1/14. Comparison of transesophageal to transthoracic color Doppler echocardiography in the identification of intracardiac mycotic aneurysms in infective endocarditis.We report on cases of mycotic aneurysms in a group of 14 patients with infective endocarditis, all of whom were evaluated with transthoracic (TTE) and transesophageal (TEE) color Doppler echocardiography. Four mycotic aneurysms were found, one each in the left ventricular outflow tract, the right coronary sinus of valsalva, the anterior mitral leaflet, and the atrial septum. With TTE, only three of four cases of mycotic aneurysms could be detected. Utilizing TEE, however, all were detected and their connections with the heart chambers or great vessels could be readily and clearly depicted, especially those in the atrial septum and mitral leaflet. We are of the opinion that TEE is superior to TTE in the identification and detailed analysis of mycotic aneurysms complicating infective endocarditis. In addition, we feel that echocardiography may help evaluate the progress of the disease, the location and direction of infection, and the extent of involvement of the mycotic aneurysms, providing useful information for guiding surgical intervention.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/14. Three ventriculoplasty techniques applied to three left-ventricular pseudoaneurysms in the same patient.A 59-year-old male patient underwent surgery for triple-vessel coronary artery disease and left-ventricular aneurysm in 1994. Four months after coronary artery bypass grafting and classical left-ventricular aneurysmectomy (with Teflon felt strips), a left-ventricular pseudoaneurysm developed due to infection, and this was treated surgically with an autologous glutaraldehyde-treated pericardium patch over which an omental pedicle graft was placed. Two months later, under emergent conditions, re-repair was performed with a diaphragmatic pericardial pedicle graft due to pseudoaneurysm reformation and rupture. A 3rd repair was required in a 3rd episode 8 months later. Sternocostal resection enabled implantation of the left pectoralis major muscle into the ventricular defect. Six months after the last surgical intervention, the patient died of cerebral malignancy. Pseudoaneurysm reformation, however, had not been observed. To our knowledge, our case is the 1st reported in the literature in which there have been 3 or more different operative techniques applied to 3 or more distinct episodes of pseudoaneurysm formation secondary to post-aneurysmectomy infection. We propose that pectoral muscle flaps be strongly considered as a material for re-repair of left-ventricular aneurysms.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/14. Tortuous internal mammary artery angioplasty: accordion effect with limitation of flow.Mechanical straightening of a tortuous vessel during angioplasty has been well described. It can be mistaken for thrombus, dissection or spasm. This report presents a case in which straightening of vessel due to stiff guide wire results in accordion effect and flow limitation.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
4/14. Multiple coronary artery aneurysms resulting in myocardial infarction in a young man: treatment by double aorta-coronary saphenous vein bypass grafting.A 26-year-old Japanese man was treated for a transmural myocardial infarct caused by multiple aneurysms of the left main (LMC), left anterior descending (LAD), and the right coronary arteries (RCA). He underwent successful double aorta-coronary saphenous vein bypass grafting. The etiology of the aneurysm remains uncertain but an inflammatory origin is most probable. review of the literature has indicated that this is the seventh case of coronary artery aneurysms without arteriovenous fistulas to be managed by grafting techniques with the saphenous vein. This experience has suggested that young patients presenting with anginal pain or myocardial infarction whould be carefully examined for coronary artery aneurysms. Since most of the patients developed myocardial infarction probably from thrombotic occlusion or embolism of the distal vessel, this lesion should be considered for surgery whenever anatomically feasible. Coronary artery reconstruction by grafting techniques, with or without resection of the aneurysm, is the treatment of choice. Although surgical treatment has provided good clinical amelioration to our patient as well as the patients previoulsy reported, a careful long-term follow-up should be continued for patients with multiple coronary artery aneurysms of doubtful origin.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/14. Coronary embolism and subsequent myocardial abscess complicating ventricular aneurysm and tachycardia.A 62-year-old female experienced a ventricular aneurysm and tachycardia caused by coronary embolism from mitral valve endocarditis. The patient underwent endoventricular patch plasty and cryoablation concomitant with valve replacement and survived without any operative complications. Pathological examination suggested that abscess formation played an important role regarding the disruption of the ventricular wall and development of the ventricular aneurysm and tachycardia. In previous reports, a myocardial abscess caused by a septic embolism has only been diagnosed using postmortem examinations as colony growth around the capillary vessels in the myocardium. We considered that our operation was effective and feasible in such an occurrence.