Left Coronary Ostium Research Articles

Aortic root morphometry revisited-Clinical implications for aortic valve interventions.

The complex anatomy of the aortic root is of great importance for many surgical and transcatheter cardiac procedures. Therefore, the aim of this study was to provide a comprehensive morphological description of the nondiseased aortic root. We morphometrically examined 200 autopsied human adult hearts (22.0% females, 47.9 ± 17.7 years). A meticulous macroscopic analysis of aortic root anatomy was performed. The largest cross-section area of the aortic root was observed in coaptation center plane (653.9 ± 196.5 mm2), followed by tubular plane (427.7 ± 168.0 mm2) and basal ring (362.7 ± 159.1 mm2) (p < 0.001). The right coronary sinus was the largest (area: 234.3 ± 85.0 mm2), followed by noncoronary sinus (218.7 ± 74.8 mm2) and left coronary sinus (201.2 ± 78.08 mm2). The noncoronary sinus was the deepest, followed by right and left coronary sinus (16.4 ± 3.2 vs. 15.9 ± 3.1 vs. 14.9 ± 2.9 mm, p < 0.001). In 68.5% of hearts, the coaptation center was located near the aortic geometric center. The left coronary ostium was located 15.6 ± 3.8 mm above sinus bottom (within the sinus in 91.5% and above sinutubular junction in 8.5%), while for right coronary ostium, it was 16.2 ± 3.5 mm above (83.5% within sinus and 16.5% above). In general, males exhibited larger aortic valve dimensions than females. A multiple forward stepwise regression model showed that anthropometric variables might predict the size of coaptation center plane (age, sex, and heart weight; R2 = 31.8%), tubular plane (age and sex; R2 = 25.6%), and basal ring (age and sex; R2 = 16.9%). In conclusion, this study presents a comprehensive analysis of aortic-root morphometry and provides a platform for further research into the intricate interplay between structure and function of the aortic root.

Study of Left Coronary Artery and Its Variations: A Cadaveric Study from Gujarat Region

Background: A lot of variations have been analyzed in the case of the left coronary artery (LCA) which makes it a leading cause of death globally. Therefore, awareness of normal and variant anatomy of this artery in relation to its main trunk and branches is the key to physicians, cardiologists, and radiologists in the management of various cardiac pathologies. Materials and Methods: Eighty embalmed and formalin-fixed adult human cadaveric hearts of both genders with no history or signs of pathology were dissected meticulously during educational hours. Results and Conclusion: Among 80 hearts studied, 71 hearts left coronary ostia were located below the sinotubular junction. The mean distance of left coronary ostia from the supravalvular ridge lying above and below was 2.93 ± 0.39 mm and 2.72 ± 0.92 mm, respectively. The mean diameter of the left coronary ostium was 3.67 ± 0.94 mm. The mean length and diameter of the LCA main trunk (LCAMT) were 13.06 ± 2.42 mm and 4.93 ± 0.60 mm, respectively. The most common branching pattern of LCAMT was bifurcation. The most frequent range of length of left anterior descending (LAD) and circumflex (Cx) artery was 10–12 cm and 6.5–8 cm, respectively. The most common termination point of LAD was at the anterior one-third part of posterior interventricular sulcus and for Cx artery was between the crux and obtuse border of the heart. Right coronary dominance was the most common.

Repeated acute coronary syndrome caused by a mind-bending mural thrombus in ascending aorta: a case report and review of the literature

