Occlusion Of Left Circumflex Artery Research Articles

AGE AND GENDER CLINICAL-DIAGNOSTIC CHARACTERISTICS OF PATIENTS WITH ISCHEMIC HEART DISEASE – FOCUS ON DIGITALIZATION OF ECG

The aim – to establish the leading clinical and diagnostic features of patients with coronaryheart disease, including the indicators of differentiated ECG, in age and gender distribution.Material and methods. During the research, 135 patients with coronary heart disease wereexamined. Patients were divided into comparison groups based on age (age ≥60 yearsand age <60 years) and according to gender (women, men). The participants of the studyunderwent a clinical examination, general clinical, biochemical blood tests and functionalresearch methods (echocardiography, coronary ventriculography, ECG digitization based onthe own software «Smart- ECG»). The results.Patients aged≥60 years had a lower quality of life according to the EQ-VAS scale(59.34±2.40%, Δ –11.06%, p=0.026), higher values of the erythrocyte sedimentation rate(16.13±1.97 mm/h, Δ +50.89%, p=0.026) and creatinine (110.25±3.98 μmol/l, Δ +12.16%,p=0.038), lower hemoglobin values (142.18± 2.27 g/l, Δ –4.78%, p=0.021), erythrocytes(4.68±0.07 T/l, Δ –5.26%, p=0.011) and platelets (224.80± 8.04 G/l, Δ –10.60%, p=0.015),a lower ejection fraction (54.22±0.91%, Δ –5.33%, p=0.009), but larger sizes of the leftatrium (4.66±0.06 cm, Δ +8.37%, p<0.001), slightly higher values of the height of the slopeof the ST segment (STH) of the differentiated ECG in the ischemiс zone (0.61±0.04 mm,Δ +17,31%, p=0.074) than in patients aged <60 years. Also, elderly patients, in comparisonwith the young and middle-aged group, are characterized by more hemodynamicallysignificant lesions of the coronary arteries with left circumflex artery occlusion. Women hada higher quality of life according to the EQ-VAS scale (66.91±2.43%, Δ +10.94%, p=0.050),lower heart rate (71.82±1.53 bpm, Δ –5.87%, p=0.082), higher values of total cholesterol(5.95±0.19 mmol/l,Δ+10.39%, p=0.038), erythrocyte sedimentation rate (16.67±2.19 mm/h,Δ +39.03%, p=0.068), lower hemoglobin values (138.00±2.29 g/l, Δ –7.64%, p<0.001),erythrocytes (4.65± 0.08 T/l, Δ –4.52%, p=0.045) and lower creatinine (97.01±4.43 μmol/l,Δ –10.74%, p=0.054), a higher ejection fraction (57.29±0.76%, Δ +4.82%, p=0.028),but smaller sizes of the left atrium (4.36±0.07 cm, Δ –4.39%, p=0.026), end systolicdimension (3.47±0.06 cm, Δ –10.80%, p<0.001), end diastolic dimension (5.05±0.07 cm,Δ –6.83, p<0.001), lower values of STH of the differentiated ECG in the ischemia zone(0.51±0.03 mm, Δ –16.39%, p=0.053) than in men. Also, for women, in comparison withmen, the damage of the right coronary artery is less common.Conclusions. Thus, changes in clinical, laboratory and instrumental indicators arecorrelated with age and sex, have a marker role in predicting the course of the disease,choosing methods on influencing risk factors and optimizing treatment, and the indicatorsof a differentiated ECG using the «Smart- ECG» software significantly improve thediagnostic opportunities.

