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Sample records for left hepatic arteries

  1. Traumatic common hepatic artery injury causing isolated right hepatic ischemia due to a left accessory artery. A case report.

    PubMed

    Fernandes, Eduardo; Pedrazzani, Corrado; Gerena, Marielia; Omi, Ellen

    2017-08-08

    Hepatic arterial liver flow is renowned for its redundancy. Previous studies have demonstrated that the common hepatic artery is not essential for liver survival. We present a case of a 31year-old involved in a high-speed motor vehicle accident whose liver survived thanks to the presence of an accessory hepatic artery. We present the case of a 31year-old male who sustained a traumatic injury of the proper hepatic artery following a motor vehicle accident. The patient suffered temporary right liver lobe ischemia due to the presence of an accessory left hepatic artery. This resulted in the selective formation of 'biliary lakes' distinctively within the territory of the right hepatic artery supply. Simultaneously the patient developed a pseudo-aneurysm of the proper hepatic artery which required radiology intervention. At the time of pseudo-aneurysm embolisation, a rich network of arterial collaterals had formed between the accessory left hepatic and the inferior phrenic artery. On follow up the biliary lakes to the right lobe had resolved, but a small area at the periphery of the right lobe had encountered atrophy. This case report is an 'in vivo' demonstration of liver resilience to arterial flow re-distribution and demonstrates the ability of the biliary epithelium to recover from and ischemic injury. Parenchymal liver survival is mostly independent from flow within the common hepatic artery. Acute and chronic liver parenchyma changes following interruption of hepatic artery flow can still occur. Copyright © 2017. Published by Elsevier Ltd.

  2. Catheterization of the Hepatic Artery Via the Left Common Carotid Artery in Rats

    SciTech Connect

    Li Xiao; Wang Yixiang, J.; Zhou Xiangping Guan Yongsong; Tang Chengwei

    2006-12-15

    The commonly used approach for rat hepatic artery catheterization is via the gastroduodenal artery, which is ligated after the procedure. A new method of rat hepatic artery catheterization via the left common carotid artery (LCCA) is described. The LCCA is repaired after catheterization. The catheterization procedures included the following: (1) opening the rat's abdominal cavity and exposing the portion of abdominal aorta at the level of the celiac trunk; (2) separating and exposing the LCCA; inserting a microguidewire and microcatheter set into the LCCA via an incision; after placement into the descending aorta, the microguidewire and microcatheter are maneuvered into the hepatic artery under direct vision; (3) after transcatheter therapy, the catheter is withdrawn and the incision at the LCCA is repaired. This technique was employed on 60 male Sprague-Dawley rats with diethylnitrosamine-induced liver cancer, using a 3F microguidewire and microcatheter set. Selective hepatic artery catheterization was successfully performed in 57 rats. One rat died during the operation and five rats died within 7 days after the procedure. It is envisaged that as experience increases, the catheterization success rate will increase and the death rate will decrease. A new approach for selective hepatic artery catheterization via the LCCA in rats is introduced, which makes repeat catheterization of this artery possible and allows large embolization particles to be delivered by using a 3F catheter.

  3. Supraduodenal Branch of the Left Hepatic Artery: A Rare Cause of Bleeding Duodenal Ulcer

    SciTech Connect

    Kapoor, Baljendra S.; Berscheid, Bruce; Saddekni, Souheil

    2009-07-15

    This is a case report describing a rare cause of massive duodenal ulcer hemorrhage resulting from the erosion of the supraduodenal branch of the left hepatic artery. This arterial branch is not a well known variation and is rarely recognized as a source of duodenal bleeding.

  4. Angiographic management of the left hepatic artery disruption following motor vehicle accident.

    PubMed

    Dullet, Navjit; Marshall, Dustyn

    2017-09-01

    Trauma is a leading cause of death in younger individuals. Blunt abdominal trauma has the potential to mask severe injuries-there can be serious organ or vascular injury underneath intact skin. Increasingly, there is a trend toward nonoperative management of blunt abdominal trauma. We report the case of a left hepatic artery transection managed in the interventional radiology suite.

  5. Origins of Feeding Arteries of Hepatocellular Carcinoma Located Near the Umbilical Fissure of the Left Hepatic Lobe: Angiographic Evaluation

    SciTech Connect

    Miyayama, Shiro Yamashiro, Masashi; Shibata, Yoshihiro; Hashimoto, Masahiro; Yoshida, Miki; Tsuji, Kazunobu; Toshima, Fumihito; Matsui, Osamu

    2012-12-15

    Purpose: To analyze the origins of the feeding arteries of hepatocellular carcinomas (HCCs) near the umbilical fissure of the left hepatic lobe. Methods: Twenty-eight HCCs with a mean {+-} SD tumor diameter of 3.4 {+-} 1.0 cm (range 1-4.4 cm) in contact with the right or left side of the umbilical fissure were treated by superselective transcatheter arterial chemoembolization (TACE). The origins of the tumor-feeding arteries were analyzed with arteriograms and computed tomography or cone-beam computed tomography images obtained during and 1 week after TACE.ResultsTwenty-one HCC lesions were located in segment 3 and seven were located in segment 4. Of 21 tumors in segment 3, 13 (61.9%) were supplied by the lateral inferior subsegmental artery (A3), three (14.3%) by the medial subsegmental artery (A4), three (14.3%) by both A4 and A3, one (4.8%) by a branch arising from the left lateral hepatic artery, and one (4.8%) by a branch of the right gastric artery. In particular, all tumor-feeding branches arising from A4 were the first branch of A4. Of seven tumors in segment 4, four (57.1%) were supplied by A4 and three (42.9%) by A3. In particular, all tumor-feeding branches arising from A3 were the first branch of A3. Conclusion: This study demonstrates crossover blood supply to HCC lesions located near the umbilical fissure, in addition to direct feeding from a separate branch. In particular, the first branch of the opposite subsegmental artery may feed tumors when crossover blood supply is present.

  6. Outcome of partial reconstruction of multiple hepatic arteries in pediatric living donor liver transplantation using left liver grafts.

    PubMed

    Lee, Kyo Won; Lee, Sanghoon; Oh, Dong Kyu; Na, Byung Gon; Choi, Jin Yong; Cho, Wontae; Lee, Seunghwan; Kim, Jong Man; Choi, Gyuseong; Kwon, Choon Hyuck David; Joh, Jae-Won; Lee, Suk-Koo

    2016-08-01

    Partial liver grafts used in living donor liver transplantation (LDLT) may have multiple hepatic artery (HA) stumps. This study was designed to validate the safety of partial reconstruction of multiple HAs in pediatric LDLT cases. From January 2000 to June 2014, 136 pediatric LDLT recipients were categorized into three groups: single HA group (Group 1, n = 74), multiple HAs with total reconstruction group (Group 2, n = 23), and multiple HAs with partial reconstruction group (Group 3, n = 39). Partial reconstruction was performed only when there was pulsatile back-bleeding after larger HA reconstruction and sufficient intrahepatic arterial flow was confirmed by Doppler ultrasound (DUS). There was no significant difference in biliary complication rate, artery complication rate, patient survival, and graft survival among these groups. Risk factor analysis revealed that the presence of multiple HAs and partial reconstruction of multiple HAs were not risk factors of biliary anastomosis stricture. In conclusion, partial reconstruction of HAs during pediatric LDLT using a left liver graft with multiple HA stumps does not increase the risk of biliary anastomosis stricture or affect graft survival when intrahepatic arterial communication is confirmed by pulsatile back-bleeding and DUS. © 2016 Steunstichting ESOT.

  7. Left Lobe Recurrent Hepatocellular Carcinoma Treated with Lipiodol-TAE via the Left Internal Mammary Artery

    SciTech Connect

    Kanetsuki, Ichiro; Hori, Akira; Ohshiro, Kiyoshi; Nishi, Hirokazu; Yasutani, Tadashi; Sueyoshi, Takeshi; Tanaka, Hitoshi

    1997-09-15

    A multinodular hepatocellular carcinoma (HCC) was treated with seven transarterial interventions via the hepatic artery over a 2-year, 5-month period before the eighth angiography showed a recurrent HCC in the anterior portion of the left hepatic lobe. The left internal mammary artery (IMA) was feeding the tumor. This was successfully treated with Lipiodol-transcatheter arterial embolization using a coaxial system via a branch of the left IMA. No complications resulted from the procedure. The left IMA should be considered as a possible feeding artery to an HCC occurring in the anterior portion of the left hepatic lobe.

  8. Left Main Coronary Artery Aneurysm

    PubMed Central

    Doustkami, Hossein; Maleki, Nasrollah; Tavosi, Zahra

    2016-01-01

    Aneurysms of the left main coronary artery are exceedingly rare clinical entities, encountered incidentally in approximately 0.1% of patients who undergo routine angiography. The most common cause of coronary artery aneurysms is atherosclerosis. Angiography is the gold standard for diagnosis and treatment. Depending on the severity of the coexisting coronary stenosis, patients with left main coronary artery aneurysms can be effectively managed either surgically or pharmacologically. We herein report a case of left main coronary artery aneurysm in a 72-year-old man with a prior history of hypertension presenting to our hospital because of unstable angina. The electrocardiogram showed ST-segment depression and T-wave inversion in the precordial leads. All the data of blood chemistry were normal. Echocardiography showed akinetic anterior wall, septum, and apex, mild mitral regurgitation and ejection fraction of 45%. Coronary angiography revealed a saccular aneurysm of the left main coronary artery with significant stenosis in the left anterior descending, left circumflex, and right coronary artery. The patient immediately underwent coronary artery bypass grafting and ligation of the aneurysm. At six months’ follow-up, he remained asymptomatic. PMID:27403190

  9. Right hepatic artery crossing the common hepatic artery: an unusual blood supply to the liver.

    PubMed

    Felli, Emanuele; Vennarecci, Giovanni; Santoro, Roberto; Guglielmo, Nicola; Ettorre, Giuseppe Maria

    2016-04-01

    To perform hepatic surgery a precise preoperative and intraoperative study of liver vascular supply is mandatory. Detecting vascular variations may have great importance on surgical strategy and outcome, and details of anatomy do not concern only academical knowledge but become deeply involved in practice. We present a case of unusual blood supply to the liver, the common hepatic artery was directed to the right liver and a right hepatic artery originating from the superior mesenteric artery was directed to the left liver. The right hepatic artery crossed the common hepatic artery in the proximal part of the hepatic pedicle, anterior to the portal vein. To our knowledge this type of anatomical variation has not been described before and it represents a rare finding that has to be kept in mind, especially in case of major hepatectomies and more demanding splitting liver procedures such as A.L.P.P.S., in situ split, ex situ split and living donor liver transplantation.

  10. Hepatic Artery Infusion Chemotherapy

    PubMed Central

    Schüller, J.; Kroiss, A.; Dinstl, K.

    1990-01-01

    Hepatic artery chemotherapy was given to 36 patients, using totally implantable devices consisting of a port and external pump. Twenty-seven patients had inoperable liver metastases of colorectal origin. The infusion system was inserted by laparotomy into the hepatic artery via the gastroduodenal artery. There was no operative mortality. Thirteen infusion systems could not be used for chemotherapy due to dislodgement, early death and lack of follow-up. FUdR was infused every two weeks. There were minor local complications like thrombosis of the system and dislodgement of the port. Toxic effects could be managed by reducing the dose. Response to chemotherapy was evaluated by survival, clinical condition, CEA, ultrasound and CT six months after onset of arterial chemotherapy. Ten/twenty-three patients (43%) responded to therapy, eight of them died on the average 19 months after initial chemotherapy. Six patients were non-responders, seven had stable disease. Five/ten patients developed extrahepatic metastases. Mean survival time was 13.1 months, mean interval until relapse 10.6 months. PMID:2149279

  11. Anomalous left coronary artery from pulmonary artery with mitral stenosis.

    PubMed

    Das, Mrinalendu; Mahindrakar, Pallavi; Das, Debasis; Behera, Sukanta Kumar; Chowdhury, Saibal Roy; Bandyopadhyay, Biswajit

    2011-08-01

    The usual presentation of anomalous left coronary artery from pulmonary artery is severe left-sided heart failure and mitral valve insufficiency presenting during the first months of life. The manifestations of left heart failure may be masked if pulmonary artery pressure remains high. We believe this is a rarest of rare case of anomalous left coronary artery from pulmonary artery with severe mitral stenosis and pulmonary hypertension in which pulmonary hypertension, along with good collateral circulation helped to preserve left ventricular function.

  12. Right hepatic artery aneurysm.

    PubMed

    Bernal, Astrid Del Pilar Ardila; Loures, Paulo; Calle, Juan Cristóbal Ospina; Cunha, Beatriz; Córdoba, Juan Camilo

    2016-01-01

    We report a case of an aneurysm of the right hepatic artery and its multidisciplinary management by general surgery, endoscopy and radiology services. Being a case of extremely low incidence, it is important to show its diagnostic and therapeutic approach. RESUMO Relatamos um caso de aneurisma da artéria hepática direita conduzido de forma multidisciplinar pelos Serviços de Cirurgia Geral, Endoscopia e Radiologia. Em se tratando de caso de incidência baixíssima, é importante mostrar o enfoque diagnóstico e terapêutico usado em seu manejo.

  13. Splenic Artery Transposition Graft Usage for the Supply of the Right Hepatic Artery: A Case Report

    PubMed Central

    Odabasi, Mehmet; Eris, Cengiz; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Akbulut, Sami; Saglam, Abdullah

    2013-01-01

    Hepatic artery aneurysms are responsible for 12% to 20% of all visceral arterial aneurysms. Because most patients are asymptomatic, this disease is generally diagnosed incidentally during radiologic examination. Aneurysm rupture develops in 14% to 80% of cases, depending on the aneurysmatic segment's diameter and location, as well as other etiologic factors. Mortality rates associated with rupture range between 20% and 70%. Thus, early diagnosis and timely initiation of medical interventions are critical to improve survival rates. Here, we present a male patient, age 69 years, with a hepatic artery aneurysm that was detected incidentally. The 3-cm aneurysm was detected on contrast-enhanced computed tomography and extended from the common hepatic artery to the hepatic trifurcation. A laparotomy was performed using a right subcostal incision. After dissection of the hepatoduodenal ligament, the common, right, and left hepatic arteries, as well as the gastroduodenal artery, were suspended separately. Then, the aneurysmatic hepatic artery segment was resected, and the gastroduodenal artery stump was ligated. An end-to-end anastomosis was formed between the left and common hepatic arteries, followed by an end-to-end anastomosis formed between the right hepatic artery and splenic artery using a splenic artery transposition graft. Postoperative follow-up examinations showed that both hepatic arterial circulations were good, and no splenic infraction had developed. PMID:23971784

  14. Splenic artery transposition graft usage for the supply of the right hepatic artery: a case report.

    PubMed

    Odabasi, Mehmet; Eris, Cengiz; Yildiz, Mehmet Kamil; Abuoglu, Hasan; Akbulut, Sami; Saglam, Abdullah

    2013-01-01

    Hepatic artery aneurysms are responsible for 12% to 20% of all visceral arterial aneurysms. Because most patients are asymptomatic, this disease is generally diagnosed incidentally during radiologic examination. Aneurysm rupture develops in 14% to 80% of cases, depending on the aneurysmatic segment's diameter and location, as well as other etiologic factors. Mortality rates associated with rupture range between 20% and 70%. Thus, early diagnosis and timely initiation of medical interventions are critical to improve survival rates. Here, we present a male patient, age 69 years, with a hepatic artery aneurysm that was detected incidentally. The 3-cm aneurysm was detected on contrast-enhanced computed tomography and extended from the common hepatic artery to the hepatic trifurcation. A laparotomy was performed using a right subcostal incision. After dissection of the hepatoduodenal ligament, the common, right, and left hepatic arteries, as well as the gastroduodenal artery, were suspended separately. Then, the aneurysmatic hepatic artery segment was resected, and the gastroduodenal artery stump was ligated. An end-to-end anastomosis was formed between the left and common hepatic arteries, followed by an end-to-end anastomosis formed between the right hepatic artery and splenic artery using a splenic artery transposition graft. Postoperative follow-up examinations showed that both hepatic arterial circulations were good, and no splenic infraction had developed.

  15. The hepatic-arterial/portal-venous scintiangiogram in alcoholic hepatitis

    SciTech Connect

    Stewart, C.; Sakimura, I.; Siegel, M.E.; Harley, H.; Lee, K.

    1984-01-01

    This study was designed to identify abnormalities in the hepatic-arterial/portal-venous scintiangiogram (SA) in alcoholic hepatitis (AH). SA's were performed in 35 patients with acute alcoholic hepatitis (AAH), 8; acute alcoholic hepatitis superimposed on cirrhosis (A/C), 14; and cirrhosis (C), 13. Posterior flows were done with a bolus of 10 mCi Tc-99m sulfur colloid with computer time-activity curves over the liver and left kidney. Curves were analyzed for per cent of hepatic arterial (HA) and portal venous contribution using the slope ratio method. Hepatic arterialization was estimated from the angle of the HA component of the curve. Reversal of the relative contribution of the hepatic and portal components of total flow were seen in all groups. Although quite severe in AH, the degree of reversal could not be used to differentiate among the groups. The average HA angle in AAH was 48.3 +- 8.1, in A/C 41.5 +- 10.6, and in C 30.4 +- 12.1. In reviewing the data of only those in the acute clinical phase of AH and not the recovery phase (1 AAH, 3 A/C) and those without other causes of alteration in hepatic arterialization (1 hepatoma, 1 portalcaval shunt, 6 renal failure), the average HA angle in AAH was 50.1 +- 6.6, 45.4 +- 8.2 in A/C, and 23.2 +- 4.2 in C. In 6 with renal failure (2 C, 2AAH, 2 A/C) the HA angle ws 52.7 +- 5.7. In all cases cirrhosis could be differentiated from both A/C (P=.05) and AAH (P<.01) using the HA angle. In absence of renal failure, portal shunt, or hepatoma, P was <.01 in both comparisons.

  16. Two Rare Variants of Left Vertebral Artery.

    PubMed

    Singh, Rajani

    2017-02-15

    Though the variations of vertebral artery are clinically asymptomatic yet abnormalities are of diagnostic importance either prior to vascular surgery in the neck region or in patients of intravascular diseases such as arteriovenous malformations or cerebral aneurysms. Therefore, the aim of the study is to bring out 2 variations in the configuration of vertebral artery and their clinical implication. During dissection of thorax of 2 female cadavers, 2 different variants of configurations of left vertebral arteries were observed. In 1 patient, the left vertebral artery arose aberrantly from arch of aorta between left common carotid artery and left subclavian artery. This artery then, following oblique course, abnormally entered into foramen transversarium of C4 vertebra. In the second patient, the left common stump emerged from arch of aorta in the left side of left common carotid artery and then instantly bifurcated into vertebral artery and subclavian artery. Then following the usual oblique course, the left vertebral artery anomalously entered into foramen transversarium of C3 vertebra at the level of upper border of thyroid cartilage. The knowledge of these rare variations in the origin of vertebral artery is of paramount importance to surgeons performing surgery in neck region, radiologist performing angiography to avoid misinterpretation of radiographs and to anatomists for rare variations in academics and research.

  17. Left Main Coronary Artery Hypoplasia in Elderly

    PubMed Central

    Kenar Tiryakioglu, Selma; Bahadir, Hakan

    2016-01-01

    Congenital anomalies of the coronary artery causing coronary occlusive disease may be of many different types. A 67-year-old woman with no coronary risk factors was referred for coronary angiography with few months' history of angina. The patient underwent coronary angiography due to ischemic cardiac symptoms with nondiagnostic exercising test. In coronary angiography, the left main coronary artery was arising from normal anatomical position; however, left anterior descending artery and circumflex artery were hypoplastic. The treatment of patient was discussed in cardiology-cardiovascular surgery council and coronary surgery was found inappropriate due to the hypoplasia of the left coronary system entirely. PMID:27047696

  18. [Left ventricular function in pulmonary arterial hypertension].

    PubMed

    Khomaziuk, V A

    1998-12-01

    Echocardiographic evaluation was done of left ventricular functional state in 90 patients with primary and secondary pulmonary arterial hypertension with and without intercavitary shunting. Changes in left ventricular function were identified in 86% cases; they reflected disturbances in both ventricles compensatory interaction. The degree of changes depended on the degree of dilatation of the right ventricle and level of interchamber shunting.

  19. Massive Hemorrhage From Multiple Hepatic Artery Aneurysms.

    PubMed

    Kahn, S Lowell; McClain, Jonathan; Kaufman, Jeffrey L

    2016-10-01

    A 66-year-old man, with an abnormal porta hepatis, consistent with tumor or inflammation, developed massive bleeding from one of numerous hepatic artery aneurysms, and coil embolization achieved control of bleeding. He died of subsequent multisystem organ failure, and the most likely diagnosis was either polyarteritis nodosa or segmental arterial mediolysis. Although the dual hepatic blood supply allows a degree of arterial embolization, this case demonstrates the risks associated with large territory hepatic arterial embolization in the presence of hemodynamic instability. We discuss the management issues related to massive hepatic bleeding when no surgical approach is possible.

  20. Celiac Axis, Common Hepatic and Hepatic Artery Variants as Evidenced on MDCT Angiography in South Indian Population

    PubMed Central

    Parthasarathy, Ramesh

    2016-01-01

    Introduction With the increase in the hepatobiliary, pancreatic surgeries and liver transplantation, being aware of the anatomic variations of the celiac axis and the hepatic arteries is of paramount importance. Aim To illustrate the normal anatomy and variants of the celiac axis and the hepatic arteries with multidetector computed tomographic (MDCT) angiography in South Indian population and determine the potential variations in the celiac axis anatomy and the hepatic arteries, thus assisting the hepatobiliary surgeon and the interventional radiologist in avoiding iatrogenic injury to the arteries. Materials and Methods Two hundred patients undergoing abdominal CT angiography from July 2014 till July 2015 were retrospectively studied for hepatic arterial and celiac axis anatomical variation. The anatomic variations in our study were correlated with other studies. Results The celiac axis (CA) and the hepatic artery (HA) variations were analysed as per criteria laid by Song et al., and Michel. Out of 15 possible CA variations, 5 types of celiac artery variations were seen in 14 patients. A normal CA was seen in 179(89.5%) patients of the 200 patients. In the remaining 7 patients, the CA anatomy was classified as ambiguous since there was separate origin of the right and left hepatic arteries from the CA with absent common hepatic artery (CHA). The CHA originated normally from the celiac axis in 94% of the cases. Variation of CHA origin was seen in 5 patients. Normal HA anatomy was seen in 114 (57%) patients. Variation in HA anatomy was seen in 86 (43%) patients. Origin of the right hepatic artery (RHA) from the hepatic artery proper was seen in 182 (91%) patients and replaced origin of RHA from the superior mesenteric artery (SMA) was seen in 18 (9%) of the cases. Accessory RHA was seen in 7(3.5%) patients. The left hepatic artery (LHA) originated from the hepatic artery proper in 186 (93%) patients and replaced origin of LHA from the left gastric artery (LGA) was

  1. Surgical Management of Intramyocardial Left Anterior Descending Artery.

    PubMed

    De Salvatore, Sergio; Segreto, Antonio; Chiusaroli, Alessandro; Congiu, Stefano; Bizzarri, Federico

    2015-11-01

    An intramyocardial left anterior descending artery can be found in up to 30% of patients undergoing coronary artery bypass graft procedures. We review the various techniques available to identify an intramyocardial left anterior descending artery.

  2. Multidetector CT of hepatic artery pathologies.

    PubMed

    Karaosmanoglu, D; Erol, B; Karcaaltincaba, M

    2012-01-01

    The hepatic artery can be involved by a variety of pathology and diseases.Today MDCT enables high quality imaging of the hepatic artery using axial, MIP and volume rendered images. We illustrate MDCT findings of anatomical variations, aneurysm, dilatation, dissection, arteriovenous fistula, thrombosis and stenosis. Aneurysms can be saccular, fusiform and multiple and may develop due to atherosclerosis, vasculitis, trauma and biopsy. Dilatation of hepatic artery can be seen in portal hypertension, Osler-Weber-Rendu disease and hemangiomatosis. Hepatic artery can be occluded after trauma and transplantation. Dissection develops due to atherosclerosis, Marfan and Ehler Danlos syndromes and during pregnancy. Arteriovenous fistula can be congenital and acquired. We conclude that various hepatic artery pathologies can be confidently diagnosed by MDCT.

  3. Left internal carotid artery agenesis associated with basilar and left vertebral artery aneurysm.

    PubMed

    Paşaoğlu, Lale; Vural, Murat; Ziraman, Ipek; Uyanιk, Sadιk Ahmet

    2011-01-01

    Agenesis of the internal carotid artery (ICA) is a rare congenital anomaly. Most of the patients are asymptomatic and it is usually discovered incidentally by computed tomography (CT) or magnetic resonance imaging (MRI). There is close association of the cranial aneurysms and subarachnoid hemorrhage with ICA agenesis. We present a case of a 61-year-old male with left ICA agenesis associated with basilar artery and left vertebral artery aneurysms. The patient complained of headaches and numbness on the right-side of the face. Physical examination showed high blood pressure (210/90 mmHg). Neurological examination revealed nystagmus and decreased sensation on the right-side of the face. Agenesis of left ICA, left carotid canal with basilar and left vertebral artery aneurysms were demonstrated incidentally using CT, MRI, and digital subtraction angiography, as a part of an evaluation for suspected cerebrovascular accident.

  4. Hepatic Artery Pseudoaneurysm: Delayed Presentation after a Blunt Trauma

    PubMed Central

    Batur, Abdussamet; Yavuz, Alpaslan; Toktas, Osman; Bora, Aydın; Bulut, Mehmet Deniz

    2015-01-01

    Summary Background Ruptured hepatic artery pseudoaneurysm is a rare condition that is life-threatening if not diagnosed and treated rapidly. We present a case of a spontaneously ruptured hepatic artery pseudoaneurysm that occurred after a blunt trauma, and provide a review of the current literature on this topic. This case study demonstrates a spontaneously ruptured hepatic artery pseudoaneurysm which emerged following a blunt trauma and it also presents current literature studies on the topic. Case Report A man at the age of 34 years with blunt trauma dating back to 1.5 month was admitted to the emergency department of a hospital with hematemesis and epigastric tenderness. He also had a duodenal ulcer, blood in the gastric lumen and a large pseudoaneurysm that developed from the left hepatic artery. Soon after the diagnosis, the patient worsened and underwent distal gastrectomy and cholecystectomy that included removing the bleeding aneurysm. Conclusions Ruptured hepatic artery pseudoaneurysm stands as a deadly condition which has to be diagnosed and managed as soon as possible. Physicians need to take aneurysms of abdominal arteries into consideration after routine diagnostic practises as long as the cause of gastrointestinal haemorrhage is unidentified. PMID:26171087

  5. Arterial conduits for hepatic artery revascularisation in adult liver transplantation.

    PubMed

    Muralidharan, Vijayaragavan; Imber, Charles; Leelaudomlipi, Surasak; Gunson, Bridget K; Buckels, John A C; Mirza, Darius F; Mayer, A David; Bramhall, Simon R

    2004-05-01

    Arterial complications after orthotopic liver transplantation (OLT), including hepatic artery thrombosis (HAT), are important causes of early graft failure. The use of an arterial conduit is an accepted alternative to the utilisation of native recipient hepatic artery for specific indications. This study aims to determine the efficacy of arterial conduits and the outcome in OLT. We retrospectively reviewed 1,575 cadaveric adult OLTs and identified those in which an arterial conduit was used for hepatic revascularisation. Data on the primary disease, indication for using arterial conduit, type of vascular graft, operative technique and outcome were obtained. Thirty-six (2.3%) patients underwent OLT in which arterial conduits were used for hepatic artery (HA) revascularisation. Six of these were performed on the primary transplant, while the rest (n=30) were performed in patients undergoing re-transplantation, including six who had developed hepatic artery aneurysms. The incidence of arterial conduits was 0.4% (6/1,426 cases) in all primary OLTs and 20.1% (30/149 cases) in all re-transplants. Twenty-nine procedures utilised iliac artery grafts from the same donor as the liver, six used iliac artery grafts from a different donor, and a single patient underwent a polytetrafluoroethylene (PTFE) graft. Two techniques were used: infra-renal aorto-hepatic artery conduit and interposition between the donor and recipient native HAs, or branches of the HAs. The 30-day mortality rate for operations using an arterial conduit was 30.6%. Three conduits thrombosed at 9, 25 and 155 months, respectively, but one liver graft survived without re-transplantation. The arterial conduits had 1- and 5-year patency rates of 88.5% and 80.8%. The 1- and 5-year patient survival rates were 66.7% and 44%. We can thus conclude that an arterial conduit is a viable alternative option for hepatic revascularisation in both primary and re-transplantation. Despite a lower patency rate than that of

  6. Stabilization of a Percutaneously Implanted Port Catheter System for Hepatic Artery Chemotherapy Infusion

    SciTech Connect

    Shindoh, Noboru; Ozaki, Yutaka; Kyogoku, Shinsuke; Yamana, Daigo; Sumi, Yukiharu; Katayama, Hitoshi

    1999-07-15

    A port catheter system for hepatic artery infusion chemotherapy was implanted percutaneously via the left subclavian artery in 41 patients for treatment of unresectable liver metastases. The catheter tip was inserted into the gastroduodenal artery (GDA), the end hole was occluded with a guidewire fragment, and a side-hole for infusion was positioned at the bifurcation of the proper hepatic artery and the GDA. The GDA was embolized with steel coils around the infusion catheter tip via a transfemoral catheter. This procedure is designed to reduce the incidence of hepatic artery occlusion and infusion catheter dislocation.

  7. Intra-arterial digital subtraction angiogrpahy: comparison with conventional hepatic arteriography

    SciTech Connect

    Flannigan, B.D.; Gomes, A.S.; Stambuk, E.C.; Lois, J.F.; Pais, S.O.

    1983-07-01

    To evaluate the efficacy of arterial digital subtraction angiography (DSA), 28 patients with a variety of hepatic lesions underwent intra-arterial DSA immediately following conventional celiac or hepatic arteriography. Thirty-one studies were obtained and the results of DSA were compared with the conventional arteriograms. DSA showed good visualization of the arteries in the early arterial phase of the examination. The late arterial phase was better evaluated on conventional arteriograms due to the decreased spatial resolution of DSA. Arterial DSA was most useful in the evaluation of the parenchyma of the liver; the use of remasking techniques allowed improved visualization of hepatic lesions, particularly in the left lobe of the liver. It is concluded that arterial DSA is useful in hepatic imaging and may supplant conventional hepatic arteriography as the technology improves.

  8. Coil Embolization of an Arteriobiliary Fistula Caused by Hepatic Intra-Arterial Chemotherapy

    SciTech Connect

    Takao, Hidemasa Doi, Ippei; Makita, Kohzoh; Watanabe, Toshiaki

    2005-12-15

    Arteriobiliary fistula is a rare complication of hepatic intra-arterial chemotherapy. We report successful coil embolization of an arteriobiliary fistula. An 80-year-old woman underwent percutaneous placement of an indwelling catheter into the replaced right hepatic artery for intra-arterial chemotherapy of liver metastases. Coil embolization of the left hepatic artery was not performed. The patient complained of abdominal pain during intra-arterial chemotherapy. Angiography revealed a fistula between the replaced right hepatic artery and the common bile duct. The fistula was successfully treated by coil embolization via the indwelling catheter, and the indwelling catheter was removed. Although such complications usually herald the termination of intra-arterial chemotherapy, the patient underwent percutaneous implantation of a new catheter-port system, and intra-arterial chemotherapy was restarted.

  9. Inferior pancreaticoduodenal artery aneurysm associated with common hepatic artery occlusion.

    PubMed

    Bracale, G; Porcellini, M; Bernardo, B; Selvetella, L; Renda, A

    1996-12-01

    A unique case of true inferior pancreaticoduodenal artery aneurysm (IPDA) associated with occlusion of common hepatic artery is reported. Radiological and MRI findings are described. Because of high risk of visceral ischemia that contraindicated a percutaneous transluminal embolization, a successful tangential resection of aneurysm was performed.

  10. Left Ventricular Thrombus Formation After Repair of Anomalous Left Coronary Artery From the Pulmonary Artery

    PubMed Central

    Freud, Lindsay R.; Koenig, Peter R.; Russell, Hyde M.; Patel, Angira

    2014-01-01

    Although thrombus formation following myocardial infarction in adults is well known, intracardiac thrombosis in children is uncommon. We report the case of a large left ventricular thrombus in an infant with ischemic cardiomyopathy secondary to anomalous origin of the left coronary artery from the pulmonary artery. Given its mobility and protrusion across the aortic valve, the patient underwent urgent thrombus removal through a transaortic approach. There were no embolic or neurologic complications. This case highlights that thrombectomy may be performed safely and successfully in critically ill pediatric patients. PMID:24668990

  11. Segmental mediolytic arteritis involving hepatic arteries.

    PubMed

    Armas, O A; Donovan, D C

    1992-05-01

    Segmental mediolytic arteritis is a rare, noninflammatory arteriopathy that involves the splanchnic arteries of adults with shock and the coronary arteries of neonates with hypoxemia. We report the first case (to our knowledge) of segmental mediolytic arteritis involving the hepatic arteries. The lesion begins with cytoplasmic vacuolar degeneration of the arterial smooth-muscle cells, which then progresses to coalescence of vacuoles, leading to disruption of the media, intramural hemorrhage, and periadventitial fibrin deposition. Segmental mediolysis results in arterial wall defects, which can lead to dissecting aneurysms or hemorrhage due to arterial rupture. The intima and internal elastica are spared from the lytic process, and there is minimal periadventitial inflammation. Segmental mediolytic arteritis is not a true arteritis; therefore, segmental mediolytic arteriopathy may be a preferable term. Morphological similarities exist between segmental mediolytic arteritis and arterial fibromuscular dysplasia. In our case, hepatic ischemia correlated with mediolysis involving the hepatic arterial branches. Segmental mediolytic arteritis is thought to be due to an inappropriate vasospastic response, developing in the setting of hypoperfusion and hypoxemia.

  12. Intravascular ultrasound for angiographically indeterminant left main coronary artery disease.

    PubMed

    Parashara, D K; Jacobs, L E; Ledley, G S; Yazdanfar, S; Oline, J; Kotler, M N

    1994-01-01

    The precise diagnosis of the presence of significant left main coronary artery disease has profound prognostic and therapeutic implications. Coronary cineangiography has shown to be imprecise and inaccurate to determine the percent stenosis of the left main coronary artery. We report a case with significant left main coronary artery disease in whom coronary cineangiography was in discordance with the clinical data and intravascular ultrasonography. Based on the intravascular ultrasound findings, the patient underwent coronary artery bypass graft surgery. Therefore, the intravascular ultrasonography may be the procedure of choice for assessing indeterminant left main coronary artery lesions by coronary angiography.

  13. Arterial Embolization of Giant Hepatic Hemangiomas

    SciTech Connect

    Giavroglou, Constantinos; Economou, Hippolete; Ioannidis, Ioannis

    2003-02-15

    Hepatic cavernous hemangiomas are usually small and asymptomatic. They are usually discovered incidentally and only a few require treatment. However, giant hemangiomas may cause symptoms,which are indications for treatment. We describe four cases of symptomatic giant hepatic hemangiomas successfully treated with transcatheter arterial embolization, performed with polyvinyl alcohol particles. There were no complications. Follow-up with clinical and imaging examinations showed disappearance of symptoms and decrease in size of lesions.

  14. Open arterial reconstruction of multiple hepatic artery aneurysms in a patient with hereditary hemorrhagic telangiectasia

    PubMed Central

    Ozawa, Hirotsugu; Ohki, Takao; Kanaoka, Yuji; Maeda, Koji; Hagiwara, Shin

    2016-01-01

    Abstract Background: Hereditary hemorrhagic telangiectasia (HHT) is characterized by mucocutaneous telangiectasia and visceral vascular malformations (VMs). Liver involvement with VMs may lead to high-output cardiac failure, portal hypertension, and biliary disease. There is no curative treatment for the disease, and liver transplantation is indicated for life-threatening complications. Herein, we report a case of multiple hepatic artery aneurysms (HAAs) in a patient with HHT in which open arterial reconstruction was performed. There have only been a few case reports on HAA occurring with HHT. Thus, this case provides important information for the management of HHT-associated HAAs. Case summary: A 62-year-old female with known HHT was referred to our facility to seek further treatment for a giant HAA. She denied any symptoms except recurrent epistaxis. A computed tomography (CT) scan revealed a right HAA with a diameter of 72 mm, in addition to 2 other minor HAAs. The CT scan also revealed the VMs that were scattered in the liver, and a continuously dilated and tortuous artery existing from the celiac trunk to the right and left hepatic arteries. We performed open arterial reconstruction of the HAAs. Her postoperative course was uneventful. Conclusions: When treating HAAs, there are a variety of options. However, hepatic VMs might affect HHT patients in various ways postprocedurally. Ligation and embolization of the hepatic artery may lead to complications, such as massive hepatic necrosis. Hepatectomy should be avoided if possible, because a postoperative hyperperfusive state in the remaining liver can cause adverse events. We believe that arterial reconstruction of HHT-associated HAAs might reduce the risk of postprocedural complications with minimal hemodynamic changes in the liver, thus obviating the need for hepatectomy or liver transplantation. PMID:27861387

  15. Symptomatic Type IV Dual Left Anterior Descending Coronary Artery

    PubMed Central

    Papadopoulos, Kyriacos; Georgiou, Georgios M.; Nicolaides, Evagoras

    2016-01-01

    Dual left anterior descending coronary artery is a rare congenital anomaly with 4 subtypes. Double left anterior descending coronary artery originating from the left main stem and the right coronary artery (type IV dual left anterior descending artery) has been reported to occur in 0.01% to 0.7% of patients undergoing cardiac catheterization. We report a case of a 49-year-old woman who was found to have this anomaly during coronary angiography. The patient had been complaining of chest pain that mimics angina pectoris and exercise tolerance test was positive for myocardial ischemia. PMID:28203572

  16. Same day arterial embolisation followed by hepatic resection for treatment of giant haemangioma.

    PubMed

    Bailey, James; Di Carlo, Sara; Blackwell, James; Gomez, Dhanny

    2016-02-25

    Cavernous haemangiomas are the most common tumour of the liver; they are benign in nature and have an incidence of up to 7.3% at autopsy. Occasionally, they may cause symptoms necessitating intervention. We report the case of a woman who presented with non-specific abdominal pain and evidence of a giant hepatic haemangioma on abdominal imaging. She underwent selective hepatic arteriography with transcatheter arterial embolisation followed by same-day left hemi-hepatectomy, making an uneventful recovery. We discuss the management of giant hepatic haemangiomas and present same day transcatheter arterial embolisation prior to hepatic resection as a safe and viable treatment strategy in selected cases.

  17. Gastric air contrast: useful adjunct to hepatic artery scintigraphy

    SciTech Connect

    Wahl, R.L.; Ziessman, H.A.; Juni, J.; Lahti, D.

    1984-08-01

    The utility of scintigraphic views obtained after administration of sodium bicarbonate-citric acid-simethicone crystals (E-Z-GAS) for the determination of gastric extrahepatic perfusion was evaluated in 20 technetium-99m macroaggregated albumin hepatic arterial perfusion studies performed in 19 patients. These crystals produce carbon dioxide gas, distend the stomach, and allow better delineation of gastric activity (extrahepatic perfusion to the stomach). Conversely, a lack of change in activity in the left upper quadrant after the effervescent crystals have been ingested suggests no gastric activity (and no extrahepatic perfusion to the stomach). These air-contrast views added useful information in 16 of 20 studies. Air contrast views of the stomach can be extremely helpful in verifying or excluding the diagnosis of gastric extrahepatic perfusion on technetium-99m macroaggregated albumin hepatic arterial perfusion studies.

  18. Hepatic artery reconstruction in living donor liver transplantation from the microsurgeon's point of view.

    PubMed

    Furuta, S; Ikegami, T; Nakazawa, Y; Hashikura, Y; Matsunami, H; Kawasaki, S; Makuuchi, M

    1997-07-01

    Microvascular surgery for the reconstruction of the hepatic artery in living donor liver transplantation is discussed from the microsurgeon's point of view. A refined operative procedure to improve the safety of the anastomosis is described. In living donor liver transplantation, the hepatic artery of the graft is short and small, the operative site is deep and mobile, and the anatomic arrangement of the graft left hepatic artery may differ from that of the recipient's dilated hepatic artery. To create a safe anastomosis under these conditions, recipient arteries that were slightly smaller than the graft artery were dissected. Without the size discrepancy, and end-to-end anastomosis could be created. Some refinements to create a good operative field made the anastomosis easy. The apparatus and techniques used in free-flap transfer facilitated a clean anastomosis. We anastomosed 44 arteries in 40 patients undergoing living donor liver transplantation using microsurgical techniques. Neither a decrease in the arterial blood flow nor hepatic artery thrombosis was noted. The refined operative procedure we describe in this report can be used to overcome the problems associated with the hepatic artery anastomosis in living donor liver transplantation.

  19. Congenital hepatic artery aneurysm simulating pancreatic carcinoma

    SciTech Connect

    Gavin, P.M.; Matalon, T.A.S.; Petasnick, J.P.; Roseman, D.L.

    1984-09-01

    The authors report a case of a hepatic artery aneurysm that simulated a mass in the head of the pancreas. The correct diagnosis was made preoperatively based on several findings: curvilinear calcification within the mass on CT, a well-defined crystic collection on ultrasound, absence of biliary duct dilatation or jaundice, and a presence of other aneurysms.

  20. Transcatheter Arterial Embolization Alone for Giant Hepatic Hemangioma

    PubMed Central

    Zhang, Yue-Lin; Zhou, Guan-Hui; Ai, Jing; Zhou, Tan-Yang; Zhu, Tong-Yin; Zhang, Ai-Bin; Wang, Wei-Lin; Zheng, Shu-Sen

    2015-01-01

    Giant hepatic hemangioma is a benign liver condition that may be treated using surgery. We studied the digital subtraction angiographic (DSA) characteristics of giant hepatic hemangioma, and the effectiveness of transcatheter arterial embolization (TAE) alone for its treatment. This was a retrospective study of 27 patients diagnosed with giant hepatic hemangioma and treated with TAE alone (using lipiodol mixed with pingyangmycin) at the Division of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University, between January 2010 and March 2013. The feeding arteries were identified using DSA. All patients were followed up for between three weeks and 12 months. Changes in tumor diameter and symptoms were observed. The 27 patients included had giant hepatic hemangiomas ranging from 5.3 to 24.5 cm (mean, 11.24±5.08 cm) in the right (n = 13), left (n = 1) or both (n = 13) lobes. Preoperative hepatic angiography showed multiple abnormal vascular lakes in the early phase, known as the “early leaving but late returning, hanging nut on a twig” sign. On the day after TAE, hepatic transaminase levels were increased (ALT: 22.69±17.95 to 94.88±210.32 U/L; ALT: 24.00±12.37 to 99.70±211.54 U/L; both P<0.05), but not total bilirubin. Six patients complained of abdominal pain, and 12 experienced transient fever. In the months after TAE, tumor size decreased (baseline: 11.24±5.08; 3 months: 8.95±4.33; 6 months: 7.60±3.90 cm; P<0.05), and the patients’ condition improved. These results indicated that TAE was effective and safe for treating giant hepatic hemangioma. TAE may be a useful alternative to surgery for the treatment of hepatic hemangioma. PMID:26287964

  1. Anatomical variation of celiac axis, superior mesenteric artery, and hepatic artery: Evaluation with multidetector computed tomography angiography

    PubMed Central

    Farghadani, Maryam; Momeni, Mohammad; Hekmatnia, Ali; Momeni, Fateme; Baradaran Mahdavi, Mohammad Mehdi

    2016-01-01

    Background: The celiac axis, superior mesenteric artery (SMA), and hepatic artery are the most important branches of abdominal aorta due to their vascularization field. The aim of our study was to evaluate the prevalence of different anatomical variation of celiac axis, SMA, hepatic artery, and its branches with multidetector computed tomography (MDCT) angiography of upper abdomen arteries. Materials and Methods: MDCT of 607 kidney donor and traumatic patients that referred to MDCT unit at Al Zahra Hospital in Isfahan from 2012 to 2015 were retrospectively evaluated. We excluded patients with history of abdominal vascular surgery and hepatic or pancreatic surgery. Computed tomography images of the patient were obtained with 64-row MDCT scanner and anatomical variations were analyzed. Results: Three hundred and eighty-eight (63.9%) of the 607 patients had classic arterial anatomy and 219 (36.1%) patients had variant types. The most common type of variation was the origin of the right hepatic artery (RHA) from SMA (9.6%), and the next common variation was the origin of the left hepatic artery (LHA) from the left gastric artery (6.9%). Variations in the origin of the common hepatic artery (CHA) were seen in 16 (2.6%) patients. Buhler arc was identified in two patients. The RHA originated from the celiac axis in 11 (1.8%) patients and from the aorta in 8 (1.3%) patients. Trifurcation of CHA into gastroduodenal artery, RHA, and LHA was detected in 11 (1.8%) patients. Conclusion: The results of the present study showed that anatomical variation occurs in a high percentage of patients. Detection of these variations can guide surgical and radiological interventional planning.

  2. Anomalous origin of left coronary artery from pulmonary artery. Surgical considerations in the adult.

    PubMed

    Barrand, K G; Brooksby, I A; Webb-Peploe, M M; Braimbridge, M V

    1975-04-01

    The usually recommended treatment for anomalous origin of a left coronary artery from the pulmonary artery is proximal ligation of the anomalous artery with a saphenous vein bypass graft to restore aortocoronary continuity. In an adult patient with large collateral vessels and with the left coronary artery arising from the back of the pulmonary artery, the technical surgical problems associated with this procedure are formidable. Closure of the orifice of the anomalous left coronary artery from inside the pulmonary artery is suggested as the treatment of choice in such a case.

  3. Disposal of replaced common hepatic artery coursing within the pancreas during pancreatoduodenectomy: report of a case.

    PubMed

    Yamamoto, Satoshi; Kubota, Keiichi; Rokkaku, Kyu; Nemoto, Takehiko; Sakuma, Atsushi

    2005-01-01

    A replaced common hepatic artery (RCHA) originating from the superior mesenteric artery (SMA) is a rare anomaly. We herein report such a case in a 62-year-old man who was scheduled to undergo a pancreatoduodenectomy for lower bile duct cancer. Computed tomography (CT) showed the RCHA to run along the ventral side of the pancreas. Abdominal angiography showed an RCHA originating from the SMA, which communicated with an aberrant left hepatic artery from the left gastric artery. No gastroduodenal artery was observed, but instead a direct ramification of a right gastroepiploic artery was seen. Similar cases from the English literature were reviewed. The RCHA was confirmed to course first along the ventral side of, and then within, the pancreas. Clamping of the RCHA did not influence the arterial flow in the liver, and the RCHA was subsequently divided without reconstruction. In three of the five reviewed cases in which the RCHA coursed either within or along the ventral side of the pancreas, no gastroduodenal artery was found, but instead a direct ramification of a right gastroepiploic artery was observed. A combination of CT and angiographic findings can help in both the diagnosis of an anomalous RCHA coursing either within or along the ventral side of the pancreas as well as in selecting optimal operative procedures. Pancreatoduodenectomy was performed with a curative resection according to our usual practice except for the fact that we preserved the aberrant left hepatic artery.

  4. Traumatic pseudoaneurysm of left internal mammary artery graft.

    PubMed

    Agathos, E A; Hussein, A; Trehan, H; Trenholme, S E; Floten, H S

    1993-10-01

    Traumatic pseudoaneurysm of the left internal mammary artery was recognized as a possible causal factor in the early recurrence of angina in a 51-year-old man. This patient underwent reoperation for revascularization with the left internal mammary artery graft in situ.

  5. Left atrial myxoma associated with obstructive coronary artery disease.

    PubMed

    Gismondi, Ronaldo Altenburg Odebrecht Curi; Kaufman, Renato; Correa, Gabriel Angelo de Cata Preta; Nascimento, César; Weitzel, Luiz Henrique; Reis, José Oscar Brito; da Rocha, Antônio Sérgio Cordeiro; da Cunha, Ademir Batista

    2007-01-01

    We describe a case of a 67 year-old patient with obstructive coronary artery disease that, in the preoperative survey for inguinal herniorraphy surgery, discovered, by a two-dimensional echocardiogram, a tumor in left atrium, mobile, non-obstructive. The patient underwent a cineangiocoronariography showing severe stenosis in the left anterior descending artery, moderate stenosis in the left circumflex artery, near the origin of the first marginal branch, and a non-obstructive plaque in the right coronary artery. There was also moderate left ventricular dysfunction. After that, the patient has gone coronary artery bypass surgery and resection of the left atrial tumor. The histological exam revealed that the tumor was, in fact, a myxoma.

  6. First jejunal artery, an alternative graft for right hepatic artery reconstruction.

    PubMed

    Aryal, Bibek; Komokata, Teruo; Kadono, Jun; Motodaka, Hiroyuki; Ueno, Tetsuya; Furoi, Akira; Imoto, Yutaka

    2015-04-08

    Common bile duct cancer invading right hepatic artery is sometimes diagnosed intraoperatively. Excision and safe reconstruction of the artery with suitable graft is essential. Arterial reconstruction with autologous saphenous vein graft is the preferred method practiced routinely. However the right hepatic artery reconstruction has also been carried out with several other vessels like gastroduodenal artery, right gastroepiploic artery or the splenic artery. We report a case of 63-year-old man presenting with history of progressive jaundice, pruritus and impaired appetite. Following various imaging modalities including computed tomography, endoscopic retrograde cholangiopancreatography, magnetic resonance cholangiopancreatography, intraductal ultrasound extrahepatic bile duct cancer was diagnosed; however, none of those detected vessel invasion. Intraoperatively, right hepatic artery invasion was revealed. Right hepatic artery was resected and reconstructed with a graft harvested from the first jejunal artery (JA). Postoperative outcome was satisfactory with a long-term graft patency. First JA can be a reliable graft option for right hepatic artery reconstruction.

  7. Abnormal origin of the left subclavian artery from the left pulmonary artery in a patient with double outlet right ventricle.

    PubMed

    Lee, Youngok; Hong, Seong Wook

    2014-02-01

    Anomalous aortic origin of the left subclavian artery (LSCA) from the left pulmonary artery (LPA) is a rare congenital cardiac malformation. We describe a case of LSCA from the LPA via ductus arteriosus in association with a double-outlet right ventricle, which never has been reported previously in Korea.

  8. Management of early hepatic arterial thrombosis after pediatric living-donor liver transplantation.

    PubMed

    Sevmis, S; Karakayali, H; Tutar, N U; Boyvat, F; Ozcay, F; Torgay, A; Haberal, M

    2011-03-01

    Early hepatic arterial thrombosis after living-donor liver transplantation is a cause of graft loss and patient mortality. We analyzed early hepatic arterial thrombosis after pediatric living-donor liver transplantation. Since September 2001, we performed 122 living-donor liver transplants on 119 children. Ten hepatic arterial thromboses developed in the early postoperative period. The 7 male and 4 female patients of overall mean age of 6.3±6.1 years underwent 5 left lateral segment, 3 right lobe, and 2 left lobe transplantations. Among 10 children with hepatic arterial thrombosis, 8 diagnoses were made before any elevation of liver function tests. One child displayed fever at the time of the hepatic arterial thrombosis. The median time for diagnosis was 5 days. Hepatic arterial thrombosis was treated with interventional radiologic techniques in 9 children, with 1 undergoing surgical exploration owing to failed radiologic approaches, and a reanastomosis using a polytetrafluoroethylene graft. Successful revascularization was achieved in all children, except 1. Four children died, the remaining 6 are alive with good graft function. During the mean follow-up of 52.7±18.8 months, multiple intrahepatic biliary stenoses were identified in 1 child. Routine Doppler ultrasonography is effective for the early diagnosis of hepatic arterial thrombosis. Interventional radiologic approaches such as arterial thrombolysis and intraluminal stent placement should be the first therapeutic choices for patients with early hepatic arterial thrombosis; if radiologic methods fail, one must consider surgical exploration or retransplantation. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Anomalous origin of the left subclavian artery from the pulmonary artery.

    PubMed

    Ugurlucan, Murat; Arslan, Ahmet Hulisi; Besikci, Resmiye Tore; Karadeniz, Oktay; Ay, Sibel; Yildiz, Yahya; Cicek, Sertac

    2014-02-01

    Isolated left subclavian artery from the pulmonary trunk is a rare congenital cardiovascular malformation. In this report, we present the images of ascending aortic aneurysm and left subclavian artery originating from the pulmonary artery in a 4-year-old girl in addition to her congenital cardiac pathology.

  10. The hepatic artery in orthotopic liver transplantation

    PubMed Central

    Lerut, J. P.; Gordon, R. D.; Tzakis, A. G.; Stieber, A. C.; Iwatsuki, S.; Starzl, T. E.

    2011-01-01

    Summary Hepatic artery thrombosis (HAT) is a dreadful complication of orthotopic liver transplantation (OLT). This complication occurred in 27 grafts (68% = 27/393 grafts) in 25 patients (9% = 25/313 patients). HAT was responsible for a high mortality (64% = 16/25 patients) despite a high retransplantation rate (70% = 19/27 grafts). HAT should be suspected in case of fulminant liver failure, delayed bile leak or unexplained fever of sepsis of unknown etiology occurring after liver transplantation. Pulsed doppler examination and arteriogram are the decisive diagnostic procedures. Patients presenting HAT can only be rescued by early diagnosis and retransplantation. Aneurysms of the hepatic arterial supply must also be treated urgently, either by conventional vascular repair if possible or by retransplantation, because or the high incidence of fatal rupture (3/4 patients = 75%). PMID:3049463

  11. Accessory left gastric artery aneurysms in granulomatosis with polyangiitis: a case report and literature review

    PubMed Central

    Tomosugi,, Toshihide; Takahashi, Takuji; Kawase, Yoshihisa; Yoshida, Koichi; Hayashi, Shogo; Sugiyama, Takefumi; Shimizu, Mitsuya; Shoka, Michita; Sawaki, Kohichi; Onishi, Eiji; Hayashi, Naomi; Matsushita, Hidenobu; Okochi, Osamu

    2017-01-01

    ABSTRACT Aneurysm formation is a potential complication of granulomatosis with polyangiitis (GPA), previously known as Wegener’s granulomatosis. It is a very rare complication, but immediate diagnosis and therapy should be performed because an aneurysm can be life-threatening if it ruptures. An accessory left gastric artery (ALGA) is also a rare variant gastric artery that may obtain its blood supply from the left hepatic artery and left gastric artery. We herein describe a 57-year-old Japanese man who was diagnosed with GPA complicated by aneurysm rupture in an ALGA. Emergency surgery was performed after failure of arterial coil embolization to interrupt blood flow in the ALGA. The patient underwent partial resection of the lesser omentum, which contained all aneurysms. During partial resection of the lesser omentum, both the left gastric artery and ALGA were ligated because they were thought to be feeders of the aneurysms. Postoperative recovery was uneventful; no bleeding or recurrence of the aneurysms occurred. Immediate diagnosis and therapy should be performed for patients with GPA with symptoms of vascular ischemia or aortitis. Endovascular intervention is the first-choice therapy especially for hemodynamically stable patients with ruptured aneurysms or aneurysms located on variant arteries, which may have multiple blood supplies. In the present case, although endovascular treatment failed, the approach described herein was helpful during open surgery. PMID:28303064

  12. Aberrant hepatic arteries running through pancreatic parenchyma encountered during pancreatoduodenectomy

    PubMed Central

    Wang, Lei; Xu, Jianwei; Sun, Dong; Zhang, Zongli

    2016-01-01

    Abstract Background: Aberrant hepatic arteries (HAs) encountered during pancreatoduodenectomy are difficult to manage. Mehtods: Two cases with rare types of aberrant HA running through the pancreatic parenchyma were reviewed. Results: The first case, a 68-year-old man, was admitted with obstructive jaundice. A tumor of the pancreatic head and aberrant HAs were suspected on computed tomography (CT) scan. At laparotomy, a new variation was identified; namely, 2 aberrant arteries—a right replaced HA and middle HA (RMHA) that both originated from the superior mesenteric artery (SMA) and ran via intrapancreatic paths posterior and anterior to the pancreatic head, respectively. Branches of the RMHA to the pancreas were ligated and severed and the trunk preserved. The RMHA was mistakenly identified as an aberrant left HA (RLHA), whereas the RLHA was overlooked and not dissected intraoperatively. CT angiography performed 11 days postoperatively identified that the RLHA originated from the left gastric artery (LGA). The second case had a variation of Michels IX. A 58-year-old woman presented with obstructive jaundice and a distal cholangiocarcinoma was suspected on the basis of enhanced CT scan. At laparotomy, the common hepatic artery (CHA) was found to originate entirely from the SMA and run posterior to the pancreatic head via an intrapancreatic path. The segment of CHA in the pancreatic parenchyma was removed and reconstructed with the LGA. Conclusions: Preoperative identification of aberrant HAs helps in planning appropriate operative procedures and minimizing unnecessary complications. Both preservation and reconstruction of these arteries are technically safe and feasible; however, preservation is preferable. PMID:27930504

  13. Absence of left circumflex with superdominant right coronary artery

    PubMed Central

    Quijada-Fumero, Alejandro; Pimienta-González, Raquel; Rodriguez-Esteban, Marcos

    2014-01-01

    Congenital anomalies of coronary arteries are a group of diseases that are infrequently found. Their prevalence has been reported from 0.6% to 1.3%. Most clinical manifestations are benign and asymptomatic. Congenital absence of the left circumflex artery is a very rare congenital anomaly of the coronary circulation, and only a few cases have been reported in the literature. We report a case of a 51-year-old man who underwent a cardiac catheterisation. Coronary angiography showed a left anterior descending coronary artery with no circumflex and a dominant right coronary artery. PMID:25535241

  14. [Liver transplantation: anomalies of the hepatic artery and the liver in 80 donors].

    PubMed

    Chaib, E

    1993-01-01

    The author has studied the main hepatic artery (HA) alterations and liver related disease (LRD) in 80 donors. The normal arterial anatomy with a single HA arising from the celiac trunk was seen in 61% of cases; a left hepatic artery (LHA) off left gastric artery (LGA) in 19% of cases and a right hepatic artery (RHA) arising from superior mesenteric artery (SMA) in 15% of cases. Two rare anomalies: an HA off anastomosis connecting celiac trunk to SMA and a LHA off LGA around the esophagus. A case of absence of celiac artery and the splenic artery (SA) was found arising directly from the aorta, and another one the SM arose from RHA. Six livers were turned down: 3 by cholecystitis, 2 by preoperative hypoxia and 1 by hepatic polycystic disease. Steatosis and hemangioma have been among the others LRD. In conclusion, HA and LRD have occurred in approximately 50% of donors, this fact underline the importance of searching the anomalies of the HA and LRD during the organ retrieval.

  15. Aberrant Left Inferior Bronchial Artery Originating from the Left Gastric Artery in a Patient with Acute Massive Hemoptysis

    SciTech Connect

    Jiang, Sen Sun, Xi-Wen Yu, Dong Jie, Bing

    2013-10-15

    Massive hemoptysis is a life-threatening condition, and the major source of bleeding in this condition is the bronchial circulation. Bronchial artery embolization is a safe and effective treatment for controlling hemoptysis. However, the sites of origin of the bronchial arteries (BAs) have numerous anatomical variations, which can result in a technical challenge to identify a bleeding artery. We present a rare case of a left inferior BA that originated from the left gastric artery in a patient with recurrent massive hemoptysis caused by bronchiectasis. The aberrant BA was embolized, and hemoptysis has been controlled for 8 months.

  16. Left circumflex artery aneurysm: the end-to-end reconstruction.

    PubMed

    Cuttone, Fabio; Guilbeau-Frugier, Céline; Roncalli, Jérome; Glock, Yves

    2015-08-01

    This report describes a surgical myocardial revascularization procedure for a huge, atherosclerotic left circumflex coronary artery aneurysm. The technique proposed in this paper is based on the isolation of the aneurysm followed by the aneurysmectomy and a complete reconstruction of the circumflex artery by an end-to-end anastomosis.

  17. Left coronary artery stenosis causing left ventricular dysfunction in two children with supravalvular aortic stenosis.

    PubMed

    Yildiz, Okan; Altin, Firat H; Kaya, Mehmet; Ozyılmaz, Isa; Guzeltas, Alper; Erek, Ersin

    2015-04-01

    Congenital supravalvar aortic stenosis (SVAS) is an arteriopathy associated with Williams-Beuren syndrome (WBS) and other isolated elastin gene deletions. Cardiovascular manifestations associated with WBS are characterized by obstructive arterial lesions such as SVAS and pulmonary artery stenosis in addition to bicuspid aortic valve and mitral valve prolapse. However, coronary artery ostial stenosis may be associated with SVAS, and it increases the risk of sudden death and may complicate surgical management. In this report, we present our experience with two patients having SVAS and left coronary artery ostial stenosis with associated left ventricular dysfunction. © The Author(s) 2014.

  18. Impact of arterial stiffening on left ventricular structure.

    PubMed

    Roman, M J; Ganau, A; Saba, P S; Pini, R; Pickering, T G; Devereux, R B

    2000-10-01

    Aging of the vasculature results in arterial stiffening and an increase in systolic and pulse pressures. Although pressure load is a stimulus for left ventricular hypertrophy, the extent to which vascular stiffening per se, independent of blood pressure, influences left ventricular structure is uncertain. Two hundred seventy-six subjects (79 normotensive and 197 otherwise healthy hypertensive individuals) underwent echocardiography to assess left ventricular structure. Arterial stiffness was estimated by the pressure-independent stiffness index, beta, and the pressure-dependent elastic modulus derived from simultaneous carotid ultrasound and applanation tonometry. Systemic arterial compliance (the inverse of stiffness) was estimated by the arterial compliance index. In multivariate analysis, beta was related to age (P<0.001) and smoking history (P<0.01) but not mean pressure, whereas elastic modulus was related to age and mean pressure (both P<0.001). The arterial compliance index was only related to age. Whereas systolic and diastolic pressures and the elastic modulus were positively associated with left ventricular mass (all P<0.001), primarily because of increases in wall thicknesses, beta and the arterial compliance index bore no relation to left ventricular mass. beta was inversely related to chamber diameter and directly related to left ventricular relative wall thickness, the ratio of wall thickness to chamber radius. Younger and older hypertensive subjects had comparable left ventricular mass, despite higher systolic and pulse pressures in the older group, whereas older hypertensives had higher mean relative wall thickness, associated with a significant increase in arterial stiffness (beta, 7.06 versus 5.17; elastic modulus, 595 versus 437 dyne/cm(2) x10(-6)) and reduction in the arterial compliance index (0.87 versus 1.05 mL/mm Hg per square meter) (all P<0.001). Thus, the extent to which arterial stiffness relates to left ventricular hypertrophy is

  19. Gastrointestinal bleeding and obstructive jaundice: Think of hepatic artery aneurysm

    PubMed Central

    Vultaggio, Fabrice; Morère, Pierre-Henri; Constantin, Christophe; Christodoulou, Michel; Roulin, Didier

    2016-01-01

    Hemobilia is an uncommon and potential life-threatening condition mainly due to hepato-biliary tree traumatic or iatrogenic injuries. Spontaneously ruptured aneurysm of the hepatic artery is seldom described. We report the case of an 89-year-old woman presenting with abdominal pain, jaundice and gastrointestinal bleeding, whose ultrasound and computed tomography revealed a non-traumatic, spontaneous aneurysm of the right hepatic artery. The oeso-gastro-duodenoscopy and colonoscopy did not reveal any bleeding at the ampulla of Vater, nor anywhere else. Selective angiography confirmed the diagnosis of hepatic artery aneurysm and revealed a full hepatic artery originating from the superior mesenteric artery. The patient was successfully treated by selective embolization of microcoils. We discuss the etiologies of hemobilia and its treatment with selective embolization, which remains favored over surgical treatment. Although aneurysm of the hepatic artery is rare, especially without trauma, a high index of suspicion is needed in order to ensure appropriate treatment. PMID:27358680

  20. Impact of Multislice CT Angiography on Planning of Radiological Catheter Placement for Hepatic Arterial Infusion Chemotherapy

    SciTech Connect

    Sone, Miyuki Kato, Kenichi; Hirose, Atsuo; Nakasato, Tatsuhiko; Tomabechi, Makiko; Ehara, Shigeru; Hanari, Takao

    2008-01-15

    The objective of this study was to assess prospectively the role of multislice CT angiography (MSCTA) on planning of radiological catheter placement for hepatic arterial infusion chemotherapy (HAIC). Forty-six patients with malignant liver tumors planned for HAIC were included. In each patient, both MSCTA and intra-arterial digital subtraction angiography (DSA) were performed, except one patient who did not undergo DSA. Comparison of MSCTA and DSA images was performed for the remaining 45 patients. Detectability of anatomical variants of the hepatic artery, course of the celiac trunk, visualization scores of arterial branches and interobserver agreement, presence of arterial stenosis, and technical outcome were evaluated. Anatomical variations of the hepatic artery were detected in 19 of 45 patients (42%) on both modalities. The course of the celiac trunk was different in 12 patients. The visualization scores of celiac arterial branches on MSCTA/DSA were 3.0 {+-} 0/2.9 {+-} 0.2 in the celiac trunk, 3.0 {+-} 0/2.9 {+-} 0.3 in the common hepatic artery, 2.9 {+-} 0.2/2.9 {+-} 0.3 in the proper hepatic artery, 2.9 {+-} 0.3/2.9 {+-} 0.4 in the right hepatic artery, 2.8 {+-} 0.4/2.9 {+-} 0.4 in the left hepatic artery, 2.9 {+-} 0.2/2.9 {+-} 0.3 in the gastroduodenal artery, 2.1 {+-} 0.8/2.2 {+-} 0.9 in the right gastric artery, and 2.7 {+-} 0.8/2.6 {+-} 0.8 in the left gastric artery. No statistically significant differences exist between the two modalities. Interobserver agreement for MSCTA was equivalent to that for DSA. Two patients showed stenosis of the celiac trunk on both modalities. Based on these imaging findings, technical success was accomplished in all patients. In conclusion, MSCTA is accurate in assessing arterial anatomy and abnormalities. MSCTA can provide adequate information for planning of radiological catheter placement for HAIC.

  1. Impact of multislice CT angiography on planning of radiological catheter placement for hepatic arterial infusion chemotherapy.

    PubMed

    Sone, Miyuki; Kato, Kenichi; Hirose, Atsuo; Nakasato, Tatsuhiko; Tomabechi, Makiko; Ehara, Shigeru; Hanari, Takao

    2008-01-01

    The objective of this study was to assess prospectively the role of multislice CT angiography (MSCTA) on planning of radiological catheter placement for hepatic arterial infusion chemotherapy (HAIC). Forty-six patients with malignant liver tumors planned for HAIC were included. In each patient, both MSCTA and intra-arterial digital subtraction angiography (DSA) were performed, except one patient who did not undergo DSA. Comparison of MSCTA and DSA images was performed for the remaining 45 patients. Detectability of anatomical variants of the hepatic artery, course of the celiac trunk, visualization scores of arterial branches and interobserver agreement, presence of arterial stenosis, and technical outcome were evaluated. Anatomical variations of the hepatic artery were detected in 19 of 45 patients (42%) on both modalities. The course of the celiac trunk was different in 12 patients. The visualization scores of celiac arterial branches on MSCTA/DSA were 3.0 +/- 0/2.9 +/- 0.2 in the celiac trunk, 3.0 +/- 0/2.9 +/- 0.3 in the common hepatic artery, 2.9 +/- 0.2/2.9 +/- 0.3 in the proper hepatic artery, 2.9 +/- 0.3/2.9 +/- 0.4 in the right hepatic artery, 2.8 +/- 0.4/2.9 +/- 0.4 in the left hepatic artery, 2.9 +/- 0.2/2.9 +/- 0.3 in the gastroduodenal artery, 2.1 +/- 0.8/2.2 +/- 0.9 in the right gastric artery, and 2.7 +/- 0.8/2.6 +/- 0.8 in the left gastric artery. No statistically significant differences exist between the two modalities. Interobserver agreement for MSCTA was equivalent to that for DSA. Two patients showed stenosis of the celiac trunk on both modalities. Based on these imaging findings, technical success was accomplished in all patients. In conclusion, MSCTA is accurate in assessing arterial anatomy and abnormalities. MSCTA can provide adequate information for planning of radiological catheter placement for HAIC.

  2. Left pulmonary artery hypoplasia presenting with unilateral hyperluscent lung.

    PubMed

    Sunavala, A J; Thacker, H P; Khann, J N

    2011-03-01

    Agenesis or hypoplasia of the right or left pulmonary arteries are among the rarest pulmonary artery anomalies with left sided anomalies being reported even less frequently. Pulmonary artery agenesis should be suspected in asymptomatic patients if a plain chest X-ray shows asymmetric lung fields, lung hypoplasia, or hyperinflation of the contralateral lung. It must be considered as a rare cause of recurrent lower respiratory tract infections in childhood and in subjects with a low threshold for or recurrent "High Altitude Pulmonary Edema".

  3. Total occlusion of left main coronary artery without angina pectoris.

    PubMed

    DePace, N L; Kimbiris, D; Iskandrian, A S; Bemis, C E; Segal, B L

    1983-05-01

    A patient had total occlusion of the left main coronary artery that was proved by coronary arteriography. The patient was initially seen with clinical signs of congestive heart failure but without symptoms of angina pectoris or ECG evidence of myocardial infarction. The patient's extensive right-to-left coronary artery collaterals may have contributed to the absence of chest pain. Because of the severe left ventricular dysfunction and the absence of chest pain, the patient was treated with medical therapy. Six months after the cardiac catheterization, he was alive and well under New York Heart Association functional classification II.

  4. Successful Angioplasty of Left Vertebral Artery and Right Subclavian Artery Via Retrograde Approach

    PubMed Central

    Namazi, Mohammad Hasan; Momenizadeh, Amir; Dousti, Amir; Naderian, Mohammadreza

    2017-01-01

    We describe a 77-year-old male who had right upper limb ischemic symptoms and history of unsuccessful right subclavian artery angioplasty. According to ultrasound findings, upper limb angiography was performed which confirmed stenosis of the left vertebral and right subclavian arteries. Percutaneous angioplasty and stenting of left vertebral and right subclavian arteries were performed in two separate sessions. Retrograde approach was scheduled for right subclavian artery angioplasty which is challenging due to potential risks to adjacent vertebral artery. This case reports underscores that percutaneous approaches may be preferential given their confirmed long-term efficacy and lower morbidity.

  5. Contrast Media Delivery in the Assessment of Anomalous Left Coronary Artery From the Pulmonary Artery.

    PubMed

    Saade, Charbel; Al-Hamra, Salam; Al-Mohiy, Hussain; El-Merhi, Fadi

    2016-05-01

    A patient with a history of mitral valve prolapse and regurgitation that was corrected with a mitral ring repair 15 years earlier received a diagnosis of anomalous left coronary artery arising from the pulmonary artery and underwent repair. Coronary computed tomography angiography (CTA) was employed to image the patient before surgical intervention. Synchronizing contrast media administration to opacify the right coronary artery in the arterial phase and the left coronary artery in the venous phase required a test-bolus approach. Matching compromised cardiovascular dynamics with patient-specific contrast media administration protocols was improved considerably with the use of a test-bolus technique during electrocardiography-gated coronary CTA.