BackgroundAcute coronary syndrome due to coronary artery embolism in the setting of ascending aortic thrombus is an uncommon condition, even rarer when there is no aortic pathology such as aneurysm, severe atherosclerosis, aortic dissection, or thrombophilia (whether inherited or acquired).Case presentationWe report a case of a 58-year-old male presented with acute chest pain, electrocardiogram showing non-ST-elevation acute coronary syndrome. The computed tomography angiography of coronary artery revealed a mural thrombus in the proximal part of ascending aorta, located above the left coronary artery ostium, without any aortic pathologies. With the exception of hypertension and cigarette smoking, no other risk factors were identified in this patient that may increase the risk of thrombosis. Given the life-threatening risk of interventional therapy and surgery, the patient determinedly opted for anticoagulant and dual antiplatelet therapy. Then he experienced the reoccurrence of chest pain after 6-day treatment, progressed to anterior and inferior ST-segment elevation myocardial infarction. Coronary artery embolism originating from the ascending aortic thrombus was suspected. Considering the hemodynamic instability of the patient, the medical treatment was continued and bridged to warfarin and aspirin after discharge. Follow-up computed tomography angiography at 6 months showed no obstruction in coronary artery and complete resolution of the thrombus. No thromboembolic events occurred henceforward.ConclusionsAcute coronary syndrome could be a manifestation of secondary coronary embolism due to ascending aortic thrombus. Currently, there is no standardized guideline for the treatment of aortic mural thrombus, individualized treatment is recommended. When surgical therapy is not applicable for the patient, anticoagulation and dual antiplatelet treatment are alternative treatments that may successfully lead to the resolution of the aortic thrombus.

NOT JUST A SIMPLE FEVER: DIAGNOSIS OF COMPLICATED INFECTIVE ENDOCARDITIS ON BICUSPID AORTIC VALVE IN A YOUNG MAN

Abstract Bicuspid aortic valve is the most common form of congenital heart disease (prevalence of 0.5 to 2.0%). These patients develop infective endocarditis at significantly higher rates than the general population; furthermore, they are at increased risk of developing infective endocarditis at a younger age owing to intrinsic factors of the aortic valve, but demonstrate better long–term survival after surgical treatment. This case report concerns a 33–year–old caucasian man who presented to the emergency department for persistent fever. He had no significant past medical history, except for a known bicuspid aortic (type 0) valve. The laboratory test demonstrated an active infection and blood cultures were positive, so we performed a transthoracic echocardiogram showing a mobile mass on the aortic valve, associated to a severe aortic regurgitation. Hence, we decided to perform a transesophageal echocardiogram that documented a bicuspid aortic valve with an extensive endocarditic vegetation on anterior leaflet, cusp prolapse and a non–homogenous peri–valvular area, involving the mitral–aortic junction, compatible with abscess. Perivalvular extension of infective endocarditis is the most frequent cause of uncontrolled infection and is associated with a poor prognosis so, as suggested by ESC Guidelines, this clinical case represented an indication for early surgery. The patient was transferred to cardiac surgery department where he underwent surgery. Extensive debridement of the endocarditic lesion was performed; the mitral–aortic junction was reconstructed by suturing a double patch of heterologous pericardium. The defect resulting from the debridement beneath the left coronary ostium was also reconstructed using an additional sutured pericardial patch; then, an Inspiris Resilia size 23 prosthesis was implanted. Transesophageal echocardiography revealed good functioning of the aortic valve prosthesis with mild mitral insufficiency. Meanwhile, blood cultures resulted positive for Staphylococcus Aureus coagulase–negative, so specific antibiotic therapy was started.

NoiseNet, a fully automatic noise assessment tool that can identify non-diagnostic CCTA examinations

Image noise and vascular attenuation are important factors affecting image quality and diagnostic accuracy of coronary computed tomography angiography (CCTA). The aim of this study was to develop an algorithm that automatically performs noise and attenuation measurements in CCTA and to evaluate the ability of the algorithm to identify non-diagnostic examinations. The algorithm, “NoiseNet”, was trained and tested on 244 CCTA studies from the Swedish CArdioPulmonary BioImage Study. The model is a 3D U-Net that automatically segments the aortic root and measures attenuation (Hounsfield Units, HU), noise (standard deviation of HU, HUsd) and signal-to-noise ratio (SNR, HU/HUsd) in the aortic lumen, close to the left coronary ostium. NoiseNet was then applied to 529 CCTA studies previously categorized into three subgroups: fully diagnostic, diagnostic with excluded parts and non-diagnostic. There was excellent correlation between NoiseNet and manual measurements of noise (r = 0.948; p < 0.001) and SNR (r = 0.948; <0.001). There was a significant difference in noise levels between the image quality subgroups: fully diagnostic 33.1 (29.8–37.9); diagnostic with excluded parts 36.1 (31.5–40.3) and non-diagnostic 42.1 (35.2–47.7; p < 0.001). Corresponding values for SNR were 16.1 (14.0–18.0); 14.0 (12.4–16.2) and 11.1 (9.6–14.0; p < 0.001). ROC analysis for prediction of a non-diagnostic study showed an AUC for noise of 0.73 (CI 0.64–0.83) and for SNR of 0.80 (CI 0.71–0.89). In conclusion, NoiseNet can perform noise and SNR measurements with high accuracy. Noise and SNR impact image quality and automatic measurements may be used to identify CCTA studies with low image quality.