Abstract 12522: Non-Ischemic Papillary Muscle Rupture Due to MRSA Myocarditis

Case Presentation: A 46-year-old male with diabetes, ESRD, and recurrent MRSA bacteremia, presented with septic shock and suffered cardiac arrest. Following resuscitation EKG showed inferolateral ischemia. TTE revealed acute mitral valve regurgitation resulting from posteromedial papillary muscle rupture (PMR). An intra-aortic balloon pump was implanted for cardiogenic shock. Coronary angiography revealed right dominant circulation and thrombotic occlusion of a small caliber distal left circumflex artery (LCX). Emergent mitral valve replacement surgery was performed. Pathologic analysis of the excised muscle and leaflet showed marked acute inflammation, bacterial invasion, and myocyte necrosis, confirming non-ischemic rupture due to MRSA myocarditis. Discussion: PMR predominantly occurs after MI, complicating 0.03% of STEMI cases in the reperfusion era. Non-ischemic causes are rare. Coexistence of myocarditis, infective endocarditis (IE), and MI poses a challenge in determining etiology. Establishing causation guides whether to expedite emergent valve surgery or focus on cardiomyocyte salvage by revascularization. The posteromedial papillary muscle is most commonly involved in PMR due to single blood supply from the PDA (most commonly a branch of the RCA, and less commonly the LCX). Coronary angiography, postoperative histopathology, and culture results determined the etiology of PMR was fulminant MRSA bacteremia culminating in myocarditis. Bacterial colonization and resultant inflammation induced physical and mechanical strain leading to complete rupture. The occluded LCX was incidental, and may have been the result of septic embolization, which occurs in up to 65% of left-sided IE. Albeit rare, non-ischemic etiologies must be considered when the anatomic presentation of acute PMR on TTE is incongruent with angiography. Definitive treatment relies on surgical intervention and mechanical circulatory support is often necessary.

Abstract 12538: Myocardial Bridge Induced Cardiomyopathy

Introduction: A myocardial bridge(MB) is a condition in which the epicardial coronary artery traverses through the myocardium, has an intra-myocardial course of varying length, and then exits the myocardium and appears on the surface of the heart. Clinical Presentation: A 54-year-old male with no significant past medical history except tobacco abuse and anxiety presented to the hospital with retrosternal chest pain radiating to the back and shoulder and associated with nausea and diaphoresis. His SBP was 100/60, and his heart rate 46. His EKG showed ST elevation in inferior leads, and he was given a nitro tablet, which improved the chest pain to 5/10. He was emergently taken to the Cath lab and found to have proximal left circumflex artery occlusion and underwent PCI with a 2.25x23 Xience Drug-eluting stent. Troponin was elevated to 2.35. His cath also showed a significant mid-LAD myocardial bridge. His echocardiogram showed mid and apical anterior, anterior septal, apical wall, and inferior wall hypokinesis. His EF has been reduced to 30%. Coronary CTA showed mid-LAD has myocardial bridging, which is more than 2 cm long and 5 mm deep in the muscle. The patient has persistently low HR in 40-45, beta-blocker was not started. Due to significant cardiomyopathy induced by a myocardial bridge, unroofing of LAD was done off-pump. His EF improved to 55% after three months of surgery. Discussion: CABG or myotomy is the treatment of choice for patients with symptomatic myocardial bridging refractory to medical therapy, evidence of myocardial ischemia or infarction, or >75% systolic coronary compression on angiography. Incidental myocardial bridging finding without ischemia or symptoms does not require any treatment. Symptomatic patients with ischemia on stress tests can be offered beta or calcium channel blockers. Medical therapy is superior to revascularization with percutaneous intervention.

Correlation between echocardiographic and primary percutaneous coronary intervention for proximal right coronary artery in inferior-wall myocardial infarction

Abstract Background Diagnosing myocardial infarction (MI) of the right ventricle (RV) is difficult. ECG remains the main tool for diagnosis of acute RVMI. For accurate diagnosis of RVMI, angiography can be done to enforce RVMI diagnosis. The physiology of the RV makes it less likely to suffer muscle infarction, but this can happen in cases of acute severe right coronary-artery (RCA) occlusion. Echocardiographic parameters have proven their efficacy in predicting proximal RCA infarction, including annular velocity and tricuspid annular-plane systolic excursion. Aim Assessment of the value of RV echocardiographic parameters in the diagnosis of early acute inferior RVMI in relation to coronary angiogram of proximal RCA. Patients and methods This prospective study was conducted on 125 patients diagnosed with inferior MI. ECG, echocardiographic RV parameters, and primary percutaneous coronary-intervention technique for proximal RCA were performed for all included patients at the Cardiovascular Medicine Department Tanta University Hospitals from June 2019 to December 2019. Results RV infarction occurred mostly in cases of proximal RCA occlusion and few cases with mid-segment of RCA lesion. This was reported by echocardiography using tricuspid annular-plane systolic excursion and S-wave tissue Doppler. Few cases showed impairment in RV function in left circumflex-artery occlusion as culprit vessel reported by echocardiography and the impairment occurred only with S wave. RV function was not affected with left circumflex-artery occlusion as culprit lesion. Conclusion Echocardiographic parameters of RV are useful in predicting RVMI due to proximal RCA occlusion.

