Branch Of Left Coronary Artery Research Articles

Extrapleural harvesting of the internal thoracic artery - impact on early postoperative results and pulmonary function.

The internal thoracic artery (ITA) has proven to be the best graft for surgical myocardial revascularization, especially in the configuration left ITA (LITA) to the anterior descending branch of left coronary artery (LAD). Its harvesting is usually accompanied by pleurotomy, followed by drainage tube placement into the pleural cavity, using the so called intrapleural method. Extrapleural technique for LITA harvesting is also practiced in many cardiac surgery centers and with this technique the pleura is left intact.

Congenital morphological patterns of myocardial bridges

Myocardial bridging (MB) is a coronary anomaly in which a segment of the coronary artery is overlapped by a layer of myocardial tissue. Nowadays, there is no scientific agreement on if the MB are congenital or acquired or on the factors that determine their presence and/or absence. This study is performed to analyze the anatomical characteristics of adult and children's hearts regarding the shape of the left coronary artery branching, presence of pre-bridge arterial branch, coronary dominance and its correlations to MB formation. We analyzed 240adults heart specimens and 63children's specimens. The frequency of the myocardial bridges (MB) occurrence was performed through observational study of the anatomical specimens. The shape of the left coronary artery (LCA) branching, presence of pre-bridge arterial branch (PBB) and coronary dominance was determined superficial dissection of the epicardial adipose tissue and careful evaluation of the hearts. A relation between the trifurcated pattern of the LCA and the presence of MB (P<0.0001, odds ratio=3.74) was found in adults heart and in children's hearts (P=0.003, odds ratio=16.0), as well as a relation between the presence of PBB and the presence of MB in adult hearts (P<0.0001) and children's hearts (P<0.0001). Our findings suggest for the first time that the myocardial bridges are related to the presence of trifurcation of the left coronary artery and the pre-bridge arterial branch in adult and children's hearts.

Analysis on missed diagnosis or misdiagnosis of anomalous origin of left coronary artery from pulmonary artery by echocardiography from one single medical center

Objectives: To analyze the reasons of missed diagnosis or misdiagnosis on anomalous origin of left coronary artery from pulmonary artery (ALCAPA) by echocardiography. Methods: This is a retrospective study. Patients with ALCAPA who underwent surgical treatment in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from August 2008 to December 2021 were included. According to the results of preoperative echocardiography and surgical diagnosis, the patients were divided into confirmed group or missed diagnosis/misdiagnosis group. The results of preoperative echocardiography were collected, and the specific echocardiographic signs were analyzed. According to the experience of the doctors, the echocardiographic signs were divided into four types, namely clear displayed, vague/doubtful displayed, no display and no notice, and the display rate of each sign was calculated (display rate=number of clearly displayed cases/total number of cases×100%). By referring the surgical data, we analyzed and recorded the pathological anatomy and pathophysiological characteristics of the patients, and the rate of missed diagnosis/misdiagnosis of echocardiography in patients with different characteristics was compared. Results: A total of 21 patients were enrolled, including 11 males, aged 1.8 (0.8, 12.3) years (range 1 month to 47 years). Except for one patient with anomalous origin of left anterior descending artery, the others were all originated from the main left coronary artery (LCA). There were 13 cases of ALCAPA in infant and children, and 8 cases of adult ALCAPA. There were 15 cases in the confirmed group (diagnostic accuracy was 71.4% (15/21)), and 6 cases in the missed diagnosis/misdiagnosis group (three cases were misdiagnosed as primary endocardial fibroelastosis, two cases were misdiagnosed as coronary-pulmonary artery fistula; and one case was missed diagnosis). The working years of the physicians in the confirmed group were longer than those in the missed diagnosis/misdiagnosed group ((12.8±5.6) years vs. (8.3±4.7) years, P=0.045). In infants with ALCAPA, the detection rate of LCA-pulmonary shunt (8/10 vs. 0, P=0.035) and coronary collateral circulation (7/10 vs. 0, P=0.042) in confirmed group was higher than that in missed diagnosis/misdiagnosed group. In adult ALCAPA patients, the detection rate of LCA-pulmonary artery shunt was higher in confirmed group than that in missed diagnosis/misdiagnosed group (4/5 vs. 0, P=0.021). The missed diagnosis/misdiagnosis rate of adult type was higher than that of infant type (3/8 vs. 3/13, P=0.410). The rate of missed diagnosis/misdiagnosis was higher in patients with abnormal origin of branches than that of abnormal origin of main trunk (1/1 vs. 5/21, P=0.028). The rate of missed diagnosis/misdiagnosis in patients with LCA running between the main and pulmonary arteries was higher than that distant from the main pulmonary artery septum (4/7 vs. 2/14, P=0.064). The rate of missed diagnosis/misdiagnosis in patients with severe pulmonary hypertension was higher than that in patients without severe pulmonary hypertension (2/3 vs. 4/18, P=0.184). The reasons with an echocardiography missed diagnosis/misdiagnosis rate of≥50% included that (1) the proximal segment of LCA ran between the main and pulmonary arteries; (2) abnormal opening of LCA at the right posterior part of the pulmonary artery; (3) abnormal origin of LCA branches; (4) complicated with severe pulmonary hypertension. Conclusions: Echocardiography physicians' knowledge of ALCAPA and diagnostic vigilance are critical to the accuracy of diagnosis. Attention should be paid to the pediatric cases with no obvious precipitating factors of left ventricular enlargement, regardless of whether the left ventricular function is normal or not, the origin of coronary artery should be routinely explored.