Cracking The Case of The Cryptic Coronary: Diagnostic Strategies for Anomalous RCA Originating from LAD

Background: Coronary artery anomalies are typically congenital, though they may remain undetected until routine cardiac catheterization is performed. With a detection rate of only 1.3%, these anomalies often go unnoticed. In rare cases, the right coronary artery may originate from the left coronary system, but this anomaly is generally benign. Case presentation: A 55-year-old male patient was diagnosed with NSTEMI and underwent coronary angiography. However, despite multiple attempts, the medical team could not cannulate into the right coronary ostium. The left coronary ostium was located in the left sinus of Valsalva. Selective left coronary arteriography revealed normal courses of the left main and LAD but identified a critical stenosis in the LCx and a possible CTO at the RCA ostium. The patient received a stent in the LCx and returned the following month for another angiography, during which he received a stent in the proximal LAD. However, during cine angiography, it was found that the patient had an anomalous RCA that originated from the mid-portion of LAD, coursing anteriorly to the pulmonary artery and down to the right atrioventricular groove. Subsequent CCTA confirmed the RCA's origin from the mid-LAD. Conclusion: The report finds a rare RCA origin in the mid-LAD. The heart and its complex arterial network may be examined thoroughly, appreciate to coronary CTA, a non-invasive imaging approach. This allows for effective interventional cardiovascular therapy and is helpful for medical cardiac abnormality detection and assessment. Keyword: Anomalous Right Coronary Artery, CT Coronary Angiography, RCA from LAD, Single Coronary Artery.

Morphometry of the heart orifices and morphometry and topography of the coronary ostia in the goat.

The coronary vessels have been described in various species of domestic and wild ruminants. However, no studies on the detailed morphology and morphometry of heart orifices and coronary ostia in the Polish goat are available. The study was carried out on 112 female, adult dairy goats belonging to Polish Fawn Improved and Polish White Improved breed, closely related to French Alpine and Saanen, respectively. In all examined individuals, all heart orifices and heart valves were of normal structure. There was no significant difference between diameter of the aortic and pulmonary orifice. The right atrioventricular opening was significantly wider than the left atrioventricular opening. The dimension of the left coronary ostium ranged from 1.0 to 5.5 mm with the arithmetic mean (± standard deviation [SD]) of 4.3 ± 0.8 mm. The dimension of the right coronary ostium ranged from 0.5 to 5.0 mm with the arithmetic mean (± SD) of 2.8 ± 0.7 mm. Both coronary artery ostia were located under the sinotubular junction. Out of 112 examined goats, 39 (34.8%) had variations in the structure of the coronary ostia such as the lack of main trunk or the presence of additional coronary ostia. They were observed in one (in 34/39 goats) or both coronary arteries (5/39 goats). In goats, the dimensions of aortic and pulmonary orifices are similar while the right atrioventricular opening outsizes the left one. On the other hand, the left coronary ostium is wider than the right one. Morphological variations in the coronary ostia occur in approximately one third of goats, more often in the right than in the left ostium.