Acute occlusion of an anomalous left circumflex artery after aortic valve replacement

Acute occlusion of an anomalous left circumflex artery after aortic valve replacement

Identifying the culprit artery via 12-lead electrocardiogram in inferior wall ST-segment elevation myocardial infarction: Ameta-analysis.

Inferior wall ST-segment elevation myocardial infarction (STEMI) is mostly caused by acute occlusion of right coronary artery (RCA) and left circumflex artery (LCX). Several methods and algorithms using 12-lead ECG were developed to localize the lesion in inferior wall STEMI. However, the diagnostic properties of these methods remain under-recognized. The aim of this meta-analysis is to compare the diagnostic properties among the methods of identifying culprit artery in inferior wall STEMI using 12-lead ECG. We performed a meta-analysis to calculate the pooled sensitive, specificity, area under the curve (AUC) and diagnostic odds ratio (DOR) of each method. Thirty-three studies with 4414 participants were included in the analysis. Methods using double leads had better diagnostic properties, especially ST-segment elevation (STE) in III > II [with pooled sensitivity 0.89 (0.84-0.93), specificity 0.68 (0.57-0.79), DOR 17 (9-32), AUC 0.88 (0.85-0.91)], ST-segment depression (STD) in aVL > I [with pooled sensitivity 0.82 (0.72-0.90), specificity 0.69 (0.48-0.86), DOR 11 (4-29), AUC 0.85 (0.81-0.88)], and STD V3/STE III ≤1.2 [with pooled sensitivity 0.88 (0.78-0.95), specificity 0.59 (0.42-0.75), DOR 12 (5-27), AUC 0.82 (0.78-0.85)]. Diagnostic algorithms, including Jim score[pooled sensitivity 0.70 (0.55-0.85), specificity 0.88 (0.75-0.96)], Fiol's algorithm [pooled sensitivity 0.54 (0.44-0.62), specificity 0.92 (0.88-0.96)] and Tierala's algorithm [pooled sensitivity 0.60 (0.49-0.71), specificity 0.91 (0.86-0.96)], were not superior to these simple methods. Our meta-analysis indicated that diagnostic methods using double leads had better properties. STE in III > II together with STD in aVL > I may be the most ideal method, for its accuracy and convenience.

Coronary Artery-Ventricular Pseudoaneurysm Fistula After Myocardial Infarction

A 56-year-old man presented to the emergency department with chest pain. The diagnosis of acute myocardial infarction caused by a left circumflex artery occlusion was made. After conservative treatment, a fistula between the circumflex artery and the left ventricle, and the evolution of the pseudoaneurysm, were noted. (Level of Difficulty: Advanced.)

Abstract 17085: An Anomalous Outcome Of Renal Transplant

Case Presentation: A 65 year old man with diabetic renal disease developed acute dyspnea at rest on the first post-operative day after an uncomplicated deceased donor renal transplant. He was hypertensive, tachycardic, and hypoxemic. His electrocardiogram showed anterior ST elevations with reciprocal inferior ST depressions and his chest x-ray revealed pulmonary edema. He was given anti-platelet therapy, nitroglycerin, beta blocker and taken emergently for angiography. He had a thrombotic occlusion of a co-dominant anomalous left circumflex artery arising from the ostium of a moderate caliber right coronary artery. He underwent successful percutaneous coronary intervention. His post-revascularization echocardiogram showed a hypokinetic to akinetic inferior wall with preserved global left ventricular systolic function. Coronary CT for further assessment of the course of the anomalous artery was not pursued given minimal benefit and the risk of worsening graft function. He was discharged on dual anti-platelet therapy, beta blocker and a statin. Discussion: There is no consensus about risk stratification before renal transplant. Our patient’s pre-operative exercise treadmill test (ETT) showed reduced functional capacity at 5.6 metabolic equivalents, failure to reach target heart rate, with 1.0 mm down sloping ST depression in infero-lateral leads with no ischemic symptoms. While our patient had an equivocal ETT, his lack of angina argued against further work-up. Post-operatively, a pro-inflammatory state, increased shear stress, acquired thrombophilia and immunosuppressive medications can all contribute to plaque rupture with thrombus formation. Atherosclerosis due to diabetes and renal disease coupled with mechanical factors such as passive compression at the intraarterial course, acute angle take-off or valve-like closure of the slit orifice may have subjected our patient with an anomalous left circumflex artery to an acute ST-elevation MI.

