Surgical anterior ventricular endocardial restoration (SAVER) is a technique that improves hemodynamic status by excluding akinetic or dyskinetic portions of the left ventricle, restores the ventricle to normal elliptical shape and reduces ventricular wall tension to normal level in patients with acute anterior wall myocardial infarction that accompanies aneurysm. We performed redo-SAVER procedure in a 40-year old man with remodeled dilated ventricle who had already underwent LV aneurysmectomy 12 years earlier, and the results were satisfactory.
Adult ; Aneurysm* ; Anterior Wall Myocardial Infarction ; Heart Ventricles ; Hemodynamics ; Humans

The exact etiology of the coronary slow flow phenomenon (CSFP) is not certain. CSFP is not a normal variant as it is an absolutely pathological entity. Furthermore, CSFP not only leads to myocardial ischemia but it can also cause classical acute ST elevation myocardial infarction, which necessitates coronary angiography for a definite diagnosis.
Anterior Wall Myocardial Infarction ; Coronary Angiography ; Myocardial Infarction ; Myocardial Ischemia ; No-Reflow Phenomenon

BACKGROUND AND OBJECTIVES: Dual blood supply to the anterior interventricular septum (IVS), derived from the septal branches of the left anterior descending artery (LAD) and the conal branch of the right coronary artery (RCA), may prevent ST segment elevation in lead V1 during an anterior acute myocardial infarction (AMI), and predict a favorable in-hospital clinical course. SUBJECTS AND METHODS: The admission 12-lead electrocardiogram (ECG), and the coronary angiograms performed within 10 days of hospital admission, were evaluated in 67 patients with anterior wall AMI, as defined by a ST segment elevation > or =2mm in at least 2 of the V1 to 4 leads. The patients were divided into two groups according to the magnitude of the ST segment elevation in V1 lead: group 1 (ST <1.5 mm, n=22) and group 2 (ST > or =1.5 mm, n=45). The conal branch types were classified into small (a diameter <0.5 mm), not reaching the IVS, and large (a diameter >0.5 mm), reaching the IVS. RESULTS: A large conal branch was found in 11 patients of each group 50 and 24%, respectively (p=0.04). There was no significant relation between the sites of the LAD lesion, whether proximal or distal to the first septal branch, and the presence of ST segment elevation in lead V1. The serum cardiac enzymes, Killip class and the incidence of in-hospital congestive heart failure, were not significantly different. CONCLUSION: The absence of ST segment elevation in lead V1 during an anterior AMI suggested that the IVS is protected by a large conal branch, in addition to the septal branch of the LAD, but this did not influence the in-hospital clinical course.
Anterior Wall Myocardial Infarction* ; Arteries ; Coronary Vessels* ; Electrocardiography ; Heart Failure ; Humans ; Incidence ; Myocardial Infarction ; Prognosis

BACKGROUND AND OBJECTIVES: Acute myocardial infarction-related heart failure (HF) is associated with poor outcome. This study was designed to investigate the usefulness of global longitudinal strain (GLS), global circumferential strain (GCS) and mean longitudinal strain of left anterior descending artery territory (LSant) measured by 2-dimensional speckle tracking echocardiography (2D STE) in prediction of acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI)-related HF. METHODS: A total of 171 patients with ant-STEMI who underwent successful primary coronary intervention and had available 2D STE data were enrolled. Patients were divided into 3 groups: in-hospital HF, post-discharge HF, and no-HF groups. RESULTS: In-hospital and post-discharge HF developed in 39 (22.8%) and 13 (7.6%) of patients, respectively and 113 patients (69.6%) remained without HF. Multivariate analysis showed that GLS was the only factor significantly associated with the development of in-hospital HF. For post-discharge HF, LSant was the only independent predictor. Other echocardiographic or laboratory parameters did not show independent association with the development of ant-STEMI-related HF. CONCLUSIONS: GLS is a powerful echocardiographic parameter related to development of in-hospital HF and LSant was significantly associated with post-discharge HF in patients with successfully reperfused ant-STEMI.
Anterior Wall Myocardial Infarction ; Arteries ; Echocardiography ; Heart Failure ; Heart ; Humans ; Multivariate Analysis ; Myocardial Infarction

The de Winter electrocardiogram pattern is an acute ST-segment elevation myocardial infarction equivalent, however this specific electrocardiogram change is easily ignored by clinicians. The de Winter electrocardiogram pattern in patients with acute chest pain mostly indicates sub-complete or complete occlusion of the left anterior descending or the diagonal branch. Patients with acute chest pain and such electrocardiographic finding should undergo emergency coronary angiography immediately to determine the coronary condition, and reperfusion therapy should be performed as soon as possible to reduce the incidence of adverse cardiovascular events.
Anterior Wall Myocardial Infarction ; Cognition ; Coronary Angiography ; Electrocardiography ; Humans ; ST Elevation Myocardial Infarction/diagnosis*