A Rare Case of Robotic Revascularization for Obstructed Left Main with Automated Suture Fastener

In comparison to traditional, manual knot-tying, the use of an automated titanium suture fastening device has demonstrated a considerable reduction in cardiopulmonary bypass time, aortic cross-clamp time, and operative time in valve procedures. However, there aren't many reports in the literature on the side effects related to using such device. Here we present a case in which the automated titanium suture fastener resulted in left main coronary artery ostium obstruction following its use in the aortic position and subsequent treatment with robotic Coronary Artery Bypass Grafting (CABG).

Abstract 17501: Initial Experience With a Novel Transcatheter Aortic Valve With Open-Cell Design and Staged Delivery for Challenging Anatomies in a Developing Country

Introduction: Overcoming challenges of transcatheter aortic valve (TAVI) implantation, as coronary access, conduction disturbances and paravalvular leak are goals of device development. We aimed to describe the initial experience with a recently-approved self-expandable bioprosthetic valve, with supravalvular leaflets, a novel open-cell design and 2-stage deployment, in terms of efficacy and safety. Methods: Consecutive patients with aortic valve (AV) stenosis and indication for TAVI with favorable anatomy for self-expandable prostheses were prospectively enrolled in a high-volume center in Belo Horizonte, Brazil. Demographic, clinical and procedural data were collected in an online dedicated database (Coreware, RIBAC). Echocardiographic and CT-angio measurements were performed by 2 experts with proprietary software (Phillips Heart Navigator). Outcomes were prospectively collected. Results: At total, 23 patients eligible for the Acurate Neo/Neo2 TAVI were enrolled, being 15 men, mean age of 82±6 years (69 - 93). Hypertension was present in 20, diabetes in 8 and dyslipidemia in 17, and all were severely symptomatic, being 20 in functional class 3. The STS-score (morbi-mortality) was high: 19±6%. The mean AV area on echo was 0.7±0.2 cm 2 , with mean gradient of 44±15 mmHg. In CT-angio, the median calcium score was 2284, mean annular perimeter was 72±5 mm, and the height of the right and left coronary ostia were 15.2±2.6 mm and 11.9±3.2 mm (&lt;10 mm in 5 cases). All implants were transfemoral (14F) and with general anesthesia, given the high-risk profile. Pre-dilation was performed in 20 (91%) and the TAVI was deployed without repositioning in all cases, with no coronary compromise. Post-dilation was required in 13 cases, being 11 due to mild and 2 due to moderate paravalvular leak: all regressed to trivial. Vascular complications requiring surgery occurred in 1 case, and 1 (4%) patient underwent permanent pacing. All patients were discharged home, with a mean AV gradient of 9.7±3.7 mmHg. Conclusion: The initial experience in Brazil with the novel Acurate Neo/Neo2 prosthesis was promising, with high success rates in challenging anatomical scenarios, and low rates of pacemaker implantation and no occurrence of coronary obstruction or significant leak.

The impact of left circumflex coronary artery ostium stenosis on outcomes for patients after percutaneous coronary intervention for unprotected left main disease.

The impact of left circumflex coronary artery (LCX) ostium atherosclerosis in left main coronary artery (LM) bifurcation disease is not well-known. The study aimed to assess whether the involvement of LCX ostium carries prognostic implications in patients undergoing unprotected LM percutaneous coronary intervention (PCI). Consecutive 564 patients with unprotected LM (ULMCA) disease who underwent LM PCI between January 2015 and February 2021, with at least 1 year of available follow-up were included in the study. The first group was composed of 145 patients with ULMCA disease with LCX ostium stenosis, and the second group consisted of 419 patients with ULMCA disease without LCX ostium stenosis. Patients in the group with ULMCA disease with LCX ostium stenosis were significantly older and had more comorbidities. The two-stent technique was used more often in the group with LCX ostium stenosis (62.8% vs. 14.6%; P <0.001). During 7-year follow-up, all-cause mortality did not differ significantly between groups with and without LCX ostium stenosis (P = 0.50). The use of one-stent or two-stent technique also did not impact mortality in patients with LCX ostial lesions (P = 0.75). Long-term mortality subanalysis for three groups of patients: (1) patients with LM plus LCX ostium stenosis; (2) LM plus left anterior descending artery (LAD) ostium stenosis; (3) LM plus LCX ostium plus LAD ostium stenosis also did not differ significantly (P = 0.63). LCX ostium involvement in LM disease PCI is not associated with adverse long-term outcomes, which is highly beneficial for the Heart Team's decision-making process.