Categorising myocardial infarction with advanced cardiovascular imaging

A 66-year-old man collapsed at home with chest pain. He was found by paramedics to be in ventricular fibrillation leading to a cardiac arrest. A post-resuscitation electrocardiogram showed sinus rhythm and inferolateral ST-segment elevation. On arrival at our department he had an emergency invasive coronary angiogram which showed an occluded left circumflex artery, confirming myocardial infarction (MI). We opened the artery using a balloon, and following recanalisation, we identified a substantial filling defect indicative of a large thrombus (figure). Following stent implantation, normal coronary artery flow was restored and the patient made an uneventful recovery—although brief paroxysms of atrial fibrillation were noted on cardiac monitoring in the ensuing 24 h.

Clinical value of left ventricular strain analysis by cardiovascular magnetic resonance in patients with coronary chronic total occlusion

Objective: To explore the clinical value of quantitatively assessment of left ventricular strain in patients with coronary chronic total occlusion (CTO) by cardiac magnetic resonance imaging (CMR)-feature tracking (CMR-FT) technique. Methods: In this retrospective and observation study, patients with single CTO, who underwent CMR examination in Beijing Anzhen Hospital from November 2014 to January 2019, were selected as case group (CTO group), and those without cardiovascular diseases defined by echocardiography, electrocardiogram (ECG) and clinical history and with normal CMR results were selected as healthy control group (control group). General clinical data including age, gender, discharge diagnosis, and the examination results of echocardiography and ECG were obtained from the electronic medical record system. Two-dimensional CMR-FT was applied to measure left ventricle (LV) global peak radial, circumferential, and longitudinal strains (GPRS, GPCS and GPLS, respectively), and the regional myocardial strain in the target vessel area of CTO was analyzed. Grayscale thresholds of 5 standard deviations (SDs) were used to quantify late gadolinium enhancement (LGE). Patients with CTOs were divided into infract size>10% group and infarct size≤10% group, and left ventricular ejection fraction (LVEF)≥50% group and LVEF<50% group, respectively. The differences between various groups were compared. Results: There were 52 patients in CTO group (34 males, age (54.1±11.7) years, body mass index (BMI) (26.2±2.5)kg/m2) and 30 patients in control group (14 males, age(51.6±12.3)years, BMI (25.6±3.3)kg/m2). There was no significant difference in age, gender, and BMI between the two groups (all P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower in CTO group than in control group (all P<0.05), left ventricular volume (LVEDV) was similar between the two groups (P>0.05). Among the patients with CTO, there were 26 patients with infarct size>10% and 26 patients with infarct size≤10%. GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEF and LVEDV were similar in CTO patients with infarct size≤10% as compared to control group (both P>0.05). LVEF, GPRS, GPCS and GPLS were significantly lower (all P<0.05), while LVEDV was similar in CTO patients with infarct size>10% (P>0.05) as compared to control group. GPRS and GPCS were significantly lower (both P<0.05), while LVEF, LVEDV and GPLS were similar in CTO patients with infarct size>10% as compared to infarct size≤10% group. There were 40 subjects in LVEF≥50% group and 12 subjects in LVEF<50% group. Compared with the control group, GPCS and GPLS of CTO patients were significantly lower in LVEF≥50% group and LVEF<50% group (all P<0.01), LVEF and LVEDV was similar in CTO patients with LVEF≥50% (both P>0.05), but LVEF was lower and LVEDV was larger in LVEF<50% group (both P<0.05). The GPRS, GPCS, GPLS and LVEF of CTO patients in LVEF ≥ 50% group were higher than those in LVEF<50% group (all P<0.0l), and the myocardial infarction size was smaller than that in LVEF reduced group (P<0.0l), but there was no significant difference in LVEDV between the two groups (P=0.07). In the CTO group, there were 21 patients with left anterior descending artery (LAD) occlusion and 126 segments supplied by the target vessels. The peak radial strain (PRS), circumferential strain (PCS) and longitudinal strain (PLS) in the blood supply area were lower than those in the control group (all P<0 01). In 7 patients with left circumflex artery (LCX) occlusion, the number of myocardial segments supplied by the target vessels was 35, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0 05). In 24 patients with right coronary artery (RCA) occlusion, the number of myocardial segments supplied by the target vessels was 120, and the PRS, PCS and PLS in the target vessel supply area were lower than those in the control group (all P<0.01). Among the 126 segments in 21 patients with LAD CTO, 91 (72.2%) segments had infarct size≤25%, 17 (13.5%) segments had infarct size between 26%-50%, 11 segments (8.7%) had infarct size between 51%-75%, and 7 (5.6%) segments had infarct size between 76%-100%. Among the 35 segments in 7 patients with LCX CTO, 31 (88.6%) segments had infarct size≤25%, and 4 (11.4%) segments had infarct size between 26%-75%. Among the 120 segments in 24 patients with RCA CTO, 96 (80.0%) segments had infarct size≤25%, 11 (9.2%) segments had infarct size between 26%-50%, 8 (6.7%) segments had infarct size between 51%-75%, and 5 segments (4.2%) had infarct size between 76%-100%. Conclusions: In this study with single CTO, although the LVEF is preserved in the majority of the patients, the left ventricular global and regional strain values are significantly decreased. The larger the infarct size, the greater the impact on radial and circumferential motion, reflecting the early impairment of left ventricular function in these patients.