Single coronary artery presenting dilated cardiomyopathy and hyperlipidemia with the SCN5A and APOA5 gene mutation: A case report and review of the literature.

We present a 55-year-old man with chest tightness and dyspnoea after activity lasting for 2 months who was diagnosed with single coronary artery (SCA) and presented with dilated cardiomyopathy (DCM) with the c.1858C > T mutation in the SCN5A gene. The computed tomography coronary angiogram (CTCA) showed congenital absence of the right coronary artery (RCA), and the right heart was nourished by the left coronary artery branch with no apparent stenosis. Transthoracic echocardiography (TTE) revealed enlargement of the left heart and cardiomyopathy. Cardiac magnetic resonance imaging (CMR) revealed DCM. Genetic testing showed that the c.1858C > T variant of the SCN5A gene could lead to Brugada syndrome and DCM. SCA is a rare congenital anomaly of the coronary anatomy, and this case reported as SCA accompanied by DCM is even rarer. We present a rare case of a 55-year-old man with DCM with the c.1858C > T (p. Arg620Cys)/c.1008G > A (p.(Pro336=) variant of the SCN5A gene, congenital absence of RCA, and c.990_993delAACA (p. Asp332Valfs*5) variant of the APOA5 gene. To our knowledge, this is the first report of DCM combined with the SCN5A gene mutation in SCA after searching the PubMed, CNKI and Wanfang databases.

Redistribution of Perfusion and Myocardial Function in Patients With Multivessel Disease and Myocardial Infarction With ST Segment Elevation After Recanalization of an Infarct-Associated Artery According to the Results of Single Photon Emission Computed Tomography, Synchronized With Electrocardiography

BACKGROUND Numerous studies have shown that coronary reperfusion with primary percutaneous coronary intervention (PCI) improves outcomes in patients with ST-segment elevated myocardial infarction (STEMI). However, the question of the effect on the myocardium as a whole of an isolated intervention on an infarct-related artery in multivessel coronary disease remains incompletely studied.AIM OF STUDY To study the features of perfusion redistribution and myocardial function using perfusion single photon emission computed tomography (SPECT) in patients with STEMI and multivessel coronary disease after isolated PCI on an infarct-related artery.MATERIAL AND METHODS SPECT-ECG (electrocardiography) was performed in 32 patients (27 men and 5 women) with STEMI. According to the ECG results, the location of focal myocardial changes was regarded as “lower” MI in 19 (59%) patients, “anterior” in 13 patients (41%). Coronary angiography revealed a multivessel lesion of the coronary vessels in all of them. The patients were divided into groups according to the location of the infarction and the area of the lesion: group 1 — lower MI (stenting of the right coronary artery (RCA) and its branches) — 19 patients (mean age — 57.7±2.5; median — 55 [51.5; 63.5]), of which 8 with small-focal (1a) and 11 with large-focal infarction (1b); group 2 — anterior MI (stenting of the left coronary artery (LCA) and its branches) — 13 patients (mean age — 55.4±3.5; median — 54 [48.5; 62.5]), of which 5 with small-focal (2a) and 8 with large-focal infarction (2b). SPECT-ECG was performed 3 times: 1st — on days 2–3 after PCI of the infarct-related artery, 2nd — 6 days after PCI, and 3rd — 6 months after PCI.RESULTS After RCA stenting in patients with lower MI and multivessel coronary disease, SPECT-ECG revealed a statistically significant decrease in local contractility of individual segments of the anterior septal and lateral walls (with sufficient revascularization of the RCA system) and worsening of perfusion and right ventricular (RV) volumes. After stenting of the LCA branches in patients with anterior MI and multivessel coronary disease, a statistically significant decrease in local contractility in the basal segment of the diaphragmatic wall was observed, as well as impaired perfusion and an increase in the volume of the RV (with successful revascularization of the anterior interventricular branch). All these findings could be the result of partial steal of the blood supply to neighboring areas and myocardial remodeling after PCI in patients with multivessel coronary artery disease.CONCLUSION 1. According to the data of single-photon emulsion computed tomography synchronized with electrocardiography in the early and late period of myocardial infarction after percutaneous coronary intervention in patients with multivessel coronary disease, there is a significant improvement in perfusion and function of the infarct-associated artery system. 1. Recanalization of only the left coronary artery with remaining stenoses in the right coronary artery in the long-term period can lead to an increase in the size of the cavity of the right ventricle of the heart and uneven distribution of perfusion in its The revealed statistically significant disturbances in perfusion and local contractility of neighboring areas after percutaneous coronary intervention of an infarct-related artery may be the result of steal of the blood supply and early myocardial remodeling in multivessel disease. 3. Disturbances in perfusion and local contractility in neighboring myocardial blood supply pools after percutaneous coronary intervention of an infarct-related artery dictates the need to repeated single-photon emulsion computed tomography synchronized with electrocardiography as early as possible in patients with multivessel coronary disease in order to assess the redistribution of perfusion and myocardial remodeling for timely complete revascularization, preventing recurrent coronary