  6. Anomalous Origin of the Left Coronary Artery From the Pulmonary Artery

    PubMed Central

    Gangadharan, Venkat; Sivagnanam, Kamesh; Murtaza, Ghulam; Ponders, Michael; Teixeira, Otto; Paul, Timir

    2017-01-01

    A 36-year-old woman was seen with complaints of exertional chest pain and shortness of breath. Her medical history included atrial fibrillation and diabetes. Physical examination was unremarkable except for an irregular cardiac rhythm. Myocardial perfusion imaging revealed the presence of a large area of infarction involving the entire anterior and apical walls and part of the anteroseptal wall with minimal periinfarct ischemia. Computed tomography coronary angiogram revealed an anomalous left main coronary artery arising from the main pulmonary artery. Right and left heart catheterizations demonstrated moderate pulmonary hypertension with a slight step-up in oxygen saturation between the right ventricle and main pulmonary artery. Coronary angiography showed a large tortuous right coronary artery with collaterals to the left anterior descending artery that drained into the main pulmonary artery. She was referred for surgery. This case demonstrates a rare coronary artery anomaly in an adult where survival is dependent on collateral circulation. PMID:28210637

  7. Ultrasound diagnosis of pulmonary sling with proximal stenosis of left pulmonary artery and patent arterial duct.

    PubMed

    Mądry, Wojciech; Karolczak, Maciej A

    2013-03-01

    Authors discuss methods of echocardiographic diagnosis of the pulmonary sling with stenosis and hypoplasia of the left pulmonary artery and patent arterial duct with massive left-to-right shunt, based on a case of the newborn with resistant to treatment heart failure, with initial diagnosis of patent ductus arteriosus, referred to surgical treatment. The optimal echocardiographic views permitting establish diagnosis of the pulmonary sling were suggested. The special attention was paid to high parasternal and suprasternal views visualizing vessels of the upper mediastinum as well as characteristic differences between the normal and pathologic picture. The typical features of the echocardiogram suggesting pulmonary sling, like the lack of the left pulmonary artery in its expected position, and the abnormal branching pattern of the right pulmonary artery were indicated. The greatest diagnostic difficulties in visualization of the abnormal route of the left pulmonary artery were related to the presence of air-containing tissues, like lungs and central airways between the ultrasound probe and area of interest. The other was the masking influence of the large patent arterial duct, that may mimic the left pulmonary artery arising from the pulmonary trunk. The other entities requiring differentiation with sling, like aplasia of the left lung, the direct or indirect aortic origin of the left pulmonary artery, were discussed. The role of other visualization technics, like computed 3D tomography, and magnetic nuclear resonance, as well as direct visualization of central airways with bronchoscopy in establishing precise diagnosis were stressed.

  8. Rare multiple fistulas with large saccular aneurysms originating from left anterior descending artery and left main coronary artery.

    PubMed

    Emre, Ender; Aktas, Mujdat; Sahin, Tayfun; Ural, Ertan; Ural, Dilek

    2014-12-16

    A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment.

  9. Rare multiple fistulas with large saccular aneurysms originating from left anterior descending artery and left main coronary artery

    PubMed Central

    Emre, Ender; Aktas, Mujdat; Sahin, Tayfun; Ural, Ertan; Ural, Dilek

    2014-01-01

    A 49-year-old female patient consulted us for a cardiac evaluation before undergoing colon adenocarcinoma surgery. Three years prior, the patient underwent coronary angiography for dyspnea. The coronary angiography examination revealed a fistula originating from the left anterior descending artery and left main coronary artery, which had soft aneurysmal sacs and most likely drained into the pulmonary artery. Parasternal short axis echocardiography revealed a color flow that could be related to the fistula, but the other echocardiographic findings were normal. The patient did not accept the proposed examination and invasive treatment. PMID:25516873

  10. Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection

    PubMed Central

    Hako, René; Fedačko, Ján; Morochovič, Radoslav; Kristian, Pavol; Pekárová, Tímea; Tuomainen, Petri; Pella, Daniel

    2017-01-01

    Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension. PMID:28154579

  11. Abnormal right hepatic artery injury resulting in right hepatic atrophy: diagnosed by laparoscopic cholecystectomy

    PubMed Central

    Martino, Valter; Ferrarese, Alessia; Bindi, Marco; Marola, Silvia; Gentile, Valentina; Rivelli, Matteo; Ferrara, Yuri; Enrico, Stefano; Berti, Stefano; Solej, Mario

    2015-01-01

    An intact hepatic artery is the gateway to successful hepato-biliary surgery. Introduction of laproscopic cholecystectomy (LC) has stimulated a renewed interest in the anatomy of hepatic artery. In this case report we have highlighted importance of variations of right hepatic artery in terms of origin and course We present a rare asymptomatic case of liver atrophy due to an intraoperative lesion of right hepatic artery. We also performed a literature review about surgical vascular lesions and tried to confirm the right concept behind “non trivial procedure” of the LC. PMID:28352750

  12. Asymptomatic anomalous origin of left anterior descending artery from the pulmonary artery and multiple atherosclerotic stenoses revealed by silent ischaemia.

    PubMed

    Murat, Gurbuz; Cellier, François; Leobon, Bertand; Boudou, Nicolas

    2015-02-01

    Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital disease responsible for a high mortality rate in childhood. Here, we report for the first time the case of an asymptomatic 61-year old patient showing a combination of anomalous origin of the left anterior descending artery from pulmonary artery and atherosclerotic stenosis in both the right coronary artery and the left circumflex artery without anomalous origin.

  13. Hepatic artery reinforcement after post pancreatectomy haemorrhage caused by pancreatitis

    PubMed Central

    Merdrignac, Aude; Bergeat, Damien; Levi Sandri, Giovanni Battista; Agus, Marina; Boudjema, Karim; Sulpice, Laurent

    2016-01-01

    Post-pancreatectomy hemorrhage (PPH) is a major complication occurring in 6–8% of patients after pancreaticoduodenectomy (PD). Arterial bleeding is the most frequent cause. Mortality rate could reach 30% after grade C PPH according to ISGPS classification. Complete interruption of hepatic arterial flow has to be a salvage procedure because of the high risk of intrahepatic abscess following the procedure. We report a technique to perform an artery reinforcement after PPH caused by pancreatitis. A PD according to Whipple’s procedure with child’s reconstruction was performed in a 68-year-old man. At postoperative day 12, the patient presented a sudden violent abdominal pain with arterial hypotension and tachycardia. Computed tomography (CT) with intravenous contrast injection was performed. Arterial and venous phases showed a contrast extravasation on the hepatic artery. Origin of PPH was found as an erosion of hepatic artery caused by pancreatic leak. A peritoneal patch was placed around hepatic artery to reinforce damaged arterial wall. The peritoneal patch was harvested from right hypochondrium with a thin preperitoneal fat layer. The patch was sutured around hepatic artery with musculoaponeurotic face placed on the arterial wall. A CT was performed and hepatic artery was permeable with normal caliber in the portion of peritoneal patch reinforcement. The technique described in the present case consists in reinforcing directly arterial wall after occurrence of PPH. The use of a peritoneal patch during pancreatic surgery has first been described to replace a portion of portal vein after venous resection with the peritoneal layer placed on the intraluminal side of the vein. The present case describes a salvage technique to reinforce damaged artery after PPH in context of pancreatic leak. This simple technique could be useful to avoid complex arterial reconstruction and recurrent bleeding in septic context. PMID:27563565

  14. [Gigantic coronary aneurysm arisen from coronary fistula between the left circumflex artery and the left ventricle].

    PubMed

    Uchida, T; Andou, H; Yasutsune, T; Iwai, T; Fukumura, F; Tanaka, J

    2008-12-01

    A 71-year-old male was referred to our hospital due to abnormality detected by a chest roentgenogram. He had no symptoms except for slight chest oppression. He was found to have a giant coronary aneurysm. It was originated from a coronary artery (left circum flex branch) left ventricular fistula. The orifice of this fistula to the left ventricle was also dilated and formed diverticulum. Ligation of the feeding coronary branch, closure of the aneurysmal fistula in the left ventricular wall and aneurysmectomy were performed under cardiopulmonary bypass. Postoperative course was uneventful. A giant aneurysm originated from a coronary-left ventricular fistula was considered to be very rare.

  15. Estimation of specific hepatic arterial water space.

    PubMed

    Sahin, S; Rowland, M

    1998-08-01

    The aim of this study was to estimate the specific arterial water space and associated blood flow using statistical moments of the frequency versus time outflow profile, with a model with specific spaces for hepatic arterial (HA) and portal venous (PV) flows in parallel with a common space. Studies were performed in the in situ dual-perfused rat liver (n = 6-10), using Krebs-bicarbonate buffer with constant PV flow (12 ml/min) and various HA flow rates (3-6 ml/min). An impulse input-output technique was employed, varying the route of input, using [14C]urea as the reference indicator. Regardless of flow conditions, the frequency outflow profile after HA input was flatter and broader and the mean transit time longer than after PV input. Excellent recovery of marker was obtained in all cases. Applying the above model, the specific arterial space was estimated to be 9.7 +/- 2.3 of total water space and receives approximately 17% of the HA flow, with the remainder mixing with portal blood in the common space. The estimated total water content of liver (0.67-0.72 ml/g liver) agrees well with that determined by desiccation (0.72 +/- 0.01 ml/g liver).

  16. [Anomalous left coronary artery origin from the pulmonary artery causing angina: Report of one case].

    PubMed

    Ugalde P, Héctor; Rozas A, Sebastián; Sanhueza F, María Ignacia; Yubini L, María Cecilia; García B, Sebastián

    2017-01-01

    Anomalies of the origin of coronary arteries are detected in 0.5-1.5% of all angiographies. Anomalous origin of the left main trunk is the most uncommon and its origin from pulmonary artery in adults is exceptional, usually because it is associated with a short survival. We report a 49-year-old female, presenting with a two months history of angina. The exercise electrocardiogram suggested ischemia. A coronary angiography was performed, showing the absence of the left main trunk in the left coronary sinus, a dilated right coronary artery, with no lesions and extensive collateral circulation to the anterior descending and circumflex arteries, with inverted flow and the left main trunk draining to the pulmonary artery. The left ventricle was mildly dilated with middle and apical anterior hypokinesia. Global systolic function was conserved. A surgical correction was decided, occluding the left main anomalous origin and performing a coronary artery bypass grafting from the left internal thoracic artery. The patient was discharged with no complications. At two years of follow-up she is symptom free and has a normal physical capacity.

  17. Left subclavian artery revascularization as part of thoracic stent grafting.

    PubMed

    Saouti, Nabil; Hindori, Vikash; Morshuis, William J; Heijmen, Robin H

    2015-01-01

    Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our experience with the surgical technique, indications and the results of LSA revascularization. Between 2000 and 2013, 51 patients of 444 patients who were treated by TEVAR, had LSA revascularization. All elective patients had a preoperative work-up with magnetic resonance angiography to evaluate the circle of Willis. In all, surgical access was through a left supraclavicular incision only. The majority (90%) had prophylactic LSA revascularization because of incomplete circle of Willis and or dominant left vertebral artery (LVA) (n=29), patent left internal mammary artery (n=1), prevention spinal cord ischaemia (SCI) (n=2), prevention left arm ischaemia due to small LVA (n=2) and LVA origin in arch (n=1). Fourteen percent had secondary revascularization, either immediate because of malperfusion of the left arm (n=2) or late after TEVAR because of persisting left arm claudication (n=5). In 12 patients, the following early complications were observed: re-exploration for bleeding, n=1; left recurrent nerve paralysis, n=2; left phrenic nerve paralysis, n=1; left sympathetic chain neuropraxia, resulting in Horner's syndrome, n=3; Chyle duct lesions, resulting in persistent Chyle leakage, n=3. Neither strokes nor SCI was observed. One patient experienced occlusion of the bypass at 6 months. The present study shows that the procedure of LSA revascularization as part of TEVAR is safe with low morbidity consisting of mainly (transient) nerve palsy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  18. Anatomical variations of the celiac trunk and hepatic arterial system: an analysis using multidetector computed tomography angiography*

    PubMed Central

    Araujo Neto, Severino Aires; Franca, Henrique Almeida; de Mello Júnior, Carlos Fernando; Silva Neto, Eulâmpio José; Negromonte, Gustavo Ramalho Pessoa; Duarte, Cláudia Martina Araújo; Cavalcanti Neto, Bartolomeu Fragoso; Farias, Rebeca Danielly da Fonseca

    2015-01-01

    Objective To analyze the prevalence of anatomical variations of celiac arterial trunk (CAT) branches and hepatic arterial system (HAS), as well as the CAT diameter, length and distance to the superior mesenteric artery. Materials and Methods Retrospective, cross-sectional and predominantly descriptive study based on the analysis of multidetector computed tomography images of 60 patients. Results The celiac trunk anatomy was normal in 90% of cases. Hepatosplenic trunk was found in 8.3% of patients, and hepatogastric trunk in 1.7%. Variation of the HAS was observed in 21.7% of cases, including anomalous location of the right hepatic artery in 8.3% of cases, and of the left hepatic artery, in 5%. Also, cases of joint relocation of right and left hepatic arteries, and trifurcation of the proper hepatic artery were observed, respectively, in 3 (5%) and 2 (3.3%) patients. Mean length and caliber of the CAT were 2.3 cm and 0.8 cm, respectively. Mean distance between CAT and superior mesenteric artery was 1.2 cm (standard deviation = 4.08). A significant correlation was observed between CAT diameter and length, and CAT diameter and distance to superior mesenteric artery. Conclusion The pattern of CAT variations and diameter corroborate the majority of the literature data. However, this does not happen in relation to the HAS. PMID:26811552

  19. Echocardiographic diagnosis of anomalous origin of the left coronary artery from the pulmonary artery.

    PubMed

    Drinkovic, Niksa; Margetic, Eduard; Smalcelj, Anton; Brida, Vojtjeh

    2008-03-01

    We found increased systolic coronary flow in transthoracic pulsed wave (PW) Doppler in a 42-year-old patient with anomalous origin of left main coronary artery from the pulmonary artery. This is a characteristic echocardiographic finding in this anomaly in the presence of collateral circulation and coronary L-R shunt. In comparison with so far used echocardiographic criteria this parameter when present allows quick recognition of anomalous origin of left coronary artery from the pulmonary artery, and its differentiation from other potentially lethal coronary anomalies.

  20. Phasic Compression of Left Circumflex Coronary Artery during Atrial Systole.

    PubMed

    Roberto, Edward Samuel; Agarwal, Ajay

    2017-04-01

    Phasic coronary artery compression is typically associated with spasm or myocardial bridging. Compression caused by acquired anatomic changes to the surrounding heart chambers has been reported only infrequently. We present a possibly unique case of phasic compression of the proximal left circumflex coronary artery during atrial contraction in association with a dilated left atrium. A 55-year-old man with multiple cardiac risk factors presented with worsening exertional dyspnea. An electrocardiogram and echocardiogram revealed marked left atrial dilation and a left ventricular ejection fraction of 0.15 to 0.20 with elevated filling pressures. Angiograms showed compression of the proximal segment of the left circumflex coronary artery during late ventricular diastole: the compression occurred in phase with atrial systole, whereas good flow without compression was present during atrial diastole. We attributed this phenomenon to ballooning of the lateral region of the atrial wall toward the atrioventricular groove during atrial systole. The patient complied with antihypertensive therapy, and his status improved after one year. To identify coronary artery compression in the presence of abnormal chamber geometry and to guide the treatment of the contributing medical conditions, we recommend careful analysis of angiographic results.

  1. Absence of Middle Hepatic Vein Combined with Retro-Aortic Left Renal Vein: a Very Rare Case Report

    PubMed Central

    Turamanlar, Ozan; Kırpıko, Oğuz; Özen, Oğuz Aslan; Değirmenci, Bumin; Akçer, Sezer; Uygur, Ramazan

    2012-01-01

    The hepatic and renal veins drain into the inferior vena cava. The upper group of hepatic veins consists of three veins which extend to the posterior face of the liver to join the inferior cava. The left renal vein passes anterior to the aorta just below the origin of the superior mesenteric artery. We detected a variation in the hepatic and renal veins in a multislice CT angiogram of a nine-year-old male patient in the Radiology Department of Afyon Kocatepe University Medical School. The upper group hepatic veins normally drains into the inferior vena cava as three separate trunks, namely the right, left and middle. In our case, we found that only the right and left hepatic veins existed and the middle hepatic vein was absent. Furthermore, the left renal vein, which normally passes anterior to the abdominal aorta, was retro-aortic. Left renal vein variations are of great importance in planning retroperitoneal surgery and vascular interventions. Knowledge of a patient’s hepatic vein and renovascular anatomy and determining their variations and anomalies are of critical importance to abdominal operations, transplantations and preoperative evaluation of endovascular interventions. PMID:25206997

  2. Anomalous left main coronary artery detected by CT angiography.

    PubMed

    Forte, Ernesto; Inglese, Marianna; Infante, Teresa; Schiano, Concetta; Napoli, Claudio; Soricelli, Andrea; Salvatore, Marco; Tedeschi, Carlo

    2016-10-01

    The growing improvements of computed tomography have made this technique more and more available for cardiac evaluation. Coronary artery anomalies (CAAs) are often incidental findings in subjects with suspected coronary artery disease (CAD) undergoing coronary angiography or computed tomography coronary angiography (CTCA). In some cases, CAAs can be clinically relevant so their identification could change radically patient management and treatment. We report the case of a 68-year-old male patient with known CAD and associated anomalous origination of the left coronary artery from the opposite sinus.

  3. Multimodality Imaging of Left Circumflex Artery to Coronary Sinus Fistula

    PubMed Central

    Sze, Tan Ling; Abdul Aziz, Yang Faridah; Abu Bakar, Norzailin; Mohd Sani, Fadhli; Oemar, Hamid

    2015-01-01

    Coronary artery fistula (CAF) is a rare anomaly of the coronary artery. Patients with this condition are usually asymptomatic. However, cardiac failure may occur later in life due to progressive enlargement of the fistula. Diagnosis is traditionally made by echocardiogram and conventional angiogram. However with the advantage of new technologies such as computed tomography (CT) coronary angiography, the course and communications of these fistulae can be delineated non-invasively and with greater accuracy. We report a case of a left circumflex artery fistula to the coronary sinus which was suspected on echocardiogram and the diagnosis was clinched on ECG-gated CT. PMID:25793089

  4. Common hepatic artery aneurysm: Pseudopseudocyst of the pancreas

    SciTech Connect

    Shultz, S.; Druy, E.M.; Friedman, A.C.

    1985-06-01

    The preoperative diagnosis of hepatic artery aneurysm is uncommon, and its presentation as a pancreatic mass is rare. Because of its great potential for rupture early diagnosis and treatment is essential. The authors report two cases of aneurysms of the common hepatic artery, which on CT presented as a cystic mass in the head of the pancreas. These cases illustrate the importance of using 10-mm serial sections through the pancreas after a bolus injection of intravenous contrast material in order to allow distinction between hepatic artery aneurysm and other, more common, cystic masses of the pancreas.

  5. Anomalous origin of the left coronary artery from the pulmonary artery in children: diagnostic use of multidetector computed tomography.

    PubMed

    Shen, Quanli; Yao, Qiong; Hu, Xihong

    2016-09-01

    Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital anomaly. It is important to demonstrate the anomalous origin of the left coronary artery and its course before surgery. To explore the clinical diagnostic use of multidetector CT coronary angiography in detecting anomalous origin of the left coronary artery from the pulmonary artery in children. Nine children (2 boys, 7 girls) ages 2 months to 9 years with surgically confirmed anomalous origin of the left coronary artery from the pulmonary artery were studied. Clinical data, transthoracic echocardiography and CT coronary angiography images were retrospectively analyzed. Transthoracic echocardiography correctly diagnosed anomalous origin of the left coronary artery from the pulmonary artery in 7 of 9 patients (95% CI: 40-97%). CT coronary angiography revealed the anomalous origin of the left coronary artery in all children (95% CI: 66-100%). In a 4-year-old girl and a 9-year-old girl, CT coronary angiography showed dilation of the right coronary artery and collateral circulation between the right and the left coronary arteries. CT coronary angiography is a useful method to show the anomalous origin of the coronary artery in children with anomalous origin of the left coronary artery from the pulmonary artery, especially for patients in whom origin of the left coronary artery cannot be detected by transthoracic echocardiography.

  6. Heart transplant for anomalous origin of left coronary artery from pulmonary artery.

    PubMed

    Nair, Kiron K S; Zisman, Lawrence S; Lader, Ellis; Dimova, Aneta; Canver, Charles C

    2003-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery is a congenital coronary artery malformation most commonly present in infancy. A variety of surgical procedures have been described to achieve physiological correction of the coronary flow abnormalities. These techniques are effective as long as there is potential for myocardial recovery. However the sequelae of chronic myocardial ischemia that characterize this entity often irreversibly damage the heart and preclude correction and palliation of the native anomaly. In this type of setting, heart transplantation is a realistic option. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) occasionally presents in adulthood. Anatomic repair with a two coronary artery system may not be optimal in patients presenting with ischemic cardiomyopathy. We report an adult patient with platelet factor 4 (PF4) antibodies who underwent orthotopic heart transplantation (OHT) for ALCAPA.

  7. Embolization of Hepatic Arterial Branches to Simplify Hepatic Blood Flow Before Yttrium 90 Radioembolization: A Useful Technique in the Presence of Challenging Anatomy

    SciTech Connect

    Karunanithy, Narayan; Gordon, Fabiana; Hodolic, Marina; Al-Nahhas, Adil; Wasan, Harpreet S.; Habib, Nagy; Tait, Nicholas P.

    2011-04-15

    Purpose: In the presence of variant hepatic arterial anatomy, obtaining whole-liver coverage with yttrium 90 (Y90) radioembolization may be challenging. The purpose of this study was to determine whether a technique whereby variant hepatic arterial branches are embolized and then Y90 is administered selectively into one remaining hepatic arterial branch results in whole-liver coverage and effective therapy. A retrospective comparison of treatment response was made between a group of patients who underwent this technique before Y90 administration and a group of patients who received standard Y90 administration as a single dose into the proper hepatic artery or in divided doses into the immediate hepatic artery branches. The rest of the workup and treatment were identical in both groups, including routine embolization of potential nonhepatic, nontarget vessels (e.g., the gastroduodenal artery). Methods: A total of 32 patients (mean age 56.9 years, range 39-77 years) treated with Y90 between June 2004 and March 2008 were analyzed. The primary malignancy was colorectal in 29, breast in 2, and cholangiocarcinoma in 1. Group 1 comprised 20 patients who had no alterations to their hepatic arterial supply. Group 2 comprised 12 cases who had undergone prior embolization of hepatic arterial branches before administration of Y90. The response to treatment was assessed by comparing standardized uptake value (SUV) on the pre- and postprocedure fludeoxyglucose positron emission tomographic studies of representative lesions within the right and left lobes of the liver. Results: In group 1, significant response (P < 0.001) was seen among right lobe lesions but not among left lobe lesions (P = 0.549). In group 2, there was a significant response among both right (P = 0.028) and left (P = 0.014) lobe lesions. No difference was found in the response of right lobe lesions (P = 0.726) between groups 1 and 2; a significantly greater response was found in group 2 compared to group 1 (P

  8. Cannulation of the extrathoracic left common carotid artery for thoracic aorta operations through left posterolateral thoracotomy.

    PubMed

    Veron, Sebastien; Neri, Eugenio; Buklas, Dimitrios; Pula, Giorgio; Benvenuti, Antonio; Massetti, Massimo; Bizzarri, Federico; Sassi, Carlo

    2004-11-01

    The femoral artery is the usual site of arterial cannulation in thoracic aorta operations through left posterolateral thoracotomy that require cardiopulmonary bypass (CPB) with deep hypothermic circulatory arrest (DHCA). The advantage of this perfusion route is in limiting the duration of circulatory arrest. It is associated, however, with the risk of retrograde embolization or, in cases involving aortic dissection, malperfusion of vital organs. To prevent these risks, we have used the extrathoracic left common carotid artery as the perfusion route. From December 1999 to January 2003, we used cannulation of the left extrathoracic common carotid artery in 42 thoracic aorta operations through posterolateral thoracotomy with an open proximal anastomosis technique during DHCA. The indication for thoracic aortic repair was atherosclerotic ulcer in 7 cases, chronic aortic aneurysm in 18, acute type B dissection in 5, and chronic type B dissection in 12. Cannulation of the extrathoracic left common carotid artery was successful in all patients. Postoperative recovery was uneventful, with no cerebrovascular events in all cases. No cannulation-related complications were observed. One patient died from cardiac insufficiency on postoperative day 5. No peripheral neurological deficits (paraplegia or paraparesis) were observed. Postoperative complications included atrial fibrillation in five patients, reoperation to control hemorrhage in six, respiratory insufficiency in nine, and renal insufficiency in six. These results indicate that cannulation of the left extrathoracic common carotid artery is a useful, reliable method for proximal perfusion during CPB in patients undergoing repair of the descending thoracic aorta through left posterolateral thoracotomy. By providing effective perfusion of the brain, this technique can prolong safe DHCA time. Another advantage is the prevention of cerebral emboli, ensuring retrograde flow to the aortic arch.

  9. Multiple arterial phase MRI of arterial hypervascular hepatic lesions: improved arterial phase capture and lesion enhancement.

    PubMed

    Ikram, Nabia S; Yee, Judy; Weinstein, Stefanie; Yeh, Benjamin M; Corvera, Carlos U; Monto, Alexander; Hope, Thomas A

    2017-03-01

    To establish if triple-phase arterial imaging improves the detection of arterial phase hyperintense lesions based on arterial phase capture, motion artifact degradation, and lesion enhancement when compared to single-phase imaging. Patients at risk for hepatocellular carcinoma were imaged at 3.0T. Seventy-three consecutive patients with a standard single-phase MRI and eighty-five consecutive patients were imaged using extracellular contrast with triple arterial phase MRI using three sequential accelerated acquisitions of 8 s. Arterial phase capture and image quality were qualitatively categorized. Forty single-phase and forty-four triple-phase studies contained arterially enhancing lesions > 1 cm with washout appearance. The contrast-to-noise ratio (CNR) of the lesions was calculated. We compared the differences in means with Student t-tests and those in arterial phase capture with a Chi squared test with Yates correction. The triple-phase acquisitions captured the early or late arterial phases more frequently than did the single-phase acquisition (99% vs 86%; P value = 0.006). Triple-phase also provided greater number of patients with early or late arterial phase imaging without motion artifact (92% vs 79%, P-value = 0.05). The lesion analysis revealed increased maximum CNR in the triple-phase imaging (704.4) vs. single-phase imaging (517.2), P-value < 0.001. Triple-phase acquisition provides more robust arterial phase imaging for hepatic lesions, with increased lesion CNR, compared to standard single-phase arterial phase imaging.

  10. Hepatic Artery Angiography and Embolization for Hemobilia Following Laparoscopic Cholecystectomy

    SciTech Connect

    Nicholson, Tony; Travis, Simon; Ettles, Duncan; Dyet, John; Sedman, Peter; Wedgewood, Kevin; Royston, Christopher

    1999-01-15

    Purpose: The effectiveness of angiography and embolization in diagnosis and treatment were assessed in a cohort of patients presenting with upper gastrointestinal hemorrhage secondary to hepatic artery pseudoaneurysm following laparoscopic cholecystectomy. Methods: Over a 6-year period 1513 laparoscopic cholecystectomies were carried out in our region. Nine of these patients (0.6%) developed significant upper gastrointestinal bleeding, 5-43 days after surgery. All underwent emergency celiac and selective right hepatic artery angiography. All were treated by coil embolization of the right hepatic artery proximal and distal to the bleeding point. Results: Pseudoaneurysms of the hepatic artery adjacent to cholecystectomy clips were demonstrated in all nine patients at selective right hepatic angiography. In three patients celiac axis angiography alone failed to demonstrate the pseudoaneurysm. Embolization controlled hemorrhage in all patients with no further bleeding and no further intervention. One patient developed a candidal liver abscess in the post-procedure period. All patients are alive and well at follow-up. Conclusion: Selective right hepatic angiography is vital in the diagnosis of upper gastrointestinal hemorrhage following laparoscopic cholecystectomy. Embolization offers the advantage of minimally invasive treatment in unstable patients, does not disrupt recent biliary reconstruction, allows distal as well as proximal control of the hepatic artery, and is an effective treatment for this potentially life-threatening complication.

  11. Anomalous hepatic vein drainage into a giant left atrium.

    PubMed

    Gonzalez Lengua, Carlos Andres; Rioboo Leston, Lucia; Hecht, Harvey S; Jacobi, Adam

    2015-01-01

    A 56-year-old man with a history of complex atrial-septal defect repair, atrial fibrillation, and severe mitral regurgitation presented with progressive shortness of breath. A cardiac CT examination was done as part of a preoperative protocol before mitral valve replacement and it showed a severely enlarged left atrium and an anomalous hepatic vein draining into the left atrium. These findings were totally unsuspected and changed the patient management, highlighting the benefit of cardiac CT beyond the coronary finding. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.

  12. Left circumflex coronary artery occlusion due to a left atrial appendage closure device

    PubMed Central

    Katona, András; Temesvári, András; Szatmári, András; Forster, Tamás; Fontos, Géza

    2015-01-01

    Nowadays, percutaneous left atrial appendage (LAA) closure is spreading, and a large number of patients with this procedure have concomitant coronary artery disease. With the presented case it could be concluded that coronary angiography is recommended before LAA closure. PMID:25848378

  13. Rare Anomalous Origin of Superior Left Pulmonary Artery from Left Subclavian Vein

    SciTech Connect

    Lv, Tian-shi Wang, Chao Song, Li Lv, Yong-xing Zou, Ying-hua

    2013-10-15

    We report for the first time an extremely rare anomalous origin of the superior left pulmonary artery in a 60 year-old man. Although it was occult in clinical indications, such a malformation still ought to be considered, especially during endovascular procedures.

  14. Spontaneous rupture of an intrahepatic aneurysm of the right hepatic artery caused by segmental arterial mediolysis.

    PubMed

    Beerle, Corinne; Soll, Christopher; Breitenstein, Stefan; Grieder, Felix

    2016-03-18

    Segmental arterial mediolysis (SAM) is a non-arteriosclerotic, non-inflammatory arteriopathy characterised by dissecting aneurysms and most commonly found in abdominal arteries. A rupture of a visceral artery aneurysm is generally associated with high mortality. We present the case of a 57-year-old woman with a rupture of an intrahepatic aneurysm that led to intra-abdominal haemorrhage. The patient was surgically treated by evacuating the abdominal haematoma and ligature of the right hepatic artery. Histology of the right hepatic artery revealed the diagnosis of SAM. Six months postoperatively, the patient was in excellent physical condition with normal liver function and arterial blood flow of the right hepatic sections over collateral circulation.

  15. Exercise thallium-201 myocardial imaging in left main coronary artery disease: sensitive but not specific

    SciTech Connect

    Rehn, T.; Griffith, L.S.; Achuff, S.C.; Bailey, I.K.; Bulkley, B.H.; Burow, R.; Pitt, B.; Becker, L.C.

    1981-08-01

    To determine the usefulness of thallium-201 scintigraphy for identifying left main coronary artery disease, the results of scintigraphy at rest and during exercise were compared in 24 patients with 50 percent or greater narrowing of the left main coronary artery and 80 patients with 50 percent or greater narrowing of one or more of the major coronary arteries but without left main coronary involvement. By segmental analysis of the scintigrams, perfusion defects were assigned to the left anterior descending, left circumflex or right coronary artery, singly or in combination, and the pattern of simultaneous left anterior descending and circumflex arterial defects was used to identify left main coronary artery disease. Of the 24 patients with left main coronary artery disease, 22 (92 percent) had abnormal exercise scintigrams. Despite this high sensitivity, the pattern of perfusion defects was not specific; the ''left main pattern'' was found in 3 patients (13 percent) with left main coronary artery disease but also in 3 (33 percent) of 9 patients with combined left anterior descending and left circumflex arterial disease, 4 (19 percent) of 21 patients with three vessel disease and 3 (6 percent) of 50 patients with one or two vessel disease but excluding the group with left anterior descending plus left circumflex arterial disease. The pattern of perfusion defects in the patients with left main coronary artery disease was determined by the location and severity of narrowings in the coronary arteries downstream from the left main arterial lesion. Concomitant lesions in other arteries were found in all patients with left main coronary disease (one vessel in 1 patient, two vessels in 7 patients and three vessels in 16). For this reason, it is unlikely that even with improvements in radiopharmaceutical agents and imaging techniques, myocardial perfusion scintigraphy will be sufficiently specific for definitive identification of left main coronary artery disease.

  16. Resection of Celiac Artery Aneurysm with Bypass Grafting to the Splenic and Common Hepatic Arteries

    PubMed Central

    Pattakos, Gregory; Tolpin, Daniel

    2017-01-01

    Celiac artery aneurysms are rare and typically warrant surgical treatment. Atherosclerosis is their chief cause. Symptomatic patients usually present with abdominal pain. Surgical resection of celiac artery aneurysms is associated with low morbidity and mortality rates. We report the case of a patient whose 2.2-cm celiac artery aneurysm we resected, with subsequent saphenous vein bypass grafting from the celiac trunk to the splenic and common hepatic arteries. In addition, we briefly discuss other treatment options. PMID:28265220

  17. Spontaneous rupture of hepatic artery aneurysm associated with polyarteritis nodosa.

    PubMed

    Parent, Brodie A; Cho, Sung W; Buck, David G; Nalesnik, Michael A; Gamblin, T Clark

    2010-12-01

    Polyarteritis nodosa (PAN) is a vasculitis, which often involves small and medium sized visceral arteries. This condition may result in multifocal aneurismal formation and end-organ damage. Uncommonly, PAN may present with rupture of hepatic artery aneurysms. Here, we report a rare case of a ruptured intrahepatic aneurysm associated with PAN. A 79-year-old woman presenting with abdominal pain had CT scan of the abdomen, which revealed hematoma in the right hepatic lobe. Visceral angiogram confirmed pseudo-aneurysm of a right hepatic arterial branch, and this was managed with endovascular coil embolization. The diagnosis of PAN was made and corticosteroid therapy was initiated. We also performed a literature review to define this condition's demographics, clinical presentations, and appropriate management. The review revealed 17 published cases of ruptured PAN-related intrahepatic aneurysms. We conclude that unexplained findings of visceral arterial aneurysms should prompt investigations for vasculitis as the etiology.

  18. Detection of left anterior descending coronary artery disease in patients with left bundle branch block.

    PubMed

    Civelek, A C; Gozukara, I; Durski, K; Ozguven, M A; Brinker, J A; Links, J M; Camargo, E E; Wagner, H N; Flaherty, J T

    1992-12-15

    The detection of coronary artery disease is difficult if a patient has electrocardiographic evidence of left bundle branch block (BBB). Septal blood flow may be reduced in patients with left BBB, despite no angiographic evidence of left anterior descending (LAD) coronary artery disease. We have developed a new method of quantification of Thallium-201 single-photon emission computed tomographic (SPECT) images with the aim of better separating patients with left BBB and LAD disease from those with left BBB alone. The study cohort comprised 8 normal subjects (group I) and 20 patients with left BBB and chest pain who underwent thallium-201 SPECT imaging and coronary angiography. Eight patients (group II) had < or = 50% LAD stenosis, and 12 (group III) had > or = 70% LAD stenosis. Septal abnormality scores on the second short-axis slice from the base were computed, based on comparison of each subject's short-axis circumferential profile with a normal reference curve. This followed a procedure in which each profile was scaled to minimize differences in its absolute level in relation to the reference curve. Septal abnormality scores on stress images were 0.8 +/- 22 for group I, 27 +/- 43 for group II, and 165 +/- 67 for group III (p = 0.15 for group I vs II, and p < 0.0001 between groups I and III, and II and III).(ABSTRACT TRUNCATED AT 250 WORDS)

  19. Acute left main coronary artery thrombosis due to cocaine use.

    PubMed

    Apostolakis, Efstratios; Tsigkas, Grigorios; Baikoussis, Nikolaos G; Koniari, Ioanna; Alexopoulos, Dimitrios

    2010-08-19

    It is common knowledge that cocaine has been linked to the development of various acute and chronic cardiovascular complications including acute coronary syndromes. We present a young, male patient, drug abuser who underwent CABG due to anterolateral myocardial infarction. Our presentation is one of the very rare cases reported in literature regarding acute thrombosis of left main coronary artery related to cocaine use, in a patient with normal coronary arteries, successfully operated. Drug-abusers seem to have increased mortality and morbidity after surgery and high possibility for stent thrombosis after percutaneous coronary interventions, because of their usually terrible medical compliance and coexistent several problems of general health. There are no specific guidelines about treatment of thrombus formation in coronary arteries, as a consequence of cocaine use. So, any decision making concerning the final treatment of these patient is a unique and individualized approach. We strongly recommend that all these patients should be treated surgically, especially patients with thrombus into the left main artery.

  20. Visualization of hepatic arteries with 3D ultrasound during intra-arterial therapies

    NASA Astrophysics Data System (ADS)

    Gérard, Maxime; Tang, An; Badoual, Anaïs.; Michaud, François; Bigot, Alexandre; Soulez, Gilles; Kadoury, Samuel

    2016-03-01

    Liver cancer represents the second most common cause of cancer-related mortality worldwide. The prognosis is poor with an overall mortality of 95%. Moreover, most hepatic tumors are unresectable due to their advanced stage at discovery or poor underlying liver function. Tumor embolization by intra-arterial approaches is the current standard of care for advanced cases of hepatocellular carcinoma. These therapies rely on the fact that the blood supply of primary hepatic tumors is predominantly arterial. Feedback on blood flow velocities in the hepatic arteries is crucial to ensure maximal treatment efficacy on the targeted masses. Based on these velocities, the intra-arterial injection rate is modulated for optimal infusion of the chemotherapeutic drugs into the tumorous tissue. While Doppler ultrasound is a well-documented technique for the assessment of blood flow, 3D visualization of vascular anatomy with ultrasound remains challenging. In this paper we present an image-guidance pipeline that enables the localization of the hepatic arterial branches within a 3D ultrasound image of the liver. A diagnostic Magnetic resonance angiography (MRA) is first processed to automatically segment the hepatic arteries. A non-rigid registration method is then applied on the portal phase of the MRA volume with a 3D ultrasound to enable the visualization of the 3D mesh of the hepatic arteries in the Doppler images. To evaluate the performance of the proposed workflow, we present initial results from porcine models and patient images.

  1. ANATOMIC VARIATIONS OF HEPATIC ARTERY: A STUDY IN 479 LIVER TRANSPLANTATIONS.

    PubMed

    Fonseca-Neto, Olival Cirilo Lucena da; Lima, Heloise Caroline de Souza; Rabelo, Priscylla; Melo, Paulo Sérgio Vieira de; Amorim, Américo Gusmão; Lacerda, Cláudio Moura

    2017-01-01

    The incidence of anatomic variations of hepatic artery ranges from 20-50% in different series. Variations are especially important in the context of liver orthotopic transplantation, since, besides being an ideal opportunity for surgical anatomical study, their precise identification is crucial to the success of the procedure. To identify the anatomical variations in the hepatic arterial system in hepatic transplantation. 479 medical records of transplanted adult patients in the 13-year period were retrospectively analyzed, and collected data on hepatic arterial anatomy of the deceased donor. It was identified normal hepatic arterial anatomy in 416 donors (86.84%). The other 63 patients (13.15%) showed some variation. According to the Michels classification, the most frequently observed abnormalities were: right hepatic artery branch of superior mesenteric artery (Type III, n=27, 5.63%); left hepatic artery branch of the left gastric artery (Type II, n=13, 2.71%); right hepatic artery arising from the superior mesenteric artery associated with the left hepatic artery arising from the left gastric artery (Type IV, n=4, 0.83%). Similarly, in relation to Hiatt classification, the most prevalent changes were: right hepatic accessory artery or substitute of the superior mesenteric artery (Type III, n=28, 6.05%)), followed by liver ancillary left artery or replacement of gastric artery left (Type II, n=16, 3.34. Fourteen donors (2.92%) showed no anatomical abnormalities defined in classifications, the highest frequency being hepatomesenteric trunk identified in five (01.04%). Detailed knowledge of the variations of hepatic arterial anatomy is of utmost importance to surgeons who perform approaches in this area, particularly in liver transplantation, since their identification and proper management are critical to the success of the procedure. A incidência das variações anatômicas da artéria hepática varia de 20-50% em diferentes casuísticas. Elas s

  2. Isolation of the left subclavian artery-origin from the left pulmonary artery by way of ductus arteriosus: multidetector row computed tomographic angiographic imaging.

    PubMed

    Jesudian, Vimala; Ravikumar, Radhakrishnan; Kumar, R Suresh

    2009-05-01

    Right aortic arch with isolation of the left subclavian artery is a rare anomaly. It has been reported to occur with conotruncal anomalies and may be associated with 22q11 deletion. Multidetector-row computed tomographic angiogram images of a 15-year-old African boy with Tetralogy of Fallot who had right aortic arch and isolated left subclavian artery arising from the left pulmonary artery by way of ductus arteriosus are presented.

  3. Hepatic artery reconstruction first for the treatment of hilar cholangiocarcinoma bismuth type IIIB with contralateral arterial invasion: a novel technical strategy

    PubMed Central

    de Santibañes, Eduardo; Ardiles, Victoria; Alvarez, Fernando A; Pekolj, Juan; Brandi, Claudio; Beskow, Axel

    2012-01-01

    Background En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure. Methods The authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion. Arterial reconstruction between the posterior branch of the RHA and the left hepatic artery (LHA) was performed as the first surgical step. Once arterial vascular flow was restored, a left trisectionectomy with caudate lobe resection and portal vein reconstruction was performed. Results In both patients an R0 resection was achieved. Both patients made a full recovery and were discharged within 14 days of surgery. Both patients remain free of disease at 18 months. Conclusions This new technique allows a R0 resection to be achieved in patients with Bismuth type IIIB hilar CC with contralateral arterial involvement. PMID:22151454

  4. Hepatic artery reconstruction first for the treatment of hilar cholangiocarcinoma bismuth type IIIB with contralateral arterial invasion: a novel technical strategy.

    PubMed

    de Santibañes, Eduardo; Ardiles, Victoria; Alvarez, Fernando A; Pekolj, Juan; Brandi, Claudio; Beskow, Axel

    2012-01-01

    En-bloc liver resection with the extrahepatic bile duct is mandatory to obtain tumour-free surgical margins and better long-term outcomes in hilar cholangiocarcinoma (CC). One of the most important criteria for irresectability is local extensive invasion to major vessels. As hilar CC Bismuth type IIIB often requires a major left hepatic resection, the invasion of the right hepatic artery (RHA) usually contraindicates this procedure. The authors describe a novel technique that allowed an oncological resection in two patients with hilar CC Bismuth type IIIB and contralateral arterial invasion. Arterial reconstruction between the posterior branch of the RHA and the left hepatic artery (LHA) was performed as the first surgical step. Once arterial vascular flow was restored, a left trisectionectomy with caudate lobe resection and portal vein reconstruction was performed. In both patients an R0 resection was achieved. Both patients made a full recovery and were discharged within 14 days of surgery. Both patients remain free of disease at 18 months. This new technique allows a R0 resection to be achieved in patients with Bismuth type IIIB hilar CC with contralateral arterial involvement. © 2011 International Hepato-Pancreato-Biliary Association.

  5. Intrathoracic fire during preparation of the left internal thoracic artery for coronary artery bypass grafting

    PubMed Central

    2010-01-01

    A surgical fire is a serious complication not previously described in the literature with regard to the thoracic cavity. We report a case in which an intrathoracic fire developed following an air leak combined with high pressure oxygen ventilation in a patient with severe chronic obstructive pulmonary disease. The patient presented to our institution with diffuse coronary artery disease and angina pectoris. He was treated with coronary artery bypass graft surgery, including left internal thoracic artery harvesting. Additionally to this rare presentation of an intrathoracic fire, a brief review of surgical fires is included to this paper. PMID:20219127

  6. Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol.

    PubMed

    Wang, Lei; He, Fu-Liang; Liu, Fu-Quan; Yue, Zhen-Dong; Zhao, Hong-Wei

    2015-08-28

    To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol. Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 mL of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 mL of saline, respectively. Hepatic arteriography and direct portal phlebography were performed on all animals before and after perfusion, and the portal venous pressure and diameter were measured before perfusion, immediately after perfusion, and at 2, 4 and 6 wk after perfusion. The following procedures were performed at different time points: routine blood sampling, blood biochemistry, blood coagulation and blood ammonia tests before surgery, and at 2, 4 and 6 wk after surgery; hepatic biopsy before surgery, within 6 h after surgery, and at 1, 2, 3, 4 and 5 wk after surgery; abdominal enhanced computed tomography examination before surgery and at 6 wk after surgery; autopsy and multi-point sampling of various liver lobes for histological examination at 6 wk after surgery. In experimental group 1, different degrees of hepatic fibrosis were observed, and one pig developed hepatic cirrhosis. In experimental group 2, there were cases of hepatic cirrhosis, different degrees of increased portal venous pressure, and intrahepatic portal venous bypass, but neither extrahepatic portal-systemic bypass circulation nor death occurred. In experimental group 3, two animals died and three animals developed hepatic cirrhosis, and different degrees of increased portal venous pressure and intrahepatic portal venous bypass were also observed, but there was no extrahepatic portal-systemic bypass circulation. It is feasible to establish an animal model of hepatic cirrhosis and

  7. Treatment of an Iatrogenic Left Internal Mammary Artery to Pulmonary Artery Fistula with a Bovine Pericardium Covered Stent

    SciTech Connect

    Heper, Gulumser Barcin, Cem; Iyisoy, Atila; Tore, Hasan F.

    2006-10-15

    We report a case with an acquired fistula between the left internal mammary artery and the pulmonary artery following coronary bypass surgery treated with a bovine pericardium covered stent. We also reviewed similar cases reported previously.

  8. Arterial Wave Reflection and Subclinical Left Ventricular Systolic Dysfunction

    PubMed Central

    Russo, Cesare; Jin, Zhezhen; Takei, Yasuyoshi; Hasegawa, Takuya; Koshaka, Shun; Palmieri, Vittorio; Elkind, Mitchell S.V.; Homma, Shunichi; Sacco, Ralph L.; Di Tullio, Marco R.

    2011-01-01

    Objectives Increased arterial wave reflection is a predictor of cardiovascular events and has been hypothesized to be a cofactor in the pathophysiology of heart failure. Whether increased wave reflection is inversely associated with left ventricular (LV) systolic function in subjects without heart failure is not clear. Methods Arterial wave reflection and LV systolic function were assessed in 301 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using 2-dimensional echocardiography and applanation tonometry of the radial artery to derive central arterial waveform by a validated transfer function. Aortic augmentation index (AIx) and wasted energy index (WEi) were used as indices of wave reflection. LV systolic function was measured by ejection fraction (LVEF) and tissue Doppler imaging (TDI). Mitral annulus peak systolic velocity (Sm), peak longitudinal strain and strain rate were measured. Participants with history of coronary artery disease, atrial fibrillation, LVEF <50% or wall motion abnormalities were excluded. Results Mean age of the study population was 68.3±10.2 years (64.1% women, 65% hypertensive). LV systolic function by TDI was lower with increasing wave reflection, whereas LVEF was not. In multivariate analysis, TDI parameters of LV longitudinal systolic function were significantly and inversely correlated to AIx and WEi (p values from 0.05 to 0.002). Conclusions In a community cohort without heart failure and with normal LVEF, an increased arterial wave reflection was associated with subclinical reduction in LV systolic function assessed by novel TDI techniques. Further studies are needed to investigate the prognostic implications of this relationship. PMID:21169863

  9. Relationship between left coronary artery bifurcation angle and restenosis after stenting of the proximal left anterior descending artery

    PubMed Central

    Yamamoto, Tadashi; Funayama, Naohiro; Nishihara, Hiroshi; Hotta, Daisuke

    2016-01-01

    Introduction Restenosis after a percutaneous coronary intervention for proximal left anterior descending (pLAD) coronary artery disease remains a clinical challenge. However, the relationship between the left main trunk (LMT)/LAD bifurcation angle and the pLAD artery restenosis is unclear. This study examined the relationship between the LMT–LAD bifurcation angle and restenosis after stent implantation for pLAD disease. Methods We analysed the data of 177 consecutive patients who underwent stent implantation for pLAD disease, followed by coronary angiography between December 2008 and September 2013. The LMT–LAD bifurcation angle was measured in the left or the right anterior oblique caudal (CAU) angiographic view. Results and discussion Out of 177 patients, 12 developed in-stent restenosis and 21 developed in-segment restenosis. The mean angle in patients with in-stent restenosis (52.2°±14.5°) in the left anterior oblique CAU view was significantly larger than that in patients without restenosis (32.0°±18.1°; P<0.001). The LMT–LAD angle in the right anterior oblique CAU view was significantly larger in patients with in-segment restenosis (27.3°±14.3°) than in patients without restenosis (17.5°±10.1°; P<0.001). Moreover, by multivariate analysis, the LMT–LAD angle was an independent predictor of in-stent and in-segment restenosis, after adjustment for significant confounders such as diabetes, hypertension, dyslipidaemia, final minimum lesion diameter and lesion length. Conclusion This study suggests that a wide LMT–LAD angle is a predictor of restenosis after stent implantation for pLAD artery disease. PMID:27214275

  10. Single Coronary Artery with Prepulmonic Coursing Left Main Coronary Artery Manifesting as Prinzmetal's Angina

    PubMed Central

    Sanford, Garrett B.; Molavi, Behzad; Sinha, Anjan K.; Garza, Luis; Angelini, Paolo

    2007-01-01

    We report the case of a 32-year-old man who presented at the emergency department with severe chest pressure, left arm pain, and dizziness. These symptoms were described as intermittent, occurring after exercise and at rest. He had undergone several stress tests during the past 8 years, but no objective evidence of ischemia was produced. His history of hyperlipidemia and increasing frequency of symptoms prompted us to perform coronary angiography, which showed a single coronary artery with an ostium at the right sinus of Valsalva. The vessel had an initial, mixed common trunk that gave rise to both the right coronary artery proper and to the left coronary artery. The left main trunk followed a prepulmonic course. The anatomic features were eventually confirmed by computed tomographic angiography. The left main stem had a fixed 50% to 60% area narrowing, at baseline study. A treadmill stress myocardial perfusion study showed no evidence of ischemia. The patient was referred to a 2nd facility, where intravascular ultrasonography, at baseline, revealed 63% left main narrowing without evidence of atherosclerosis. Acetylcholine provocation demonstrated worsening of the stenosis to about 80%, with reproduction of angina and ST-segment depression, which indicated that medical management of spasm might provide symptomatic relief. PMID:18172528

  11. Rare Case of Vasculitis of the Hepatic Artery.

    PubMed

    Mali, Padmavathi; Muduganti, Sudheer R; Goldberg, Jerry

    2015-12-01

    Vasculitis is an accumulation of inflammatory leucocytes in the blood vessels with reactive damage to mural structures. Isolated vasculitis of the gastrointestinal tract without systemic involvement is rare. We report a unique case of a female patient who presented with abdominal pain, and was found, on serology, to have elevated inflammatory markers without autoantibodies. A computed tomography scan of the abdomen and pelvis was suggestive of vasculitis of the hepatic artery. To the best of our knowledge, this is the first case, to date, of vasculitis of hepatic artery. © 2015 Marshfield Clinic.

  12. Embolization of an Hepatic Artery Pseudoaneurysm Following Laparoscopic Cholecystectomy

    SciTech Connect

    Rivitz, S. Mitchell; Waltman, Arthur C.; Kelsey, Peter B.

    1996-11-15

    Vascular injuries during laparoscopic cholecystectomy can occur in an analogous fashion to biliary injuries, with potential laceration, transection, and occlusion of blood vessels. A patient presented with symptomatic hemobilia 1 month following laparoscopic cholecystectomy and was found to have a right hepatic artery pseudoaneurysm which communicated with the common bile duct. This was successfully embolized with several embolic agents, resulting in rapid resolution of all signs and symptoms. The patient has been free of symptoms during a follow-up period of 1 year. A brief discussion of hepatic artery pseudoaneurysms is presented.

  13. Hepatic artery pseudoaneurysm; a rare complication of amoebic liver abscess.

    PubMed

    Khan, Anam; Pal, Khawaja Muhammad Inam; Khan, Hussain Ijaz

    2011-08-01

    Hepatic artery pseudoaneurysm (HAP) is an infrequently encountered entity, usually seen secondary to blunt or penetrating trauma. The clinical presentation is often due to complications such as intrahepatic or intraperitoneal bleeding as a result of rupture of the pseudoaneurysm. Diagnosis is frequently delayed and made by splanchnic angiography. HAP associated with a liver abscess, has very rarely been described in the literature. We report the case of a 50-year-old man with amoebic liver abscess and right hepatic artery pseudoaneurysm which was suspected on high resolution contrast-enhanced abdominal computer tomography (CT). The lesion was confirmed by arteriography and treated prophylactically with transcatheteter embolization.

  14. Percutaneous coronary intervention of an obstructive left anterior descending artery with anomalous origin of right coronary artery.

    PubMed

    Dubey, Laxman

    2013-03-01

    Coronary artery anomalies are a rare type of congenital anomalies with an incidence of 1.3% during routine cardiac catheterization. Anomalous origin of the coronary arteries is considered an incidental finding without clinical significance. This case describes a patient in whom evaluation of chest pain revealed an obstructive left anterior descending artery as well as an anomalous right coronary artery arising from the left coronary sinus. The patient underwent successful percutaneous coronary intervention of the left anterior descending artery and was discharged home free of angina 3 days later.

  15. A rare type of single coronary artery with right coronary artery originating from the left circumflex artery in a child

    PubMed Central

    Kim, Jong Min; Lee, Ok Jeong; Kang, I-Seok; Huh, June; Kim, Geena

    2015-01-01

    The presence of a single coronary artery is a rare congenital anomaly; such patients often present with severe myocardial ischemia. We experienced the case of a 13-year-old girl with the right coronary artery originating from the left circumflex artery. She visited our Emergency Department owing to severe chest pain; her cardiac enzyme levels were elevated, but her initial electrocardiogram (ECG) was normal. Echocardiography showed normal anatomy and normal regional wall motion. When she presented with recurrent chest pain on admission, the ECG showed significant ST-segment elevation in the left precordial leads and inferior leads with ST-segment depression in aVR lead, suggesting myocardial ischemia, and her cardiac enzyme levels were also elevated. We performed coronary angiography that showed a single right coronary artery originating from the left circumflex artery without stenosis. We confirmed the presence of a single coronary artery using coronary computed tomography. In addition, the treadmill test that was performed showed normal results. She was discharged from the hospital without any medications but with a recommendation of a regular follow-up. PMID:25729398

  16. Anomalous origin of the left innominate (brachiocephalic) artery in the right aortic arch: How can it be anomalous when the left innominate artery is absent?

    PubMed Central

    Raimondi, Francesca; Bonnet, Damien; Geva, Tal; Sanders, Stephen P

    2016-01-01

    An unusual case of a rare vascular ring, which has been called right aortic arch with aberrant left innominate artery, is presented. The appearance of this case led to the realization that there is really no innominate artery present in this anomaly but only the left dorsal aorta. We present a clarification of the nature and likely development of the vessels present. PMID:27212855

  17. Successful microscopic renal autotransplantation for left renal aneurysm associated with segmental arterial mediolysis.

    PubMed

    Yoshioka, Takashi; Araki, Motoo; Ariyoshi, Yuichi; Wada, Koichiro; Tanaka, Noriyuki; Nasu, Yasutomo

    2016-12-14

    Segmental arterial mediolysis (SAM) is an uncommon, nonarteriosclerotic vascular disease. SAM is characterized by lysis of arterial media and can lead to aneurysm formation. The renal arteries are the third most common arteries associated with SAM. We report the case of a 32-year-old man with left renal artery aneurysm associated with SAM. We successfully performed left renal autotransplantation using microscopic vascular reconstruction. SAM is characterized by vascular fragility; therefore, microscopic surgery is favorable for treating aneurysms associated with SAM.

  18. Technical strategy in a patient with symptomatic thoracic aneurysm near the origin of the left subclavian artery and left internal thoracic artery coronary graft.

    PubMed

    Babic, Srdjan D; Radak, Djordje J; Sotirovic, Vuk A; Unic-Stojanovic, Dragana R; Babic, Dusan S; Popov, Petar Z; Sagic, Dragan Z

    2012-11-01

    Thoracic endovascular aortic repair (TEVAR) is a safe and reliable technique utilized in the treatment for aortic aneurysms. However, in up to 40% of patients, devices are typically placed over the left subclavian artery (LSA) origin. In this report, we present a case of a successful TEVAR procedure following the transposition of the LSA with protective carotico-axillary/carotid bypass in a patient with a patent left internal thoracic artery (LITA)-left anterior descending (LAD) coronary artery bypass graft and right internal carotid artery (ICA) occlusion. © 2012 Wiley Periodicals, Inc.

  19. A case of ruptured segmental arterial mediolysis of the hepatic artery: report of a case.

    PubMed

    Tomonaga, Tetsuo; Eguchi, Susumu; Hidaka, Masaaki; Takatsuki, Mitsuhisa; Soyama, Akihiko; Muraoka, Izumi; Mizutani, Akimasa; Fukui, Hiroshi; Kanematsu, Takashi

    2011-01-01

    This article reports a patient with intra-abdominal hemorrhage secondary to a rare vascular disease, segmental arterial mediolysis (SAM). The patient was a 68-year-old male who presented with chilling and severe abdominal pain. Abdominal computed tomography results suggested the presence of an intra-abdominal hemorrhage. Although visceral angiography illustrated multiple aneurysms in the branches of the hepatic artery, active bleeding was not evident. Conservative therapy including transfusion was performed, and re-angiography revealed the disappearance of multiple hepatic arterial aneurysms 8 months later. This is the first case of intra-abdominal hemorrhage related to SAM of the hepatic artery in which natural history of SAM was seen.

  20. Hepatic artery duplex Doppler ultrasound in severe alcoholic hepatitis and correlation with Maddrey's discriminant function.

    PubMed

    Abhilash, Haridas; Mukunda, Madhavan; Sunil, Premaletha; Devadas, Krishnadas; Vinayakumar, Katoor Ramakrishnan Nair

    2015-01-01

    Alcoholic hepatitis is associated with altered hepatic artery hemodynamics. Maddrey's discriminant function (MDF) can identify patients with poor prognosis (DF >32). We studied hepatic artery hemodynamic parameters of hepatic artery diameter (HAD), resistive index (RI) and pulsatility index (PI) in severe acute alcoholic hepatitis (SAAH) and for the presence of correlation of parameters with severity factor MDF. A total of 20 consecutive SAAH patients defined as MDF >32 and a group of 20 alcoholic cirrhosis patients without alcoholic hepatitis formed the two study groups. Hepatic artery Doppler parameters HAD, RI, PI were determined after admission in the Gastroenterology Department, Government Medical College, Thiruvananthapuram, India. MDF score of SAAH was calculated at the time of admission to the hospital. The mean HAD showed statistically significant increase in SAAH compared with cirrhosis (3.96±0.51 vs. 2.86±0.41, P<0.001). There was statistically significant decrease in mean RI (0.49±0.08 vs. 0.81±0.09, P<0.001) and mean PI (1.67±0.13 vs. 1.80±0.13, P<0.001) in SAAH compared with alcoholic cirrhosis. Statistically significant correlation between MDF and HAD (r=0.63, P<0.003) was found in SAAH. On linear regression, 36% of the variability in MDF could be independently predicted by HAD. Hepatic artery parameters of HAD, RI, PI had a significant difference in SAAH compared with alcoholic cirrhosis patients thereby being useful as a diagnostic tool. HAD showed correlation with MDF score assessing the severity of alcoholic hepatitis and may be a useful non-invasive prognostic tool.

  1. Bilateral vs single internal thoracic artery grafting for left main coronary artery occlusion.

    PubMed

    Otaki, M; Lust, R M; Sun, Y S; Norton, T O; Spence, P A; Zeri, R S; Hopson, S B; Chitwood, R

    1994-10-01

    This study was conducted to compare the coronary flow distributed by single and bilateral internal thoracic artery (ITA) grafts in the setting of the left main coronary occlusion. Ten dogs underwent coronary artery bypass grafting through a left thoracotomy, off pump, using a brief local occlusion to perform the anastomosis. Dogs were randomly assigned to receive either a single left ITA (LITA) graft to the circumflex coronary artery (CFX), or bilateral ITA grafts, with additional placement of the right ITA (RITA) to the left anterior descending artery (LAD). After the grafts were placed, the left main coronary artery was ligated. Electromagnetic flows were obtained in the LAD and the CFX proximally and distally to ITA grafts in both groups before grafting and after grafting. ITA flow in situ was also measured before rotation from the chest wall. Total left ventricular flow requirements were satisfied equally well by either a single LITA graft (116.7 +/- 11.6 mL/min) or bilateral ITA grafts (total, 116.8 +/- 9.6 mL/min divided as LITA, 55.9 +/- 7.4 mL/min; RITA, 60.9 +/- 12.0 mL/min). When two grafts were replaced, competitive flow in the proximal regions of both native vessels was noted, although basal flow requirements were maintained. When an individual graft was occluded in the bilaterally grafted system, the remaining graft immediately recruited the additional flow, demonstrating that either right or left ITA can support flow demands five to six times higher than in situ chest wall flow (RITA, 21.9 +/- 3.1 mL/min; LITA, 22.3 +/- 4.9 mL/min). These data suggest that in this canine model, a single ITA graft can support the entire flow requirements of the left ventricle. Assuming no intervening stenosis is present in native coronary systems, bilateral ITA grafting may provide a margin of safety, but under resting conditions, provides no perfusion advantages over a single ITA graft.

  2. Anomalous Right Coronary Artery Originating from the Left Sinus of Valsalva in a Yucatan Minipig

    PubMed Central

    Matthews, Kristin A; Gogas, Bill D; Sumida, Arihiro; Nagai, Hiroyuki; King, Spencer B; Chronos, Nicolas; Hou, Dongming

    2012-01-01

    A 39.2-kg, castrated male Yucatan minipig (Sus scrofa domestica) was presented for enrollment in a coronary artery study. Angiography revealed an anomalous right coronary artery originating from the left sinus of Valsalva. The left anterior descending, left circumflex, and anomalous right coronary arteries were implanted with metallic stents without complications. The minipig remained on the study for 3 mo until it reached its predetermined study endpoint, during which time it showed no clinical signs of disease. Histologic examination of the implanted coronary arteries revealed no differences between the normal (left anterior descending and left circumflex arteries) and the anomalous right coronary artery. Swine are important models for coronary research. Although several cases of anomalous human coronary arteries have been documented, the current case is the first report of a coronary artery anomaly in a minipig. PMID:22546919

  3. Long term follow up results of sequential left internal thoracic artery grafts on severe left anterior descending artery disease

    PubMed Central

    2010-01-01

    Purpose Several alternative procedures have been proposed to achieve complete revascularization in the presence of diffuse left anterior descending coronary artery (LAD) disease. With the extensive use of internal thoracic artery grafts in coronary artery bypass procedures, sequential anastomosis of the left internal thoracic artery (LITA) to LAD has gained popularity in these challenging cases. The long term results of sequential LITA to LAD anstomosis were examined in this study. Patients and Methods In order to determine the long term results of the sequential revascularization of LAD by LITA graft, 41 out of 49 patients operated between January 2001 and December 2005 were selected for control coronary arteriography. The median period for control coronary arteriography was 64 months. Results Seventy five anastomoses were found to be fully patent (91,46%) among the 82 sequential LITA anastomoses (41 LITA grafts) on the LAD at a median follow-up period of 64 months (53 to 123 months). Among the 41 LITA grafts used for this purpose, 36 were found intact (complete patency of the proximal and distal anastomoses) (87,8%). Two LITA grafts (4 anastomoses) were found to be totally occluded (4,87%). The proximal anastomosis of the LITA graft was observed to be 90% stenotic in one patient (1,21%). In one patient tight stenosis of the distal anastomosis line was observed (1,21%), while in another patient 70% narrowing of LITA lumen after the proximal anastomosis was detected (1,21%). Conclusion We strongly beleive that sequential LITA grafting of LAD is a safe alternative in the presence of severe LAD disease to achieve complete revascularization of the anterior myocardium with patency rates not much differing from conventional single LITA to LAD anastomosis. PMID:20958964

  4. Horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of upper lobe bronchi.

    PubMed

    Oguz, Berna; Alan, Serdar; Ozcelik, Ugur; Haliloglu, Mithat

    2009-09-01

    Horseshoe lung, a rare congenital anomaly, is almost always associated with unilateral (usually right-sided) lung hypoplasia, and, in most cases, in conjunction with the scimitar syndrome. We present an 8-month-old boy with horseshoe lung associated with left-lung hypoplasia, left pulmonary artery sling and bilateral agenesis of the upper lobe bronchi, diagnosed by multidetector CT (MDCT) imaging. The study also revealed an anomalous origin of the left vertebral artery as the last branch of the aortic arch, distal to the left subclavian artery, and an anomalous origin of the left common carotid artery from the brachiocephalic trunk. A hemivertebral anomaly of the seventh cervical vertebra was incidentally detected. MDCT with high-quality multiplanar and three-dimensional reconstructions is a noninvasive and rapid technique for detecting the complex combination of vascular, tracheobronchial and parenchymal anomalies, and any potential bone anomalies, in one imaging study.

  5. An alternative technique for direct implantation of an anomalous left coronary artery arising from the pulmonary artery with complex coronary arteries

    PubMed Central

    Ishimaru, Kazuhiko; Araki, Kanta; Nakamura, Tsuneyuki; Sawa, Yoshiki

    2016-01-01

    A 2-month-old patient with anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) underwent an alternative repair involving coronary transfer with the bay window technique because of the very short left main coronary trunk. This procedure is a clinically relevant and feasible technique for ALCAPA with such a delicate coronary artery anomaly. PMID:27656197

  6. Echocardiographic presentation of anomalous origin of the left coronary artery from the pulmonary artery.

    PubMed

    Silverman, Norman H

    2015-12-01

    In the 1970s, diagnosing anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) was often uncertain using imaging alone; however, with the advances in high-frequency transducers, advanced image processing, and other ultrasound modalities such as Doppler colour flow imaging, tissue Doppler imaging, and speckle tracking to asses regional wall motion abnormalities, modern echocardiography now permits accurate diagnosis of ALCAPA with greater certainty. Although many consider ultrasound to be the only imaging test necessary if there is a question as to the diagnosis, other imaging modalities such as MRI, CT, and cardiac catheterisation with angiography remain valuable complementary tests, especially in older patients.

  7. Hepatobiliary scintigraphy in patients receiving hepatic artery infusion chemotherapy

    SciTech Connect

    Housholder, D.F.; Hynes, H.E.; Dakhil, S.R.; Marymont, J.H. Jr.

    1984-01-01

    Two patients receiving hepatic artery infusion chemotherapy (HAIC) required cholecystectomy for both acute and chronic cholecystitis with cholelithiasis suggesting chemical cholecystitis. To evaluate the incidence of gall bladder dysfunction in patients receiving HAIC, the authors performed hepatobiliary scintigraphy using Tc-99m DISIDA or PIPIDA on eight patients receiving HAIC through an indwelling hepatic artery catheter and Infusaid (trademark) pump. In 7 of 8 patients, there was non-visualization of the gall bladder throughout the hepatobiliary study. In the eighth patient, the gall bladder visualized at 2 hr. One patient with non-visualization of the gall bladder at 4 hr developed acute symptoms requiring cholecystectomy which showed acute and chronic cholecystitis with cholethiasis. There was prominent sclerosis which was thought to be due to chemical cholecystitis as well as cholelithiasis. In all 10 patients, no evidence of cholecystitis had been observed during the surgical placement of the hepatic artery catheter and Infusaid pump. The hepatobiliary scintigraphic finding of gall bladder dysfunction in all eight patients studied is most likely due to chemical cholecystitis from HAIC. This series suggests that chemical cholecystitis is common during HAIC and can be identified by hepatobiliary scintigraphy. The authors consider elective cholecystectomy during the operative placement of the hepatic artery catheter and Infusaid pump.

  8. Reconstructing single hepatic artery with two arterial stumps: biliary complications in pediatric living donor liver transplantation.

    PubMed

    Julka, Karan D; Lin, Tsan-Shiun; Chen, Chao-Long; Wang, Chih-Chi; Komorowski, Andrzej L

    2014-01-01

    Liver grafts can at times have two hepatic arterial stumps. This can result in a dilemma whether to reconstruct single or both the arteries. Hepatic artery (HA) thrombosis is the most dreaded complication in pediatric living donor liver transplantation (LDLT) as it can result in biliary complications and subsequent graft loss. We herein report the feasibility of reconstructing single hepatic artery in pediatric living donor liver transplantation having two arterial stumps in the liver graft. From 2008 to 2010, 87 pediatric patients undergoing LDLT were divided into three groups. Group 1 (n = 20): two HA stumps with two HA reconstruction, Group 2 (n = 22): two HA stumps with one HA reconstruction and Group 3 (n = 45): one HA stump with one HA reconstruction. The decision regarding the reconstruction of single or multiple HAs was made depending on the pre-operative radiological and intraoperative assessments. The incidence of HA thrombosis (p = 0.126) and biliary complications (p = 0.617), was similar in the three groups. Single HA reconstruction does not increase the risk of biliary strictures in pediatric LDLT recipients having dual hepatic arterial stumps in the liver graft.

  9. Fetal hepatic haematopoiesis is modulated by arterial blood flow to the liver.

    PubMed

    Kunisaki, Shaun M; Azpurua, Humberto; Fuchs, Julie R; Graves, Sara C; Zurakowski, David; Fauza, Dario O

    2006-08-01

    We describe an as yet unrecognised relationship between fetal hepatic haematopoiesis and arterial blood flow to the liver. To increase hepatic arterial flow, the common bile duct (CBD) was ligated in fetal lambs. Reduction of hepatic arterial flow was accomplished in age-matched animals by hepatic artery (HA) ligation. Multiple analyses performed before term showed a significant increase in haematopoietic cell density in CBD animals when compared with sham controls and HA animals. In contrast, HA animals demonstrated a decrease in liver haematopoietic activity. Fetal hepatic haematopoiesis is dependent upon arterial blood flow to the liver.

  10. Vertebral Artery Aneurysm Mimicking as Left Subclavian Artery Aneurysm in a Patient with Transforming Growth Factor Beta Receptor II Mutation.

    PubMed

    Afifi, Rana O; Dhillon, Baltej Singh; Sandhu, Harleen K; Charlton-Ouw, Kristofer M; Estrera, Anthony L; Azizzadeh, Ali

    2015-10-01

    We report successful endovascular repair of a left vertebral artery aneurysm in a patient with transforming growth factor beta receptor II mutation. The patient was initially diagnosed with a left subclavian artery aneurysm on computed tomography angiography. The patient consented to publication of this report.