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/14. The use of multiple coronary guidewires to occupy secondary branch vessels and facilitate PCI of a complex aneurysmal stenosis.Percutaneous revascularization of complex coronary stenosis is dependent on establishing suitable guidewire position in the vascular bed distal to the lesion. We report the use of multiple 0.0014'' coronary guidewires to occupy unintended branch vessels and to facilitate PCI of a high-grade left circumflex obtuse marginal branch lesion with post-stenotic aneurysmal dilation of the vessel and multiple branch vessels. This technique enabled successful placement of a nitinol hydrophilic-coated wire into the distal vascular bed beyond the region of obstruction followed by placement of a drug-eluting stent with restoration of luminal dimensions and TIMI-3 angiographic flow.- - - - - - - - - - ranking = 7keywords = vessel (Clic here for more details about this article) |
7/14. Pediatric patients with Kawasaki disease and a case report of Kitamura operation.Kawasaki disease (KD), also called mucocutaneous lymph node syndrome, is an acute, self-limiting, small-vessel vasculitis with an unknown cause that affects children between the ages of 6 months and 5 years. It is the most common cause of acquired coronary artery disease in childhood. Acute myocardial infarction and coronary artery aneurysm are major complications.We present a cohort of patients with KD who were followed up and treated in the Heart Center, North Rhine-Westphalia. Included is a review of important relevant items common to cases of KD, such as clinical data and management, including medical management of the acute condition and the diagnosis and management of coronary vasculitis and aneurysms as well as the application of coronary artery bypass grafting (CABG) in those conditions.Between January 2002 and January 2006, we evaluated the findings and characteristics of 18 pediatric patients with a history of KD and their long-term outcome. The acute illness occurred between the ages of 4 months and 14 years of age. Anomalies of the coronary arteries were found in 6 patients ranging in age from 5 months to 10 years. One patient had acute myocardial infarction; another underwent CABG after 5 years from disease onset at the age of 15 years. Kitamura operation was performed successfully. The other patients are still under observation.Coronary artery aneurysms and stenosis requiring surgery are rare in KD; nevertheless, CABG is the standard therapy when myocardial ischemia is detected. Kitamura operation provides good growth potential and long-term graft patency.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/14. Perforated ventricular aneurysm in a male suffering from pneumonia.In a 49-year-old male with fever, dyspnea, and chest pain, thoracic x-ray revealed pneumonia with enlarged heart silhouette. Antibiotics were successful, pneumonia healed and complaints disappeared. Yet, during the following 3 months, echocardiography showed mild persistent pericardial effusion while in ECG both sinus tachycardia and ST-T changes were found suggesting chronic pericarditis. magnetic resonance imaging, however, revealed an extensive posterobasal aneurysm with pericardial effusion substantiated by ventriculography. coronary angiography showed diffuse three-vessel disease. Surgery revealed aneurysm with distinct perforation of the left ventricle and pericardial thrombi, thus aneurysmectomy as well as bypass grafts were performed. One year postoperatively, magnetic resonance imaging confirmed the absence of aneurysm with only a small irreversible posterobasal perfusion defect remaining as shown by thallium scintigraphy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/14. A case of four coronary artery fistulae originating from three vessels associated with aneurysm.A case of an aneurysm associated with four coronary artery fistulae originating from three vessels is reported. The patient, a 52-year-old woman, had chest heaviness and palpitations. Coronary arteriography revealed the four fistulae originating from three coronary vessels with an aneurysm draining into the left ventricle and the main pulmonary artery. The patient's symptoms were relieved after fistulectomy and the aneurysmectomy, suggesting that a coronary steal phenomenon through the fistulae was the cause of her symptoms. This case is of interest because of its rarity, since this is the first case report of an aneurysm associated with four coronary artery fistulae from three vessels.- - - - - - - - - - ranking = 7keywords = vessel (Clic here for more details about this article) |
10/14. rupture of right coronary artery aneurysm into the right atrium.A 63-year-old man presented with acute congestive heart failure and was found to have a continuous murmur. Two years earlier, he had an inferior myocardial infarct, when no murmurs were heard. Angiography showed a right coronary artery aneurysm communicating with the right atrium. The distal vessel was occluded. The aneurysm was resected and the patient remains well. It is proposed that this was a congenital aneurysm which led firstly to the myocardial infarct and finally ruptured into the right atrium.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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