Andreas Y Andreou

Journal - Türk Kardiyoloji Dernegi arsivi : Türk Kardiyoloji Derneginin yayin organidir (Turkey )

Journal - Experimental and clinical cardiology (Canada )

Abstract :

The internal thoracic artery (ITA) is considered to be the optimal conduit for surgical coronary artery revascularization. Variations in ITA anatomy are relatively common and may impact surgical results. The ITA usually arises from the intrascalenic (first) part of the subclavian artery (SCA) and, occasionally, from the interscalenic (second) part. Origination from the extrascalenic (third) part of the SCA is rare, with a reported incidence rate of 0.5% to 1.0% in anatomical studies, and 1.5% in one angiographic study. Such an aberrant ITA descends inferomedially, anterior to the distal attachment of the scalenus anterior muscle, passes posterior to the first rib and enters the thorax, from where it follows its usual course. A patient with a five-year history of in situ grafting of the left ITA to the anterior inter-ventricular artery is presented. Coronary angiography performed because of anterior wall ischemia revealed an aberrantly arising ITA from the extras-calenic part of the SCA. The implications of this ITA variant with regard to bypass surgery, postoperative angiography and subclavian vein catheterization are discussed.

Journal - Experimental and clinical cardiology (Canada )

Abstract :

Two young women, without risk factors for atherosclerotic coronary artery disease, were admitted to hospital because of an acute anterior myocardial infarction and treated with thrombolysis. Thrombolysis failed and the immediate coronary angiography performed displayed spontaneous occlusive left anterior descending artery dissection in both cases. The patients underwent successful left internal mammary artery grafting to the left anterior descending artery. The present article highlights the pathology and angiographic presentation of spontaneous coronary artery dissection as well as the possible adverse effect of thrombolysis. Evolution of a dissection into a flap and, ultimately, into a stenosis without a flap is described, and is proposed as a potential mechanism of recurrent ischemia.

Journal - Experimental and clinical cardiology (Canada )

Abstract :

A 43-year-old patient was admitted to hospital because of an inferior-posterior myocardial infarction. The admission electrocardiogram was suggestive of a right coronary artery (RCA) culprit lesion. Coronary angiography following successful thrombolysis revealed a normal left system and mild intraluminal disease of the dominant RCA, which arose from the left aortic sinus and travelled an interarterial course; the latter was depicted in a subsequent computed tomographic angiogram. The lack of ST segment elevation in V4R and the absence of right ventricular wall motion abnormalities on echocardiography precluded the proximal ectopic vessel from being the culprit. The patient was managed medically; one year following discharge, he is asymptomatic. In cases of aberrant anomalous origin of a coronary artery from the opposite sinus with interarterial course, the proximal ectopic vessel is intussuscepted within the aortic wall, potentially leading to ischemia. The present article highlights that, although medical treatment in cases of such an aberrant RCA without apparent ischemia-driven sequelae may be valid, the need for interventional treatment could be substantiated following investigation of the anatomofunctional features of the intussuscepted proximal ectopic segment with intravascular ultrasound.

Journal - Türk Kardiyoloji Dernegi arsivi : Türk Kardiyoloji Derneginin yayin organidir (Turkey )

Journal - Journal of cardiovascular medicine (Hagerstown, Md.)

Abstract :

In patients with rest angina, the ECG pattern of precordial ST segment depression with positive T wave has been correlated with a subtotal occlusion of the left anterior descending artery (LADA); it represents regional anterior wall subendocardial ischemia. We present a patient with preinfarction angina and this unusual ECG pattern in whom the culprit LADA lesion coexisted with a left circumflex artery lesion. The absence of ST segment elevation in the posterior leads or contractile abnormalities across the inferior-lateral wall precluded the latter lesion from being the culprit. The ST segment elevation recorded in leads III and aVF was ascribed to transmural ischemia across the apical LADA, likely due to distal embolization. This study highlights that awareness of this ECG pattern and its correlation with a culprit LADA lesion may facilitate avoiding the erroneous diagnosis of diffuse subendocardial ischemia in cases of rest angina and multivessel disease in which the precordial T waves are negative.

Journal - Clinical anatomy (New York, N.Y.)

Journal - International journal of cardiology

Abstract :

The left anterior descending artery (LADA) is defined as the vessel that travels in the anterior interventricular sulcus (AIVS) supplying septal branches to the anterior interventricular septum. Duplication of the LADA entails that two vessels are located in the AIVS. This report presents some comments regarding a case of the so called "parallel LADA" which has been erroneously recognized as dual LADA.

Journal - Türk Kardiyoloji Dernegi arsivi : Türk Kardiyoloji Derneginin yayin organidir (Turkey )

Journal - Journal of cardiovascular medicine (Hagerstown, Md.)

Abstract :

Right ventricular infarction (RVI) during inferior myocardial infarction (MI) is readily diagnosed when ST-segment elevation (STE) is recorded in lead V4R. RVI may also yield precordial STE and such an electrocardiographic (ECG) pattern may be misinterpreted as a sign of anterior MI. We present a case of inferior-right ventricular (RV) MI due to occlusion of a dominant right coronary artery manifesting STE in the inferior, all precordial and right chest leads. RV dilation due to acute ischemic insult facilitated STE in leads V1-V4 despite the dominant opponent inferior and posterolateral left ventricular injury current. This case illustrates that dilation of an infarcted RV should be considered when such an ECG pattern is encountered during inferior MI, specifically a dominant one. Awareness of the circumstances under which this ECG pattern develops facilitates avoidance of misinterpretation as a sign of anterior MI and proper management.

Journal - Surgical and radiologic anatomy : SRA

Abstract :

The left posterior sinus node artery (PSNA) originates from the posterolateral left circumflex artery, is quite common and shows more frequently a retrocaval mode of termination. In contrast, the right PSNA that arises from the terminal right coronary artery has been rarely described while information on its mode of termination is generally lacking. The PSNA courses close to the ostia of the superior pulmonary veins; hence, it may get injured during surgical or catheter ablation procedures performed for the treatment of atrial fibrillation. The left PSNA terminates retrocavally more frequently than the usual SNAs; hence, it may be at a greater risk of transection during the popular superior septal approach to the mitral valve. We present a case of right PSNA which terminated in a previously unreported course, i.e., the pericaval. Discussion pertains to the anatomic features of the PSNA that render it susceptible to the aforementioned complications.

Journal - Journal of cardiovascular medicine (Hagerstown, Md.)