  11. Hybrid Coronary Artery Revascularization for Takayasu Arteritis with Major Visceral Collateral Circulation from the Left Internal Thoracic Artery

    PubMed Central

    Sim, Hyung Tae; Kim, Jeong-Won; Yoo, Jae Suk; Cho, Kwang Ree

    2017-01-01

    Coronary arterial involvement in Takayasu arteritis (TA) is not uncommon. Herein, we describe a case of TA with celiac trunk and superior mesenteric artery occlusion combined with coronary artery disease. Bilateral huge internal thoracic arteries (ITAs) and the inferior mesenteric artery provided the major visceral collateral circulation. After percutaneous intervention to the right coronary artery, off-pump coronary artery bypass grafting for the left coronary territory was done using a right ITA graft and its large side branch because of its relatively minor contribution to the visceral collateral circulation. PMID:28382269

  12. Separate origin of the main components of the left coronary artery in Syrian hamsters (Mesocricetus auratus).

    PubMed

    Durán, A C; Arqué, J M; Fernández, B; Fernández, M C; Fernández-Gallego, T; Sans-Coma, V

    2007-08-01

    This study describes a rare congenital coronary artery anomaly in the Syrian hamster; namely, the separate origin of the obtuse marginal and left circumflex arteries which are the main components of the left coronary artery. The hearts of nine affected animals were examined by means of a corrosion-cast technique and histology. The hamsters belonged to a laboratory inbred family with a high incidence of coronary artery anomalies and bicuspid aortic valve. The aortic valve was tricuspid in three hamsters and bicuspid in the other six hamsters. In all cases, the right coronary artery was normal, whereas the left coronary artery main trunk was absent. The present anomalous coronary artery patterns could be classified into two main entities: (i) ectopic origin of the obtuse marginal artery from the right aortic sinus or from the right coronary artery, with the left circumflex artery arising from the left side of the aortic valve; and (ii) ectopic origin of both the obtuse marginal artery from the right aortic sinus or from the right coronary artery and left circumflex artery from the dorsal aortic sinus. In all cases, the obtuse marginal artery coursed to the right side of the heart through the ventral wall of the right ventricular outflow tract. When the left circumflex artery arose from the dorsal aortic sinus, it formed an acute angle with the aortic wall. This report seems to be the first to describe the separate origin of the main components of the left coronary artery in a non-human mammalian species. In man, the congenital coronary artery and aortic valve defects reported herein may entail the risk of clinical complications. However, none of the affected hamsters showed signs of disease.

  13. Giant aneurysm of the left anterior descending coronary artery in a pediatric patient with Behcet's disease.

    PubMed

    Cook, Amanda L; Rouster-Stevens, Kelly; Williams, Derek A; Hines, Michael H

    2010-07-01

    Behcet's disease is a rare autoimmune vasculitis characterized by oral aphthosis, genital ulcers, and ocular and cutaneous lesions. Vascular involvement usually affects the veins more commonly than the arteries, and coronary arterial involvement is extremely rare. We report an adolescent with Behcet's disease who developed a large pseudoaneurysm of the left anterior descending coronary artery requiring a coronary arterial bypass graft.

  14. Arterial hypertension and cardiovascular damage in the elderly: focus on arterial stiffness and left ventricular hypertrophy.

    PubMed

    Paciaroni, E; Antonicelli, R; Gambini, C; Sirolla, C

    1993-01-01

    Both aging and Arterial Hypertension (AH) cause a series of structural and functional changes in the cardiovascular apparatus. The reduction of aortic distensibility (RAD) and left ventricular hypertrophy (LVH) are, in particular, two significant markers of cardiovascular damage apart from being factors of serious and widespread morphological alterations. In this paper, the Authors analyze the effects of aging and of AH on the cardiovascular apparatus in order to find a possible clinical significance in relation to both RAD and LVH.

  15. Segmental arterial mediolysis of left gastric artery: a case report and review of pathology

    PubMed Central

    2013-01-01

    Background Segmental arterial mediolysis (SAM) is a rare non inflammatory vascular disease that can present with massive haemorrhage, which may lead to death without prompt surgical intervention. Case presentation A 60 years old Aboriginal female presented with life threatening, spontaneous intra-abdominal bleeding requiring an emergency laparotomy. The source of bleeding was found to be ruptured left gastric artery. A total gastrectomy was performed as a damage control procedure. A staged Roux-en-Y oesophago-jejunostomy with Hunt Lawrence pouch reconstruction was undertaken thirty six hours later. Histopathological findings revealed evidence of non-inflammatory segmental vascular damage with microaneurysm, consistent with segmental arterial mediolysis. Conclusion Prompt resuscitation and surgical intervention can decrease the morbidity and mortality in this rare clinical entity. PMID:24168034

  16. Saphenous vein patch for correction of anomalous origin of the right coronary artery from the left main coronary artery

    PubMed Central

    AlQuadan, Obadah F.; AlSmady, Moaath M.; Saleh, Suhayl S.; Aqel, Raed A.; Al-Antary, Eman T.

    2017-01-01

    Anomalous origin of the coronary arteries is a rare congenital heart defect that may lead to disturbed life style, myocardial infarction and sudden death. This report describes a young lady with the right coronary artery arising from the left main coronary artery, which was confirmed by coronary angiography and corrected surgically using saphenous vein patch. PMID:28096325

  17. Emergency Stenting of Unprotected Left Main Coronary Artery after Acute Catheter-Induced Occlusive Dissection

    PubMed Central

    Akgul, Ferit; Batyraliev, Talantbek; Besnili, Fikret; Karben, Zarema

    2006-01-01

    Left main coronary artery dissection occurs very rarely during selective coronary angiography, but it generally progresses to complete coronary occlusion. The traditional treatment of occlusive dissection of the unprotected left main coronary artery has been surgical. Percutaneous treatment has been sporadic and controversial. We report a case of iatrogenic occlusive dissection of the unprotected left main coronary artery during diagnostic coronary angiography, followed by successful stenting of the lesion. PMID:17215985

  18. Left anterior descending artery percutaneous coronary intervention via the left internal mammary artery in a 54-year-old type 1 diabetic woman: a case report

    PubMed Central

    Kasprzak, Jarosław

    2013-01-01

    Data on the treatment of left anterior descending artery (LAD) stenosis involving or localized distally to left internal mammary artery anastomosis are scarce and not homogeneous. Both surgery (CABG) and percutaneous interventions (PCI) have been attempted, but the most effective treatment has not yet been established. We report a case of a 54-year-old woman suffering from chronic, stable angina and diabetes type 1 successfully treated with percutaneous angioplasty of LAD via the left internal mammary artery with drug-eluting stent implantation with excellent short-term results. PMID:24570698

  19. Isolated Hypoplasia of Left Pulmonary Artery with Agenesis of Left Lobe of Thyroid: A Case Report

    PubMed Central

    Khadir, Mohammed Abdul; Narayana, Ganesh; Nayar, Pradeep G

    2016-01-01

    Isolated Unilateral hypoplasia or agenesis of a branch of pulmonary artery is very rare. It is usually seen associated with congenital heart diseases such as tetralogy of Fallot, atrial septal defect, coarctation of the aorta, right aortic arch, truncus arteriosus, patent ductus arteriosus and pulmonary atresia. It occurs as a result of lack of embryological development of either the left or right sixth aortic arch and has been found to present itself with various clinical manifestations as during childhood it presents as contralateral pulmonary hypertension and in adults as haemoptysis. Early diagnosis and early surgical indication avoids the evolution of pulmonary hypertension to unfavourble state of more severe and progressive degrees and also prevents the development of pulmonary systemic collateral circulation, which is mainly responsible for subsequent haemoptysis in the adulthood. We hereby, report the case of an infant who presented with features of lower respiratory tract infection and later diagnosed as isolated congenital hypoplasia of left pulmonary artery and hence planned for proper follow-up for early surgery thereby preventing complications in the future. PMID:28208970

  20. Isolated Hypoplasia of Left Pulmonary Artery with Agenesis of Left Lobe of Thyroid: A Case Report.

    PubMed

    Khadir, Mohammed Abdul; Narayana, Ganesh; Ramagopal, Ganavi; Nayar, Pradeep G

    2016-12-01

    Isolated Unilateral hypoplasia or agenesis of a branch of pulmonary artery is very rare. It is usually seen associated with congenital heart diseases such as tetralogy of Fallot, atrial septal defect, coarctation of the aorta, right aortic arch, truncus arteriosus, patent ductus arteriosus and pulmonary atresia. It occurs as a result of lack of embryological development of either the left or right sixth aortic arch and has been found to present itself with various clinical manifestations as during childhood it presents as contralateral pulmonary hypertension and in adults as haemoptysis. Early diagnosis and early surgical indication avoids the evolution of pulmonary hypertension to unfavourble state of more severe and progressive degrees and also prevents the development of pulmonary systemic collateral circulation, which is mainly responsible for subsequent haemoptysis in the adulthood. We hereby, report the case of an infant who presented with features of lower respiratory tract infection and later diagnosed as isolated congenital hypoplasia of left pulmonary artery and hence planned for proper follow-up for early surgery thereby preventing complications in the future.

  1. Retrograde approach to an ostial left anterior descending chronic total occlusion through a left internal mammary artery graft.

    PubMed

    Hari, Pawan; Kirtane, Ajay J; Bangalore, Sripal

    2016-05-01

    Retrograde approach to chronic total occlusions (CTO) has been described via saphenous vein grafts, septal and epicardial collaterals. We report for the first time a successful retrograde approach to an ostial left anterior descending (LAD) artery CTO through a failed left internal mammary artery (LIMA) to LAD anastamosis. This case demonstrates the technical aspects of using a LIMA conduit as a retrograde approach to CTO. © 2015 Wiley Periodicals, Inc.

  2. A New Soluble Gelatin Sponge for Transcatheter Hepatic Arterial Embolization

    SciTech Connect

    Takasaka, Isao; Kawai, Nobuyuki; Sato, Morio Sahara, Shinya; Minamiguchi, Hiroyuki; Nakai, Motoki; Ikoma, Akira; Nakata, Kouhei; Sonomura, Tetsuo

    2010-12-15

    To prepare a soluble gelatin sponge (GS) and to explore the GS particles (GSPs) that inhibit development of collateral pathways when transcatheter hepatic arterial embolization is performed. The approval of the Institutional Committee on Research Animal Care of our institution was obtained. By means of 50 and 100 kDa of regenerative medicine-gelatin (RM-G), RM-G sponges were prepared by freeze-drying and heating to temperatures of 110-150{sup o}C for cross-linkage. The soluble times of RM-GSPs were measured in vitro. Eight swine for transcatheter hepatic arterial embolization were assigned into two groups: six received 135{sup o}C/50RM-GSPs, 125{sup o}C/100RM-GSPs, and 138{sup o}C/50RM-GSPs, with soluble time of 48 h or more in vitro; two swine received Gelpart GSPs (G-GSPs) with insoluble time of 14 days as a control. Transarterial chemoembolization was performed on two branches of the hepatic artery per swine. RM-GSPs heated at temperatures of 110-138{sup o}C were soluble. Mean soluble times of the RM-GSPs increased with higher temperature. Hepatic branches embolized with G-GSP remained occluded after 6 days, and development of collateral pathways was observed after 3 days. Hepatic branches embolized with 135{sup o}C/50RM-GSP and 125{sup o}C/100RM-GSP remained occluded for 4 h, and recanalization was observed after 1 day. Hepatic branches embolized with 138{sup o}C/50RM-GS remained occluded for 1 day, and recanalization was observed after 2 days with no development of collateral pathways. In RM-GSs with various soluble times that were prepared by modulating the heating temperature, 138{sup o}C/50RM-GSP was the soluble GSP with the longest occlusion time without inducing development of collateral pathways.

  3. Establishment of a hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol

    PubMed Central

    Wang, Lei; He, Fu-Liang; Liu, Fu-Quan; Yue, Zhen-Dong; Zhao, Hong-Wei

    2015-01-01

    AIM: To determine the feasibility and safety of establishing a porcine hepatic cirrhosis and portal hypertension model by hepatic arterial perfusion with 80% alcohol. METHODS: Twenty-one healthy Guizhou miniature pigs were randomly divided into three experimental groups and three control groups. The pigs in the three experimental groups were subjected to hepatic arterial perfusion with 7, 12 and 17 mL of 80% alcohol, respectively, while those in the three control groups underwent hepatic arterial perfusion with 7, 12 and 17 mL of saline, respectively. Hepatic arteriography and direct portal phlebography were performed on all animals before and after perfusion, and the portal venous pressure and diameter were measured before perfusion, immediately after perfusion, and at 2, 4 and 6 wk after perfusion. The following procedures were performed at different time points: routine blood sampling, blood biochemistry, blood coagulation and blood ammonia tests before surgery, and at 2, 4 and 6 wk after surgery; hepatic biopsy before surgery, within 6 h after surgery, and at 1, 2, 3, 4 and 5 wk after surgery; abdominal enhanced computed tomography examination before surgery and at 6 wk after surgery; autopsy and multi-point sampling of various liver lobes for histological examination at 6 wk after surgery. RESULTS: In experimental group 1, different degrees of hepatic fibrosis were observed, and one pig developed hepatic cirrhosis. In experimental group 2, there were cases of hepatic cirrhosis, different degrees of increased portal venous pressure, and intrahepatic portal venous bypass, but neither extrahepatic portal-systemic bypass circulation nor death occurred. In experimental group 3, two animals died and three animals developed hepatic cirrhosis, and different degrees of increased portal venous pressure and intrahepatic portal venous bypass were also observed, but there was no extrahepatic portal-systemic bypass circulation. CONCLUSION: It is feasible to establish an

  4. Occlusion of the left main coronary artery and collateral circulation via the conus branch.

    PubMed

    de Agustin, Jose Alberto; Nunez-Gil, Ivan Javier; del Carmen Manzano, Maria; Vivas, David; Mateos, Borja Ruiz; Carda, Rocio; Vilacosta, Isidre; Zamorano, Jose Luis; Macaya, Carlos

    2009-05-01

    We report the case of a 71-year-old-man, a smoker, admitted for unstable angina. Subsequent investigation revealed complete proximal occlusion of the left main coronary with an unusual collateral circulation. The left coronary artery was filled by a large conus branch originating from the right sinus of Valsalva. This case shows the importance of looking for atypical collateral circulation in patients with chronic occlusion of the left main coronary artery and normal left ventricular function.

  5. Gallbladder infarction following hepatic transcatheter arterial embolization: angiographic study

    SciTech Connect

    Kuroda, C.; Iwasaki, M.; Tanaka, T.; Tokunaga, K.; Hori, S.; Yoshioka, H.; Nakamura, H.; Sakurai, M.; Okamura, J.

    1983-10-01

    Gallbladder infarction developing after transcatheter arterial embolization (TAE) in patients with malignant hepatic tumors was studied by comparing preoperative angiographic and postoperative macroscopic and histological findings. Eight patients demonstrated occlusion of the cystic artery or its branches by embolic materials on post-TAE angiograms. Surgery revealed infarction of the gallbladder in 6 patients; no infarction was noted in the other 2, although branches of the cystic artery were occluded on the post-TAE angiogram. Due to recanalization of the occluded artery, the infarcted area could be assessed only by follow-up angiography. No patient experienced perforation of the gallbladder as a result of infarction. The authors suggest that patients with post-TAE infarction of the gallbladder can be treated consevatively if they are kept under close observation.

  6. Congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery: an interesting case report.

    PubMed

    Turker, Yasin; Tibilli, Hakan

    2014-01-01

    Intercoronary communication is a very rare coronary artery anomaly. It is defined as an open-ended circulation with bidirectional blood flow between two coronary arteries. Coronary artery fistulas are abnormal communications between a coronary artery and a cardiac chamber or major vessel. A 62-year-old man was admitted to our hospital with sudden development of general weakness, dizziness and a sensation of compression in his chest. At presentation his blood pressure was 80/40 mmHg and heart rate was 65 beats/min. The ECG revealed sinus rhythm and 1-2 mm ST elevation in the anterior leads. The patient was taken to the catheterization laboratory for percutaneous coronary intervention. The left main and left circumflex coronary arteries were normal. Coronary angiography showed a communication between the left main and the diagonal branch of the left anterior descending and a fistula between the intercoronary connection and the left atrium. The other coronary arteries were normal. Laboratory test results, including cardiac troponin I and creatine kinase-MB levels, were normal. The angina symptoms disappeared and the ST elevation resolved within four hours. We report an interesting case of congenital coronary artery fistula in an intercoronary communication between the left main and the diagonal branch of the left anterior descending coronary artery presenting as an acute coronary syndrome. To the best of our knowledge, this is the first case in the literature involving a coronary artery fistula in an intercoronary communication. Copyright © 2013 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  7. Amoebic liver abscess with hepatic artery pseudoaneurysm: successful treatment by interventional radiology.

    PubMed

    Yadav, Ajit K; Gupta, Saumya; Hariprasad, Sudarsan; Kumar, Ashish; Ghuman, Samarjit S; Gupta, Arun

    2015-03-01

    Amoebic liver abscess is most common extra-intestinal presentation of amoebiasis. It is rarely complicated with vascular involvement including thrombosis of hepatic vein or IVC and pseudo-aneurysm of hepatic artery. We describe a case of hepatic artery pseudo-aneurysm as a complication of amoebic liver abscess treated with percutaneous embolization.

  8. Morphologic expression of the left coronary artery in pigs. An approach in relation to human heart

    PubMed Central

    Gómez, Fabian Alejandro; Ballesteros, Luis Ernesto

    2014-01-01

    Introduction In spite of its importance as an experimental model, the information on the left coronary artery in pigs is sparse. Objective To determine the morphologic features of the left coronary artery in pigs. Methods We evaluated 158 pig hearts. The left coronary artery was perfused with synthetic resin after their ostia had been catheterized. Diameters and courses of the vascular beds were measured with an electronic caliper (Mitutoyo®). Results The diameter of left coronary artery was 6.98 ± 1.56 mm and its length was 3.51±0.99 mm. It was found to end up by bifurcating itself into the anterior interventricular artery and the circumflex artery in 79% of the cases, and by trifurcating in 21% of the cases, with the presence of the diagonal artery. The anterior interventricular artery ended up at the apex in 79.7% of the cases, and the circumflex artery at the posterior aspect of the left ventricle in 64% of the case, this artery never reached the posterior interventricular sulcus. An anastomosis between the terminal branches of the anterior interventricular artery and the posterior interventricular artery was found in 7.6% of the specimens. The antero-superior branch of the anterior interventricular artery occurred in 89.9% of the hearts. A left marginal branch was observed in 87.9% of the cases with a diameter of 2.25±0.55 mm. Conclusion Compared with humans, pigs have shorter left coronary artery trunks and branches; even the circumflex artery never reaches the posterior interventricular sulcus. Our findings are useful for the design of experimental hemodynamic and procedural models. PMID:25140471

  9. Hepatic imaging following intra-arterial embolotherapy.

    PubMed

    Kallini, Joseph Ralph; Miller, Frank H; Gabr, Ahmed; Salem, Riad; Lewandowski, Robert J

    2016-04-01

    To discuss guidelines and salient imaging findings of solid tumors treated with common intra-arterial procedures used in interventional oncology. A meticulous literature search of PubMed-indexed articles was conducted. Key words included "imaging + embolization," "imaging + TACE," "imaging + radioembolization," "imaging + Y90," "mRECIST," and "EASL." Representative post-treatment cross-sectional images were obtained from past cases in this institution. Intra-arterial therapy (IAT) in interventional oncology includes bland embolization, chemoembolization, and radioembolization. Solid tumors of the liver are the primary focus of these procedures. Cross-sectional CT and/or MR are the main modalities used to image tumors after treatment. Traditional size-based response criteria (WHO and RECIST) alone are of limited utility in determining response to IAT; tumoral necrosis and enhancement must be considered. Specifically for HCC, the EASL and mRECIST guidelines are becoming widely adopted response criteria to assess these factors. DWI, FDG-PET, and CEUS are modalities that play an adjunctive but controversial role. Radiologists must be aware that the different forms of intra-arterial therapy yield characteristic findings on cross-sectional imaging. Knowledge of these findings is integral to accurate assessment of tumor response and progression.

  10. Anomalous origin of the left coronary artery from the pulmonary artery with coronary artery steal in adults. Report of two cases and review of the literature.

    PubMed Central

    Ihekwaba, F N; Davidson, K G; Ogilvie, B; Caves, P K

    1976-01-01

    Patients with anomalous left coronary artery arising from the pulmonary artery rarely survive to adult life. Those who attain adulthood may present with angina indistinguishable from coronary artery disease and are liable to sudden death. Myocardial infarction, though rare in young adults, may occur and may be due to coronary artery steal. Accurate diagnosis requires coronary arteriography. Two further cases of coronary artery steal in adults with anomalous origin of the left coronary artery from the pulmonary artery are presented. In both patients aortocoronary bypass grafting using a reversed autogenous saphenous vein with closure of the origin of the anomalous left coronary artery was successfully performed. This operation provided complete symptomatic relief and may protect patients against the risk of sudden death. Images PMID:781907

  11. Continuous transcatheter arterial thrombolysis for early hepatic artery thrombosis after liver transplantation.

    PubMed

    Zhou, J; Fan, J; Wang, J-H; Wu, Z-Q; Qiu, S-J; Shen, Y-H; Shi, Y-H; Huang, X-W; Wang, Z; Tang, Z-Y; Wang, Y-Q

    2005-12-01

    Early hepatic artery thrombosis (HAT) after orthotopic liver transplantation remains a significant cause of graft loss and patient death. The most effective treatment approach is still controversial. The purpose of this study was to assess the effect of continuous transcatheter arterial thrombolysis in the treatment of early HAT. Routine posttransplant color Doppler imaging (CDI) was performed to monitor hepatic artery blood flow. HAT was confirmed by arterial angiography in suspected cases. HAT was identified in 8 patients (8/287, 2.8%) which occurred on days 2 to 19 (mean, 5.2 days) after liver transplantation. Patients with HAT were treated with continuous transcatheter arterial thrombolysis using urokinase. Successful revascularization through thrombolysis was obtained in all eight cases. One patient died of a pulmonary infection at 2 months after liver transplantation. Another patient underwent retransplantation because of resistant allograft rejection and recurrence of HAT 6 months after the first operation, but died from multiple system organ failure 2 months later. The other six patients remained in good health during the follow-up period of 3 to 27 months. Our results demonstrate that CDI is an effective method to monitor the occurrence of early HAT after liver transplantation. Furthermore, continuous transcatheter arterial thrombolysis with urokinase could be a rational therapeutic approach to rescue the allograft following early HAT diagnosis confirmed by arterial angiography.

  12. Diffuse coronary artery ectasia in a patient with left main coronary artery trifurcation

    PubMed Central

    Desperak, Piotr; Bujak, Kamil; Głowacki, Jan; Gąsior, Mariusz

    2016-01-01

    The term coronary ectasia is reserved to describe a diffuse dilatation of coronary artery segments that have a diameter that exceeds the size of normal adjacent coronary segments by 1.5 times. The occurrence of coronary artery ectasia (CAE) ranges from 3% to 8% in the group of patients undergoing coronary computed tomography angiography. The CAE is associated with traditional risk factors and often co-exists with coronary atherosclerosis, which suggests that ectasia may represent an advanced form of atherosclerosis. Nevertheless, there is a lack of consensus on the clinical implications and management of patients in whom the occurrence of CAE is observed, especially in patients without concomitant obstructive atherosclerosis. Here, we present a rare case of a 62-year-old patient with multiple CAEs and left main trifurcation. PMID:27785148

  13. Evaluation of Allen's test in both arms and arteries of left and right-handed people.

    PubMed

    Oettlé, A C; van Niekerk, A; Boon, J M; Meiring, J H

    2006-03-01

    The Allen's test as described in 1929 by Edgar V. Allen has been modified, adapted and complemented by other newer modalities but remains a first line standard test to evaluate the arterial supply of the hand. In this study an attempt has been made to add more information regarding the arterial supply of the hand, in left- and right-handed individuals, left and right hands and the ulnar and radial arteries, when doing the Allen's test. A modified Allen's test using an oxygen saturation monitor was used. The sample group consisted of 80 (30 left-handed and 50 right-handed) students. No significant differences between the Allen's test of the left and right hands in the left and right-handed individuals were found. There was a marginal but not significant difference between the two arteries. The ulnar artery took slightly longer to reach baseline values as compared to the radial artery. The results suggest that a positive Allen's test can be found in both left and right-handed people, with regard to the left and right hands and both radial and ulnar arteries may be implicated. This information should be kept in mind when selecting either the radial or ulnar artery for grafting purposes (e.g. coronary angiosurgery) and forearm artery cannulation.

  14. [Extrahepatic vessels depending on the hepatic artery. Identification and management].

    PubMed

    Arias Fernández, J; Martín Martín, B; Pinheiro da Silva, N; Díaz, M L; Bilbao, J I

    2011-01-01

    Patients with malignant liver tumors, whether primary tumors or metastases, that are not candidates for surgical treatment can benefit from different endovascular treatments with proven efficacy in local control of the disease. Correct treatment requires a careful angiographic technique and precise knowledge about the vascular anatomy afferent to the lesion. Occasionally, lesions considered relapse are actually areas that were untreated because the afferent pedicle was not adequately detected. On the other hand, some of the complications of endovascular treatments are related with material passing into non-hepatic vessels. Knowing the hepatic vascular anatomy and correctly identifying all the extrahepatic vessels will make it possible to perform safer, more efficacious treatments. In this article, we present different representative examples of extrahepatic vessels that originate in the hepatic artery. Copyright © 2010 SERAM. Published by Elsevier Espana. All rights reserved.

  15. Left Gastric Artery Aneurysm: Successful Embolization with Ethylene Vinyl Alcohol Copolymer (Onyx)

    SciTech Connect

    Vargas, Hebert Alberto Cousins, Claire; Higgins, J. Nicholas; See, Teik Choon

    2008-03-15

    Patients with left gastric artery aneurysms present with hemorrhagic shock due to rupture or occasionally it is an incidental finding on abdominal CT examinations. Due to the increased morbidity and mortality from this condition, adequate diagnosis and treatment are essential. In this article we present a patient with a left gastric artery aneurysm treated with a new embolization agent, ethylene vinyl alcohol copolymer (Onyx)

  16. Hepatic Arterial Infusion Chemotherapy Combined with Venous Embolization in a Patient with Hepatic Metastases with an Arteriovenous Shunt

    SciTech Connect

    Nishiofuku, Hideyuki; Tanaka, Toshihiro; Sakaguchi, Hiroshi; Yamamoto, Kiyosei; Inoue, Masayoshi; Sueyoshi, Satoru; Shinnkai, Takayuki; Hasegawa, Masatoshi; Kichikawa, Kimihiko

    2009-07-15

    We describe herein a patient who had hepatic metastases with an arteriovenous shunt and was treated by hepatic arterial infusion chemotherapy. The arteriovenous shunt was diagnosed by {sup 99m}Tc-macroaggregated albumin scintigraphy and hepatic venous embolization was performed to reduce shunt flow.

  17. Left main coronary artery atresia and associated cardiac defects: report on concomitant surgical treatment.

    PubMed

    Jatene, Marcelo; Juaneda, Ignacio; Miranda, Rogerio Dos Anjos; Gato, Rafaella; Marcial, Miguel Lorenzo Barbero

    2011-10-01

    A 9-year-old boy with congenital atresia of the left main coronary artery underwent myocardial revascularization. Coarctation of the aorta and ventricular septal defect were diagnosed at the age of 1 year. At age 7 years, the child presented with syncope while exercising. Preoperative evaluation included cardiac catheterization which revealed the unexpected finding of congenital atresia of the left main coronary artery with origin of the circumflex artery from the right coronary artery. Surgical correction included myocardial revascularization by means of left internal mammary artery graft to the anterior descending coronary artery, coarctation resection, and ventricular septal defect repair. The patient recovered uneventfully. We report the details of this extremely rare case with successful concomitant surgical management of the congenital coronary artery anomaly and the associated structural heart disease.

  18. Localizing intramyocardially embedded left anterior descending artery during coronary bypass surgery: literature review

    PubMed Central

    2013-01-01

    Proper detection of the deeply embedded left anterior descending artery remains a challenge. Many authors proposed different methods for artery identification, such as ultrasound Doppler, cineangiography, retrograde dissection overlying tissues, and exposure over the probe. Choice of the technique often depends on the surgeon's acquaintance and experience. The article compares and summarizes different procedures for the detection of intramyocardially located left anterior descending artery. PMID:24172140

  19. Surgical management in paediatric patients with left abnormal subclavian artery and right aortic arch.

    PubMed

    Sodian, R; Rassoulian, D; Kaczmarek, I; Kozlik-Feldmann, R; Huber, A; Reichart, B; Daebritz, S

    2007-06-01

    Left abnormal subclavian artery and right aortic arch is described as a rare cause of dyspnoea and dysphagia in paediatric patients. The optimal surgical management of such cases is not clearly established. We propose a single-stage repair by transection of the patent ductus arteriosus or ligamentum arteriosum and an additional transection of the left abnormal subclavian artery with reimplantation into the common carotid artery.

  20. Left medial parietal lobe and receptive language functions: mixed transcortical aphasia after left anterior cerebral artery infarction.

    PubMed

    Ross, E D

    1980-02-01

    Three aphasic patients with infarctions involving the left anterior cerebral artery have been studied. Two had trancortical motor aphasia, and one had mixed transcortical (or isolation) aphasia. Based on computerized tomography in two patients and whole-brain sections in one, the patient with mixed transcortical aphasia had a lesion that went beyond the rolandic fissure to involve the anterior precuneus lobule of the left medial parietal lobe. In the patients with transcortical motor aphasia, the lesion was confined to the frontal lobe. From these cases and other data, it seems likely that the left medial parietal lobe has receptive language functions analogous to the motor language functions of the left medial frontal lobe, thus accounting for the mixed transcortical aphasia observed in the patient whose left anterior cerebral artery infarction involved both the medial parietal and medial frontal lobes.

  1. Anomalous Origin of the Right Coronary Artery from the Midportion of the Left Anterior Descending Artery: A Rare Coronary Anomaly

    PubMed Central

    Gholoobi, Arash

    2016-01-01

    The anomalous origin of the right coronary artery (RCA) as a branch from the left anterior descending artery (LAD) is a very rare variation of the single coronary artery anomaly. The anomalous vessel arises from the proximal or midportion of the LAD and courses anterior to the pulmonary artery trunk in most instances. In this case report, a 61-year-old woman is introduced who underwent coronary angiography following inferoposterior myocardial infarction, in which an anomalous RCA was seen originating from the midportion of the LAD. There was also a separate small artery originating from the right coronary sinus, which was most probably a right atrial branch. PMID:27956915

  2. Post-traumatic hepatic artery pseudo-aneurysm combined with subphrenic liver abscess treated with embolization

    PubMed Central

    Sun, Long; Guan, Yong-Song; Wu, Hua; Pan, Wei-Min; Li, Xiao; He, Qing; Liu, Yuan

    2006-01-01

    A 23-year-old man with post-traumatic hepatic artery pseudo-aneurysm and subphrenic liver abscess was admitted. He underwent coil embolization of hepatic artery pseudo-aneurysm. The pseudo-aneurysm was successfully obstructed and subphrenic liver abscess was controlled. Super-selective trans-catheter coil embolization may represent an effective treatment for hepatic artery pseudo-aneurysm combined with subphrenic liver abscess in the absence of other therapeutic alternatives. PMID:16718774

  3. Right Aortic Arch with a Retroesophageal Left Subclavian Artery and an Anomalous Origin of the Pulmonary Artery from the Aorta

    PubMed Central

    Jeon, Chang-Seok; Shim, Man-shik; Yang, Ji-Hyuk; Jun, Tae-Gook

    2017-01-01

    We report the case of a newborn with a rare anatomic variation: a right aortic arch with a retroesophageal left subclavian artery and an anomalous origin of the pulmonary artery from the aorta. This variation was diagnosed using echocardiography and computed tomography, and we treated the condition surgically. PMID:28180103

  4. Extra-anatomic autologous reconstruction with hepatic-iliac artery bypass graft for aortic endograft infection.

    PubMed

    Buora, Adelaide; Floriani, Marco; Gabrielli, Livio

    2015-01-01

    We present a new intra-abdominal extra-anatomic bypass graft for a 64-year-old man treated with an abdominal aortic endograft and with signs of endograft infection. We performed surgical removal of the endograft and intra-abdominal extra-anatomic reconstruction of a hepatic-to-right external iliac artery bypass with autologous superficial femoral vein and a crossover graft between the right and left external iliac artery with the great saphenous vein. The later occlusion of the saphenous vein graft led us to perform a femoral-femoral prosthetic crossover. At 42 months from the intervention, the patient was in good health, and duplex scanning confirmed the patency of all grafts. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  5. Hepatic Cryotherapy and Subsequent Hepatic Arterial Chemotherapy for Colorectal Metastases to the Liver

    PubMed Central

    Alwan, Majeed H.; Booth, Michael W. C.

    1998-01-01

    This paper presents an experience of thirty consecutive patients with hepatic colorectal metastases who were treated with hepatic cryotherapy and subsequent hepatic arterial infusion (HAI) chemotherapy using 5FU. Patients with colorectal metastases confined to the liver but not suitable for resection, and with liver involvement of less than 50% were offered the treatment. Prospective documentation of all patients was undertaken with data being recorded on a computerised database. Patients had a median of 6 (2–15) lesions with sizes ranging from 1–12 cm. There was no 30 day mortality. Postoperative complications developed in 8 patients but were followed by full recovery in all instances. Side effects from chemotherapy occured in 23% of cycles. Twenty seven patients have died. Median survival from the time of cryotherapy was 18.2 months (7–34), or 23months (9–44) from diagnosis of liver lesions. Hepatic cryotherapy with subsequent arterial chemotherapy is safe and well tolerated. The results suggest survival of patients with colorectal hepatic metastases can be improved by the use of this modality of treatment. PMID:9893239

  6. Tissue levels of chemotherapeutic agents for hepatic metastasis during hepatic arterial and portal injection.

    PubMed

    Kaneko, A; Naomoto, Y; Aoyama, M; Tanaka, N

    1999-01-01

    Hepatic metastasis is one of the most important prognostic factors in digestive organ cancer, and hepatic arterial infusion is aggressively performed for therapy of nonresectable metastatic liver cancer. Although comparatively high response rates have been attained in some cases, this treatment has been ineffective in not a few cases because these metastatic tumors are frequently hypovascular in nature. To develop better methods of administering chemotherapeutic agents, we performed basic experiments concerning intraportal administration which has been regarded as having a generally negative effect, focusing on a report indicating that portal supply is dominant along the borders of metastatic liver cancer tumors. VX2 carcinoma cells were inoculated into the hepatic parenchyma beneath the capsule of juvenile Japanese white rabbits. Drugs were infused 2 weeks after the inoculation, then tissue and blood were sequentially sampled. Mitomycin C (1.7 mg/kg) was infused either by bolus injection to the hepatic artery (arterial infusion group) or by bolus injection to the portal vein (portal infusion group). Five-fluorouracil (9.5 mg/kg) and Cisplatin (1.6 mg/kg) were likewise infused continuously over 60 min, and tissue levels of the drugs were compared between the two groups. Mitomycin C and 5-fluorouracil levels were measured by HPLC and Cisplatin levels were measured by atomic absorption spectrophotometry. As a result, the levels of every drug in VX2 tumor tissue did not significantly differ between the arterial infusion group and the portal infusion group, while the levels were significantly higher than those in the intravenous infusion group. Using portal infusion, we observed a drug transition which was not inferior to that of arterial infusion, suggesting that an imported antitumoral effect may be obtained with this method compared with intravenous infusion.

  7. Ductal stenting retrains the left ventricle in transposition of great arteries with intact ventricular septum.

    PubMed

    Sivakumar, Kothandam; Francis, Edwin; Krishnan, Prasad; Shahani, Jagdish

    2006-11-01

    In late presenters with transposition of the great arteries, intact ventricular septum, and regressing left ventricle, left ventricular retraining by pulmonary artery banding and aortopulmonary shunt is characterized by a stormy postoperative course and high costs. Ductal stenting in the cardiac catheterization laboratory is conceptualized to retrain the left ventricle with less morbidity. Recanalization and transcatheter stenting of patent ductus arteriosus was performed in patients with transposition to induce pressure and volume overload to the regressing left ventricle. Serial echocardiographic monitoring of left ventricular shape, mass, free wall thickness, and volumes was done, and once the left ventricle was adequately prepared, an arterial switch was performed. The ductal stent was removed and the remaining surgical steps were similar to a 1-stage arterial switch operation. Postoperative course, need for inotropic agents, and left ventricular function were monitored. Ductal stenting in 2 patients aged 3 months resulted in improvement of indexed left ventricular mass from 18.9 to 108.5 g/m2, left ventricular free wall thickness from 2.5 to 4.8 mm, and indexed left ventricular volumes from 7.6 to 29.5 mL/m2 within 3 weeks. Both patients underwent arterial switch (bypass times 125 and 158 minutes) uneventfully, needed inotropic agents and ventilatory support for 3 days, and were discharged in 8 and 10 days. Ductal stenting is a less morbid method of left ventricular retraining in transposition of the great arteries with regressed left ventricle. Its major advantages lie in avoiding pulmonary artery distortion and neoaortic valve regurgitation resulting from banding and also in avoiding thoracotomy.

  8. [A case of hepatic artery aneurysm that had formed asymptomatically and penetrated into the duodenum].

    PubMed

    Hatogai, Ken; Nakazawa, Atsushi; Takita, Maiko; Kishino, Ryouhei; Seki, Eri; Iwasaki, Eisuke; Izumiya, Motoko; Maeda, Norio; Motegi, Katsuhiko; Mukai, Kiyoshi; Tsukada, Nobuhiro

    2012-02-01

    A 41-year-old man was admitted to our hospital with gastrointestinal bleeding. Esophagogastroduodenoscopy revealed a submucosal protrusion with erosion in the duodenal bulb which was thought to be the bleeding source. Dynamic CT scan, ultrasonography and angiography of the abdomen revealed a hepatic artery aneurysm and a dilated celiac artery that dissected from its origin. Although we considered percutaneous transcatheter arterial embolization with metallic coils, we chose surgical resection and vascular reconstruction to prevent hepatic ischemia resulting from interruption of collateral circulation. On the 8(th) day, hepatic artery aneurysmectomy and revascularization with a great saphenous vein was carried out without any severe complication. The pathological specimen demonstrated segmental arterial mediolysis.

  9. Early outcomes after left subclavian artery revascularisation in association with thoracic endovascular aortic repair.

    PubMed

    Oladokun, Dare; Patterson, Benjamin O; Brownrigg, Jack Rw; deBruin, Jorg L; Holt, Peter J; Loftus, Ian; Thompson, Matthew M

    2017-02-01

    Approximately 40-50% of patients undergoing thoracic endovascular aortic repair require left subclavian artery coverage for adequate proximal landing zone. Many of these patients undergo left subclavian artery revascularisation. However, outcomes data for left subclavian artery revascularisation in the context of thoracic endovascular aortic repair remain limited. In this study, 70 left subclavian artery revascularisation procedures, performed on thoracic endovascular aortic repair patients at a tertiary hospital, were retrospectively reviewed. Particular emphasis was placed on revascularisation-related outcomes during staging interval between revascularisation and thoracic endovascular aortic repair. Forty-six (66%) carotid-subclavian bypass, 17 (24%) carotid-carotid-subclavian bypass and 7 (10%) aorto-inominate-carotid-subclavian bypass procedures were performed. There were no strokes or mortalities following left subclavian artery revascularisation procedures alone. Three (10%) minor complications occurred including a seroma, a haematoma and a temporary neuropraxia. Separation of complications following left subclavian artery revascularisation from those of the associated thoracic endovascular aortic repair can be difficult. Early outcomes data from patients who underwent left subclavian artery revascularisation in isolation indicate that the procedure is safe with low complication rates.

  10. Left main bronchus compression due to main pulmonary artery dilatation in pulmonary hypertension: two case reports.

    PubMed

    Jaijee, Shareen K; Ariff, Ben; Howard, Luke; O'Regan, Declan P; Gin-Sing, Wendy; Davies, Rachel; Gibbs, J Simon R

    2015-12-01

    Pulmonary arterial dilatation associated with pulmonary hypertension may result in significant compression of local structures. Left main coronary artery and left recurrent laryngeal nerve compression have been described. Tracheobronchial compression from pulmonary arterial dilatation is rare in adults, and there are no reports in the literature of its occurrence in idiopathic pulmonary arterial hypertension. Compression in infants with congenital heart disease has been well described. We report 2 cases of tracheobronchial compression: first, an adult patient with idiopathic pulmonary arterial hypertension who presents with symptomatic left main bronchus compression, and second, an adult patient with Eisenmenger ventricular septal defect and right-sided aortic arch, with progressive intermedius and right middle lobe bronchi compression in association with enlarged pulmonary arteries.

  11. N-butyl Cyanoacrylate Glue Embolization of Arterial Networks to Facilitate Hepatic Arterial Skeletonization before Radioembolization

    SciTech Connect

    Samuelson, Shaun D.; Louie, John D.; Sze, Daniel Y.

    2013-06-15

    Purpose. Avoidance of nontarget microsphere deposition via hepatoenteric anastomoses is essential to the safety of yttrium-90 radioembolization (RE). The hepatic hilar arterial network may remain partially patent after coil embolization of major arteries, resulting in persistent risk. We retrospectively reviewed cases where n-butyl cyanoacrylate (n-BCA) glue embolization was used to facilitate endovascular hepatic arterial skeletonization before RE. Methods. A total of 543 RE procedures performed between June 2004 and March 2012 were reviewed, and 10 were identified where n-BCA was used to embolize hepatoenteric anastomoses. Arterial anatomy, prior coil embolization, and technical details were recorded. Outcomes were reviewed to identify subsequent complications of n-BCA embolization or nontarget RE. Results. The rate of complete technical success was 80 % and partial success 20 %, with one nontarget embolization complication resulting in a minor change in treatment plan. No evidence of gastrointestinal or biliary ischemia or infarction was identified, and no microsphere-related gastroduodenal ulcerations or other evidence of nontarget RE were seen. Median volume of n-BCA used was <0.1 ml. Conclusion. n-BCA glue embolization is useful to eliminate hepatoenteric networks that may result in nontarget RE, especially in those that persist after coil embolization of major vessels such as the gastroduodenal and right gastric arteries.

  12. Comprehensive analysis of myocardial infarction due to left circumflex artery occlusion: comparison with infarction due to right coronary artery and left anterior descending artery occlusion

    SciTech Connect

    Huey, B.L.; Beller, G.A.; Kaiser, D.L.; Gibson, R.S.

    1988-11-01

    Forty consecutive patients with creatine kinase-MB confirmed myocardial infarction due to circumflex artery occlusion (Group 1) were prospectively evaluated and compared with 107 patients with infarction due to right coronary artery occlusion (Group 2) and 94 with left anterior descending artery occlusion (Group 3). All 241 patients underwent exercise thallium-201 scintigraphy, radionuclide ventriculography, 24 h Holter electrocardiographic (ECG) monitoring and coronary arteriography before hospital discharge and were followed up for 39 +/- 18 months. There were no significant differences among the three infarct groups in age, gender, number of risk factors, prevalence and type of prior infarction, Norris index, Killip class and frequency of in-hospital complications. Acute ST segment elevation was present in only 48% of patients in Group 1 versus 71 and 72% in Groups 2 and 3, respectively (p = 0.012), and 38% of patients with a circumflex artery-related infarct had no significant ST changes (that is, elevation or depression) on admission (versus 21 and 20% for patients in Groups 2 and 3, respectively) (p = 0.001). Abnormal R waves in lead V1 were more common in Group 1 than in Group 2 (p less than 0.003) as was ST elevation in leads I, aVL and V4 to V6 (p less than or equal to 0.048). These differences in ECG findings between Group 1 and 2 patients correlated with a significantly higher prevalence of posterior and lateral wall asynergy in the group with a circumflex artery-related infarct. Infarct size based on peak creatine kinase levels and multiple radionuclide variables was intermediate in Group 1 compared with that in Group 2 (smallest) and Group 3 (largest). During long-term follow-up, the probability of recurrent cardiac events was similar in the three infarct groups.

  13. Left ventricular dysfunction in patients with suspected pulmonary arterial hypertension*

    PubMed Central

    Gavilanes, Francisca; Jr, José Leonidas Alves; Fernandes, Caio; Prada, Luis Felipe Lopes; Jardim, Carlos Viana Poyares; Morinaga, Luciana Tamie Kato; Dias, Bruno Arantes; Hoette, Susana; Souza, Rogerio

    2014-01-01

    OBJECTIVE: To evaluate the role of right heart catheterization in the diagnosis of pulmonary arterial hypertension (PAH). METHODS: We evaluated clinical, functional, and hemodynamic data from all patients who underwent right heart catheterization because of diagnostic suspicion of PAH-in the absence of severe left ventricular dysfunction (LVD), significant changes in pulmonary function tests, and ventilation/perfusion lung scintigraphy findings consistent with chronic pulmonary thromboembolism-between 2008 and 2013 at our facility. RESULTS: During the study period, 384 patients underwent diagnostic cardiac catheterization at our facility. Pulmonary hypertension (PH) was confirmed in 302 patients (78.6%). The mean age of those patients was 48.7 years. The patients without PH showed better hemodynamic profiles and lower levels of B-type natriuretic peptide. Nevertheless, 13.8% of the patients without PH were categorized as New York Heart Association functional class III or IV. Of the 218 patients who met the inclusion criteria, 40 (18.3%) and 178 (81.7%) were diagnosed with PH associated with LVD (PH-LVD) and with PAH, respectively. The patients in the HP-LVD group were significantly older than were those in the PAH group (p < 0.0001). CONCLUSIONS: The proportional difference between the PAH and PH-LVD groups was quite significant, considering the absence of echocardiographic signs suggestive of severe LVD during the pre-catheterization investigation. Our results highlight the fundamental role of cardiac catheterization in the diagnosis of PAH, especially in older patients, in whom the prevalence of LVD that has gone undiagnosed by non-invasive tests is particularly relevant. PMID:25610501

  14. Anomalous Origin of the Left Vertebral Artery from the Aortic Arch

    PubMed Central

    Einstein, Evan H.; Song, Linda H.; Villela, Natalia L. A.; Fasani-Feldberg, Gregory B.; Jacobs, Jonathan L.; Kim, Dolly O.; Nathawat, Akshay; Patel, Devika; Bender, Roger B.; Peters, Daniel F.

    2016-01-01

    Anatomic anomalies of the aortic arch have implications for clinical practice if their significance is understood. Our case study involves a cadaveric finding of the left vertebral artery originating directly from the aortic arch. Although this anatomical variation has been documented, the prevalence of this anomaly may be generally underestimated. After noting this anomaly, we analyzed 27 cases and found that four female cadavers had the left vertebral artery originating from the aortic arch rather than the left subclavian artery. With a prevalence rate of 14.8%, it would seem that this anomaly is more significant than previously thought, which could have implications for surgical practice. PMID:27757404

  15. Functional assessment of a left coronary-pulmonary artery fistula by coronary flow reserve

    PubMed Central

    Sasi, Viktor; Forster, Tamás; Ungi, Imre

    2014-01-01

    We report a 71-year-old man who presented with atypical chest pain. Coronary angiography did not reveal left main or proximal left anterior descending coronary artery stenosis, but a fistulous communication with a stronger tube-like fistula was present originating from the proximal left anterior descending coronary artery and emptying into the main pulmonary artery. Fractional flow reserve and coronary flow reserve measurements were performed to gain more data on the potential functional aspects of this fistula. With the present case, the importance of functional evaluation of these fistulas is demonstrated. PMID:25061466

  16. Coronary-Cameral Fistula Connecting the Left Anterior Descending Artery and the First Obtuse Marginal Artery to the Left Ventricle: A Rare Finding

    PubMed Central

    Khan, Arshad Ameer; Qureshi, Ghazanfar; Balakrishna, Pragathi

    2017-01-01

    Coronary-cameral fistulas are rare congenital malformations, often incidentally found during cardiac catheterizations. The majority of these fistulas are congenital in nature but can be acquired secondary to trauma or invasive cardiac procedures. These fistulas most commonly originate in the right coronary artery and terminate into the right ventricle and least frequently drain into the left ventricle. Depending upon their size and location, coronary-cameral fistulas can lead to congestive heart failure, myocardial infarction, and bacterial endocarditis. We describe a case of 49-year-old woman who presented with worsening exertional dyspnea and leg swelling. Transthoracic echocardiogram revealed an ejection fraction of 35%. Cardiac catheterization demonstrated a fistula connecting the left anterior descending artery and the first obtuse marginal artery to the left ventricle. In this report, the authors provide a concise review on coronary fistulas, complications, and management options. PMID:28194284

  17. Hepatic arterial spin labelling MRI: an initial evaluation in mice

    PubMed Central

    Ramasawmy, R; Campbell-Washburn, A E; Wells, J A; Johnson, S P; Pedley, R B; Walker-Samuel, S; Lythgoe, M F

    2015-01-01

    The development of strategies to combat hepatic disease and augment tissue regeneration has created a need for methods to assess regional liver function. Liver perfusion imaging has the potential to fulfil this need, across a range of hepatic diseases, alongside the assessment of therapeutic response. In this study, the feasibility of hepatic arterial spin labelling (HASL) was assessed for the first time in mice at 9.4 T, its variability and repeatability were evaluated, and it was applied to a model of colorectal liver metastasis. Data were acquired using flow-sensitive alternating inversion recovery-arterial spin labelling (FAIR-ASL) with a Look–Locker readout, and analysed using retrospective respiratory gating and a T1-based quantification. This study shows that preclinical HASL is feasible and exhibits good repeatability and reproducibility. Mean estimated liver perfusion was 2.2 ± 0.8 mL/g/min (mean ± standard error, n = 10), which agrees well with previous measurements using invasive approaches. Estimates of the variation gave a within-session coefficient of variation (CVWS) of 7%, a between-session coefficient of variation (CVBS) of 9% and a between-animal coefficient of variation (CVA) of 15%. The within-session Bland–Altman repeatability coefficient (RCWS) was 18% and the between-session repeatability coefficient (RCBS) was 29%. Finally, the HASL method was applied to a mouse model of liver metastasis, in which significantly lower mean perfusion (1.1 ± 0.5 mL/g/min, n = 6) was measured within the tumours, as seen by fluorescence histology. These data indicate that precise and accurate liver perfusion estimates can be achieved using ASL techniques, and provide a platform for future studies investigating hepatic perfusion in mouse models of disease. Copyright © 2014 John Wiley & Sons, Ltd. PMID:25522098

  18. Maldevelopment of conotruncal and aorto-pulmonary septum with absent left central pulmonary artery: anatomical and clinical implications.

    PubMed Central

    Schulze-Neick, I.; Hausdorf, G.; Lange, P. E.

    1994-01-01

    In a patient with pulmonary valve atresia with hypoplastic main pulmonary artery selective angiography showed absence of the central left pulmonary artery and a right pulmonary artery originating from the ascending aorta close to the left coronary artery. This unusual anatomical arrangement complicates interventional and surgical treatment. Images PMID:8297705

  19. Endovascular Treatment of a Huge Hepatic Artery Aneurysm by Coil Embolization Method: A Case Report.

    PubMed

    Hemmati, Hossein; Karimian, Mehdi; Moradi, Habibollah; Farid Marandi, Kambiz; Haghdoost, Afrooz

    2015-07-01

    Hepatic artery aneurysms are rare but potentially life threatening. We describe a novel case of a successful endovascular coil embolization of a huge hepatic artery aneurysm. A 67-year-old woman presented with recent abdominal pain that had begun from 2 weeks before referring to our hospital. Sonographic and computerized tomographic (CT) findings revealed a huge hepatic artery aneurysm with 95 mm × 83 mm diameter. The patient underwent an endovascular technique. In aortic angiography, the celiac artery orifice and superior mesenteric artery were so narrow, so sonography was used in order to determine the exact position of the catheter in the celiac artery orifice. The aneurysm was thrombosed using coil embolization. Pulsation of the aneurysm immediately disappeared. Huge hepatic artery aneurysm can be safely treated using coil embolization.

  20. Improvement of left ventricular exercise hemodynamic function after aorta-coronary artery bypass grafting.

    PubMed

    Vlietstra, R E; Chesebro, J H; Frye, R L; Wallace, R B

    1981-01-01

    In 39 patients with coronary artery disease and angina pectoris, exercise hemodynamic evaluation, left ventriculography, and coronary arteriography were performed both before and 3 to 36 months (mean 17 months) after aorta-coronary artery bypass grafting. Of the 32 patients with abnormal exercise hemodynamic responses before operation, 11 returned to normal at the postoperative study (Group N) and 21 remained abnormal (Group A). Preoperative characteristics (mean age, functional class, prior myocardial infarction, left ventriculographic appearance, mean ejection fraction, and mean number of vessels diseased) were similar in the two groups. Of the perioperative and postoperative characteristics examined (mean number of grafts, operative myocardial infarction, postoperative functional class, treadmill test result, and adequacy of left coronary artery revascularization), only the adequacy of left coronary artery revascularization differed between Groups N and A. Eight of 11 Group N and only three of 20 Group A patients had complete revascularization, with patent grafts, of the left coronary artery. We conclude that improved exercise hemodynamic function does occur in some patients after aorta-coronary artery bypass operations. Such improvement is most likely when all major lesions of the left coronary artery are completely revascularized.

  1. Ligation of the left hepatic vein for dilated intrahepatic collaterals late after fontan operation.

    PubMed

    Park, Chun Soo; Park, Jeong-Jun; Park, In-Sook; Goo, Hyun Woo

    2014-07-01

    A 17-year-old male presented with two episodes of syncope, cyanosis, and exercise intolerance 13 years after the Fontan operation. Echocardiography and magnetic resonance imaging showed dilated intrahepatic collaterals, which drained into the atrium through the left hepatic vein, and 24-hour Holter monitoring revealed sinus node dysfunction. We performed ligation of the left hepatic vein using intrahepatic collaterals as channels draining hepatic venous blood into the Fontan pathway, and implanted an epicardial dual chamber pacemaker. At one-year follow-up, the patient remained asymptomatic and his cardiac performance was much improved.

  2. Left anterior descending coronary artery dissection during ventricular tachycardia ablation - case report.

    PubMed

    Kresimir, Kordic; Sime, Manola; Ivan, Zeljkovic; Ivica, Benko; Nikola, Pavlovic

    2017-07-26

    Fascicular left ventricular tachycardia (VT) is the second most frequent idiopathic left VT in the setting of a structurally normal heart. Catheter ablation is curative in most patients with low complication rates. We report a case of ostial left anterior descending coronary artery (LAD) occlusion during fascicular ventricular tachycardia ablation. Dissection was the most likely cause of LAD obstruction. To the authors' best knowledge, this is the first case reporting selective LAD dissection during electrophysiology study with no left main coronary artery (LMCA) affection.

  3. Implantation of a stent graft in the right pulmonary artery enables radical resection of a central endothelial sarcoma of the left pulmonary artery.

    PubMed

    Kissling, Pascal; Brosi, Philippe; Kull, Christof; Toia, Damien; Maurer, Christoph Andreas

    2013-09-01

    In a patient with a huge endothelial sarcoma of the left pulmonary artery, we report successful implantation of a stent graft in the right pulmonary artery, including the pulmonary arterial trunk. This preoperative measure enabled a safe and radical left-sided pneumonectomy, including the tumor and the central parts of the left pulmonary artery. No major blood loss occurred, and neither use of a heart-lung machine nor cardiopulmonary bypass was necessary.

  4. [Anomalous systemic arterial supply to normal basal segments of the left lung (Pryce type I)].

    PubMed

    Ryu, Chusei; Sawada, Takahiro; Machino, Ryusuke

    2013-03-01

    Patient 1 was a 54-year-old female diagnosed with anomalous systemic arterial supply to normal basal segments of the left lung discovered as an abnormality on chest X-ray radiography. Patient 2 was a 47-year-old male in whom the disease was diagnosed by close examination of bloody sputum. Division of the abnormal artery and left lower lobectomy were performed in patient 1. Arterial congestion and serpentine distribution were noted in the basal segments of the lung, which was the region perfused by the abnormal artery, on histopathological examination. Arteriosclerotic changes were noted in the vascular wall, but no abnormal vascular wall or alveolar structure was noted in S6, which was not included in theperfused region. Based on the above findings, division of the abnormal artery and left basal segmentectomy were performed in patient 2. Bloody sputum disappeared, and activity of daily living( ADL) were not impaired after surgery.

  5. Right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum*

    PubMed Central

    Faistauer, Ângela; Torres, Felipe Soares; Faccin, Carlo Sasso

    2016-01-01

    We report a case of an uncommon thoracic aorta anomaly-right aortic arch with aberrant left innominate artery arising from Kommerell's diverticulum-that went undiagnosed until adulthood. PMID:27777481

  6. Two cases of Bezold-Jarisch reflex induced by intra-arterial nitroglycerin in critical left main coronary artery stenosis.

    PubMed

    Shah, Sachin P; Waxman, Sergio

    2013-01-01

    The Bezold-Jarisch reflex, a well-described phenomenon, occurs upon the stimulation of intracardiac mechanoreceptors and is mediated by vagal afferent nerve fibers. Several factors can sensitize the cardiovascular system to develop this reflex, including acute myocardial ischemia, natriuretic peptides, and, rarely, nitroglycerin administration in the setting of acute myocardial infarction. The development of the Bezold-Jarisch reflex in the presence of severe coronary artery stenosis, specifically left main coronary artery stenosis, has not been described. We report 2 cases of patients who underwent elective coronary angiography and were given intra-arterial nitroglycerin during radial sheath insertion to reduce radial artery spasm. In both patients, bradycardia and hypotension developed along with diaphoresis, consistent with the Bezold-Jarisch reflex. Coronary angiography revealed critical (>90%) left main coronary artery stenosis in both patients. Critical left main coronary artery stenosis might sensitize mechanoreceptors or vagal afferents to the development of the Bezold-Jarisch reflex after intra-arterial nitroglycerin use; however, the mechanism of this possible relationship is unclear. In addition to discussing our patients' cases, we review the medical literature relevant to the Bezold-Jarisch reflex.

  7. [Experimental studies of segmental hepatic artery embolization with a super absorbent embolic agent].

    PubMed

    Inoue, E; Hori, S; Narumi, Y; Fujita, M; Ishiguro, S; Kuroda, C

    1990-11-25

    Super absorbent (Sumikagel) is a unique polymer mainly composed of polysodium acrylate (PSA). When PSA contacts water, it absorbs water and swells in a few seconds. This new embolic material suspended in Lipiodol (Lp-PSA), was used for hepatic artery embolization in five dogs. The purpose of this study is to examine the necrotizing effect of the new embolic material on segmental hepatic artery embolization. Gross liver examination demonstrated congestion and segmental infarction within the embolized area, and microscopically focal necrosis of liver parenchyma was observed. Segmental hepatic artery embolization with Lp-PSA should be an effective method of hepatic tumor embolization.

  8. Anomalous middle hepatic artery in laparoscopic cholecystectomy: Wolf in sheep's clothing

    PubMed Central

    Grifson, Johnrose John; Perungo, Thirumaraichelvan; Sengamalai, Durairaj; Duraisamy, Bennet; Anbalagan, Amudhan; Raju, Prabhakaran; Kannan, Devy Gounder

    2017-01-01

    Laparoscopic cholecystectomy is a simple but dangerous operation. The complex anatomy and frequent anomalies of the hepatic arterial and biliary system are often a shocking surprise to the laparoscopic surgeon. When these vital structures cannot be identified correctly, potentially crippling serious vascular and biliary injury can occur. A very rare case of middle hepatic artery encountered in the Calot's coursing over the gall bladder and travelling extraparenchymal into segment IV is reported. Identification and preservation of the middle hepatic artery is essential to prevent the possibility of hepatic artery thrombosis and to avoid ischemic cholangiopathy of segment IV duct. A comprehensive understanding of the hepatic arterial and biliary anatomy of the liver will empower laparoscopic surgeons to avoid crippling vascular and biliary injury. PMID:27251829

  9. Huge Left Atrial Myxoma and Concomitant Silent Coronary Artery Disease in a Young Man.

    PubMed

    Gennari, Marco; Rubino, Mara; Andreini, Daniele; Polvani, Gianluca; Agrifoglio, Marco

    2016-01-01

    Severe but silent coronary artery disease may rarely exist in young patients with a low-risk profile but with a family history of coronary artery disease. We describe the case of a 33-year-old Caucasian male with progressive shortness of breath caused by a huge left atrial myxoma who was diagnosed to have significant coronary artery disease in the preoperative assessment. After investigations, the patient underwent resection of the left atrial tumor and coronary artery bypass grafting (CABG) with a successful outcome. Even in the case of a young male, it may be prudent to investigate silent coronary artery disease in the presence of cardiovascular risk factors and family history of coronary artery disease. The learning objective of this case is to debate about the usefulness of a preoperative coronary study even in the young population with cardiac nonischemic pathologies (ie, valve pathology, cardiac tumors, etc.).

  10. Huge Left Atrial Myxoma and Concomitant Silent Coronary Artery Disease in a Young Man

    PubMed Central

    Gennari, Marco; Rubino, Mara; Andreini, Daniele; Polvani, Gianluca; Agrifoglio, Marco

    2016-01-01

    Severe but silent coronary artery disease may rarely exist in young patients with a low-risk profile but with a family history of coronary artery disease. We describe the case of a 33-year-old Caucasian male with progressive shortness of breath caused by a huge left atrial myxoma who was diagnosed to have significant coronary artery disease in the preoperative assessment. After investigations, the patient underwent resection of the left atrial tumor and coronary artery bypass grafting (CABG) with a successful outcome. Even in the case of a young male, it may be prudent to investigate silent coronary artery disease in the presence of cardiovascular risk factors and family history of coronary artery disease. The learning objective of this case is to debate about the usefulness of a preoperative coronary study even in the young population with cardiac nonischemic pathologies (ie, valve pathology, cardiac tumors, etc.). PMID:28096692

  11. Intravascular Treatment of Left Subclavian Artery Aneurysm Coexisting with Aortic Coarctation in an Adult Patient

    PubMed Central

    Pogorzelski, Ryszard; Wołoszko, Tomasz; Toutounchi, Sadegh; Fiszer, Patryk; Krajewska, Ewa; Jakuczun, Wawrzyniec; Szostek, Małgorzata M; Celejewski, Krzysztof; Gałązka, Zbigniew

    2017-01-01

    Abstract Coexistence of aortic coarctation with aneurysm of subclavian artery is a uncommon situation and may require unusual treatment in patients. A 40-year-old patient diagnosed incidentally with left subclavian artery aneurysm coexisting with aortic coarctation. Patient was initially referred for hybrid treatment. Initially ostium of the left subclavian artery was covered with a stent-graft. Over a 30-month follow-up period aneurysm became thrombosed all the way up to the ostium of internal mammary artery. The patient did not present with neurological symptoms or signs of upper limb ischemia. Taking into consideration good blood supply to the axillary artery via reversed blood flow in the thyreocervical trunk, hence we decided not to proceed with cervicoaxillary bypass grafting. Implantation stent-graft into aorta coarctation with covering axillary artery is proper way of treatment and may need no other surgical procedures. PMID:28401193

  12. Relationship between occupational exposure to lead and local arterial stiffness and left ventricular diastolic function in individuals with arterial hypertension

    SciTech Connect

    Poreba, Rafal; Gac, Pawel; Poreba, Malgorzata; Antonowicz-Juchniewicz, Jolanta; Andrzejak, Ryszard

    2011-08-01

    Relationship between occupational exposure to lead and frequency of complications in persons with arterial hypertension has been poorly investigated. This study aimed at evaluation of the relationship between occupational exposure to lead and manifestation of an increased local arterial stiffness and left ventricular diastolic dysfunction. The studies included 105 men (mean age: 44.47 {+-} 9.12 years) with arterial hypertension, treated with hypotensive drugs: group I - men occupationally exposed to lead (n = 53), and group II - men not exposed to lead (n = 52). In echocardiographic examination, the left ventricular diastolic dysfunction was diagnosed significantly more frequently in group I than in group II. In eTracking examination mean values of stiffness parameter ({beta}), augmentation index (AI) and one-point pulse wave velocity (PWV-{beta}) were significantly higher and mean values of arterial compliance (AC) were significantly lower in group I than in group II. The logistic regression showed that in the group of persons with arterial hypertension occupationally exposed to lead a more advanced age, higher blood lead concentration and higher mean values of augmentation index represent independent risk factors of left ventricular diastolic dysfunction. The multifactorial regression showed that amongst persons with arterial hypertension occupationally exposed to lead higher blood zinc protoporphyrin concentration, a more advanced age and higher value of body mass index (BMI) represent independent risk factors of an increased local arterial stiffness. In summary, we should note that in the group of persons with arterial hypertension occupationally exposed to lead the study has demonstrated a significantly more frequent manifestation of left ventricular diastolic dysfunction and an increase in local arterial stiffness. - Highlights: > Amongst persons with AH exposed to Pb higher ZnPP represent independent risk factor of increased local arterial stiffness

  13. A One-Sided Affair: Unoriginal Origin of the Left Coronary Artery, a Case Report

    PubMed Central

    Ali, Omair; Rehman, Saifur; Jbara, Yaser; White, Bryan

    2014-01-01

    Coronary artery anomalies constitute a group of congenital malformations that have a multitude of clinical manifestations and highly variable pathophysiology. We report a 56-year-old male with angina due to an anomalous origin of the left main coronary artery; approach and management.

  14. Obstruction of the Aorta and Left Pulmonary Artery After Gianturco Coil Occlusion of Patent Ductus Arteriosus

    SciTech Connect

    Kuo, H.-Cg; Ko, Sheung-Fat; Wu, Yu-Tsun; Huang, Chien-Fu; Chien, Shao-Ju; Tiao, Mao-Meng; Liang, Chi-Di

    2005-01-15

    We report an unusual case of simultaneous obstruction of the left pulmonary artery and descending thoracic aorta after Gianturco coil occlusion in a 15-month-old boy. The diagnosis was made by echocardiography and cardiac angiography. At surgery, thrombi coating on the protruded parts of the Gianturco coil in the pulmonary artery and aorta were found.

  15. Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals Associated with Left Pulmonary Artery Interruption.

    PubMed

    Mun, Da-Na; Park, Chun Soo; Kim, Young-Hwue; Goo, Hyun Woo

    2016-10-01

    A multistage plan and multidisciplinary approach are the keys to successful repair in patients with pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs). In this article, we present a multidisciplinary approach adopted to treat a patient with PA with VSD and MAPCAs associated with left pulmonary artery interruption.

  16. Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals Associated with Left Pulmonary Artery Interruption

    PubMed Central

    Mun, Da-Na; Park, Chun Soo; Kim, Young-Hwue; Goo, Hyun Woo

    2016-01-01

    A multistage plan and multidisciplinary approach are the keys to successful repair in patients with pulmonary atresia (PA) with ventricular septal defect (VSD) and major aortopulmonary collateral arteries (MAPCAs). In this article, we present a multidisciplinary approach adopted to treat a patient with PA with VSD and MAPCAs associated with left pulmonary artery interruption. PMID:27733998

  17. Contained rupture of mycotic aneurysm of the left circumflex coronary artery in a child.

    PubMed

    Joshi, Reena K; Jyoti, Aman; Aggarwal, Neeraj; Aggarwal, Mridul; Joshi, Raja

    2015-01-01

    Coronary artery aneurysm (CAA) is defined as dilatation of a coronary artery segment to a diameter of more than 1.5-fold normal size. Rupture of CAA is a catastrophic event and may result in sudden death or myocardial infarction. We report this unusual case of contained rupture of the left circumflex CAA. © The Author(s) 2014.

  18. Anomalous origin of the right coronary artery from the pulmonary artery: an autopsied sudden death case with severe atherosclerotic disease of the left coronary artery.

    PubMed

    Nagai, T; Mukai, T; Takahashi, S; Takada, A; Saito, K; Harada, K; Mori, S; Abe, N

    2014-03-01

    Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is a rare anomaly. It may contribute to myocardial ischemia or sudden death, although the lesion is usually asymptomatic. We report a sudden death case of a 58-year-old man with ARCAPA coexisting with severe atherosclerotic coronary artery disease. He had been healthy until he complained of chest pain, several days before death, despite the discovery of heart murmur in childhood and suspicion of valvular heart disease. The autopsy revealed not only typical findings of the right coronary anomaly with well-developed collateral circulations but also severe atherosclerotic lesions of the left coronary artery, and ischemic change of the myocardium in the left and right coronary arterial perfusion territory. In addition to the "coronary steal" phenomenon primarily caused by ARCAPA, the reduced flow of both coronary arteries and further increase of "coronary steal" due to atherosclerotic obstructive coronary disease might have contributed to the patient's death.

  19. Double outlet right ventricle with unilateral absence of left pulmonary artery.

    PubMed

    Ugurlucan, Murat; Arslan, Ahmet H; Yildiz, Yahya; Ay, Sibel; Cicek, Sertac

    2013-06-01

    Congenital absence of unilateral pulmonary artery, either as a primary defect or in combination with other congenital cardiovascular malformations, is very rare. Double outlet right ventricle pathology in combination with unilateral absence of pulmonary artery has only been reported once in the literature. In this report, we present our experience with double outlet right ventricle with unilateral absence of left pulmonary artery in a 3-year-old female patient who underwent a palliative procedure and was scheduled for correction.

  20. Asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract.

    PubMed

    Mustelier, Juan Valiente; Rego, Julio Oscar Cabrera; Aquiles, Eddy W Olivares; Llerena, Luis Roberto

    2010-12-01

    Coronary artery fistulas are unusual congenital or acquired coronary artery abnormalities in which blood is shunted into a cardiac chamber, great vessel or other structure, bypassing the myocardial capillary network (Jung et al. in Cardiovasc Ultrasound 5:10, 2007). We present a young adult patient with an asymptomatic fistula from a giant aneurysmatic left anterior descending artery to the right ventricular outflow tract, first diagnosed by echocardiography examination and further confirmed by 128-slice computed tomography coronary angiography.

  1. A case of left main pulmonary artery aneurysm associated with valvular pulmonary stenosis in a child.

    PubMed

    Lee, Ran; Son, Jae Sung; Park, Yong Mean

    2011-10-01

    Aneurysm of the main pulmonary artery is a rare clinical entity that can be congenital or acquired. Most cases occur in association with other congenital malformations, severe pulmonary hypertension, vasculitides, infectious agents, or collagen vascular disorders. We report here a pediatric case of left pulmonary artery aneurysm associated with valvular pulmonary stenosis and a hypoplastic right pulmonary artery, which we confirmed via multidetector computed tomography angiography.