Primary Percutaneous Coronary Intervention in an Anomalous Left Circumflex Artery: Search for the Hidden Culprit

Congenital coronary anomalies are rarely detected in patients undergoing diagnostic coronary angiography. They pose a challenge in delay to identify the anomalous artery as well as difficulty in engaging the anomalous vessel. The present case report was of 56-years-old male patient presented with acute onset of chest pain. On evaluation, his electrocardiogram was suggestive of ST segment elevation in inferior leads. He underwent diagnostic coronary angiogram which revealed totally occluded Left Circumflex Artery (LCx) arising anomalously from right coronary osteum. Primary Percutaneous Coronary Intervention (PCI) of LCx could not be performed with routine guide catheters necessitating the use of special multipurpose guide catheter with balloon support. The case highlights the need for the knowledge of coronary anatomy and anomalous origins of coronary arteries and the selection of appropriate guiding catheters and coronary wires.

Delayed presentation of acute coronary syndrome with mechanical complication during COVID-19 pandemic: a case report

BackgroundThe World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. We report a patient with acute myocardial infarction (AMI) who presented late due to fears of contracting COVID-19.Case summaryA 65-year-old man with a history of hypertension presented late to the emergency department (ED) with AMI. He gave a 2-month history of exertional angina but avoided seeking medical consult due to fears of contracting COVID-19. On the day of admission, he had 4 h of severe chest pain before presenting to the ED. He was hypotensive and tachycardic on arrival. Electrocardiogram showed inferolateral ST-elevation myocardial infarction. Chest radiograph revealed widened superior mediastinum and bedside echocardiogram revealed inferoseptal and inferolateral hypokinesia with features of cardiac tamponade. An urgent computed tomography aortogram showed possible left ventricular (LV) wall perforation with resulting haemopericardium and cardiac tamponade. Subsequent coronary angiogram showed 100% occlusion of mid left circumflex artery and a contained LV wall rupture was confirmed with LV ventriculogram. He was transferred to a tertiary centre and underwent successful emergency surgical repair.DiscussionOur index case demonstrates the impact of the COVID-19 pandemic on health seeking behaviour due to fears of contracting COVID-19 and the ensuing impact of delayed medical intervention. Cardiologists worldwide are seeing an alarming rate of rare complications of AMI in patients who present late. Physicians need to be aware of this phenomenon and have an active role to play in public education.

