Distal Left Circumflex Artery Research Articles

Acute Myocardial Infarction of the Right Coronary Artery Originating From the Distal Left Circumflex Artery

A case of acute myocardial infarction (AMI) of the distal left circumflex, near the origin of an aberrant right coronary artery is presented. Coronary stenting was successfully performed. According to several reports, this anomaly is a common site for coronary atherosclerosis, but this is the first report of AMI.

Value of ST‐segment depression in lead V4R in predicting proximal against distal left circumflex artery occlusion in acute inferoposterior myocardial infarction

Lead V(4R) faces the right ventricular free wall; it also reflects ischemia in the posterolateral wall lying opposite and manifests as ST-segment depression. The aim of this study was to evaluate the usefulness of V(4R) ST-segment depression in distinguishing proximal from distal left circumflex artery occlusion in acute inferoposterior wall myocardial infarction. We retrospectively analyzed 239 patients who had first acute inferoposterior myocardial infarction, were admitted within 6 h from onset of symptom, and had coronary angiography performed within 4 weeks. Patients who had bundle-branch block or concomitant significant stenoses in the proximal and distal segments of the same vessel or of both vessels were excluded. The electrocardiographic and angiographic findings were reviewed by two independent groups of investigators. V(4R) ST-segment depression > or =1.0 mm was found in 8 of 46 patients (17.4%) with left circumflex artery occlusion but none (0%) with right coronary artery occlusion. Among the group with left circumflex artery occlusion, the mean magnitude of V(4R) ST-segment depression was greater in proximal than distal occlusion (0.82 +/- 0.65 vs. 0.03 +/- 0.12 mm, p < 0.0001). V(4R)ST-segment depression > or =1.0 mm was found in 8 of 14 patients (57.1%) with proximal occlusion but none (0%) in 32 patients with distal occlusion. The sensitivity and specificity to predict proximal occlusion were 57.1 and 100%, respectively. V(4R) ST-segment depression > or =1.0 mm was not useful for differentiating left circumflex and right coronary artery occlusion because of its low sensitivity. It is a fairly sensitive and very specific sign of proximal left circumflex artery occlusion.

Troubleshooting for a Stuck Balloon-Catheter

A 79-year-old man underwent elective percutaneous coronary intervention due to silent myocardial ischemia in view of planned surgery for descending aortic aneurysm. Coronary angiography revealed a three-vessel disease with occluded right coronary artery, 60% stenosis of the left anterior descending artery, and two calcified (> 90%) obstructions of the proximal and distal left circumflex artery (LCX) (Fig 1A) shown in a right anterior oblique view (RAO) with white arrows marking the greater than 90% LCX obstructions.

