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Iatrogenic Right Coronary Artery Dissection  [PDF]
Müslüm ?ahin,Mehmet Vefik Yaz?c?o?lu,Regayip Zehir,Elnur Alizade
Ko?uyolu Kalp Dergisi , 2012,
Abstract: Iatrogenic coronary artery dissection is a rare condition. But, it is potentially catastrophic complication. We present a case of iatrogenic right coronary artery dissection resulting from vigorous hand-injection of contrast medium. The patient was treated successfully by stenting and was obtain optimal coronary blood flow.
Spontaneous coronary dissection presenting with reperfusion arrhythmia: A case report  [PDF]
Khawar Maqsood, Muhammad R. Sardar, Marwan Badri, James F. Burke, Wajeeha Saeed, Ghazi Mirrani, Nosheen Sarwar, Joseph Kusick, Frank C. McGeehin, Paul M. Coady
Case Reports in Clinical Medicine (CRCM) , 2013, DOI: 10.4236/crcm.2013.23058

Spontaneous coronary dissection is more commonly reported in females and is an important differential diagnosis for acute coronary syndrome. Accelerated idioventricular rhythm has been reported before with reperfusion post myocardial ischemia. We report a case of accelerated idioventricular rhythm in a patient with spontaneous coronary artery dissection. A 45-year-old Caucasian female presented with left sided chest pain radiating to the neck and palpitations. Admission ECG showed accelerated idioventricular rhythm. Troponin I peaked at 0.5 ng/ml. Coronary angiography showed mid to distal left anterior descending artery dissection with adequate distal flow. Patient was initially medically managed with aspirin, metoprolol, intravenous heparin and eptifibatide infusions but continued to have symptoms of unstable angina. She underwent successful percutaneous coronary intervention with 2 drug eluting stents and was discharged back home symptom free on dual platelet therapy. Spontaneous coronary artery dissection is an important differential diagnosis for acute coronary syndrome especially in younger females. Accelerated idioventricular rhythm can be a presentation of coronary dissection and may indicate instability. Early percutaneous coronary intervention should be considered in such patients.

Angioplastia com implante de stents para o tratamento de dissec??o coronária espontanea
Ishii, Edmílson Y.;Chamié, Daniel;Staico, Rodolfo;Las Casas, Fabrício R.;Feres, Fausto;Abizaid, Alexandre;Mattos, Luiz Alberto P.;Chaves, áurea;Sousa, Amanda G. M. R.;Sousa, J. Eduardo;
Revista Brasileira de Cardiologia Invasiva , 2007, DOI: 10.1590/S2179-83972007000100015
Abstract: this is the description of a 40-year-old hypertensive female patient who was also a smoker. the patient was admitted with non-st elevation myocardial infarction. baseline coronary angiography revealed a moderate lesion in the mid third of the circumflex artery. percutaneous treatment of the lesion was indicated. at angiography no lesion on the circumflex artery could be visible, but instead, an extensive dissection in the left descending coronary artery from the ostium to mid third with timi iii distal flow. clinical treatment was the choice. however, while in hospital patient's ecg presented recurrent angina and st elevation. a new coronary angiography revealed dissection extension to the distal part of the vessel, and slower flow (timi ii). the patient was then successfully submitted to an intra-coronary ultrasound-guided coronary angioplasty with implant of three stents.
Septal rupture with right ventricular wall dissection after myocardial infarction
Carlos J Soriano, José L Pérez-Boscá, Sergio Canovas, Francisco Ridocci, Pau Federico, Ildefonso Echanove, Rafael Paya
Cardiovascular Ultrasound , 2005, DOI: 10.1186/1476-7120-3-33
Abstract: We present a case of a 59-year-old man who had a septal rupture with right ventricular wall dissection after inferior and right ventricular myocardial infarction. Transthoracic echocardiography, as first line examination, established the diagnosis, and prompt surgical repair allowed long-term survival in our patient.Outcomes after right ventricular intramyocardial dissection following septal rupture related to myocardial infarction has been reported to be dismal. Early recognition of this complication using transthoracic echocardiography at patient bedside, and prompt surgical repair are the main factors to achieve long-term survival in these patients.The occurrence of ventricular septal rupture after acute myocardial infarction is an uncommon complication in the reperfusion era [1], however, this condition implies a high mortality rate, even after surgical repair [2]. In patients with inferior myocardial infarction, septal rupture generally involves basal inferoposterior septum, and the communicating tract between left and right ventricle is often serpiginous with a variable degree of right ventricular wall extension [3]. Right ventricular wall dissection following septal rupture related to previous myocardial infarction has been reported in a very few cases [4-6], in many of them this condition has been diagnosed in post-mortem studies [4]. In a recent report long-term survival has been achieved after promptly echocardiographic diagnosis and surgical repair [6].A 59-year-old man was admitted to Coronary Care Unit because of suspected ST-segment-elevation myocardial infarction. The patient was complaining of typical coronary chest pain during the last twelve hours. He had a history of dyslipidemia, type 2 diabetes mellitus, smoking habit and a transient ischemic attack without any sensitive or motor squele one year ago. On admission, his blood pressure was 100/60 and heart rate was 110 beats per minute. Cardiac examination revealed jugular vein distension, and no s
Cardiac Arrest from Postpartum Spontaneous Coronary Artery Dissection  [cached]
Malford T Pillow,Ngoc Anh Nguyen,Dick Kuo
Western Journal of Emergency Medicine : Integrating Emergency Care with Population Health , 2011,
Abstract: We present the case of a 32-year-old woman who presented to the emergency department with a witnessed cardiac arrest. She was otherwise healthy with no cardiac risk factors and had undergone an uneventful repeated cesarean section 3 days priorly. The patient underwent defibrillation, out of ventricular fibrillation to a perfusing sinus rhythm, and was taken to the catheterization laboratory where coronary angiography findings showed spontaneous dissection of the left anterior descending artery. The patient received a total of 6 stents during her hospital stay and was eventually discharged in good condition. Spontaneous coronary artery dissection is a rare entity with a predilection for pregnant or postpartum women. Early diagnosis and treatment are key for survival, and when identified early, mortality is good. [West J Emerg Med. 2011;12(4):567–570.]