Frequency of Three-Vessel Disease Among Patients With Non-ST Segment Elevation Myocardial Infarction.

Background: Though the presence of three-vessel disease (3VD) among patients with non-ST Segment Elevation Myocardial Infarction (NSTEMI) is relatively common, very limited data is available regarding its clinical significance. The current study aimed to determine the frequency of 3VD among NSTEMI patients presenting at the tertiary care hospital of Karachi, Pakistan.Methodology: This cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi from August 15 2015 to February 15 2016 over a sample of 139 NSTEMI patients. Data regarding patients' baseline characteristics were recorded in a proforma. Coronary angiography was performed to determine the presence of 3VD. The frequency of occluded arteries and 3VD was also recorded and the collected data was then analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 (IBM Corp., Armonk, NY, USA).Results: A total of 139 NSTEMI patients were enrolled in the study with a mean age of 50.47 ± 12.47 years. The majority of them were males (70.5%), mostly ≥ 40 years of age (67.6%). Among the comorbidities, 50.4% of patients had diabetes mellitus (DM), 61.9% were hypertensive and 30.9% had dyslipidemia. The overall frequency of 3VD among the enrolled NSTEMI patients was 30.2%. Three major arteries were found to be occluded; 68.3% NSTEMI patients had occlusion in the left anterior descending (LAD) artery, followed by right coronary artery (RCA) among 49.6%, 40.3% had left circumflex (LCX) artery occlusion, and 50.4% had diagonal and obtuse marginal (OM) artery occlusion respectively. Among the effect modifiers, no significant impact of age, gender, and smoking habits was observed on the frequency of 3VD among NSTEMI patients (p > 0.05). Among the reported comorbidities, DM was significant among NSTEMI patients with 3VD (p < 0.05).Conclusion: Our study results indicated that a significant proportion of NSTEMI patients had 3VD, independent of the effect of age and gender.

Abstract 16801: Papillary Muscle Tip Approximation in Repair of Ischemic Mitral Regurgitation in a Chronic Swine Model

Introduction: Mitral valve (MV) repair with undersized annuloplasty (UMA) for ischemic mitral regurgitation (IMR) is being abandoned in favor of valve replacement (MVR) following CTSN trial results. However, in patients with durable repair, survival and left ventricular function (LVF) were significantly better than MVR. Achieving a durable repair with UMA is challenging as it draws leaflets away from papillary muscle (PM) insertions, causing unphysiological tethering and unicuspid configuration that fails (FigA-B). Hypothesis: Drawing PM tips together with an approximating stitch (PMT-A) can relieve leaflet tethering and enable better repair (FigC). A chronic swine model of IMR was used to compare effects of isolated PMT-A, UMA and PMT-A+UMA on MV and LV at 3 months post surgery. Methods: Twenty-five farm swine underwent catheterization and occlusion of left circumflex artery, resulting in postero-lateral myocardial infarction (MI). Two months after MI, IMR severity of &gt;2+ was confirmed on echo, and animals underwent one of the 3 repairs: PMT-A (n=6), UMA (n=8), PMT-A+UMA (n=11). Echo was performed postoperatively and repeated with MRI at 3 months (FigD). MV kinematics, coaptation geometry, and LVF were assessed. Results: IMR was eliminated after all repairs and did not recur through the study. Annulus continued to grow after PMT-A, but not in UMA or PMT-A+UMA group (FigE1) without increasing severity of IMR. Compared to prerepair, tenting depth was significantly reduced only in PMT-A and PMT-A+UMA groups (FigE2). Both leaflet excursion angles (diastolic minus systolic angles) increased after PMT-A, but not in other groups (FigE3-4). LV size and LVF was similar between groups, confirming that PMT-A did not perturb diastolic filling. Conclusions: In this model of IMR, PMT-A improved leaflet mobility, compared to isolated UMA or PMT-A+UMA. PMT-A is a simple technique that can potentially improve durability of MV repair by restoring valvular kinematics.

