Volume 20 - Issue 2 - February, 2008

Double Right Coronary Artery with Acute Inferior Wall Myocardial Infarction

Manojkumar Rohit, MD, DM, Shivkumar Bagga, MD, DM, Kewal Krishan Talwar, MD, DM

The incidence of primary congenital coronary anomalies varies from 0.95–2% in the adult population undergoing coronary angiography (CAG).1–4 The majority of these are reported to be anomalies of origin or distribution, with separate ostia of the left anterior descending artery and left circumflex artery being the most common. Coronary artery anomalies are divided into those that cause and those that do not cause myocardial ischemia.5,6 We describe a rare benign anomaly, a double right coronary artery (RCA) presenting as acute inferior wall myocardial infarctio...

Ductal Stent and Cavo-Atrial Sac Occlusion in an Adult with Profound Cyanosis after Palliated Cyanotic Congenital Heart Disease

§Daniel H. Gruenstein, MD, *Robert H. Beekman III, MD, *Robert L. Spicer, MD

Interventional catheterizations are an increasingly important component in the management of the growing population of adults with congenital heart disease (CHD). The experience of interventions on adults with CHD from some centers has been reported and the types of procedures resemble those that are common in the pediatric population.1,2
We report a unique case of a 35-year-old female with palliated complex who underwent two unusual interventions during the same catheterization procedure. The first, patent ductus arteriosus (PDA) stent placement, is an uncommon procedure t...

Retrieval of a Detached Partially Expanded Stent Using the SpideRX and EnSnare Devices — A First Report

Farrukh Hussain, MD, Barry Rusnak, MD, James Tam, MD

Case Report. A 66-year-old male with previous two-vessel coronary artery bypass graft surgery (CABG) presented with an acute coronary syndrome. Angiography demonstrated a critical 95% stenosis in the ostium of the saphenous vein graft (SVG) to the obtuse marginal (OM) of a dominant circumflex vessel, and another 70% thrombotic lesion in the mid portion of the same graft (Figure 1). The left internal thoracic artery (was widely patent, supplying a diffusely diseased distal left anterior descending artery not amenable to percutaneous intervention. Intervention was p...

Treatment of High-Burden Thrombus in a Large Right Coronary Artery

*Jaime Molden, MD, §John Kao, MD, *Atman P. Shah, MD

Case Report. A 30-year-old male with no previous medical history presented to an emergency department at a community hospital with left-sided, substernal chest pain. The pain was pressure-like and nonradiating. It began shortly after performing weight-lifting activity and lasted for more than 2 hours. In the emergency department, the patient was initially treated medically with aspirin and intravenous nitroglycerin, resulting in partial relief of the chest pain.
The patient was hemodynamically stable and physical examination, including cardiac auscultat...

Double Balloon Angioplasty for Unstentable Large-Caliber Right Coronary Stenosis

Scott B. Baron, MD, Clifford Nielson, CVT

Despite newer lower-profile stent technologies, placing coronary stents may still remain challenging when vessels are extremely tortuous. We describe a case of a very large-caliber right coronary artery (RCA) with a “shepherd’s crook” configuration, which could not be stented, and for which double balloon angioplasty was successfully performed.
Case Report. A 69-year-old Caucasian male was hospitalized for an acute coronary syndrome. Diagnostic heart catheterization revealed a 90% eccentric stenosis past the genu of the right coronary artery. The...

Prophylactic, Standby, or Rescue Support for High-Risk PCI: Who Knows?

*,§Fayaz Shawl, MD and *,£Robert J. Lederman, MD

This series from Mount Sinai Hospital extends the reported experience with prophylactic deployment of a percutaneous transseptal cardiopulmonary bypass system during high-risk elective coronary angioplasty. These highly experienced operators employed a dual-“preclose” technique in the majority of patients, implanting arterial sutures before pump deployment that permitted immediate postprocedure arterial closure. The short-term outcome was excellent, reported complications minimal, and intermediate-term outcomes reasonable for the high-risk patient cohort described.
How sh...

Twin Circumflex Arteries: A Rare Coronary Artery Anomaly

M.N. Attar, MD, MRCP, Roger K. Moore, MD, MRCP, Sarfraz Khan, FRCP, FCPS

Case Report. A 62-year-old Caucasian male presented with recurring angina. He was experiencing angina attacks on walking 10 to 20 yards. The patient had suffered a myocardial infarction in the past and had undergone percutaneous intervention to his left anterior descending artery (LAD). Following the procedure, he remained relatively angina-free until recently. He was diabetic and hypertensive. There was a strong family history of premature coronary artery disease. He was unable to perform an exercise stress test due to peripheral neuropathy. In view of a positive...

Effects of B-Type Natriuretic Peptide (Nesiritide) on Coronary Epicardial Arteries, Systemic Vasculature and Microvessels

*Gui Fu Wu, MD, PhD, §Joanna J. Wykrzykowska, MD, £Jamal S. Rana, MD, §Duane S. Pinto, MD,
§C. Michael Gibson, MD, §Jian Li, MD, §Frank W. Sellke, MD, §Roger J. Laham, MD

Nesiritide (Natrecor®, Scios Inc., Fremont, California) is a recombinant form of human B-type (brain) natriuretic peptide (BNP) that has beneficial vasodilatory, diuretic and neurohormonal effects.1 It activates membrane-bound guanylyl cyclase A-receptor, resulting in accumulation of intracellular cGMP, which in turn mediates the vasodilatory effects in vascular smooth muscle cells.23 Nesiritide is manufactured from E. coli using recombinant DNA technology with a molecular weight of 3,464 g/mol with the same 32 amino acid sequence as th...

Use of Radiofrequency Energy and Covered Stents in Patients with an Occluded Superior Vena Cava and Requiring Endocardial Pace

Gianfranco Butera, MD, PhD, Ezio Aimè, MD, Mario Carminati, MD

Obstructions of the caval veins may develop in various clinical settings in subjects with tumoral lesions, after surgery on the caval veins — as in the Mustard/Senning operation, after radiation therapy, or due to central lines, dialysis catheters and pacing wires.1–4 In particular, patients with a history of multiple cardiac surgical procedures or with a history of infections of the pacemaker site and electrodes may easily develop an iatrogenic occlusion of the venous access.2 Various kinds of interventions have been performed in these subjects, including ...

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