Neovascularization From Coronary Artery Leaking to Fungus Ball in the Lung

HomeCirculationVol. 114, No. 17Neovascularization From Coronary Artery Leaking to Fungus Ball in the Lung Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBNeovascularization From Coronary Artery Leaking to Fungus Ball in the Lung Kwang Kon Koh, MD, Seung Hwan Han, MD, Jeong Ho Kim, MD, Sang Jin Lee, MD and Jin Yong Kim, MD Kwang Kon KohKwang Kon Koh From the Division of Cardiology, Gil Heart Center (K.K.K., S.H.H., S.J.L., J.Y.K.), and Division of Cardiovascular Imaging and Interventional Radiology, the Department of Radiology (J.H.K.), Gachon Medical School, Incheon, Korea. Search for more papers by this author , Seung Hwan HanSeung Hwan Han From the Division of Cardiology, Gil Heart Center (K.K.K., S.H.H., S.J.L., J.Y.K.), and Division of Cardiovascular Imaging and Interventional Radiology, the Department of Radiology (J.H.K.), Gachon Medical School, Incheon, Korea. Search for more papers by this author , Jeong Ho KimJeong Ho Kim From the Division of Cardiology, Gil Heart Center (K.K.K., S.H.H., S.J.L., J.Y.K.), and Division of Cardiovascular Imaging and Interventional Radiology, the Department of Radiology (J.H.K.), Gachon Medical School, Incheon, Korea. Search for more papers by this author , Sang Jin LeeSang Jin Lee From the Division of Cardiology, Gil Heart Center (K.K.K., S.H.H., S.J.L., J.Y.K.), and Division of Cardiovascular Imaging and Interventional Radiology, the Department of Radiology (J.H.K.), Gachon Medical School, Incheon, Korea. Search for more papers by this author and Jin Yong KimJin Yong Kim From the Division of Cardiology, Gil Heart Center (K.K.K., S.H.H., S.J.L., J.Y.K.), and Division of Cardiovascular Imaging and Interventional Radiology, the Department of Radiology (J.H.K.), Gachon Medical School, Incheon, Korea. Search for more papers by this author Originally published24 Oct 2006https://doi.org/10.1161/CIRCULATIONAHA.106.630657Circulation. 2006;114:e551–e552A 68-year-old woman came to the clinic for evaluation of an operation risk. She had the sensation of a mass in her abdomen for 10 years, and ventral hernia was diagnosed. Her weight was 96 kg and her height was 157 cm; her body mass index was 38.95 kg/m2. She had a history of diabetes for 3 years. She also had a history of aspergillosis, which had been cured 10 years ago. She reported no chest pain on exercise. Chest radiography demonstrated a fungus ball in the left upper lung (Figure 1). Radionuclide imaging (technetium 99m sestamibi scan) showed reversible, moderate-sized perfusion defects in the apical to mid-inferior area, suggesting right coronary artery lesion. The echocardiogram showed no abnormal findings. The coronary angiogram revealed neovascularization from the distal left circumflex artery and proximal right coronary artery to the left upper lung (Figure 2). There was no significant stenosis in the left and right coronary arteries. To confirm the site where the neovascularization leaked, we performed a multislice computed coronary angiogram. Axial images of the thorax in the mediastinal and lung settings showed close proximity between the left atrioventricular groove and a cavity mass. However, we failed to observe clear neovascularization flow because of the patient’s body fat and because the vessels had a very thin diameter. Instead, we confirmed a definite fungus ball in the left upper lung (Figure 3). We concluded neovascularity from both coronary arteries leaking to a fungus ball in the left lung. Download figureDownload PowerPointFigure 1. Posteroanterior view of the chest film showed a round mass with surrounding crescent air shadow in the upper left lung field (arrows), a finding compatible with fungus ball.Download figureDownload PowerPointFigure 2. Coronary angiogram revealed neovascularization from the distal left circumflex artery (A) and the proximal right coronary artery (B) to the left upper lung.Download figureDownload PowerPointFigure 3. Axial images of thorax with mediastinal (A) and lung settings (B) show close proximity between the left atrioventricular groove (arrowhead) and a cavity mass (arrows). However, neovascularization could not be seen in this image because of the very thin diameter of the vessels. The mass had eccentric, nonenhanced soft tissue density and crescent air density, typical radiological findings highly suggestive of fungus ball.DisclosuresNone.FootnotesCorrespondence to Kwang Kon Koh, MD, FACC, FAHA, Vascular Medicine and Atherosclerosis Unit, Cardiology, Gil Heart Center, Gachon Medical School, 1198 Kuwol-dong, Namdong-gu, Incheon, Korea 405–760. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By (2013) Engineering and Sport Exercising Computational Modeling for Anthropometry, 10.1201/b15763-6, (65-83), Online publication date: 18-Sep-2013. Guazzelli L, Severo C, Hoff L, Pinto G, Camargo J and Severo L (2012) Bola fúngica por Aspergillus fumigatus em cavidade pleural, Jornal Brasileiro de Pneumologia, 10.1590/S1806-37132012000100017, 38:1, (125-132), Online publication date: 1-Feb-2012. October 24, 2006Vol 114, Issue 17 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.106.630657PMID: 17060390 Originally publishedOctober 24, 2006 PDF download Advertisement SubjectsComputerized Tomography (CT)Imaging

Absence of the right coronary artery detected by 64-detector-row multislice computed tomography

The absence of the right coronary artery is an extremely rare variety of single coronary artery. We report a patient in whom the right coronary artery arose from the distal left circumflex artery. This is the first report describing images of this anomaly obtained by multislice computed tomography.