  2. Vascular complications after orthotopic liver transplantation: hepatic artery thrombosis.

    PubMed

    Pareja, E; Cortes, M; Navarro, R; Sanjuan, F; López, R; Mir, J

    2010-10-01

    Hepatic artery thrombosis (HAT) is the second main cause of liver graft failure after primary nonfunction. It is the most frequent arterial complication in orthotopic liver transplantation (OLT). The consensus for early HAT definition consists of an arterial thrombosis detected during the first month after OLT. HAT is associated with markedly increased morbidity, being the leading cause of graft loss (53%) and mortality. However, improvements in postoperative care have resulted in a marked reduction of its incidence. We performed a review of all patients who underwent liver transplantations from January 1991 to December 2009, involving 1560 subjects who underwent 1674 OLT, excluding children. To analyze the impact of the study period on HAT, we defined 3 periods: the first between January 1991 and April 1993, the second from May 1993 to December 2003, and the last from January 2004 to December 2009. The total number of patients with HAT was 48 (2.8%) including 32 (1.9%) early HAT and 16 (0.9%) late HAT. The incidence of HAT diminished as the surgical team gained experience from 9.3% in the first period to 2.1% in the last. Most patients with early HAT presented acute fulminant hepatic failure (30%) and most were retransplantations (81%). In general, there are 3 modalities for HAT: revascularization, retransplantation, and observation. The choice of the treatment depended on the time of diagnosis although retransplantation was the treatment of choice for most groups. Minimizing risk factors, protocols for early detection, and good operative techniques should be the standard in all centers. Copyright © 2010 Elsevier Inc. All rights reserved.

  3. Rare associations of tetralogy of Fallot with anomalous left coronary artery from pulmonary artery and totally anomalous pulmonary venous connection.

    PubMed

    Sen, Supratim; Rao, Suresh G; Kulkarni, Snehal

    2016-06-01

    We describe the cases of two patients with tetralogy of Fallot, aged 4 years and 8 months, who were incidentally detected to have concomitant anomalous left coronary artery from pulmonary artery and total anomalous pulmonary venous connection, respectively, on preoperative imaging. They underwent surgical correction with good mid-term outcomes. In this study, we discuss the embryological basis, physiological effects, and review the literature of these two unusual associations. Awareness of these rare associations will avoid missed diagnoses and consequent surgical surprises.

  4. Chemoembolization for Hepatocellular Carcinoma Supplied Exclusively by the Hepatic Falciform Artery

    SciTech Connect

    Kim, Gyoung Min; Kim, Hyo-Cheol Chung, Jin Wook; Lee, In Joon; Kim, Han Myun; Jae, Hwan Jun; Park, Jae Hyung

    2012-08-15

    Purpose: The purpose of this study was to describe imaging appearances of hepatocellular carcinoma (HCC) supplied exclusively by the hepatic falciform artery (HFA) and safety of chemoembolization via the HFA. Methods: During the past 6 years, we have performed chemoembolization for the treatment of 12 patients with HCCs supplied exclusively by the HFA. Computed tomography (CT) scans, digital subtraction angiograms, and medical records were retrospectively reviewed by consensus. Results: Tumors were located in Couinaud segments IV (n = 7) and III (n = 5) and in subcapsular areas around the falciform ligaments. Tumor size ranged from 1.0 to 1.8 cm (mean, 1.3 cm; median, 1.3 cm). HFAs originated from A4 (n = 7), A3 (n = 4), and the left hepatic artery near the umbilical point (n = 1). All tumors were supplied exclusively by the HFA. Prophylactic embolization of the distal HFA before chemoembolization was performed using gelatin sponge particles in only one patient, and selective chemoembolization via the HFA was achieved in all patients. One patient suffered from a skin rash after chemoembolization and recovered after conservative management. Individual responses of tumors supplied exclusively by the HFA were complete response (n = 8), partial response (n = 1), and stable disease (n = 2) at the first follow-up enhanced CT scan. Conclusions: The HFA can supply HCC located in subcapsular areas around the falciform ligament, and the tumors can be safely chemoembolized without significant complications.

  5. Surgical reconstruction of the left main coronary artery: fresh autologous pericardium or saphenous vein patch.

    PubMed

    Raanani, Ehud; Kogan, Alexander; Shapira, Yaron; Sagie, Alex; Kornowsky, Ran; Vidne, Bernardo A

    2004-11-01

    Isolated stenosis of the left main coronary artery is usually treated by coronary bypass surgery. However, this approach restores a less physiologic perfusion of the myocardium that leads to occlusion of the left main coronary artery, and restores only a retrograde perfusion of a rather extensive myocardial area. Coronary ostial plasty has been described as an alternative surgical technique in isolated ostial left main coronary artery stenosis without calcification. We review our experience with 15 patients. After placing the patient on cardiopulmonary bypass and aortic cross clamping, the main pulmonary trunk was retracted laterally. The left main coronary artery was approached anteriorly through a curved aortotomy. Reconstruction was performed using fresh pericardial patch or saphenous vein that was tailored as a patch. There were no early mortality or perioperative myocardial infarctions. During mean follow-up of 55 +/- 39 months, no patients had any cardiac events or required repeated coronary intervention. All patients underwent follow-up transesophageal echocardiography, which demonstrated a wide open left main coronary artery (range 3 to 8 mm), normal flow pattern by pulsed-wave Doppler, and no aneurysmal dilatation or calcification of the onlay patch. Coronary angiography and intravascular ultrasound were performed in 2 patients because of nonspecific chest discomfort. In both cases, the left main coronary artery was found to be wide open, and there were no signs of patch calcification. Surgical reconstruction of the left main coronary artery is safe and effective for the treatment of selected cases of isolated left main stenosis. The use of autologous pericardium appears to be as safe as saphenous vein patch. Neither method was associated with postoperative aneurysmal dilatation or calcification.

  6. Right aortic arch with aberrant left subclavian artery symptomatic in adulthood.

    PubMed

    Bashar, Abul Hasan Muhammad; Kazui, Teruhisa; Yamashita, Katsushi; Terada, Hitoshi; Washiyama, Naoki; Suzuki, Kazuchika

    2006-07-01

    Congenital malformations of the aortic arch are rarely found in adulthood. We describe three cases of right aortic arch with aberrant left subclavian artery with left-sided ligamentum arteriosum presenting in adulthood as vascular rings with symptoms of tracheal compression. Varying presentation as well as surgical strategy which was individualized according to the pathological anatomy of each case are discussed.

  7. Total left main coronary artery occlusion after aortic aneurysm repair and valve replacement.

    PubMed

    DePace, N L; Lemole, G M; Wolf, N W; Dowinsky, S; Untereker, W; Spagna, P M

    1991-02-01

    A 38-year-old woman with complete occlusion of the left main coronary artery secondary to cannulation during aortic valve replacement is presented. The clinical course was characterized by progressive left ventricular dysfunction and congestive heart failure. Recognition of this potential problem when it occurs is important as to institute therapeutic measures which may interrupt a patient's progressive clinical deterioration.

  8. Hepatic arterial embolization in patients with neuroendocrine tumors

    PubMed Central

    2014-01-01

    Liver metastases occur in 46-93% of patients with neuroendocrine neoplasms (NENs). Presence and extension of liver metastases are considered important prognostic factors, as they may significantly impair the patient’s quality of life, because of either tumor bulk or hormonal hypersecretion. Therapies for NEN liver metastases include surgical resection, liver transplantation, chemotherapy and biotherapy. Surgery is the gold standard for curative therapy, but in most of NEN patients with liver metastases, when surgery can not be applied, minimally invasive therapeutic approaches are adopted. They include trans-arterial embolization (TAE), trans-arterial chemoembolization (TACE), radiofrequency thermal ablation and new emerging techniques. TAE is based on selective infusion of particles in the branch of the hepatic artery supplying the tumor lesions. The goal of TAE is to occlude tumor blood vessels resulting in ischemia and necrosis. Many reports have shown that TAE can reduce tumor size and hormone output, resulting in palliation of symptoms without the use of cytotoxic drugs, resulting in better tolerability. This review will focus on TAE performance and safety in NEN patients with liver metastases. PMID:24887262

  9. Liver Retransplantation for Hepatic Abscess Due to Hepatic Artery Thrombosis: A Case Report.

    PubMed

    Zanus, G; Romano, M; Finotti, M; Dalla Bona, E; Sgarabotto, D; Bassi, D; Mescoli, C; Angeli, P; Burra, P; Gringeri, E; Vitale, A; D'Amico, F; Feltracco, P; Cillo, U

    2017-05-01

    Hepatic artery thrombosis (HAT) is a well-recognized complication of liver transplantation (LT). HAT is an important risk factor for infectious, in particular hepatic abscess, which can cause graft loss and increasing morbidity and mortality. We present a case report of complicated LT in a 52-year-old Caucasian man with primary sclerosing cholangitis. In 2007 the patient was included on the waiting list in Padua for LT. In 2012 the patient underwent percutaneous transhepatic biliary drainage for bile duct stricture, complicated with acute pancreatitis. A diagnostic laparoscopy was performed with choledochotomy and Kehr's T tube drainage. On February 14, 2012, the patient underwent LT with arterial reconstruction and choledochojejunostomy. The postoperative course was complicated with HAT, multiple liver abscesses, and sepsis associated with bacteremia due to Enterococcus faecium despite massive intravenous antibiotic therapy and percutaneous drainages. On November 28, 2012, the patient underwent retransplantation. Four years after transplantation the patient is still in good general condition. Hepatic abscess formation secondary to HAT following LT is a major complication associated with important morbidity and mortality. In selected cases retransplantation should be considered as our case demonstrates. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Coronary steal from a left internal mammary artery coronary bypass graft by a left upper extremity arteriovenous hemodialysis fistula.

    PubMed

    Crowley, Steven D; Butterly, David W; Peter, Robert H; Schwab, Steve J

    2002-10-01

    In patients with end-stage renal disease undergoing hemodialysis, the upper extremity arteriovenous (AV) fistula is the dialysis access recommended by the DOQI guidelines for patients with appropriate vasculature. Upper extremity AV fistulae have long periods of usefulness, high flow rates, and low associated complication rates. Placement of AV access may result in increased cardiac output and increased cardiac oxygen demand in these patients. In general, cardiovascular complications from AV access have been limited. We report a novel cardiovascular complication of AV access in an end-stage renal disease patient with a coronary artery bypass graft employing the left internal mammary artery who experienced angina while undergoing hemodialysis. The angina was mediated at least in part by cardiac catheterization laboratory-documented steal of blood flow from the internal mammary artery graft. This phenomenon suggests the need to consider the impact of upper extremity access placement on blood flow to the left internal mammary artery in patients who previously have undergone placement of a coronary artery bypass graft. Copyright 2002 by the National Kidney Foundation, Inc.

  11. Disappearance of myocardial bridging of the left anterior descending coronary artery after inferior myocardial infarction.

    PubMed

    Yıldız, Bekir Serhat; Esin, Fatma; Alihanoğlu, Yusuf Izzettin; Kılıç, Ismail Doğu; Evrengül, Harun

    2014-06-01

    Myocardial bridging (MB) is defined as the intramural course of a major epicardial coronary artery, and is mostly confined to the left ventricle and the left anterior descending coronary artery (LAD). MB is a common congenital abnormality of a coronary artery, and is usually thought to be a benign anatomical variant. Although rare, previous studies have reported that patients with MB may suffer from myocardial ischemia, myocardial infarction (MI), arrhythmias, and even sudden death. Therefore, the diagnosis and treatment of MB are both important. Since MB is congenital, its disappearance is unlikely. We here report a very rare case of disappearance of MB after inferior MI.

  12. Atelectasis of the left lung induced by subcarinal pulmonary artery sling.

    PubMed

    Choo, Ki Seok; Chang, Yun Hee; Lee, Hyoung Doo; Sung, Si Chan; Kim, Suk; Lee, Tae Hong; Jung, Yeon Joo

    2005-05-01

    Pulmonary artery sling is an unusual cause of respiratory distress in the neonatal period. Despite the use of conventional diagnostic tools such as ECHO or angiography, delineation of the course of the pulmonary artery and its relationship with the neighbouring bronchus may be difficult. We describe an infant with complete collapse of the left lung due to an aberrant left pulmonary artery in whom the combination of axial CT and three-dimensional reconstruction was of great value in facilitating the diagnosis and surgical planning.

  13. Vasoactive intestinal peptide may participate in the vasodilation of the dog hepatic artery

    SciTech Connect

    Varga, G.; Kiss, J.Z.; Papp, M.; Vizi, E.S.

    1986-08-01

    The possible direct action of vasoactive intestinal peptide (VIP) on dog hepatic arterial wall or on the noradrenergic innervation of the artery was investigated in vitro. In addition, VIP-containing nerve fibers and terminals were located in the wall of the artery with immunochemical staining. Direct evidence showed that VIP did not affect the release of (TH)norepinephrine but reduced the response of the isolated hepatic artery to electrical field stimulation and exogenous norepinephrine. This suggest that the effect of VIP is postjunctional on the smooth muscle of the artery. VIP-containing nerve fibers and varicosities were observed in the adventitial and medial layer of the arterial wall. These findings strongly support the hypothesis that vasoactive intestinal peptide is a physiological mediator of vasodilation in the hepatic artery.

  14. Transcatheter Embolization of Bronchial Artery Arising from Left Circumflex Coronary Artery in a Patient with Massive Hemoptysis

    SciTech Connect

    Cho, Jaemin; Shin, Taebeom Jun, Kyeongneo; Ryoo, Jaeuk; Choi, Hocheol; Choi, Bongryeong; Hwang, Jinyong

    2010-02-15

    It has been reported that anastomoses between the bronchial and the coronary arteries can become dilated and functional in certain diseases, provoking angina pectoris through coronary steal syndrome. The condition can be treated with endovascular or surgical management. It is possible that this abnormality may be associated with hemoptysis in patients with parenchymal or vascular disease of the lung but this condition is very rare. We present the coronary CT angiographic findings of bronchial arteries arising from the left coronary artery and their treatment with transcatheter embolization for the control of massive hemoptysis.

  15. Changes in Hepatic Blood Flow During Transcatheter Arterial Infusion with Heated Saline in Hepatic VX2 Tumor

    SciTech Connect

    Cao Wei; Li Jing; Wu Zhiqun; Zhou Changxi; Liu Xi; Wan Yi; Duan Yunyou

    2013-06-15

    Purpose. This study evaluates the influence of transcatheter arterial infusion with heated saline on hepatic arterial and portal venous blood flows to tumor and normal hepatic tissues in a rabbit VX2 tumor model. Methods. All animal experiments were approved by the institutional animal care and use committee. Twenty rabbits with VX2 liver tumors were divided into the following two groups: (a) the treated group (n = 10), which received a 60 mL transarterial injection of 60 Degree-Sign C saline via the hepatic artery; (b) the control group (n = 10), which received a 60 mL injection of 37 Degree-Sign C saline via the hepatic artery. Using ultrasonography, the blood flows in both the portal vein and hepatic artery were measured, and the changes in the hemodynamic indices were recorded before and immediately after the injection. The changes in the tumor and normal liver tissues of the two groups were histopathologically examined by hematoxylin and eosin staining after the injection. Results. After the transcatheter arterial heated infusion, there was a decrease in the hepatic arterial blood flow to the tumor tissue, a significant decrease in the hepatic artery mean velocity (P < 0.05), and a significant increase in the resistance index (P < 0.05). On hematoxylin and eosin staining, there were no obvious signs of tissue destruction in the normal liver tissue or the tumor tissue after heated perfusion, and coagulated blood plasma was observed in the cavities of intratumoral blood vessels in the treated group. Conclusions. The changes in tumor blood flow in the rabbit VX2 tumor model were presumably caused by microthrombi in the tumor vessels, and the portal vein likely mediated the heat loss in normal liver tissue during the transarterial heated infusion.

  16. Successful Endovascular Treatment of a Left Common Carotid Artery Aneurysm Following Failed Surgery of a Right Common Carotid Artery Aneurysm

    SciTech Connect

    Cil, Barbaros E. Ucar, Ibrahim; Ozsoy, Fatma; Arat, Anil; Yorgancioglu, Cem; Boeke, Erkmen

    2005-04-15

    Aneurysm of the common carotid artery is a rare and serious disease requiring prompt treatment in order to avoid neurologic complications. A 39-year-old man presented with voice impairment and a pulsatile mass at the right side of his neck and was found by color Doppler examination to have bilateral common carotid artery aneurysms of unknown origin. The right-sided large aneurysm was treated with placement of an 8 mm interposition Gore-Tex graft between the right common and internal carotid arteries. The surgical graft thrombosed 7 days after the surgery but the left-sided aneurysm was successfully treated by a Jostent peripheral stent-graft. Color Doppler examination showed a patent stent and no filling of the aneurysm on his first and sixth-month follow-up. Bilateral common carotid artery aneurysm is an exceptionally unusual condition and endovascular treatment of carotid artery aneurysms with covered stents may become an effective treatment alternative for these lesions.

  17. Thirty Years Later: Evolution of Treatment for Acute Left Main Coronary Artery Occlusion

    PubMed Central

    Ben-Dov, Nissan; Karkabi, Basheer; Jaffe, Ronen

    2016-01-01

    Acute occlusion of left main coronary artery is a catastrophic event. We describe two patients with acute occlusion of the left main coronary artery treated thirty years apart. The first patient was treated in 1982 and survived the event without revascularization but developed severe heart failure. His survival was so unusual that it merited a case report at that time. The second patient was treated at the end of 2015. Early revascularization resulted in myocardial reperfusion and near normal left ventricular function. These patients exemplify the progress in therapeutic cardiology over the last 30 years. PMID:28078145

  18. Clinical presentation and outcomes in type IV dual left anterior descending artery anomaly

    PubMed Central

    Çanga, Yiğit; Güvenç, Tolga Sinan; Karataş, Mehmet Baran; Güngör, Bariş; Çetin, Rengin; Bolca, Osman

    2016-01-01

    Type IV dual left anterior descending artery (LAD) anomaly constitutes a rare subset of coronary anomalies in which the anterior and anterolateral wall of the left ventricle is supplied by a short LAD originating from the left coronary artery along with a long LAD that originates from the right sinus of Valsalva. Albeit rare, the angiographic presentation is challenging since the appearance of the short LAD is similar to a total occlusion beyond first few diagonal or septal branches. Here, we present a series of four cases with type IV dual LAD anomaly with different clinical and angiographic presentations. PMID:28250981

  19. Comparative analysis of the patency of the internal thoracic artery in the CABG of left anterior descending artery: 6-month postoperative coronary CT angiography evaluation

    PubMed Central

    Deininger, Maurilio Onofre; Moreira, Luiz Felipe Pinho; Dallan, Luiz Alberto Oliveira; de Oliveira, Orlando Gomes; Magalhães, Daniel Marcelo Silva; Coelho, José Reinaldo de Moura; Deininger, Eugênia di Giuseppe; Lopes, Norland de Souza; Queiroga, Ricardo Wanderley; Belmont, Elizabeth Ferreira

    2014-01-01

    Objective To assess the patency of the pedicled right internal thoracic artery with an anteroaortic course and compare it to the patency of the left internal thoracic artery , in anastomosis to the left anterior descending artery in coronary artery bypass grafting by using coronary CT angiography at 6 months postoperatively. Methods Between December 2008 and December 2011, 100 patients were selected to undergo a prospective coronary artery bypass grafting procedure without cardiopulmonary bypass. The patients were randomly divided by a computer-generated list into Group-1 (G-1) and Group-2 (G-2), comprising 50 patients each, the technique used was known at the beginning of the surgery. In G-1, coronary artery bypass grafting was performed using the left internal thoracic artery for the left anterior descending and the free right internal thoracic artery for the circumflex, and in G-2, coronary artery bypass grafting was performed using the right internal thoracic artery pedicled to the left anterior descending and the left internal thoracic artery pedicled to the circumflex territory. Results The groups were similar with regard to the preoperative clinical data. A male predominance of 75.6% and 88% was observed in G-1 and G-2, respectively. Five patients migrated from G-1 to G-2 because of atheromatous disease in the ascending aorta. The average number of distal anastomoses was 3.48 (SD=0.72) in G-1 and 3.20 (SD=0.76) in G-2. Coronary CT angiography in 96 re-evaluated patients showed that all ITAs, right or left, used in situ for the left anterior descending were patent. There were no deaths in either group. Conclusion Coronary artery bypass grafting surgery involving anastomosis of the anteroaortic right internal thoracic artery to the left anterior descending artery has an outcome similar to that obtained using the left internal thoracic artery for the same coronary site. PMID:25140469

  20. Left subclavian artery-esophageal fistula induced by a paper star: a case report.

    PubMed

    Lin, Chen-Sheng; Lin, Cheng-Wen

    2016-06-01

    A subclavian artery-esophageal fistula usually occurs on the right side of an aberrant subclavian artery. It also rarely appears in the site between a non-aberrant subclavian artery and the esophagus due to the ingestion of a foreign body. Upper gastrointestinal bleeding in the case of a subclavian artery-esophageal fistula is rare but often fatal. Here, we report on a 62-year-old male patient with a left subclavian arteryesophageal fistula complicated by hemorrhagic shock. He swallowed a foreign body at a birthday party. An upper gastrointestinal endoscopy indicated a paper star lodged at 20 cm from the incisors, inducing a kissing esophageal ulcer around the esophageal sphincter. One month later, he suffered an unusually strong episode of hematemesis. Subsequently, a computed tomography angiography was performed and demonstrated a left subclavian artery-esophageal fistula. Finally, the fistula induced by the ingestion of a paper star was successfully treated by endovascular stent grafting.

  1. [Treatment of compression of the left main coronary artery in patients with pulmonary hypertension].

    PubMed

    Talavera, María L; Diez, Mirta; Cáneva, Jorge O; Boughen, Roberto P; Valdivieso, León; Mendiz, Oscar

    2011-01-01

    Chest pain is a frequent symptom in patients with pulmonary hypertension of any etiology. Its pathophysiology has not been clearly established, the proposed causes are ischemia due to increased right ventricle wall stress, transient increased pulmonary hypertension resulting in acute pulmonary artery dilatation and external compression of the left main coronary artery (LMCA) by a dilated pulmonary artery. We report and discuss here three cases where the association between chest pain and compression of the LMCA by a dilated pulmonary artery could be shown, and they were treated with coronary stenting.

  2. Percutaneous Management of a Hepatic Artery Aneurysm: Bleeding After Liver Transplantation

    SciTech Connect

    Millonig, Gunda; Graziadei, Ivo W. Waldenberger, Peter; Koenigsrainer, Alfred; Jaschke, Werner; Vogel, Wolfgang

    2004-09-15

    In this article we present an unusual case of hepatic artery aneurysm bleeding due to a hepatic artery thrombosis after liver transplantation. The patient developed a recurrent hepatic artery thrombosis leading to severe graft failure in four consecutive liver transplantations. While being evaluated for a fifth transplant, stabilization of the clinical situation was attempted by interventional therapy. The first intervention was to place a stent into the hepatic artery to prevent further ischemic damage. This failed to improve graft function, but unfortunately led to the development of a pseudoaneurysm at the distal end with a subsequent rupture into the biliary tree. Bleeding was treated successfully by direct puncture and coil embolization of the aneurysm. In addition, the patient demonstrated a hemodynamically relevant portal vein stenosis on the CT scan. Stenting of the portal vein markedly improved graft function. After extensive investigations, a paroxysmal nocturnal hemoglobinuria was found to be the underlying cause of the recurrent hepatic artery thrombosis. Here we suggest that hepatic artery aneurysm bleeding is a rare but potentially fatal complication that can be successfully treated by percutaneous coil embolization. Additionally, we propose that stenting of the portal vein can lead to a significant improvement of the graft perfusion even though the hepatic artery remained occluded.

  3. Donor Hepatic Artery Thrombosis Recognized During Organ Procurement for Liver Transplant.

    PubMed

    Scalera, Irene; Perera, Mapatunage Thamara Prabhath Ranasinghe; Muiesan, Paolo

    2015-06-01

    Arterial injuries in graft organs may be recognized during procurement and may contribute to organ waste. These injuries may be more likely in the presence of abnormal anatomy. We observed 2 liver grafts that had hepatic artery thrombosis in the donor vessels. The graft from a 64-year-old woman who had circulatory death was discarded because of potential decreased perfusion of the lobe and risk of thrombosis extending to the main hepatic artery after transplant. The graft from a 68-year-old woman donor who had brain death was used successfully as a reduced-size liver graft that included the caudate lobe. In summary, donor grafts that have hepatic artery thrombosis may or may not be used in transplant, depending on the cause of donor death, graft quality, and anatomic location of donor hepatic artery thrombosis.

  4. Incidence and treatment of hepatic artery complications after orthotopic liver transplantation

    PubMed Central

    Zhao, Ji-Chun; Lu, Shi-Chun; Yan, Lu-Nan; Li, Bo; Wen, Tian-Fu; Zeng, Yong; Cheng, Nan-Sheng; Wang, Jing; Luo, Yan; Pen, Yu-Lan

    2003-01-01

    AIM: To investigate the incidence and treatment of hepatic artery complications after orthotopic liver transplantation. METHODS: From February 1999 to May 2002, orthotopic liver transplantations (OLT) were performed in 72 patients with end-stage liver diseases with an average age of 40.2 ± 13.6 years (ranged from 11 to 68 years), 56 were males and 16 females. The preoperative evaluation for the 72 patients was performed using duplexsonography, abdominal CT scan, and angiography of the hepatic artery. All donor grafts were perfused and preserved in University of Wisconsin solution at 4 °C. OLT was performed with standard techniques with or without a veno-venous bypass. Reconstructions of hepatic artery were performed between the branch patches of gastroduodenal/hepatic or splenic/common hepatic artery confluence of the donors and recipients, and an end-to-end anastomosis between other arterial vessels of the donors and recipients was done. Arterial anastomosis was performed with interrupted 7-0/8-0 monofilament polypropylene suture under 3.5 x loupe magnification. Diagnosis of the complications of hepatic artery after OLT was based on the clinical presentations, ultrasound findings and arterial angiography. All patients were followed up regularly for duplex ultrasound scan after discharge. RESULTS: The overall incidence of arterial complications in 72 patients after OLTs was 1.4% (1/72). One 3 cm pseudoaneurysm at the side of anastomotic site of hepatic artery was found by urgent arteriogram due to hemoperitoneum secondary to bile leakage after OLT. Subsequently the pseudoaneurysm was successfully embolized and the blood flow toward the donor liver in hepatic artery remained. The overall postoperative 30-day mortality rate was 8.33%. The one-year survival rate was 83.72% in 50 patients with benign diseases and was 71.43% in 22 patients with malignant diseases following OLT. No death associated with complications of hepatic artery occurred. CONCLUSION: Careful

  5. [Abnormal origin of the left coronary artery from the pulmonary artery: a retrospective study of 36 cases].

    PubMed

    Richard, A; Godart, F; Brevière, G-M; Francart, C; Foucher, C; Rey, C

    2007-05-01

    The aim of this study was to show the evolution of diagnostic techniques revealing an abnormal origin of the left coronary artery and present the follow-up results of patients operated for this malformation at different ages. This retrospective study includes 36 children or adults, with a mean age at the moment of of 28 months old, ranging from 7 days to 39 years. In 9% of cases, patients were asymptomatic. Before 1990, 81% of children had a cardiac catheterization, versus 25% after. Indeed, echocardiography with color Doppler enabled the diagnosis of abnormal origin of the left coronary artery in 70% of cases. The pre-operative mortality is at 21% (12.5% after 1990). Twenty-three patients had surgery: left coronary artery reimplantation (n=16), bypass (n=5), at mean of 44 months old for the entire series, but 21 months old after 1990. The follow-up was clinical, ECG and radiographic and echocardiographic after 1975; when possible an exercise test, cardiac nuclear imaging and more recently coronary CT scan and MRI have been performed. In conclusion, children are operated earlier and the follow-up should focus on the detection of occlusion of the re-implanted left coronary artery by echocardiography, with or without stress, exercise test, cardiac nuclear imaging, MRI and sometimes, coronary angiography.

  6. Systematic comparison of the effectiveness of radial artery and saphenous vein or right internal thoracic artery coronary bypass grafts in non-left anterior descending coronary arteries

    PubMed Central

    Hu, Xiang; Zhao, Qiang

    2011-01-01

    Coronary artery bypass grafting surgery is increasingly being carried out on patients with multi-vessel coronary artery disease, but the best grafting candidate for non-left anterior descending coronary arteries is unclear. This research sought to systematically compare the efficacies and safeties of coronary bypass with radial artery and other available grafts. A systematic literature retrieval was performed for all clinical trials comparing the outcomes of coronary artery bypass surgery with radial artery and other grafts in PubMed, EMBASE, and the Cochrane Library. Seven eligible clinical studies, comparing radial artery and great saphenous vein grafts, were found between 1966 and 2010: one prospective non-randomized and six prospective randomized trials. The pooling analysis obtained a relative risk of 0.507 (P<0.05) of graft occlusion in radial arteries compared with great saphenous veins. There was a significantly lower infection rate in arms (i.e., harvest sites for radial arteries) relative to legs (harvest sites for veins), with a pooled relative risk of 0.140 (P<0.05). From the reports on mortality after follow-up ranging from one year to six years, there was no significant difference in mortality between the two graft types (P=0.927). In addition, four cohort controlled trials for radial and right internal thoracic artery grafts were included. The radial graft was associated with less cardiac related events relative to the right internal thoracic artery graft (P=0.014), but with comparable mortality and comparable rates of repeat percutaneous transluminal coronary angioplasty. Subjects with radial arteries seemed to have a lower occlusion rate and a lower graft harvest site infection rate than those with great saphenous veins. Moreover there were fewer cardiac related events with radial arteries relative to the right internal thoracic artery grafts. More studies are needed to confirm these findings concerning the favorable outcomes of coronary artery

  7. The Anterior Branch of the Left Inferior Phrenic Artery Arising from the Right Inferior Phrenic Artery: An Angiographic and CT Study

    SciTech Connect

    Hieda, Masashi Toyota, Naoyuki; Kakizawa, Hideaki; Ishikawa, Masaki; Horiguchi, Jun; Ito, Katsuhide

    2009-03-15

    The purpose of this study was to retrospectively analyze the frequency and anatomical pattern of the anterior branch of the left inferior phrenic artery (LIPA) arising from the right inferior phrenic artery (RIPA). Angiography of the RIPA for patients (n = 140) with hepatic malignancy was retrospectively reviewed. The frequency at which the anterior branch of the LIPA arose from the RIPA was 14.3% (20 of 140 patients [pts]). Among the three branches that may arise from the RIPA in these cases (the anterior branch of the LIPA and the anterior and posterior branches of the RIPA), the anterior branch of the LIPA was the first branch of the RIPA in 9 of 20 pts (45%), and the posterior branch of the RIPA in 11 of 20 pts (55%). The anterior branch of the LIPA ran along the ventral side of the esophagus or stomach and supplied the esophagogastric region and dome of the left diaphragm in all cases. In conclusion, the anterior branch of the LIPA arises from the RIPA at a comparatively high frequency. In embolization of the RIPA, to effectively treat and avoid possible complications, interventionalists should be aware of this potential variant anatomy.

  8. Laparoscopic repair for intraoperative injury of the right hepatic artery during cholecystectomy.

    PubMed

    Fujioka, Shuichi; Fuke, Azusa; Funamizu, Naotake; Nakayoshi, Tomoko; Okamoto, Tomoyoshi; Yanaga, Katsuhiko

    2015-02-01

    Right hepatic artery (RHA) injury is a complication that occurs during laparoscopic cholecystectomy, which can sometimes cause hepatic artery pseudoaneurysm or ischemic hepatic necrosis. Therefore, RHA should be managed carefully. Herein, we report a case of intraoperative RHA injury that was successfully repaired during laparoscopic cholecystectomy. Bleeding was controlled prior to the cholecystectomy with vascular clamp forceps that had been inserted through an additional trocar, and repair of the RHA injury was then performed laparoscopically. The postoperative course was uneventful, and patency of the RHA and its sectional arteries were confirmed by CT arteriography. Laparoscopic repair of minor RHA injuries can be managed safely if bleeding is adequately controlled.

  9. Assessment of Influences of Stenoses in Right Carotid Artery on Left Carotid Artery Using Wall Stress Marker

    PubMed Central

    Ghagare, Dushali; Chattopadhyay, Himadri

    2017-01-01

    Purpose. Atherosclerosis is a diseased condition of blood vessel. It causes partial blockage in lumen of vessel and affects hemodynamic of localized flowing blood. Complex geometries like region of bifurcation also affects hemodynamic to a larger extent. Complexity further increases in presence of stenoses at region of bifurcation. Such morphological change in vessel largely affects parent as well as corresponding sister and daughter vessels. In this paper, complexity in hemodynamic of blood in pair of carotid arteries (left and right carotid arteries) is evaluated in presence of stenoses at basilar segment of right artery in three-dimensional domain using reconstructed tomographic images of patient. Methods. Transient information of blood flow is obtained using four-dimensional phase-contrast MRI technique. Haematocrit component of blood at diseased condition is considered using Power Law and Quemada model. Numerical techniques are used to solve pressure-coupled governing equations of flowing blood. Results. Dysfunctions of endothelial cells near the wall are characterised by evaluating shear stress markers. Wall shear stress and its gradient based and harmonic based descriptors are calculated over complete geometry during one cardiac cycle. Conclusion. Internal branch of left carotid artery and external branch of right carotid artery are found prone to secondary stenoses in presence of primary stenoses at basilar segment of right carotid artery. PMID:28191460

  10. Resection-Reconstruction of Aberrant Right Hepatic Artery During Whipple Procedure (Pancreaticoduodenectomy).

    PubMed

    Sayyed, Raza; Rehman, Iffat; Niazi, Imran Khalid; Yusuf, Muhammed Aasim; Syed, Aamir Ali; V, Faisal

    2016-06-01

    Aberrant hepatic arterial anatomy poses a challenge for the surgeon during Whipple procedure. Intraoperative injury to the aberrant vasculature results in hemorrhagic or ischemic complications involving the liver and biliary tree. We report a case of replaced right hepatic artery arising from the superior mesenteric artery in a patient with periampullary carcinoma of the pancreas, undergoing pancreaticoduodenectomy. The aberrant artery was found to be coursing through the pancreatic parenchyma. This is a rare vascular anomaly. Resection of the arterial segment and end-to-end anastomosis was fashioned. Intrapancreatic course of the replaced right hepatic artery is a rare anomaly and is best managed by preoperative identification on radiology and meticulous intra-operative dissection and preservation. However, for an intrapancreatic course, resection and reconstruction may occasionally be required.

  11. Arterial devices for regional hepatic chemotherapy: transaxillary versus laparotomic access.

    PubMed

    Arru, M; Aldrighetti, L; Gremmo, F; Ronzoni, M; Angeli, E; Caterini, R; Ferla, G

    2000-01-01

    Introduction. Intra-Arterial Hepatic Chemotherapy (IAHC) based on floxuridine (FUdR) infusion is an effective treatment for hepatic metastases from colorectal cancer. A percutaneously implanted intra-arterial device may overcome the surgical stress of the laparotomic placement allowing an increase in the number of patients treated by IAHC. The aim of the present study is the comparative analysis of surgical and percutaneous transaxillary approaches to implant the catheter into the hepatic artery (HA) for IAHC. Materials and Methods. Between September 1993 and February 1999, 56 patients received an implantable infu-sion system [SynchroMed(R) (Medtronic, USA) or Port-a-cath(R) (Deltec, USA) connected to an external infusion pump (CADD(R) , Deltec, USA)] for IAHC. Twenty-eight patients (LPT group) underwent laparotomy to implant the catheter into the HA, the other 28 patients (PCT group) received a percutaneous catheter into the HA through a transaxillary percutaneous access. Indications for the laparotomic placement were: 1) synchronous metastases not suitable [technically unresectable or large (>40% of liver parenchyma) or multiple (> 3) metas-tases] for hepatic resection during colorectal surgery; 2) metachronous metastases treated by radical hepatic resection and subsequent adjuvant IAHC. Indications for percutaneous placement were: 1) metachronous metastases not suitable [see above] for hepatic resection; 2) metachronous metastases suitable for hepatic resection after neoadjuvant IAHC for tumor downstaging. All patients received IAHC based on continuous infusion of FU-dR (dose escalation 0.15-0.30 mg/kg/day for 14 days every 28 days) plus dexamethasone 28 mg. For the purpose of the study, the LPT group and the PCT group were comparatively analyzed in terms of age, gender, primary diagnosis, vascular anatomy of HA, ligation/embolization of aberrant HA, previous intestinal or hepatic surgery, contextual systemic chemotherapy, concomitant diseases. Safety and

  12. Excimer laser debulking for percutaneous coronary intervention in left main coronary artery disease.

    PubMed

    Topaz, On; Polkampally, Pritam R; Mohanty, Pramod K; Rizk, Maged; Bangs, Julie; Bernardo, Nelson L

    2009-11-01

    Excimer laser has been successfully applied to complex atherosclerotic plaques in acute coronary syndromes; however, its role in debulking in left main coronary artery disease has not been fully explored. Details of a series of 20 patients who underwent excimer laser revascularization of a spectrum of left main coronary artery lesions are presented. Twenty symptomatic patients who received excimer laser debulking were examined for procedural outcome and follow up results. The left main coronary artery was characterized as protected, semi-protected, poorly protected, or unprotected, depending on the presence or absence of patent bypass grafts to the left anterior descending (LAD) and circumflex (CX) arteries. A fully protected left main coronary artery (LMCA) was present in only 20% of the patients. The target lesions included 11(55%) distal LMCA stenoses, six (30%) ostial stenoses, and one (5%) mid-portion lesions. Two (10%) patients had in-stent re-stenosis of the entire length of the LMCA. Small (0.7 mm-1.4 mm) excimer laser catheters were mostly used. A relatively high number of laser energy pulses (1,334 +/- 643) were required to achieve adequate debulking. Successful LMCA intervention was performed in 19 (95%) patients, while in-hospital complications occurred in only one (5%) patient. Subacute/late stent thrombosis developed 3 months after the procedure in one patient, and two patients died from non-cardiac causes during follow-up. Lesions in LMCAs can be revascularized in selected patients by laser debulking and adjunct stenting. Inadequate protection by bypass grafts and decreased left ventricular function do not contradict utilization of excimer laser. Small laser catheters and high energy levels are required during laser debulking of stenoses of left main coronary arteries.

  13. Unusual origin of the left ophthalmic artery from the basilar trunk.

    PubMed

    Rivera, Rodrigo; Choi, In Sup; Sordo, Juan Gabriel; Giacaman, Pablo; Badilla, Lautaro; Bravo, Eduardo; Echeverria, Daniel

    2015-05-01

    The formation of the ophthalmic artery (OA) is a complex process with two different proposed embryological steps for its development. Several anatomical variants have been described. We present a very unusual origin of the ophthalmic artery from the basilar trunk, in a 45-year-old male with a history of pontine hemorrhagic stroke. MRI and CTA showed evidence of previous hemorrhage in the pons and several intracranial arterial dysplastic dilatations. DSA confirmed several fusiform dilatations of the basilar trunk. In the left ICA, no ophthalmic artery was seen arising from the carotid siphon. The left ophthalmic artery arises from the basilar trunk and runs lateral to the cavernous sinus through the middle cranial fossa, entering the left orbit at the superior orbital fissure. The patient was treated conservatively. Two main theories for this anomaly are known, one from Lasjaunias and the other from Paget. To our knowledge, this basilar origin of the OA has only been described three times in the literature. For its origin, we propose a partial persistence of the trigeminal artery together with a dominance of the dorsal ophthalmic artery.

  14. Right coronary artery from the left sinus of valsalva: Multislice CT and transradial PCI

    PubMed Central

    Bagur, Rodrigo; Gleeton, Onil; Bataille, Yoann; Bilodeau, Sylvie; Rodés-Cabau, Josep; Bertrand, Olivier F

    2011-01-01

    A 42-year-old-woman presented with de novo crescendo angina. Thallium-scintigraphy showed inferior ischemia. Coronary angiogram revealed a right coronary artery (RCA), originating from the left sinus of Valsalva with a severe proximal systolic compression. She underwent successful transradial percutaneous coronary intervention with stent implantation. Multislice-computed tomography (MSCT) is usually used to evaluate coronary artery anomalies and can effectively show the anomalous RCA and the inter-arterial trajectory between the aorta and pulmonary arteries. Anomalies of the origin of the coronary arteries are rare, but can produce specific clinicopathological entities that should be diagnosed with accuracy. This case report illustrates the role of MSCT in the detailed description of an abnormal coronary artery and the use of stenting for symptoms relief. PMID:21390197

  15. Successful surgical treatment of a giant right coronary artery aneurysm with a patent left internal thoracic artery graft.

    PubMed

    Nakahara, Yoshinori; Yoshida, Shigehiko; Yamamoto, Yosuke; Uemura, Hisashi; Yamagishi, Shunsuke; Furuhata, Ken; Hanzawa, Yoshikatu; Kanemura, Takeyuki; Osaka, Shinichi

    2017-05-01

    We report a rare case of a giant right coronary artery aneurysm 13 years after coronary artery bypass grafting. Coronary angiography at the time of primary surgery demonstrated irregular aneurysmal dilatation in the mid-right coronary artery that expanded greatly over a 13-year period to a maximum diameter of 80 mm. The patient underwent aneurysmectomy and interposition using a saphenous vein graft through a right lateral thoracotomy. The patient did not undergo dissection or clamping of the left internal thoracic artery graft, and myocardial protection was obtained using systemic hypothermia and hyperkalaemia in addition to continuous antegrade cardioplegia. Postoperatively, coronary computed tomography showed a lack of residual aneurysm and good flow in the saphenous vein graft. The patient made an uneventful recovery.

  16. [Dissecting aneurysms at the bases of the brachiocephalic artery and the left common carotid artery due to localized dissection of the aortic arch; report of a case].

    PubMed

    Higashi, Shigeki; Yoshida, Y; Mitsuoka, H

    2007-07-01

    A 43-year-old male lost consciousness immediately after archery practice, and was brought to our hospital by ambulance. Angiography showed dissecting aneurysms at the bases of the brachiocephalic artery and the left common carotid artery, causing compression of these arteries. Under cardiopulmonary bypass with selective cerebral perfusion, the blood supply to these arteries was restored with a bifurcated graft. Surgical specimen showed localized dissection of the aortic arch at the bifurcation to the brachiocephalic artery and the left common carotid artery, with the formation of dissecting aneurysms at the bases of both arteries. The aneurysms were filled with thrombi. In addition to these dissecting aneurysms, there were arterial dissections involving the brachiocephalic artery and the bilateral common carotid arteries. Histopathological examination of the vessel wall showed no evidence of atherosclerosis or vasculitis, and no abnormalities in the arrangement of elastic fibers.

  17. Anomalous left anterior descending artery arising from the pulmonary trunk: a rare cause of angina.

    PubMed

    Ibrahim, Abdalla; Power, Stephen P; Kelly, Peter

    2017-09-07

    A 60-year-old man with a medical history of hypertension and dyslipidaemia presented to our rapid access chest pain clinic with a 2-month history of chest pain on exertion. An exercise stress test was arranged, which showed electrical evidence of inducible ischaemia. Subsequently, a coronary angiogram revealed an anomalous left anterior descending artery arising from the main pulmonary artery that received grade 3 collaterals from a large right coronary artery arising from the aorta. The circumflex arises from the right coronary sinus with a retroaortic course and provided collaterals to the anomalous left anterior descending artery. The patient was managed medically with the recommended pharmacological measures for stable angina and responded well with complete resolution of his symptoms, and he is currently under regular follow-up in the cardiology outpatient department. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  18. [Ligation of the left coronary artery ostium in its origin from the pulmonary trunk].

    PubMed

    Fal'kovskiĭ, G E; Aleksi-Meskhishvili, V V; Berishvili, I I

    1980-02-01

    Operation was performed on 8 patients whose left coronary artery arose from the pulmonary artery; one of the patients was operated on twice. Three patients had been operated on twice before 1972, the operation in all of them consisted in talcum suspension insufflation into the pericardium. The results of these operations were poor. Operation for ligation of the orifice of the left coronary artery was conducted on 6 patients (including one with the ineffective talcum suspension insufflation into the pericardium). All patients who were operated on at the age of over one year survived. In children of the first year of life with a low ejection fraction and absence of expulsion on the level of the pulmonary artery the results of surgery were poor.

  19. Rare case of truncus arteriosus with anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) and unilateral left pulmonary artery agenesis.

    PubMed

    Mittal, Kartik; Dey, Amit K; Gadewar, Rohit; Sharma, Rajaram; Pandit, Nilesh; Rajput, Priya; Hira, Priya

    2015-04-01

    The incidence of congenital heart disease (CHD) is 2.4-3.8/1000 live births. Up to 70.7 % of all cases of CHD are reported to be benign; complex heart anomalies are extremely rare. Our case is extremely rare, as we report three very rare findings-truncus arteriosus, anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA), and unilateral left pulmonary artery agenesis-in a single patient. Congenital complex cardiac abnormalities are very rare, and two-dimensional echocardiography screening should be supported by cardiac computed tomography (CT). We report a case of truncus arteriosus associated with ARCAPA and left pulmonary artery agenesis diagnosed by cardiac computed tomography; we believe that such an unusual case with all three of these entities has never been reported before.

  20. High Take Off Left Main and Abnormal Origin of Right Coronary Artery: A Case Report

    PubMed Central

    Salehi, Negar; Abdi, Seyfollah; Pouraliakba, Hamid Reza; Vakili-Zarch, Anoushiravan

    2013-01-01

    Coronary anomalies are rare congenital disorders with mostly benign course. We report a case of 54-year-old white male who was with stable angina scheduled for coronary angiography. Due to the difficulty of catheterization, patient underwent CT angiography and high take off left main and right coronary arteries were revealed. We conclude that anomalous coronary arteries are important and coronary interventions may be difficult in their presence.

  1. Left subclavian artery stenting: an option for the treatment of the coronary-subclavian steal syndrome

    PubMed Central

    de Almeida, Bruno Lorenção; Kambara, Antonio Massamitsu; Rossi, Fabio Henrique; Moreira, Samuel Martins; de Oliveira, Eduardo Silva Jordao; Linhares Filho, Frederico Augusto de Carvalho; Metzger, Patrick Bastos; Passalacqua, Aldo Zampieri

    2014-01-01

    Introduction The subclavian steal syndrome is characterized by the vertebral artery flow inversion, due to a stenotic lesion in the origin of the subclavian artery. The Coronary-subclavian Steal Syndrome is a variation of the Subclavian Steal Syndrome and is characterized by inversion of flow in the Internal Thracic artery that has been used as conduct in a myocardial revascularization. Its diagnosis must be suspected in patients with difference in pulse and arterial pressure in the upper limbs, that present with angina pectoris and that have done a myocardial revascularization. Its treatment must be a surgical bypass or a transluminal angioplasty. Objective The objective is to show the left subclavian artery stenting as a safe and effective method to treat the coronary-subclavian steal syndrome. Methods Historical prospective, non-randomized trial, through revision of the hospital records of the patients treated with the stenting of the left subclavian artery, from January 2006 to September 2012. Results In the mentioned period, 4.291 miocardial revascularizations were performed with the use of the left mammary artery, and 16 patients were identified to have the Coronary-subclavian steal syndrome. All of them were submitted to endovascular treatment. The success rate was 100%; two patients experienced minor complications; none of them presented with major complications. Eleven of the 16 patients had ultrassonographic documentation of patent stent for at least one year; two patients lost follow up and other two died. Conclusion The stenting of the left subclavian artery is a good option for the treatment of the Coronary-subclavian Steal Syndrome, with high level of technical and clinical success. PMID:25140474

  2. Isolated Anomalous Origin of Left Pulmonary Artery From the Descending Aorta: An Embryologic Ambiguity.

    PubMed

    Gnanappa, Ganesh Kumar; Laohachai, Karina; Orr, Yishay; Ayer, Julian

    2016-11-01

    Anomalous origin of a branch pulmonary artery from the aorta is a rare malformation, accounting for 0.12% of all congenital heart defects. Anomalous origin of the left pulmonary artery from the aorta (ALPA) constitutes a small proportion of these cases. ALPA has been reported to arise from the ascending aorta with various embryologic postulates. We report a case of isolated ALPA arising from the descending aorta in association with a patent ductus arteriosus, to emphasize its embryologic ambiguity.

  3. Ruptured Left Gastric Artery Aneurysm: Unique Presentation with Hemothorax and Hemomediastinum

    SciTech Connect

    Lee, Michael K.S. Vrazas, John I.

    2006-06-15

    Although splanchnic artery aneurysms are uncommon and remain mostly asymptomatic, they are associated with a high mortality rate when they rupture. We discuss the case of a 66-year-old woman who had successful embolization of a left gastric artery aneurysm after presenting with acute chest pain and the unusual computed tomography findings of hemothorax and hemomediastinum. To our knowledge, only one other similar case has been published in the literature.

  4. Glucagon-Induced Vasospasm of Hepatic Artery Branches During Visceral Angiography

    SciTech Connect

    Dziedzic, T. Scott; Smith, Tony P.

    2008-07-15

    Glucagon is often used in radiology to decrease bowel motility for enhanced imaging, including visceral digital subtraction angiography. We present a case in which branch hepatic artery vasospasm followed the intravenous administration of glucagon during visceral angiography.

  5. Duplicated left pulmonary artery: an unknown disease? Three case reports and review of the literature.

    PubMed

    Giudici, Valentina; Kanani, Mazyar; Muthialu, Nagarajan; Carr, Michelle; Calder, Alistair D; Owens, Catherine M; Cook, Andrew C; Marek, Jan

    2016-02-01

    We report three cases of an abnormal finding of duplicated left pulmonary artery: two of these occurring in children with Kabuki syndrome and configuring the setting of a pseudo-pulmonary sling without any clinical or cardiac cross-sectional evidence of tracheal compression. The other case instead represents duplicated left pulmonary artery with pulmonary sling caused by the retro-tracheal course of the lower left pulmonary artery associated with "Christmas Tree" arrangement of the tracheo-bronchial system. In both patients with pseudo-pulmonary sling and Kabuki syndrome, the abnormal finding was incidental during echocardiographic examination and neither of the patients required surgical repair for the condition. To the best of our knowledge, they represent the third and fourth cases in which such an anomaly of the pulmonary artery branches not forming a sling is seen in association with Kabuki syndrome. Another case represents our second experience and the second case reported in literature with duplicated left pulmonary artery in the setting of a complex tracheal anatomy. In this symptomatic patient, surgical repair of atrial septal defect and relief of the vascular ring were indicated, and the surgical repair was performed successfully at the age of 3 years.

  6. An Alternative Surgical Technique for Repair of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

    PubMed Central

    Kim, Young-su; Lee, Mina; Cho, Yang Hyun; Yang, Ji-Hyuk; Jun, Tae-Gook

    2014-01-01

    Background For the surgical management of anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), there have been various techniques that reduce the tension and kinking of the coronary artery during reimplantation to the aorta. The aim of this study is to describe the results of our modified technique of coronary reimplantation for the treatment of ALCAPA. Methods Between October 2003 and February 2011, seven patients underwent coronary reimplantation with the modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta). The median follow-up duration was 52 months (range, 4 to 72 months). Clinical outcomes and serial echocardiographic data were reviewed. Results There was no mortality. One patient had a small amount of cerebral hemorrhage postoperatively and improved without any sequelae. Another patient had left diaphragm palsy and underwent diaphragm plication. Follow-up echocardiogram showed that all patients had normal ventricular function without chamber enlargement. Conclusion Our modified technique (tubing formation with the sinus wall of the pulmonary artery and trapdoor formation at the site of implantation in the aorta) demonstrated successful clinical outcomes. We conclude that this surgical technique can be a potential alternative for the treatment of ALCAPA. PMID:25207218

  7. A rare case of single right coronary artery with congenital absence of left coronary artery in an adult: a case report.

    PubMed

    Fu, Fengli; Jin, Hongfeng; Feng, Yue

    2015-04-21

    Single right coronary artery with congenital absence of left coronary artery is one of the rarest coronary artery anomalies. Most coronary anomalies are asymptomatic and incidental findings. We report a case of single right coronary artery with congenital absence of left coronary artery detected by coronary CT angiography. Physical examination revealed a well-nourished female with a blood pressure of 130/75 mmHg and a pulse rate of 56 beats per minute. The myocardial enzymes and blood lipid levels showed normal findings. The dynamic electrocardiogram revealed frequent ventricular premature beats. Dual-source CT angiography was performed for evaluation of coronary artery. The imaging showed a very large single coronary artery arising from the right coronary sinus of Valsalva, and demonstrated absence of the left coronary artery. Meanwhile, the findings were confirmed by coronary angiography.

  8. Percutaneous transluminal angioplasty of the left subclavian artery to prevent or treat the coronary-subclavian steal syndrome.

    PubMed

    Marques, K M; Ernst, S M; Mast, E G; Bal, E T; Suttorp, M J; Plokker, H W

    1996-09-15

    A hemodynamic significant left subclavian artery stenosis or occlusion proximal to the origin of the left internal mammary artery (LIMA) can result in an impaired or reversed flow through the LIMA and the coronary artery to which it has been anastomosed. In this study, we report on our immediate and long-term follow-up results in 31 consecutive patients who underwent percutaneous transluminal coronary angioplasty of the left subclavian artery shortly before or after coronary artery bypass grafting with use of the LIMA.

  9. Transposition of the great arteries associated with a double left ventricular outflow tract.

    PubMed Central

    Kinsley, R H; Levin, S E; O'Donovan, T G

    1979-01-01

    A case is described in which, at semilunar valve level, the aorta and pulmonary artery arose from inappropriate ventricles. Despite this, the outflow tracts to both vessels originated from the left ventricle. Embryologically, it is speculated that this anomaly is the result of normal rotation of the proximal conus, without concomitant truncal inversion, and excessive leftward shift of the proximal conus and conal septum or anterior and rightward deviation of the anterior segment of the ventricular septum. Surgical repair using a double conduit between the right ventricle and pulmonary artery and left ventricle and aorta, respectively, was unsuccessful. Images PMID:508480

  10. Symptomatic obstruction of the brachiocephalic and left subclavian arteries obscured by aortic stenosis.

    PubMed

    Hashim, Peter W; Assi, Roland; Grecu, Loreta; Dardik, Alan

    2014-04-01

    Stenosis or occlusion of the brachiocephalic artery represents an uncommon cause of cerebrovascular insufficiency. We report a patient with combined brachiocephalic and left subclavian obstruction with clinical manifestations of lightheadedness, syncope, and left-sided weakness who remained misdiagnosed essentially because of symmetrical pressures in the upper extremities. Aortic valve replacement for aortic stenosis failed to provide symptomatic relief. Eventual stenting of the brachiocephalic trunk resolved the patient's symptoms. Our report highlights the diagnostic challenges in this case of bilateral supraaortic vessel disease and shows that equal upper extremity pressures do not rule out brachiocephalic artery obstruction.

  11. Further evaluation of the surgical treatment of obstructive disease of the left main coronary artery.

    PubMed Central

    Alford, W C; Page, H L; Burrus, G R; Frist, R A; Stoney, W S; Thomas, C S; Walker, W E

    1978-01-01

    A protocol for the operative management of two patient groups with left main coronary artery disease has been evaluated. The period prior to and during induction of anesthesia is managed without using aortic balloon counterpulsation. Of the 86 patients undergoing coronary artery bypass for left main coronary artery disease from 1970 to 1973, there was a surgical mortality of 8.1%. Follow-up of the survivors from 48 to 87 months revealed three coronary and five non-coronary related deaths with survival to seven years of 75.6 +/- 5%. If the operative mortality is excluded, there is an observed survival to seven years of 82.4 +/- 4.8%, almost the same as a "normal" population of similar age and sex. Utilizing the same protocol, 90 similar patients undergoing coronary artery bypass in 1976 had an operative mortality of 4.4%. The deaths were not related to induction of anesthesia. The perioperative infarction rate (2%) and postoperative cardiac enzyme determinations were no greater in a random group having the same operation for less severe forms of coronary artery disease during the same time period. This method of management for patients with significant left main coronary artery disease is judged superior to other more complex techniques. PMID:306229

  12. Value of left ventricular ejection fraction during exercise in predicting the extent of coronary artery disease.

    PubMed

    DePace, N L; Iskandrian, A S; Hakki, A H; Kane, S A; Segal, B L

    1983-04-01

    To determine the relation between left ventricular performance during exercise and the extent of coronary artery disease, the results of exercise radionuclide ventriculography were analyzed in 65 patients who also underwent cardiac catheterization. A scoring system was used to quantitate the extent of coronary artery disease. This system takes into account the number and site of stenoses of the major coronary vessels and their secondary branches. The conventional method of interpreting the coronary angiograms indicated that 26 patients had significant coronary artery disease (defined as 70% or more narrowing of luminal diameter) of one vessel, 21 had multivessel disease and 18 had no significant coronary artery disease. Although the exercise left ventricular ejection fraction was significantly higher in patients with no coronary artery disease than in patients with one or multivessel disease (probability [p] less than 0.001), there was considerable overlap among the three groups. With the scoring system, a good correlation was found between the coronary artery disease score and the exercise left ventricular ejection fraction (r = -0.70; p less than 0.001). If the exercise heart rate was 130 beats/min or greater or the age of the patient was 50 years or less, an even better correlation was found (r = -0.73 and r = -0.82, respectively). The exercise ejection fraction (but not the change in ejection fraction, end-diastolic volume and end-systolic volume from rest to exercise) correlated with the extent of coronary artery disease. The exercise ejection fraction is the most important exercise variable that correlates with the extent of coronary artery disease when the latter is assessed quantitatively by a scoring system rather than the conventional method of reporting coronary angiograms. Young age and greater exercise heart rate strengthened the correlation. The change in ejection fraction from rest to exercise is useful in the diagnosis of coronary artery disease

  13. Multivessel spontaneous coronary artery dissection of left and right coronary systems

    PubMed Central

    Asrar ul Haq, Muhammad; Mutha, Vivek; van Gaal, William J

    2013-01-01

    Spontaneous coronary artery dissection (SCAD) involving multiple coronary arteries simultaneously is extremely rare. It should be considered in younger patients, especially who do not have traditional cardiac risk factors. We present a case of young male patient presenting with acute coronary syndrome associated with ST segments elevation on ECG following physical stress whose coronary angiography revealed SCAD of the left anterior descending as well as the right coronary artery and discuss the therapeutic options with a brief review of the limited evidence. PMID:24158301

  14. Multiple coronary artery-left ventricular fistulas associated with hereditary hemorrhagic telangiectasia.

    PubMed

    Jacob, M A; Goyal, S B; Pacifico, L; Spodick, D H

    2001-10-01

    Coronary artery-left ventricular (LV) fistulas are extremely rare and can cause myocardial ischemia from coronary steal. We describe an elderly woman who presented with unstable angina from multiple and extensive coronary artery-LV fistulas. She also had clinical features suggestive of hereditary hemorrhagic telangiectasia (HHT). Association of coronary artery-LV fistulas with HHT has not been reported and can pose a management dilemma in view of the risks of extensive cardiopulmonary surgery and potential complications of myocardial ischemia, stroke, and brain abscess.

  15. Interrupted Aortic Arch Associated with Absence of Left Common Carotid Artery: Imaging with MDCT

    SciTech Connect

    Onbas, Omer Olgun, Hasim; Ceviz, Naci; Ors, Rahmi; Okur, Adnan

    2006-06-15

    Interrupted aortic arch (IAA) is a rare severe congenital heart defect defined as complete luminal and anatomic discontinuity between ascending and descending aorta. Although its association with various congenital heart defects has been reported, absence of left common carotid artery (CCA) in patients with IAA has not been reported previously. We report a case of IAA associated with the absence of left CCA which was clearly shown on multidetector-row spiral CT.

  16. An alternative technique for harvesting marginal liver grafts with a replaced or accessory right hepatic artery.

    PubMed

    Addeo, Pietro; Souche, Regis; Bachellier, Philippe

    2015-07-01

    The presence of a replaced or accessory right hepatic artery (R/A RHA) originating from the superior mesenteric artery represents one of the most common anatomical vascular variants of the hepatic artery and comprises the most frequently injured vessels during liver harvesting. Vascular arterial injuries following liver procurement are associated with decreased patient and graft survival and higher retransplantation rates. We describe an alternative technique for harvesting marginal liver grafts with replaced or accessory right hepatic arteries in the absence of pancreatic procurement. The entire procedure is divided and schematically described in six steps for didactical purposes. This technique has been used in 72 liver harvests over a three-year period with no R/A RHA injury. The technical advantages and limitations of this alternative method are discussed.

  17. Left Aberrant Gastric Vein Causing Isolated Left Hepatic Portal Venous Gas Secondary to an Incarcerated Diaphragmatic Hernia

    PubMed Central

    Mittal, Kartik; Anandpara, Karan; Dey, Amit K.; Kedar, Pradnya; Hira, Priya; Kale, Sunita

    2015-01-01

    Summary Background Hepatic portal venous gas (HPVG) is an ominous radiological sign suggestive of underlying intestinal sepsis, infection or trauma. Portal pneumatosis secondary to gastric pathologies is rare. Case Report We report a rare case of a 34-year-old man who presented with acute epigastric pain and vomiting, diagnosed to have an incarcerated diaphragmatic hernia causing gastric pneumatosis and resultant portal venous gas. Conclusions Our case highlights an unusual presentation of gastric pneumatosis secondary to an incarcerated hiatal hernia with resultant portal venous gas involving only the left lobe of the liver. An aberrant left gastric vein was responsible for this phenomenon in our case. A sound understanding of anatomical variants is thus crucial to radiological diagnosis. PMID:26251676

  18. Effect of age on left ventricular function during exercise in patients with coronary artery disease

    SciTech Connect

    Hakki, A.H.; DePace, N.L.; Iskandrian, A.S.

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p . not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p . 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p . not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  19. Effect of age on left ventricular function during exercise in patients with coronary artery disease.

    PubMed

    Hakki, A H; DePace, N L; Iskandrian, A S

    1983-10-01

    The purpose of this study was to assess the effect of age on left ventricular performance during exercise in 79 patients with coronary artery disease (greater than or equal to 50% narrowing of one or more major coronary arteries). Fifty patients under the age of 60 years (group I) and 29 patients 60 years or older (group II) were studied. Radionuclide angiograms were obtained at rest and during symptom-limited upright bicycle exercise. The history of hypertension, angina or Q wave myocardial infarction was similar in both groups. Multivessel coronary artery disease was present in 30 patients (60%) in group I and in 19 patients (66%) in group II (p = not significant). There were no significant differences between the two groups in the hemodynamic variables (at rest or during exercise) of left ventricular ejection fraction, end-diastolic volume, end-systolic volume and cardiac index. Exercise tolerance was higher in group I than in group II (7.8 +/- 0.4 versus 5.7 +/- 0.4 minutes, p = 0.009), although the exercise heart rate and rate-pressure product were not significantly different between the groups. There was poor correlation between age and ejection fraction, end-diastolic volume and end-systolic volume at rest and during exercise. Abnormal left ventricular function at rest or an abnormal response to exercise was noted in 42 patients (84%) in group I and in 25 patients (86%) in group II (p = not significant). Thus, in patients with coronary artery disease, age does not influence left ventricular function at rest or response to exercise. Older patients with coronary artery disease show changes in left ventricular function similar to those in younger patients with corresponding severity of coronary artery disease.

  20. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: The Role of Multislice Computed Tomography (MSCT)

    PubMed Central

    Al Umairi, Rashid Saif; Al Kindi, Faiza; Al Busaidi, Fadhila

    2016-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital coronary abnormality also known as Bland-White-Garland syndrome. The incidence of ALCAPA is about 1 in every 300,000 live births, and constitutes 0.24% and 0.46% of all congenital cardiac disease. It has a high infant mortality rate reaching up to 90% if left untreated. For many years, the diagnosis of ALCAPA was by angiography or autopsy. However, multislice computed tomography (MSCT) is a non-invasive imaging tool that allows accurate, non-invasive diagnosis of ALCAPA. Here we report a case of ALCAPA in a six-month-old girl who presented with a two-week history of cough, fever, tachypnea, and sweating during feeding. During admission, an echocardiogram was performed that revealed ALCAPA, which was confirmed using CT. We discuss the role of MSCT in its diagnosis. PMID:27602196

  1. Determining arterial pressure, left atrial pressure and cardiac output from the left pneumatic drive line of the total artificial heart.

    PubMed

    Rosenberg, G; Landis, D L; Phillips, W M; Stallsmith, J; Pierce, W S

    1978-01-01

    These data presented here demonstrate how careful analysis of mock loop testing can lead to useful measurements for long-term calf experiments. The accuracy of the data rae primarily dependent upon a valid circulatory system analog and good experimental technique. These methods of determining arterial pressure, left atrial pressure and cardiac output have allowed us to obtain recordds of these important parameters for periods as long as 100 days in calves with total artificial heart implantation. These methods have also enabled us to automatically control the artifical heart under conditions of rest, exercise and pharmacologic treatment with the use of only one external pneumatic drive line pressure transducer.

  2. Left atrial myxoma, ruptured chordae tendinae causing mitral regurgitation and coronary artery disease.

    PubMed

    Kumar, Bhupesh; Raj, Ravi; Jayant, Aveek; Kuthe, Sachin

    2014-01-01

    Mitral regurgitation is uncommon with left atrial myxoma. The echocardiographic assessment of presence of mitral regurgitation and its severity are impaired by the presence of left atrial myxoma. We describe an uncommon association of left atrial myxoma with coronary artery disease and mitral regurgitation. MR was reported as mild on pre-operative transthoracic echocardiography but found to be severe due to ruptured chordae tendinae during intra-operative transesophageal echocardiography, which lead to change in the surgical plan to mitral valve replacement in addition to excision of myxoma.

  3. Treatment of a Left Internal Mammary Artery to Pulmonary Artery Fistula with Polytetrafluoroethylene Covered Stents: A Case Report and Review of the Literature

    SciTech Connect

    Abbott, J. Dawn; Brennan, Joseph J.; Remetz, Michael S.

    2004-01-15

    Internal mammary artery (IMA) to pulmonary artery (PA) fistula is a rare complication of coronary artery bypass grafting (CABG) that may present as myocardial ischemia. We describe a case of left IMA-to-PA fistula treated with balloon expandable coronary polytetrafluoroethylene (PTFE) graft stents and review previously reported cases of this entity.

  4. Coronary spasm as the cause of myocardial ischaemia in a patient with anomalous origin of the left anterior descending artery from the proximal right coronary artery

    PubMed Central

    Nakazato, Jun; Hirata, Kazuhito; Wake, Minoru

    2014-01-01

    A 49-year-old woman developed angina at rest. A CT of the coronary artery revealed that the left anterior descending artery arose from the right coronary artery, and traversed between the aorta and pulmonary trunk. An exercise stress myocardial scintigraphy did not reproduce myocardial ischaemia or anginal symptoms. A coronary angiography did not show any atherosclerotic changes. Finally, an ergotamine provocation test for vasospasm revealed diffuse severe spasm in the right coronary artery and the left anterior descending artery. Surgical correction of the anomaly was deferred and the patient was managed with medications to control spasm with good clinical outcome. PMID:24920513

  5. Comparison of Methods for the Reconstruction of the Hepatic Artery in Mouse Orthotopic Liver Transplantation

    PubMed Central

    He, Jinjing; Li, Song; Lv, Xiangwei; Wang, Liming; Liu, Qinlong

    2015-01-01

    Background The mouse model of arterialized orthotopic liver transplantation (AOLT) has played an important role in biomedical research. The available methods of sutured anastomosis for reconstruction of the hepatic artery are complicated, resulting in a high incidence of complications and failure. Therefore, we developed and evaluated a new model of AOLT in mice. Materials and methods Male inbred C57BL/6 mice were used in this study. A continuous suture approach was applied to connect the suprahepatic inferior vena cava (SHVC). The portal vein and infrahepatic inferior vena cava (IHVC) were connected according to the "two-cuff" method. The common bile duct was connected by a biliary stent. We used the stent (G3 group) or aortic trunk (G2 group) to reconstruct the hepatic artery. The patency of the hepatic artery was verified by transecting the artery near the graft after one week. The survival rate of the recipients and serum alanine aminotransferase (ALT) levels, hepatic pathologic alterations, apoptosis and necrosis were observed at one week postoperatively. Results The patency of the hepatic artery was verified in eight of ten mice in G3 and in six of ten mice in G2. The 7-day survival rate, extents of necrosis and apoptosis, and TGF-β levels were not significantly different among the three groups (P>0.05). However, the serum ALT levels and operation time were markedly lower in G3 compared with G2 or G1 (both P<0.05). Conclusions Reconstruction of the hepatic artery using a stent can be performed quickly with a high rate of patency. This model simplifies hepatic artery anastomosis and should be promoted in the field of biomedical research. PMID:26207367

  6. Remodeling of left circumflex coronary arterial tree in pacing-induced heart failure

    PubMed Central

    Huo, Yunlong

    2015-01-01

    Congestive heart failure (CHF) is a very serious heart disease that manifests an imbalance between left ventricle supply and demand. Although the mechanical demand of the failing heart has been well characterized, the systematic remodeling of the entire coronary arterial tree that constitutes the supply of the myocardium is lacking. We hypothesize that the well-known increase in ventricle wall stress during CHF causes coronary vascular rarefaction to increase the vascular flow resistance, which in turn compromises the perfusion of the heart. Morphometric (diameters, length, and numbers) data of the swine left circumflex (LCx) arterial tree were measured in both CHF (n = 6) and control (n = 6) groups, from which a computer reconstruction of the entire LCx tree was implemented down to the capillary level to enable a hemodynamic analysis of coronary circulation. The vascular flow resistance was increased by ∼75% due to a significant decrease of vessel numbers (∼45%) and diameters in the first capillary segments (∼10%) of the LCx arterial tree after 3-4 wk of pacing. The structural remodeling significantly changed the wall shear stress in vessel segments of the entire LCx arterial tree of CHF animals. This study enhances our knowledge of coronary arterial tree remodeling in heart failure, which provides a deeper understanding of the deterioration of supply-demand relation in left ventricle. PMID:26159756

  7. Coronary artery bypass for isolated disease of the left anterior descending artery. Late survival of 648 patients.

    PubMed Central

    Killen, D A; Wathanacharoen, S; Reed, W A; Piehler, J M; Borkon, A M; Gorton, M E; Meuhlebach, G F

    1998-01-01

    We studied a series of 648 consecutive patients who underwent coronary artery bypass grafting for isolated primary disease of the anterior descending coronary artery. We evaluated the patients periodically during a long-term follow-up period of up to 17 years. We studied factors such as survival, survival without acute event (i.e., acute myocardial infarction, repeat coronary artery bypass, and percutaneous transluminal coronary angioplasty), and asymptomatic survival (i.e., survival without acute event or angina). We further analyzed these factors as they occurred in patients who received only saphenous vein grafts versus their occurrence in patients who received internal mammary artery grafts. There was 1 death in the early postoperative period (defined as 30 days or earlier after the operation). The 5-, 10-, and 15-year survival rates were 94.8%, 86.6%, and 72.2%, respectively. These survival rates are slightly better than those of an age- and sex-matched United States census population. In our series, the rates of survival, event-free survival, and asymptomatic survival were better, although not significantly so, in the group of 108 patients in whom the internal mammary artery was used as the bypass conduit. We conclude that patients who undergo coronary artery bypass grafting for isolated disease of the left anterior descending coronary artery enjoy normal survival rates, in comparison with the survival rates of an age- and sex-matched United States census population, through at least the 1st 16 postoperative years. Additionally, patients who receive an internal mammary artery bypass graft have slightly better rates of survival, event-free survival, and asymptomatic survival than do those who receive only saphenous vein grafts. PMID:9782557

  8. Technical dilemmas in portacaval shunt operations as a consequence of replaced right hepatic artery.

    PubMed

    Eckhauser, F E; Strodel, W E; Thompson, N W; Turcotte, J G

    1980-10-01

    Surgical procedures designed to decompress the portal venous system in patients with cirrhosis and bleeing esophageal varices may be complicated by anatomic variations in the extrahepatic arterial circulation. Anomalous right hepatic arteries which arise from the superior mesenteric artery may be encountered in 18 to 20 per cent of the normal population. Replaced arteries are not accessory vessels but rather provide the sole arteries circulation to well defined segments of the liver. Unfortunate injury may result in severe ischemic truama of the liver. Preoperative vicseral arteriography is essential prior to any contemplated portosystemic shunt procedure. The unusual anatomic relationship of such an anomalous right to hepatic artery to the portal vein may contraindicate standard portacaval, interposition portacaval or portarnal shunt procedures; graft angulation and anastomotic distortion may jeopardize shunt patancy and result in recurrent variceal hemmorrhage. A technique for portal vein-hepatic artery transposition and end-to-side portacaval shunt is presented as a feasible alternative if anomalies of the hepatic artery preclude standard shunt procedures.