Myocardial bridge over coronary arteries and myocardial coat over coronary sinus: a cadaveric study

Abstract Funding Acknowledgements Type of funding sources: None. Background Myocardial Bridge (MB) over the coronary artery and myocardial coat (MC) over the cardiac veins are sometimes detected in angiography and cadaveric dissection. Left anterior descending (LAD) branch of left coronary artery is most frequent site of MB. Rarely MB is also seen over right coronary artery (RCA) branch. MB has proven association with ischemic heart disease and other critical cardiac consequences like myocardial infarction (MI)(1)(2). MC on the other hand has not gained enough attention in erstwhile studies. Large MB can be readily identified in angiograms, but minute MB can be picked up by newer imaging studies like multi-detector computed tomography (MDCT) and optical coherence tomography (OCT) scan(3). Cadaveric dissection however holds its unique place in direct visualization and studying the macro and micro-anatomical characteristics. Purpose To study the prevalence and anatomical attributes of MB and MC in cadaveric hearts. Methods Ten adult cadaveric hearts (6 male and 4 female) were dissected as part of routine undergraduate teaching during academic year 2021-22. MB over the coronary artery and MC over cardiac vein was identified. Data pertaining to the MB and MC dimensions were measured with digital vernier calliper. Histology of the MC was carried out to confirm its presence and observe the cyto-architecture pattern. Relevant gross macroscopic and microscopic images were photographed and photomicrographed. Results 20% of the dissected cadavers revealed MB involving LAD in first heart while LAD and RCA both in second heart with length 7.5 mm, 11.5 mm and 1.8 mm respectively. MC was noted over coronary sinus and proximal few millimeters of great and middle cardiac veins. Histological examination revealed cardiac striated muscle in MC with typical cyto-architecture. The mean myocardial muscle index (MMI) of MBs was 1.39. Conclusions Present study highlights 20% prevalence of MBs in cadavers involving both right and left coronary artery. 10% of the subjects had histologically confirmed MC over cardiac veins. MC over coronary sinus and other cardiac veins needs more elaborate explorative studies to quantify the anatomic properties and to examine the possible association with cardiovascular disease. Nevertheless, anatomic attributes should be kept in mind to better appreciate MI in evolution and MI at evaluation in a case with MB.

Non-electrocardiography- and electrocardiography-gated computed tomography angiography for the evaluation of feline coronary arteries.

ObjectivesFew studies have directly compared the clinical feasibility of electrocardiography-gated and non-electrocardiography-gated multidetector computed tomography for evaluating coronary arteries in veterinary medicine. We aimed to characterize and visualize feline coronary arteries using these two imaging modalities. We hypothesed that ECG-gated MDCT is superior to or advantageous to the non-ECG gated.MethodsThis prospective, controlled, comparative pilot study examined six client-owned cats (five clinically normal and one with hypertrophic cardiomyopathy) using non-electrocardiography-gated and retrospective electrocardiography-gated scans. Optimal non-electrocardiography scan timing or electrocardiography-gated R-R reconstruction interval for coronary artery visualization was determined. The degree of opacification and sharpness of proximal coronary branches was subjectively graded; coronary dominance, left coronary artery branching types, and the diameter and length of coronary artery branches were also assessed.ResultsNon-electrocardiography-gated images provided the least information on the bilateral coronary artery ostium and proximal segments, while electrocardiography-gated images clarified the detailed course of the main coronary branches at diastole in all cats. The degree of opacification and sharpness of the coronary arteries was subjectively evaluated as good/excellent in all cats. Coronary dominance (left: four; right: two) and left coronary artery branching types (three different patterns, two additional tortuous branches) varied. Body weight and sex were not significantly associated with coronary artery length or diameter. Vertebral heart score positively correlated with the right coronary artery and negatively correlated with the left main coronary artery.Clinical significanceElectrocardiography-gated multidetector computed tomography provides images with adequate resolution to identify the anatomy of feline coronary arteries. Detailed morphological knowledge of feline coronary vessels will enable novel diagnostic and therapeutic methods in veterinary medicine.

