Coronary Artery Bypass ; Coronary Occlusion ; diagnosis ; etiology ; Female ; Heparin ; administration & dosage ; therapeutic use ; Humans ; Middle Aged

Coronary Artery Disease ; diagnosis ; etiology ; Graft Occlusion, Vascular ; diagnosis ; etiology ; Heart Transplantation ; adverse effects ; Humans

Angioplasty, Balloon, Coronary ; Coronary Occlusion ; diagnostic imaging ; therapy ; Fluoroscopy ; adverse effects ; Humans ; Male ; Middle Aged ; Radiodermatitis ; etiology ; Treatment Failure

We report the case of a female who died of suspected acute myocardial infarction. Post-mortem CT angiography (PMCTA) was performed with intravascular contrast infusion before the standard autopsy, and it successfully demonstrated the complete thrombotic occlusion of a coronary artery and also a corresponding perfusion defect on myocardium. We herein describe the PMCTA findings of a cardiac death with special emphasis on the potential benefits of this novel CT technique in forensic practice.
*Autopsy ; Coronary Occlusion/*diagnosis/etiology/radiography ; Coronary Vessels/pathology/radiography ; Female ; Humans ; Middle Aged ; Myocardial Infarction/etiology/pathology ; Myocardium ; Thrombosis/complications/*diagnosis ; Tomography, X-Ray Computed

A 53-yr-old man underwent radiofrequency ablation to treat persistent atrial flutter. After the procedure, the chest pain was getting worse, and the electrocardiogram showed ST-segment elevation in inferior leads with reciprocal changes. Immediate coronary angiography showed total occlusion with thrombi at the distal portion of the right coronary artery, which was very close to the ablation site. Intervention with thrombus aspiration and balloon dilatation was successful, and the patient recovered without any kind of sequelae. Although the exact mechanism is obscure, the most likely explanation is a thermal injury to the vascular wall that ruptured into the lumen and formed thrombus. Vasospasm and thromboembolism can also be other possibilities. This case raise the alarm to cardiologists who perform radiofrequency ablation to treat various kinds of cardiac arrhythmias, in that myocardial infarction has been rarely considered one of the complications.
Acute Disease ; Angioplasty, Balloon, Coronary ; Atrial Flutter/*surgery ; Catheter Ablation/*adverse effects ; Chest Pain/etiology ; Coronary Occlusion/etiology ; Coronary Vessels/radiography ; Humans ; Male ; Middle Aged ; Myocardial Infarction/*diagnosis/etiology/therapy ; Thrombosis/surgery

OBJECTIVETo evaluate the feasibility and efficacy of percutaneous coronary intervention (PCI) for graft occlusion post coronary artery bypass graft (CABG).

METHODSThe clinical data of 135 post-CABG patients with bypass graft occlusion and angina pectoris symptoms admitted to our department between June 2003 and June 2007 were analyzed. The mean interval from CABG to index angiography was 33.8 +/- 23.5 months. Among 318 grafts, 29 left internal mammary artery (LIMA, 29/128, 22.7%) and 117 saphenous vein bypass grafts (117/188, 62.2%) were occluded. A total of 158 target lesions from these 146 vessels were treated with PCI. All target lesions were B2/C type lesion with 29.7% (47/158) chronic total occlusions.

RESULTSA total of 310 DES were implanted. The total success rate of PCI procedure was 96. 3% (130/135), and lesion success rate was 96.8% (153/158). No major clinical complications occurred during peri-intervention period. All patients underwent PCI were followed at 12 month. Angiographic follow-up was obtained in 89 patients and the angiographic restenosis rate was 5.6% (5/89) in these patients. The major adverse cardiac events and target vessel revascularization rates were 5.4% (7/130) and 6.2% (8/130), respectively.

CONCLUSIONThis study demonstrates that PCI procedure for graft occlusion post-CABG is feasible and safe and associated with a high procedure success rate and favorable long-term clinical and angiographic outcomes.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass, Off-Pump ; adverse effects ; Female ; Graft Occlusion, Vascular ; etiology ; therapy ; Humans ; Male ; Middle Aged

PURPOSE: When performing coronary angiography (CAG), diagnostic catheter intubation to the ostium can cause damping of the pressure tracing. The aim of this study was to determine the predictors of atherosclerotic ostial stenosis in patients showing pressure damping during CAG. MATERIALS AND METHODS: In total, 2926 patients who underwent diagnostic CAG were screened in this study. Pressure damping was defined as an abrupt decline of the coronary blood pressure with a blunted pulse pressure after engagement of the diagnostic catheter. According to CAG and intravascular ultrasound (IVUS), we divided damped ostia into two groups: atherosclerotic ostial lesion group (true lesion group) and non-atherosclerotic ostium group (false lesion group). Clinical and angiographic characteristics were compared between the two groups. RESULTS: The overall incidence of pressure damping was 2.3% (68 patients and 76 ostia). Among the pressure damped ostia, 40.8% (31 of 76 ostia) were true atherosclerotic ostial lesions (true lesion group). The true lesion group had more frequent left main ostial damping and more percutaneous coronary interventions (PCIs) performed on non-ostial lesions, compared to the false lesion group. On multivariate logistic regression analysis, left main ostial damping [hazard ratio (HR) 4.11, 95% confidence interval (CI) 1.24-13.67, p=0.021] and PCI on non-ostial lesion (HR 5.34, 95% CI 1.34-21.27, p=0.018) emerged as independent predictors for true atherosclerotic ostial lesions in patients with pressure damping. CONCLUSION: Left main ostial damping and the presence of a non-ostial atherosclerotic lesion may suggest a significant true atherosclerotic lesion in the coronary ostium.
Aged ; *Coronary Angiography ; Coronary Artery Disease/etiology/*radiography ; Coronary Occlusion/diagnosis/*therapy ; Coronary Stenosis/etiology/*radiography ; Coronary Vessel Anomalies/radiography ; Coronary Vessels/*pathology ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Percutaneous Coronary Intervention/adverse effects/methods ; Predictive Value of Tests ; Proportional Hazards Models ; Radiography, Interventional