  9. Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting

    SciTech Connect

    Jenssen, Guttorm L. Wirsching, Jan; Pedersen, Gustav; Amundsen, Svein Roar; Aune, Steinar; Dregelid, Einar; Jonung, Torbjorn; Daryapeyma, Alireza; Laxdal, Elin

    2007-06-15

    Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

  10. Extreme externalisation of a Riata defibrillator lead conductor cable with prolapse into the left pulmonary artery.

    PubMed

    Oktay, A Afşin; Dibs, Samer R; Silver, Jeffrey M; Akbar, M Sikander

    2014-12-01

    The Riata family of defibrillator leads (St. Jude Medical, Sylmar, CA) has been recalled because of externalisation of conductor cables and increased electrical failure. We describe the case of a man with an incidental finding of extreme externalisation of a conductor from the right ventricular defibrillator lead (Riata family) with prolapse into the left pulmonary artery.

  11. Embolization of a left uterine artery mycotic aneurysm after a neglected, perforated appendicitis before delivery

    PubMed Central

    van Doorn, Dette Elise Anne; van Leuken, Maarten; Rijnders, Robertus Johannes Paulus

    2014-01-01

    Key Clinical Message We report a case of a successful embolization of a mycotic aneurysm of the left uterine artery in the puerperium after a neglected perforated appendicitis. A mycotic aneurysm, meaning an infection of the vessel wall which leads to an aneurysmatic dilatation of the vessel, is potentially life threatening if rupture occurs. PMID:25614809

  12. Intimal sarcoma of the left pulmonary artery: diagnosis, treatment and survival.

    PubMed

    Gosalbez, F; Gudin, C; Miralles, M; Naya, J; Valle, J M

    1993-08-01

    A rare case of intimal sarcoma of the left pulmonary artery, diagnosed by fine needle aspiration biopsy and treated by pneumonectomy, is presented. Survival was nearly 4 years and the patient died as the result of attempted resection of a local recurrence. The literature is reviewed.

  13. Left ventricular aneurysm and prognosis in patients with first acute transmural anterior myocardial infarction and isolated left anterior descending artery disease.

    PubMed

    Shen, W F; Tribouilloy, C; Mirode, A; Dufossé, H; Lesbre, J P

    1992-01-01

    To determine the clinical and angiographic factors responsible for left ventricular aneurysm formation and the prognosis of patients with aneurysm, 79 patients with a first acute transmural anterior myocardial infarction and angiographically documented isolated left anterior descending artery disease were retrospectively evaluated. Presence of large infarct size and left ventricular volumes, reduced left ventricular function, and evidence of clinical functional impairment were more common in patients with aneurysm (n = 31) than in those without (n = 48). Patients with aneurysm often had total occlusion of the proximal left anterior descending artery without collateral vessels on angiography. During a mean follow-up of 53 months, 10 patients with and three without aneurysm died (P less than 0.01). Compared to survivors with or without aneurysm, the nonsurvivors were older, had significantly larger infarct size and left ventricular volumes and poor systolic function. The incidence of total occlusion of the left anterior descending artery without collaterals was higher in nonsurvivors. In patients with aneurysm, stepwise multivariate analysis revealed that left ventricular ejection fraction and the status of left anterior descending artery obstruction and collaterals were independent predictors of mortality. The study indicates that in patients with a first acute transmural anterior myocardial infarction and isolated anterior descending artery disease, left ventricular aneurysm often results from a large infarct caused by total occlusion of the proximal left anterior descending artery without collateral supply to the infarct region. The reduced survival rate for patients with aneurysm is primarily related to severe global left ventricular dysfunction which may be determined by assessing the residual flow to the infarct region.

  14. Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery.

    PubMed

    Granillo, Alejandro; Pena, Celia A; Pham, Thuy; Pandit, Lavannya M; Taffet, George E

    2017-02-20

    The present methodology teaches the investigator how to measure and use the LAV as a surrogate of chronic elevations in Left Ventricular diastolic pressure through echocardiography, as well as to obtain measurements of the Aorta and PA diameter in mice. Mice older than 10 d of age can be analyzed using the present technique. The technique is composed of 3 main steps: set-up, image acquisition, and image analysis. The set-up step consists of getting the mouse anesthetized with 1% isoflurane, shaving it, and taping it in a supine position to a heated EKG board where the image acquisition will take place. The image acquisition step consists of learning to identify the cardiac structures and obtaining all the required images with its correspondent probe and axis in order to be able to calculate volumes and diameters. The image analysis step consists of measuring the previously acquired images with the aid of computer software. Advantages of the proposed technique include a fast (15 min) procedure that would allow the researcher to evaluate interventions in a non-invasive, non-terminal approach and therefore follow the same mouse over time; each mouse can be used as its own control. This fact plus having the same operator perform all the acquisition and analysis for the entire experiment minimizes the limitation of operator-dependency. The present methodology is useful for mouse researchers in cardiovascular and pulmonary medicine.

  15. Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection

    PubMed Central

    Francisco, Lloret Estañ; Asunción, López Conesa; Antonio, Capel Alemán; Ricardo, Robles Campos; Manuel, Reus Pintado; Caridad, Marín Hernández

    2010-01-01

    Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in approximately 1% of hepatic trauma cases. Most are extrahepatic (80%) and have a late onset. Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications, especially breakage. Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices. Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection. We present a case of post-traumatic hepatic artery pseudoaneurysm that was successfully treated using this combined technique. PMID:21160978

  16. Post-traumatic hepatic artery pseudoaneurysm treated with endovascular embolization and thrombin injection.

    PubMed

    Francisco, Lloret Estañ; Asunción, López Conesa; Antonio, Capel Alemán; Ricardo, Robles Campos; Manuel, Reus Pintado; Caridad, Marín Hernández

    2010-02-27

    Post-traumatic hepatic artery pseudoaneurysm is uncommon, appearing in approximately 1% of hepatic trauma cases. Most are extrahepatic (80%) and have a late onset. Although they are usually asymptomatic, they should always be treated becasue of the high risk of complications, especially breakage. Currently the treatment of choice is endovascular embolization with coils or the exclusion of the pseudoaneurysm using other intravascular devices. Recently there have been accounts of a treatment that combines embolization with coils and image-guided percutaneous human thrombin injection. We present a case of post-traumatic hepatic artery pseudoaneurysm that was successfully treated using this combined technique.

  17. Outcomes of Coronary Artery Bypass and Stents for Unprotected Left Main Coronary Stenosis.

    PubMed

    Chang, Yin-Shu; Wang, Jia-Xiang; Chang, Da-Wei

    2017-08-01

    This study assessed the short-, medium-, and long-term outcomes of coronary artery bypass grafting vs stenting for patients with unprotected left main coronary artery disease through a meta-analysis of randomized controlled trials. PubMed, Embase, Scopus, Web of Science, Cochrane Library, and major conference proceedings databases were systematically searched for randomized controlled trials of coronary artery bypass grafting compared with stents in unprotected left main coronary artery disease. End points assessed were all-cause death, myocardial infarction, major adverse cardiac and cerebrovascular events, target vessel revascularization, and cerebral stroke. A meta-analysis was conducted according to predefined clinical end points. All-cause death and stroke were similar between stenting and coronary artery bypass grafting at 1 year and at follow-up beyond 1 year. The incidence of myocardial infarction was similar between stenting and coronary artery bypass grafting at each separate time point. The incidence of repeat revascularization was similar between the two groups at 30 days but was higher for stenting at 1 year and beyond. There was a trend toward fewer major adverse cardiac and cerebrovascular events after stenting compared with coronary artery bypass grafting at 30 days, but this difference was no longer significant at 1 year and reversed at follow-up beyond 1 year. The early advantages of stenting over coronary artery bypass grafting have been shown to progressively shift to coronary artery bypass grafting over time. Further larger sample randomized controlled trials are warranted to confirm the results. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Adult presentation of right lung agenesis and left pulmonary artery sling.

    PubMed

    Espinosa, L; Agarwal, P

    2008-02-01

    The combination of right lung agenesis and left pulmonary artery (LPA) sling is a rare entity that has been described only in the pediatric population. Cross-sectional imaging modalities such as magnetic resonance imaging (MRI) and computed tomography (CT) have an advantage over echocardiography and pulmonary angiography in demonstrating the anomalous left pulmonary artery, particularly in the presence of coexisting lung agenesis, as exemplified in this case. We report the first case of this rare entity in an adult. It is important to be aware that this abnormality, though rare, can present even in adulthood, and therefore close attention should be paid to the course of the pulmonary artery to ensure detection of a sling in association with lung agenesis.

  19. [Two Cases of Effective Hepatic Arterial Infusion Chemotherapy for Liver Metastases of Colon Cancer Resistant to Systemic Chemotherapy].

    PubMed

    Date, Yusaku; Hisaka, Toru; Takahashi, Kenjiro; Nakayama, Goichi; Akashi, Masanori; Kawahara, Ryuichi; Sakai, Hisamune; Ishikawa, Hiroto; Yasunaga, Masafumi; Uchida, Shinji; Horiuchi, Hiroyuki; Okuda, Koji; Matsunaga, Mototsugu; Miwa, Keisuke; Akagi, Yoshito

    2015-11-01

    A 69-year-old man underwent right hemicolectomy for ascending colon cancer with liver metastases. Postoperative systemic chemotherapy did not reduce the metastases, and therefore, hepatic arterial infusion chemotherapy (HAI) was administered. The metastases decreased in size after 26 rounds of therapy, and the patient underwent resection. He is recurrence-free 63 months after the primary operation. A 57-year-old man underwent Hartmann's operation for sigmoid colon cancer with liver metastases. He underwent hepatic left lobe resection after metastases reduction by systemic chemotherapy. However, multiple liver metastases were detected 2 months later. Because the disease progressed despite the administration of systemic chemotherapy, HAI was utilized instead. The metastases decreased in size remarkably, and resection was performed. The patient is surviving 52 months after the primary operation while being continuously treated with HAI, resection, and systemic chemotherapy for re-recurrence. HAI is a potential alternative treatment for patients with colorectal liver metastases resistant to systemic chemotherapy.

  20. Selective internal radiation therapy of hepatic tumors: procedural implications of a patent hepatic falciform artery.

    PubMed

    Schelhorn, Juliane; Ertle, Judith; Schlaak, Joerg F; Mueller, Stefan; Bockisch, Andreas; Schlosser, Thomas; Lauenstein, Thomas

    2014-01-01

    Selective internal radiation therapy (SIRT) using 90-yttrium is a local therapy for unresectable liver malignancies. Non-targeted 90-yttrium diversion via a patent hepatic falciform artery (HFA) is seen as risk for periprocedural complications. Therefore, this study aimed to evaluate the impact of a patent HFA on SIRT. 606 patients with SIRT between 2006 and 2012 were evaluated retrospectively. SIRT preparation was performed by digital subtraction angiography including (99m)Tc-HSAM administration and subsequent SPECT/CT. Patients with an angiographically patent HFA were analyzed for procedural consequences and complications. 19 of 606 patients (3%) with an angiographically patent HFA were identified. Only 11 of these 19 patients received 90-yttrium in the hepatic vessel bed containing the HFA. Initial coil embolization of the HFA succeeded only in three of 11 patients. Out of the eight remaining patients four had no abdominal wall (99m)Tc-HSAM accumulation. The other four patients presented with an abdominal wall (99m)Tc-HSAM accumulation, for those a reattempt of HFA embolization was performed or ice packs were administered on the abdominal wall during SIRT. In summary, all patients tolerated SIRT well. A patent HFA should not be considered a SIRT contraindication. In patients with abdominal wall (99m)Tc-HSAM accumulation HFA embolization or ice pack administration seems to prevent complications.

  1. Percutaneous closure of a coronary fistula between the right coronary artery to the left atrium.

    PubMed

    Drago, Manuela; Chessa, Massimo; Gianfranco, Butera; Bossone, Eduardo; Carminati, Mario

    2004-01-01

    We describe a case of a congenital coronary artery fistula of the right coronary artery draining into the left atrium in an eight-year-old boy. The initial diagnosis was made after the detection of a continuous cardiac murmur at the age of six years. Transthoracic echocardiography showed the right coronaric ostium dilatation, the site of drainage in the left atrium and left ventricle volume overload. Catheterization confirmed the diagnosis. The patient underwent percutaneous closure by PDA occluder device. Immediate post-closure angiograms showed complete occlusion of the fistula. The patient showed transient ischemic changes on ECG associated to an increase of plasmatic levels of the cardiac enzyme. ECG and cardiac enzyme were normal one week after the procedure.

  2. Isolated Left Subclavian Artery, Complete Atrioventricular Block, and Tricuspid Atresia in a Neonate

    PubMed Central

    Prasad, Deepa; Ashwath, Ravi; Strainic, James P.; Snyder, Christopher S.

    2016-01-01

    Isolated left subclavian artery is one of the rarer aortic arch anomalies. It has been associated with other congenital heart diseases, typically tetralogy of Fallot, double-outlet right ventricle, and atrial and ventricular septal defects. Its significant clinical implications include a left-to-right shunt from the vertebrobasilar system, which causes pulmonary overcirculation and subclavian steal. We present an unusual case of a premature infant who was diagnosed prenatally with congenital complete atrioventricular block and tricuspid atresia and was found to have an isolated left subclavian artery postnatally. The patient underwent implantation of a permanent single-chamber epicardial pacing system. To our knowledge, this combination of lesions has not been reported—and in our case, it influenced our surgical planning. PMID:28100981

  3. Spasms of the Hepatic Artery Following Percutaneous Transluminal Angioplasty and Tolazoline Administration in a Liver Transplant Patient

    SciTech Connect

    Propst, Albert; Waldenberger, Peter; Propst, Theresa; Vogel, Wolfgang; Koenigsrainer, Alfred

    1996-05-15

    Vascular complications after liver transplantation include occlusion or stenosis near the sites of anastomosis in the hepatic artery, portal vein, and vena cava. Balloon angioplasty of these stenoses carries little risk and is a useful procedure for the treatment of these problems. Here we describe the case of a liver transplant patient who underwent balloon angioplasty for stenosis of the hepatic artery and who developed spasms of the hepatic artery which were aggravated following intraarterial administration of Tolazoline.

  4. Right coronary artery fistula to left ventricle treated by transcatheter coil embolization: a case report and literature review.

    PubMed

    Jiang, Zhenni; Chen, Han; Wang, Jian'an

    2012-01-01

    A coronary artery fistula between a coronary artery and a cardiac chamber is a rare condition. We reported a case of right coronary artery fistula to the left ventricle in a 57-year-old man who had 2-year history of chest pain and exercise dyspnea without significant coronary atherosclerosis with abnormal left ventricular size and function. It was important to recognize this anomaly and our experience showed that transcatheter occlusion of coronary artery fistula was a safe and effective procedure in the presence of symptoms of congestive heart failure, significant left-to-right shunt or refractory to medical treatment.

  5. Physiologic Functional Evaluation of Left Internal Mammary Artery Graft to Left Anterior Descending Coronary Artery Steal due to Unligated First Thoracic Branch in a Case of Refractory Angina

    PubMed Central

    Sawaya, Fadi J.; Liberman, Henry; Devireddy, Chandan

    2016-01-01

    Unligated side branches of the left internal mammary artery (LIMA) have been described in the literature as a cause of coronary steal resulting in angina. Despite a number of studies reporting successful side branch embolization to relieve symptoms, this phenomenon remains controversial. Hemodynamic evidence of coronary steal using angiographic and intravascular Doppler techniques has been supported by some and rejected by others. In this case study using an intracoronary Doppler wire with adenosine, we demonstrate that a trial occlusion of the LIMA thoracic side branch with selective balloon inflation can confirm physiologic significant steal and whether coil embolization of the side branch is indicated. PMID:26981289

  6. Endovascular treatment of hepatic artery aneurysm in a patient with Ehlers-Danlos syndrome. Case report.

    PubMed

    Casana, R; Nano, G; Dalainas, I; Tealdi, D G

    2004-09-01

    Ehlers-Danlos syndrome (EDS) is a rare, variably inherited disorder affecting connective tissue. Patients with EDS often develop aneurysms of the thoracic and abdominal aorta as well as the visceral arteries. We report our experience with an elective endovascular exclusion of an hepatic artery aneurysm in a 26-year-old female patient with EDS type IV. A balloon-expandable 4x26 mm stent-graft was placed in the common hepatic artery, excluding the aneurysm. The follow-up at the 2, 6 and 18 months showed the patency of the common hepatic artery, the absence of endo-leak and the right location of the stent-graft. In EDS patients, the endovascular treatment could be preferable to open surgery because of the minimum trauma.

  7. Hepatic resection, hepatic arterial infusion pump therapy, and genetic biomarkers in the management of hepatic metastases from colorectal cancer.

    PubMed

    McAuliffe, John C; Qadan, Motaz; D'Angelica, Michael I

    2015-12-01

    The liver is the most common site of colorectal cancer metastasis. Fortunately, improvements have been made in the care of patients with colorectal liver metastasis (CRLM). Effective management of CRLM requires a multidisciplinary approach that is tailored to individuals in order to achieve long-term survival, and cure. Resection and systemic chemotherapy provides benefit in selected individuals. An adjunct to resection and/or systemic chemotherapy is the use of hepatic arterial infusion pump (HAIP) therapy. Many studies show HAIP provides benefit for select patients with CRLM. Added to the crucible of a multidisciplinary approach to managing CRLM is the ever growing understanding of tumor biology and genetic profiling. In this review, we discuss the outcomes of resection, systemic therapies and HAIP therapy for CRLM. We also discuss the impact of recent advances in genetic profiling and mutational analysis, namely mutation of KRAS and BRAF, for this disease.

  8. Hepatic resection, hepatic arterial infusion pump therapy, and genetic biomarkers in the management of hepatic metastases from colorectal cancer

    PubMed Central

    McAuliffe, John C.; Qadan, Motaz

    2015-01-01

    The liver is the most common site of colorectal cancer metastasis. Fortunately, improvements have been made in the care of patients with colorectal liver metastasis (CRLM). Effective management of CRLM requires a multidisciplinary approach that is tailored to individuals in order to achieve long-term survival, and cure. Resection and systemic chemotherapy provides benefit in selected individuals. An adjunct to resection and/or systemic chemotherapy is the use of hepatic arterial infusion pump (HAIP) therapy. Many studies show HAIP provides benefit for select patients with CRLM. Added to the crucible of a multidisciplinary approach to managing CRLM is the ever growing understanding of tumor biology and genetic profiling. In this review, we discuss the outcomes of resection, systemic therapies and HAIP therapy for CRLM. We also discuss the impact of recent advances in genetic profiling and mutational analysis, namely mutation of KRAS and BRAF, for this disease. PMID:26697204

  9. Acute occlusion of the left iliac artery after long-distance-running.

    PubMed

    Schmidt, O; Thaler, K H; Lang, W

    2001-02-01

    We report a case of spontaneous iliac occlusion in a 44-year-old male patient after long-distance running. Atherogenic risk factors like hypertension, diabetes, hypercholesterolemia and smoking were missing. Spontaneous iliac occlusion is extremely rare and only a few cases have been documented. Angiography showed occlusion of the left iliac artery with collateral flow via the obturator artery to the common femoral artery. Thrombectomy was performed but reocclusion occurred. An iliacofemoral bypass, arterial lysis and bypass thrombectomy was necessary within a few months. At the last follow-up visit two years afterwards the patient was symptom-free. This case indicates that exercise-dependent blood flow disturbances in long-distance-runners could produce changes of the intima.

  10. [MINIMALLY INVASIVE MULTIVESSEL CORONARY ARTERY BYPASS GRAFTING VIA SMALL LEFT THORACOTOMY].

    PubMed

    Sakaguchi, Taichi

    2016-03-01

    Although a minithoracotomy approach has several advantages over a sternotomy approach in terms of superior cosmesis and faster recovery, coronary artery bypass grafting (CABG) via sternotomy has been the gold standard for revascularization in multivessel coronary artery disease. Recently, nonsternotomy approaches, including the minimally invasive cardiac surgery CABG (MICS-CABG) via small left thoracotomy, have emerged as safe, effective alternatives. Excellent clinical results have been reported including equivalent mid-term graft patency as compared with a sternotomy approach. Successful use of bilateral internal thoracic arteries in MICS-CABG has also been reported. Although the durability of this approach and its impact on long-term survival have yet to be confirmed, and there is a certain technical learning curve, MICS-CABG will be one important option to treat multivessel coronary artery disease.

  11. Young male survivor of a spontaneous left main coronary artery dissection treated with surgery

    PubMed Central

    Endara, Santiago A.; Ayala, Andres V.; Davalos, Gerardo A.; Moscoso, Juan; Montero, R. Alejandra

    2013-01-01

    Spontaneous dissection of the coronary arteries is a rare disease with a wide range of clinical presentations ranging from angina to myocardial infarction (MI); its pathophysiology has not yet been fully established. In this paper, we present the case of a 31-year-old male with an acute coronary syndrome. The initial results of the electrocardiogram and cardiac enzymes were consistent with MI. However, a coronary angio-tomography revealed a dissection of the left main coronary artery and the patient underwent emergent surgery with coronary artery bypass grafting. The treatment of spontaneous dissection of the coronary arteries depends on the anatomical location and the patient's clinical presentation. Coronary revascularization is associated with good results. PMID:24964467

  12. Isolation of the Left Subclavian Artery with Right Aortic Arch in Association with Bilateral Ductus Arteriosus and Ventricular Septal Defect

    PubMed Central

    Lee, Ji Seong; Park, Ji Young; Ko, Seong Min; Seo, Dong-Man

    2015-01-01

    Right aortic arch with isolation of the left subclavian artery is a rare anomaly. The incidence of bilateral ductus arteriosus is sporadic, and a right aortic arch with isolation of the left subclavian artery in association with bilateral ductus arteriosus is therefore extremely rare. Since the symptoms and signs of isolation of the left subclavian artery can include the absence or underdevelopment of the left arm, subclavian steal syndrome, or pulmonary artery steal syndrome, the proper therapeutic approach is controversial. We report a case in which surgical reconstruction was used to treat isolation of the left subclavian artery with right aortic arch in association with bilateral ductus arteriosus and a ventricular septal defect. PMID:26665110

  13. Feasibility and Safety of Transradial Arterial Approach for Simultaneous Right and Left Vertebral Artery Angiographic Studies and Stenting

    SciTech Connect

    Yip, H.-K.; Youssef, Ali A.; Chang, W.-N.; Lu, C.-H.; Yang, C.-H.; Chen, S.-M.; Wu, C.-J.

    2007-09-15

    Objectives. This study investigated whether the transradial artery (TRA) approach using a 6-French (F) Kimny guiding catheter for right vertebral artery (VA) angiographic study and stenting is safe and effective for patients with significant VA stenosis. Background. The TRA approach is commonly performed worldwide for both diagnostic cardiac catheterization and catheter-based coronary intervention. However, to our knowledge, the safety and feasibility of left and right VA angiographic study and stenting, in the same procedure, using the TRA approach for patients with brain ischemia have not been reported. Methods. The study included 24 consecutive patients (22 male, 2 female; age, 63-78 years). Indications for VA angiographic study and stenting were (1) prior stroke or symptoms related to vertebrobasilar ischemia and (2) an asymptomatic but vertebral angiographic finding of severe stenosis (>70%). A combination of the ipsilateral and retrograde-engagement technique, which involved a looping 6-F Kimny guiding catheter, was utilized for VA angiographic study. For VA stenting, an ipsilateral TRA approach with either a Kimny guiding catheter or a left internal mammary artery guiding catheter was utilized in 22 patients and retrograde-engagement technique in 2 patients. Results. A technically successful procedure was achieved in all patients, including left VA stenting in 15 patients and right VA stenting in 9 patients. The mean time for stenting (from engagement to stent deployment) was 12.7 min. There were no vascular complications or mortality. However, one patient suffered from a transient ischemic attack that resolved within 3 h. Conclusion. We conclude that TRA access for both VA angiographic study and VA stenting is safe and effective, and provides a simple and useful clinical tool for patients unsuited for femoral arterial access.

  14. Variations in the Origin and Course of Right Hepatic Artery and its Surgical Significance.

    PubMed

    Mugunthan, Narayanaperumal; Kannan, Rajendran; Jebakani, Christilda Felicia; Anbalagan, Jayaram

    2016-09-01

    Variations in the Right Hepatic Artery (RHA) are exceedingly common and these variations are of great importance to surgeons and interventional radiologists. A thorough knowledge of the right hepatic arterial anatomy is mandatory while performing hepatic surgery and hepatic arteriography. To find out the variations in the origin and course of the RHA and its surgical significance. This study was conducted in 60 embalmed adult cadavers of both sexes of age group between 50 to 80 years. Abdomen was opened by a linear midline incision extending from the xiphoid process to the pubic symphysis. The origin of RHA from the proper hepatic artery was traced. The presence of aberrant right hepatic arteries -replaced and accessory were noted. The source of origin of accessory or replaced RHA arising from the superior mesenteric artery (SMA), right renal artery and inferior mesenteric artery was traced. The course of normal and aberrant RHA from its origin to the entrance into the right lobe of the liver was followed and structures related to it were noted. The RHA mostly originated from the main trunk of the proper hepatic artery in 52 specimens (86.6%). Presence of aberrant RHA was found in 8 specimens (13.3%). Among 8 specimens of aberrant RHA, replaced RHA arising from SMA was found in 5 specimens (8.3%) and accessory RHA arising from SMA was observed in 3 specimens (5%). In 86.6% of specimens, the RHA coursed dorsal to the duct system to enter the Calot's triangle. In 8.3% of specimens, the RHA coursed ventral to duct system to reach the Calot's triangle. The caterpillar like loop of the RHA was found in two specimens (3%). The replaced and accessory RHA (13.3%) arising from the SMA had a course dorsal to duct system to reach the Calot's triangle. Right hepatic artery is subject to anatomical variation in its origin and course. Our study identified the variations in the origin and course of right hepatic artery. Adequate knowledge of these variations would be of

  15. Unusual Combination of Total Occlusion of Left Main Coronary Artery and Heart Failure with Pulmonary Hemosiderosis: Case Report

    PubMed Central

    Elayda, MacArthur A.; Mathur, Virendra S.; Hall, Robert J.

    1983-01-01

    A case of total occlusion of the left main coronary artery, congestive heart failure, and pulmonary hemosiderosis in a 54-year-old man is reported. Cardiac catheterization showed total occlusion of the left main coronary artery, subtotal occlusion of the right coronary artery, severely deranged hemodynamics, and an akinetic left ventricle except for a hypokinetic posterobasal segment. A radionuclide left ventricular performance study revealed an ejection fraction of 0.16 with diffuse biventricular hypokinesis and dilatation. Despite all the risk factors, the patient underwent a total of six saphenous vein grafts without perioperative or immediate postoperative complications. Images PMID:15227138

  16. Association between mitral and aortic valve calcification and preferential left or right coronary artery disease.

    PubMed

    Yosefy, Chaim; Malushitsky, Ariela; Jamal, Jafary; Sahar, Gideon; Katz, Amos

    2009-11-01

    Mitral annular calcification (MAC) and aortic valve calcification (AVC) are predictive of coronary artery disease (CAD). However, no data exist concerning the association between preferential CAD side localization to the left or right coronary arteries and MAC or AVC. A cohort analysis was performed of 1,000 consecutive coronary angiographies recorded in patients with CAD. The angiographies were divided according to the distribution of CAD to the isolated right coronary tree disease, left coronary tree disease, or both. The echocardiograms were reviewed for MAC, AVC or combined valvular calcification (CVC). Significant CAD (lumenal stenosis > 70%) was observed in 688 patients, among whom 167 had isolated (right or left) CAD and 521 double-sided coronary tree disease. Valvular calcification (VC) was observed in 70 (42%) of the isolated CAD patients; of these, 41 had isolated left CAD and 29 isolated right CAD. Among the isolated left CAD patients with VC, 13 (32%) had AVC, 22 (53%) had CVC, and only six (15%) had MAC (p < 0.01). Among the isolated right CAD patients with VC, 18 (62%) had MAC, nine (31%) had CVC, and only two (7%) had AVC (p < 0.01). VC was observed in 266 patients (51%) with mixed CAD; of these, 152 (57%) had CVC, 103 (39%) had AVC, and 11 (4%) had MAC (p < 0.01). Isolated left CAD is associated with AVC or CVC more frequently than with MAC. In contrast, isolated right CAD is associated with MAC or CVC, but rarely with AVC.

  17. Computational Fluid Dynamics Analysis of the Effect of Plaques in the Left Coronary Artery

    PubMed Central

    Chaichana, Thanapong; Sun, Zhonghua; Jewkes, James

    2012-01-01

    This study was to investigate the hemodynamic effect of simulated plaques in left coronary artery models, which were generated from a sample patient's data. Plaques were simulated and placed at the left main stem and the left anterior descending (LAD) to produce at least 60% coronary stenosis. Computational fluid dynamics analysis was performed to simulate realistic physiological conditions that reflect the in vivo cardiac hemodynamics, and comparison of wall shear stress (WSS) between Newtonian and non-Newtonian fluid models was performed. The pressure gradient (PSG) and flow velocities in the left coronary artery were measured and compared in the left coronary models with and without presence of plaques during cardiac cycle. Our results showed that the highest PSG was observed in stenotic regions caused by the plaques. Low flow velocity areas were found at postplaque locations in the left circumflex, LAD, and bifurcation. WSS at the stenotic locations was similar between the non-Newtonian and Newtonian models although some more details were observed with non-Newtonian model. There is a direct correlation between coronary plaques and subsequent hemodynamic changes, based on the simulation of plaques in the realistic coronary models. PMID:22400051

  18. A rare case of myocardial bridge involving left anterior descending, obtuse marginal and ramus intermediate coronary arteries

    PubMed Central

    Koprulu, Diyar; Elmali, Muzaffer; Zeren, Gonul; Erdogan, Guney

    2016-01-01

    Myocardial bridging, a congenital coronary anomaly, is a cluster of myocardial fibers crossing over the epicardial coronary arteries. It is most frequently seen in the left anterior descending artery (LAD), and rarely involves the circumflex (CX) and right coronary artery (RCA). We report a patient with an unusual coronary bridge crossing over the left anterior descending, obtuse marginal and ramus intermediate branches. The patient presented with exercise-induced angina pectoris that was relieved with medical therapy. PMID:28096838

  19. Arterial stiffness, body fat compartments, central hemodynamics, renal function and left atrial size.

    PubMed

    Katulska, Katarzyna; Milewska, Agata; Wykretowicz, Mateusz; Krauze, Tomasz; Przymuszala, Dagmara; Piskorski, Jaroslaw; Stajgis, Marek; Guzik, Przemyslaw; Wysocki, Henryk; Wykrętowicz, Andrzej

    2013-10-01

    Left atrial (LA) size is an important predictor of stroke, death, and atrial fibrillation. It was demonstrated recently that body fat, arterial stiffness and renal functions are associated with LA diameter. However, data are lacking for comprehensive assessments of all these risk factors in a single population. Therefore, the aim of the present study was to investigate the association between LA size and different fat descriptors, central hemodynamics, arterial stiffness, and renal function in healthy subjects. To this end, body fat percentage, abdominal, subcutaneous fat, and general descriptors of body fat were estimated in 162 healthy subjects (mean age 51 years). Echocardiography was performed to assess LA diameter. Arterial stiffness and peripheral and central hemodynamics were estimated by digital volume pulse analysis and pulse wave analysis. Glomerular filtration rate was estimated by MDRD formula. There were significant (p < 0.05) bivariate correlations between LA diameter and all descriptors of body fat (except subcutaneous fat). Arterial stiffness and estimated glomerular filtration rate (eGFR) were also significantly correlated with LA size. Multiple regression analysis including all significant confounders, such as sex, mean arterial pressure, arterial stiffness, eGFR and body fat descriptors, explained 35% of variance in LA diameter. In conclusion, the present study reveals significant, independent relationships between body fat, arterial stiffness, and LA size.

  20. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult: a case report.

    PubMed

    Kristensen, Thomas; Kofoed, Klaus Fuglsang; Helqvist, Steffen; Helvind, Morten; Søndergaard, Lars

    2008-05-26

    Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual clinical course is severe left sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. Arrhythmias or sudden cardiac death in adult life may be the first clinical presentation in patients with ALCAPA. We report a case, where a 39-year old woman presented with ventricular fibrillation during phycial exertion. Coronary angiography and CT-angiography revealed an anomalous origin of the left coronary artery, and an aortic reimplantation of the left coronary artery was performed followed by ICD implantation. A review of the literature on ALCAPA is presented along with CT images before and after surgery.

  1. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult: a case report

    PubMed Central

    Kristensen, Thomas; Kofoed, Klaus Fuglsang; Helqvist, Steffen; Helvind, Morten; Søndergaard, Lars

    2008-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual clinical course is severe left sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. Arrhythmias or sudden cardiac death in adult life may be the first clinical presentation in patients with ALCAPA. We report a case, where a 39-year old woman presented with ventricular fibrillation during phycial exertion. Coronary angiography and CT-angiography revealed an anomalous origin of the left coronary artery, and an aortic reimplantation of the left coronary artery was performed followed by ICD implantation. A review of the literature on ALCAPA is presented along with CT images before and after surgery. PMID:18503713

  2. Catastrophic myocardial ischemia resulting from a left coronary artery anomaly with an origin in the right sinus of Valsalva.

    PubMed

    Takazawa, Ippei; Kawahito, Koji; Sugaya, Akira; Yokota, Ayako; Hoshide, Satoshi; Kario, Kazuomi; Misawa, Yoshio

    2016-06-01

    A congenital left coronary artery anomaly originating from the right aortic sinus is a rare congenital defect associated with the risk of sudden death in young individuals. In most cases, the proximal portion of the anomalous left coronary artery exists between the ascending aorta and pulmonary trunk, and it has an intramural aortic course; this could critically impair the left coronary flow owing to compression of the anomalous left main trunk between the great vessels during exercise. Herein, we report a 14-year-old boy who experienced cardiac collapse due to an acute myocardial infarction after long-distance running. After resuscitation using percutaneous cardiopulmonary support, computed tomography and coronary angiography revealed an anomalous origin of the left main coronary artery in the right sinus of Valsalva and a proximal course between the aorta and pulmonary trunk. The patient was successfully treated using an unroofing procedure of the intramural left coronary artery.

  3. Primary Neuroendocrine Tumor of the Left Hepatic Duct: A Case Report with Review of the Literature

    PubMed Central

    Bhandarwar, Ajay H.; Shaikh, Taher A.; Borisa, Ashok D.; Palep, Jaydeep H.; Patil, Arun S.; Manke, Aditya A.

    2012-01-01

    Primary Biliary Tract Neuroendocrine tumors (NET) are extremely rare tumors with only 77 cases been reported in the literature till now. We describe a case of a left hepatic duct NET and review the literature for this rare malignancy. To the best of our knowledge the present case is the first reported case of a left hepatic duct NET in the literature. In spite of availability of advanced diagnostic tools like Computerized Tomography (CT) Scan and Endoscopic Retrograde Cholangio Pancreaticography (ERCP) a definitive diagnosis of these tumors is possible only after an accurate histopathologic diagnosis of operative specimens with immunohistochemistry and electron microscopy. Though surgical excision remains the gold standard treatment for such tumors, patients with unresectable tumors have good survival with newer biologic agents like Octreotride. PMID:23213596

  4. Anomalous Origin of Right Coronary Artery from Distal Left Circumflex Artery: A Case Study and a Review of its Clinical Significance

    PubMed Central

    Pourafkari, Leili; Taban, Mohammadreza; Ghaffari, Samad

    2014-01-01

    Single coronary arteries are rare congenital anomalies in which the whole heart circulation is supplied by a coronary artery arising from a single ostium. Single left coronary artery with right coronary artery (RCA) originating from distal left circumflex artery (LCX) is a very rare anomaly with only few cases reported in the literature. We report a 44 years old male presenting with anterior myocardial infarction who was found to have a single left coronary artery during angiography. RCA had an abnormal origin arising from distal of a dominant LCX that retrogradely followed the course of a normal RCA to the base of the heart. A brief review of the reported cases with emphasis on the clinical significance of this unusual anomaly is presented. PMID:25031830

  5. Anomalous Origin of the Left Common Carotid Artery from the Main Pulmonary Artery: A Rare Association in an Infant with CHARGE Syndrome

    PubMed Central

    Jones, Blaise; Hirsch, Russel

    2016-01-01

    Case Report. Isolated carotid artery originating from the pulmonary trunk is an exceedingly rare anomalous origin of head and neck vessels. We present this finding, along with a persistent embryonic trigeminal artery, in a male infant with multiple cardiac defects and other congenital anomalies associated with CHARGE syndrome. After extensive investigations, cardiac catheterization revealed the anomalous left common carotid artery arising from the cranial aspect of the main pulmonary artery. There was retrograde flow in this vessel, resulting from the lower pulmonary pressure, essentially stealing arterial supply from the left anterior cerebral circulation. The persistent left-sided trigeminal artery provided collateral flow from the posterior circulation to the left internal carotid artery territory, allowing for safe ligation of the anomalous origin of the left common carotid artery, thereby reversing the steal of arterial blood flow into the pulmonary circulation and resulting in a net improvement of cerebral perfusion. Conclusion. The possibility of this vascular anomaly should be considered in all infants with CHARGE syndrome. Surgical repair or ligation should be tailored to the specific patient circumstances, following a careful delineation of all sources of cerebral perfusion. PMID:27974985

  6. Embolization for Acute Small-Bowel Bleeding from the Collateral Artery of the Superior Mesenteric Left Deep Circumflex Iliac Artery Associated with Narrowing of the Bilateral Common External Iliac Arteries

    SciTech Connect

    Shimohira, Masashi Ogino, Hiroyuki; Sasaki, Shigeru; Nishikawa, Hiroko; Shibamoto, Yuta

    2009-03-15

    We present a case of acute small-bowel bleeding from the collateral artery of the superior mesenteric-left deep circumflex iliac artery that was successfully managed by transarterial coil embolization.

  7. [Left ventricular relaxation and ambulatory blood pressure in mild, untreated arterial hypertension].

    PubMed

    Herpin, D; Raynier, P; Ciber, M; Amiel, A; Boutaud, P; Demange, J

    1989-03-01

    Twenty patients with mild, untreated arterial hypertension had ambulatory blood pressure recordings and a digitized echocardiographic study of the left ventricle with measurement of its mass (LVM) and of relaxation parameters. A significant correlation was found between LVM and ambulatory systolic pressure during daytime (r = 0.64; p less than 0.01; n = 20) and during 24 hours (r = 0.79; p less than 0.001; n = 16). One of the relaxation parameters studied, the time taken to reach maximal speed of left ventricular enlargement, was closely related to the diurnal diastolic blood pressure (r = 0.58; p less than 0.01; n = 20), whereas in this population with mild arterial blood pressure none of the parameters was related to the amount of increase of LVM. One may therefore consider the abnormalities of left ventricular relaxation as likely to appear at an early stage of arterial hypertension; their discovery may antedate that of LVM and confirm that the hypertensive disease is real. However, the methodological problems encountered with type of exploration ought to be stressed: left ventricular relaxation is a multifactorial phenomenon, and its echocardiographic approach is subject to many hazards.

  8. Coronary endarterectomy in left anterior descending artery combined with coronary artery bypass grafting – midterm mortality and morbidity

    PubMed Central

    Domaradzki, Wojciech; Krauze, Jolanta; Kinasz, Leszek; Jankowska-Sanetra, Justyna; Świątkiewicz, Małgorzata; Paradowski, Krzysztof; Cisowski, Marek

    2015-01-01

    Introduction Completeness of myocardial revascularization is essential in surgical treatment of coronary artery disease. The aim of this study is to determine the effectiveness of coronary endarterectomy as an adjunct to coronary artery bypass grafting (CABG) in the most difficult cases. Material and methods Among 1559 patients who had CABG in our department, the cases of 17 who underwent an adjunct left anterior descending endarterectomy were analyzed. All procedures were performed with median sternotomy, extracorporeal circulation and in mild hypothermia (34°C), by the same surgeon. No coronary artery endarterectomy was planned before surgery. Results There was no infarction or cardiac arrest during hospitalization. Only one patient required mechanical circulatory support (intra-aortic balloon counterpulsation). Each patient was contacted and investigation for major adverse cardiac and cerebrovascular events (MACCE) was performed. Eleven patients (65%) already underwent midterm clinical evaluation. There was no death, myocardial infarction or cerebrovascular incident during the entire period (mean follow-up at 15.3 months). One patient required urgent coronarography due to chest pain. No other patient had chest pain or significant deterioration of ventricular function in echocardiography. Conclusions Outcomes and potential indications for performing left anterior descending coronary endarterectomy as an adjunct to CABG are discussed. PMID:26855644

  9. Coronary endarterectomy in left anterior descending artery combined with coronary artery bypass grafting - midterm mortality and morbidity.

    PubMed

    Domaradzki, Wojciech; Sanetra, Krzysztof; Krauze, Jolanta; Kinasz, Leszek; Jankowska-Sanetra, Justyna; Świątkiewicz, Małgorzata; Paradowski, Krzysztof; Cisowski, Marek

    2015-12-01

    Completeness of myocardial revascularization is essential in surgical treatment of coronary artery disease. The aim of this study is to determine the effectiveness of coronary endarterectomy as an adjunct to coronary artery bypass grafting (CABG) in the most difficult cases. Among 1559 patients who had CABG in our department, the cases of 17 who underwent an adjunct left anterior descending endarterectomy were analyzed. All procedures were performed with median sternotomy, extracorporeal circulation and in mild hypothermia (34°C), by the same surgeon. No coronary artery endarterectomy was planned before surgery. There was no infarction or cardiac arrest during hospitalization. Only one patient required mechanical circulatory support (intra-aortic balloon counterpulsation). Each patient was contacted and investigation for major adverse cardiac and cerebrovascular events (MACCE) was performed. Eleven patients (65%) already underwent midterm clinical evaluation. There was no death, myocardial infarction or cerebrovascular incident during the entire period (mean follow-up at 15.3 months). One patient required urgent coronarography due to chest pain. No other patient had chest pain or significant deterioration of ventricular function in echocardiography. Outcomes and potential indications for performing left anterior descending coronary endarterectomy as an adjunct to CABG are discussed.

  10. [Hemodynamic compensatory mechanisms of impaired left ventricular contraction in coronary artery disease (author's transl)].

    PubMed

    Bleifeld, W; Pop, T

    1975-01-01

    The effect of chronic coronary insufficiency on the hemodynamics, the geometry and muscle mass of the left ventricle were studied in 30 patients and compared to 13 controls. In these patients the cardiac output was normal in spite of impaired contractility and left ventricular wall movement. The impaired cardiac performance was compensated by 1. hypertrophy and 2. dialatation of the left ventricle. In one-vessel disease of the the coronary arteries left ventricular muscle mass was modestly, but not significant increased. Hypertrophy decreased from +20% in one vessel disease to +10% in three vessel disease. In contrast, left ventricular dilatation increased from +23% in one vessel disease to 43% in two vessel disease and to 70% in patients with sclerotic lesions in three vessels. Left ventricular dilatation seems to be the main hemodynamic compensatory mechnism resulting in a relative increase of the pump function of the heart compared to non dilated hearts. However, dilatation leads in the end-phase to left ventricular failure. By increased wall tension in the presence of impaired coronary blood flow dilatation bears the risk of deterioration of left ventricular function.

  11. Resolution of Hepatic Encephalopathy Following Hepatic Artery Embolization in a Patient with Well-Differentiated Neuroendocrine Tumor Metastatic to the Liver

    SciTech Connect

    Erinjeri, Joseph P. Deodhar, Ajita; Thornton, Raymond H.; Allen, Peter J.; Getrajdman, George I.; Brown, Karen T.; Sofocleous, Constantinos T.; Reidy, Diane L.

    2010-06-15

    Hepatic encephalopathy is considered a contraindication to hepatic artery embolization. We describe a patient with a well-differentiated neuroendocrine tumor metastatic to the liver with refractory hepatic encephalopathy and normal liver function tests. The encephalopathy was refractory to standard medical therapy with lactulose. The patient's mental status returned to baseline after three hepatic artery embolization procedures. Arteriography and ultrasound imaging before and after embolization suggest that the encephalopathy was due to arterioportal shunting causing hepatofugal portal venous flow and portosystemic shunting. In patients with a primary or metastatic well-differentiated neuroendocrine tumor whose refractory hepatic encephalopathy is due to portosystemic shunting (rather than global hepatic dysfunction secondary to tumor burden), hepatic artery embolization can be performed safely and effectively.

  12. Iatrogenic Aortic Dissection During Left Subclavian Artery Stenting: Immediate Detection by Calcium Sign Under Fluoroscope

    SciTech Connect

    Wang, Yi-Chih Hwang, Juey-Jen; Lai, Ling-Ping; Tseng, Chuen-Den

    2011-02-15

    Calcified aorta with acute iatrogenic aortic dissection is a potential but rarely reported complication of subclavian or innominate artery intervention. We report a patient who developed aortic dissection during stenting for left subclavian artery. A newly developed 'calcium sign,' signifying displacement of the intimal calcification from the outer soft-tissue margin and which is traditionally recognized on chest radiograph, was detected by real-time fluoroscopy and served as the diagnostic clue. Type B aortic dissection was further confirmed by chest computed tomography.

  13. [Iatrogenic lesion of the hepatic artery in the course of pancreatic surgery].

    PubMed

    Rosa, Fausto; Pacelli, Fabio; Papa, Valerio; Tortorelli, Antonio Pio; Bossola, Maurizio; Doglietto, Giovanni Battista

    2009-01-01

    The authors report a case of operative injury of the hepatic artery during a total spleno-pancreasectomy procedure for a mixed-type intraductal papillary mucinous neoplasm. During the preparation of the structures of the hepatic pedicle, a "true" hepatic artery was not identified, but only a small arterial vessel measuring about 2 mm in diameter, just in front of the portal vein, apparently emerging from the parenchyma of the pancreatic head. To obtain complete mobilisation of the duodeno-pancreatic block from the portal vein, it was necessary to cut this small arterial vessel. In the postoperative period, the patient developed extensive liver ischaemia, which was gradually resolved, but resulted in multiple stenosis of the intra- and extra-hepatic biliary tree. At follow-up at three years, the patient was in fairly good condition, with a permanent percutaneous biliary drainage, but with no clinical or radiological signs of local or distant disease. Although interruption of hepatic arterial flow is usually well tolerated, this is not always the case. It is important to predict in what circumstances complications are likely to occur. The main determinants that should guide the surgeon faced with this problem are whether the portal circulation is normal, whether structures carrying collateral blood supply have been interrupted, and whether some form of biliary reconstruction is needed.

  14. Comparison of exercise radionuclide angiography with thallium SPECT imaging for detection of significant narrowing of the left circumflex coronary artery

    SciTech Connect

    Dilsizian, V.; Perrone-Filardi, P.; Cannon, R.O. 3d.; Freedman, N.M.; Bacharach, S.L.; Bonow, R.O. )

    1991-08-01

    Although quantitation of exercise thallium tomograms has enhanced the noninvasive diagnosis and localization of coronary artery disease, the detection of stenosis of the left circumflex coronary artery remains suboptimal. Because posterolateral regional wall motion during exercise is well assessed by radionuclide angiography, this study determined whether regional dysfunction of the posterolateral wall during exercise radionuclide angiography is more sensitive in identifying left circumflex disease than thallium perfusion abnormalities assessed by single-photon emission computed tomography (SPECT). One hundred ten consecutive patients with CAD were studied, of whom 70 had a significant stenosis of the left circumflex coronary artery or a major obtuse marginal branch. Both regional function and segmental thallium activity of the posterolateral wall were assessed using visual and quantitative analysis. Left ventricular regional function was assessed objectively by dividing the left ventricular region of interest into 20 sectors; the 8 sectors corresponding to the posterolateral free wall were used to assess function in the left circumflex artery distribution. Similarly, using circumferential profile analysis of short-axis thallium tomograms, left ventricular myocardial activity was subdivided into 64 sectors; the 16 sectors corresponding to the posterolateral region were used to assess thallium perfusion abnormalities in the left circumflex artery territory. Qualitative posterolateral wall motion analysis detected 76% of patients with left circumflex coronary artery stenosis, with a specificity of 83%, compared with only 44% by qualitative thallium tomography (p less than 0.001) and a specificity of 92%.

  15. Anomalous origin of the left circumflex coronary artery from the pulmonary artery. A very rare congenital anomaly in an adult patient diagnosed by cardiovascular magnetic resonance.

    PubMed

    Korosoglou, Grigorios; Ringwald, Gerd; Giannitsis, Evangelos; Katus, Hugo A

    2008-01-21

    Here we report for the first time on the diagnostic potential of cardiovascular magnetic resonance (CMR) to delineate the proximal course of an anomalous left circumflex coronary artery (LCX) originating from the right pulmonary artery in an adult patient with no other form of congenital heart disease. The patient was referred to our institution due to exertional chest discomfort. X-Ray coronary angiography showed a normal left anterior descending coronary artery (LAD) and right coronary artery (RCA), while the LCX was filled retrograde by collateral flow through the LAD and the RCA. The origin of the LCX was postulated to be the pulmonary artery, but the exact origin of the anomalous artery could not be depicted on conventional angiograms. CMR provided the unambiguous depiction of the origin of the anomalous LCX from the right pulmonary artery and the delineation of its proximal course in this case of a very rare coronary anomaly in adults.

  16. Association between high arterial stiffness and left ventricular filling pressures in patients with acute myocardial infarction.

    PubMed

    Milewska, Agata; Krauze, Tomasz; Piskorski, Jarosław; Minczykowski, Andrzej; Wykrętowicz, Andrzej; Guzik, Przemysław

    2015-01-01

    High arterial stiffness increases the left ventricular (LV) filling pressures in different cardiac disorders. The association between arterial stiffness and LV filling pressures has not been studied so far in patients with acute myocardial infarction (MI). The aim of the study was to assess the association between arterial stiffness and LV filling pressures in patients with acute MI. Arterial stiffness, measured using the digital volume pulse stiffness index (SIDVP), and LV filling pressures, quantified as the ratio of early transmitral flow velocity to early diastolic septal mitral annulus velocity (E/e'), were evaluated in 263 patients with acute MI (mean age, 63.8 ±11 years; 69 women). The association between high E/e' (>15) and very stiff arteries (SIDVP >18 m/s) was analyzed by logistic regression, with data presented as odds ratios (OR s) and 95% confidence intervals (CIs). A multivariate logistic regression analysis revealed an association between E/e' >15 and SIDVP >18 m/s (OR, 4.7; 95% CI, 1.8-12.3), independently of female sex (OR, 4.3; 95% CI, 1.4-10.2), LV ejection fraction <35% (OR, 3.1; 95% CI, 1.2-8.2), left atrial volume >34 ml/m2 (OR, 17.4; 95% CI, 5.8-52.0). There was no significant association between E/e' >15 and previous MI (OR, 2.2; 95% CI, 0.9-5.7). High arterial stiffness is an independent risk factor for LV diastolic dysfunction in patients with acute MI. A reduction in arterial stiffness may improve LV diastolic function in this patient group.

  17. Arterial Stiffness and Wave Reflection: Sex Differences and Relationship with Left Ventricular Diastolic Function

    PubMed Central

    Russo, Cesare; Jin, Zhezhen; Palmieri, Vittorio; Homma, Shunichi; Rundek, Tatjana; Elkind, Mitchell S.V.; Sacco, Ralph L.; Di Tullio, Marco R.

    2012-01-01

    Increased arterial stiffness and wave reflection have been reported in heart failure with normal ejection fraction (HFNEF) and in asymptomatic left ventricular (LV) diastolic dysfunction, a precursor of HFNEF. It is unclear whether women, who have higher frequency of HFNEF, are more vulnerable than men to the deleterious effects of arterial stiffness on LV diastolic function. We investigated in a large community-based cohort, whether sex differences exist in the relationship between arterial stiffness, wave reflection and LV diastolic function. Arterial stiffness and wave reflection were assessed in 983 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using applanation tonometry. Central pulse pressure/stroke volume index (cPP/SVi), total arterial compliance, pulse pressure amplification and augmentation index were used as parameters of arterial stiffness and wave reflection. LV diastolic function was evaluated by two-dimensional echocardiography and tissue-Doppler imaging. Arterial stiffness and wave reflection were greater in women compared to men, independent of body size and heart rate (all p<0.01), and showed inverse relationships with parameters of diastolic function in both sexes. Further adjustment for cardiovascular risk factors attenuated these relationships; however, higher cPP/SVi predicted LV diastolic dysfunction in women [odds ratio (OR) 1.54, 95% confidence intervals (CI) 1.03–2.30] and men (OR: 2.09, 95% CI 1.30–3.39) independent of other risk factors. In conclusion, in our community-based cohort study, higher arterial stiffness was associated with worse LV diastolic function in men and women. Women’s higher arterial stiffness, independent of body size, may contribute to their greater susceptibility to develop HFNEF. PMID:22753223

  18. Persistent right aortic arch and aberrant left subclavian artery in a white Bengal tiger (Panthera tigris).

    PubMed

    Ketz, C J; Radlinsky, M; Armbrust, L; Carpenter, J W; Isaza, R

    2001-06-01

    A 3-mo-old male white Bengal tiger (Panthera tigris) presented with the chief complaint of regurgitation of solid food since weaning at 2 mo of age. Compared with its littermates, the tiger was in poor body condition and weighed only 10.3 kg when its littermates were estimated at 20-25 kg. Thoracic radiographs showed a megaesophagus cranial to the heart base. A contrast esophagram more clearly outlined the megaesophagus, and fluoroscopy demonstrated normal motility of the caudal esophagus. Endoscopic examination revealed a structure coursing dorsally from right to left over the esophagus and a constrictive band on the left of the esophagus at the heart base. Nonselective angiography confirmed the presence of a persistent right aortic arch, as well as an aberrant left subclavian artery. A left fourth intercostal thoracotomy was performed, and the ligamentum arteriosum was double ligated and divided. The left subclavian artery did not cause significant compromise of the esophagus and was not manipulated at surgery. The tiger recovered well from anesthesia and surgery. Solid food was slowly introduced over a 2-mo period without any regurgitation. The cub gained weight rapidly after surgery.

  19. Hepatic Artery Reconstruction Using 3-in-1 Segmental Resection in Pediatric Living Donor Liver Transplantation: A Case Report and Literature Review.

    PubMed

    Luo, Y; Zhao, D; Zhang, M; Zhou, T; Qiu, B-J; Zhang, J-J; Xia, Q

    2017-09-01

    We report a transplant of the left lateral liver segments with 3 arteries for a pediatric recipient from a living donor. A 6-month-old female infant was diagnosed with liver cirrhosis secondary to biliary atresia and scheduled for living donor liver transplantation (LDLT; mother as donor). Left lateral hepatectomy was performed at the donor site. The dissection of the left hepatic artery (HA), which was divided immediately after its origin, showed 3 branches for segments II, III, and IV. The arteries for segment II, segment III, and segment IV were anastomosed to the recipient HA. No postoperative complications were observed. The outcome of this case demonstrates that left lateral segments with 3 arteries can be successfully used if proper surgical techniques are applied. From this experience we can recommend "3-in-1 segmental resection" in the donor can be safely done by skilled microvascular surgeons and this technique should be considered for selected cases where multiple tiny arteries supply the graft. Copyright © 2017. Published by Elsevier Inc.

  20. Pulmonary artery perforation by plug anchoring system after percutaneous closure of left appendage.

    PubMed

    Bianchi, Giacomo; Solinas, Marco; Gasbarri, Tommaso; Bevilacqua, Stefano; Tiwari, Kaushal Kishore; Berti, Sergio; Glauber, Mattia

    2013-07-01

    Patients receiving oral anticoagulant therapy for atrial fibrillation who are at high risk of bleeding are increasingly referred for percutaneous left atrial appendage exclusion. Although effective, this procedure is not free from risk. We report a case of pericardial tamponade due to pulmonary artery tear caused by a trespassing anchoring hook of an AGA plug. Intraoperatively, no actual bleeding was found from the left appendage, a proof of its complete occlusion by the device. The patient underwent successful surgical repair and radio-frequency ablation of atrial fibrillation was performed by pulmonary veins encircling. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Pre-procedural combined coronary angiography and stress myocardial perfusion imaging using 320-detector CT in unprotected left main and ostial left anterior descending artery intervention.

    PubMed

    Ko, Brian S; Crossett, Marcus; Seneviratne, Sujith K

    2015-07-01

    Pre-procedural anatomic and functional coronary assessment plays a crucial role in selection of patients suitable for unprotected left main percutaneous coronary intervention. Combined coronary computed tomography angiography and adenosine stress computed tomography myocardial perfusion imaging is a non-invasive technique which may provide this information. This is the first report describing its use to assist patient selection and procedural planning prior to elective left main and ostial left anterior descending artery coronary intervention.

  2. Robotic-Assisted Placement of an Hepatic Artery Infusion Pump and Catheter for Regional Chemotherapy of the Liver.

    PubMed

    Dhir, Mashaal; Magge, Deepa; Novak, Stephanie; Bartlett, David L; Zureikat, Amer H

    2016-12-01

    Hepatic artery infusion (HAI) chemotherapy is an effective regional therapy for unresectable colorectal liver metastases (U-CRLM).1 (,) 2 One of its limitations is the need for a laparotomy, which can delay the use of systemic therapy.3 Here, we describe a purely robotic technique for placement of an HAI pump (Fig 1). A 62-year-old male presented with a symptomatic ascending colon cancer and multiple bilobar unresectable liver metastases. He underwent laparoscopic right colectomy followed by six cycles of FOLFOXIRI and bevacizumab with stable disease by RECIST (Response Evaluation Criteria in Solid Tumors) criteria, and also underwent robotic HAI pump placement. The patient was placed supine on a split-leg table, and four robotic and two laparoscopic assistant ports were placed as shown. Use of the robot allowed for precise dissection of the common hepatic artery (CHA) and gastroduodenal artery (GDA), as well as a portal lymphadenectomy. A standard cholecystectomy was performed and the GDA was dissected for a distance of 2-3 cm from its takeoff from the CHA. The robotic scissors were used to create a precise transverse GDA arteriotomy, and the HAI pump catheter tip was advanced to the CHA/GDA junction and secured with two silk ties. Finally, a methylene blue dye injection test was performed to ensure uniform distribution within the liver. Operative time was 147 min, estimated blood loss was 20 ml, and the postoperative course was uneventful. The first dose of HAI with floxuridine was administered on postoperative day 4 (day of discharge) and systemic chemotherapy was administered 2 weeks later. The robotic platform allows for minimally invasive HAI pump placement. Fig. 1 Port placement for robotic-assisted hepatic artery infusion pump placement using the DaVinci Si platform. Illustration depicts a 12 mm periumbilical port for the robotic camera (upper green port), three 8 mm (purple) robotic working ports (the left MCL, right MCL, and right AAL for robotic arms

  3. Coronary Ostioplasty for Congenital Atresia of the Left Main Coronary Artery Ostium in a Teenage Boy.

    PubMed

    Sugimoto, Ai; Shiraishi, Shuichi; Moon, Jiyong; Takahashi, Masashi; Tsuchida, Masanori

    2016-11-01

    Atresia of the left coronary artery ostium is extremely rare. We report the case of a 13-year-old boy who played volleyball in school and collapsed with severe chest pain during practice. He was referred to our hospital, and imaging modalities showed atresia of the left main coronary artery ostium. Urgent coronary ostioplasty was performed using a patch of 0.6% glutaraldehyde-treated autologous pericardium. His postoperative course was uneventful, and he has had a normal everyday life without chest pain 8 months postoperatively. Physicians should be aware of the patient's history, as in this case, because prompt imaging diagnosis is essential when there is a high likelihood that the event is related to myocardial ischemia. Since long-term outcome is uncertain even after successful surgical revascularization, close follow-up is required. © The Author(s) 2015.

  4. Reflex responses to stimulation of mechanoreceptors in the left ventricle and coronary arteries in anaesthetized dogs.

    PubMed Central

    al-Timman, J K; Drinkhill, M J; Hainsworth, R

    1993-01-01

    1. Previous work has shown that physiological increases in mean aortic root pressure, which change the pressure in both the coronary circulation and the left ventricle, result in reflex vasodilatation. This study was undertaken to attempt to localize the reflexogenic area mainly responsible for the reflex. 2. In anaesthetized, artificially ventilated dogs, cannulae connected to perfusion systems were inserted in the ascending aorta, left ventricular apex and left atrium. This allowed us to change the pressures in: (a) the aortic root including both the coronary arteries and the left ventricle; (b) aortic root and coronary arteries, at constant ventricular pressure; and (c) in the ventricle, with mean (although not pulse) aortic pressure constant. Aortic and carotid baroreceptors were perfused at constant pressure and reflex responses were determined from changes in perfusion pressures (flows constant) to a vascularly isolated hindlimb and to the remainder of the systemic circulation. 3. Combined changes in mean aortic root (coronary arterial) and ventricular systolic pressures consistently resulted in decreases in perfusion pressures. A change in only mean aortic root (coronary arterial) pressure, with ventricular pressure constant, also resulted in decreases in perfusion pressures and these were only a little smaller than those to the combined stimulus. Changes in ventricular systolic pressure resulted in responses averaging only about 30% of those to the combined stimulus. 4. Setting mean aortic root or ventricular systolic pressures at different levels did not affect the responses to changes in pressures in the other region. 5. These results show that physiological increases in pressure in the aortic root and coronary arteries, in the absence of changes in pressure in the left ventricle, cause reflex vasodilatation. The relatively small response occurring when ventricular pressure was changed could be due either to a contribution from ventricular receptors or to

  5. Angiographic Assessment of the Right Hepatic Artery for Encasement by Hilar Cholangiocarcinoma: Comparison Between Antero-Posterior and Right Anterior Oblique Projections

    SciTech Connect

    Furukawa, Hiroyoshi; Iwata, Ryoko; Moriyama, Noriyuki

    2001-01-15

    Purpose: To evaluate the usefulness of right anterior oblique (RAO) arteriography for evaluating encasement of the right hepatic artery (RHA) by hilar cholangiocarcinoma.Methods: Celiac arteriography was performed in both the antero-posterior (AP) and RAO projection in ten patients with cholangiocarcinoma. The lengths of the arteries between the bifurcation of the anterior and posterior branch of the liver and the following points were measured: (a) the bifurcation of the left and right hepatic artery (AP-LR), (b) the bifurcation of the proper hepatic artery and the gastroduodenal artery (AP-PG). Additionally, image quality in investigating the invasion of the RHA was evaluated.Results: On the AP images, the average lengths of AP-LR and AP-PG were 24.5 {+-} 5.1 mm and 30.0 {+-} 4.9 mm, respectively. On RAO images, the lengths were 28.2 {+-} 4.6 mm and 32.7 {+-} 4.8 mm, respectively. Every length was different between the two projections (p < 0.01). In 6 of 10 patients with hilar cholangiocarcinoma, images in RAO projections were superior to AP images for evaluation of encasement.Conclusion: We conclude that angiography obtained in the RAO projection yields images that are superior to those obtained in the conventional AP projection for assessment of RHA encasement.

  6. Sling left pulmonary artery with patent type IIA tracheobronchial anomaly and imperforate anus.

    PubMed

    Rosenbaum, Daniel G; Kasdorf, Ericalyn; Renjen, Pooja; Brill, Paula; Kovanlikaya, Arzu

    2014-01-01

    We present a 3-month-old boy with a type IIA sling left pulmonary artery associated with imperforate anus and rectourethral fistula. Tracheobronchial abnormalities are demonstrated using multidetector CT with 3-D volume rendering of the airways. This case represents a novel variant of an already rare entity with an unusually high right upper lobe bronchus and no evidence of associated tracheobronchial stenosis. Copyright © 2014 Elsevier Inc. All rights reserved.

  7. An electronic circuit that detects left ventricular ejection events by processing the arterial pressure waveform

    NASA Technical Reports Server (NTRS)

    Gebben, V. D.; Webb, J. A., Jr.

    1972-01-01

    An electronic circuit for processing arterial blood pressure waveform signals is described. The circuit detects blood pressure as the heart pumps blood through the aortic valve and the pressure distribution caused by aortic valve closure. From these measurements, timing signals for use in measuring the left ventricular ejection time is determined, and signals are provided for computer monitoring of the cardiovascular system. Illustrations are given of the circuit and pressure waveforms.

  8. Rare cause of central cyanosis: right pulmonary artery to left atrial fistula.

    PubMed

    Muthialu, Nagarajan; Joshi, Shreedhar; Hoskote, Aparna; Bhole, Vinay

    2016-11-01

    A fistula between the right pulmonary artery and the left atrium is a very rare cause of central cyanosis. A clinical diagnosis is often made by first excluding other common causes and then performing diagnostic catheterization. Surgical closure offers a definitive cure for this rare congenital anomaly. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  9. A Case of Rheumatoid Vasculitis Involving Hepatic Artery in Early Rheumatoid Arthritis.

    PubMed

    Lee, Ji Eun; Kim, In Je; Cho, Min Sun; Lee, Jisoo

    2017-07-01

    Rheumatoid vasculitis is a rare, but most serious extra-articular complications of long-standing, seropositive rheumatoid arthritis (RA). Vasculitis of hepatic artery is an extremely rare but severe manifestation of rheumatoid vasculitis. A 72-year-old woman who presented with polyarthralgia for 2 months was diagnosed with early RA. Since she had manifestations of livedo reticularis, and liver dysfunction which was atypical for RA patients, a percutaneous needle liver biopsy was performed revealing arteritis of a medium-sized hepatic artery. Extensive investigations did not reveal evidences of other systemic causes such as malignancy or systemic vasculitis. The patient was diagnosed with rheumatoid vasculitis involving hepatic arteries based on Bacon and Scott criteria for rheumatoid vasculitis. With high dose corticosteroid and cyclophosphamide induction and methotrexate and tacrolimus maintenance treatment, she was successfully recovered. Association of rheumatoid vasculitis at very early stages of the disease may represent an early aggressive form of RA. © 2017 The Korean Academy of Medical Sciences.

  10. Left main coronary artery obstruction by dislodged native-valve calculus after transcatheter aortic valve replacement.

    PubMed

    Durmaz, Tahir; Ayhan, Huseyin; Keles, Telat; Aslan, Abdullah Nabi; Erdogan, Kemal Esref; Sari, Cenk; Bilen, Emine; Akcay, Murat; Bozkurt, Engin

    2014-08-01

    Transcatheter aortic valve replacement can be an effective, reliable treatment for severe aortic stenosis in surgically high-risk or ineligible patients. However, various sequelae like coronary artery obstruction can occur, not only in the long term, but also immediately after the procedure. We present the case of a 78-year-old woman whose left main coronary artery became obstructed with calculus 2 hours after the transfemoral implantation of an Edwards Sapien XT aortic valve. Despite percutaneous coronary intervention in that artery, the patient died. This case reminds us that early recognition of acute coronary obstruction and prompt intervention are crucial in patients with aortic stenosis who have undergone transcatheter aortic valve replacement.

  11. Relation of left ventricular midwall function to cardiovascular risk factors and arterial structure and function.

    PubMed

    Devereux, R B; de Simone, G; Pickering, T G; Schwartz, J E; Roman, M J

    1998-04-01

    Left ventricular (LV) midwall shortening (MWS) is subnormal in relation to LV circumferential end-systolic stress (ESS) (ESS-corrected MWS) in many hypertensive patients with normal LV chamber function and predicts subsequent morbidity and mortality. However, little is known of the relations of LV midwall function to demographic and metabolic variables or to arterial geometry. Asymptomatic, unmedicated normotensive (n=366) or hypertensive (n=282) adults were assessed with echocardiography and carotid ultrasound. In normal adults, lower LV MWS and ESS-corrected MWS, an index of LV contractility, were related independently to high total peripheral resistance, high heart rate, and male gender (all P<.00001), lower serum HDL cholesterol (P=.001) and diastolic pressure (P=.003), and for ESS-corrected MWS only, arterial relative wall thickness (RWT, P=.03). Among hypertensive patients, lower values for both midwall function indices were associated independently with higher peripheral resistance (P<.00001), heart rate (P<.00005), body mass index (P<.01), and arterial RWT (P=.04), as well as male gender (P<.0002). In the entire population, lower LV MWS was independently related to higher peripheral resistance, heart rate (both P<.00001), body mass index (P=.0006) and arterial RWT (P=.009); male gender (P<.00001); and lower age (P=.004), diastolic pressure (P=.042), and systolic carotid artery expansion (P=.032). Lower ESS-corrected MWS in the entire population was independently associated with higher peripheral resistance and heart rate (both P<.00001), body mass index (P=.0006), arterial RWT (P=.004); male gender; and lower diastolic pressure (both P<.00001), age (P<.00005), arterial expansion in systole (P=.006), and serum HDL cholesterol levels (P=.04). Among a subset (n=60), ESS-corrected MWS was positively related to apolipoprotein A1 (P=.004) and negatively to hemoglobin A1c (P<.01). Thus, higher LV midwall function is associated with female gender and more favorable

  12. Surgical reconstruction of the left main coronary artery with patch-angioplasty

    PubMed Central

    2011-01-01

    Background Conventional coronary artery bypass grafting (CABG) has been established as the treatment of choice for left main coronary artery (LMCA) stenosis However, the conventional grafting provides a retrograde perfusion to extensive myocardial area and leads prospectively to competitive flow of the non-occluded coronaries thus consuming the grafts. Surgical reconstruction of the LMCA with patch-angioplasty is an alternative method that eliminates these drawbacks. Methods Between February 1997 and July 2007, 37 patients with isolated LMCA stenosis were referred for surgical ostial reconstruction. In 27 patients (73%) surgical angioplasties have been performed. All patients were followed up clinically and with transesophageal echocardiography (TEE) and coronary angiography when required. Results In 10 patients (27%) a LMCA stenosis could not be confirmed. There were no early mortality or perioperative myocardial infarctions. The postoperative course was uneventful in all patients. In 25 patients, TEE demonstrated a wide open main stem flow pattern one to six months after reconstruction of the left main coronary artery with one patch mild aneurysmal dilated. Conclusions The surgical reconstruction with patch-angioplasty is a safe and effective method for the treatment of proximal and middle LMCA stenosis. Almost one third of the study group had no really LMCA stenosis: antegrade flow pattern remained sustained and the arterial grafts have been spared. In the cases of unclear or suspected LMCA stenosis, cardio-CT can be performed to unmask catheter-induced coronary spasm as the underlying reason for isolated LMCA stenosis. PMID:21375723

  13. Late presentation of an anomalous left coronary artery from the pulmonary artery treated with conservative surgical management with long-term cardiac magnetic resonance imaging follow-up.