Quantification of myocardial blood flow and myocardial flow reserve by 13N-NH3 PET/CT is not significantly affected by pixel size.

Myocardial blood flow (MBF) and myocardial flow reserve (MFR) are measurable by 13N-NH3 positron emission tomography (PET). MFR, which is the ratio of MBF under adenosine stress to MBF at rest, is prognostically valuable. The ASNC imaging guidelines/SNMMI procedure standards recommend using 2-3mm pixels, and pixel size does differ between institutions. We sought to evaluate the effects of pixel sizes on the quantitative values calculated from 13N-NH3 PET images. Thirty consecutive patients with ischemic heart disease who underwent 13N-NH3 PET were retrospectively enrolled. Dynamic images were quantified using PMOD's cardiac PET analysis tool (pixel sizes: 3.18, 2.03, and 1.59mm). MBF under adenosine stress, MBF at rest, and MFR for the right coronary artery (RCA) region, left anterior descending artery region, and left circumflex coronary artery branch region innervation regions were calculated at each pixel size and compared. Quantitative values did not significantly differ according to pixel size in any of the regions. However, MFR values for the RCA fluctuated the most. Ischemic and non-ischemic regions remained visually discernible in qualitative images, with no variation in quantitative values, regardless of pixel size. Quantitative values were not significantly affected by pixel sizes within the recommended range of 2-3mm. Values for the RCA region may have been overestimated, but this was true for all pixel sizes.

Thrombotic Left Main Coronary Artery Occlusion Treated With Bioresorbable Scaffold.

A 56-year-old man with a history of smoking presented with an extensive anterolateral ST-segment-elevation myocardial infarction (Killip class III) and moderate left ventricular (LV) systolic dysfunction. Emergency coronary angiograms revealed acute thrombotic occlusion of the unprotected left main coronary artery (LMCA) (Fig. 1A) and a dominant right coronary artery contributing to Rentrop grade 2 collateral circulation (Fig. 1B). We directed a guidewire into the left anterior descending coronary artery (LAD) and then, under optical coherence tomographic (OCT) imaging guidance, deployed a 3.5 × 28-mm Absorb bioresorbable vascular scaffold (Abbott Vascular; no longer commercially available) in the unprotected LMCA and LAD. Next, we dilated the vessels with a 3.5 × 20-mm noncompliant balloon. The good angiographic result indicated that patency had been achieved (Fig. 1C). With use of OCT, we confirmed the correct apposition of the scaffold (Fig. 2A), but also identified a small distal edge dissection in the LAD unsuitable for stenting, leaving the ostium of the left circumflex coronary artery caged by struts (Fig. 2B). At the patient's 40-month follow-up visit, his LV function had recovered, and a coronary angiogram confirmed that the treated unprotected LMCA-LAD remained patent (Fig. 1D). Optical coherence tomograms showed most of the struts to be adequately covered with neointima and in the process of being reabsorbed (Fig. 2C); they also showed no remaining scaffold struts or neointimal bridges at the ostium of the left circumflex coronary artery and other branches (Fig. 2D).To our knowledge, this is the first reported case of catastrophic acute thrombosis of an unprotected LMCA being treated with a bioresorbable scaffold. Acute myocardial infarction due to unprotected LMCA disease is rare, but it is also clinically catastrophic and associated with a high mortality rate even after successful revascularization.1 Despite the withdrawal of the Absorb bioresorbable scaffold from commercial sale,2 bioresorbable scaffolds in general are still an attractive therapeutic option for de novo lesions or spontaneous coronary artery dissections during percutaneous coronary interventions, particularly in young patients with less complex lesions.

High Risk Primary Percutaneous Coronary Intervention (Pci) in Patient with Acute Stemi Anterior, Chronic Kidney Disease, and Confirmed Covid-19

Background: An acute ST-elevation myocardial infarction (STEMI) anterior occurs due to occlusion of left anterior descending artery (LAD) branch of left coronary artery. The occlusion causing transmural myocardial ischemia which in turn to myocardial infarction due to myocardial injury or necrosis. Not only Primary Percutaneous Coronary Intervention (PCI) should be performed in STEMI less than 120 minutes as the risk of the adverse events would increase if exceeding the total ischemic time, but also the procedure can be high risk in patients with multiple clinical factors or comorbidities which can increase the risk of complications.Case Report: We report a case of a 57 years old man who presented Acute STEMI Anterior, Coronary Artery Disease (CAD) 3 Vessel Diseases (VD), Hypertension Heart Disease (HHD), Chronic Kidney Disease (CKD) on Hemodialysis (HD), with COVID-19 confirmed.Results: The left coronary artery was successfully stented by PCI and Coronary Angiogram (CAG) procedures with TIMI 3 flow, minimal bleeding and others complications.

Today We Walk. Tomorrow We Dance.