Anomalous Origin of the Left Coronary Artery from the Right Sinus of Valsalva, which Presented as Acute Myocardial Infarction

Among all the congenital coronary anomalies, an anomalous origin of the left coronary artery (LCA) from the right sinus of Valsalva is rare. A 48-year-old male patient suffering with lateral acute myocardial infarction was referred for primary percutaneous coronary intervention. The initial angiogram failed to show the LCA, which originated from the right coronary sinus. A critical stenotic lesion was observed in the distal left circumflex artery. The lesion was treated successfully with stenting. We report here on a case of an anomalous origin of the left coronary artery from the right sinus of Valsalva, and the patient presented as acute myocardial infarction. He was successfully treated with primary percutaneous intervention. (Korean Circulation J 2006;36:817-819)

Successful Treatment of Ischemic Dysfunction of the Sinus Node with Thrombolytic Therapy: A Case Report

We report on a case of ischemic dysfunction of the sinus node as a complication after percutaneous transluminal coronary angioplasty of the distal left circumflex artery. After local thrombolytic therapy in the sinus node artery, sinus node arterial flow was re-established and sinus node function normalized over the period of a week. Our experience suggests that immediate reperfusion of a totally occluded nodal artery can be re-established. Ischemic dysfunction of the sinus node, as a complication of angioplasty, is generally transient and requires a prolonged period for recovery. Therefore the decision to implant a permanent pacemaker should be delayed for at least one week after the ischemic insult.

Biodistribution of DiI-Labeled Bone Marrow-Derived Mononuclear Cells Following Intracoronary Injection in a Porcine Model of Chronic Myocardial Ischemia.

Background. We demonstrated previously that intracoronary (IC) injection, in a dose-escalating fashion, of autologous bone marrow (BM)-derived mononuclear cells (MNCs) in normal pigs (n = 3) was safe. Although IC injection with the highest cell dose (15 x 10^6 cells) resulted in transient significantly reduced [Thrombolysis In Myocardial Infarction (TIMI) grade 1] flow in the injected artery, this did not result in myocardial infarction (MI), as determined by measurement of plasma biomarkers of myocardial necrosis and histopathologic examination. We further studied IC injection of autologous BM-derived MNCs in a porcine chronic myocardial ischemia model. Here we report the biodistribution of CM dioctadecyl tetramethylindocarbocyanine (CM-DiI)-labeled MNCs in solid organs and BM following IC injection.Methods. Chronic myocardial ischemia was induced in domestic pigs (n = 5) by surgical placement via lateral thoracotomy of an ameroid cuff around the distal left circumflex artery. Coronary angiography three weeks later confirmed absent or significantly reduced (TIMI grades 0 or 1, respectively) coronary blood flow. BM was aspirated (40 – 60 mL, mean 45.4 mL) from the right femur. MNCs were isolated by Ficoll density gradient centrifugation. Cells were labeled with CM-DiI at 37 °C for 20 minutes. A total of 15 x 106 MNCs in 5 mL of phosphate-buffered saline with autologous plasma was injected by IC delivery. Seven days later, BM was aspirated from the left femur, after which animals were euthanized. The heart and major organs were harvested for histological studies. Alternate sections were either stained with hematoxylin and eosin or left unstained for immunofluoroscence microscopy for CM-DiI visualization.Findings. Neither gross inspection nor histopathology revealed evidence of MI. Cell injection resulted in TIMI grade 1 coronary flow that resolved after 10 minutes and was not associated with vasospasm. There was no significant elevation in plasma biomarkers of myocardial necrosis at one or seven days following cell therapy. A limited number of labeled MNCs were observed in perivascular structures in myocardium at the injection site. Labeled cells were not seen elsewhere in either the myocardium or identified in lung, liver, or kidney. DiI-labeled MNC localization was observed in spleen harvested from one of the animals. BM aspirates, which did not allow for quantitation of cell numbers, indicated labeled MNCs.Conclusions. IC injection of DiI-labeled BM-derived MNCs resulted in cell localization in the perivascular areas of myocardium supplied by the injected vessel. Cell localization was not observed in most major solid organs, with spleen localization identified in only one animal. Labeled cells were identified in BM aspirates from the three animals injected with CM-DiI-labeled MNCs, suggesting a role for BM engraftment and repopulation as a possible mechanism for MNC localization in myocardium. It remains to be determined whether IC MNC injection resulted in initial homing to BM followed by migration to myocardium, or whether IC cell delivery resulted in initial myocardial deposition followed by BM localization. Ongoing studies include additional biodistribution studies of DiI-labeled BM- and umbilical cord blood-derived stem cell populations in a rat model of acute MI.