    PubMed

    Gouda, Pishoy; Gouda, John; Butler, Craig; Welsh, Robert C

    2017-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery is rare congenital abnormality that most commonly presents in childhood and is associated with a high mortality. In the elderly, patients may present acutely with arrhythmias or signs of ischemia or with vague chronic presentations of shortness of breath and fatigue. In the high-risk elderly population, it is unclear as to whether conservative surgical management by means of suture ligation of the left coronary artery is associated with positive long-term outcomes. We present a case of a 69-year-old patient diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, which was treated with conservative surgical management and followed up for 15 years with cardiovascular magnetic resonance imaging, with positive outcomes.

  14. Late presentation of an anomalous left coronary artery from the pulmonary artery treated with conservative surgical management with long-term cardiac magnetic resonance imaging follow-up

    PubMed Central

    Gouda, Pishoy; Gouda, John; Butler, Craig; Welsh, Robert C

    2017-01-01

    Anomalous origin of the left coronary artery from the pulmonary artery is rare congenital abnormality that most commonly presents in childhood and is associated with a high mortality. In the elderly, patients may present acutely with arrhythmias or signs of ischemia or with vague chronic presentations of shortness of breath and fatigue. In the high-risk elderly population, it is unclear as to whether conservative surgical management by means of suture ligation of the left coronary artery is associated with positive long-term outcomes. We present a case of a 69-year-old patient diagnosed with anomalous origin of the left coronary artery from the pulmonary artery, which was treated with conservative surgical management and followed up for 15 years with cardiovascular magnetic resonance imaging, with positive outcomes. PMID:28321308

  15. Safety of Curcuma aromatica oil gelatin microspheres administered via hepatic artery

    PubMed Central

    Deng, Shi-Gui; Wu, Zhi-Feng; Li, Wei-Ying; Yang, Zhi-Gang; Chang, Gang; Meng, Fan-Zhe; Mo, Li-Li

    2004-01-01

    AIM: To evaluate the safety of Curcuma aromatica oil gelatin microspheres (CAO-GMS) infused via hepatic artery against primary liver cancer. METHODS: The safety of CAO-GMS was evaluated in view of its acute toxicity in rats, long-term toxicity in Beagle dogs and general pharmacology in rats and mongrel dogs. RESULTS: The 50% lethal dose (LD50) of CAO-GMS infused via the hepatic artery was 17.19 mg/kg, and the serum biochemical indices of dying rats after the administration changed markedly while those of survived rats did not. Subsequent pathological examination of the tissues from the dead rats indicated improper embolism. Similar edema and small necrotic foci in the hepatic lobule were found in the hepatic tissue of rats receiving 10 and 5 mg/kg CAO-GMS and GMS 60 d after the last administration, while not in the rats of the blank control group, indicating that microspheres infused via the hepatic artery may induce irreversible liver damage dose-dependently. General pharmacological study showed that the activities (posture and gait), respiration frequency, blood pressure or heart rate of the dogs were not affected by CAO-GMS, nor were salivation, tremor or pupil changes of the rats observed or their balancing ability compromised, suggesting CAO-GMS infused via the hepatic artery did not significantly affect the nervous, respiratory and cardiovascular systems. CONCLUSION: CAO-GMS embolization administered via the hepatic artery is safe but undesired embolization induced by vascular variation should be given due attention in its clinical application. Individualized embolization dosage and super-selective catheterization technique are recommended to avoid undesired embolism and reduce complications. PMID:15309710

  16. Safety of Curcuma aromatica oil gelatin microspheres administered via hepatic artery.

    PubMed

    Deng, Shi-Gui; Wu, Zhi-Feng; Li, Wei-Ying; Yang, Zhi-Gang; Chang, Gang; Meng, Fan-Zhe; Mo, Li-Li

    2004-09-15

    To evaluate the safety of Curcuma aromatica oil gelatin microspheres (CAO-GMS) infused via hepatic artery against primary liver cancer. The safety of CAO-GMS was evaluated in view of its acute toxicity in rats, long-term toxicity in Beagle dogs and general pharmacology in rats and mongrel dogs. The 50% lethal dose (LD50) of CAO-GMS infused via the hepatic artery was 17.19 mg/kg, and the serum biochemical indices of dying rats after the administration changed markedly while those of survived rats did not. Subsequent pathological examination of the tissues from the dead rats indicated improper embolism. Similar edema and small necrotic foci in the hepatic lobule were found in the hepatic tissue of rats receiving 10 and 5 mg/kg CAO-GMS and GMS 60 d after the last administration, while not in the rats of the blank control group, indicating that microspheres infused via the hepatic artery may induce irreversible liver damage dose-dependently. General pharmacological study showed that the activities (posture and gait), respiration frequency, blood pressure or heart rate of the dogs were not affected by CAO-GMS, nor were salivation, tremor or pupil changes of the rats observed or their balancing ability compromised, suggesting CAO-GMS infused via the hepatic artery did not significantly affect the nervous, respiratory and cardiovascular systems. CAO-GMS embolization administered via the hepatic artery is safe but undesired embolization induced by vascular variation should be given due attention in its clinical application. Individualized embolization dosage and super-selective catheterization technique are recommended to avoid undesired embolism and reduce complications.

  17. Left-sided portal hypertension: Successful management by laparoscopic splenectomy following splenic artery embolization

    PubMed Central

    Patrono, Damiano; Benvenga, Rosa; Moro, Francesco; Rossato, Denis; Romagnoli, Renato; Salizzoni, Mauro

    2014-01-01

    INTRODUCTION Left-sided portal hypertension is a rare clinical condition most often associated with a pancreatic disease. In case of hemorrhage from gastric fundus varices, splenectomy is indicated. Commonly, the operation is carried out by laparotomy, as portal hypertension is considered a relative contraindication to laparoscopic splenectomy (LS). Although some studies have reported the feasibility of the laparoscopic approach in the setting of cirrhosis-related portal hypertension, experience concerning LS in left-sided portal hypertension is lacking. PRESENTATION OF CASE A 39-year-old man was admitted to the Emergency Department for haemorrhagic shock due to acute hemorrhage from gastric fundus varices. Diagnostic work up revealed a chronic pancreatitis-related splenic vein thrombosis causing left-sided portal hypertension with gastric fundus varices and splenic cavernoma. Following splenic artery embolization (SAE), the case was successfully managed by LS. DISCUSSION The advantages of laparoscopic over open splenectomy include lower complication rate, quicker recovery and shorter hospital stay. Splenic artery embolization prior to LS has been used to reduce intraoperative blood losses and conversion rate, especially in complex cases of splenomegaly or cirrhosis-related portal hypertension. We report a case of complicated left-sided portal hypertension managed by LS following SAE. In spite of the presence of large varices at the splenic hilum, the operation was performed by laparoscopy without any major intraoperative complication, thanks to the reduced venous pressure achieved by SAE. CONCLUSION Splenic artery embolization may be a valuable adjunct in case of left-sided portal hypertension requiring splenectomy, allowing a safe dissection of the splenic vessels even by laparoscopy. PMID:25194596

  18. Highland mountain hiking and coronary artery disease: exercise tolerance and effects on left ventricular function.

    PubMed

    Huonker, M; Schmidt-Trucksäss, A; Sorichter, S; Irmer, M; Dürr, H; Lehmann, M; Keul, J

    1997-12-01

    Physical exercise has become a well-established concept in the secondary prevention of coronary artery disease. We investigated the exercise requirements of extensive highland mountain hiking (8.7 km, 470 m to 1220 m over sea level, average incline 8.5%, mean walking velocity < 3 km x h-1) in 11 regularly exercising male patients with history of MI and stable coronary artery disease (CAD; mean age +/- SD:61.0 +/- 3.9 yr) and 9 age-matched male healthy controls (CO; mean age +/- SD:61.2 +/- 5.0 yr). All subjects underwent continuous ECG monitoring; arterial blood pressure and blood lactate concentrations were measured several times during mountain hiking. Before and after exercise, cardiac dimensions and functions were assessed by two-dimensional echocardiography and Doppler echocardiography. The mean exercise levels for heart rate and blood lactate were compared with the corresponding data of a multistage upright cycle ergometry. Clinical manifestations of coronary insufficiency, left ventricular myocardial dysfunction, or cardiac arrhythmias > Lown IIIb were not observed in any case. No significant differences in left atrial and left ventricular dimensions and no changes in systolic left ventricular function compared with the preexercise values were found after the mountain hike tour. Doppler echocardiography demonstrated significant changes in diastolic left ventricular function in CAD, but not in CO. The peak exercise intensity during mountain hiking was equivalent to a workload of 100-125 W (1.25-1.5 W x kg-1 body weight) in a multistage upright cycle ergometry. Extensive highland mountain hiking may be a low risk alternative within the outpatient rehabilitation program for secondary prevention of CAD for MI patients with a cycle ergometric exercise tolerance > 1.5 W x kg-1 body weight.

  19. Left Main Coronary Artery Stenting to Relieve Extrinsic Compression by a Giant Pulmonary Artery Aneurysm in a Patient with Idiopathic Pulmonary Artery Hypertension.

    PubMed

    Pan, Hung-Chih; Wang, Kuo-Yang; Liang, Kae-Woei

    2016-10-01

    Pulmonary artery aneurysm (PAA) is a rare but lethal disease. We present a female patient with idiopathic pulmonary artery hypertension (IPAH)-related PAA, who suffered from unstable angina pectoris. Multi-detector computed tomography and coronary angiogram revealed extrinsic compression of the left main coronary artery (LMCA) caused by a giant PAA with severe ostial stenosis. Intravascular ultrasound showed an oval-shaped ostium of the LMCA, indicating extrinsic compression. After successful LMCA stent implantation, chest pain was greatly relieved. This case illustrates that beyond right ventricle ischaemia and coronary atherosclerotic disease, LMCA compression by PAA should be considered in the differential diagnosis of angina in patients with IPAH related PAA. In addition, intravascular ultrasound can be used to confirm the diagnosis and guide the stent implantation safely. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  20. [Right-side aortic arch with aberrant left subclavian artery and Kommerell's diverticulum. A cause of vascular ring].

    PubMed

    Tamayo-Espinosa, Tania; Erdmenger-Orellana, Julio; Becerra-Becerra, Rosario; Balderrabano-Saucedo, Norma; Segura-Standford, Begoña

    2017-06-15

    The right-side aortic arch may be associated with aberrant left subclavian artery, in some cases this artery originates from an aneurismal dilatation of the aorta called Kommerell diverticulum. We report 2 cases of vascular ring formed by a right-side aortic arch, anomalous left subclavian artery, Kommerell's diverticulum and left patent ductus arteriosus. Copyright © 2017 Instituto Nacional de Cardiología Ignacio Chávez. Publicado por Masson Doyma México S.A. All rights reserved.

  1. Hepatic Arterial Embolization with Doxorubicin-Loaded Superabsorbent Polymer Microspheres in a Rabbit Liver Tumor Model

    SciTech Connect

    Gupta, Sanjay Wright, Kenneth C.; Ensor, Joe; Van Pelt, Carolyn S.; Dixon, Katherine A.; Kundra, Vikas

    2011-10-15

    Objectives: The pharmacokinetic profile after hepatic arterial embolization with superabsorbent microspheres (QuadraSpheres) loaded with doxorubicin was studied. Methods: Rabbits with hepatic VX2 tumors were treated with intra-arterial administration of QuadraSpheres loaded with doxorubicin, or transarterial chemoembolization (TACE) using doxorubicin, Lipiodol and Embospheres, or hepatic arterial infusion (HAI) of doxorubicin. Tumor specimens were evaluated by fluorescence microscopy, and plasma and tumor concentrations of doxorubicin were measured. Results: The peak plasma concentration of doxorubicin was lower in the QuadraSphere group (309.9 ng/ml) than in the HAI (673.4 ng/ml) or TACE (360.5 ng/ml) groups, suggesting higher tumor retention in the QuadraSphere group. Intratumoral doxorubicin levels declined to negligible levels at 1 and 3 days after treatment, respectively, in the HAI and TACE groups. In the QuadraSphere groups, intratumoral doxorubicin level declined after day 1, but was still detectable at 14 days after treatment and was higher than that in the other groups at 1, 3, and 7 days. Intratumoral doxorubicin fluorescence was detected at all time points in the QuadraSphere group, but only at 1 day after treatment in the TACE group. Conclusions: Hepatic arterial administration of doxorubicin-loaded QuadraSpheres enables the sustained release of doxorubicin to hepatic tumors.

  2. Hepatic Arterial Embolization with Doxorubicin-Loaded Superabsorbent Polymer Microspheres in an Animal Model

    PubMed Central

    Gupta, Sanjay; Wright, Kenneth C.; Ensor, Joe; Van Pelt, Carolyn S.; Dixon, Katherine A.; Kundra, Vikas

    2014-01-01

    Objectives To study the pharmacokinetic profile after hepatic arterial embolization with superabsorbent microspheres (QuadraSpheres) loaded with doxorubicin. Materials and Methods Rabbits with hepatic VX2 tumors were treated with intra-arterial administration of QuadraSpheres loaded with doxorubicin, or transarterial chemoembolization (TACE) using doxorubicin, Lipiodol and Embospheres, or hepatic arterial infusion (HAI) of doxorubicin. Tumor specimens were evaluated by fluorescence microscopy, and plasma and tumor concentrations of doxorubicin were measured. Results The peak plasma concentration of doxorubicin was lower in the QuadraSphere group (309.9 ng/ml) than in the HAI (673.4 ng/ml) or TACE (360.5 ng/ml) groups, suggesting higher tumor retention in the QuadraSphere group. Intratumoral doxorubicin levels declined to negligible levels at 1 and 3 days after treatment, respectively in the HAI and TACE groups. In the QuadraSphere groups, intratumoral doxorubicin level declined after day 1, but was still detectable at 14 days after treatment and was higher than that in the other groups at 1, 3, and 7 days. Intratumoral doxorubicin fluorescence was detected at all time points in the QuadraSphere group, but only at 1 day after treatment in the TACE group. Conclusions Hepatic arterial administration of doxorubicin-loaded QuadraSpheres enables the sustained release of doxorubicin to hepatic tumors. PMID:21479746

  3. The Diagnostic Value of Hepatic Arterial Velocity in Venoocclusive Disease After Pediatric Hematopoietic Stem Cell Transplantation.

    PubMed

    Kaya, Nusabe; Erbey, Fatih; Atay, Didem; Akçay, Arzu; Bozkurt, Ceyhun; Ozturk, Gulyuz

    2017-03-06

    The aim of this study was to determine usefulness of measurements of maximal systolic velocity of the hepatic artery with Doppler ultrasonography in the diagnosis of venoocclusive disease (VOD) after hematopoietic stem cell transplantation. We prospectively obtained 5 sonograms per patient: pretransplantation, day +1, +7, +14, and +28 on 36 nonconsecutive children who underwent hematopoietic stem cell transplantation. We examined the hepatic artery, the portal, hepatic and splenic veins, the thickness of the gallbladder wall, the presence of ascites, and the liver and spleen size. The diagnosis of VOD was based on clinical and laboratory data. Patients were divided into 2 groups: those with VOD (n=18) and those without VOD (n=18). The variance of 2 groups was analyzed. Vmax of the hepatic artery had a strong correlation with clinical VOD diagnosis (P<0.001). There was no statistically significant difference in the other Doppler parameters. The results of our study showed that the measurement of Vmax of the hepatic artery can provide important support in the diagnosis of VOD and can be useful in the follow-up of treatment response.

  4. Hepatic arterial perfusion scintigraphy with Tc-99m-MAA: use of a totally implanted drug delivery system

    SciTech Connect

    Ziessman, H.A.; Thrall, J.H.; Yang, P.J.; Walker, S.C.; Cozzi, E.A.; Niederhuber, J.E.; Gyves, J.W.; Ensminger, W.D.; Tuscan, M.C.

    1984-07-01

    Tc-99m-MAA hepatic arterial perfusion scintigraphy (HAPS) using a totally implanted drug delivery system was employed for hepatic arterial chemotherapy in 147 patients (335 studies). Complete perfusion of the involved liver was seen in 88% of patients initially and remained good on follow-up. A significant decrease in hepatic and/or extrahepatic perfusion associated with a hot spot at the tip of the catheter indicated hepatic arterial thrombosis. Extrahepatic perfusion was seen in 14% of cases, usually in the distribution of the stomach, small bowel, and spleen. Significant symptoms of drug toxicity were seen in 70% of patients with extrahepatic perfusion, compared to 19% of those without it.

  5. Liver abscess developed after cadaveric liver transplantation due to ligation of an accessory right hepatic artery of the donor graft.

    PubMed

    Yu, Young-Dong; Kim, Dong-Sik; Byun, Geon-Young; Suh, Sung-Ock

    2012-10-01

    It is important that extrahepatic arteries are identified precisely at the time of graft procurement. We present a case where the accessory right hepatic artery of the liver was ligated leading to postoperative liver abscess formation in the liver graft. A forty-seven-year-old female patient diagnosed with liver cirrhosis underwent orthotopic cadaveric liver transplantation due to altered mentality. The donor graft showed a variant of the hepatic artery anatomy where an accessory right hepatic artery arose from the superior mesenteric artery. This artery was accidentally transected during procurement. Since the back bleeding test using perfusion fluid was good, the artery was ligated. Postoperative abdominal computed tomography scan revealed a 6 cm low attenuating lesion in the liver. The patient underwent conservative treatment. We believe that even small accessory arteries (1 to 2 mm) should be reconstructed whenever possible to avoid postoperative complications such as liver abscess.

  6. Iatrogenic left main-stem dissection extending to the circumflex artery and retrogradely involving the left and non-coronary sinuses of Valsalva: iatrogenic aortocoronary dissection.

    PubMed

    Zwoliński, Radosław; Marcinkiewicz, Anna; Szymczyk, Konrad; Pietruszyński, Robert; Jaszewski, Ryszard

    2015-11-23

    We present the case of a 57-year-old female who experienced iatrogenic left main-stem (LMS) dissection during elective coronary angiography. The dissection immediately affected the circumflex artery (Cx), causing its total distal occlusion, and the left anterior descending artery (LAD), in which a metal stent, implanted six months earlier, provided blood flow. The dissection spread retrogradely to the left and non-coronary sinuses of Valsalva (SV). Ventricular fibrillation (VF) occurred but the patient was successfully defibrillated. The subsequent introduction of a catheter resulted in recurrent VF, again successfully defibrillated. Total arterial myocardial revascularisation with double skeletonised internal thoracic arteries was performed without complications and SV repair was avoided. At the one-year follow up, a control multi-slice CT (MSCT) angiography was conducted, revealing complete healing of the SV and LMS dissections. It also showed native blood flow, the left internal thoracic artery (LITA) graft to the Cx occlusion, and a patent right internal thoracic artery (RITA) graft implanted to the LAD.

  7. Relation of arterial structure and function to left ventricular geometric patterns in hypertensive adults.

    PubMed

    Roman, M J; Pickering, T G; Schwartz, J E; Pini, R; Devereux, R B

    1996-09-01

    The present study sought to determine whether conduit artery structure and function vary according to the pattern of left ventricular adaptation to hypertension. Although left ventricular geometric pattern has been shown to predict cardiovascular events in hypertension, the arterial status in patients with the different patterns is unknown. We evaluated arterial structure and function by carotid ultrasound and applanation tonometry in 271 unmedicated hypertensive patients classified by echocardiography as having normal ventricular geometry (n = 176), concentric remodeling (n = 54), concentric hypertrophy (n = 16) or eccentric hypertrophy (n = 25). All groups were similar in age, gender distribution and body size. Patients with concentric and eccentric hypertrophy had similar blood pressures (mean 173/100 and 171/99 mm Hg, respectively) and left ventricular mass, but compared with patients with normal left ventricular geometry and concentric remodeling, only those with concentric hypertrophy had increased arterial wall thickness (0.96 +/- 0.20 vs. 0.80 +/- 0.18 mm, p < 0.05), end-diastolic diameter (6.38 +/- 0.97 vs. 5.76 +/- 0.87 mm, p < 0.05), cross-sectional area (22.1 +/- 5.71 vs. 16.6 +/- 5.4 mm(1)2 p < 0.05) and elastic modulus (713 +/- 265 vs. 471 +/- 241 dynes/cm2 x 10(-5), p < 0.05). Patients with concentric remodeling and eccentric hypertrophy had similar values for these measures (0.85 +/- 0.22 and 0.89 +/- 0.21 mm, 5.67 +/- 0.77 and 6.04 +/- 0.44 mm, 17.2 +/- 5.4 and 19.7 +/- 5.9 mm2, 558 +/- 263 and 614 +/- 257 dynes/cm2 x 10(-6), respectively), despite lower systolic blood pressures in the former group (156/94 mm Hg, p < 0.001). The prevalence of plaque was comparable in patients with concentric (56%) and eccentric (42%) hypertrophy and significantly greater than that in patients [corrected] with normal geometry (21%). Among patients with generally mild, uncomplicated systemic hypertension, arterial structure and function are most abnormal when

  8. Randomized comparison of transradial coronary angiography via right or left radial artery approaches.

    PubMed

    Kanei, Yumiko; Nakra, Navin C; Liou, Michael; Vales, Lori L; Gowda, Ramesh; Rosero, Hugo; Kwan, Tak; Fox, John T

    2011-01-15

    Previous studies have shown that the right radial approach encounters more tortuosity than the left radial approach during transradial coronary angiography. The objective of this study was to compare the procedural difficulty of the right and left radial approaches in the modern era with dedicated transradial catheters. One hundred ninety-three patients scheduled for transradial coronary angiography with normal Allen test results and without histories of coronary artery bypass grafting were randomized to the right or left radial approach. The choice of catheter was left to the discretion of the operator, with the preferred catheter being a dedicated transradial Optitorque catheter. The primary end point was procedural difficulty, defined as (1) hydrophilic or coronary wire use for tortuosity, (2) stiff wire use for the coronary engagement, (3) multiple catheters used, or (4) nonselective injection. The clinical characteristics were similar between the 2 groups. Procedural success was achieved in 98 of 101 (98%) in the right radial group and 91 of 92 (99%) in the left radial group. Procedural difficulty, fluoroscopy time, and contrast use were similar between the 2 groups. The use of a single catheter was more common in the right radial group (73% vs 18%, p <0.001). In conclusion, procedural success and difficulty were similar in the comparison groups. The right and left radial approaches are feasible and effective to perform coronary angiography and intervention.

  9. Emergency Percutaneous Coronary Intervention Through the Left Radial Artery is Associated with Less Vascular Complications than Emergency Percutaneous Coronary Intervention Through the Femoral Artery.

    PubMed

    Qi, Guoqing; Sun, Qi; Xia, Yue; Wei, Liye

    2017-01-01

    To compare the advantages and disadvantages of emergency percutaneous coronary intervention through the left radial artery with those of emergency percutaneous coronary intervention through the femoral artery. A total of 206 patients with acute myocardial infarction who required emergency percutaneous coronary intervention and were admitted to our hospital between January 2011 and August 2013 were divided into the following two groups: a group that underwent percutaneous coronary intervention through the left radial artery and a group that underwent percutaneous coronary intervention through the femoral artery. The times required for angiographic catheter and guiding catheter placement, the success rate of the procedure and the incidence of vascular complications in the two groups were observed. There was no significant difference in catheter placement time or the ultimate success rate of the procedure between the two groups. However, the left radial artery group showed a significantly lower incidence of vascular complications than the femoral artery group (p<0.05). Emergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery and is thus potentially advantageous for patients.

  10. Emergency Percutaneous Coronary Intervention Through the Left Radial Artery is Associated with Less Vascular Complications than Emergency Percutaneous Coronary Intervention Through the Femoral Artery

    PubMed Central

    Qi, Guoqing; Sun, Qi; Xia, Yue; Wei, Liye

    2017-01-01

    OBJECTIVE: To compare the advantages and disadvantages of emergency percutaneous coronary intervention through the left radial artery with those of emergency percutaneous coronary intervention through the femoral artery. METHODS: A total of 206 patients with acute myocardial infarction who required emergency percutaneous coronary intervention and were admitted to our hospital between January 2011 and August 2013 were divided into the following two groups: a group that underwent percutaneous coronary intervention through the left radial artery and a group that underwent percutaneous coronary intervention through the femoral artery. The times required for angiographic catheter and guiding catheter placement, the success rate of the procedure and the incidence of vascular complications in the two groups were observed. RESULTS: There was no significant difference in catheter placement time or the ultimate success rate of the procedure between the two groups. However, the left radial artery group showed a significantly lower incidence of vascular complications than the femoral artery group (p<0.05). CONCLUSION: Emergency percutaneous coronary intervention through the left radial artery is associated with less vascular complications than emergency percutaneous coronary intervention through the femoral artery and is thus potentially advantageous for patients. PMID:28226025

  11. Traumatic coronary arteriovenous fistula communicating the left main coronary artery to pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis: case report.

    PubMed

    Rangel, A; Badui, E; Verduzco, C; Valdespino, A; Enciso, R

    1990-02-01

    The authors present a case of a seventeen-year-old white male who suffered from a knife chest wound and secondarily developed a traumatic coronary arteriovenous fistula communicating the left main coronary artery to the pulmonary artery, associated with pulmonary valvular insufficiency and endocarditis.

  12. Successful Chemoradiotherapy for Undifferentiated Malignant Neoplasm Arising from the Left Pulmonary Artery

    PubMed Central

    Kumagai, Hozumi; Nio, Kenta; Okumura, Yuta; Komoda, Masato; Shirakawa, Tsuyoshi; Kusaba, Hitoshi; Yasuda, Shioto; Odashiro, Keita; Arita, Shuji; Ariyama, Hiroshi; Yamada, Yuichi; Yamamoto, Hidetaka; Oda, Yoshinao; Nakamura, Katsumasa; Akashi, Koichi; Baba, Eishi

    2014-01-01

    Undifferentiated malignant neoplasms, which occur primarily in the pulmonary artery, are extremely rare and associated with poor outcomes as there is no effective therapy. A 67-year-old woman visited our hospital with complaints of dry cough and dyspnea on exertion. A contrast-enhanced chest computed tomography revealed an intravascular tumor obstructing the left pulmonary artery and a pedunculated lesion extending to the main and right pulmonary artery. Multiple metastases in the lung, bones and bilateral adrenal glands were identified by fluorodeoxyglucose-positron emission tomography. A small sample was obtained by catheter aspiration biopsy of the intravascular tumor, and examination revealed undifferentiated small atypical cells. The tumor was diagnosed as an undifferentiated neoplasm arising from the pulmonary artery based on immunohistochemical findings, including the absence of expressions of organ-specific markers. Systemic chemotherapy (paclitaxel and carboplatin) and concurrent radiation were performed as treatment for the primary tumor. Marked shrinkage of the intravascular tumor was achieved, and no serious adverse events were observed during therapy. Chemotherapy was continued for 5 months, but the patient died because of tumor progression 9 months after the initial diagnosis. Chemoradiotherapy has efficacy against undifferentiated neoplasm of the pulmonary artery. PMID:25202263

  13. Malignant Course of Anomalous Left Coronary Artery Causing Sudden Cardiac Arrest: A Case Report and Review of the Literature

    PubMed Central

    Anantha Narayanan, Mahesh; DeZorzi, Christopher; Akinapelli, Abhilash; Mahfood Haddad, Toufik; Smer, Aiman; Baskaran, Janani; Biddle, William P.

    2015-01-01

    Sudden cardiac arrest has been reported to occur in patients with congenital anomalous coronary artery disease. About 80% of the anomalies are benign and incidental findings at the time of catheterization. We present a case of sudden cardiac arrest caused by anomalous left anterior descending artery. 61-year-old African American female was brought to the emergency department after sudden cardiac arrest. Initial EKG showed sinus rhythm with RBBB and LAFB with nonspecific ST-T wave changes. Coronary angiogram revealed no atherosclerotic disease. The left coronary artery was found to originate from the right coronary cusp. Cardiac CAT scan revealed similar findings with interarterial and intramural course. Patient received one-vessel arterial bypass graft to her anomalous coronary vessel along with a defibrillator for secondary prevention. Sudden cardiac arrest secondary to congenital anomalous coronary artery disease is characterized by insufficient coronary flow by the anomalous left coronary artery to meet elevated left ventricular (LV) myocardial demand. High risk defects include those involved with the proximal coronary artery or coursing of the anomalous artery between the aorta and pulmonary trunk. Per guidelines, our patient received one vessel bypass graft to her anomalous vessel. It is important for clinicians to recognize such presentations of anomalous coronary artery. PMID:26257964

  14. [The surgical treatment of an aneurysm of the celiac trunk and hepatic artery].

    PubMed

    Rodríguez-Camarero, S J; Menéndez, A I; Rodero, J I; Alvarez, J L; Cermeño, B; Viana, M M

    1993-01-01

    We report a case of splenic aneurysms with double location, at the celiac trunks and at the common hepatic artery, in the same patient that was treated by a surgical procedure. We also review literature about the hepatic aneurysms at the celiac trunks, with special attention on the aspects of etiology, natural evolutions and different surgical procedures available. It is remarkable on this kind of pathology that special attention should be paid in order to avoid the simple ligature-exclusion of the aneurysm, it involves realizing an endoaneurysmorrhaphy followed by an aorto-hepatic by-pass.

  15. Early and late outcome of skeletonised bilateral internal mammary arteries anastomosed to the left coronary system

    PubMed Central

    Bonacchi, M; Battaglia, F; Prifti, E; Leacche, M; Nathan, N S; Sani, G; Popoff, G

    2005-01-01

    Objectives: To investigate in a retrospective study the technical aspects of using the in situ bilateral internal mammary arteries (IMAs), with the right IMA (RIMA) used for revascularisation of the circumflex system, and to evaluate early and late outcome. Materials and methods: Between January 1997 and July 2003, 552 consecutive patients underwent grafting of the circumflex artery system with an in situ skeletonised RIMA routed through the transverse sinus (eventually retrocaval). Mean (SD) age was 63.8 (11) years. 331 (60%) patients underwent total arterial myocardial revascularisation. Mean follow up was 26 (9) months. Results: The success rate of skeletonised RIMA grafting to the circumflex branch was 100%. There were 19 (3.4%) in-hospital deaths. Perioperative myocardial infarction occurred in 12 (2.2%) patients. In 155 patients undergoing postoperative angiography, two had an occluded RIMA and a string-like phenomenon was seen in three RIMA and one left IMA (LIMA). Three RIMA and three LIMA had stenotic lesions. The patency rates of RIMA and LIMA were 94% and 97.4%, respectively. Strong predictors of non-functional IMA grafts were a recipient coronary artery diameter of < 1.5 mm (p  =  0.022), < 60% stenosis of the recipient coronary artery (p  =  0.015), diffuse stenotic lesions of the recipient coronary artery (p  =  0.018), and a small IMA calibre (p  =  0.0001). Cumulative actuarial survival at three years was 96.4% and event-free cumulative survival was 93.8%. Conclusions: Use of the bilateral IMAs offers the possibility of constructing various configurations, making total arterial myocardial revascularisation possible with a minimum number of arterial conduits. Use of the skeletonised RIMA through the transverse sinus and eventually retrocavally can reach most branches of the circumflex system and is associated with an excellent patency rate. Patients who received bilateral IMA grafts for left coronary system revascularisation had

  16. [Diagnostic image (162) A woman with temporary hemiplegia. Temporary embolic occlusion of the left middle cerebral artery by a thrombus].

    PubMed

    Groeneveld, G J; van der Schaaf, I C

    2003-10-25

    A 48-year-old woman with right-sided hemiplegia by embolic occlusion of the left middle cerebral artery was treated with alteplase. A pre- and post-treatment CT angiography scan showed the vanishing blood clot.

  17. Coronary angioplasty and left ventricular function in single vessel coronary artery disease.

    PubMed

    Najm, Y C; Timmis, A D; Maisey, M N; Pinies, L M; Salinas, A; Curry, P V; Sowton, E

    1989-03-01

    Left ventricular function was investigated in 86 patients with single vessel coronary artery disease before and three to six months after successful angioplasty. Before angioplasty thallium-201 perfusion scintigraphy and technetium-99m gated equilibrium ventriculography in most patients showed that stress testing (exercise and ice water stimulation and isometric handgrip respectively) induced myocardial perfusion defects that were associated with a mean (SD) drop in left ventricular ejection fraction from 64 (6)% to 56 (7)%. After angioplasty there was residual coronary stenosis of less than or equal to 20% of the diameter of the vessel in 78 patients (group 1) and of between 20 and 50% in eight patients (group 2). After the procedure the perfusion defects seen during stress resolved in 86% of group 1 and in 87% of group 2. Despite the apparent improvement in myocardial perfusion left ventricular dysfunction persisted in group 2--that is during stress the left ventricular ejection fraction fell from 65% (6) to 56% (5). In group 1, on the other hand, the improvement in myocardial perfusion was associated with significant improvement in left ventricular function with a normal increase in ejection fraction from 63 (5) at rest to 67 (6) during stress. Radionuclide studies, one to six weeks after angioplasty in 30 group 1 patients showed continuing left ventricular decompensation during stress in nine (30%) of them despite correction of perfusion defects. But reinvestigation three to six months after the procedure showed recovery of left ventricular function with an increase in ejection fraction from 66 (5) at rest to 69 (7) during stress. These data indicate that coronary angioplasty procedures that give a residual stenosis of left ventricle to stress. The functional improvement may be delayed for up to three months, however, possibly because arterial healing at the angioplasty site is delayed. On the other

  18. Successful recanalization of a left circumflex artery jailed with a polytetrafluoroethylene-covered stent after coronary perforation during stent implantation in the left main bifurcation.

    PubMed

    Taniguchi, Norimasa; Takahashi, Akihiko; Mizuguchi, Yukio; Yamada, Takeshi; Hata, Tetsuya; Nakajima, Shunsuke

    2015-01-01

    An 88-year-old woman underwent emergency percutaneous coronary intervention (PCI) to treat circulatory collapse with severe stenosis in the distal left main coronary artery (LMCA). After 3.5/18-mm stent deployment from the LMCA to the left anterior descending artery (LAD), coronary perforation occurred in the LAD ostium. Therefore, we implanted a polytetrafluoroethylene (PTFE)-covered stent crossing over the left circumflex artery (LCX), and achieved successful hemostasis. Additional PCI was undertaken to recanalize the LCX. A Confienza 8-20 guidewire was able to penetrate the wall of the PTFE-covered stent, and coronary flow was successfully recovered after deployment of a 2.5/8-mm stent in the proximal LCX.

  19. Evaluation of Intrahepatic Perfusion on Fusion Imaging Using a Combined CT/SPECT System: Influence of Anatomic Variations on Hemodynamic Modification Before Installation of Implantable Port Systems for Hepatic Arterial Infusion Chemotherapy

    SciTech Connect

    Ikeda, Osamu Tamura, Yoshitaka; Nakasone, Yutaka; Shiraishi, Shinya; Kawanaka, Kouichi; Tomiguchi, Seiji; Takamori, Hiroshi; Chikamoto, Akira; Kanemitsu, Keiichirou; Yamashita, Yasuyuki

    2007-06-15

    Background. In some patients with hepatic tumors, anatomic variations in the hepatic arteries may require hemodynamic modification to render effective hepatic arterial infusion chemotherapy delivered via implantable port systems. We used a combined CT/SPECT system to obtain fused images of the intrahepatic perfusion patterns in patients with such anatomic variations and assessed their effects on the treatment response of hepatic tumors. Methods. Using a combined SPECT/CT system, we obtained fused images in 110 patients with malignant liver tumors (n = 75) or liver metastasis from unresectable pancreatic cancer (n = 35). Patients with anatomic hepatic arteries variations underwent hemodynamic modification before the placement of implantable port systems for hepatic arterial infusion chemotherapy. We evaluated their intrahepatic perfusion patterns and the initial treatment response of their liver tumors. The perfusion patterns on the fused images were classified as homogeneous, local hypoperfusion, and/or perfusion defect. Using the WHO criteria of complete response (CR), partial response (PR), no change (NC), and progressive disease (PD), we evaluated the patients' tumor responses after 3 months on multislice helical CT scans. The treatment was regarded as effective in patients who achieved a complete response or partial response. Results. Anatomic hepatic artery variations were present in 15 of the 110 patients (13.6%); 5 manifested replacement of the left hepatic artery (LHA), 8 of the right hepatic artery (RHA), and 1 each had replacement of the RHA and LHA, and replacement of the LHA plus an accessory RHA. In 13 of these 15 patients (87%), occlusion with metallic coils was successful. On fusion imaging, the perfusion patterns were recorded as homogeneous in 6 patients (43%), as hypoperfusion in 7 (50%), and 1 patient had a perfusion defect (7.1%) in the embolized arterial region. Of the 8 patients with RHA replacement, 4 manifested a homogeneous distribution and

  20. Severe stenosis of a long tracheal segment, with agenesis of the right lung and left pulmonary arterial sling.

    PubMed

    Munro, Hamish M; Sorbello, Andrea M C; Nykanen, David G

    2006-02-01

    A baby presented at term with respiratory distress was managed with extracorporeal membrane oxygenation. Bronchoscopy revealed tracheal hypoplasia, complete tracheal rings, and agenesis of the right main bronchus. Echocardiography showed a left pulmonary arterial sling arising from the proximal part of the right pulmonary artery. Cardiac catheterization demonstrated abnormal pulmonary vasculature in the left lung which would have prevented survival, even after surgical repair. Diagnostic catheterization was important in delineating the anatomy, and aided in the decision not to proceed with surgical repair.

  1. Off-pump coronary revascularization for left main coronary artery stenosis.

    PubMed

    Mannam, Gopichand; Sajja, Lokeswara R; Dandu, Satya B R; Pathuri, Satyendra N; Saikiran, Krishnamurthy V S S; Sompalli, Sriramulu

    2008-12-01

    Experience of on- and off-pump coronary artery bypass in 379 patients with significant left main coronary artery stenosis was retrospectively reviewed. Beating-heart operations were performed on 219 patients between January 2001 and October 2007. Their results were compared with 160 who underwent revascularization under cardiopulmonary bypass during the same period. All patients had multivessel grafting via a median sternotomy. Both groups were comparable demographically. Off-pump patients received significantly fewer grafts per patient (3.21 +/- 0.86 vs 3.74 +/- 0.82). The use of moderate or high doses of inotropics (> 5 microg kg(-1) min(-1)) was more frequent in the on-pump group (44% vs 26%). Postoperative blood transfusion requirement was lower in off-pump patients, and fewer of them experienced worsening of preexisting renal insufficiency. There were 2 operative deaths in the on-pump group and 1 in the off-pump group. The off-pump procedure is safe and effective in patients with left main coronary artery disease.

  2. [Clinical profile and treatment of left main coronary artery disease in a real-world practice].

    PubMed

    Kuznetsov, V A; Bessonov, I S; Zyrianov, I P; Samoĭlova, E P; Gorbatenko, E A; Ignatov, D I

    2014-01-01

    Aim of this study was to assess clinical profile, treatment and long-term results in patients with left main coronary artery disease in a real-world practice. 225 cases were analyzed. Long-term results were evaluated from 213 (97.7%) patients. Median follow-up period was 49 months. Fifty two (23.9%) patients received nonsurgical treatment, coronary artery bypass grafting (CABG) was performed in 106 (48.6%) patients, percutaneous coronary interventions (PCI) in 60 (27.5%) patients. Patients of nonsurgical group had more severe clinical profile compared with PCI group. There was no differences between nonsurgical and CABG groups as well as between CABG and PCI groups in clinical profile. Major adverse cardiac and cerebrovascular event rate was higher in nonsurgical group. There was no difference between CABG and PCI groups. Survival in CABG and PCI groups was higher compared with nonsurgical group. Survival effect of revascularization was observed immediately (before 6 months) and continued long-term (more than 60 months). Revascularization was independent predictor of improved long-term survival. After diagnosis of left main coronary artery stenosis PCI was performed more quickly than CABG.

  3. Distinguishing between anomalous origin of the left coronary artery from the pulmonary trunk and dilated cardiomyopathy: role of echocardiographic measurement of the right coronary artery diameter.

    PubMed Central

    Koike, K; Musewe, N N; Smallhorn, J F; Freedom, R M

    1989-01-01

    Patients with anomalous origin of the left coronary artery from the pulmonary trunk usually have a large right coronary artery. This study examines the diagnostic value of measuring the diameter of the right coronary artery by echocardiography in distinguishing between this lesion and other causes of dilated cardiomyopathy. The diameter of the right coronary artery and the right coronary artery/aorta ratio were measured in the parasternal short axis view in 40 controls, 11 patients with dilated cardiomyopathy, and 10 with anomalous origin of the left coronary artery from the pulmonary trunk. In the controls, the diameter of the right coronary artery increased with age, but the right coronary artery/aorta ratio remained constant. In the control group the 95% upper limits of prediction for right coronary artery diameter were 1.6 mm for one month of age, 1.8 mm for three months, 2.0 mm for one year, 2.2 mm for two years, 2.4 mm for three years, 2.6 mm for four years, 2.7 mm for six years, 3.0 mm for eight years, and 3.2 mm for 10 years; and for right coronary/aorta ratios the limits were 0.17 for one month to one year, 0.18 for one to six years, 0.19 for six to 10 years, and 0.20 for more than 10 years. All patients with dilated cardiomyopathy had normal right coronary artery diameters and right coronary artery/aorta ratios (0.10-0.13). Those patients with anomalous origin of the left coronary artery from the pulmonary trunk had larger than normal right coronary artery diameter and a significant increase in the right coronary artery/aorta ratio (0.21-0.29). The presence of an anomalous left coronary artery was likely if the diameter of the right coronary artery or the right coronary artery/aorta ratio was larger than the normal 95% limits of prediction. Images Fig 1 PMID:2923759

  4. Hemorrhage associated with hepatic artery pseudoaneurysms after regional chemotherapy with floxuridine: case report.

    PubMed

    Samaras, Panagiotis; Pfammatter, Thomas; Pestalozzi, Bernhard C

    2008-07-11

    Pseudoaneurysms of the hepatic artery are a rare complication in patients with primary or secondary liver tumors treated with intra-arterial chemotherapy. We present two patients who developed this complication after placement of a catheter system into the gastroduodenal artery and initiation of regional chemotherapy with floxuridine. Diagnosis was made after symptomatic bleeding occurred, necessitating emergency angiography with coil embolization. Pseudoaneurysms usually occur after mechanical damage of the vessel wall, but the chemical toxicity of floxuridine may add to the development of vascular impairment.

  5. Late Recurrence of a Hepatic Artery Aneurysm After Treatment Using an Endovascular Stent

    SciTech Connect

    Downer, Jonathan; Choji, Kiyoshi

    2008-11-15

    Endovascular stent placement and coil embolization have become established options in the treatment of visceral arterial aneurysms. In this article we report the case of an 83-year-old presenting with gastrointestinal hemorrhage due to a recurrent hepatic arterial aneurysm occurring 12 years after treatment with an endovascular stent. The recurrent aneurysm had resulted from stent fracture and was successfully treated by coil embolization. To our knowledge, stent fracture complicating the endovascular treatment of a visceral artery aneurysm has not been described in the published literature. With the increasing use of metallic endoprostheses in interventional radiology, recognizing and reporting device failure are of critical importance.

  6. Left ventricular, systemic arterial, and baroreflex responses to ketamine and TEE in chronically instrumented monkeys

    NASA Technical Reports Server (NTRS)

    Koenig, S. C.; Ludwig, D. A.; Reister, C.; Fanton, J. W.; Ewert, D.; Convertino, V. A.

    2001-01-01

    Effects of prescribed doses of ketamine five minutes after application and influences of transesophageal echocardiography (TEE) on left ventricular, systemic arterial, and baroreflex responses were investigated to test the hypothesis that ketamine and/or TEE probe insertion alter cardiovascular function. Seven rhesus monkeys were tested under each of four randomly selected experimental conditions: (1) intravenous bolus dose of ketamine (0.5 ml), (2) continuous infusion of ketamine (500 mg/kg/min), (3) continuous infusion of ketamine (500 mg/kg/min) with TEE, and (4) control (no ketamine or TEE). Monkeys were chronically instrumented with a high fidelity, dual-sensor micromanometer to measure left ventricular and aortic pressure and a transit-time ultrasound probe to measure aortic flow. These measures were used to calculate left ventricular function. A 4-element Windkessel lumped-parameter model was used to estimate total peripheral resistance and systemic arterial compliance. Baroreflex response was calculated as the change in R-R interval divided by the change in mean aortic pressure measured during administration of graded concentrations of nitroprusside. The results indicated that five minutes after ketamine application heart rate and left ventricular diastolic compliance decreased while TEE increased aortic systolic and diastolic pressure. We conclude that ketamine may be administered as either a bolus or continuous infusion without affecting cardiovascular function 5 minutes after application while the insertion of a TEE probe will increase aortic pressure. The results for both ketamine and TEE illustrate the classic "Hawthorne Effect," where the observed values are partly a function of the measurement process. Measures of aortic pressure, heart rate, and left ventricular diastolic pressure should be viewed as relative, as opposed to absolute, when organisms are sedated with ketamine or instrumented with a TEE probe.

  7. Left ventricular, systemic arterial, and baroreflex responses to ketamine and TEE in chronically instrumented monkeys

    NASA Technical Reports Server (NTRS)

    Koenig, S. C.; Ludwig, D. A.; Reister, C.; Fanton, J. W.; Ewert, D.; Convertino, V. A.

    2001-01-01

    Effects of prescribed doses of ketamine five minutes after application and influences of transesophageal echocardiography (TEE) on left ventricular, systemic arterial, and baroreflex responses were investigated to test the hypothesis that ketamine and/or TEE probe insertion alter cardiovascular function. Seven rhesus monkeys were tested under each of four randomly selected experimental conditions: (1) intravenous bolus dose of ketamine (0.5 ml), (2) continuous infusion of ketamine (500 mg/kg/min), (3) continuous infusion of ketamine (500 mg/kg/min) with TEE, and (4) control (no ketamine or TEE). Monkeys were chronically instrumented with a high fidelity, dual-sensor micromanometer to measure left ventricular and aortic pressure and a transit-time ultrasound probe to measure aortic flow. These measures were used to calculate left ventricular function. A 4-element Windkessel lumped-parameter model was used to estimate total peripheral resistance and systemic arterial compliance. Baroreflex response was calculated as the change in R-R interval divided by the change in mean aortic pressure measured during administration of graded concentrations of nitroprusside. The results indicated that five minutes after ketamine application heart rate and left ventricular diastolic compliance decreased while TEE increased aortic systolic and diastolic pressure. We conclude that ketamine may be administered as either a bolus or continuous infusion without affecting cardiovascular function 5 minutes after application while the insertion of a TEE probe will increase aortic pressure. The results for both ketamine and TEE illustrate the classic "Hawthorne Effect," where the observed values are partly a function of the measurement process. Measures of aortic pressure, heart rate, and left ventricular diastolic pressure should be viewed as relative, as opposed to absolute, when organisms are sedated with ketamine or instrumented with a TEE probe.

  8. Different Accumulation of Elements in Proximal and Distal Parts of the Left Anterior Descending Artery Beneath the Myocardial Bridge.

    PubMed

    Tohno, Yoshiyuki; Tohno, Setsuko; Minami, Takeshi; Pakdeewong-Ongkana, Nutcharin; Suwannahoy, Patipath; Quiggins, Ranida

    2016-05-01

    To elucidate the action of the myocardial bridge (MB) on the coronary artery, the authors first prepared the hearts with the MB located in the middle one third of the left anterior descending (LAD) artery and then investigated element accumulation in the LAD artery of the hearts with the MB by direct chemical analysis. Eighty-four formalin-fixed adult Thai hearts were dissected and the MBs were found in 39 of 84 hearts with a total of 44 MBs. The 37 MBs were located in the middle one third of the LAD artery. To examine the action of the MB on element accumulation in the LAD artery, the hearts with the MB which was located in the middle one third of the LAD artery and was longer than 1.5 cm were used as Materials. The left main coronary (LMC) and LAD arteries were removed from these hearts successively and the isolated arteries were divided into eight to ten segments. After incineration of arteries with nitric acid and perchloric acid, seven element contents of Ca, P, S, Mg, Zn, Fe, and Na were determined by inductively coupled plasma-atomic emission spectrometry. To examine the endothelial changes of the LAD artery, the inner surface of segments of the LAD artery was observed by scanning electron microscopy. It was found that the extent of accumulation of Ca, P, Zn, and Na was not uniform throughout the LAD artery and was higher in the proximal part than in the distal part with regard to the LAD artery beneath the MB (the tunneled LAD artery). The extent of accumulation of Ca, P, Zn, and Na in the proximal part of the tunneled LAD artery was similar to that in the segments proximal to the MB, whereas the extent of accumulation of Ca, P, Zn, and Na in the distal part of the tunneled LAD artery was similar to that in the segments distal to the MB.

  9. Anomalous origin of the left coronary artery from the right side of the aortic valve in Syrian hamsters (Mesocricetus auratus).

    PubMed

    Durán, A C; Fernández-Gallego, T; Fernández, B; Fernández, M C; Arqué, J M; Sans-Coma, V

    2006-05-01

    This study describes the coronary artery distribution patterns associated with the anomalous origin of the left coronary artery from the right side of the aortic valve in Syrian hamsters. The hearts of 15 affected animals were examined by means of a corrosion-cast technique, histology and scanning electron microscopy. The hamsters belonged to a laboratory inbred colony with a high incidence of coronary artery anomalies and bicuspid aortic valves. The aortic valve was tricuspid in eight hamsters and bicuspid in the other seven. In all cases, the right coronary artery was normal, whereas the left main coronary artery trunk arose from the right aortic sinus or from the right side of the ventral aortic sinus when the aortic valve was bicuspid. In 12 specimens, the left main trunk crossed the infundibular septum and then divided into the left circumflex branch and the obtuse marginal branch. In another specimen, the course of the left main trunk was ventral to the right ventricular outflow tract; in the remaining two, it surrounded the aorta dorsally. In man, some of these distribution patterns may cause myocardial ischaemia and sudden death. The present findings prove that the origin of the left coronary artery from the right aortic sinus occurs in primitive mammals such as the Syrian hamster, suggesting that the defect may occur in other mammalian species. Its possible occurrence should be borne in mind in domestic animals, especially in those with signs of myocardial ischaemia after strenuous activity.

  10. Left pleural effusion and fever of unknown origin--a clue to thoracic arterial pathology.

    PubMed

    Schattner, Ami; Klepfish, Abraham

    2012-08-01

    The subset of patients who have both fever of unknown origin (FUO) and a nondiagnostic pleural effusion on presentation has not been previously investigated. A retrospective search of all patients classified as 'classic' FUO one week after admission to a department of general internal medicine identified 71 patients over 15 years. Seven were found to have associated pleural effusion(s) on admission (9.8%). In three patients thoracic large vessel pathology was diagnosed (chronic aortic dissection, giant cell arteritis and Takayasu arteritis). In these patients, the pleural effusion was predominantly left-sided, small to moderate in amount and nondiagnostic on thoracentesis. The effusions resolved spontaneously or with appropriate treatment. Thus, in patients with prolonged fever and systemic symptoms, a 'bland' left-sided pleural effusion may be a diagnostic clue to underlying inflammation of large thoracic arteries. Pleural irritation due to its anatomical proximity to the large arteries on the left side of the thorax may underlie the pathogenesis. Recognition of this sign may lead to a more timely diagnosis of occult thoracic large vessel pathology.

  11. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    PubMed Central

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    Summary Background To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Material/Methods Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. Results During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Conclusions Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery. PMID:26150902

  12. Successful Control of Liver Metastases From Pancreatic Solid-Pseudopapillary Neoplasm (SPN) Using Hepatic Arterial Embolization

    SciTech Connect

    Violari, Elena G. Brody, Lynn A.; Covey, Anne M.; Erinjeri, Joseph P.; Getrajdman, George I.; Sofocleous, Constantinos T.; Reidy, Diane L.; Jarnagin, William R.; Brown, Karen T.

    2015-04-15

    No systemic agents that are known to be effective for the treatment of solid-pseudopapillary neoplasm (SPN) are available. We report the prolonged and sustained control of metastatic pancreatic SPN to the liver using hepatic arterial embolization (HAE), where a total of 13 HAE sessions were performed over a 6-year period.

  13. Pseudoaneurysm of the hepatic artery, a rare complication of an amebic liver abscess

    PubMed Central

    Tacconi, D.; Lapini, L.; Giorni, P.; Corradini, S.; Caremani, M.

    2009-01-01

    Hepatic artery pseudoaneurysm is a rare complication of amebic or pyogenic liver abscesses, and it is generally diagnosed because of hemobilia due to rupture of the aneurysm into the biliary tract. The authors describe a case of vascular complication in a patient affected by amebic liver abscess. Pseudoaneurysm was diagnosed and resolved without hemobilia. PMID:23396987

  14. Direct communication between the left circumflex and the right coronary arteries: a very rare coronary anomaly circulation

    PubMed Central

    Oliveira, Marcos Danillo Peixoto; Cavalcanti, Rafael R. César; Kajita, Alexandre H.; Miranda, Thais; Kajita, Luiz J.; Horta, Pedro E.; Ribeiro, Expedito E.

    2016-01-01

    Coronary artery anomalies (CAA) are congenital changes in their origin, course, and/or structure. Intercoronary communication (ICC) is a very rare subset with uni- or bidirectional blood flow between two or more coronary arteries. We present the case of a 58-year-old man with an acute coronary syndrome whose coronary angiography incidentally showed a surprising and very rare communication between the right coronary and left circumflex arteries. PMID:26885496

  15. High rate of right ventricular infarction after ligation of mid left anterior descending artery in rats.

    PubMed

    Samsamshariat, Seyed Ahmad; Movahed, Mohammad-Reza

    2005-01-01

    The left anterior descending artery (LAD) supplies the left ventricle in humans. LAD ligation has been commonly used in rats to induce left ventricular (LV) infarction for research purposes. However, the myocardial supply territories of LAD are not well established in rats. We measured the infarction zone in rats after ligation of the mid-LAD. Twenty-four male Sprague-Dawley rats weighing 300-350 g were selected for LAD ligation for the induction of ischemic cardiomyopathy. The surgery was performed under full anesthesia. Left-sided thoracotomy was performed through cuts in the fifth and sixth ribs. Ligation of the LAD was performed 1 to 2 mm distal to a line between the left border of the pulmonary conus and the right border of the left atrial appendage. LAD was ligated after the first diagonal and septal branches. After 24 h, the hearts were removed and stained with Tetrazolium Tetrachloride (TTC) for the detection of infracted areas. Ligation of LAD induces 85% infarction of the right anterior free wall and anterior right ventricular septum and induces 100% infarction of the anterior free wall of the left ventricle and anterior septum. Infarction after LAD ligation extends all the way to the distal of the ligation site down to the apex of the heart. Mid-LAD ligation after the first septal and diagonal branches causes substantial right ventricular infarction in addition to LV infarct in rats. Therefore, the hemodynamic effect of right ventricle infarct should be considered in research involving LAD ligation in rats.

  16. Anomalous left main coronary artery: case series of different courses and literature review.

    PubMed

    Marler, Adam T; Malik, Jamil A; Slim, Ahmad M

    2013-01-01

    Background. Congenital anomalies of the coronary arteries are a cause of sudden cardiac death. Of the known anatomic variants, anomalous origination of a coronary artery from an opposite sinus of Valsalva (ACAOS) remains the main focus of debate. Case Series. We present three cases, all presenting to our facility within one week's time, of patients with newly discovered anomalous origination of the left coronary artery from the right sinus of Valsalva (L-ACAOS). All patients underwent cardiac computed tomography for evaluation of coronary anatomy along with other forms of functional testing. Despite the high risk nature of two of the anomalies, the patients are being treated medically without recurrence of symptoms. Summary. After review of the literature, we have found that the risk of sudden cardiac death in patients with congenital coronary anomalies, even among variants considered the highest risk, may be overestimated. In addition, the exact prevalence of coronary anomalies in the general population is currently underestimated. A national coronary artery anomaly registry based on cardiac computed tomography and invasive coronary angiography data would be helpful in advancing our understanding of these cardiac peculiarities. The true prevalence of congenital coronary anomalies and overall risk of sudden cardiac death in this population are not well known. Surgical intervention remains the mainstay of therapy in certain patients though recent investigations into the pathophysiology of these abnormalities have shown that the risk of surgery may outweigh the minimal reduction in risk of sudden cardiac death.

  17. Rescue AVE Stent Placement for Left Anterior Descending Coronary Artery Occlusion During Diagnostic Angiography.

    PubMed

    van Dijk D; Ernst; Six; Plokker

    1996-06-01

    In a 65-year-old male with coronary artery disease a proximal occlusion of the left anterior descending coronary artery occurred during diagnostic coronary angiography. The most likely cause was an occlusive dissection. This resulted in acute myocardial ischemia and immediate cardiogenic shock. The decision was made to proceed to emergency percutaneous transluminal coronary angioplasty (PTCA). After balloon dilatation, a 3.5 mm AVE stent was deployed successfully at the site of the lesion. This resulted in a satisfactory angiographic result and an immediate improvement of the clinical picture. We conclude that placement of an AVE stent can provide a means for restoring flow in case of acute occlusive dissection during coronary angiography.

  18. Effect of electron radiation on vasomotor function of the left anterior descending coronary artery

    NASA Astrophysics Data System (ADS)

    Sanzari, Jenine K.; Billings, Paul C.; Wilson, Jolaine M.; Diffenderfer, Eric S.; Arce-Esquivel, Arturo A.; Thorne, Pamela K.; Laughlin, Maurice H.; Kennedy, Ann R.

    2015-01-01

    The left anterior descending (LAD, interventricular) coronary artery provides the blood supply to the mid-region of the heart and is a major site of vessel stenosis. Changes in LAD function can have major effects on heart function. In this report, we examined the effect of electron simulated solar particle event (eSPE) radiation on LAD function in a porcine animal model. Vasodilatory responses to adenosine diphosphate (ADP; 10-9-10-4 M), bradykinin (BK; 10-11-10-6 M), and sodium nitroprusside (SNP; 10-10-10-4 M) were assessed. The LAD arteries from Control (non-irradiated) and the eSPE (irradiated) animals were isolated and exhibited a similar relaxation response following treatment with either ADP or SNP. In contrast, a significantly reduced relaxation response to BK treatment was observed in the eSPE irradiated group, compared to the control group. These data demonstrate that simulated SPE radiation exposure alters LAD function.

  19. Ghrelin Suppression and Fat Loss after Left Gastric Artery Embolization in Canine Model

    SciTech Connect

    Bawudun, Dilmurat; Xing Yan; Liu Wenya Huang Yujie; Ren Weixin; Ma Mei; Xu Xiaodong; Teng Gaojun

    2012-12-15

    Purpose: To evaluate the effects of left gastric artery embolization (LGAE) on plasma ghrelin levels, abdominal fat, and body weight in beagles. Methods: The institutional animal care and use committee approved this study. Fifteen healthy adult beagles (12 male and three female animals) were randomly divided into three experimental groups: LGAE was proceeded with mixed emulsion of bleomycin A{sub 5} hydrochloride and lipiodol (group A), and polyvinyl alcohol particles (group B). Transcatheter saline injections in the left gastric artery were performed as a control. Weight and fasting plasma ghrelin levels were obtained at baseline and at weekly intervals for 8 weeks after the procedure in all animals. All animals were scanned and measured by multidetector computed tomography at baseline and at week 8 for evaluation of abdominal fat. Results: In LGAE-treated animals, plasma ghrelin and body weight significantly decreased compared to control animals (group A: P = 0.007 and P = 0.000; group B: P = 0.004 and P = 0.000, respectively). Subcutaneous fat size was also significantly reduced (P = 0.011 and P = 0.027 for groups A and B, respectively). The decreasing percentage in ghrelin levels at week 6 (peak of recovery) of LGAE-treated animals were negatively correlated with the size of area supplied by left gastric artery (r = -0.693, P = 0.026). Conclusion: LGAE could suppress the plasma concentration of ghrelin, which results in subcutaneous fat size reduction and weight loss. Compensatory ghrelin production might occur in the remnant gastric fundus after LGAE.

  20. Acute arterial embolism of left lower extremity caused by paradoxical embolism in Ebstein's anomaly

    PubMed Central

    LI, Jun-Sheng; Ma, Jie; Yan, Zi-Xing; Cheng, Dong-Ming; Chang, Liang; Zhang, Hai-Chun; Liu, Jiang-Yan

    2017-01-01

    Abstract Introduction: Ebstein's anomaly is a benign and stable congenital heart disease for asymptomatic patients. Despite a low incidence of Ebstein's anomaly (EA), patients’ quality of life can be badly affected by EA without positive surgical intervention. Especially EA is associated with other congenital heart disease, such as the atrial septal defect, patent foramen ovale, and arterial embolism exclude other reasons, it is often considered to be the consequence of paradoxical embolism, and surgical intervention must be conducted. Case report: An 11-year-old girl falling off the bed suffered pain from left lower extremity. Echocardiographic evaluation revealed an EA, severe tricuspid regurgitation, and secundum atrial septal defect. Both left leg amputation and cardiac surgery were conducted after recovery. Under the condition of anesthesia cardiopulmonary bypass extracorporeal circulation, atrial septal defect repair and Cone reconstruction of the tricuspid valve were performed. Patient recovered well and left hospital smoothly. Discussion: EA is a rare and complex congenital cardiac malformation. There are about 80% to 90% of EA patients with combined atrial septal defect and patent foramen ovale. Sudden arterial occlusion is very rare especially in childhood. When thoracic roentgenoscopy, arterial blood gas analysis, coagulation test, and echocardiographic of lower extremity deep venous system are all normal, one should consider the possibility of a paradoxical embolism. If patients have the paradoxical embolism or worsening tricuspid regurgitation, the most suitable therapeutic regimen should be chosen according to patients’ condition. With surgical techniques and methods renewed continuously, cone reconstruction of the tricuspid valve has been confirmed in clinical trials, which can use its own tissues to form not only central bloodstream, but also the coaption between leaflet and leaflet. PMID:28151866

  1. 010. Coronary artery bypass in prior left pneumonectomy postoperative use of iloprost

    PubMed Central

    Ignatiadis, Agisilaos; Ampatzidou, Fotini; Kechagioglou, George; Antoniou, Konstantinos; Michail, Nikolaos; Karaiskos, Theodoros; Sileli, Maria; Drossos, George

    2015-01-01

    Background The rare procedure of coronary artery bypass in a prior left pneumonectomy patient characterized by postoperative cardiopulmonary complications. Acute right heart failure due to anatomic and physiologic changes because of pneumonectomy is the most serious complication. It is very helpful to prevent this condition by reducing pulmonary vascular resistance index which represents the right heart afterload. In our case we have recorded the favorable hemodynamic effects of inhaled Iloprost. Methods A 60-year-old man presented to our department with acute coronary syndrome. He had undergone a left pneumonectomy nine years ago because of bronchial carcinoma. Coronary angiography, which was performed during acute coronary syndrome, revealed left main disease (70% stenosis) and 50% stenosis in right coronary artery. Pulmonary function tests revealed severe restrictive disease: forced vital capacity (FVC): 1.47 L (30% of predicted) and forced expiratory volume (FEV) 1: 1.41 L (25% of predicted). Coronary artery bypass surgery (CABG) procedure was successfully completed with cardiopulmonary bypass (CPB) and patient was transferred in ICU. Patient’s inotropic support was 0.1 μg/kg/min Epinephrine and 0.06 μg/kg/min Noradrenaline. In the ICU, in order to avoid RV dysfunction the patient was ventilated with low tidal volume, Vt 6 mL/kg and with low positive end-expiratory pressure (PEEP). He was under careful fluid balance. Hemodynamic profile revealed high values of PVRI. This undesirable high RV afterload was managed with inhaled Iloprost (prostacyclin analogue) because of its elective pulmonary vessels dilator properties. Results The patient was extubated 5 hours postoperatively. Postoperative vigorous chest physiotherapy and bronchodilation due to transient brochospasm contributed to the uncomplicated respiratory function. The patient discharged on 7th postop day. Conclusions CABG in postpneumonectomy patients is a challenging procedure. The use of selective

  2. Transmural differences in myocardial function and metabolism during direct left ventricular to coronary artery sourcing.

    PubMed

    de Zeeuw, Sandra; Borst, Cornelius; Verlaan, Cees W J; Gründeman, Paul F

    2005-07-01

    We investigated the hypothesis that in the absence of collateral circulation, a left ventricle-coronary artery (LV-CA) bypass will maintain normal LV wall function and metabolism transmurally, both at rest and during stress, when the left anterior descending coronary artery (LAD) is acutely occluded proximally. In 18 anesthetized pigs (74 +/- 7 kg, mean +/- standard deviation), a covered stent was placed transmurally in the lateral wall of the beating LV and connected to the proximal LAD via an arterial graft. Subepicardial and subendocardial segmental shortening as well as interstitial lactate and glucose concentrations were measured regionally by sonomicrometry and microdialysis, respectively. When the LAD was occluded proximally, direct left ventricular sourcing decreased the net LAD flow to 64 +/- 25% of the native flow (n = 18, all animals). In the subepicardium, systolic shortening (SS) decreased to 87 +/- 18% of baseline (p = 0.124), with the appearance of minor postsystolic shortening (PSS), and minor changes in interstitial lactate and glucose levels. In the subendocardium, in contrast, SS decreased to 54 +/- 20% (p = 0.001). Marked PSS concurred with a sixfold increase in lactate (p = 0.008), and a 65 +/- 31% decrease in glucose (p = 0.003), indicating subendocardial anaerobic metabolism. Stress induced by infusion of dobutamine increased lactate and decreased glucose concentration in the subepicardium to subendocardial levels, indicating transmural anaerobic metabolism. In the anesthetized pig, direct sourcing by a LV-CA bypass distal to an acute coronary occlusion resulted in a 36% decrease in net forward coronary flow, subendocardial anaerobic metabolism, and loss of subendocardial contractile function at rest. These adverse effects extended into the subepicardium when the heart was stressed.

  3. [A Case of Left Vertebral Artery Aneurysm Showing Evoked Potentials on Bilateral Electrode by the Left Vagus Nerve Stimulation to Electromyographic Tracheal Tube].

    PubMed

    Kadoya, Tatsuo; Uehara, Hirofumi; Yamamoto, Toshinori; Shiraishi, Munehiro; Kinoshita, Yuki; Joyashiki, Takeshi; Enokida, Kengo

    2016-02-01

    Previously, we reported a case of brainstem cavernous hemangioma showing false positive responses to electromyographic tracheal tube (EMG tube). We concluded that the cause was spontaneous respiration accompanied by vocal cord movement. We report a case of left vertebral artery aneurysm showing evoked potentials on bilateral electrodes by the left vagus nerve stimulation to EMG tube. An 82-year-old woman underwent clipping of a left unruptured vertebral artery-posterior inferior cerebellar artery aneurysm. General anesthesia was induced with remifentanil, propofol and suxamethonium, and was maintained with oxygen, air, remifentanil and propofol. We monitored somatosensory evoked potentials, motor evoked potentials, and electromyogram of the vocal cord. When the manipulation reached brainstem and the instrument touched the left vagus nerve, evoked potentials appeared on bilateral electrodes. EMG tube is equipped with two electrodes on both sides. We concluded that the left vagus nerve stimulation generated evoked potentials of the left laryngeal muscles, and they were simultaneously detected as potential difference between two electrodes on both sides. EMG tube is used to identify the vagus nerve. However, it is necessary to bear in mind that each vagus nerve stimulation inevitably generates evoked potentials on bilateral electrodes.

  4. Stent-grafts placement for treatment of massive hemorrhage from ruptured hepatic artery after pancreaticoduodenectomy

    PubMed Central

    Wang, Mao-Qiang; Liu, Feng-Yong; Duan, Feng; Wang, Zhi-Jun; Song, Peng; Fan, Qing-Sheng

    2010-01-01

    AIM: To present a series of cases with life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm after pancreaticoduodenectomy (PD) treated with placement of stent-grafts. METHODS: Massive hemorrhage from ruptured hepatic artery pseudoaneurysm after PD in 9 patients (6 men, 3 women) at the age of 23-75 years (mean 48 years), were treated with placement of percutaneous endovascular balloon-expandable coronary stent-grafts. All patients were not suitable for embolization because of a non-patent portal vein. One or more stent-grafts, ranging 3-6 mm in diameter and 16-55 mm in length, were placed to exclude ruptured pseudoaneurysm. Follow-up data, including clinical condition, liver function tests, and Doppler ultrasound examination, were recorded at the outpatient clinic. RESULTS: Immediate technical success was achieved in all the 9 patients. All stent-grafts were deployed in the intended position for immediate cessation of bleeding and preservation of satisfactory hepatic arterial blood flow. No significant procedure-related complications occurred. Recurrent bleeding occurred in 2 patients at 16 and 24 h, respectively, after placement of stent-grafts and treated with surgical revision. One patient died of sepsis 12 d after the interventional procedure. The remaining 6 patients were survived when they were discharged. The mean follow-up time was 10.5 mo (range 4-16 mo). No patient had recurrent bleeding after discharge. Doppler ultrasound examination verified the patency of hepatic artery and stent-grafts during the follow-up. CONCLUSION: Placement of stent-grafts is an effective and safe procedure for acute life-threatening hemorrhage from ruptured hepatic artery pseudoaneurysm. PMID:20677346

  5. Hepatic Arterial Configuration in Relation to the Segmental Anatomy of the Liver; Observations on MDCT and DSA Relevant to Radioembolization Treatment

    SciTech Connect

    Hoven, Andor F. van den Leeuwen, Maarten S. van Lam, Marnix G. E. H. Bosch, Maurice A. A. J. van den

    2015-02-15

    PurposeCurrent anatomical classifications do not include all variants relevant for radioembolization (RE). The purpose of this study was to assess the individual hepatic arterial configuration and segmental vascularization pattern and to develop an individualized RE treatment strategy based on an extended classification.MethodsThe hepatic vascular anatomy was assessed on MDCT and DSA in patients who received a workup for RE between February 2009 and November 2012. Reconstructed MDCT studies were assessed to determine the hepatic arterial configuration (origin of every hepatic arterial branch, branching pattern and anatomical course) and the hepatic segmental vascularization territory of all branches. Aberrant hepatic arteries were defined as hepatic arterial branches that did not originate from the celiac axis/CHA/PHA. Early branching patterns were defined as hepatic arterial branches originating from the celiac axis/CHA.ResultsThe hepatic arterial configuration and segmental vascularization pattern could be assessed in 110 of 133 patients. In 59 patients (54 %), no aberrant hepatic arteries or early branching was observed. Fourteen patients without aberrant hepatic arteries (13 %) had an early branching pattern. In the 37 patients (34 %) with aberrant hepatic arteries, five also had an early branching pattern. Sixteen different hepatic arterial segmental vascularization patterns were identified and described, differing by the presence of aberrant hepatic arteries, their respective vascular territory, and origin of the artery vascularizing segment four.ConclusionsThe hepatic arterial configuration and segmental vascularization pattern show marked individual variability beyond well-known classifications of anatomical variants. We developed an individualized RE treatment strategy based on an extended anatomical classification.