Today We Walk. Tomorrow We Dance Allen Callaci Roughly 10 years ago I was helicoptered from my local community hospital to Cedars-Sinai with less than a 25% chance of surviving the brief flight. I left work early, not feeling well that afternoon, and shortly after arriving home, blacked out across my bathroom floor. The heart that had been beating inside me for 40-plus years was in complete collapse. After more than 40 years, it was discovered that the circumflex branch of my left coronary artery had been underdeveloped since birth. My other arteries overcompensated over the ensuing decades, which slowly wore my heart down. I was tired in the years leading up to my transplant but I attached that weariness to my rich and active life, which was filled to the rim with working two jobs, being a grad student and occasionally singing in a rock ’n’ roll band. They say life changes in an instant. Mine changed quicker than that. I left work that afternoon thinking I’d be back in a day or so and catching a Bruce Springsteen concert I had tickets to the following week. Instead I woke up in a hospital bed hooked to oxygen and the symphony of a beeping heart monitor, connected to 27 IVs and two heart assist devices attached to each side of my heart. I woke in a medicated fog with my sister mentioning I was going to be having a heart transplant. I wondered if my situation was real or if I was dreaming and had been swept to a hospital located in Oz. The most positive and painful moments of my recovery and quest to get back home could sometimes be part of the same moment. There were excruciatingly painful moments as I balanced myself on a walker surrounded by a pit crew of nurses helping me balance all the IVs and an oxygen tank. One of the crew followed close behind me with a wheelchair if I should tire on my trek around the nurse’s station and should need a rest. Having not walked in weeks and weeks, each step was excoriatingly painful. My legs felt like a pair of wet flimsy noodles as I stood up for the first [End Page 120] time in a month and a half. My mind knew exactly what it was supposed to do, but the body wasn’t getting the message But as painful as these steps were (and they really were), I saw each step as one step closer to home. The staff at Cedars-Sinai were not just staff taking another patient on a walk—they made me feel like they were my crew with their reassuring and positive attitude as they guided me. I’ll be forever grateful to the nurse who, on one of my first brutally painful walks around the nurse’s station, lightheartedly told me that “today we walk, tomorrow we’ll dance.” I’ve known fewer moments as hopeful, humorous, and humanizing as that one. That mindset transferred onto me as we made our daily walks around the nursing station. Those walks became less and less painful with each passing day. I saw my progress as I graduated from walker, to cane, to being able to walk independently again. I have not stopped thinking of my donor and their family in the years since returning home from Cedars-Sinai, although I only know minimal details about them. I know they were 25 years old and a male. I have reached out to the family with written expressions of my enduring and unending gratitude over the years through the proper channels but have yet to hear back. When I sent out my initial note to the family, I was told that the odds were that I would likely not hear back as it can be an overwhelming emotional experience for donor families to meet the donor. This is more than understandable. My hope is only that my donor family found some small comfort and a sense of closure in my messages. I am often told by others what a journey I have been on. And it has been a journey...

Morphometrical Description of the Left Ventricular Summit Vascular Triangle

BackgroundPrecise anatomical description of coronary vascular topography in the epicardial area adjacent to left atrial appendage (LAA) is crucial for many procedures performed in this region. The aim of this study was to assess the mutual relations between branches of left coronary artery and great cardiac vein in the left ventricular summit region and to determine their neighborhood with the LAA.MethodsLeft coronary artery with its branches, great cardiac vein and selected cardiac structures were segmented from 200 contrast enhanced computed tomography scans and visualized using three dimensional semi‐automatic algorithms.ResultsIn 97.0% of cases the area between left coronary artery branches and great cardiac vein had triangular‐like shape, with area of 253.0±160.0mm2. The length of the left anterior descending and left circumflex coronary artery sections forming the triangle sides were 24.6±8.8mm and 20.8±6.5mm, respectively. The mean length of the triangle base formed by great cardiac vein was 26.2±11.3mm. On average, 78.8±25,3% of the triangle area was covered by LAA. In 30.5% the ramus intermedius coronary artery intersected the triangle. Within the triangle, the Dg1 was present in 53.0% of hearts, the Dg2 in 4.5%, Mg1 in 29.0% and Mg2 in 3.5%.ConclusionsThis study provided detailed morphometrical description of the left ventricular summit vascular triangle. The proximal parts of the left coronary artery branches are closely adjacent to LAA in most cases. Three‐dimensional visualizations of coronary vessels and LAA may lead to increased safety of invasive procedures performed in this region.

