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Mildly symptomatic chronic mitral regurgitation. Analysis of left ventricular systolic function and mitral regurgitant fraction under pharmacological influence: echocardiographic study
Rivera, Ivan Romero;Moisés, Valdir Ambrósio;Carvalho, Antonio Carlos;Paola, Angelo Amato V. de;
Arquivos Brasileiros de Cardiologia , 2003, DOI: 10.1590/S0066-782X2003000200003
Abstract: objective: to study echocardiographic parameters of left ventricular systolic function and valvar regurgitation under pharmacological influence in mildly symptomatic patients with chronic mitral regurgitation (mr). methods: we carried out a double-blind placebo controlled study in 12 patients with mr, mean aged 12.5 years old, who were randomized in 4 phases: a) digoxin; b) enalapril; c) digoxin + enalapril; d) placebo. the medication was administered for 30 days in each phase, and the following variables were analyzed: shortening and ejection fractions, wall stress index of left ventricle, left ventricular meridional end-systolic wall stress, doppler-derived mean rate of left ventricular pressure rise (mean dp/dt), stroke volume and mr jet area. the clinical variables analysed were heart rate and systemic arterial pressure. results: no significant variation was observed in the clinical variables analysed. the shortening and ejection fraction, the mean dp/dt and stroke volume significantly increased and the wall stress index of left ventricle, the meridional left ventricular end systolic wall stress and the mitral regurgitation jet area decreased in the phases with medication as compared with that in the placebo phase. conclusion: the parameters of left ventricular systolic function improved significantly and the degree of mr decreased with the isolated administration of digoxin or enalapril in mildly symptomatic patients with chronic mr. the combination of the drugs, however, did not show better results.
Mildly symptomatic chronic mitral regurgitation. Analysis of left ventricular systolic function and mitral regurgitant fraction under pharmacological influence: echocardiographic study  [cached]
Rivera Ivan Romero,Moisés Valdir Ambrósio,Carvalho Antonio Carlos,Paola Angelo Amato V. de
Arquivos Brasileiros de Cardiologia , 2003,
Abstract: OBJECTIVE: To study echocardiographic parameters of left ventricular systolic function and valvar regurgitation under pharmacological influence in mildly symptomatic patients with chronic mitral regurgitation (MR). METHODS: We carried out a double-blind placebo controlled study in 12 patients with MR, mean aged 12.5 years old, who were randomized in 4 phases: A) digoxin; B) enalapril; C) digoxin + enalapril; D) placebo. The medication was administered for 30 days in each phase, and the following variables were analyzed: shortening and ejection fractions, wall stress index of left ventricle, left ventricular meridional end-systolic wall stress, Doppler-derived mean rate of left ventricular pressure rise (mean dP/dt), stroke volume and MR jet area. The clinical variables analysed were heart rate and systemic arterial pressure. RESULTS: No significant variation was observed in the clinical variables analysed. The shortening and ejection fraction, the mean dP/dt and stroke volume significantly increased and the wall stress index of left ventricle, the meridional left ventricular end systolic wall stress and the mitral regurgitation jet area decreased in the phases with medication as compared with that in the placebo phase. CONCLUSION: The parameters of left ventricular systolic function improved significantly and the degree of MR decreased with the isolated administration of digoxin or enalapril in mildly symptomatic patients with chronic MR. The combination of the drugs, however, did not show better results.
Visualization of anomalous origin and course of coronary arteries in 748 consecutive symptomatic patients by 64-slice computed tomography angiography
Franz von Ziegler, Marco Pilla, Lori McMullan, Prasad Panse, Alexander W Leber, Norbert Wilke, Alexander Becker
BMC Cardiovascular Disorders , 2009, DOI: 10.1186/1471-2261-9-54
Abstract: Imaging datasets of 748 consecutive symptomatic patients referred for cardiac MDCTA were analyzed and CAAs of origin and further vessel course were grouped according to a recently suggested classification scheme by Angelini et al.An overall of 17/748 patients (2.3%) showed CAA of origin and further vessel course. According to aforementioned classification scheme no Subgroup 1- (absent left main trunk) and Subgroup 2- (anomalous location of coronary ostium within aortic root or near proper aortic sinus of Valsalva) CAA were found. Subgroup 3 (anomalous location of coronary ostium outside normal "coronary" aortic sinuses) consisted of one patient with high anterior origin of both coronary arteries. The remaining 16 patients showed a coronary ostium at improper sinus (Subgroup 4). Latter group was subdivided into a right coronary artery arising from left anterior sinus with separate ostium (subgroup 4a; n = 7) and common ostium with left main coronary artery (subgroup 4b; n = 1). Subgroup 4c consisted of one patient with a single coronary artery arising from the right anterior sinus (RAS) without left circumflex coronary artery (LCX). In subgroup 4d, LCX arose from RAS (n = 7).Prevalence of CAA of origin and further vessel course in a symptomatic consecutive patient population was similar to large angiographic series, although these patients do not reflect general population. However, our study supports the use of 64-slice MDCTA for the identification and definition of CAA.Coronary artery anomalies (CAAs) are still topic of intense discussions. This diverse group of congenital disorders is likely to show a broad variability of clinical manifestations as well as pathophysiological mechanisms of disease [1-3]. Diagnosis of CAA is usually established during invasive coronary angiography (ICA). However, due to the two-dimensional projectional nature of ICA, the visualization of a complex three-dimensional vessel course as well as clarification of the exact relationship to
Anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman
Jacob, José Luiz Balthazar;Salis, Fernando Vilela;
Arquivos Brasileiros de Cardiologia , 2003, DOI: 10.1590/S0066-782X2003001000008
Abstract: we report a rare case of anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman. the approach and technique used for selective catheterization of an anomalous left coronary artery arising from the pulmonary trunk are described. six years after diagnosis, echocardiography showed left ventricular disfunction, and surgical treatment was indicated again. the origin of the left coronary artery from the pulmonary trunk was closed, and the postoperative period was uneventful, with recovery of left ventricular function and disappearance of ischemic features on stress myocardial perfusion imaging with 99m tc-sestamibi, performed 4 weeks after surgery.
Anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman
Jacob José Luiz Balthazar,Salis Fernando Vilela
Arquivos Brasileiros de Cardiologia , 2003,
Abstract: We report a rare case of anomalous origin of the left coronary artery from the pulmonary trunk in a 45-year-old woman. The approach and technique used for selective catheterization of an anomalous left coronary artery arising from the pulmonary trunk are described. Six years after diagnosis, echocardiography showed left ventricular disfunction, and surgical treatment was indicated again. The origin of the left coronary artery from the pulmonary trunk was closed, and the postoperative period was uneventful, with recovery of left ventricular function and disappearance of ischemic features on stress myocardial perfusion imaging with 99m Tc-sestamibi, performed 4 weeks after surgery.
Anomalous Right Coronary Artery from Left Main Coronary Artery and Subsequent Coursing between Aorta and Pulmonary Trunk  [PDF]
Deephak Swaminath,Ragesh Panikkath,Jason Strefling,Alvaro Rosales,Roshni Narayanan,Jason Wischmeyer
Case Reports in Medicine , 2013, DOI: 10.1155/2013/195026
Abstract: Anomalous origin of left main coronary artery or right coronary artery from the aorta with subsequent coursing between the aorta and pulmonary trunk is rare and can be sometimes life threatening. After hypertrophic cardiomyopathy, coronary artery anomalies are the second most common cause of sudden cardiac deaths among young athletes. This is a case presentation of an anomalous origin of right coronary artery from left main coronary artery coursing between the pulmonary trunk and aorta. Patient presented with STEMI and had coronary bypass surgery. 1. Case Description The patient is a 33-year-old male with an unremarkable past medical history and was transferred from an outside facility with an acute inferior myocardial infarction and ventricular tachycardia. Patient initially presented to the outside facility with complaints of chest pain. ECG showed lateral ST elevation and subtle inferior ST elevation. At the outside facility, patient developed ventricular tachycardia, and CPR was initiated with cardioversion 4 times before return of spontaneous circulation. The patient was subsequently intubated and transferred to our facility for further management. Upon transfer, the patient was taken for left heart catheterization (LHC) and selective coronary angiography. Left heart catheterization and angiography showed an 80% long tubular stenosis of the proximal to mid left anterior descending coronary artery (LAD) as well as an anomalous takeoff of the right coronary artery (RCA) from a left main coronary artery (Figures 2(a), 2(b), and 2(c)). LHC revealed markedly elevated left ventricular end diastolic pressure (LVEDP). The patient was aggressively diuresed after LHC revealed an elevated LVEDP. Dynamic ST changes improved with dual antiplatelet therapy, heparin, nitrates, and aggressive diuresis. Cardiac CT angiography with 3D reconstruction (Figures 1(a) and 1(b)) showed an anomalous origin of the right coronary artery coursing from the left main coronary artery between the aorta and pulmonary trunk. There was more than 70% narrowing at the origin of the right coronary artery from an apparent impingement from a plethoric pulmonary trunk. Cardiovascular surgery was consulted for surgical intervention. Aortocoronary bypass was performed with a left internal mammary artery bypass to the left anterior descending coronary artery and saphenous vein graft bypass to the right coronary artery. Postoperatively, the patient recovered and was discharged home. Figure 1: (a) Cardiac CT angiography with 3D reconstruction with digital subtraction of pulmonary arteries. (b)
Bosentan in the treatment of pulmonary arterial hypertension with the focus on the mildly symptomatic patient
Christopher J Valerio, John G Coghlan
Vascular Health and Risk Management , 2009, DOI: http://dx.doi.org/10.2147/VHRM.S4713
Abstract: osentan in the treatment of pulmonary arterial hypertension with the focus on the mildly symptomatic patient Review (4558) Total Article Views Authors: Christopher J Valerio, John G Coghlan Published Date August 2009 Volume 2009:5 Pages 607 - 619 DOI: http://dx.doi.org/10.2147/VHRM.S4713 Christopher J Valerio, John G Coghlan Department of Cardiology, Royal Free Hospital, London, UK Abstract: Pulmonary arterial hypertension (PAH) is a progressive disease with poor survival outcomes. Bosentan is an oral endothelin-1 receptor antagonist (ERA) that has been shown in a large randomized placebo-controlled trial (BREATHE-1) to be effective at improving exercise tolerance in patients with PAH in functional class III and IV. Further studies have been conducted showing: benefit in smaller subgroups of PAH, eg, congenital heart disease, efficacy in combination with other PAH therapies, eg, sildenafil, improved long-term survival compared with historical controls. More recently, controlled trials of new ERAs have included patients with milder symptoms; those in functional class II. Analysis of the functional class II data is often limited by small numbers. These trials have generally shown a similar treatment effect to bosentan, but there are no controlled trials directly comparing these new ERAs. The EARLY trial exclusively enrolled functional class II patients and assessed hemodynamics at 6 months. Though significant, the reduction in pulmonary vascular resistance is merely a surrogate marker for the intended aim of delaying disease progression. Significant adverse effects associated with bosentan include edema, anemia and transaminase elevation. These may preclude a long duration of treatment. Further studies are required to determine optimum treatment strategy in mild disease.