A rare case of left main coronary artery atresia misdiagnosed as an anomalous left coronary artery from the pulmonary artery and presented as dilated cardiomyopathy

Left main coronary artery atresia is one of the rarest congenital anomalies characterized by the absence of the left coronary ostium and the left main trunk. This case report presents an extremely rare left main coronary artery atresia case in a 14-week-old female infant presenting with severe symptoms of dilated cardiomyopathy. The patient underwent surgery after successful weaning from extracorporeal membrane oxygenation (ECMO) support but died because of cranial complications after the second run of ECMO.

Atherosclerotic Disease in a Single Coronary Artery: Right Coronary Artery Supplies Left Anterior Descendens and Left Circumflex Artery with Absent Left Coronary Ostium

We report a case of a 62-year-old man with a right-sided single coronary ostium supplying the complete myocardium. This case was diagnosed based on an aberrant exercise tolerance test and complementary angiography. The patient was revascularized by a coronary artery bypass graft to the single coronary artery because of a significant stenosis in its course.

Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up.

Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve's durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes.

Acute occlusion of the left main coronary ostium by an endocarditis vegetation.

Acute occlusion of the left main coronary ostium by an endocarditis vegetation.

Successful management of aortic root thrombosis in a patient with Heartmate 3.

A 74-year-old female with ischemic cardiomyopathy underwent Heartmate 3 (HM 3) implantation for advanced heart failure as destination therapy. Anticoagulation with unfractionated heparin was started within 24 h after implantation. Warfarin and aspirin were started on post-operative Day 3. The patient was mostly in the therapeutic range of the international normalized ratio and activated partial thromboplastin time. On a post-operative Day 11, the patient took a chest computed tomography (CT) for the evaluation of new-onset dyspnea. The CT demonstrated a large aortic root thrombosis (ART) measuring 2.9 cm in maximum diameter covering all three cusps of the aortic valve (AV) (Panel A) and showed a close location with the left coronary ostium (Panel B, arrow: left coronary ostium). After a multidisciplinary discussion with heart failure physicians, cardiac surgeons, and cardiac imaging specialists, we decided to intensify anticoagulation and withhold thrombectomy. We also increased the pump speed in an effort to minimize the AV motion for the prevention of systemic embolization or myocardial infarction. After 3 weeks, follow-up CT showed regression of the ART (Panel C). Accordingly, we lowered the left ventricular assist device (LVAD) pump speed for adequate AV opening to prevent recurrent ART. Three-dimensional (3D) CT reconstruction of the LVAD (Panel D) and follow-up chest x-ray (Panel E) showed well positioned LVAD. The patient was discharged and has been doing well for more than a year with a good therapeutic target range of anticoagulation.