Adult ; Angioplasty, Balloon, Coronary ; adverse effects ; Balloon Occlusion ; Cardiac Tamponade ; etiology ; Catheter Ablation ; adverse effects ; Catheterization ; adverse effects ; Coronary Disease ; surgery ; therapy ; Female ; Humans ; Male ; Middle Aged ; Mitral Valve Stenosis ; therapy ; Retrospective Studies ; Stents ; adverse effects

OBJECTIVEAssess the clinical implication of microvasculopathy detected by endomyocardial biopsy samples in patients post heart transplantation.

METHODSLight microscopic evaluations were performed in 278 endomyocardial biopsies harvested from 64 patients post heart transplantation for more than one year, microvasculopathy was defined as stenotic endothelial and/or medial disease.

RESULTSThe patients with stenotic microvasculopathy were younger than those without microvasculopathy (40.7 ± 15.9 vs. 49.4 ± 8.7, P < 0.05). The mean score of acute cellular rejection (0.83 ± 0.39 vs. 0.37 ± 0.32, P < 0.01) and the numbers of ≥ grade II acute rejection (0.84 ± 0.16 vs. 0.23 ± 0.10, P < 0.01) were significantly greater in stenotic microvasculopathy group compared to those of non-stenotic group. Multivariate regression analysis confirmed that stenotic microvasculopathy is the independent risk factor for the mean acute rejection score (OR = 3.40, 95%CI, 4.62 - 193.07, P < 0.01), but not for the Quilty lesion, coronary heart disease of donor, diabetes mellitus. Angiographically confirmed coronary vasculopathy and cardiac dysfunction (χ(2) = 0.94, P > 0.05 and χ(2) = 2.90, P > 0.05) were similar between microvasculopathy group and non-microvasculopathy group.

CONCLUSIONPost heart transplantation microvasculopathy is an immune-mediated phenomenon and associated with higher mean score of acute cellular rejection and higher numbers of ≥ grade II acute rejection but was not the prognostic risk factor for coronary vasculopathy and function reduction after heart transplantation.

Adolescent ; Adult ; Coronary Disease ; surgery ; Endocardium ; pathology ; Female ; Graft Occlusion, Vascular ; etiology ; pathology ; Graft Rejection ; pathology ; Heart Transplantation ; adverse effects ; Humans ; Male ; Middle Aged ; Myocardium ; pathology ; Prognosis ; Risk Factors ; Young Adult

OBJECTIVETo explore the effect of erythropoietin (EPO) on reperfusion arrhythmias in rats and identify the possible mechanism involved.

METHODSForty-five SD rats were randomized into a sham-operated group and 4 cardiac ischemia/reperfusion (IR) injury groups, which were further divided into IR group, LY294002 group, EPO group, and EPO+LY294002 group. Cardiac IR injury was induced in the 4 IR injury groups by ligating the left anterior descending branch of the coronary artery (LAD) for 30 min followed by reperfusion for 3 h, with subsequent treatments accordingly. The occurrence of arrhythmias was monitored and scored during experiment, and the levels of serum CK-MB and cTnI were detected. The content of MDA in the myocardium was determined by thiobarbituric acid (TBA) method, and the content of SOD by xanthine oxidase method.

RESULTSThe arrhythmia score in EPO group was significantly lower than those in IR, LY294002 and EPO+ LY294002 groups (P<0.05). The levels of serum CK-MB and cTnI were significantly lower in EPO group than in the other 3 IR groups (P<0.001). The EPO group showed also significantly lower MDA content (P<0.001) and higher SOD content than the other 3 IR groups (P<0.001).

CONCLUSIONEPO at the dose of 1000 mg/kg decreases the incidence of reperfusion arrhythmias in rats, and this effect can be attenuated by LY294002 pretreatment, suggesting that the cardioprotective effect of EPO involves antioxidation mediated by the phosphoinositide 3-kinase (PI3K) pathway.

Animals ; Arrhythmias, Cardiac ; etiology ; prevention & control ; Chromones ; therapeutic use ; Coronary Occlusion ; complications ; drug therapy ; Erythropoietin ; therapeutic use ; Female ; Male ; Morpholines ; therapeutic use ; Myocardial Reperfusion Injury ; complications ; metabolism ; prevention & control ; Phosphatidylinositol 3-Kinases ; metabolism ; Random Allocation ; Rats ; Rats, Sprague-Dawley