Behcet's disease with concomitant thrombotic thrombocytopenic purpura (TTP), coronary artery stenosis and coronary artery pseudo aneurysm is rare. Here we report a case of Behcet's disease with several cardiovascular complications, namely: pericarditis, deep vein thrombosis (DVT), TTP, coronary artery stenosis, and a coronary artery pseudo aneurysm. A 37-year-old female presented with sudden dyspnea and syncope at our emergency room and underwent pericardiectomy and pericardial window formation for the diagnosis of cardiac tamponade with acute hemorrhagic pericarditis. Thereafter, TTP and DVT complicated her illness. After confirmation of Behcet's disease on the basis of a history of recurrent oral and genital ulcers and erythema nodosum, remission was achieved after treatment with methylprednisolone pulse therapy, colchicine, catheter directed thrombolysis and thrombectomy. However, whilst maintaining anticoagulation therapy, a newly developed pericardial aneurysmal dilatation was noted on follow-up radiologic evaluation. Further evaluation revealed right coronary artery stenosis and a left coronary artery pseudo aneurysm; these additional problems were treated with the nonsurgical insertion of an endovascular graft stent . At the time of writing three months later after stent insertion, the aneurysm has continued to regress and no additional complications have intervened with combined immunosuppressive therapy.
Venous Thrombosis/diagnosis/*etiology ; Purpura, Thrombotic Thrombocytopenic/diagnosis/*etiology ; Pericarditis/diagnosis/*etiology ; Humans ; Female ; Echocardiography ; Coronary Vessels/*physiopathology ; Coronary Stenosis/diagnosis/*etiology ; Cardiac Tamponade/diagnosis/*etiology ; Behcet Syndrome/*complications/diagnosis ; Aneurysm, False/diagnosis/*etiology ; Adult

OBJECTIVETo investigate the impact of depression on clinical outcome of patients undergoing revascularization.

METHODSSelf-rating depression scale (SDS) assessment was made before and after coronary artery bypass grafting (CABG, n = 345) and percutaneous coronary intervention (PCI, n = 308) procedure. Patients were divided into depression and non-depression group. All patients were followed up for 12 months after procedure for the occurrence of rehospitalization and major adverse cardiovascular events (MACE) including all-cause mortality, nonfatal myocardial infarction or target lesion revascularization.

RESULTSDepression was present in 40.9% (n = 141) of patients after CABG, which was significantly higher than before procedure (24.3%, P < 0.01). The MACE rate was significantly higher in patients with post-procedure depression [8.5% (12/141)] than in patients without depression [2.9% (6/204), P < 0.05] and the incidences of target lesion revascularization and rehospitalization were also significantly higher in depression patients than in non-depression patients during the 12 months follow-up (all P < 0.05). Depression was present in 36.4% (n = 112) of patients after PCI, which was significantly higher than that before procedure (28.6%, P < 0.05). The MACE rate [8.0% (9/112) vs. 2.0% (4/196)] and rehospitalization rate [12.5% (14/112) vs. 4.6% (9/196)] were significantly higher in depression patients than in patients without depression during the 12 months follow-up (P < 0.05). There was no significant difference on SDS score between the PCI and CABG before the procedure. However, after the procedure, the SDS score for patients undergoing CABG was significantly higher than in patients undergoing PCI (48.9 ± 9.8 vs. 45.7 ± 10.5 P = 0.01). The level of serum IL-6 was significantly higher in depression patients than in patients without depression (P < 0.05).

CONCLUSIONPrevalence of depression is high in patients treated with revascularization procedures and is linked with poor post-procedure prognosis.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Disease ; diagnosis ; psychology ; therapy ; Coronary Stenosis ; Depression ; etiology ; Female ; Humans ; Male ; Middle Aged ; Prognosis ; Treatment Outcome

Kawasaki Disease (KD) is an acute, febrile, multisystem disease of children. More severe complications in 15~25% of cases include, the development of coronary aneurysms, ischemic heart disease, and sudden cardiac death. The standard treatment for significant coronary artery stenosis has generally been aortocoronary bypass surgery, although percutaneous transluminal coronary angioplasty (PTCA) has been described in a small number of patients. This report describes a 14 year old boy with a history of KD who developed multiple coronary aneurysms and stenosis. We performed PTCA, which was successful in relieving the stenosis of the left circumflex artery.
Adolescent ; *Angioplasty, Transluminal, Percutaneous Coronary ; Coronary Aneurysm/diagnosis/etiology/therapy ; Coronary Angiography ; Coronary Stenosis/diagnosis/etiology/*therapy ; Coronary Vessels/ultrasonography ; Endosonography ; Follow-Up Studies ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome/*complications/diagnosis

