Ostium Of Coronary Artery Research Articles

Acute coronary syndrome as the initial manifestation of infective endocarditis in an apparently normal native valve: a case report

Abstract Background Acute coronary syndrome (ACS) is a rare complication of infectious endocarditis (IE). We present the case of a patient with a bicuspid aortic valve who presented an acute ST elevation myocardial infarction (STEMI) of the inferior wall secondary to vegetation that generated obstruction of the ostium of the right coronary artery (RCA). Case summary A 54-year-old patient with only a history of smoking was admitted for chest pain. An acute ST elevation myocardial infarction (STEMI) in the inferior wall was documented; he underwent an emergent coronary angiography, which showed a mass that obstructed the ostium of the right coronary artery that did not allow its channeling. An angiotomography of the aorta was performed, where dissection was ruled out and the presence of a mass in the right coronary sinus that protruded towards the ostium of the coronary artery was confirmed. In the extension studies, a bicuspid aortic valve, thrombosis in the right brachial artery and in the infrarenal abdominal aorta were documented. Discussion The case was taken to a medical meeting and given the embolic and mechanical compromise; it was decided to perform surgery where a mass that invaded the proximal segment of the right coronary artery was resected. The histopathological study documented findings of vegetation; the cultures were positive for Staphylococcus epidermidis, and he finally received antibiotic and anticoagulation treatment.

Catheter-induced ostial coronary artery dissection during percutaneous coronary intervention assessed by intravascular ultrasound

Abstract Background Catheter-induced ostial coronary artery dissection is one of the possible complications of percutaneous coronary intervention (PCI), sometimes resulting in serious consequences. The incidence of catheter-induced ostial coronary artery dissection has been assessed by coronary angiography, but rarely by intravascular ultrasound (IVUS). Prognosis of ostial coronary artery dissection is also unclear. Purpose To determine the incidence and prognosis of catheter-induced ostial coronary artery dissection during PCI by IVUS assessment. Methods The study population consisted of 1468 consecutive patients undergoing PCI at our institution between January 2019 and March 2020. Patients who had previously received a stent in the ostial coronary artery to be treated and patients who were scheduled to receive a stent in the ostial coronary artery during the procedure were excluded. The analysis was performed on 246 patients undergoing IVUS assessment of the ostial coronary artery at the end of the procedure. The 1-year cumulative rates of all-cause death, nonfatal myocardial infarction, and any revascularization procedure were compared between patients with and without ostial coronary artery dissection (dissection and nondissection groups). Results Ostial coronary artery dissection was detected by coronary angiography in 13 patients (5.2%) and by IVUS in 49 patients (19.9%). There were no significant differences between the dissection and nondissection groups (49 patients vs. 197 patients) in the percentage of the treated coronary artery (right coronary artery: 34.7% vs. 36.0%, p = 0.86), acute coronary syndrome (30.6% vs. 41.6%, p = 0.15), or the use of a backup catheter (32.7% vs. 20.8%, p = 0.09). The dissection group had more moderate to severe calcified lesions than the nondissection group (42.9% vs. 22.3%, p<0.01). There were no significant differences between the dissection and nondissection groups in the 1-year cumulative incidence of all-cause death (6.1% vs. 6.6%, p = 0.88), nonfatal infarction (6.1% vs. 4.1%, p = 0.54), or any revascularization procedure (10.2% vs. 8.6%, p = 0.72). Eight patients (16%) in the dissection group received additional intervention for ostial coronary artery dissection and had a significantly higher rate of dissection detected by coronary angiography than conservatively treated patients (75.0% vs. 17.1%, p<0.01). In addition, no conservatively treated patients received additional intervention for worsening dissection within one year of the index procedure. Conclusion IVUS may be more useful than coronary angiography in detecting ostial coronary artery dissection. With proper management, ostial coronary artery dissection may not lead to worse 1-year outcomes, and many dissections detected by IVUS may not require additional intervention.

Coronary Artery Dimensions on Computed Tomography Following the Neonatal Arterial Switch Operation for the Complete Transposition of the Great Arteries.