BACKGROUND: Left ventricular thrombus is a common complication after acute myocardial infarction. Methods and RESULTS: To Study the incidence of left ventricular thrombosis (LVT) after acute myocardial infarction, we performed serial two-dimensional echocardiography (2D-Echo) in 35 consecutive patients with acute myocardial infarction prospectively ; 10 patients had inferior wall myocardial infarction, 25 patients had anterior wall myocardial infarction. 2D-Echo was obtained within 3 days of acute myocardial infarction, at 4-10 days after symptom onset, and 2-4 weeks after symptom onset serially in each case. 19 out of 35 patients received thrombolytic therapy with urokinase. Left ventricular thrombi were identified in 9(25.7%) of the 35 study patients. The location of myocardial infarction was anterior and apical in all cases with left ventricular thrombi. The shape of thrombi was mural in 6 cases and protruding in 3 cases. The incidence of left ventricular thrombi in patients who received urokinase was not significantly different from that in patients who didn't(31.9% vs 18.8%,p=0.22). Wall motion score was significantly higher in patients who developed left ventricular thrombi than in patients who had no left ventricular thrombus(8.2+/-1.9 vs 5.8+/-2.6, p<0.005). All thrombi appeared within 10 days after myocardial infarction. CONCLUSIONS: Thus left ventricular thrombi develops within 10 days following myocardial infarction with large anterior and apical location. The thrombolysis therapy has no effect in the incidence of left ventricular thrombi in this study. But because of confounding effect of thrombolysis and location of myocardial infarction and extent of myocardial infarction, further investigation is needed.
Anterior Wall Myocardial Infarction ; Echocardiography ; Humans ; Incidence* ; Inferior Wall Myocardial Infarction ; Myocardial Infarction* ; Prospective Studies ; Thrombolytic Therapy ; Thrombosis* ; Urokinase-Type Plasminogen Activator

Coronary artery anomalies are rare presentations in primary percutaneous coronary interventions of acute myocardial infarction. Herein, we report the case of a 59-year-old man with acute anterior myocardial infarction who had anomalous separate origin of left anterior descending artery (LAD) and left circumflex artery (LCX) from the left coronary aortic sinus. Coronary angiography showed a normal right coronary artery and LCX, but no visualization of the LAD. After several unsuccessful attempts to cannulate the LAD, we found the LAD ostium located by the side of the LCX ostium. There was total occlusion at proxymal LAD. Coronary computed tomography angiography demonstrated the precise, separate origin of LAD and LCX from the left coronary aortic sinus.
Angiography ; Anterior Wall Myocardial Infarction ; Arteries ; Coronary Angiography ; Coronary Vessel Anomalies ; Coronary Vessels ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Sinus of Valsalva

To investigate whether ischemic postconditioning (IPTC) can promote the recovery of left ventricular impaired regional or global longitudinal systolic function.
 Methods: The trial was divided into a percutaneous coronary intervention (PCI) group, an PCI+IPTC group and a control group. Thirty-two patients with anterior acute anterior wall ST-segment elevation myocardial infarction (STEMI) underwent the first emergency PCI in the PCI group, 28 patients with anterior acute STEMI underwent the combination of PCI and IPTC in the PCI+IPTC group, while 30 patients underwent coronary angiography in the control group. Two-dimensional dynamic echocardiography was collected before operation, 0.5 h, 1 day, 3 days, 1 week, 1 month and 6 months after operation, respectively. The longitudinal strain parameters at different time points were analyzed and compared in the 3 groups.
 Results: The regional longitudinal strain of infracted segments in the PCI+IPTC group after the operation within 1 week was higher than that in the PCI group (P<0.05). The left ventricular global longitudinal strain in the PCI+IPTC group seemed to be higher than that in PCI group after the operation within 1 week, but there was not statistically difference (P>0.05). There was no significant difference in the long-term regional and global longitudinal strains of left ventricle between the PCI+IPTC group and the PCI group (both P>0.05).
 Conclusion: The IPTC can improve the short-term longitudinal systolic function of the reperfused myocardium in patients with acute anterior wall STEMI after PCI.
Anterior Wall Myocardial Infarction ; Humans ; Ischemic Postconditioning ; Myocardium ; Percutaneous Coronary Intervention ; ST Elevation Myocardial Infarction ; Treatment Outcome ; Ventricular Function, Left

OBJECTIVETo observe the changes of hospitalization rates and in-hospital mortality for coronary heart disease (CHD) in Beijing from 2007-2012.

METHODSPatients hospitalized for CHD in Beijing from 1 January 2007 to 31 December 2012 were identified from"The Cardiovascular Disease Surveillance System in Beijing". In total, 421 929 patients aged ≥25 years of permanent Beijing residents were admitted for CHD in Beijing during the 6 years. After excluding duplicate records and validation for the completeness and accuracy of the records, the hospitalization rates for CHD and in-hospital CHD mortality were analyzed. Trends in hospitalization rates and the in-hospital mortality for CHD were analyzed with Poisson regression models.

RESULTSThe age-standardized average hospitalization rate of CHD was 515.3 per 100 000 population in patients aged ≥25 years in Beijing. During the six years, an increasing trend was observed in the hospitalization rates for CHD after adjusting the age and gender (P<0.001). The age-standardized hospitalization rates of CHD increased by 43.0% in the past six years. The greatest increases of hospitalization rates were noted in both men and women between 45 to 54 years. The age-standardized in-hospital mortality decreased from 3.3% to 2.2% over the time (P<0.001), with a in-hospital mortality reduction for acute myocardial infarction from 11.3% to 8.5%.

CONCLUSIONSAn increasing trend in hospitalization rate was observed during 2007-2012 for Beijing residents aged ≥25 years, indicating an urgent need in CHD prevention in Beijing. The in-hospital mortality reduction during this period might reflect the improvement in the in-hospital treatment modalities of CHD.

Adult ; Aneurysm, Dissecting ; complications ; pathology ; Anterior Wall Myocardial Infarction ; etiology ; Aortic Aneurysm, Thoracic ; complications ; Humans ; Male