ASSESSMENT OF THE CORONARY OSTIA PARAMETERS IN MEN: INTRAVASCULAR ULTRASOUND STUDY

Morphometric parameters are an important component in the assessment of the anatomy of the cardiovascular system; they are the basis for choosing an appropriate intervention method. The use of intravascular ultrasound (IVUS) for conducting a morphometric study allows for measurements from the lumenal surface of the vessel, which ensures high accuracy of calculations. Limited use of IVUS in Ukraine has resulted in insufficient data on morphometric analysis of coronary ostia among Ukrainian citizens.&#x0D; The Aim is to measure the minimum diameter, average diameter, maximum diameter, and area of the right and left coronary ostia in men with structural changes of the coronary arteries using IVUS; to evaluate the correlation of the obtained data with age and anthropometric indicators.&#x0D; Materials and methods. The research materials include the images of intravascular ultrasound examination (performed during coronary angiography) of 16 men with structural lesions of the coronary arteries. The following methods were applied: IVUS, angiography, mathematical and statistical calculations. The measured parameters were as follows: the minimum diameter, the maximum diameter, the mean diameter, the area of the ostia of the coronary arteries. Clinical data were the following: age, height, weight, body mass index and body surface area.&#x0D; Results of the study. Analysis of the coronary arteries’ parameters according to IVUS in men with structural changes of the coronary arteries (mean age 61.69±10.03 years, n=16) showed that, on average, the area of vessels is 22.89±5.92 mm2, the mean diameter of the coronary ostia (mean d) is 5.34±0.73 mm, minimum diameter (min d) is 4.78±0.89 mm, and maximum diameter (max d) is 5.91±0.66 mm.&#x0D; When comparing the parameters of the left and right coronary ostia, it was proved that all indicators of the right coronary artery are higher than those of the left coronary artery. A significant difference between these parameters was inherent in the indicators of the area – by 29.86% (26.29±2.74 m2 vs. 20.25±6.49 m2, p=0.023), the maximum diameter – by 15.90% (6.40±0.40 mm vs. 5.52±0.57 mm, p=0.002) and the average diameter – by 13.42% (5.72±0.40 mm vs. 5.04±0.80 mm, p=0.043). A direct relationship of medium strength between age and height was also proved (τ=+0.62, p=0.030).&#x0D; Conducting a study of paired correlations in patients who underwent IVUS examination of the right coronary artery (n=7), proved the existence of a strong inverse relationship between the minimum diameter of the right coronary artery and body weight in men with structural changes of the coronary arteries (τ=-0.83, p=0.020) and with the BSA indicator (τ=-0.75, p=0.021), as well as the inverse relationship of the medium strength between the mean diameter of the right coronary artery and body weight (τ=-0.65, p =0.046). No significant pairwise correlations were established between age, height, and other anthropometric data in the studied patients (p&gt;0.05).&#x0D; Conclusions. In men with structural changes of the coronary arteries who underwent the intravascular ultrasound examination, the minimum diameter, mean diameter, maximum diameter, and area of the right coronary ostium were bigger than the corresponding parameters of the left coronary ostium. Different relationships with age and anthropometric parameters were established for the right and left coronary arteries.

Congenital Absence of Left Coronary Artery Ostium in a Patient Presenting With Anterior ST-Elevation Myocardial Infarction

A 73-year-old man developed chest pain 12 hours before arriving at our hospital. An electrocardiogram revealed ST-segment elevation in leads V2–V6 (Figure 1A); therefore, an emergent coronary angiography was performed. Several attempts were made to engage the left coronary artery (LCA), but they were unsuccessful. Left coronary cusp angiography and subsequent right coronary angiography demonstrated a single right coronary artery (RCA) with blood flow to the left circumflex coronary artery (LCX) and the congenital absence of the LCA ostium at the left, right, and posterior Valsalva sinuses (Figure 1B, Video 1).