Occult anomalous origin of the left coronary artery from the pulmonary artery with ventricular septal defect
Awasthy Neeraj,Marwah Ashutosh,Sharma Rajesh
Annals of Pediatric Cardiology , 2011,
Abstract: Manifestations of anomalous left coronary artery from the pulmonary trunk may be masked in the presence of an associated shunt lesion that prevents fall of pulmonary artery pressures and allows perfusion of the anomalous coronary artery. We present such a patient with a large ventricular septal defect associated with the anomalous coronary artery from the pulmonary artery.
Consideration of the Necessity of Prophylactic Bypass Grafting for Anomalous Origin of the Right Coronary Artery—Based on a Case with Concomitant Left Main Trunk Disease Resuscitated from Cardiopulmonary Arrest  [PDF]
Hirotaro Sugiyama, Keisuke Miyajima, Kazuyoshi Hatada, Toshihiro Ishikawa, Sawa Matsumoto, Shigeo Umezawa, Masao Takahashi
World Journal of Cardiovascular Surgery (WJCS) , 2017, DOI: 10.4236/wjcs.2017.76010
Abstract: Anomalous origin of the right coronary artery is a rare congenital anomaly, but is associated with sudden death. Originating from the opposite sinus of Valsalva, an interarterial?course and an intramural course are especially considered as the risk factor for fatal cardiac events. Surgical indication remains controversial because many patients are asymptomatic. A 52-year-old man with anomalous origin of the right coronary artery with an interarterial?course concomitant with the left main trunk disease was resuscitated from cardiopulmonary arrest. It was likely to be attributed to the left main trunk disease, but anatomical structure of the right coronary artery suggests its possible involvement. Prophylactic bypass grafting for the right coronary artery was performed using saphenous vein graft without ligating native vessel to prevent future cardiac events, as well as revascularization of the left main trunk disease. All grafts were patent in one-year follow-up coronary angiography. Any cardiac event has not occurred.
Anomalous origin of the left coronary artery from the pulmonary trunk. Clinical features and midterm results after surgical treatment
Amaral, Fernando;Carvalho, Julene S.;Granzotti, Jo?o A.;Shinebourne, Elliot A.;
Arquivos Brasileiros de Cardiologia , 1999, DOI: 10.1590/S0066-782X1999000300004
Abstract: objective: to report the authors' experience with the anomalous origin of the left coronary artery (aolca) from the pulmonary trunk, emphasizing preoperative data, surgical aspects and midterm results of the follow-up. methods: retrospective analysis of 11 patients operated upon at the royal brompton hospital from october, 84 to april, 97. results: nine infants had heart failure (hf) and two other children presented with dyspnea and chest pain. all had ecg changes. the echocardiogram identified the anomalous origin of the coronary artery in 7 (64%) patients and hemodynamic studies were performed in 7 patients. all infants were operated upon between the 2nd and 10th month of life. six patients were treated with aortic reimplantation of the left coronary artery, whereas five were operated upon according to the takeuchi technique. all patients are alive, with clear improvement of the ecg changes and ventricular function, as evaluated by echocardiography. two patients operated upon according to the takeuchi technique required additional surgery due to severe supravalvular pulmonary stenosis. conclusion: aolca is a rare disease. most patients show early signs of severe hf associated with ecg findings. surgical therapy must be instituted early in the disease, preferentially through aortic implantation of the anomalous coronary artery, with a high possibility of success. shortly after surgery, clinical and ecg improvement, as well as normalization of left ventricular function, should be expected.
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