Coronary events are life-threatening long-term complications of the arterial switch operation for complete transposition of the great arteries. The aim of our study was to assess the dimensions of the reimplanted coronary arteries and their relationship with the various geometric characteristics to gain a better understanding of the involved mechanisms. Coronary computed tomography angiography (CCTA) scans of 78 asymptomatic pediatric patients were performed at the age of 10.7 (6.3-17.8) years. The position of the ostia, the branching angles, and the diameters of the coronary arteries were determined in a subgroup of 51 patients presenting the usual preoperative coronary anatomy. Mean Z-score of the left main coronary artery (LMCA), left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and right coronary artery (RCA) diameters were 0.7 ± 1.2, - 0.4 ± 1.1, - 0.3 ± 1.1, and - 0.3 ± 1.1, respectively. The Z-score of the ostial LMCA diameter had a positive correlation with the remoteness from the main pulmonary artery (p < 0.001) and the branching angle (p = 0.001). The ostial diameter Z-score of the LMCA had a negative correlation with the interval between the arterial switch operation and the CCTA (p = 0.004). Even though most of the coronary diameters fell within the accepted range, which suggests normal overall development, acute branching angle and more anterior origin were associated with smaller ostial coronary artery diameter Z-scores. To prove the clinical relevance of the smaller ostial diameter of high-risk left coronary arteries and the decrease of ostial coronary artery Z-scores over time needs further follow-up studies.

Papillary Fibroelastoma of the Aortic Valve:Acute Coronary Syndrome Due to Dynamic Obstruction of the Right Coronary Artery Ostium.

A 59-year-old woman, who had a history of acute coronary syndrome (ACS) but without obstructive coronary lesions 2 years previously, presented with vertigo. MRI revealed a left cerebellar embolism. TEE detected a mobile aortic valve tumor, suggesting a papillary fibroelastoma (PFE). Reviewing previous echocardiograms, it was discovered that the tumor was present at the time of the ACS event. At surgery, the PFE was present on the right coronary cusp. When the aortic valve was opened, it was found that the tumor was obstructing the right coronary artery (RCA) ostium. ACS was probably caused by PFE's dynamic obstruction of the RCA ostium.

997 Ascending Aorta Pseudoaneurysm 40 Years Following Surgical Atrial Septal Defect Repair

Abstract Background Ascending aorta pseudoaneurysm is a rare postoperative complication of cardiac surgery. It is often attributed to infection and dehiscence at sites of aortotomy, cannulation, cross-clamp placement, and proximal coronary anastomoses. Mortality risk is 29-46% and this requires prompt surgical intervention. Case summary A 48-year-old woman who underwent atrial septal defect repair at 8 years of age, presented with chest pain radiating to the right shoulder and dyspnoea. Cardiac-gated CT angiography demonstrated a 21mm pseudoaneurysm arising anteriorly from the proximal ascending aorta, 6mm above the right coronary artery ostium, likely the site of previous cardioplegia cannula. There was active blood flow from the aorta into the pseudoaneurysm sac. It was heavily calcified, apart from a thinned irregular wall inferiorly, from which rupture was imminent. She underwent emergency surgery. Using femoro-femoral cardiopulmonary bypass, the chest was safely re-entered. Under mild hypothermia and distal ascending aorta cross-clamping, the pseudoaneurysm was resected and aorta repaired using a Gelweave patch. The patient recovered uneventfully and was discharged home after one week. Discussion Accurate imaging, primarily via cardiac-gated CT angiography, is crucial for diagnosis and surgical planning in patients presenting with aortic pseudoaneurysm, particularly those close to the aortic valve and coronary arteries. Operative strategy, including need for deep hypothermic circulatory arrest and/or graft replacement of aorta, depends on pseudoaneurysm anatomy. It is recommended that preventative measures are taken during the primary operation, inserting the cardioplegia cannula tip through full-thickness purse-strings and/or addition of separate oversewing sutures after decannulation. Alternative techniques of pseudoaneurysm repair are also discussed.

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.

Strategic Multidisciplinary Management of Chemotherapy-induced Ostial Coronary Artery Disease: A Rare Case Report with Literature Review

Cancer and coronary artery disease, both leading global causes of mortality, share common risk factors and are exacerbated by various cancer treatments. Coronary artery disease may delay cancer treatment initiation. Revascularization improves the safety of subsequent cancer treatment and long-term survival. Radiation commonly induces ostial coronary artery disease due to its proximity to the mediastinum, while ostial coronary artery disease related to chemotherapy is rarely reported. In this case, we explore an instance of Serous cystadenocarcinoma of the ovary, treated with Neo Adjuvant chemotherapy based on Paclitaxel, subsequently presented with ostial coronary artery disease, leading to cardiogenic shock and heart failure. The condition was successfully managed through bailed out angioplasty, followed by debulking oophorectomy surgery. The patient was under regular follow up for the past 3 years.