  6. Successful Covering of a Hepatic Artery Aneurysm with a Coronary Stent Graft

    SciTech Connect

    Sakai, Hidetsugu; Urasawa, Kazushi; Oyama, Naotsugu; Kitabatake, Akira

    2004-09-15

    In a 54-year-old woman with liver cirrhosis who underwent orthotopic liver transplantation, the postoperative course was complicated by aneurysm formation in the hepatic artery. Abdominal ultrasonography showed a daily increase in the size of the aneurysm in spite of careful management including strict rest and continuous intravenous infusion of antihypertensive agents. Since the patient's poor systemic status was a major obstruction to operative resection, transcatheter therapy was thought more preferable. We evaluated the lesion with intravascular ultrasonography as an adjunct to angiography and a dissection with a flap was well visualized. The aneurysm was covered with a commercially available stent-graft, designed for treatment of the coronary artery. This is a rare case in which a Jostent was implanted into the hepatic artery after liver transplantation.

  7. Spontaneous hepatic artery dissection—a rare presentation of fibromuscular dysplasia

    PubMed Central

    Su, Kevin Y.C.; Stanhope, Melanie L.; Kaufman, Brendan P.W.

    2016-01-01

    Fibromuscular dysplasia (FMD) is a rare condition that causes structural compromise of the blood vessel presenting either as an incidental radiological finding, dissection or stenosis usually of the renal or craniocervical arteries. Seldom, patients present with spontaneous dissection in visceral arteries and there are few reports of hepatic involvement. This report outlines the case of a 43-year-old female who presented with severe right upper quadrant pain with a subsequent diagnosis of FMD manifesting as spontaneous hepatic artery dissection. The patient was treated with conservative antiplatelet therapy and regular radiographic follow-up, decided by the treating team as no clear guidelines exist for management of this particular presentation of FMD. Surgical management is not currently recommended to this patient due to the risk of further dissection, but may be considered if there is severe haemodynamic compromise or refractory pain. PMID:28031848

  8. Isolated left brachiocephalic artery with the right aortic arch: A rare differential of large patent ductus arteriosus

    PubMed Central

    Dubey, Gajendra; Gupta, Saurabh Kumar; Kothari, Shyam Sundar

    2017-01-01

    We report a case of isolation of the left brachiocephalic artery with the right aortic arch in a 9-year-old male child masquerading as large patent ductus arteriosus with left-to-right shunt. We have emphasized the subtle clinical findings which served as clues to the diagnosis. PMID:28163435

  9. Dissection of left iliac artery during anterior lumbar interspace fusion: Report of a case.

    PubMed

    Fischer, Uwe M; Davies, Mark G; El Sayed, Hosam

    2015-04-01

    Vascular injury is an uncommon complication of spine surgery. Among the different approaches, anterior lumbar interbody fusion has increased potential for vascular injuries, since the great vessels and their branches overly the disc spaces to be operated on, and retraction of these vessels is necessary to gain adequate surgical exposure. The reported incidence for anterior lumbar interbody fusion-associated vascular injuries ranges from 0% to 18.1%, with venous laceration as the most common type. We report a case of anterior lumbar interbody fusion-associated left common iliac artery dissection leading to delayed acute limb ischemia developing in early post-operative period.

  10. Management of left main coronary artery obstruction after transcatheter aortic valve replacement utilizing a periscope approach.

    PubMed

    Drexel, Todd; Helmer, Gregory; Garcia, Santiago; Raveendran, Ganesh

    2017-09-20

    Coronary obstruction is a rare but potentially fatal complication of transcatheter aortic valve replacement (TAVR). It can result from native leaflet or stent frame obstruction of the coronary ostia. There are reports detailing the difficulty of percutaneous coronary intervention following TAVR, but none that describe a periscope approach to access the left main ostia in the presence of a braided nitinol frame. This report describes an alternative approach to access a coronary artery when the valve stent struts are prohibitive to equipment delivery. © 2017 Wiley Periodicals, Inc.

  11. Percutaneous coronary intervention in left main coronary artery disease in a patient with hemophilia B.

    PubMed

    Arzu, Er; Emre, Altekin R; Mehmet, Kabukcu; Selim, Yalcinkaya; Necmi, Deger

    2011-05-01

    A 77-year-old male patient with the diagnosis of hemophilia presented himself at the cardiology clinic with unstable angina and a coronary angiography was planned. Factor IX was prepared before the procedure due to the risk of hemorrhage. Critical lesions were detected in the left main coronary artery (LMCA) and the procedure was performed on the LMCA in the same session. No complication of hemorrhage developed. Having rarely found in literature on any procedure on the LMCA without factor IX infusion we wished to report on this rare case of concurrent hemophilia B and acute coronary syndrome.

  12. [THE INFLUENCE OF ABDOMINAL OBESITY ON LEFT VENTRICULAR MYOCARDIALREMODELING IN PATIENTS WITH ARTERIAL HYPERTENSION].

    PubMed

    Poteklzin, N P; Sarkisov, K A; Orlov, F A; Alatortseva, I A; Starovoitova, L M; Drozdova, I N

    2015-01-01

    The obesity dependence of selected clinical and instrumental characteristics of 10 male patients with arterial hypertension (AH) was evaluated Group I included 79 patients with grade II hypertensive disease (HD), normal body weight and waist circumference. Group 2 comprised 61 patients with grade II HD and abdominal obesity. Patients of both groups showed high frequency of left ventricular (LV) hypertrophy (59.2 and 73.8% respectively). Concentric LV hypertrophy prevailed in group I and eccentric hypertrophy in group 2. 24 hr ECG monitoring showed that signs of relative coronary insufficiency were recorded more frequently in group 2 and cardiac rhythm disturbances in group I.

  13. Single primitive ventricle with normally related great arteries and atresia of the left A-V valve.

    PubMed Central

    Coto, E O; Raggio, J M; Malo, P; Sainz, C; Aparisi, R; Gomez-Ullate, J M

    1978-01-01

    A child aged 2 years and 9 months was angiocardiographically diagnosed to have a single ventricle with normally related great arteries and atresia of the left A-V valve. A Blalock-Hanlon procedure and division of a large patent ductus arteriosus were followed by reduction in pulmonary artery pressure, but after operation the patient showed signs of left ventricular failure unresponsive to medical treatment, necessitating pulmonary artery banding. We have found only three similar published cases, and this is the only one with full angiographic documentation. Images PMID:725830

  14. How to manage the left subclavian artery during endovascular stenting of the thoracic aorta.

    PubMed

    Rehman, Syed M; Vecht, Joshua A; Perera, Ryan; Jalil, Rozh; Saso, Srdjan; Anderson, Jon R; von Segesser, Ludwig Karl; Athanasiou, Thanos

    2011-04-01

    We performed a systematic review of the literature to establish whether revascularisation of the left subclavian territory is necessary when this artery is covered by a stent. We retrieved data from 99 studies incorporating 4906 patients. Incidences of left-arm ischaemia (0.0% vs 9.2%, p=0.002) and stroke (4.7% vs 7.2%, p<0.001) were significantly less following revascularisation, although mortality (10.5% vs 3.4%, p=0.032) and endoleak incidence (25.8% vs 12.6%, p=0.008) were increased. No significant differences in spinal-cord ischaemia were seen. Revascularisation may reduce downstream ischaemic complications but can cause significant risk. Indications must be carefully considered on an individual patient basis.

  15. Drug-eluting stents in unprotected left main coronary artery disease.

    PubMed

    Bernelli, Chiara

    2014-11-01

    Though coronary bypass graft surgery (CABG) has traditionally been the cornerstone of therapy in patients with unprotected left main coronary artery (ULMCA) disease, recent evidence supports the use of percutaneous coronary intervention in appropriate patients. Indeed in patients with ULMCA disease, drug-eluting stents (DES) have shown similar incidence of hard end points, fewer periprocedural complications and lower stroke rates compared with CABG, though at the cost of increased revascularization with time. Furthermore, the availability of newer efficacious and safer DES as well as improvements in diagnostic tools, percutaneous techniques and, importantly, a better patient selection, allowed percutaneous coronary intervention a viable alternative to CABG of left main-patients with low disease complexity; however, even in this interventional era characterized by efficacious DES, patients with ULMCA disease remain a challenging high-risk population where outcomes strongly depend on clinical characteristics, anatomical disease complexity and extension and operator's experience. This review summarizes the role of DES in ULMCA disease patients.

  16. Scuba diving, acute left anterior descending artery occlusion and normal ECG.

    PubMed

    Doll, Sébastien Xavier; Rigamonti, Fabio; Roffi, Marco; Noble, Stéphane

    2013-01-31

    We report the case of an acute proximal occlusion of the left anterior descending coronary (LAD) artery following a scuba diving decompression accident and associated with normal ECG. Following uneventful thromboaspiration and coronary stenting, the patient was discharged on day 4 with secondary preventative therapies. A transthoracic echocardiography performed at this point showed a complete recovery compared with an initial localised akinesia involving the anterior and apical portion of the left ventricle upon admission. This case highlights that significant acute coronary lesions involving the LAD can occur without any ECG anomaly. The presence of acute and persistent angina associated with troponin elevation should prompt physicians to consider coronary angiography without delay, independently of the ECG results.

  17. Minimally invasive coronary artery bypass grafting versus stenting for patients with proximal left anterior descending coronary artery disease.

    PubMed

    Shirai, Kazuyuki; Lansky, Alexandra J; Mehran, Roxana; Dangas, George D; Costantini, Costantino O; Fahy, Martin; Slack, Steven; Mintz, Gary S; Stone, Gregg W; Leon, Martin B

    2004-04-15

    The purpose of this study was to compare the clinical outcomes of stenting and minimally invasive coronary artery bypass grafting (MIDCAB) in patients with proximal left anterior descending (LAD) coronary artery disease. The Patency, Outcome, Economics of Minimally invasive direct coronary bypass (POEM) study demonstrated that MIDCAB had similar safety and long-term efficacy for LAD revascularization compared with conventional coronary artery bypass grafting. Although LAD stenting is superior to conventional balloon angioplasty, whether it is comparable to MIDCAB is not known. We identified a matched population of 429 consecutive patients with 1-vessel disease who underwent elective proximal LAD stenting and compared their clinical outcomes with those of the 152 patients in the MIDCAB group of the POEM study. The in-hospital event rate was similar in both groups, except for a shorter length of hospital stay with LAD stenting compared with MIDCAB (2.68 vs 4.07 days, p <0.0001). At 6-month follow-up, the incidence of death and Q-wave myocardial infarction or that of cerebrovascular accident was not significantly different between these 2 groups. However, target vessel revascularization was significantly higher with LAD stenting than MIDCAB (13.3% vs 6.6%, p = 0.045). In the subgroup of patients without diabetes, all clinical events were similar in both groups, and the benefit of a shorter hospital stay associated with stenting was maintained. Compared with MIDCAB, LAD stenting is associated with higher repeat revascularization rates but offers the advantage of shorter hospitalization. For nondiabetics with proximal LAD disease, stenting may be the revascularization strategy of choice.

  18. Segmentation of hepatic artery in multi-phase liver CT using directional dilation and connectivity analysis

    NASA Astrophysics Data System (ADS)

    Wang, Lei; Schnurr, Alena-Kathrin; Zidowitz, Stephan; Georgii, Joachim; Zhao, Yue; Razavi, Mohammad; Schwier, Michael; Hahn, Horst K.; Hansen, Christian

    2016-03-01

    Segmentation of hepatic arteries in multi-phase computed tomography (CT) images is indispensable in liver surgery planning. During image acquisition, the hepatic artery is enhanced by the injection of contrast agent. The enhanced signals are often not stably acquired due to non-optimal contrast timing. Other vascular structure, such as hepatic vein or portal vein, can be enhanced as well in the arterial phase, which can adversely affect the segmentation results. Furthermore, the arteries might suffer from partial volume effects due to their small diameter. To overcome these difficulties, we propose a framework for robust hepatic artery segmentation requiring a minimal amount of user interaction. First, an efficient multi-scale Hessian-based vesselness filter is applied on the artery phase CT image, aiming to enhance vessel structures with specified diameter range. Second, the vesselness response is processed using a Bayesian classifier to identify the most probable vessel structures. Considering the vesselness filter normally performs not ideally on the vessel bifurcations or the segments corrupted by noise, two vessel-reconnection techniques are proposed. The first technique uses a directional morphological operator to dilate vessel segments along their centerline directions, attempting to fill the gap between broken vascular segments. The second technique analyzes the connectivity of vessel segments and reconnects disconnected segments and branches. Finally, a 3D vessel tree is reconstructed. The algorithm has been evaluated using 18 CT images of the liver. To quantitatively measure the similarities between segmented and reference vessel trees, the skeleton coverage and mean symmetric distance are calculated to quantify the agreement between reference and segmented vessel skeletons, resulting in an average of 0:55+/-0:27 and 12:7+/-7:9 mm (mean standard deviation), respectively.

  19. Congenital Giant Right Coronary Artery to Pulmonary Artery Fistula and Congenital Left Main Coronary Artery Atresia: A Case Report.

    PubMed

    Ding, Ya-Hui; Zou, Hai

    2016-02-01

    Both of congenital giant RCA, RCA to PA fistula, and CLMCA-A are one of exceedingly rare vascular abnormalities. We present the case of a 34-year-old man with multiple congenital coronary anomalies above, and a successful surgical intervention was proceeded for our patient.This is a case of a 34-year-old man presented with apical systolic murmur and exertional chest pain. Furthermore, a dilated left heart and abnormal pulmonary blood flow was observed in this patient. Coronary CTA and selective CAG showed a 15-mm diameter RCA with a fistula to pulmonary trunk and CLMCA-A. During cardiac surgery, the coronary abnormalities were confirmed and the outlet of the fistula was closed. After surgery, less chest pain, respiratory infection, and left heart failure were observed in this patient.This case illustrates that the surgery of closing the fistula between the giant RCA and pulmonary trunk could improve the symptoms and signs for this patient. It could be predicted that simplified operation could be a promising therapy for patient with giant RCA to PA fistula and CLMCA-A. Moreover, CABG should be taken full account of when myocardial ischemia was found in the blood-supply area of LAD.

  20. Transcathether closure of a right pulmonary artery-to-left atrial fistula using Amplatzer muscular ventricular septal defect occluder.

    PubMed

    Ece, Ibrahim; Uner, Abdurrahman; Cuce, Ferhat; Balli, Sevket

    2014-10-01

    A right pulmonary artery-to-left atrial fistula is a very rare cyanotic congenital heart defect and is characterized by cyanosis and normal auscultation of the heart. Interventional closure of the fistula using occluder devices and coils has been rarely reported. We report the successful closure of a RPA-to-left atrial fistula using an Amplatzer muscular ventricular septal defect occluder in a child with cyanosis. The two-dimensional echocardiogram with bubble contrast study demonstrated the communication between right pulmonary artery and left atrium. Computerized tomography confirmed the diagnosis and delineated the anatomy.

  1. Relationship between left ventricular diastolic function and arterial stiffness in asymptomatic patients with diabetes mellitus.

    PubMed

    Roos, Cornelis J; Auger, Dominique; Djaberi, Roxana; de Koning, Eelco J; Rabelink, Ton J; Pereira, Alberto M; Bax, Jeroen J; Delgado, Victoria; Jukema, J Wouter; Scholte, Arthur J

    2013-03-01

    Left ventricular (LV) diastolic dysfunction and increased arterial stiffness are common in patients with diabetes mellitus (DM). However, the relation between these two pathophysiological factors remains unclear. The aim of this study was to investigate the relationship between LV diastolic function and arterial stiffness as assessed with applanation tonometry. In 142 asymptomatic patients with DM (mean age 48 years, 75 (53 %) men, 72 (51 %) patients with type 2 DM) LV diastolic function was assessed with echocardiography. Arterial stiffness was evaluated measuring the aortic pulse wave velocity (PWV) whereas wave reflection was assessed measuring central systolic blood pressure (cSBP), central pulse pressure (cPP), and augmentation index (AIx) with applanation tonometry. Mean E/A ratio, E' and E/E' ratio were 1.1 ± 0.3, 8.1 ± 2.3 and 9.2 ± 3.3 cm/s, respectively. Mean PWV, mean cSBP, median cPP and mean AIx were 7.9 ± 2.4 m/s, 122 ± 17 mmHg, 40 [35-51] mmHg and 17.9 ± 12.1 %, respectively. PWV was independently associated with LV diastolic dysfunction grade (β = 0.76, p = 0.03). In contrast, measures of wave reflection, cPP, cSBP and AIx were independently related with E/A ratio, but not with the LV diastolic dysfunction grade. Parameters of arterial stiffness and wave reflection are associated with echocardiographic indices of LV diastolic function in asymptomatic patients with DM. Therapies that prevent progression of arterial stiffness and reduce late-systolic pressure overload may help to reduce the prevalence of LV diastolic dysfunction in this population.

  2. Changes in left ventricular performance related to perioperative myocardial infarction in coronary artery bypass graft surgery

    SciTech Connect

    Roberts, A.J.; Spies, S.M.; Lichtenthal, P.R.; Moran, J.M.; Sanders, J.H.; Michaelis, L.L.

    1983-05-01

    Strict electrocardiographic, enzymatic, scintigraphic, and hemodynamic criteria for perioperative myocardial infarction (MI) were defined and related to serial assessments of left ventricular performance during rest and exercise in patients seen early and late after coronary artery bypass graft operation. Global left ventricular performance was determined by radionuclide ventriculography from which changes in the pattern of serial postoperative ejection fractions (EF) were obtained. Patients were divided into two groups based on the presence or absence of perioperative MI, and were matched in pairs on the basis of preoperative EF and extent as well as location of coronary artery obstructions. The results indicate that neither short- nor long-term depression in resting EF occurred subsequent to perioperative MI. However, an exercise-related increase in EF eight months postoperatively was depressed in patients who had perioperative MI compared with those who did not. Patients with new Q waves and abnormal postoperative elevation in serum levels of the myocardial isoenzyme of creatine kinase (CK-MB) had a greater early decrease in EF compared with patients without evidence of perioperative MI. However, seven days after operation, the EF in both groups returned to preoperative levels. Patients with abnormal technetium 99m-pyrophosphate scintigrams had changes in perioperative EF similar to those in patients without MI. The presence of low cardiac output syndrome immediately after operation was associated with immediate and short-term decreases in EF, which were not seen in any of the other patient subgroups.

  3. Left ventricular volumes and function during atrial pacing in coronary artery disease: a radionuclide angiographic study

    SciTech Connect

    Rozenman, Y.; Weiss, A.T.; Atlan, H.; Gotsman, M.S.

    1984-02-01

    This study set out to determine the pathophysiologic changes in the left ventricle during atrial pacing in 22 patients with coronary artery disease. Graduated right atrial pacing to a rate of 160 beats/min, or the induction of angina pectoris or significant ST depression was undertaken. Ventricular volumes were measured at rest and at rates of 100, 120, 140 and 160 beats/min using radionuclide angiography. The volumes at a pacing rate of 100 beats/min were used as a reference standard (100%). In the 22 patients with coronary artery disease, left ventricular end-diastolic volume decreased from 118 +/- 3% at rest to 80 +/- 5% at a rate of 160 beats/min; stroke volume from 121 +/- 3% to 54 +/- 5%; and ejection fraction (EF) from 49 +/- 3% to 37 +/- 5%. End-systolic volume decreased from 118 +/- 4% at rest, reached its minimal value of 94 +/- 5% at a rate of 120 beats/min and then increased slightly to 106 +/- 9% at 160 beats/min. Cardiac output and blood pressure did not change significantly. Compared to the control group of 10 normal subjects, the patients had a significantly smaller decrease in end-diastolic volume and end-systolic volume than in normal control subjects. EF in the normal subjects did not change. Blood pressure, cardiac output and stroke volume were similar in both groups. Atrial pacing tachycardia induced reversible ventricular dysfunction with a decrease in EF. Stroke volume was maintained because of relative ventricular dilatation.

  4. Polymorphisms of the tumor suppressor gene LSAMP are associated with left main coronary artery disease.

    PubMed

    Wang, L; Hauser, E R; Shah, S H; Seo, D; Sivashanmugam, P; Exum, S T; Gregory, S G; Granger, C B; Haines, J L; Jones, C J H; Crossman, D; Haynes, C; Kraus, W E; Freedman, N J; Pericak-Vance, M A; Goldschmidt-Clermont, P J; Vance, J M

    2008-07-01

    Previous association mapping on chromosome 3q13-21 detected evidence for association at the limbic system-associated membrane protein (LSAMP) gene in individuals with late-onset coronary artery disease (CAD). LSAMP has never been implicated in the pathogenesis of CAD. We sought to thoroughly characterize the association and the gene. Non-redundant single nucleotide polymorphisms (SNPs) across the gene were examined in an initial dataset (168 cases with late-onset CAD, 149 controls). Stratification analysis on left main CAD (N = 102) revealed stronger association, which was further validated in a validation dataset (141 cases with left main CAD, 215 controls), a third control dataset (N = 255), and a family-based dataset (N = 2954). A haplotype residing in a novel alternative transcript of the LSAMP gene was significant in all independent case-control datasets (p = 0.0001 to 0.0205) and highly significant in the joint analysis (p = 0.00004). Lower expression of the novel alternative transcript was associated with the risk haplotype (p = 0.0002) and atherosclerosis burden in human aortas (p = 0.0001). Furthermore, silencing LSAMP expression in human aortic smooth muscle cells (SMCs) substantially augmented SMC proliferation (p<0.01). Therefore, the risk conferred by the LSAMP haplotype appears to be mediated by LSAMP down-regulation, which may promote SMC proliferation in the arterial wall and progression of atherosclerosis.

  5. Myocardial strain may be useful in differentiating Takotsubo cardiomyopathy from left anterior descending coronary artery ischemia.

    PubMed

    Cai, LiYing; Addetia, Karima; Medvedofsky, Diego; Spencer, Kirk T

    2017-03-01

    Stress-induced cardiomyopathy (SCM) is characterized by transient apical wall motion abnormalities of the left ventricle (LV) in the absence of obstructive coronary artery disease. Although the echocardiographic findings of SCM mimic those of left anterior descending coronary artery ischemia or infarction (LAD), the regional LV wall motion pattern and degree of RV involvement may differ. We sought to systematically assess regional LV and RV function with myocardial strain imaging to assess if ventricular involvement may differ between SCM and LAD. This was a retrospective cohort study, with 3 groups: patients with SCM (n=55), patients with LAD (n=36), and 37 normal subjects. All the patients had a comprehensive transthoracic echocardiographic examination, including assessment of longitudinal strain (LS). Global LV longitudinal strain was markedly decreased in both the SCM and LAD groups. However, SCM patients differed by more severe involvement the mid-inferolateral, mid-inferior, apical-lateral, and apical-inferior segments. When compared to the LAD patients, SCM patients had significantly more RV involvement both visually and quantitatively (27-42% versus 0-25%). Predictors of SCM included visually reduced RV systolic function, abnormal TAPSE, RVS' and RV LS in the apical segment. Of the LV variables, regional LS in the mid-inferior and apical-inferior segments could differentiate the groups. Our results suggest that RV involvement and the pattern of LV regional LS abnormalities may help differentiate SCM from LAD disease during echocardiographic imaging. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Two problems and a single solution: Covered stent implantation to close an anterograde pulmonary flow and treat hypoplastic left pulmonary artery after Fontan operation.

    PubMed

    Butera, Gianfranco; Taha, Fatma

    2016-05-01

    Several issues may impact on the function of a Fontan circulation including accessory source of pulmonary blood flow and pulmonary artery anatomy. Here we report on a 5.5-year-old boy who showed failing Fontan circulation due to left pulmonary artery stenosis/hypoplasia and significant forward pulmonary blood flow through the native pulmonary artery. Successful implantation of a 34-mm CP covered stent in the left pulmonary artery in a Fontan patient was useful for simultaneous successful treatment of residual antegrade flow from the systemic ventricle to the pulmonary artery and enlargement of hypoplastic left pulmonary artery. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.

  7. Partial Portal Vein Arterialization Attenuates Acute Bile Duct Injury Induced by Hepatic Dearterialization in a Rat Model

    PubMed Central

    Wei, Jishu; Wu, Junli; Gao, Wentao; Li, Qiang; Jiang, Kuirong

    2016-01-01

    Hepatic infarcts or abscesses occur after hepatic artery interruption. We explored the mechanisms of hepatic deprivation-induced acute liver injury and determine whether partial portal vein arterialization attenuated this injury in rats. Male Sprague-Dawley rats underwent either complete hepatic arterial deprivation or partial portal vein arterialization, or both. Hepatic ischemia was evaluated using biochemical analysis, light microscopy, and transmission electron microscopy. Hepatic ATP levels, the expression of hypoxia- and inflammation-associated genes and proteins, and the expression of bile transporter genes were assessed. Complete dearterialization of the liver induced acute liver injury, as evidenced by the histological changes, significantly increased serum biochemical markers, decreased ATP content, increased expression of hypoxia- and inflammation-associated genes and proteins, and decreased expression of bile transporter genes. These detrimental changes were extenuated but not fully reversed by partial portal vein arterialization, which also attenuated ductular reaction and fibrosis in completely dearterialized rat livers. Collectively, complete hepatic deprivation causes severe liver injury, including bile infarcts and biloma formation. Partial portal vein arterialization seems to protect against acute ischemia-hypoxia-induced liver injury. PMID:27872855

  8. Computer Modeling of Yttrium-90-Microsphere Transport in the Hepatic Arterial Tree to Improve Clinical Outcomes

    SciTech Connect

    Kennedy, Andrew S.; Kleinstreuer, Clement; Basciano, Christopher A.; Dezarn, William A.

    2010-02-01

    Purpose: Radioembolization (RE) via yttrium-90 ({sup 90}Y) microspheres is an effective and safe treatment for unresectable liver malignancies. However, no data are available regarding the impact of local blood flow dynamics on {sup 90}Y-microsphere transport and distribution in the human hepatic arterial system. Methods and Materials: A three-dimensional (3-D) computer model was developed to analyze and simulate blood-microsphere flow dynamics in the hepatic arterial system with tumor. Supplemental geometric and flow data sets from patients undergoing RE were also available to validate the accuracy of the computer simulation model. Specifically, vessel diameters, curvatures, and branching patterns, as well as blood flow velocities/pressures and microsphere characteristics (i.e., diameter and specific gravity), were measured. Three-dimensional computer-aided design software was used to create the vessel geometries. Initial trials, with 10,000 noninteracting microspheres released into the hepatic artery, used resin spheres 32-{mu}m in diameter with a density twice that of blood. Results: Simulations of blood flow subject to different branch-outlet pressures as well as blood-microsphere transport were successfully carried out, allowing testing of two types of microsphere release distributions in the inlet plane of the main hepatic artery. If the inlet distribution of microspheres was uniform (evenly spaced particles), a greater percentage would exit into the vessel branch feeding the tumor. Conversely, a parabolic inlet distribution of microspheres (more particles around the vessel center) showed a high percentage of microspheres exiting the branch vessel leading to the normal liver. Conclusions: Computer simulations of both blood flow patterns and microsphere dynamics have the potential to provide valuable insight on how to optimize {sup 90}Y-microsphere implantation into hepatic tumors while sparing normal tissue.

  9. Dynamic Viscoelasticity and Surface Properties of Porcine Left Anterior Descending Coronary Arteries.

    PubMed

    Burton, Hanna E; Freij, Jenny M; Espino, Daniel M

    2017-03-01

    The aim of this study was, for the first time, to measure and compare quantitatively the viscoelastic properties and surface roughness of coronary arteries. Porcine left anterior descending coronary arteries were dissected ex vivo. Viscoelastic properties were measured longitudinally using dynamic mechanical analysis, for a range of frequencies from 0.5 to 10 Hz. Surface roughness was calculated following three-dimensional reconstructed of surface images obtained using an optical microscope. Storage modulus ranged from 14.47 to 25.82 MPa, and was found to be frequency-dependent, decreasing as the frequency increased. Storage was greater than the loss modulus, with the latter found to be frequency-independent with a mean value of 2.10 ± 0.33 MPa. The circumferential surface roughness was significantly greater (p < 0.05) than the longitudinal surface roughness, ranging from 0.73 to 2.83 and 0.35 to 0.92 µm, respectively. However, if surface roughness values were corrected for shrinkage during processing, circumferential and longitudinal surface roughness were not significantly different (1.04 ± 0.47, 0.89 ± 0.27 µm, respectively; p > 0.05). No correlation was found between the viscoelastic properties and surface roughness. It is feasible to quantitatively measure the viscoelastic properties of coronary arteries and the roughness of their endothelial surface.

  10. Vortex formation and recirculation zones in left anterior descending artery stenoses: computational fluid dynamics analysis

    NASA Astrophysics Data System (ADS)

    Katritsis, D. G.; Theodorakakos, A.; Pantos, I.; Andriotis, A.; Efstathopoulos, E. P.; Siontis, G.; Karcanias, N.; Redwood, S.; Gavaises, M.

    2010-03-01

    Flow patterns may affect the potential of thrombus formation following plaque rupture. Computational fluid dynamics (CFD) were employed to assess hemodynamic conditions, and particularly flow recirculation and vortex formation in reconstructed arterial models associated with ST-elevation myocardial infraction (STEMI) or stable coronary stenosis (SCS) in the left anterior descending coronary artery (LAD). Results indicate that in the arterial models associated with STEMI, a 50% diameter stenosis immediately before or after a bifurcation creates a recirculation zone and vortex formation at the orifice of the bifurcation branch, for most of the cardiac cycle, thus allowing the creation of stagnating flow. These flow patterns are not seen in the SCS model with an identical stenosis. Post-stenotic recirculation in the presence of a 90% stenosis was evident at both the STEMI and SCS models. The presence of 90% diameter stenosis resulted in flow reduction in the LAD of 51.5% and 35.9% in the STEMI models and 37.6% in the SCS model, for a 10 mmHg pressure drop. CFD simulations in a reconstructed model of stenotic LAD segments indicate that specific anatomic characteristics create zones of vortices and flow recirculation that promote thrombus formation and potentially myocardial infarction.

  11. A Combination of Two Rare Coronary Anomalies Makes It Even Rarer: Right Sided Single Coronary Artery with Dual Left Anterior Descending Artery

    PubMed Central

    Addai, Theodore; Kola, Monahar; Raqeem, Muhammad Wajih; Barsamyan, Sergey; Mirrakhimov, Aibek E.

    2016-01-01

    An 82-year-old female with history of hyperlipidemia and hypertension presented to the clinic with chief complaint of nonradiating chest tightness accompanied by exertional dyspnea. Cardiac catheterization showed the absence of left coronary system; the entire coronary system originated from the right aortic sinus as a common trunk which then gave off the right coronary artery and the left main coronary artery. Cardiac catheterization demonstrated also another rare coronary anomaly: dual left anterior descending artery. Patient underwent percutaneous coronary intervention and subsequent multidetector computed tomography angiography confirmed the above angiography findings. Patient was subsequently discharged home on double antiplatelet therapy with aspirin and clopidogrel and has been asymptomatic since then. PMID:27293909

  12. Left ventricular dysfunction causing ischemia in patients with patent coronary arteries.

    PubMed

    Nguyen, Thach; Do, Hoang; Pham, Tri; Vu, Loc T; Zuin, Marco; Rigatelli, Gianluca

    2017-08-01

    New onset of heart failure (HF) is an indication for the assessment of coronary artery disease. The aim of this study was to clarify the mechanistic causes of new onset HF associated with ischemic electrocardiograph (EKG) changes and chest pain in patients with patent or minimally diseased coronary arteries. Twenty consecutive patients (Group A) were retrospectively reviewed if they had an history of new onset of HF, chest pain, electrocardiographic changes indicating ischemia (ST depression or T wave inversion in at least two consecutive leads and a negative coronary angiogram [CA]) and did not require percutaneous coronary intervention or coronary artery bypass grafting. A 1:1 matched cohort (Group B) was adopted to validate the results. All patients had a negative CA. The majority of subjects in Group A had a higher left ventricular end diastolic pressure (LVEDP) when compared to the control group (p<0.05). Similarly, the aortic diastolic (AOD) pressure was lower in Group A than in Group B (p<0.05). In patients with elevated LVEDP and low AOD, with a coronary perfusion pressure (CPP) <20 mmHg, deep T wave inversion in two consecutive leads were more frequently observed. When the CPP was between 20-30 mmHg, a mild ST depression were more frequently recorded (p<0.05). Conversely, when the CPP was >30 mmHg, only mild non-specific ST-T changes or normal EKG were observed. In patients with HF and EKG changes suggestive of ischemia in at least two consecutive leads, a lower AOD could aggravate ischemia in patients with elevated left ventricular end diastolic pressure.

  13. Echocardiographic detection of free-floating thrombus in left ventricle during coronary artery bypass grafting

    PubMed Central

    Vaggar, Jagadeesh N.; Gadhinglajkar, Shrinivas; Pillai, Vivek; Sreedhar, Rupa; Cahndran, Roshith; Roy, Suddhadeb

    2015-01-01

    We report an incident of detection of a free-floating thrombus in the left ventricle (LV) using intraoperative two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) during proximal coronary artery bypass graft anastomosis. A 58-year-old man presented to us with a 6-month history of chest pain without any history suggestive of myocardial infarction or transient ischemic attacks. His preoperative echocardiography revealed the systolic dysfunction of LV, mild hypokinesia of basal and mid-anterior wall, and the absence of an aneurysm. He was scheduled for on-pump coronary artery bypass surgery. On intraoperative TEE before establishing cardiopulmonary bypass (CPB), a small immobile mass was found attached to LV apical area. After completion of distal coronary artery grafting, when the aortic cross-clamp was removed, the heart was filled partially and beating spontaneously. TEE examination using 2D mode revealed a free-floating mass in the LV, which was suspected to be a thrombus. Additional navigation using biplane and 3D modes confirmed the presence of the thrombus and distinguished it from papillary muscles and artifact. The surgeon opened the left atrium after re-establishing electromechanical quiescence and removed a thrombus measuring 1.5 cm × 1 cm from the LV. The LV mass in the apical region was no longer seen after discontinuation of CPB. Accurate TEE-detection and timely removal of the thrombus averted disastrous embolic complications. Intraoperative 2D and recent biplane and 3D echocardiography modes are useful monitoring tools during the conduct of CPB. PMID:26440248

  14. [Occupational stress as a factor of left ventricular myocardial remodeling in people with normal arterial pressure].

    PubMed

    Sorokin, A V; Prazdnov, A S; Korovina, O V

    2007-01-01

    The authors studied correlations between occupational stress, caused by high tension at work, and disturbances in 24-hour arterial pressure (AP), lipid level, and left ventricular (LM) myocardial remodeling in locomotive engineers with normal AP. Two hundred and five locomotive engineers with NAP (according to 2004 classification by Russian Scientific Society of Cardiologists) aged 20 to 45 years were included in this cross-sectional study; the subjects present a whole sample of the locomotive crew of Chelyabinsk railway station. The control group consisted of III persons working eight fixed working hours a day whose work was not associated with high tension (turners and metalworkers). The examination of the both groups included bifunctional 24-hour AP and ECG monitoring during the subjects'days off, Echo CG, measurement of blood lipids, and measurement of table salt sensitivity threshold. Also evaluated were the prevalence of horizontal and vertical family background of arterial hypertension, excessive body weight, hypokinesia, and smoking. The study demonstrated that the prevalence of the chief factors of chronic non-infectious diseases as well as the values of office and 24-hour systolic and diastolic arterial pressure (SAD; DAD) were the same in both groups. At the same time, the locomotive engineers with normal AP had unfavorable hemodynamic AP profile (24-hour SAD index (p = 0.008) was lower indicating insufficient SAD decrease at night; the speed of morning SAD and DAD increase was elevated 1.5 to 2 times; heart rate was higher as well) which can be considered signs of hypersympathicotonia. By comparison with the controls, the locomotive engineers had more pronounced morphofunctional changes in the left ventricular (LV), myocardium; LV mass was greater, and LV myocardial hypertrophy was more frequent in this group (17.9 and 1.8%, respectively). The data demonstrate the contribution of occupational stress-related non-hemodynamic factors to myocardial

  15. [A case of double cancer of gastric and hepatocellular carcinoma associated with cirrhosis treated by hepatic resection after intra-hepatic arterial infusion chemotherapy].

    PubMed

    Une, Y; Nagabuchi, E; Ogasawara, K; Kamiyama, T; Sato, Y; Kawamukai, Y; Sato, N; Nakajima, Y; Uchino, J

    1990-08-01

    A case of double cancer, early gastric cancer and hepatocellular carcinoma, was reported. The patient was diabetic and had liver cirrhosis. After gastrectomy for gastric cancer which was hemorrhagic, he was treated by intra-hepatic arterial infusion chemotherapy followed by hepatic resection. Histopathologically, about half of the main tumor showed necrosis, but very viable new cancer cell nests were seen around the main nodule. The patient is in good condition without recurrence of hepatic lesion 1 year after resection. The usefulness of arterial infusion chemotherapy was demonstrated in the case of double cancer, in which it is difficult to resect both cancers simultaneously.

  16. Acute Increase in Hepatic Arterial Flow During TIPS Identified by Intravascular Flow Measurements

    SciTech Connect

    Radeleff, Boris Sommer, Christof-Matthias; Heye, Tobias; Lopez-Benitez, Ruben; Sauer, Peter; Schmidt, Jan; Kauczor, Haus-Ulrich; Richter, Goetz Martin

    2009-01-15

    The purpose of this study was to investigate alterations of hepatic arterial flow during transjugular intrahepatic portosystemic stent shunt (TIPS) applying intravascular Doppler sonography. This prospective monocenter study included 25 patients with liver cirrhosis (alcohol induced [n = 19], chronic hepatitis associated [n = 3], primary biliary cirrhosis associated [n = 1], and cryptogenic [n = 2]) successfully treated with TIPS. All patients underwent intravascular hepatic arterial flow measurements during TIPS using an endoluminal flow sensor. The average arterial peak velocity (APV) and the maximum arterial peak velocity (MPV) were registered. Twenty-two patients (88%) showed increased APV, one patient (4%) showed unaffected APV, and two patients (8%) showed decreased APV after TIPS. The average portosystemic pressure gradient decreased significantly, from 22.0 {+-} 5.1 mmHg before TIPS to 11.0 {+-} 4.1 mmHg after TIPS (-50.0%; p < 0.0001). The average APV increased significantly, from 41.9 {+-} 17.8 cm/s before TIPS to 60.7 {+-} 19.0 cm/s after TIPS (+44.9%; p < 0.0001). The average MPV increased significantly, from 90.8 {+-} 31.7 cm/s before TIPS to 112.6 {+-} 34.9 cm/s after TIPS (+24.0%; p = 0.0002). These changes in perfusion set in within seconds after TIPS tract formation in all the patients with increased APV. We conclude that TIPS-induced portosystemic decompression leads to a significant increase in hepatic arterial flow. The changes occurred within seconds, suggesting a reflex-like mechanism.

  17. [Superselective fibrinolysis for a middle cerebral artery embolism caused by a left atrial myxoma: case report].

    PubMed

    Yamanome, T; Yoshida, K; Miura, K; Ogawa, A

    2000-07-01

    A case of successful treatment by local fibrinolysis of a middle cerebral artery embolism caused by a thrombus from a left atrial myxoma is reported. A 62-year-old woman using a pacemaker and suffering from sick sinus syndrome was admitted on December 29th 1996, complaining of transient restlessness. CT and cerebral angiography revealed no abnormal vascular lesions. Eighteen months after the initial episode, she suffered a sudden onset of left hemiparesis and loss of consciousness. CT scan performed during the second episode revealed no lesions and, in particular, no early CT infarction sign, but emergent cerebral angiography revealed a right middle cerebral artery embolic occlusion. Local fibrinolysis using a tissue plasminogen activator was performed within 3 hours after the beginning of the episode, and partial recanalization was obtained within one hour after initiation of the fibrinolytic therapy. On the first hospital day, though CT revealed a small low-density area in the right basal ganglia, motor deficits gradually improved. Considering the possibility of a cardiac source of the embolism, trans-esophageal echocardiography was performed and revealed a left atrial tumor suspected to be a myxoma. It was removed by surgery on the 34th hospital day. Histological examination proved it to be a myxoma. Nine months after local fibrinolytic therapy, the patient returned to work. The diagnosis of cerebral embolism caused by cardiac myxoma is difficult to make at the time when the patient is first examined after admission. It is also hard to discover during emergent cerebral angiography with fibrinolytic therapy. Therefore, in the case of patients with cerebral embolism for which local fibrinolysis is ineffective, it should be presumed that cardiac myxoma is the source of the embolus. Direct PTA alone may be effective for such tumoral embolism.

  18. Correlation of coronary artery stenosis evaluation with left heart structure and function by multi-slice computed tomography.

    PubMed

    Song, L N; Cao, A D; Niu, Y J; Liu, N

    2014-08-07

    The aim of this study was to determine the impact of multi-slice computed tomography (MSCT) evaluation of coronary artery stenosis on left heart structure and systolic function. Coronary artery CT angiography was performed in 200 patients diagnosed with coronary heart disease, and then according to the AHA coronary artery 17-segment fractionation method, the Gensini score (GS) was determined for every narrow segment, and one-stop assessment of the correlation between left heart structure and function was performed. After the grouping of GS quartiles from low to high, there were differences between different patients with regard to LVDD, LADD, LVEDV, LVESV, MM, LVEF, and FS, while no difference in SV and CO. GS showed linear negative correlation with LVEF and FS, and linear positive correlation with LVDD, LADD, LVEDV, LVESV, and MM, while no correlation with SV and CO. That is, GS of coronary artery stenosis was negatively correlated with left ventricular systolic function and positively correlated with myocardial mass. The narrower the coronary artery, the worse the cardiac function and the higher the myocardial hypertrophy. Coronary artery stenosis was one of the important causes of the decrease in left ventricular systolic function and cardiac remodeling.

  19. Arterial Stiffness Is Significantly Associated With Left Ventricular Diastolic Dysfunction in Patients With Cardiovascular Disease.

    PubMed

    Namba, Takayuki; Masaki, Nobuyuki; Matsuo, Yuki; Sato, Atsushi; Kimura, Toyokazu; Horii, Shunpei; Yasuda, Risako; Yada, Hirotaka; Kawamura, Akio; Takase, Bonpei; Adachi, Takeshi

    2016-12-02

    Left ventricular (LV) diastolic dysfunction is considered the main cause of heart failure with preserved ejection fraction (HFpEF). There have been few reports on the correlation between LV diastolic dysfunction and arterial stiffness in patients with clinical cardiovascular disease.This cross-sectional study enrolled 100 patients (67 men, 33 women; mean age, 70 years). All participants were diagnosed with cardiovascular disease. A total of 89 (89%) patients had coronary artery disease or HF. Patients with reduced EF and valvular disease were excluded. Arterial stiffness was assessed by the cardio-ankle vascular index (CAVI), and LV diastolic dysfunction was estimated using echocardiography. The patients were divided into two groups based on the median value of CAVI. In all patients the ratio of early diastolic transmitral flow velocity to early diastolic mitral annular velocity (E/e') was significantly higher in the high CAVI group than in the low CAVI group (15.5 ± 6.4 versus 12.5 ± 2.9, P = 0.003). In the HF subgroup, E/e' was also significantly higher in the high CAVI group than in the low CAVI group (17.2 ± 5.9 versus 13.0 ± 3.1, P = 0.026). In univariate regression analysis, CAVI was significantly associated with E/e' in all patients (β = 0.28, P = 0.004) and in HF patients (β = 0.4, P = 0.028). Also in multivariate analysis, CAVI remained as an independent predictive factor of E/e' (β = 0.252, P = 0.037).A high CAVI was independently associated with LV diastolic dysfunction in patients with clinical cardiovascular disease. These results suggested that arterial stiffness contributed to the development of LV diastolic dysfunction.

  20. Detection of Helicobacter pylori DNA in Aortic and Left Internal Mammary Artery Biopsies

    PubMed Central

    Iriz, Erkan; Cirak, Meltem Yalinay; Engin, Evren Doruk; Zor, Mustafa Hakan; Erer, Dilek; Ozdogan, Mehmet Emin; Turet, Sevgi; Yener, Ali

    2008-01-01

    We investigated the relationship between acute coronary ischemia and the presence of Helicobacter pylori DNA in aortic regions that were absent macroscopic atheromatous plaques. The study group (Group 1) consisted of 42 patients who underwent coronary artery bypass grafting. Biopsy samples were obtained from 2 different locations: from regions of the aorta that were free (macroscopically) of atheromatous plaque (Group 1A), and from the internal mammary artery (Group 1B). The control group (Group 2) of 10 patients who had no atherosclerotic vascular disease provided aortic tissue samples for comparison. The real-time polymerase chain reaction method was used to detect H. pylori DNA in all biopsy samples. Eleven of 42 aortic tissue samples (26%) in Group 1A were positive for H. pylori DNA. Neither biopsies from the left internal mammary arteries of those patients nor biopsies from the aortas of the control group (Group 2) were positive for H. pylori DNA. There was a statistically significant difference between 1A and 1B in terms of H. pylori positivity (P=0.001). In Group 1 as a whole, acute coronary ischemia was more prevalent in the H. pylori-positive patients than in the H. pylori-negative patients (P=0.001). To our knowledge, this is the 1st study to investigate the detection of H. pylori DNA in aortic biopsy samples that are macroscopically free of atheromatous plaque. Such detection in patients who have atherosclerotic coronary artery disease could be an important indication of the role of microorganisms in the pathogenesis of atherosclerosis. PMID:18612444

  1. Left-Sided Reoperations After Arterial Switch Operation: A European Multicenter Study.

    PubMed

    Vida, Vladimiro L; Zanotto, Lorenza; Zanotto, Lucia; Stellin, Giovanni; Padalino, Massimo; Sarris, Georges; Protopapas, Eleftherios; Prospero, Carol; Pizarro, Christian; Woodford, Edward; Tlaskal, Thomas; Berggren, Hakan; Kostolny, Martin; Omeje, Ikenna; Asfour, Boulos; Kadner, Alexander; Carrel, Thierry; Schoof, Paul H; Nosal, Matej; Fragata, Josè; Kozłowski, Michał; Maruszewski, Bohdan; Vricella, Luca A; Cameron, Duke E; Sojak, Vladimir; Hazekamp, Mark; Salminen, Jukka; Mattila, Ilkka P; Cleuziou, Julie; Myers, Patrick O; Hraska, Viktor

    2017-09-01

    We sought to report the frequency, types, and outcomes of left-sided reoperations (LSRs) after an arterial switch operation (ASO) for patients with D-transposition of the great arteries (D-TGA) and double-outlet right ventricle (DORV) TGA-type. Seventeen centers belonging to the European Congenital Heart Surgeons Association (ECHSA) contributed to data collection. We included 111 patients who underwent LSRs after 7,951 ASOs (1.4%) between January 1975 and December 2010. Original diagnoses included D-TGA (n = 99) and DORV TGA-type (n = 12). Main indications for LSR were neoaortic valve insufficiency (n = 52 [47%]) and coronary artery problems (CAPs) (n = 21 [19%]). Median age at reoperation was 8.2 years (interquartile range [IQR], 2.9-14 years). Seven patients died early after LSRs (6.3%); 4 patients with D-TGA (5.9%) and 3 patients with DORV TGA-type (25%) (p = 0.02). Median age at last follow-up was 16.1 years (IQR, 9.9-21.8 years). Seventeen patients (16%) required another reoperation, which was more frequent in patients with DORV- TGA type (4 of 9 [45%]) than in patients with D-TGA (13 of 95 [14%]). Late death occurred in 4 patients (4 of 104 [3.8%]). The majority of survivors were asymptomatic at last clinical examination (84 of 100 [84%]). Reoperations for residual LSRs are infrequent but may become necessary late after an ASO, predominantly for neoaortic valve insufficiency and CAPs. Risk at reoperation is not negligible, and DORV TGA-type anatomy, as well as procedures on the coronary arteries, were significantly associated with a higher morbidity and a lower overall survival. Recurrent reoperations after LSRs may be required. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Prognosis after acute coronary syndrome in relation with ventricular-arterial coupling and left ventricular strain.

    PubMed

    Milewska, Agata; Minczykowski, Andrzej; Krauze, Tomasz; Piskorski, Jarosław; Heathers, James; Szczepanik, Adam; Banaszak, Agnieszka; Guzik, Przemyslaw; Wykretowicz, Andrzej

    2016-10-01

    The value of modern non-invasive indices of the left ventricle (LV) and arterial system function, and their interaction for determining prognosis in contemporarily treated patients with acute coronary syndrome (ACS) is not well established. The study aimed to determine the association of ventricular-arterial (VA) coupling, LV global longitudinal peak systolic strain (GLPSS), global strain rate (GSR) and end-diastolic volume at end-diastolic pressure 30mmHg (V30) with long-term clinical outcomes in patients with ACS. Echocardiography was applied in 569 ACS patients followed up for >12months after hospitalization. Univariate Cox proportional hazard regression models adjusted to various clinical factors, including reduced LV ejection fraction <40%, were used to compare patients between the first and third tertiles of various indices of LV and arterial systems function and their interaction for the prediction of a combined end-point (defined as either stroke, myocardial infarction or death). Results are presented as hazard ratio (HR) with 95% confidence interval (CI). There were 57 clinical outcomes during a median follow-up of 625days. Increased VA coupling >1.68 (HR 2.4; 95% CI: 1.04-5.6); V30>107mL (HR 4.5; 95% CI: 1.9-10.6), GLPSS > -12.8% (HR 2.4; 95% CI: 1.02-5.7), GSR > -0.96 1/s (HR 3.8; 95% CI: 1.6-9.1) were robustly associated with increased hazard. With a sample of contemporarily treated ACS patients, abnormal values of non-invasive indices of LV function and their interaction with arterial system, predict adverse clinical outcomes, independently of LV ejection fraction. Copyright © 2016. Published by Elsevier Ireland Ltd.

  3. Single left coronary ostium and an anomalous prepulmonic right coronary artery in 2 dogs with congenital pulmonary valve stenosis.

    PubMed

    Visser, Lance C; Scansen, Brian A; Schober, Karsten E

    2013-06-01

    A coronary artery anomaly characterized by the presence of a single left coronary ostium with absence of the right coronary ostium and an anomalous prepulmonic right coronary artery course was observed in two dogs with concurrent congenital pulmonary valve stenosis. This unique coronary artery anatomy is similar to the previously described single right coronary ostium with anomalous prepulmonic left coronary artery, the so-called type R2A anomaly, in that an anomalous coronary artery encircles the pulmonary valve annulus. Both dogs of this report, a boxer and an English bulldog, were of breeds known to be at risk for the type R2A anomaly. As such, veterinarians should be aware that the echocardiographic presence of a left coronary ostium in a dog with pulmonary valve stenosis does not exclude the possibility of a prepulmonic coronary artery anomaly that may enhance the risk of complications during balloon pulmonary valvuloplasty. A descriptive naming convention for coronary artery anomalies in dogs is also presented, which may be preferable to the older coding classification scheme.

  4. [Right versus left radial artery approach for coronary angiography. Differences observed and the learning curve].

    PubMed

    Fernández-Portales, Javier; Valdesuso, Raúl; Carreras, Raúl; Jiménez-Candil, Javier; Serrador, Ana; Romaní, Sebastián

    2006-10-01

    There are anatomical differences between right and left radial artery approaches for coronary catheterization that could influence application of the technique. We present the results of a randomized study that compared the effectiveness of the two approaches and identified factors associated with failure of the procedure. The study involved 351 consecutive patients: a left radial approach was used in 180, and a right radial approach, in 171. The procedure could not be completed using the initial approach selected in 15 patients (11 right radial vs. 4 left radial; P=.007). Use of a right radial approach, lack of catheterization experience, patient age >70 years, and the absence of hypertension were found to be independently associated with prolonged fluoroscopy duration and failure using the initial approach. Use of the right radial approach in patients aged over 70 years was associated with a 6-fold increase in the risk of an adverse event. Consequently, use of the right radial approach should be avoided in patients aged over 70 years when trainee practitioners are on the learning curve.

  5. Alterations in echocardiographic left ventricular function after percutaneous coronary stenting in diabetic patients with isolated severe proximal left anterior descending artery stenosis.

    PubMed

    Nabati, Maryam; Taghavi, Morteza; Saffar, Naser; Yazdani, Jamshid; Bagheri, Babak

    There are conflicting theories regarding the use of percutaneous coronary intervention (PCI) of isolated severe proximal left anterior descending (LAD) artery stenosis in place of left internal mammary artery grafting in diabetic patients. The aim of this study was to investigate the effect of PCI on left ventricular function and determine difference between diabetics and non-diabetics. A prospective study was conducted on 50 patients with isolated severe proximal LAD stenosis: 23 diabetic and 27 non-diabetic patients. Successful PCI with everolimus-eluting stents was performed for all of the patients. These patients underwent transthoracic echocardiography within 24h before and 1 month after PCI, and alterations in the left ventricular parameters were compared between the two groups. There was a significant 12% increment in the mitral annular peak systolic velocity (s') (p=0.02), 21% decrement in the trans mitral early filling deceleration time (DT) (p<0.001), 10% decrement in the systolic left ventricular internal dimension (LVIDs) (p=0.002), significant increment in the left ventricular ejection fraction (LVEF) (p=0.004), and significant decrement in the left atrial diameter (p=0.006) in the diabetic patients after performing PCI. Conversely, the non-diabetic patients showed a statistically significant 14% increase in the DT, 6.3% decrease in the s' velocity, 8% increase in the LVIDs, significant increment in the left atrial diameter and no change in LVEF after PCI. Our study demonstrated that everolimus-eluting stents favorably improved the markers of left ventricular systolic and diastolic function in diabetic patients with isolated severe proximal LAD stenosis compared with those of non-diabetic patients with the same condition. Copyright © 2016. Published by Elsevier B.V.

  6. Percutaneous Coronary Intervention versus Coronary Artery Bypass Grafting in Patients with Diabetic Nephropathy and Left Main Coronary Artery Disease

    PubMed Central

    Li, Hsin-Ru; Hsu, Chiao-Po; Sung, Shih-Hsien; Shih, Chun-Che; Lin, Shing-Jong; Chan, Wan-Leong; Wu, Cheng-Hsueh; Lu, Tse-Min

    2017-01-01

    Background Patients with diabetic nephropathy and unprotected left main (LM) coronary artery disease suffer from high cardiovascular morbidity and mortality. Although surgical revascularization is currently recommended in this special patient population, the optimal revascularization method for this distinct patient group has remained unclear. Methods We collected 99 consecutive patients with unprotected LM disease and diabetic nephropathy, including 46 patients who had undergone percutaneous coronary intervention (PCI), and 53 who had coronary artery bypass grafting (CABG), with a mean age of 72 ± 10; with 80.8% male. Diabetic nephropathy was defined as overt proteinuria (proteinuria > 500 mg/day) and estimated glomerular filtration rate (eGFR) by the modified Modification of Diet in Renal Disease (MDRD) equation of less than 60 mL/min/1.73 m2. The baseline characteristics, angiographic results and long-term clinical outcomes were retrospectively analyzed. Results The baseline characteristic of all patients were similar except for smokers, low density lipoprotein (LDL) level and extension of coronary artery disease involvement. The median follow-up period was 3.8 years. There were 73 patients (74%) considered as high risk with additive European System for Cardiac Operative Risk Evaluation (EuroSCORE) ≥ 6. During follow-up period, the long term rate of all-cause death (PCI vs. CABG: 45.7% vs. 58.5%, p = 0.20) and all-cause death/myocardial infarction (MI)/stroke (PCI vs. CABG: 52.2% vs. 60.4%, p = 0.41) were comparable between the PCI and CABG group, whereas the repeat revascularization rate was significantly higher in the PCI group (PCI vs. CABG: 32.6% vs. 9.4%, p < 0.01). eGFR remained an independent predictor for all-cause death [hazard ratio: 0.97, 95% confidence interval: 0.96 to 0.99; p = 0.002] in multivariate logistic regression. Conclusions In the real-world practice of high-risk patients with unprotected LM disease and diabetic nephropathy, we found

  7. Endovascular Treatment of Pseudoaneurysm of the Common Hepatic Artery with Intra-aneurysmal Glue (N-Butyl 2-Cyanoacrylate) Embolization

    SciTech Connect

    Garg, Ashwin Banait, Swati; Babhad, Sudeep; Kanchankar, Niraj; Nimade, Pradeep; Panchal, Chintan

    2007-09-15

    A 40-year-old man, a chronic alcoholic, presented with acute epigastric pain. Selective celiac arteriography showed a pseudoaneurysm arising from the common hepatic artery. We hereby describe a technical innovation where complete pseudoaneurysm exclusion was seen after intra-aneurysmal N-butyl 2-cyanoacrylate (glue) injection with preservation of antegrade hepatic arterial flow and conclude that intra-aneurysmal liquid injection may have potential as a therapeutic option to reconstruct a defective vessel wall and thereby maintain the antegrade flow.

  8. Stenting of "unprotected" left main coronary artery stenoses: early and late results

    PubMed Central

    Laruelle, C; Brueren, G; Ernst, S; Bal, E; Mast, G; Suttorp, M; de la Riviere, A B.; Plokker, T

    1998-01-01

    Objective—To assess short and long term efficacy of coronary stent implantation for unprotected left main coronary artery stenosis.
Design—Retrospective follow up study.
Setting—Tertiary referral centre for interventional cardiology and cardiac surgery.
Patients—Eighteen consecutive patients (12 men; age 70.8 years) between May 1993 and July 1996. Ten patients presented with stable angina and underwent the procedure electively, eight patients presented either with unstable angina or myocardial infarction and underwent the procedure in emergency.
Intervention—Johnson and Johnson Palmaz-Schatz stents were used in 16 patients, and a Microstent and a Gianturco-Roubin in one patient each. An intra-aortic balloon pump was prophylactively used for two patients in the elective group. In the acute group, six required an intra-aortic balloon pump.
Main outcome measures—Procedural success rate and major adverse cardiac events.
Results—Successful stent implantation was achieved in all patients. In the elective group, no major adverse cardiac event occurred during the procedure, but one patient had to undergo repeated angioplasty before discharge. All patients of the elective group were discharged alive and there has been one non-cardiac death during a follow up of (mean (SD)) 10 (4) months. In the emergency group, one patient died during the procedure, one patient developed a non Q-wave myocardial infarction, one patient underwent emergency coronary bypass surgery, while another patient died suddenly before hospital discharge. Six patients of the emergency group were discharged alive and there has been one non-cardiac death during a follow up of 7 (4) months.
Conclusions—Elective stent implantation for unprotected left main coronary artery stenosis is safe and effective in selected stable patients. Urgent stent implantation, however, cannot be considered as a definitive procedure in emergency situation.

 Keywords: stent;  left main

  9. Phase I Study of Hepatic Arterial Melphalan Infusion and Hepatic Venous Hemofiltration Using Percutaneously Placed Catheters in Patients With Unresectable Hepatic Malignancies

    PubMed Central

    Pingpank, James F.; Libutti, Steven K.; Chang, Richard; Wood, Bradford J.; Neeman, Ziv; Kam, Anthony W.; Figg, William D.; Zhai, Souping; Beresneva, Tatiana; Seidel, Geoffrey D.; Alexander, H. Richard

    2008-01-01

    Purpose We conducted a phase I study of a 30-minute hepatic artery infusion of melphalan via a percutaneously placed catheter and hepatic venous hemofiltration using a double balloon catheter positioned in the retrohepatic inferior vena cava to shunt hepatic venous effluent through an activated charcoal filter and then to the systemic circulation. The purpose of the study was to demonstrate feasibility in an initial cohort and subsequently determine the maximum tolerated dose and dose-limiting toxicity of melphalan. Patients and Methods The initial cohort (n = 12) was treated with 2.0 mg/kg of melphalan before dose escalation to 3.5 mg/kg (n = 16). Total hepatic drug delivery, systemic levels, and percent filter efficiency were determined. Patients were assessed for hepatic and systemic toxicity and response. Results A total of 74 treatments were administered to 28 patients. Twelve patients with primary and metastatic hepatic tumors received 30 treatments (mean, 2.5 per patient) at an initial melphalan dose of 2.0 mg/kg. At 3.5 mg/kg, a dose-limiting toxicity (neutropenia and/or thrombocytopenia) was observed in two of six patients. Transient grade 3/4 hepatic and systemic toxicity was seen after 19% and 66% of treatments, respectively. An overall radiographic response rate of 30% was observed in treated patients. In the 10 patients with ocular melanoma, a 50% overall response rate was observed, including two complete responses. Conclusion Delivery of melphalan via this system is feasible, with limited, manageable toxicity and evidence of substantial antitumor activity; 3 mg/kg is the maximum safe tolerated dose of melphalan administered via this technique. PMID:15908655

  10. Stent-Graft for the Management of Hepatic Artery Rupture Subsequent to Transcatheter Thrombolysis and Angioplasty in a Liver Transplant Recipient

    SciTech Connect

    Yamakado, Koichiro Nakatsuka, Atsuhiro; Takaki, Haruyuki; Usui, Masanobu; Sakurai, Hiroyuki; Isaji, Shuji; Uemoto, Shinji; Takeda, Kan

    2008-07-15

    Arterial rupture subsequent to angioplasty occurs in about 5% of cases. Thrombolysis with re-establishment of flow without resolving underlying anatomic defects such as hepatic arterial stenosis leads to re-thrombosis. We present a case of arterial anastomotic rupture after thrombolysis and angioplasty of an underlying anastomotic hepatic arterial stenosis. Both the underlying anatomic defect and the rupture were resolved successfully with placement of a stent-graft, with a resultant patent artery for 1 year after the procedure.

  11. Occlusion of a hepatic artery to portal vein fistula with Bucrylate

    SciTech Connect

    Kerlan, R.K. Jr.; Hoddick, W.K.; Pogany, A.C.; Bank, W.O.; Sollenberger, R.D.

    1983-08-01

    A 49-year-old woman with cirrhosis and portal hypertension was evaluated for a portal-systemic shunt procedure following recurrent variceal hemorrhage. The preoperative visceral angiogram demonstrated a hepatic arterial to portal venous fistula, presumably a complication of a previous liver biopsy. The fistula was successfully closed using isobutyl-2-cyanoacrylate (Bucrylate) delivered through a flow-directed, calibrated-leak balloon microcatheter.

  12. Pseudoaneurysms of the Common Hepatic Artery Following Pancreaticoduodenectomy: Successful Emergency Embolization

    SciTech Connect

    Radeleff, Boris Noeldge, Gerd; Heye, Tobias; Schlieter, Martin; Friess, Helmut; Richter, Goetz M.; Kauffmann, Guenter W.

    2007-02-15

    We report a rare case of two communicating pseudoaneurysms of the common hepatic artery 1 month postoperatively following pylorus-preserving pancreaticoduodenectomy due an abscess formation. We describe the superselective transcatheteral embolization technique with deployment of interlocking detachable coils and Histoacryl-Lipiodol in this case and discuss the recent literature. Despite the technical success by achieving hemodynamic stability with initial preservation of liver function, the patient died 23 days postembolization due to multiorgan failure.

  13. Impact of hepatic arterial hemodynamics in predicting early hepatic arterial thrombosis in pediatric recipients younger than three yr after living donor liver transplantation.

    PubMed

    Gu, Lihong; Fang, Hua; Li, Fenghua; Zhang, Shijun; Shen, Conghuan; Han, Longzhi

    2015-05-01

    We used Doppler US to evaluate the changes in hepatic arterial hemodynamics that occur following LDLT in pediatric recipients, with a view to assessing the utility of these parameters in predicting early HAT. A retrospective review of 144 pediatric recipients (73 males, 71 females) who underwent routine Doppler US in the first week after LDLT was undertaken, and changes in hepatic arterial hemodynamics were assessed. The HARI and HAPSV were compared in patients with early HAT (defined as occurring in the first postoperative week) and a control group, and the utility of these parameters in predicting early HAT after LDLT was determined. A total of 11 pediatric recipients experienced early HAT, being diagnosed on average four and a half days after LDLT. HARI and HAPSV values were significantly different between the early HAT group and controls. HARI values <0.6 on the day before the onset of early HAT were able to predict HAT development with a sensitivity of 81.8% and specificity of 95.2%. This provides evidence for routine Doppler US examination in these patients and supports consideration of more intensive anticoagulation in these high-risk patients. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  14. Frequency and potential consequences of origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch.

    PubMed

    Zhang, Junlin; Guileyardo, Joseph M; Roberts, William C

    2016-10-01

    Described herein are findings in a 58-year-old man in whom necropsy disclosed origin of the left vertebral artery (or the arteria thryoidea ima) directly from the aortic arch. No functional consequences resulted. Study of previous publications disclosed the frequency of this anomaly in adults to be approximately 3.5%. Dissection has been reported to be more frequent in the left vertebral artery when it arises directly from the aorta than when it arises from the left subclavian artery.

  15. Percutaneous pulmonary valve implantation in left pulmonary artery branch in a patient with a functional single lung.

    PubMed

    Qureshi, Athar M; Krasuski, Richard A; Prieto, Lourdes R

    2012-09-01

    Percutaneous pulmonary valve technology has had a great impact on patients with congenital and acquired heart disease. In some patients, implantation of a percutaneous pulmonary valve may not be possible due to the morphology of the existing right ventricular outflow tract. In this report, we describe implantation of a Melody transcatheter pulmonary valve in the left pulmonary artery in a patient with acquired right pulmonary artery occlusion and a large right ventricular outflow tract.

  16. Isolated huge aneurysm of the left main coronary artery in a 22-year-old patient with type 1 neurofibromatosis.

    PubMed

    Pontailler, Margaux; Vilarem, Didier; Paul, Jean-François; Deleuze, Philippe H

    2015-03-01

    A 22-year-old patient with neurofibromatosis type 1 presented with acute chest pain. A computed tomography scan and coronary angiography revealed a partially thrombosed huge aneurysm of the left main coronary artery. Despite medical treatment, the patient's angina recurred. The patient underwent a coronary bypass grafting operation and surgical exclusion of the aneurysm. Postoperative imaging disclosed good permeability of the 3 coronary artery bypass grafts and complete thrombosis of the excluded aneurysm.

  17. Primary percutaneous coronary intervention of an anomalous right coronary artery originating from the left sinus of valsalva.

    PubMed

    Conde-Vela, César; Sabaté, Manel; Quevedo, Pilar Jiménez; Hernández-Antolín, Rosana

    2006-01-01

    The presence of an anomalous origin of a coronary artery as the infarct related vessel during primary percutaneous coronary intervention for acute ST elevation myocardial infarction is rare and may present a technical challenge. We reported on a primary coronary percutaneous intervention performed in a right coronary artery originating from the left coronary sinus. The technical tips and tricks of treating congenital coronary anomalies are reviewed.

  18. Everolimus-Eluting Stents or Bypass Surgery for Left Main Coronary Artery Disease.

    PubMed

    Stone, Gregg W; Sabik, Joseph F; Serruys, Patrick W; Simonton, Charles A; Généreux, Philippe; Puskas, John; Kandzari, David E; Morice, Marie-Claude; Lembo, Nicholas; Brown, W Morris; Taggart, David P; Banning, Adrian; Merkely, Béla; Horkay, Ferenc; Boonstra, Piet W; van Boven, Ad J; Ungi, Imre; Bogáts, Gabor; Mansour, Samer; Noiseux, Nicolas; Sabaté, Manel; Pomar, José; Hickey, Mark; Gershlick, Anthony; Buszman, Pawel; Bochenek, Andrzej; Schampaert, Erick; Pagé, Pierre; Dressler, Ovidiu; Kosmidou, Ioanna; Mehran, Roxana; Pocock, Stuart J; Kappetein, A Pieter

    2016-12-08

    Patients with obstructive left main coronary artery disease are usually treated with coronary-artery bypass grafting (CABG). Randomized trials have suggested that drug-eluting stents may be an acceptable alternative to CABG in selected patients with left main coronary disease. We randomly assigned 1905 eligible patients with left main coronary artery disease of low or intermediate anatomical complexity to undergo either percutaneous coronary intervention (PCI) with fluoropolymer-based cobalt-chromium everolimus-eluting stents (PCI group, 948 patients) or CABG (CABG group, 957 patients). Anatomic complexity was assessed at the sites and defined by a Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score of 32 or lower (the SYNTAX score reflects a comprehensive angiographic assessment of the coronary vasculature, with 0 as the lowest score and higher scores [no upper limit] indicating more complex coronary anatomy). The primary end point was the rate of a composite of death from any cause, stroke, or myocardial infarction at 3 years, and the trial was powered for noninferiority testing of the primary end point (noninferiority margin, 4.2 percentage points). Major secondary end points included the rate of a composite of death from any cause, stroke, or myocardial infarction at 30 days and the rate of a composite of death, stroke, myocardial infarction, or ischemia-driven revascularization at 3 years. Event rates were based on Kaplan-Meier estimates in time-to-first-event analyses. At 3 years, a primary end-point event had occurred in 15.4% of the patients in the PCI group and in 14.7% of the patients in the CABG group (difference, 0.7 percentage points; upper 97.5% confidence limit, 4.0 percentage points; P=0.02 for noninferiority; hazard ratio, 1.00; 95% confidence interval, 0.79 to 1.26; P=0.98 for superiority). The secondary end-point event of death, stroke, or myocardial infarction at 30 days occurred in 4.9% of the

  19. [Infarct in the area of the left anterior cerebral artery. II. Language disorders].

    PubMed

    Bogousslavsky, J; Assal, G; Regli, F

    1987-01-01

    Language disturbances and other neuropsychological dysfunctions were evaluated in 10 right-handed patients with left anterior cerebral artery (ACA) infarcts with CT correlation. Transcortical motor aphasia was present in 4 cases, related to involvement of the supplementary motor area (SMA) or the underlying and immediately anterior white matter. In 4 patients with sparing of the SMA but with involvement of the cingulate region, only alterations of verbal memory were found. Sensory or mixed transcortical aphasia was not observed, in any of the patients, including those in whom the supplementary sensory area (SSA) or the underlying white matter were involved, casting doubt upon the presumed receptive role in language function attributed to the SSA by some authors. Buccolingual-facial apraxia was related to subcortical lesions. A callosal disconnection syndrome was uncommon (2 patients) and no hemi-neglect was encountered, even in those cases with cingulate involvement.

