre cross-sections of LADs with MB from 22 autopsied cases were taken from the left coronary ostium to the cardiac apex and were immunohistochemically stained with antibodies against eNOS, ET-1, and ACE. The extent of atherosclerosis in each section was calculated using the atherosclerosis ratio (intimal cross-sectional area/medial cross-sectional area) determined by histomorphometry. The results were analysed according to their anatomical location relative to the MB, either proximal, beneath, or distal. The extent of atherosclerosis was significantly lower beneath the MB, compared with proximal and distal segments. The expression of eNOS, ET-1, and ACE was also significantly lower beneath the MB. The expression of these agents correlated significantly with the extent of atherosclerosis. Because nitric oxide, after its production by eNOS, is believed to be degraded by superoxide radicals, the effect of eNOS expression on atherosclerosis remains controversial. However, the present findings clearly indicate that the expression of ET-1 and ACE is directly related to the development of human coronary atherosclerosis in vivo through shear stress.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Agents; Coronary Artery Disease; Coronary Vessel Anomalies; Endothelin-1; Female; Humans; Immunoenzyme Techniques; Male; Middle Aged; Nitric Oxide Synthase; Peptidyl-Dipeptidase A; Stress, Mechanical