219 ISOLATED CORONARY OSTIAL STENOSIS DUE TO RECURRENT AORTIC WALL THROMBOSIS

Abstract Background Coronary ostial lesions are a rare entity and isolated coronary ostial stenosis is even less frequent. Diffuse coronary artery atherosclerosis is the main cause for the non-isolated stenosis, based on old post-mortem series and histological analysis of tissue removed during atherectomies. Case presentation A 49-year-old woman suffering from mild non-familial hypercholesterolemia reported to her family physician repeated episodes of chest pain related to exercise. During a cardiological outpatient evaluation, 12 lead electrocardiogram (ECG) and echocardiography turned out normal. During a stress test she had recurrent chest pain coupled with ECG ischemic changes (diffuse ST segment elevation). She was immediately referred to the emergency department where the ECG was back to normal and the troponin dosage within normal range. Coronary angiography was performed: non-selective cannulation revealed some irregularities of the aortic wall profile at the level of the right coronary ostium, with inability to visualize the right coronary artery. The selective cannulation of the left main coronary artery (LMCA), left anterior descending (LAD) and left circumflex branches showed a critical ostial stenosis at the origin of the LMCA without any other relevant lumen restriction, in a left-dominant pattern of coronary circulation. A suspicion of LAD dissection was raised when a laminar flux was observed at its origin. At the end of the procedure, the patient suddenly collapsed. The recorded rhythm was initially bradycardia, evolving to episodes of ventricular tachycardia for which multiple shocks were applied. Despite the resuscitation efforts, the patient never recovered. Autopsy was performed at the local hospital. At gross analysis, a non-uniform pale-tan thickening at the level of the sino-tubular junction was evident with involvement of both the right and left coronary ostia. Histological examination allowed to ascribe the thickening to recurrent thrombosis, without any underlying inflammatory process at the level of the aortic wall and with only minimal atherosclerotic plaques. No coronary artery dissection nor significant stenosis was present in all the coronary tree. Regarding the ventricular myocardium, one focus of replacement-type fibrosis was identified at subendocardial level in the infero-septal wall coupled with a small spot of loose connective tissue rich in hemosiderin-laden macrophages in the same region, consistent with an area of subacute ischemic damage. Conclusion Several series reported a higher frequency of isolated coronary ostial stenosis in women versus men. In fact, female sex along with hypertriglyceridemia have been recognized as independent risk factors for ostial lesions. The case herein reported highlights the diagnostic relevance of the autopsy investigation together with clinicopathological correlation, particularly in cases where the definite diagnosis can't be achieved in vivo.

A Case of Native Aortic Valve Thrombus Complicating Intermittent Occlusion of a Left Main Coronary Artery.

Intermittent left main coronary artery ostium obstruction (LMOO) caused by native aortic valve thrombus (NAVT) is an extremely rare condition. It may therefore be challenging to identify the cause using only coronary angiography, even though the clinical presentation and electrocardiography (ECG) strongly suggest myocardial infarction. We herein report a 53-year-old man with NAVT complicating intermittent occlusion of left main disease in preexisting coronary artery stenosis.

Anythink for CT-based aorta root measurements before transcatheter aortic valve replacement: measurement consistency with 3mensio and impact on short-term prognosis

To evaluate the consistency and reproducibility of aortic root measurements by Anythink, a semi-automated preoperative CT analysis software, with those of 3mensio. Sixty-seven patients undergoing transcatheter aortic valve replacement (TAVR) in the First Medical Center of Chinese PLA General Hospital from December, 2016 to February, 2022 were retrospectively enrolled in this study. A cardiology resident who completed his professional training used both the software Anythink and 3mensio (as the gold standard) to reconstruct the aortic root model and analyze the parameters of the aortic annulus and the surrounding structures. The correlation and consistency of the measurement results of two software were analyzed. Two independent residents also used Anythink software to repeat the measurements for the same patient for assessment of the reproducibility of Anythink measurements. The valve models were selected based on the measurements by Anythink and 3mensio, and similarities and differences of the two software in clinical valve selection were assessed. The measurements of the distances from the anulus plane to the left and right coronary ostium, average diameter of the anulus, anulus area, anulus perimeter, and the angle between the annulus and horizontal plane did not differ significantly between the two software (P > 0.05), and their measurements showed positive correlations (r= 0.884-0.981, P < 0.01). The intra-group and inter-group correlation coefficients of the anulus parameters measured by Anythink ranged from 0.894 to 0.992 and from 0.651 to 0.954, respectively. The Kappa-test values of valve models selected by Anythink and 3mensio based on the average diameter, area diameter and perimeter diameter were 0.886, 0.796 and 0.775, respectively. The intra-group Kappa values for the valve models selected based on Anythink measurements were 0.819, 0.841, and 0.795, and the inter-group Kappa values were 0.812, 0.812, and 0.768, respectively. Compared with the measurements by 3mensio, the recommended area diameter measured by Anythink was slightly greater in patients with postoperative paravalvular leakage, but slightly smaller in patients with postoperative new-onset conduction block. Anythink has excellent measurement consistency and high reproducibility for aortic root measurements, and trained cardiologists can use Anythink to obtain accurate aortic root parameters before TAVR.