1/25. Incipient left ventricular rupture complicating anomalous left coronary artery.A 4-month-old girl presented with 2 weeks of symptoms and physical signs of heart failure. echocardiography demonstrated marked left ventricular dilation, thinning of the myocardium with anterolateral akinesis, mitral regurgitation, a moderate pericardial collection, and an anomalous left coronary artery from the pulmonary artery. At operation there was a tense hemopericardium and a site of imminent rupture through a transmural anterior infarction. The anomalous artery was reimplanted in the ascending aorta, and an extensive infarct resection and ventricular repair performed. Support with a left ventricular assist device was required for 3 days, but the infant subsequently made a satisfactory recovery. Left ventricular rupture is a very rare complication of this lesion, but should be considered if there is evidence of a pericardial collection.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/25. Cardiac arrest during exercise: anomalous left coronary artery from the pulmonary trunk.Anomalous origin of the left coronary artery from the pulmonary trunk is associated with high mortality in infancy but in rare cases the condition is diagnosed in adults. The present report describes three adult cases of this anomaly. Two of the patients (age 18 and 34 years) were resuscitated from cardiac arrest, which had occurred in relation to physical exercise. The third patient (20 years) had presented with angina pectoris and signs of ischaemia on exercise ECG. In all patients, coronary arteriography revealed a large right coronary artery with collateral filling of the left coronary artery, which originated from the pulmonary trunk. A successful surgical correction of the anomalous coronary artery was performed in two of the patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/25. Anomalous origin of the main stem of the left coronary artery from the non-facing sinus of valsalva associated with sudden death in a young athlete.A young female athlete is described with anomalous origin of the main stem of the left coronary artery from the non-facing sinus of valsalva who sustained myocardial infarction and died suddenly after physical exertion. autopsy findings illustrated the mechanistic importance of acute angle take-off of the left main coronary artery and a slit-like orifice, which was likely compressed and obstructed by acute expansion of the aortic wall. This rare type of coronary anomaly has been regarded as having little clinical significance, but it can lead to sudden cardiac death under physical exertion.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/25. Silent single coronary artery anomaly depicted by magnetic resonance angiography.Coronary artery anomalies are rare and usually benign. They are detected by coronary angiograms during invasive catheterization. Single coronary artery anomaly, with the left main artery originating from the proximal right coronary artery, can be responsible for myocardial blood supply insufficiency and causes chest pain or sudden death, especially during physical exercise, as it courses between the aorta and the pulmonary artery. We report a case of a fortuitous diagnosis of single coronary artery anomaly discovered during coronary angiogram and investigated in addition with magnetic resonance angiography. magnetic resonance imaging can provide a precise description of the coronary artery anomaly and its course between great arteries, allowing accurate surgical planning.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/25. Left main coronary artery originating in the right sinus of valsalva.A forty-one-year-old male, with no risk factors for coronary artery disease (CAD) and with moderate alcohol intake, was admitted in 1992 to Portalegre Hospital with heart failure due to viral cardiomyopathy. He was re-admitted in 1998 with acute pulmonary edema and was put on mechanical ventilation for 48 hours, and transferred to Pulido Valente Hospital when stable. The physical exam was without abnormalities. ECG showed first degree AV block, left ventricular hypertrophy and 2 mm ST depression in the precordial leads. The echocardiogram revealed left ventricular dilatation and depressed systolic function. coronary angiography showed single-vessel CAD and coronary artery anomaly. dobutamine stress echocardiography was halted due to hypertension, making it impossible to evaluate ischemic response. Holter monitoring showed five-complex ventricular tachycardia. The patient was discharged medicated with amiodarone, with indication for cardiac scintigraphy and electrophysiological study.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/25. Anomalous origin of the left main coronary artery from the right sinus of valsalva with an intramural course identified by transesophageal echocardiography in a 14 year old with acute myocardial infarction.Coronary artery anomalies have an incidence of 0.6% to 1.3% in angiographic studies and 0.3% in an autopsy series. Anomalous origin of the left main coronary artery (LMCA) from the right sinus of valsalva (RSOV) represents a small fraction (1.3%) of these anomalies, with an overall prevalence of 0.017% to 0.03% in angiographic studies. The high incidence of sudden cardiac death associated with this specific anomaly during or immediately after vigorous physical exercise makes identification and appropriate surgical intervention critical. We present a case report of a 14-year-old patient with an LMCA arising from the RSOV with an initial intramural course, presenting with acute myocardial infarction (AMI) as the first indication of the anomaly. Transthoracic echocardiogram suggested this anomaly, which was confirmed by cardiac catheterization and transesophageal echocardiogram.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/25. Sudden cardiac death associated with an extremely rare coronary anomaly of the left and right coronary arteries arising exclusively from the posterior (noncoronary) sinus of valsalva.Congenital anomalies of the coronary arteries are relatively uncommon conditions and have been associated with sudden cardiac death (SCD) in children. Although anomalous coronary artery distribution is widely reported in the literature, no articles to date address the origin of both the right (RCA) and left coronary arteries (LCA) from the posterior (noncoronary) sinus of valsalva. This is a report of a 16-year-old black male in good health, who collapsed and was unable to be resuscitated after physical exertion while playing basketball. In this patient, postmortem evaluation revealed the LCA and RCA originating exclusively from the posterior (noncoronary) sinus with acute angle takeoff of the LCA which likely lead to ischemia, causing SCD. We discuss the incidence of coronary artery anomalies and the proposed mechanisms that led to SCD in these patients.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/25. Surgical therapy of an aberrant origin of the left anterior descending coronary artery from the right sinus of valsalva: a case report.Anomalous aortic origin of a coronary artery from the incorrect coronary sinus of valsalva is a rare congenital cardiac defect that is associated with an increased risk of sudden death. In most of these defects, the anomalous coronary artery takes an intramural course between the great arteries and leaves the aortic wall from the appropriate coronary sinus of valsalva. Many times this anomalous artery shares a common orifice with the other coronary artery. We report on a previously healthy 15-year-old boy who presented with signs of an anterolateral myocardial infarction after physical activity (soccer game). Transthoracic echocardiography revealed an aberrant origin of the left anterior descending coronary artery from the right sinus of valsalva. Repair was accomplished by unroofing the intramural segment. Because the intramural segment was below the commissure, detachment of the intercoronary commissure was not necessary. To conclude, transthoracic echocardiography can accurately depict this rare anomaly, and in symptomatic patients surgical therapy is indicated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/25. myocardial bridging causing transmural ischemia. Successful coronary artery bypass surgery.myocardial bridging is a common and usually benign inborn coronary anomaly. We report on a 51-year-old man who presented with recent angina on minimum physical effort. cineangiography showed myocardial bridging of the mid-left anterior descending artery (LAD), and intracoronary ultrasonography excluded atherosclerotic disease. Gated single-photon emission computed tomography (SPECT), with exercise stress, showed an extensive anterior perfusion defect, and remarkable ST-segment elevation (up to 10 mm) in recovery. Vasospasm of the LAD was the main hypothesis. Additional oral drugs did not bring about improvement, as indicated on a new SPECT; disabling angina persisted. Surgical revascularization of the LAD by left internal mammary artery graft was performed. Two years later, SPECT and exercise tests returned to normal. The patient remains asymptomatic.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/25. 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 = physical (Clic here for more details about this article) |
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