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 Case of Surgical Treatment for Coronary Artery Ostium Obstruction and Aortic Regurgitation due to Cardiovascular Syphilis

A Case of Surgical Treatment for Coronary Artery Ostium Obstruction and Aortic Regurgitation due to Cardiovascular Syphilis

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).

Iatrogenic Dissection of the Left Internal Mammary Artery During Percutaneous Coronary Intervention of Jump Radial Artery Graft Bifurcation Disease: A Case Report

Iatrogenic Dissection of the Left Internal Mammary Artery During Percutaneous Coronary Intervention of Jump Radial Artery Graft Bifurcation Disease: A Case Report

Effects of guiding catheter on franctional flow reserve and non-hyperemic pressure ratios for the assessment of coronary artery stenoses

Abstract Aims Non-hyperemic pressure-derived Indexes (NHPI) provide diagnostic efficacy equivalent to fractional flow reserve (FFR) to guide percutaneous coronary interventions. In the Disengage (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, selective decannulation of the guiding catheter (GC) within the coronary ostium during FFR assessment was associated with a significant overall decrease in FFR, particularly when the stenosis was located in the proximal and middle coronary segments. So far it is unclear what influence the selective cannulation of the catheter in the coronary artery ostium has on the NHPI. This prospective registry aimed to evaluate the influence of GC engagement within the coronary ostium on FFR and NHPI values. Methods and results In the DISENGAGE@Rest (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) 133 patients with 164 intermediate coronary artery stenoses (40-90%) were enrolled. We evaluated: 1) the impact of GC engagement within the coronary ostium on FFR and NHPI values; 2) implications for clinical decision making; 3) the relationship between coronary physiology indices and study site (proximal, middle and distal coronary segments). Disengagement of GC was associated with a significant decrease in FFR (FFReng, 0.85±0.07 vs. FFRdis, 0.83±0.07; p&amp;lt; .001), Pd/Pa (Pd/Paeng, 0.94±0.05 vs. Pd/Padis, 0.93±0.05; p&amp;lt; .001) and RFR values (RFReng, 0.91±0.07 vs. RFRdis, 0.90±0.07; p= .018). This significant decrease in invasive physiologic indexes was driven by a significant increase in mean Pa value (Pa eng, 93±15 mm Hg vs. Pa dis, 97±15 for FFR; P &amp;lt; .001; Pa eng, 94±15 mm Hg vs Pa dis, 96±15 for Pd/Pa; P &amp;lt; .001 Pa eng, 95±15 mm Hg vs Pa dis, 97±15 for RFR; P &amp;lt; .001), without changes in mean Pd value. In 24 (15%), 12 (7%) and 17 (10%) lesions, FFR, RFR and Pd/Pa values, respectively, shifted below the cut-off point after GC disengagement with changes in clinical decision-making. There was a significant FFR change, but no NHPI, across different segments (ΔFFReng–FFRdis proximal 0.04±0.03 vs. ΔFFReng–FFRdis middle 0.02±0.02 vs. ΔFFReng–FFRdis distal 0.03±0.04; p= .018). Conclusions The results confirm a significant overall decrease in FFR after GC disengagement and extend this to Pd/Pa and RFR. In case of proximal coronary artery disease, GC disengagement should be performed in order not to underestimate the hemodynamic significance of the lesion under examination.

Abstract 15837: Anomalous Bronchial Artery Origin- The Canary in the Coal Mine- For the Diagnosis of Chronic Thromboembolic Pulmonary Hypertension

Introduction- Anomalous bronchial artery origin is seen in 8.3% to 35% of cases with most originating from the aortic arch, internal mammary artery, and subclavian artery. Origin of this vessel from a coronary artery is extremely rare. Case presentation- A 49-year-old male with history of unprovoked pulmonary embolisms (PE) in the setting of triple antibody positive Antiphospholipid antibody syndrome on lifelong anticoagulation presented with left sided chest pain and dyspnea. Initial lab work showed a troponin of 5.46 ng/mL, BNP of 602 pg/mL and D-dimer of 0.62 ug/mL. EKG showed normal sinus rhythm with non-specific ST segment changes in anterior leads. Computed Tomography Angiography (CTA) was positive for a PE. There was concern for a false positive result due to previous history of multiple PEs while on therapeutic levels of warfarin and near normal D-dimer. Echocardiogram showed ejection fraction of 38% with akinesis of anteroapical and inferoapical segments and no evidence of shunt on bubble study. Cardiac catheterization showed non-obstructive coronaries. From the ostium of the right coronary artery there appeared a fistula like structure extending into the pulmonary vasculature. Pulmonary angiogram was performed and showed chronic occlusion in branches of right pulmonary artery (RPA), pulmonary hypertension (PH) with mean pulmonary artery pressure of 36 mmHg and no evidence of acute thrombus. There was aberrant origin of the right bronchial artery from the right coronary artery that was hypertrophied as it supplied collateral flow to the area of the occluded RPA. The patient was started on guideline directed medical therapy for heart failure and follow up was arranged for further outpatient management of PH. Discussion- A rare congenital anomaly was used to guide the diagnosis of a potentially devastating and treatable medical condition. It shows the limitations of a CTA in the setting of chronic PE.