Woven left coronary artery disease

CASE 1. S.L., a 60-year-old patient, developed angina pectons and had a positive thalhum scan. Coronary ang~ograms showed apparently normal left mam trunk and proximal left anterior descending artery (LAD). Subsequently, the LAD subdivided into 3 channels, intertwining along their course. The diameter of the distal branches was small (Figure 1); consequently, we could not assess anglographically whether the branches fused again. The proximal left circumflex artery sutxtivlded into 2 channels that fused again along the mid-left circumflex artery. The d~stal obtuse marginal and the distal left circumflex artery showed a morphology w~th no angiographic evidence for reanastomosis CASE 2: T.G, a 62,year-old man, had ang~ography for angina after acute myocardial mfarcuon angina. The left coronary anglograms showed 85% stenosls of the m~dLAD. The left circumflex artery subdivided into 2 woven channels that fused again (Figure 2). A 50%

Effects of H1-receptor stimulation on coronary arterial diameter and coronary hemodynamics in humans.

Effects of H1-receptor stimulation on coronary arterial diameter and coronary hemodynamics were examined in 11 patients with angiographically normal coronary arteries and without variant angina or resting angina. Selective H1-receptor stimulation was achieved by infusing histamine into the left coronary artery at a rate of 2.0 micrograms/min for 5 minutes after pretreatment with cimetidine (25 mg/kg). Plasma histamine concentration in the coronary sinus, coronary sinus blood flow, heart rate, and aortic pressure were measured before, during, and after the histamine infusion. Coronary arterial diameter was measured by cinevideodensitometric analysis of coronary arteriograms performed before and immediately after the histamine infusion. During the histamine infusion, plasma histamine concentration in the coronary sinus increased from 0.33 +/- 0.06 to 5.86 +/- 0.71 ng/ml (p less than 0.01); coronary sinus blood flow increased from 98 +/- 12 to 124 +/- 13 ml/min (p less than 0.01), and coronary vascular resistance decreased from 1,113 +/- 117 to 851 +/- 91 mm Hg.min/l (p less than 0.01). Heart rate and aortic pressure remained unchanged. The mean luminal diameters of the proximal, middle, and distal left anterior descending artery increased by 9.4 +/- 3.6% (p less than 0.05), 19.2 +/- 3.8% (p less than 0.001), and 31.5 +/- 5.6% (p less than 0.001), respectively, after the histamine infusion. The mean luminal diameters of the proximal, middle, and distal left circumflex artery increased by 15.2 +/- 3.6% (p less than 0.01), 17.5 +/- 5.2% (p less than 0.01), and 20.6 +/- 4.3% (p less than 0.001), respectively, after the histamine infusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Value of the ST-T segment in lead V4R in inferior wall acute myocardial infarction to predict the site of coronary arterial occlusion

The treatment of acute myocardial infarction (AMI) has changed dramatically with the introduction of thrombolytic therapy, immediate angioplasty and emergency coronary artery bypass surgery. Several studies1e3 have shown that the success rate of these procedures depends on the time interval between the onset of complaints and the achievement of reperfusion. In patients admitted with an inferior wall AMI, the coronary artery causing the AM1 can be the right or the left circumflex artery. Our previous investigations, as well as those of others,4-6 have shown that the recording of lead V4R in the acute phase of an inferior wall AM1 can distinguish those patients with a proximal occlusion of the right coronary artery from those with an occlusion of the distal right or left circumflex artery, the first group of patients showing ST-T-segment elevation I1 mm in lead V4R. However, it is not possible to differentiate between occlusion of a distal right coronary artery and a circumflex artery using this criterion. In these patients (possible candidates for intracoronary thrombolytic therapy), coronary arteriography might start with the “wrong” coronary artery leading to a delay in reperfusion. Retrospectively, we have analyzed the configuration of the ST-T segment in lead V4R to determine if changes in the ST-T segment can help predict the site of coronary occlusion in inferior wall AMI.

Digital fluoroscopy and intravenous cardiac angiography for the detection of coronary artery disease in selected subjects. A feasibility study.