Utilizing Biology-Guided Radiotherapy for Coronary Artery Avoidance During Free-Breathing External Beam Radiation Delivery

Radiation-induced cardiotoxicity is associated with the dose delivered to the coronary arteries (CA). Breath-hold and respiratory gating may help reduce CA dose in some individuals, but patients with cardiopulmonary comorbidities may not be candidates for these strategies. Biology-guided radiotherapy (BgRT) uses outgoing tumor PET emissions to deliver a tracked dose distribution to a moving target during the normal breathing cycle, which may reduce dose to sensitive structures like the CA without the need for additional motion management techniques. To understand dosimetric implications for the CA, we conducted a planning study utilizing the RefleXion X1 to develop plans for lung tumors in the biology-guided mode.Right coronary artery (RCA) and left coronary artery (LCA) branches were delineated in three lung cancer patients (P1 = Left upper lung tumor, P2 = Right upper lung tumor, and P3 = Right lower lung tumor). BgRT plans were created with AAPM TG-101 50 Gy in 5-fraction protocol using a research version of the RefleXion treatment planning system (TPS), and dose-volume parameters of the heart, RCA, and LCA were analyzed. Using the Pearson correlation model, the correlation between: (1) the mean heart dose (MHD) and tumor location, (2) the MHD and RCA relationship, (3) the MHD and LCA relationship, (4) tumor-to-ipsilateral/contralateral branches and mean coronary dose were evaluated.The BgRT-PTVs were 27.3, 14, and 66.7 cm3 for P1, P2, and P3, respectively. The average MHD was 2.15 Gy (Range: 0.48-5.03 Gy). The MHD was highly correlated with the tumor location (R = -0.99 and P = 0.037). The RCA and LCA received an average mean dose of 1.46 Gy (Range: 0.3-3.21 Gy) and 1.01 Gy (Range: 0.75-1.45 Gy), respectively. The RCA branches in P1, P2, and P3 received a low dose (1 Gy) of 0.50%, 40.70%, and 91.10%, respectively. Also, LCA branches in P1, P2, and P3 received V1 dose of 45.70%, 37.20%, and 58.00%, respectively. The LCA V15 was less than 10% in all cases, meeting the constraint recently proposed by Atkins, et al. The MHD had a correlation coefficient of 1.00 (P = 0.06) and 0.98 (P = 0.14) with mean RCA and LCA doses, respectively. There were insignificant correlations between targets-to-ipsilateral/contralateral branches and mean coronary dose.Tracked dose distributions utilizing biology-guidance were associated with robust CA avoidance without the requirement for gating or breath-holding maneuvers. This observation also held for MHD, which was correlated with CA dose in this investigation.O.M. Oderinde: Stock Options; RefleXion Medical. T. Cornwell: Stock Options; RefleXion Medical. M. Owens: Stock Options; RefleXion Medical. S. Tian: None. X. Yang: None. K.A. Higgins: Research Grant; RefleXion Medical. Consultant; Astra Zeneca, Varian, Precisca. Advisory Board; Genetech; NRG Oncology. A. Da Silva: None. S.M. Shirvani: Employee; Sutter Health. Stock; RefleXion Medical. Stock Options; RefleXion Medical. Manage clinical, medical and scientific affairs; RefleXion Medical.

Anomalous Origin of Left Main Coronary Artery from Right Coronary Artery in A Patient Presenting with Inferior Wall Myocardial Infarction: A Case Report

Anomalous origin of the coronary arteries is a very rare phenomenon and is seen only in less than 1% of the general population. Single coronary artery (SCA) is a congenital anatomic abnormality identified by a single coronary ostium giving rise to one coronary artery. Our case presented at 40 years with intermittent chest discomfort, effort intolerance and a history of getting Streptokinase one month back due to AMI (Inferior). Diagnosis was confirmed with elective conventional coronary angiography and coronary CT angiography as an extremely rare variant of the left main coronary artery (LMCA) branching off from the right coronary artery (RCA) and then following a pre-pulmonic course. We did Off Pump CABG surgery with four grafts and discharged the patient uneventfully with guidelinedirected medical therapy with a beta-blocker, statin, and dual antiplatelet agents and the patient is on follow up. Bangladesh Heart Journal 2021; 36(1) : 61-66

3D Rapid Prototyping Heart Model Validation for Teaching and Training - A Pilot Project in a Teaching Institution.

IntroductionRapid prototyping is a process by which three-dimensional (3D) computerized surface models are converted into physical models. In this study, a 3D heart bio model was created using the rapid prototyping method and the accuracy of this heart model was assessed by clinicians.MethodsThe two-dimensional images of normal heart from gated computed tomography scan datasets were used to create a 3D model of the heart. The slices were then processed using the software BioModroid and printed with the 3D printer. The evaluation of the model was performed by a questionnaire answered by four cardiothoracic surgeons, 12 cardiologists, five radiologists, and nine surgical registrars.ResultsEighty-six percent of the anatomy structures showed in this model scored 100% accuracy. Structures such as circumflex branch of left coronary artery, great cardiac vein, papillary muscle, and coronary sinus were each rated 77%, 70%, 70%, and 57% accurate. Among 30 clinicians, a total of 93% rated the model accuracy as good and above; 64% of the clinicians evaluated this model as an excellent teaching tool for anatomy class. As a visual aid for surgery or interventional procedures, the model was rated excellent (40%), good (50%), average (23%), and poor (3%); 70% of the clinicians scored the model as above average for training purpose. Overall, this 3D rapid prototyping cardiac model was rated as excellent (33%), good (50%), and average (17%).ConclusionThis 3D rapid prototyping heart model will be a valuable source of anatomical education and cardiac interventional management.