Syphilitic ostial coronary artery occlusion treated with percutaneous coronary intervention: Case series and literature review

IntroductionNon-atherosclerotic causes of acute coronary syndrome (ACS) are important contributors to a substantial number of acute ischemic coronary events. Syphilitic aortitis is a rare complication of tertiary cardiovascular syphilis that may result in ostial coronary artery stenosis, aortic insufficiency, and ascending aortic aneurysm. MethodsIn this manuscript, we present two Case Reports of patients with bilateral syphilitic coronary artery ostial occlusion, and we review the associated literature. The immunofluorescent test was positive for syphilis in both patients. ResultsDiagnostic coronary angiography revealed bilateral occlusions of the left main coronary artery (LMCA) and right coronary artery (RCA), which were successfully treated with percutaneous coronary intervention (PCI) with bare metal stents (BMS). After deployment of the stents, arterial blood flow was re-established with TIMI flow grade 3. DiscussionThe angiographic finding of bilateral coronary ostial lesions in young patients should raise the suspicion of cardiovascular syphilis. Options for revascularization should be discussed amongst the patient and the Heart Team. PCI may be an option for treatment of isolated syphilitic coronary stenosis in the setting of acute hemodynamic instability or chronic inflammation.

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.

Morphometry and topography of the coronary ostia in the dog.

The purpose of this study was to perform a morphometric examination of the coronary ostia, including their location in the area of the aortic sinuses, and to describe variations in ostia structure in the domestic dog. The study was conducted on the hearts of 91 pedigree dogs of both sexes, aged 1 to 18 years (median 9 years), with a body weight from 1.2 to 65 kg (median 20.7 kg). Morphometric examinations of the coronary ostia were performed in the studied individuals, and the location of the structures in relation to the intercommissural lines was determined. Three types of location of the coronary ostia were distinguished, i.e. below the intercommissural line (type I), on the intercommissural line (type II), and above the intercommissural line (type III). In the studied dogs, the most common location of the ostia was type I - found in the left coronary artery of 74/91 dogs (81%) and in the right coronary artery of 42/91 dogs (46%). Morphological variations were shown in 36/91 dogs (40%) in the structure of the coronary ostia, including the presence of accessory ostia. The most common variation was the presence of an accessory ostium near the ostium of the right coronary artery, which was found in 28/91 dogs (31%). The results may be useful in developing standards for procedures to replace the whole or part of the aortic valve and repair the coronary artery.

Commissural alignment in the Evolut TAVR procedure: conventional versus hat marker-guided shaft rotation methods.

Coronary cannulation after TAVR is sometimes difficult due to an overlap between native and neo-commissures, especially in Evolut devices with a supra-annular position. The Evolut C-tab corresponds to a neo-commissure, and the hat marker is in a fixed position. Therefore, the orientation of the hat marker can be adjusted to minimise overlaps. We investigated whether the HAt marker-guided SHaft rotation method (HASH, stylised as the #rotation method) is effective in facilitating coronary artery access after transcatheter aortic valve replacement (TAVR) with an Evolut system. We retrospectively analysed 95 patients who underwent electrocardiogram-gated cardiac computed tomography after TAVR. In the #rotation method, the hat marker of the delivery catheter was adjusted to face the greater curvature of the descending thoracic aorta in the left anterior oblique view. Its orientation was maintained while the system passed through the aortic arch. In total, 60 and 35 patients underwent TAVR with the #rotation and non-#rotation methods, respectively. A ±15° angle between the native and neo-commissures was more frequent in the #rotation group (p=0.001). Favourable angles and appropriate frame orientation for access to the left coronary artery were significantly more frequent in the #rotation group than in the non-#rotation group (p<0.001 and p=0.001). Although the #rotation method showed a higher rate of favourable angles and frames in the right coronary artery, statistically significant differences were not found. The #rotation method is useful for improving commissural post alignment in TAVR with Evolut devices, especially in the ostium of the left coronary artery.