  20. Value of non-contrast sequences in magnetic resonance angiography of hepatic arterial vasculature.

    PubMed

    Kalra, Vivek B; Gilbert, John W; Krishnamoorthy, Saravanan; Cornfeld, Daniel

    2014-06-01

    To evaluate value of adding non-contrast MR angiographic sequence (In-Flow Inversion Recovery [IFIR]) to standard fat-suppressed T1-weighted postcontrast sequence (3D spoiled gradient echo [3D-GRE]) for evaluating hepatic arterial anatomy. Retrospective evaluation of 30 consecutive patients undergoing multiphase liver MRI. Individual vessels for IFIR/3D-GRE sequences were evaluated by two blinded readers using a four-point scale. Statistical analysis was performed using the Wilcoxon signed-rank test for vessel conspicuity between IFIR/3D-GRE sequences. IFIR alone diagnostically imaged 8.1% of vessels, 3D-GRE alone 25.8%, 55.8% by both 3D-GRE/IFIR, and 10.3% of vessels by neither. Two patients with variant vascular anatomy were visualized with both sequences. Addition of IFIR to 3D-GRE resulted in statistically significant increase in arterial visualization (p<0.001), 10% relative increase in identified vessels, and 3-5 mi increase in acquisition time for total scan time of 30-35 min. IFIR may be a useful adjunct to 3D-GRE in hepatic angiography without adding considerably to scan time. 10% more hepatic arteries were seen when combining information from IFIR/3D-GRE vs. 3D-GRE alone. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. [A case of DiGeorge syndrome with left internal carotid artery absence probably causing one-and-a-half syndrome].

    PubMed

    Maruyama, Shigeru; Suda, Masashi; Kobayashi, Takehiro

    2012-09-01

    We experienced a case of DiGeorge syndrome with left internal carotid artery absence probably causing one-and-a-half syndrome. MR angiogram demonstrated the apparent absence of the left internal carotid artery and consequently abnormal blood supply to the left middle cerebral artery, which was derived from the basilar artery via the left posterior communicating artery. The patient alsoshowed both an extremely narrow carotid canal on the left side and a very fine vessel extending to the terminal of the left internal carotid artery. Therefore, we regarded this abnormality as severe hypoplasia of left internal carotid artery and supposed that this hypoplasia had originated in maldevelopment of the third aortic arch based on the coexisting lower bifurcation of the right common carotid artery. Since the lesion of one-and-a-half syndrome is restricted to the pontine tegmentum, we speculated that it had resulted from ischemia of the basilar artery area during the embryonic period associated with the absence of the internal carotid artery. To our knowledge, DiGeorge syndrome has never been reported as a complication of internal carotid artery absence. The patient did not demonstrate either chromosome 22q11.2 deletion or TBX1 gene mutation, which is considered the gene responsible for 22q11.2 deletion syndrome. Therefore, the etiology of DiGeorge syndrome in this case remains unclear.

  2. Unexpected cause of cyanosis and dyspnea in an adult: direct communication of the right pulmonary artery and left atrium.

    PubMed

    Kilic, Ismail Dogu; Alihanoglu, Yusuf I; Karabulut, Nevzat; Durna, Fırat; Emrecan, Bilgin

    2014-05-01

    Direct communication of the right pulmonary artery and the left atrium is an extremely rare congenital malformation of the pulmonary vasculature. A 41-year-old woman with a history of cyanosis since childhood presented with mild exertional dyspnea. On physical examination, she had central cyanosis, clubbing of the fingers, and an upright position caused by orthodeoxia. Imaging studies showed a very large aneurysm in the distal right pulmonary artery with a direct communication to the left atrium. The patient underwent successful repair, with resolution of hypoxia and exertional symptoms. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Anomalous left-to-right shunting communication between the ascending aorta and right pulmonary artery in a dog.

    PubMed

    Scollan, Katherine; Salinardi, Brenda; Bulmer, Barret J; Sisson, D David

    2011-06-01

    Anomalies of conotruncal septation are rare in dogs and uncommon in humans. Congenital conotruncal defects most commonly reported in veterinary medicine include aorto-pulmonary window and persistent truncus arteriosus. We report a case of an anomalous vessel connecting the ascending aorta to the right pulmonary artery causing left-to-right shunting, left-sided volume overload, and pulmonary overcirculation. Transesophageal echocardiography, cardiac catheterization, and contrast-enhanced computed tomography assisted in the diagnosis and facilitated the surgical correction of the anomalous vessel. The authors hypothesize this defect represents an unusual anomalous vessel connecting the ascending aorta to the right pulmonary artery.

  4. Stenting of "unprotected" left main coronary artery stenoses: early and late results.

    PubMed

    Laruelle, C J; Brueren, G B; Ernst, S M; Bal, E T; Mast, G E; Suttorp, M J; Brutel de la Rivière, A; Plokker, T H

    1998-02-01

    To assess short and long term efficacy of coronary stent implantation for unprotected left main coronary artery stenosis. Retrospective follow up study. Tertiary referral centre for interventional cardiology and cardiac surgery. Eighteen consecutive patients (12 men; age 70.8 years) between May 1993 and July 1996. Ten patients presented with stable angina and underwent the procedure electively, eight patients presented either with unstable angina or myocardial infarction and underwent the procedure in emergency. Johnson and Johnson Palmaz-Schatz stents were used in 16 patients, and a Microstent and a Gianturco-Roubin in one patient each. An intra-aortic balloon pump was prophylactively used for two patients in the elective group. In the acute group, six required an intra-aortic balloon pump. Procedural success rate and major adverse cardiac events. Successful stent implantation was achieved in all patients. In the elective group, no major adverse cardiac event occurred during the procedure, but one patient had to undergo repeated angioplasty before discharge. All patients of the elective group were discharged alive and there has been one non-cardiac death during a follow up of (mean (SD)) 10 (4) months. In the emergency group, one patient died during the procedure, one patient developed a non Q-wave myocardial infarction, one patient underwent emergency coronary bypass surgery, while another patient died suddenly before hospital discharge. Six patients of the emergency group were discharged alive and there has been one non-cardiac death during a follow up of 7 (4) months. Elective stent implantation for unprotected left main coronary artery stenosis is safe and effective in selected stable patients. Urgent stent implantation, however, cannot be considered as a definitive procedure in emergency situation.

  5. Simultaneous measurement of arterial and left ventricular pressure in conscious freely moving rats by telemetry.

    PubMed

    Segreti, Jason A; Polakowski, James S; Blomme, Eric A; King, Andrew J

    2016-01-01

    Comprehensive cardiovascular assessment in conscious rodents by utilizing telemetry has been limited by the restriction of current devices to one pressure channel. The purpose of this study was to test and validate a dual pressure transmitter that allows the simultaneous measurement of arterial pressure (AP) and left ventricular pressure (LVP) in conscious freely moving rats. Six rats were surgically implanted with dual pressure transmitters. Baseline hemodynamics and circadian rhythm were observed to return within 7days. AP, heart rate (HR), LVP and indices of left ventricular contractility were stable and demonstrated a prominent circadian rhythm over a two-week period of uninterrupted recordings. Administration of the vasodilator nifedipine produced the anticipated dose-dependent decrease in AP which was accompanied by a baroreflex mediated increase in HR and cardiac contractility. The negative inotrope verapamil produced the expected dose-dependent decreases in AP and cardiac contractility. Finally, a terminal validation of the dual pressure transmitter was performed under anesthesia by measuring AP and LVP simultaneously via telemetry and from a fluid filled arterial catheter and an intraventricular Millar catheter, respectively. A range of pressures and cardiac contractility were studied by administering sequential intravenous infusions of the positive inotrope dobutamine followed by verapamil. Linear regression analysis revealed a high level of agreement between pressures measured by the dual pressure transmitter and the exteriorized catheters. Histopathologic analysis of the heart revealed mild peri-catheter fibrosis. In conclusion, the simultaneous measurement of AP and LVP offers the potential for more detailed cardiovascular assessment in conscious rats. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Arterial stiffness is associated with left ventricular dysfunction in patients with rheumatoid arthritis.

    PubMed

    Ilter, Abdulselam; Kiris, Abdulkadir; Karkucak, Murat; Sahin, Mursel; Serdar, Omer Faruk; Ugan, Yunus

    2016-11-01

    Arterial stiffness (AS) has a detrimental effect on cardiovascular system particularly on left ventricle (LV). The aim of the study was to evaluate the impact of AS on LV functions in patients with rheumatoid arthritis (RA). Forty patients with RA and 25 age-sex matched control subjects (mean age 48.5 ± 6.3 vs. 45.1 ± 6.9 years, respectively, p = 0.06) were enrolled in study. AS was assessed by carotid-femoral pulse wave velocity (CF-PWV) and heart rate corrected augmentation index (AIx@75) measured by applanation tonometry (SphygmoCor). LV function was evaluated using tissue Doppler-derived myocardial performance index (MPI) from lateral mitral annulus. CF-PWV (28.3 ± 10.3 vs. 21.8 ± 9.3 m/s, p = 0.03), AIx@75 (10.2 ± 2.3 vs. 9.2 ± 1, %, p = 0.01) and MPI (0.46 ± 0.12 vs. 0.36 ± 0.1, p < 0.001) were significantly higher in patients with RA than in controls. LV MPI was found to be significantly positive correlated with CF-PWV, AIx@75, and ESR (r = 0.360, p = 0.005; r = 0.334, p = 0.009; r = 0.293, p = 0.023, respectively). Arterial stiffness parameters including CF-PWV and AIx@75 are associated with subclinical left ventricular dysfunction in patients with RA.

  7. Unusual Survival of Anomalous Left Coronary Artery From the Pulmonary Artery With Severe Rheumatic Mitral Stenosis in Septuagenarian Women: Foes Becoming Friends?

    PubMed Central

    Sinha, Santosh Kumar; Khanra, Dibbendhu; Jha, Mukesh Jitendra; Singh, Karandeep; Razi, Mahamdulla; Goel, Amit; Mishra, Vikas; Asif, Mohammad; Sachan, Mohit; Afdaali, Nasar; Kumar, Ashutosh; Thakur, Ramesh; Krishna, Vinay; Pandey, Umeshwar; Varma, Chandra Mohan

    2016-01-01

    ALCAPA syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a rare disease but lethal with clinical expression from myocardial infarction, congestive heart failure to death during early infancy and unusual survival to adulthood. We report a 73-year-old woman with ALCAPA who presented with exertional dyspnea (NYHA functional class II) over past 2 years. Physical examination revealed soft S, long mid diastolic rumbling murmur and apical pan-systolic murmur. Electrocardiography displayed biatrial enlargement and poor R progression and normal sinus rhythm. Echocardiography established calcified severe mitral stenosis (MS), presence of continuous flow entering the pulmonary trunk, turbulent continuous flow in inter-ventricular septum with left to right shunt in contrast echocardiography and normal systolic function. Coronary angiogram showed absence of left coronary artery (LCA) originating from aorta, dilated and tortuous right coronary artery (RCA) and abundant Rentrop grade 3 intercoronary collateral communicating with LCA originating from pulmonary trunk which was also confirmed on coronary CT angiogram thus establishing diagnosis of ALCAPA. It is exceedingly rare to be associated with severe MS. However, such a long survival in our patient can be explained by the severe pulmonary arterial hypertension which may be contributing to lesser coronary steal. PMID:27635184

  8. Effect of electron radiation on vasomotor function of the left anterior descending coronary artery

    PubMed Central

    Sanzari, Jenine K.; Billings, Paul C.; Wilson, Jolaine M.; Diffenderfer, Eric S.; Arce-Esquivel, Arturo A.; Thorne, Pamela K.; Laughlin, M. H.; Kennedy, Ann R.

    2015-01-01

    The left anterior descending (LAD, interventricular) coronary artery provides the blood supply to the mid-region of the heart and is a major site of vessel stenosis. Changes in LAD function can have major effects on heart function. In this report, we examined the effect of electron simulated solar particle event (eSPE) radiation on LAD function in a porcine animal model. Vasodilatory responses to adenosine diphosphate (ADP; 10−9 – 10−4 M), bradykinin (BK; 10−11 – 10−6 M), and sodium nitroprusside (SNP; 10−10 – 10−4 M) were assessed. The LAD arteries from Control (non-irradiated) and the eSPE (irradiated) animals were isolated and exhibited a similar relaxation response following treatment with either ADP or SNP. In contrast, a significantly reduced relaxation response to BK treatment was observed in the eSPE irradiated group, compared to the control group. These data demonstrate that simulated SPE radiation exposure alters LAD function. PMID:26072960

  9. Left Ventricular Diastolic Function Assessment of a Heterogeneous Cohort of Pulmonary Arterial Hypertension Patients

    PubMed Central

    Hernandez-Suarez, Dagmar F.; Lopez Menendez, Francisco R.; Palm, Denada; Lopez-Candales, Angel

    2017-01-01

    Background Pulmonary arterial hypertension (PAH) is known to trigger right ventricular (RV) remodeling that might compromise left ventricular (LV) filling due to inter-ventricular interdependence. In this study, we aimed to examine standard echocardiographic measurements of LV diastolic function in PAH patients. Methods In this retrospective study, we identified clinical as well as complete echocardiographic data from 128 chronic PAH patients to fully assess LV diastolic dysfunction (LVDD) using standard recommended Doppler guidelines. Accordingly, patients were divided into three groups: LVDD 0, LVDD 1 and LVDD 2. Results The mean age of the studied population was 57 ± 14 years with a mean pulmonary artery systolic pressure (PASP) of 55 ± 21 mm Hg. A total of 36% of the study patients had normal LV diastolic function. However, 64% had LVDD with LVDD stage 1 being the most common (48%). In terms of echocardiographic data, significant differences were found among the three LVDD groups in regards to PASP, LV end systolic and diastolic volumes, tricuspid annular plane systolic excursion, right ventricular fractional area change as well as many other tissue Doppler imaging parameters. Finally, just age and PASP were predictors of abnormal LV diastolic function (P < 0.05). Conclusions Impaired relaxation is a common abnormality in PAH patients. Additional studies are warranted to determine whether LVDD alters prognosis or is related to changes in the symptomatic profile of this group of patients. PMID:28270896

  10. Stenting of the left main coronary artery. Local experience in Liège.

    PubMed

    Ghavami, A; Boland, J; Legrand, V; Materne, P

    2000-06-01

    We examined the immediate and long-term outcome after stenting of the left main coronary artery (LMCA) in 41 consecutive patients who had been considered unsuitable for coronary artery bypass graft surgery (CABG). The procedure was elective in thirty-two patients (78%) with a protected LMCA in 24 patients and non-protected LMCA in 8 patients; the procedure was acute in the setting of myocardial infarction or complication of a diagnostic angiography in 9 patients (22%). The mean follow-up duration was 19 +/- 13 months. There were 5 in-hospital and 3 late deaths; repeat angioplasty was performed in 5 cases, but only one for LMCA restenosis. Results varied considerably depending on the clinical presentation. For acute patients, technical success was achieved in 89%, survival at hospital discharge was 44% and there was no cardiac event at the late follow-up. For elective patients, technical success was achieved in 100%, survival at hospital discharge was 96% and 90% at follow-up. The results of our study suggest that when patients have surgical risks, elective LMCA stenting either protected or unprotected may be undertaken with a high procedural success rate and a favourable clinical late follow-up.

  11. Left ventricular mechanics and arterial-ventricular coupling following high-intensity interval exercise.

    PubMed

    Cote, Anita T; Bredin, Shannon S D; Phillips, Aaron A; Koehle, Michael S; Glier, Melissa B; Devlin, Angela M; Warburton, Darren E R

    2013-12-01

    High-intensity exercise induces marked physiological stress affecting the secretion of catecholamines. Sustained elevations in catecholamines are thought to desensitize cardiac beta receptors and may be a possible mechanism in impaired cardiac function following strenuous exercise. In addition, attenuated arterial-ventricular coupling may identify vascular mechanisms in connection with postexercise attenuations in ventricular function. Thirty-nine normally active (NA) and endurance-trained (ET) men and women completed an echocardiographic evaluation of left ventricular function before and after an acute bout of high-intensity interval exercise (15 bouts of 1:2 min work:recovery cycling: 100% peak power output and 50 W, respectively). Following exercise, time to peak twist and peak untwisting velocity were delayed (P < 0.01) but did not differ by sex or training status. Interactions for sex and condition (rest vs. exercise) were found for longitudinal diastolic strain rate (men, 1.46 ± 0.19 to 1.28 ± 0.23 s(-1) vs. women, 1.62 ± 0.25 to 1.63 ± 0.26 s(-1); P = 0.01) and arterial elastance (men 2.20 ± 0.65 to 3.24 ± 1.02 mmHg · ml(-1) · m(-2) vs. women 2.51 ± 0.61 to 2.93 ± 0.68 mmHg · ml(-1) · m(-2); P = 0.04). No cardiac variables were found associated with catecholamine levels. The change in twist mechanics was associated with baseline aortic pulse-wave velocity (r(2) = 0.27, P = 0.001). We conclude that males display greater reductions in contractility in response to high-intensity interval exercise, independent of catecholamine concentrations. Furthermore, a novel association of arterial stiffness and twist mechanics following high-intensity acute exercise illustrates the influence of vascular integrity on cardiac mechanics.

  12. Endovascular repair of traumatic aortic injury using a custom fenestrated endograft to preserve the left subclavian artery.

    PubMed

    Gilani, Ramyar; Ochoa, Lyssa; Wall, Matthew J; Tsai, Peter I; Mattox, Kenneth L

    2011-08-01

    To describe the use of custom fenestrated endografts to preserve left subclavian artery (SCA) flow when requiring coverage during endovascular repair of blunt aortic injury (BAI). A 39-year-old male involved in a motor vehicle accident sustained injuries including intracranial hemorrhage, BAI, and extremity fractures. Immediate neurosurgical intervention was required. Once neurologically stabilized, endovascular repair was performed with a commercially available device modified with a custom fenestration to preserve flow into the left SCA. Serial follow-up CT angiography (CTA) demonstrates satisfactory repair with prograde left SCA flow and no evidence of endoleak. Left SCA coverage is often required for successful endovascular repair of BAI. A subgroup of patients who undergo left SCA coverage will require revascularization. The use of custom fenestrated endografts for preserving left SCA during thoracic endovascular aortic repair (TEVAR) for BAI is an innovative and feasible option in patients who require revascularization.

  13. 74-year-old man with left main and carotid artery disease - how life can change plans.

    PubMed

    Kübler, Piotr; Ilnicki, Dawid; Telichowski, Artur; Reczuch, Krzysztof

    2013-01-01

    An unexpected incident or rapid deterioration of a patient's condition may require optimal adaptation of the treatment to the current state of the patient. We present a case of a 74-year-old man with significant left main coronary artery stenosis and tight stenoses of both carotid arteries. The case was initially qualified for bypass grafting with accompanying carotid artery endarterectomy, but an unexpected accident changed our way of treatment. Three days after angiography the patient suffered an ischemic stroke. We held a multidisciplinary meeting of the "Neuro-Vascular-Heart Team" and decided to treat the patient percutaneously.

  14. 74-year-old man with left main and carotid artery disease – how life can change plans

    PubMed Central

    Ilnicki, Dawid; Telichowski, Artur; Reczuch, Krzysztof

    2013-01-01

    An unexpected incident or rapid deterioration of a patient's condition may require optimal adaptation of the treatment to the current state of the patient. We present a case of a 74-year-old man with significant left main coronary artery stenosis and tight stenoses of both carotid arteries. The case was initially qualified for bypass grafting with accompanying carotid artery endarterectomy, but an unexpected accident changed our way of treatment. Three days after angiography the patient suffered an ischemic stroke. We held a multidisciplinary meeting of the “Neuro-Vascular-Heart Team” and decided to treat the patient percutaneously. PMID:24570726

  15. Novel anaesthetic approach for surgical access and haemodynamic management during off-pump coronary artery bypass through a left thoracotomy.

    PubMed

    Maddali, Madan Mohan; Al-Jadidi, Abdullah M; Zacharias, Sunny

    2012-01-01

    For myocardial revascularization on a beating heart through a thoracotomy, a properly deployed endobronchial blocker (EBB) provides ideal conditions for surgical access. In addition, adequate volume replacement to achieve optimal cardiac performance is a primary goal of haemodynamic management in patients undergoing off-pump coronary artery bypass grafting. To achieve both these ends, this case report describes the combined use of a left-sided EBB along with a volumetric pulmonary artery catheter in a patient who underwent a successful off-pump coronary artery bypass surgery through an anterolateral thoracotomy.

  16. Preoperative dual-phase 3D CT angiography assessment of the right hepatic artery before gastrectomy.

    PubMed

    Yamashita, Keishi; Sakuramoto, Shinichi; Mieno, Hiroaki; Shibata, Tomotaka; Nemoto, Masayuki; Katada, Natsuya; Kikuchi, Shiro; Watanabe, Masahiko

    2014-10-01

    In the current study, we evaluated the efficacy of dual-phase three-dimensional (3D) CT angiography (CTA) in the assessment of the vascular anatomy, especially the right hepatic artery (RHA), before gastrectomy. The study initially included 714 consecutive patients being treated for gastric cancer. A dual-phase contrast-enhanced CT scan using 32-multi detector-row CT was performed for all patients. Among the 714 patients, 3D CTA clearly identified anomalies with the RHA arising from the superior mesenteric artery (SMA) in 49 cases (6.9 %). In Michels' classification type IX, the common hepatic artery (CHA) originates only from the SMA. Such cases exhibit defective anatomy for the CHA in conjunction with the celiac-splenic artery system, resulting in direct exposure of the portal vein beneath the #8a lymph node station, which was retrospectively confirmed by video in laparoscopic gastrectomy cases. Fused images of both 3D angiography and venography were obtained, and could have predicted the risk preoperatively, and the surgical finding confirmed its usefulness. Preoperative evaluations using 3D CTA can provide more accurate information about the vessel anatomy. The fused images from 3D CTA have the potential to reduce the intraoperative risks for injuries to critical vessel, such as the portal vein, during gastrectomy.

  17. Transcatheter Coil Embolization of a Coronary Artery-Left Ventricular Fistula Associated with Single Coronary Artery Anomaly

    PubMed Central

    Celebi, Ozlem Ozcan; Canbay, Alper; Diker, Erdem; Çil, Barbaros; Aytemir, Kudret; Oto, Ali

    2014-01-01

    Single coronary artery anomaly associated with coronary fistula is a rare entity. Transcatheter coil embolization is the treatment of choice for coronary artery fistulas. In this case report, we describe a patient with both single coronary artery anomaly and coronary fistula who was successfully treated with coil embolization. PMID:24744954

  18. Computational solution of the velocity and wall shear stress distribution inside a left carotid artery under pulsatile flow conditions

    NASA Astrophysics Data System (ADS)

    Arslan, Nurullah; Turmuş, Hakan

    2014-08-01

    Stroke is still one of the leading causes for death after heart diseases and cancer in all over the world. Strokes happen because an artery that carries blood uphill from the heart to the head is clogged. Most of the time, as with heart attacks, the problem is atherosclerosis, hardening of the arteries, calcified buildup of fatty deposits on the vessel wall. In this study, the fluid dynamic simulations were done in a left carotid bifurcation under the pulsatile flow conditions computationally. Pulsatile flow waveform is given in the paper. In vivo geometry and boundary conditions were obtained from a patient who has stenosis located at external carotid artery (ECA) and internal carotid artery (ICA) of his common carotid artery (CCA). The location of critical flow fields such as low wall shear stress (WSS), stagnation regions and separation regions were detected near the highly stenosed region and at branching region.

  19. Evolution from electrophysiologic to hemodynamic monitoring: the story of left atrial and pulmonary artery pressure monitors

    PubMed Central

    Mooney, Deirdre M.; Fung, Erik; Doshi, Rahul N.; Shavelle, David M.

    2015-01-01

    Heart failure (HF) is a costly, challenging and highly prevalent medical condition. Hospitalization for acute decompensation is associated with high morbidity and mortality. Despite application of evidence-based medical therapies and technologies, HF remains a formidable challenge for virtually all healthcare systems. Repeat hospitalizations for acute decompensated HF (ADHF) can have major financial impact on institutions and resources. Early and accurate identification of impending ADHF is of paramount importance yet there is limited high quality evidence or infrastructure to guide management in the outpatient setting. Historically, ADHF was identified by physical exam findings or invasive hemodynamic monitoring during a hospital admission; however, advances in medical microelectronics and the advent of device-based diagnostics have enabled long-term ambulatory monitoring of HF patients in the outpatient setting. These monitors have evolved from piggybacking on cardiac implantable electrophysiologic devices to standalone implantable hemodynamic monitors that transduce left atrial or pulmonary artery pressures as surrogate measures of left ventricular filling pressure. As technology evolves, devices will likely continue to miniaturize while their capabilities grow. An important, persistent challenge that remains is developing systems to translate the large volumes of real-time data, particularly data trends, into actionable information that leads to appropriate, safe and timely interventions without overwhelming outpatient cardiology and general medical practices. Future directions for implantable hemodynamic monitors beyond their utility in heart failure may include management of other major chronic diseases such as pulmonary hypertension, end stage renal disease and portal hypertension. PMID:26500556

  20. [Pulmonary artery sling and single ventricle treated with a simultaneous operation of slide tracheoplasty, left pulmonary artery reimplantation, and bidirectional cavo-pulmonary shunt].

    PubMed

    Kawahito, Tomohisa; Takano, Shinji; Egawa, Yoshiyasu; Iwamura, Yoshinobu; Nakahara, Yasuo; Nii, Akira; Ohnishi, Tatsuya; Miyagi, Yuhichi; Terada, Kazuya; Ohta, Akira

    2013-07-01

    Pulmonary artery sling is frequently combined with tracheal stenosis, and occasionally combined with congenital heart defects. However, there are few reports of successfully treated cases that were combined with single ventricle. In this article, we report a successfully treated case of pulmonary artery sling combined with tracheal stenosis, single ventricle, pulmonary atresia, vascular ring, and bilateral superior vena cava. A male infant was referred to our hospital for central cyanosis, and was diagnosed with single ventricle (tricuspid stenosis, multiple ventricular septal defect, and hypoplastic right ventricle)with pulmonary atresia by echocardiogram. Tracheal stenosis was shown at cardiac catheterization. Pulmonary artery sling and tracheal diverticulum were diagnosed by computed tomography (CT) and magnetic resonance imaging(MRI)examination. Furthermore, the patient was complicated by vascular ring, which consisted of right aortic arch, an aberrant left subclavian artery, and patent ductus arteriosus, and this ductus arteriosus was connected to the left subclavian artery and pulmonary arterial trunk. After 6 months of medical treatment, including continuous infusion of prostaglandin, re-evaluation was performed by cardiac catheterization. We considered that bidirectional cavo-pulmonary shunt was appropriate for the patient since his pulmonary vasculature had matured well. An operation was performed under the use of cardio-pulmonary bypass. Release of vascular ring by division of the ductus, bilateral bidirectional cavo-pulmonary shunt, and a slide tracheoplasty for tracheal stenosis were performed simultaneously. His recovery was uneventful, and he is currently waiting to receive a Fontan-type operation.

  1. Short-Term Left Ventricular Remodeling After Revascularization in Subacute Total and Subtotal Occlusion With the Infarct-Related Left Anterior Descending Artery

    PubMed Central

    Celik, Ahmet; Kalay, Nihat; Korkmaz, Hasan; Dogdu, Orhan; Sahin, Omer; Elcik, Deniz; Karacavus, Seyhan; Dogan, Ali; Inanc, Tugrul; Ozdogru, Ibrahim; Oguzhan, Abdurrahman; Topsakal, Ramazan

    2011-01-01

    Background Large randomized studies revealed that percutaneous coronary intervention has no clinical benefit in patients with total occlusion. The purpose of this study is to evaluate left ventricular remodelling after PCI for total and subtotal infarct-related left anterior desending artery in stable patients who have not received trombolytic theraphy. Methods Sixty stable patients with subacute anterior myocardial infarction who have total or subtotal occlusion in the infarct-related left anterior descending artery were enrolled the study (20 patient in the total-medical group, 20 patient in the total-PCI group and 20 patient in the subtotal-PCI group). All patients’ left ventricular diameters, volumes and ejection fractions measured at admission and after a month. Results The necrotic segment number in scintigraphy were similar in three groups. In the total-PCI group, there were significant increases in left ventricular diastolic diameter, left ventricular end-diastolic volume and left ventricular end-systolic volume at first month. A borderline significant increase was observed in LVEDV in the total-medical group at first month. No significant difference was seen in all echocardiographic parameters in the subtotal-PCI group at a month after discharge. The percentage of increase in LVEDV was significantly higher and the percentage of increase in LVESV was borderline significantly higher in the total-PCI group than the other groups. Conclusions In stable patients, PCI for total occlusion in the subacute phase of anterior MI causes an increase in LV remodeling. Nevertheless PCI for subtotal occlusion in the subacute phase of anterior MI may prevent LV remodeling.

  2. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants *

    PubMed Central

    Araujo Neto, Severino Aires; de Mello Júnior, Carlos Fernando; Franca, Henrique Almeida; Duarte, Cláudia Martina Araújo; Borges, Rafael Farias; de Magalhães, Ana Guardiana Ximenes

    2016-01-01

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications. PMID:26929461

  3. Multidetector computed tomography angiography of the celiac trunk and hepatic arterial system: normal anatomy and main variants.

    PubMed

    Araujo Neto, Severino Aires; de Mello Júnior, Carlos Fernando; Franca, Henrique Almeida; Duarte, Cláudia Martina Araújo; Borges, Rafael Farias; de Magalhães, Ana Guardiana Ximenes

    2016-01-01

    Although digital angiography remains as the gold standard for imaging the celiac arterial trunk and hepatic arteries, multidetector computed tomography in association with digital images processing by software resources represents a useful tool particularly attractive for its non invasiveness. Knowledge of normal anatomy as well as of its variations is helpful in images interpretation and to address surgical planning on a case-by-case basis. The present essay illustrates several types of anatomical variations of celiac trunk, hepatic artery and its main branches, by means of digitally reconstructed computed tomography images, correlating their prevalence in the population with surgical implications.

  4. Surgical technique of orthotopic liver transplantation in rats: the Kamada technique and a new splint technique for hepatic artery reconstruction.

    PubMed

    Ishii, Eiichi; Shimizu, Akira; Takahashi, Mikiko; Terasaki, Mika; Kunugi, Shinobu; Nagasaka, Shinya; Terasaki, Yasuhiro; Ohashi, Ryuji; Masuda, Yukinari; Fukuda, Yuh

    2013-01-01

    Orthotopic liver transplantation (OLT) in rats is technically feasible and useful for the assessment of clinical liver transplantation and analysis of inflammatory liver diseases. OLT in rats was pioneered by Lee et al. in 1973 using hand-suture techniques of all vessels. This model has not been widely used due to the long operative time and technical demand. The cuff method was introduced by Kamada in 1979, and today, the Kamada technique is the one most commonly used worldwide. However, this technique does not include hepatic artery reconstruction, although this procedure is routinely performed in clinical transplantation. Nevertheless, several techniques for hepatic artery reconstruction in rat OLT have been reported recently, and our group also developed a simple splint technique from recipient right renal artery to donor celiac axis bearing the hepatic artery. In the present article, we describe the Kamada technique, as a standard surgical method for rat OLT. In addition, we also describe our splint technique for hepatic artery reconstruction. Then, we compare the features of Kamada technique and our splint technique for hepatic artery reconstruction and all other surgical techniques currently in use for rat OLT. The widespread use of the rat OLT model should help to provide full assessment of transplant immunology and the mechanism and treatment of inflammatory liver diseases.

  5. Prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients without coronary artery disease.

    PubMed

    Prada-Delgado, Oscar; Barge-Caballero, Eduardo; Peteiro, Jesús; Bouzas-Mosquera, Alberto; Estévez-Loureiro, Rodrigo; Barge-Caballero, Gonzalo; López-Pérez, Manuel; Vázquez-González, Nicolás; Castro-Beiras, Alfonso

    2015-02-01

    We sought to assess the prognostic value of exercise-induced left ventricular systolic dysfunction in hypertensive patients with normal resting echocardiography and absence of coronary artery disease. From our database of patients referred for treadmill exercise echocardiography, we identified 93 hypertensive patients with preserved resting left ventricular ejection fraction (≥ 50%), no evidence of structural heart disease, and absence of coronary artery disease on angiography. Overall, 39 patients developed exercise-induced left ventricular systolic dysfunction (defined as a decrease in left ventricular ejection fraction below 50% at peak exercise) and 54 exhibited a normal left ventricular ejection fraction response to exercise. The mean follow-up was 6.1 (3.7) years. End points were all-cause mortality, cardiac death, heart failure, and the composite event of cardiac death or heart failure. Patients who developed exercise-induced left ventricular systolic dysfunction were at higher risk of death from any cause (hazard ratio=3.4; 95% confidence interval, 1.1-10.3), cardiac death (hazard ratio=5.6; 95%CI, 1.1-29.4), heart failure (hazard ratio=8.9; 95% confidence interval, 1.8-44.2), and the composite end point (hazard ratio=5.7; 95% confidence interval, 1.7-19.0). In the multivariate analysis, exercise-induced left ventricular systolic dysfunction remained an independent predictor of both heart failure (hazard ratio=6.9; 95% CI, 1.3-37.4) and the composite event of cardiac death or heart failure (hazard ratio=4.5; 95% confidence interval, 1.2-16.0). In hypertensive patients with preserved resting left ventricular ejection fraction and absence of coronary artery disease, exercise-induced left ventricular systolic dysfunction is a strong predictor of cardiac events and may represent early hypertensive heart disease. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Biliary complications secondary to late hepatic artery thrombosis in adult liver transplant patients.

    PubMed

    Margarit, C; Hidalgo, E; Lázaro, J L; Murio, E; Charco, R; Balsells, J

    1998-01-01

    Biliary complications (BC) are the usual presentation of late hepatic artery thrombosis (HAT) of the liver graft. Our aim was to study the clinical features and outcome of BC secondary to HAT compared to BC which occurred in liver transplant (LT) patients with patent vessels. We present a retrospective study of 224 LTs performed in 204 patients between 1988 and 1996. The mean recipient x s age was 51 years. A choledochocholedochostomy without T-tube was used as biliary reconstruction in most cases (67%); in 12%, a choledochojejunostomy was performed. An iliac conduit was necessary in 15% of cases and back-table arterial reconstruction was performed in 10% of cases of anatomic variants in graft arteries. Different donor, recipient and intraoperative variables, as well as treatment and outcome. were studied in the two groups of patients presenting BC with or without HAT. BC occurred in 38 cases (17%) whereas HAT was diagnosed in 11 cases (4.9%). Therefore, 23% of BC encountered after LT were secondary to HAT. Nine cases of late HAT manifested as BC, septicaemia (88%) and hepatic bilomas (8 cases). Percutaneous or surgical drainage of hepatic bilomas was performed in all cases, followed by retransplantation in six cases (66%). BC secondary to HAT appeared later than the rest of BC. Donor age was the only significant predisposing factor found in our study. Graft survival is significantly reduced as most patients needed retransplantation. In conclusion, BC secondary to HAT presented later in livers from older donors in the form of biliary sepsis and hepatic biloma. Retransplantation was ultimately required in most cases and graft survival was significantly diminished.

  7. Impaired Development of Left Anterior Heart Field by Ectopic Retinoic Acid Causes Transposition of the Great Arteries

    PubMed Central

    Narematsu, Mayu; Kamimura, Tatsuya; Yamagishi, Toshiyuki; Fukui, Mitsuru; Nakajima, Yuji

    2015-01-01

    Background Transposition of the great arteries is one of the most commonly diagnosed conotruncal heart defects at birth, but its etiology is largely unknown. The anterior heart field (AHF) that resides in the anterior pharyngeal arches contributes to conotruncal development, during which heart progenitors that originated from the left and right AHF migrate to form distinct conotruncal regions. The aim of this study is to identify abnormal AHF development that causes the morphology of transposition of the great arteries. Methods and Results We placed a retinoic acid–soaked bead on the left or the right or on both sides of the AHF of stage 12 to 14 chick embryos and examined the conotruncal heart defect at stage 34. Transposition of the great arteries was diagnosed at high incidence in embryos for which a retinoic acid–soaked bead had been placed in the left AHF at stage 12. Fluorescent dye tracing showed that AHF exposed to retinoic acid failed to contribute to conotruncus development. FGF8 and Isl1 expression were downregulated in retinoic acid–exposed AHF, and differentiation and expansion of cardiomyocytes were suppressed in cultured AHF in medium supplemented with retinoic acid. Conclusions The left AHF at the early looped heart stage, corresponding to Carnegie stages 10 to 11 (28 to 29 days after fertilization) in human embryos, is the region of the impediment that causes the morphology of transposition of the great arteries. PMID:25929268

  8. Ostial stenosis of the left main coronary artery in a young woman 10 years after radiation therapy.

    PubMed

    Orzan, F; Bellis, D; Mollo, F; Brusca, A

    1995-01-01

    A 26-year-old woman developed critical stenosis of the left main coronary artery 10 years after radiation treatment for Hodgkins disease. She was operated on but died in the immediate postoperative period. At autopsy the pathological findings were indistinguishable from those described in "typical" atherosclerotic plaques.

  9. Anomalous origin of the left brachiocephalic artery in the right aortic arch: Is there a method to the madness?

    PubMed

    Krishna, Mani Ram; Gnanappa, Ganesh Kumar; Fitzpatrick, Rachel; Ayer, Julian; Winlaw, David

    2017-01-01

    The anomalous origin of the left brachiocephalic artery in a right sided aortic arch is a rare vascular ring which might lead to esophageal compression. The exact embryological origin of this anomaly is still widely debated. We present an infant who presented with esophageal compression symptoms and review the various hypotheses about the embryological origin of this anomaly.

  10. A case of catatonia status-post left middle cerebral artery cerebrovascular accident, treated successfully with olanzapine.

    PubMed

    Spiegel, David R; Klaiber, Nicholas

    2013-01-01

    Catatonia is a psychomotor phenomenon associated with psychiatric/medical conditions. We present a patient who developed catatonia status-post left middle cerebral artery infarct. With a Bush Francis Catatonia Rating Scale score of 43 on admission, treatment with olanzapine reduced this score to 2, by discharge.

  11. Surgical management of an aberrant left subclavian artery originating from a left patent ductus arteriosus in a dog with a right aortic arch and abnormal branching.

    PubMed

    Saunders, Ashley B; Winter, Randolph L; Griffin, Jay F; Thieman Mankin, Kelley M; Miller, Matthew W

    2013-06-01

    An increase in the availability of advanced imaging modalities has led to improved recognition of cardiovascular anomalies. Computed tomography angiography (CTA) provides a non-invasive means of acquiring 3D images with a relatively short acquisition time thereby providing essential information in regards to patient anatomy and procedure planning. The dog in this report had a right aortic arch and abnormal branching with an aberrant left subclavian artery originating from the ampulla of a left patent ductus arteriosus (PDA) that was detected with CTA. The PDA was creating a volume overload to the left side of the heart as well as contributing to the vascular ring and compression of the esophagus. Therefore, ligation and transection instead of a minimally invasive catheter-based procedure was required. This aortic arch anomaly and surgical management have not been previously reported in dogs. Copyright © 2013 Elsevier B.V. All rights reserved.

  12. Effects of propranolol on resting and postextrasystolic potentiated left ventricular function in patients with coronary artery disease.

    PubMed

    Friedman, M J; Temkin, L P; Goldman, S; Ovitt, T W

    1983-01-01

    The effect of propranolol on global and segmental left ventricular function at rest and after postextrasystolic potentiation was studied in 12 patients with chest pain. Heart rate was controlled with atrial pacing, and left ventricular cineangiograms were performed before and after 0.15 mg/kg of propranolol. During each ventriculogram a premature ventricular stimulus was introduced by means of a programmed stimulator. Propranolol decreased global left ventricular ejection fraction from 64 +/- 4.5 to 58 +/- 4.6 (p less than 0.03). Postextrasystolic potentiated global ejection fraction was not affected by propranolol (78 +/- 3.5 vs 73.6 +/- 3.4; p = NS). The area ejection fraction of the anteroapical region was decreased after propranolol (64 +/- 4.8 vs 52 +/- 6.5; p less than 0.01); however, the postextrasystolic potentiated area ejection fraction was not affected by propranolol (78 +/- 2.6 vs 71 +/- 4.6; p = NS). Frame by frame analysis of the ventriculograms demonstrated that propranolol depressed global and segmental left ventricular function by affecting the second one-third ejection fraction without influencing the first or third one-third ejection fraction. Propranolol has a small depressant effect on global and segmental left ventricular function in patients with coronary artery disease. Postextrasystolic potentiated global and segmental left ventricular function and early systolic ejection phase indices are not altered by propranolol and therefore may be useful in assessing left ventricular function in patients with coronary artery disease who are taking propranolol.

  13. Tumour growth of colorectal rat liver metastases is inhibited by hepatic arterial infusion of the mTOR-inhibitor temsirolimus after portal branch ligation.

    PubMed

    Sperling, Jens; Ziemann, Christian; Gittler, Anika; Benz-Weißer, Anna; Menger, Michael D; Kollmar, Otto

    2015-04-01

    Portal branch ligation (PBL) can be performed before major hepatic resection of colorectal liver metastases (mCRC) to increase the remnant liver mass. However, PBL may also stimulate mCRC growth through hepatic arterial hyperperfusion and growth factor release. Herein, we studied whether hepatic arterial infusion (HAI) of the mTOR-inhibitor temsirolimus (Tem) is capable of inhibiting the growth of colorectal liver metastases after PBL. WAG/Rij rats were randomized to four groups (n=6 each) and underwent subcapsular implantation of 5×10(5) CC531 cells into the left liver lobe. The animals of two groups underwent simultaneous PBL of the tumour bearing liver lobe. Ten days later animals underwent a HAI either of temsirolimus (Tem and PBL Tem) or saline solution (Sham and PBL Sham). Tumour size was analyzed at days 10 and 13 using three-dimensional ultrasound. In Sham controls tumour volume increased by 43%. After PBL Sham tumour volume increased by 52%. In contrast, in animals undergoing HAI of temsirolimus the tumour growth was not only completely inhibited, but tumour volume was found decreased, irrespective of PBL. After HAI of temsirolimus immunohistochemistry revealed an increased cleaved caspase-3 activity, indicating stimulation of apoptotic cell death. In parallel temsirolimus treatment was associated with a significant reduction of PECAM-1 positive cells within the tumour tissue, implying a reduced tumour vascularisation. HAI of temsirolimus is capable of inhibiting the growth of CC531 colorectal rat liver metastases also after PBL.

  14. Transatrial access for left atrial pressure (LAP) monitoring line placement in arterial switch operation (ASO) in neonates.

    PubMed

    Akhtar, Mohammad Irfan; Hamid, Mohammad; Amanullah, Muneer; Ahsan, Khalid

    2013-11-01

    Left Atrial pressure monitoring is a useful and accurate method to guide Left ventricle filling in the patients who undergo Arterial switch operation for transposition of great arteries. We have used a different technique in three TGA patients for LA pressure monitoring line placement. After cleaning and draping,right internal jugular vein (rt IJV) located through 22G venous cannula, guide wire was put in followed by sliding the 22G x 8cm vygon arterial catheter over the guide wire into the right atrium that was directed transatrially into LA by the operating surgeon during atrial septum repair. The catheter was secured by silk on the neck and dressed with transparent dressing and was kept for a period of 48-72 hrs. LA pressure monitoring is helpful in anticipating LV dysfunction in ASO.

  15. Preservation of arterial flow to the liver: goal in treatment of extrahepatic and post-traumatic intrahepatic aneurysms of the hepatic artery.

    PubMed Central

    Mathisen, D J; Athanasoulis, C A; Malt, R A

    1982-01-01

    Post-traumatic intrahepatic aneurysms are frequent sources of intrahepatic and intrabiliary bleeding. The authors describe selective management of ten recent post-traumatic intrahepatic aneurysms, five extrahepatic aneurysms, and one ruptured hepatic artery in a patient with Ehlers-Danlos syndrome. Twelve patients had gastrointestinal bleeding or jaundice. Intraperitoneal rupture occurred twice. One aneurysm grew to 9 cm in diameter during nine years. Angiography should precede surgery whenever possible, and transcatheter occlusion should in general receive first priority. Aneurysms of the common hepatic artery usually can be excluded by proximal and distal ligation. Arterial bypass or serial angiographic occlusion is preferred for aneurysms of the proper hepatic artery. Intrahepatic aneurysms should usually be treated by angiographic thrombosis. Eigation of the proper hepatic artery or its branches should be reserved for exsanguination from unsuspected intrahepatic aneurysms encountered in the operating room. Lobectomy is required rarely. Images Fig. 1. Fig. 2a-d. Fig. 2a-d. Fig. 3a-c. Fig. 3a-c. Fig. 4a-c. Fig. 4a-c. Fig. 5. PMID:7125727

  16. Left leg apraxia after anterior cerebral artery territory infarction: functional analysis using single-photon emission computed tomography.

    PubMed

    Ito, Ikuno; Ito, Kimiteru; Shindo, Naoko

    2013-01-01

    Left hand apraxia is known as a unique symptom of callosal apraxia, but lower limb symptoms are rarely mentioned. We report a patient who experienced left ideomotor apraxia affecting both the upper and lower limbs after a stroke in the territory of the right anterior cerebral artery. His spontaneous gait was normal, but he was unable to move his left leg intentionally either by verbal command or by imitation. His leg symptoms gradually improved over time. We evaluated the change in cerebral blood flow in this patient using single-photon emission computed tomography. The results showed an increase in blood flow in the posterior corpus callosum; therefore, we suggested that the callosal pathway might contribute to left leg as well as left hand volitional movement. Copyright © 2013 S. Karger AG, Basel.

  17. Anatomic variations of inferior mesenteric artery and left colic artery evaluated by 3-dimensional CT angiography: Insights into rectal cancer surgery - A retrospective observational study.

    PubMed

    Ke, Jia; Cai, Jiawei; Wen, Xiaofeng; Wu, Xianrui; He, Zhen; Zou, Yifeng; Qiu, Jianping; He, Xiaowen; He, Xiaosheng; Lian, Lei; Wu, Xiaojian; Zhou, Zhiyang; Lan, Ping

    2017-05-01

    To demonstrate the clinical applicability of 3-dimensional CT angiography (3D-CTA) in evaluating the anatomic variations of inferior mesenteric artery (IMA) and left colic artery (LCA), to help make pre-operative strategies of rectal cancer surgery. 188 patients with abdominal and pelvic contrast-enhanced CT scan were retrospectively enrolled and 3D-CTA was reconstructed. The origin and branching patterns of IMA, tracking patterns of LCA, intersectional patterns among IMA, LCA and inferior mesenteric vein (IMV) were examined, and their associations with clinical features were analyzed. The origin of IMA was located 42.1 ± 7.7 mm above iliac artery bifurcation, 64.4% within the area of the 3rd lumbar vertebra. 47.3% of LCA arose independently from IMA, 27.1% arose at the root of sigmoid artery (SA), 20.7% shared a common trunk with SA while 4.8% of LCA was absent. As for track of LCA before anastomosis with marginal artery, 53.2% went straight upward while medial to the inner border of left kidney (Type A), 27.1% traveled diagonally across left kidney (Type B) and14.9% went infero-laterally to the lower border of left kidney (Type C). Short IMA trunk was independently associated with type A LCA and lower site of IMA origin. At the horizontal level of IMA origin, 29% of the LCA went distant from IMV, while 71% (21% medial, 50% lateral) were mutually close, and the close type was independently associated with type A LCA. Preoperative understanding of the vascular variations and the mutual relationship among LCA, IMA and IMV could be obtained by 3D-CTA, which would further help surgeons to set detailed plans for laparoscopic rectal cancer surgery. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  18. [Evaluation of the consequences of hepatic artery embolization under experimental conditions].

    PubMed

    Słomka, M; Szczerbo-trojanowska, M; Celiński, K; Skrzydło-Radomańska, B

    1991-01-01

    The experiments were performed in the healthy mongrel dogs aged 5 to 8 years whose body weight ranged from 10-20 kg. Just after the coeliac arteriography the hepatic artery was embolized. The dogs were divided into 2 groups because of the application of two different embolizing materials. Spongostan was used as the embolizing material in group I consisting of 7 dogs. In group II consisting of 5 dogs the embolizing material was absolute ethyl alcohol with urogranic acid. The symptoms of the postembolization syndrome were observed in all dogs after the embolization for 1-5 days. In most dogs the transient increase of the aminotransferase activity was observed while the results of thymol turbidity test and bilirubin levels in serum were not significantly changed. In dogs of group II the clinical picture after the embolization was clearly more severe. The anatomo- and histopathological examinations in dogs after the hepatic artery embolization were carried out. In group I no hepatic changes were found macroscopically. In the histopathological studies of liver the numerous, tiny foci of coagulative necrosis with the resorptive reactions were noticed. In group II multifocal deliquescent necrosis in the liver, numerous, small perivascular and extravascular foci of coagulative-deliquescent necrosis with the inflammatory and the resorptive reactions were noted.

  19. A Variant in COX-2 Gene Is Associated with Left Main Coronary Artery Disease and Clinical Outcomes of Coronary Artery Bypass Grafting

    PubMed Central

    Liu, Hanning; Sun, Cheng

    2017-01-01

    As a particular severe phenotype of coronary artery disease (CAD), left main coronary artery disease (LMCAD) is heritable. Genetic variants related to prostaglandin metabolism are associated with LMCAD. Cyclooxygenase-2 (COX-2), a key synthase in prostaglandin pathways, displays high density in atherosclerotic lesions and promotes early atherosclerosis in CAD progression. We hypothesized that genetic variants in COX-2 gene contribute to LMCAD phenotype susceptibility compared to more peripheral coronary artery disease (MPCAD). In this study, we genotyped COX-2 rs5275, rs5277, and rs689466 of 1544 CAD patients undergoing coronary artery bypass grafting (CABG) and found that rs5277 C allele carriage was associated with LMCAD (adjusted OR: 1.590; 95% CI: 1.103~2.291; p = 0.013). Furtherly, long-term follow-up data suggested that rs5277 C allele carriage increased risk of major adverse cardiac and cerebrovascular events (MACCE) in the whole cohort (adjusted HR: 1.561; 95% CI: 1.025~2.377; p = 0.038) and LMCAD subgroup (adjusted HR: 2.014; 95% CI: 1.036~3.913; p = 0.039) but not in MPCAD subgroup (adjusted HR: 1.375; 95% CI: 0.791~2.392; p = 0.259). In conclusion, we demonstrate that COX-2 rs5277 C allele increases the risk of left main coronary artery lesion and is also correlated with poor prognosis of LMCAD patients with CABG therapy. PMID:28194409

  20. Inducible Myocardial Ischemia and Outcomes in Patients with Coronary Artery Disease and Left Ventricular Dysfunction

    PubMed Central

    Panza, Julio A.; Holly, Thomas A.; Asch, Federico M.; She, Lilin; Pellikka, Patricia A.; Velazquez, Eric J.; Lee, Kerry L.; Borges-Neto, Salvador; Farsky, Pedro S.; Jones, Robert H.; Berman, Daniel S.; Bonow, Robert O.

    2013-01-01

    Objectives To test the hypotheses that ischemia during stress testing has prognostic value and that it identifies those coronary artery disease (CAD) patients with left ventricular (LV) dysfunction who derive the greatest benefit from coronary artery bypass graft surgery (CABG) compared to medical therapy. Background The clinical significance of stress-induced ischemia in patients with CAD and moderately to severely reduced LV ejection fraction (EF) is largely unknown. Methods The Surgical Treatment of IsChemic Heart failure (STICH) trial randomized patients with CAD and EF ≤35% to CABG or medical therapy. In this study, we assessed the outcomes of those STICH patients who underwent either a radionuclide (RN) stress test or a dobutamine stress echocardiogram (DSE). A test was considered positive for ischemia by RN if the summed difference score (difference in tracer activity between stress and rest) was ≥4 or if ≥2 of 16 segments were ischemic during DSE. Clinical endpoints were assessed by intention-to-treat during a median follow-up of 56 months. Results Of the 399 study patients (51 women, mean EF 26±8%), 197 were randomized to CABG and 202 to medical therapy. Myocardial ischemia was induced during stress testing in 256 patients (64% of the study population). Patients with and without ischemia were similar in age, multi-vessel CAD, previous myocardial infarction, LV EF, LV volumes, and treatment allocation (all p=NS). There was no difference between patients with vs. those without ischemia in all-cause mortality (hazard ratio: 1.08; 95% CI: 0.77–1.50; p=0.66), cardiovascular mortality, or all-cause mortality plus cardiovascular hospitalization. There was no interaction between ischemia and treatment for any clinical endpoint. Conclusions In CAD with severe LV dysfunction, inducible myocardial ischemia does not identify patients with worse prognosis or those with greater benefit from CABG over optimal medical therapy. Clinical Trial ID: Clinical

  1. [Endovascular and surgical treatment of a patient with traumatic rupture of the aorta and hepatic artery].

    PubMed

    Chernaya, N R; Muslimov, R Sh; Selina, I E; Kokov, L S; Vladimirova, E S; Navruzbekov, M S; Gulyaev, V A

    2016-01-01

    Traumatic rupture of the aorta is the second most common cause of death in closed chest injury. The latest findings of autopsy showed that 80% of lethal outcomes in aortic injury occur in the prehospital period. Taking into consideration the incidence and high rate of death prior to the diagnosis stage, aortic rupture in closed thoracic injury is an important problem. Due to the characteristic mechanism of the development (during sharp deceleration of the body) this type of traumatic lesion of the aorta became known as "deceleration syndrome". The most vulnerable to tension aortic portion is its neck where the mobile part of the thoracic aorta is connected to the fixed arch in the place of the arterial ligament attachment. Open surgical intervention in patients with severe closed chest injury (often concomitant injury) is associated with high mortality and complications. Currently endovascular prosthetic repair of the aorta is a method of choice at the primary stage of treatment of patients with aortic injury. In this article we present a rare case report of concomitant lesion of large vessels (the descending aortic portion and proper hepatic artery) in a patient with severe concomitant injury, as well as peculiarities of diagnosis and combined treatment (endovascular prosthetic repair of the aorta and hepatic artery with an aotovein).

  2. Association between arterial stiffness and left ventricular diastolic function in relation to gender and age

    PubMed Central

    Kim, Hack-Lyoung; Lim, Woo-Hyun; Seo, Jae-Bin; Chung, Woo-Young; Kim, Sang-Hyun; Kim, Myung-A.; Zo, Joo-Hee

    2017-01-01

    Abstract Left ventricular (LV) diastolic dysfunction and subsequent overt heart failure are more prevalent in elderly women. Close interaction between arterial stiffness and LV morphology/function has been reported. The aim of this study was to investigate whether there is an age- and gender-dependent relationship between arterial stiffness and LV diastolic function. A total of 819 subjects (58.6 ± 13.3 years, 50.2% men) without structural heart disease (LV ejection fraction ≥50%) were retrospectively analyzed. All participants underwent transthoracic echocardiography and brachial-ankle pulse wave velocity (baPWV) measurement on the same day. The association of baPWV with septal e′ velocity and average E/e′ was assessed. In the total study subjects, baPWV was negatively correlated with septal e′ velocity (r = 0.383, P < 0.001), and positively correlated with E/e′ (r = −0.266, P < 0.001). These linear correlations remained significant even after stratificaion of the study subjects by age (<65 years vs ≥65 years) and genders (P < 0.05 for each). There were obvious differences in baPWV according to groups with normal LV diastolic function, intermediate profile and LV diastolic dysfunction in young (P = 0.010) and elderly (≥65 years) women (P < 0.001) and eldery men (P = 0.012) but not in elderly men (P = 0.270). There was a significant association of baPWV with septal e′ velocity (β = −0.258, P = 0.020) and E/e′ (β = 0.122, P = 0.030) in elderly women even after controlling for multiple clinical covariates. This independent association was not seen in younger women and men (P > 0.05 for each). In conclusion, baPWV was independently associated with septal e′ velocity and E/e′ in elderly women but not in younger women or men. The results of this study provide additional evidence that increased arterial stiffness plays an important role in the development of heart failure with

  3. Pulmonary Arterial Capacitance Predicts Cardiac Events in Pulmonary Hypertension Due to Left Heart Disease

    PubMed Central

    Sugimoto, Koichi; Yoshihisa, Akiomi; Nakazato, Kazuhiko; Jin, Yuichiro; Suzuki, Satoshi; Yokokawa, Tetsuro; Misaka, Tomofumi; Yamaki, Takayoshi; Kunii, Hiroyuki; Suzuki, Hitoshi; Saitoh, Shu-ichi; Takeishi, Yasuchika

    2016-01-01

    Background Although pulmonary hypertension due to left heart disease (LHD-PH) accounts for the largest proportion of pulmonary hypertension, few reports on the epidemiological analysis of LHD-PH exist. Recently, pulmonary arterial capacitance (PAC) has attracted attention as a possible factor of right ventricular afterload along with pulmonary vascular resistance. We therefore investigated the clinical significance of PAC in LHD-PH. Methods The subject consisted of 252 LHD-PH patients (145 men, mean age 63.4 ± 14.7 years) diagnosed by right heart catheterization. PAC was estimated by the ratio between stroke volume and pulmonary arterial pulse pressure. Patients were classified into four groups according to the PAC (1st quartile was 0.74 to 1.76 ml/mmHg, the 2nd quartile 1.77 to 2.53 ml/mmHg, the 3rd quartile 2.54 to 3.59 ml/mmHg, and the 4th quartile 3.61 to 12.14 ml/mmHg). The end-points were defined as rehospitalization due to worsening heart failure and/or cardiac death. The Cox proportional hazard regression model was used to determine what variables were associated with cardiac events. Results The patients in the 1st quartile had the lowest cardiac index and stroke volume index, and the highest mean pulmonary arterial pressure, mean pulmonary capillary wedge pressure, and pulmonary vascular resistance compared with the 2nd, 3rd, and 4th quartiles. Fifty-four patients experienced cardiac events during the follow-up period (median 943 days). The event-free rate of the 1st quartile was significantly lower than that of the 3rd and 4th quartiles (66.7% vs 82.5% [3rd quartile], P = 0.008; and 92.1% [4th quartile], P < 0.001). The Cox hazard analysis revealed that PAC was significantly associated with cardiac events (HR 0.556, 95% CI 0.424–0.730, P < 0.001). Conclusion PAC is useful in the prediction of cardiac event risk in LHD-PH patients. PMID:27875533

  4. Effect of coronary artery bypass graft surgery on left ventricular systolic function

    PubMed Central

    Koene, Ryan J.; Kealhofer, Jessica V.; Adabag, Selcuk; Vakil, Kairav

    2017-01-01

    Background Changes in left ventricular (LV) systolic function in response to coronary artery bypass grafting (CABG) have not been fully assessed. Methods Between January 2001 and December 2014, 2,838 consecutive patients underwent isolated CABG at the Minneapolis Veterans Affairs Health Care System. Of these, 375 had echocardiographic assessment of LV function before (within 6 months) and after (3 to 24 months) CABG and were included in this analysis. Results While the mean LV ejection fraction (LVEF) did not change following CABG [(49±13)% vs. (49±12)%, P=0.51], LVEF decreased in the subgroup with normal (≥50%) pre-operative LVEF [from (59±5)% to (56±9)%, P<0.001] and improved in those with decreased (<50%) pre-operative LVEF [from (36±9)% to (41±12)%, P<0.001]. There was a significant reduction in LV internal diameter during end-diastole (LVIDd) (5.4±0.8 vs. 5.3±0.9, P=0.002) and an increase in left atrial diameter (LAD) (4.4±0.7 vs. 4.6±0.7, P<0.001). There were no perioperative changes in LV internal diameter during end-systole, LV mass, posterior wall thickness, or septal wall thickness. LVEF improved by >5% in 24% of the study population, did not change (+/− 5%) in 55%, and worsened by >5% in 21%. Patients with improved EF were less often diabetic and had lower pre-operative LVEF, and greater LV dimensions at baseline. Conclusions After CABG, there was a decrease in LVIDd and an increase in LAD. Also, a decrease in LV systolic function with CABG was observed in patients with normal pre-operative LVEF and an improvement in LV systolic function was observed in patients with decreased pre-operative LVEF. PMID:28275473

  5. The Effects of Right Ventricular Apical Pacing Frequency on Left Ventricle Function and Pulmonary Artery Pressure.

    PubMed

    Fanari, Zaher; Hammami, Sumaya; Hammami, Muhammad Baraa; Hammami, Safa; Shuraih, Mossaab

    2015-08-01

    We studied the effect of the frequency of right ventricular (HV) pacing on left ventricle (LV) function pulmonary hypertension. The incidence of new or worsening pulmonary hypertension after permanent pacemaker (PPM) or implantable cardioverter defibrillator (lCD) lead placement has not been well investigated. We reviewed the charts of all patients undergoing PPM or ICD lead placement in our electrophysiology laboratory from December 2007 to December 2012. Two hundred and six patients (120 with PPM and 86 with ICD) had baseline echocardiography within six months before, and a follow up study at least six months after lead insertion. The mean age was 74 ± 14 years; 56 percent were men. The follow-up period was 29 ± 19 months. RV pacing was associated with a worsening of left ventricular ejection fraction (LVEF) in patients with high frequency of RV (55 ± 16 vs. 44 ± 18; P = 0.001), but not with those with low frequency pacing (55 ± 16 vs. 54 ± 17; P = 0.87). Similarly, RV pacing was associated with a worsening in both right ventricular systolic pressure (RVSP) (42 ± 14 vs. 48 ± 15; P = 0.01) and Pulmonary Artery Systolic Pressure (PASP) (50 ± 17 vs. 56 ± 18; P = 0.005) in patients with high frequency RV, but not in those with low frequency RV pacing [RVSP (43 ± 12 vs. 46 ± 13; P = 0.06) and PASP (51 ± 15 vs. 54 ± 16; P = 0.11)]. PPM or IICD lead implantation worsens LV function and pulmonary hypertension in patients with high frequency of RV pacing frequency. This is probably caused by the mechanical dyssynchrony induced by RV pacing.

  6. Distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR): common hepatic arterial stump pressure should determine the need for arterial reconstruction.

    PubMed

    Mittal, Anubhav; de Reuver, Philip R; Shanbhag, Satya; Staerkle, Ralph F; Neale, Michael; Thoo, Catherine; Hugh, Thomas J; Gill, Anthony J; Samra, Jaswinder S

    2015-04-01

    Tumors arising in the neck and body of the pancreas often invade the common hepatic artery and celiac axis (CA), necessitating distal pancreatectomy, splenectomy, and celiac axis resection (DPS-CAR). In these patients, the need for revascularization of the common hepatic artery (CHA) can be avoided on the basis of the pressure change in the CHA after clamping of the CA. All patients presenting to North Shore Hospital Campus of University of Sydney with advanced pancreatic malignancy of the neck and body between 2007 and 2014 were included in the study. The pressure in the CHA was measured pre- and postclamping of the CA; a decrease of more than 25% in the mean arterial pressure necessitated vascular reconstruction of the CHA. Seven patients underwent a DPS-CAR between 2007 and 2014. Arterial reconstruction was required in 2 patients based on a decrease of >25% mean arterial pressure in the CHA after clamping the CA. There was no in hospital or 90-day mortality, and no patients developed ischemic hepatitis. A single-stage DPS-CAR with selective arterial reconstruction based on the CHA pressure change after clamping the CA is a safe approach. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Fatal delayed cardiac tamponade due to rupture of micropseudoaneurysm of left anterior descending coronary artery following stab to the chest.

    PubMed

    Xing, Jingjun; Li, Shangxun; Zhang, Lin; Yang, Yi; Duan, Yijie; Li, Wenhe; Zhou, Yiwu

    2015-01-01

    Traumatic coronary pseudoaneurysm has been described to be mainly associated to iatrogenic lesion of the coronary arteries. However, chest-stab-wound-related coronary pseudoaneurysm caused by isolated partial incision of a coronary artery giving rise to fatal delayed cardiac tamponade is very rare. We describe an autopsy case in which this potentially fatal complication developed 8 days later after a thoracic stab wound. Unfortunately, the imaging examination failed to detect this defect during hospitalization. Postmortem examination revealed that the posterior wall of the left anterior descending coronary artery was intact but that the anterior wall was incised, forming a micropseudoaneurysm which had ruptured. This case highlights that isolated coronary artery injuries must be considered in any patient with a penetrating wound to the thorax, and coronary pseudoaneurysms should not be missed in these patients.

  8. Spontaneous left main coronary artery dissection complicated by pseudoaneurysm formation in pregnancy: role of CT coronary angiography.

    PubMed

    Rahman, Shahid; Abdul-Waheed, Mohammed; Helmy, Tarek; Huffman, Lynn C; Koshal, Vipin; Guitron, Julian; Merrill, Walter H; Lewis, David F; Dunlap, Stephanie; Shizukuda, Yukitaka; Weintraub, Neal L; Meyer, Christopher; Cilingiroglu, Mehmet

    2009-04-01

    We report a case of a 26-year-old female, who presented at 34 weeks of an uncomplicated pregnancy with an acute ST elevation anterior wall myocardial infarction. Cardiac catheterization suggested a left main coronary artery dissection with pseudoaneurysm formation. The patient's course was complicated by congestive heart failure. She was initially managed conservatively by a multidisciplinary team including heart failure specialists, obstetricians, and cardiovascular surgeons. 4 days after admission, her LMC was imaged by dual-source 64 slice Cardiac computed tomography, coronary dissection was identified extending to the lumen, and the presence of pseudoaneurysm was confirmed. She underwent subsequently a staged procedure, which included placement of an intra-aortic balloon pump, cesarean section, and coronary artery bypass grafting. This case illustrates the utility of coronary artery CT imaging to assess the complexity and stability of coronary artery dissections, thereby helping to determine the need for, and timing of revascularization procedures.

  9. Sudden Cardiac Death in a Case of Non-Dominant Coronary Artery Obstruction Without Depressed Left Ventricular Function

    PubMed Central

    Chen, Hung Yi

    2013-01-01

    Acute myocardial infarction complicated with lethal cardiac arrhythmia remains the major cause of sudden death. The possible clinical presentation leading to lethal ventricular arrhythmia has been demonstrated but the data are limited. The previous study revealed no significant correlation between sudden cardiac death and the location of coronary obstruction site. And the possible mechanism of sudden cardiac death in non-dominant coronary artery obstruction is unclear. We presented a case of acute myocardial infarction with mid left circumflex artery occlusion complicated with new onset atrial fibrillation initially. The rhythm degenerated into ventricular fibrillation immediately and sudden cardiac death occurred. After resuscitation, he received coronary angioplasty, and the rhythm recovered to sinus after the occluded coronary artery reopened. We thick new onset atrial fibrillation could be a potential risk factor leading to sudden death in acute myocardial infarction with obstruction of non-dominant coronary artery. Control of ventricular rate and early restoration of sinus rhythm may be potential benefit.

  10. Arterial Vascularization of the Gastrointestinal Tract of the Pampas Deer (Ozotoceros bezoarticus, Linnaeus, 1758).

    PubMed

    Pérez, W; Vazquez, N; Ungerfeld, R

    2016-06-01

    Based on gross dissection of fifteen adult animals (11 females, 4 males), we described the arterial supply of the stomach and intestines of the pampas deer (Ozotoceros bezoarticus), a South American endangered species. The coeliac artery emitted the splenic, left gastric and hepatic arteries. The splenic artery directed towards the spleen, and the right ruminal artery, which is its only collateral directed towards the stomach, being the main artery of the rumen. The left gastric artery gave origin to the left ruminal, the reticular and the left gastroepiploic arteries. The left gastroepiploic artery originated the reticular accessory artery. Both arteries, gastric and left gastroepiploic, anastomosed their right counterparts derived from the hepatic artery on the curvatures of the abomasum. The cranial mesenteric artery irrigated the second half of the duodenum until the beginning of the descending colon. The thickest branch emitted by the cranial mesenteric artery was the ileocolic artery, which was destined to the ascending colon, caecum and ileum. The colic branches and the right colic arteries were irradiated on the right surface of the spiral loop of the ascending colon and distributed to both centripetal and centrifugal coils of the ascending colon; the colic branches were also anastomosed with the last jejunals and ileals and with the right colic arteries. There were no variations in the origin of any of the main branches derived from the coeliac and cranial mesenteric arteries. This species had a basic pattern of arterial distribution similar to small domestic ruminants. © 2015 Blackwell Verlag GmbH.

  11. Mitral regurgitation in patients with coronary artery disease and low left ventricular ejection fractions. How should it be treated?

    PubMed Central

    Christenson, J T; Simonet, F; Maurice, J; Bloch, A; Velebit, V; Schmuziger, M

    1995-01-01

    In recent years, coronary artery bypass grafting has been extended to include patients with very low left ventricular ejection fractions. Should concomitant mitral valve regurgitation be corrected simultaneously? Between January 1990 and July 1994, 43 patients with preoperative left ventricular ejection fractions < or = 25% and echocardiographic evidence of concomitant mitral valve regurgitation (grade I, 18 patients; II, 19 patients; and III, 6 patients) underwent primary coronary artery bypass grafting. None of these patients underwent simultaneous mitral valve surgery. Twenty-four patients (56%) had pulmonary artery pressures > or = 40 mmHg (pulmonary hypertension). The mean preoperative left ventricular ejection fraction was 18.7% +/- 4.4% (range, 10% to 25%), and the mean pulmonary artery pressure was 45.6 +/- 15.8 mmHg. The average of number of grafts per patient was 4.5 +/- 1.5. Five patients underwent simultaneous repair of a left ventricular aneurysm. The hospital mortality rate was 4.7% (2/43). Transient low cardiac output occurred postoperatively in 13 patients (30%). Sixteen patients (37%) had no postoperative complications. The average follow-up of the 41 hospital survivors was 6 months (range, 1 to 32 months). One patient died 8 months after surgery for an overall mortality rate of 7%. Another 2 patients had graft occlusions that did not require reoperation. In the 40 surviving patients, follow-up echocardiography revealed that 37 patients (93%) had either no mitral valve regurgitation or only very mild mitral valve regurgitation (grade I). Three patients had grade II mitral valve regurgitation, but none required mitral valve surgery. The New York Heart Association functional class improved significantly in all hospital survivors (from 3.4 +/- 0.6 to 1.7 +/- 0.7; p > 0.001), and left ventricular ejection fractions rose from 19.0% +/- 4.6% to 42.0% +/- 8.3%. Coronary artery bypass grafting is possible in patients with very low left ventricular ejection

  12. Off-pump coronary artery bypass grafting for a left main lesion due to cardiac allograft vasculopathy in Japan: first report of a case.

    PubMed

    Fujita, Tomoyuki; Kobayashi, Junjiro; Hata, Hiroki; Murata, Yoshihiro; Seguchi, Osamu; Yanase, Masanobu; Shimahara, Yusuke; Sato, Shunsuke; Nakatani, Takeshi

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