1/11. Catheter-based techniques for closure of coronary fistulae.This study details different methodologies of percutaneous closure of arteriosystemic and arteriovenous coronary fistula. Seven patients underwent transcatheter intervention of 10 fistulas, with 7 fistulas successfully closed: 6 with embolic coil devices and 1 with a covered stent obstructing the fistula ostium. The major complication encountered was one death as a result of device recoil into a major epicardial vessel. Percutaneous transcatheter closure of coronary fistulas appears to be simple, facile, and effective. However, device recoil into an undesired arterial segment, while irritating in a noncoronary arterial tree, may be catastrophic when occurring in an epicardial coronary artery.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
2/11. Ectopic origin of the left anterior descending coronary artery from the right coronary sinus. Report of a case simulating anterior descending obstruction.A patient with anomalous aortic origin of the left anterior descending coronary artery was studied. The clinical picture and the preliminary angiographic findings simulated obstruction of the left anterior descending coronary artery near its origin. Careful catheter exploration of the right coronary sinus led to the correct diagnosis, emphasizing the importance of complete visualization of all branches of the coronary tree, including distal radicles of a supposedly occluded vessel.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
3/11. Case report: MRI evaluation of congenital coronary artery fistulae.Congenital coronary artery fistula is a rare disease and MRI is a promising technique that may be useful to demonstrate the coronary artery tree. We report three patients who underwent cardiac MRI to investigate right coronary artery fistulae. On clinical examination, a continuous murmur was heard along the left sternal border, and chest X-ray showed moderate cardiomegaly with enlargement of right chambers in all patients. Transthoracic Doppler echocardiography showed fistulae in two cases; the third case was not demonstrated by transthoracic or transoesophageal echocardiography. MRI demonstrated the course of the fistulous vessels in all patients. All patients underwent surgical closure of their coronary artery fistulae. MRI may show detailed anatomy of congenital coronary artery fistulae and may be useful as an additional non-invasive method in their investigation.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
4/11. Unusual case of single coronary artery: questions of methods and basic concepts.Coronary artery anomalies continue to constitute a confusing subject in modern cardiology. While most anomalies are considered to have a benign prognosis, the literature and cardiologic culture frequently imply an intrinsic, systematic association of coronary anomalies with severe clinical presentations. We present a case of unusual single coronary artery, in order to elucidate the logical process that should be used to study similar cases. A 56-year-old female presented with a 6-year history of atypical chest pain and an abnormal electrocardiogram. Heart catheterization revealed an abnormal coronary tree interpreted by some observers as a benign coronary anomaly, by others to indicate the need for coronary angioplasty. A nuclear stress test was performed after 1 year of unrelenting symptoms and showed mildly abnormal findings, leading to a more definitive angiographic study that clarified the anatomy and the prognosis. The case is essentially and only an example of single coronary artery with origin of all branches from the right coronary sinus, but with an unusual triple origin of the branches serving the left anterior descending territory. The notion that a case of single coronary artery may have significant prognostic and clinical repercussion is frequently repeated in the current inconclusive literature. A rational discussion should deal both with individual case objective evidence and theoretical general consideration.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
5/11. The anomalous origin of the left coronary artery from the right aortic sinus: is the coronary angiography still a 'gold standard'?Coronary artery anomalies remain a poorly understood topic in modern cardiology. The most important issue is the origin of the left coronary artery or the left anterior descending artery from the opposite aortic sinus, frequently associated with sudden cardiac death. We report our experience concerning the evaluation of these anomalies. From 15 April 1997 to 1 December 2004, we performed 13.407 coronary angiographies and found eight patients with these anomalies. In seven patients the coronary angiography was sufficient for the ultimate decision. However, in one case was the angiographic signs contradictory and the optimal imaging of the coronary tree was received by the multi-slice spiral computer tomography. We consider the coronary angiography a sufficient method of evaluation in most of the patients with the coronary artery anomalies, but the 'gold standard' is 3-dimensional examination by the multi-slice computer tomography or the magnetic resonance. The computer tomography is the method of the choice to distinguish interarterial, intraseptal and prepulmonary course of the left coronary artery originating from the right aortic sinus.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
6/11. Intralobar pulmonary sequestration with arterial supply from the coronary circulation.Pulmonary sequestration is an unusual malformation. It consists of a nonfunctioning mass of lung tissue that shows no normal continuity with the tracheobronchial tree and derives its arterial blood supply from the systemic circulation. The thoracic and abdominal aortas are the most common sites of origin of the abnormal nutrient branches. Arterial supply of a sequestration from the coronary circulation is extremely rare. We present a case of a right middle lobe sequestration deriving its branches from the left coronary artery.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
7/11. myocardial ischemia caused by a coronary anomaly left anterior descending coronary artery arising from right sinus of valsalva.We present the case of a patient in anomalous origin of the left anterior descending coronary artery that caused myocardial ischemia and led to positive myocardial scintigraphic results. coronary angiography showed that the left anterior descending coronary artery arose from the right coronary ostium-an anomaly that has been associated with chest discomfort-without atherosclerotic lesions. Left circumflex artery and the diagonal branches were arising from the left main coronary artery and the whole coronary tree were free of atherosclerosis.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
8/11. An unusual cause of obstructive emphysema.A 6-month-old child presented with a history, physical signs and radiographic findings suggestive of the presence of a foreign body in the tracheobronchial tree. However, further investigation revealed extrinsic compression of the left main bronchus by a grossly enlarged left atrium. Treatment of the patient's heart failure resulted in resolution of the signs. Anomalous origin of the left coronary artery was found to be the cause.- - - - - - - - - - ranking = 1keywords = tree (Clic here for more details about this article) |
9/11. Unusual intra-arterial communication in the normal right coronary tree.Among 136 patients with a history of angina pectoris who underwent selective coronary arteriography, two patients (1.4%) with a normal right coronary artery were found to have angiographically demonstrated communications between the various branches of the same coronary artery. Such findings, unaccompanied by coronary artery disease, have been hitherto unknown and suggest a congenital variation in coronary anatomy rather than a clinically significant condition. The purpose of this report is to demonstrate that the angiographic appearance of the anastomotic vessels in such cases is entirely different from that which obtains in cases of obstructive coronary artery disease. The author notes the rarity of angiographic visualization of homocoronary communications in normal right coronary arteries and emphasizes the necessity of distinguishing these from the homocoronary collaterals found in atherosclerotic coronary artery disease.- - - - - - - - - - ranking = 4keywords = tree (Clic here for more details about this article) |
10/11. Anomalous origin of the left coronary arterial tree through three stems--one from the pulmonary trunk.In an 18-year-old asymptomatic male athlete, the left anterior descending coronary artery was found to arise from the pulmonary trunk. The remainder of the left coronary arterial tree arose through two stems from the aorta. Collateral retrograde filling of the left anterior descending coronary artery from the right coronary artery and the left circumflex coronary artery was demonstrated, but we found no evidence of left-to-right shunting into the pulmonary trunk. The patient has chosen conservative treatment, thus offering an unusual opportunity to follow the natural course of this lesion, which may increase understanding of its natural history.- - - - - - - - - - ranking = 5keywords = tree (Clic here for more details about this article) |
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