Influence of bifurcation angle in left coronary artery with stenosis: A CFD analysis.

The left coronary artery commonly known as LCA gets divided into two branches, such as the left circumflex (LCX) and left anterior descending (LAD) at a particular angle. This angle is varies from person to person. The present computational study contributes remarkable expertise about the influence of this angle variation on the hemodynamic parameters in the presence of 80% area stenosis at the LAD branch. This study aimed to compare the effect of the bifurcation angle on hemodynamic parameters in the left coronary artery with 80% stenosis. Computational models of left coronary bifurcation angles of 30°, 60°, 90°, 120° were developed to understand the flow behavior of left coronary artery branches. The 80% area stenosis (AS) is considered at the LAD branch immediate to bifurcation. Measurements of pressure, velocity and wall shear stress were carried out corresponding to various bifurcation angles. It was found that the drop-in pressure increases as the angle increases from narrow to wider. A slight elevation in the velocity at the stenosis was observed. In addition, the obtained results further reveal a recirculation region immediately after the plaque, which leads to more deposition of plaque in the flow obstructed area. It is known that the shear stress at the arterial wall across the stenosis increases as the angle of bifurcation increases from narrow to wider. The bifurcation of the left coronary artery and size of the stenosis have a notable impact on the pressure and wall shear stress. These two factors should be given due consideration by cardiologists to assess the complexity of stenosis in the LCA branches.

Anatomical Study of Triangle of Brocq and Mouchet in Human Cadaveric Heart

Right and left coronary arteries maintain the nutritional supply of heart. The left coronary artery (LCA) bifurcates into Anterior Interventricular Artery (AIA) and Circumflex Artery (CA). Triangle of Brocq and Mouchet is an arterio-venous triangle formed by AIA and CA of left coronary artery and great cardiac vein (GCV) that lies between conus aretriosus and left auricle. This study aims to determine frequency of Brocq and Mouchet triangle and its anatomical details. This study was conducted in thirty formalin fixed cadaveric hearts collectively available in the Department of Anatomy, Nepal Medical College from November 2019 till April 2020. The incidence of heart showing the triangle was 93.3% with the most common type being closed which is followed by inferiorly opened, superiorly opened, and completely opened. Most frequent content of the triangle was median artery followed by diagonal branches of AIA and CA. the mean area of the triangle was 218.84mm2(527.97 mm2-57.26 mm2). The branches of LCA varied from bifurcation to pentafurcation. Relationship of GCV with AIA and CA was found to be either superficial or deep. The anatomical knowledge of the Brocq and Mouchet triangle regarding arterio-venous relationship will be required for angiographic procedures. Also, the triangle is a potential epicardial access route to mitral valve annulus thus detailed anatomical knowledge of the triangle will help cardiologist to achieve successful cardiological procedures with minimal complications.

Entwined Pattern of Coronary Arteries

A 67-year-old asymptomatic man with a history of the Bentall procedure 20 years ago for aortic root dilatation and severe aortic regurgitation underwent a routine evaluation, for residual aortic root dilatation, by coronary computed tomography angiography. The image analysis highlighted a crossing of the mid left circumflex (thin white arrows) with the obtuse marginal artery (wide black arrows) in their proximal segments both in volume rendering (Supplemental Figs. S1 and S2) and in maximum intensity projection (Supplemental Fig. S3) reconstructions. The basic information about the scanner and the scanning protocol is available in Supplemental Appendix S1. Very few cases of crossing coronary arteries have been previously described in the literature, and it remains considered as a normal variant of coronary anatomy.1Trivellato M. Angelini P. Leachman R.D. Variations in coronary artery anatomy: normal versus abnormal.Cardiovasc Dis, Bull Tex Heart Inst. 1980; 7: 357-370Google Scholar Other coronary arteries, as left anterior descending and diagonal branches, may also be involved.2Pandey N.N. Sharma A. A curious case of crossing coronary arteries.Asian Cardiovasc Thorac Ann. 2020; 28: 219Crossref PubMed Scopus (1) Google Scholar It's frequently a fortuitous diagnosis as performing coronary computed tomography angiography or coronary angiogram for another purpose. There is currently no evidence of functional significance attributed to this condition. Precise data on epidemiology remain unknown. We herein add a supplementary exception to the generally accepted anatomic postulate describing the major branches of the coronary arteries running parallel to one another without any crossing pattern.3Silverman J.F. Coronary Angiography. Addison Wesley, Inc., Menlo Park, CA1984: 66Google Scholar Albeit mostly asymptomatic, this condition may have a therapeutic impact by influencing the revascularization strategy either by percutaneous coronary intervention or coronary artery bypass grafting in multivessel disease involving left circumflex coronary artery branches. Indeed, crossing coronary arteries suggest that one vessel may be intramyocardial and thus cannot be bypassed.4Bilazarian S.D. Jacobs A.K. Fonger J.D. Faxon D.P. Case report of a coronary anomaly: crossing obtuse marginal arteries.Cathet Cardiovasc Diagn. 1991; 23: 130-132Crossref PubMed Scopus (3) Google Scholar In such cases, it has been proposed to perform an arterioarterial shunt at the crossing point in case of a significant stenosis involving the proximal segment of one branch5Muyldermans L.L. van den Heuvel P.A. Ernst S.M. Epicardial crossing of coronary arteries: a variation of coronary arterial anatomy.Int J Cardiol. 1985; 7: 416-419Abstract Full Text PDF PubMed Scopus (6) Google Scholar when coronary artery bypass grafting is planned, provided the other is healthy.Novel Teaching Points•Major branches of the coronary arteries may cross each other rather than running parallel to one another as generally stipulated.•Crossing coronary arteries may influence the revascularization strategy, especially when coronary artery bypass grafting is planned. •Major branches of the coronary arteries may cross each other rather than running parallel to one another as generally stipulated.•Crossing coronary arteries may influence the revascularization strategy, especially when coronary artery bypass grafting is planned.