Extensive Dissection to the Coronary Sinus of Valsalva During Percutaneous Intervention in Right Coronary Artery—A Case Report and Literature Review
Li Li* and Yunshan Cao
Clinical Medicine Insights: Cardiology , 2012, DOI: 10.4137/CMC.S6447
Abstract: Severe retrograde dissection extending into the sinus of Valsalva is a rare complication during percutaneous coronary intervention (PCI), but life threatening. There is some literature about this complication, but this particular complication has not been previously reported in China. We present a case of coronary artery dissection during a PCI in which progressively extended retrogradely into the sinus of valsalva, and was successfully treated with stenting without an operation.
The role of Intravascular Ultrasound in the management of spontaneous coronary artery dissection
Jayanth R Arnold, Nick EJ West, William J van Gaal, Theodoros D Karamitsos, Adrian P Banning
Cardiovascular Ultrasound , 2008, DOI: 10.1186/1476-7120-6-24
Abstract: Spontaneous coronary artery dissection (SCAD) is an unusual cause of acute coronary syndromes and sudden cardiac death. The pathophysiology of SCAD remains uncertain, and considerable controversy surrounds the optimal management of patients with SCAD-related myocardial ischemia. Urgent coronary angiography is indicated if SCAD is suspected, and the diagnosis can be confirmed by intravascular ultrasound (IVUS). Percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical management have been described as management strategies. We present four cases of SCAD which were diagnosed and managed at a single centre, and we illustrate specific aspects of the presentation and management of this important condition, with particular focus on the importance of IVUS to aid diagnosis and guide subsequent PCI.A 54-year-old postmenopausal woman with no cardiovascular risk factors presented with a one week history of chest pain on exertion and at rest. The ECG revealed anterior T-wave inversion and the troponin I was elevated (0.5 ng/ml; local reference limit, 0.1 ng/ml). Despite treatment with aspirin, low-molecular weight heparin and beta-blockade, the patient remained symptomatic. Coronary angiography showed extensive dissection of the mid-vessel of the LAD (figure 1A, see additional file 1). In view of the long diseased segment and small distal vessel, percutaneous intervention was not undertaken; medical management was recommended, with beta-blockade and anti-platelet therapy.However, the patient continued to experience exertional angina and an exercise stress test was positive at a low workload. Repeat angiography at three months showed persistent dissection. IVUS examination showed near-circumferential hematoma extending deep into the media (figure 1B). No atheroma was visualised. Two 3.0 × 18 mm Cypher? stents (Cordis Corp., Miami, Florida) were deployed over the dissection with overlap. Repeat IVUS demonstrated incomplete stent deployment, and
Right Ventricular Failure Following Acute Type A Aortic Dissection: An Alternative Strategy  [PDF]
Ruchir P. Mashar, Rashmi P. Birla, Paul D. Waterworth
World Journal of Cardiovascular Surgery (WJCS) , 2019, DOI: 10.4236/wjcs.2019.93004
Abstract: Coronary malperfusion is a complication of aortic dissection, and can lead to ventricular failure. We report 2 cases of right ventricular (RV) failure, following aortic dissection, successfully bridged to recovery using right ventricular assist devices (RVADs). The first was a 54 year-old man, who had difficulty weaning from bypass due to a stunned RV following aortic root replacement. The second was a 34 year-old woman, who after replacement of the ascending aorta, suffered episodes of ventricular fibrillation (VF), and RV failure. Both had an RVAD implanted, allowing eventual recovery. We recommend more widespread use of VADs in such cases.
Everolimus-eluting coronary stents  [cached]
Alejandro Saez,Raul Moreno
Medical Devices: Evidence and Research , 2010,
Abstract: Alejandro Saez, Raul MorenoDivision of Interventional Cardiology, University Hospital La Paz, Madrid, SpainAbstract: Bare metal stents enabled a reduction in the risk of early procedural complications and restenosis in comparison with balloon angioplasty alone, but introduced a new and device-specific iatrogenic condition, ie, in-stent restenosis due to increased neointimal hyperplasia. Sirolimus- and paclitaxel-eluting stents reduce restenosis and the need for new revascularizations in comparison with bare metal stents, although at the cost of a slight increase in the risk of late stent thrombosis and a need for prolonged dual antiplatelet therapy. Everolimus is an analog of sirolimus with an increased solubility. In this review, the currently available evidence for everolimus-eluting stents is revised, including randomized trials against bare metal stents, and head-to-head trials comparing this stent with other drug-eluting stents.Keywords: coronary stents, restenosis, everolimus, review
Minimal surfaces with helicoidal ends  [PDF]
Leonor Ferrer,Francisco Martin
Mathematics , 2004,
Abstract: In this paper we describe a new deformation that connects minimal disks with planar ends with minimal disks with helicoidal ends. In this way, we are able to construct a family of complete minimal surfaces with helicoidal ends that contains the singly periodic genus one helicoid of Hoffman, Karcher and Wei.
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