Thirty-seven thin patients (height/weight ratio >2.2 cm/kg) without prior myocardial infarction underwent digital subtraction fluoroscopy and intravenous digital subtraction cardiac angiography one day before they were scheduled to undergo coronary angiography. Eighteen (49%) had at least a 50% obstruction of a major coronary artery as shown on selective coronary cineangiograms; eight of these (44%) had three calcified coronary arteries as visualized by digital fluoroscopy, five (28%) had diagnostic wall-motion abnormality by digital ventriculography, and 15 (83%) had intravenous angiographic evidence of at least one severe (>50%) coronary obstruction. Seventeen (94%) of the 18 with severe selective angiographic obstructions had at least one calcified artery detected by the digital study. Seventeen (89%) of the 19 without angiographic evidence of severe disease had none of these three abnormalities visualized on their digital intravenous images. Intravenous cardiac angiography was more accurate for predicting proximal coronary, right coronary, and left anterior descending branch obstructions, than for distal coronary and left circumflex artery obstructions.

Early atrial fibrillation during evolving myocardial infarction: a consequence of impaired left atrial perfusion.

Seven of 214 patients (3%) with acute myocardial infarction (120 inferior and 94 anterior) developed atrial fibrillation within 3 hr of the onset of chest pain. All seven patients had an inferior infarction and in all seven the left circumflex artery was occluded proximal to the origin of its left atrial circumflex branch. In five patients this occlusion was acute and was the cause of inferior infarction and in the remaining two patients the occlusion was old and the inferior infarction was due to an acute occlusion of the right coronary artery that also supplied extensive collaterals to the previously occluded left circumflex artery. All seven patients also had impaired perfusion to the atrioventricular nodal artery, as evidenced by total occlusion proximal to its origin or by stenosis proximal to its origin associated with second- or third-degree atrioventricular block. In contrast, early atrial fibrillation did not occur in any of the 18 patients with inferior myocardial infarction due to acute occlusion of the distal left circumflex artery or in any of the five patients with inferior infarction due to acute occlusion of the proximal left circumflex artery if perfusion to the atrioventricular nodal artery was not impaired. Early atrial fibrillation did not occur in any of the 90 patients with inferior infarction due to acute occlusion of the right coronary artery, including 12 patients with occlusion proximal to the sinus nodal artery, but without coexistent occlusion of the left circumflex artery.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of intracoronary injection of acetylcholine on coronary arterial diameter

The effects of intracoronary injection of acetylcholine on coronary arterial diameter was examined by coronary arteriography in 30 adult patients (13 men, 17 women), aged 23 to 67 years (mean 51), with normal or almost normal coronary arteriographic findings. Patients with angina pectoris, myocardial infarction and other severe cardiac diseases were excluded. Two minutes after injection of 30 to 100 μg of acetylcholine into the left coronary artery, significant diffuse narrowing (more than 25% reduction in diameter) of the left main trunk, the proximal, mid- and distal left anterior descending artery, and the proximal, mid- and distal left circumflex artery occurred in 1 (4%), 5 (20%), 3 (12%), 9 (36%), 6 (24%), 8 (32%) and 3 (12%) of 25 patients, respectively. After injection of 30 to 50 μg of acetylcholine into the right coronary artery, significant diffuse narrowing of the proximal, mid- and distal right coronary artery occurred in 5 (25%), 7 (35%) and 10 (50%) of 20 patients, respectively. However, significant diffuse dilatation (more than 25% increment in diameter) appeared in the left main trunk, left anterior descending, left circumflex and right coronary arteries in a few patients. These results indicate that acetylcholine induces coronary vasoconstriction in a significant number and coronary vasodilatation in a small number of adult humans, and that response of the coronary artery to acetylcholine varies along the course of the coronary artery.

Origin of the left anterior descending coronary artery from the pulmonary artery: 3 year angiographic follow-up after saphenous vein bypass graft and proximal ligation

A 55 year old woman had an extremely rare congenital anomaly of the coronary circulation in which the left anterior descending coronary artery arose from the pulmonary artery. Proximal ligation and saphenous vein grafting to the aberrant vessel were performed. Five month and 3 year angiographic follow-up studies demonstrated 1) a widely patent vein graft, 2) regression of large collateral vessels between the right coronary and circumflex arteries and the left anterior descending artery, and 3) marked attenuation of the distal right coronary and left circumflex arteries on the 3 year study. This report describes the clinical course of the oldest reported patient with this unique coronary artery anomaly and the only angiographic study of the effect of ligation and saphenous bypass grafting on its natural history.