We report a 38-year-old man with previous Kawasaki disease who presented with exertional dyspnoea and was found to have multivessel coronary aneurysm and stenoses on coronary angiography. Coronary artery bypass surgery was subsequently performed. This case highlights the angiographic and intravascular ultrasonographic imaging features of this relatively uncommon condition presenting to an adult general cardiology service in Singapore.
Adult ; Coronary Aneurysm ; diagnosis ; etiology ; Coronary Angiography ; methods ; Coronary Stenosis ; diagnosis ; etiology ; Coronary Vessels ; diagnostic imaging ; Diagnosis, Differential ; Humans ; Male ; Mucocutaneous Lymph Node Syndrome ; complications ; diagnosis ; Ultrasonography, Interventional ; methods

No abstract available.
Aged ; Angina Pectoris/diagnosis/etiology ; Coronary Angiography ; Coronary Artery Disease/*complications/diagnosis/therapy ; Coronary Stenosis/*complications/diagnosis/therapy ; Coronary Vessel Anomalies/*complications/diagnosis ; Humans ; Male ; Percutaneous Coronary Intervention/instrumentation ; Stents ; Treatment Outcome

Aortic Valve Stenosis ; blood ; diagnosis ; etiology ; Child ; Coronary Artery Disease ; blood ; diagnosis ; etiology ; Coronary Vessels ; diagnostic imaging ; pathology ; Echocardiography ; Female ; Humans ; Hyperlipoproteinemia Type II ; blood ; complications ; diagnosis ; genetics ; Lipoproteins, LDL ; blood ; Triglycerides ; blood

No abstract available.
Adult ; Colon/diagnostic imaging ; Colonoscopy ; Coronary Stenosis/*diagnosis/etiology ; Endometriosis/complications/*diagnosis/pathology ; Female ; Humans ; Middle Aged ; Neprilysin/metabolism ; Tomography, X-Ray Computed ; Ultrasonography

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

Coronary stent dislodgement is a rare complication of percutaneous coronary intervention. We report a rare case of dislodgement of two intracoronary stents. On withdrawal of two balloon catheters, one with a guide wire was mechanically distorted from the left main (LM) to the proximal left anterior descending artery (LAD) while the other was dislodged from the LM to the ostial left circumflex artery. The stent in the LAD could not be retrieved into the guide catheter using a Goose neck snare, because it was caught on a previously deployed stent at the mid LAD. A new stent was quickly deployed from the LM to the proximal LAD, because the patient developed cardiogenic shock. Both stents, including a distorted and elongated stent, were crushed to the LM wall. Stent deployment and crushing may be a good alternative technique to retrieving a dislodged stent.
Angioplasty, Balloon, Coronary/adverse effects/*instrumentation ; Cardiac Catheterization/adverse effects/*instrumentation ; Coronary Angiography ; Coronary Stenosis/diagnosis/*therapy ; Female ; Humans ; Middle Aged ; Prosthesis Failure ; Shock, Cardiogenic/etiology/therapy ; *Stents ; Treatment Outcome

To evaluate the safety and efficacy of the computed tomography coronary angiography (CTCA) for evaluation of acute chest pain in real world population, we prospectively enrolled 296 patients with acute chest pain at emergency department (ED) from November 2005 to February 2007. The patients were grouped based on the clinical information and CTCA result. The patients with a low risk profile and no significant coronary stenosis (>50%) in CTCA were discharged immediately (Group 1, n=103). On the other hand, the patients with an intermediate risk profile without significant stenosis were observed in ED for 24 hr (Group 2, n=104). The patients with significant stenosis underwent further coronary evaluation and management accordingly (Group 3, n=89). While no false negative case was found in Group 1, seven cases (6.73%) were found in Group 2, mostly during the observation period. In Group 3, there were 54 (60.67%) cases of acute coronary syndrome including 10 myocardial infarctions. The overall accuracy of CTCA for acute coronary syndrome was 88.5% (sensitivity), 85.1% (specificity), 60.7% (positive predictive value) and 96.6% (negative predictive value). In conclusion, clinical decision based on CTCA is safe and effective for low risk patients. Further validation is needed in patients with intermediate risk profile.
Adult ; Aged ; *Chest Pain/diagnosis/etiology/radiography ; Coronary Angiography/*methods ; Coronary Stenosis/radiography ; Decision Making ; Emergency Service, Hospital ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Risk Factors ; Sensitivity and Specificity ; Tomography, X-Ray Computed/*methods