Volume 18 - Issue 2 - February, 2006

Percutaneous Coronary Intervention in Anomalous Right Coronary Arteries Arising from the Left Sinus of Valsalva: A Report of Tw

Congenital anomalies of the origin and distribution of the coronary arteries are infrequent and are found in 0.3–1.2% of patients undergoing coronary angiography.1–3 The prevalence is greater if the origin of a coronary artery from an ectopic ostium that is still in the correct sinus of Valsalva is included.4
The incidence of anomalous origin of the right coronary artery (RCA) out of the right sinus of Valsalva ranges from under 0.01–0.09%.1–6 It usually arises from the left sinus of Valsalva or the ascending aorta above it, and in most reported cases



Early Ambulation and Variability in Anticoagulation during Elective Coronary Stenting with a Single Intravenous Bolus of Low-Do

Low-molecular weight heparin (LMWH), especially enoxaparin, and unfractionated heparin (UFH), is recommended in the early medical management of acute coronary syndromes.1,2 Compared to intravenous UFH, subcutaneous LMWH has a more predictable effect, a higher anti-Xa/anti-IIa ratio, does not require monitoring with an activated clotting time, and is resistant to inhibition by activated platelets.3–5 Earlier work by Collet and Montalescot,6 as well as the recent, large SYNERGY trial7 documented the efficacy of transitioning high-risk acute coronary



Refractory Hypoxemia after Mitral Valve Surgery: An Unusual Cause and Its Successful Percutaneous Treatment

A variety of approaches are used for mitral valve repair and replacement operations. Rare complications specific to the surgical method may need to be considered if patients encounter unexplained problems postoperatively. We discuss such an example here. The operative approach to the mitral valve in this case was transseptal (from the right atrium), a method which has been widely used as an alternative to the more frequently employed left atriotomy.1,2 There are certain situations in which the transseptal approach may be particularly useful — for example, allowing better visualiza



Procedural Success and 30-Day Outcomes between CYPHER™ and TAXUS® Stent Implantation for the Treatment of Bifurcation Lesions —

CYPHER™ (sirolimus-eluting stent, Cordis, Johnson and Johnson, Miami, Florida) and TAXUS® (polymer-based paclitaxel-eluting stent, Boston Scientific Corporation, Natick, Massachusetts) stents are the two drug-eluting stents (DES) currently approved by the Food and Drug Administration (FDA) for clinical use. Both DES have been proven effective in reducing the risks of restenosis and repeat revascularization in simple coronary lesions.1,2
There are fundamental differences between the CYPHER and TAXUS stents, including the drug coatings, polymers and stent platforms.



Fibromuscular Dysplasia and Acute Myocardial Infarction: Evidence for a Unique Clinical and Angiographic Pattern

Myocardial infarction (MI) typically occurs in the setting of atherosclerotic coronary artery disease (CAD). However, there are other causes of MI unrelated to atherosclerosis that include spontaneous dissection of the coronary arteries, anomalous origin of coronary arteries, vasculitis, toxins such as carbon monoxide, medications (5-fluorouracil, sumatriptan, ergotamine) and hypercoagulable states.1–7 Fibromuscular dysplasia (FMD) is a condition typically involving small and medium-sized vessels. It has been rarely described in coronary arteries at autopsy8–13 in ass



Bifurcation Intervention: Keep it Simple

The percutaneous treatment of bifurcation lesions remains suboptimal. A frequent problem, accounting for 10–20% of coronary lesions undergoing percutaneous coronary intervention (PCI), the bifurcation is plagued by acute technical challenges, long-term restenosis, and more recently, early and late stent thrombosis.1–4 Generally defined as a lesion which involves a side branch of 2.0 mm or greater, the bifurcation is in part so complex due to its variability. This variability results from inconsistent plaque distribution, unpredictable side branch angulation and large differences



Novel Intracoronary Steerable Support Catheter for Complex Coronary Intervention

Case Description. A 69-year-old female with hypertension and hyperlipidemia presented with a 2-month history of worsening exertional angina. Nuclear perfusion imaging indicated ischemia in the inferior and inferoposterior walls, with preserved left ventricular function. Coronary angiography was notable for severely calcified vessels and a right dominant circulation. The left anterior descending and left circumflex arteries were free of critical stenosis, but the right coronary artery was tortuous in its proximal segment, with a 99% mid-vessel lesion that appeared as a calcified, obst



Saphenous Vein Graft Rheology Simulating a Thrombotic Lesion

Case Presentation. A 59-year-old male was admitted for accelerated angina. Serial ECGs and cardiac enzymes ruled out a myocardial infarction. He had undergone coronary artery bypass grafting 4 years before, as well as coronary stenting of an ostial circumflex lesion 1 year after his bypass. After the procedure, he was doing well until his most recent presentation to us. Diagnostic coronary angiography documented severe native coronary artery disease with in-stent restenosis of the previously stented circumflex artery. A focal lesion was noted at the ostium of the large first septal p