Mechanisms and treatment outcomes of ostial right coronary artery in-stent restenosis.

Despite a high rate of in-stent restenosis (ISR) after stenting the right coronary artery (RCA) ostium, the mechanism of ostial RCA ISR is not well understood. We aimed to clarify the cause of ostial RCA ISR using intravascular ultrasound (IVUS). Overall, 139 ostial RCA ISR lesions were identified with IVUS, pre-revascularisation. Primary ISR mechanisms were classified as follows: 1) neointimal hyperplasia (NIH); 2) neoatherosclerosis; 3) ostium not covered by the stent; 4) stent fracture or deformation; 5) stent underexpansion (old minimum stent area <4.0 mm2 or stent expansion <50%); or 6) a protruding calcified nodule. The median duration from prior stenting was 1.2 (first quartile 0.6, third quartile 3.1) years. The primary mechanisms of ISR were NIH in 25% (n=35) of lesions, neoatherosclerosis in 22% (n=30), uncovered ostium in 6% (n=9) (biological cause 53%, n=74), stent fracture or deformation in 25% (n=35), underexpansion in 11% (n=15), and protruding calcified nodules in 11% (n=15) (mechanical cause 47%, n=65). Including secondary mechanisms, 51% (n=71) of ostial RCA ISRs had stent fractures that were associated with greater hinge motion of the ostial-aorta angle during the cardiac cycle. The Kaplan-Meier rate of target lesion failure at 1 year was 11.5%. When the mechanically caused ISRs were treated without new stents, they suffered a higher subsequent event rate (41.4%) compared with non-mechanical causes or mechanical causes treated without restenting (7.8%, unadjusted hazard ratio 6.44, 95% confidence interval: 2.33-17.78; p<0.0001). Half of the ostial RCA ISRs were due to mechanical causes. Subsequent event rates were high, especially in mechanically caused ISRs treated without the implantation of a new stent.

Sudden Cardiac Death in a Neonate Due to Bilateral Absence of Coronary Artery Ostium

Introduction: Congenital heart disease is a leading cause of neonatal mortality linked to birth defects. Despite the widespread availability of prenatal screenings, detection rates remain low. Accurate early detection of these lesions is pivotal to reducing neonatal morbidity and mortality. Methods: In this case, we present a neonate who experienced sudden cardiac death due to a rare, undiagnosed congenital cardiac anomaly - the bilateral absence of coronary artery ostium. Discussion: This case highlights the importance of prenatal detection of congenital cardiac anomalies. While fetal echocardiography is frequently utilized, it only identifies CHD in 36-50% of cases. This is attributed to inadequate imaging procedures, varied operator skills, and regional discrepancies. Early detection of severe CHD is essential for specialized treatment, thereby mitigating neonatal health risks and improving survival rates. Conclusion: Prenatal detection of CHD, especially coronary anomalies, continues to pose significant challenges. There is a pressing need to establish and enforce standardized protocols for fetal echocardiography aimed at these anomalies. To enhance care and improve outcomes, a joint effort between academic institutions and community centers is encouraged. Learning Objectives: • Congenital coronary artery anomalies are a significant cause of sudden cardiac death in children. • The absence of a coronary artery ostium is known to be associated with other congenital heart diseases, particularly pulmonary atresia with an intact ventricular septum. However, isolated coronary disease has also been reported in this case. • Prenatal echocardiography is a valuable tool for diagnosing congenital heart disease. However, certain limitations may be encountered when diagnosing coronary artery anomalies.

Austrian Syndrome: Community-Acquired Pneumonia in an Unusual Triad.

Austrian syndrome corresponds to the triad of meningitis, pneumonia, and endocarditis caused by Streptococcus pneumoniae, there is no global or local incidence given the infrequency of entity. Scarce cases are published in Latin America, with none of them in Colombia. A case of Austrian syndrome by penicillin-resistant S. pneumoniae in an immunocompetent patient is presented. Aortic valve is the most frequent site involved in Austrian syndrome; this patient had an unusual localization of the vegetation on the right coronary artery ostium. The prognosis is poor with a mortality rate of 30% or higher, this patient survived despite systemic complications. Vaccination status impacts in prevention and severity of cases because responsible serotypes are often included in available vaccines. The patient had a serotype covered by available vaccines; however, her vaccination status was unknown. Thus, we present the first case reported in Colombia of Austrian syndrome by a penicillin-resistant S. pneumoniae, in a patient with no identified comorbidities or toxicological history, with a successful evolution.