PR depression with multilead ST elevation and ST depression in aVR by left circumflex artery occlusion: How to differentiate from acute pericarditis

PR‐segment depression with multilead ST‐segment elevation and ST‐segment depression in lead aVR are classic ECG manifestation of acute pericarditis. We present a patient, where the etiology of these ECG features was acute ST‐elevation myocardial infarction due to left circumflex artery occlusion. To avoid misdiagnosis, unnecessary examinations, and inappropriate therapeutic decisions, the possibility of ST‐segment elevation myocardial infarction should be kept in mind even when ECG changes typical for pericarditis are encountered in chest pain patients. Findings of QRS widening and QT interval shortening in leads with ST‐segment elevation could help to differentiate acute ST‐segment elevation myocardial infarction from acute pericarditis.

Electrocardiographic Changes and Short term Prognosis in Patients with Acute left Circumflex Artery Occlusion versus Right Coronary Artery Occlusion

Electrocardiographic Changes and Short term Prognosis in Patients with Acute left Circumflex Artery Occlusion versus Right Coronary Artery Occlusion

Successful percutaneous treatment of an anomalous left circumflex coronary artery occlusion after tricuspid valve repair.

The risk of coronary artery injury during valve surgery is higher in case of anomalous coronary artery origin and trajectory. Unlike previous reports on coronary obstruction related to aortic or mitral surgery, we report the first case, to the best of our knowledge, of an anomalous left circumflex artery occlusion after tricuspid valve repair, and its successful percutaneous treatment.

Diffuse ST segment depression and ST segment elevation in lead aVR and V1 by left circumflex artery occlusion

The current guidelines for resting electrocardiograms of diffuse ST segment depression coupled with ST segment elevation in aVR and/or V1 that are otherwise unremarkable indicate multivessel or left main coronary artery obstruction. However, our case meets the above electrocardiogram changes, but involves left circumflex artery occlusion.

Do annuloplasty rings designed to treat ischemic/functional mitral regurgitation alter left-ventricular dimensions in the acutely ischemic ovine heart?

ObjectiveTo quantify the effects of annuloplasty rings designed to treat ischemic/functional mitral regurgitation on left ventricular septal-lateral (S-L) and commissure-commissure (C-C) dimensions. MethodsRadiopaque markers were placed as opposing pairs on the S-L and C-C aspects of the mitral annulus and the basal, equatorial, and apical level of the left ventricle (LV) in 30 sheep. Ten true-sized Carpentier-Edwards Physio (PHY), Edwards IMR ETlogix (ETL), and GeoForm (GEO; all from Edwards Lifesciences, Irvine, Calif) annuloplasty rings were inserted in a releasable fashion. After 90 seconds of left circumflex artery occlusion with the ring implanted (RING), 4-dimensional marker coordinates were obtained using biplane videofluoroscopy. After ring release, another data set was acquired after another 90 seconds of left circumflex artery occlusion (NO RING). S-L and C-C diameters were computed as the distances between the respective marker pairs at end-diastole. Percent change in diameters was calculated between RING versus NO RING as 100 × (diameter in centimeters [RING] − diameter in centimeters [NO RING])/diameter in centimeters [NO RING]). ResultsCompared with NO RING, all ring types (PHY, ETL, and GEO) reduced mitral annular S-L dimensions by −20.7 ± 5.6%, −26.8 ± 3.9%, and −34.5 ± 3.8%, respectively. GEO reduced the S-L dimensions of the LV at the basal level only by −2.3 ± 2.4%, whereas all other S-L dimensions of the LV remained unchanged with all 3 rings implanted. PHY, ETL, and GEO reduced mitral annular C-C dimensions by −17.5 ± 4.8%, −19.6 ± 2.5, and −8.3 ± 4.9%, respectively, but none of the rings altered the C-C dimensions of the LV. ConclusionsDespite radical reduction of mitral annular size, disease-specific ischemic/functional mitral regurgitation annuloplasty rings do not induce relevant changes of left ventricular dimensions in the acutely ischemic ovine heart.

TCTAP C-013 A Young CPA Case Of Von Recklinghausen’s Disease Caused by Acute Anterior Myocardial Infarction with Chronic Total Occlusion of Right Coronary Artery and Left Circumflex Artery

TCTAP C-013 A Young CPA Case Of Von Recklinghausen’s Disease Caused by Acute Anterior Myocardial Infarction with Chronic Total Occlusion of Right Coronary Artery and Left Circumflex Artery