Non-сoronary myocardial diseases (myocardial bridging, hypertrophic cardiomyopathy, secondary ischemia) – right to existence

The purpose of the study — to analyze the clinical case of the patient with symptoms of acute coronary syndrome taking into account clinical, laboratory and instrumental investigations. Material and methods. We investigate the clinical case of the patient who was conducted with acute coronary syndrome, but myocardial bridging was observed during the diagnostic manipulations. Results. Most frequently, myocardial bridging occurs at the level of mid-segment of anterior interventricular branch of left coronary artery. There are symptoms which can instigate ischemia such as spasm of coronary artery, tachycardia, myocardial hypertrophy caused by iatrogenic factors or hypertrophic cardiomyopathy. Сoronaroventriculography is the “golden criterion” of diagnostics, other methods of diagnostics are new methods of visualization and provocation tests. The opportunities of conservative and interventional treatment were assessed. Conclusion. Myocardial bridging can be a cause of ischemia of myocardium among the patients without markers of atherosclerosis but with factors of haemodynamic risk such as tachycardia, spasm of coronary artery or myocardial hypertrophy. Most frequently symptoms of acute coronary syndrome occur when myocardial bridging is located in the mid-segment of anterior interventricular branch of left coronary artery. It is caused because of the perpendicular position of muscle fiber to coronary artery which increases systolic compression. Diastolic function and blood filling can be enhanced by medical treatment with β-blockers, which are the first-line agents for the treatment of hypertrophic cardiomyopathy.

Effect of morphine preconditioning on necroptosis during myocardial ischemia-reperfusion injury in rats with heart failure

Objective To evaluate the role of morphine preconditioning on necroptosis during myocardial ischemia-reperfusion (I/R) injury in the rats with heart failure. Methods Clean-grade adult male Sprague-Dawley rats, weighing 200-230 g, were injected with 2 mg/kg doxorubicin via the tail vein once a week for 6 consecutive weeks to establish the chronic heart failure model.Thirty rats with chronic heart failure at the end of 8th week were divided into 3 groups (n=10 each) using a random number table method: sham operation group (group S), I/R group and morphine preconditioning group (group MPC). Myocardial I/R was induced by occlusion of anterior descending branch of left coronary artery for 30 min followed by 120 min reperfusion in each group except group S. In group MPC, the rats were subjected to 3 cycles of 5-min infusion of 0.1 mg/kg morphine via the femoral vein at 5 min intervals before ischemia.The animals were sacrificed at the end of reperfusion, and the myocardial specimens were obtained for determination of the area at risk (AAR), infarct size (IS), expression of Fas mRNA (by quantitative real-time polymerase chain reaction) and expression of Fas, receptor-interacting protein 1 (RIP1) and RIP3 (by Western blot). The IS/AAR ratio was calculated. Results Compared with group S, the IS and IS/AAR ratio were significantly increased at the end of reperfusion, and the expression of Fas protein and mRNA, RIP1 and RIP3 was up-regulated in group I/R (P<0.05). Compared with group I/R, the IS and IS/AAR ratio were significantly decreased at the end of reperfusion, and the expression of Fas protein and mRNA, RIP1 and RIP3 was down-regulated in group MPC (P<0.05). Conclusion The mechanism by which morphine preconditioning reduces myocardial I/R injury is related to inhibiting necroptosis in the rats with heart failure. Key words: Morphine; Ischemic preconditioning; Heart failure; Myocardial reperfusion injury; Necrosis